Search PubMed⌕ Search

Biomedical subjects

R D Alarcón

Publications and source records attributed to R D Alarcón.

At least 19 recordsLinked to original sources
PubMed2000

Proposing an algorithm for the pharmacological management of posttraumatic stress disorder.

The clinical management of posttraumatic stress disorder (PTSD) is as complex as the condition itself. Pharmacotherapy is an important component of this treatment process, which also includes psychosocial interventions and, in most cases, entails long-term efforts. The authors propose a systematic approach to the pharmacological treatment of PTSD using algorithmic techniques. After a careful history-taking phase and a review of available psychotropic agents, the practitioner usually ends up dealing with either PTSD alone or, more frequently, accompanied by other identifiable syndromes. Various antidepressants have demonstrated efficacy in the former, while the latter requires a management aimed at depressive, anxiety/dissociative, hypomanic/manic, or psychotic symptoms. The proposed algorithm provide guidelines for treatment issues such as medication choice, medication dose, maintenance pharmacotherapy, alternative options, and eventual outcomes. Algorithms summarize current information and suggest pharmacotherapy guidelines as a significant component of a comprehensive PTSD management program.

Algorithms↗
PubMed2000

Mental health policy developments in Latin America.

New assessment guidelines for measuring the overall impact of mental health problems in Latin America have served as a catalyst for countries to review their mental health policies. Latin American countries have taken various steps to address long-standing problems such as structural difficulties, scarce financial and human resources, and social, political, and cultural obstacles in the implementation of mental health policies and legislation. These policy developments, however, have had uneven results. Policies must reflect the desire, determination, and commitment of policy-makers to take mental health seriously and look after people's mental health needs. This paper describes the development of mental health policies in Latin American countries, focusing on published data in peer-reviewed journals, and legislative change and its implementation. It presents a brief history of mental health policy developments, and analyzes the basis and practicalities of current practice.

Health Policy↗
PubMed1999

Clinical relevance of contemporary cultural psychiatry.

In recent years, the field of cultural psychiatry has gained recognition and accumulated evidence of its clinical relevance. This article examines the intersections of culture and psychopathology and describes five independent but interrelated clinical dimensions that identify and define culture as: a) an interpretive/explanatory tool, b) a pathogenic/pathoplastic agent, c) a diagnostic/nosological factor, d) a therapeutic/protective element, and e) a service/management instrument. Along these lines, conceptual boundaries, clinical findings, specific applications, and research implications for each of the five dimensions are systematically reviewed. Cultural psychiatry adds significantly to the comprehensiveness of psychiatric evaluation and management and addresses prominent issues regarding understanding, classification, diagnosis, and competent treatment of most psychiatric disorders in every society and region of the world. Based on the strength of these clinical dimensions, and on the related educational and research efforts, cultural psychiatry can also contribute decisively to the design of comprehensive mental health policies.

Cultural Characteristics↗
PubMed1995

[Clinical dimensions of contemporary cultural psychiatry].

In spite of the difficulties to define the term "culture" there is agreement with regards to its profound influence in the contemporary social environment of which medicine and psychiatry are important components. Cultural psychiatry studies psychopathology inasmuch as it reflects and it is subjected to the influence of cultural factors within the biopsychosocial context. Its contemporary clinical dimensions cover five fundamental areas: culture as an interpretive/explanatory instrument of human behavior; as a pathogenic/pathoplastic agent; as a diagnostic/nosological factor; as a therapeutic/protective element, and as a tool for management and service delivery. This paper examines the conceptual nature of each of these roles and presents pertinent examples from the clinical literature, away from theoretical lucubrations. The cultural legacy of each and every patient seen by the psychiatrist or any other mental health professional demands serious studies and effective actions at all levels.

Community Psychiatry↗
PubMed1995

Personality disorders and culture: contemporary clinical views (Part A).

This article reviews the basic concepts surrounding the clinical relationships between culture and personality disorders (PDs). Culture plays a significant role in the construction of self-concept and self-image, the egocentric/sociocentric dichotomy, and the determination of biases in the clinical study of PDs. Cultural contextualization is, therefore, crucial in the demarcation between normal and abnormal personalities. From a clinical perspective, culture has three roles vis-à-vis the psychopathology of personality: (a) as an interpretive/explanatory tool; (b) as a pathogenic/pathoplastic agent; and (c) as a diagnostic/nosological factor. The first of two parts, this article examines the interpretive/explanatory and pathogenic/pathoplastic roles, substantiated by clinical examples gleaned from the existing literature.

Culture↗
PubMed1995

Personality disorders and culture: contemporary clinical views (Part B).

This article reviews the basic concepts surrounding the clinical relationships between culture and personality disorders (PDs). Part A of this article, which appeared in Cultural Diversity and Mental Health, Vol. 1, No. 1, pp 3-17 (1995), examined the interpretive/explanatory and pathogenic/ pathoplastic roles of culture. Herein, culture's role as a diagnostic/nosological factor is discussed through the use of measurement instruments and the cultural formulation included in DSM-IV (American Psychiatric Association, 1994). In addition to these three roles, some authors would also consider a therapeutic/protective function for cultured in PDs. Following a critique of the biological perspective, a research model based on the definition of the cultural profile and the estimation of the cultural distance between clinical examiners and populations is proposed. It is important to reject both biological reductionism and the extremes of cultural determinism, in order to better assess the intraethnic distribution of psychopathology, and interethnic variations represented by the notion of cultural relativism.

Culture↗
PubMed1994

Neuropsychological testing in obsessive-compulsive disorder: a clinical review.

The role of neuropsychological testing in assessment of obsessive-compulsive disorder (OCD) is examined by review of 8 case reports and 14 patient series. Investigators generally agreed on localization of dysfunctional areas (e.g., prefrontal and frontal regions, limbic system, basal ganglia). They disagreed as to hemisphere and frontal lobe side impairment, involvement of other brain areas, pathophysiological connections, and impact of developmental phases and of concomitant cognitive and affective conditions. Conclusions about OCD pathogenesis are limited by test and sample variability. The authors outline an integrative approach based on sensorial and cognitive information disruptions that require activation of less specialized circuits. OCD may be syndromic, and subgroups may exist based on related but differentiable biochemical pathways.

Humans↗
PubMed1993

[Perspectives in psychiatric research in Latin America for the 21st century].

Psychiatric research in Latin America lacks in originality and methodological rigor, and the human and economic resources are extremely limited. However, there are groups in several countries that have used their initiative and resources with a high level of efficiency, particularly in the psychosocial area. Epidemiological investigation in Latin America is exemplary and can, indeed, be one of the most significant contributions of our psychiatry. Assisted by social scientists, psychiatric researchers can study the most pressing problems in the region (alcoholism, substance abuse, violence, problems with children, adolescents and the elderly), as well as traditional areas of clinical investigation such as neuroses and psychoses. Biomedical investigation will continue in selected centers with a clear understanding of priorities and costs. Psychiatric research in Latin America requires realism and gradulism in its planning, multidisciplinary and intercountry collaboration, adequate publication of its findings, and academically trained personnel. Some countries have accumulated expertise in specialized areas and that, together with the contribution of Latin American researchers in other continents, should be positively utilized.

Forecasting↗
PubMed1991

[Towards DSM-IV: recent history, current status and future options].

The events leading to the publications of DSM-III and DSM-III-R are briefly reviewed. The appointment, in 1988, of a work group for the preparation of DSM-IV, to be published in 1993, represents an attempt to reinsert American Psychiatry in the international sphere while, at the same time, perfects the document on the basis of clinical research findings, emphasis on the prototypical model of operational diagnosis, reduction in the number of Axes, and usefulness for different professional and non professional individuals. Some of the changes currently under consideration in the different subcommittees of the working group are presented.

History, 20th Century↗
PubMed1985

[The new biological revolution in psychiatry: a Latin American point of view (2)].

The new clinical psychopharmacology has helped to expand six areas: new drugs, prediction of response, side effects, therapeutic combinations and new uses for old drugs. Basic research (theoretical and experimental) has focused primarily on schizophrenia, affective disorders and anxiety. The Latin American psychiatrist must adopt neither a dependent nor a hyper-critical attitude toward this revolution. He can successfully contribute in the areas of nosology, laboratory tests and clinical psychopharmacology. He must selectively accept or critically screen the contributions of the new neuro-radiology and basic research. Finally, he must be pragmatic and never lose sight of his unique socio-cultural perspective.

Anti-Anxiety Agents↗
PubMed1985

Euthyroid hyperthyroxinemia and rapid cycling affective disorder: case report.

A 32-year-old woman with rapid cycling bipolar illness had numerous clinical problems throughout 19 affective episodes and six hospital admissions within 34 months. Persistent hyperthyroxinemia, always associated with manic episodes, led to a diagnostic work-up that ruled out a primary thyroid dysfunction and pointed to oral contraceptives, appetite suppressants, and psychiatric illness as likely causes of elevated T4 values. The contention that an underlying thyroid hypofunction is the basis of rapid cycling is questioned. The extent to which a bipolar disorder increases T4 levels and the role of euthyroid hyperthyroxinemia in the pathogenesis of rapid cycling are discussed.

Adult↗
PubMed1984

Hyperparathyroidism and paranoid psychosis. Case report and review of the literature.

Literature on psychiatric manifestations of hyperparathyroidism published in the last four decades confirms the unusual features of a case of paranoid psychosis secondary to a parathyroid-adenoma-induced hypercalcaemia. Affective and organic symptoms are overwhelmingly dominant in hypercalcaemic patients; the majority of cases reported are women of 50 years or older, who have been vaguely ill for a prolonged time before the actual endocrinopathy appears. The severity of the psychiatric symptoms does not seem to be related to the degree of hypercalcaemia. Recent findings link the role of calcium and related ions in the production of psychopathological symptoms to membrane phenomena, dopaminergic activity, and neuroendocrine regulation.

Adenoma↗