Showing papers in "Encephale-revue De Psychiatrie Clinique Biologique Et Therapeutique in 1992"

[Study of Beck's hopelessness scale. Validation and factor analysis].

Abstract: The validation study and factorial analysis of the Beck's hopelessness scale is presented. Two groups were compared including patients suffering from depression (n = 100) and a control group (n = 93). Age and sex were comparable in the two groups. The hopelessness scale is valid, and differentiates depressive patients from control subjects. The scale has a good reliability (test-retest, r = .81) and a good internal consistency (alpha = .97) for depressive subjects and alpha = .79 for control subjects). It also shows a good concurrent validity with other scales assessing depressive cognitions, the automatic thoughts questionnaire, the dysfunctional attitudes scale (form A) and a scale assessing the suicidal risk (ERSD). No concurrent validity is found with scales assessing the intensity of depression, the Beck depression inventory and the Hamilton scale. The factorial analysis elicits a general factor, accounting for 38.15% of the variance, and reflecting negative feelings about the future. The study of all the factorial analysis shows the stability of the factorial structure.

Mixed depressive syndrome

Abstract: For a period of six months (april to october 1990) 361 manic-depressive in-patients or out-patients were examined and treated. 178 patients (119 females and 69 males) were suffering from depression at examination time. Among them, 34 women and 11 men had mixed mood disorders with a symptomatology near that of typical depression (major depression, according to the DSM III-R criteria) but not of mixed bipolar disorder. The main symptoms were: dysphoric mood with irritability; internal tension, psychic and sometimes physical agitation; emotional lability; head crowded with thoughouts or thoughts that vanish too quickly; sleep disorders with initial insomnia or with frequent night awakenings; suicidal thoughts or attempted suicide with impulsiveness. These patients sustained severe suffering. They were in no way slow-minded but rather talkative and expressive. Antidepressant drugs increased agitation and insomnia, and in some cases, suicidal impulses. BZDs had limited efficacy but neuroleptics given in small doses, anticonvulsants and lithium gave very effective results. A limited number of electroshocks provided rapid improvement. In many respects, depression with delirium seems a more severe form of the above-described combined depressive syndrome and responds to the same treatments. We think that this mood disorder includes excitement as an important component, although this was not clearly evident. However, it is not easy to conceive this syndrome as a mixture of depressive and manic symptoms; it should rather be regarded as another specific mood condition, either permanent or transient, situated between the two other conditions.

The role of sleep and wakefulness in the genesis of depression and mania.

Abstract: Disturbances of the sleep-wake cycle are frequently seen in affective illness and are exhibited in other psychiatric illness as well. In addition to being a useful research probe, manipulations of the sleep-wake cycle such as sleep deprivation (SD) and phase advance can cause depression to remit and thus can be used as alternative or as adjunctive to pharmacologic treatment. The antidepressant response to SD occurs whether antidepressant drugs are administered or not. However, there is some evidence that the concomitant use of antidepressants may prevent the relapses that occur after recovery sleep. Data from clinical investigations also indicate that disrupted sleep can trigger and intensify mania. Rapid cycling bipolar patients may be especially vulnerable to mania/hypomania after disrupted sleep or SD. Characteristic changes in body temperature have been recorded in sleep deprivation as well as in other antidepressant treatment modalities. Thermoregulatory physiology may therefore provide a framework for understanding the effects of sleep-wake manipulations in affective illness.

Mortality of mentally ill patients. Review of the literature

Abstract: Overmortality among psychiatric patients has been a regular observation from the XIXth century to nowadays. If the rates of mortality have decreased in these last fifty years, they still remain higher than in the general population Standardized Mortality Ratio (SMR) (two or three times greater than normal). The authors reviewed 53 recent articles from european, north american, japanese and israelian researches on this question. Most of them proceed from crossings between psychiatric case register and death-register, and concern inpatients only (Brook, Giel, Saugstad, Mortensen, Herman, Haugland, Rorsman, Sturt, Winokur, Zilber). Some take into account outpatients as well (Eastwood, Koranyi, Martin, Ribourdouille). SMR are calculated and comparisons are made between different groups by sex, age, diagnosis and cause of death. Those are usually divided into 2 categories: natural deaths somatic diseases) and unnatural deaths (suicides-accidents). MAIN RESULTS: Among the patients, mortality rates are higher for men than women, but SMR are higher for women. The highest mortality relative risk is observed between 20 and 40 years of age. Except for three authors, unnatural deaths are not sufficient to explain overmortality. SMR for suicides and accidental deaths are decreasing with age; the relative risk is more important for outpatients, men, some specific diagnoses (affective disorders, acute schizophrenia) and during the first two years of the course of the illness. Suicide rates have been increasing among patients these last twenty years. Natural death is more frequent among patients with organic brain syndromes but is also in excess for the other patients. Cardiovascular diseases represent the first cause of mortality but infections (pneumonia-influenza) and metabolic diseases are over-represented.(ABSTRACT TRUNCATED AT 250 WORDS) Language: fr

Major depressive episode: unipolar and bipolar II.

Abstract: Major Depressive Episod (MDE) delimits a wide range of heterogeneous disorders. Nowadays, both for research and for therapeutic aims, precise characteristization of MDE subtypes are needed, different subtypes of MDE requiring individualized short, long-term and preventive treatments. As patients mainly seek for physician help during the full-blown depressive phase, we focused our study on patients presenting a major depression as the index episode. In order to attempt to isolate subtypes of the disorder relatively to the mood spectrum disease and to obtain a better clinical characterization of each, we have considered the role of soft indicators of bipolarity or of milder mood disregulations in distinguishing among subtypes of MDE; special attention was devoted to detect spontaneous or drug-induced hypomania, as well as to assess the hyperthymic or cyclothymic temperament, and family history for mood disorders. Data on prior course, characteristics of index episode, and familial aggregation of patients with Bipolar II Disorder support the autonomy of this condition. Differently from our previous analyses we considered Bipolar II with hypomanic episodes separately from U-HT unipolar with only hyperthymic temperament. The comparison between these two subgroups showed a higher percentage of males in the hyperthymics, longer duration of illness and a greater number of depressive episodes and hospitalizations in bipolar II with hypomania. Data from our analyses are exposed and discussed.

[Crisis intervention: assessment process and long-term follow-up of patients].

Abstract: The aim of this work, which was performed in a Crisis Centre in Geneva, Switzerland, was to study the relationship between a patient's long-term follow-up and the range of the patient's difficulties as assessed during screening by a clinician. Out of the 78 patients who were referred to the Centre during a two-month period in 1985, 31 were followed-up during a complete crisis intervention program. All these patients with severe symptoms would have been hospitalized if they had not been transferred to this program. The clinician's opinion of these patients' difficulties was obtained by using a questionnaire containing open-response questions. The data obtained was then subjected to specific content analysis. The patients' clinical state, diagnosis and changes during therapy were also assessed, using various questionnaires. Our results show that there is a negative correlation between the number or range of difficulties attributed and noted by the clinician and the long-term evolution of the patient, especially after two years. This relationship is dependent on the number, not the type of difficulties noted. Thus, although it is not possible to generalize these results, we have shown that it is possible to study parameters involved in the process of a psychotherapeutic-type treatment, using a questionnaire. We have also shown that crisis intervention can be considered as an especially interesting analogue of the early steps of psychotherapy, spread over a longer period. This is an aspect which is rarely studied.

Homicide is strongly correlated to depression and not to mania

Abstract: Typical manic episodes could be the cause of penal infractions, usually benign. In contrast, forensic studies show a close relationship between depression, suicide and homicide. Killers (16-28%) are often depressed when they commit a crime. In the UK and USA, 4-35% of killers commit suicide immediately after their crime. Assessment of a depressed patient must include an evaluation of the risk of homicide as well as the risk of suicide. The past history of depression and suicidal attempts, the presence of depressive symptoms and suicidal ideas, are good predictors of impending danger of aggression and sometimes of homicide.

Effects of convulsant ligands of the GABA-benzodiazepine receptor complex in conflict and learning tasks in mice.

Abstract: A systematic study of the effects of convulsants acting at the GABA-benzodiazepine receptor complex was undertaken in mice to estimate their potential anxiogenic effects and/or performance enhancing effects in learning and memory tasks. Anxiogenic effects were assessed in a conflict task where lever presses delivered both a food pellet and a mild electric foot shock. Effects on learning were assessed through analysis of habituation to a new environment. The convulsant agents pentylenetetrazol (PTZ) and picrotoxin (PX), both acting through the GABA-benzodiazepine receptor complex, and strychnine, a convulsant acting through the glycine transmission were used. Our data show that non convulsive doses of PTZ (25 mg/kg) and PX (0.85 mg/kg), but not of strychnine (0.8 mg/kg), are anxiogenic in the conflict model. At lower doses PTZ (10 mg/kg) and PX (0.3 mg/kg), but not strychnine (0.1 to 0.6 mg/kg), enhance performance in the habituation model. Our results contribute to the validation of the idea that small decreases in GABAergic transmission are accompanied by improvement of learning whereas medium decreases induce anxiogenic effects.

Les troubles de la mémoire dans la schizophrénie

Abstract: L'interet actuel pour les troubles de la memoire dans la schizophrenie resulte de l'evolution de la conception de la schizophrenie, dont l'origine organique s'affirme de plus en plus, et de l'evolution de la conception de la memoire, selon laquelle il nexiste pas une seule memoire, mais plusieurs. Les troubles de la memoire du schizophrene ne sauraient etre envisages independamment des connaissances qui s'accumulent dans les autres domaines des sciences cognitives et des neurosciences; une comprehension plus approfondie de ces troubles necessite de confronter les differentes approches cognitives entre elles et avec les approches neurobiologiques et cliniques, pour tenter de les integrer

Le potentiel lent P300. Interet clinique dans trois pathologies mentales et neurobiologie: une revue.

Abstract: P300 is a late component of evoked potential which meet special relevance to the study of cognitive processes. P300 indexes categorization processes and the context updating of memory. Its latency reflects the stimulus evaluation time, and P300 amplitude is related to some psychological variables such as expectancy, attention and stimulus significance. In this review, clinical correlation between P300 components and mental diseases are reported, especially dementia, schizophrenia and depression. Delayed P300 latency has been found in Alzheimer disease and in other forms of dementia. Reduced P300 amplitude as well as altered topography has been reported in schizophrenia. In depression, reduced P300 amplitude has been related with longer reaction time. Unfortunately, the diagnosis utility of P300 seems limited. The authors also propose an overview of the actual knowledge on neurobiological findings in the generation of the P300 wave. Anatomical data point out the importance of the limbic system, more specifically, of the hippocampus and the locus coeruleus, in generating and modulating P300 wave. Data from the literature on the psychopharmacological modifications induced by cholinergic, catecholaminergic and other agents, are reviewed. Although the dopaminergic and noradrenergic systems are of some importance, these data emphasise the importance of the cholinergic system for the generation and modulation of P300 amplitude and latency. The value and interpretation of these neurobiological and clinical findings are discussed.

Neurobiology of memory

Abstract: A first part of the paper describes the neuro-anatomical structures involved in the processes of memory and their connections, as demonstrated by the recent hodological methods. The classical view of the Papez's limbic circuitry represents only one part of the reality. Several other circuits do exist, including those relaying in the amygdaloid complex and in the septal area. Actually, all these structures can be understood as the nodal points of a set of cortico-subcortical networks, where information is distributed and processed according to the cognitive demand and finally stored in the cortical layers. In a second part, the various mechanisms at the cellular level in relation with the processes of learning, are discussed (i.e. plasticity of synaptic transmission, dynamic neuronal changes at the morphological, electrophysiological and metabolic levels). The role played by humoral neuromodulation is examined, although it remains largely unknown at present (i.e. acetylcholine, catecholamines, GABA, glutamate, neuropeptides). Unfortunately, therapeutical implications from these fundamental data stay mostly frustrating up to now. Finally, relationships between sleep and memory are considered. The abundant experimental work performed on animals mainly stresses the REM-sleep. However, data from the human pathology are much less conclusive, and no clear evidence of a specific interaction between one aspect of sleep and one kind of memory emerges. To conclude, a few remarks are warranted on the intimal links existing between the anatomical-functional set of memory and the neurobiological bases of behavioural responses and anticipatory processes.

Pharmacological properties and mechanism of action of the cyclopyrrolones.

Abstract: We present the pharmacological properties of two cyclopyrrolones, zopiclone as a hypnotic and suriclone as an anxiolytic, and examine their mechanism of action. The effects of zopiclone on the amount of time spent at each vigilance level have been studied in freely moving rats. Zopiclone from 2.5 mg/kg i.p. extends the duration of slow wave sleep (SWS), concomitantly shortening the periods awake. This SWS inducing effect of zopiclone was more potent after 10 mg/kg i.p.; moreover, zopiclone did not depress REM sleep and no rebound of activity in wakefulness or REM sleep were observed the day after zopiclone treatment. In rats, at the cortical level, zopiclone increases the spectral energy in the delta band (0.5 to 4 hertz). This rise in energy appears at doses starting from 1.25 mg/kg p.o. and can also reach the fast frequencies (beta band: 12 to 16 hertz). This power spectrum is characteristic of a compound having tranquilizing-hypnotic potential. Taken together these EEG results corroborate the clinical studies. In man, zopiclone increased SWS, decreased SWS latency and respected sleep architecture in both healthy volunteers and insomniacs. This respect of sleep structure and the relative short duration of action of zopiclone minimized the residual effects seen upon waking (drowsiness, impairment of psychomotor performance). In the Geller-Seifter test, an operant conflict procedure, the minimal effective dose (MED) of suriclone in reversing the conflict-induced inhibition of drinking behavior was 2.5 mg.kg-1 p.o. in rats. Depression of unpunished responding is only seen at higher doses (20 mg.kg-1 p.o.).(ABSTRACT TRUNCATED AT 250 WORDS)

[Medico-economic assessment of neuroleptics in schizophrenia. Amisulpride versus haloperidol].

Abstract: The aim of this study is to assess the economic impact of neuroleptic strategies in the long-term treatment of schizophrenic patients. In this respect a new neuroleptic strategy (amisulpride) was compared to a reference drug (haloperidol) using a cost minimization method. Clinical, demographic and economic (direct medical costs) data were obtained retrospectively from patients' charts. Patients (n = 160) were randomly selected according to diagnosis (schizophrenia, DSM III-R), treatment (outpatient, amisulpride or haloperidol) and follow up period (at least 6 months). The health insurance point of view was selected for the economic analysis. We found a significant reduction of the annual number of days of relapse when patients were treated with amisulpride compared to haloperidol. This reduction was associated with a significant reduction of direct costs mainly related to shorter length of hospitalization. This result was only partly explained by demographic and clinical variables such as the severity of the disease. The differences remained significant when populations were matched. This finding illustrates the validity of the concept of efficiency in psychiatry.

Contribution of zolpidem in the management of sleep disorders

Abstract: Zolpidem is a nonbenzodiazepine hypnotic agent belonging to a new class of psychotropic drugs the imidazopyridines which enhance the GABAA receptor function by interacting with a specific receptor population. Zolpidem binds selectively to the Omega-1 receptor subtype and from a pharmacological point of view differs from benzodiazepines (BZD) by producing a strong sedative and hypnotic profile which predominates over the anticonvulsivant and anxiolytic activity and moreover appears practically devoid of myorelaxant properties. From a pharmacodynamic point of view, these results suggest that zolpidem facilitates more selectively than BZD, GABAA function and produces a selective hypnotic effect. Though if the role played by receptors in tolerance and dependence has not been yet fully elucidated, it could be described as an adaptative process to sustained stimulation of GABA function. Animal data obtained with zolpidem differs substantially from that of the BZD and indicates that repeated zolpidem administration may not lead to phenomena of tolerance and withdrawal syndrome after abrupt drug discontinuation. In human following oral intake, zolpidem is very rapidly (Tmax: 30-40 min) absorbed. The clearance is essentially metabolic and less than 1% is recovered in urine. The apparent plasma half-life is of 2.0-2.5 hours in most adult subjects and metabolites are totally inactive. The hypnotic activity of zolpidem and its effects on sleep architecture have been assessed in polysomnographic studies: 11 studies in 579 healthy volunteers and 12 studies in 202 insomniac patients. From all the patient studies, it emerges clearly that zolpidem at the dose of 10 mg significantly decreases sleep onset latency, the number and the duration of nocturnal awakenings, and concomitantly increases total sleep time. Furthermore, at variance with what observed with reference benzodiazepine hypnotics, zolpidem does not alter patient sleep architecture: it increases only moderately stage 2, it increases, when reduced, stages 3 and 4 (slow wave sleep) and it does not decrease REM sleep. Clinical studies conducted on more than 4,000 insomniac patients have clearly shown that at the dose of 10-20 mg, zolpidem induces from the first night a definite hypnotic effect in all types of insomnia. In elderly subjects an initial dose of 5 mg should be considered. The possible presence of residual effects during the day following administration of zolpidem has been assessed in 535 healthy volunteers and in 133 insomniac patients according to a double blind (versus placebo and/or benzodiazepine) controlled design.(ABSTRACT TRUNCATED AT 400 WORDS)

[Study of the uni-dimensionality of the Yesavage-Brinck geriatric depression scale. Comparison between classical methods and Rasch's model].

Abstract: The authors present a contribution to the french validation of the self-rating questionnaire of the depression in the elderly proposed by Yesavage and Brink (1982), the Geriatric Depression Scale (30 items). This study focusses on the assessment of the homogeneity and of the unidimensionality of this scale. 99 aged women living in old-people homes or attending a geriatric somatic day-hospital, not known to be psychiatrically ill, filled the GDS and were interviewed by either a psychiatrist or by a clinical psychologist. This interview yielded 44 cases of Major Depressive Disorder or of Dysthymia (DSM III). Firstly, we have applied the classical correlational methods of assessment of scale Reliability and Construct Validity: Cronbach's coefficient alpha and item-total correlations (homogeneity) and Principal Component Analysis (PCA) without rotation. Then, we have performed a Rasch Model Analysis: this method which belongs to the general frame of Latent Trait Theory relies on a probabilistic model of subject's response to individual questions. In the Rasch model, the response probability of a given subject to a given item is a logistic function of the difference between the item location parameter and the subject location parameter along a single continuous latent dimension. Our results have shown that the Cronbach's alpha was very high (.902) and that the item-total correlations were quite satisfactory (mean .470), thus giving a strong impression of homogeneity (similar to unidimensionality for many authors).(ABSTRACT TRUNCATED AT 250 WORDS)

Seasonal vulnerability to depression. Implications for etiology and treatment.

Abstract: Le risque de depression augmente a deux epoques opposees de l'annee: fin de printemps/debut d'ete et d'automne/debut d'hiver. Chez 15% des patients presentant une depression majeure recurrente, les episodes depressifs surviennent regulierement chaque annee au cours de l'une des deux periodes de risque. Il existe ainsi deux formes de troubles affectifs saisonniers: la depression a rechutes automne/hiver, et la depression a rechutes printemps/ete

Epidemiologic survey of psychiatric disorders in specialized consultation

Abstract: UNLABELLED This epidemiological survey was performed with 317 clinicians of each structure of care (hospital, private practice...), randomly selected among french psychiatrists. During one day of a week, in January or June, all outpatients completed a self-questionnaire regarding sociodemographic data, previous and actual symptoms and for some of them randomly selected, the clinicians filled in a semi-standardized evaluation form and had to give the complete diagnosis according to the DSM III-R criteria. 2686 outpatients have completed the self-questionnaire and for 1568 (51%), the diagnosis DSM III-R was given. The mean age was 41.3; most of patients were females (59.2%), married (50.5%), urban (77.2%), employees (25.2%). The most frequent main diagnoses were: mood disorders (26%), schizophrenia (19.5%) and generalized anxiety (15%); in 47% of the cases, a second diagnosis was given. There was no significant difference between the 2 periods of evaluation. IN CONCLUSION among psychiatric outpatients, the proportion of depression and anxiety disorders is nearly the same as in the total psychiatric population; in contrast, schizophrenia is more frequent, and alcohol or drug abuse less frequent.

Comparative study of the efficacy and acceptability of amineptine and fluoxetine in patients with major depression

Abstract: We compare two anti-depressant drugs, amineptine and fluoxetine, in a multicentric study. Amineptine is a dopamine reuptake inhibitor, and fluoxetine a serotonin reuptake inhibitor. Eighteen french centers participate in the study. One hundred and sixty nine outpatients were randomly assigned to either 200 mg of amineptine or 20 mg of fluoxetine during 90 days. They fulfilled the DSM III-R criteria of major depressive disorder. They were aged from 18 to 70. Minor tranquilizers were allowed during the study. The patients were evaluated at D0, D7, D21, D42 and D90. If possible, an additional evaluation was made at D4. Clinical evaluations included Clinical Global Investigation (CGI), Montgomery and Asberg Depressive Rating Scale (MADRS), HARD scale, Widlocher Retardation rating scale and Hopkins Symptom Check-list (HSCL). Somatic concerns were recorded at each visit. Among the 169 patients included in the study, only 141 ended it at D90. The two drugs had good antidepressive efficacy which was noticed as soon as D7 up to D90. If we compare the antidepressant activity, no statistical differences could be observed between the two drugs using different scales. The percentage of patients with an improvement of at least 50% of the global score at MADRS was 8.3% at D7; 41% at D21, 69.2% at D42 and 83.2% at D90 for the amineptine group. For the fluoxetine group, these percentages were, 7.7%; 37.8%; 78.9%; 82.1%. No statistical differences could be noticed between the two groups, and at any time of the study. We have tried to look for a rapid antidepressive action by a clinical evaluation at D4.(ABSTRACT TRUNCATED AT 250 WORDS)

[Alexithymia. Evaluation, quantitative and clinical data].

Abstract: Alexithymia is a concept created by Sifneos in 1972 to describe a disturbance in affective and cognitive functions characterised by an inability to find words to describe feelings or emotions. The term "alexithymia" is derived from the Greek and means "no words for feelings". The salient clinical features of alexithymia include difficulties recognizing and verbalizing feelings, endless description of physical symptoms instead of emotions, concrete speech and thougth closely tied to external events, paucity of fantasy life. Precisely, alexithymia is an inability to associate one's visual image, thoughts and fantasies with a specific emotional state. For Sifneos, "emotions" and "feelings" are different facts. He differentiates "visceral emotions" (biologic side of the affect and lying in structures of the limbic system as the hippocampus and the amygdaloid complex) and "feelings emotions" (psychologic side of the affect). For him, animals experience "visceral emotion", but only human experience "feeling emotions". Alexithymia is regarded as one of several possible risk factors that seem to increase the susceptibility to physical disease. Alexithymia describes some psychological features which has been initially described by Marty and Psychosomatic French School: a specific cognitive style characterized by a lack of absence of fantasies and a preoccupation with the minute details of external events ("pensee operatoire"). Alexithymia is a difficult concept to operationalize and only few instruments are sufficiently reliable and valid. Several scales are used to measure alexithymia but only the Beth Israel Questionnaire (BIQ) and the Toronto Alexithymie Scale (TAS) can be regarded as having sufficient psychometric properties. The first questionnaire, the BIQ--a scale created by Sifneos--, is the most widely used instrument which is a 17-items forced-choice questionnaire completed by the interviewer. The TAS is a 26-items self-report measure rated on a five-point Likert scale. The Shalling Sifneos Psychosomatic Scale (SSPS) and the M.M.P.I. Alexithymia Scale lack of validation and reliability. Furthermore the SSPS and the MMPI AS show little or no relation with BIQ or with TAS, thus limiting the comparability and generalizability of results from the studies that use them. The TAS is considered as internally consistent and to have a stable, replicable factor structure. Other measures as content analysis test, projective test (Rorschach, T.AT., SAT9) or others self-assessment questionnaires are not frequently used.(ABSTRACT TRUNCATED AT 400 WORDS)

Disorders of circadian rhythms in depression

Abstract: The authors make a synthesis of studies about circadian rhythms in depression and of hypothesis to explain them. They successively study trials on the phases, on the average levels, on the amplitude of rhythms. They conclude the most significant troubles are, shortening of latency on paradoxical sleep for phases, slump of melatonin levels, blunded amplitude of every parameter. Among possible explanations, they present and discuss a trouble of oscillators, a decrease of sensitivity to external synchronizers and a trouble in rhythm coupling.

[Excitatory amino-acids, a new class of neurotransmitters. Pharmacology and functional properties].

Abstract: The pharmacology of excitatory amino acids (EAA) like glutamate or aspartate, has defined three main types of receptors: NMDA, quisqualate (now named AMPA) and kainate receptors, associated to cationic channels. The NMDA receptor, the best characterized, is a macromolecular complex with multiple specific sites: the agonist binding site (glutamate, aspartate, NMDA); the glycine site and polyamine site mediating allosteric regulations; the site located inside the channel for activity-dependent antagonists (phencyclidine, MK-801). This channel, permeable to calcium, is blocked by magnesium in a voltage-dependent manner. The structural complexity of the NMDA receptor suggests the existence of subtle regulations, but also offers many targets for pharmacological drugs. The calcium influx induced by NMDA receptor stimulation may account for the diversity of its functional properties. First, NMDA receptors modulate neuronal plasticity during the development and even long after. Indeed, NMDA receptor can induce long term potentiation (LTP; an experimental model of synaptic facilitation) and are involved in learning and memory. On the other hand, when over-stimulated, they induce neurotoxicity. The death of the cell occurs after several hours, during which NMDA antagonists can prevent irreversible damages. EAA systems are distributed in the whole brain, interacting with numerous other neurotransmitters, but particularly concentrated in the cortico-striatal and cortico-cortical fibers and in the hippocampus. Several neuro-psychiatric disorders could be related to a glutamatergic dysfunction: acute neuronal lesions (stroke, viral disease like AIDS) and epilepsy; but also chronic neurodegenerative disorders (Alzheimer's dementia, Huntington and Parkinson diseases). A glutamatergic hypothesis of schizophrenia arose from the phencyclidine model of psychosis, arguing for an imbalance between glutamate and dopamine. The therapeutic perspectives of glutamatergic substances in these diseases will be discussed.

Le déprimé avant la dépression

Abstract: Cet article decrit cinq prototypes de depression qui se developpent sur des traits de temperament differents: timide-inhibe, dysthymique, hyperthymique, cyclothymique et initable. Les depressions correspondantes sont les depressions anxieuses, les depressions doubles, les depressions anergiques, les depressions a cycles rapides, et les depressions hostiles. Nous soutenons que, malgre un certain degre de recouvrement de la reponse pharmacologique, celle-ci est differente pour chaque prototype, incluant les benzodiazepines, les IMAO, les antidepresseurs serotoninergiques, les imipraminiques, les sels de lithium, les neuroleptiques et les antiepileptiques

Hypomania. Apropos of a cohort of young patients

Abstract: The Zurich prospective epidemiological study included 591 twenty-year old subjects. At age twenty-eight, 457 of these people (228 males, 234 females) were re-examined and 415 of them at age thirty (197 males, 218 females). The DSM III-R definition of hypomania was modified. We found the following prevalences: 1.7% with hypomania, 3% with bipolar syndromes, 18.6% with major depression (including mood disorders) and 12.3% with short recurrent depression. Compared to male subjects, the risk of major depression was twice as high in female subjects but was roughly the same for the other groups. The study compares three groups of subjects: subjects with hypomania (UM), bipolar subjects (BP) and unipolar depression. Considerable differences were found depending on the levels of treatment, positive family histories for depression or hypomania and attempted suicides. The results show that the distinction between a subject with hypomania and a bipolar subjects is not clear. The ratings of the Hopkins Symptom Checklist scales (SCL 90-R), and of the FPI personality test (Fahrenberg et al., 1973) are presented and discussed. 12.7% of major depression cases were bipolar and 8.3% of short depressions were recurrent. In this sample of normal Swiss population, the ratio of bipolar to unipolar syndromes was approximately 1:5. Language: fr

La clozapine (Leponex®) en France

Abstract: En l'absence d'etudes cliniques realisees en France, les informations concernant les 1 062 patients qui ont beneficie du Leponex® dans le cadre de la procedure «cas humanitaires» de mai 1989 a decembre 1991, constituent la premiere experience francaise de cet antipsychotique. Les resultats qui sont rapportes proviennent de l'analyse preliminaire des donnees, en grande partie retrospective, disponibles au 15 mars 1992 et concernent 602 patients. Les caracteristiques de la population traitee confirment qu'il s'agissait de patients severement atteints dont la plupart presentaient une resistance au traitement neuroleptique habituel (90,86%) et rarement une intolerance a ces derniers (2,49%)

Sleep disorders in psychiatric diseases. Epidemiological aspects

Abstract: Very few epidemiological surveys have specifically studied relationships between sleep disturbances and psychiatric diseases. In this review, we preferred to use the classification proposed in 1979 by the Association of Sleep Disorders Centers. It includes four main categories: insomnias, excessive sleepiness, troubles of the wake/sleep schedule and parasomnias. Evaluating psychiatric disorders among general populations is easier owing to DSM III and DSM III-R criteria, but there are not equivalent criteria in evaluating sleep disorders. It is almost impossible to realize polysomnographic recordings in large samples, therefore sleep disorders are to be detected by questionnaires. It has been shown that there is a good correlation between self-reports and polysomnographic recordings among clinical and general samples. The prevalence of insomnia, defined as difficulties of initiating and maintaining sleep, is estimated between 9 and 31%. It is higher among women, elderly people, separated and divorced subjects, and low educational levels' groups. It has to be noticed that polysomnographic records of some subjective insomniacs are not different from those of good sleepers, sleep latency excepted. These subjective (and not objective) insomniacs have high scores in anxiety scale, depression scale, or psychologic distress. Insomnia is more frequently noted amongst subjects with psychiatric diagnoses, especially major depressive disorders and anxiety disorders. Depressive disorders are present in 21-40% of insomniacs versus 0-1% of non-insomniacs, and anxiety disorders in 13-24% of insomniacs versus 3-10% of non-insomniacs. In depressive disorders, sleep alterations are frequently noted: they are difficulties of initiating and maintaining sleep, decreasing proportion of slow-wave sleep, decreasing time of REM (rapid eye movement) sleep and REM sleep latency, and increasing density of REM sleep. Of these modifications, the last two ones seem to be specific for depression. The relationships between sleep, aging and depression are more complex than previously noted. For example, differences between depressed and non-depressed subjects depend on the age of the population. The prevalence of hypersomnia is lower than the insomnia's. It varies between 2 and 4%. It is more frequently noted among young people, and never married subjects. Two specific aetiologies must be looked for: sleep apnea syndrome and narcolepsy. These diagnoses are respectively found in 45% and 24% of hypersomniacs examined in American Sleep Centers. Hypersomnias are objectived by the Multiple Sleep Latency Test, which measures the physiologic sleep tendency.(ABSTRACT TRUNCATED AT 400 WORDS)

Use of ROC analysis in psychiatry

Abstract: The fundamental principles of ROC analysis are described. This method provides a means to assess the overall discriminant power of psychiatric rating scales for the full range of their scores. For each cut-off, an instrument has a sensitivity (true positive rate) and a specificity (true negative rate). High values of these coefficients are desirable although they are inversely related. ROC curves can be obtained by plotting the false positive rate and the true positive rate for different thresholds of the rating scale. The curves which would be obtained with a perfect, a worthless and a typical instrument are drawn to illustrate various situations found in ROC analysis. Among the several indices proposed, the area under the curve (AUC) is the most commonly used index to assess the overall discriminant power of an instrument. To calculate this area, the non parametric trapezoidal method is advocated. The area under the curve varies between 0.50 which corresponds to the chance line up to 1.0, a value associated with perfect accuracy. This parameter can be interpreted as the probability of classifying correctly the subjects of a pair where one is normal and one is diseased. Then, the appropriate statistic to compare several ROC indices is provided for the general case of independent observations. When the observations are paired, the standard error of the difference between two areas needs to be corrected.(ABSTRACT TRUNCATED AT 250 WORDS)

The distinction between unipolar and bipolar mood disorders. A 25-years perspective.

Abstract: The paper deals with a critical appraisal of the state of art of the distinction between bipolar (manic-depressive) and unipolar recurrent affective disorders. However already propounded several years earlier by Leonhard, a distinction between bipolar and unipolar affective disorders has first been taken into general consideration during the last quarter of a century. It is currently firmly established in the most widely accepted international classification systems, and is taken into account in the major psychiatric textbooks. Looking back at the evolution of this distinction, to which research work by the present author has greatly contributed, there are reasons to feel both satisfied and unsatisfied at the same time. Satisfaction arises from the fact that a distinction between bipolar and unipolar affective disorders has contributed to advance our understanding of the nosology of the depressive states, hence, contributing to a higher degree of homogeneity in the populations of patients in research. Dissatisfaction, instead, is born by the ever increasing widening of the scope of the concept of bipolar and unipolar to which current classification systems greatly contribute.

The atypical neuroleptic concept

Abstract: Atypical neuroleptics can be defined as dopamine (DA) receptor blockers which differ from typical neuroleptics in that they have a markedly lower or absent propensity for the induction of parkinsonian side effects of tardive dyskinesias. Some of them, but not all, are also more effective in treating schizophrenic patients, i.e. those with negative symptoms or who resist to classical treatments. There may be four classes of potential atypical neuroleptics: 1) Antipsychotics such as sulpiride and remoxipride that block a subgroup of D2 receptors; 2) D1 antagonists that may prove to be a valuable new type of antipsychotic drug; 3) Partial D2 agonists and 4) Antipsychotics such as clozapine and risperidone which block DA as well as other receptors and which appear to have the most pronounced antipsychotic effect. The differences between typical and atypical neuroleptics may first relate to regional specificity in site of actions. Animal studies suggest that atypical neuroleptics may act preferentially on mesolimbic and mesocortical as opposed to striatal DA systems. Most studies which have attempted to define the biological mechanisms which subserve the differences between atypical and typical neuroleptic drugs have focused on receptor binding profile of these drugs. Relatively higher affinity for the serotonin (5HT2) receptor than for the D2 receptor may be important to the action of clozapine-like compounds. However, many other systems might be involved and it seems likely that the atypical neuroleptic profile could be achieved in more than one way.(ABSTRACT TRUNCATED AT 250 WORDS)