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P M Llorca

Publications and source records attributed to P M Llorca.

At least 19 recordsLinked to original sources
PubMed2005

Direct transition to long-acting risperidone--analysis of long-term efficacy.

This report presents data from the extension phase of a 6-month trial that evaluated the efficacy of risperidone long-acting injectable (RLAI) in stable psychotic patients requiring a treatment change. Patients continued to receive RLAI every 2 weeks for a maximum of 12 months from study entry. Symptoms were assessed using the PANSS after 1, 3, 6, 9 and 12 months of treatment (or treatment endpoint). Remission of severity criteria were defined as < or =3 points in all PANSS items suggested by the Remission in Schizophrenia Working Group.715 patients (63% male) entered the extension phase and 508 completed the 12-month study. The mean PANSS total score at Day 0 was 74.9+/-22.7. This was significantly reduced after 1 month (67.7 +/-22.3, p< or =0.001), with continued improvements over the 12 months of the study until treatment endpoint (59.7+/-21.9). Significant improvements from Day 0 to endpoint were also seen in the scores for all PANSS subscales and symptom factors. The proportion of patients who met the PANSS severity criteria for remission increased from 29% at Day 0 to 60% at endpoint, and the proportion of patients who met these criteria for < or = 6 months increased from 24% at Month 6 to 45% at endpoint. Treatment with RLAI for up to 12 months provided significant and sustained improvements in symptom control in patients with schizophrenia. These improvements may help patients to achieve and remain in remission.

Adult↗
PubMed2000

Clozapine and negative symptoms. An open study.

1. Clozapine, the first atypical antipsychotic, has demonstrated an efficacy in the treatment of resistant schizophrenia. But one of the major challenge in the treatment of schizophrenia remains the lack of efficacy of antipsychotics on negative symptoms of schizophrenia. 2. The authors studied the efficacy of clozapine in an open study in a population of 51 patients, who met the DSM IV criteria for schizophrenia. Using the positive and negative symptom scale (P.A.N.S.S.), and the Extra Pyramidal Symptoms Rating Scale (E.S.R.S.), we try to identify the specificity of the action of clozapine on the different symptomatic dimensions of schizophrenia. 3. The efficacy of clozapine was clinically significant on the negative symptomatology but was delayed compared to the efficacy on the other dimensions of symptomatology evaluated using the PANSS. 4. Nine patients, were considered as deficit patients; in this sample clozapine also demonstrated a significant efficacy on negative symptoms. The efficacy of clozapine did not seem to be a consequence of the better neurological tolerance of this antipsychotic evaluated with ESRS.

Adult↗
PubMed1999

Validity and reliability of the French-language version of the Positive and Negative Syndrome Scale (PANSS).

OBJECTIVE: The main objective of this study was to evaluate the psychometric properties of the French-language version of the Positive and Negative Syndrome Scale (PANSS). METHOD: The validity and reliability of the PANSS were studied in a population of 342 patients diagnosed as schizophrenic according to DSM-III-R criteria. RESULTS: The study of the internal consistency and principal-component analysis of the initial structure with three subscales (positive, negative and general psychopathology) led us to investigate other factorial structures. We isolated a 5-factor structure (negative, positive, hostility, disorganization and anxiety/depression) explaining 57.5% of the total variance. The internal consistency of the 5 factors isolated was good (0.87 for the negative factor, 0.82 for the positive factor, 0.78 for the hostility factor, 0.71 for the disorganization factor and 0.68 for the anxiety/depression factor, respectively). The validity study on the external criteria confirmed the relationship between the negative and anxiety/depression factors and the extrapyramidal symptoms. CONCLUSION: The stability of the PANSS factorial warrants discussion.

Adult↗
PubMed1999

An exploration of the psychometric properties of the French version of the Positive and Negative Syndrome Scale.

The psychometric properties of the French version of the Positive and Negative Syndrome Scale (PANSS) were studied in a population of 85 patients diagnosed with schizophrenia in accordance with Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria. The results of the study of the properties (internal consistency and principal-component analysis) of the initial structure with 3 scales (positive, negative, and general psychopathology) led us to investigate other factorial structures. We thus isolated a 5-factor structure (negative, hostility, positive, disorganization, and anxiety), explaining 54.7% of the total variance. The internal consistency of the 5 factors isolated was good (0.79, negative factor; 0.71, hostility factor; 0.77, positive factor; 0.66, disorganization factor; and 0.61, anxiety factor). The 3-subscale structure of the PANSS is discussed.

Adult↗
PubMed1998

Factorial structure of the Positive and Negative Syndrome Scale (PANSS): a forced five-dimensional factor analysis.

We conducted a study on 205 schizophrenic patients in order to explore the factorial structure of the Positive and Negative Syndrome Scale (PANSS). We first documented the validity and reliability of the five-dimensional structure of the PANSS, initially derived from the work of Kay and Sevy and completed by Lindenmayer et al. Some items (stereotyped thinking, mannerisms and posturing, poor attention, lack of judgement, disturbance of volition, and preoccupation) appeared to contribute little to the constitution of the dimensions initially described by Kay and Sevy. Those items were not taken into account in the forced five-dimensional factor analysis. We therefore investigated further the psychometric properties of the PANSS using only the retained items. The validity and reliability of this new five-dimensional structure are discussed.

Adolescent↗
PubMed1997

[Clozapine and treatment of negative symptoms].

The efficacy of conventional neuroleptics in the treatment of the negative symptoms of schizophrenia is highly controversial. Clozapine, the leading atypical neuroleptic, has been shown to be effective, in the majority of the controlled studies, on both the positive and negative symptoms of the disease. It appears to be active vis-à-vis both the primary and secondary negative symptoms. However, several weeks (at least 12) are required for the effect on primary negative symptoms to clearly emerge. The position of clozapine in the treatment of patients presenting with a state of deficiency remains more debatable.

Antipsychotic Agents↗
PubMed1995

[Drug addiction and AIDS].

Drug abusers are one of the main groups exposed to the HIV contamination: they account for 23.3% of the cumulative cases of contamination in France. If sharing injection equipment is the major risk factor, we must consider the use of some specific drugs, personality factors, socioeconomic status and sexual behaviors to be significant risk factors. Nowadays, programmes aimed at reducing the transmission of HIV among drug injectors are raising. Information, education, HIV testing, free access to sterile injecting equipment, methadone maintenance programmes and prevention of risky sexual behaviors are the main tools of this policy.

Acquired Immunodeficiency Syndrome↗
PubMed1993

[Mechanism of action of antidepressants].

Modifications in noradrenergic and serotonergic systems are involved in the central mechanism of action of antidepressants. Most antidepressants (electroconvulsive therapy included) induce a desensitization of the beta-noradrenergic receptor, as shown by a decrease in noradrenaline-stimulated cAMP production. Down-regulation of the beta receptor is often associated with desensitization, as well as modifications in the activity of the serotonergic system, among which alternations in 5-HT2 receptors are frequent. Finally, complex interactions between noradrenergic and serotonergic receptors may also contribute to the pharmacological effect of long term antidepressive treatment.

Animals↗
PubMedDate not supplied

[Leponex, 10 years after -- a clinical review].

Clozapine was one of the major advances in the treatment of schizophrenia since the introduction of the classic antipsychotic agent chlorpromazine in the 1950s. Over the past 10 years, clozapine has become the reference compound for the development of new antipsychotics, and new drugs have been developed which have also claimed atypical status. The indications of clozapine were recently extended to Psychosis in Parkinson's disease and harmonized in the European Union. This provides the opportunity to update the data on clozapine in the treatment of schizophrenia. In this article we review current clinical evidence in schizophrenia to address the following issues: 1) Efficacy in refractory/positive symptoms: a systematic and critical analysis of 14 double-blind clinical trials in comparison with both standard and novel antipsychotics show consistent findings in favour of clozapine, with all but three of the reports demonstrating superiority. The review of studies allow us to say little about the predictors of treatment response, time to clozapine response and about the impact of clozapine on the quality of patients'life and longer-term outcome. Treatment options for clozapine non-responders are reviewed. 2) Risk of EPS: clozapine is considered to have a minimal risk of EPS and in all studies where a valid methodology was used, a clear superiority over the other neuroleptics is demonstrated. It is pointed out that, if the prevalence and incidence of EPS with clozapine is low, it is not zero. All the studies assessing clozapine treatment for TD have major methodological limitations, so no final conclusion can be drawn. 3) Efficacy for primary and secondary negative symptoms and neurocognitive effects: the data of clinical studies where negative symptoms scales were used favour clozapine in terms of improvement. However most of the studies were carried out in populations with predominantly positive symptoms. With regard to the need to distinguish primary and secondary symptoms, data are conflicting regarding the benefit of clozapine. Due to the lack of studies with a valid methodology, no definitive conclusion can be drawn about the efficacy on clozapine on the deficit syndrome and on neurocognitive disorders. 4) Impact on suicide risk: 4 out of 6 retrospective studies provide evidence for the ability of clozapine therapy to reduce suicidal behaviour. The results of a recent randomized, parallel-group study designed to compare clozapine versus olanzapine in preventing suicide attempts seems to confirm this hypothesis. We also address the tolerability and safety data, especially haematologic, comitial, cardiovascular and metabolic side-effects. The effectiveness of blood monitoring for the management of neutropenia and agranulocytosis demands that the recommendations are strictly followed. The use of clozapine at doses higher than 600 mg daily should follow published recommendations, in order to minimize the risk of seizures; these include anticonvulsant regimens based on blood levels. With regard to the cardiovascular mortality, if clozapine therapy has negligible effects on QT interval, its association with potential fatal myocarditis cannot be excluded in young patients who should be investigated if they develop cardiac symptoms in the first weeks of treatment. Available data support the notion that the frequency of bodyweight gain is high with several new antipsychotics, including clozapine. Potential long term effects of bodyweight gain on mortality and morbidity have to be taken into consideration. The pharmacological mechanisms underlying the "unique clozapine profile" is discussed. Clozapine remains the only antipsychotic with efficacy at relatively low D2 receptor occupancy. The pharmacogenetic and pharmacokinetic aspects are also reviewed. Finally, the place of clozapine in the current treatment of schizophrenia is highlighted to inform the development of guidelines for clinical management.

Antipsychotic Agents↗