Biomedical subjects

M Escande

Publications and source records attributed to M Escande.

At least 73 records · Page 4Linked to original sources

PubMedDate not supplied

[Clinical and pharmacokinetic study of amikacin during repeated intramuscular administration in elderly patients].

Pharmacokinetics of amikacin in elderly patients during repeated intramuscular administration. The aim of the study was to evaluate a standard dosage of Amikacin, 7.5 mg/kg every 12 hours, in elderly subjects whose renal function was reduced by half, in view of the narrow therapeutic interval of the aminoglycosides. Twelve subjects, aged from 72 to 96 years (mean age: 82 years; mean weight: 58.7 kg) and suffering from severe infections, were therefore treated with intramuscular Amikacin as monotherapy at the dosage of 7.5 mg/kg repeated every 12 hours for 5 days. Clinical, biological (creatinine clearance estimated by the method of Cockroft) and bacteriological data were recorded on D0 and D5. The pharmacokinetic study included plasma Amikacin assays at the following times: D0 (control), D1 (1h, 3h, 6h, 12h), D2 (24h, 25h, 27h, 36h), D3 (48h, 49h), D5 (96h, 97h, 99h, 102h, 105h, 108h), D6 (120h, 132h). Clinical success was observed in 9 out of the 12 cases, with no undesirable side effects. At this age and at this dosage, peak concentrations (Cmax) remain close to the required "therapeutic" levels, 25 to 30 mcg/ml; the residual concentrations (Cmin), highly-correlated with creatinine clearance values, are also close to the desired levels (4-10 mcg/ml). The absence of side effects, and in particular the lack of renal side effects, during this treatment trial suggest that the usual dosage of Amikacin IM, 7.5 mg/kg/12 h, need not be reduced in elderly subjects if creatinine clearance remains above 30 ml/mn and if the treatment is of short duration.

Aged↗

PubMedDate not supplied

[Sleep electroencephalography in depression and mental disorders with depressive comorbidity].

Traditional scoring of sleep EEG in depressed patients shows abnormalities in sleep maintenance, sleep architecture, REM sleep, the distribution of slow wave and REM sleep during the night. Computerized analysis that comprises the period-amplitude analysis procedure and spectral analysis discloses changes in delta activity and distribution of delta activity. However, these methods of analysing EEG sleep are not able to distinguish the various concepts of depression: endogenous and non-endogenous depression, unipolar and bipolar depression, psychotic and non-psychotic depression. Polysomnographical data in patients with recurrent depression show alteration during remission suggesting trait-like abnormalities of sleep in depression illness. Shortened REM latency is not specific in depression. This sleep parameter is defined in many different ways explaining the heterogeneousness of study results and the failure of constituting a biological marker. Many sleep parameters are affected by several factors such as age, gender and severity. Several physiopathological hypotheses have been proposed to explain EEG sleep alterations. They refer either to circadian rhythms such as the two process model of Borbély, the phase advance hypothesis and the circadian amplitude hypothesis, or to neurotransmitter abnormalities such as the cholinergic hypothesis. None of them takes sufficient account of all the sleep abnormalities. Sleep abnormalities have also been described in other psychiatric disorders such as mania, panic and obsessional-compulsive disorders, generalized anxiety, phobias, post-traumatic stress disorder, eating disorders, borderline personality, schizophrenia and dementia. None of them have a particular sleep EEG profile which allows to differentiate between them. A concomitant episode of major depression cannot be uncovered by sleep recordings.

Comorbidity↗

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[Associations and interactions: tricyclic antidepressants and selective serotonin reuptake inhibitors].

Following the commercialization of the SSRIs clinicians described cases of drug interactions with tricyclic antidepressants among their patients. When combining tricyclic antidepressants and SSRIs clinical side effects and elevated plasma levels of tricyclics appeared. A better knowledge of the cytochrome P450 system allows to understand the mechanism of such drug interactions. The cytochrome P450 is composed of a group of isoenzymes, which are classified, into families and subfamilies on the basis of amino acid sequence homology. A number of the cytochrome genes have a genetic polymorphism responsible for poor and extensive metabolisers. The clinical importance of genetic polymorphism is highly dependent upon the therapeutic index. Thus, poor metabolisers, will experience side effects and rapid metabolisers prone to therapeutic failure. Concerning pharmacological issues SSRIs have a great affinity for at least one of the isoenzymes which accounts for drug interactions. Due to the inhibitory potential of the SSRIs drug interactions occur with tricyclics that have a narrow therapeutic index. The SSRIs do not exert the same inhibitory effect on the various isoenzymes. The inhibitory activity for an isoenzyme depends on the molecule of the SSRIs. In clinical practice, the associations between tricyclics and SSRIs should be practiced with caution. It is recommended to decrease the tricyclic dose before administering the SSRI, to start with low doses of the SSRI and to take into account the therapeutic index. Although the coadministration of tricyclics and SSRIs can produce adverse reactions it has also two main interests in clinical practice. First, the drug combination enhances clinical response to treatment. Secondly, it converts non-responders of pharmacological treatment to responders. Used with caution the association of tricyclics and SSRIs is well tolerated. However, it should be kept in mind that a single drug therapy should be tried first. These data show the complexity of drug interactions.

Antidepressive Agents, Tricyclic↗

PubMedDate not supplied

[Polysomnographic aspects of antidepressive therapy].

Sleep disorders are very common in depression. They have been quantitatively and qualitatively described by polysomnographical recordings. It is of interest to know how treatments act on polysomnographical data. In this article, we propose to evaluate five treatment approaches proposed for depressive illness. Pharmacological treatment induces marked changes in sleep continuity, sleep architecture and REM sleep. However, no specific sleep profiles emerge neither for each treatment class nor for molecules within the same pharmacological class. But actually, sleep data cannot be viewed as markers of treatment response. Psychotherapeutic interventions have only few effects on sleep of depressed patients. Treatment efficiency does not seem to be correlated to abnormal sleep parameters. Sleep deprivation induces marked changes in nearly all sleep parameters and in temporal distribution of sleep stages during the night. Actually, the efficiency of sleep deprivation cannot longer be explained by suppression of REM sleep. Sleep deprivation has only a transient effect and treatment indications are therefore secondary. Sleep parameters do not distinguish responders from non-responders. Sleep deprivation shows that there is a depressogenic effect of sleep in the end of the night. Bright light therapy shows marked changes in sleep continuity parameters. Among all studies that examine the impact of treatment on sleep EEG, ECT has received little attention. The few studies available are either case studies or with poor effectifes++. For this reason and because of methodological bias, results are heterogeneous and no definite conclusions can be drawn. But all of them agree that ECT modifies sleep EEG. So, changes in polysomnographical data cannot predict response to any treatment. Prospective sleep studies are difficult to realise on a great number of patients explaining absence of treatment predictors.

Antidepressive Agents↗

PubMedDate not supplied

[Biological factors of post-traumatic stress: neuroendocrine aspects].

The core symptoms of post-traumatic stress disorder (PTSD) include persistent reexperiencing of the traumatic event, avoidance of stimuli associated with the trauma, and autonomic hyperarousal. Many neurotransmitter systems and neurobiologic mechanisms may account for these primary symptoms of PTSD. Severe psychological trauma results in the parallel activation of these systems, producing an array of adaptive behavioral and physiologic responses necessary for survival. The pathophysiology of PTSD may involve dysfunction of several brain structures, particularly the amygdala, locus coeruleus, and hippocampus, as well as noradrenergic system and hypothalamic-pituitary-adrenal (HPA) axis. The neuroendocrinology of PTSD, and specifically hypothalamic-pituitary-adrenal axis alterations, are ways of examining biologic heterogeneity following trauma and its possible clinical implications. The decreased levels of cortisol, the increased responsiveness of glucocorticoid receptors, the increased sensitivity of the HPA negative feedback inhibition and its progressive sensitization are the neuroendocrine alterations specifically associated with the development of PTSD.

Arousal↗

PubMedDate not supplied

[Biological factors of PTSD: neurotransmitters and neuromodulators].

Subjects with posttraumatic stress disorder exhibit abnormalities in many psychobiological systems. Studies of the effects of stress on learning and memory processes suggest that fear conditioning, behavioural sensitisation, and a failure of extinction may be important in the persistence and reexperiencing of traumatic memories and stress sensitivity. All these symptoms are supported by specific biological mechanisms including NMDA receptors, noradrenergic system, etc. Recent findings show that amino acid transmitters, glutamate and GABA, are intimately involved in the process of factual memory registration, and suggest that amine neurotransmitters, norepinephrine and serotonin, are involved in encoding emotional memory. In addition, research suggests that 5-HT neurones have directs effects on both adrenergic and HPA function. Such findings provide important information that should guide current pharmacological practice and the development of innovative biological therapeutics.

Adaptation, Psychological↗

PubMedDate not supplied

[Methodological obstacles encountered in the evaluation of psychotherapies of schizophrenic patients. A general review].

Through a critical review of literature, authors suggest a methodological reflexion about problems in evaluation of effects of psychotherapies of schizophrenics, taking into account not only individual techniques but also institutional ones with psychotherapeutic orientations. Among the main difficulties are: evaluation with too much unspecific and over simplified criteria, for example criterium of rehospitalisation; lack of real comparability between groups, or techniques, and lack of validity of randomisation, still considered as a pawn of methodological rigour; diversity of levels of experience, and education of therapists, too unmatched model of functional organisation of the different centers, and in the same time too unequal recruitment of patients and at length of proposed therapeutic programs. Moreover, and even before these methodological bias, a more basic obstacle must be considered. It is the non-opening of models to the falsification, denounced by Bignami as the impossible verification of the heuristic value of the proposed models, ie the impossible verification of the utility of the proposed programs for individual therapies of schizophrenics.

Bias↗

PubMedDate not supplied

[Application of guidelines concerning systolic hypertension in patients over 80 years of age: experience in a geriatric institute].

Application of the guidelines concerning systolic hypertension in patients over 80 years of age: experience in a geriatric institute In order to compare the blood pressures of elderly hypertensive patients treated in accordance with recent guidelines, the authors measured the casual blood pressure of a population of long stay patients. Recent data from the FRAMINGHAM HEART STUDY shows that, in the general population, only 23% of women over 80 years of age attained the target values, a blood pressure less than 140/90 mmHg, and only 35% of those treated for hypertension. Eighty patients in the long stay unit of Allauch Hospital were studied in this transverse study performed from the 23rd to 25th of August 2005. The blood pressure (SBP, DBP and PP) and heart rate at consultation were measured by the same physician with the same sphygmomanometer (OMRON M4). The prescribed antihypertensive medication was noted; the presence of atrial fibrillation and the echocardiographic data including left atrial (LA) diameter in M-mode were also included. Forty-four of the 80 patients included were hypertensive (84% women, average age 88.7 years; 16% men, average age 86 years) and treated with the same objective of blood pressure (BP < 140/90 mmHg). The patients were treated by monotherapy in 6% of cases, bitherapy in 27% of cases, tritherapy in 6.8% of cases, and quadritherapy in 4.5% of cases. The distribution of antihypertensive agents in the patients over 80 years of age was almost identical to that of the ninety years of age group. The target blood pressure was attained in 67.5% of women and 71.5% of men. The incidence of atrial fibrillation in the hypertensive patients over 80 years of age was 32%, and 85.7% of them had dilated left atrium (>40 mm). The authors conclude that target blood pressures were more often attained (68% vs. 35%) in this Geriatric Institute than in the American general population probably because of environmental and motivational reasons, including those of the medical staff.

Aged, 80 and over↗

PubMedDate not supplied

[Role of psychotherapy in the treatment of schizophrenia].

Reality-adaptative, supportive psychotherapy, institutional cares, therapeutics with artistic mediations, family therapeutics are unanimously recognized as efficacious therapeutics for schizophrenic inpatients and outpatients. Conversely, the usefulness of psychoanalysis and exploratory, insight-oriented psychotherapy is questionnable. To clear up the question, we have studied controlled and non controlled studies comparing different psychotherapies, as well as the results of individual psychoanalysis. Among the controlled studies, Stanton's study stands out for its methological strictness. This study, in 164 schizophrenics, shows that insight-oriented psychotherapy is not more efficacious than supportive psychotherapy. In the continuation of this work, A. Frank and J. Gunderson show that the determinant factor of the psychotherapy's result is relational continuity and especially therapeutic alliance. Some works made in France show that 6 to 8 months are needed to appreciate the efficacy of institutional cares and psychotherapies can be observed. The psychoanalysis is not always efficacious. But these long acting experiences have provided irreplaceable knowledge towards the understanding of schizophrenic self and transference, effects of institutional cares, therapeutics with artistic mediations, supportive psychotherapy, theoretical reflection (Racamier, Rosenfeld, Searles, etc). Among the metapsychological knowledge, we must see: alterity's denial, struggle against thinking's activity, erotically paradoxical transference, receptacle's and depositary's function of therapists, inexistence of containing function. These knowledges explain that the two principal functions of the care given to schizophrenics are: help to self and presence.

Humans↗

PubMedDate not supplied

[Determination of the optimal dose of bromazepam in the elderly].

The aim of our study was to determine in patients over 70 years, the optimal dose of Bromazepam. Seven patients were administered a unique dose of Bromazepam (3 mg), then repeated doses (1.5 mg) every 12 hours for 9 days. Cmax was 42.5 +/- 12 ng/ml in Tmax ranged from 2 to 12 hours after the first dose-concentrations of Bromazepam at steady-state were between 79 and 157 ng/ml. Half life was 30.5 +/- 14.7 hrs for the unique and the repeated doses. Sleeping was noted for concentrations over 40 ng/ml. The dose of 1.5 mg bid is recommended in old patients.

Administration, Oral↗

PubMedDate not supplied

[Antihypertensive effects of intravenous nicardipine in arterial hypertension in the elderly].

In order to evaluate the antihypertensive action of intravenous (i.v.) nicardipine, a calcium channel blocker, we included 28 patients (20 women and 8 men) aged from 71 to 93 years (mean age: 80.4 yrs) poorly controlled by their normal antihypertensive treatment, which had not consisted of a calcium channel blocker. These patients had past histories of a variety of cardiovascular disorders: valve disease (n = 4), disorders of cardiac rhythm (n = 3), paced or unpaced disorders of cardiac conduction (n = 8), and cerebrovascular accident (n = 12). On inclusion, their systolic blood pressure (SBP) was greater than or equal to 180 mmHg and/or their diastolic blood pressure (DBP) greater than or equal to 100 mmHg. Blood pressure recordings (SBP, DBP, MBP) and heart rate (HR) were simultaneously taken every 3 minutes for a period of 140 minutes by an automatic apparatus and a mercury manometer, before and after i.v. administration of nicardipine at 3 increasing dosages, respectively 1.25 mg (20 th min), 2.5 mg (32 th min) and 5 mg (44 th min), each injected over a period of 6 minutes. With a cumulative dose of 8.75 mg nicardipine i.v., the SBP decreased significantly from 192.6 to 138.8 mmHg (p less than 0.001); similarly, the DBP fell from 93.9 to 65.8 mmHg (p less than 0.001) and the MBP from 126.2 to 90.1 mmHg (Hg manometric measurement). In addition, after the final dose of nicardipine, the blood pressure progressively rose to reach levels, by the end of the trial, of 172.1 mmHg (SBP) and 91.1 mmHg (DBP).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMedDate not supplied