Neuropsychopharmacology in Latin America
Thomas A. Ban
It is my privilege to present you Libro de Neuropsicofarmacologia del CLANP, edited by professors Guillermo Dorado from Argentina, Jaime Vengoechea from Columbia, and Enrique Galli from Peru, with contributions by neuroscientists and clinicians from eight Latin American countries: Argentina, Bolivia, Brazil, Colombia, Dominican Republic, Ecuador, Mexico, and Peru.
Neuropsychopharmacology is the scientific discipline that is dedicated to the study and treatment of the pathophysiology of mental illness with the employment of centrally acting drugs. It was born in the 1950s with the identification of chemical neurotransmitters in the central nervous system, the introduction of the first set of therapeutically effective psychotropic drugs, and the construction of the spectrophotofluorimeter. This new instrument provided a means to measure the effect of psychotropic drugs on the concentration of neurotransmitters and their metabolites in the brain. It also rendered psychiatric disorders accessible to scientific scrutiny. In less than 30 years pharmacotherapy became the primary form of treatment in psychiatry. By the dawn of the 21st century neuropsychopharmacology shifted the understanding of mental activity from psychological to biological, and has become the driving force in the destigmatization of mental illness.
Recognition, that one of the essential prerequisites of successful neuropsychopharmacological research is a continuous dialogue between clinicians and basic scientists, led to the founding of the Collegium Internationale Neuro-Psychopharmacologicum. The CINP was launched on the 3rd of September 1957, during the 2nd World Congress of Psychiatry by 32 prominent clinicians and basic scientists from 13 countries in a restaurant at the Zurich railway station. One of the founders of the CINP was Honorio Delgado, a prominent Peruvian psychiatrist, who, during the first half of the 20th century, was instrumental in transforming psychiatry in Latin America, by adopting phenobarbital in the treatment of epilepsy, malarial treatment in cerebral syphilis, and pentetrazol-induced convulsions and insulin coma therapy in schizophrenia. Delgado was also one of the selected psychiatrists invited to participate in the first international meeting on chlorpromazine, held in Paris, in 1955, and he was the first psychiatrist in Latin America to use imipramine in the treatment of depressive states, and to combine imipramine and electroshock in treatment refractory melancholia (Mariategui 1992). The youngest among CINP’s founders was Pedro Tellez-Carrasco, a psychiatrist from Madrid. He moved to Venezuela in .the early 1960s and has played an important role in the introduction of many psychotropic drugs, from lithium to clozapine, in Latin America (Tellez-Carrasco 1998).
At the time the CINP was founded, communication of information in general --and not just in neuropsychopharmacology-- was poor. The scarce knowledge about the pharmacology and clinical application of psychotropic drugs was scattered around, and difficult to find. There were only two books that dealt with the pharmacotherapy of mental illness: Wolfgang de Boor’s, published in 1956, in German and Abraham Wikler’s, published in 1957, in English. The first journal in the field, Psychopharmacologia, was launched in 1958, and the second, The International Journal of Neuropharmacology (now Neuropharmacology), was founded in 1961. For many years, it was one of the major tasks of CINP to provide education in neuropsychopharmacology and spread the rapidly accumulating knowledge on the use of the steadily growing number of psychotropic drugs at its biennial congresses. The first Congress of the Collegium took place in 1958, in Rome. It was organized by Emilio Trabucchi form Milan, in collaboration with an international team.of 16 neuropsychopharmacologists. Five members of this team were from Latin America: R. Casteluccio, Argentina, F. Jeri, Peru, M. Loforte Goncalves and H. Peres, Brazil, and E. Ratinoff, Chile. The Congress, was attended by more than 500 delegates, from 26 countries (Ban and Ray 1996)..
The difficulty of getting access to information in neuropsychopharmacology remained so great, and communication of knowledge in the new field was so poor that in the 1960s the World Health Organization established two International Reference Centers, one, in Washington, for Information on Psychotropic Drugs, and another, in Paris, for the Study of Adverse Effects of Psychotropic Drugs. They grew into an International Reference Center Network with National Reference Centers established around the world, including one in Mexico, under the direction of Dionisio Nieto, and another one in Colombia, under the direction of Carlos. Leon. The journal of the network, the Psychopharmacology Bulletin, edited by Alice Leeds, was distributed, (a limited number of copies freely), around the world. To meet the pressing needs of education in neuropsychopharmacology, Gaston Castellanos, a Mexican neuropsychiatrist, while an officer at WHO extended the activities of some of these centers to train educators, and provide courses for teachers, in psychopharmacology (Castellanos 2000).
The organization of national associations in neuropsychopharmacology began shortly after the 1st CINP Congress. A meeting at Jesenik Spa in 1959 gave rise to the Czechoslovak Psychopharmacological Society, and a meeting in Washington, in 1960 gave rise to the American College of Neuropsychopharmacology. The first national organization in Latin America, the Argentine Society of Psychopharmacology, was founded in 1963. In the years that followed several other national organizations in psychopharmacology emerged in Latin America. Today there are national colleges of neuropsychopharmacology in Argentina, Brazil, Chile, Colombia, Cuba, Mexico, Peru and Venezuela. These colleges play an important role in education about the use of psychotropic drugs and in the dissemination of knowledge in the field. Some of these colleges have broad ranging activities. In addition to the provision of “continuing education in psychopharmacology for psychiatrists, neurologists, neurosurgeons and general practitioners,” activities of the Colegio Peruana Neuropsychopharmacologia for example include programs for the “facilitation of an early start of pharmacotherapy in schizophrenia and depression,” and for the “fostering of research in the neurosciences” (Galli 2004). Yet the activities of these colleges are restricted to their own country and have remained by and large isolated from each other.
The founding of the Colegio Latinoamericano de Neuropsicofarmacologia (CLANP) took place on October 20, 1994, in Bahia, Brazil, with Helena Cajil, as founding president, and Jorge Costa e Silva, as honorary president. The College provides an administrative structure for the coordination of the activities of the national organizations in Latin America. The publishing of Libro de Neuropsychopharmacologia del CLAMP provides the organization with a common platform for the teaching of neuropsychopharmacology across the different countries in Latin America. It also provides a common reference for the use of psychotropic drugs in clinical practice with the highest contemporary standards.
More than forty years passed since the publication in 1965 of the first comprehensive text in Latin America, in which Edmundo Fisher, Gustavo Poch and Ronaldo Ucha Udabe from Argenina reviewed the first ten years in the development and clinical use of psychotropic drugs. Libro de Neuropsicofarmacologia del CLANP is a synthesis of over 50 years of clinical experience with psychotropic drugs, and of the rapidly accumulating knowledge in the neurobiology and pharmacological treatment of mental illness. By reflecting the state of art in neuropsychopharmacology it will help clinicians and educators in their work, and it should also stimulate basic and clinical research to develop clinically more selective and thereby more effective psychotropic medications.
Ban TA, Ray O. The first CINP Congress. In: Ban TA, Ray O. eds. A History of the CINP. Nashville; JM Productions: 1996, pp. 379-81.
Castellanos G. (2000). Notes about theWHO program in psychopharmacology. In: Ban, T.A., Healy, D., Shorter,E. eds. The Triumph of Psychopharmacology and the Story of CINP. Budapest: Animula; 2000, pp. 97-9.
De Boor W. Pharmakopsychologie und Psychopathologie. Berlin: Springer; 1956.
Fisher E, Poch G, Ucha Udabe R. Psicofarmacologia: Buenos Aires: López Eschegoyen; 1965.
Galli E. The history of the Peruvian College of Neuropsychopharmacology. In: Ban TA, Healy D, Shorter E, eds. Reflections on Twentieth Century Psychopharmacology. Budapest: Animula; 2004, pp.643-44.
Mariategui J. Honorio Delgado. In: Ban TA, Hippius H.eds.Perspectives in Psychopharmacology. A Personal Account of the Founders of the Collegium Internationale Neuro-Psychopharmacologicum. Berlin: Springer; 1992, pp. 14-15.
Tellez-Carrasco P. How I became a founder of CINP: My story before and after. In: Ban, T.A., Healy, D., Shorter, E. eds. The Triumph of Psychopharmacology and the Story of CINP. Budapest: Animula; 1998, pp.307-11.
Wikler A.The Relation of Psychiatry and Pharmacology. Baltimore: Williams & Wilkins; 1057.
Thomas A. Ban
August 22, 2013