[Schizophrenic syndromes. Diagnosis, development, treatment].
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Activities of Daily Living↗
Biomedical subjects
D Pringuey
Publications and source records attributed to D Pringuey.
Evaluation of the supervisory system in elderly subjects with and without disinhibition.
UNLABELLED: Disinhibition and irritability, defined as loss of behavioral and emotional control, are frequent in the elderly. The working hypothesis for this study was that these disorders are associated with a cognitive alteration of control processes that manifests as non-routine behavior because of the dysfunction of a general executive component known as the supervisory attentional system (SAS). METHODS: A total of 28 elderly subjects with mild cognitive impairment were recruited and divided into two groups using the Neuropsychiatric Inventory. Fourteen subjects were allocated to the disinhibited group and 14 subjects matched for age, sex and educational level formed a disinhibition-free control group. The neuropsychological battery included the following tests: Mini Mental Score Evaluation, Boston Naming test, Token test, Trail Making and Verbal Fluency. Two tasks were specifically designed to stress the SAS: 1) A specific verbal sentence arrangement task in which subjects had to use sequential reasoning with verbal material. Each test sequence consisted of a series of words shown in jumbled order. The construction of some sequences had to be done by using familiar routine associations (valid conditions). In contrast, other sequences required the overriding selection of familiar routine associations, which were inappropriate within the general context of the task (invalid conditions). 2) Using the Continuous Performance Test, four aspects were evaluated: sustained, selective, preparation and suppressive attention. RESULTS: The only group differences in neuropsychological test results were the following: 1) the sentence arrangement task. In comparison with the control group, the disinhibited group was impaired in invalid conditions and the calculated difference between the number of correct responses in invalid conditions minus that in valid conditions was significantly higher; and 2) the CPT. Disinhibited subjects had a significantly lower number of hits, exclusively in the 'suppressive attention' paradigm. These results suggest that subjects with disinhibition have impaired supervisory system function.
Aged↗
[Antidepressive agents].
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Antidepressive Agents↗
The safety and tolerability of zolpidem--an update.
Zolpidem belongs to a new class of hypnotic agents, chemically distinct from the pre-existing ones, and has a unique neuropharmacological profile. It induces sedative/hypnotic effects in rodents at doses much lower than those for anticonvulsant and myorelaxant activities. Clinically, zolpidem is indicated for the short term treatment of insomnia. It has a short half-life (2.4h), with no active metabolite, and does not accumulate during repeated administration. The pharmacokinetic profile associated with the absence of active metabolites is consistent with the short duration of action and absence of residual effects that have been observed. Polysomnographic experience indicates that zolpidem induces a sleep pattern which is similar to that of physiological sleep, and which produces either no or only minimal effects on sleep architecture after abrupt discontinuation. Aspects of the general safety of zolpidem have been studied in data obtained from healthy volunteers and patients, both adult and elderly, during its clinical development and in post-marketing experience. Zolpidem appears to be well-tolerated in adults and in the elderly, when administered in accordance with prescribing instructions. The available data indicate that, in these circumstances, the risk of abuse or dependence is minimal.
Adult↗
Initiation and supervisory processes in schizophrenia and depression.
Clinical studies show that schizophrenic and depressive subjects have problems with daily life activities, and neuropsychological studies tend to explain these problems in terms of a dysexecutive syndrome. Verbal fluency and sentence arrangement are tasks considered to focus on two aspects of the dysexecutive syndrome known as initiation and supervision processes, respectively. In this study, we assessed performance in these two tasks in schizophrenia and depression. Twenty-six schizophrenic subjects (chronic schizophrenia, DSM IV definition) were compared with 26 control subjects balanced for sex, age and educational level, and 16 depressive subjects (major depression episode, DSM IV) were compared with 11 similarly balanced control subjects. Switching and clustering scores were evaluated during a semantic fluency task as two components underlying the initiation and organization processes. Capture errors specific to failure of the supervisory system and differences between the number of correct responses in two conditions (valid/invalid) were evaluated as indexes of the supervision process in a sentence arrangement task. In the semantic fluency task, switching scores were significantly lower in the schizophrenic and depressive subjects than in their respective controls. In the sentence arrangement task, only the schizophrenic subjects made significantly more capture errors than their controls and had significantly fewer correct sequences in invalid conditions than in valid conditions. This study shows a dissociation between supervision and initiation processes in two different psychiatric populations. Initiation is impaired, but supervision is preserved in depression, whereas both initiation and supervision are impaired in schizophrenia.
Adult↗
Treatment-resistant schizophrenia: the importance of early detection and treatment. Introduction.
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Antipsychotic Agents↗
[Efficacy of antidepressants and thymoregulators in the long-term evolution of depression].
Official recommendations pointed out the long term maintenance treatment of recurrent unipolar depression on the basis of a significant effect of antidepressants and mood-stabilizers versus placebo. The results of controlled studies, mainly using imipramine or lithium salts, have not been encouraging in term of long term prognosis, due to the limited success rate for maintenance phase ranging from 30 to 48%. The "Pittsburgh study" maximized the recurrence potential by defining patients selection on at least 3 previous episodes of unipolar depression, with the immediate previous episode being no more than 2.5 years earlier, beginning the experimental maintenance therapy phase after patients remain relatively symptom free for a total of 20 weeks, and scheduled the imipramine withdrawal in the randomly assigned placebo group by a progressive reduction of 33% per week. Survival analysis in the 5 years maintenance outcome of previously imipramine responders patients demonstrated an increased risk of depressive recurrence at the beginning of discontinuation but did not prove a true prophylactic effect. Furthermore these findings do not prove that treatment are not more effective than placebo, suggesting at least a revisitation of the clinical concept of response. The putative efficacy of biological treatment should be an operational criteria to elicit vulnerability markers, mainly in the field of sleep research.
Affect↗
[Sleep disorders and psychiatry. Keys for trans-nosological symptomatology, genetic epidemiology and dynamic pathogenesis].
Sleep studies in psychiatry collect various disorders in the category of "dysomnia", and sleep EEG studies today can be routinely performed using appropriate autonomous devices. Three major needs emerge from a broad approach of the topic: a transnosological view on symptomatology--dysomnia gets its meaning from the context, a genetic epidemiology--dysomnia appears as a risk factor for psychiatric disorders and a marker of depressive vulnerability, and as a dynamic pathogeny. A wide consensus arises in the field of polysomnographic studies claiming a clear distinction between two opposite sleep EEG basic disturbances: the non specific increase of wake during the sleep process, seen in anxiety disorders, primary insomnia and several activation situations and related to a sleep-wake instability, and the specific endogenous pattern seen in depression which suggests a super-sleep syndrome. Sleep EEG studies can provide additional information on the biological basis of the disorders, both as diagnostic criteria extension and as therapeutic intervention aid.
Anxiety Disorders↗
5-Methoxypsoralen: effect on the noradrenaline circadian rhythm of sleep-deprived subjects.
5-methoxypsoralen (5-MOP), a serotonin analogue, stimulates the secretion of melatonin, which plays an important role in circadian rhythm regulation. Melatonin production is essentially controlled by noradrenaline (NA). To investigate the effect of 5-MOP on the 24 hr NA rhythm, hourly plasma NA concentrations measured over 24 hr in 7 healthy young subjects who took 40 mg 5-MOP orally at 21:00 hr the evening before were compared with values obtained in drug-free subjects. All subjects were sleep-deprived and under conditions in which sympathetic nervous system activation was repeated every hour over 24 hr. In both series of patients, a significant difference was observed between mean morning values and mean night values, reflecting persistence of a circadian rhythm. In subjects given 5-MOP, a significant difference was also observed between mean afternoon values and mean night values. However, MANOVA analysis failed to find any difference between the two series of subjects. Acute administration of 5-MOP thus had no significant effect on the NA circadian rhythm under our study conditions.
5-Methoxypsoralen↗
Circadian variation in total plasma tryptophan. Antidepressant treatment: drugs and phase advance.
The authors investigated hourly total plasma tryptophan concentrations over a 24 hour period in 3 patients with bipolar depression during 2 types of treatment: a phase advance process and conventional antidepressant therapy. Both treatment modalities increased the 24 hour mean tryptophan levels and the amplitude of circadian tryptophan concentrations. By contrast, in a previous study, moderately decreased tryptophan levels and a blunted amplitude in the circadian rhythm were observed in these same patients in a depressive phase.
Adult↗
Trimipramine: acute and lasting effects on sleep in healthy and major depressive subjects.
The acute effects of trimipramine on sleep EEG patterns were investigated in six depressed inpatients and six healthy volunteers. The effects of long-term administration were then assessed in depressed patients after 4 weeks of treatment. Sedative effects of the drug were more pronounced in healthy subjects while sleep parameters of depressed patients seemed less sensitive to the drug. Chronic effects tended to correct most of the sleep disturbances seen in depressed subjects with respect to the natural organization of sleep. The major sleep effect of trimipramine concerned REM latency which was lengthened in both groups, independently of the treatment protocol.
Adult↗
Circadian rhythm in plasma noradrenaline of healthy sleep-deprived subjects.
Under normal sleep-wake conditions, noradrenaline (NA) secretions in supine subjects exhibit a weak circadian variation with a peak that occurs around noon; the sleep span is characterized by reduced NA secretion. Some investigators have reported that the circadian NA rhythm is completely obliterated during sleep deprivation. In our laboratory, plasma NA was assayed every hour for 24 h in nine healthy men 20-23 years of age. All men were deprived of sleep and were required to eat and walk around every hour to prevent sleep. However, subjects remained supine for 20 min before blood samples were collected to eliminate the effect of activity. Persistence of a slight decrease in the night concentration in several subjects, despite sleep deprivation, suggests that NA secretion may be influenced by a biological clock whose activity becomes visible when the influence of posture is removed.
Adult↗
[Disorders of circadian rhythms in depression].
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.
Adrenocorticotropic Hormone↗
[Sleep in depression].
Insomnia is a cardinal symptom of depression, side by side with alterations of mood and slowing down of psychomotor activities. It bears witness to a rupture in the built-in circadian rhythm: architectural changes in sleep betray a biological desynchronization. Insomnia is also a failed attempt at finding a solution to depression. Total deprivation of sleep for one night may damp down the depressive disorders, and so does partial sleep deprivation in the second part of the night during several days. This leads to the conclusion that the waking-sleep system participates in the expression of symptoms of depression or even contributes to the genesis of the disease.
Antidepressive Agents↗
Diurnal variation in total plasma tryptophan in controls and in depression.
Circadian rhythms of total tryptophan were investigated by assays of hourly blood samples over 25 h. The study population consisted of four endogenously depressed patients investigated in the absence of any treatment and six healthy controls. The abnormalities detected by statistical analyses in untreated depression consisted mainly of amplitude reduction; the phase positions of the depressed patients were similar to those of the controls.
Adult↗
[Hourly serum cortisol assay over 24hr by immunoenzymology in depression].
Enzymoimmunoassays have been developed as alternatives to radioimmunoassays because they obviate the need for labelled compounds yet offering comparable specificity. The authors used an enzymoimmunoassay to investigate hourly serum cortisol levels over 24 hours in 6 patients (aged over 40 years) with endogenous depression (4 unipolar depressions, under antidepressor treatment and 2 bipolar depressions, without medication) and in 2 controls, aged 20 and 47 years. In agreement with literature data, a clear circadian rhythm was observed in controls and in the depressed patients, and hypercorticism was noted in one depressed patient. A trend towards phase advance in depression was seen in both the treated and untreated patients.
Adult↗
Circadian rhythms in depression and recovery: evidence for blunted amplitude as the main chronobiological abnormality.
Circadian rhythms of body temperature, plasma cortisol, norepinephrine (NE), thyroid stimulating hormone (TSH), and melatonin were compared in 16 endogenously depressed, 15 recovered (after 3 weeks of anti-depressant treatment), and 16 normal subjects. The depressed patients showed clear circadian rhythm abnormalities, consisting mainly in amplitude reduction. This amplitude reduction was significantly correlated with the patients' Hamilton depression scores. Normal circadian profiles were restored after recovery when amplitude, in particular, was increased. Features of the circadian rhythms observed in remission may be associated with antidepressant drug effects, whereas those observed in depression resemble the circadian rhythms observed in normal subjects living under conditions of temporal isolation and those of blind subjects. Our findings suggest that depression may be related both to a weakening of the coupling processes between internal pacemakers and to an abnormal sensitivity to environmental information.
Adult↗