Bases psicobiológicas de la adicción a cocaína

El principal mecanismo de acción de la cocaína es la inhibición de la recaptación de dopamina y noradrenalina, produciendo un aumento de estos neurotransmisores en la sinapsis. El consumo agudo de cocaína produce una serie de cambios bastante conocidos en el sistema cerebral de recompensa. Sin embargo, el consumo crónico, produce, además, otra serie de cambios a nivel molecular que llevan al sujeto desde una situación de consumo puntual, a una situación de dependencia. Se han propuesto diferentes teorías explicativas de este fenómeno como la sensibilización del incentivo, o la homeostasis y alostasis neuroquímica, planteamientos basados en el condicionamiento clásico y operante. Por otra parte, se ha señalado la intervención de diferentes moléculas y vías de segundos mensajeros, que producen, en última instancia, una serie de cambios neuronales mantenidos a muy largo plazo, probablemente permanentes, que se podrían relacionar con la vulnerabilidad a las recaídas, propia de la adicción a cocaína, incluso años después de abandonar el consumo

Crítica de Libros.

Nicolás CAPARRÓS, Tiempo, temporalidad y Psicoanálisis, Madrid, Quipú, 1994. Consuelo Escudero. lean GARRABÉ, Diccionario taxonómico de psiquiatría, México, Fondo de Cultura Económica, 1993. José María Álvarez Jean GARRABÉ, Histoire de la schizophrénie, París, Seghers, 1992. Fernando Colina Emilio LLEDÓ, Días y libros. Pequeños artículos y otras notas, Valladolid, Junta de Castilla y León, Consejería de Cultura y Turismo, 1994. Rafael Serrano García Jacques LACAN, Le séminaire IV. La relation d'objet, París, Le Seuil, 1994. Mauricio Jalón. ESTADO DE LA CUESTIÓN SOBRE TIPOLOGÍAS DEL ALCOHOLISMO BASADAS EN LA EDAD DE COMIENZO. G. Rubio. SERGE LECLAIRE, UNA OBRA CLAUSURADA. Consejo de Redacció

Crítica de Libros.

Nicolás CAPARRÓS, Tiempo, temporalidad y Psicoanálisis, Madrid, Quipú, 1994. Consuelo Escudero. lean GARRABÉ, Diccionario taxonómico de psiquiatría, México, Fondo de Cultura Económica, 1993. José María Álvarez Jean GARRABÉ, Histoire de la schizophrénie, París, Seghers, 1992. Fernando Colina Emilio LLEDÓ, Días y libros. Pequeños artículos y otras notas, Valladolid, Junta de Castilla y León, Consejería de Cultura y Turismo, 1994. Rafael Serrano García Jacques LACAN, Le séminaire IV. La relation d'objet, París, Le Seuil, 1994. Mauricio Jalón. ESTADO DE LA CUESTIÓN SOBRE TIPOLOGÍAS DEL ALCOHOLISMO BASADAS EN LA EDAD DE COMIENZO. G. Rubio. SERGE LECLAIRE, UNA OBRA CLAUSURADA. Consejo de Redacció

Revista de Revistas.

Selección de reseñas bibliográficas. (Octubre, Noviembre y Diciembre, 1991) Trastornos de la personalidad bordeline. Epidemiología (Thomas A. Widiger, Mima M. Weissman), Assessement y Diagnosis (Andrew E. Skodol y John M. Oldhan), Biological y Pharmacological Aspects (Emil F Coceara, Richard J. KavonssJ), Standarized Appraaches to individual Psychoterapy (M. Tracy Shea) y Graup y Family Tretments (Jons F Clarkin y EIsa MarzialJ) Hospital and community Psychiatry. Octuber 1991; 42 (10): 1015-1043 . M García Pérez La dopamina en la esquizofrenia: una revisión y reconceptualización Dopamine in schizophrenia: A review and reconceptualization. Kenneth L. Davis, MD, Rene S. Kahn, Mo., Grant Ka. MD, MichaelDavidson, Mo. (Del Departamento de Psiquiatría del Hospital y Escuela de Medicina de Mount Sinai, NY) AM J Psychiatry. 1991; Nov, 148: 1474-1486. M García Pérez La controversia Freud-Ferenczi. Un legado viviente. The Freud-Ferenczi controversy. A living legacy. Axel Hoffer, Brookline, Massachusetts. The International Review of Psychoanalysis. Int. Rev. Psycho-Anal. 1991; 18 (4): 465-472. A. E. Nafs Revisión de los conocimientos del Autismo Psicógeno. Revised understandings of Psychogenic Autism. Frances Tustin, Londres. The International Journal of Psycho-Analysis. Int. J. Psycho-Anal 1991; 72 (4): 585-591. A. E. Nafs Dementia of Depresion in Parkinson's Disease and Stroke. Starkstein S.E., Robinson R.G. Journal of Nervous and Mental Disease. 1991 (octubre); 179: 593-601 M. Catalina Zamora An interactionistic integrative view of depresive disordes and their tretment. C. Perris. Departamento de Psiquiátrica y colaborador del Centro de Enseñanza e Investigador de enfermedades Mentales. Universidad de Umea. Suecia Acta Psychiartr. Scand 1991; 84: 413-423E. García Yagüe Personalidad premórbida y síntomas positivos y negativos en la esquizofrenia. V. Peralta y M.J. Cuesta. Unidad de Psiquiatría del Hospital Virgen del Camino. Pamplona. España. J. Delean. Instituto Psiquiátrico de Pensilvania U.S.A. Acta Psychiatr. Scand. 1991; 84: 336-339. E. García Yagüe Interacción entre vulnerabilidad genética y ambiente familiar: estudio finlandés de familias adoptivas en la esquizofrenia. P Teinavi. Departamento Psychiatry. Acta Psychiatr. Scand 1991; 84: 460-465 E. García Yagüe Factores de estrés y enfermedad. J.L. González Rivera. Actas Luso-Esp. Neurol. Psiquiatr. 1991 (Nov-Dic); 19 (6): 290-297. J. García-Noblejas Los orígenes de la psicosis y el «origen del hombre». The origins of psychosis and "the descent of man". T.J. Crow British Journal of Psychiatry. 1991; 159 (sup. 14): 76-82 M.I. de la Hera Cabero. Hallazgos clínicos. Trastornos del estado mental y del movimiento y sus secuelas. Clínical findings. Abnormalities of the mental state and movement disorder and their correlates. Eve C. Johnstone, o.G.C. Owens, c.o. Frith and J. Leary British Journal of Psychatry 1991; 159 (supl. 13): 21-25. M.I. de la Hera Cabero Una perspectiva psicobiológica en los trastornos de la personalidad. A psycobiological perspective on the personality disorders. L.J. Siever, K. L. Davis AM. J. Psychiatry 12, Diciembre 1991; 148: 1647-1658. c. Herraez Martín de Valmaseda El estado de la cuestión en... Manifestaciones psiquiátricas en enfermos con lupus eritematosos sistémico. Salvador Robert M., Pérez Sales P.., Rubio Valladolid G

Revista de Revistas.

Selección de reseñas bibliográficas. (Octubre, Noviembre y Diciembre, 1991) Trastornos de la personalidad bordeline. Epidemiología (Thomas A. Widiger, Mima M. Weissman), Assessement y Diagnosis (Andrew E. Skodol y John M. Oldhan), Biological y Pharmacological Aspects (Emil F Coceara, Richard J. KavonssJ), Standarized Appraaches to individual Psychoterapy (M. Tracy Shea) y Graup y Family Tretments (Jons F Clarkin y EIsa MarzialJ) Hospital and community Psychiatry. Octuber 1991; 42 (10): 1015-1043 . M García Pérez La dopamina en la esquizofrenia: una revisión y reconceptualización Dopamine in schizophrenia: A review and reconceptualization. Kenneth L. Davis, MD, Rene S. Kahn, Mo., Grant Ka. MD, MichaelDavidson, Mo. (Del Departamento de Psiquiatría del Hospital y Escuela de Medicina de Mount Sinai, NY) AM J Psychiatry. 1991; Nov, 148: 1474-1486. M García Pérez La controversia Freud-Ferenczi. Un legado viviente. The Freud-Ferenczi controversy. A living legacy. Axel Hoffer, Brookline, Massachusetts. The International Review of Psychoanalysis. Int. Rev. Psycho-Anal. 1991; 18 (4): 465-472. A. E. Nafs Revisión de los conocimientos del Autismo Psicógeno. Revised understandings of Psychogenic Autism. Frances Tustin, Londres. The International Journal of Psycho-Analysis. Int. J. Psycho-Anal 1991; 72 (4): 585-591. A. E. Nafs Dementia of Depresion in Parkinson's Disease and Stroke. Starkstein S.E., Robinson R.G. Journal of Nervous and Mental Disease. 1991 (octubre); 179: 593-601 M. Catalina Zamora An interactionistic integrative view of depresive disordes and their tretment. C. Perris. Departamento de Psiquiátrica y colaborador del Centro de Enseñanza e Investigador de enfermedades Mentales. Universidad de Umea. Suecia Acta Psychiartr. Scand 1991; 84: 413-423E. García Yagüe Personalidad premórbida y síntomas positivos y negativos en la esquizofrenia. V. Peralta y M.J. Cuesta. Unidad de Psiquiatría del Hospital Virgen del Camino. Pamplona. España. J. Delean. Instituto Psiquiátrico de Pensilvania U.S.A. Acta Psychiatr. Scand. 1991; 84: 336-339. E. García Yagüe Interacción entre vulnerabilidad genética y ambiente familiar: estudio finlandés de familias adoptivas en la esquizofrenia. P Teinavi. Departamento Psychiatry. Acta Psychiatr. Scand 1991; 84: 460-465 E. García Yagüe Factores de estrés y enfermedad. J.L. González Rivera. Actas Luso-Esp. Neurol. Psiquiatr. 1991 (Nov-Dic); 19 (6): 290-297. J. García-Noblejas Los orígenes de la psicosis y el «origen del hombre». The origins of psychosis and "the descent of man". T.J. Crow British Journal of Psychiatry. 1991; 159 (sup. 14): 76-82 M.I. de la Hera Cabero. Hallazgos clínicos. Trastornos del estado mental y del movimiento y sus secuelas. Clínical findings. Abnormalities of the mental state and movement disorder and their correlates. Eve C. Johnstone, o.G.C. Owens, c.o. Frith and J. Leary British Journal of Psychatry 1991; 159 (supl. 13): 21-25. M.I. de la Hera Cabero Una perspectiva psicobiológica en los trastornos de la personalidad. A psycobiological perspective on the personality disorders. L.J. Siever, K. L. Davis AM. J. Psychiatry 12, Diciembre 1991; 148: 1647-1658. c. Herraez Martín de Valmaseda El estado de la cuestión en... Manifestaciones psiquiátricas en enfermos con lupus eritematosos sistémico. Salvador Robert M., Pérez Sales P.., Rubio Valladolid G

Suicidality in primary care patients who present with sadness and anhedonia: a prospective European study

Background: Sadness and anhedonia (loss of interest in activities) are central symptoms of major depression. However, not all people with these symptoms meet diagnostic criteria for major depression. We aimed to assess the importance of suicidality in the outcomes for primary care patients who present with sadness and anhedonia. Method: Cohort study of 2,599 unselected primary care attenders in six European countries followed up at 6 and 12 months. Results: 1) In patients with sadness and/or anhedonia who were not depressed at entry to the study, suicide plans (OR = 3.05; 95 % CI = 1.50–6.24; p = 0.0022) and suicide attempts (OR = 9.08; 95 % CI = 2.57–32.03; p = 0.0006) were significant predictors of developing new onset depression at 6 or 12 months. 2) In patients with sadness and/or anhedonia who met CIDI criteria for major depression at entry, suicidal ideation (OR = 2.93; 95 % CI = 1.70–5.07; p = 0.0001), suicide plans (OR = 3.70; 95 % CI = 2.08–6.57; p < 0.0001), and suicide attempts (OR = 3.33; 95 % CI = 1.47–7.54; p = 0.0040) were significant predictors of persistent depression at 6 or 12 months. Conclusions: Three questions on suicidality could help primary care professionals to assess such patients more closely without necessarily establishing whether they meet criteria for major depression.This research was funded by a grant from The European Commission, referencePREDICT-QL4-CT2002-00683. We are also grateful for part support in Europe from: the Estonian Scientific Foundation (grant number 5696); the Slovenian Ministry for Research (grant No.4369-1027); the Spanish Ministry of Health (grant FIS references: PI041980, PI041771, PI042450) and the Spanish Network of Primary Care Research, redIAPP (ISCIII-RETICS RD06/0018) and SAMSERAP group; and the UK NHS Research and Development office for providing service support costs in the UK. We are also grateful for the support from the University of Malaga (Spain) and to Carlos García from Loyola Andalucía University (Spain)

Predicting the onset of anxiety syndromes at 12 months in primary care attendees. The PredictA-Spain study

Background: There are no risk algorithms for the onset of anxiety syndromes at 12 months in primary care. We aimed to develop and validate internally a risk algorithm to predict the onset of anxiety syndromes at 12 months. Methods: A prospective cohort study with evaluations at baseline, 6 and 12 months. We measured 39 known risk factors and used multilevel logistic regression and inverse probability weighting to build the risk algorithm. Our main outcome was generalized anxiety, panic and other non-specific anxiety syndromes as measured by the Primary Care Evaluation of Mental Disorders, Patient Health Questionnaire (PRIME-MD-PHQ). We recruited 3,564 adult primary care attendees without anxiety syndromes from 174 family physicians and 32 health centers in 6 Spanish provinces. Results: The cumulative 12-month incidence of anxiety syndromes was 12.2%. The predictA-Spain risk algorithm included the following predictors of anxiety syndromes: province; sex (female); younger age; taking medicines for anxiety, depression or stress; worse physical and mental quality of life (SF-12); dissatisfaction with paid and unpaid work; perception of financial strain; and the interactions sex*age, sex*perception of financial strain, and age*dissatisfaction with paid work. The C-index was 0.80 (95% confidence interval = 0.78–0.83) and the Hedges' g = 1.17 (95% confidence interval = 1.04–1.29). The Copas shrinkage factor was 0.98 and calibration plots showed an accurate goodness of fit. Conclusions: The predictA-Spain risk algorithm is valid to predict anxiety syndromes at 12 months. Although external validation is required, the predictA-Spain is available for use as a predictive tool in the prevention of anxiety syndromes in primary care.This study was supported by the Spanish Ministry of Health (grant FIS references: PI041980, PI041771, PI042450 and PI06/1442) and the Andalusian Council of Health (grant references: 05/403 and 06/278); as well as the Spanish Network of Primary Care Research ‘redIAPP’ (RD06/0018), the ‘Aragón group’ (RD06/0018/0020), the ‘Baleares group’ (RD07/0018/0033), and the ‘SAMSERAP group’ (RD06/0018/0039)

Predicting the onset and persistence of episodes of depression in primary health care. The predictD-Spain study: Methodology

Background: The effects of putative risk factors on the onset and/or persistence of depression remain unclear. We aim to develop comprehensive models to predict the onset and persistence of episodes of depression in primary care. Here we explain the general methodology of the predictD-Spain study and evaluate the reliability of the questionnaires used. Methods: This is a prospective cohort study. A systematic random sample of general practice attendees aged 18 to 75 has been recruited in seven Spanish provinces. Depression is being measured with the CIDI at baseline, and at 6, 12, 24 and 36 months. A set of individual, environmental, genetic, professional and organizational risk factors are to be assessed at each follow-up point. In a separate reliability study, a proportional random sample of 401 participants completed the test-retest (251 researcher-administered and 150 self-administered) between October 2005 and February 2006. We have also checked 118,398 items for data entry from a random sample of 480 patients stratified by province. Results: All items and questionnaires had good test-retest reliability for both methods of administration, except for the use of recreational drugs over the previous six months. Cronbach's alphas were good and their factorial analyses coherent for the three scales evaluated (social support from family and friends, dissatisfaction with paid work, and dissatisfaction with unpaid work). There were 191 (0.16%) data entry errors. Conclusion: The items and questionnaires were reliable and data quality control was excellent. When we eventually obtain our risk index for the onset and persistence of depression, we will be able to determine the individual risk of each patient evaluated in primary health care.The research in Spain was funded by grants from the Spanish Ministry of Health (grant FIS references: PI04/1980, PI0/41771, PI04/2450, and PI06/1442), Andalusian Council of Health (grant references: 05/403, 06/278 and 08/0194), and the Spanish Ministry of Education and Science (grant reference SAF 2006/07192). The Malaga sample, as part of the predictD-International study, was also funded by a grant from The European Commission (reference QL4-CT2002-00683)