[Antidepressive drugs].
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Antidepressive Agents↗
Biomedical subjects
F Rouillon
Publications and source records attributed to F Rouillon.
[Genetic aspects of alcoholic behavior].
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Adoption↗
Psychopathy and nonverbal behavior in an interpersonal situation.
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Adolescent↗
[Programmes against depression].
BACKGROUND: Depressive disorders represent a major public health concern, regarding their high frequency and their important cost. Depression impair the quality of life more than any other disease, sometimes leading to suicidal ideas or behavior. Indeed, 50% of patients with severe major depression commit suicide. Numerous studies showed that depressive disorders are frequently not recognised, and regularly untreated. In France, where at least 3 millions of inhabitants are concerned, 38% of depressed patients are not using any health system. When they are asking for care, the majority of depressed patients visit their general practitioner (51%), whereas less than 10% visit a psychiatrist. Even when the diagnostic is correct, the treatment prescribed is not systematically relevant. The treatment is, for example, frequently proposed for a too short period, and sometimes the prescribed product does not have proven antidepressive efficacy. Furthermore, as incorrect informations are frequently given to patients, and as there is a general biased judgement about psychotropic drugs in the general population, the compliance is usually poor for antidepressive treatment. Therefore, only a small minority of depressed patients benefits from an adequate care. Public health information methodological asserts. To improve this situation, delivering simple and clear-cut recommendations cannot be considered as sufficiently effective, and public health interventions are required. Different programs improving the recognition of depressive disorders have already been tested in some countries with encouraging results. These programs are based on information campaigns given to the public, and the training of general practitioners about the management of depressive disorders. The "Defeat Depression" campaign in Great-Britain and the "National Depression Screening Day" in the United-States of America may represent informative examples. Restricting these programs to general practitioners only is frequently criticized, as this may reduce efficacy. A multilevel approach is crucial for the success of action programmes against depression, because synergistic effects can be expected. In Germany, the "Nürnberger Bündnis gegen Depression" project was based on four levels, and effectively reduced the suicide rate. These levels of action included "cooperation with GPs", such as training sessions based on video, and presence of a phone hotline, "public relations activities", "training sessions for multipliers", such as priests, social workers and media, and "special offers for high risk groups and self-help activities". In France, such a program is clearly required.
Antidepressive Agents↗
Sulpiride in the treatment of somatoform disorders: results of a European observational study to characterize the responder profile.
An open, observational study was conducted in five European countries to obtain information concerning the profile of patients responding to sulpiride. A total of 1,356 patients were evaluable for analysis. The majority of patients (81.1%) had at least three principal somatic complaints; asthenia being the most common, followed by dizziness and headache. Most patients (76.0%) were rated as moderately to extremely ill according to the Clinical Global Impression (CGI) severity score. All patients received oral sulpiride for 3-6 weeks (mean dose, 175 mg/day). Sulpiride demonstrated good efficacy as shown by a reduction in the incidence and severity of somatic complaints, and an improvement in CGI severity score and the Hopkins Symptom Checklist--58 items. Based on a CGI rating of very much or much improved, 58.2% of patients were rated as responders. Sulpiride was well tolerated. There were no serious adverse events and only 16 patients (1.2%) were withdrawn prematurely from the study due to adverse events. There were no differences between the countries regarding the patients' profile or their response to sulpiride. Thus, the prescription profile of sulpiride appears not to be culturally dependent.
Adolescent↗
[The tolerability and efficacy of combined antidepressant therapy: literature review].
There are many pharmacological strategies in order to manage depressed patients with treatment resistance. Combined antidepressants therapy is currently prescribed, mostly for depressions which resist to a single antidepressant, or to another therapeutic, such as electric-convulsive-therapy. Combined treatments are usually considered to have a more rapid action than monotherapy, although mainly is based on personal experience. It is generally admitted that the better efficacy of combined antidepressants therapy with different biochemical characteristics is explained by the synergic action of both norepinephrine and serotonin systems. The combination treatment of MAOI and tricyclic agents has been widely studied, sometimes on hundreds of patients. Numerous studies showed a good efficacy, and the toxicity of such an association was exaggerated, thus they are nevertheless rarely prescribed. As reversible MAOI-A are now available, combination treatment with tricyclic antidepressants is theoretically safer. The combination treatment of SSRI and tricyclic antidepressants is more frequently reported in the recent literature. Studies analysing such an association are however insufficient, and cannot lead to any clear conclusion. The combined treatment of mianserin and tricyclic antidepressants have also been quoted, with an efficacy that has been confirmed on randomized placebo-controlled studies. Resistant depressions are the main indication for combined antidepressants therapy. Anxious disorders have recently been considered as interesting new indications, such as panic disorder or obsessive compulsive disorder, with or without a comorbid mood disorder. In conclusion, controlled studies devoted to the analysis of combined antidepressants therapy are relatively few, and do not allow to draw any conclusion about their efficacy. Nevertheless, as this type of prescription is frequent, scientific evaluation of their specific efficacy is needed.
Antidepressive Agents, Tricyclic↗
[Efficacy and withdrawal of clobazam, lorazepam and buspirone in the treatment of anxiety disorders].
This multicentre study was conducted to evaluate the efficacy and consequences of progressive or abrupt withdrawal of clobazam in the treatment of Generalized Anxiety Disorder in a double blind study in comparison to lorazepam and buspirone. 128 outpatients suffering from Generalized Anxiety Disorder according to DMS III criteria were included in the study and treated for three weeks. They were randomly divided into 4 groups: group 1: 32 patients receiving clobazam, abruptly withdrawn and replaced by a placebo; group 2: 29 patients receiving clobazam with progressive withdrawal over 3 weeks, clobazam being replaced by a placebo; group 3: 33 patients receiving lorazepam with progressive withdrawal over 3 weeks, lorazepam being replaced by a placebo; group 4: 34 patients receiving buspirone, abruptly withdrawn and replaced by a placebo. The dosages were increased progressively during the first week of treatment. At the end of this time, the patients received either 30 mg clobazam or 30 mg buspirone or 3 mg lorazepam daily. After the first week, the Hamilton Anxiety Rating Scale (HARS) showed a significant improvement in clobazam and lorazepam groups but not in buspirone group. All the drugs were equally effective after three weeks of treatment. The anti-anxiety activity persisted after withdrawal of the studied drug in the 4 groups, without any signs of rebound anxiety or withdrawal syndrome. No clinically relevant differences were found between the 4 groups regarding safety. The side-effects reported were mainly drowsiness in clobazam and lorazepam groups, nausea and headache in buspirone group. In conclusion, clobazam like lorazepam improved anxiety more quickly than buspirone; after 3 weeks of therapy, efficacy was comparable with the 3 drugs and persisted after treatment discontinuation.
Adolescent↗
[What information do patients with schizophrenia have about their illness and treatment?].
Improved compliance with antipsychotic medication is a major issue in schizophrenic management. For this purpose educational programs have been used, but up to now, little or no information has been gathered or published in France concerning schizophrenic patients' opinion on information they have about their disease and their treatment. Thus we conducted a survey in concert with 78 psychiatrists from the French psychiatric health service. From this cross sectional survey we assessed 336 outpatients (male: 72%; mean age: 36 +/- 10.4 years) with schizophrenia according to the DSM IV (paranoid sub type: 57%, disorganized: 12%, catatonic: 1%, undifferentiated: 12%, residual: 18%). The mean duration of the illness was 11.6 years (sd: 8.5) and the mean duration of the follow up with the same psychiatrist was 5.4 years (sd: 5.1). Patients completed a questionnaire which assessed their level of information on mental illness and treatment. The diagnosis of schizophrenia has been told to their patients by 39% of the psychiatrists, and treatment has been explained to the patients by 96% of the practitioners. Results indicate less than half of the patients (45%) felt ill, only 46% thought they knew their illness well or very well (nevertheless only 31% of them named spontaneously the diagnosis of schizophrenia or psychosis), and 61% considered that they had been given sufficient information. Most of the patients (79%) were persuaded that their treatment was useful, and 75% of patient were completely satisfied with their treatment. Surprisingly 92% reported taking their medication regularly. Most patients think that a high level of information about their illness (74%) and treatment (79%) help them to cope better with their schizophrenia. Analysis performed according to patients characteristics indicated that paranoid patients felt more ill (p = 0.035) than others, thought to know less about their illness (p = 0.0065), and were less satisfied with their treatment (p = 0.04) and their level of information (p = 0.03). Patients with a duration of their illness longer than 10 years were more convinced of the utility of their treatment (p = 0.02) and had debated more on the choice of their treatment with their psychiatrist (p = 0.047). Patients older than 35 years were more satisfied with their information (p = 0.002). More patients with atypical antipsychotics accepted to take their treatment on a regular basis (p = 0.035) compared to patients under classical neuroleptics. This survey underlines that mental health consumers' opinions can be obtained even in the field of schizophrenia, and argues in favour of further such investigations. It also highlights the need for educational programs on schizophrenia and antipsychotic medications.
Adaptation, Psychological↗
[Cross-sectional study of the prevalence of adjustment disorder with anxiety in general practice].
Although Adjustment Disorder (AD) is considered a marginal diagnostic category by many clinicians and researchers, all the rare studies undertaken in the last decades indicate that the prevalence of this disorder is high in psychiatric settings, but has never been investigated in general practice. The purpose of this study was to evaluate the current prevalence of Adjustment Disorders With Anxiety (ADWA) in primary care settings and to describe the characteristics of the population, nature of the stressors and management of the disorder by General Practitioners (GPs). This French study involved 78 random liberal GPs, in 7 distinct regions (Paris, Lille, Bordeaux, Rouen, Dijon, Castres and Compiègne). GPs had to register all the consecutive attenders over 18 years old. For each physician, the registration period was over when 200 patients were registered, or 10 days of consultation were completed, or when 5 MINI had been performed. The average study period was 10 days per physician. At the first stage, they selected all the patients with psychological complaints, which were eventually associated to physical complaints. At the second stage, only the patients whose complaints were linked to a psychosocial stressor and without A1 and/or A2 DSM IV criteria for a Major Depressive Episode (MDE) were proposed the Mini International Neuropsychiatric Interview (MINI). The MINI is a brief structured clinical diagnostic interview that identifies the main axis-I DSM IV diagnoses in about 15 minutes. Before starting the study, all of the GPs participated in an intensive course on AD criteria recognition and were trained to use the MINI. The GPs registered a total of 7,759 consecutive patients. Twenty-two per cent (n = 1,719) of the patients reported psychological complaints, associated or not to physical complaints. Among them, 49% (n = 844) linked their complaints to identifiable psychosocial stressors. About half of the latter (n = 450) coded positive to A1 and/or A2 criteria for MDE. At the end, a total of 314 patients agreed to complete the MINI. Among the 1,719 patients with psychological complaints, the prevalence of ADWA eventually associated to other psychiatric disorders was 9.2%. The prevalence of "pure" ADWA was 4.5%. When considering the whole population of consecutive patients in primary care settings, the prevalence of pure ADWA was 1.0%. Patients suffering from pure ADWA were mostly women (66.7%), young patients (mean age: 42 years), with a professional activity. Patients had a psychiatric disorder history in 53.8% of the cases (mostly anxiety disorder). The main life events cited as being responsible for the disorder were work-associated problems (23.1%), followed by family illness (9.0%) and serious personal illness or accident (7.7%). The average duration of the disorder was 2.32 months. In 91% of the cases, GPs estimated that the patient required a pharmacological or psychological treatment. In most cases, they treated the patients with drug therapy (74.0%) associated with psychological support (counselling or psychotherapy, 76%). Anxiolytic agents were usually prescribed (64.9%), followed by antidepressants (10.8%) and hypnotics (8.1%). In conclusion, this first prevalence study of ADWA in general practice demonstrates that this disorder is frequent in primary care. It seems to be more present in patients who are of working age, especially women. ADWA would thus seem to preferentially affect active subjects. In most cases, GPs treat their patients with both psychological support and drug therapy. Anxiolytic is the elicited treatment of this disorder.
Adjustment Disorders↗
[Pharmaco-epidemiological study on antipsychotic drug prescription in French Psychiatry: Patient characteristics, antipsychotic treatment, and care management for schizophrenia].
UNLABELLED: In 2000, a one week national survey was conducted among 202 psychiatrists (129 participants) in France, from hospitals and clinics, private or public. The first 20 inpatients and 10 outpatients prescribed at least one antipsychotic drug (age range 18-65), were included. The diagnostic procedure was standardized with a structured interview: the Mini International Neuropsychiatric Interview (MINI). A total 2 068 patients were included, among whom 892 (43.1%) reached the criteria of schizophrenia according ICD-10. We present here data on these latter patients. Mean age was 38.8 years; with 38.8% females. Median duration of current antipsychotic treatment was 0.5 year in inpatients and 2 years in outpatients. Median duration of any antipsychotic treatment was 10 years, without difference between groups. Comorbid situations (anxiety disorder, depression and suicidal risk) were found in 33.1% of schizophrenic patients, with higher frequency among inpatients in private hospitals (54.8%) than in other groups. 46.8% patients were prescribed at least 2 neuroleptics, and 73.6% at least one non-neuroleptic drugs. Cyamemazine accounted for 16.6% of all neuroleptics drugs, and 56% of patients were prescribed an atypical antipsychotic (risperidone, olanzapine, amisulpride or clozapine). Atypical drugs accounted for 59.4% of patients who were prescribed only one neuroleptic drug. Inpatients had more neuroleptics coprescription than outpatients (mean 1.8 vs 1.4 drugs), with higher daily dose. In addition, inpatients had more other psychotropics prescribed (mean 1.5 vs 1.1 drugs). Overall, more other psychotropic drugs were prescribed among patients with -, than those without - comorbid situations (1.7 vs 1.2 drugs). Median time since admission, at the time of the study, were similar in private and public hospitals (107 vs 99 days) but maximal time since admission was respectively 2.8 and 48.9 years. Visit frequency for outpatients was more than one every two weeks for 43.1% in private and 24.7% in public clinics. Among inpatients only we found a difference between private and public hospitals for polypharmacy of non neuroleptics psychotropics, (mean 1.9 vs 1.5). In outpatients, long acting depot accounted for 26.6% of neuroleptics treatments in public clinics and 15.4% in private clinics. Finally, we found that polypharmacy among outpatients increased with duration of antipsychotic treatment. CONCLUSION: in France, important differences are reported in antipsychotic prescription for schizophrenia between in- and outpatients. Current antipsychotic prescription is more recent in inpatients than in outpatients, with similar duration of overall antipsychotic treatment. Inpatients have more drug prescription, antipsychotics and other psychotropics, than outpatients. Differences are less important between private and public providers. Inpatients in private hospitals receive more non neuroleptic drugs than in public hospitals, and depot antipsychotics are more used among patients of public clinics. Long term inpatients are found in public hospitals only. Outpatients follow up is more intensive in private than in public clinics.
Adolescent↗
[Cognition disorders and psychotic states].
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Antipsychotic Agents↗
[Epidemiologic survey of psychiatric disorders in specialized consultation].
UNLABELLED: This epidemiological survey was performed with 317 clinicians of each structure of care (hospital, private practice...), randomly selected among french psychiatrists. During one day of a week, in January or June, all outpatients completed a self-questionnaire regarding sociodemographic data, previous and actual symptoms and for some of them randomly selected, the clinicians filled in a semi-standardized evaluation form and had to give the complete diagnosis according to the DSM III-R criteria. 2686 outpatients have completed the self-questionnaire and for 1568 (51%), the diagnosis DSM III-R was given. The mean age was 41.3; most of patients were females (59.2%), married (50.5%), urban (77.2%), employees (25.2%). The most frequent main diagnoses were: mood disorders (26%), schizophrenia (19.5%) and generalized anxiety (15%); in 47% of the cases, a second diagnosis was given. There was no significant difference between the 2 periods of evaluation. IN CONCLUSION: among psychiatric outpatients, the proportion of depression and anxiety disorders is nearly the same as in the total psychiatric population; in contrast, schizophrenia is more frequent, and alcohol or drug abuse less frequent.
Adult↗
[[Prospects and evolution in the management of the manic patient. Introduction].
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Antimanic Agents↗
[Diogenes syndrome: a diagnostic approach].
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Cognition Disorders↗
[Changes in urinary levels of MHPG, VMA and 5-HIAA and plasma tryptophan in post-partum blues. Initial results].
In post-partum depressive illness ("post-partum blue") we measured urinary MHPG, VMA, 5-HIAA and free and total Trp. VMA and especially MHPG reflect the brain noradrenaline metabolism. Trp is the precursor of 5-HT synthesis and 5-HIAA is the main urinary catabolite of 5-HT. The clinical evaluation consisted in self-evaluation scales: Pitt scale 1, 3 and 5 days after delivery, CESD scale of NIMH (depression) and BONIS scale (anxiety) at 6th day. Moreover a psychiatrist measured depression intensity on the MADRS scale and DSM III data. First results seem to indicate a decrease of free MHPG and VMA, an increase of 5-HIAA and no alteration of free and total Trp. These modifications could involve adrenergic and serotoninergic alterations in brain.
Depression↗
[Recurrence of unipolar depression and efficacy of maprotiline].
Although antidepressive treatments have been used for about thirty years, the question of their duration remains controverted. In fact, among the large number of therapeutic trials, only about fifteen control studies versus placebo, have evaluated the prophylactic advantage of a long-term antidepressive treatment. In order to complete the small number of products evaluated for this indication (imipramine, amitriptyline, zimelidine, nomifensine, fluoxetine), we have undertaken a vast multicenter study (130 psychiatrists), including 1,141 patients suffering from depression and treated with maprotiline, double-blind versus placebo, in ambulatory, for 1 year. The controlled trial was preceded with a pre-inclusion period in which 1,339 patients suffering from depression were treated, in an open study, with maprotiline at a dose of 75 to 150 mg. Only patients who were clinically improved during this preliminary study (MADRS less than 10), were included in the prophylactic evaluation phase, and divided into four groups: maprotiline 75 mg, maprotiline 1/2 tablet of 75 mg, placebo 1 tablet or placebo 1/2 tablet. The relapse was defined by a score exceeding 27 on the MADRS or exceeding 25 during two separate work-ups of 8 days or according to the experimenter's judgment. The actuarial relapse rate at 1 year was: 16% with 75 mg of maprotiline, 23.8% with 37.5 mg of maprotiline, 31.5% with one placebo tablet and 37.5% with 1/2 tablet of placebo, the difference being statistically significant between the 4 groups except for the "placebo" groups between them. In addition, the tolerance of maprotiline was satisfactory with prolonged prescription.
Adult↗
[Blood concentrations of maprotiline in depressive patients].
Blood levels of Maprotiline were analysed and their relationship to the clinical response was examined in 89 depressed inpatients, according DSM III criteria for Major Depressive Episode, given the drug treatment for 3 weeks. Maprotiline produced marked decreases in mean MADRS and COVI scale scores by the end of treatment. On day 21, no correlation between blood levels of Maprotiline and MADRS or COVI scores were found when all patients were considered. Nevertheless, significant correlations were observed on day 14 (r = .22; p less than .05 for MADRS and r = .23; p less than .05 for COVI scale). In addition, a significant correlation between MADRS or COVI scale scores and Maprotiline blood levels were observed on days 14 and 21 in subgroups of young patients, severe depression (high scores to clinical global investigations), during of at least 3 months, treated without other drug than Maprotiline and good responders.
Adult↗
[Panic disorder in general medicine. Epidemiological data and treatment with clomipramine].
Fifty-six general practitioners, experienced in the use of diagnostic criteria from DSM III for affective and anxiety disorders, have taken part in a study involving 352 patients, 92 males (26%) and 260 females (74%) with an average age of 38.6 +/- 13.5. The epidemiologic part of this work consists in a case-control comparison of socio-demographic characteristics among subjects with panic disturbance and others unaffected with it. It allows to conclude that panic disturbance is two times more frequent in women than in men and most often in young people. The results of the therapeutic with Clomipramine at low dosage (40 mg) objective a complete removal of panic attacks in 21.5% and 64% of patients after a respectively 15 days treatment. Other criteria of evaluation (Hamilton Depression Rating scale--HDRS), Montgomery and Asberg Depression Scale--MADRS--, clinician's global assessment) evolve favorably also. It is however interesting to note that though it is not in originally more depressed patients that panic disturbance is most improved by treatment, there is on the other hand a correlation between scores from MADRS and HDRS and the number of panic attacks under treatment. These results corroborate the hypothesis that Clomipramine can be effective at low dosage in some patients with panic disturbance--here, slightly less than 2/3 of the cases--while for other patients higher dosages are necessary.
Adult↗