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Biomedical subjects

J M Azorin

Publications and source records attributed to J M Azorin.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Cushing syndrome disclosing bronchial neuroendocrine carcinoma: value of scintigraphy with octreotide].

A 44-year-old man presenting with atypical maniac behavior and hypokaliemia was diagnosed with Cushing's syndrome and treated in emergency by bilateral adrenalectomy. Endocrine investigations were suggestive of an ectopic adrenocorticotropic (ACTH) secretion, both at baseline (mean ACTH levels = 215 pg/mL, beta-lipotropic hormone = 2329 pg/mL; molar ratio > 5) and after pharmacodynamic testing (lack of inhibition of ACTH by dexamethasone, blunted ACTH response to corticotropin releasing hormone). Ectopic ACTH secretion was investigated while pituitary ACTH secretion was suppressed by dexamethasone. A paradoxical rise of ACTH from 384 to 717 pg/mL was observed after subcutaneous administration of 500 micrograms octreotide. A right lung tumor that remained occult for 7 years was only revealed by octreotide scintigraphy, despite annual chest tomodensitometric examinations. Right inferior lung lobectomy allowed allowed for removal of a 13 mm tumor corresponding to a bronchial neuroendocrine carcinoma with positive immunostaining for ACTH. Mediastinal lymph nodes were histologically normal. Perioperative ACTH measurements, showing a more than 50% decrease from baseline at 15 minutes after tumor resection, were suggestive of complete tumor removal. This was confirmed 10 days postoperatively by undetectable ACTH levels and by a negative octreotide scintigraphy after surgery. This case report of an occult ACTH secreting bronchial neuroendocrine carcinoma illustrates the diagnostic value of octreotide scintigraphy, and the prognostic value of perioperative ACTH measurements in such cases.

ACTH Syndrome, Ectopic↗
PubMed1997

[Schizophrenia: receptors and clinical aspects].

Growing knowledge in receptors and clinical aspects of schizophrenia has led to new models of understanding. These models emphasize the role of anxious and depressive dimensions in the constitution of clinical symptomatology. A more precise evaluation of these dimensions seems necessary to try to discover more specific drugs.

Antipsychotic Agents↗
PubMed1996

Red blood cell L-tryptophan uptake in depression: kinetic analysis in untreated depressed patients and healthy volunteers.

Kinetic parameters (Vmax and K(m)) of L-tryptophan (TRP) uptake into red blood cells (RBC) were measured in 72 drug-free depressed inpatients and 35 healthy volunteers. Mean Vmax and K(m) values were not significantly different between patients and volunteers. The frequency distributions of Vmax values, however, largely differed in the two groups: Vmax values were homogeneous in the volunteers while they were widely scattered in the depressed patients. Only 15 out of the 72 depressed patients (21%) had Vmax values within 1 SD from the mean control value. Forty-four percent of the patients (n = 32) had Vmax values above the control mean + 1 SD in 11 patients and above the control mean + 2 SD in 21 patients. Thirty-five depressed patients (n = 25) had Vmax values below the control mean - 1 SD in 8 patients and below the control mean - 2 SD in 17 patients. High and low K(m) values were observed in combination with high and low Vmax values. The alterations in kinetic parameters were neither associated with severity of depression nor with a specific diagnostic subtype of depression. The data show abnormalities in RBC L-TRP uptake in most depressed patients that likely reflect a disturbance in peripheral availability of TRP on which central serotonin synthesis closely depends.

Adolescent↗
PubMed1996

Elevated circulating levels of IL-6 in schizophrenia.

Schizophrenia may result from immune or inflammatory disorders, which are mediated by cytokines. Data in this field are heterogeneous and often contradictory. We investigated circulating levels of IL-6 and TNF-alpha, two distinct proinflammatory cytokines. Using immunoassay, we assessed IL-6 and TNF-alpha in serum from chronic schizophrenic patients (n = 30) and normal controls (n = 15). Circulating levels of IL-6 were higher in patients than in controls; those of TNF-alpha were not significantly higher than in controls. In addition, IL-6 levels were higher in patients with acute exacerbation of schizophrenia than in patients with remissions. Our results suggest that immunologic abnormalities in schizophrenia may be related to a specific inflammatory process mediated by IL-6. An interesting line of research would be the evaluation of IL-6 cerebral production in CSF.

Adult↗
PubMed1996

Season of birth and schizophrenia: sex difference.

1. A statistically significant increased risk of schizophrenia for individuals born in winter has been reported. The increase risk is of the order of 5-15 percent. The seasonal effect is more marked among females. This winter birth effect suggests some environmental agents, probably a neuropathogen one, acting on the foetus. 2. The present study sought to test the environmental damage hypothesis by application of the family history of psychiatric disorder distinction to season of birth data divided according to sex and using a control population. 3. From computer records, all patients admitted to the psychiatric department of Marseilles Timone hospital between January 1984 and December 1989 who satisfied DSM III, DSM III R criteria for schizophrenia were identified. Patients were then classified into two groups: family history of psychiatric disorder versus no family history. Division according to the sex was carried on after two groups were formed. 4. The data show (I) a significant excess of births in the early months of the year (p < 0.05) for all patients with no family history of psychiatric disorder, (2) a significant excess of births for females (p < 0.05) with no family history. 5. These results provide indirect support for the neurodevelopmental theory of schizophrenia.

Adult↗
PubMed1996

Antipsychotic and anxiolytic properties of risperidone, haloperidol, and methotrimeprazine in schizophrenic patients.

The subjects were 62 patients hospitalized for acute exacerbations of schizophrenia and were randomly assigned to receive risperidone (mean dose, 7.4 mg/day), haloperidol (7.6 mg/day), or methotrimeprazine (100 mg/day) for 4 weeks. Clinical improvement, defined a priori as a 20% reduction in total Positive and Negative Syndrome Scale (PANSS) scores at end point, was attained by 81% of the risperidone patients, 60% of the haloperidol patients, and 52% of the methotrimeprazine patients (p < 0.05). The reductions in total PANSS and Clinical Global Impression Scale severity scores from baseline to end point were significantly greater in the risperidone patients than in the other two groups. Reductions in scores on the Psychotic Anxiety Scale were significantly greater in the risperidone patients than the methotrimeprazine patients; the difference between haloperidol and methotrimeprazine was not significant. Extrapyramidal symptoms (scores on the Extrapyramidal Symptom Rating Scale) were more severe in the haloperidol patients than in the other two groups, but few differences were apparent between risperidone and methotrimeprazine patients. It is concluded that risperidone is an effective antipsychotic and anxiolytic agent in schizophrenic patients.

Adolescent↗
PubMed1995

Stimulus preprocessing and response selection in depression: a reaction time study.

Depressed subjects are slower than normal controls in reaction time (RT) tasks. However, it is not clear whether depression affects all stages of information-processing or only some of them. In the present study, this question was addressed by using the additive factor method. Ten inpatients and ten control subjects performed a two-choice visual RT task. Stimulus intensity and stimulus-response compatibility were manipulated. The effect of intensity was similar in both groups whereas the effect of compatibility was larger for the patients than for the controls. This suggests that stimulus preprocessing is unaffected by depression whilst response selection is impaired.

Adult↗
PubMed1995

Decrease in red blood cell L-tryptophan uptake in schizophrenic patients: possible link with loss of impulse control.

1. Kinetic parameters of erythrocyte L-tryptophan (TRP) uptake (Vmax, maximal velocity and Km, Michaelis constant) were determined in 19 neuroleptic-free schizophrenic patients and in 19 healthy volunteers. Both Vmax and Km values were significantly lower in schizophrenic patients than in controls. 2. Mean Vmax value was found to be lower in patients who had attempted suicide than in patients who had not. No difference was observed when patients were subdivided on the basis of the violence of suicide attempts. 3. A significant negative correlation was observed between Vmax and scores on the loss of impulse control item as assessed on the PANS scale. 4. Decrease in red blood cell L-TRP uptake reflects a disturbance in the peripheral metabolism of TRP that may result in a deficiency of the plasma L-TRP availability on which the central serotonin (5HT) synthesis closely depends. 5. In addition, the results suggest that the alteration in RBC L-TRP uptake is associated with loss of impulse control in schizophrenic patients.

Adult↗
PubMed1995

Long-term treatment of mood disorders in schizophrenia.

Mood disorders in schizophrenia are common and are associated with a poor outcome, an increased risk of relapse and a high rate of suicide. Consequently, treatment strategies need to take mood disorders into account. In depressed and actively psychotic schizophrenic and schizoaffective patients, treatment with neuroleptic plus antidepressant may be less effective than neuroleptic alone. However, patients with post-psychotic depression on maintenance neuroleptics respond well to tricyclic antidepressants. Mood disorders can be caused by neuroleptics and if so will often improve if the dose is reduced or if the drug is changed. Anticholinergics may also help. In schizoaffective disorder, lithium is usually beneficial, especially for patients with classical affective disorder. Carbamazepine may be more effective in patients with schizoaffective and schizophreniform disorders. At doses comparable with those effective in schizophrenia, clozapine may be as good or better than conventional neuroleptics in schizophrenic patients with psychotic mood disorder or schizoaffective disorder. In patients with high BPRS anxiety/depression scores, risperidone (8 mg/day) was more effective than haloperidol (10 mg/day). Risperidone at a mean dose of 8.6 mg/day was also more effective than haloperidol (mean dose 9.2 mg/day) or levomepromazine (methotrimeprazine -- mean dose 125 mg/day) on the Psychotic Anxiety Scale. Mood-related symptoms are therefore amenable to treatment. Risperidone and clozapine appear to be good candidates for the long-term treatment of mood disorders in schizophrenia, although long-term, double-blind, controlled studies are needed to confirm this.

Affective Symptoms↗
PubMed1995

[Spontaneous course of depression].

The study of the spontaneous course of depressions nowadays comes up against a number of obstacles. The most important of these is the necessity of using untreated cases, which virtually forces the contemporary researcher to refer to studies performed in the pretherapeutic era, if conclusions are not be drawn only from classical descriptions. Unfortunately, these studies are marked by the absence of strict diagnostic criteria, the heterogeneity of patients included in them, the lack of preciseness of evaluations and the primitive statistical methods used. They are concerned essentially with the duration of depressive phases and the factors which influence it. Among these latter are regularly found age, sex, the number of episodes, the duration of the preceding symptom-free interval, the severity and semiology of the attack, heredity, mode of onset, level of intelligence, the presence or absence of associated pathology and the presence or absence of hospitalisation. Chronicization of depression and the factors concerned with it have also been the object of several studies. A small number of investigations compare the course of the illness in untreated populations. The study of the spontaneous course of depression evidences the necessity of having consensus definitions, and may serve as a basis for a better comprehension of the process of cure and of the real impact of therapies designed to treat depression.

Adult↗
PubMed1995

[New neuroleptic agents and new models for psychoses].

Atypical neuroleptics can be defined as dopamine receptor blockers which differ from typical neuroleptics in that they have a markedly lower or absent propensity for the induction of parkinsonian side effects or tardive dyskinesias. The authors are studying varied molecules considering their mechanism of action. The differences between atypical and typical neuroleptics may relate to regional specificity in site of actions and receptor binding profile. The authors insist on clozapine, which is a D2 antagonist and in which many other systems might be involved. New neural models may help understand these interactions. The Swerdlow and Koob's model is a unified hypothesis of cortico-striato-pallido-thalamic function which can explain psychoses, depression, dyskinesias and Parkinsonian disorders. The authors make a linkage between this model and Davis's hypothesis. This author hypothesizes that schizophrenia is characterized by abnormally low prefrontal dopamine activity leading to excessive dopamine activity in mesolimbic dopamine neurons, that explains the both negative and positive symptoms coexistence. For the authors, new ways are then opened for an integrative conception of psychosis and affective disorders. This conception might be integrated into the bio-psycho-social model based on chaotics, evocation of which is the author's conclusion.

Antipsychotic Agents↗
PubMed1995

[Rapidly cycling bipolar disorders].

Rapid cyclers are defined by the occurrence of four or more mood episodes during the previous 12 months. Clinical, epidemiological and population characteristics of these patients are presented as well as studies that validate them. Hypotheses and theoretical models allowing their analysis are reviewed. The last part of the paper deals with treatments.

Bipolar Disorder↗
PubMed1995

[Management of somatization in depression].

Management of somatization in depression depends on understanding its mechanisms. This kind of somatization is the product of both specific and nonspecific factors which interact to create a chronic and hypocondriacal picture. Biological treatment looks like treatment of chronic depression. Antidepressants with anxiolytic properties have a place of choice. Psychotherapy is frequently used, particularly cognitive behavior therapy which allows the reattribution of somatic symptoms to psychological events. General practitioners need to be trained to these techniques as they are, more frequently than psychiatrists, involved in the management of these patients.

Antidepressive Agents↗
PubMed1994

Relation between lymphocyte beta-adrenergic responsivity and the severity of depressive disorders.

Basal level and isoproterenol-induced response of cyclic adenosine monophosphate (cAMP) were determined in mononuclear leucocytes from 17 drug-free patients with major depressive (n = 9) or dysthymic disorders (n = 8) and 20 normal controls. No significant difference was observed between basal cAMP levels from depressed and control subjects. The cAMP production in response to maximal stimulation by isoproterenol (ISO), a beta-agonist, was significantly lower (-34.7%) in depressed patients than in controls, and was significantly negatively correlated to the severity of the depression as assessed by the Hamilton depression rating scale score (r = -0.62; p < 0.003). When the depressed group was subdivided on the basis of the DSM-III-R (APA 1987) diagnosis criteria into major depressive and dysthymic disorders, the ISO-stimulated cAMP levels in the two groups were indistinguishable. When evaluated at the same time than the density of beta-adrenoreceptors in eight depressed patients, the ISO-stimulated cAMP levels were highly significantly correlated with the Bmax values (r = 0.89; p < 0.003). The results indicate that the decrease in beta-adrenergic responsiveness of mononuclear leukocytes can be present in depressed patients whatever the nosographical subtype of the depressive disorder and is quantitatively related to the depression severity. Based on these data, it seems that the blunted beta-adrenergic sensitivity observed in mononuclear leukocytes (MNL) cells of depressed patients is closely associated with a loss of beta-adrenoceptors.

Adult↗
PubMed1994

Lack of association between platelet tritiated imipramine binding and clinical status of depressed patients on chronic antidepressant treatment.

Platelet tritiated imipramine binding (Bmax) was studied in 33 depressed patients, before and after 1 and 4 weeks of antidepressant treatment, and in 34 healthy volunteers. The Bmax was significantly lower (-21%) in drug-free depressed patients than in controls and increased significantly as early as the first week of treatment to reach the control value, in parallel with a 38% decrease in the Hamilton depression rating scale (HDRS) score. After 4 weeks of treatment, the Bmax was still normal and remained significantly higher than the baseline value, while the clinical state of the patients had greatly improved (a 63% decrease in the HDRS score). However, an increase in the Bmax also occurred in non-responders to treatment. In addition, we observed that the ability of the treatment to increase the Bmax depended on the pharmacological profile of the drug used. The present results show that, in patients on antidepressant medication, platelet tritiated imipramine binding normalization cannot be considered as a marker of clinical remission.

Adult↗
PubMed1994

[Clinical aspects of depression in the psychotic patient].

In order to study clinical aspects of depression in psychotic patients, it is necessary to first differentiate between the following states, as a function of the currently accepted international classification of mental disorders: 1) depressions correlated with psychotic symptomatology (delirium, hallucinations); 2) psychotic disorders with depressive symptomatology; 3) schizo-affective disorders. The greatest interest is currently in the assessment of the second category, in particular study of depression in schizophrenics. This is due to a number of factors, including the relatively great frequency of the disorder, its differential significance as a function of the time in the natural history of the disease, as well as prognostic and therapeutic implications. Proper clinical evaluation is thus important. Until the last few years, this evaluation was based primarily upon use of depression scales or factorial scores, either from general psychopathology scales or specific schizophrenia scales. A number of empirical studies have recently cast some doubt upon validity of these scales for evaluation of depression in psychotic patients, and more specific instruments such as the Calgary Depression Scale (CDS) and the Psychotic Depression Scale (PDS) have been developed. The first validation studies with these scales open up an interesting perspective, in particular for the evaluation of the effects of neuroleptics.

Depressive Disorder↗