Experience of organizing collaboration of general practitioners in psychiatric studies in a specific catchment area.
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Biomedical subjects
Publications and source records attributed to M Gastpar.
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Diurnal variations during the depressive phase and healthy periods were investigated in 84 hospitalised depressive patients of different nosological diagnosis. The occurrence of different rhythm-types in this population led to the conclusion that depression induces rhythmicity: those belonging to the arhythmic group when healthy showed significant increase in rhythmicity when depressed, predominantly the classical form of diurnal variation (morning with improvement toward evening). Age and sex were found to be important factors determining diurnal variation. In the course of hospitalisation, the type of diurnal rhythm remained individually constant.
A study of linkage of bipolar manic-depressive illness to the protan/deutan colorblindness region of the X-chromosome was performed on 16 informative families, in a WHO collaborative study (eight families from Brussels, Six from Bethesda, one each from Basel and Copenhagen). Overall, the series did not support close linkage, but is possibly suggestive of loose linkage. The possibility of genetic heterogeneity of bipolar manic-depressive illness, with one form linked to colorblindness, is considered.
Six WHO Collaborating Centre took part in the study of the antithymic activity of blood sera of patients suffering from schizophrenia. Blood serum specimens from 118 schizophrenic patients and 62 mentally healthy donors were investigated. Statistically significant differences between schizophrenic patients and the controls were found (p < 0.05). It is probable that as with other biological phenomena described in schizophrenia, antithymic activity is one of the biological factors, in combination with other factors, predisposing towards the development of the schizophrenic process.
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An intensive course of drug treatment--combination of a major tranquilliser with two antidepressants--was used in 46 patients with endogenous depression and 31 with exhaustion depression, all of which had proved refractory to other forms of treatment. After one week intramuscular injection of the major tranquilliser, in order to relax the patient, intravenous infusion of the two antidepressants, clomipramine and maprotiline, was performed daily for 10-20 days, while the major tranquilliser was given orally during this period. Complete remission after 4-6 weeks was achieved in 70% of patients with endogenous depression and 48% with exhaustive depression. It is stressed that careful diagnosis and treatment by drug and psychotherapy are preconditions for the successful management of otherwise resistant depressions.
Infusion of a new soluble ester of L-5-hydroxytryptophan produced euphoria in 34/35 experiments in healthy subjects. Parallel measurements of growth hormone and mood changes showed a similar rise and fall of these two parameters in 8/11 subjects. These results indicate that central stimulatory serotoninergic mechanisms (in addition to the well-known dopaminergic and alpha-adrenergic stimulation) play a role in the control of growth hormone release.
An i.v. injectable form of the serotonin-precursor L-5-hydroxytyptophan (Ro 3-5940) was investigated for its acute psychotropic effect. The difficulties are presented which had to be overcome as it was not known which effects could be expected. It was shown that for the intensive psychotropic effect found, it was not possible to use a long and detailed self-rating scale. The problem of informed consent is discussed.
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A pharmacokinetic analysis of a new antidepressant drug, mianserin (ORG GB-94), was undertaken in 4 male volunteers, each of whom received 15 mg mianserin on two occasions. Plasma levels peak at 2 h with a median level of 11.0 ng/ml, a median beta-phase half-life of 10.0 h, and a median apparent volume of distribution of 3.3 X 10(3) 1. EEG profile analysis shows mianserin to increase frequencies below 6 Hz, decrease those from 7.5 to 15 Hz, and increase frequencies above 18 Hz, a pattern similar to amitriptyline. Peak EEG effects range from 2 to 5 h with a pattern of measured changes that parallels plasma levels with varying latency. Decreases in vigilance measures and in critical flicker-fusion frequency show a similar time course. Mianserin is a putative thymoleptic on EEG profile analysis with high cerebral penetrance.
L-5-hydroxytryptophan ethylester (Ro 3-5940), a new soluble form of this serotonin precursor, was administered to 26 healthy, non-depressed subjects after premedication with the peripheral decarboxylase inhibitor benserazide (Ro 4-6402) in a total of 51 infusions. Those conditions were chosen for the main trial which in a pre-trial investigation had proved to combine minimal side effects with clear central effects in particular the observed marked mood elevation after 1-5HTP. Using these standardized conditions of application, an interindividually similar pattern of the time course of substance effects could be shown, and convincing evidence was deducible for an objective mood elevating effect of 1-5HTP infusion. Amongst the most impressive results was the parallelity of the time course of mood changes and concomitant changes in serum growth hormone levels. Especially emphasized are the important questions of effectivity, specificity and clinical practicability or safety, which are essential for any precursor study. Arguments are presented supporting the assumption that primarily serotoninergic changes underlie these mood effects. In our opinion this mode of i.v. application of 1-5HTP represents a practicable strategy for investigating biochemical hypotheses as to serotonin mediated normal and deviant human behaviour, especially in affective disorders.
L-5HTP was found to act primarily on mood, and unequivocally in the direction of elation. The subjective, protocols, psychometric results, and a double-blind study demonstrated convincingly and intra-individually consistent course of action of the substance under the chosen conditions of application. This course of effects can be described in three phases: In a first phase (about 0 to 1 1/2 hours after end of infusion) an intensive mood elevation (mostly experienced as a disharmonious feeling), psychomotoric activity, changed perception, as well as somatic side effects were observed. A second phase (about 1 1/2 to 3 1/2 hours after end of infusion) was characterized by elevated mood (feeling of well-being) together with a tendency to inactivity, whereas other phenomena were less often reported. A third phase (about 3 1/2 to 6 hours after end of infusion) was characterized by mood decline and the feeling of having again reached "normality". Side effects again tended to occur. It is shown that neither placebo nor situative effects greatly influenced elevation of mood or other substance effects. This is demonstrated by the homogenous time course and the blind studies.
In a precursor study with i.v. 1-5HTP (Ro 3-5940) after peripheral decarboxylase inhibition with benserazide (Ro 4-4602) in healthy human subjects the following biochemical changes were found: 1. Prolactin release was stimulated by benserazide alone, and further stimulated by 1-5HTP (more in women than in men). 2. Basal growth hormone secretion was not affected by benserazide, but was significantly stimulated by 1-5HTP, often to extremely high values. The time course of growth hormone release followed that of mood elevation in 8/11 subjects (and was even correlated in 3), providing data for speculation as to the interrelationships between affective state and neuroendocrinological function. 3. Cortisol levels were higher than normal throughout the experiment, but followed the diurnal decline. A late stimulation of cortisol release after 1-5HTP was observed. 4. The lack of increased platelet serotonin after 1-5HTP indicated efficacious peripheral decarboxylase inhibition by benserazide. 5. Benserazide treatment inhibited platelet MAO activity in certain subjects. Short-term increases in MAO activity after 1-5HTP were observed. 6. 1-5HTP displaced albumin-bound tryptophan by 20%.