Uso clínico de los nuevos antidepresivos que poseen un mecanismo de acción dual (revisión de la literatura) / Clinical use of new antidepressive agents with dual action (literature review)

The effective pharmacological treatment of depression started in 1958 with the introduction of iproniazide and imipramine. New agents quickly followed with more specific actions and a safer side effect profile. Very recently, fourth generation antidepressants with dual action have been introduced. These new agents pose a challenging dilemma. Is it better to develop drugs ever more selective towards specific monoamine receptor subpopulations, or drugs that act upon several monoamines in a more focused way? The priority seems to be the investigation of the interactions of the various monoaminergic systems. This paper reviews the clinical use of the new antidepressants that implement the notion of dual action as an important element for efficacy combined with receptor-specific action as a basis for tolerability.

Bases neurobiológicas de la agresión: implicaciones farmacoterapéuticas / The neurobiological bases of aggression: the pharmacotherapeutic implications

The aim of this paper is to attempt a classification of aggressive behavior based on neurobiological mechanisms and to shed some light on the pharmacological treatment of this condition. Drugs that enhance serotonin transmission are indicated in conditions related to decreased serotonergic transmission. Dopamine blockers are useful in the acute control of aggression and the violence displayed by schizophrenic patients. Clozapine probably has an anti-aggressive effect independent of its antipsychotic action. Noradrenergic agents have been shown effective in chronic aggression of organic brain syndromes. Gabaergic drugs are effective in acute aggression and in organic brain syndromes

El síndrome de Capgras: estudio clínico de nueve casos / The Capgras syndrome: a clinical study of 9 cases

The Capgras' syndrome is the delusional belief that a person or object has been replaced by an identical duplicate, usually with evil intent. A clinical, psychometric and electroencephalographic study of 9 patients afflicted with this syndrome and its variants was performed. The clinical course and the therapeutic response were assessed during the follow up that run between 2 and 11 years. The aim of this paper is to discuss the etiologically relevant psychodynamic, organic and mythological issues and to postulate an explanatory model that integrates limbic mechanisms, affect recognition processes, psychodynamic factors and anthropological aspects

Intervención comunitaria durante un desastre económico. / [Community intervention during economic disasters]

A political conflict forced banks to close down in Panama during March 1988. Thus, thousand of families were unable to meet their most basic needs during that lapse of time. This paper describes a community intervention program that was set up in the midst of such an economic disaster. That program emphasized mental health consultation techniques to help devising an effective organizational action as well as developing standards to determine needs, and a clear-cut two-way communication with the affected families. The incidence of emotional disorder was assessed with the Self Report Questionnaire, and crisis intervention was offered to any people who should apply for it. Cognitive responses, coping behaviors, and social supports were also assessed. Results showed that those individuals excluded from a full participation in their culture were much more likely to develop emotional disorders. Finding that affected people showed a scarce self-help behavior was interpreted as a feature of the transcultural transaction between affected people, and professionals.

Transacciones familiares y adhesión a la farmacoterapia con litio. / [Family interactions and adherence to lithium pharmacotherapy]

A random sample of thirty families containing a member with a bipolar disorder were interviewed by a psychiatrist and two clinical psychologists with training in family evaluations and therapy. During the interview the family was given the task of discussing the possible causes of the patients illness and to consider specific steps to help prevent relapses. The raters independently scored the Beavers Timberlawn Family Evaluation Scale and the Family Response to the Illness Scale. The patients were also evaluated using the Social Support Network Inventory, and a number of clinical and demographic indicators were routinely recorded. The research team showed good interrater reliability with the instruments, and evidence of validity is presented for the FRIS. A Cluster Analysis was performed and a two clusters solution was found. The first cluster contained twelve patients and the second is composed of eighteen patients. The clusters seem to differentiate patients along clinical outcome measures, drug compliance and cultural background. Family variables related to the structural dimensions of the system were found to cut across both clusters. Family variables measuring empathy, affect and expression of feelings were found to predict medication compliance and clinical outcome. The findings are discussed in the light of the concept of underorganization of family structures.