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Biomedical subjects

M Ansseau

Publications and source records attributed to M Ansseau.

At least 181 records · Page 10Linked to original sources
PubMed1984

Methodology required to show clinical differences between benzodiazepines.

Clinical differences exist between the benzodiazepines but demonstration of such differences requires a more specialized methodology than that normally used in comparative trials. It is recommended that double-blind studies should be carried out in hospitalized patients with severe and chronic anxiety, selected according to precise criteria, and that the trials should be designed as crossover rather than as parallel group studies, with randomization of the stages and flexible dosage. A simple graphic method of representing the clinical profile of individual benzodiazepines is described and it is suggested that this could help clinicians adapt their prescribing to each patient's symptoms.

Anti-Anxiety Agents↗
PubMed1984

REM latency distribution in major depression: clinical characteristics associated with sleep onset REM periods.

In a sample of 92 inpatients with major depression, REM latency showed a unimodal, rather than bimodal, distribution, with peak frequency between 50-59 min (on each of 4 consecutive nights). A total of 20 patients (21.6%) exhibited a sleep onset REM period (SOREMP-10) i.e., REM latency less than or equal to 10 min, during at least 1 of the 4 nights; an additional 11 patients (12%) showed REM latencies of 11-20 min on at least one night. SOREMP-10 positive patients were older both at the time of study (p less than 0.01) and at the age of onset of depressive illness (p less than .01) than the rest of the sample. They also showed greater sleep continuity disturbances, while patients with at least one SOREMP-20, i.e., REM latency less than or equal to 20 min, exhibited higher REM percentage (p less than or equal to 0.05) and a higher first-period density (p less than 0.05) than the remaining patients. No other clinical or polysomnographic correlates of SOREMP positivity were noted with regard to gender, RDC subtypes, severity of illness, or clinical response to tricyclic antidepressants. The unimodal distribution of REM latency, as well as the absence of a relationship between SOREMP positivity and severity of depression or therapeutic outcome, may result from the low representation of psychotic depressives in this sample (n = 6), who might constitute a qualitatively different subgroup.

Adolescent↗
PubMed1983

Lormetazepam and amobarbital sodium in the outpatient treatment of insomnia: a controlled trial.

In a double-blind clinical trial, 50 psychiatric outpatients with moderate insomnia (requiring daily treatment with a hypnotic drug) were treated for two weeks with lormetazepam (1 mg) or amobarbital sodium (100 mg). In interviews before and after treatment, data were collected on the patients' demographic characteristics, sleep disturbances, concomitant organic or psychiatric disorders, and opinions of the drug taken during the two-week period. During the trial the patients took notes on their use of the drug, the quality and duration of their sleep, and any adverse effects of the drug they were using. Lormetazepam and amobarbital were equivalent in the amount of time it took patients receiving each drug to fall asleep and in the duration of the patients' sleep, but insomnia disappeared (or the condition improved) in a larger proportion of patients receiving lormetazepam, and there were fewer adverse effects (eg, hangover in the morning, sedation in the morning and during the day, and dry mouth) in patients receiving lormetazepam than in patients receiving amobarbital.

Adult↗
PubMedDate not supplied

Age and gender effects on the diagnostic power of the DST.

Among 365 major and 158 minor depressive inpatients, the dexamethasone suppression test (DST) yielded an overall diagnostic sensitivity of 50%, a specificity of 85%, and a confidence level of 88%. Age was significantly correlated with the post-dexamethasone cortisol levels in the whole sample (r = 0.11; P less than 0.01); however, this low relationship disappeared when all subgroups defined by gender or diagnostic were considered. Gender did not appear to influence DST results; however, among the patients between 30 and 39 years, the diagnostic performance of the DST was significantly lower among female as compared to male patients, suggesting possible interferences with endocrine variables.

Adult↗
PubMedDate not supplied

[Girls are more successful than boys at the university. Gender group differences in models integrating motivational and aggressive components correlated with Test-Anxiety].

It is surprising to note the evolution of success rates in Belgian universities especially in the first Year. Men are less successful than women and the differences are escalating in an alarming way. Dropouts take the same direction and women now represent a majority of the students at the university. In a previous study, we assessed 616 students in the first Year at the university of Liège with Vasev, the English name of which was TASTE, a self report questionnaire constituted of 4 factors: anxiety, self confidence, procrastination and performance value; anxiety particularly concerned somatic expression of students before and during test evaluations; self confidence was a cognitive component close to self efficacy; procrastination was the behavioral component characterizing avoidance when students are confronted with the risk of failure; performance value referred to intrinsic and extrinsic motivations. French validation of TASTE led to an abbreviated version of 50 items (THEE) consisting of 5 factors, the four of TASTE and an additional one, very consistent, at first called depression because of its correlations with this dimension, then called sense of competence on account of its semantic content. Self-competence has been described in the literature of Achievement Motivation and corresponded to expectancy and ability beliefs in performance process which was also relevant to self-efficacy except the particularity of comparison with others, which was not included in the last construct. Self-competence has been considered as an important part of the Worry component of test anxiety. Some Authors didn't hesitate to view causality flowing from self-competence to test anxiety and have conceptualized the latter as a failure of the self where one's sense of competence has been undermined as a result of experienced failure. In our study, only that factor was equally scored in women and men whereas it was scored higher in failed students. In other respects anxiety and performance value were scored higher in women, self-confidence and procrastination higher in men. Because TASTE didn't discriminate the different components of motivation (performance value referred to intrinsic and extrinsic motivations without precise distinction) we decided to use the MPS (Multidimensional Perfectionism Scale) which gave the opportunity to distinguish SOP (Self Oriented Perfectionism) ie, the self-imposed unrealistic standards with inability to accept faults in order to know and master a subject, that corresponded to intrinsic motivation; SPP (Socially Prescribed Perfectionism) ie, the exaggerated expectancies of others which are subjectively believed as imposed and uncontrollable leading to anxiety, feelings of failure or helplessness, that corresponded to extrinsic motivation; POO (Perfectionism Oriented to Others) ie, the unrealistic demands expected from significant others, which especially characterized males. We assumed that women attached more importance to succeed and submitted more to society exigencies. That way extrinsic and intrinsic motivations were probably more combined unlike men who, dreading a loss of self esteem, tried to avoid failure responsibility in using self handicapping or aggressive behaviours, so separating motivation in an extrinsic part turned to performance value and an intrinsic one more concerned by self confidence and sense of competence with the result that the motivational balance was surely disrupted in case of high competition leading to failure or avoidance. In another previous study we established a structural model illustrating, according to gender, correlations between anxiety, sense of incompetence, self-oriented perfectionism and socially prescribed perfectionism. Self-oriented perfectionism was less correlated to socially prescribed perfectionism in boys than in girls; furthermore especially by those who had never failed, it was negatively correlated to sense of incompetence, thus leading to lower scores of anxiety while in girls, by contrast, such a correlation didn't exist, thus involving higher anxiety. That way, on the one hand, intrinsic and extrinsic motivations by female students complementarily operated on the sense of incompetence and consequently on anxiety, the emotional component of test anxiety; on the other hand, by male students, intrinsic motivation had a negative correlation with the sense of incompetence and a lower correlation with extrinsic motivation, thereby shedding some light on the problem of anxiety level differences according to gender. More, that observation corresponded well to the model of self-worth where test anxiety was understood as a manifestation of perceived incompetence and as a defensive way to ward off negative self-evaluation; that model suited particularly well to boys and explained their attempts to maintain self-worth when risking academic failure. The present research assumes that independence or combination of motivation components is also correlated to different expressions of aggressiveness: hostility corresponding to threat and characterizing more girls while physical aggression is corresponding to personal challenge, a more masculine attribution. If fighting against the sense of incompetence actually characterizes men and consequently shows too the competitive aspects of performance strong enough to mobilize intrinsic motivation, what would be expected regarding the notion of threat suspected to be predominant in girls? The idea of using a questionnaire discriminating the specific dimensions of aggressiveness in fact the Aggression Questionnaire should meet the following purposes: At first establish a French version of that aggression questionnaire, perform the factorial analyses and internal consistency, compare them with other previous samples, then differentiate gender in general and in failure versus success situations. Finally include the different components of aggressiveness in the first described model and build a new one liable to define in boys the explicit pathways between test anxiety, perfectionism and aggressiveness. Statistical analyses have confirmed, in a 3 factor solution, the presence of emotional (anger), cognitive (hostility) and behavioural (physical aggression) components. Internal consistency is satisfactory. It is demonstrated that physical aggression characterizes boys (F=12.04, p=0.0001) while hostility (F=5.22, p=0.0015) and anger (F=0.49, p=0.0001) characterizes girls; furthermore it is noted that physical aggression characterizes more failed students (F=13.43, p=0.0003). Four models (see figures 2, 3, 4, 5) have been established, at first focused on the distinction of correlations between motivation and cognitive and emotional components on the samples of boys (n=268) and girls (348), then developed on the samples of successful students, male (n=193) and female (n=271). They describe the differentiated action of intrinsic and extrinsic motivations on the different components of aggressiveness and test-anxiety according to gender and without experience of failure. The dynamic process of the organizational factors is different according to gender and psychopathology resulting from the combinations of behaviors, cognitions and emotions would be assumed, prioritizing physical aggression and psychopathy by boys, anxiety and depression by girls. Anyway more explanation about the evolution of success rates of boys and girls in Belgian universities is proposed.

Adult↗
PubMedDate not supplied

Temperament and character inventory (TCI) and depression.

Although several studies have assessed the relationships between the temperament dimensions of the Cloninger model of personality and depression, little is known about the role played by the character dimensions proposed by the seven-factor model of Cloninger in depression. In this study, the relationships between the Temperament and Character Inventory (TCI) and depression were examined in a sample of 40 major depressive patients and 40 healthy controls. Depressed patients exhibit higher harm avoidance and self-transcendence scores as well as lower self-directedness and cooperativeness scores as compared to healthy controls. However, the three other dimensions do not differ between depressive patients and controls. Among the depressive group, harm avoidance, self-directedness and cooperativeness dimensions are related to the severity of depression as assessed by the Hamilton scale. This study confirms the state dependence of the harm avoidance dimension and suggests a relationship between the character dimensions of the Cloninger model and depression.

Adult↗
PubMedDate not supplied

Controlled comparison of two anxiolytic benzodiazepines, cloxazolam and bromazepam.

The clinical activity and the tolerance of cloxazolam (4 mg/day), a new anxiolytic benzodiazepine, was compared to bromazepam (12 mg/day) in two parallel groups of 427 and 410 psychiatric outpatients, respectively. The duration of the study was 4 weeks with clinical assessments at inclusion and after 2 and 4 weeks of therapy by the Hamilton anxiety scale and visual analogue scales. While the Hamilton anxiety scale did not exhibit significant differences between the two benzodiazepines, visual analogue scales showed significant superiority of cloxazolam over bromazepam on psychological anxiety, somatic anxiety, depressed mood, and sleep, with a lack of significant difference related to the sedative effect, but less muscle-relaxant effect with cloxazolam than with bromazepam. The better efficacy and tolerance of cloxazolam compared to bromazepam was confirmed by the global assessments using visual analogue scales; moreover, a significantly larger proportion of patients in the cloxazolam group wanted to continue the same treatment.

Adult↗
PubMedDate not supplied

Controlled comparison of buspirone and oxazepam in generalized anxiety.

The anxiolytic activity, the tolerance, and the withdrawal symptoms of buspirone and oxazepam were compared in two groups of 14 and 12 outpatients, respectively, suffering from generalized anxiety in a double-blind study with random allocation of patients. The 6-week active period was preceded and followed by 1 and 2 weeks on placebo, respectively. Clinical assessments were performed before and after the predrug placebo period and every 2 weeks thereafter and included Hamilton anxiety and depression scales and AMDP anxiety subscale. The initial daily dose was 15 mg buspirone or 45 mg oxazepam in 3 intakes and the mean final daily doses were 22.2 and 55.8 mg, respectively. Results showed a slower anxiolytic activity of buspirone compared to oxazepam with less improvement after 2 weeks of treatment. The rebound anxiety following abrupt discontinuation of the drug and the level of side effects did not significantly differ between the two compounds.

Adult↗
PubMedDate not supplied

Psychopathological correlates of dopaminergic disturbances in major depression.

In a recent report, we confirmed the role of dopamine in the pathophysiology of depression by demonstrating a blunted response of growth hormone (GH) to apomorphine, a selective dopaminergic agonist, in endogenous depressive patients. Few data are available on the possible psychopathological correlates of disturbances in the apomorphine test. In this study, we assessed the relationship between GH response to apomorphine and the Minnesota multiphasic personality inventory (MMPI) scales in a sample of 20 major depressive inpatients. The GH response (area under the curve) after apomorphine injection was positively correlated with the social introversion scale scores (r = 0.56, df = 19, p less than 0.01) and the anxiety scale scores (r = 0.45, df = 19, p = 0.04). These results suggest dopaminergic overactivity in anxious psychopathology rather than in depressive psychopathology. The relationship between the social introversion scale score and the apomorphine test is in agreement with the dopaminergic hypothesis of schizophrenic disorders.

Adult↗
PubMedDate not supplied

[Therapeutic monitoring of antidepressant drugs].

Depression is a pathology frequently observed in general medicine (10%). Treatment of depression makes great use of drugs from different pharmacological classes. The optimal posology is difficult to establish, and clinicians prefer to avoid side effects by prescribing low regimen. This study is related to an evaluation of seric antidepressant concentrations in comparison with the daily doses in a large psychiatric population. Side effects of drugs are appreciated by enzymatic determinations.

Antidepressive Agents↗
PubMedDate not supplied

[Biological markers in schizotypal and borderline personality disorders].

A preliminary but growing body of evidence supports the existence of biological substrates in personality disorders. Based on a review of the literature, the article deals with the major biological markers: genetic, cognitive, biochemical, electrophysiological and organic markers, of schizotypal and borderline personality disorders. In addition, the article compares these findings in these two types of pathological personality. In the field of genetics, we notice several indices in favour of a relationship between schizotypal personality disorder (SPD) and chronic schizophrenia. In contrast, in borderline personality disorder (BPD), indices were lacking for such a relationship between this disorder and one of the axis I diagnosis, or a clear genetic transmission. In the field of cognitive tests, we can note in both SPD and BPD, that the abnormalities which would be at the level of temporal and frontal lobes, may be implicated in the observable cognitive troubles in these two disorders. In the field of neurobiochemistry, the dopaminergic and serotonergic systems seem to be implicated in the etiology of SPD while several data point out the fact that several neurotransmitter systems (dopaminergic, serotonergic, noradrenergic and cholinergic) seem to be involved in the etiology of BPD. Finally, in the field of electrophysiology, we notice that some of these tests observed in SPD (smooth pursuit eye movements, evoked potentials, modification of the electrodermic response) seem reinforcing the relationship between SPD and schizophrenia while those observed in BPD seem reinforcing either a relationship between BPD and depression (sleep studies), or a relationship between BPD and schizophrenia (evoked potentials, smooth pursuit eye movements).

Biomarkers↗
PubMedDate not supplied

[Role of the neurohypophysis in psychological stress].

Effects of different psychological stimuli on oxytocin (OT) and vasopressin (AVP) secretion are reviewed in animals and in humans. The secretion of neuropituitary hormones is also discussed in various psychiatric diseases such an anorexia nervosa, bipolar disorder, schizophrenia and obsessive-compulsive disorder. AVP and OT are secreted into the hypophyseal portal circulation by neurons which project from the paraventricular nucleus to the external zone of the median eminence. AVP and OT-containing neurons in the suprachiasmatic and paraventricular nuclei project to limbic areas, including the hippocampus, the subiculum, the ventral nucleus of the amygdala and the nucleus of the diagonal band. Specific AVP receptors which are pharmacologically different from the pressor and antidiuretic AVP receptors have been found in the anterior pituitary. OT receptors have been identified in a variety of forebrain sites. The neurohypophyseal secretion is regulated by the cholinergic muscarinic, histaminergic and beta-adrenergic systems. Stress alters the secretion of one or more of the hypothalamic factors which interact at the pituitary to increase the secretion of ACTH. AVP and OT have been shown to modulate the effect of Corticotropin-Releasing Factor (CRF) on ACTH secretion and appear to play a key role in mediating the ACTH response to stress. Although AVP is a relatively weak secretagogue for ACTH, it markedly potentiates the activity of CRF both in vitro and in vivo. The role of OT is more complex. In vitro, OT stimulates ACTH release at high doses whereas in human it inhibits ACTH secretion at low doses. The type of stressor appear to determine the relative importance of these secretatogues in ACTH response. Several recent studies indicate that psychological stressors display a similar degree of variety of secretagogue release patterns as was found earlier for physical stressors. A bewildering array of technique produces a bewildering array of conclusions. In rats, OT may be an important secretagogue during a novel stimulus, whereas the role for AVP is less clear. Indeed two studies out of ten suggest a stimulating role for AVP. In response to frustration and submission, OT and AVP are secreted. Regarding social isolation, results are difficult to interpret and the role of AVP could be species-dependent. In contrast plasma OT levels do not change. After restraint, ACTH release is primarily mediated by the active increase of OT and AVP does not appear to play a role. When restraint is associated with moderate levels of physical components and during immobilisation, all two secretagogs are involved in the ACTH response. With fear, ACTH response appears to be driven by OT. In humans, one study indicates that high emotionality women increase plasma OT in response to uncontrollable noise. Various neuroendocrine dysregulations have been observed in psychiatric disease. Either an increase or a decrease of the hypothalamic-pituitary-adrenal (HPA) function have been described in several illnesses. Effects of OT appear to be reciprocal to the effects of AVP. OT has been called the "amnestic" neuropeptide due to its capacity to attenuate memory consolidation and retrieval. AVP exhibits a central activating action on mood, memory and selective attention. Underweight patients with anorexia nervosa have abnormally high levels of centrally directed AVP and reduced OT levels. These modifications could enhance the retention of cognitive distortions of aversive consequences of eating. Patients with bipolar disorder show a biphasic secretion of AVP. Depressive episodes are associated with decreased vasopressinergic activity whereas manic episodes involve an increased release. AVP might be responsible for an increased catecholamine activity. In addition, lithium could act as an antagonist to AVP. In schizophrenic patients, studies using the apomorphine stimulation suggest increased oxytoninergic and decreased vasopressinergic functions. These findings are consistent with the beneficial role of AVP on schizophrenic symptoms noted in several trials. The increased OT could be responsible for "positive" symptomatology such as delusions and hallucinations. Obsessive compulsive disorder (OCD) includes a range of cognitive and behavioral disturbances that could be influenced by OT. In animals, several studies have emphasized the role of AVP in promoting repetitive grooming behaviors and maintaining conditioned response to aversive stimuli. In OCD patients, one study have reported that AVP/OT ratio was negatively correlated with symptom severity. However, an independent report found similar AVP concentrations in OC patients without a personal or family history of tic disorder and in normal subjects. Whether these modifications are only a consequence of the central disturbances or whether those peptides could participate in the pathogenesis of these affections remains to be elucidated.

Adrenocorticotropic Hormone↗
PubMedDate not supplied

[French version of TASTE (test for the ability and evaluation)].

Ability to study and evaluation is only one example of performance among many others but research and publications concerning this issue for more than 50 years, especially in the context of test anxiety and need of achievement, conferred upon it a prototypical dimension. Investigations about motivation also stimulate many scientists and constitute another foundation of this study (13). The level of performance depends on knowledge and motivation (33). Time devoted to study is essential to succeed; so motivation and procrastination are in competition. The importance of reinforcement (extrinsical motivation) and the desire for learning and knowing (intrinsical motivation) are determinant. Other elements must be emphasized: guarantee of obtaining rewards, self efficacy and causal attribution. These considerations point out the multidimensional and interactive aspects of test anxiety (7, 31). The number of components is not described unanimously but experts agree with emotional, cognitive and behavioral dimensions (25). So, anxiety was approached in its motivational properties, and it was the case until the sixties, in terms of drive corresponding to a need like thirst or hunger (18); then it was conceptualized in a dynamic context broader than that of stress and coping (29, 30). Last, it constitutes the object of theories highlighting cognitive interference (9, 23, 26) or defective skills (8, 32). A lot of questionnaires were built without answering the different aspects and for instance without linking the theoretical and therapeutic components concerning this problem. Committed to the traditional fields of research (test anxiety and need of achievement), to Weiner's work about attribution theory (34) and that of Bandura in self efficacy (4, 5), E. Depreeuw (10) was particularly interested in Heckhausen's model (16, 17), trying to associate experimental conceptions with the clinical reality. On this basis, he elaborated the TASTE (10, 12, 20): test for ability to study and evaluation. At first constituted of 121 items, the self-questionnaire, after factorial analysis, was reduced to 78 items assessing 4 factors which represent the 8 components of Heckhausen's model (16). The first factor (30 items) concerns anxiety in its emotional and cognitive characteristics. Interesting data were observed by Depreeuw and confirmed in the Netherlands and in Greece (19), especially the fact that anxiety of girls is higher than that of boys when they are confronted with an exam. The second one (19 items) represents self-confidence: confidence in ability to succeed and on using adequate strategies. The third factor (14 items) squared with value attributed to performance. It especially comments on the intrinsical component of motivation. The fourth factor (15 items) corresponds to procrastination; study is postponed on behalf of activities which actually reduce the achievement process. The self-report questionnaire (where answers run from total disagreement to total agreement whether they correspond to the way of thinking or acting) takes account of the emotional, cognitive and behavioral dimensions of the model. The multidimensional aspect of this questionnaire, but mainly its connections with theory and clinic, are convincing; we adopted it with other tests in research about fear of failure. Validation of the French translation is the subject of this article. In order to realize this operation, we chose the initial version of TASTE (121 items) to assess a Belgian sample of french-speaking students in the first year of University of Liège (n = 617). They are differentiated by gender, faculty (Economy, Medicine, Philosophy, Psychology, Applied Sciences) and experience of failure, i.e. the fact of repeating a school year. Statistics were realized with SPSS and SAS. A comprehension test and a back translation are satisfactory. The stability over time too: the one week test-retest was achieved with a sample of 33 student nurses; comparing the factors two by two, intra-class correlations ranged from 0.5 to 0.95. The component analysis with Varimax rotation does not allow us to find the four factors of construction. We obtain the same disappointing results with the version of 78 items. According to the screentest, we adopted the solution of five factors which confirms the original construction. A fifth particularly strong factor (Cronbach's alpha 0.82) corresponds to devalorisation. The internal reliability is very satisfactory. If we consider the items strong loading (more than 0.30), the French version is constituted of 94 items. If we consider the items which are specifically loading each factor, we can reduce the questionnaire to 50 items. Internal reliability remains the same. Correlations between the data obtained with this brief version are satisfactory; comparing the factors in pairs. Pearson's coefficients range from 0.8 to 0.89. The study of E. Depreeuw was realized ten years ago with a Belgian sample of Flemish-speaking students; is the cultural context or an evolution in test anxiety which explains such a difference in the results? We are now assessing a sample in another country which used the TASTE in 1996 in order to have some information about comparison of samples. In any case, the questionnaire of E. Depreeuw respects the multidimensional aspect of test anxiety. Our choice of 5 factors according to principal components confirms the original structure of the test but also discriminates another factor which could be predictive of psychopathology (panic, depression). This new dimension measures negative perception of ability and achievement especially when compared with other students. One aim of such a study is to discern clusters of students i.e. groups of students with characteristics such as Covington (7), Depreeuw (20) and Zeidner (35) describe them. This description is very important; the French version is only a part of a very broader study including other tests and could differentiate student's profiles. The French version of 5 factors finally gives results in agreement with the original. The items (10 per factor) are selected according to their highest specificity and after elimination of redundancy. Validity remains in the short version, making it more useful in clinical practice.

Adolescent↗
PubMedDate not supplied

[What is the interest of Klinefelter's syndrome for (child) psychiatrists?].

Klinefelter's syndrome (KS) concerns men and is usually characterized by tallness, underdeveloped testes and sterility. It is generally due to the 47,XXY genotype, ie one extra X chromosome in each cell. Its estimated frequency among newborn boys is 1/500 to 1/700. It seems that 64% KS would be undiagnosed. Abnormally low levels of testosterone blood values are very common in this syndrome. In this case, replacement androgen therapy should be initiated (ideally at the age of 11-15) which prevents osteoporosis and enhances secondary sexual features. Case report - Since early childhood, Mr X has been shy, passive with few friends. When he was 13 years old, the school physician noted a delay of puberty and referred him to an endocrinologist who diagnosed KS. Androgen therapy was introduced but rapidly stopped, because the boy and his parents thought it was useless. Mr X consulted a psychiatrist at the age of 21. He presented a schizo-affective disorder with influence syndrome, auditory and visual hallucinations, labile mood with disinhibited and depressive periods. He was admitted in a psychiatry ward of a general hospital. An endocrinologist confirmed the diagnosis of KS and found very low blood testosterone levels. Besides lithium and risperidone which had already been introduced before the hospitalization, androgens (testosterone undecanoate) were very progressively given to Mr X with a daily psychiatric evaluation. One month after discharge, a major depressive episode led to the adjunction of citalopram. After one year of follow-up, Mr X shows increased social adjustment and enhanced interest; the influence syndrome has partially regressed and his mood is more stable. Discussion - In the years '60 and '70, systematic screenings in psychiatric hospitals have detected 1.3% KS among hospitalized boys, ie 10 times more than in the general population, and 0.6 to 1% KS among hospitalized men. A large variety of psychiatric disorders have been described. Boys presenting KS are usually described as shy, with little energy and initiative, and few friends. They cry more often than compares. Neuropsychological studies demonstrate significantly lower verbal IQ than controls, while performance IQ is generally normal and global IQ is in the normal range with large individual variations. Language acquisition is always delayed. However, agressiveness is not increased. In his follow-up study of 20 years, Nielsen at al found more psychiatric disorders among KS patients, compared to a group of hypogonadal patients at first examination (mean age=27 years). After 20 years follow-up, however, no significant difference remained between the two cohorts concerning the frequency of psychiatric hospitalizations or mental diseases. Several hypotheses have been proposed to explain psychological aspects of KS such as low levels of androgens during foetal and child development, personality disorder related to hypogonadism, delay of mitosis of cells with an extra X chromosome, but none of them is able to explain the specificity of psychological problems associated with KS. Concerning therapeutic aspects, specialists prone substitutive androgen therapy in case of too low testosterone blood levels, from the time of increase in FSH (around the age of 11-15). It prevents osteoporosis, backache and excessive tiredness often found in males with KS; testosterone also improves social drive, mood, concentration and ability at work. If KS diagnosis is made at adult age, androgen therapy has also shown some efficacy, though less than if started earlier. Due to the oral and written language problems of KS boys between 5 and 12 years of age, Graham et al. recommend anticipatory guidance for these boys. In addition, they insist on the importance of the information of the parents, language therapy, the reduction of the length of the instructions given by schoolmasters and specially stimulating and stable childhood conditions. Though it is generally thought that androgens increase agressiveness, we found no consistent data in litterature proving that the restoration of physiological androgen blood levels increases crimes nor aggressiveness. In the contrary, Miller and Sulkes described four cases of KS men presenting chronic fire-setting behaviors. Testosterone was introduced. For three of them, follow-up was available: their behavior seemed improved and none of them recurred. However, the initiation of androgen therapy for patients with severe psychiatric illness should be done very carefully. Conclusion - The Klinefelter's syndrome is frequent and, if not diagnosed (which seems to be the most common case), these men have higher risks to develop psychiatric disorders. Therefore, child psychiatrists and psychiatrists should evoke that diagnosis when they examine boys or men who present typical physical traits of KS (tallness, underdevelopped testes) associated to school problems and/or psychiatric disorders. Indeed, if the diagnosis is confirmed by an endocrinologist and a genetic testing, psychological follow-up and testosterone undecanoate treatment (in case of abnormal testosterone blood levels) should be initiated. This therapy generally improves physical well-being and improves mood, concentration, capacity at work. There is no consistent data in the litterature proving that restoring physiological testosterone blood levels would be dangerous for KS men presenting severe psychiatric troubles. However, this should be discussed in each situation with caution, and androgens should be introduced very progressively.

Adult↗
PubMedDate not supplied

[Lipids, depression and suicide].

Polyunsatured fatty acids are made out of a hydrocarbonated chain of variable length with several double bonds. The position of the first double bond (omega) differentiates polyunsatured omega 3 fatty acids (for example: alpha-linolenic acid or alpha-LNA) and polyunsatured omega 6 fatty acids (for example: linoleic acid or LA). These two classes of fatty acids are said to be essential because they cannot be synthetised by the organism and have to be taken from alimentation. The omega 3 are present in linseed oil, nuts, soya beans, wheat and cold water fish whereas omega 6 are present in maize, sunflower and sesame oil. Fatty acids are part of phospholipids and, consequently, of all biological membranes. The membrane fluidity, of crucial importance for its functioning, depends on its lipidic components. Phospholipids composed of chains of polyunsatured fatty acids increase the membrane fluidity because, by bending some chains, double bonds prevent them from compacting themselves perfectly. Membrane fluidity is also determined by the phospholipids/free cholesterol ratio, as cholesterol increases membrane viscosity. A diet based on a high proportion of essential polyunsatured fatty acids (fluid) would allow a higher incorporation of cholesterol (rigid) in the membranes to balance their fluidity, which would contribute to lower blood cholesterol levels. Brain membranes have a very high content in essential polyunsatured fatty acids for which they depend on alimentation. Any dietary lack of essential polyunsatured fatty acids has consequences on cerebral development, modifying the activity of enzymes of the cerebral membranes and decreasing efficiency in learning tasks. EPIDEMIOLOGICAL DATA: The prevalence of depression seems to increase continuously since the beginning of the century. Though different factors most probably contribute to this evolution, it has been suggested that it could be related to an evolution of alimentary patterns in the Western world, in which polyunsatured omega 3 fatty acids contained in fish, game and vegetables have been largely replaced by polyunsatured omega 6 fatty acids of cereal oils. Some epidemiological data support the hypothesis of a relation between lower depression and/or suicide rates and a higher consumption of fish. These data do not however prove a relation of causality. CHOLESTEROL AND DEPRESSION: Several cohort studies (on nondepressed subjects) have assessed the relationship between plasma cholesterol and depressive symptoms with contradictory results. Though some results found a significant relationship between a decrease of total cholesterol and high scores of depression, some other did not. Studies among patients suffering from major depression signalled more constantly an association between low cholesterol and major depression. Besides, some trials showed that clinical recovery may be associated with a significant increase of total cholesterol. CHOLESTEROL AND SUICIDAL BEHAVIOR: The hypothesis that a low cholesterol level may represent a suicidal risk factor was discovered accidentally following a series of epidemiological studies which revealed an increase of the suicidal risk among subjects with a low cholesterol level. Though some contradictory studies do exist, this relationship has been confirmed by several subsequent cohort studies. These findings have challenged the vast public health programs aimed at promoting the decrease of cholesterol, and even suggested to suspend the administration of lipid lowering drugs. Recent clinical studies on populations treated with lipid lowering drugs showed nevertheless a lack of significant increase of mortality, either by suicide or accident. In addition, several controlled studies among psychiatric patients revealed a decrease of the concentrations of plasma cholesterol among patients who had attempted suicide in comparison with other patients. POLYUNSATURATED FATTY ACID AND DEPRESSION: In major depression, all studies revealed a significant decrease of the polyunsaturated omega 3 fatty acids and/or an increase of the omega 6/omega 3 ratio in plasma and/or in the membranes of the red cells. In addition, two studies found a higher severity of depression when the level of polyunsaturated omega 3 fatty acids or the ratio omega 3/omega 6 was low. Parallel to these modifications, other biochemical perturbations have been reported in major depression, particularly an activation of the inflammatory response system, resulting in an increase of the pro-inflammatory cytokines (interleukins: IL-1b, IL-6 and interferon g) and eicosanoids (among others, prostaglandin E2) in the blood and the CSF of depressed patients. These substances cause a peroxidation and, consequently a catabolism of membrane phospholipids, among others those containing polyunsaturated fatty acids. The cytokines and eicosanoids derive from polyunsaturated fatty acids and have opposite physiological functions according to their omega 3 or omega 6 precursor. Arachidonic acid (omega 6) is, among others, precursor of pro-inflammatory prostaglandin E2 (PGE2), whereas polyunsaturated omega 3 fatty acids inhibit the formation of PGE2. It has been shown that a dietary increase of polyunsaturated omega 3 fatty acids reduced strongly the production of IL-1 beta, IL-2, IL-6 and TNF-alpha (tumor necrosis factor-alpha). In contrast, diets with a higher supply of linoleic acid (omega 6) increased significantly the production of pro-inflammatory cytokines, like TNF-alpha. Therefore, polyunsaturated omega 3 fatty acids could be associated at different levels in the pathophysiology of major depression, on the one hand through their role in the membrane fluidity which influences diverse steps of neurotransmission and, on the other hand, through their function as precursor of pro-inflammatory cytokines and eicosanoids disturbing neurotransmission. In addition, antidepressants could exhibit an immunoregulating effect by reducing the release of pro-inflammatory cytokines, by increasing the release of endogenous antagonists of pro-inflammatory cytokines like IL-10 and, finally, by acting like inhibitors of cyclo-oxygenase. THERAPEUTIC USE OF FATTY ACIDS: Data available concerning the administration of supplements of DHA (docosahexanoic acid) or other polyunsaturated fatty acids omega 3 are limited. In a double blind placebo-controlled study on 30 patients with bipolar disorder, the addition of polyunsaturated omega 3 fatty acids was associated with a longer period of remission. Moreover, nearly all the other prognosis measures were better in the omega 3 group. Very recently, a controlled trial showed the benefits of adding an omega 3 fatty acid, eicosopentanoic acid, among depressed patients. After 4 weeks, six of the 10 patients receiving the fatty acid were considered as responders in comparison with only one of the ten patients receiving placebo. CONCLUSIONS: Some epidemiological, experimental and clinical data favour the hypothesis that polyunsaturated fatty acids could play a role in the pathogenesis and/or the treatment of depression. More studies however are needed in order to better precise the actual implication of those biochemical factors among the various aspects of depressive illness.

Adolescent↗
PubMedDate not supplied

An open multicentre study to evaluate the efficacy and tolerance of fluoxetine 20 mg in depressed ambulatory patients.

In this study, 544 out-patients suffering from depressive disorders were enrolled in 6 weeks open study with fluoxetine 20 mg. A statistically significant decrease of the Hamilton Rating Scale for Depression (HRS-D) score is observed during treatment. All individual item HRS-D scores and in particular suicidal ideation, sleep disturbances and anxiety showed the same improvement. Side-effects were carefully recorded and presented a lower incidence rate than in other studies. New issues in methodology management concerning ambulatory studies are discussed.

Adult↗
PubMedDate not supplied

[Failure effects and gender differences in perfectionism].

Perfectionism is a dimension which has been studied very little as a separate entity. It is not even considered as a nosological factor. No classification of the medical sciences underlines its importance other than to speak of a personality trait, of an aspect, or of a parameter. Nevertheless, perfectionism is related to multiple disorders such as depression (18, 20, 36), suicide (8, 16, 55), nutritional problems (11, 28), anxiety (3), obsessive-compulsive personality disorder (53), social phobia (2), as well as insomnia (46). Certain authors stress the possible role of perfectionism in the development or the persistence of a substantial number of these disorders (7, 22, 38). Given these facts, it is all the easier to understand the interest shown by clinicians and researchers in the subject. Better detection and evaluation of its impact on behaviour is important in putting therapies in place (6, 53). Relationships between perfectionism and fear of failure have been approached (21, 51, 54). Correlations between perfectionism and high levels of state and trait anxiety have been demonstrated (23). The evaluation of perfectionism has been dealt with very little. Some questionnaires devote a sub-category to it, such as the Eating Disorder Inventory and the Irrational Beliefs Test. However, recently, it has been recognized that perfectionism is a multidimensional construct. Two Multidimensional Perfectionism Scales have been developed and investigated in relative isolation. Frost, Marten, Lahart and Rosenblate defined perfectionism as the setting of excessively high standards for performance associated with critical self-evaluation. Six dimensions are described: concern over making mistakes, high personal standards, parental expectations, parental criticism, doubt about quality of performance and organization. Internal consistency and validity have been established (25, 26). Hewitt and Flett (30, 31, 33, 35) have developed another approach where three dimensions of perfectionism are described: SOP (Self Oriented Perfectionism) related to high standards and self criticism, SPP (Socially Prescribed Perfectionism) related to the need of approval from others and fear of negative evaluation, OOP (Other-Oriented Perfectionism) reflecting a tendency to set high expectations for others and to evaluate them in a demanding way; this component is related, especially for males, to self-esteem, hostility and authoritarianism. Validity and internal consistency have been established too (30, 31, 35). The Frost and al's Multidimensional Perfectionism Scale and the Hewitt and Flett's scales are closely associated, except concerning the OOP. Because this component could provide new information, we have chosen the second scale, referring to the French translation and validation of Labrecque (45). EMP is the French name of MPS; it is a self-report questionnaire of 45 questions, in fact three subscales of 15 items rated on a 7-point Likert-type scale. MPS was administered to 617 first year students at the university of Liège (table II). Differences are considered according to gender and experience of failure i.e. the fact of repeating an academic year. We realized a component analysis with promax rotation. Among the different possibilities offered by the scree-test the choice of a 4 factor solution stresses the original structure: SOP (14 items), SPP (12 items), OOP (9 items) and anti OOP (10 items); the last one is additional but allows for respecting semantics and saturation of the items. The first aim of confirming validity and internal consistency is satisfactory. In other respects the multidimensional structure of the concept leads to consideration of a positive, adaptive perfectionism and a more negative perfectionism, facilitating psychopathology (59, 60, 61). So it seems interesting to compare the different components of MPS in order to find an eventual sex-failure effect. The evaluation of perfectionism is obvious, considering it as a personality trait, but it can be used also in taking into account stress and its impact, for instance that of academic performance (29, 37, 39, 58). Conferring on MPS more pertinence in gender differentiation and failure evaluation is an other goal of this research. Through the particular choice of statistical results, sex and sex-failure effects can be demonstrated: a MANOVA underlines sex effect (lambda de Wilks = 0.96, p = 0.001) and sex-failure effect (lambda de Wilks = 0.98, p = 0.05). Structure of MPS is different in four groups (FE: women with failure, FnE: women without failure, ME: men with failure, MnE: men without failure). ANOVA show differences of MPS3, MPS1 and MPS2. Far more promising is the use of LISREL method allowing for the construction of a coherent model of relationships between some dimensions of MPS and Test-Anxiety, approached here with THEE (test d'habileté aux études et à leur évaluation) French abbreviated version (49) of TASTE (Test for Ability to Study and Evaluation). In fact according to the literature of fear of failure, girls score higher on anxiety and procrastination but less on self-confidence. The structural model shows different pathways, more especially between SPP (socially prescribed perfectionism), T2 (sense of incompetence) and T1 (anxiety). SOP (self oriented perfectionism) and SPP (socially prescribed perfectionism) by girls are very much correlated; it seems that they are more subjected to society and its exigencies of studying but consequently they are more at risk of anxiety and a sense of incompetence. SOP (self oriented perfectionism) by boys functions more indiscriminately of SPP (socially prescribed perfectionism) and is negatively correlated with self-incompetence; boys are more self-confident but they usually procrastinate more probably because failure expectancies would be particularly harmful for their self-esteem; consequently, failure should be related to something else than their own capacity; this may be an explanation of the high rate of male dropouts and failure in the first year at the university of Liège; also a factor explaining the female domination at the university. In the same way the first choice of studies is moving towards shorter and less difficult orientation (46). In case of failure the model is very similar according to gender: SOP (self oriented perfectionism) and T1 (anxiety) are directly connected; SOP and SPP are in this case better correlated by boys but the path between SPP, sense of incompetence and anxiety is less significant than in girls. In conclusion, providing some modifications according to semantics, the choice of a four factor solution allows for confirmation of the original structure of MPS and for internal consistency. The different components of MPS vary according to gender: SOP and more OOP discriminate men and women; SPP allows for differentiating women with failure. A structural model enhances the role of perfectionism in the cognitive and behavioural contexts; for instance it clarifies its action on fear of failure and success rates according to gender.

Adult↗
PubMedDate not supplied

[Value of sleep and neuroendocrine tests as biological markers of depression in children and adolescents].

In this article, we systematically reviewed the results of application of biological markers of depression to children and adolescents. Concerning sleep EEG, only three studies on a total of twelve among 267 depressed children and adolescents aged 6 to 19 years found the typical sleep abnormalities described in depressed adults (eg, shortened REM latency and decreased sleep efficiency). Most authors insisted on the age-related sleep changes as a major confounding factor. Two studies of the effect of antidepressant therapy on sleep showed a decrease in sleep efficiency but a discrepancy in the evolution of REM latency. Concerning the dexamethasone suppression test, twenty studies including 374 depressed children and adolescents (3-20 years) and 533 psychiatric controls yielded an overall sensitivity of 57% and an overall specificity of 78%. These results may be considered as interesting, despite the lack of agreement among authors on various methodological parameters (dose of dexamethasone, times of blood sampling, method of cortisol assay ...) and the composition of control groups which often comprise subjects presenting disorders very close to major depression (dysthymia, minor depression ...). Among the other tests, the TRH test, used in two studies, showed limited interest. In contrast, the study of growth hormone secretion, performed in one centre, could present diagnostical usefulness. In conclusion, biological markers of depression in children and adolescents should still be considered as research tools and be part of a multidisciplinary approach to depressive illness.

Adolescent↗