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Biomedical subjects

C Bryois

Publications and source records attributed to C Bryois.

At least 19 recordsLinked to original sources
PubMed2006

[Attempted suicide in Switzerland: from practice to prevention].

Prevention of suicide and recurrent suicidal behaviour is actually a prior issue for the Canton de Vaud, in order to elaborate an accurate Health Management. After a brief description of the swiss and Vaud situation we report epidemiological data about attempted suicides in Morges' hospital, collected since the beginning of the activity of a Consultation-Liaison psychiatrist and we confront them with the level of functioning of the medical system. Consultation-Liaison Psychiatry, through an early intervention during such a critical period, can provide better detection and prevention of those situations. It offers also the opportunity to develop adapted plans of observation, orientation and treatment for those patients already within a somatic setting.

Adolescent↗
PubMed2006

[Somatoform disorders: diagnosis and treatment].

Somatoform disorders include several diagnoses, the treatment of which concerns somaticians as well as psychiatrists. This paper defines those diagnosis features, differential diagnosis, epidemiological aspects and etiology hypothesis. Regarding treatments, emphasis is stressed upon, the high level of collaboration between somaticians and psychiatrists, regarding those long term follow-up, well known for potential high-costs in terms of individual suffering and financial terms.

Female↗
PubMed2006

[Psychiatry].

During the year 2005 much of the attention was given to the debate on the risk of suicide during treatments with selective serotonin reuptake inhibitors. Our review concludes with a moderate increased risk of suicidal behaviour but not a risk of death by suicide. Caution, not panic, is indicated, particularly for children and adolescents given that, in this age group, benefits of these drugs have not been well established. We also report two synthesis concerning the latest developments in the fields of cognitive psychotherapy for depressive disorders (rather stimulating news) and of pharmacotherapy for borderline personality disorders (no breaking news).

Adolescent↗
PubMed2005

[Treatment of agitation in the emergency room].

The treatment of agitation in the emergency room is a subject regularly treated in different studies and conferences because of the diagnosis difficulties and the psychological impact on medical teams. Differential diagnosis includes organic, toxic and psychiatric causes. Non-pharmacological means (emergency rooms' organisation, communication skills, first care teams' formation) allow resolution of some of these situations. When psychopharmacological intervention is required benzodiazepines (lorazepam) and neuroleptics (haloperidol, olanzapine) are indicated, first orally, then intramuscularly if requested by noncollaborative patient. Combination of drugs is not to be recommanded. Side effects of current medication are to be well known, that's why only a small number of molecules are to be used, after controlled studies.

Diagnosis, Differential↗
PubMed2005

[Psychiatry].

The main innovation of the year 2004 was the introduction of a new, second-generation antipsychotic drug with a new mechanism of action (partial dopamine agonist), encouraging first clinical results, and an advantageous clinical tolerance profile. Additionally, three new galenic forms are presented: an oral, extended-release form of methylphenidate that could be useful in the treatment of attention-deficit/hyperactivity disorders; an intramuscular depot form of a second-generation antipsychotic drug (risperidone) with the advantage of improving adherence; and an intramuscular form of a second generation antipsychotic (olanzapine) that is valuable in emergency situations. Finally, we will briefly give an update on the advantages of lamotrigine in bipolar depression.

Antidepressive Agents↗
PubMed2001

Pharmacokinetic drug interaction potential of risperidone with cytochrome p450 isozymes as assessed by the dextromethorphan, the caffeine, and the mephenytoin test.

Two published case reports showed that addition of risperidone (1 and 2 mg/d) to a clozapine treatment resulted in a strong increase of clozapine plasma levels. As clozapine is metabolized by cytochrome P450 isozymes, a study was initiated to assess the in vivo interaction potential of risperidone on various cytochrome P450 isozymes. Eight patients were phenotyped with dextromethorphan (CYP2D6), mephenytoin (CYP2C19), and caffeine (CYP1A2) before and after the introduction of risperidone. Before risperidone, all eight patients were phenotyped as being extensive metabolizers of CYP2D6 and CYP2C19. Risperidone at dosages between 2 and 6 mg/d does not appear to significantly inhibit CYP1A2 and CYP2C19 in vivo (median plasma paraxanthine/caffeine ratios before and after risperidone: 0.65, 0.69; p = 0.89; median urinary (S)/(R) mephenytoin ratios before and after risperidone:0.11, 0.12; p = 0.75). Although dextromethorphan metabolic ratio is significantly increased by risperidone (median urinary dextromethorphan/dextrorphan ratios before and after risperidone: 0.010, 0.018; p = 0.042), risperidone can be considered a weak in vivo CYP2D6 inhibitor, as this increase is modest and none of the eight patients was changed from an extensive to a poor metabolizer. The reported increase of clozapine concentrations by risperidone can therefore not be explained by an inhibition of CYP1A2, CYP2D6, CYP2C19 or by any combination of the three.

Adult↗
PubMed1999

[Antidepressants and somatic disease].

Depression is the most frequent psychiatric disease associated with chronic somatic disorders. Diagnosis, however, is frequently difficult to make, due on one hand to the presence of symptoms that depression and chronic somatic disorders have in common, and on the other hand to the assumption shared by the physician and its patient that depression is a normal reaction to a somatic illness. Accurate diagnosis is nevertheless necessary in order to initiate the appropriate treatment. A review of pharmacological treatments of depression related to frequent chronic somatic disorders is presented.

Antidepressive Agents↗
PubMed1999

Pharmacokinetic consequences of a citalopram treatment discontinuation.

In this pilot study, the pharmacokinetics of citalopram (CIT) were examined in five hospitalized depressed patients after an abrupt discontinuation of a treatment with 40 mg/d of this selective serotonin reuptake inhibitor (SSRI). During the 8-day study period, clinical ratings were regularly carried out. Between days 5 and 8, the patients were treated with clomipramine (75 mg/d). The enantiomers of CIT and its metabolites, demethyl-CIT (DCIT) and CIT-propionic acid derivative (CIT-PROP), were measured repeatedly from day 0 to day 8 by a stereoselective high-performance liquid chromatography (HPLC) procedure. The following drug plasma half-lives were measured (means +/- SD): R-CIT: 66+/-11 h; S-CIT: 42+/-13 h; R-DCIT: 228+/-148 h; S-DCIT: 93+/-35 h; R-CIT-PROP: 82+/-31 h; S-CIT-PROP: 186+/-93 h.

Adolescent↗
PubMed1998

[Withdrawal syndrome caused by selective serotonin reuptake inhibitors: apropos of a case].

During the past 4 years, several case reports have been published on the withdrawal syndrome which may be observed after acute interruption of a treatment with selective serotonin reuptake inhibiting antidepressants (SSRI). Paroxetine is the most frequently cited antidepressant in the literature, whereas fluoxetine is the less frequently cited of this type of drugs. The withdrawal symptoms appear a few days after stopping treatment or after a decrease of the dose. The typical symptoms are of the gastro-intestinal type, such as loss of appetite, nausea, vomiting, diarrhea and abdominal cramps. Other symptoms are sensation of instability, vertigo, dizziness, headache, malaise, muscular pains, asthenia, as well as a syndrome of pseudo-influenza. Brief electric shocks throughout the body, which last one or two seconds, have also been reported. A case is reported in detail by the authors, who observed some of these symptoms in a patient after stopping his treatment with paroxetine. This withdrawal syndrome may be due to a rebound phenomenon of the serotonergic systems after interruption of the treatment with SSRIs. It is, therefore, recommended that treatment with SSRIs is progressively stopped over a period of several weeks.

Acute Disease↗
PubMed1997

The association carbamazepine-mianserin in opiate withdrawal: a double blind pilot study versus clonidine.

Our clinic has fortuitously developed the therapeutic use of the association of mianserin (maximum daily dose 90 mg) and carbamazepine (maximum daily dose 400 mg) in opiate withdrawal management. If animal studies have suggested efficacy of mianserin in such indication, no human studies have been performed. To test the efficacy of such an association, a comparison was made to clonidine (maximum daily dose 0.600 mg) in a one week treatment period according to a double blind pilot study design. Thirty-two patients were included (16 in each treatment group). The two treatments did not differ in the intensity of the withdrawal, according to the rate of retention in treatment and symptoms, and the psychic distress which were auto-evaluated every other day with the Opiate Withdrawal Questionnaire and several Visual Analog Scales (VAS). The clonidine group, however, scored significantly higher (P < 0.05) on the VAS rating of the global feeling of satisfaction on the last day. The patients in the mianserin group fortuitously had a moderately lower number of daily heroin intakes but there was no significant correlation between this variable and the global OWQ scores on Days 1, 3, 5 and 7. Given the size of the groups, we cannot conclude that the association carbamazepine-mianserin is as effective as clonidine, but a real effectiveness is probable. A study versus placebo would be necessary to draw more definitive conclusions.

Adult↗
PubMed1994

[New psychopharmacologic alternatives in treatment of schizophrenia].

Clozapine, risperidone and remoxipride are three neuroleptics that represent an interesting alternative in the psychopharmacological treatment of schizophrenia. Pharmacodynamic and pharmacokinetic properties, efficacy, dosages as well as the indication of these three substances are studied. In certain particular situations, a complementary treatment is of important therapeutic use, the addition of benzodiazepines, lithium, carbamazepine or beta-blockers are discussed.

Antipsychotic Agents↗
PubMed1992

Dextromethorphan and mephenytoin phenotyping of patients treated with thioridazine or amitriptyline.

The metabolism of most tricyclic antidepressants and some phenothiazine neuroleptics is under the genetic control of hepatic cytochrome P-450IID6, which also regulates the metabolism of dextromethorphan. This study investigated the effect of treatment with amitriptyline or thioridazine on testing for genetically regulated efficiency of the metabolism of dextromethorphan and mephenytoin. One group of 33 patients was treated with 150 mg amitriptyline a day (the AMI group); 25 other patients received a daily dose of thioridazine, either 200 mg (200-THD group; n = 7) or 400 mg (400-THD group; n = 18). Before and after 10 days of this treatment, all patients were tested with 25 mg dextromethorphan and 100 mg mephenytoin to determine their pharmacogenetic status with respect to their hepatic drug oxidizing systems (cytochrome P-450IID6 and P-450 MP). Two patients were poor metabolizers (PMs) of dextromethorphan and three of mephenytoin. Treatment with either psychotropic drug was without significant effect on the metabolism of mephenytoin, but both amitriptyline and thioridazine increased significantly the metabolic ratio of dextromethorphan/dextrorphan. Thioridazine had the effect of changing the pharmacogenetic status of 15 efficient metabolizers of dextromethorphan to poor metabolizers; amitriptyline did not have such an effect. There was no significant correlation between day-11 plasma levels of thioridazine, mesoridazine, or sulforidazine and the metabolism of dextromethorphan, but there was a correlation between the metabolism of dextromethorphan and plasma levels of amitriptyline and nortriptyline. Amitriptyline (p less than 0.05), but not thioridazine, decreases the ratio of conjugated/total dextrorphan in urine.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Theodor Kocher and César Roux].

96 letters addressed by César Roux (1857-1934), the most prestigious surgeon from the Canton of Vaud, to his fiancée, Anna Begoune, native of Russia, allow us to evoke Roux's training in Kocher's department of surgery. The letters shed light on Roux's relationship with Theodor Kocher, whom he compares successively with Billroth and von Volkmann.

General Surgery↗
PubMed1989

[The length of survival and cause of death in Huntington chorea].

The authors studied in retrospect the length of survival and the causes of death of 12 swiss patients with Huntington's chorea. These patients were born between 1873 and 1897 and were first admitted to the Psychiatric University Hospital of Cery before their 65th year. Clinically, the age of onset of the disease was between 34 and 41 years for the female patients. It was earlier in those patients to whom the disease was transmitted by the father than by the mother. The average length of survival was 13 years and 2 months. In general, the later the disease appeared, the longer the patients survived. The most frequent cause of death in this study is bronchopneumonia. The next is secondary to a cachectic and bedridden state associated with advanced dementia, which seems to be the natural evolution of the disease. The absence of death by suicide in these patients can be explained by the small size of our sample but probably also by the fact the patients were hospitalized in a late phase of the disease in which the risk of suicide seems lower.

Adult↗