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Biomedical subjects

H Dufour

Publications and source records attributed to H Dufour.

162 records · Page 9Linked to original sources
PubMedDate not supplied

[Treatment of depression by a combination of clomipramine and triiodothyronine].

The clinical efficacy of a treatment with clomipramine (150 mg/day) associated with a daily dose of 50 micrograms of LT3 (CMI + LT3) compared to a treatment with clomipramine (150 mg/day) (CMI + placebo) for a period of 42 days has been examined in a pilot study, randomized in double-blind conditions, including 20 patients with a normal thyroid status, but presenting a major depressive syndrome (DSM III). The minimum including score was 30 on the Montgomery Asberg Scale (MADRS). The patients were considered as remitted when the MADRS-score was < or = 10. After 28 days of treatment, the efficacy of CMI + LT3 was found to be superior to CMI + placebo (p < 0.05). Side effects (CHESS 84) were those generally described for tricyclic antidepressants (constipation, dry mouth, lipothymia, tremor). Patients of the CMI + LT3 group experienced a slight hyperthyroidism. The determination of the plasma levels of CMI and desmethylclomipramine (DCMI) showed the presence of three non-compliant patients, but also that there was no relationship between plasma levels and clinical efficacy of the drug. Significant correlations were found between CMI and DCMI levels on day 14 compared with those of day 28 and 42, respectively. LT3 was without effect on the plasma levels of CMI and DCMI.

Adolescent↗
PubMedDate not supplied

[Treatment of resistant depression with the citalopram-lithium combination. Methodology of a double-blind multicenter study and preliminary results].

Citalopram, a new bicyclic antidepressant, is the most selective serotonin reuptake inhibitor. In a number of double-blind controlled studies, citalopram was compared to placebo and to known tricyclic antidepressants. These studies have shown their efficacy and good safety. The inefficacy of a psychotropic treatment in at least 20% of depressives has led a number of authors to propose original drug combinations and associations, like antidepressant/lithium (Li), antidepressant/sleep deprivation (agrypnia), antidepressant/ECT, or antidepressant/LT3. The aim of this investigation is to evaluate the clinical effectiveness and safety of a combined citalopram/lithium treatment in therapy-resistant patients, taking account of serotonergic functions, as tested by the fenfluramine/prolactin test, and of drug pharmacokinetics and pharmacogenetics of metabolism. DESIGN OF THE STUDY: A washout period of 3 days before initiating the treatment is included. After an open treatment phase of 28 days (D) with citalopram (20 mg D1-D3; 40 mg D4-D14; 40 or 60 mg D15-D28; concomitant medication allowed: chloral, chlorazepate), the nonresponding patients [less than 50% improvement in the total score on the 21 item-Hamilton Depression Rating Scale (HDRS)] are selected and treated with or without Li (randomized in double-blind conditions: citalopram/Li or citalopram/placebo) during the treatment (D29-D35). Thereafter, all patients included in the double-blind phase subsequently receive an open treatment with citalopram/Li for 7 days (D36-D42). The hypothesis of a relationship between serotoninergic functions in patients using the fenfluramine/prolactin test (D1) and the clinical response to citalopram (and Li) is assessed. Moreover, it is evaluated whether the pharmacogenetic status of the patients, as determined by the mephenytoin/dextromethorphan test (D0-D28), is related to the metabolism of fenfluramine and citalopram, and also to the clinical response. CLINICAL ASSESSMENT: Patients with a diagnosis of major depressive disorders according to DSM III are submitted to a clinical assessment of D1, D7, D14, D28, D35, D42: HDRS, CGI (clinical global impression), VAS (visual analog scales for self-rating of depression), HDRS (Hamilton depression rating scale, 21 items), UKU (side effects scale), and to clinical laboratory examens, as well as ECG, control of weight, pulse, blood pressure at D1, D28, D35. Fenfluramine/prolactin test: A butterfly needle is inserted in a forearm vein at 7 h 45 and is kept patent with liquemine. Samples for plasma prolactin, and d- and l-fenfluramine determinations are drawn at 8 h 15 (base line). Patients are given 60 mg fenfluramine (as a racemate) at 8 h 30. Kinetic points are determined at 9 h 30, 10 h 30, 11 h 30, 12 h 30, 13 h 30. Plasma levels of d- and l-fenfluramine are determined by gas chromatography and prolactin by IRNA. Mephenytoin/dextromethorphan test: Patients empty their bladders before the test; they are then given 25 mg dextropethorphan and 100 mg mephenytoin (as a racemate) at 8 h 00. They collect all urines during the following 8 hours. The metabolic ratio is determined by gas chromatography (metabolic ratio dextromethorphan/dextrorphan greater than 0.3 = PM (poor metabolizer); mephenytoin/4-OH-mephenytoin greater than 5.6, or mephenytoin S/R greater than 0.8 = PM). Citalopram plasma levels: Plasma levels of citalopram, desmethylcitalopram and didesmethylcitalopram are determined by gas chromatography--mass spectrometry. RESULTS OF THE PILOT STUDY. The investigation has been preceded by a pilot study including 14 patients, using the abovementioned protocol, except that all nonresponders were medicated with citalopram/Li on D28 to D42. The mean total score (n = 14) on the 21 item Hamilton scale was significantly reduced after the treatment, ie from 26.93 +/- 5.80 on D1 to 8.57 +/- 6.90 on D35 (p less than 0.001). A similar patCitalopram, a new bicyclic antidepressant, is the most selective serotonin reu

Adult↗
PubMedDate not supplied

[Patients treated for one year with tianeptine. Results at one of the centers of South-Eastern France].

Tianeptine is a new antidepressant with a tricyclic molecular structure. Its main neurochemical effect consists in an increase in serotonine re-uptake. Its efficacy as antidepressant and its good clinical safety have been confirmed in controlled trials against reference drugs. 1,231 patients with a DSM III diagnosis of major depression or dysthymic disorder were included in a long-term trial with tianeptine. 510 patients completed the one-year treatment period. The results of a subgroup of 100 patients treated in one of the centres of south-east France will be presented. 47 of these patients completed the trial. This study allowed to evaluate the therapeutic efficacy as well as the clinical safety of tianeptine during long-term prescription. Patients were treated in an open design after a 4-7 day placebo washout period. Therapeutic effects were assessed by the C.G.I. items (1 and 2), MADRS, HARS and HSCL. For the evaluation of clinical and paraclinical safety, spontaneous complaints of the patients and CGI-3 were documented; body weight, blood pressure and blood chemistry were also measured. Homogeneity between completers and non-completers was tested before statistical analysis of the clinical effects. Results of completers were analyzed using a two-way ANOVA (time x subjects); Newman-Keuls tests were performed in the case of a significant time effect. End-point analysis was used to test the results of the total sample. Patients completing the trial had a mean MADRS baseline score of 32.8. Given high this score, the patients have to be considered genuinely depressed at inclusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[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↗
PubMedDate not supplied

[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↗
PubMedDate not supplied

[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↗
PubMedDate not supplied

[Erythrocyte membrane transport of L-tyrosine and L-tryptophan in 66 patients with depressive syndromes. Preliminary results].

The transport of Tyrosine and Tryptophan by the membrane of red blood cells has been studied in a group of 66 depressed patients (DSM-III: 27 major depressions, single episode or recurrent; 17 bipolar disorders, depressed; 22 dysthymic disorders). Anomalies were observed: tyrosine transport was decreased in the bipolar disorders and in the major depressions; tryptophan transport was increased in the major depressions and in the dysthymic disorders. These results suggest that membrane transports are disturbed in depressed syndromes, and may be related to dysfunction in the monoaminergic balance.

Adult↗
PubMedDate not supplied

[Role of carbamazepine in the treatment of endogenous psychoses. Results of an open study].

The authors report the results of an open trial which aims at specifying the clinical profile of responders to carbamazepine among a population of twenty patients aged from fifteen to seventy, suffering from endogenous, schizophrenic, affective psychoses and paranoid states according to the criteria of the ICD 9. The trial points out a proof of Kishimoto's criteria and a preferential acting of the molecule on schizo-affective psychoses and mixed affective states. The results are interpreted according to psychopathological concepts from the Vienna school that highlight the clinical profile of the responders.

Adolescent↗
PubMedDate not supplied

[Choice of antidepressive agents as a function of membrane transport (erythrocytes) of monoamine precursors (L-tyrosine and L-tryptophan)].

In a group of 66 depressed patients, the choice of the antidepressant drug was based upon the result of tyrosine and tryptophan uptake by the membrane of red blood cells. After one month of treatment, 56 subjects were improved, that is 85% of the cases. This result is discussed in comparison with the percentage of improvement described in the literature.

Antidepressive Agents↗
PubMedDate not supplied

[Note on the mixed nature, hematic and melanic, of pigmentations in phlebology].

Venous pigmentations are not only tissue deposits of extravasated haemosiderin. Histology reveals that these deposits are often accompanied by excessive melanocyte activity. This combination of various sorts of pigmentation, haematic and melanic, is also found in other non-phlebological ferric hyperchromias. The excess of iron appears to be responsible for the hypermelanosis, but the mechanism is not understood.

Biopsy↗
PubMedDate not supplied

[AMDP system and psychopathology (author's transl)].

The psychopathological scale of AMDP system is voluntary limited to descriptive aspects of psychopathology. If the term psychopathology could be considered identical to psychiatric semiology, the words signs and symptoms go above the descriptive stade: the greek name sumptôma contains sun (with) and piptein (appear), while the word sign is an intellectual deduction of observed symptoms. In the AMDP-3, the sense of evaluated symptoms results from the configurational approach, for example a factor analysis. The splitting of german psychopathological concepts in items and the evaluation of these items in relation to observable compounds bind to their configurational structure will, no doubt, permit to avoid the obstacle of a different conceptualisation of the same symptoms from one school to the other. Furthermore, the AMDP-3 scale and its manual constitute a remarkable teaching instrument for psychopathology, not always enough appreciated.

Humans↗
PubMedDate not supplied

[7 years study of erythrocyte membrane transport of monoamine precursors. 395 patients (335 depressed, 60 schizophrenic patients)].

According to the monoaminergic hypothesis of affective and schizophrenic syndromes, a perturbation of influx of precursors of monoamines such as tyrosine (TYR) and tryptophan (TRYP) into the brain might be correlated with the clinical syndromes. The measure of blood cell membrane transports of TYR and TRYP is an interesting peripheral model for the study of these syndromes. This work concerns 395 patients (335 depressed and 60 schizophrenics); 215 of depressed patients were followed after the antidepressant therapy. The transport of TYR and TRYP into erythrocytes was measured as followed: erythrocytes were incubated in plasma for 10 min. at 0 degree and 37 degrees C with radiolabeled TYR and TRYP; facilitated diffusion was calculated by subtracting from the total amount of radioactivity taken up by the cells at 37 degrees C (total uptake) that accumulated at 0 degree C (passive diffusion). The results showed that: 1) The depressive syndromes were characterised by a decrease of facilitated diffusion of TYR, an increase of facilitated diffusion of TRYP and a decrease of the index diffusion of TYR/TRYP. 2) The means of variables were different according to the diagnostic sub-groups (DSM III). In the depressions with alcoholism, the facilitated diffusions were increased compared to depressive syndromes without others diagnosis. The depressions with dementia were in intermediate position. 3) After treatment with antidepressant drugs, the biological variables improved with the clinical improvement, without complete normalization compared to controls. The patients without clinical improvement showed no change in the biological measures. 4) Patients for whom the choice of antidepressant drug was done according to the facilitated diffusions showed a 87% rate of clinical improvement, while this rate was 60% in the other patients. 5) In schizophrenic patients, the biological variables were different than in depressed or normal controls and showed a little decrease of facilitated diffusion of TYR, a marked decrease of diffusion of TRYP and an increased index of diffusion TYR/TRYP.

Adolescent↗
PubMedDate not supplied

[Subjective perception of the effect of neuroleptics by outpatient schizophrenic patients: a cross-sectional study].

UNLABELLED: Subjective response to neuroleptics is essential to long term observance of treatment and quality of life of patients. Numerous factors (pharmacological, relational and psychopathological) are responsible of this subjective response. Objectives of this study are: (a) to examine psychometric features of the french version of the Drug Attitude Inventory (DAI-30) [13] and (b) to explore pharmacological, relational and psychopathological factors related to this subjective response. SUBJECTS AND METHODS: 78 subjects were rated (self rated response rate 61% (n = 48)) for (a) subjective response to neuroleptics, (b) compliance, (c) therapeutic alliance, (d) symptoms (e) severity of disorder. RESULTS: Factor analysis yielded 2 main clinically relevant factors, similar to the original version: (I) global subjective response and (II) specific subjective response. Internal consistency is high. Correspondance analysis showed two important dimensions in the treatment of schizophrenic patients: (I) Recovery--aggravation, (II) Therapeutic ambition--positive or negative symptoms. CONCLUSION: French version of DAI-30 seems to have a similar structure and psychometric features as the original version. It shows concordance with the degree of compliance. Pharmacological factors are not the only factors implicated in subjective response, but are still to be identified. Limitations of our study are: (a) nonhomogenous indication for treatment, (b) small rate and degree of non compliance in our sample. Relationships between therapeutic ambition, type of symptoms and treatment outcome should be further studied.

Adult↗