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Biomedical subjects

H Hilleret

Publications and source records attributed to H Hilleret.

16 recordsLinked to original sources
PubMed2006

[Anxiety in palliative care].

In palliative care, the intensity and duration of anxiety as well as its consequences on the patient's daily activities can significantly decrease his quality of life. Anxiety that does not incapacitate the patient to the point of his being unable to communicate or perform his usual activities does not necessarily require drug treatment. The non pharmacological treatments of anxiety are presented in some detail. Prescription of anxiolytic drugs in renal or hepatic failure, as well as when oral intake or venous access are difficult, is briefly discussed.

Anxiety↗
PubMed2001

Mania resulting from continuous positive airways pressure in a depressed man with sleep apnea syndrome.

The authors report the case of a 50-year-old man, with no previous history of bipolar illness, hospitalized with a very severe depression and who was resistant to a 7-weeks treatment of venlafaxine and trazodone (the respective daily doses were 300 and 50 mg which were stable during the last 4 weeks). A diagnosis of sleep apnea syndrome led to the use of the continuous positive airways pressure technique (CPAP). A few days after starting CPAP, he presented a mood switch, first hypomanic, then mixed. The authors discuss the contribution of the sleep apnea syndrome to the appearance and the maintenance of the depressive disorder.

Bipolar Disorder↗
PubMed2000

Sleep disordered breathing in the elderly.

Sleep disordered breathing (SDB), i.e., obstructive, central or mixed sleep apneas, has been recognized as a common occurrence in the elderly. Aging is per se associated with a decrease in the quality of sleep; SDB may further disrupt the sleep architecture in older subjects. The prevalence of obstructive sleep apnea (OSA) increases with aging; available studies report prevalence rates of 11-62%. Furthermore, OSA has been associated with increased mortality in older adults. Central apneas and periodic breathing occur with increased frequency either in subjects with neurological disorders such as infarction, tumor, sequelae of infection, diffuse encephalopathies, or in chronic heart failure. Patients with cerebrovascular disease (stroke, or transient ischemic attacks) have a markedly high prevalence of SDB, mainly OSA. In these patients, SDB is associated with a poorer functional prognosis at 3 and 12 months after the acute event, and a higher mortality. The clinical impact of SDB on cognitive function appears to be modest in patients without dementia, although there is a moderate increase in daytime sleepiness. In Alzheimer's disease (AD) however, SDB occurs more frequently than in non-demented older subjects, and its severity is correlated with the degree of cognitive impairment. The hypothesis of a causal relationship between AD and SDB remains a subject of controversy. The possibility of SDB should be considered in the elderly in the differential diagnosis of "reversible dementias", increased daytime sleepiness, or unexplained right-sided heart failure.

Aged↗
PubMed2000

[L-tryptophan plasma levels in treatment resistant depressive states].

10 to 30% of depressions are resistant to standard treatment. Different therapeutic strategies are used to treat the resistant depressions. Therefore, before initiating an antidepressant treatment, it would be important to know which patients will probably not respond to a standard treatment. Numerous studies have shown that serotonin is involved in depressive illness and its synthesis in the brain is dependent on the availability of tryprophan from plasma. As tryptophan plasma level is decreased in depression, resistant depressions may also be characterized by alterations of tryptophan plasma level. 141 depressed patients were admitted in our psychiatric unit in Geneva between 1984 and 1990. 36 were diagnosed as treatment resistant depression. Although treatment resistant patients group had more women and a more severe score of depression on the AMDP-4 scale, we did not observe a significant difference in tryptophan plasma level compared to patients who respond to treatment.

Adult↗
PubMed2000

[Respiratory sleep disorders in the elderly].

Ageing is often associated with a decrease in the quality of sleep. In older subjects, sleep-related breathing disorders (SRBD) are increasingly recognized as being responsible for alterations in the quality of sleep. The prevalence of obstructive sleep apnea (OSA) increases with ageing; despite sometimes major disturbances in sleep structure, clinical symptoms are often subtle in this age group. Central apnea and periodic breathing, also more frequent in older subjects, most often occur in patients suffering either from neurological problems (such as tumors, brain infarcts, sequelae of infection, diffuse encephalopathies) or moderate to severe heart failure. In fact, patients suffering from cerebro-vascular diseases (such as brain infarcts or transient ischemic attacks) have a higher prevalence of SRBD than a control age-matched population. In these patients, SRBD are associated with a poorer prognosis in terms of functional recovery and survival. The clinical impact of SRBD on cognitive function appears to be modest in patients without dementia, albeit for a slight increase in daytime somnolence. However, in patients suffering from Alzheimer's disease, SRBD occur more frequently than in non-demented subjects, and indexes of severity of SRBD have been correlated with the importance of cognitive impairment. The hypothesis of a causal relationship between SRBD and the degree neuropsychological impairment in either Alzheimer's disease or multi-infarct dementia remains a matter of controversy. SRBD should be considered as a possible cause of "reversible dementia" and sought for in the presence of daytime somnolence, delirium, or unexplained right-sided heart failure in older patients.

Age Distribution↗
PubMed1997

Weak association between blood sodium, potassium, and calcium and intensity of symptoms in major depressed patients.

In previous reports, we showed that plasma and erythrocyte magnesium were increased in many drug-free hospitalized depressed patients. Furthermore, we observed that erythrocyte magnesium content was related to the intensity of the symptoms. Highly depressed patients had the highest magnesium values. Today, we report the results of plasma and erythrocyte sodium and potassium, and of total and ultrafilterable plasma calcium in 66 hospitalized patients with major depression compared to 58 healthy controls. No consistent differences in these biochemical parameters are observed between patients when separated according to intensity of anxiety, psychomotor retardation, and moral distress. Plasma sodium is higher and plasma potassium lower in female patients of all subgroups as compared to controls. Both male patients and controls have erythrocyte sodium and potassium levels that are significantly different from those of females. This clearly suggests a separation into genders in such studies. In conclusion--in contrast to blood magnesium--sodium, potassium, and calcium levels do not seem to be related to the intensity of the main clinical symptoms in hospitalized patients with major depression.

Adult↗
PubMed1995

Relationship between erythrocyte magnesium, plasma electrolytes and cortisol, and intensity of symptoms in major depressed patients.

53 male and female drug-free major depressed patients were separated into three groups according to the severity of the depression. In the entire regrouped population, plasma and erythrocyte magnesium (Mg) were shown to increase as compared with 48 healthy controls, confirming our previous studies. The middle and highly depressed patients had higher erythrocyte and also plasma Mg levels than either lowly depressed patients or controls. Only, a few differences were noticed in plasma sodium, potassium and calcium (Ca) in the three groups of patients, except for ultrafiltrable plasma Ca, measured for the first time in affective disorders. Thus, erythrocyte and also plasma Mg are shown to be associated with the intensity of the depression. As blood hypomagnaesemia is often related to hyperexcitability, further investigations are actually in process to shown whether hypermagnesaemia might be, in contrast, associated with psychomotor retardation as observed in many depressed patients.

Adult↗
PubMed1995

Sodium-magnesium exchange in erythrocyte membranes from patients with affective disorders.

The Vmax of erythrocyte sodium-magnesium exchange was measured for the first time in 63 patients suffering from affective disorders and compared to that in 33 healthy subjects. Depressed patients had a significantly higher Vmax (215 +/- 13 vs. 151 +/- 14 mumol/l.cells/h; p < 0.005; mean +/- SEM). This tendency was conserved after division of the 63 patients into three clinical subgroups according to the DSM-III-R criteria. Thirty-four patients from this panel were divided into three subgroups according to the chemical class of the antidepressant drug used and were followed up during a 3-month period of drug treatment. Mood improvement over the 3-month period was associated with a slow increase in Vmax of Na/Mg exchange (delta increase approximately 25 mumol/l.cells/h), except in the subgroup of patients treated with non-tricyclic antidepressants (n = 8). These results are consistent with the previously reported link between high erythrocyte magnesium content and affective disorders. Indeed, enhanced Na/Mg exchange Vmax, which probably results from an increased number of transport units per cell, contributes to the normalization of red blood cell magnesium content correlated with mood improvement.

Adolescent↗
PubMed1993

Lack of effect of anxiety on total plasma MHPG in depressed patients.

This report was undertaken to test the noradrenergic deficiency hypothesis of depression and the postulated increase in noradrenergic activity associated to anxiety states. A possible dual effect of both depression and anxiety on total plasma MHPG levels was hypothesized and assessed in anxious and non-anxious depressed patients. The findings show a decrease in plasma MHPG levels in depressed patients whatever their degree of anxiety. There was no difference in total plasma MHPG levels either between anxious and non-anxious depressed patients or between low and high anxiety to depression ratio (ADR) depressed patients. Following antidepressant drug-treatment, a decrease in plasma MHPG was found. A positive correlation between the drug-induced decrease in NA activity and the severity of depression was observed, and suggested a relationship between the severity of depression and the instability of the NA system. No correlation between the drug-induced decrease in plasma MHPG and the degree of anxiety was found. The results do not suggest out an effect of anxiety on total plasma MHPG levels in depressed patients.

Adult↗
PubMed1993

Adrenaline-induced platelet aggregation in depressed patients and control subjects.

We measured alpha 2-adrenoceptor-mediated platelet primary aggregation in depressed patients and healthy subjects. Both initial velocity and maximum amplitudes of platelet response to increasing concentrations of adrenaline were decreased in drug-free depressed patients as compared with controls. The EC50 of both initial slope and maximum amplitude were also increased in drug-free depressed patients. The results suggested a lowered platelet alpha 2-adrenoceptor function. Demographic factors (age and sex) and the time between blood collection and start of aggregation monitoring did not influence the results. This report is consistent with postsynaptic receptor desensitization in depressed patients. The precise molecular mechanism for this impairment remains to be elucidated.

Adolescent↗
PubMed1993

Blood magnesium, potassium, sodium, calcium and cortisol in drug-free depressed patients.

Many biochemical variables, including plasma and erythrocyte magnesium, were simultaneously measured in drug-free depressed patients (n = 34), compared to healthy controls (n = 35). Higher plasma and erythrocyte magnesium concentrations were observed in patients than in controls (+12 per cent, P < 0.0001 and 14 per cent, P < 0.0001, respectively). In contrast, patients showed a lower plasma potassium level (-10 per cent; P < 0.007). Cortisol secretion was much higher in patients (+35 per cent; P < 0.02), particularly in females, showing overactivity of the hypothalamo-hypophyseo-adrenal axis in the patients. Except in a few cases, plasma sodium and calcium in patients did not differ from control values. Significant differences in magnesium and cortisol levels were observed between patients classified in diagnostic groups and by sex, whereas little variation in the other biochemical indices was noted. The increase in blood magnesaemia and its possible association with central hypocatecholaminergic deficiency in affective disorders are discussed.

Calcium↗
PubMed1992

Evolution of blood magnesium, sodium and potassium in depressed patients followed for three months.

No consensus has been obtained about blood electrolyte status, especially about magnesium, in affective disorders. This is mainly due to the lack of information about the distribution of the patients in clinical subgroups, sex, type of treatment and about the severity of their illnesses. Most of these studies concerned treated patients. We confirmed in this study that drug-free depressed patients have higher erythrocyte and plasma magnesium than controls, as shown in previous reports. Significant differences are observed in as shown in previous reports. Significant differences are observed in patients for sex and between clinical subgroups. Low plasma potassium levels are described in both male and female depressed patients. The erythrocyte magnesium level tends to normalize in parallel with clinical improvement, depending on sex and clinical subgroup, and seems then to be related to the intensity of the depression. Plasma magnesium in male and female patients, except for female unipolars, remains higher than controls in all conditions and might be related to the diagnosis of affective disorders.

Adult↗
PubMed1988

[Apropos of a case of functional dysphagia].

Isolated functional dysphagia (IFD) was rarely cited in human adults. Here we reported a case of a patient which presented IFD. A constructivist approach revealed a primacy of the assimilation and an incapacity to overcoming the difficulties. The constructivist approach permitted the disappearing of the symptom. The concept and the technic of such approach are discussed.

Adult↗
PubMedDate not supplied

[Erythrocyte membrane transport and plasma levels of tyrosine and tryptophan in depression].

L-Tyrosine and L-Tryptophan were studied in 80 depressed patients, hospitalised in Genova and Marseille. After a washout period of ten days, the erythrocyte membrane transports (MT) of L-Tyrosine and L-Tryptophan were measured, as well as their plasma levels; plasma phenylalanine was moreover measured. 33 normal subjects served as control group. In the whole population of patients, the mean of MT's was different compared to controls (MT tyrosine low and MT tryptophan high) and the plasma tyrosine was low. The perturbations of these variables were different according to diagnostic groups (DSM III): MT tyrosine, plasma tyrosine and tryptophan low in bipolar disorders depressed; MT tyrosine low, MT tryptophan high, plasma tryptophan low in major depressions; MT tryptophan high in dysthymic disorders. Phenylalanine was in the normal range compared to controls. The perturbations of MT's involved the part incubated at 37 degrees C for tyrosine, e.g. the facilitated diffusion, and the part incubated at 0 degrees C for tryptophan, e.g. probably the passive and facilitated diffusion. These results were in agreement with the monoaminergic hypothesis of affective disorders and might provide a useful peripheral model.

Adult↗