An Updated Review of Werner Janzarik’s Psychopathological Model of Endogenous (Idiopathic) Psychoses
Riccardo Dalle Luche,
Simone Giovannini,
Carlo Maggini
Issue:
Volume 11, Issue 3, September 2023
Pages:
55-63
Received:
24 June 2023
Accepted:
14 July 2023
Published:
24 July 2023
Abstract: “Dynamische Grundkonstellationen in endogenen Psychosen” is Werner Janzarik’s most influential work. It is aimed at defining an unitary psychopathological model of endogenous psychoses independently from categorical nosology. His main contribution is the distinction between dynamic (the whole of emotions, impulses and intentions) and structure (the whole of psychic contents which remain stable throughout the course of life), whose intersection is well elicitable both in organic and in endogenous psychoses. Janzarik describes different types of dynamic alterations (dynamic constellations) in the different stages of the psychotic course: dynamic reduction in depressive phases, dynamic expansion in manic states, instability and depletion in the different clinical phases of long-term schizophrenic psychoses. Janzarik’s work is nowadays completely forgotten. In the paper the Authors resume his main clinical ideas on major mental illnesses, because they fit well with long term courses of psychoses as observable in mental health public services, in an era of serious crisis of categorical distinctions. Janzark supports a dynamic model of psychoses, characterized by different stages and switchovers between different psychotic categories over time. In addition, this model could be used in standardized pharmacological trials to define which treatments are really effective in the different “dynamic” alterations of both affective and schizophrenic psychotic courses.
Abstract: “Dynamische Grundkonstellationen in endogenen Psychosen” is Werner Janzarik’s most influential work. It is aimed at defining an unitary psychopathological model of endogenous psychoses independently from categorical nosology. His main contribution is the distinction between dynamic (the whole of emotions, impulses and intentions) and structure (the...
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New Frontiers in Ketamine Research: From Mechanisms of Action to Novel Psychiatric Treatment Approaches
Marcus Christian Rosenhagen,
Julien Elowe,
Alberto Forte,
Nicolas Schaad
Issue:
Volume 11, Issue 3, September 2023
Pages:
64-72
Received:
19 July 2023
Accepted:
7 August 2023
Published:
17 August 2023
Abstract: Ketamine, initially developed as a safer alternative to phencyclidine, has emerged as a groundbreaking treatment in psychiatric practice. It gained popularity after its approval by the FDA in 1970 for its analgesic properties and ability to induce altered consciousness while maintaining vital functions. In the 1990s, researchers discovered its rapid and potent antidepressant effects, especially in patients with treatment-resistant depression. The mechanism of action of ketamine involves blocking N-Methyl-D-Aspartate receptors, leading to the release of inhibitory signals and increased glutamate levels. This process triggers a series of events promoting neuron growth and synaptic plasticity relevant to antidepressant outcomes. Various administration methods have been explored, including intravenous, intranasal, oral, subcutaneous, and intramuscular routes, each with its own advantages and limitations. IV ketamine administration has been widely used, but intranasal and sublingual forms are gaining popularity due to improved accessibility and safety. The FDA and European Medicines Agency approved intranasal S-ketamine for treatment resistant depression and depressive symptoms. Ketamine treatment is being extensively researched for its impact on various psychiatric domains, including resistant depression, suicidal crises, anxiety disorders, substance use disorders, and others. Preliminary evidence suggests potential benefits in conditions such as obsessive compulsive and personality disorders, although further research is needed. Ketamine's safety profile is generally favorable, with mild, temporary, and self-limiting side effects. However, caution is advised in individuals with uncontrolled hypertension, cardiovascular conditions, a history of psychosis, or substance abuse. Contraindications also apply to pregnant women. Ketamine interactions with other medications should be carefully considered, especially regarding benzodiazepines, and lamotrigine use. To optimize ketamine treatment in psychiatric diseases, guidelines recommend it as a third-line option after multiple unsuccessful antidepressant treatments for treatment resistant depression. Intravenous racemic ketamine has Level 1 evidence supporting its efficacy, while the evidence for non-intravenous formulations is limited. International guidelines vary slightly, but overall, the use of ketamine shows great potential in addressing challenging psychiatric conditions. This update highlights the expanding literature on ketamine in psychiatric treatment, focusing on its applications in treatment-resistant depression and its potential to revolutionize acute psychiatric emergency departments. Moreover, it provides insights into administration methods, safety considerations, and international guidelines for optimized ketamine usage in psychiatric practice.
Abstract: Ketamine, initially developed as a safer alternative to phencyclidine, has emerged as a groundbreaking treatment in psychiatric practice. It gained popularity after its approval by the FDA in 1970 for its analgesic properties and ability to induce altered consciousness while maintaining vital functions. In the 1990s, researchers discovered its rapi...
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