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The aetiology and pathophysiology of alcohol dependence are complex, derived from genetics, parenting, peer and societal norms and rules, pharmacology and mental health comorbidity. This chapter explores some of the contributing factors that make alcohol dependence a more complex phenomenon than one merely of personal choice. It explores the various aspects of family history that contribute to the heritability of alcohol use disorders, and summarises relevant social and psychological factors. It then provides a nuanced understanding of the pharmacological rationale underpinning withdrawal and relapse prevention treatment, including an understanding of the role of GABA, glutamate and opioid systems. The chapter concludes by highlighting the ways in which patients with psychiatric disorders may be at greater risk of alcohol use disorders. In doing so, consideration is given to trauma-informed principles of care in light of the high prevalence of childhood trauma in this group.
Expose the potential beneffits of ayahuasca from neuropharmacology and clinical existing evidence.
Methods
A literature review was carried out in the databases pubmed, clinical key and texts of scientific dissemination.
Results
There´s scientific literature about the potential therapeutic use of ayahuasca in dependencies, anxiety symtoms and depression, near death experiences and terminal illnesses. Possible benefit is postulated in impulsivity and personality disorders. It induces an introspective state, triggered by thoughts, emotions and autobiographical memories, which promotes reflection on personal issues, allowing new perspectives on certain life issues. It is common for users to describe it as analogous to a psychotherapeutic intervention. 5HTA2 agonists stimulate the expression of genes that encode transcription factors such as c-fos, egr 1, egr 2 and brain-derived neurotrophic factor (BDNF), which influence neuronal plasticity and are associated with cognitive aspects such as memory and attention. MAOIs and 5HT2A agonism have anxiolytic and antidepressant effects. Sigma -1 agonism promotes neuroplasticity. Decrease and remission in the consumption of alcohol and cocaine has been reported in patients with abuse and dependence. There has been significant decrease in depressive symptomatology, in observational studies, cases and controls and double blind compared with placebo. Improvement in different domains measured with mindfulness scales, similar to those observed in meditators, suggests an association between mindfulness techniques and experiences with ayahuasca.
Conclusions
There is existing evidence about potential therapeutical uses of ayahuasca. More studies are needed with biger samples, to establish it´s clinical use.
Little is known about the effect of methylphenidate (MPH) on attention in Alzheimer's disease (AD). MPH has shown to improve apathy in AD, and both apathy and attention have been related to dopaminergic function. The goal was to investigate MPH effects on attention in AD and assess the relationship between attention and apathy responses.
Methods:
MPH (10 mg PO twice daily) or placebo was administered for six weeks in a randomized, double-blind trial in mild-to-moderate AD outpatients with apathy (Neuropsychiatric Inventory (NPI) Apathy ≥ 4). Attention was measured with the Wechsler Adult Intelligence Scale – Digit Span (DS) subtest (DS forward, selective attention) and apathy with the Apathy Evaluation Scale (AES). A mixed effects linear regression estimated the difference in change from baseline between treatment groups, defined as δ (MPH (DS week 6–DS baseline)) – (placebo (DS week 6–DS baseline)).
Results:
In 60 patients (37 females, age = 76 ± 8, Mini-Mental State Examination (MMSE) = 20 ± 5, NPI Apathy = 7 ± 2), the change in DS forward (δ = 0.87 (95% CI: 0.06–1.68), p = 0.03) and DS total (δ = 1.01 (95% CI: 0.09–1.93), p = 0.03) favored MPH over placebo. Of 57 completers, 17 patients had improved apathy (≥3.3 points on the AES from baseline to end point) and 40 did not. There were no significant associations between AES and NPI Apathy with DS change scores in the MPH, placebo, AES responder, or non-responder groups. DS scores did not predict apathy response to MPH treatment.
Conclusion:
These results suggest MPH can improve attention and apathy in AD; however, the effects appear independent in this population.
This chapter describes the use of the roundworm Caenorhabditis elegans and the zebrafish Danio rerio in sleep research. Vertebrate sleep research has traditionally been performed using mammalian model organisms. Like mammalian sleep, zebrafish sleep is controlled by a homeostatic mechanism. Several studies have shown that mammalian sleep/wake neuropharmacology is broadly conserved in zebrafish, supporting the notion that similar mechanisms regulate sleep in zebrafish and mammals. Genetic screens are a powerful approach to discover mechanisms that underlie biological processes. Logistical challenges limit the use of such screens in mammals. The genetic analysis using cavefish/surface fish hybrids suggests that a small number of genes with dominant effects are responsible for sleep loss in cavefish, and that these genes may differ among independent cave populations. Importantly, the cavefish system offers the unmatched opportunity to understand sleep regulation and evolution within the context of a well-defined ecology.
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