[Psychotherapy in depression]. / Psychothérapies de la dépression.

The field of psychotherapies has in general widely evolved for these ten last years in France and more in depressive disorders treatment, namely owing to short structured therapies development and especially cognitive-behaviour therapies well fitted for controlled studies assessment. Pyschoanalytically oriented psychotherapies have also changed but not so much and they still remain less efficacious in this area. Henceforth the numerous technicals of this kind of therapy will be modified in the eclective and integrative approach; they must not be compared in opposition one another but used in a collaborative way on the basis of scientific data in order to make them more effective. So some very exciting prospects are open in the future of that field of research. Practically, nowadays the best outcomes are obtained in the association of both antidepressant drugs and cognitive-behavior psychotherapy.

[Long-term clinical experience with clozapine]. / Expérience clinique de longue durée de la clozapine.

This study reports a clinical experience among twenty schizophrenic patients treated by clozapine during two years and eight months within a range extending from three months to seven years. These twenty patients had previously shown long-term resistance to usual neuroleptics but three out of them met the diagnosis of mental retardation or childhood disintegrative disorder (F.84.3-ICD 10). These patients were put under clozapine for their violent behavior. The methodology was retrospective, descriptive with intra-individual comparison, each patient being his own reference before and after treatment. Diagnosis met CD 10 criteria and were assessed without using standard examination. This study aimed at assessing once more clozapine efficacy and tolerance upon a long time follow up. Single therapy has been the rule and dosages have been progressively increased reaching a mean daily dosage of 350 mg per day. The efficacy, assessed by the way of BPRS, GAF (DSM III-R) and simplified form of CGIS, has been verified in approximately 30% of the patients, mainly concerning positive symptoms. Clozapine was also able to alleviate severe behavior troubles brought about by delusional states, without this latter being markedly softened when it was a long term one. Clozapine tolerance has shown it to be satisfactory, however we noticed the occurrence of a leucopenia with neutropenia after seventeen weeks of treatment, followed, some days later, by a Quincke oedema, which forced to interrupt the treatment. White blood cells came back in a normal range fifteen days later. The other side effects (transitory hypersialorrhea, tachycardia, without clinical and ECG perturbations) have been usually well tolerated and have never caused treatment interruption. No extrapyramidal side effect have been noticed among our twenty patients. The end of this paper consists in the presentation of four clinical cases: one about the efficacy of clozapine upon violent antisocial behaviour in a schizotypital disorder; one delusional chronic schizophrenic patient whose violence has been controlled despite of the delusion; one paranoid schizophrenic patient who has been able to maintain a satisfactory professional and family adaptation; and finally a childhood disintegrative disorder (F.84.3-ICD 10) in whom occurred the only leucopenia side effect of our study. These four clinical cases have seemed particularly meaningful regarding our clinical experience of clozapine which has been lasting for almost seven years now.

[Patient education about neuroleptic treatment, can it reduce costs? A pilot study]. / L'éducation au traitement neuroleptique peut-elle réduire les coûts? Une évaluation pilote.

Costs generated by chronically mentally ill are very high. Concerning direct costs (hospitalisations, outpatient services, medications), they are estimated from 120,000 to 160,000 french francs per year. Indirect costs (social security, gain lost) are assessed as being at least three times more than direct costs. Trimestrial costs, charged to insurance, of the first fourteen patients who followed the UCLA medication management module, have been retrospectively calculated on the base of the number of consultations, days at the hospital and community day center during the previous and following year of the introduction of the program. The intervention lasts 3 months with two weekly sessions of 1 h 30. The medication module aims the following goals: 1) Obtaining information about antipsychotic medication; 2) Knowing correct self-administration and evaluation of medication; 3) Identifying side effects of medication; and 4) Negotiating medication issues with health-care providers. The mean trimestrial costs curve goes down following the application of the program and this reduction continues 9 months after the end of the intervention. The small numbers of patients and the absence of control group do not allow to draw conclusions about these results. However, these data provide support to formulate an hypothesis about the effect of the module on medication compliance.

Insulin-like growth factor-1 (IGF-1) specifically binds to bovine lens epithelial cells and increases the number of fibronectin receptor sites.

The purpose of the study was to determine the quantitative characteristics of IGF-1 binding sites in lens cells and to investigate its ability to modulate cell growth, in particular by inducing integrin expression. Studies were carried out in bovine lens epithelial cells in culture. IGF-1 receptor binding parameters were measured from saturation experiments with 125I-IGF-1. Scatchard plot indicates one class of high affinity sites (Kd = 2.5 +/- 1.5 nM). In addition, we showed that this growth factor was synthesized and released by lens cells. The characteristics of the receptor sites are in accordance with the effects of the growth factor (e.g. stimulation of DNA synthesis) in the range of nM concentrations. Moreover, by incubating cells with IGF-1 (12 nM) for 40 hr we demonstrated that the expression of integrin, the fibronectin receptor, was activated (N = 885 +/- 169 x 10(3) sites/cell vs N = 453 +/- 105 x 10(3) sites/cell in control cultures) without modification of its affinity (Kd congruent to 16 x 10(-8) M). These new data emphasize the role of IGF-1 in the regulation of migration, proliferation and differentiation of mature lens cells.

Inhibition of cell adhesion to lens capsule by LCM 1910, an RGD-derived peptide.

Opacification of the posterior lens capsule, (secondary cataract), is one of the major complications of extracapsular cataract extraction. The lens epithelial cells remaining after surgery migrate and proliferate along posterior capsule, and give rise to structures such as pearls and cells with contractile properties, which considerably hamper vision. One pharmacological approach aimed at limiting this phenomenon would be to stop this cell migration, thus inhibiting their proliferation. It has been shown that cells adhere and migrate on their support via adhesion molecules such as integrins. Generally, the tripeptide sequence Arg-Gly-Asp (RGD) is the recognition motif for these receptors. In this study, cell adhesion inhibition in the presence of RGD peptides and derivatives was measured on extracellular matrix and lens capsule. One of these compounds, the [N alpha-acetyl-NG(H+)-arginyl]-glycyl-[C beta (H)-C alpha -benzyl]-aspartamid- HCl] (LCM 1910), significantly inhibited cell migration at millimolar concentrations, and could be of interest in prevention of secondary cataract.

Study of the unidimensionality of the Bech-Rafaelsen Melancholia Scale using Rasch analysis in a French sample of major depressive disorders.

In a French sample of 73 major depressive disorders (according to the DSM III definition), the unidimensionality of the Bech-Rafaelsen Melancholia Scale was studied; firstly by means of traditional but not really valid methods (i.e., factor analysis and Cronbach's alpha), and second, using the Rasch logistic model. These methods would seem to show that the B.R.M.E.S. provides a unidimensional measurement of depression.

[Anorexia nervosa. A frequent antecedent of obsessive compulsive disorder]. / L'anorexie mentale. Un antécédent fréquent dans les troubles obsessionnels-compulsifs.

In a population of 60 patients suffering from obsessive-compulsive disorders, the authors find 5 patients (8.3% of the whole group), all female (13.1% of the whole female subgroup) with an anorexia nervosa among their antecedents, which represents a relatively important rate compared to the rarity of anorexia nervosa in the general population. Clinical particularities of the subgroup are then studied. Results from this work are partially comparable with those found in the single similar study in the literature.

[French adaptation, concurrent validation and factorial analysis of the Bech and Rafaelsen melancholia scale]. / Adaptation Française, validation concurrente et analyse factorielle de l'échelle de mélancolie de Bech et Rafaelsen.

33 depressive patients diagnosed major depressive episode (DSM III) have been assessed by the French translation of the melancholia scale of Bech and Rafaelsen and the following scales: scale of depressive retardation (ERD) (Widlocher), Hamilton depression rating scale with 26 items (HDS 26), Montgomery and Asberg depression rating scale (MADRS). A concurrent validation shows that Bech-Rafaelsen melancholia scale is valid. A principal components analysis with VARIMAX rotation found 4 principal components: retardation and blunted affect, asthenia, anxiety, suicidal impulses.

[Retrospective comparative study of treatment with delayed-action neuroleptics and neuroleptics administrated orally in long-term psychosis]. / Etude rétrospective comparative des traitements neuroleptiques d'action prolongée et des traitements neuroleptiques par voie orale dans les psychoses au long cours.

Through a retrospective study, we have tried to compare the indication spectrum and efficacy of depot neuroleptics versus oral neuroleptics on two hundred patients suffering from long term psychosis. For each group, we selected one hundred patients who met the following requirements: the minimal duration of chemotherapy was of 3 years, the patients were aged 16 to 60. Patients receiving depot neuroleptics, although their original prognosis were worse than those of patients receiving oral neuroleptics, obtained the same good results concerning most semiological, chemotherapeutic and institutional criteria. However, good results for patients receiving depot neuroleptics must be qualified because of a more important number of chronic and defect states and a lack of autonomy.