“Psicofarmacología Psicodinámica II.
Aspectos neuroquímicos, neuropsiquiátricos y psicológicos”

Julio Moizeszowicz

Buenos Aires, Barcelona, México: Editorial Paidós,
671 pp. 1988.

Psychiatric Journal of the University of Ottawa 1989,
14 Nº3: 500

 

 

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 disease.
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 receptor (adenylcyclase).
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