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Biomedical subjects

D Sechter

Publications and source records attributed to D Sechter.

At least 37 records · Page 2Linked to original sources
PubMed1997

Tricyclic antidepressant-induced extrapyramidal side effects.

Two cases of tricyclic antidepressant-related extrapyramidal side effects are reported and, the authors review the literature describing these effects. Despite clear case reports, these side effects are not well known. Given the wide prescription of tricyclic antidepressants (TCA) and the low number of case reports, the prevalence of these side effects is indeed low, but clinical implications exist. The extrapyramidal symptoms induced by TCA alone are acute or tardive dyskinesia, akathisia, myoclonus, rabbit syndrome and dystonia. These symptoms seem to be non age-related, but often dose-related, and were responders to antiparkinsonian agents or propranolol. The factors that predispose an individual to the development of these side effects are not completely understood. Some risk factors such as prior exposure to neuroleptics and/or lithium or estrogens could facilitate the development of these side effects. In some cases, they can disappear even though the same dose of TCA is continued, and they do not seem to be a drug class reaction. The susceptibility of each individual patient to the development of these disorders may be limited to only one or a few of these agents.

Adolescent↗
PubMed1997

Paroxetine and galactorrhea.

The authors report a case of galactorrhea following antidepressant treatment where paroxetine might be responsible. Paroxetine is a selective serotonergic reuptake inhibitor (SSRI). Galactorrhea occasionally is a dopamine-mediated side effect observed with neuroleptic drugs. However, the ability to produce extrapyramidal side effects is known for tricyclic as well as for SSRIs. Thus the potential of SSRIs to induce dopamine-dependent side effects is a clinical reality and it was not surprising to observe galactorrhea due to paroxetine. However, in a review of the literature no reported cases of galactorrhea associated with paroxetine were found.

Adult↗
PubMed1997

[A new study of secondary effects in prescribing practices of neuroleptics].

Within the context of our knowledge of the neuroleptics, side-effects have not only been considered for a number of years as an unavoidable element of these agents; they in fact practically constitute a defining feature of such drugs. Advances in knowledge and the availability to prescribing practitioners of so-called "atypical" neuroleptics allow some redefinition of the above problem. A multidimensional approach which goes beyond more nosographic considerations, and the addition of a temporal dimension to a question for too long reduced to its spatial aspect are new elements which help put the issue of side-effects in perspective. However, any examination of this subject must also take into account the quality of life and the subjective experience of patients undergoing treatment with neuroleptics, since these considerations represent important pathways for the future. Such analysis must also take into account the current situation, in which excessive prescription of corrective agents, the prevalence of co-prescription of psychotropic agents and wide variations in prescribing of neuroleptics (for too long overlooked, in terms of both analysis and education) have given rise to coercive control strategies. The system of Opposable Medical References (OMR) forms part of a panoply of measures aimed at control rather than education. However, education constitutes a key element in this field if the goal of re-appropriation is to be achieved.

Antipsychotic Agents↗
PubMed1997

[Indications for electroconvulsive therapy].

ECT, in which first experiments were made by the italian Cerletti more than half a century ago, underwent, in the seventies, a definite decline, as it was less and less applied to patients, a result of the influence of anti psychiatry. During the last fifteen years, there has been a legitimate renewal of the interest for this therapy; its indications seem now well codified and its techniques and practises have evolved considerably. Actually, in order to carry out ECT under general anaesthesia, it is necessary to have a pluridisciplinary team, assembling nurses, anaesthesists and psychiatrists that will use more and more effective appliances and adequate anaesthetics. Many of the parameters able to influence ECT's effectiveness are now well known and can be used and adapted according the individual characteristics of each patient. These parameters are: the lateralisation of the electrodes, the intensity of the electric current, the duration of the epileptic fit, the modification that appear in electroencephalography and the frequence of the sessions. According to different investigations, it seems that we must systematically question the medical treatments we associate to ECT. For instance, it is highly recommended not to prescribe with ECT benzodiazepines or antiepileptic mood stabilizers, while antidepressants or neuroleptics do not seem to exert any influence on the effectiveness of the treatment. Some authors think caffeine and triiodothyronin (T3) could have an interesting effect when combined with ECT. As to the indications of shock therapy, they can be now more and more precisely defined making of this treatment an indispensable instrument in the cure of depressive disorders. But ECT is also appropriate in maniac disorders once neuroleptic treatment has failed or else in the very beginning in highly acute cases, and mainly in mixed episodes for which medical treatment is often difficult to adapt. In schizophrenia, ECT can also be prescribed in definite circumstances as catatonia, paranoid states or schizoaffective episodes. Therefore, ECT constitutes a safe and comfortable therapy for the patient since its side effects are essentially characterized by cognitive disorders, and its main contraindications consist of severe cardiovascular diseases. ECT is also an essential tool in some definite cases.

Antidepressive Agents↗
PubMed1996

CYP 2D6 PM phenotype hypothesis of antidepressant extrapyramidal side-effects.

Extrapyramidal symptoms occur as side-effects of neuroleptics. For many years, case reports of such side-effects, linked to antidepressant treatments, have been published, but this phenomenon is not well known. Tricyclic and serotonergic antidepressants are both involved. The authors present an hypothesis which provides one possible neurobiochemical explanation for the aetiology of these side-effects. The proposed explanation is related to the inhibition of the CYP 2D6 isoenzyme by antidepressants (or neuroleptics) that may be involved in the genesis of the observed extrapyramidal side-effects.

Antidepressive Agents↗
PubMed1996

The effect of fluoxetine on anxiety and depression symptoms in cancer patients.

Little has been done to study the effectiveness of antidepressants in controlling anxiety/depression in a population of cancer patients. A double-blind placebo-controlled study was therefore designed to assess the effectiveness of 20 mg fluoxetine. Of 115 cancer patients who fulfilled entry criteria for levels of distress, 45 patients were randomized to a fluoxetine treatment group (FA) and 46 patients to a placebo group (PA) after a 1-week placebo period designed to exclude placebo responders. The Montgomery and Asberg Depression Scale (MADRS), the Hamilton Anxiety Scale (HAS), the Hospital Anxiety and Depression Scale (HADS), the Revised Symptom Checklist (SCL90-R) and the Spitzer Quality of Life Index (SQOLI) were used to assess the efficacy of fluoxetine. The response rate, defined by a HADS score lower than 8 after 5 weeks of treatment, was not significantly higher in the FA group (11%) compared to the PA group (7%). Compared to the PA group, patients in the FA group showed a significantly greater decrease in SCL90-R mean total score after 5 weeks, but not a greater decrease in HADS mean score. No difference between the two groups was found in observer-reported assessments (MADRS, HAS and SQOLI). Significantly more drop-outs were observed in the FA group (n = 15) than in the PA group (n = 7), although the frequencies of side-effects were not significantly different.

Adult↗
PubMed1995

Fluvoxamine and fluoxetine: interaction studies with amitriptyline, clomipramine and neuroleptics in phenotyped patients.

The in vivo pharmacokinetic interaction between two selective serotonin reuptake inhibitors (SSRI) (fluvoxamine, fluoxetine) and tricyclic antidepressants (TCAs) (amitriptyline, clomipramine) or neuroleptics (haloperidol, cyamemazine, levomepromazine, propericiazine) was assessed in 29 in-patients. They were phenotyped twice with dextromethorphan and mephenytoin: first in steady state conditions while under treatment with TCAs or neuroleptics; and also 10 days after an associated treatment with fluvoxamine (150 mg day(-1)) or fluoxetine (20 mg day(-1)). A clear and statistically significant increase in the mean urinary metabolic ratio (MR) of dextromethorphan/dextrorphan and in the mean mephenytoin S/R ratio (S/R) was seen with the fluvoxamine and fluoxetine treatment. The mean MR increased from 0.13 to 0.27 (P<0.01) with fluoxetine and from 0.34 to 0.84 with fluvoxamine (P<0.05). The (dextromethorphan) 'extensive metabolizer' phenotype switched to the 'poor metabolizer' phenotype in six patients by the 10-day fluoxetine treatment, and in two patients by the fluvoxamine treatment. The mean S/R increased from 0.24 to 0.34 (P<0.05) with fluoxetine, and from 0.33 to 0.58 (P<0.002) with fluvoxamine. These results are in agreement with the observed modification of TCA plasma levels after the SSRI association. During fluvoxamine treatment, amitriptyline and clomipramine plasma levels (P<0.06 both) tendentially increased, and those of demethylclomiprarnine decreased (P<0.06). Fluoxetine addition lead to a significant increase (P<0.02) of the desmethylclomipramine plasma levels. Fluvoxamine induced a moderate augmentation of the plasma levels of haloperidol and its reduced metabolite and no change in the plasma levels of cyamemazine and levomepromazine. But patients treated with neuroleptics are to few to draw any firm conclusion. This study suggests, that fluoxetine and fluvoxamine differ in their interaction with the metabolism of some other basic psychotropic drugs, by a mechanism which implies CYP2D6 and CYPmeph and possibly other isoformes of cytochrome P-450. Moreover, the interactions produced varied with the TCA prescribed.

Adult↗
PubMed1995

[Long-term clinical effects of antidepressive agents].

According to long term studies with antidepressants versus placebo, the therapeutic efficacy is prolonged: a long term treatment in full dosage seems to reduce from almost half the risk of relapse and recurrence till five years, during recurrent major affective disorders. We should therefore be cautious and we should not have a systematic prescription for all types of depressions; antidepressants are efficacious but have side effects and we do not know well their abilities in long term use. During bipolar disorders the prescription of long term antidepressants, even in association with normothymics, does not give benefits and can induce rapid cycles. In dysthymias and depressions with personality disorders, a psychotherapy is indicated, and it is difficult to evaluate the efficacy of a long term antidepressant treatment. Tricyclics antidepressants, MAOI's and SSRI's have classical side effects, and they can also induce: modifications of the symptomatology, of cognitive functions, of sleep, eating and sexual behaviours; modifications of the course of depressive illness, induction of manic switches, and may be sometimes an exacerbation of suicidal ideation ... pharmacogenetic modifications with their action on hepatic metabolism, neuroendocrine alterations and long term effects on monoamines. We have also to take into account the long term treatment consequences on quality of life, on self esteem with the importance of psychodynamic and relationships modifications. The use of a long term antidepressant treatment should be adapted to each individual, being cautious of its potential benefits and risks.

Antidepressive Agents↗
PubMed1995

[Practical modalities of consolidation treatment].

Long-term treatment has the double objective of consolidating the beneficial therapeutic effect of the initial treatment and of preventing the aggravations which usually occur within 6 or 8 months following the beginning of a depressive episode. The practical measures in long-term treatment of a depressive state are fairly well laid down. Effective antidepressant treatment for an isolated acute depressive episode should be prolonged, at the same dose, for 4 to 6 months following relief from the episode. Epidemiological studies confirm the superiority of antidepressant treatment over placebo in the prevention of recurrence of depressive episodes, complementing a psychotherapeutic approach. Treatment should always be stopped very gradually. If further recurrence occurs, it becomes necessary to continue treatment beyond the 6th month.

Affect↗
PubMed1995

[Survey of the use of international classification (DSM III-R--ICD-10) in France, in private and public psychiatry].

653 french psychiatrists replied to a questionnaire sent to them by mail regarding international classifications. The vast majority of them use these classifications, mainly for research purposes, and 94% own a copy of DSM III-R. Almost 3/4 of them have used this classification at least once in the context of scientific studies or natural science surveys. In contrast, a little over half of them use it only rarely for diagnostic purposes, and ICD-10 is more frequently used by hospital doctors. The scoring system of the latter is in fact designed to outline hospital activities for the administration. The benefits of these international classifications in the training of general practitioners and students should be emphasized, provided instruction in semiology and classical nosography is also given. It should also be noted that terminology tends to evolve, particularly among younger psychiatrists: thus, for instance, the notion of obsessional disorder is gradually coming to replace that of obsessional neurosis.

Adult↗
PubMed1994

[Value of plasma assays of psychotropic drugs].

An increased use of determinations of psychotropic drug levels has been noted during recent years. The contribution of "biological techniques" has led to a change in the relationship between physician and patient by rationalizing medical prescription and by augmenting the medical nature of this relationship. Follow-up of plasma levels is of interest for psychotropic drugs having therapeutic and (or) side effects that are linked to blood concentrations. Such drugs include the imipraminic antidepressants and regulators of thymic function. There is no consensus concerning the benzodiazepines and neuroleptic drugs. Their clinical effect does not seem to be strictly linked to plasma levels and the range of dosages is greater. Such determinations have proved to be particularly interesting in "resistant" cases, in surveillance of drug interactions and to evaluate treatment compliance.

Causality↗
PubMed1994

Correlation of clinical response (PANSS) and plasma levels of haloperidol and reduced haloperidol in schizophrenia.

1. The authors attempted to correlate plasma concentrations in H/rH and clinical efficacy from 8 schizophrenic patients (DSM IIIR) on H. 2. No significant correlations were found between H, rH plasma levels and positive and negative subscale for each patient. 3. The authors observed an opposite evolution concerning the mean results between plasma concentrations and PANSS total score.

Adult↗
PubMed1994

[Long-term treatment with an antidepressant. Objectives and side effects].

The value of long-term therapy in recurrent affective disorders has been investigated in various pharmacological studies. These studies demonstrated the efficacity of various antidepressant drugs on preventing relapse and recurrence and when compared to placebo. Prolonged treatment with antidepressant may have deleterious side effects, such as rapid cycling phenomena or increased risk of suicide. The need for long-term antidepressant treatment must be discussed on an individual basis.

Antidepressive Agents↗