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J Dalery

Publications and source records attributed to J Dalery.

At least 73 records · Page 4Linked to original sources
PubMedDate not supplied

Drug extrapyramidal side-effects or not: is there a dextromethorphan phenotype difference?

A recent hypothesis suggests the possible role of cytochrome P450 2D6 (CYP2D6) polymorphism (involved in the metabolism of a large number of drugs), as a potential risk factor for the development of extrapyramidal side-effects of psychotropic drugs. The CYP2D6 metabolizer phenotype (dextromethorphan test) of 31 drug treated psychiatric adult patients suffering from extrapyramidal side-effects (group 1) and of 31 matched patients without drug side effects (group 2) were compared. In the first group, 13 poor metabolizer patients (41.9 per cent) were found, characterized by a dextromethorphan metabolic ratio > 0.3, and only two patients in the second group (6.4 per cent). These data provide some support for the notion that in subjects in whom CYP2D6 is probably saturated, the risk of drug extrapyramidal side-effects may be increased. In such patients the choice of psychotropic drugs 'without' this risk must be preferred.

Adolescent↗
PubMedDate not supplied

[Validation of the French version of the Raine Schizotypal Personality Disorder Questionnaire--categorial and dimensional approach to schizotypal personality traits in a normal student population].

Most of existing self-report measures of schizotypal personality assess only few of the nine traits of Schizotypal Personality Disorder (SPD) according to DSM III-R or DSM IV. The Raine's Schizotypal Personality Questionnaire (SPQ) is one of the most widely used questionnaire for SPD diagnosis. This well adapted tool for screening SPD in large samples from general population allows simple and quick evaluations by the mean of 74 items and nine sub-scales exploring DSM IV criteria of the trouble. With the original sample of American students, Raine found SPQ to have high internal reliability (0.91) and reported cutoffs for the top and the bottom ten percents of SPQ scores at respectively 41/74 and 12/74. We reported here the validation study of the French version of the SPQ in a sample of 232 students (males: n = 107; females: n = 125; mean age: 21.17 +/- 1.47; mean educational level: 13.36 +/- 1.06). The French version has high internal reliability (SPQ total: Cronbach's alpha = 0.91; SPQ nine subscales: Cronbach's alpha = 0.57 to 0.76). The ten percent high and low cutoff scores on the distribution of SPQ scores are respectively 40/74 and 7/74 for the total sample. However, gender differences are observed: 38/74 and 9/74 for females; 42/74 and 6/74 for males. A Principal Component Analysis (PCA) confirms the high internal reliability. Moreover, PCA evidences a three-factor model of schizotypy reflecting "positive or cognitive-perceptual", "negative or social-interpersonal", and "disorganization" latent factors. These results replicate previous works on the topic with the same instrument.

Adolescent↗
PubMedDate not supplied

[Executive and amnestic functions of a group of first-degree relatives of schizophrenic patients].

Several lines of evidence seem to indicate that some neurocognitive measures could be phenotypic markers of predisposition to schizophrenia. The aim of this study was to investigate 21 patients with schizophrenia, 51 of their first-degree relatives and 46 nonpsychiatric controls, with a series of tests known to be sensitive to prefrontal cortical damage--the Trail Making Test, part B (TMT B), the Wisconsin Card Sorting Test (WCST) and a verbal fluency test (VFT)- and/or sensitive to temporo-hippocampic dysfunctions: verbal and visual memory and verbal learning tests from the Wechsler Memory Scale-Revised (Wechsler, 1987). Since parents and siblings share on average 50% of their genes with the schizophrenic proband, firstly we predicted that the first-degree relatives' performance would be at an intermediate level between patients and control subjects and secondly, we expected that a higher proportion of relatives than of control subjects would be impaired. The patients demonstrated deviant patterns of neuropsychological performance on the three tests sensitive to frontal dysfunctions and on most of the memory and learning tests. In the relative group, performance on the TMT B, VFT, immediate verbal recall and verbal learning was at an intermediate level between both other groups and significantly impaired compared to control subjects. However, the relative group did not differ from the control group on the WCST, immediate visual recall, and delayed verbal and visual recalls. Furthermore, compared to the control group, the percentages of patients and relatives who scored one standard deviation below the mean control group were significantly higher for the VFT and immediate verbal recall scores. Among all the tests studied, the verbal fluency and the immediate verbal recall appeared to be valuable phenotypic markers of schizophrenia since: (i) their mean scores were poorer in the patient and in the relative groups, (ii) the percentages of patients and relatives with poor performance were higher than the percentage of controls, (iii) these deficits were not due to poorer general intellectual abilities in the relative group, (iv) these deficits did not correlate with anxiety or depression scores.

Adult↗
PubMedDate not supplied

[Glutaminergic hypothesis of schizophrenia: clinical research studies with ketamine].

Several lines of evidence suggest that the glutamatergic N-methyl-D-aspartate (NMDA) receptor is involved in schizophrenia pathophysiology. Post-mortem studies have revealed a lower density of glutamatergic receptors in patients with schizophrenia. Other studies of cerebrospinal fluid reported lower levels of glutamate in patients with schizophrenia in healthy comparison subjects. The most compelling evidence is provided by the psychomimetic effects of the NMDA antagonists phencyclidine and ketamine. Recently, much interest has been given to the study related to the role of NMDA receptor in pathophysiology of schizophrenia by administration of sub-anesthetic doses of ketamine. A phencyclidine hydrochloride derivate, ketamine, is a dissociative anesthetic and a non competitive antagonist of the NMDA receptor. In healthy subjects, ketamine produces: 1) positive symptoms of psychosis, such as illusions, thought disorder and delusions; 2) negative symptoms similar to those associated with schizophrenia including blunted emotional responses, emotional detachment, and psychomotor retardation; 3) cognitive impairments, in particular impairments on tests of frontal cortical function including increased distractibility, reduced verbal fluency and poorer performance on the Wisconsin Card Sorting Test. During smooth pursuit eye tracking, ketamine induces nystagmus as well as abnormalities which are among the characteristics of schizophrenia. In patients with schizophrenia, the administration of ketamine produces an activation of their psychotic symptoms, which have striking similarities to symptoms of their usual psychotic episodes. Ketamine effects on memory and other cognitive functions in schizophrenic patients are controversial. The psychomimetic effects of ketamine are transitional, reversible and influenced by time, dose and administration conditions. Susceptibility to the psychotomimetic effects of ketamine is minimal or absent in children and becomes maximal in early adulthood. The similarity between ketamine effects and endogenous psychoses created interest in the capacity of antipsychotic medications to block ketamine effects. Haloperidol failed to block this ketamine-induced psychomimetic effects in healthy subjects and in schizophrenic patients. However, clozapine, the prototype of atypical antipsychotic agents significantly reduced the ketamine-induced increase in positive symptoms in schizophrenic patients. Recently, lamotrigine significantly decreased ketamine-induced positive and negative symptoms in healthy subjects. Brain regions responsible for NMDA-mediated psychosis have not been established. Using positron emission tomography and [18F] fluorodeoxyglucose, the sub-anesthetic ketamine administration produces bilateral increases in metabolic activity in the prefrontal cortex. In a [15O] H2O positron emission tomography study, ketamine selectively increases cerebral blood flow in the anterior cingulate cortex and reduces cerebral blood flow in the hippocampus and primary visual cortex. The mechanism of neuropsychiatric effects of sub-anesthetic ketamine is not clear. A dysfunction in glutamate-dopaminergic interactions has been suggested as a mechanism for these effects of ketamine. Ketamine has been reported to primarily block NMDA receptor complex giving support to a glutamate deficiency hypothesis in schizophrenia. In addition, ketamine caused increases in cortical and striatal synaptic dopamine concentrations. The effects of NMDA receptor antagonist administration are argued to support a neurobiological hypothesis of schizophrenia, which includes pathophysiology within several neurotransmitter systems, manifested in behavioral pathology. Pharmacological modulation of the effects of NMDA receptor antagonists, such as ketamine, may lead to development of novel therapeutic agents for psychiatric illnesses such as schizophrenia.

Brain↗
PubMedDate not supplied

[Study of P 300 in schizophrenia. Some reflexions on methodological difficulties].

We underscore the methodological difficulties in studying cognitive evoked potentials in schizophrenic patients. The main difficulties of such a study include the interruption of medication, the need of cooperation and immobility of subjects during the recordings, as well as of a correct patient-control matching for motivation, intellectual quotient, social and cultural levels. To establish correlations between clinical symptomatology and P 300 amplitude and latency we used both the DSM III-R and clinical rating scales. Clinical and electrophysiological testing must be performed the same day and have an excellent interrater agreement. Otherwise correlations are not reliable. Use of small patient samples is one major drawback which prevents to draw definitive conclusions. These difficulties usually unsaid are inherent to research in biological psychiatry and may partially explain the heterogeneity of results in the literature.

Electroencephalography↗
PubMedDate not supplied

[Comparative study of the efficacy and acceptability of amineptine and fluoxetine in patients with major depression].

We compare two anti-depressant drugs, amineptine and fluoxetine, in a multicentric study. Amineptine is a dopamine reuptake inhibitor, and fluoxetine a serotonin reuptake inhibitor. Eighteen french centers participate in the study. One hundred and sixty nine outpatients were randomly assigned to either 200 mg of amineptine or 20 mg of fluoxetine during 90 days. They fulfilled the DSM III-R criteria of major depressive disorder. They were aged from 18 to 70. Minor tranquilizers were allowed during the study. The patients were evaluated at D0, D7, D21, D42 and D90. If possible, an additional evaluation was made at D4. Clinical evaluations included Clinical Global Investigation (CGI), Montgomery and Asberg Depressive Rating Scale (MADRS), HARD scale, Widlocher Retardation rating scale and Hopkins Symptom Check-list (HSCL). Somatic concerns were recorded at each visit. Among the 169 patients included in the study, only 141 ended it at D90. The two drugs had good antidepressive efficacy which was noticed as soon as D7 up to D90. If we compare the antidepressant activity, no statistical differences could be observed between the two drugs using different scales. The percentage of patients with an improvement of at least 50% of the global score at MADRS was 8.3% at D7; 41% at D21, 69.2% at D42 and 83.2% at D90 for the amineptine group. For the fluoxetine group, these percentages were, 7.7%; 37.8%; 78.9%; 82.1%. No statistical differences could be noticed between the two groups, and at any time of the study. We have tried to look for a rapid antidepressive action by a clinical evaluation at D4.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[In utero exposure to benzodiazepine. Is there a risk for anal atresia with lorazepam?].

Drugs of the Benzodiazepine family are among the most frequently prescribed in France. Since anxiety disorders, for which these substances are mostly indicated, affect 10% of pregnant women, it is very likely that such a treatment could expose many foetuses to BZD during the first three Months of pregnancy. We know that the teratologic effect is not necessarily based on dose rate, but that it is associated with fetal drug exposure during the first 12 weeks of gestation, when organ formation occurs. Most epidemiologists concur that the baseline incidence of congenital damage is 2-2,5% in Europe. The results from a large number of stu-dies on associations between the use of BZDs in pregnancy and congenital malformations are conflicting. An in-depth analysis of existing literature shows results that are hardly comparable, if not contradictory, due to extreme differences in methodological approaches. In a recent meta-analysis case-control studies and cohort studies were analyzed separately. Among the case-control studies significant associations were found between BZD exposure and both, major malformations and oral clefts, whereas the cohort studies showed no association between BZD and any kind of malformation. The purpose of our study is to search for a specific teratogenic effect of this class of drugs, using data collected (1976-1997) by the French Central-East (FCE) registry of congenital malformations, member of the International Clearinghouse for Birth Defects Monitoring Systems (ICBDMS) located in Lyon, France. This registry monitor malformations among 100,000 births per Year. We analyzed 13,703 cases where information is available on whether or not the mother took a drug during her first trimester of pregnancy. Among them, 3,603 (28%) actually took a drug, and 262 (6.8%) took some sort of benzodiazepine (BDZ). BZD were divided into 9 categories, 8 being the most frequently present, plus one broad category of "others". Malformations were divided into ten categories: congenital anomalies of heart, cleft lip and/or cleft palate, neural tube defects, other anomalies of central nervous system, hypospadias, urinary malformations, anal atresia, other digestive anomalies, limb reduction defects, and genetic anomalies, including chromosome aberrations and monogenic conditions. Other malformations were grouped in an eleventh category. The interesting aspect of this study is that it takes into account the BZD metabolism. It is worth noting that the hepatic catabolism of benzodiazepine is a very complex one, because it leads to derived molecules which are sometimes active and/or present in the common metabolic route of major commercial drugs. Our hypothesis is that if one BZD is associated specifically to a certain type of congenital defect, we may find this BZD to be overrepresented, as compared with other BZDs, in newborns exhibiting some type of congenital defect. The analysis was run according to a case-control approach. Odd ratios (OR) and their 95% confidence intervals were calculated by logistic regression with adjustment for maternal age and parity. When one category of defects was considered, infants having the corresponding malformation were considered as cases, while infants with other malformations were considered as controls. In a similar way infants having being exposed to a given drug were considered as exposed, while infants exposed to any other drug were considered as unexposed. The analysis then was run in 4 steps. Step 1: full sample. With 13,703 cases. We observed no increased risk for any specific malformation type associated with use of BZD. Step 2: further defining drug exposure as a specific BZD, and all others unexposed, a significant association was seen between lorazepam and anal atresia. OR=6.2 (95% CI2.4-15.7, p=0.01). Step 3: this finding was upheld and no other emerged when exposure was defined as the drug or any of its active metabolites. This step was performed because hepatic catabolism of BDZs leads to derived molecules that are sometimes active and/or present in the common metabolic route of major marketed BZDs. Step 4: similarly, the lorazepam/anal atresia finding was upheld when the analysis was restricted to the 262 malformed infants exposed to BZDs in utero. Six cases of anal atresia were found among all newborns exposed to BZD in utero, and five of them were exposed to lorazepam, representing a hypothesis to be tested in further. We are not aware of other reports of this association, and it should be regarded as preliminary until confirmed in other data sets.

Anus, Imperforate↗
PubMedDate not supplied

[Towards a neurodevelopmental hypothesis in schizophrenia].

Since the first designation by E. Bleuler, various etiopathogenic theories have been proposed in schizophrenia. The dopaminergic hyperactivity hypothesis remains the more valid one. Recently, a neurodevelopmental hypothesis has been suggested in schizophrenia. This hypothesis postulates an early disturbance in the development of central nervous system, mainly in the temporo-limbic areas. This disturbance is not secondary to a degenerative process. It may take place during the end of the second trimester of the pregnancy and be complete at the time of puberty. Genetic and environmental factors co-occur to explain these brains developmental disturbances. This hypothesis has been formulated according to a tremendous amount of various data obtained with different methodologies. Neuropathological techniques observed a reduction in the number of cells and cyto-architectural anomalies in different brain areas such as hippocampus and para-hippocampus gyrus. The lack of associated gliosis suggests an early phenomenon developing before birth. Structural brain abnormalities have been demonstrated using various neuroimaging techniques. Computed tomographic scanning and magnetic resonance imaging reveal structural anomalies such as ventricular dilatation, and positron emission tomography functional ones such as frontal hypometabolism. These results appear to be unrelated to the severity, the duration and the treatment of the disease. More informations are needed to eventually confirm this hypothesis. Clinical, cognitive and neuropsychological data have to be completed. Longitudinal studies are urgently needed using clinical, epidemiological, genetic and neuroimaging techniques.

Central Nervous System Diseases↗
PubMedDate not supplied

[X-ray computed tomographic abnormalities in schizophrenia. Trial of relationship with clinical data].

Computerized tomography (CT-scan) studies in schizophrenia revealed that some patients have neuromorphological abnormalities. The structural changes consist mainly in lateral and third ventricle enlargement, and in cortical atrophy. The present study evaluates these three changes in 42 schizophrenics aged 18 to 50, compared to 24 healthy controls. Diagnosis were established from information gathered by personal interview with the SADS-LA. Clinical sub-types were evaluated according to the DSM III-R criteria. Moreover, detailed symptoms were rated according to the Positive And Negative Syndrome Scale (PANSS). CT scans were recorded in floppy disks and blindly analyzed. Schizophrenics shown significant higher mean size of lateral and third ventricles, and higher mean anterior cortical atrophy than healthy subjects. Significant differences were also found between subtypes, with more marked abnormalities in the disorganized group. The relationship between brain abnormalities and clinical symptoms recorded with the PANSS, were analysed using Pearson correlates. Positive correlations concerned mainly negative symptoms like blunted affect, emotional withdrawal, difficulties in abstract thinking, passive apathetic social withdrawal and lack of spontaneity of conversation. Positive correlations are also observed with some symptoms classified with the PANSS in the General Psychopathology scale such as mannerism and disorientation. Negative correlation concerned most of PANSS positive symptoms.

Adolescent↗
PubMedDate not supplied

[Seasons of birth and psychiatry. A retrospective inpatients study].

UNLABELLED: Births of schizophrenics tend to occur more often than expected during the first months of the year. This phenomenon has been repeatedly demonstrated in large samples of patients, but data from France are not yet available. METHOD. Medical records of 2,215 inpatients born in France, have been studied with DSM III-R. Admissions were unduplicated. Inpatient population is described table I. The 230 schizophrenic patients were also classified into three groups according with family history for psychotic diseases (Positive, Negative and Unknown). The year was divided in quarters, but also in two climatic half-years (Cold and Warm). Two different populations were used as controls: first, the live births data in France collected by the INSEE; and second, the 1726 non psychotic inpatients hospitalised in the same unit as the psychotics, during the same period. RESULTS. The season of birth effect can be demonstrated from our sample. When the whole schizophrenic group is compared to the INSEE data, a significant excess of births is found for the winter quarter (p less than .04) and for the cold half-year (p less than .01). In the DSM III-R disorganized patients the seasonal variation becomes significant at a level of p less than .001. The other subtypes of schizophrenia do not show significant seasonal variations (table II). The pattern of birth of the other DSM III-R diagnoses, does not significantly differ from INSEE control data (table III). Schizophrenic patients without psychiatrically ill relatives show a slight, non significant excess of births in winter which become significant for the cold half-year (p less than .03). Subjects with possible family history do not show any trend suggesting a seasonal effect (table IV). DISCUSSION. Few reports include an entire inpatient population as we have done. Such data in our study offers an element of useful comparison with the schizophrenics. Clinic data: Most of seasonal studies have used ICD-8, ICD-9 or Tsuang and Winokur criteria, to compare only paranoid and non paranoid subjects, and some of them found a very small excess of paranoid births in winter. The discrepancies between these studies and ours, can reflect both variability among environmental factors and variability in the diagnostic criteria. CONTROL DATA: Most of the subjects were born between 1920 and 1960. All live births in France for the same years could be used as controls, but unfortunately INSEE data were not available by months or quarters before 1949. But since in western and southern European general population, the season of birth appears to be relatively uniform and stable over time, it seemed possible to use the posterior INSEE data to compare with our anterior inpatients data. Familial data: We found a birth excess in the cold season, only for schizophrenics without any family history. This finding is consistent with various other reports. CONCLUSION. In conclusion, our findings are consistent with the suggestion that the season of birth is important in the aetiology of the disorganized subgroup of schizophrenic aetiology of the disorganized subgroups of schizophrenic patients. Moreover, the excess of winter births is only observed in the "negative family history" group.

Adolescent↗
PubMedDate not supplied

[Seasonal rhythm of melatonin in manic depressive patients].

Melatonin is secreted by the pineal gland with a circadian and a circannual rhythm. For some authors the circadian rhythm is modified during depressive states. The present study evaluates the melatonin circannual rhythm in five manic-depressive patients. Each patient is clinically and biologically evaluated every month during one year. The results of the present study show a lack of clinical relapse and a lack of seasonal variation of plasma melatonin level.

Adult↗
PubMedDate not supplied

[Melatonin and schizophrenia].

Many research studies have been conducted with melatonin, a pineal hormone, in psychiatry. Studies with melatonin in schizophrenic patients are rare. Blood plasma samples were drawn at 24 hours and 12 hours in 23 schizophrenic subjects and 26 controls, during the same season. Plasma melatonin levels were obtained using a specific radioimmunoassay technique. The 24 hours levels significant decreased in schizophrenic patients compared with controls (p less than 0.01). Methodology, specificity of results and concomitant study of cortisol levels are discussed.

Adult↗
PubMedDate not supplied

[Platelet serotonin concentrations in autistic children and members of their families].

Children with early infantile autism have often high platelet serotonin (5 HT) levels. According to this fact, we wondered if a genetic abnormality of 5 HT metabolism could be detected in family members of autistic children. We has thus determined platelet 5 HT levels in these children's mothers, fathers and siblings. It is noteworthy to find out that: autistic children have a mean platelet 5 HT level significantly higher than their siblings' (p less than 0.01); fathers' levels are significantly lower (-29%; p less than 0.001) than those of other family members' and of control group. Furthermore, for future purposes, we studied platelet 5 HT levels at different times during pregnancy in controls and in a woman already mother of an autistic child. We observed a raise (+31%; p less than 0.01) in platelet 5 HT during the first trimester of the pregnancy with a lowering towards normal levels during the eight month, in the woman with an autistic child as well as in the controls.

Autistic Disorder↗
PubMedDate not supplied

[Daily profiles of melatonin, cortisol and gonadotropins in 8 adolescents with anorexia nervosa].

From a biological study of 8 patients with anorexia nervosa and an analysis of the daily profiles of gonadotropins, cortisol and melatonin, the authors discuss the possible relationship between anorexia nervosa and affective disorders. At the initial phase of the illness, plasmatic levels of FSH, LH and oestradiol were very low. 24-hour plasma cortisol values were comparable with those of a depressive population; when weight loss was equal to or higher than 25% of the initial weight, there was no suppression by dexamethasone. The daily profile of melatonin was maintained, with melatonin plasma levels significatively higher than in a control group of depressed patients.

Adolescent↗
PubMedDate not supplied

[Melatonin. Chronobiologic peripheral endocrine index in depressive states].

The chronobiological studies with melatonin constitute valid arguments to consider melatonin as a peripheral index of depressive disorders. In a group of patients with major depression, we reported a lowering of melatonin nocturnal plasma levels, associated with cortisol hypersecretion. A similar lowering of melatonin was observed in a group of patients with cluster headaches, but without quantitative modification of cortisol secretion. Other studies are necessary in order to determine wether melatonin may be considered as a "state marker" of depression itself or a marker of the genetic vulnerability to depression.

Adult↗
PubMedDate not supplied

[Analysis of 94 dexamethasone tests in a population of patients manifesting depressive symptomatology within the framework of a manic-depressive psychosis or other psychotic state].

The authors report a study of 94 dexamethasone-suppression-tests conducted in a group of 29 patients with either a manic-depressive psychosis (n = 14) or a depressive symptomatology associated or not with a chronic psychotic disorder. 1 mg of dexamethasone was given orally at 11 p.m. and plasma cortisol levels were determined the following day at 4 p.m. The same day, a MADS was calculated. These tests were repeated every month for each patient independently of the clinical state. 9 patients received between 4 and 11 tests. A non suppression (cortisol plasma levels greater than or equal to 140 nmol/l) was observed in 27% of the tests. A comparable percentage was obtained in the whole group of patients and in the manic-depressive psychosis group. A good correlation appeared between plasma cortisol level at 4 p.m. and score for MADS. The study of the validity of the test shows a sensibility of 50% and a specificity of 85%. These results are similar with those presented in the literature.

Adult↗