Cannabinoids: Emerging developments in neuropsychopharmacology and biological psychiatry.

Cannabinoids from the cannabis plant were one of the earliest psychoactive phytochemicals harnessed by humanity for their medicinal properties and remain one of the most frequently used and misused classes of chemicals in the world. Despite our long-standing history with cannabinoids, much more is said than is known regarding how these molecules influence the brain and behavior. We are in a rapidly evolving discovery phase regarding the neuroscience of cannabinoids. This period of insight began in the mid-1990s when it was discovered that phytocannabinoids (e.g., delta-9-tetrahydrocannabinol) act on G protein-coupled receptors (i.e., CB1/CB2) in the brain to produce their psychoactive effects. Shortly thereafter, it was discovered that endogenous ligands (i.e., endocannabinoids) exist for these receptor targets and, that they are synthetized on demand under a variety of physiological conditions. Thus, we can now study how phytochemicals, endogenous ligands, and synthetic/metabolic enzymes of the endocannabinoid system influence the brain and behavior by activating known receptor targets. Our increased ability to study cannabinoid interactions with the brain and behavior coincides with an increase in international interest in utilizing cannabinoids as a medicine. At the same time, the potency of, and administration routes by which cannabinoids are used is rapidly changing. And, these trends in cannabinoid misuse are producing lasting neural adaptations that have implications for mental health. In this special edition, we will summarize our recent period of discovery regarding how: 1) phytocannabinoids, synthetic cannabinoids and endocannabinoids act on the brain to produce behavioral effects; 2) cannabinoids can be harnessed to produce pharmacotherapeutic utility in the field of medicine; and 3) use of increasingly more cannabinoid variants through unique routes of administration alter the brain and behavior, especially when used in critical developmental periods like pregnancy and adolescence.

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.

Conciencia y naturaleza: en los límites del fisicalismo / Consciousness and nature. The limits of physicalism

Con la esperanza de que los conocimientos en neurociencia ayudasen a comprender al ser humano y a tratar de modo científico sus pérdidas de equilibrio mental, durante los últimos años del siglo XX se dedicaron grandes esfuerzos a la investigación del cerebro, dando lugar a la comúnmente denominada psiquiatría biológica. Sin embargo, debido a los límites y conveniencia de estos conocimientos en su aplicación práctica, junto con las dudas que proporciona la ciencia actual sobre la percepción humana, un número creciente de científicos y filósofos han abierto nuevas líneas de investigación y desarrollado nuevas hipótesis sobre la actividad mental y las relaciones mente-materia que podrían cambiar nuestra comprensión del mundo

In the hope that knowledge in neuroscience helped to understand human beings and treat their losses of mental balance in a scientific way, during the last years of the 20th century great efforts were devoted to brain research, leading to the so-called “biological psychiatry”. However, due to the limits and convenience of this knowledge in its practical application, together with the existing doubts regarding current science about human perception, an increasing number of scientists and philosophers have opened new lines of research and developed new hypotheses about mental activity and mind-matter relationships that might change our understanding of the world

[A selective review of recent research results in biological psychiatry]. / Aktuelle Forschungsergebnisse aus dem Bereich der biologischen Psychiatrie.

In accordance with the motto of this year's German Society for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) conference, this article surveys very recent developments in biological psychiatry and neurosciences that have the potential to open up new vistas for the psychiatry and psychotherapy of the future. The work reported includes progress in genome-wide association studies, the implications of these findings for psychiatric nosology and gene-environment interactions, new methods to characterize mechanisms of altered brain function in animal models and humans and the translation of these findings into new therapies. As a core methodology for the psychiatry of the future, biological and applied neuroscience approaches should benefit from sustained structural funding to ensure that these advances impact real-world patient care.

Psiquiatria Biológica e Psicofarmacologia: a formação de uma rede tecnocientífica / Biological Psychiatry and Psychopharmacology: a techno-scientific network in debate

Resumo A Psiquiatria Biológica emerge nos anos de 1980, nos Estados Unidos, com a publicação do DSM-III (Diagnostic and Statistical Manual of Mental Disorders). Este manual tem a proposta de ser a-teórico e apresentar descrições objetivas dos, então, chamados "distúrbios mentais" a partir de um critério classificatório que não inclui discussões acerca da etiologia destes "distúrbios". Isto implica que, apesar da denominação biológica conferida a esta vertente psiquiátrica, não houve nenhuma descoberta acerca da etiologia biológica destes distúrbios que justificasse sua denominação e seu estrondoso sucesso mundial. Neste artigo, pretendemos analisar as modificações ocorridas na psiquiatria norte-americana a partir da introdução do DSM-III, dos primeiros medicamentos psicotrópicos e o subsequente papel desempenhado pela indústria farmacêutica neste processo. Desse modo, o que está em análise neste artigo é que, ao se apropriar dos medicamentos psicotrópicos como primeira opção terapêutica, a Psiquiatria Biológica cria uma aliança com a indústria farmacêutica que a insere numa rede tecnocientífica que dificulta saber os limites entre Psiquiatria Biológica, Psicofarmacologia e Indústria farmacêutica.

Abstract Biological Psychiatry emerged in the 1980s in the United States with the publication of DSM-III (Diagnostic and Statistical Manual of Mental Disorders). This manual intends to be a-theoretical and to provide objective descriptions of "mental disorders" by using diagnostic criteria that do not include discussions about the aetiology of these "disorders". Hence and despite the "biological" label conferred to this branch of psychiatry, there is no explicit concern to ascertain the possible biological origins of "mental disorders" in DSM-III. In this paper we intend to examine the modifications in North American Psychiatry following the introduction of the first psychotropic medications and the subsequent role played by the pharmaceutical industry in this process. Thus, what is under analysis in our article is that, by appropriating psychotropic drugs as the first therapeutic option, Biological Psychiatry creates an alliance with the pharmaceutical industry that inserts it into a technoscientific network that makes it difficult to know the limits between Biological Psychiatry, Psychopharmacology and the Pharmaceutical industry.

¿Quo vadis, psiquiatría? / Quo vadis, psychiatry?

En este artículo llevamos a cabo una breve introducción a la cuestión de lo que se ha dado en llamar "postpsiquiatría". Desde el artículo fundacional de Patrick Bracken y Philip Thomas en 2001 hasta nuestros días, y con la perspectiva de los más de 15 años transcurridos, intentamos analizar algunos aspectos de este movimiento plural, así como las reacciones que se han producido en contra del mismo, planteando cuál es nuestra posición personal en el debate acerca de qué tipo de psiquiatría queremos tener y cómo ncaminarnos hacia ese objetivo (AU)

In this article we provide a brief introduction to the question of what has been called "postpsychiatry". From the foundational article by Patrick Bracken and Philip Thomas in 2001 to the present and with the perspective of the more than 15 years elapsed, we try to analyze some aspects of this plural movement, as well as the reactions that have occurred against it, exposing our personal position in the debate about what kind of psychiatry we want to have and how can we contribute towards that goal (AU)

Paradigmas en estallido: epistemologías para una ¿post?psiquiatría / Shattered paradigms: epistemologies for a post?psychiatry

Las epistemologías feministas y poscoloniales han hecho importantes aportaciones a múltiples campos teóricos. La postpsiquiatría, en tanto que nacida durante el periodo posmoderno y orientada a rehacer parte de la teoría y la práctica psiquiátrica, es uno de los campos donde otras miradas y la experiencia de otros paradigmas asimismo cuestionados y ampliamente debatidos resultan enriquecedoras. A partir de puntos de conflicto paralelos se estudian las analogías y diferencias entre los distintos campos teóricos, buscando qué soluciones puede incorporar la psiquiatría contemporánea si quiere definirse como postpsiquiatría (AU)

Feminist and postcolonial epistemologies have hugely contributed to different theorical fields. Postpsychiatry, as a field born during the postmodern period, and also intended to restore some part of the theory and praxis that sustain contemporary psychiatry, is one of the areas where the consideration of different approaches and the experience from other questioned and even rejected paradigms could prove illuminating. Starting from parallel points of conflict we investigate the analogies and differences between different theoretical fields with the aim of finding solutions which contemporary psychiatry could incorporate in order to be defined as postpsychiatry (AU)

Relación terapéutica y tratamientos en postpsiquiatría / Therapeutic relationship and treatments in postpsychiatry

El valor de "verdad" de las narrativas de la psiquiatría moderna, su enfoque centrado en el individuo y en la provisión de tecnología condicionan una relación terapéutica vertical. La postpsiquiatría cuestiona estos presupuestos y propone una relación terapéutica horizontal en la que la voz de los usuarios es crucial, los contextos adquieren mayor protagonismo como fuentes de significación y la ética se coloca por delante de la tecnología (AU)

The value of "truth" in the narratives of modern psychiatry, its focus on the individual and the provision of technology, determine a vertical therapeutic relationship. Post-psychiatry challenges these premises and proposes a horizontal therapeutic relationship where the voice of the users is crucial, the contexts take on a greater role in providing other meanings and ethics is placed before technology (AU)

Viaje con nosotras (destino postpsiquiatría, billete sólo de ida) / Travel with us (destination postpsychiatry, one-way ticket)

Nosotras somos enfermeras con muchos años de experiencia trabajando en psiquiatría. Durante todos estos años, partiendo del modelo biologicista habitual en el que nos formamos, hemos estado buscando un modelo de trabajo que se corresponda con nuestros valores y creencias y, sobre todo, que sea verdaderamente útil para las personas con las que trabajamos. El presente artículo relata nuestro viaje en busca de ese modelo de trabajo partiendo del panóptico foucaltiano, el construccionismo social, la narrativa y otras influencias como la terapia breve y la indagación apreciativa, definiendo nuestra posición postpsiquiátrica. Planteamos también algunos desafíos de nuestra mirada posmoderna para nuestro trabajo cotidiano. Sabemos que no es un modelo teórico completo y tampoco pretendemos que lo sea. Contamos nuestro camino y lo compartimos para quien pueda serle útil (AU)

We are nurses with several years of experience working in psychiatry. During all these years, starting from the common biological model in which we were trained, we have been in search of a model of work that corresponds to our values and beliefs and, above all, that is truly useful for the people with whom we work. The present article describes our journey in search of this model starting with the Foucauldian Panopticon, social constructionism, narratives and other influences such as brief therapy and appreciative inquiry, defining our own postpsychiatric position. Our postmodern views also pose challenges to our daily work. We know that it is not a complete theoretical model and we do not aim it to be such a model. We inform about our own way and share it for whoever might find it useful (AU)

Clozapina: una revisión / Clozapine: a review

La esquizofrenia es el trastorno psiquiátrico que constituye el paradigma de la enfermedad mental. Su tratamiento continúa siendo un tema controvertido, especialmente cuando hablamos de efectos secundarios, remisión de los síntomas, funcionalidad y calidad de vida del individuo que la sufre. La clozapina, desde su introducción en 1959 y aceptación oficial por la FDA para el tratamiento de la esquizofrenia resistente en 1990, es el medicamento que más controversia ha causado debido a su perfil atípico y a su acción en múltiples receptores que condicionan efectos secundarios que, a pesar de no poner en riesgo la integridad del paciente (p. ej. sialorrea, sedación), sí pueden representar una amenaza para su calidad de vida, o por efectos que pueden por sí mismos poner en riesgo la vida del paciente (p. ej. agranulocitosis, miocarditis); sin embargo, el conocimiento de la molécula, sus indicaciones de uso y la monitorización necesaria son acciones que permiten el uso de la sustancia de una forma segura, que beneficie al paciente y por lo tanto a su familia, principalmente por la acción terapéutica no solo de mejoría en síntomas psicóticos positivos y negativos, sino por su efecto incisivo en el riesgo suicida y la agresividad, mayor que otros antipsicóticos, además de su uso en pacientes que cuentan con patologías concomitantes como enfermedad de Parkinson, discinesia tardía, entre otras (AU)

Schizophrenia is a psychiatric disorder that is the paradigm of mental illness. Its treatment remains a controversial issue, especially as regards side effects, remission of symptoms, function, and the quality of life of the individual who suffers from it. Clozapine, since its introduction in 1959, and its formal acceptance by the FDA for treatment resistant schizophrenia in 1990, is the drug that has led to most controversy, due to its atypical profile action at multiple receptors. These actions determine the side effects (e.g., hyper-salivation, sedation), and although not placing the integrity of the patient at risk, can be a threat to their quality of life. There are other side effects that can, in themselves, endanger the patient's life (e.g., agranulocytosis, myocarditis). However, the knowledge of the molecule, its indications for use, as well as mandatory monitoring, are actions that allow the safe use of the substance that can benefit the patients, and therefore their families. This is mainly due to the therapeutic action not only improving the positive and negative psychotic symptoms, but also its significant effect on suicidality and aggressiveness, which is greater than other antipsychotics. It can also be used in patients with concomitant diseases, such as Parkinson's disease, and tardive dyskinesia (AU)

Neuroimagen estructural de primeros episodios psicóticos en consumidores de cánnabis / Neuroimaging of first-episode-psychosis in cannabis users: a review

Antecedentes. Existen muchos estudios de neuroimagen con el objetivo de evaluar los cambios que se dan a nivel del sistema nervioso central en consumidores de cánnabis. Sin embargo, pocos han sido realizados en sujetos con un primer episodio psicótico (PEP), una de las poblaciones con mayor prevalencia de uso de esta droga ilícita. Objetivos. Evaluar las alteraciones estructurales que se dan en consumidores de cánnabis que debutan con un PEP y sus implicaciones en el curso y pronóstico de la enfermedad psicótica. Estrategia de búsqueda: búsqueda sistematizada en la base electrónica PubMed de artículos publicados entre el 2003 y el 2013. Criterios de selección: se han incluido todos los estudios que evalúan las diferencias a nivel del sistema nervioso central, en base a pruebas de RMN estructural en población con un PEP según criterios DSM-IV/R o CID-10 e historia de consumo de cánnabis. Resultados. Las variables fueron analizadas y registradas en forma de tablas. Las principales alteraciones en PEP en consumidores de cánnabis se encontraron a nivel del córtex del giro cingulado, hipocampo, tercer ventrículo, ventrículo lateral, lóbulo occipital izquierdo, córtex prefrontal dorsolateral y sustancia gris total. Conclusiones. Los hallazgos presentan mucha variabilidad entre estudios y estos presentan una considerable cantidad de sesgos. La alteración más frecuentemente reportada es la reducción del córtex cingulado y la sustancia gris total en PEP de consumidores de cánnabis. Sin embargo, se precisa mucha más investigación al respecto (AU)

Background. There are many neuroimaging studies that aim to evaluate the changes that occur in the CNS of cannabis users. However, few studies have been conducted on subjects with a First Episode Psychosis (FEP), one of the largest populations with the highest prevalence of cannabis drug usage. Objectives. To evaluate the specific structural abnormalities that appear in FEP in Cannabis users and the implications on the clinical course and outcome of the psychotic disease. Searching strategy: Systematic research of articles published in the electronic database PubMed from 2003 to 2013. Selection criteria: All studies were included that assess the differences in CNS based on findings in structural MRI in a FEP population diagnosed using DSM-IV/R criteria and a history of cannabis usage. Results. The variables had been analysed and registered in tables. The main alterations of FEP appear in cingulate gyrus grey matter, hippocampus, third ventricle, and lateral ventricle, as well as left occipital lobe, dorsolateral prefrontal cortex, and total grey matter. Conclusions. The findings show a high variability among the studies, and these same studies have a statistical bias. The most frequent alteration reported is the reduction in cingulate cortex and total grey matter. Therefore, further studies are required (AU)

Trastorno de conducta durante el sueño REM: a propósito de un caso concomitante con depresión / REM sleep behaviour disorder: report of a case with concomitant depression

El trastorno de conducta durante el sueño REM (TCSR) es una parasomnia que no debe ser considerada como un simple trastorno del sueño, sino como una manifestación de una enfermedad neurológica, pues puede constituir hasta en un 50% de casos un síntoma inicial de una enfermedad neurodegenerativa (especialmente de la enfermedad de Parkinson y la demencia por cuerpos de Lewy), circunstancia que hace imprescindible el conocimiento de este síndrome por parte del psiquiatra, pues por su consulta transitarán muchos de estos pacientes, que deberemos redirigir para completar el estudio y realizar el diagnóstico definitivo, que además de clínico, requiere un estudio polisomnográfico de confirmación. Esto facilitará un diagnóstico precoz de la enfermedad neurológica. El TCSR se manifiesta como sueños vívidos o pesadillas asociadas a conductas motoras y vocales vigorosas, simples o complejas, durante el sueño y falta de la atonía fisiológica durante la fase REM. Los pacientes parecen «actuar sus sueños», que a menudo incluyen temáticas de persecución o lucha. Habitualmente ocurre en hombres a partir de 55 años. Su prevalencia se desconoce, aunque se estima entre un 0,5-2%. Parece que los antidepresivos, especialmente los ISRS, pueden desencadenar el cuadro. La depresión comórbida es frecuente. El tratamiento más eficaz es el clonazepam a dosis bajas (0,5-3 mg antes del sueño), que resulta exitoso hasta en el 89,5% de pacientes, asociado a consejo (AU)

REM sleep behaviour disorder (RBD) is classified as a parasomnia. However, it should not be considered as a simple sleep disorder, but as a manifestation of a neurological disease, since it can be an initial symptom of a neurodegenerative disorder in up to 50% of cases (especially Parkinson's disease and Lewy bodies dementia). It is essential that psychiatrists are aware of this syndrome, as many of these patients are first seen in psychiatric outpatient clinics. Psychiatrists should be redirected to complete the study and make the final diagnosis, which also requires confirmation by polysomnography. RBD manifests as vivid dreams or nightmares associated with simple or complex vigorous motor and vocal behaviours during REM sleep. This will facilitate early diagnosis of neurological disease. Patients appear to ‘act out their dreams’, which often include themes of persecution or fight. It usually occurs in men over 55 years. Its prevalence is unknown, but is estimated at between 0.5% and 2%. Antidepressants, especially SSRIs, seem to trigger the disorder. Comorbid depression is common. The most effective treatment is clonazepam at low doses (0.5-3 mg before sleep), which is successful in up to 89.5% of patients, with associated counselling (AU)

Hepatitis tóxica secundaria al tratamiento con ácido valproico: diagnóstico diferencial; a propósito de un caso / Hepatotoxicity secondary to treatment with valproic acid: differential diagnosis; a case report

Presentamos el caso de un varón de 70 años diagnosticado de trastorno afectivo bipolar que ingresa en la unidad de psiquiatría por episodio maniforme tras abandono de su tratamiento habitual. Nueve días después de la reintroducción del tratamiento (quetiapina y ácido valproico), el paciente comienza con síntomas compatibles con hepatitis tóxica: dolor epigástrico y malestar general acompañado de orinas colúricas, elevación brusca de las enzimas hepáticas y pico febril de 39,3 °C. Ante esta situación, tras ser valorado por los servicios de medicina interna y digestivo, se decide la retirada de ambos fármacos. Se realizaron varias pruebas médicas. Finalmente en los hemocultivos se aisló el germen Escherichia coli, tras lo cual se inició tratamiento antibiótico. El paciente mejoró con la suspensión de los fármacos y el tratamiento antibiótico: remitieron los signos y síntomas, y los valores de las enzimas hepáticas comenzaron a descender paulatinamente hasta normalizarse. En este caso, por la presentación y evolución del cuadro, se puede concluir que el origen de la hepatitis fue probablemente infeccioso. Cabe destacar la importancia de realizar un buen diagnóstico diferencial de las posibles causas que puedan contribuir a potenciar la toxicidad hepática (AU)

The case is presented of a 70 year-old male with bipolar affective disorder, who was admitted to the psychiatric inpatient unit due to a mania episode after stopping taking his usual treatment. Nine days after the reintroduction of the treatment (quetiapine and valproic acid), the patient started to suffer symptoms compatible with toxic liver disease, with epigastric pain and general discomfort followed by voiding a dark urine, sudden elevation of liver enzymes, and a fever of 39.3 °C. After being assessed by Internal Medicine and Gastroenterology department, both drugs were removed. Several physical examinations were performed. Finally, blood cultures were positive for E. coli, for which antibiotic treatment was started. The patient improved with the discontinuation of drugs and the antibiotic treatment. The signs and symptoms decreased and liver enzymes began to descend gradually until they returned to normal. In this case, it may be concluded, due to the presentation and the evolution of the symptoms, that the most likely cause of hepatitis was infection. However, we want to point out the importance of performing an adequate differential diagnosis of causes of hepatotoxicity (AU)

Biopsiquiatría vs Postpsiquiatría: debates entre la explicación neurobiológica y la comprensión hermenéutica / Biopsychiatry vs postpsychiatry: debates between neurobiological explanation and hermeneutical comprehension

El presente artículo pone en discusión dos enfoques de la psiquiatría contemporánea, que sostienen importantes diferencias desde el punto de vista epistemológico: la biopsiquiatría o psiquiatría biológica y la postpsiquiatría. Desde una perspectiva crítica en psiquiatría que reconoce como influencia principal los trabajos de Michel Foucault sobre la medicina, la psiquiatría y la locura, analizamos fragmentos de proyectos u organismos líderes representantes de la psiquiatría biológica mainstream. Seleccionamos para tal fin, declaraciones del National Institute of Mental Health (NIMH), perteneciente al National Institutes of Health (NIH); y de los dos principales proyectos que se están llevando a cabo para el estudio del cerebro: Human Brain Project (HBP) y Brain. Luego introducimos al lector en la propuesta de la postpsiquiatría, para finalmente presentar una reseña de la hermenéutica y su revalorización en la comprensión de la experiencia de la enfermedad mental

Two paradigms of the contemporary psychiatry which maintain important differences from an epistemologycal point of view are discussed: biopsychiatry or biological psychiatry and postpsychiatry. From a critical perspective in psychiatry, mainly influenced by Michel Foucault´s work in medicine, psychiatry and madness, we consider statements of a leading organization and two projects that take part in the mainstream biological psychiatry. Namely we examine annoucements of the National Institute of Mental Health (NIMH), belonging to the National Institutes of Health (NIH); and statements from the most important projects for the brain study: ‘Human Brain Project’ (HBP) and ‘Brain’, developed by the European Union and the United States government respectively. Then we present the postpsychiatry proposal and finally we describe hermeneutics and the retrieval of the postpsychiatry perspective in the mental illness comprehension