[Carpipramine, a specific psychotropic drug between neuroleptics and anti-depressive drugs].
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Biomedical subjects
Publications and source records attributed to H Lôo.
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The concept of disinhibitory agent is heterogeneous. If the disinhibitory property refers to inhibition in its clinical meaning, all psychotropic drugs can answer the denomination of disinhibitory agent when they are prescribed in some pathological entities. Traditionally this denomination refers to a few major tranquillizers, the antipsychotic action of which is linked to the improvement of the affective indifference and of the decrease of the psychomotor activity. However the pharmacokinetic data reveal that some potent sedative neuroleptics can become disinhibitors at high doses and some disinhibitory agents can become sedative substances at higher doses.
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An open clinical study was conducted with carpipramine in 100 hospitalized subjects presenting various mental disorders. The therapeutic results on symptoms were assessed both as a whole and with the help of a rating scale. Doses varied from 50 to 400 mg per day. Carpipramine seems to be particularly efficient on schizophrenias, 66 cases of which were tested. The best results were observed in hebephrenic forms and depressive syndroms during the illness; in these indications, carpipramine exerts a clear psychomotor stimulating activity which is useful in decreasing indifference, apathy and ideomotor slowness. Schizophrenias with paranoid delusions or depersonalization anxiety tend to be somehow aggravated. Carpipramine does not seem to be a true antidepressant despite its desinhibitory properties. The compound proves useful in deficits of the psychomotor tone such as those occuring in psychasthenia or the deficit syndrom which follows withdrawal from opiates. Clinical and biological tolerances seem to be excellent and extrapyramidal side effects are exceptional. Carpipramine may be considered as a strongly desinhibitory neuroleptic agent which bears some resemblance to antidepressants because of its psychoanaleptic effect. The authors raise the question of possible antipsychotic properties in higher doses in relation to pharmacological data and a bipolar, antipsychotic and predominantly desinhibitory, therapeutic action.
The authors try to determine the incidence of long-term lithium treatments on sleep, appetite and sexual behaviour. The study was conducted in fifty outpatients of both sexes who have been for at least six months on lithium only and whose mood disturbances are stabilized. In two thirds of the cases of this clinical study, lithium seems to have beneficient qualitative and quantitative effects on sleep as opposed to other psychotropic drugs which cause discomforting sleepiness. Lithium seems to influence appetite slightly although it is responsible for the gain in weight in a fourth of the treated outpatients. Half of the subjects consider that lithium modifies their sexuality towards a decrease of the desire without modifying their capacities of realization. In a comparison study conducted with the psychotropic drugs that had been administered before, the repercussions of lithium on sexuality appear thus opposite to those of psychotropic drugs, major tranquilizers and antidepressants which impair the capacities without reducing the desire. Despite the specific side effects on some instinctive functions, lithium seems to be a treatment well lived by the subjects.
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The dosage of the whole tryptophan and of the free tryptophan was conducted in 16 normal subjects to establish reference values and in 12 schizophrenic subjects among whom 7 were under treatment and 5 were not. The method of dosage is made by spectrofluorimetry by increasing the native fluorescence of tryptophan. The results give mean values for the free tryptophan and for the ratio of the free tryptophan to the whole tryptophan values that are higher in the schizophrenics than in the normal subjects used as reference, while the whole tryptophan seems to be little modified ; this increase is more noticeable in the schizophrenics under treatment. The limited number of the cases studied does not enable us yet to establish correlations between the increase of the free tryptophan found in some cases and the nature of the schizophrenia, its age and its evolutivity or even the clinical response to the treatment. However, some figures for the free tryptophan being very much higher than the mean value in some schizophrenics, suggest ways of research for understanding the pathogenisis of schizophrenia and the mechanisms of the therapeutic action of the psychotropic drugs.
Widespread use of certain drugs (amphetamines, L.S.D., hypnotics) in France, allowed us to observe more than 200 cases of acute or chronic psychoses among addicts. Sometimes these are transitory outburst but the occurrence of a delusional psychosis with long range evolution raises a difficult diagnosis problem in relation to functional psychoses. The emphasis should be put on respective roles of the drug and of a predisposed mental state. Circumstances of beginning, apparently direct relationship between drug taking and pathological symptoms, therapy efficiency, absence of earlier pathological traits (as in many of our patients) and relapse when intoxication starts again, are in favour of a pharmacological origin of the troubles.
A clinical trial on fifty patients studied a new compound with a quadricyclic structure, Ciba 34.276-Ba or Maprotiline in any category of depression. The product was found to have notable antidepressive properties, capable to act on the melancholic depressions of the manic depressive psychosis and of involutive melancholia. The best results were noted in the neurotic and reactive depressions perhaps because a tranquilizing activity marked in the majority of the cases. The clinical tolerance was found good and the side effects which reminded of those caused by derivates of Imipramine, remained moderate while the biological tolerance was perfect. The modifications of the electroencephalogram were of two types, one of them suggesting thymoanaleptic activity, the other suggesting rather a sedative activity.
Pharmaco-psychiatry has contributed to the study of mood regulation mechanisms (thymo-regulation). Anti-manic neuroleptics may induce depressions: anti-depressants may cause mood inversion (with artificial "bipolarity"), and lithium has an action upon alternating disorders of the mood. Correlations with the extrapyramidal syndromes are to be noted: parkinsonism going along with depression, and the antiparkinsonian action with the stimulation of mood. The extent of the role played by neuro-hormones, beta-inhibitors, and releasing-factors is still under discussion. The theoretical notion of mood regualtion makes it possible to single out a special type of psycho-stimulation implying manifold applications.
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