[Minor hypochondriasis].
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Antidepressive Agents↗
Biomedical subjects
J C Samuelian
Publications and source records attributed to J C Samuelian.
[Epileptic psychosis].
A relationship between serious psychiatric disorders and epilepsy has been observed since antiquity. An association between schizophrenia and epilepsy has been noted since the turn of century, but this relationship appeared to be uncertain. From the 1950s on, a number of studies were devoted to this subject. Epileptic patients are more risk for psychosis than the general population. Others psychiatric syndromes, some of which have been individualized recently, can occur in patients with epilepsy: alternative psychosis, affective states, postictal psychoses, postoperative psychoses. In this article we present the different aspects of the psychoses of epilepsy. Their knowledge allows in most cases a precise diagnosis and an appropriate treatment.
Affective Disorders, Psychotic↗
Three-dimensional structure of the Hospital Anxiety and Depression Scale in a large French primary care population suffering from major depression.
Few studies have been specifically carried out to characterize the dimensional structure of the Hospital Anxiety and Depression Scale (HADS) and those that have, have yielded contradictory results. We have examined the factor structure and sensitivity to change of the HADS in a large French outpatient primary care population treated with sertraline for major depression (DSM-IV criteria). Factor analysis of the HADS was performed in 2669 outpatients and in subsamples using a principal component procedure with Varimax rotation. Concurrent change sensitivity of the HADS was compared with that for the Hamilton Depression Rating Scale (HDRS) after at least 45 days of sertraline treatment. Three distinct factors emerged from the HADS factor analysis: a "depression" factor and two separate anxiety subscales: "psychic anxiety" and "psychomotor agitation" whose mean reductions in scores from baseline were significantly correlated (0.36-0.45) with the reduction of the HDRS baseline score. These new data provide support for the use of the HADS's three-dimensional structure to measure improvement of selected symptoms of anxiety during antidepressant therapy.
Adult↗
Clinical factors of drug resistance in juvenile myoclonic epilepsy.
Juvenile myoclonic epilepsy is a comparatively benign form of idiopathic generalised epilepsy. Little is known about the prevalence of difficult to treat or drug resistant patients. Among 155 consecutive patients with newly diagnosed juvenile myoclonic epilepsy evaluated between 1981 and 1998 and followed up for at least 1 year (61 men, 94 women; aged 15-70 years, mean 33 (SD 10.3); onset of juvenile myoclonic epilepsy at the age of 14.5 (SD 3.7), range 6-26; follow up 1-52 years, mean 13.5 (SD 9.9)), there were 15 pseudoresistant patients (9.7%: lack of compliance (eight), insufficient treatment (three), abnormal lifestyle (four)) and 24 patients (15.5%) who had persisting seizures despite adequate therapy and lifestyle. Clinical features associated with drug resistance were (1) the presence of psychiatric problems (58.3% v 19%; chi(2) p<0.001) and (2) independently, the combination of seizure types (Fischer's exact 2 by 4, p=0.0026). Three types were present in 62.5% of resistant patients versus 23.3% in non-resistant patients (chi(2), p=0.0001). None of the resistant patients had myoclonic jerks as the only seizure type or a combination of absences and myoclonic jerks. Family history of epilepsy, age at onset of seizures, sex, presence of photoparoxysmal response, results of conventional neuroimagings (CT and MRI), and delayed diagnosis were not significantly associated with drug resistance. There is thus a significant subgroup of patients with juvenile myoclonic epilepsy who pose difficult therapeutic problems, and the prevalence of resistant cases may be increased in the experience of a referral epilepsy centre.
Adolescent↗
[Psychiatric disorders in juvenile myoclonic epilepsy].
Mild personality problems have been described in patients with juvenile myoclonic epilepsy (JME), but clinical practice shows that JME can be diagnosed in patients with more or less severe psychiatric disorders (PD). The presence in JME patients of personality disorders has been described repeatedly, but never quantified. We thus decided to evaluate, using the DSM IV, the current prevalence and types of PD in a large series of consecutive, newly referred patients with JME. Among 170 consecutive JME cases referred to two departments of epileptology (Marseilles and Nice) between 1981 and 1998 (66 males, 104 females; aged 11.7-70; mean+/-SD 32.4+/-10.4 follow-up 12.7+/-10 [0.5-52]), we found 45 patients (26.5p.100) with PD. According to the DSM IV, they could be classified as severe mental retardation (main diagnosis) (one case); pervasive developmental disorders (2 cases); tic disorder (1 case); enuresis (1 case); psychotic disorders (5 cases, including schizophrenia paranoid type (1 case), disorganized type (1 case), delusional disorder (1 case), unspecified (2 cases)); depressive disorders (3 cases); generalized anxiety (6 cases); anorexia nervosa (2 cases); personality disorders (24 cases, including borderline personality (11 cases), dependent personality (5 cases), histrionic personality (2 cases), obsessive-compulsive personality (1 case), not specified (5 cases)). Sudden unexplained death occurred in 2 cases (borderline personality and pervasive developmental disorder not otherwise specified, respectively) and death due to pneumonia in 1 cases (anorexia). Although uncommonly severe cases of JME may have been selected in our referral centers, it appears that JME may be associated with PD. Comparatively mild personality disorders are the most common finding, and may be part of the clinical picture to some extent, while severe PD are less common, and probably coincidental. The presence of PD does not exclude the diagnosis of JME, and PD may represent a further challenge in the comprehensive care of these patients.
Adolescent↗
[Epilepsy surgery followed by schizophrenia].
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Adult↗
Is schizophrenia a risk factor for epilepsy or acute symptomatic seizures?
PURPOSE: The precise prevalence of epilepsies and seizures in patients with schizophrenia remains unclear. METHODS: To assess the prevalence of epilepsy and of acute symptomatic seizures in schizophrenics, we conducted a survey in a urban sector of Marseilles that includes 56,910 inhabitants, among whom 1,154 had been treated for psychiatric disorders, including 460 for schizophrenia or paranoid disorder (PD) (DSM III-R 295 and 297.1, respectively; mean age, 41.9 years; range, 17-79 years; 215 men and 245 women). RESULTS: All 460 patients were receiving long-term neuroleptic drug therapy, and 397 had been hospitalized at least once in the past year, whereas 63 were followed up as outpatients only. Seizures were present in the history of 12 patients: five had various forms of chronic epilepsy (four men, one woman; DSM III-R 295.1, one case; 295.3, two cases; 295.9, two cases), and three of these experienced seizures only after the onset of their psychiatric condition; five had acute symptomatic seizures (four men, one woman; 295.1, two cases; 295.3, 295.9, and 297.1, one case), and two had only pseudoepileptic events (both 295.3). CONCLUSIONS: This survey shows that the prevalence of epilepsy and acute symptomatic seizures is comparatively low in patients with schizophrenia or PD (10.8 per thousand each, respectively), and that the prevalence of a history of seizures (21.7 per thousand in this study) is not particularly increased in this middle-aged population. In contrast to childhood-onset autistic disorders, schizophrenia or PD are not major risk factors for epilepsy or acute symptomatic epileptic seizures.
Acute Disease↗
A double-blind comparison of the efficacy and safety of milnacipran and fluoxetine in depressed inpatients.
This double-blind, randomised, multicentre study compared the antidepressant efficacy and safety of two doses of milnacipran (100 mg/day and 200 mg/day) and fluoxetine (20 mg/day) in 289 inpatients with endogenous depression. After a placebo washout period of 4-7 days, assessments were performed weekly during the first 4 weeks, and then after 6, 8 and 12 weeks, using the 17-item Hamilton Depression Rating Scale (HDRS), the Montgomery-Asberg Depression Rating Scale (MADRS) and the Clinical Global Impression (CGI). HDRS total score was reduced by a mean of 14.8 in the milnacipran 100 mg/day group, 12.9 in the milnacipran 200 mg/day group and 12.1 in the fluoxetine 20 mg/day group. MADRS total score decreased by 17.4, 15.8 and 14.6, respectively. No significant difference could be shown between the three treatment groups for either the HDRS or MADRS total scores. However, the time-by-time change showed a trend in favour of milnacipran 100 mg/day, which was found significantly superior to fluoxetine at day 28 for several converging parameters (MADRS, CGI-3). Overall, efficacy ratings for all parameters were highest for milnacipran 100 mg/day, followed by milnacipran 200 mg/day and fluoxetine 20 mg/day. Side-effect profiles were not significantly different between groups except for a significantly greater frequency of dose-related increase in heart rate > or = 100 bpm in milnacipran recipients and a significantly greater weight loss in fluoxetine recipients.
Adolescent↗
A randomized, double-blind, parallel-group comparison of venlafaxine and clomipramine in outpatients with major depression.
A multicentre, randomized, double-blind study was conducted to compare the safety and antidepressant efficacy of venlafaxine and clomipramine in 102 outpatients with major depression. The patients received either venlafaxine or clomipramine at a dose titrated from 50 mg to a maximum of 150 mg/day during the first 2 weeks of treatment. Treatment was continued for up to 43 days. Montgomery Asberg Depression Rating Scale (MADRS) and Hamilton Depression Rating Scale (HAM-D) scores decreased significantly (p < or = 0.05) from baseline in each treatment group but were not significantly different between groups. Response rates on the MADRS and HAM-D were 62% and 59%, respectively, with venlafaxine and 54% and 43%, respectively, with clomipramine. Treatment-emergent study events were the primary reason for withdrawal in only 13% of venlafaxine-treated patients and 20% of clomipramine-treated patients. On questionnaires, the incidence of anticholinergic-type events was 60% with venlafaxine and 68% with clomipramine. However, significantly (p = 0.043) more patients in the clomipramine group reported multiple anticholinergic events than in the venlafaxine group. In the clomipramine group, mean ventricular heart rate increased significantly (p = 0.003) and mean systolic blood pressure decreased significantly (p = 0.028) from baseline, but no clinically significant electrocardiographic changes were observed. These results confirm the efficacy and safety of venlafaxine in the treatment of outpatients suffering from major depression.
Adolescent↗
[Incidence of the deficit form in refractory schizophrenia].
The treatment and management of schizophrenic patients "resistant" to neuroleptics is one of the major problem areas in current psychiatry, as is deficitary (non-productive) schizophrenia, which is considered to be the least curable clinical form of the disease. What is the scope of these definitions? The majority of definitions amalgamate affective blunting, social withdrawal, poverty of ideas and speech when describing the deficitary clinical picture. Even though there are differences between authors such as Andreasen and Kay, the consensus opinion holds that there is impoverished emotional range and diminished spontaneous movement. The term "resistance" refers to resistance to neuroleptic treatments. Kane, for example, stipulates that 3 antipsychotic treatments at effective doses and prescribed for an adequate length of time must have proved to be ineffective before the patient can be termed "treatment-resistant". Based on studies, 5 to 20% of these patients are also intolerant of neuroleptics, in particular of their extrapyramidal effects, which induce Parkinson's syndrome, akathisia and tardive dyskinesia. The sedative and extrapyramidal effects of neuroleptics may incidentally augment the negative symptoms (Möller, 1993). Currently there is no scientific method of predicting the likely profile of responders and non-responders to neuroleptics. Collaborative studies carried out by the National Institute of Mental Health (Cole et al., 1964, 1966) on the response to neuroleptics in the acute phase of schizophrenia showed that 3% of patients were worsened, 22% marginally improved and 69% greatly improved by treatment. Recognition of negative forms in resistant schizophrenia also requires distinction between depressive features which develop during the course of schizophrenia. Symptoms such as anhedonia, apathy, social withdrawal and poverty of speed which are typical of depressive illness are also considered to be schizophrenic symptoms (Maier et al., 1990). It is currently accepted that 10 to 25% of schizophrenic patients may be considered as non-responders to antipsychotic treatments. When evaluating this response not only the disappearance of positive and negative symptoms, but also the ability to function socially and professionally and the number of hospitalizations must be taken into account (Strauss and Carpenter, 1972), (Brenner, 1990). It is highly appropriate to evaluate the beneficial effects of treatments on positive and negative symptoms. Johnstone et al. (1978) verified the hypothesis that the traditional neuroleptics were less effective against negative symptoms. Kay and Opler (1987) showed that improvement in these symptoms took longer to become established. The negative symptoms which characterize type II schizophrenia described by Crow (1980, 1985) are considered to be non-responders to treatment. However, authors such as Goldberg (1985) and Meltzer et al. (1986) in the French tradition have dismissed this argument. Studies on the evaluation of treatment currently tend to make a sharp distinction between negative and positive poles. In all cases, biological treatment is rarely adequate and it is essential to combine it with psychosocial therapy. Information from patient and family on the type of illness involved and on the different types of assistance which can be provided, as much medical as purely social, invariably proves useful.
Antipsychotic Agents↗
[Malignant hyperthermia and neuroleptic malignant syndrome: report of 4 clinical cases].
Very numerous publication in the literature suggest the probable relationship between three clinical entities: peranesthesic malignant hyperthermia (PMH), exercitional malignant hyperthermia (EMH) and neuroleptic malignant syndrome (NMS). We briefly describe the clinical history and define, as subjects of research, the personal and familial histories of neuromuscular disease of 4 of our patients having presented with neuroleptic malignant syndrome, as recommended by the European group on malignant hyperthermia, the reference contracture test on neuromuscular fibers and anatomic and cytopathological investigations of neuromuscular fibers. We compare the results for our 4 patients having presented with neuroleptic malignant syndrome and their courses. We confirm the necessity of pursuing both case history and laboratory research in order to elucidate the debate on the hypothesis of a common etiopathogenesis for the 3 syndrome entities.
Adult↗
[Recurrent psychiatric manifestations during malaria prevention with mefloquine. A case report].
The authors report the case of a 22 years old woman without psychiatric antecedent who started a prophylaxis with mefloquine for a journey in a chloroquino resistant area. The first tablet induced an acute psychiatric syndrome which lasted five days; the second tablet induced the recidive of the psychiatric data and a suicide attempt by drowning.
Adult↗
[Congenital neuroichthyosis and psychiatric involvement. Apropos of a case].
Sjögren-Larsson syndrome is a rare disorder of childhood characterized by ichthyosis, mental retardation, and spastic paraplegia. The authors report the case of a patient presenting a congenital neuroichtyosis and psychotic disorders, and discuss the nosology of their case.
Humans↗
[Role of carbamazepine in the treatment of endogenous psychoses. Results of an open study].
The authors report the results of an open trial which aims at specifying the clinical profile of responders to carbamazepine among a population of twenty patients aged from fifteen to seventy, suffering from endogenous, schizophrenic, affective psychoses and paranoid states according to the criteria of the ICD 9. The trial points out a proof of Kishimoto's criteria and a preferential acting of the molecule on schizo-affective psychoses and mixed affective states. The results are interpreted according to psychopathological concepts from the Vienna school that highlight the clinical profile of the responders.
Adolescent↗
[Modification of cognitive functions by 2 anxiolytic treatments in patients suffering from generalized anxiety].
The aim of this randomized, double-blind, multicentric study was to assess and compare cognitive impairment in patients treated with either lorazepam or hydroxyzine, for generalized anxiety. Only non depressed patients were selected according to MADRS criteria. The cognitive assessment was performed with the BEC 96 rating scale, the intensity of anxiety symptoms was evaluated through the Hamilton-anxiety and Covi scales. The level of relation, mood and sedation was assessed for each item with a visual analog scale (VAS). The patient's and investigator's opinion on the global efficiency of the treatment were also evaluated on VAS. After an 8-day wash-out period under placebo, the treatment was given in a double-blind way for 28 days: either hydroxyzine 25 mg at a daily dosage of 100 mg t.i.d. (25 mg - 25 mg - 50 mg), or lorazepam 1 mg at a daily dosage of 4 mg t.i.d. (1 mg - 1 mg - 2 mg). The results were as follows: after the 28-day treatment period, patients showed at the BEC 96 a cognitive improvement in both groups, but the improvement in the hydroxyzine group was significantly higher. Furthermore, the improvement appeared more quickly in the hydroxyzine group. The Hamilton-anxiety and Covi scales showed an improvement in the anxiety level in both groups with no significant difference. The visual analog scales assessing relation, mood and sedation improved in both groups as well as the patient's and investigator's opinion. The five assessments all showed a significant by higher improvement in the hydroxyzine group.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Adjustment disorders: apropos of an epidemiologic survey. Epidemiology and Psychiatry Group].
An epidemiologic survey performed in France in 1990 allowed us to analyze the epidemiologic characteristics of adjustment disorders (AD). AD were defined according to the DSM III-R guidelines. AD are strongly correlated to personality disorders. The study population was young (mean age: 39 years) and predominantly female (60.3%). Marriage or life with a partner, living in the country or in small towns, liberal profession and a high level of schooling are the most significant social and demographic characteristics that emerge from this study. These patients tend to have multiple medical contacts, seeing many doctors but consuming little medication (25% of them). Comorbidity with associated personality disorders (15%) and dependency behaviors (alcohol, drugs) are frequent (9.3%), although no causative link was found between these disorders. Alcoholism may have a tendency to protect against AD. There is no seasonal factor. The patients mostly see private physicians; their geographic distribution is the inverse of the distribution of alcoholism. Numerous social and demographic risk factors for AD were found. Among the personal psychiatric history, disorders of feeding behavior and early adjustment problems were prominent. The family history often shows the existence of mental disorders in the parents. The treatment history points to a lesser consummation of psychotropic drugs, mostly limited for two classes, i.e. antidepressants (50%) and tranquilizers (40.9%), although a different pattern of behaviour was found according to the clinical types of AD. The present therapeutic approach is recent and based on psychotherapy. It differs little according to the clinical forms, with the possible exception of co-prescribed medication. This study has thus allowed us to observe the epidemiologic characteristics of AD. Adjustment disorders appear to be frequent, but their particularities do not differentiate them significantly from other types of mental disorders.
Adjustment Disorders↗
[Clinical and epidemiologic study of "generalized anxiety" in general practice].
Recent studies have shown that 16 to 43% of general practice attenders express minor psychiatric disorders (Barrett et al. 1988). The present survey was carried out among a sample of 1,177 patients seen by 121 private general practitioners through out France. Its purpose was: to rate the point-prevalence of general anxiety disorders (GAD) according to DSM III criteria, to evaluate sociodemographic and clinical status of patients with a GAD, to identify the anxiety symptoms that were the most frequently exhibited in a primary-care practice. 181 patients (15.4%) were assessed a GAD diagnosis. 217 patients (18.4%) were assessed a "secondary anxiety" diagnosis ie anxiety associated with an affective disorder (14.8%), phobia (2.5%), panic disorder (1%). Patients with a GAD were predominantly female, between the age of 35-50 years. They tended to be widowed, separated or divorced and of an average socio-economic level. They also had more previous psychiatric disorders. The GAD appeared to start at the middle age of the life (36 years), to be chronic (lasting over one year) in half of the cases, and to be recurrent. The somatic expression of anxiety was frequent (21%) but 34% of the patients expressed directly their psychological distress. Psychotropic drugs were prescribed to 75% of the subjects. Benzodiazepines were prescribed in 34% of the cases. More surprisingly, antidepressive drugs were prescribed more often when a GAD was diagnosed. This results confirm the high point-prevalence rate of anxiety disorders in general practice.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗