Documentos de Académico
Documentos de Profesional
Documentos de Cultura
S
Adiccion y enfermedades
psiquiatricas.
SINAPSIS QUÍMICA
*
Cortical and limbic connections: role of
monoamines (serotonin, norepinepherine, dopamine)
Todas las monoaminas tienen sus DA ventral tegmental area
Nucleos en el tronco. substantia nigra
NE locus ceruleus
midbrain
pons
VTA
LC
DRN
Abbrev: dorsal raphe nucleus DRN; locus ceruleus LC; ventral tegmental area VTA; serotonin 5HT, glutamate glu,
*
4. Paralimbic/limbic circuits
4. Liberacion de neurotransmisor
6. Expresion de genes.
*
Background to understand the neurobiology
of pyschiatric illnesses
Neurocircuitry
• Frontal-subcortical circuits
• Frontal-limbic circuits
Neurotransmitters
• GABA
• Glutamate
• Role of monoamines 5HT, NE, DA
CORTICAL AND LIMBIC CONNECTIONS
mPFC
AC
OFC
GABA
mPFC
AC
Caudate
Thalamus
excitatory
inhibitory Amygdala Hippocampus
11
According to the DSM-IV, a person who suffers from major depressive
disorder must either have a depressed mood or a loss of interest or
pleasure in daily activities consistently for at least two week period.
Persistent sad, anxious or "empty" feelings
Feelings of hopelessness and/or pessimism
Feelings of guilt, worthlessness and/or helplessness
Irritability, restlessness
Loss of interest in activities or hobbies once pleasurable, including sex
Fatigue and decreased energy
Difficulty concentrating, remembering details and making decisions
Insomnia, early–morning wakefulness, or excessive sleeping
Overeating, or appetite loss
Thoughts of suicide, suicide attempts
MDD
(SLC6A4)
Paroxetine
SIDE EFFECTS OF SSRIS
Slowly developing effect (minimum of 2+
weeks)
Acute anxiogenic effect
Nausea, vomiting
Diarrhoea
Insomnia
Decreased libido
Sexual disfunction such as anorgasmia
Agitation
Aggressivity
ANTIDEPRESSANT ACTION
CATECOLAMINAS
Synthesis of Catecholamines
DOPAMINE
low dopamine levels Perdida de control motor,
adiccion, craving, compulsion are loss of motor
control, addictions, cravings, compulsion y
Perdida de satisfaccion .
Dopamina elevada anxiety o hyperactividad.
Drugs like cocaine, opium, heroin, and alcohol increase the
levels of dopamine, as does nicotine.
The severe mental illness schizophrenia has been shown to
involve excessive amounts of dopamine in the frontal lobes,
and drugs that block dopamine are used to help
schizophrenics.
On the other hand, too little dopamine in the motor areas of
the brain are responsible for Parkinson's disease, which
involves uncontrollable muscle tremors.
ABUSO DE SUSTANCIA
Control Cocaína
Metabolismo reducido en un paciente con enfermedad cardíaca
40,000
Synthetic Opioids other than Methadone
(primarily fentanyl)
30,000 Psychostimulants with Abuse Potential
(primarily methamphetamine)
Cocaine
Antidepressants
0
*Includes deaths with underlying causes of unintentional drug poisoning (X40–X44), suicide drug poisoning (X60–X64), homicide drug
poisoning (X85), or drug poisoning of undetermined intent (Y10–Y14), as coded in the International Classification of Diseases, 10th Revision.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death 1999-2019 on CDC
WONDER Online Database, released 12/2020.
Figure 3. National Overdose Deaths Involving Any Opioid,
Number Among All Ages, by Gender, 1999-2019
50,000 49,860
Total
Female
Male
40,000
30,000
21,089
20,000
10,000
*Among deaths with drug overdose as the underlying cause, the any opioid subcategory was determined by the following ICD-10
multiple cause-of-death codes: natural and semi-synthetic opioids (T40.2), methadone (T40.3), other synthetic opioids (other than
methadone) (T40.4), or heroin (T40.1). Source: Centers for Disease Control and Prevention, National Center for Health Statistics.
Multiple Cause of Death 1999-2019 on CDC WONDER Online Database, released 12/2020.
Figure 4. National Overdose Deaths Involving Prescription
Opioids*, Number Among All Ages, 1999-2019
25,000 Total
Female
Male
20,000
14,583 14,139
15,000
10,000
5,000
*Among deaths with drug overdose as the underlying cause, the prescription opioid subcategory was determined by the following ICD-10
multiple cause-of-death codes: natural and semi-synthetic opioids (T40.2) or methadone (T40.3). Source: Centers for Disease Control and
Prevention, National Center for Health Statistics. Multiple Cause of Death 1999-2019 on CDC WONDER Online Database, released 12/2020.
Figure 6. National Overdose Deaths Involving Psychostimulants
with Abuse Potential (Primarily Methamphetamine)*, by Opioid
Involvement, Number Among All Ages, 1999-2019
25,000 All Psychostimulants
Psychostimulants in Combination with Synthetic Opioids other than Methadone
20,000 Psychostimulants without any Opioid
16,167
15,000
10,000
5,000
1,854
*Among deaths with drug overdose as the underlying cause, the psychostimulants with abuse potential (primarily methamphetamine)
category was determined by the T43.6 ICD-10 multiple cause-of-death code. Abbreviated to psychostimulants in the bar chart above.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death 1999-2019 on CDC
WONDER Online Database, released 12/2020.
RECREATIVO VS ADICTIVO.
10.6 % (28.6 millones) de la población de USA (mayor de 12 años) consumio
algun tipo de drogas ílicitas o no recetadas (aunque legal)en los ultimos 30
dias .(marihuana> pain killers)
Alcohol: 50.7 % (136.7 millones) de los mayores de 12 son consumidores. (6%
heavy drinkers, 24.2 % binge)
Nicotina: 23.6 % (63.4 millones) son consumidores de algún tipo de tabaco.
7.5% (20.1 millones) cumplen el criterio para considerar que tienen un
Desorden de uso de sustancia (SUD).
Results from the 2016 National Survey on Drug Use and Health Summary of
National Findings
Biología/Genes Ambiente
DROGA
Mecanismos Cerebrales
Adicción
Genes y cia
2 teorias sobre transicion a la adiccion
1- centrada en la disponibilidad de droga
2- centrada en predisposicion individual.
Motivación
Placer
movement
motivación
DOPAMINA
Recompensa y
adicción
bienestar
Las recompensas naturales elevan los niveles de dopamina
Comida SEXO
DA Concentration (% Baseline)
200 200
NAc shell
% of Basal DA Output
150 150
Copulation Frequency
100 100
15
Empty 10
50
Box Feeding
5
0 0
0 60 120 180 ScrScr Scr Scr
BasFemale 1 Present Female 2 Present
Time (min) Sample 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Number
Mounts
Intromissions
Ejaculations
% of Basal Release
900
800 DA
DA 300 DOPAC
700 DOPAC HVA
600 HVA
500 200
400
300
200 100
100
0
0 1 2 3 4 5 hr 0
0 1 2 3 4 5 hr
Time After Amphetamine Time After Cocaine
250
250 NICOTINE Accumbens ETHANOL
% of Basal Release
100
0
0 1 2 3 hr 0
0 1 2 3 4hr
Time After Nicotine Time After Ethanol
Source: Di Chiara and
¿CUÁL ES EL
MECANISMO POR
EL QUE LAS
DROGAS
AUMENTAN LA
LIBERACIÓN DE
DOPAMINA?
Circuitos cerebrales
involucrados en la
adicción
Control PFC
inhibitorio ACG
OFC Hipp
SCC
NA Recompensa
Motivación cc VP
(drive) Amyg
(saliency)
Memoria/
aprendizaje
Ventral Striatum
•Direct pathway associated with reward
•Indirect pathway associated with aversive stimul
Autoadministración
Los animales trabajan por las
drogas (IV, oral, inhalación)
Schedules de refuerzo (fixed,
progressive ratio)
Autoadministración de drogas
LIBERACIÓN DE DOPAMINA EN EL
NAC LUEGO DE LA ESTIMULACIÓN
DE LA VTA
los animales responden a las drogas que
liberan dopamina
Autoadministración
la dopamina produce un resfuerzo positivo en animales
Auto-estimulación
DA
D1R
Glu
D2R
Medial forebrain DA
bundle (MFB) passes
through lateral
NAc hypothalamus
VTA
AUTO-ADMINISTRACIÓN I.V
Esquema simple
Fix ratio: el número de respuestas requeridas para obtener una
dosis es pre fijada a un número fijo. Funciona en forma estable
solo con ciertas dosis.
Fixed interval: la frequencia de la administración de una dosis
esta dada por el intervalo impuesto y no por el número de
respuestas.
AUTO-ADMINISTRACIÓN:
PROGRESSIVE RATIO.
La dopamina ayuda a los animales a
aprender dónde suceden cosas
importantes (salientes)
A los animales les “gusta” el efecto de las drogas
droga
Condicionamiento de preferencia al lugar
Unbaised CPP
extinction
training reinstatment
3 months
drug saline
self administration self administration
•Cue
•Stress
•Drug (i.v)
cue
Deroche-Gamonet..Piazza, 2004 Science
3 months of SA, repeatedly evaluation the intensity of three behaviors
considered hallmarks of substance dependence in DSM-IV:
The subject has difficulty stopping drug use or limiting drug intake.
measured persistence of cocaine seeking during a period of signaled
nonavailability of cocaine. The daily SA session included three 40-min
“drug periods” separated by two 15-min “no-drug periods.” During the
drug periods, a standard FR5 reinforcement schedule was in effect: Five
nose-pokes = infusion of 0.8 (mg/kg). During the no-drug periods, nose-
pokes had no effect. The two different periods were signaled by a
change in the illumination of the SA chamber
The subject has an extremely high motivation to take the drug, with
activities focused on its procurement and consumption. progressive-ratio
schedule. The maximal amount of work that the animal will perform
before stop responding (breaking point) is considered a reliable index of
the motivation for the drug .
Substance use is continued despite its harmful consequences. We
measured the persistence of the animals' responding for the drug when
drug delivery was associated with a punishment.
Fig. 1. Development of addiction-like behaviors over subsequent cocaine SA sessions in rats
showing high (⚫, HRein) or low (◯, LRein) cocaine-induced reinstatement after 5 days of
withdrawal.
Published by AAAS
Síntomas son opuestos a los
❑ Auto-administración:
observados en la respuesta
consumo de droga.
aguda a la droga.
❑ ICSS: cambios en umbral
Se pueden evaluar:
de recompensa.
1. Síntomas a nivel
motivacional. ❑ CPA
2. Síntomas físicos.
❑ Drug Discrimination:
MODELOS
progressive DE
ratioSINTOMAS
interrupciones en las
NEGATIVOS
respuestas
DE DROGAS DE ABUSO
ABSTINENCIA
ABSTINENCIA
SÍNTOMAS FÍSICOS:
Wet dog shake
Grooming
B6
Shaking
Tremors
Teeth chatering
Diaherria
Anxiety.
Analgesia
Locomoción
DBA
INCENTIVE-SENSITIZATION
MODEL
SENSITIZATION
Behavioral sensitization is the augmented motor-stimulant
response that occurs with repeated, intermittent exposure to
most drugs of abuse, including cocaine. Sensitization, which is
a long-lasting phenomenon, is thought to underlie drug
craving and relapse to drug use.
24 hs
D1 D2 D3 D4 D5 Challenge
Half dose.
7 days
28 days
PET = Positron Emission Tomography
Radioactive marker injected
Scanner detects light waves from decay
COCAINE STUDY
CONTINUED