Compared to benzodiazepinic anxiolytics, new anxiolytic drugs are supposed to have a comparable efficacy, but a better profile of safety (abuse liability, rebound effects, cognitive impairment, sedative effects for example). Methodological issues concerning the development of new anxiolytic drugs are numerous: The diagnostic definition and classification of "Anxiety Disorders" (DSM, ICD) remain discussed and regularly revised. Anxiety disorders, while being heterogeneous, often occur in combination with each other or with depression and anxiety appears to be an ubiquitous component of most psychiatric disorders. Studies of new anxiolytic drugs use to assess their efficacy and safety. In most cases, those studies are double-blind, randomized, parallel-group studies versus placebo and reference drug. Usually, the reference drugs remain benzodiazepinic anxiolytics. It would be interesting to develop trials comparing new anxiolytics with each other and with non-pharmacological therapeutics, to improve therapeutic strategies in anxiety disorders. But, in this topic, a lot of methodological difficulties remain unsolved. The choice of dosages may be difficult because dose-ranging studies are not always available for the drugs and the anxiety disorders studied: it actually the lowest effective dose is not well known. Moreover, it could be more useful to study the therapeutic index of the drug. The duration of short and medium term studies, which are the most performed with anxiolytics, is about 4 to 12 weeks. The duration of long term studies is about 4 to 6 months. Those durations are empirically determined and might not always be appropriate. For clinical efficacy assessment, the choice of evaluation criteria is difficult because no tool is perfect. Then, a main criterion and several different criteria have to be chosen among anxiety rating scales, self rating scales and global ratings of psychopathology. Safety assessment of a new anxiolytic specifically use to focus on sedative effects, cognitive impairment, rebound effects and abuse liability. Several methods are interesting to assess abuse liability: for example, looking for a withdrawal syndrome (the most common), determining the profile of subjective effects of the drug using questionnaires and auto-administration or discrimination studies. Sedative effects and cognitive impairment assessment use various batteries of tests. Concerning general assessment of side effects, both check-lists and open reporting have got advantages and drawbacks. Assessment intervals depend on the aim and the duration of the study: weekly in short-term studies and two-weekly or monthly in long-term studies. Those empirically determined intervals, which take into account the practical achievement of the studies, might not detect some drug effects. The number of subjects entering the study has to be determined before its beginning: about 30 to 40 subjects in each group in trials versus placebo and about 120 to 150 subjects in each group in studies versus reference drug. Ethical and legal issues are important in clinical trials of new anxiolytics. The french law (Loi Huriet 1988) has introduced the necessity for investigators to obtain from subjects their informed and written consent for their participation in the study. Also, the representatively of subjects participating in new anxiolytics trials is a matter of concern. However, those difficulties and the requirements of french health department have not yet obstructed clinical research of new anxiolytic drugs, as shown by the number of new beginning studies.

Adult↗

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[Limitations of efficacy of chemotherapies in schizophrenia].

The concept of treatment-resistant schizophrenia cannot be defined as this of resistant depression: schizophrenia is a long-term illness; its evolution is almost always influenced by neuroleptics--but complete recovery is rare. French psychiatry tends to use clinical-empirical criteria, while english speaking studies prefer quantitative criteria, by extended use of clinical and psycho-social scales. The definition of resistant schizophrenia by Kane et al. is a typical example of this method of work. We propose to overview the limits of neuroleptics efficiency in schizophrenia from three groups of studies: a) The effects of maintenance therapy: 24 studies of the last twenty years show that 2/3 of schizophrenics under neuroleptics maintain their remission over one or two years, opposed to less than 1/3 of those who discontinue their treatment. These data seem to be independant from the method of the study, the choice of the neuroleptic drug, the dose and the way of administration (per os or depot treatment). b) A second group of studies tries to define the clinical characteristics of treatment-resistant schizophrenia. French psychiatry uses an empirical graduation of neuroleptics clinical efficiency: these drugs are more effective on hallucinations than on delusional ideas--they are more effective on recent and acute hallucinations and delusions than on those of which course is chronic. Other studies specify predictive factors of poor response to neuroleptics, as few affective symptoms and presence of negative symptoms--a controversed factor. c) Not clinical factors of poor neuroleptics efficiency in schizophrenia begin to be studied.(ABSTRACT TRUNCATED AT 250 WORDS)

Antipsychotic Agents↗

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[Discontinuation of neuroleptic treatment in patients with schizophrenia].

Neuroleptic maintenance treatment in schizophrenia is a conflicting issue. There is no reliable criteria to identify patients for which neuroleptic withdrawal can be experienced. However, treatment discontinuation, whose risks can be limited, must be attempted for reasons such as the patient's wellbeing, longterm side-effects prevention and patient-doctor relationship management. Anyway, it can lead to more specific indications for drug maintenance.

Antipsychotic Agents↗

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[Clinical classification of neuroleptics. Critical study and current prospects].

Clinical classifications of neuroleptics constitute a particularity of European clinical psychopharmacology. However, the importance of evaluation scales in American psychiatry may also lead to an "implicit" clinical classification, since these drugs do not have the same effects upon the same patient. The main European classifications are described and some of actual clinic of neuroleptics are criticised, in particular the concepts of sedative, antipsychotic, antidelusional or antihallucinatory action. We have pointed out three clinical actions which should be selected in a present classification of neuroleptics; a) angolytic effect i.e. specific antianxiety action upon psychotic anxiety, often initiating the therapeutic processes; b) psychic reorganization effect that is the resultant, in schizophrenia, of the antiproductive and antideficitary effects; c) thymoleptic effect, i.e. reductive action upon the strength of passionate insistence and vindication in paranoïac disorders.

Acute Disease↗

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[Schizophrenia and dopaminergic modulation. Diagnostic and therapeutic implications].

Explore the source record for details and available documents.

Dopamine↗

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[Sweet bulimia, salty bulimia. Emotional profiles and weight status].

In this study we precise eating and non specific symptomatology of 56 patients with DSM III bulimia syndrome. Results confirm our first hypotheses, particularly the distinction between sweety and salty bulimia and the heterogeneity of patients with this syndrome. We specially studied two types of clinical dimensions: emotional components and weight status. According to emotional profile, bulimics differ from other psychopathologic populations and present some particular features. Impulsivity is a characteristic of sweety bulimics, dysphoria and affective lability characterise salty ones.

Adult↗

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[Adherence to neuroleptic treatment of schizophrenic patients].

Non adherence is a topical problem: about 50% of psychiatric patients do not take their medication as prescribed. Literature's overview is revealing a lack of definition of treatment adherence and the unsatisfactoriness of methods to measure it. Reasons for reluctance to take drugs include complex treatment regimen, drug presentation, duration of treatment and side-effects, most notably akathisia and akinesia. Information exchange with patients and their family about medication is also an important factor. The patient-doctor relationship appears to be a very sensitive aspect of the problem: attempting to view non adherence psychodynamically could lead to improve it.

Antipsychotic Agents↗

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[Sweet bulimia, salty bulimia. 2 syndromes].

We report the psychopathological study of 20 subjects with the Bulimia syndrome (DSM III criteria) specifying affective, emotional state and psychiatric symptoms associated with the eating disorder. Evaluation was made using self-rating questionnaires, anxiety and depression rating scales and specific rating scales for various clinical dimensions (impulsivity and mood). Two groups of subjects differing from one another on their elective appetite and taste for two types of food (sweet versus salty) are distinguished. Clinical characteristics of each group are different: Carbohydrate bulimics are more impulsive, dysphoric, make much greater use of medications, drugs, and alcohol than salted food bulimics do. Patients of the second group are more anxious and emotionally blunted. Anorexia nervosa was more often present in their past. The two groups differ also in their responses to serotoninergic and noradrenergic medications used here in open trial. These results are consistent with literature data on carbohydrate metabolism, impulsivity disorders, depression and cerebral serotonin.

Bulimia↗

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