Psykofarmakologisk behandling af angst

The clinical and theoretical rationale of psychopharmalogical treatment of anxiety disorders is reviewed from the viewpoint of neuropsychiatry. It is underlined that anxiety in clinical settings is a broad concept, and that a rigorous differential diagnosticprocess according to DSM-III or ICD-10 classification systems is mandatory for rational pharmacotherapy. Recent investigations of the pharmacodynamics of anxiolytic psychotropic drugs has focused on neurotransmitter enzymes and receptors. The delineation of different families of serotonin and dopamin receptors represents important progress in the development of drugs with greater clinical efficacy and more favourable side effects. The importance of combining psychopharmacological treatmentand psychotherapy is discussed.Det kliniske og teoretiske rationale for psykofarmakologisk behandling af angst belyses udfra et neuropsykiatrisk synspunkt.Det fremhæves, at angst i klinisk sammenhæng er et bredt begreb, og at grundig differentialdiagnostik efter DSM-lll ellerJCD-10 er enforudsætningfor rationel farmakoterapi. Nyere undersøgelser over angstdæmpende farmakas virkningsmekanismerhar fokuseret på neurotransmittere, enzymer og receptorer. Afgrænsning af forskellige undergrupper (familier) af serotoninogdopaminreceptorer betragtes som et væsentligt fremskridt i udviklingen af farmaka med større effekt og færre bivirkninger.Betydningen af kombineret psykofarmakologisk og psykoterapeutisk behandling diskuteres

DEPRESSION: FRA KLINIK TIL GEN

Artiklen giver en kort oversigt over neuropsykiatrisk forskning af depressive tilstande i HjerneÅret. Psykiske processer ses som emergente fænomener, der kræver videnskabelig beskrivelse på mange niveauer. Der gives eksempler fra klinisk og basalvidenskabelige forskning og de terapeutiske konsekvenser omtales. Det søges illustreret, at moderne neuropsykiatriske forskning baseres på en tværfaglig tilgang med udgangspunkt i den biopsykosociale sygdomsmodel og med empirisme som erkendelsesteoretisk position.A short review of neuiropsychiathic research of affectiv disorders is presented to illustrate major search activities within the Year of the Brain. Psychological processes are conceived as emergent phenomena requiring scientific analyses at different theoretical and conceptual levels. Examples are given from current basic psychiatric research of affective disorders and the therapeutic implications are stated. It is underlined that modern neuropsychiatric research requires a multidisciplinary approach as evidenced by the application of a bio-psycho-social disease model with an empiristicepistemology.Keyword: psychiatry; neuropsychiatry; affective disorder; neurobiology; neuropsycholog; psychopharmacology; psychotherapy

Sarcopenia and cachexia: the adaptations of negative regulators of skeletal muscle mass

Recent advances in our understanding of the biology of muscle, and how anabolic and catabolic stimuli interact to control muscle mass and function, have led to new interest in the pharmacological treatment of muscle wasting. Loss of muscle occurs as a consequence of several chronic diseases (cachexia) as well as normal aging (sarcopenia). Although many negative regulators [Atrogin-1, muscle ring finger-1, nuclear factor-kappaB (NF-κB), myostatin, etc.] have been proposed to enhance protein degradation during both sarcopenia and cachexia, the adaptation of mediators markedly differs among these conditions. Sarcopenic and cachectic muscles have been demonstrated to be abundant in myostatin- and apoptosis-linked molecules. The ubiquitin–proteasome system (UPS) is activated during many different types of cachexia (cancer cachexia, cardiac heart failure, chronic obstructive pulmonary disease), but not many mediators of the UPS change during sarcopenia. NF-κB signaling is activated in cachectic, but not in sarcopenic, muscle. Some studies have indicated a change of autophagic signaling during both sarcopenia and cachexia, but the adaptation remains to be elucidated. This review provides an overview of the adaptive changes in negative regulators of muscle mass in both sarcopenia and cachexia

90'erne, hjernernes år

90'erne er blevet udnævnt til »The Decade of the Brain« for herved at stimulere tværdisciplinærudforskning af hjernen. En naturalistisk tilgang til studiet af psykiske lidelser er dermed konsolideret. Nogle resultater fra de senere års forskning af psykiske lidelser omtales, specielt den »Neo-Kraepelinske Revolution« karakteriseret ved empiriskforskningsmetodologi og medicinsk sygdomsopfattelse. Neuropsykiatrisk forskning bliver højt prioriteret i 90'eme.»The Decade of the Brain«, which started January 1, 1990, consolidates a naturalistic approach to psychiatry. Research trends from the »Neo-Kraeplinian Revolution« are presented. Empirical methodology and a medical disease conception ha~ had high priority in psychiatry research. Hence, the future importance of neuropsychiatry has been underlined

Health-related quality of life between naturalism and hermeneutics

Interest in measuring Quality of life (QOL) in modern medicine has increased considerably in recent years. However, there is no generally agreed definition of QOL, but the term encompasses several constructs, including physical, functional, emotional, social and cognitive domains. A psychometric approach is typically applied, but major problems conceptual confront this tradition. It is argued that QOL research follows a naturalistic tradition in medicine, and that the theoretical status of the QOL concept remains ambiguous. Hence, the more neutral term multidimensional evaluation is suggested as more appropriate than QOL. Hermeneutic thinking with its focus on meaning, understanding and interpretation of the individual placed in a historical and social context is briefly introduced and its role for QOL discussed. A radical hermeneutic position focusing solely on the subjectivity of the individual is rejected, and a balanced view is suggested. Such a view should not ignore that man is a biological organism which can be subjected to naturalistic studies, but it should also take into account those features which constitutes man as a person, e.g. understanding and interpretation. Future QOL research may benefit from an integration of philosophical reflection on health and disease issues and a psychometric tradition.Quality of life psychometrics hermeneutics philosophy of science