Conclusion
The emergence of molecular neurobiology has profoundly changed the traditional focus of neuropsychopharmacologic research, shifting it toward events occurring beyond the receptors. One can now entertain the possibility that abnormal behavior patterns—affective, cognitive, and somatosensory—might be the consequence of a disarray in the temporal regulation of gene expression in response to internal (ie, neurohumoral, endocrine) and external (ie, environmental) stimuli that have rendered the individual vulnerable to psychiatric disorder. The demonstration that a nurturing defect in mice is linked to the absence of transcription factor Fos B in the preoptic area of the hypothalamus suggests that this transcription factor controls a complex behavior.
Several primary variables are involved in the effect of neuropharmacologic agents and psychotherapy: the neurotransmitters 5-HT, dopamine, norepinephrine, acetylcholine, GABA, and glutamate, acting via various subtypes of receptors; perhaps nitrous oxide and carbon monoxide; and others that are virtually unknown. Second messengers are fewer, but the number of transcription factors is enormous. It has been estimated that the human genome encodes as many as 3000 different gene-specific transcription factors. The nuclear import of these proteins is modulated in response to external stimuli whose transduction is modified by psychotropic (and other neuropharmacologic) agents. It is predicted that the nascence of molecular neuropsychopharmacology will enable the development of new, more effective psychotropic drugs and will provide the foundation for a molecular biological psychiatry.
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