Messaging in Biological Psychiatry: Misrepresentations, Their Causes, and Potential Consequences.

Most experts in the field of psychiatry recognize that neuroscience advances have yet to be translated into clinical practice. The main message delivered to laypeople, however, is that mental disorders are brain diseases cured by scientifically designed medications. Here we describe how this misleading message is generated. We summarize the academic studies describing how biomedical observations are often misrepresented in the scientific literature through various forms of data embellishment, publication biases favoring initial and positive studies, improper interpretations, and exaggerated conclusions. These misrepresentations also affect biological psychiatry and are spread through mass media documents. Exacerbated competition, hyperspecialization, and the need to obtain funding for research projects might drive scientists to misrepresent their findings. Moreover, journalists are unaware that initial studies, even when positive and promising, are inherently uncertain. Journalists preferentially cover them and almost never inform the public when those studies are disconfirmed by subsequent research. This explains why reductionist theories about mental health often persist in mass media even though the scientific claims that have been put forward to support them have long been contradicted. These misrepresentations affect the care of patients. Indeed, studies show that a neuro-essentialist conceptualization of mental disorders negatively affects several aspects of stigmatization, reduces the chances of patients' healing, and overshadows psychotherapeutic and social approaches that have been found effective in alleviating mental suffering. Public information about mental health should avoid these reporting biases and give equal consideration to the biological, psychological, and social aspects of mental health.

Clinical guidelines for the management of treatment-resistant depression: French recommendations from experts, the French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental.

BACKGROUND: Clear guidance for successive antidepressant pharmacological treatments for non-responders in major depression is not well established. METHOD: Based on the RAND/UCLA Appropriateness Method, the French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental developed expert consensus guidelines for the management of treatment-resistant depression. The expert guidelines combine scientific evidence and expert clinicians' opinions to produce recommendations for treatment-resistant depression. A written survey comprising 118 questions related to highly-detailed clinical presentations was completed on a risk-benefit scale ranging from 0 to 9 by 36 psychiatrist experts in the field of major depression and its treatments. Key-recommendations are provided by the scientific committee after data analysis and interpretation of the results of the survey. RESULTS: The scope of these guidelines encompasses the assessment of pharmacological resistance and situations at risk of resistance, as well as the pharmacological and psychological strategies in major depression. CONCLUSION: The expert consensus guidelines will contribute to facilitate treatment decisions for clinicians involved in the daily assessment and management of treatment-resistant depression across a number of common and complex clinical situations.

Fear Extinction Retention: Is It What We Think It Is?

There has been an explosion of research on fear extinction in humans in the past 2 decades. This has not only generated major insights, but also brought a new goal into focus: how to maintain extinction memory over time (i.e., extinction retention). We argue that there are still important conceptual and procedural challenges in human fear extinction research that hamper advancement in the field. We use extinction retention and the extinction retention index to exemplarily illustrate these challenges. Our systematic literature search identified 16 different operationalizations of the extinction retention index. Correlation coefficients among these different operationalizations as well as among measures of fear/anxiety show a wide range of variability in four independent datasets, with similar findings across datasets. Our results suggest that there is an urgent need for standardization in the field. We discuss the conceptual and empirical implications of these results and provide specific recommendations for future work.

Clinical guidelines for the management of depression with specific comorbid psychiatric conditions French recommendations from experts (the French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental).

BACKGROUND: Recommendations for pharmacological treatments of major depression with specific comorbid psychiatric conditions are lacking. METHOD: The French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental developed expert consensus guidelines for the management of depression based on the RAND/UCLA Appropriatneness Method. Recommendations for lines of treatment are provided by the scientific committee after data analysis and interpretation of the results of a survey of 36 psychiatrist experts in the field of major depression and its treatments. RESULTS: The expert guidelines combine scientific evidence and expert clinician's opinion to produce recommendations for major depression with comorbid anxiety disorders, personality disorders or substance use disorders and in geriatric depression. CONCLUSION: These guidelines provide direction addressing common clinical dilemmas that arise in the pharmacologic treatment of major depression with comorbid psychiatric conditions.

WFSBP * and IAWMH ** Guidelines for the treatment of alcohol use disorders in pregnant women.

OBJECTIVES: These practice guidelines for the treatment of alcohol use disorders during pregnancy were developed by members of the International Task Force of the World Federation of Societies of Biological Psychiatry and the International Association for Women's Mental Health. METHODS: We performed a systematic review of all available publications and extracted data from national and international guidelines. The Task Force evaluated the data with respect to the strength of evidence for the efficacy and safety of each medication. RESULTS AND DISCUSSION: There is no safe level of alcohol use during pregnancy. Abstinence is recommended. Ideally, women should stop alcohol use when pregnancy is planned and, in any case, as soon as pregnancy is known. Detecting patterns of alcohol maternal drinking should be systematically conducted at first antenatal visit and throughout pregnancy. Brief interventions are recommended in the case of low or moderate risk of alcohol use. Low doses of benzodiazepines, for the shortest duration, may be used to prevent alcohol withdrawal symptoms when high and chronic alcohol intake is stopped and hospitalisation is recommended. Due to the low level of evidence and/or to low benefit/risk ratio, pharmacological treatment for maintenance of abstinence should not be used during pregnancy. At birth, foetal alcohol spectrum disorders must be searched for, and alcohol metabolites should be measured in meconium of neonates in any doubt of foetal alcohol exposure.

WFSBP guidelines on how to grade treatment evidence for clinical guideline development.

OBJECTIVE AND METHODS: This paper reviews sources of data typically used in guideline development, available grading systems, their pros and cons, and the methods for evaluating risks of bias in publications, and proposes a revised method for grading evidence and recommendations for use in development of clinical treatment guidelines. RESULTS: The new World Federation of Societies of Biological Psychiatry (WFSBP) grading system allows guideline developers to follow a multi-step approach of defining levels of evidence, applying criteria for grading (define the acceptability) and the grading of recommendations. CONCLUSIONS: Further, these updated WFSBP recommendations for rating evidence and treatment recommendations provide a grading system that takes into account potential biases in sources of evidence in arriving at final ratings that are likely more clinically meaningful and pragmatic and thus should be used for the development of future treatment guidelines.

Cerebrospinal fluid and blood biomarkers for neurodegenerative dementias: An update of the Consensus of the Task Force on Biological Markers in Psychiatry of the World Federation of Societies of Biological Psychiatry.

In the 12 years since the publication of the first Consensus Paper of the WFSBP on biomarkers of neurodegenerative dementias, enormous advancement has taken place in the field, and the Task Force takes now the opportunity to extend and update the original paper. New concepts of Alzheimer's disease (AD) and the conceptual interactions between AD and dementia due to AD were developed, resulting in two sets for diagnostic/research criteria. Procedures for pre-analytical sample handling, biobanking, analyses and post-analytical interpretation of the results were intensively studied and optimised. A global quality control project was introduced to evaluate and monitor the inter-centre variability in measurements with the goal of harmonisation of results. Contexts of use and how to approach candidate biomarkers in biological specimens other than cerebrospinal fluid (CSF), e.g. blood, were precisely defined. Important development was achieved in neuroimaging techniques, including studies comparing amyloid-ß positron emission tomography results to fluid-based modalities. Similarly, development in research laboratory technologies, such as ultra-sensitive methods, raises our hopes to further improve analytical and diagnostic accuracy of classic and novel candidate biomarkers. Synergistically, advancement in clinical trials of anti-dementia therapies energises and motivates the efforts to find and optimise the most reliable early diagnostic modalities. Finally, the first studies were published addressing the potential of cost-effectiveness of the biomarkers-based diagnosis of neurodegenerative disorders.

The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Acute and long-term treatment of mixed states in bipolar disorder.

OBJECTIVES: Although clinically highly relevant, the recognition and treatment of bipolar mixed states has played only an underpart in recent guidelines. This WFSBP guideline has been developed to supply a systematic overview of all scientific evidence pertaining to the acute and long-term treatment of bipolar mixed states in adults. METHODS: Material used for these guidelines is based on a systematic literature search using various data bases. Their scientific rigour was categorised into six levels of evidence (A-F), and different grades of recommendation to ensure practicability were assigned. We examined data pertaining to the acute treatment of manic and depressive symptoms in bipolar mixed patients, as well as data pertaining to the prevention of mixed recurrences after an index episode of any type, or recurrence of any type after a mixed index episode. RESULTS: Manic symptoms in bipolar mixed states appeared responsive to treatment with several atypical antipsychotics, the best evidence resting with olanzapine. For depressive symptoms, addition of ziprasidone to treatment as usual may be beneficial; however, the evidence base is much more limited than for the treatment of manic symptoms. Besides olanzapine and quetiapine, valproate and lithium should also be considered for recurrence prevention. LIMITATIONS: The concept of mixed states changed over time, and recently became much more comprehensive with the release of DSM-5. As a consequence, studies in bipolar mixed patients targeted slightly different bipolar subpopulations. In addition, trial designs in acute and maintenance treatment also advanced in recent years in response to regulatory demands. CONCLUSIONS: Current treatment recommendations are still based on limited evidence, and there is a clear demand for confirmative studies adopting the DSM-5 specifier with mixed features concept.

[French Society for Biological Psychiatry and Neuropsychopharmacology and Fondation FondaMental task force: Formal Consensus for the management of treatment-resistant depression]. / Prise en charge des troubles dépressifs résistants : recommandations françaises formalisées par des experts de l'AFPBN et de la fondation FondaMental.

Major depression represents among the most frequent psychiatric disorders in the general population with an estimated lifetime prevalence of 16-17%. It is characterized by high levels of comorbidities with other psychiatric conditions or somatic diseases as well as a recurrent or chronic course in 50 to 80% of the cases leading to negative repercussions on the daily functioning, with an impaired quality of life, and to severe direct/indirect costs. Large cohort studies have supported that failure of a first-line antidepressant treatment is observed in more than 60% of patients. In this case, several treatment strategies have been proposed by classical evidence-based guidelines from internationally recognized scientific societies, referring primarily on: I) the switch to another antidepressant of the same or different class; II) the combination with another antidepressant of complementary pharmacological profile; III) the addition of a wide range of pharmacological agents intending to potentiate the therapeutic effects of the ongoing antidepressant medication; IV) the association with appropriate psychological therapies; and, V) the use of non-invasive brain stimulation techniques. However, although based on the most recently available data and rigorous methodology, standard guidelines have the significant disadvantage of not covering a large variety of clinical conditions, while currently observed in everyday clinical practice. From these considerations, formalized recommendations by a large panel of French experts in the management of depressed patients have been developed under the shared sponsorship of the French Association of Biological Psychiatry and Neuropsychopharmacology (AFPBN) and the Fondation FondaMental. These French recommendations are presented in this special issue in order to provide relevant information about the treatment choices to make, depending particularly on the clinical response to previous treatment lines or the complexity of clinical situations (clinical features, specific populations, psychiatric comorbidities, etc.). Thus, the present approach will be especially helpful for the clinicians enabling to substantially facilitate and guide their clinical decision when confronted to difficult-to-treat forms of major depression in the daily clinical practice. This will be expected to significantly improve the poor prognosis of the treatment-resistant depression thereby lowering the clinical, functional and costly impact owing directly to the disease.

Documento de posicionamiento de la Sociedad Española de Psiquiatría Biológica / Positioning document of the Spanish Biological Psychiatry Society

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Documento de posicionamiento de consenso por el Colectivo de Psiquiatras por la Actualización de Clozapina / Consensus position document by the Clozapine Update Psychiatrists Group

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How to: Measuring blood cytokines in biological psychiatry using commercially available multiplex immunoassays.

Cytokines produced by both immune and non-immune cells are likely to play roles in the development and/or progression of psychiatric disorders. Indeed, many investigators have compared the blood cytokine levels in psychiatric patients with those of healthy controls or monitored their levels in patients during disease progression to identify biomarkers. Nevertheless, very few studies have confirmed that such cytokines remain stable in healthy individuals through periods of weeks and months. This is an important issue to consider before using blood cytokine levels as biomarkers of disease traits, disease state, or treatment response. Although multiplex assay technology represents an advance in identifying biomarkers because it allows simultaneous examination of large panels of analytes from a small volume of sample, it is necessary to verify whether these assays yield enough sensitivity and reproducibility when applied to the blood from neuropsychiatric patients. Therefore, we compared two multiplex immunoassays, the bead-based Luminex® (Bio-Rad) and the electro-chemiluminescence-based V-plex® (MesoScaleDiscovery), for the detection and quantification of 31 cytokines, chemokines and growth factors in both the sera and plasma of patients with major depressive episodes (MDE) and age- and sex-matched healthy control subjects during a 30-week period. Although both platforms exhibited low coefficients of variability (CV) between the duplicates in the calibration curves, the linearity was better in general for the V-PLEX® platform. However, neither platform was able to detect the absolute values for all of the tested analytes. Among the 16 analytes that were detected by both assays, the intra-assay reproducibility was in general better with the V-PLEX® platform. Although it is not a general rule that the results from sera and plasma will be correlated, consistent results were more frequent with the V-PLEX® platform. Furthermore, the V-PLEX® results were more consistent with the gold standard ELISA simplex assay for IL-6 in both sera and plasma. The intra-individual variability of the measurements, among the sera and plasma for the 4 samples harvested from each healthy individual, was low for Eotaxin, G-CSF, IL-4, IL-7, IL-9, IL-12p40, IL-12p70, IL-15, MIP-1ß, PDGF-BB, TNF, TNF-ß and VEGF, but intermediate or high for IFN-γ, IL-6, IL-8, IL-10, and IP10. Together, these data suggest that extreme caution is needed in translating the results of multiplex cytokine profiling into biomarker discovery in psychiatry.

El abordaje de la depresión en el ámbito del trabajo: recomendaciones clave / Management of depression in the work setting: key recommendations

La depresión en el ámbito del trabajo representa una de las primeras causas de pérdida de productividad, absentismo laboral, incremento de accidentes laborales, utilización de los servicios de salud y jubilación anticipada. Los costes totales atribuibles a la depresión constituyen más del 1% del PIB, por lo que su correcto abordaje repercutirá no solo en el bienestar emocional de los trabajadores sino también en la productividad de las empresas y la sostenibilidad del Sistema Nacional de Salud. La depresión no solo es un problema estrictamente sanitario, sino que hay que enmarcarlo en un contexto mucho más amplio vinculado al bienestar social. El presente documento es el resultado de un proceso de consulta y reuniones entre un grupo multidisciplinar de expertos y ofrece una serie de recomendaciones sobre la definición, detección y opciones de tratamiento de la depresión, con especial interés en el ámbito del trabajo. Entre otras medidas, se propone promover programas que permitan concienciar y ayudar a los empleados y empleadores a reconocer y manejar la depresión en los lugares de trabajo, así como mejorar las políticas y la legislación que les protegen. Esta estrategia multidimensional y efectiva, basada en un acercamiento holístico al problema, debe situar la depresión como un problema clave en las empresas, cuyo abordaje debe ser un objetivo estratégico prioritario (AU)

Depression in the work setting is one of the leading causes of lost productivity, absenteeism, increased accidents, use of health services, and early retirement. As the total costs attributable to depression are more than 1% of GDP, the correct approach will impact not only on the emotional welfare of workers but also on business productivity and sustainability of the National Health System. Depression is not just a health problem, but should be framed it in a much broader context linked to social welfare. This document is the result of a process of consultation and meetings between a multidisciplinary group of experts, and offers a series of recommendations on the definition, detection and treatment options of depression, with special interest in the occupational setting. Among other measures, it intends to promote programs that should raise awareness and help employees and employers to recognise and manage depression in the workplace, and to improve policies and legislation that protect them. This multidimensional and effective strategy, based on a holistic approach to the problem, places depression as a key problem in companies, for which the approach should be a priority strategic objective (AU)

Validación española de la Escala de Observación Enfermera de la Intensidad Sintomática en unidades de hospitalización psiquiátrica (NOIIS) / Spanish validation of the Nursing Observed Illness Intensity Scale in psychiatric units

Introducción. La revisión de la investigación existente evidencia las deficiencias en la oferta de instrumentos útiles para controlar el estado de pacientes psiquiátricos institucionalizados. Sin embargo, la escala Nursing Observation Illness Intensity Scale (NOIIS) en inglés ha demostrado evaluar de manera objetiva y rápida el estado de los pacientes en unidades de hospitalización psiquiátrica. En este contexto, nuestro principal objetivo es demostrar la utilidad, así como la fiabilidad y la validez, de la escala NOIIS en español. Método. Tras la traducción y retrotraducción de la escala NOIIS, esta se administró a una muestra de 34 pacientes. Para evaluar la fiabilidad, la escala fue administrada por 2 profesionales, y para controlar su validez se recogieron datos de otras escalas psicopatológicas (BPRS, la escala de dimensiones psicopatológicas DSM-5, la escala ICG y la escala de funcionamiento social SIX). Resultados. El coeficiente alpha de Cronbach mostró valores superiores a 0,89 por ítem, y una fiabilidad del 98% para la puntuación total de la escala. La correlación de Pearson entre la NOIIS y la escala BPRS fue de 70% (p = 0,00). Además, se observó una correlación negativa entre la NOIIS y la SIX. Con la ICG y la escala de dimensiones psicopatológicas DSM-5 también se encontró correlación, aunque inferior a la BPRS. Conclusión. A pesar de que la muestra fue pequeña, los resultados muestran que la versión en español de la NOIIS es aplicable en el medio hospitalario. Asimismo, se demuestra la fiabilidad entre jueces y la validez con respecto a otras escalas de uso en enfermería en salud mental (AU)

Introduction. The reviews of recent literature reveal that there is no really useful scale to monitor patient condition. However, the English version of the Nursing Observed Illness Intensity Scale (NOIIS) has demonstrated to be an objective and quick evaluation of patient status in psychiatric inpatients units. In this context, our aim is demonstrate the usefulness, reliability, and validity of Spanish version of the NOIIS in mental health units. Methods. After the translation and re-translation of NOIIS, 34 patients completed it. To evaluate the reliability, the scale was administered by two professionals. To control the validity data were obtained from other psycho-pathological scales (BPRS, pathological dimensional scale DSM-5, ICG scale, and the social functioning scale SIX). Results. The Cronbach Alpha reliability showed higher values of 0.89 by item, and 98% for total scored. We found a 70% Pearson correlation between NOIIS and BPRS (P = .00), and to a lesser extent between NOIIS and ICG and with the DSM-5 pathological dimensional scale. In addition, we observed a negative correlation between the NOIIS and SIX scale. Conclusion. Even though our sample was small, the results show that the Spanish version of the NOIIS is applicable in the hospital setting. Furthermore, it has also demonstrated its reliability between raters, and the validity compared to other scales used in mental health (AU)

Salud mental y salud pública en España: vigilancia epidemiológica y prevención / Mental health and public health in Spain: epidemiological surveillance and prevention

Este documento destaca aspectos de la salud mental de interés en salud pública según una reunión de profesionales. La prevención primaria (más factible en daño cerebral traumático, depresión por estrés sociolaboral o económico, conductas adictivas en jóvenes y trastornos de incidencia creciente) habría de completarse con prevención secundaria y terciaria. La vigilancia según el esquema de las enfermedades crónicas (estudios de encuestas, publicaciones científicas, etc.) priorizaría la depresión, el suicidio, las adicciones y las patologías del espectro autista, así como los pacientes crónicos complejos. Serian abordajes específicos: 1) El estudio de diagnósticos al alta hospitalaria y de causas de muerte para trastornos mayores, suicidios, tentativas de suicidio, nuevos pacientes psicóticos y trastornos de personalidad y de conducta alimentaria en adolescentes y jóvenes. 2) La identificación de una red clínica de salud mental de base poblacional capaz de revelar determinados eventos centinela: ejemplo de Italia. 3) La realización de encuestas sobre determinadas problemáticas en población asistida (AU)

This document highlights aspects of mental health of interest in Public Health, as identified in a meeting of health professionals. Primary prevention (most feasible in traumatic brain injury, depression induced by socio-occupational or financial stress, addictive behaviours among adolescents and young adults, and disorders in which incidence is on the increase) would have to be completed with secondary and tertiary prevention. Surveillance patterned on that of chronic diseases (survey studies, scientific papers, etc.) would prioritise depression, suicide, addictions, autism spectrum disorders and complex chronic patients. This would entail specific approaches such as: 1) The study of hospital discharge diagnoses and causes of death for major disorders, suicides, attempted suicide, new psychotic patients, and personality and eating disorders among adolescents and youth. 2) The identification of a population-based, clinical mental-health networks capable of pinpointing certain sentinel events, as for example in Italy. 3) The undertaking of surveys of certain problem areas in the population requiring assistance (AU)

Tratamiento exitoso con clozapina en un caso de polidipsia-hiponatremia y discinesia tardía en un paciente con esquizofrenia / Successful treatment with clozapine in a case of polydipsia-hyponatraemia and tardive dyskinesia in a patient with schizophrenia

La polidipsia en el seno de las psicosis crónicas y la hiponatremia subsecuente (también conocido como síndrome PIP: polidipsia, hiponatremia intermitente y psicosis) presentan una prevalencia elevada, probablemente infraestimada, de hasta el 17,5% en pacientes institucionalizados. El tratamiento de la misma con clozapina ha sido propuesto en numerosas ocasiones, siendo además este fármaco considerado de elección en el caso de cuadros de discinesia tardía, entidad secundaria al empleo de fármacos antipsicóticos y que puede llegar a ser tremendamente invalidante para los pacientes, careciendo de tratamiento específico y de difícil manejo terapéutico. Ambos síndromes suponen un prevalente y relevante problema clínico, en el que la ética hace imprescindible evitar el nihilismo terapéutico. Presentamos el caso de un varón de 54 años diagnosticado de esquizofrenia, en el que el cambio de tratamiento a clozapina supuso una importante mejoría en ambos procesos, especialmente en la reducción de la ingesta hídrica, manteniendo estabilidad clínica en el proceso psicopatológico esquizofrénico de base tras el cambio de tratamiento (AU)

Polydipsias within chronic psychosis and subsequent hyponatraemia (also known as PIP syndrome: polydipsia, intermittent hyponatraemia and psychosis) have a high prevalence, probably underestimated, and up to 17.5% in institutionalised patients. The treatment with clozapine has been proposed numerous times, and is also considered the drug of choice in cases of tardive dyskinesia, an entity secondary to the use of antipsychotic drugs, which can be extremely disabling for patients, lacking specific treatment and with a difficult therapeutic management. Both syndromes are prevalent and pose a significant clinical problem, in which ethics are essential to avoid therapeutic nihilism. The case is presented of a 55 year-old male with schizophrenia, in whom the change of treatment to clozapine resulted in a significant improvement in both processes, especially in reducing fluid intake, and maintaining clinical stability of the schizophrenic mental disorder after the intervention (AU)

¿Por qué la necesidad de una Guía de Práctica Clínica de Patología Dual? Análisis de la evidencia / Why a Dual Pathology Clinical Guideline? Analysis of the evidence

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Utilización de olanzapina en el tratamiento de la esquizofrenia y el trastorno bipolar / Use of olanzapine in the treatment of schizophrenia and bipolar disorder

La olanzapina es un derivado tienobenzodiacepínico que pertenece al grupo de los fármacos antipsicóticos de segunda generación. Fue aprobada por la Food and Drug Administration (FDA) y la European Medicines Agency (EMA) en el año 1996 para el tratamiento de la esquizofrenia, y en el mismo año la EMA autorizó su utilización en el trastorno bipolar. Más tarde se aprobó para el tratamiento de episodios depresivos del trastorno bipolar en combinación con fluoxetina (FDA, año 2003), tratamiento a largo plazo y prevención de recaídas del trastorno bipolar I (FDA, año 2004) y depresión resistente en combinación con fluoxetina (FDA, año 2009). Los autores realizaron una revisión crítica y exhaustiva de la evidencia científica existente acerca de la eficacia y la seguridad de la olanzapina en la esquizofrenia y en el trastorno bipolar I (AU)

Olanzapine is a derived of tienobenzodiazepina that integrate in a group of second generation of antipsychotics drugs. It was aproved by the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) in the year 1996 for the treatment of schizophrenia, and in the same year the EMA authorizes their use in bipolar disorder. Sooner it was approved for the treatment of depressive Bipolar Disord episodes in combination with fluoxetine (FDA, year 2003), treatment in long term and prevention relapses of bipolar disorder I (FDA, year 2004) and resistant depression in combination with fluoxetine (FDA, year 2009). The authors carried out a critical and thorough review of existing scientific evidence about the efficacy and safety of olanzapine in schizophrenia and bipolar I disorder (AU)

¿Qué aportan a la Psiquiatría los estudios en cerebro post mórtem? / Do post-mortem brain studies provide useful information for Psychiatry?

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