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Biomedical subjects

M Ansseau

Publications and source records attributed to M Ansseau.

At least 199 records · Page 11Linked to original sources
PubMedDate not supplied

[Value of prazepam drops in the brief treatment of anxiety disorders].

In order to assess the clinical usefulness of benzodiazepine brief therapy with planned tapering, prazepam as drops was administered to 40 psychiatric outpatients suffering from generalized anxiety disorder. After a one-week placebo period, the patients received prazepam 40 mg daily (i.e., 10 drops in the morning, 10 drops at noon and 20 drops in the evening) during 3 weeks, with the possibility to adjust the doses after one week. The doses were then tapered at 4 mg/d (i.e., 1 drop in the morning, 1 drop at noon and 2 drops in the evening) until complete suppression of the treatment. The assessments, performed before the placebo period, at inclusion, after 1 and 3 weeks of active treatment, and after 1 and 2 weeks of tapering, included the Hamilton anxiety scale, the Lader tranquillizer withdrawal rating scale, and the collection of side effects; moreover, the patients completed daily a visual analogue scale. Results showed a very marked anxiolytic effect of prazepam with an already very significant decrease in the scores on the various scales after 1 week of treatment when the daily dose was significantly reduced. Three quarters of the patients were able to take part in the tapering of prazepam doses without exhibiting any reappearance of anxious symptomatology, rebound anxiety, or withdrawal symptoms. The tolerance of the treatment was rated as good or very good in 91.9% of the patients. This study demonstrates the possibility of a brief anxiolytic treatment followed by tapering in a majority of patients with generalized anxiety disorders. For this strategy, the availability of a drop form represents an obvious advantage.

Administration, Oral↗
PubMedDate not supplied

[Electroconvulsive therapy and its mechanism of action].

Electroconvulsive therapy (ECT) is known as an effective treatment for some depressive disorders. Nevertheless ECT continues to be a subject of controversy. The absence of a unifying theory for its mechanisms of action explains the mistrust about ECT. The aim of this article is to review the literature about ECT and to propose a synthesis concerning its mechanisms of action. At the present time, the most reliable hypothesis suggests selective activations of central serotonergic and dopaminergic systems on the one hand, and a direct stimulation of the neuroendocrine neurons on the other hand.

Animals↗
PubMedDate not supplied

[Benzodiazepines and sleep].

Benzodiazepines currently represent the most widely prescribed family of hypnotic drugs. They possess obvious advantages: actual hypnotic efficacy, at least with short-term use, low toxicity, and excellent tolerance. However, several side effects need to be mentioned: besides morning drowsiness (which represents the untoward continuation of their sedative properties), anterograde amnesia, increase of daytime anxiety, and rebound insomnia. Moreover, benzodiazepines significantly modify several sleep parameters: they decrease slow wave sleep and delay the first period of REM sleep. Any hypnotic benzodiazepine should only be prescribed in case of actual need and after exclusion of non-pharmacologic means. The "softest" agent, at the lowest dose, and during the shortest period should always be preferred.

Anti-Anxiety Agents↗
PubMedDate not supplied

[Assessment of the clinical activity of fluoxetin (Prozac) according of the "Stars of Liège" model].

Ten psychiatrists have independently rated the clinical profile of fluoxetin (Prozac) at the daily dose of 20 mg according to a "Stars of Liège" model comprising three parameters of therapeutic activity (antidepressant, psychostimulant and anxiolytic) and three parameters of side-effects (anticholinergic, sedative and hypotensive). Each parameter, graduated from 0 to 5 (no, very weak, weak, moderate, potent, very potent effect) was rated by each investigator according to his personal experience with at least 10 patients. Mean ratings given to fluoxetine show a moderate antidepressant effect, equal to amitriptyline (Rédomex, Tryptizol 75 mg/d, clomipramine (Anafranil 75 mg/d and nialamide (Niamide 100 mg/d, weak psychostimulating and anxiolytic effects, a very weak sedative effect and a lack of anticholinergic and hypotensive effects. Digestive side-effects of moderate intensity were also noted as well as a very weak anorexia. The important variability between investigators in the rating of the clinical profile of fluoxetine suggests that more experience is needed in order to define better its physiognomy.

Anti-Anxiety Agents↗
PubMedDate not supplied

[The Newcastle Index for the diagnosis of endogenous depression. Comparison with the Research Diagnostic Criteria for major depression].

The Newcastle index comprises 10 items (with a positive or negative score) the sum of which enables us to separate endogenous and neurotic depressive patients. We applied this index to a sample of 41 depressive inpatients who met Research Diagnostic Criteria (RDC) for major depression. According to Newcastle index, 20 patients were considered to be endogenous and 21 to be neurotic. There was no significant difference between the two groups with regard to sex distribution and mean age. The distribution of scores suggested a trend toward bimodality. Endogenous depressives exhibited higher severity level than neurotic depressives, as shown by the total score on the Hamilton depression scale as well as the scores on various items related to depressive mood, guilt, decreased activity, psychomotor disturbances, genital symptoms, helplessness, hopelessness, and worthlessness. This higher severity level was confirmed by the higher frequency of two symptomatic criteria of major depression among endogenous depressives as compared to neurotic depressives: psychomotor and memory disturbances. Moreover, endogenous depressives defined by Newcastle index were more frequently of primary, endogenous, agitated and simple RDC subtypes whereas neurotic depressives were more frequently of secondary and situational RDC subtypes. Therefore, the results of this preliminary study suggest that the Newcastle index may enable us to define two subtypes of depressive patients characterized by different symptomatic severity levels.

Adult↗
PubMedDate not supplied

A Belgian multicentre study of fluvoxamine in depressive outpatients.

Fluvoxamine, a new antidepressant that specifically inhibits serotonin reuptake, was studied in 272 outpatients in a six-week multicentre trial in Belgium. On the Hamilton Depression Scale, the mean score dropped from 25.2 to 8 after six weeks (p less than 0.00001). The Clinical Global Impression scores showed similar evolution. Fluvoxamine is a real antidepressant with a marked effect on mood. Its effective dosage is 100 mg to 200 mg/day. Its tolerance, notably at the cardiovascular level, is excellent.

Adult↗
PubMedDate not supplied

A technique to examine phasic thermoregulation during human sleep.

A technique for inducing cyclic skin temperature changes during sleep is described. Stimulation of the facial area induces relatively localized skin temperature responses in the fingers. This centrally mediated response can be used to efficiently probe thermal regulation during sleep. Sleep and skin temperature results from three volunteers support the validity and feasibility of the technique.

Adult↗
PubMedDate not supplied

[Novel comparative profile of the clinical activity of antidepressive agents].

In order to develop practical criteria to guide in the selection of antidepressant medication according to depressive symptomatology, we propose a graphical representation of the clinical activity of 24 antidepressants according to a "star" model. Six parameters have been evaluated from 0 to 5 in comparison to reference drugs (rated 5) by 11 independent "blind" psychiatrists expert in pharmacotherapy. Three parameters were used as measures of therapeutic activity: antidepressant, psychostimulant, and anxiolytic, with iproniazide 75 mg/d, metamphetamine 15 mg/d, and diazepam 20 mg/d as reference drugs respectively. Three additional parameters assessed the level of side-effects: anticholinergic, sedative, and hypotensive, with atropine 0.75 mg/d, phenobarbital 200 mg/d, and iproniazide 75 mg/d as reference drugs respectively. The defined dose represented the standard maintenance daily dose for depressive outpatients. Mean values for each parameter, rounded off to the closest number, were used for the graphical representation. Results showed an excellent agreement among evaluators for the clinical profile of classical tricyclic and MAOI antidepressants, but serious divergences for the more recent drugs (e.g., viloxazine and mianserine), possibly reflecting more atypical or more variable clinical profile of these compounds.

Antidepressive Agents↗
PubMedDate not supplied

[Lormetazepam and amobarbital in the treatment of insomnia in psychiatric outpatients. A controlled study].

During a double-blind clinical study, a new hypnotic benzodiazepine, lormetazepam (Wy 4082), was compared at a fixed dose of 1 mg to sodium amobarbital at a fixed dose of 100 mg for the treatment of moderate insomnia in 2 groups of 25 psychiatric outpatients. The medication was given at bedtime and the duration of the study was limited to 2 weeks. The quality of sleep was evaluated by the patient after the first night and at the end of the first and second week and by investigator at the end of the 2 weeks trial. The two products appeared effective on global assessment, but with an advantage in favour of lormetazepam: earlier onset of sleep and excellent acceptability on the final evaluation. Fifty two per cent of patients treated with amobarbital had side effects, mainly hangover and sedation during the morning, while only one patient treated with lormetazepam complained of headaches in the morning.

Adult↗
PubMedDate not supplied

Interest of 5-hydroxytryptophan (5-HTP) as a neuroendocrine marker in depressive illness. A negative report.

Among 8 primary depressives, 4 schizophrenics, 4 manics and 4 normal controls, 5-hydroxytryptophan (5-HTP), the precursor of serotonin (200 mg p.o.), appears devoid of any stimulating activity on the liberation of growth hormone (GH). So, 5-HTP test can not be useful as a specific neuroendocrine marker of serotoninergic metabolism in depressive patients.

5-Hydroxytryptophan↗
PubMedDate not supplied

Pilot study of a specific serotonergic antagonist, pirenperone, in the treatment of anxiety disorders.

Pirenperone (R 47465) is the prototype of a new class of psychotropic drugs, selective serotonin 5-HT2 receptor blocking agents. In an open pilot study, the anxiolytic properties of pirenperone were evaluated in a sample of five anxious inpatients who met Research Diagnostic Criteria for current Generalized Anxiety Disorder and who had a score of at least 25 on the Hamilton Anxiety Scale (HAS). Three dosage levels were tested: 15, 30 and 60 mg/a day in 3 divided doses. Each dosage period lasted at least 5 days, at the end of which patients were reassessed by HAS, Clinical Global Impression and a side-effects checklist. Results suggested a modest anxiolytic activity, without a clear dose-response relationship and with good tolerance. Subsequent treatment by lorazepam (7.5 mg/d) seemed to result in more specific improvement.

Adult↗
PubMedDate not supplied

[Factor analysis of the French revision of the AMDP rating scales. Results of an international study of 388 cases].

A total of 388 patients from 10 Belgian and French Centers were evaluated with the 1981 revision of the psychopathological and somatic scales of the AMDP System. Principal components factor analyses indicate that the somatic items contribute little to the structure. A 10-factors solution of the psychopathological items generate the following factors after orthogonal rotation: Obsessions-Phobias, Dramatization, Anxiety, Depression, Retardation, Organicity, Dissociation, Delusions, Mania, Dysphoria. This structure is similar to the analyses of the previous German edition except for Anxiety (due to additional French items) and Dramatization (which replaces the German factor on Hypochondriasis). The correlations between raw factor scores and item scores of the BPRS and of a similar AMDP-derived scale contribute to the validation of the AMDP factors and to the justification of a 13-item AMDP Syndromic Scale.

Adolescent↗
PubMedDate not supplied

[Compatibility between AMDP scales and "Research Diagnostic Criteria" (RDC) for the diagnosis of endogenous depression].

Research Diagnostic Criteria represent the most widely used system in research in biological psychiatry to select homogenous samples of patients with a defined psychiatric illness. The AMDP system represents the most complete system for documentation and quantification of psychopathology. On the conceptual point of view, it seems possible to use AMDP psychopathological and somatical scales to select patients who meet criteria of "major depressive disorder" of RDC. In fact, equivalents exist for most of the criteria. For an optimal correspondence, only two psychopathological reserve items--in place of little useful items--and two somatical reserve items could easily be included. A preliminary study has enabled to control the sense of this methodology. A more complete study that verifies the compatibility of both approaches and the ability to automatically select endogenous depressives from AMDP scales is ongoing.

Depressive Disorder↗
PubMedDate not supplied

[The necessity for standardized diagnosis in research in biological psychiatry. Attempted integration of "Research Diagnostic Criteria" into the AMDP system].

Standardization of diagnosis is an essential preliminary in the clinical research in biological psychiatry. Between the different systems of nosographical selection, Research Diagnostic Criteria (RDC) are the most internationally diffused. After having recalled the spirit of RDC, we have looked for seven major illnesses (major and minor depressive disorders, endogenomorphic major depressive disorder, schizophrenia, manic disorder, panic disorder and generalized anxiety disorder) equivalents of RDC criteria in psychopathological and somatical items of AMDP system. With a minimum of modifications (adjonction of some reserve items for each illness), AMDP scales could become compatible. The verification of this theorical equivalence secondly makes it a duty to use jointly RDC and AMDP scales and to analyse both of them separately. After this methodological control, patients who meet RDC criteria could be automatically selected from AMDP scales.

Anxiety Disorders↗
PubMedDate not supplied

Biochemical and neuroendocrine approaches to a malignant syndrome of neuroleptics.

A 20 year old patient who has been hospitalized for depressive schizoidia is treated by nomifensine (75 mg/d) plus pimozide (4 mg/d). Four days later, he shows a typical neuroleptic malignant syndrome (Syndrome malin de Delay et Deniker). The biological explorations show that inflammatory blood tests are increased, hepatic tests are disturbed and the pituitary tests suggest a hypothalamic disturbance of the balance between NE and DA (reduced STH, FHS and LH) with a relative NE predominance, but also an increase of DA (increased HVA in CSF. A pathogenic interaction between nomifensine, an antidepressant inhibiting the reuptake of NE and DA, and pimozide, a neuroleptic blocking dopaminergic postsynaptical receptors is to be considered.

Adult↗
PubMedDate not supplied

[Pharmaco-clinical aspects of methadone. Literature review of its importance in treatment of substance dependence].

In order to assess the initial hypotheses of Dole, who set the objectives of methadone maintenance in 1966, this article reviews all research findings available in the field. The side-effects of methadone appear rather infrequent with few long lasting effects. The selection of a dose sufficiently high to block opiat receptors seems make the patient little or not sensitive to heroin intake whereas treatment compliance seems to be dose-related until a plateau of about 120 mg/day. All studies show a dramatic decrease in heroin intake. In contrast, a change in the drug use profile toward an increase in alcoholism and cocaine intake appears in certain subjects. Regarding AIDS, results seem less clear, showing a global decrease in intravenous use as behavior at risk but providing apparently not a total protection unless complete discontinuation. The decrease in antisocial behavior appears clearly, interpreted as a decrease in the economic pressure on the consumer. As a consequence of these results, an assistance in social rehabilitation appears more effective. Whereas the literature regarding withdrawal clearly shows the usefulness of the technique regarding the duration and the persistence of withdrawal symptoms, it remains very blurred regarding long-term results. The average age (about 30 years) and the average duration of drug abuse (about 10 years) of the patients included in those studies lead to the conclusion that only a marginal part of the total population is taken in charge, meaning that these techniques will never be solutions to a problem of society but only individual therapies. This article also raises the problem of the passionate climate associated with these issues--with negative consequences regarding objectivity--and the methodological limitations found in too many studies on this topic.

Dose-Response Relationship, Drug↗
PubMedDate not supplied

[Biological markers in schizophrenia].

Based on a review of the literature, the article deals with the major biological markers of schizophrenia. Recent developments in molecular biology have shown a possible association between schizophrenia and various HLA markers (A1, A2, A9, A10, A28, B27, BW16), and a linkage--in several families--between the disease and some polymorphisms of chromosome 5. On the other hand, chromosome X might also be involved. Neuropathological abnormalities have often been found in the brains of schizophrenics, such as cellular alterations in the basal ganglia and the limbic structures. Investigations by means of CT-scan and Magnetic Resonance Imaging have pointed out an enlargement of cerebral ventricles and/or an atrophy of frontal areas, especially amongst patients with prominent negative symptoms. The dopaminergic hypothesis of schizophrenia reposes on the major following facts: the therapeutic efficiency of neuroleptics (dopaminergic antagonists); a positive correlation between plasma homovanillic acid (metabolite of dopamine) concentration and the severity of schizophrenic illness; a higher density of dopaminergic D2-receptors (revealed by Positron Emission Tomography thanks to specific radioligands), particularly in the striatum; and an abnormal plasmatic growth-hormone response to apomorphine (dopaminergic agonist). Central noradrenergic dysfunctions might also occur in paranoid schizophrenia, as underlined by higher cerebrospinal fluid levels of norepinephrine, and a lack of decrease of plasma 3-methoxy-4-hydroxy-phenylglycol (MHPG, metabolite of norepinephrine) after clonidine (alpha-2-adrenergic agonist) dispensation. Nevertheless, in patients with predominating negative symptoms, this is a trouble in serotoninergic functions which has been suggested. In the field of immunology, some findings such as alteration in lymphocytes populations (T4/T8, CD5), anti-cerebral auto-antibodies, abnormal lymphocytes responses to mitogens, decreased production of interleukin-2, have lead to two main hypotheses: autoimmunity and immunologic incompetence. On the other hand, electrophysiological studies have shown a hypovariability of alpha-rythm on the EEG; a lower amplitude of the component P300 from visual evoked potentials; sleep disorders such as a shorter rapid eye movement sleep latency and a decreased total slow-wave sleep percent; irregular smooth pursuit eyes-movements; an electrodermal response according to either the hyper-responder either the non-responder type. At last, troubles in sensory integration, motor coordination and attention have also been demonstrated. All those many findings outline the heterogeneity of schizophrenic disorders.

Biomarkers↗