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Biomedical subjects

T Brochier

Publications and source records attributed to T Brochier.

34 records · Page 2Linked to original sources
PubMed1992

[Current concept of mood disorders. Impact on the therapeutic management].

The unipolar-bipolar distinction underlines the recurrence of the disorder (40 to 80% of unipolars and 95% of bipolars) and also the transition from one subtype to the other (10 to 15% of unipolars will become bipolars). Some semiological forms of depressive illness may give clues concerning the required management modalities. Depressions with psychotic features have a good response to ECT or to TCAs+neuroleptics. As other authors, Quitkin et al. find a good response of atypical depression to MAOIs. The comorbidity of mood disorders with personality disorders may be of poor prognosis. Akiskal suggested the presence of a depressive personality, Hudson and Pope suggest the notion of an affective disorders spectrum in which bulimia and OCD have a good response to serotoninergic antidepressants, whereas panic disorders have a good response to clomipramine, imipramine and MAOIs. Patient management should start with taking both the history of the disease and patient's previous treatment with a much precision as possible. Today the focus is on the particular progressive forms of resistant and chronic depressions, among which there are patients who have not received adequate treatment, and of rapid cyclers. The hypothesis of hypothyroïdism in rapid cyclers has been suggested recently. Carbamazepine and Valproate seem to be efficacious in several recent open studies and in controlled for carbamazepine. The initiation of chemotherapy to prevent the recurrences of depression takes into account the unipolar or bipolar aspect of the mood disorder. Lithium has emerged as the prophylactic agent of choice in bipolar disorders, especially if the index episode is manic. Early prophylaxis is justified when the first episode is manic or after two depressive episodes.(ABSTRACT TRUNCATED AT 250 WORDS)

Antidepressive Agents↗
PubMed1991

[Prediction of the efficacy of thymoregulators].

Among clinical factors, the compliance amounts to 47 to 82% of the patients. Recent data contradict the classical poor response of unipolar patients to lithium. Most studies realized on bipolar patients concern bipolars type I. Bipolar patients type II often show comorbidity factors which predict poor response to lithium or carbamazepine. The clarity of mood disorders and the frequency of cyclers have a bearing on the treatment response. But hypothyroidisms described in rapid cyclers do not predict response to L. thyroxine. We should also take into account the sequence of episodes and the type of index episode. The data concerning other possible mood stabilizers are scarce. Among biological parameters, the results are very upsetting. The calcium levels, serotonin levels, the red blood cell/plasma lithium ratio essentially predict tolerance or compliance. The various psychological tests do not enable us to identify a sub-group of patients responding to lithium. The remaining difficulties in the predictive capacity enhance the importance of establishing for each patient the precise history of the illness and previous treatments.

Antidepressive Agents↗
PubMed1990

[Relations between intelligence and perversion. Small essay on ethics].

Excepted vegetarians, everybody let kill and may kill for self-defence. The killed-one suffers and dies. Perversity is to kill or to let suffer without personnal life's saving's necessity--for the treasure of the "perverse subject". We think that such subjects must not be considered as non responsible, excepted when they present a mental retardation. The sexual perversions are probably not the most dangerous: the most are subjects using a personnal high level of intelligence to domination and destruction, including in the sexual behaviours.

Adult↗
PubMed1990

[Lithium as founding the concept of endogenous mental disease].

The abnormal life--potentially the death--of the cell can be restored by a metalloid--lithium--which is nearly as common as sodium in the mineral world. This established fact grounds indirectly, contrary to apparent and scientific logic, the concept of endogenous brain disease which was until then an abstract concept because of a lack of objective evidence. Seven case reports are described.

Adult↗
PubMedDate not supplied

[The lithium test, test of endogenous criteria].

The lithium-test (Li-T) requests hospitalisation of the patient, administration of Li to obtain a plasma/level of at the lust 0, 8 mEq/l, since the third to the eight day. It improve depressions, acute delusions, pseudo-dementias: the field of the lithiodépendent endogenic diseases as to be enlarged. The Li-T may distinguish between this lithiodependence of the other, non-lithiodépendent, in dysthymic psychotic disorders.

Adult↗
PubMedDate not supplied

[Non-verbal clinical psychiatric aspects].

Mimic, involuntary movements, agitation or immobility, are parts of description, comprehension and evaluation of any human behaviour, normal or not: they were included in the classic european psychiatries. They almost disappear from the actual scales of evaluation, or from the training through scales. It seems possible to complete such scales, exclusively verbal, by scales of behaviours-suicidal attempt being a good instance of such behaviours.

Facial Expression↗
PubMedDate not supplied

[Stress and depression].

Can modern life foster more depression life? Neuroendocrine, epidemiological and even immunological approaches allow us to suppose a passage between stress and depression, far beyond the archetype of exhaustion depression (break down syndrome).

Antibody Formation↗
PubMedDate not supplied

[Obsessive-compulsive disorder and the study of thyroid function].

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.

Adult↗
PubMedDate not supplied

[Biomedical researches: for whom? for what? how?].

The law of December 20th 1988 provides for the protection of those people who lend themselves to clinical research, both patients and healthy subjects. The ex-expert clinicians are confronted with new drugs and protocols of experimentation enacted by industry. Grey areas still exist, authors try to limit them for want of being able to through light on them, today.

Clinical Trials as Topic↗
PubMedDate not supplied

[Sequence in prescribing neuroleptics: a therapeutic alternative in refractory schizophrenia?].

Although clozapine (CLZ) is effective in resistant schizophrenia, it fails in some cases leading to a therapeutic problem. Authors report a case of schizophrenia which resists several neuroleptic trials (including haloperidol, chlorpromazine and thioproperazine) and responds to a sequence of CLZ and amisulpride. These two atypical neuroleptics have the same main target (mesolimbic system) but have different and complementary affinities to neuromediator receptors: CLZ has strong serotoninergic and anticholinergic action, noradrenergic alpha 1 affinity and moderately active dopaminergic antagonism; amisulpride has a high and specific dopaminergic D2 antagonism when used at high posology. This clinical improvement can be related to "second treatment effect", described by Goldman in 1966: his study included two groups of refractory schizophrenic patients who received successively during two 6 months periods, 2 neuroleptics (fluphenazine and trifluperazine). Without initial therapeutic response, he noted a significant improvement only after change of neuroleptic medication. Tricyclic antidepressants may turn to be effective, after an initial failure, when they are given after an uneffective ECT trial. The same model may be applied and the clozapine-amisulpride sequence is proposed as an alternative treatment in resistant schizophrenia: even if CLZ is uneffective, it may produce carryover effects which ease the action of amisulpride. The hypothesis of an action on 5HT2-D2 antagonism is advanced. It leads to the general question of the opportunity of neuroleptic sequential prescription in resistant schizophrenia as a therapeutic option.

Adult↗
PubMedDate not supplied

[Hyperparathyroidism with lithium].

Lithium has proved to be a highly effective preventive measure in mood disorders and an increasing number of patients are receiving long-term lithium carbonate therapy. Among other biologically and clinically important effects of lithium, the possible induction of hyperparathyroidism was first suggested in 1973 by Garfinkel et al. About thirty other case reports have since been described, but they could simply have represented the coincidental occurrence of primary hyperparathyroidism and lithium carbonate treatment in the same patients. Eleven cross-sectional studies of calcium metabolism in patients treated with lithium carbonate have been reported. Evidence of a causal relationship of lithium to hyperparathyroidism can lead to a loss of effectiveness of lithium in controlling the affective symptoms. Interestingly, coexistence with hypothyroidism is not uncommon. Low serum phosphate, high serum chloride are also observed. Bone mineral content may decrease. In addition, several studies have shown that lithium treatment increases serum magnesium level. Unusual metabolic features are associated with hyperparathyroidism and long-term lithium treatment: low urinary calcium excretion, absence of nephrolithiasis, and normal urinary cyclic AMP excretion. Lithium inhibition of PTH sensitive adenylcyclase in the kidney would explain these features. In vitro studies suggested that lithium is a potent inhibitor of several hormone responsive adenylcyclase systems. It is possible that the tissue susceptibility to adenylcyclase inhibition in an individual may decide the nature of endocrine dysfunction seen during lithium treatment. Information about the time course with which abnormalities may develop is derived from longitudinal studies. Several months to several years are needed for lithium inducing primary hyperparathyroidism. In vitro studies provide strong evidence that lithium can induce a shift in the set-point for inhibition of PTH secretion by calcium and a direct stimulation of PTH secretion. The extent to which we can extrapolate these data to the clinical situation is discussed. In vivo data from Shen an Seely are compatible with these two mechanisms. These alterations should cause parathyroid hyperplasia. The possibility that a generalized parathyroid stimulus might lead to formation of a single adenima is not proved. Several recommendations regarding parathyroid function in patients receiving lithium have been suggested. Measurement of total calcium and serum proteins or of serum calcium ion values when available should be performed before therapy is begun. If elevated values are obtained, lithium treatment should be deferred and evaluation for hyperparathyroidism performed. Serum calcium should be monitored periodically during lithium treatment. Sustained hypercalcemia or true hyperparathyroidism require parathyroidectomy. If hypercalcemia is mild without complication and psychiatric symptoms well controlled, perhaps surgery should not be employed.

Adult↗
PubMedDate not supplied

[Recurrent depression without lithium therapy. A lost chance].

By four patients hospitalized for a depressive recurrent the favorable element of clinic evolution was a lithotherapy then bring the effect very rapidly (three to seven days) grace using gluconate of lithium. The lithium being antidepressant, the absence of lithotherapy tentative in the course of major depressive status recurrent is a loss of chance for patients.

Adult↗
PubMedDate not supplied

[Lithium in the treatment of refractory depression].

The definition of treatment-resistant depression is variously interpreted. There is no agreement of different authors on its meaning. The present vagueness of criteria for the diagnosis of a refractory depression contrasts with the many studies reporting potentiation of antidepressants by lithium. De Montigny in 1981, after early works by Zall and by Lingjaerde, initiated this approach that still remains poorly understood in terms of biochemical mechanisms. A review of the controlled studies shows that the delay of antidepressant action varies and the term "lithium potentiation" does not seem totally relevant. From a pharmacological point of view, several types of data suggest a synergic potentiation rather than a true potentiation. This effect applies to all classes of antidepressants and improves about 50% of patients who did not respond positively to an adequate treatment received during 4 to 6 weeks. Many questions remain unanswered particularly concerning the lithium levels, factors predicting a positive response and the strategy for the maintenance treatment. Studies are necessary in order to compare the relevance of this potentiation technique with the mere substitution by another antidepressant and to understand the biochemical mechanisms underlying the synergic effect.

Antidepressive Agents↗
PubMedDate not supplied

[Critical analysis of controlled pharmacologic studies in obsessive compulsive disorder].

Controlled pharmacologic studies in obsessive-compulsive disorder (OCD) are recent, scare and concern only antidepressants. Clomipramine constitutes the reference drug in the treatment of OCD and in comparative studies. The present paper includes a compendium of the results of 15 controlled studies and a critical approach of their methodologies and conclusions. The discussion continues about the genuine anti-obsessive effect of antidepressants, its specificity and the underlying neurochemical mechanisms.

Antidepressive Agents↗