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Biomedical subjects

S Peretti

Publications and source records attributed to S Peretti.

At least 19 recordsLinked to original sources

Safety and tolerability considerations: tricyclic antidepressants vs. selective serotonin reuptake inhibitors.

OBJECTIVE: An important consideration in the choice of an antidepressant is its safety and tolerability. METHOD: We present a review of literature, clinical trials and meta-analyses regarding the safety and tolerability of the tricyclic antidepressants (TCAs) and the selective serotonin reuptake inhibitors (SSRIs) in depressed patients. RESULTS: The SSRIs have a very favourable side-effect profile compared to the TCAs and are associated with fewer treatment discontinuations. Unlike the TCAs, they do not cause anticholinergic, hypotensive or sedating reactions, and are not associated with impaired cognitive function. Their most common side-effects (nausea, vomiting, nervousness, insomnia, headache and sexual dysfunction) are usually mild and typically disappear as treatment continues. The SSRIs also exhibit lower toxicity and lower lethality when taken in an overdose situation. Although the safety profiles of the principal SSRIs appear to be comparable, there is some data showing important differences in the severity and frequency of specific adverse events. CONCLUSION: The SSRIs have a more favourable safety profile than the TCAs in both acute and long-term treatment of major depression.

Antidepressive Agents, Tricyclic↗

The state of functioning of working memory in schizophrenia.

The functioning of working memory in schizophrenic patients according to Baddeley's model was examined in two complementary experiments. Experiment 1 comprised 27 patients and their controls, matched in age and level of education. Of this pool, 20 pairs participated also in Experiment 2. Digit span, reading rate, and immediate serial recall assessed the functioning of the phonological loop. Corsi and pattern span tasks assessed the capacity of visuo-spatial memory. The central executive's ability to monitor two concurrent tasks was evaluated in a dual task paradigm, and its capacity to control action in a random generation task. A preliminary set of analyses showed that the patients' performances were reduced in all tasks explored, except in digit span. This initial pattern changed consistently after controlling for reading rate. While slow and fast reading patients were comparable in demographic and clinical criteria, slow reading patients showed impaired performance in all tasks, whereas fast reading patients exhibited reduced performance in visuo-spatial tasks and in the random generation task only. The state of functioning of working memory in schizophrenia appears, therefore, to vary consistently among the components of the model and is markedly impaired in slow reading patients. The implications of slowness are discussed.

Adult↗

Effects of chlorpromazine and lorazepam on explicit memory, repetition priming and cognitive skill learning in healthy volunteers.

To assess the influence of neuroleptics on explicit memory and two forms of implicit memory, repetition priming and cognitive skill learning, the effects of two low doses of chlorpromazine (12.5 and 25 mg orally) were contrasted to those of lorazepam (2.5 mg orally) and of a placebo using a free-recall task, a word-completion task and repeated testing on the Tower of Toronto puzzle, a version of the Tower of Hanoi puzzle. Seventy-two healthy volunteers took part in this double-blind study. Chlorpromazine spared free-recall and word-completion performance, but impaired the acquisition of a cognitive routine in the subjects who completed the first trials of the Tower of Toronto puzzle efficiently. Lorazepam induced an opposite pattern of memory disruption. These preliminary results suggest that chlorpromazine and lorazepam induced a double dissociation between priming and the acquisition of a cognitive routine. They provide evidence that the two forms of implicit memory rely upon distinct neurochemical systems, the latter, but not the former, being dependent upon dopaminergic systems.

Adult↗

[Paroxysmal neurological manifestations disclosing panic attacks].

Thirty-seven patients presented with paroxysmal neurological manifestations attributed to anxiety attacks. The manifestations included loss of consciousness, focal sensorimotor deficits, diffuse dysesthaesiae, visual disorders and tremor. They lasted 10 to 45 minutes and occurred once per day to once per week. Organic pathology was dismissed on the basis of normal examinations and atypical course. In all patients questioning revealed symptoms that were those of acute anxiety. The fact that these attacks took place in suggestive (circumstances e.g. in crowds and car driving), and that they could be induced by challenge tests hyperpnoea, infusion of lactate) suggested that these disorders were consecutive to panic attacks.

Adult↗

[Memory disorders in schizophrenia].

The current interest in memory disorders in schizophrenia results from the way perceptions of schizophrenia--whose organic origin is becoming increasingly evident--and memory--according to which there exist not one, but several memories--have developed. Memory disorders in the schizophrenic cannot be considered in isolation from knowledge accumulated in other areas of the cognitive and neuro-sciences; a more detailed understanding of these disorders requires a comparison of the different cognitive approaches, both with each other and with the neurobiological and clinical approaches, so that they can be integrated. Despite numerous methodological and conceptual difficulties, it now appears to have been established that the schizophrenic's memory deficit should be seen in the context of a wider cognitive deficit, that the memory tasks are not all disturbed and that the memory deficit cannot be identified with one specific form of memory. Thus, iconic formation, short-term memory in the traditionally accepted sense and implicit memory are hardly, if at all, affected; in contrast, the early processing of information, working memory and explicit memory are disturbed, probably to the extent that they require the implementation of strategies to organise the information to be memorized. Finally, in certain tasks, such as those evaluating latent inhibition or negative priming, schizophrenics perform better than normal subjects, suggesting that schizophrenics' cognitive deficit is localised. This profile of memory disorders is compatible with a dysfunction predominating in the frontal and temporo-hippocampal regions. Neuroleptics and anticholinergics have opposite effects on cognitive and mnesic performance, which is improved by the former and aggravated by the latter. The influence of clinical symptoms, positive or negative, institutionalisation of patients and chronic tardive dyskinesia is unclear. Among the theoretical proposals put forward to account for the observed disorders, those relating to a disturbance of the action planning process and to that of the internal representation of context are compatible with the observed memory disorders. All the clinically derived data and those produced by the cognitive and neurosciences indicate a need to reformulate the links between memory, selective attention and evaluation of the relevance of a stimulus, to develop a general model of the reciprocal interactions between cognition and affectivity and to look for the origin of a pathology as complex as schizophrenia, not in a local lesion in an isolated cerebral structure but in a disturbance of the dynamic interactions within a functional, parallel and distributed network of broadly interconnected regions.

Antipsychotic Agents↗

[Complete neuroleptic withdrawal in patients with schizophrenia with intense symptoms and resistant to treatment].

We report 2 studies evaluating the effects of a complete and progressive neuroleptic withdrawal on the symptomatology of 2 groups of 10 young chronically ill schizophrenic inpatients. In a preliminary open study, we compare the psychiatric symptomatology during a 4-week-period before the beginning of withdrawal and during a similar period following the end of withdrawal. We observe the significative improvement of the blunted affect, the deterioration of an aspecific psychiatric symptomatology (including irritability, excitement, hostility) and the non-modification of the specific schizophrenic symptomatology (in its 3 main components: positive signs, negative signs, disorganization). The second study (a double blind one) reports the effects of a complete neuroleptic withdrawal maintained during a longer period (8 weeks): 1. The improvement of the blunted affect is transiently observed during the 2 first weeks after the end of withdrawal but not after this time. 2. The deterioration of the aspecific psychiatric symptomatology by opposition to the non-significative modification of the specific schizophrenic symptomatology is a fact confirmed by this second study. Even if we can not exclude that the influence of neuroleptic withdrawal on the specific psychotic symptoms may require a longer time frame than 8 weeks to detect, this dichotomic evolution raises the problem of the specific action of neuroleptics in this particular category of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗