ORGANIZACIÓN SEMESTRAL

PSICOSIS I
ABORDAJE TERAPÉUTICO DE LAS PSICOSIS AGUDAS

Responsable: Dr. Sebastián Lema Spinelli

 PUNTEO
o Preguntas Guía
o Introducción
o Perfil de Acción
o Medicamentos
o Tratamiento
o Bibliografía
 PREGUNTAS GUÍA
o ¿Cual son las posibles evoluciones diagnósticas de un Primer Episodio Psicótico y sus porcentajes?
o ¿Cuál es la ocupación óptima de receptores dopaminérgicos estriatales D2 para la eficacia clínica?
o ¿En qué se basan las guías terapéuticas para plantear tratamientos de primera línea en un Episodio Psicótico no
Afectivo?
o ¿Durante cuánto tiempo se debe realizar la escalada terapéutica hasta lograr la dosis deseada?
o ¿Cómo se realiza el cross-over switching?
o ¿Cuánto tiempo se debe tratar farmacológicamente un Primer Episodio Psicótico?
o ¿Cuales son las tasas de recaída al primer y segundo año de suspendido el tratamiento comparado con el
tratamiento mantenido?
 INTRODUCCIÓN

Stahl S. Psychosis, Schizophrenia, and the Neurotransmitter Networks Dopamine, Serotonin, and Glutamate. Stahl S. Stahl’s Essential Psychopharmacology. Neuroscientific Basis and
Practical Applications. Cambridge Medicine. 5° Ed. 2021. 77-158
 INTRODUCCIÓN

Stahl S. Psychosis, Schizophrenia, and the Neurotransmitter Networks Dopamine, Serotonin, and Glutamate. Stahl S. Stahl’s Essential Psychopharmacology. Neuroscientific Basis and
Practical Applications. Cambridge Medicine. 5° Ed. 2021. 77-158
 INTRODUCCIÓN

Stahl S. Psychosis, Schizophrenia, and the Neurotransmitter Networks Dopamine, Serotonin, and Glutamate. Stahl S. Stahl’s Essential Psychopharmacology. Neuroscientific Basis and
Practical Applications. Cambridge Medicine. 5° Ed. 2021. 77-158
 INTRODUCCIÓN

Stahl S. Psychosis, Schizophrenia, and the Neurotransmitter Networks Dopamine, Serotonin, and Glutamate. Stahl S. Stahl’s Essential Psychopharmacology. Neuroscientific Basis and
Practical Applications. Cambridge Medicine. 5° Ed. 2021. 77-158
 PERFIL DE ACCIÓN

Stahl S. Psychosis, Schizophrenia, and the Neurotransmitter Networks Dopamine, Serotonin, and Glutamate. Stahl S. Stahl’s Essential Psychopharmacology. Neuroscientific Basis and
Practical Applications. Cambridge Medicine. 5° Ed. 2021. 77-158
 PERFIL DE ACCIÓN

Stahl S. Psychosis, Schizophrenia, and the Neurotransmitter Networks Dopamine, Serotonin, and Glutamate. Stahl S. Stahl’s Essential Psychopharmacology. Neuroscientific Basis and
Stahl S.Applications.
Practical Psychosis, Schizophrenia, and the Neurotransmitter
Cambridge Medicine. Networks Dopamine, Serotonin, and Glutamate. Stahl S. Stahl’s Essential Psychopharmacology. Neuroscientific Basis and
5° Ed. 2021. 77-158
 PERFIL DE ACCIÓN

Stahl S. Psychosis, Schizophrenia, and the Neurotransmitter Networks Dopamine, Serotonin, and Glutamate. Stahl S. Stahl’s Essential Psychopharmacology. Neuroscientific Basis and
Practical Applications. Cambridge Medicine. 5° Ed. 2021. 77-158
 PERFIL DE ACCIÓN

Stahl S. Psychosis, Schizophrenia, and the Neurotransmitter Networks Dopamine, Serotonin, and Glutamate. Stahl S. Stahl’s Essential Psychopharmacology. Neuroscientific Basis and
Practical Applications. Cambridge Medicine. 5° Ed. 2021. 77-158
 PERFIL DE ACCIÓN

Stahl S. Psychosis, Schizophrenia, and the Neurotransmitter Networks Dopamine, Serotonin, and Glutamate. Stahl S. Stahl’s Essential Psychopharmacology. Neuroscientific Basis and
Practical Applications. Cambridge Medicine. 5° Ed. 2021. 77-158
 PERFIL DE ACCIÓN

Stahl S. Psychosis, Schizophrenia, and the Neurotransmitter Networks Dopamine, Serotonin, and Glutamate. Stahl S. Stahl’s Essential Psychopharmacology. Neuroscientific Basis and
Practical Applications. Cambridge Medicine. 5° Ed. 2021. 77-158
 PERFIL DE ACCIÓN

Stahl S. Psychosis, Schizophrenia, and the Neurotransmitter Networks Dopamine, Serotonin, and Glutamate. Stahl S. Stahl’s Essential Psychopharmacology. Neuroscientific Basis and
Practical Applications. Cambridge Medicine. 5° Ed. 2021. 77-158
 PERFIL DE ACCIÓN

Stahl S. Psychosis, Schizophrenia, and the Neurotransmitter Networks Dopamine, Serotonin, and Glutamate. Stahl S. Stahl’s Essential Psychopharmacology. Neuroscientific Basis and
Practical Applications. Cambridge Medicine. 5° Ed. 2021. 77-158
 PERFIL DE ACCIÓN

Stahl S. Psychosis, Schizophrenia, and the Neurotransmitter Networks Dopamine, Serotonin, and Glutamate. Stahl S. Stahl’s Essential Psychopharmacology. Neuroscientific Basis and
Practical Applications. Cambridge Medicine. 5° Ed. 2021. 77-158
 PERFIL DE ACCIÓN

Stahl S. Psychosis, Schizophrenia, and the Neurotransmitter Networks Dopamine, Serotonin, and Glutamate. Stahl S. Stahl’s Essential Psychopharmacology. Neuroscientific Basis and
Practical Applications. Cambridge Medicine. 5° Ed. 2021. 77-158
 PERFIL DE ACCIÓN

Stahl S. Psychosis, Schizophrenia, and the Neurotransmitter Networks Dopamine, Serotonin, and Glutamate. Stahl S. Stahl’s Essential Psychopharmacology. Neuroscientific Basis and
Practical Applications. Cambridge Medicine. 5° Ed. 2021. 77-158
 PERFIL DE ACCIÓN

Stahl S. Psychosis, Schizophrenia, and the Neurotransmitter Networks Dopamine, Serotonin, and Glutamate. Stahl S. Stahl’s Essential Psychopharmacology. Neuroscientific Basis and
Practical Applications. Cambridge Medicine. 5° Ed. 2021. 77-158
 PERFIL DE ACCIÓN

Stahl S. Psychosis, Schizophrenia, and the Neurotransmitter Networks Dopamine, Serotonin, and Glutamate. Stahl S. Stahl’s Essential Psychopharmacology. Neuroscientific Basis and
Practical Applications. Cambridge Medicine. 5° Ed. 2021. 77-158
 PERFIL DE ACCIÓN

Stahl S. Psychosis, Schizophrenia, and the Neurotransmitter Networks Dopamine, Serotonin, and Glutamate. Stahl S. Stahl’s Essential Psychopharmacology. Neuroscientific Basis and
Practical Applications. Cambridge Medicine. 5° Ed. 2021. 77-158
 MEDICAMENTOS

Stahl S. Psychosis, Schizophrenia, and the Neurotransmitter Networks Dopamine, Serotonin, and Glutamate. Stahl S. Stahl’s Essential Psychopharmacology. Neuroscientific Basis and
Practical Applications. Cambridge Medicine. 5° Ed. 2021. 77-158
 MEDICAMENTOS

Stahl S. Psychosis, Schizophrenia, and the Neurotransmitter Networks Dopamine, Serotonin, and Glutamate. Stahl S. Stahl’s Essential Psychopharmacology. Neuroscientific Basis and
Practical Applications. Cambridge Medicine. 5° Ed. 2021. 77-158
 MEDICAMENTOS

Stahl S. Psychosis, Schizophrenia, and the Neurotransmitter Networks Dopamine, Serotonin, and Glutamate. Stahl S. Stahl’s Essential Psychopharmacology. Neuroscientific Basis and
Practical Applications. Cambridge Medicine. 5° Ed. 2021. 77-158
 MEDICAMENTOS

Stahl S. Psychosis, Schizophrenia, and the Neurotransmitter Networks Dopamine, Serotonin, and Glutamate. Stahl S. Stahl’s Essential Psychopharmacology. Neuroscientific Basis and
Practical Applications. Cambridge Medicine. 5° Ed. 2021. 77-158
 MEDICAMENTOS

Stahl S. Psychosis, Schizophrenia, and the Neurotransmitter Networks Dopamine, Serotonin, and Glutamate. Stahl S. Stahl’s Essential Psychopharmacology. Neuroscientific Basis and
Practical Applications. Cambridge Medicine. 5° Ed. 2021. 77-158
 MEDICAMENTOS

Stahl S. Psychosis, Schizophrenia, and the Neurotransmitter Networks Dopamine, Serotonin, and Glutamate. Stahl S. Stahl’s Essential Psychopharmacology. Neuroscientific Basis and
Practical Applications. Cambridge Medicine. 5° Ed. 2021. 77-158
 MEDICAMENTOS

Stahl S. Psychosis, Schizophrenia, and the Neurotransmitter Networks Dopamine, Serotonin, and Glutamate. Stahl S. Stahl’s Essential Psychopharmacology. Neuroscientific Basis and
Practical Applications. Cambridge Medicine. 5° Ed. 2021. 77-158
 MEDICAMENTOS

Stahl S. Psychosis, Schizophrenia, and the Neurotransmitter Networks Dopamine, Serotonin, and Glutamate. Stahl S. Stahl’s Essential Psychopharmacology. Neuroscientific Basis and
Practical Applications. Cambridge Medicine. 5° Ed. 2021. 77-158
 MEDICAMENTOS

Stahl S. Psychosis, Schizophrenia, and the Neurotransmitter Networks Dopamine, Serotonin, and Glutamate. Stahl S. Stahl’s Essential Psychopharmacology. Neuroscientific Basis and
Practical Applications. Cambridge Medicine. 5° Ed. 2021. 77-158
 TRATAMIENTO

0 2 8 12
semanas semanas semanas

cross-over switching

International Early Psychosis Association Writing Group. International clinical practice guidelines for early psychosis. Br J Psychiatry Suppl. 2005 Aug;48:s120-4
 TRATAMIENTO

0 2 8 12
semanas semanas semanas semanas

cross-over switching

International Early Psychosis Association Writing Group. International clinical practice guidelines for early psychosis. Br J Psychiatry Suppl. 2005 Aug;48:s120-4
 TRATAMIENTO

0 2 8 12
semanas semanas semanas semanas

cross-over switching

International Early Psychosis Association Writing Group. International clinical practice guidelines for early psychosis. Br J Psychiatry Suppl. 2005 Aug;48:s120-4
 DURACIÓN

Remisión < 1 mes

y
Leve

Remisión > 1 mes

o
Grave

Remisión Parcial

International Early Psychosis Association Writing Group. International clinical practice guidelines for early psychosis. Br J Psychiatry Suppl. 2005 Aug;48:s120-4
 DURACIÓN

Remisión < 1 mes

y
1
Leve año

Remisión > 1 mes

o
2
Grave años

Remisión Parcial
5
años
International Early Psychosis Association Writing Group. International clinical practice guidelines for early psychosis. Br J Psychiatry Suppl. 2005 Aug;48:s120-4
 BIBLIOGRAFÍA
. International Early Psychosis Association Writing Group. International clinical practice guidelines for early
psychosis. Br J Psychiatry Suppl. 2005 Aug;48:s120-4. link
. Recio Barbero M, Cabezas Garduño J, Segarra Echebarría R. Cuándo, Cómo y Cuánto tiempo se debe tratar
farmacológicamente un PEP. Segarra R. Abordaje Integral de las Fases Iniciales de las Psicosis. 187-210
. Begemann MJH, et al. To continue or not to continue? Antipsychotic medication maintenance versus dose-
reduction/discontinuation in first episode psychosis: HAMLETT, a pragmatic multicenter single-blind randomized
controlled trial. Trials. 2020 Feb 7;21(1):147 link
. Stahl S. Psychosis, Schizophrenia, and the Neurotransmitter Networks Dopamine, Serotonin, and Glutamate. Stahl S.
Stahl’s Essential Psychopharmacology. Neuroscientific Basis and Practical Applications. Cambridge Medicine. 5° Ed.
2021. 77-158 link
. Stahl S. Targeting Dopamine and Serotonin Receptors for Psychosis, Mood, and Beyond: So-Called “Antipsychotics”.
Stahl S. Stahl’s Essential Psychopharmacology. Neuroscientific Basis and Practical Applications. Cambridge Medicine.
5° Ed. 2021. 159-243 link
. Bernardo Arroyo M, Bioque Alcazar M, Leal Cercos C. Primeros Episodios Psicoticos. En: Vallejo J, Leal C. Tratado de
Psiquiatría. Marbán. 2012. 952-962.
 BIBLIOGRAFÍA
. Long Term Treatment of First Episode of Psychosis - Psychopharmacology Institute link
. Tratamiento a largo plazo del primer episodio psicótico - Psychopharmacology Institute link
. The Effects of antipsychotic Treatment on the Brain of patients with First Episode Schizophrenia -
Psychopharmacology Institute link
. Psychopharmacology for Treatment Resistant Estoy Psychosis - Psychopharmacology Institute link
. Antipsychotic for First Episode of Psychosis - Psychopharmacology Institute link
. Manejo del primer episodio psicótico: antipsicóticos - Psychopharmacology Institute link
. Zhang JP, Gallego JA, Robinson DG, et al. Efficacy and safety of individual second-generation vs. first-generation
antipsychotics in first-episode psychosis: A systematic review and meta-analysis. Int J Neuropsychopharmacol
2013;16: 1205–1218. link
. Barnes TR, Drake R, Paton C, Cooper SJ, Deakin B, Ferrier IN. Evidence-based guidelines for the pharmacological
treatment of schizophrenia: Updated recommendations from the British Association for Psychopharmacology.
Journal of Psychopharmacology. 2020;34(1),3-78. link
. Chen EYH, Hui CLM, Lam MML, et al. Maintenance treatment with quetiapine versus discontinuation after one year
of treatment in patients with remitted first episode psychosis: Randomised controlled trial. BMJ. 2010;341: c4024.
link
 BIBLIOGRAFÍA
. Freudenreich, O., Schulz, S.C. & Goff, D.C., Initial medical workup of first-episode psychosis: a conceptual review.
Early Interven Psychiatry, 2009. 3(1): p. 10-18. link
. Gaebel W, Riesbeck M, Wölwer W, et al. Relapse prevention in first-episode schizophrenia – maintenance vs
intermittent drug treatment with prodrome-based early intervention: Results of a randomized controlled trial within
the German Research Network on Schizophrenia. J Clin Psychiatry 2011;72: 205–218. link
. Gitlin M, Nuechterlein K, Subotnik KL, et al. Clinical outcome following neuroleptic discontinuation in patients with
remitted recent-onset schizophrenia. Am J Psychiatry 2001;158: 1835–1842. link
. Hui CLM, Honer WG, Lee EHM, Chang WC, Chan SKW, Chen ESM, et al. Long-term effects of discontinuation from
antipsychotic maintenance following first-episode schizophrenia and related disorders: a 10 year follow-up of a
randomised, double-blind trial. The Lancet Psychiatry. 2018;5(5):432–42. link