Knowledge, actual and potential use of HIV self-sampling testing kits among MSM recruited in eight European countries.

AIM: To describe the knowledge as well as current and potential use of self-sampling kits among men who have sex with men (MSM) and to analyse their preferred biological sample and result communication method. METHODS: We analyse data of MSM of HIV negative or unknown serostatus from an online survey conducted in eight countries (Belgium, Denmark, Germany, Greece, Portugal, Romania, Slovenia and Spain) between April and December 2016. It was advertised mainly in gay dating websites. We conduct a descriptive analysis of the main characteristics of the participants, and present data on indicators of knowledge, use and potential use of HIV self-sampling as well as their preferences regarding blood or saliva sample and face or non-face-to-face result communication by country of residence. RESULTS: A total of 8.226 participants of HIV negative or unknown serostatus were included in the analysis. Overall, 25.5% of participants knew about self-sampling (range: 18.8-47.2%) and 1.1% had used it in the past (range: 0.3-8.9%). Potential use was high, with 66.6% of all participants reporting that they would have already used it if available in the past (range: 62.1-82.1%). Most (78.6%) reported that they would prefer using a blood-based kit, and receiving the result of the test through a non-face-to-face-method (70.8%), even in the case of receiving a reactive result. CONCLUSION: The high potential use reported by MSM recruited in eight different European countries suggests that self-sampling kits are a highly acceptable testing methodology that could contribute to the promotion of HIV testing in this population.

Gender differences in C-reactive protein and homocysteine modulation of cognitive performance and real-world functioning in bipolar disorder.

BACKGROUND: Cognitive and psychosocial impairment has been associated with increased levels of C-reactive protein (CRP) and homocysteine in bipolar disorder, but gender differences have seldom been studied. METHODS: Two hundred and twenty-four bipolar outpatients were included. Cognitive performance was assessed through the Screen for Cognitive Impairment in Psychiatry (SCIP). Psychosocial functioning was evaluated using the Functioning Assessment Short Test (FAST) and the General Assessment of Functioning (GAF). Homocysteine and CRP levels were determined. Separate analyses were performed by gender. Partial correlations were calculated to test for associations between biomarkers and cognitive and psychosocial functioning. Hierarchical multiple regression was used to assess factors predicting cognitive and psychosocial functioning. Covariates were: age, education, duration of illness, hospital admissions, depressive symptoms, tobacco consumption, and BMI. RESULTS: A better performance was noted in women in delayed verbal learning (p = 0.010), along with better occupational functioning (p = 0.027) and greater leisure time impairment (p = 0.034). In men, CRP and homocysteine levels were associated with psychosocial dysfunction (interpersonal relationships and financial functioning, respectively). In women, CRP levels correlated with cognitive performance (SCIP total raw score, immediate and delayed verbal learning, and verbal fluency). CRP was a predictor of cognitive performance in women only. LIMITATIONS: The choice of the cognitive scale and covariates and the lack of a control group may be the main limitations. CONCLUSIONS: A gender difference was found in biomarker modulation of cognition and psychosocial functioning. A gender-based approach to cognition and real-world functioning should be considered in bipolar disorder to ensure an optimal outcome.

Integrative action of axonal membrane explored by trains of subthreshold stimuli applied to the peripheral nerve.

OBJECTIVE: The objective of this study was to provide evidence on the integrative action of axonal membrane in humans and its ability to integrate multipulse subthreshold stimuli and generate action potential. METHODS: The median nerve was stimulated at the wrist in six healthy subjects and 17 patients who underwent low spine surgery by means of percutaneous electrodes, with trains of one to nine near-threshold constant-current stimuli of 500-µs duration. The interstimulus interval between stimuli was 2 or 4 ms. The compound muscle action potential (CMAP) was recorded from the abductor pollicis brevis muscle using subcutaneous needle electrodes in patients and surface electrodes in healthy subjects. Total intravenous anesthesia (TIVA) without a muscle relaxant was used in all patients, and measurements were performed at the end of surgery. RESULT: A single near-threshold stimulus did not generate CMAP either in the healthy subjects or in the patients. However, when the number of near-threshold stimuli was increased to two to nine stimuli, and packed into a short train with interstimulus intervals of 2 or 4 ms, a CMAP of varying amplitude from 100 to 200 µV was successfully elicited. CONCLUSION: We concluded that the described phenomenon might be explained by the integrative action of the axonal membrane, which is able to summate the trains of subthreshold stimuli, increasing the resting potential to the firing level, and consequently generating CMAP. This is because the subthreshold stimuli make the axonal membrane hyperexcitable. SIGNIFICANCE: This phenomenon is not very well explored in clinical neurophysiology, and it needs to be studied further. This can explain some neurophysiologic phenomena during intraoperative monitoring.

Intraoperative monitoring of carotid endarterectomy by transcranial motor evoked potential: a multicenter study of 600 patients.

OBJECTIVE: This study was to investigate the utility of motor evoked potential monitoring elicited by transcranial electrical stimulation (tcMEP) during CEA in addition to the established median nerve somatosensory evoked potentials (mSSEPs). METHODS: We retrospectively reviewed data from 600 patients undergoing CEA under general anesthesia with monitoring of mSSEPs and tcMEPs in a multicenter study. MSSEP and tcMEP parameters were recorded during internal carotid artery (ICA) cross clamping and compared with the postoperative motor outcome, demographic and patient history data. RESULTS: The intraoperative monitoring of tcMEPs was successful in 594 of the patients (99%) and selective shunt was performed in 29 of them (4.83%). Nine of the patients showed a transient contralateral loss of tcMEPs, without changes in mSSEPs and required intervention (1.5% "false-negative"). Three of them showed postoperative motor deficits. The time period from tcMEP loss to intervention was significantly longer (p = 0.01) in this group compared to the patients without postoperative motor deficit. CONCLUSION: TcMEPs during CEA may be an adjunct to mSSEP monitoring to avoid "false-negative" mSSEP results, as mSSEPs seem to lack specificity for detecting isolated ischemia of corticospinal pathway. SIGNIFICANCE: TcMEPs seem to improve postoperative outcome, especially in case of a timely correction of cerebral ischemia.

Clinical and serotonergic predictors of non-affective acute remitting psychosis in patients with a first-episode psychosis.

OBJECTIVE: The study aimed to establish clinical predictors of non-affective acute remitting psychosis (NARP) and assess whether these patients showed a distinct serotonergic profile. METHOD: First-episode never treated psychotic patients diagnosed of paranoid schizophrenia (n=35; 21 men and 14 women) or NARP (n=28; 15 men and 13 women) were included. RESULTS: NARP patients showed significantly lower negative symptomatology, better premorbid adjustment, shorter duration of untreated psychosis, more depressive symptomatology and a lower number of 5-HT2A receptors than the paranoid schizophrenia patients. In the logistic regression, the four variables associated with the presence of NARP were: low number of 5-HT2A receptors; good premorbid adjustment; low score in the item 'hallucinatory behaviour' and reduced duration of untreated psychosis. CONCLUSION: Our findings support the view that NARP is a highly distinctive condition different from either affective psychosis or other non-affective psychosis such as schizophrenia, and highlight the need for its validation.

[Course and prognosis of a case of central pontine myelinolysis in eating behavior disorder]. / Evolución y pronóstico de un caso de mielinólisis central pontina en al trastorno de la conducta alimentaria.

Central pontine myelinolysis (CPM) is a serious disorder that has been described in multiple diseases, generally involving important metabolic and hydroelectrolyte alterations. Although initially, its prognosis was usually fatal, there are a growing number of cases where the clinical symptoms begin abruptly and end after a short period, albeit with a persistence of the neuroimaging lesions. The case of a 22 year-old woman with a 6 year history of serious eating disorder with important physical deterioration and neurological and psychiatric symptoms suggestive of CPM is described. Despite the confirmation of the brain lesions through magnetic resonance imaging, neurological and psychiatric symptoms fully disappeared within a few weeks while the typical lesions of CPM remained. Although the risk of appearance of CPM exists during the course of an eating disorder, its prognosis does not seem to be as fatal as it was previously thought. Close monitoring of the clinical symptoms and neuroimaging findings should be carried out in these patients during the first months.

Evolución y pronóstico de un caso de mielinólisis central pontina en el trastorno de la conducta alimentaria / Course and prognosis of a case of central pontine myelinolysis in eating behavior disorder

La mielinólisis central pontina (MCP) es una alteración grave cuya aparición se ha descrito en múltiples procesos patológicos que generalmente cursan con alteraciones metabólicas e hidroelectrolíticas importantes. Aunque inicialmente su pronóstico se consideró siempre grave, cada vez se describen más casos en los que la sintomatología se inicia de manera brusca y cede en poco tiempo, aunque permanezcan lesiones en las imágenes neurorradiológicas. Se describe el caso de una mujer de 22 años con historia de trastorno de la conducta alimentaria grave de 6 años de evolución, con un importante deterioro del estado general, que se inicia con síntomas neurológicos y psiquiátricos sugestivos de MCP durante el tratamiento. A pesar de la confirmación de la lesión a través de resonancia magnética, los síntomas desaparecieron totalmente a las pocas semanas, mientras que permanecieron las lesiones típicas de MCP. Aunque existe el riesgo de aparición de MCP a lo largo de la evolución de un trastorno de la conducta alimentaria, su pronóstico no parece ser tan funesto en todos los casos como se pensaba previamente, debiéndose realizar un seguimiento de la evolución de los síntomas clínicos y de la neuroimagen a lo largo de los primeros meses

Central pontine myelinolysis (CPM) is a serious disorder that has been described in multiple diseases, generally involving important metabolic and hydroelectrolyte alterations. Although initially, its prognosis was usually fatal, there are a growing number of cases where the clinical symptoms begin abruptly and end after a short period, albeit with a persistence of the neuroimaging lesions. The case of a 22 year-old woman with a 6 year history of serious eating disorder with important physical deterioration and neurological and psychiatric symptoms suggestive of CPM is described. Despite the confirmation of the brain lesions through magnetic resonance imaging, neurological and psychiatric symptoms fully disappeared within a few weeks while the typical lesions of CPM remained. Although the risk of appearance of CPM exists during the course of an eating disorder, its prognosis does not seem to be as fatal as it was previously thought. Close monitoring of the clinical symptoms and neuroimaging findings should be carried out in these patients during the first months

Lower weight gain with the orally disintegrating olanzapine than with standard tablets in first-episode never treated psychotic patients.

OBJECTIVE: A post-hoc analysis of the data from a randomised clinical trial involving prescription of antipsychotic treatment to never treated first-onset psychotic patients was used to compare the weight change after 6-week olanzapine treatment (standard tablets vs. orally disintegrating formulation). METHOD: In the subgroup of 38 patients randomised to olanzapine, standard olanzapine tablets were non-randomly and consecutively prescribed to the first 19 patients, with the orally disintegrating formulation being prescribed to the following 19 patients. RESULTS: After 6-week treatment with olanzapine, a significant higher increase in weight was noted in those patients on standard tablets (mean weight increase 6.3 +/- 1.9 Kg) as compared to those on orally disintegrating olanzapine (mean weight increase 3.3 +/- 3.2 Kg) (F = 7.7; p = 0.009). BMI increase was also significantly higher in the olanzapine tablet group (mean increase of 2.1 Kg/m(2) as compared with 1.1 Kg/m(2) in the orally disintegrating group) (F = 4.7; p = 0.036). Substantial weight gain (SWG) (> or =7% increase from baseline weight) was noted in 84.2% (n = 16) of the olanzapine tablet patients and in 31.6% (n = 6) of the orally disintegrating olanzapine patients, with the olanzapine tablet group showing a significant increase in the mean percentage of weight gain (F = 4.0; p = 0.014). CONCLUSIONS: Partial sublingual absorption occurring with orally disintegrating olanzapine may bypass gastrointestinal metabolisation and hence lead to differences in metabolite versus parent compound ratios. However, the need arises to replicate the present study with a longer follow-up.

A naturalistic multicenter study of intramuscular olanzapine in the treatment of acutely agitated manic or schizophrenic patients.

BACKGROUND: We conducted a naturalistic, multicenter, 24-hour, nonrandomized, observational study describing for the first time the effectiveness and safety of intramuscular (IM) olanzapine to control agitation and aggression in "real world" patients with psychosis. The data thus obtained was compared with that reported from randomized double-blind clinical trials. METHOD: 92 patients attending psychiatric emergency settings were enrolled. The study subjects were 44 male and 48 female patients with a mean age of 36.5+/-12 years and DSM-IV-TR diagnoses of schizophrenia (48.9%), psychotic disorder not specified (23.9%) or bipolar disorder (27.2%). 10 mg IM olanzapine was administered to all patients. An optional second injection was permitted> or =2 hours later in line with hospital policy. Evaluations (PANSS-EC and CGI-S) were performed at baseline and 2 and 24 hours following the IM injection. RESULTS: Two hours after IM olanzapine was administered, a mean decrease of -9.6 in the PANSS-EC from a baseline score of 26.5 was recorded. At the 24-hour endpoint a statistically and clinically significant reduction in the PANSS-EC scores (11.6+/-5.3) was observed as compared with values at study entry (26.5+/-5.9) and at 2 hours endpoint (16.9+/-9.3), which represent a mean decrease of -14.9 and -5.3, respectively. CONCLUSION: The present naturalistic study provides naturalistic data on the effectiveness of IM olanzapine in the treatment of acute agitation in patients with schizophrenia or bipolar mania that is in line the data obtained in randomized double-blind clinical trials.

Pharmacological management of acutely agitated schizophrenic patients.

Agitation is commonly seen in acute schizophrenic patients and core symptoms include a wide range of symptom. It requires rapid and effective treatment approaches in order to protect patient and caregiver from potential injury. Clinician's decision of pharmacological treatment should be individualized to the needs and circumstances of the patient. Benzodiazepines, typical antipsychotics, and combinations of typical antipsychotics and benzodiazepines have been widely used as treatment options. Atypical antipsychotics have clear advantages over the typical drugs as they generally show a much better safety and tolerability profile, particularly to EPS and related side effects, however clinical perception regarding efficacy in treating acutely agitated psychotic patient is controversial. New intramuscular atypical antipsychotic formulations offer evidence of being at least as effective as typical antipsychotics in controlling agitation. Therefore, they should be considered as first line therapy in agitated schizophrenic patients.

[Rhabdomyolysis due to polydipsia in a patient with psychotic disorder]. / Rabdomiólisis por polidipsia aguda en un paciente con trastorno psicótico.

Polydipsia is a frequent clinical entity in psychiatric patients, especially in those with a psychotic disorder. Acute episodes of polydipsia can produce important metabolic alterations and even coma and death. Psychogenic polydipsia is a underestimated diagnosis, due to multiple causal factors and an etiology that has not been clearly established. We present the case of a patient with psychiatric background who was seen due to a clinical situation of severe acute renal failure by high rhabdomyolysis that needed hemodialysis, due to acute polydipsia. We also review some of the epidemiological and clinical factors and etiopathogeny of the polydipsia. It is considered necessary to keep in mind the in mind the diagnosis of polydipsia in any psychiatric patient showing acute symptoms of confusion.

Rabdomiólisis por polidipsia aguda en un paciente con trastorno psicótico / Rhabdomyolysis due to polydipsia in a patient with psychotic disorder

La polidipsia es un cuadro clínico frecuente en pacientes psiquiátricos, especialmente en pacientes psicóticos. En episodios agudos puede producir alteraciones metabólicas importantes, e incluso coma y muerte. La polidipsia psicógena es un diagnóstico infravalorado debido a tener múltiples factores causales y una etiopatogenia no claramente establecida. Se presenta el caso de un paciente con antecedentes psiquiátricos que es atendido por un cuadro clínico de insuficiencia renal aguda severa por intensa rabdomiólisis que requirió hemodiálisis, relacionado con conducta aguda de polidipsia. Se revisan también algunos de sus factores epidemiológicos, clínicos y etiopatogénicos de la polidipsia. Se establece la conveniencia de tener en cuenta el diagnóstico de potomanía ante cualquier paciente psiquiátrico que presente síntomas agudos de confusión (AU)

Loss of the circadian variation of platelet [3H]imipramine binding in delusional compared with non-delusional endogenously depressed patients.

BACKGROUND: The circadian variations of the serotonin reuptake sites were studied in 16 patients meeting DSM-IV criteria for major depression with melancholia, either with (n=8) or without (n=8) psychotic symptomatology. METHOD: The [3H]imipramine binding sites were measured in platelet samples. RESULTS: While no statistically significant difference was found between the morning (09:00 h) and evening (21:00 h) [3H]imipramine B(max) values in the control group, both the non-delusional and delusional melancholic patients showed higher evening than morning B(max) values, which were only statistically significant in the former. When both diagnostic groups were compared, the delusional patients showed significantly lower [3H]imipramine binding values than the non-delusional patients both in the morning and evening samples. Within the non-delusional depressed patients, those individuals with mood circadian variation, assessed by the 18th item of the HDRS, showed significantly lower B(max) values than those without mood variation. Lowest morning and evening B(max) values were noted in the delusional depressed group without mood variations. CONCLUSIONS: These results suggest that delusional depressions might have a different neurobiological substrate with loss of chronobiological rhythms.

[Instruments of depression assessment in schizophrenia]. / Instrumentos de evaluación de la depresión en la esquizofrenia1.

Lately, numerous reports have focused on the evaluation of depressive symptoms of schizophrenia. This assessment has been hampered by the temporal variability of the depressive symptoms and by their overlap with both the negative symptoms of schizophrenia and the extrapyramidal effects of the antipsychotic treatment. So far, classical assessment instruments such as the Hamilton Depression Rating Scale (HDRS) or the Montgomery-Asberg Rating Depression Scale (MARDS) have been used in those patients suffering from schizophrenia with depressive symptomatology, despite the important limitations concerning their use in subpopulations other than the one they have been developed for. New specific depression scales for schizophrenia such as the Calgary Depression Scale for Schizophrenics (CDSS) seems to have more efficiency and ability to distinguish between depression, negative and extrapyramidal symptoms. The present paper reviews the instruments used so far on the assessment of depressive symptomatology in schizophrenic patients.

Instrumentos de evaluación de la depresión en la esquizofrenia / Instruments of depression assessment in schizophrenia

Existe un creciente interés por el estudio de la sintomatología depresiva en la esquizofrenia. Su evaluación viene dificultada por la variabilidad de los síntomas a lo largo del tiempo y a la confusión con los síntomas negativos o los efectos secundarios extrapiramidales del tratamiento antipsicótico. Algunos instrumentos clásicos como la Escala de Depresión de Hamilton (HDRS) o la Escala de Depresión de MontgomeryAsberg (MARDS) han sido frecuentemente utilizados, pero también presentan limitaciones importantes al ser aplicados a pacientes para los que no fueron desarrollados. Nuevas escalas específicas de depresión para la esquizofrenia como la Escala de Depresión de Calgary (CDSS) parecen mostrar un mejor rendimiento y no estar sesgadas por la sintomatología negativa y extrapiramidal. Se realiza una revisión de los instrumentos utilizados hasta ahora para medir la depresión en la esquizofrenia y sus principales características (AU)

[Genetic dysfunction of the serotonin receptor 5-HT2A in psychiatric disorders]. / Disfunción genética del receptor de serotonina 5-HT2A en los trastornos psiquiátricos.

So far, there is increasing evidence of the active role of molecular biology in the psychiatric nosology as well as in the identification of psychiatric fenotypes. In this respect, the neurotransmitter serotonin (5-HT) has been involved in the etiopathogeny of multiple psychiatry conditions, such as affective disorder, schizophrenia, panic disorder, obsessive-compulsive disorder, alcoholism, eating disorder and personality disorder. The 5-HT2 receptor family includes the subtype 5-HT2A, a G protein coupled receptor whose activation leads to the stimulation of the enzyme phospholipase C and to the subsequent hydrolysis of the membrane located phosphoinositides, with the synthesis of the second messengers inositol triphosphate and diacylglicerol. This paper includes a review of the main findings concerning the polymorphism of the 5-HT2A in psychiatric disorders.

Disfunción genética del receptor de serotonina 5-HT2A en los trastornos psiquiátricos / Genetic dysfunction of the serotonin receptor 5-HT2A in psychiatric disorders

Estudios realizados hasta el momento han demostrado la participación de la genética molecular en muchos de los síndromes definidos por la nosología psiquiátrica, así como su utilidad en la clasificación de los trastornos psiquiátricos y en la identificación de determinados fenotipos. La serotonina (5-HT) constituye uno de los más importantes neuromediadores desde el punto de vista filogenético y ontogénico, y ha sido implicada en la etiopatogenia de múltiples trastornos psiquiátricos como los trastornos a fectivos, la esquizofrenia, el trastorno de pánico, el trastorno obsesivo-compulsivo, la dependencia de alcohol, los trastornos del control de impulsos y los trastornos alimenticios. La familia del receptor 5-HT2 incluye el receptor 5-HT2A, un receptor acoplado a las proteínas G y cuya activación produce la estimulación de la fosfolipasa C y la hidrólisis de los fosfoinosítidos de membrana, con la formación de los segundos mensajeros inositol trifosfato y diacilglicerol. En este artículo se revisarán los principales resultados publicados hasta el momento sobre la posible alteración genética del receptor 5-HT2A en diversos trastornos psiquiátricos (AU)

Aproximación terapeútica de la dependencia de cocaína / No disponible

Objetivo: en los últimos años se han ensayado un gran número de fármacos para el tratamiento de la dependencia de cocaína conjuntamente con diversos abordajes psicológicos. En líneas generales, las estrategias utilizadas son adaptaciones de las utilizadas para el tratamiento de otras dependencias. Material y método: analizar la eficacia clínica del tratamiento psicofarmacológico en pacientes con dependencia de cocaína. Resultados: los ensayos clínicos abiertos han sido el primer paso para la evaluación de nuevos fármacos, sin embargo los estudios controlados, doble ciego y aleatorizados son los que permiten confirmar o desmentir la eficacia de los tratamientos. Los grupos farmacológicos utilizados han sido antidepresivos, eutimizantes, agonistas dopaminérgicos, estimulantes del SNC, precursores de los neurotransmisores, agonistas y antagonistas opioides, y una larga lista de fármacos que se encuentran en fase experimental y pueden constituir una alternativa terapéutica para el tratamiento de la dependencia de cocaína. Conclusiones: la combinación de terapias farmacológicas y conductuales o cognitivas son las que ofrecen mejores resultados en el tratamiento de los pacientes con dependencia de cocaína (AU)

Objective: during recent years, several pharmacological and psychological approaches for the treatment of cocaine dependence have been developed. Overall, the strategies are similar to those applied in the drug dependence field. Material and methods: to assess the clinical response to pharmacotherapy in cocaine dependent patients. Results: although open clinical trials are the first step in the evaluation of new pharmacological treatments, randomized, doubleblind, controlled trial are the best instrument to confirm the efficacy in the treatment programs. Accordingly, different pharmacological agents as antidepressants, mood stabilizers, dopaminergic, serotonergic, CNS stimulants, precursors, opioid, and other experimental drugs, are some examples of the variety of therapeutic tools now available for the treatment of cocaine dependence. Conclusions: the joining of pharmacotherapy and psychotherapy has shows the best results for cocaine dependent patients (AU)

Altered 5-HT(2A) binding sites and second messenger inositol trisphosphate (IP(3)) levels in hippocampus but not in frontal cortex from depressed suicide victims.

The binding parameters of 5-HT(2A) and levels of its second messenger, 1,4,5-trisphosphate (IP(3)), were simultaneously studied in frontal cortex and hippocampus from the brains of 18 control subjects and 18 depressed suicide victims. All suicides met DSM-III-R criteria for depressive symptoms, suffered a violent death and had not taken any antidepressant drugs for at least 6 months prior to death. A significant decrease in the number of 5-HT(2A) binding sites (154+/-22 vs. 254+/-36 fmol/mg), together with a significantly lower apparent affinity constant (1.02+/- 0.08 vs. 1. 36+/-0.09 nM), was detected in hippocampus but not in frontal cortex from the depressed suicides compared to the control subjects. Furthermore, IP(3) concentrations were significantly increased in hippocampus (3.2+/-0.3 vs. 2.1+/-0.3 pmol/g) but not in frontal cortex (1.3+/-0.3 vs. 2.7+/-0.5 pmol/g) from the suicide victims. The reported results may indicate a significant hypersensitivity of the 5-HT(2A) postsynaptic receptor located in the hippocampus from depressed suicide victims, giving rise to an enhancement of its intracellular signaling system with higher IP(3) production.

Terapia electroconvulsiva y sistema serotoninérgico / Electroconvulsive therapy and serotonergic system

Numerosos estudios han descrito la participación de diversos sistemas de neurotransmisión en el mecanismo de acción y la eficacia clínica de la terapia electroconvulsiva (TEC). Estudios recientes sugieren que la serotonina, a través de la activación de sus receptores específicos, constituye el neurotransmisor más implicado en el mecanismo de acción del TEC. Dentro del sistema serotoninérgico, la administración de TEC puede producir alteración de las concentraciones de 5-HT o de sus metabolitos, alteraciones del número de diversos receptores presinápticos y postsinápticos, y por último, alteraciones de los mecanismos de señal asociados a la activación de determinados receptores, como el sistema de la adenilato ciclasa o de los fosfoinosítidos. (AU)