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Biomedical subjects

D Ginestet

Publications and source records attributed to D Ginestet.

At least 37 records · Page 2Linked to original sources

[Tricyclic antidepressive agents].

The tricyclic antidepressive agents are still the drugs of choice because of their reliable action and the percentage of successes obtained (60 to 75%), especially in major depressions with deep melancholia. The course of antidepressive drugs is well documented, any depression needs at least three to four months' maintenance treatment after an initial phase of one month's treatment, frequently intravenous treatment is required. Current research is aimed at providing tricyclic agents without anticholinergic activity, the cause of most of their undesirable side-effects.

Antidepressive Agents, Tricyclic↗

[Consumption of benzodiazepines: good and bad uses].

In both general practice and psychiatry, the indication for benzodiazepines recognized by the French Technical Commissions--"all forms of anxiety"--remains very broad, and absolute contraindications are limited to severe respiratory insufficiency and, for certain drugs, myasthenia. Responsibility for deciding at what moment it becomes necessary to prescribe benzodiazepines therapy lies with the individual doctor--he is sole judge in his relationship with the patient: reactional anxiety, anxiety or distress accompanying somatic disease, insomnia. Benzodiazepines should not be prescribed to children, unless there are exceptional reasons for doing so. In psychiatry, higher doses are authorized for neurotic or psychotic anxiety, which are considered to be more serious forms. It is more or less accepted practice to prescribe benzodiazepines in combination therapy of various kinds with other psychotropic drugs. There are certain indications for which benzodiazepines in monotherapy are wrongly used, such as depressive states, and others where their use is contested, schizophrenic states, for example. Pharmacokinetic data are now beginning to provide a guide to dosage scheduling and to the choice of drug for the different indications. Maximum duration of benzodiazepine therapy should not exceed 4 months in certain cases. Risk of withdrawal syndrome appears to be slight for usual therapeutic doses. Finally, benzodiazepines are not the first choice of the drug addicts.

Ambulatory Care↗

[Psychological effects of neuroleptics (author's transl)].

The short term activity of neuroleptics allows the possibility to distinguish between: 1 - their instictive-affective effects which can, according to the case, either diminish agitation, vigilance, aggressivity, anxiety and mood, or the disinhibitors in case of anti-autistic action; 2 - their effects reducing hallucinations and delusions. After 6 months, and more, in the case of schizophrenia or other psychotic evolution, the preventive effect on psychotic relapses appears as unquestionable to many psychiatrists even though there do exist discrepancies in controlled studies. A regularly administrated treatment reveals the possibility of a favorable evolution with a restitution of social and hedonic capacities. Indeed, although the patients behave in a neurotic or psychopathic way, there is no indication that they are to shift from their psychotic structure. We think it necessary to find new trends in the biological treatment of psychosis when unpredictable neurological or endocrinal side-effects occur, or when too numerous patients to remain neuroleptic-resistant.

Antipsychotic Agents↗

[Iatrogenic depression (author's transl)].

A number of drugs are traditionally blamed for causing depression: in general medicine, the antihypertensives, the oral contraceptives and the appetite suppressants; in psychiatry, the neuroleptics. The identification of iatrogenic depression is difficult methodologically, for two reasons: 1. Detection of the depression. 2. Linking convincingly that state of depression with the administration of a particular drug, given the presence of many non-pharmacological factors. The literature and the experience of clinicians provide fairly contradictory evidence, but an analysis of published work calls for the following observations: --the type and severity of depression are rarely specified;--a history of psychiatric disorder is commonly stressed;--the specific role of the disability caused by physical or mental illness and the need to use palliative rather than curative measures are usually underestimated;--biochemically, it is surprising that the effects which some of these drugs are known to have upon the cerebral amines do not cause more depression of mood. In fact, if we consider how widely the drugs incriminated are used, it is clear that real drug-caused depression is rather uncommon.

Antihypertensive Agents↗

Standard and long-acting depot neuroleptics in chronic schizophrenics: an 18-month open multicentric study.

The overall objective of this 18-month open study was to compare standard neuroleptics and long-acting depot neuroleptics following the current psychiatric practice in order to determine the best therapy. Thirty French psychiatrists from 15 different wards participated in this experiment. One hundred eighty-one chronic schizophrenic patients were randomly assigned to receive one of the following three treatments: standard neuroleptics, pipotiazine palmitate, or fluphenazine decanoate. Criteria used for evaluation were an overall clinical evaluation by a psychiatrist, a Brief Psychiatric Rating Scale, and a Nurse's Observation Scale for Inpatient Evaluation. No significant difference (P greater than .05) was observed between the three groups in drug effectiveness or tolerance.

Adult↗

[Neuroleptic disinhibitory agents].

The concept of "disinhibition" appeared in 1956 (Broussolle and Dubor) with a study of the activity of prochlorpémazine in chronic schizophrenia. Each chemical group of neuroleptics includes at least one or two disinhibitory compounds. This activity intervenes upon the affective and intellectual life without necessarily the usual extra-pyramidal akathisia side-effects. Psycho- and sociotherapy are strongly adviced with disinhibitory effect.

Affect↗

[Preliminary report on the neuropsychological study of women treated by beta-mimetic drugs in a gynecological clinic].

Twenty women hospitalized in a gynaecological clinic for threatening miscarriages were treated by beta-mimetic drugs and examined from a neuro-psychological viewpoint. Disorders in the quality of sleep, trembling fingers and modification in the tone of voice were noted, and associated in five cases, to a slight hypertonia, extra-pyramidal-like. Eleven women had difficulties in concentrating, and seventeen felt distressing changes of mood: mentism, pessimistic thoughts, feeling of being abandonned, and sometimes, beliefs of being persecuted, which in two patients required the administration of Haldol.

Abortion, Threatened↗

["Heat stroke" and/or "Malin's syndrome" in a patient treated with fluphenazine decanoate].

The role of the "heat stroke" is discussed on account of an observation of hyperthermia (42 degrees C or 107.6 Farenheit) that occured with a patient under fluphenazine decanoate, during the summer 1976 heat wave. Contrary to the American descriptions of heat strokes, the patient kept his perspiring ability. Moreover, there was no hypertonic extrapyramidal syndrome, but hypotonia instead. It is to be noted that the preliminary treatment by the corresponding standard neuroleptic (fluphenazine chlorhydrate) did not prevent that hyperthermia whose evolution was rapidly favorable.

Adult↗

Critical study of the use of long acting neuroleptics (depot neuroleptics) in France.

Long acting neuroleptics (L.A.N.) represent 11% of the medical prescription of neuroleptics in France (about 40,000 patients in 1974). Some psychiatrists remain reluctant to prescribe long acting-neuroleptics and many problems related to their use are still solved empirically:1) relation between the posology of the standard Neuroleptic and the corresponding L.A.N. 2)the problem of dose-interval. 3) the necessary prescription of an parkinsonian. The superiority of N.A.P. over the Neuroleptic Standard has received no experimental confirmation in France, but the L.A.N. appear to us as an original therapy, the "pivot chemotherapy" around which psychotherapy and sociotherapy can be arranged without anarchical and ceaseless changes of neuroleptic compounds and of posology.

Antipsychotic Agents↗

[Chemotherapy of melancholia by sequential neuroleptic-viloxazine association].

Viloxazine administered as a unique antidepressant may in some cases cause an aggravation of anxiety and agitation or manic states. In order to control this effect, we thought of administering neuroleptics and anxiolytics: 1) Before Viloxazine for a few days. 2) Then during antidepressant treatment. The results were as follow: 1) Quick and efficient upon melancholic states in manic -- depressive psychoses. 2) Irregular and questionable upon other depressions.

Adjustment Disorders↗

[Comparison of clinical effects of delta-9-tetrahydrocannabinol with the classic effects of hashish].

Moreau de Tours's classical studies about haschisch had pointed out to a rich symptomatology: visual and auditive hallucinations preceded by the "primordial effect": "the dissociation of ideas". This delirious state was assimilated to dream. Modern studies, conducted with Delta-9-THC, in healthy voluntaries, again suggest the comparison or even the identity of the modifications caused by cannabis with sleep and dream. 10 mg of Delta-9-THC was absorbed in sesame oil by the voluntaries, and all of them presented disturbances of their vigilance, changes of their mood, now with euphoris and now with dysphoria, and slight psycho-sensorial alterations. The voluntaries EEG showed important and specific individual reactivity. Three subjects presented an arousal tendency, three other a greater towards sleep. Slight morphological changes have appeared, such as desynchronised periods, rapid shifts between I A, I B, II stages of sleep or an hypovariable I B stage of sedation with period of occular movements resembling to REM-stage.

Adult↗

[Attempt at classification and orientation of prescriptions using an index of psychotropic drugs in computers].

We designed a method of rational classification of psychotropic drugs belonging to neuroleptic class. Standard profiles were determined along BELSON'S Method (partially modified). Neuroleptic population is analysed according to two leading variables : desinhibiting action and powerful sedative action. The remaining variables are graded depending upon their binding with leading variable, we called them explanatory variables. Profile of drug is found along these explanatory variables. Results are set out with : list of decomposition with clauses, list of variables selected by method, dichotomic graphic, identification of drugs. Our purpose is to find objective tests, for classification of these therapeutic drugs. It must enable a best evaluation of indications and contra-indications, practice in every day.

Computers↗

[Pharmacoclinical value of the study of lithium cycles during 24 hours].

One cannot base a posology only upon morning lithiemy which turns out to be an unreliable criterion. It is useful to appreciate therapy equilibration through lithiemic cycle i.e. and every two hours dosage among patients on lithium carbonate or gluconate. Certain patients with quite an insufficient lithiemic morning level may be well equilibrated during day time. Lithiemy variations during the day are constantly reliable with the same patient. The study of nycthemeral variations among lithium salts treated patients allows us to understand some pathological subphenomena : intermittent tremor, subconfusional transitory onsets. Lastly lithiemic cycles allow comparison between lithiemy variations in manic or depressive relapses.

Carbonates↗

[Limits of efficacy and tolerance of antidepressive medications].

About 35 to 40 % of all depressions still resist antidepressants either imipraiminic or M.A.O.I. In some cases recourse to E.S.T. may even be required. Recurrent monopolar depressions, hypochondriac depressions in aged patients, depressive states in psychotic evolutions are among the most difficult to be treated. Some factors of resistance (such as side benefits) happen in reactive and neurotic depressions and are independent of the pharmacological action. Among the problems of tolerance that have not been completely solved it is interesting to note, in the case of the tricyclics, confusional states and the dangers of toxicity for the heart, and in the case of M.A.O.I. the numerous forbidden associations (such as morphine-like substances, tricyclics, sympathicomimetic drugs...). The new compounds with supposed antidepressive action, such as hypothalamic factors (T.R.H. or M.I.F.) or the 5 H.T.P. represent research hypotheses rather than safe ground of treatment. The problems of maximal doses and long-acting antidepressants are also discussed.

Adjustment Disorders↗