Aproximación terapéutica del uso-abuso de MDMA (Extasis)

P. A. Sáiz Martínez, M. González García-Portilla, S. Martínez Barrondo, M. T. Bascarán Fernández, M. Bousoño García, J. Bobes García

Resumen


El uso de éstasis (MDMA), una anfetamina sintética, se ha ido popularizando tanto en España como en Europa durante los últimos 10 años, siendo considerada como una sustancia “segura”. A pesar de ello, en la literatura científica, se han descrito un no desdeñable número de muertes y reacciones adversas de tipo físico y psíquico relacionadas con su consumo. El tratamiento del uso-abuso de MDMA está mucho menos desarrollado que el tratamiento de otros tipos de drogas. No obstante, desde la perspectiva del uso-abuso de sustancias, la mejor aproximación terapeútica consistiría en combinar los “tres pilares del tratamiento”: biológico, social y psicológico. Finalmente, se hace referencia al manejo de las reacciones adversas severas, tanto de tipo físico como de tipo psíquico.


Palabras clave


MDMA; tratamiento; uso crónico; reacciones físicas adversas; reacciones psíquicas adversas

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Referencias


Andreu V, Mas A, Bruguera M, Salmerón JM, Moreno V, Nogué S et al (1998): Ecstasy: a common cause of severe acute hepatotoxicity. J Hepatol, 29: 394-397.

Barret PJ, Taylor GT (1993): Ecstasy ingestion: a case report of severe complications. Journal of the Royal Society of Medicine, 86: 233-234.

Benazzi F, Mazzoli M (1991): Psychiatric illness associated with “ecstasy”. Lancet, 338: 1520.

Bobes J (1995): Extasis: Aspectos farmacológicos, psiquiátricos y médico-legales. Barcelona: Ediciones Neurociencias.

Bobes J, González MP, Sáiz PA, González JC (1998): Psicopatología y trastornos psiquiátricos relacionados con el uso de MDMA. En: Bobes J, Lorenzo P, Sáiz PA eds. Extasis (MDMA): un abordaje comprehensivo. Barcelona: Masson SA. p. 173-197.

Brauer RB, Heidecke CD, Nathrath W, Beckurts KT, Vorwald P, Zilker TR et al (1997): Liver transplantation for the treatment of fulminant hepatic failure induced by the ingestion of ecstasy. Transpl Int, 10: 229-233.

Brown C, Osterloh J (1987): Multiple severe complications from recreational ingestion of MDMA (“ecstasy”). JAMA, 258: 780-781.

Bryden AA, Rothwell PJN, Oreilly PH (1995): Urinary retention with misuse of ecstasy. BMJ, 310: 504.

Campkin NTA, Davies UM (1992): Another death from ecstasy. Journal of the Royal Society of Medicine, 85: 61.

Chadwick IS, Curry PD, Linsley A, Freemont AJ, Doran B (1991): Ecstasy, 3-4 methylenedioxymethamphetamine (MDMA), a fatality associated with coagulopathy and hyperthermia. Journal of the Royal Society of Medicine, 84: 371.

Cohen RS (1996): Adverse symptomatology and suicide associated with the use of ethylenedioxymethamphetamine (MDMA; “Ecstasy”). Biol Psychiatry, 39: 819-820.

Colado MI, Green AR (1995): The spin trap reagent alphaphenyl-N-tert-butylnitrone prevents “ecstasy” –induced neurodegeneration of 5-hydroxytryptamine neurones. Eur J Pharmacol, 280: 343.

Colado MI, Lorenzo P: MDMA (éxtasis) (1995): Farmacología y toxicología. En: Bobes J, ed. Extasis: Aspectos farmacológicos, psiquiátricos y médico-legales. Barcelona: Ediciones Neurociencias. p. 1-46.

Colado MI (1998): Neurotoxicidad inducida por MDMA y su prevención farmacológica. En: Bobes J, Lorenzo P, Sáiz PA, eds. Extasis: Un abordaje comprehensivo. Barcelona: Masson, SA. p. 41-72.

Coore JR (1996): A fatal trip with ecstasy: a case of 3,4 methylenedioxymethamphetamine / 3,4 methylenedioxyamphetamine toxicity. Journal of the Royal Society of Medicine, 89: 51P-52P.

Cregg MT, Tracey JA (1993): Ecstasy abuse in Ireland. Irish Medical Journal, 86: 118-120.

Creighton FJ, Black DL, Hyde CE (1991): Ecstasy psychosis and flashbacks. BR J Psychiatry, 159: 713-715.

DGPNSD (1996): Memoria 1995. Madrid: Ministerio de Justicia e Interior.

DGPNSD (1997): Encuesta sobre drogas a la población escolar, 1996. Madrid: Ministerio de Justicia e Interior.

DGPNSD (1998): Encuesta domiciliaria sobre consumo de drogas, 1997. Madrid: Ministerio de Justicia e Interior.

Demirkiran M, Jankovic J, Dean JM (1996): Ecstasy intoxication: an overlap between serotonin syndrome and neuroleptic malignant syndrome: Clin Neuropharmacol, 19: 157-164.

Dowling GP (1990): Human deaths and toxic reactions attributed to MDMA and MDEA. En: Peroutka SJ ed. Ecstasy: the clinical, pharmacological and neurotoxicological effects of the drug MDMA. Hingham, Mass: Kluwer Academic Publishers.

Downing J (1986): The psychological and physiological effects of MDMA on normal volunteers. J Psychoactive Drugs, 18: 335-340.

Drake WM, Broadhurst PA (1996): QT-interval prolongation with ecstasy. South African Medical Journal, 86: 180-181.

Dykhuizen RS, Brunt PW, Atkinson P, Simpson JG, Smith CC (1995): Ecstasy induced hepatitis mimicking viral hepatitis. Gut, 36: 939-941.

Ellis AJ, Wendon JA, Portmann P, Williams R (1996): Acute liver damage and ecstasy ingestion. Gut, 38: 454-458.

EMCDDA (1997): New trends in synthetic drugs in the European Union. Portugal: EMCDDA.

Fahal IH, Sallomi DF, Yaqoob M, Bell GM (1992): Acute-renalfailure after ecstasy. BMJ, 305: 29.

Farfel GM, Seiden LS (1995): Role of hypothermia in the mechanism of protection against serotonergic toxicity. I. Experiments using 3,4-methylenedioxymethamphetamine, dizocilpine, CGS 19755 and NBOX. J Pharmacol Exp Ther, 272: 860.

Fidler H, Dhillon A, Gertner D, Burroughs A (1996): Chronic ecstasy (3,4-methylenedioxymethamphetamine) abuse: a recurrent and unpredictable cause of severe acute hepatitis. J Hepatol, 25: 563-566.

Gamella JF, Alvárez A (1997): Drogas de síntesis en España. Patrones y tendencias de adquisición y consumo. Madrid: DGPNSD.

Gledhill JA, Moore DF, Bell D, Henry JA (1993): Subarachnoid haemorrhage associated with MDMA abuse. Journal of Neurology Neurosurgery and Psychiatry, 56: 1036-1037.

Gorard DA, Davies SE, Clark ML (1992): Misuse of ecstasy. BMJ, 305: 309.

Greer G, Tolbert P (1986): Subjective reports of the effects of MDMA in a clinical setting. J Psychoactive Drugs, 18: 319-327.

Griffiths P, Vingoe L (1997): The use of amphetamines, ecstasy and LSD in the European Community: A review of data on comsumption patterns and current epidemiological literature. Report prepared for the EMCDDA by the National Addiction Centre, London. London: National Addiction Centre.

Grob Ch (1998): Investigación humana con MDMA. En: Bobes J, Lorenzo P, Sáiz PA eds. Extasis (MDMA): un abordaje comprehensivo. Barcelona: Masson SA. p. 99-105.

Harries DP, De Silva R (1992): “Ecstasy” and intracerebral haemorrhage. Scottish Medical Journal, 37: 150-152.

Henry JA (1992): Ecstasy and the dance of death. BMJ, 305: 5-6.

Henry JA, Jeffreys KJ, Dawling S (1992): Toxicity and deaths from 3,4-methylenedioxymethamphetamine (“ecstasy”). Lancet, 340: 384-387.

Holden R, Jackson MA (1996): Near-fatal hyponatraemic coma due to vasopressin oversecretion after “ecstasy” (3,4-MDMA). Lancet, 347: 1052.

Holmes SB, Banerjee AK, Alexander WD (1999): Hyponatraemia and seizures after ecstasy use. Postgrad Med J, 75: 32-33.

Huarte MP, Pueyo AM (1995): Hepatitis aguda a causa de la ingestión de éxtasis. Revista Española de Enfermedades Digestivas, 87: 681-683.

Hughes JC, McCabe MC, Evans RJ (1993): Intracranial haemorrhage associated with ingestion of “ecstasy”. Source Archives of Emergency Medicine, 10: 372-374.

Ijzermans JNM, Tilanus HW, De Mann RA, Metselaar HJ (1993): Ecstasy and liver transplantation. Annales de Medicine Interne, 144: 568.

Jansen KL (1999): Ecstasy (MDMA) dependence. Drug Alcohol Depend, 53: 121-124.

Kessel B (1993): Hyponatraemia after ingestion of ecstasy. BMJ, 308: 414.

Khakoo SI, Coles CJ, Armstrong JS, Barry RE (1995): Hepatotoxicity and accelerated fibrosis following 3,4-methylenedioxymethamphetamine (“ecstasy”). J Clin Gastroenterol, 20: 244-247.

Keenan E, Gervin M, Dorman A, O’Connor JJ (1993): Psychosis and recreational use of MDMA (“ecstasy”). Irish J Psychol Medicine, 10: 162-163.

King GR, Ellinwood Jr EH (1997): Amphetamines and other stimulants. En: Lowinson JH, Ruiz P, Millman RB, Langrod JG, eds. Substance abuse. A comprehensive textbook. 3th edition. Baltimore: Williams & Wilkins. p. 207-223.

Landabaso MA, Sanz J, Calle R, Iraurgi I, Ruiz de Apodaka J (1998): Utilidad clínica de la olanzapina en el abuso / adicción de drogas de síntesis (MDMA). Actas Luso Esp Neurol Psiquiatr Cienc Afines, 26 (número especial): 107.

Lehman E, Thom CH, Croft DN (1995): Delayed severe rhabdomyolysis after taking ecstasy. Postgrad Med J, 71: 186-187.

Levine AJ, Drew S, Rees GM (1993): Ecstasy induced pneumomediastinum. Journal of the Royal Society of Medicine, 86: 232-233.

Llopis JJ, Paris B (1998): Servicios de atención y orientación telefónica a familiares y consumidores de MDMA. En: Bobes J, Lorenzo P, Sáiz PA, eds. Extasis: Un abordaje comprehensivo. Barcelona: Masson, SA. p. 199-211.

Logan A, Stickle B, O’Keefe N, Hewitson H (1993): Survival following “ecstasy” ingestion with a peak temperatura of 42 degrees centigrade. Anaesthesia, 48: 1017-1018.

Mallick A, Bodenham AR (1997): MDMA induced hyperthermia: a survivor with an initial body temperature of 42.9 degrees C. J Accid Emerg Med, 14: 336-338.

Manchanda S, Connolly MJ (1993): Cerebral infarction in association with ecstasy abuse. Postgraduate Medical Journal, 69: 874-889.

Mas M, Farré M, de la Torres R, Roset PN, Ortuño J, Segura J et al (1999): Cardiovascular and neuroendocrine effects and pharmacokinetics of 3,4-methylenedioxymethamphetamine in humans. J Pharmacol Exp Ther, 290: 136-145.

Maxwell DL, Polkey MI, Henry JA (1993): Hyponatremia and catatonic stupor after taking ecstasy. BMJ, 307: 1399.

McCann UD, Ricaurte GA (1991): Lasting neuropsychiatric sequelae of methylenedioxymethamphetamine (“ecstasy”) in recreational uses. J Clinical Psychopharm, 11: 302-305.

McCann UD, Ricaurte GA (1992): MDMA (“ecstasy”) and panic disorder. Biol Psychiatry, 32: 950-953.

McCann UD, Ricaurte GA (1998): Aproximación a la neurobiología y neurotoxicidad comparada inducida por la MDMA. En: Bobes J, Lorenzo P, Sáiz PA eds. Extasis (MDMA): un abordaje comprehensivo. Barcelona: Masson SA. p. 89-97.

McGuire P, Fahy T (1991): chronic paranoid psychosis after misuse of MDMA (“ecstasy”). BMJ, 302: 697.

McGuire PK, Cope H, Fahy TA (1994): Diversity of psychopathology associated with use of 3,4-methylenedioxymethamphetamine (“ecstasy”). British J Psychiatry, 165: 391-395.

Milroy CM, Clark JC, Forrest ARW (1996): Pathology of death associated with “ecstasy” and “eve” misuse. Journal of Clinical Pathology, 49: 149-153.

Newcombe R (1994): Guidelines for good practice at dance parties and nightclubs. Liverpool: 3D Research Bureau.

Pallanti S, Mazzi D (1992): MDMA (ecstasy) precipitation of panic disorders. Biol Psych, 32: 91-94.

Randall T (1992): Ecstasy-fueled “rave” parties become dances of death for english youths. JAMA, 268: 1505-1506.

Roig A (1993): Efectos adversos asociados al uso recreativo de éxtasis. En: IV Congreso de la Sociedad Española de Toxicomanías. Valencia.

Roig Traver A (1994): Sobre el uso recreativo de la metilendioximetanfetamina: aspectos históricos y efectos adversos. Adicciones, 6: 437-452.

Roques V, Perney P, Beaufort P, Hanslik B, Ramos J, Durand L et al (1998): Acute hepatitis due to ecstasy. Presse Med, 27: 468-470.

Rothwell PM, Grant R (1993): Crerebral venous sinus thrombosis induced by ecstasy. Journal of Neurology Neurosurgery and Psychiatry, 56: 1035.

Satchell SC, Connaughton M (1994): Inappropiate antidiuretic-hormone secretion and extreme rises in serum creatinine kinase following MDMA ingestion. British Journal of Hospital Medicine, 51: 495.

Saunders N (1995): Ecstasy and the dance culture. London: Neal’s Yard Desktop Publishing Studio.

Schifano F (1991): Chronic atypical psychosis associated with MDMA (“ecstasy”) abuse. Lancet, 338: 1335.

Schifano F, Magni G (1994): MDMA (“ecstasy”) abuse: psychopathological features and craving for chocolate: a case series. Biol Psychiatry, 36: 763-767.

Schlaeppi M, Prica A, de Torrente A (1999): Cerebral hemorrhage and “ecstasy”. Schweiz Rundsch Med Prax, 88: 568-572.

Schmidt CJ, Taylor VL (1987): Acute effects of methylenedioxymethamphetamine (MDMA) on 5-HT synthesis in the brain. Pharmacologist, 29: Abs. 224.

Schmidt CJ (1989): Acute anf long-term neurochemical effects of methylenedioxymethamphetamine in the rat. En: Peroutka SD, ed. Ecstasy: the clinical, pharmacological and neurotoxiocological effects of the drug MDMA. Massachussets: Kluwer Academic Publishers.

Screaton GR, Cairns HS, Sarner M, Singer M, Thrasher A, Cohen SL (1992): Hyperpyrexia and rhabdomyolysis after MDMA (ecstasy) abuse. Lancet, 339: 677-678.

Series H, Boeles S, Dorkins E, Peveler R (1994): Psychiatric complications of ecstasy use. J Psychopharmacol, 8: 60-61.

Shearman JD, Satsangi J, Chapman RWG, Ryley NG, Weatherhead S (1992): Misuse of ecstasy. BMJ, 305: 309.

Skopp G, Aderjan R, Koster J (1995): Hair analysis in the diagnosis of toxic hepatitis after drug abuse. Dentsche Medizinische Wochenschrift, 120: 1165-1168.

Vollenweider FX, Gamma A, Lietchi M, Huber T (1998): Psychological and cardiovascular effects and short-term sequelae of MDMA (“ecstasy”) in MDMA-naive healthy volunteers. Neuropsychopharmacology, 19: 241-251.

Watson JD, Ferguson C, Hinds CJ, Skinner R, Coakley JH (1993): Exertional heat stroke induced by amphetamine analogues. Does dantrolene have a place?. Anaesthesia, 48: 1057-1060.

Williams H, Meagher D, Galligan P (1993): MDMA (“ecstasy”); a case of possible drug-induced psychosis. Ir J Med Sci, 162: 43-44.

Windhaber J, Maierhofer D, Dantendorfer K (1997): Panic disorder induced by methylenedioxymethamphetamine resolved by paroxetine. European Neuropsychopharmacology, 7 (Suppl. 2): S240.

Wodarz N, Boning J (1993): “Ecstasy” induced psychotic despersonalization syndrome. Nervenarzt, 64: 478-480.

Woodrow G, Harnden P, Turney JH: Acute renal failure due to accelerated hypertension following ingestion of 3,4-methylenedioxymethamphetamine (“ecstasy”). Nephrology Dialysis Transplantation 1995; 10: 399-400.




DOI: https://doi.org/10.20882/adicciones.630

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