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Biomedical subjects

G Bertschy

Publications and source records attributed to G Bertschy.

At least 73 records · Page 4Linked to original sources
PubMed1988

Valpromide increases the plasma concentrations of amitriptyline and its metabolite nortriptyline in depressive patients.

The effects of valpromide on amitriptyline (AMT) and nortriptyline (NT) plasma levels were examined in 20 depressed inpatients. They all were treated with AMT, 125 mg once daily, and 10 patients also received 600 mg of valpromide daily after 10 days on AMT. In the 10 patients receiving valpromide in addition to AMT, the mean AMT level increased from 70.5 +/- 35 to 105.5 +/- 49 ng/ml (p less than 0.0003) and the mean NT level from 61.0 +/- 34 to 100.5 +/- 65 ng/ml (p less than 0.01). This increase was not related to valpromide metabolite plasma levels, nor to the age of the patients. The addition of valpromide to a stable AMT regimen may result in an increase of antidepressant plasma level with clinical implications.

Adult↗
PubMedDate not supplied

[Consumption of benzodiazepines in a university hospital center].

Benzodiazepine consumption has been studied in an inpatient population of a hospitalo-universitary center. The different user wards were classified by their cost or the importance of their benzodiazepine use. In a second step, the authors studied the prescription in the 6 most consumer medical wards. The most prescribed benzodiazepines were lorazepam and dipotassium clorazepate (27 and 23% respectively). In these six wards, on the day of the study, 48% of the 227 inpatients were taking benzodiazepines. Fourteen out of them were taking more than one of these drugs. In 80% of the cases, the patient was asking for the prescription. Out of the 110 inpatients found to have taken a benzodiazepine on the day of the study, 74 had already regularly used it during the years before hospital admission, mainly women (64%) and old people. Finally, out of the 227 inpatients studied, the hospitalization is a possible inducer of the benzodiazepine intake and dependence in 16% of the patients. The results are discussed against the background of other studies concerning benzodiazepine consumption.

Adult↗
PubMedDate not supplied

[Translation and validation of a French version of the Young Mania Rating Scale (YMRS)].

Both the Young Mania Rating Scale (YMRS) and the Mania Assessment Scale (MAS) have been widely used during the last decade for the evaluation of severity of mania in clinical trials. For both scales good inter-rater reliability, validity and sensitivity to change have been reported. The French version of the MAS has been validated. To our know-ledge, the YMRS has not yet been translated into French and validated. The main objective of the present study was to validate a French version of the YMRS and to test its use in manic patients entering a study on the effectiveness of valproic acid and olanzapine combination. After translating the items in French, we tested this version of the YMRS on two samples of psychiatric patients recruited in a ward of adult inpatients (18 to 65 Years old) at the Department of Psychiatry, Geneva University Hospital. The first sample included 18 (hypo) manic inpatients (10 males, 8 females). Mean age was 37.0 (standard deviation 10.1). Interviews were video taped and assessed by three different judges on both scales (YMRS and MAS). The second sample included 20 inpatients (5 males, 15 females) who provided written informed consent to enter a study on the association of valproic acid and olanzapine in the treatment of mania. Mean age was 40.0 (standard deviation 11.3). Patients were followed over four weeks and assessed on both scales (YMRS and MAS) every seven days (day 0, 7, 14, 21 and 28). On day 7, patients were assessed during a joint interview by two of three judges who independently administered both scales in permuted order. On days 0, 14, 21 and 28, patients were evaluated by one of the same three raters. Inter-rater reliability was assessed by comparing item scores and total scores assigned by different judges with intra-class correlation coefficient ICC (2,1). Three judges were considered for patients in sample 1. Two judges were considered for patients in sample 2 (day 7 assessment). Concurrent validity with the MAS was analysed in sample 2 on days 0, 7, 14, 21 and 28 using Spearman rank-order correlation coefficient. Sensitivity to change was assessed in sample 2 by comparing total score at inclusion and at last observation using Wilcoxon signed ranks test. For both the MAS and YMRS, intraindividual change was calculated as the difference between total scores at inclusion and discharge (last observation carried forward approach). The relationship between changes on the two scales was analysed through Spearman correlation coefficient. Significance level was set to 0.05 for each test. Ranges of YMRS total scores were 2 to 32 in sample 1 and 1 to 28 in sample 2, indicating symptom severity from euthymic to moderately manic. Inter-rater reliability was very good for the total scores in both samples, both for the MAS and the YMRS (ICC>0.89). When considering YMRS individual items, correlation coefficient varied from 0.61 to 0.96 in the first sample. In the second sample, 9 of 11 items displayed values above 0.63. The remaining two items, increased motor activity and energy and Language-thought disorder, presented modest inter-rater reliability (ICC=0.54 and 0.50 respectively). This was largely attributable to a single patient, who was perceived very differently by the two judges (scores 0-2 for increased motor activity and energy; 1-4 for Language-thought disorder). When this patient was excluded, intra-class correlation coefficients were above 0.69 for both items. Overall, inter-rater reliability of the YMRS items was in the same range as for the MAS items (0.61-0.96 vs 0.61-0.93 in sample 1; 0.50-0.93 vs 0.54-0.83 in sample 2). Correlation between the two instruments was very high and statistically significant at each weekly assessment (rs>0.91, p<0.001) except for day 21 which displayed a somewhat lower correlation (rs=0.75, p<0.01). This latter result was attributed to a reduced spread of values and number of patients on day 21. YMRS and MAS total scores as a function of time in patients receiving combined treatment with olanzapine and valproic acid (sample 2) show that for both at for both scales, total scores significantly decreased from day 0 to last observation (Wilcoxon signed ranks test, p<0.001), with median decrease of 18 points both on the YMRS (range 9-32) and MAS (range 10-33). Median relative decrease was 67% for the YMRS and 69% for the MAS. When analysing the relationship between intraindividual changes on the YMRS and MAS, highly significant correlation was observed (Spearman rs=0.93, p<0.001), showing that the two scales were virtually interchangeable in assessing treatment efficacy. In conclusion, the YMRS is a simple and easy-to-use instrument for measuring severity of manic symptoms The newly translated French version was satisfactory in terms of inter-rater reliability, concurrent validity with the MAS, and sensitivity to change in patients receiving treatment for manic symptoms. This should allow its future use for international comparison studies.

Adolescent↗
PubMedDate not supplied

[Relations between mood disorders and personality. Recent data].

In the field of studies of links between mood disorders and personality, the need to study only completely remitted patients has been demonstrated recently. Indeed, the clinically depressed state strongly influences the assessment of some personality traits in a more pathological direction (for instance for emotional stability, extraversion, interpersonal dependency, ego strength). The studies concerning unipolar depression have been mainly made according to two methodological approaches which results are relatively consistent. The first one uses batteries of standard self-report personality inventories such as the Hirschfeld and Klerman battery which includes the Guilford-Zimmerman Temperament Survey, the Interpersonal Dependency Inventory, the shortened version of the Lazare-Klerman-Armor Personality Inventory and two subscales of the MMPI. This approach shows that compared to normal population, recovered depressive, have less emotional strength more interpersonal dependency and a more introverted personality. The second approach uses diagnostic criteria of personality disorders according to DSM III. The clinical evaluation can be performed with the help of the Structured Interview for DSM III Personality Disorders (SIDP) or with of the help the Millon Clinical Multiaxial Inventory (MCMI), a self rated questionnaire. The most frequent personality disorder among recovered unipolar patients is dependent personality, followed by the avoidant and histrionic personalities and lastly the schizoïd, schizotypal, borderline, compulsive and passive-aggressive personalities. But the interpretation of all these results must be cautious given that a recent study dealing with premorbid personality invites one to consider that not only depression influences personality assessment during illness, but also that depression may result in personality change after recovery. Few studies are available concerning bipolar patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Depressive Disorder↗
PubMedDate not supplied

[The link between suicide and depression. Epidemiologic aspects].

Reviewing the literature, the authors offer a synthesis about the relations between depression and its possibly lethal outcome. The first approach of the topic is descriptive and deals with the quantification of the relations between depression and suicide. A double aspect can be distinguished. The first aspects considers depression as a cause of suicide. Using literature data, one can estimate that 60 to 70% of the subjects attempting suicide were suffering of mood disorders. Such figures are suggested by the studies offering the best methodological characteristics. The second aspect deals with the risk of suicide for depressed patients. The average annual risk is about 3/1000. Actually such a risk is mainly concentrated in the periods of active depression. Two others indices may be proposed to quantify the risk of suicide for depressed patients: the lifetime risk, which is about 15%, and the relative risk as compared with the general population not suffering from depressive disorders, which is about 30. The second approach of the topic is analytic and concerns the risk factors of suicide among depressed patients. Five groups of factors can be considered: The sociodemographic factors: depressed men are more at risk than depressed women. It is the case too for people living alone or having suffered of affective isolation during their childhood or their adolescence. Age does not seem to play a role. The nosographic factors: neither the bipolar--unipolar subtypes distinction nor the endogenous--non endogenous subtypes distinction contribute to the determination of a risk factor. Similarly, the recurrent--non recurrent subtypes distinction is not helpful.(ABSTRACT TRUNCATED AT 250 WORDS)

Bipolar Disorder↗
PubMedDate not supplied

[Yawning and sexual excitation under clomipramine. Role of serotoninergic mechanisms. Apropos of 2 cases].

We report two cases of a singular side effect induced by clomipramine, one in a man, the other in a woman (both patients were beninese). This consisted of the occurring of the association of very frequent yawning and sexual excitation (sexual excitation with vaginal lubrification for the woman and hypogastric feeling of sexual pleasure for the man). It appeared after a few days of ambulatory treatment of a depression with clomipramine 75 mg/day. Clomipramine and demethylclomipramine blood levels were respectively 85 and 95 ng/ml and 70 and 80 ng/ml for the two patients. Three similar cases had been reported in the literature with this same tricyclic antidepressant. Recently a first case has been reported with fluoxetin. On this basis, it could be suggested that serotoninergic mechanisms are involved in the development of such clinical manifestations. But it seems reasonable to consider that serotoninergic mechanism could interact with a dopaminergic one. In favour of this hypothesis is the implication of dopaminergic mechanisms in yawning in man or in the association yawning--penile erections in the rat. Some others clinical arguments are discussed.

Adult↗
PubMedDate not supplied

Debrisoquine and dextromethorphan phenotyping and antidepressant treatment.

The correlation between debrisoquine and dextromethorphan oxidation polymorphism was studied in 16 depressed in-patients. There was a close correlation between both phenotypes (r = 0.81 p less than 0.0017). During a treatment with amitriptyline during two weeks there was no significant modification of the dextromethorphan polymorphism. In the same way, the association of amitriptyline and toloxatone during two other weeks did not change this polymorphism in a significant way, even if there was a non significant shift towards higher values of the dextromethorphan metabolic ratio.

Adult↗
PubMedDate not supplied

[Valpromide-amitriptyline interaction. Increase in the bioavailability of amitriptyline and nortriptyline caused by valpromide].

Valpromide is largely used in the therapy of affective disorders for its presumed thymoregulating activity. So, it is often associated with tricyclic antidepressant treatment. Previous clinical studies lead us to consider the possibility of an interaction between valpromide and tricyclic antidepressants, interaction which could result in an increase of antidepressant plasma concentrations. But no pharmacokinetic study has been realized up to now in order to clearly demonstrate such a phenomenon. The authors studied amitriptyline and nortriptyline plasma levels in two groups of ten patients receiving 125 mg amitriptyline, once a day, during 20 days. In the second group, patients also received 600 mg valpromide daily after ten days on amitriptyline. In the first group amitriptyline and nortriptyline plasma concentrations remained stable between the tenth and the twentieth day. In the second group, addition of valpromide resulted in a significant increase of antidepressant plasma levels: from 70.5 +/- 35 to 105.5 +/- 49 ng/ml (p less than 0.0003) for amitriptyline, and from 61.0 +/- 34 to 100.5 +/- 65 ng/ml (p less than 0.01) for nortriptyline.

Amitriptyline↗
PubMedDate not supplied

[Amineptin dependence. Detection of patients at risk. Report of 8 cases].

The authors relate eight cases of amineptine dependency collected between 1980 and 1988 in 7 women and 1 man treated in the CHU of Besançon (France). The pharmacodependency appeared to be limited mainly to an abuse and a psychic dependence, i.e. a compulsive need to use the drug on a periodic (two cases) or continuing (six cases) basis in order to experience its psychomotor stimulant like effect. The used dosages ranged between 1,000 and 2,500 mg per day. The daily dose was divided into little doses, every hour for example. The induction modality was progressive during weeks or months and a stable dose period was then encountered. In one patient only, we observed a progressive increase of the dose without stabilisation of the dose. The withdrawal of amineptine was obtained without problem except in 2 cases where we observed clinical manifestations of anxiety, psychomotor agitation or bulimia during one day. Four years after the beginning, amineptine dependence was still present in 2 patients. In 4 patients we obtained an interruption of the amineptine pharmacodependency for one to three years. We did not see again the two remaining patients. In two cases, the main diagnosis, according to DSM III, was a major personality disorder (borderline). In the six other cases the diagnosis was a bipolar affective disorder (including four cases with only hypomanic episodes only). In these six patients the main characteristic of their affective illness was the association with other psychiatric disorders, especially personality disorders, such as borderline personality in one case and atypical personality with uncontrolled behavior as the main feature, in the 5 other patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Compliance, subdosage and overdosage of antidepressive agents in the first prescription in a hospital milieu].

It is common clinical experience that depressed patients comply poorly with their treatment schedules. In a retrospective study, the authors studied the compliance with the tricyclic antidepressant treatment (TCA) in 1,023 in-patients and evaluated the frequency of the plasma levels under or above the therapeutic range, following a first prescription of TCA. To describe the adherence to the TCA regimen, the investigators have classified patients as either "compliant" or "bad compliant" on the basis of two different arbitrary dividing points: plasma levels of tertiary OR secondary amine lower than 20 ng/ml, or plasma levels of tertiary AND secondary amine lower than 20 ng/ml. The antidepressant plasma levels were measured, on steady state conditions, using a gas chromatographic method. The incidence of bad compliance ranged between about 2.5 and 10%, depending on the criteria used, the incidence of plasma levels under or above the therapeutic window ranged respectively between 26 and 54%-4 and 24%. The results from this study should encourage TCA plasma level measurements.

Antidepressive Agents↗