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J M Vanelle

Publications and source records attributed to J M Vanelle.

At least 19 recordsLinked to original sources
PubMed2001

Consensus on the Practical Use of Amisulpride, an Atypical Antipsychotic, in the Treatment of Schizophrenia.

Clinical expectations in schizophrenia treatment have greatly increased since the introduction of new atypical antipsychotics, but the choice of therapeutic strategy has become more complex and reference guidelines are scarce. This paper summarizes the consensus of a broad range of professionals after long-term commercialization in France of an atypical antipsychotic, amisulpride. Participants were from psychiatric hospitals, private clinics, out-patients settings and research; all were experienced with the drug. Discussions focused on the practical use of amisulpride, as, in addition to the double-blind trials information, it may be useful for psychiatrists of other countries to intuitively understand the therapeutic properties of amisulpride. The topics selected include acute psychotic episodes, short- and long-term follow-up, feasibility of treating the initial phase, the elderly and switching treatments. The French experience emphasizes the central role of amisulpride as a first-line treatment of schizophrenia.

Adult↗
PubMed2001

A double-blind comparative study of clozapine and risperidone in the management of severe chronic schizophrenia.

OBJECTIVE: This prospective, double-blind, multicenter, parallel-group study compared the efficacy and safety of therapeutic doses of clozapine and risperidone in patients with severe chronic schizophrenia and poor previous treatment response. METHOD: Male or female patients aged 18-65 years who met DSM-IV criteria for schizophrenia and study requirements for poor previous treatment response (N=273) were randomly assigned to double-blind treatment with either clozapine or risperidone administered over 12 weeks in increasing increments. The primary efficacy measures were the magnitude of improvement in Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression (CGI) scores. Adverse events were recorded throughout the study. RESULTS: The magnitude of improvement in mean BPRS and CGI scores from baseline to end of the study was significantly greater in the clozapine group than in the risperidone group. Statistically significant differences in favor of clozapine were also seen for most of the secondary efficacy measures (Positive and Negative Syndrome Scale, Calgary Depression Scale, Psychotic Depression Scale, and Psychotic Anxiety Scale). The adverse event profile was similar for both treatment groups, with a lower risk of extrapyramidal symptoms in the clozapine group. CONCLUSIONS: Clozapine showed superior efficacy over risperidone in this patient population. Both treatments were equally well tolerated as demonstrated through their adverse event profiles, although as expected clozapine was associated with a lower risk of extrapyramidal symptoms than risperidone.

Adolescent↗
PubMed1997

Controlled efficacy study of fluoxetine in dysthymia.

BACKGROUND: There have been very few controlled studies of antidepressants in dysthymia, particularly in samples diagnosed reliably and with an adequate length of follow-up. In this investigation, we measured the long-term outcome in a large group of patients meeting DSM-III-R criteria for dysthymia. This study was designed to investigate whether fluoxetine is effective in the treatment of dysthymia. METHOD: This randomised study including 140 patients, compared fluoxetine (91 patients) and placebo (49 patients) on a double-blind basis in two distinct phases: a short-term end-point (3 months with 20 mg/day fluoxetine) and a medium-term end-point (6 months) where the initial responders continued double-blind treatment unchanged and non-responders received an additional treatment of 20 mg/day fluoxetine. RESULTS: After three months of treatment, response was seen more frequently in the fluoxetine group (42/72) than in the placebo group (14/39, P < 0.0001). Improved patients at 3 months were still improved at 6 months. Furthermore, 50% of the nonresponders at 3 months improved and rated as responders at 6 months, after fluoxetine was increased to 40 mg daily. CONCLUSIONS: This study showed the significant and persistent action of fluoxetine on dysthymia. The finding that 50% of the non-responders at 3 months were improved at 6 months, after fluoxetine dosage was increased to 40 mg daily, argues in favour of treating dysthymic patients for at least 6 months, and with a higher dosage if the initial doses are ineffective.

Adult↗
PubMed1996

[Profile of the action of neuroleptics in deficit schizophrenia].

Schizophrenic patients have a deficit syndrom which now is better known with new scales like the SANS of N. Andreasen and the PANSS of Kay. The dichotomy of schizophrenia in two kinds of disease--positive and negative schizophrenia--needs a critical review; but treatment of negative symptoms remains a real and difficult problem. Effects of antipsychotic medication (neuroleptics) on negative symptoms of schizophrenia have been hypothesized since 1958 by french psychiatrists: Broussole and Dubor. The main classifications of neuroleptics by Delay-Deniker, Bobon, Colonna-Petit have acknowleged the action that is called: antiautistic effect, antideficit effect or desinhibiting effect. This conception is a quasi specific position of french psychiatrists in opposition to most of the american psychiatrists who have thought during a long time that negative symptom did not respond, or poorly, to neuroleptics. The improvement of the methodology of clinical studies has made possible to confirm the clinical impression of an effect of some typical neuroleptics on negative symptoms: flupentixol, fluphenazine or pimozide. Moreover, a bipolar action of some NLP: desinhibition at low doses and sedative at higher doses has been individualised for some compounds: sulpiride, pipotiazine or amisulpride. Atypical neuroleptic like clozapine or risperidone also can reduce negative symptoms. Today we are not able to determine "the good desinhibiting NLP for the good schizophrenic patient"; so new studies are needed.

Antipsychotic Agents↗
PubMed1995

Sensitive assay of thyroid stimulating hormone in depressed patients.

A decreased thyroid stimulating hormone (TSH) response to thyrotropin releasing hormone (TRH) has been noted in major depression. Some authors found a positive correlation between baseline TSH levels and TSH response to TRH, especially with sensitive assays of TSH. Serum TSH was assayed by a sensitive method in 55 depressed patients and 38 healthy volunteers. Patients were subclassified according to DSM-III as suffering from major depression (n = 40) and non-major depression (n = 15). The patients' mean score on the Hamilton Rating Scale for Depression (HRSD) was 50 (SD = 10). The TSH value was significantly lower in depressed patients compared with healthy control subjects, and in major compared with non-major depression. No differences in TSH levels distinguished the various subtypes of major depression. There was a significant negative correlation between global HRSD scores and TSH concentrations. The most anxious patients tended to have significantly lower TSH values compared with the least anxious subjects. Total HRSD insomnia scores correlated negatively with TSH concentrations after log transformation. The sensitive determination of TSH may also provide an index of thyroid function in depression that is simpler to implement than measurements of the TSH response to TRH.

Adult↗
PubMed1995

[Treatment refractory schizophrenia].

Historically, first case-report of resistant schizophrenia were described under insulin therapy. Later on, the development of classical neuroleptics has permitted a better outcome but the persistence of a lack of improvement in certain patients has induced the individuation of treatment-refractory schizophrenia criteria. The difficulties in defining the refractory schizophrenic patients are described: variability of the schizophrenia diagnostic criteria, variability of outcome, lack of consensus about the good practices in neuroleptic treatment, difficulties in defining response criteria and the confusion between resistance, chronicity and severity. Three kinds of treatment refractory schizophrenia criteria are available: by Kane et al., May et Dencker, Brenner Dencker et al. There are few studies including resistant schizophrenic patients: their results are not homogeneous, perhaps because the prevalence of treatment-refractory schizophrenia is poorly known, with ranges from 5 to 25%. The following factors are hypothesized as being readily associated to a poor outcome and perhaps resistance: male sex, early illness beginning, severity of negative or formal thought disorder, absence of an affective syndrome, morphological CT scans abnormalities, pharmacological factors, late treatment initiation, variability of biodisposibility... Then the therapeutic point of view is considered under three main axes: neuroleptic drugs (NLP) are the basis of chemotherapy, but other therapeutic approaches complete the biological treatment: coherent institutional work and implication of family environment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

New antipsychotics in schizophrenia: the French experience.

Since the beginning of the neuroleptics in 1952, French psychiatrists have proposed a classification of neuroleptics, taking into account the pharmacological and therapeutic differences between these drugs. They distinguished 3 different clinical effects of neuroleptics: sedative effects, effects on the positive symptoms of schizophrenia and effects on the negative symptoms. The effect of some neuroleptics on negative symptoms is recognized by the international community, which considers clozapine to be effective. In France, in most cases, the indication of clozapine is still refractory paranoid schizophrenia. The effect of this atypical neuroleptic on other types of schizophrenic patient is not well known. Remoxipride appears to be as effective in treating psychotic symptoms and to have fewer side effects than haloperidol. Remoxipride is effective for both positive and negative symptoms. Loxapine has been prescribed in France since 1980. Its pharmacological profile is close to that of clozapine: it has dopamine (D2), histamine (H1), serotonin (5-HT2) and adrenergic (alpha 1)-blocking activities. Its best indication seems to be paranoid schizophrenia, although some data suggest bipolar action. The bipolar action of some new neuroleptics is illustrated by amisulpride, a substitute benzamide derivative. The originality of this molecule lies in its two opposite actions at two distinct doses. Doses of 600-1200 mg/day are effective against positive symptoms; 50-150 mg/day improves negative symptoms. This latter effect could be mediated by activation of the dopamine system.(ABSTRACT TRUNCATED AT 250 WORDS)

Antipsychotic Agents↗
PubMed1994

Maintenance ECT in intractable manic-depressive disorders.

Twenty-two patients suffering from intractable recurrent unipolar or bipolar mood disorders were enrolled in a maintenance-ECT protocol (ECT-M) for more than 18 months, with a treatment at approximately monthly intervals. Eleven have continued treatment for > 2 years. Whereas 44% of the year had been spent in the hospital with at least three episodes a year prior to ECT-M, only 7% of the year was spent in the hospital during ECT-M with only one relapse every 16 months requiring admission (p < 0.001). Forty-five percent of the patients were in full remission and 27% in partial remission according to DSM-III-R criteria. ECT-M responsiveness of rapid-cyclers and delusional depressed patients usually drug refractory has been very encouraging with full or partial remission for 100% of rapid-cyclers and 80% of delusional depressed patients.

Adult↗
PubMed1994

[Drug discontinuation in depression].

Before stopping or starting medications in depression, the first step is a through assessment of the patient's mood disorder: past medical general and psychiatric history, psychological profile, past specific treatment history... Today some data are well demonstrated: antidepressant or lithium or carbamazepine discontinuation should be done gradually (over weeks or months) and with an intensive medical follow-up; after the acute treatment of the index depressive episode, a full therapeutic dose of the antidepressant agent should be continued for at least 4 to 6 months; antipsychotic drugs and minor tranquilizers use should be limited: combination of a neuroleptic and an antidepressant in depression with psychotic features, combination of a minor tranquilizer in depression with anxiety during the first three weeks if necessary. A contario the timing and the method of discontinuing maintenance treatment (lithium or antidepressant) have not been well studied. Literature data are discussed: frequency of recurrence during treatment discontinuation, even after long-term euthymia; possible risk for developing rapid-cycles or non response after lithium discontinuation. More precise clinical guidelines are necessary.

Antidepressive Agents↗
PubMed1992

[Clozapine: an exclusive treatment?].

Clozapine is an atypical antipsychotic drug which must only be prescribed for the treatment resistant schizophrenic patients. Contra-indications and precautionary measures (F.e no use of a drug that can enhance the potential for a granulocytoxic reaction) have to be well known and respected. There is an increased risk of granulocytopenia, and 1 or 2% of granulocytopenia may induce an agranulocytosis. This risk is compared with what is observed with other psychotropic drugs, phenothiazines particularly. Beyond clozapine adverse effects, three cases of severe cardio-vascular and respiratory dysregulation, one case of sudden death, and one case of induced coma are presented in detail from the literature: possible interactions between clozapine and adjunctive medications are discussed. Appropriate patients should be proposed a treatment by clozapine, in principle without association to any other psychotropic drug and in all the necessary precautions.

Agranulocytosis↗
PubMed1991

[Predictive factors of response to electronarcosis].

There is an international consensus on the indications of electroconvulsive treatment (ECT): they result in particular from the limitations of antidepressant drug treatment. Even though the global effect of ECT is considered as satisfactory, 10 to 20% of depressed patients eligible for ECT are treatment refractory. This warrants a search for factors predicting efficacy or lack of efficacy of ECT. Predicting factors prior to ECT: Usual clinical criteria, such as the presence of delusional thoughts, are generally classified with endogenous signs of depression. Among biological criteria, EEG data, tests assessing reactivity of autonomous nervous system, plasma measures of catecholamines, calcium and cortisol do not seem relevant parameters. Dexamethasone suppression test and stimulation of TSH by TRH have no more predictive value. Predictive indices during treatment: Empirically clinicians identified a sequence in the response of depressive symptoms, although no conclusion can be drawn from these clinical impressions. Among biological factors some authors stress the importance of the epileptogenic threshold and of measuring plasma levels of peptides released by the posterior lobe of hypophysis. Such data have to be confirmed and their physiopathological value better understood. Actually some parameters representing good therapeutic practices are valued by physicians using ECT: sufficient duration of electrical crisis, total seizure time during the series of electroshocks. Those conceptions are close to the classical emphasis on the adequate number of ECTs and to the discussion on the comparative efficacy of unilateral and bilateral ECT. After ECT most authors shift to antidepressants, although data about medium and long term outcome prediction with this approach are also lacking.

Depressive Disorder↗
PubMed1991

[Role of electroshock therapy in puerperal mental disorders].

Ten cases of psychotic patients requiring electroconvulsivotherapy (ECT) are reported during pregnancy and puerperium. The interest and the safety of ECT are confirmed. ECT is principally indicated in severe cases and in typical or atypical mood disorders.

Adult↗
PubMed1990

[Psychiatric complications of corticotherapy].

Corticosteroid therapy may induce numerous psychiatric disorders. Minor changes of the euphoric mood type are observed in 75% of the patients under treatment. Major adverse effects are encountered in not more than about 5% of the cases. They consist of acute polymorphous psychotic manifestations which may be manic or depressive or, when high doses of corticosteroids are taken, of the organic confusion type. Such manifestations are particularly frequent in women and in some diseases such as lupus erythematosus or pemphigus. In the vast majority of cases they follow a favourable course when corticosteroids are reduced or discontinued and a symptomatic treatment with neuroleptic drugs is prescribed. Psychic dependence on corticosteroids and withdrawal syndromes have also been reported.

Adrenal Cortex Hormones↗