Biological and cognitive aspects of somatoform disorders

A practical clinical subdivision of Psychosomatic Syndromes is proposed. Physiological and clinical features of both of them are discussed. The real and serious clinical problem that this entities represents is stated. Actual concepts about functional disorders of the Gl are being analyzed. Special focus is placed in the relation between the anatomical and physiological arrangement of the visceral afferent pathways, and the clinical presentations of these entities. The terms and concepts: hypersensitivity, hyperalgesia, pain thresholds, somatic reference of visceral pain, pain memory, receptive fields are studied.The mechanisms that allows and conduces to the hole expression of the syndrome are thought to have the special characters of the visceral sensorial modalities.It is proposed that many functional psychosomatic patients (Somatoform patients) have alterations in sensorial process at a peripheral level, with alterations in the pain and noxious memory of the Sensitive neurons of the dorsal horn. Cognitive process is being discussed, and an integrative point of view is proposed.It is concluded that the unique clinical, anatomical and physiological feature of visceral sensitive process: Ambiguity, and lack of accuracy, makes it more biased to distortions in the information process

Most common interactions of psychotropic drugs

Interaction between psychotropic drugs is an important issue due to the fact that very often a patient will take more than one drug. Interactions belongs to two main field Pharmacokinetic and Pharmacodynamic. Pharmacokinetic is related to Absorption, Distribution, Metabolism and Excretion. Many drugs interacts at this level. Enzymatic Induction and Inhibition are one of the most important mechanism of interaction and psychotropic drugs. Cytochrome P 450 is a highly sensitive enzyme to induction and inhibition, and responsible for many of these interactions. Lithium has many interactions in the kidney, where his elimination can be strongly affected by drugs, as non-steroid antiinflamatories and diuretics. Anticholinergic effect addition is one very frequent pharmacodynamic interaction, e.g. with Tricyclic Antidepressants and Neuroleptics. Alcohol affects all available psychotropic drugs, enhancing their sedative effects, and interfering with their therapeutic effects. Surgery is a condition where drug-drug interactions are potentially dangerous, so doctors have to take care of this avoiding anticholinergic summatory effect.

Aspectos clinicos y neuroquimicos en las psicosis maniaco depresivas en la juventud y la adolescencia / Clinical and neurochemical aspects in the maniac-depressive psychoses in youth and adolescence

La psicosis maníaco-depresiva es una patología cuya incidencia en la infancia es de difícil determinación las dificuldades diagnósticas. Kraepelin mencionaba la conducta maniforme como fisiológica en la infancia, entre estas dificuldades. En la adolescencia el cuadro sería un poco más claro para su diagnóstico. La tendencia a subrediagnosticar trastornos esquizoafectivos debe ser adecuadamente valorada. Muchos casos de Psicosis Maníaco Depresiva, suelen recibir ese diagnóstico. Diversos aspectos deben ser evaluados para el abordaje de las distimias en la infancia. En primer lugar los factores genéticos que juegan un rol fundamental en estas patologías. En segundo lugar los marcadores bilógicos: entre ellos debemos destacar los característicos transtornos en la arquitectura del sueño, los marcadores neuroendócrinos (TRH/TSH test, Test de Supresión de la Dexametasona) y los marcadores neuroquímicos. Este último grupo ha adquirido gran relevancia, debiéndose destacar el MHPG, la actividad MAO plaquetaria y los desórdenes a nivel de la neurotransmisión serotoninérgica, entre los que incluímos a los denominados compuestos metílados como la Bufotenina, O. Metil Bufotenina y N.N. Dimentiltriptamina, que se comportarían como marcadores de rasgo de predisposición para padecer trantornos psicóticos, particularmente sensoperceptuales. Se discuten los diversos abordajes terapêuticos.