Saturday, April 16, 2011

Savanna Samson Two Men




One of the reasons used to defend the health-visitor interaction is the fact that RESTATEMENT provides professional information about their discipline and on different and new pharmaceutical options. Is a valid argument if one does not have realized that we already installed a few years old in the XXI century ... Today, the possibilities offered by the Internet for information (and help to spread it) are so tremendous that represent a revolution about the state of scientific publication ten years ago. As an example, the network offers twitter, if one follows the right people (we, as in life itself) abundant medical information and specifically therapeutic. And again, not necessarily biased information as you provide our beautiful relationship with pharmaceutical industry. We strongly recommend monitoring, for example, Carlos Oropesa or Vicente Baños. High quality information.

And it was precisely because of information found on twitter as we learned of more severe adjustment plan (the etymology of adjustment supposed to come over oh, what a fright that justice is not ) that the Catalan government has designed for the public health community. The journal Public stated in a recent news some of the consequences of such adjustment: various hospitals of Catalonia in summer care of your plants and significantly reduced their surgical activity. A general reduction of salaries and increased workload due to the lack of substitutions, adding the non-recruitment of many specialists now completing their training. But these measures, burdensome to us as professionals, will be on anecdotes if you start to fire workers or the lowering of salaries continues, or if our residents year after year begin to systematically go to the street ... And do not say what has already announced to close hospital wards, with the consequent collapse of emergency and operating rooms, with which you can imagine what will happen with the famous waiting lists ... What do you tell the patient will have to wait days in ER in a corridor because there are fewer beds to enter, or does that, instead of six months, will take a year in operation? ... As I said once, we can be accused of being alarmist. And really, I wish I be.

But we will radically change of pace. No more talk of health spending and public deficit. No more prophesying the end of the welfare state and public health equality for all. No more bad feeling. Let's talk now, as the title of our input, sweet dreams. And sweet remedies to get them.

In current psychiatric care is very, very common prescription insomnia and hypnotic medication immediately. Not just talking about patients admitted psychotic episode or severe depressive and manic phases. We talked of many patients with varying degrees of discomfort or anxiety of mind more or less diffuse or paroxysmal and even people is difficult to define as a patient but has trouble falling or staying asleep. Although our current ratings and those to come, the true challenge is not listed as patient a wide variety of categories and / or dimensions ... Wonders of comorbidity ....

And the question arises: what is the proper hypnotic? There is a whole range of possibilities, depending on the type of insomnia severity, patient clinical characteristics, etc. This entry is not intended as a lecture on the treatment of insomnia (because that is in any book and it's a very very interesting), but noted some general options based on our clinical practice:

  • Insomnia mild settlement lorazepam or lormetazepam perhaps zolpidem.
    Insomnia
  • conciliation and / or maintenance: flurazepam.
  • mnatenimiento Insomnia conciliation or more severe: levomepromazine, clotiapine.

Of course, all this as indicative only and without any desire to create school. Although we are seeing more on our various partners around the prescribed as hypnotic quetiapine, either as immediate-release or extended-release form (although we still do not understand how a drug with a half life allows once-daily, it lasts 24 hours, can be used as a hypnotic ...).

And now, for as our loyal readers and would imply, a relationship should have the first part of the entrance to the second, let's make a list of hypnotics with their prices (as vademecum, 2008 except seroquel prolong, which is data, 2009). You'll see what education:

  • Lorazepam (orfidal) 1 mg (50 comp.): 1.72 €.
  • Lormetazepam (Noctamid, loramet) 2 mg (20 comp.): 2.36 €.
  • Zolpidem (Stilnox) 10 mg (30 comp.): 3.11 €.
  • Flurazepam (dormodor) 30 mg (30 comp.): 3.75 €.
  • levomepromazine (Sinogan) 25 mg (20 comp.): 1.64.
  • Clotiapine (etumina) 40 mg (30 comp.): 2.17 €.

And the winner is ...

  • Quetiapine (Seroquel) 25 mg ( 6 comp.): 3.2 €.
  • Quetiapine (Seroquel) 100 mg (60 comp.): € 88.06.
  • Quetiapine (Seroquel) 200 mg (60 comp.): € 133.88.
  • Quetiapine (Seroquel) 300 mg (60 comp.): € 187.29.
  • of Quetiapine Prolonged Liberación (seroquel prolong) 50 mg (60 comp.): € 91.79.
  • of Quetiapine Prolonged Liberación (seroquel prolong) 200 mg (60 comp.): € 165.06.
  • of Quetiapine Prolonged Liberación (seroquel prolong) 300 mg (60 comp.) 195.63.
  • of Quetiapine Prolonged Liberación (seroquel prolong) 400 mg (60 comp.) 226.21.

Obviously, one would think that quetiapine is much better than all other hypnotic. Because if it were not so, what is the justification for prescribing under the public health system that, in turn, is lowering wages to their workers, not hiring specialists and threatening form of plant closures and operating rooms, not to mention various copayments ...?

So we set out in search of data and studies to justify the use of quetiapine in insomnia, so rest assured that our money (and yours) was was well spent. And we have a comprehensive document published by the Canadian State University of British Columbia (Vancouver capital, for details) in 2010, which summarized a few paragraphs especially clarifiers below

have been published only two randomized clinical trials to study the hypnotic effect of quetiapine. One in healthy subjects, with a sample size of 14 ( uauh ... ), 2 of whom left for orthostatic hypotension. The others were distributed randomly and double blind between placebo and doses of quetiapine of 25 g and 100 mg. Both doses of quetiapine resulted in increased sleep time. The other study was conducted with 25 patients with primary insomnia, distribute them randomly between placebo and quetiapine. There was no statistically significant differences in any sleep variables studied.

Regarding the possibility of side effects have been associated with the use of quetiapine at both high and low doses, other extrapyramidal symptoms such as dystonia, akathisia or tardive dyskinesia. Frequently Secundary effects at high doses (considered these as 150 to 800 mg / day) are: weight gain, drowsiness, increased cholesterol and triglycerides, insulin resistance, dry mouth and orthostatic hypotension. In rare cases you may receive neuroleptic malignant syndrome or neutropenia. A small double-blind trial found that Quetiapine worsens cognitive decline in dementia.

The findings from the report reproduced in full:

  • Quetiapine is not approved or recommended for primary insomnia.
  • Quetiapine is commonly prescribed off-sheet as a hypnotic, but only A clinical trial examined its use in patients with insomnia. Found no benefit.
  • No published clinical trials comparing quetiapine with other drugs for insomnia.
  • The management of primary insomnia should focus on education and promoting healthy sleep habits.
  • drugs should be limited to short-term, intermittent or daily use only in exceptional cases.

summary, quetiapine prescribed (Seroquel) or, even more surreal, quetiapine extended release (Seroquel XR) as a hypnotic, although there is no evidence of efficacy for such use and although there are other much cheaper options ... We can be proud.

Finally, to conclude with the post title, we sweet dreams to all our dear readers ... We also try to sleep without too many turns to some of the money that the state has failed to pay us or to be saved by not hiring residents coming years, or do not say which will be trimmed at the expense of delaying operations and income of patients, will be used to pay for AstraZeneca boxes and boxes of seroquel seroquel and prolong hypnotic prescription and ...

prefer what he said Estopa :

Do not have pasta, then sleep for a while,
not spend it sleeping, is much cheaper ...


Saturday, April 9, 2011

Jc Pennies Salons In Beaufort Sc

A Lacanian Sweet dreams and a stoic enter a bar ...

... Not really. Despite the title, the entry is not a joke. What we have just to try to attract (more) readers, because if we put the real, as frighten us. This is a work we did on Stoic philosophy, particularly in its ethical aspect, and a possible interpretation of their problems from the viewpoint of Lacanian psychoanalysis. Then, the real title and the essay:

" Stoic ethics and conflict free / destination and pathos / logos: notes from psychoanalysis "

"Stoic" is a term referring to an attitude of serenity to fate and to overcome the passions, on the assumption that metaphysical reality is rational order. The reality would, therefore, a natural whole governed by a causal sequence logos provident as necessary. Chance does not exist, is just a way of saying we do not know the causes. Everything happens by necessity: the destination ( heimarmene, fatum ) prevails without limitations. Based on Heraclitus, the Stoics identified the universal law of nature with the logos.

divine Logos is the source of all things, the foundation of the legality of the events, and to establish a relationship between human reason and the cosmic, universal law because the things are included and the subject, so that match reality with the conceptual structures of thought. Just as the logos dominates the universe, man is encouraged and driven by the soul, which is not purely intangible, material it is a breath (pneuma ).

The doctrine of the logos, pneuma processes makes it possible to conceive of nature not only in a mechanistic, but teleologically, and where there is also for standards to be achieved. To the extent that apprehends teleologically, nature is revealed as a regulatory and therefore be concluded that is not random but due to a cause, since the objective law-policy has that have some merit.

There is only one perfect wisdom, which is the Logos or Reason of God, eternal and subsisting, which is like an infinite seed from which the individual logos of men, all of which are participation the only divine logos.

The constant transformation of the universe unfolds in rhythmic cycles and periodic governed by law and necessary immanent ( logos) that is the cause of all things, past, present and future. Each cycle of development of the universe ends with a conflagration ( ekpirosis ) in which destroys all individual beings, leaving nothing but the two eternal principles: matter and the primordial fire. Of them will never be reborn all things in the same order, repeated endlessly ( palingenesia ). The worlds will occur in successive cycles. All things are repeated countless times exactly.

The Cosmos absolute stoic rationality corresponds an absolute necessity. In his world there is no room for contingency. Nothing happens by chance, but all necessary. There is no movement without a cause. Some facts are because of others. All gear is developed within the cosmic cause and effect. In this cosmic unity everything is rigorously sorted, concatenated and determined by the logos, which is identified with Reason, Providence, Fate or necessity, and would not be blind necessity or purely mechanical, but this logos orders all things to an end of perfection, which it always does best.

In the Cosmos, governed by logos, everything would be perfectly ordered in the set. The specific disorders are only from a limited and partial view. The evil is apparent and only exists in the particular, but even those who appear evil, they are well integrated into the overall purpose of the universe.

Within finalist Stoic determinism, it is essential to leave some space for freedom if you will make it possible to develop some sort of ethics. This freedom is trying to save Chrysippus reconciled with the need, distinguishing between perfect and principal causes (remote) and auxiliary causes (forthcoming). The destination would be the main reason remote drives us to action. But a move to get to be need not be barred by the proximate causes, to which we give or refuse our assent. The destination determines the order, and perhaps provides the means.

Anyway, it is futile to pretend to rebel the impulse of necessity, being such a claim the cause of our suffering. It would be best to let go, to cooperate with our free consent to the movement of Nature. This will achieve the perfect serenity and peace of mind, typical of the sage who is referred to the need providential. However, this freedom is reduced to a power, ineffective resistance to the destination. One can only useless or cooperation or resistance to universal impulse necessary but not sufficient to invalidate the rigid determinism that carries all things.

The ideal Stoic sage is perfect virtue, and therefore also of perfect happiness, because only he has a perfect insight of what is in their power and what goes beyond. Like other human beings, the sage experience passions and emotions, not let it influence their actions or not in attitude and thus in a state of complete freedom. The wise man is free because he understands, accepts and lives by the strict law that orders all events. For the Stoics, the telos is perfect to live in total agreement with nature. To be happy is to live according to nature. So obey rationality itself is to follow the order and harmony of nature, because if the reason is the same in the universe and man, if human nature is essentially rational, and if the kosmos is equally rational, in that case as regards our rationality will concern both the immediate and nature. This situation can be described as the desire to live according to nature or to follow nature.

The supreme principle of virtue is to live according to nature and, thus, the wise man also lives in accordance with himself, or vice versa, living by himself, the wise man also lives under the universal nature . This is also the means to ensure true happiness, which is always linked to virtue, and suffering vice.

An equivalent formula is to live according to reason, then live up to the individual right is to live according to the Reason that rules the world order. In all things there is an instinctive impulse to self-preservation and to achieve perfection, which is the proper end of nature. In minerals, plants and animals that momentum is unconscious. The man, meanwhile, is the largest among animals and has intelligence (logos), which should raise the natural impulse of appetite simple rational volition and choice. Human life, therefore, be characterized as rational and free. And the virtuous life consists in acting rationally and freely, adjusting conduct the universal order of all nature, governed by universal Reason.

Zeno, founder of the school of Stoicism, had merely stated that the purpose of human life is "living consistently" Cleanthes appearing to be adding "according to nature." Some authors argue that "living consistently" Zeno and must be inferred "according to nature." In any case, the addition is important because it means moving on the nature of man to nature as a whole. Chrysippus says that the end becomes the live according to nature, which is equivalent to according to nature and the universe.

When considering the possibility of acting irrationally is when we face various problems. First, the logical problem of trying to obtain a duty of someone (as happens when rules are derived from nature). In fact, the idea of \u200b\u200ba natural order of nature is useless from a practical point of view until they determine their content in any way, since the requirement to live according to nature is empty, or rather too abstract and therefore unable to reach specific duties, if not filled in some way the idea of \u200b\u200bnature, which is necessary to resort to the experience. The Stoics take standing on the observable fact instinctive regularities in the behavior of certain animals. The attempt to determine the universal natural law from the generalization of empirical features of behavior only makes sense under the assumption that in this particular case the law is also universal.

A key problem in Stoic ethics is that if the metaphysical determination of duty is strong to the point of being is rooted in the universal law of nature, and whether it is universally required, how is it possible to act against the duty? Either the objective reason determines all in need and then it is superfluous all called to act in the sense of duty (for all work would be "natural"), or, if such a requirement makes sense, man is not subject unconditionally to the law of nature (here is human freedom) must think that the passions and affections can deflect the soul, so you lose control over the shares. Hence the need to eliminate a stoic and others, for only thus ensuring the rationality of actions and the harmony of the soul, but the passions and affections are to remain "natural" in some sense. And another problem arises: how can act outside the law of nature if it establishes a causal concatenation needed between events past, present and future?

The Stoics, on the one hand, presented as natural and instinctive behavior metaphysical foundation for the thesis that moral action is an action in accordance with nature. But on the other hand, are forced to accept an opposition between reason and instinct, because only thus can speak of irrational behavior and moral demands.

For Zeno, passion is an "irrational and innate movement of the soul as a boost intemperate", with deviations from normal operation and because of reason, ie, are perturbations of reason. Passion, and generally evil is irrational as a loss of reason, not as arising from some authority or power that is not right, because human beings are essentially logos.

Chrysippus in turn argued that although the subjects were acting from external stimuli, the manner in which responses to such stimuli, the behavior is determined by the intrinsic structure of the subject. Chrysippus tries to reconcile the submission of all processes to the universal law of nature with the recognition of human freedom and responsibility for one's actions. The solution is to hold that man is logos, the hegemonikon is pure logos, then must say that man is determined by the logos will be the same as support that determines itself.

The Stoics puzzle over much on the analysis of the passions (pathos ). The passions have their origin in the general thrust of primitive nature. When the initial impulse in man is not governed by reason and is not subject to it is irrational, it deviates from righteousness and since it goes against nature itself. The passions of the disorder consist of reason caused by the ignorance that clouds the mind and causes of false opinions and misjudgments. The ignorant always does wrong.

Stoic moral rationalism is revealed in his concept of passions, it is necessary not only to dominate and submit to reason, but remove them to get the impassivity essential to the serenity of the soul and freedom characteristic of wise and base their happiness.

consist The Stoics make virtue and wisdom in a kind of freedom, this freedom, in turn, is responsive in the absence of determination, of pathos ("affection" from a root meaning "suffering" or "be concerned" .... "passion"). Absence is said in Greek pathos apathy (impassive). The passions are, for example, pleasure, pain, desire and fear.

The first dichotomy is striking to address the issue of Stoic ethics is what stands between freedom or fate or necessity. Despite his runner-deterministic view, the Stoics attempt to safeguard the freedom enough, through the proximate causes of Chrysippus, to maintain accountability of the subject. In the wise this freedom is acceptance of destiny (destination, for its part, the irrational animal also accepts without freedom). Then this freedom, if exercised to break or modify the path of destiny, is the freedom to make mistakes, to err. And if you can not break down that path, then there is no freedom or responsibility, and it is impossible to speak of an ethic worthy of the name. Then the alternative apparently arises whether freedom exists is between being free to accept the slavery of fate or be free to fall into error and evil.

And the problem is not minor or less obvious, how a universal right that all orders and is perfect, you can live with error, ignorance and evil that denounced the Stoics in most men being so few scholars. This avoids saying that even what looks bad due to a perfect outcome plan. But if evil is part of the universal plan, how accountable and punish the wicked?

One possible solution to these issues is that the determinism of the universal logos is the same individual reason, which one is given but in a sense, himself. And if one is determined by itself, in a sense also preserved their freedom and their responsibility as well. It is a similar idea expressed by the psychoanalysis to consider the subject led by their unconscious, their first experiences, their hidden desires, secret defenses. While on a conscious level we often ignore why we do what we do, everything has a cause and an address in the negotiations that unconscious level established between desires and impulses of the id and superego prohibitions, with the ego and its defenses in the middle of this fight, making agreements acceptable to all parties that give rise to symptoms in the psychoanalytic sense, beyond the morbid. The subject, therefore, is determined by his unconscious, but did not know or see, and choose freely their choices and is responsible for them. Not your self, only part of the psyche, but all its instances we call, precisely, subject.

Another problem arises in the comparison between animals and man as a rational animal. The animals have no human reason, live by instinct and based on these instincts follow the nature, the universal logos without the possibility of error. Man as rational animal is higher, but the logos decide to obey or not the instincts, and there arises the possibility of error. Moreover, these instincts in man may degenerate into passions that cloud reason and rush into evil. The question is, if that human reason is part of universal reason, how is it possible that just the only animals that have are the ones who can do evil and ignorance. Or that human reason in such high regard were the Stoics, as we do, implies the germ of those passions whose existence leads to disaster.

A first entry could be made from psychoanalytic concepts of instinct and drive. Animals have instincts, which can be understood as operating rules that decide and organize their behavior at all, whether relating to self-preservation or perpetuation of the species. Therefore, we would say from a Stoic point of view, following the universal law governing the kosmos . Man as rational animal, as well as instincts, is understood as forces drives or impulses that cry out to your satisfaction. But, unlike instincts, do not have a default object to be addressed. The uniquely human instinct is, so say, blind. And from that blindness, each subject (from his unconscious and from its responsibility) must choose each object that runs the drive. That is, the man, unlike animals, do not come with operating rules. No instruction book. Not tied to the universal law, which may or may not follow.

stoic vision evokes the image of a compelling reason to fight and in the wise, wins and removes these unhealthy passions. From psychoanalysis, that reason would be more aware as part of the psyche, like a nut shell drifting in the ocean of the unconscious, full of desires unconfessed of drives / irrational passions which, if controlled, are equally unaware of defense forces, no reason as such even know of such struggles.
Then
or reason is weak, as claimed by psychoanalysis and not against passions and impulses, or that human reason is not part of the universal logos but opposed to it. How do you explain that the only beings endowed with reason in the world are the ones who make mistakes? No men in the world, the universal law would be fulfilled smoothly without errors. The world would be in equilibrium, marked by nature, consisting of a sum of ecosystems (understanding biological systems such as those in which man is absent), away from danger, that the Stoics could not anticipate and we can not ignore, climate change, nuclear wars and various planetary disasters.

That human reason, the Stoics as high as banal for psychoanalysis, what is specific? A Lacanian view would insist on the role of language as a structuring of the psyche, leaving the subject as its level. That is, the language which is not complete us. Leave a rest is not predictable, not specified, you can not put into words, a lack native to which is added after passage through the Oedipus, the frustration, incompleteness, castration, ie the terrible discovery that you can not have everything you want. The full introduction of the fault, causing the desire and essential part of being speaker. Therefore, the superior animal endowed with reason implies its own contradiction: the higher rationality that accompanied language gives no remedy the fault that generates the desire, drive, passion, and that makes it so difficult to impassivity aspirations of the Stoic sage, leading to the best of a standard and normalizing neurosis. Lacanian language that we determined and inevitably generates both and desperately reason and passion, logos and pathos , constituting the subject human as we know it.


Bibliography:

  • Salvador Mas, "History of Ancient Philosophy. Greece and Hellenism. " UNED.
  • Salvador Mas, "Hellenistic Philosophy. Selected Texts. " UNED.
  • Guillermo Fraile, "History of Philosophy. Volume I ". BAC.
  • Marzoa Felipe Martinez, "History of Philosophy. Volume I ". Isthmus.
  • Sigmund Freud, Complete Works. " RBA.
  • Jacques Lacan, "Selected Works." RBA.

Sunday, April 3, 2011

Una Ragazza Molto Viziosa Con Lilli Carati

"Merchants in the temple paradigm hegemony of commercial bio-psychiatry"

With this title, Journal of the English Association of Neuropsychiatry we just published an article in which we work hard few months ago. As you can imagine such a thing fills us with pride and is an honor for us. This paper talks about the (more problematic) relationship between the pharmaceutical industry and psychiatry through the review of different studies and different opinions that we believe are relevant, including our personal conclusions on the matter.

hope you like it (though perhaps not so).