Consideraciones hacia los psicofármacos en profesionales y estudiantes de medicina en España, y en profesionales de la medicina en México y en Colombia : un estudio comparativoun estudio comparativo

Abstract

A psychotropic medication considering itself as one that exerts profound and beneficial effects on behavior, mood and cognition, although frequency scam, do not alter the underlying disease process (Schatzberg, Cole, & DeBattista, 2010). The three major types of psychoactive drug used in the treatment of mental problems and which have been taken as reference for our research are anxiolytics, antidepressants and neuroleptics or antipsychotics. Anxiolytics The first drugs with selective anxiolytic and hypnotic were barbiturates (Stolerman, 2010). Benzodiazepines, perhaps the best known and most widely used anxiolytics (Stahl, 2008) are very safe and effective in treating short-term anxiety (Preston, O'Neal, & Talaga, 2013). Antidepressants. Antidepressant drugs include selective inhibitors of serotonin reuptake, tricyclic and monoamine oxidase inhibitors of the resulting effective in the treatment of comorbid depression and anxiety (Leonard, 2001). Antidepressants produce a transient increase in the brain in certain monoamine neurotransmitters, such as serotonin and norepinephrine, or by inhibiting its degradation, or type, blocking their reuptake or reuptake by neurons in the synapses (González & Perez , 2007). Antipsychotics. Antipsychotic drugs are used to counter painkillers inner restlessness, psychomotor agitation and severe insomnia, states that can arise in the following contexts: schizophrenic psychosis, especially in its severe forms paranoid, mania, psychotic syndromes in the aftermath of an organic disorder brain and depression, especially that causes symptoms of agitation and anxiety (Spiegel, 2003). The prescription of psychotropic drugs in primary care, deserves special attention, since it is often done without the use of other prior or parallel interventions for mental disorders and more durable than recommended requirements and even indefinitely (Galleguillos Crag Garay Gonzalez, & Vogel, 2003). The psychotropic drugs are a group of high consumption in the Spanish Health System (Romo et al., 2003). According to the results of ESEMeD, 16% of the Spanish population interviewed had consumed some type of psychotropic drugs during the year prior to the survey, with the probability of consumption doubled for women. Benzodiazepines (alone or in combination) were the most consumed guy with a 11,4%, followed by antidepressants with 4,7%, within which, the most used were selective inhibitors of serotonin reuptake with 59,5%. Antipsychotics were consumed in 2,1% of cases and mood stabilizers on a 0,1% (Codony et al., 2007). The development of a drug is a highly complex process which begins in the preclinical phase. It is evaluated in animals bioavailability, metabolism and toxicity of the drug, its known effects on biological targets and representation of the disease in various animal models. After obtaining sufficient data in animal studies, the drug can be tested in humans (Schatzberg & Nemeroff, 2009). The U.S. Agency for Food and Drugs (Food and Drug Administration or FDA) warns that psychotropic medication may increase the risk of suicide, which raises concerns about prescribing in patients with psychiatric disorders, many of which already have an increased risk of suicide. Therefore, clinicians must understand the risks and benefits associated with the use of psychotropic medication (Fawcett, Baldessarini, Coryell, Silverman, & Stein, 2009). The objectives of this research for the review between professionals and medical students, and medical professionals from Mexico and Colombia in its considerations towards psychoactive drugs, exploring their attitudes toward efficacy, side effects, mechanisms of action, in relation to their prescribing habits, comparing turn the differences between medical students and also differentiating between Spaniards and foreigners. 2. Method This research is descriptive-analytical and non-experimental (ex post facto) nature, transversal, using as a method for gathering information, and as a technical survey, the questionnaire, which is based on obtaining a wealth of information in order to characterize a population. The sample collection was carried out by a diffusion process under investigation attaching the link of the questionnaire on-line. The accepting sample was composed by 210 subjects, of which corresponds to 61,9% of primary care health professionals in the countries of Spain, Mexico and Colombia and 38,1% with 5th year students of the Faculty of Medicine Seville and Granada. Among the sample of medical professionals, the 48,46% were male with a mean age 46,16 years versus 38,75% of students of the same gender, the average age of the latter group 22,74 years. As no case a susceptible questionnaire to satisfy the purposes of this research was available this gave rise the "Attitudes toward psychotropic drugs in Medical Professionals Questionnaire." 3. Results According to what throughout this investigation has been being shown by the example of doctors belonging to the Spanish country, a predominant profile of physician primary care provider could be described in relation to attitudes toward psychiatric medications relates. The overall characteristics of this pattern could be detailed as follows: � To consider each patient with mental health problems a choice between psychopharmacological and one psychotherapeutic treatment. � To make use of a higher frequency of prescription of psychotropic drugs versus psychotherapy for patients with mental problems. � They prefer the model that argues that psychiatric drugs correct an abnormal brain state, which are treatments for mental illness, its therapeutic action derives from its effects on the pathogenesis of the disease, and that psychotropic medication is like insulin for diabetes (Moncrieff & Cohen, 2005). � Reported on a not clearly defined towards psychoactive drugs and instead very favorable attitude toward psychotherapy. Comparatively predominant profile described for the Spanish physician and again according to the information reported by the representation of Mexico and Colombia has also explained. It has been possible with the prudence required by the sample size, the most representative profile of professional primary care in these countries in terms of attitudes towards psychotropic drugs are concerned, which would be defined by: � To think before each patient with mental health problems a choice between psychopharmacological and one psychotherapeutic treatment. � To make use of a higher frequency of prescription of psychotropic drugs versus psychotherapy for patients with mental problems. � They prefer the model that argues that psychotropic drugs create an abnormal brain state, which are psychoactive drugs and their useful effects are consequences of a state induced by themselves and psychotropic medication would like alcohol for social anxiety (Moncrieff & Cohen , 2005). � Report to a slightly more critical attitude towards psychoactive drugs that Spanish doctors, and also in favor of prescribing psychotherapy. 4. Discussion It seems evident that the prescription of psychotropic drugs and attitudes towards them could be influenced by cultural determinants that come to differ between the Spanish context framed in Europe on the one hand, and recourse to Mexico and Colombia, made in Latin America, with a different philosophy around the concept of mental disorders (Raskovsky, 2010). Finally, students of medicine is the group that leans more widely for taking the model of action of psychoactive drugs in these correctors are conceived as an abnormal brain state and under the paradigm of insulin for diabetes. Consistent seems denoted a predilection towards this model in university education. However, in practice the Spanish context supporting this model is lower than in the student sample, although it is preferred, although the alternative model cuts distances relevant way. In the Latin American context, this situation is reversed, and the alternative model that interprets psychotropic drugs create an abnormal brain state and assigned to the paradigm of alcohol for social anxiety would be more dominant than the other. In our country, the tendency to consider that psychiatric drugs correct an abnormal brain state, which have a therapeutic effect for treating mental illness derived from its specific action on the pathogenesis of the disease in the same way that insulin acts about diabetes, is greater than the consideration of psychotropic drugs as psychoactive drugs that induce altered brain state a useful effect on a psychopathological condition in the same way that alcohol relieves social anxiety. This difference is accentuated in the case of students of medicine, and this, despite the lack of solid evidence for the pathophysiologic mechanisms responsible for mental disorders (Moncrieff, 2008), but whose hypotheses (dopaminergic, serotonergic and / or noradrenergic) set forth by opposition to the effect of drug prepared with the same confusion in terms of validity of a hypothesis formulated to explain the origin of headache relief produced by starting an aspirin tablet, were to attribute the genesis of pain at a low level of aspirin in the body (Perez, 2007). Although pharmaceutical companies often suggest otherwise, there is no correlation between anxiety or depression and low serotonin levels (Lane & Muñoz, 2010) However, the efforts of the scientific community in clinging to the fact that the alterations in neurotransmission are agents involved in mental disorders despite the lack of objective confirmation, should lead to reconsideration of such hypotheses and reveal, if that was the case, its relationship to non-scientific interests (Healy, 2002; Moncrieff, 2008; Perez,2007)