Aspectos neuroquímicos, neuropsiquiátricos y psicológicos”
Buenos Aires, Barcelona, México: Editorial Paidós,
Psychiatric Journal of the University of Ottawa 1989,
This is the second edition of Psychodynamic Psychopharmacology,
written in Spanish by an Argentinian psychopharmacologist and
psychiatrist. It is a volume of 671 pages, which integrates
the latest advances in biological psychiatry and the relation
between psychodynamics and psychopharmacology.
There are fourteen chapters dealing systematically with the
major group of drugs and it detail, with drug therapy in pediatric
and geriatric practice, alcoholism, epilepsy and Parkinson’s
In the first chapter, the author outlines the master plan from
a clinical and experimental perspective. He deals with the nonspecific
factors in drug response, the history of clinical responsiveness
to drugs and finally the specific factors. Expertly and succinctly,
he moves from clinical psychiatry to psychodynamics and to pharmacodynamics.
The book relies principally on neurochemistry, neurophysiology
and pharmacokinetics. Each psychotropic drug is classified on
table 3 according to whether they act on the pre-synaptic or
post-synaptic cleft, as agonist or antagonist and on what particular
receptors and neurotransmitters. Nineteen tables throughout
the text are an example of its clarity. For example, one of
these tables presents the followings classification of different
treatment approaches for tardive dyskinesias:
- dopamine blocking agents: e.g., butyrophenones;
- catecholamine depleting agents: e.g., alpha-methyldopa (Aldomet);
- cholinergic agents: e.g., dimethy1-amino-ethanol (Deaner);
- gaba agonists: e.g., Valproic acid, Baclofen, and,
- dopamine releasing agents: e.g., amantadine
Seven mechanisms of action are imputed to lithium: 1) increases
adrenaline re-uptake: 2) increases the intraneural breakdown
of catecholamines by stimulating M.A.O.ase activity; 3) displacement
of Na, K, Mg and Ca; 4) increase neuronal uptake of tryptophan;
5) increase the conversion of tryptophan to serotonin; 6) chronic
administration of lithum (more than 10 days) decreases the activity
of the enzyme tryptophan-hydroxylase and consequently the conversion
of tryptophan to serotonin; and, 7) it blocks the postsynaptic
Several promising drugs not available in Canada are given a
place in the armamentarium, including: bupropion, fluovoxamine,
zimelidine, viloxazine among the antidepressants. Vasopressin
(Sandoz) ACTH 4-10 (Organon) and Sincalide (CCK8) (Squibb) are
under investigation for memory disturbances in geriatric psychiatry.
Nooanaleptics, GABA derivatives such as piracetam and many vasodilators
have been approved in several countries for use in neuropsychiatric.
Interesting development in the area are the use of vincamine,
citidincholine, and cyclandelate as cerebral vasodilators. The
latter are classified in four groups: 1) arteriolar spasmolytic,
alpha-blocking or beta agonist; 2) those that inhibit the phosphodiesterase
and ca-ATPsa balance; 3) those that produce neuronal metabolic
changes; and, 4) those that inhibit platelet aggregation.
Each of the fourteen chapters has an updated bibliography mostly
from English speaking world with an unmistakable emphasis on
biological psychiatry, neuropsychiatry and neurology. A useful
list of all available drugs is offered from page 623 to page
648, and from page 649 to 662, an index of drugs. Tables on
drug equivalences, drug interactions, half-life of drug effect,
bio-transformation, release, absorption, distribution, metabolism
and elimination; (R.A.D.M.E) are of tremendous practical importance.
Differences between side effects of lithium and carbamazepine,
useful clinical step-wise approach to the treatment of major
depression with or without psychoses and dysthymias etc., make
this compendium eminently suitable not only to psychiatrist
but to general practitioners and neurologists.
No doubt this book compares with the best textbooks on psychopharmacology.
It is perhaps too ambitious or overinclusive pharmacotherapy
or psychotherapy alone or in combination and over representing
many drugs that have not been shown to be clinically useful.
Hector Warnes, M.D.
Ottawa, Ontario, Canadá