[Sensitivity to psychotropic drugs in schizophrenia].
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Biomedical subjects
Publications and source records attributed to M F Poirier.
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We evaluated thyroid function (T3, T4, TSH) and TRH Test in 17 patients with obsessive-compulsive disorder (DSM III criteria and at least 1 year duration) not associated to major depression (absence of DSM III criteria and depression Hamilton scale score, 17 items, below 16). Blood tests were performed following a drug-free period of at least 2 weeks. We accidentally discovered one case of hyperthyroidism with the diagnosis of Graves' disease. In the remaining group (n = 16), basal values of thyroid hormones and TSH were normal. 12.5% (2 cases) showed a blunted delta TSH (less than 5 mUl/l) and 0% a high delta TSH (greater than 20 mUl/l). A significant degree of negative correlation was only noted between delta TSH and age (r = -0.65). Lastly, we report a curious comorbidity between OCD and Graves' disease found in 3 cases within a population of 50 OC patients (or 6%) recruited in our psychiatric unit. The characteristics of these observations will be presented.
The authors have reviewed the records of 50 heroin addicts treated with methadone, a drug which, in France, is delivered under strict and daily supervision to only few patients. This retrospective study yielded the following data: (1) the success rate of maintenance treatment with methadone exceeded 50 percent and remained the same in HIV positive patients; (2) social and environmental factors predictive of poor response to methadone were the absence of professional activity at the beginning of treatment and a painfully disturbed family context. A history of trouble with the law was not a factor of poor prognosis. These data raise the problem of importance of an early treatment which might have a strong influence on subsequent developments.
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The association between changes in platelet MAO activity and Major Depressive Episode have been demonstrated. Cyclical changes in sex hormones serum levels had never been related with changes of MAO activity in depressed patients. Platelet MAO activity, oestrogen serum levels, progesterone serum levels and testosterone serum levels, have been measured in drug free depressed patients: 22 men and 42 women. This study demonstrates no relationship between serum levels hormons and platelet MAO activity, measured in men and in women. If young women are separated from menopaused women, platelet MAO activity is negatively correlated with oestrogen serum levels, in non menopaused women. Significance of this variation in studies about the use of MAO as a biochemical marker in depression is discussed.
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Cognitive functions are known to be impaired by ECT. The aim of this study is to differentiate the effects of electroconvulsive therapy on some cognitive functions according to the mode of application of the electrodes. The brief-pulse Thymatron DG apparatus allows to control four electrical parameters and to assess electroencephalographic data. The preliminary sample comprises nine patients suffering of major depressive disorder; they are randomly assigned to the mode of application of the electrodes, bilateral or unilateral to the non dominant hemisphere. Clinical evolution is surveyed by the Montgomery and Asbert Depression Rating Scale. Non mnesic functions are assessed: arousal by CFF (Critical Fusion Frequency), and attentional, motor and decisional abilities by CRT (Choice Reaction Test). Different mnesic function are studied by selective reminding test, cued recall test, block tapping test and picture fragmentation test. After treatment by ECT, verbal mnesic functions assessed by selective reminding test are impaired with the bilateral application. Whereas they are not modified with the unilateral application. The variance of CFF regains a physiological value in the bilateral group, but remains altered in the unilateral.
Through a review of the literature, the average mortality in schizophrenia is twice higher than among the population. This over mortality is highest among the 20-40 years range of age and added risk tends to disappear after 60 years. All studies stress the unnatural causes of death, suicide or accidental deaths. However several studies found an over mortality caused by natural death. The pathologies most often involved are: infections, lung, gastrointestinal, urogenital and cardiovascular diseases. Cancer mortality in schizophrenic patients is still debated. Some studies point out a reduced mortality compared to the general population whereas other studies find similar or over mortality. Nevertheless mortality ratio is found to be near 1 in the majority of studies. So it can be admitted that schizophrenic patient do really not differ from the general population in regard to cancer mortality. Premature death is highly linked to suicide. The epidemiological indicators that enable us to estimate the importance of suicide mortality are: the rate of suicide per 105 patients per year varies between 150 and 500, the percentage of death by suicide range between 10 and 15 percent. Suicide risk factors are numerous. Some of them are accepted as valid and others are still discussed. The former are: male gender, young and medium age ten first years of the illness course, associated depressive symptoms, past history of suicide attempts, iterative relapses and post hospital discharge period. The latter are: social isolation, celibacy, unemployment, high level of instruction, delusional and hallucinatory activity and familiar rejection.
The authors present a critical overview of the multiple studies of cognitive functions of patients with obsessive compulsive disorder. First are mentioned some correlations between neurological diseases and obsessive compulsive disorder. Then, the authors analyse the results obtained by the patients in WAIS, in the tactual perception memory test, in visual memory and orientation and in verbal memory. Verbal behaviour, performances in sensory perception tests, motor performances, attention and, lastly, troubles in information processing are reviewed. With these results, the authors try to develop the relevant theories about the mechanisms in obsessive compulsive disorder: dysfunction of the dominant hemisphere and abnormality of the serotoninergic system.
Behavioural modifications induced by psychotropic drugs results primarily from their pharmacological properties. According to classification of psychotropic drugs, sedative compounds contrast with psychostimulating medications. Behavioural effects of psychotropic drugs depend on dosing, subject's status (patient or healthy volunteer), acute or chronic administration, and environment. Some psychotropic compounds, particularly sedative drugs, decrease the level of mental alertness and cognitive functioning. But those deleterious effects tend to disappear during the course of a repeated administration. Some psychotropic drugs, especially benzodiazepines, induce a tolerance effect, eventually a psychic or a physiological dependence state evidenced by withdrawal reactions. Such similar dependence processes have been reported with other psychotropic drugs. Forensic problems have been attributed to some psychotropic compounds, like benzodiazepines: paradoxical aggressive reactions, psychomotor automatism; Psychotropic drugs usually can confer a positive effect on behaviour owing to their therapeutic action by the way of improving the illness and consequently the life of patients in the cases of depression, anxiety or schizophrenia.
The prevalence rate of transsexualism varies from 1 to 50,000, to 1 to 100,000. Although it remains an infrequent affliction, transsexualism generates usually major suffering and may be responsible of many complications like suicide, self-mutilations, affective disorders and social disabilities. Since the first descriptions of Esquirol in the nineteenth, the medical community has always been questioned on medical, legal, social or ethical aspects of transsexualism. The aetiology of the trouble is still unknown. In the absence of biological marker, the syndrome of transsexualism can be defined only with clinical criteria. The main differential diagnosis are sexual ambiguities and psychotic disorders. For the specialists, satisfying the patients demand of a surgical and social reassignment still remains the only way to improve their clinical condition and avoid the onset of many dramatic complications. Without any treatment, the evolution of the trouble is chronic, without remission. Longitudinal studies of transsexual patients with a five year follow-up demonstrated subjective improvement in two thirds of the patients and don't find either higher rates of suicides nor psychotic decompensations after surgery and hormonotherapy. Clinical and neuropsychological studies of sexually differentiated cognitive abilities of transsexual patients, before and after hormonotherapy, could allow us in improving the understanding of sexual differences of the brain.