Effect of recovery on the cortisol circadian rhythm of depressed patients.
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Adult↗
Biomedical subjects
D Pringuey
Publications and source records attributed to D Pringuey.
Plasma 3,4-dihydroxyphenylethyleneglycol and 3-methoxy-4-hydroxyphenylethyleneglycol as indicators of central noradrenergic activity. A comparative study on control subjects and depressed patients.
Animal studies have suggested interspecies differences in brain norepinephrine (NE) metabolism, especially with regard to the relative proportions of 3,4-dihydroxyphenylethyleneglycol (DOPEG) compared to 3-methoxy-4-hydroxyphenylethyleneglycol (MOPEG). In order to question the value of both glycol metabolites as peripheral indices of central noradrenergic activity, a comparative study of plasma DOPEG and MOPEG (measured by HPLC) related to depression, sex, age and diagnostic categories (DSM-III) was carried out on depressed and control subjects. In addition, two groups of 8 patients were randomly submitted to a desipramine 150 mg/day, or a metapramine 450 mg/day antidepressant treatment influencing the formation of DOPEG and MOPEG in a different way. The study did not demonstrate any difference between DOPEG and MOPEG for most of the experimental factors. We found also a significant positive correlation between plasma levels of DOPEG and MOPEG. Our results support the idea that each of these two biological indices can be used in the assessment of central noradrenergic activity.
Adult↗
24-hour profile of plasma norepinephrine in affective disorders.
The circadian rhythm of plasma norepinephrine (NE) was investigated in the depressed (major affective disorder, DSM III; n = 12), recovered (after 3 weeks of treatment using usual antidepressant drugs; n = 12) and normal (volunteers, age and sex matched; n = 10) states. Data analysis (based on the evaluation of circadian parameters, on the chronogram method and on the chronobiological analysis) revealed a clear NE circadian rhythm in normal subjects, a rhythm which was disturbed in depression, with amplitude reduction and abnormal phase position. These abnormalities tended to disappear during recovery since circadian parameters were similar to those of controls. These circadian abnormalities could be linked to the impairment of the peripheral and central catecholaminergic systems. They may also support the chronobiological hypothesis of affective disorders.
Adult↗
The circadian rhythm of plasma thyrotropin in depression and recovery.
The 24-hr patterns of plasma thyrotropin have been observed in 12 endogenous depressed patients in both depressed and recovered states and in 13 normal subjects. A clear circadian rhythm was detected in controls with high values at night. In depression, the circadian rhythm was altered with amplitude reduction and blunted nocturnal secretion, abnormalities particularly relevant in bipolar patients. This flattened profile could be linked to the blunted response of TSH to TRH administration reported in depressed patients. Normal nyctohemeral patterns have been restored after recovery. These chronobiological abnormalities as well as their normalization under antidepressant drugs seem to be similar to those reported for various parameters (e.g. temperature, cortisol, etc) in depression which could support the chronobiological hypothesis for affective disorders.
Antidepressive Agents↗
[Circadian rhythms and depression].
The degree to which nature's cycles influence our body is now obvious, owing to the recent progress of chronobiology. It seems thus that the harmonious internal organization of our circadian rhythms depends on the dual influence of the internal clocks as well as the external temporal informations. These endogenous pacemakers, able to spontaneously generate a rhythmicity the period of which is close to 24 hours, could be triggered by environmental informations, such as light/dark or sleep/Wake cycles, on a 24 hours schedule. The disruption of this entrainment could be involved in major affective disorders. This internal or external desynchronisation seems thus to be the central concept of different models for depression. The internal coincidence model suggests that a phase advance of the strong oscillator in reference to the weak oscillator causes depression. An external coincidence model suggests that depression is caused when light/dark cycle or photoperiod provide too little illumination during a critical photosensitive interval which could be located in the second half of the night. At last, a model comparing the biological rhythms of depressed patients and of healthy volunteers during temporal isolation, suggests that the internal clocks of depressed subjects could be temporarily "blind" to environmental time cues involving internal desynchronisation. These emerging findings should open a new therapeutic approach for depression.
Antidepressive Agents, Tricyclic↗
Positive correlation between total 3-methoxy-4-hydroxyphenylglycol in plasma and 24-h urine in psychiatric patients.
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Adult↗
Lithium kinetics during hemodialysis in a patient with lithium poisoning.
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Affective Disorders, Psychotic↗
[Antidepressant monotherapy: efficacy and tolerability of mianserin (Athymil)].
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Adult↗
[Transsexualism].
According to the literature, the transsexual phenomenon can be assessed as a distinct psychiatric illness. Transsexualism, a rare but spectacular disorder, realizes a gender identity reversal raising questions regarding systems of psychiatric diagnosis, nosology and treatment. A better clinical knowledge of this "experiment" and its follow-up allow studying processes contributory to marked deviation of gender identity and furthering concepts of development of masculinity and feminity. Current research deals with hypotheses that can be stated as testable propositions about underlying dynamics in various fields: learning factors, psychoanalytic components and psycho-biological data. Focusing on the early infantile development and the environmental influences reflects a variety of non specific psychogenetic precursors. The treatment of "gender dysphoria syndrom", i.e. hormonal treatment, sex-reassignment surgery and psychotherapic processes, aims towards réduction of psychic pain and social adjustment in the cross-gender role. Transsexual phenomenon largely overlaps the psychopathological area; beyond surgical and medical aspects, social implications and legal positions refer to an ethical problem.
Adult↗
Antidepressant effects of the sleep/wake cycle phase advance. Preliminary report.
Five patients with endogenous depression were asked to participate in a phase-advance procedure consisting in advancing by 5 h the time schedule of the major external synchronizers such as light/dark, sleep/wake, meal time and social activity cycles. Clinical and biological parameters were observed throughout this 2-week process which followed one night of partial sleep deprivation. All patients improved with partial sleep deprivation and four of the five showed continuing remission during the phase-advance process. The antidepressant effects of the phase-advance process are discussed in light of different chronobiological models for depression.
Adult↗
[Treatment of clozapine-induced granulocytopenia with lithium (two observations)].
Despite the availability of new treatments, the antipsychotic effectiveness of clozapine has not been matched yet. Unfortunately, its regulation is limited by the side effects. The most detrimental is the hematologic toxicity (neutropenia and agranulocytosis) which requires a regular biological monitoring. Treatment with clozapine must be stopped in those cases of secondary granulocytopenia for about 3% of the patients. The current psychiatric drug lithium carbonate has an opposite effect: it can induce leukocytosis. Thus, lithium carbonate is administered in leukopenia, as well as in many hematologic and immunological diseases. However, few teams have used lithium in order to alleviate clozapine-induced granulocytopenia. We report here 2 patients who developed severe neutropenia (neutrophil count<1.5 yen 10 (9)/L) and for whom the use of lithium enabled us to continue the treatment by clozapine. The first patient had a granulocyte rate constitutionally low which rapidly decreased with clozapine. Thanks to the administration of lithium, he recovered quickly a normal blood cell count, which in fact was much higher than his normal rate. According to our research, it's the first time that lithium is reported to be so efficacious in a patient with such a low rate of granulocytes before treatment. It may be that clozapine is not used for those kinds of patients. The second patient developed granulocytopenia after one year of treatment with clozapine. The use of lithium increased so much the number of granulocytes that we continued the treatment with clozapine alone. After 4 months, there is no reappearance of granulocytopenia. We must take into account the partial and contradictory reports in the literature. However, if this result is confirmed, it could be of a high interest to extend the prescription of clozapine, the most effective current antipsychotic drug.
Adult↗
Behavioral and psychological symptoms in Alzheimer's disease. Relation between apathy and regional cerebral perfusion.
Fundamental and therapeutic research in Alzheimer's disease (AD) focused for a long time exclusively on cognitive aspects. However, AD also frequently involves complex disorders of affect and behavior, which are currently grouped under the heading 'behavioral and psychological signs and symptoms of dementia' (BPSSD). Several rating tools have been developed over the years on the basis of a variety of source data. Some are derived from psychiatric practise or have specifically been developed for dementia, such as the Neuropsychiatric Inventory (NPI). In this study we prospectively used the NPI to examine BPSSD. Sixty-three French patients (mean age 74.7 years, SD 7.9) with a Mini-Mental State Examination (MMSE) score higher than 10 were examined. BPPSD were detected by NPI in 95. 2% of the patients. Anxiety was the most common abnormality (65.1%), followed by apathy and dysphoria (58.7%). The highest frequency x severity NPI score was observed for apathy. In order to identify the relationship between regional cerebral perfusion and apathy, 20 of these AD patients underwent a technetium-99m-bicisate SPECT protocol within the same week as the NPI evaluation. The mean age of this population was 74.4 years (SD 5.3) and the mean MMSE score was 21 (SD 4.1). The apathy NPI score was correlated with right cingulate deficit whereas the highest correlation for the MMSE was with the left temporoparietal area. This stresses the interest to focus on SPECT imaging of AD patients not only in the posterior areas. CopyrightCopyright 1999S.KargerAG,Basel
Aged↗
[Neurocognitive subtypes of schizophrenia according to performance at verbal fluency tasks].
UNLABELLED: There is a general agreement that schizophrenia is an heterogeneous disorder and cognitive performances could be an interesting feature in order to allow a better description of specific subtypes. The aim of this study was: 1) to describe clinical and neuropsychological performances of 45 DSM IV schizophrenic patients divided in two groups according to their performances in verbal fluency task; 2) to compare each group with the performances of healthy subjects matched for sex, age and education. METHOD: The differentiation criteria was the total number of words generated during 3 formal and 3 semantic fluency tasks. Data were analysed using a disjoint clustering procedure with Euclidean distance. A two cluster solution was considered optimal. Cluster S1 includes 21 schizophrenic subjects defined as low performer (range: 40-83, mean 66.7). Cluster S2 includes 24 schizophrenic subjects (range: 87-158, mean 102.8). All schizophrenic patients were clinically evaluated with SANS, SAPS and a psychosocial aptitude rating scale (PARS). Patients and controls were assessed with the following battery: verbal fluency, Trail making test A & B, Stroop test, Brown Peterson paradigm for evaluation of working memory. RESULTS: Patients with low verbal fluency had significantly higher scores at the SANS and PARS. Furthermore, the low performers (cluster S1) were differentiated from those with better performances (cluster S2) by significantly poorer results in all neuropsychological tests. Comparison with healthy subjects indicated that cluster S1 patients also had significantly poorer results in all neuropsychological tests. Relative to their 24 controls cluster S2 patients performances was lower in all measures excepted in one subscore of the Stroop test and in the number of cluster produced. This later result could indicate that some capacities for willed intention were preserved in this group and that the alteration in verbal fluency performances were better explained by impairment of the other cognitive processes. DISCUSSION: These findings point out that: 1) use of performance in cognitive executive task such as verbal fluency is a possible criteria in order to separate different types of schizophrenic patients; 2) in the two groups of schizophrenic subjects, various processes defects underline cognitive performances indicating the presence of different neurobiological dysfunctioning.
Adult↗
[Sleep polygraphy: diagnostic value in depressive pseudo-dementia. Attempt to improve visual scoring by digital periodic analysis].
ARGUMENT: Pseudo depressive dementia is a common pathology for elderly patients. Classically, it is said that depression is taking the mask of dementia, but very often deterioration and depression are present at the same time. Sleep EEG can help the clinician to differentiate dementia and depression in pseudo depressive dementia. Slow Wave Sleep (SWS) is a good indicator of deterioration process. We tried to improve the sleep recording and analysis and our ability to differentiate SWS in this indication. We use a portable digital recording material (Hypnotrace). The signal is analysed by the association of a visual standard method to Digital Periodic Analysis (DPA) which is very sensitive to SWS. The visual analysis gives informations about the macroarchitecture of the night. The Digital Periodic Analysis gives at any moment the value of the wave frequency and thus informations about the microarchitecture. Our hypothesis is that this association helps to better recognise SWS and thus improves sleep EEG as a diagnostic tool in this indication. METHODS: 23 inpatients meeting both the criteria for major depression and dementia (DSM IV) have been recorded during two nights after 15 days of wash out and before antidepressant treatment. The recordings are analysed with the visual standard method and with the help of DPA. The patients are evaluated every 15 days during two months in order to define three groups based on the clinical evolution. RESULTS: The scoring with DPA is more sensitive to Slow Wave Sleep, particularly for the patients with good clinical evolution (with the strongest depressive component). Thus, this method could be a good diagnostic tool to differentiate dementia and depression in pseudo depressive dementia.
Aged↗
[Circadian rhythm of plasma norepinephrine in depressive disorders. Preliminary study].
The biological desynchronisation hypothesis of (endogenous) depressive disorders arises from the disturbances in the circadian rhythmicity of several biological functions in depressive illness and clinical improvement during various sleep deprivation processes. Furthermore, supportive evidence exists to postulate a central noradrenergic dysfunction, at least in a sub group of depressive disorders. We studied the 24 h kinetics of plasma norepinephrine in patients suffering from Affective Disorders-Major Depressive Episode according to DSM III criteria. Blood samples were drawn hourly from an indwelling venous catheter in supine subjects. Plasma NE was measured by HPLC with electrochemical detection. 5 patients (age: 35-63) were studied in base line drug free depressive state and compared with 5 control subjects (age: 44-53), then, in 4 patients, on the 8th and 21st days under antidepressant treatment. Control subjects exhibited a circadian rhythm of TP but a weak amplitude and low values during sleep, as previously described. Depressed patients did not display any rhythmicity because of a reduced amplitude and high plasma levels during sleep. Antidepressants did not restore the rhythm. Our results suggest a rhythmic instability involving a circadian lability linked to an ultradian release during sleep. This NA disinhibition could participate in the depressive desynchronisation and the potential relationships with sleep disorders must be discussed.
Adult↗
[Efficacy of antidepressants selected as a function of erythrocyte membrane transport and plasma levels of L-tyrosine and L-tryptophan].
The present study concerned 69 depressed patients (26 men, 43 women). The antidepressant drug was prescribed in accordance with perturbations of tyrosine and tryptophan membrane transports (MT) across the red cell, measured in vitro after a wash-out period of ten days. After two to four months of treatment, the clinical results were divided into two groups: normal mood (AMDP - Depression Scale less than 6) and no recovery (AMDP - Depression Scale greater than 6). The initial criteria (e.g. MT) was completed by using plasma tyrosine, tryptophan and the product MT by plasma level. Indeed, the success of this treatment was corresponding to precise abnormalities of variable: (i) tyrosine and tryptophan values for imipramine, (ii) tyrosine values, plasma tryptophan and tryptophan product for desipramine, (iii) tryptophan variables and plasma tyrosine for fluvoxamine (and indalpine). The analysis of clinical failures permitted to complete our previous choice of antidepressant drug.
Adult↗
[Joint evolution of erythrocyte membrane transport of tyrosine and tryptophan as a function of the clinical course of depression].
The clinical state and the erythrocyte membrane transports of tyrosine and tryptophan were studied longitudinally during one year (minimum period of 3 months) in 44 depressive patients, 21 men and 23 women of 30 to 77 years of age. According to the DSM III, 18 patients had bipolar disorders (8 with short cycles), 14 had recurrent major depressions and 12 dysthymic disorders. Abnormal values for the membrane transports are found in the majority of patients; the pattern of these abnormalities differs among the nosological groups but decreased ratio of the tyrosine to tryptophan is the predominant finding. The membrane transports normalize as the clinical status improves. In bipolar disorders, the changes observed at the time of switching into mania differ among short and long cyclers. Short cyclers who become manic generally present a short period of normal mood and show values of membrane transports higher than when depressed or euthymic and higher than those of normal controls. Long cyclers directly switch into mania, and when manic have the same ratio of tyrosine to tryptophan than when depressed. Based on these biochemical observations, long cyclers resemble patients with recurrent major depression and short cyclers resemble dysthymic disorder patients, a group for which it has been suggested that one fifth become bipolar within years of evolution.
Adult↗
[Erythrocyte membrane transport and plasma levels of tyrosine and tryptophan in depression].
L-Tyrosine and L-Tryptophan were studied in 80 depressed patients, hospitalised in Genova and Marseille. After a washout period of ten days, the erythrocyte membrane transports (MT) of L-Tyrosine and L-Tryptophan were measured, as well as their plasma levels; plasma phenylalanine was moreover measured. 33 normal subjects served as control group. In the whole population of patients, the mean of MT's was different compared to controls (MT tyrosine low and MT tryptophan high) and the plasma tyrosine was low. The perturbations of these variables were different according to diagnostic groups (DSM III): MT tyrosine, plasma tyrosine and tryptophan low in bipolar disorders depressed; MT tyrosine low, MT tryptophan high, plasma tryptophan low in major depressions; MT tryptophan high in dysthymic disorders. Phenylalanine was in the normal range compared to controls. The perturbations of MT's involved the part incubated at 37 degrees C for tyrosine, e.g. the facilitated diffusion, and the part incubated at 0 degrees C for tryptophan, e.g. probably the passive and facilitated diffusion. These results were in agreement with the monoaminergic hypothesis of affective disorders and might provide a useful peripheral model.
Adult↗