Biomedical subjects

S Lancrenon

Publications and source records attributed to S Lancrenon.

49 records · Page 3Linked to original sources

PubMedDate not supplied

[Bipolar obsessive-compulsive disorder: confirmation of results of the "ABC-OCD" survey in 2 populations of patient members versus non-members of an association].

Clinical data are largely focused on depressive comorbidity in OCD. However in practice, treating resistant or severe OCD sufferers revealed many cases who seem to have an authentic OCD with a hidden comorbid bipolar disorder. Most reports had evaluated the OCD comorbidity in unipolar and bipolar mood disorders (Kruger et al., 1995; Chen et Dilsaver, 1995). The only investigation in clinical population focused on the reverse issue was conducted in Pisa. Perugi et al. (1997) have showed in a consecutive series of 315 OCD outpatients, that 15.7% presented a bipolar comorbidity, mostly with BP-II disorder. Further analyses suggested that when comorbidity occurs with bipolar and unipolar depression, it has a differential impact on the clinical picture and course of OCD. The rate of bipolar comorbidity in OCD was analyzed in a recent epidemiological survey undertaken by the French Association of patients suffering from OCD (FA-OCD or AFTOC in French). In a sample of 453 OCD patients, 76% had suffered from a major depression, 11% from bipolar disorder (DSM IV mania or hypomania), 30% from hypomania (cases that obtained a score > or = 10 on the self-rated Angst Hypomania Checklist). According to the score > or = 10 on Self-rated Questionnaire for Cyclothymic Temperament, 50% were classified as cyclothymic. The self-assessment of soft-bipolar dimensions, such as hypomania and cyclothymia was previously validated in a multi-site study in major depression (Hantouche et al., 1998). Further analyses showed that comorbidity with soft bipolarity was characterized by significant interactions with high levels of impulsivity, anger attacks and suicidal behavior. In order to confirm these data, another cohort (n = 175 patients treated by psychiatrists for OCD) was formed and named "PSY-OCD". Comparative analyses between the two populations allowed showing very few demographic and clinical differences. The frequency rate of "bipolar OCD" was equivalent in both populations: BP-II disorder (DSM IV criteria) was present in 11% of FA-OCD and 16% of PSY-OCD. Furthermore using the Hypomania Checklist showed that BP-II disorder rate (score > or = 10) was higher: 32% of in both populations. Cyclothymic rate was also globally higher, but significant difference was obtained: 56% of FA-OCD versus 45% of PSY-OCD (p = 0.02). Moreover, mood switching rate under anti-OCD drugs was equivalent in both OCD populations (respectively 38% and 33%, p = ns). In case of BP comorbidity, patients had presented a greater number of concurrent major depressive episodes and suicidal attempts. When concurrent depression was considered, the rate diagnosis of soft bipolarity was 2.5 fold, and the number of suicidal attempts augmented by 7 fold (by comparison versus non-depressed OCD). Despite very early descriptions (since the beginning of the last century) of particular relationships between so-called "psychasthenia, folie de doute, folie raisonnante" and "circular and intermittent madness or cyclothymia", a few attention has been devoted to this complex pattern of comorbidity. The comparative data deriving from the collaborative survey with patients who are members of AFTOC and with a cohort of psychiatric outpatients, confirm the reality of bipolar-OCD comorbidity, which is largely under-recognized in clinical practice. More in depth analyses are now undertaken in order to investigate the characteristics of "bipolar OCD" by comparison to "non bipolar OCD".

Adolescent↗

PubMedDate not supplied

[A controlled double-blind study of tetrabamate versus lorazepam and placebo in generalized anxiety].

The anxiolytic efficacy of tetrabamate was evaluated in a multicentric double-blind study versus lorazepam and placebo, in 269 patients with a generalized anxiety disorder according to DSM III-R criteria. The anxiolytic activity of tetrabamate (at 900 mg/day) was significantly superior than that of placebo from day 7 of treatment and equivalent to lorazepam efficacy (at 4.5 mg/day). In the tetrabamate group, 55.3% were considered as "good responders" (as defined by a HARS score reduction equal or superior to 50%), versus 51.3 and 32.9% respectively in the lorazepam and the placebo groups (chi-square = 9.63, p = 0.008). Sheehan's scales (parts 1 and 2), Norris visual analogue scales, CHESS 84, CHESS complement 82 for withdrawal evaluation, physician's overall evaluation of efficacy and tolerance, were also used to assess the clinical effects of tetrabamate. The data on these measures confirmed the anxiolytic efficacy of tetrabamate and showed some advantages in the tetrabamate group in comparison with the lorazepam group: a better global tolerance at the study end point (day 35), a greater efficacy on some anxiety somatic items and lesser frequency and severity of withdrawal symptoms during treatment tapering off.

Adult↗

PubMedDate not supplied

[Clonidine versus a placebo trial in manic disorder].

Clonidine efficacy was evaluated in 24 manic inpatients, hospitalised in a locked ward. This is a double blind and randomized study. The duration of the trial was 14 days, and the daily dose of clonidine was 0.225 mg/day during the first week, increased to 0.450 mg/day during the second week, in the case of incomplete improvement. There was a trend for a better efficacy of clonidine over placebo, but this did not reach significant, due to an important amelioration of many patients under placebo. The effects of the hospitalisation in a locked ward are discussed.

Administration, Oral↗

PubMedDate not supplied

[Disorders of catecholamine metabolism in infantile autism. Comparative study of 22 autistic children].

In a group of 22 autistic children aged 5 to 16 y., and a group of normal controls matched for age and sex, catecholamines metabolism has been investigated in plasma, platelets and urine. This investigation was part of a research project in which several biological parameters (including serotonin) were simultaneously explored in the same children. In the autistic group, epinephrine and norepinephrine and dopamine were significantly lower in isolated platelets, and no significant difference was found between the two groups for the urinary excretion of epinephrine, norepinephrine, dopamine, DOPAC and MHPG. Other differences between the two groups in the statistical correlations of several biochemical parameters (plasma norepinephrine and dopamine with platelet MAO activity, platelet norepinephrine with platelet dopamine, platelet dopamine, platelet dopamine with platelet serotonin) also suggest abnormalities of bioamine metabolism in the platelets of autistic children.

Adolescent↗

PubMedDate not supplied

[Metabolism of serotonin in autism in children].

In this controlled study of 22 autistic children and 22 normal controls matched for age and sex, the frequency of hyperserotonemia in infantile autism was confirmed. Platelet serotonin was elevated in patients. Comparative to controls, serotonin was also high in urine of autistic patients, while, on the contrary there was no difference for the urinary excretion of 5-HIAA. No difference was observed either for serotonin uptake and efflux or for MAO activity, in isolated platelets. The elevation of plasma free tryptophan - significant only with the Kolmogorov Smirnov test - suggests that 5-HT biosynthesis might be enhanced. In the group of patient reported in this study, disorders of serotonin metabolism are associated with disturbances of platelet catecholamines, and also with elevated immunoglobulins and enhanced cellular immunity reactions.

Adolescent↗

PubMedDate not supplied

[Double-blind study of the efficacy of an antiserotoninergic drug, pizotifen, in Duchenne's muscular dystrophy].

In 40 patients presenting with Duchenne muscular dystrophy, a double blind therapeutic trial of 18 months was undertaken in order to appreciate the efficacy of pizotifen, an anti-serotoninergic drug. Quarterly evaluations were performed. Each of them included muscular testing on 31 pairs of muscles, timed tests, dynamometric study of the thumb-forefinger grip, functional testing, respiratory function tests, muscular enzyme determinations, parents' subjective estimation and search for side-effects. With respect to the evolution of Duchenne muscular dystrophy, this study did not show significant differences between pizotifen at a dose of 1.5 mg/day and placebo, except for a parents' preference for the drug.

Child↗

PubMedDate not supplied

[The Pleasure-Displeasure Scale. Use in the evaluation of depressive illness].

The Pleasure-displeasure Scale is a self-report instrument consisting of 82 items for measuring the intensity of subjects' affective responses to usually pleasant and unpleasant situations. 81 depressed inpatients were compared to 120 normal subjects. The responses of the depressed patients to the Pleasure sub-scale (French translation of the Fawcett-Clark's Pleasure Scale) are more anhedonic than those of the normal subjects; but the difference did not reach statistical significance. Pleasure scores in the depressive group are bimodally distributed; a distinct subset (11% of depressives) is characterised by an extremely anhedonic Pleasure score. The sensitivity to unpleasant stimuli is significantly greater in the depressive group; however this difference seems to be related rather to a low cultural level than to depression itself. Finally pleasure and displeasure scores are closely correlated: this could possibly imply that anhedonia is not an independent symptom but rather belongs to the wider constellation of affective anesthesia.

Adult↗

PubMedDate not supplied

[Major agitated-anxious versus blunted-retarded depression: differential effects of fluoxetine].

A multi-centre study was designed to evaluate the efficacy and tolerance of fluoxetine in two groups of major depression: "agitated-anxious" and "blunted-retarded". The study included 50 patients presenting a major depressive episode (following DSM III-R criteria and score > or = 20 on MADRS): 26 in "agitated-anxious" group (score > or = 15 on Hamilton anxiety scale and > or = 10 on Tyrer anxiety brief scale) and 24 in the "blunted-retarded" group (score > or = 15 on Widlöcher retardation scale and > or = 10 on Abrams-Taylor blunted affect scale). After one week period on placebo, all patients were treated in an open design with fluoxetine at a fixed daily dose of 20 mg and followed on a period of 6 weeks with active treatment. In spite of a significant antidepressant efficacy of fluoxetine in the two groups, better results were observed in the "agitated-anxious" depressed group: marked improvement on MADRS total score at day 42 (76% decrease vs 62% in the "blunted-retarded" group, p = 0.012), greater number of "responders" defined by a decrease > or = 50% on MADRS total score and a total score < or = 12 (95% vs 63%, p = 0.04), better patient's global impression on efficacy (54% of "excellent efficacy" vs 18%, p = 0.012), more improvement on HSCL-58 total score (mean decrease of 69% vs 39%, p = 0.016), higher improvement on "hostility/interpersonal hypersensitivity" score (mean decrease of 74% vs 37%, p = 0.001) and on "anger attacks/irritability" sub-score (mean decrease of 73% vs 30%, p = 0.0002).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

[Effect of antidepressant treatment on sense of dyscontrol: preliminary studies].

Cumulative data in the field of phenomenology, neurobiology and psychopharmacology indicate "discontrol" as a dimension probably linked to serotonin central activity and frequently observed in major depression and other related disorders. A new questionnaire for evaluating this dimension is proposed: Behavioral Discontrol Scale (BDS). The BDS was constructed in 1990 and validated through multiple clinical studies: the first validation study included 166 patients (subdivided in 4 subgroups, anxious, depressed, alcohol abusers and bulimics fulfilling DSM III-R criteria) and 35 controls. The second validation study concerned a large clinical population suffering from major depression according tho DSM III-R criteria (n = 1360 patients). The episodes classified as psychogenic or neurotic and characterised as "agitated, anxious, impulsive and/or suicidal"' showed the highest scores on discontrol (p < 0.001). Following these initial studies, the present study was conducted to evaluate prospectively the sensitivity of BDS to change under different antidepressant treatments (serotonergic versus other agents). Preliminary data were obtained within a group of 62 outpatients suffering from major depression (DSM III-R criteria), treated naturalisticly and followed on a 4 weeks period. Results showed that discontrol is sensitive to change, especially in the fluoxetine group (decrease at day 28 by 35% vs 23% and 24% in other groups, p = 0.17). Changes of discontrol scores was shown to be related to benzodiazepine (BZD) combination to antidepressant treatment. In fact, in the group "with BZD" (n = 42), the magnitude of BDS score variation was less important than in the group "without BZD" (n = 19): respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMedDate not supplied

[Comparative double-blind study of bromazepam versus prazepam in non-psychotic anxiety].

The efficacy of bromazepam and prazepam for the different components of anxiety: inhibition, asthenia and somatisation is evaluated in a multi-centric, comparative and randomised study, conducted as double blind and in parallel groups in 159 adult patients showing a manifest anxiety according to the F.D.A. criteria. After a 7 day wash-out period, the patients receive either bromazepam in a 12 mg/d dose or prazepam in a 40 mg/d dose, over 4 weeks (D0-D28), then in a decreasing dose from D28 to D43; follow-up is carried out using the anxious inhibition scale W.P.2, auto-questionnaire A.D.A., the Hamilton anxiety scale and the Tyrer questionnaire (benzodiazepine withdrawal symptoms questionnaire). Patients are evaluated seven times during the study: at day 7 for inclusion, day 0 for randomisation, then day 7 and day 14 for following visits, at day 28 for efficacy and tolerance evaluation, and at day 50 for utilisation and withdrawal evaluation. The major efficacy criteria are the evolution of inhibition, asthenia and somatisation as compounds of anxiety respectively evaluated by W.P.2 scale, asthenic partial score of autoquestionnaire A.D.A. and somatic partial score of Hamilton anxiety scale. The analysis of results don't show any significant difference between the two groups on the evolution of the components asthenia and inhibition. However the evolution of the somatic component clearly makes a significant difference in favour of bromazepam. There is also a significant difference in terms of global anxiolytic action efficacy, in favour of bromazepam.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMedDate not supplied

[Prevalence of obsessive-compulsive disorders in a large French patient population in psychiatric consultation].

Recent epidemiologic studies were conducted in general population, showing high rate prevalence of obsessive-compulsive disorder (OCD) (2-3%). Although more investigation of OCD prevalence in clinical population is still warranted. The prevalence of DSM III-R diagnosis of OCD and obsessive-compulsive syndromes (OCS) is reported in 4 364, 16-70 year old new consecutive patients, consulting in out-patient psychiatry. Point prevalence rates of 9.2% were recorded for OCD and 17% for OCS. Significantly different from non obsessional patients, it was observed in OCD and OCS patients more male representation (41% vs 37%, p = 0.007), a younger current age (36 y vs 39 y, p < 10(-4)) and age of disorder onset, higher rate of celibat (31.5% vs 28.6%) and lesser of separated or widowed (9.4% vs 16.2%, p = 0.003), more anxiety and depression comorbidity (50% vs 39%, p < 10(-4), a higher suicidal risk (17% vs 14%, p = 0.04--especially in OCS patients: 18.3%), more chronicity (mean current episode duration: 14.8 months vs 11.2 m., p < 10(-4)) and higher rate of global functioning impairment (score at GAF: 53.9 vs 57.9, p < 10(-4)). The results of the french survey confirmed the high prevalence of OCD and OCS in patients seeking psychiatric treatment. OCS (or subclinical OCD) seem to form a valid group (high rates of comorbidity and suicidal attempts) which need to be recognized and to receive adequate treatment.

Adolescent↗

PubMedDate not supplied

[Clinical aspects of obsessive-compulsive syndromes: results of phase 2 of a large French survey].

Obsessive-Compulsive Disorder (OCD) had received a new interest from fundamental research (psychopharmacology, neurobiology and brain imagery...). Although more investigation of OCD clinical aspects are needed, especially in large cohorts of patients, not seen nor investigated only in high specialized psychiatric units. A large french survey "Screening-Understanding-Treating OCD" was conducted in 1994 with the participation of 240 psychiatrists. The survey had included 4,363 new consecutive patients consulting in out-patient psychiatry. The phase 1 had shown a point prevalence rates of 9.2% for OCD (full criteria of DSM III-R) and 17% for OCS (Obsessive-Compulsive Syndromes). From 731 patients, the phrase 2 was conducted on a cohort of 646 patients with OCD or OCS and had explored in details in the clinical aspects of the OC illness (typology, symptomatic categories, comorbidity, OCD spectrum, psychiatric family history and treatment history...). The results of the french survey phase 2 had confirmed a variety of classical and current literature data, especially: the ICD 10 proposal for diagnostic sub-typology according to symptomatic predominance (obsessions, compulsions or both); the symptomatic clustering of obsessions and compulsions into three major categories, suggested by a recent study from the Boston University; the high rate of comorbidity with anxiety and depressive disorders and with disorders related to the large OCD spectrum (somatoform disorders, eating disorders, impulse-control disorders, compulsive buying...); the impact of clinical parameters (as slowness, avoidance, lack of insight) on clinical global OCD and OCS severity; the high rate of intrafamilial psychiatric morbidity (OCD, depression, anxiety disorders).

Adult↗

PubMedDate not supplied

[Repeat evaluation of impulsiveness in a cohort of 155 patients with obsessive-compulsive disorder: 12 months prospective follow-up].

UNLABELLED: Relationships between OCD and impulsivity are currently under research. METHOD: In the phase 3 of the national study on OCD, 155 patients suffering from an OCD (DSM III-R criteria, score on NIMH-OC > or = 7) had entered a naturalistic follow-up of 12 months duration. Impulsivity was assessed by using the BDS (Behavioral Dyscontrol Scale, offautoquestionnaire of 24 items) at day 0, 6th and 12th months and a semi-structured interview for Obsessive-Compulsive Related Syndrome and Behaviors Spectrum, as defined by Hollander (DSM III-R criteria). RESULTS: Impulsivity was more intense in females (mean score on BDS 35.6 vs 31.9, p = 0.06), in patients with personal history of anxiety-depression (36.3 vs 32.3, p = 0.04) and suicidal behavior (38.3 vs 33.2, p = 0.06) and familial history of OCD (37.1 vs 33.0, p = 0.07). Moreover, syndromal typology of obsessions or compulsions did not seem to influence impulsivity. In contrast, presence of co-existing OC Related Syndrome was significantly linked to higher impulsivity score, especially with "Intermittent Explosive Syndrome" (mean score = 40.1 vs 30.8, p < 10(-4), "Compulsive Buying" (38.5 vs 32.4, p = 0.005), "Hypochondriasis" (36.7 vs 32.1, p = 0.02), "Dysmorphophobia" (37.1 vs 32.4, p = 0.02) and "Depersonnalization" (37.7 vs 32.9, p = 0.05). Paradoxically, impulsivity was augmented in patients with important to severe slowness syndrome (38.3 vs 31.8, p = 0.001). This mixed association between slowness and impulsivity can be an excellent testimony of "Dyscontrol" phenomenon. In 130 patients who had received an anti-obsessional pharmacologic treatment during 12 months follow-up, impulsivity score was gradually reduced from day 0 (mean score = 34.1) at M6 (24.8-22% reduction) and at M12 (20.1-36% reduction). After one year of follow-up, a decreased by > or = 50% of impulsivity score was observed in 42% of obsessional patients. Finally, the response rate of OCD to pharmacotherapy seemed to be modulated by the dimensions of impulsivity and slowness. In fact, the best results after 6 months of treatment were observed in the sub-groups presenting high level of "impulsivity" (62-66% were responders) versus 39% in the sub-group with important to severe slowness.

Adult↗