[Hormonal treatments for disorders of sexual conduct]. / Traitements hormonaux des troubles des conduites sexuelles.

Because of the limits of justice, our society turns itself towards the medical need and demands efficient treatments. Mutilating neuro-surgery and treatment with estrogens have been used and then stopped. Medroxyprogesterone (MPA) and Cyproterone (CPA) acetate have been proved to be efficient in 80% of cases studied and published. However the therapeutic use of CPA is limited in France by three drawbacks: exclusive oral route of administration, lack of available biological criteria as a control of good observance and lack of official indication. Therefore the authors studied a GnRH analogue (triptorelin) which induces a reversible hormonal castration and which is administered by I.M. route monthly. It was efficient in five out of six aggressive hypersexual patients. An ethical study is proposed after which the authors call for an evolution of the mentalities about this question.

[The death of Helene Althusser: a case of altruistic homicide reported by the melancholic person]. / La mort d'Hélène Althusser: un cas d'homicide altruiste rapporté par le mélancolique.

Authors suggest to read carefully the text written by Louis Althusser concerning the murder of his wife, Hélène. In place of hypothetical psychopathological elaborations they propose to take into account the narration of his personal story, and his illness leading to a delusional and confusional depression. The precision in the written report by Althusser on his painful manic depression demonstrates that there is no place for hypothesis too different from an ordinary reality.

[Efficacy of tianeptine in the treatment of psychasthenia. A study versus placebo]. / Efficacité de la tianeptine dans le traitement de la psychasthénie. Etude versus placebo.

Tianeptine is an effective antidepressant with original neurochemical properties. Tianeptine increases the serotonin (5-HT) reuptake after acute and chronic treatment. The efficacy of tianeptine (T) versus placebo (P) was evaluated in the treatment of psychasthenia, because of the role of 5-HT in obsessive-compulsive disorders, the last state of psychasthenia in term of severity. Patients were recruited using the psychasthenia scale; then, their MADRS scores limited those who turned out to the depression. Mean inclusion MADRS scores where 12 (T) and 11.8 (P). Tianeptine is an effective treatment for patients suffering from psychasthenia. Tianeptine is more effective than placebo in global score and in sub-scores (asthenia and somatic symptoms) of the psychasthenia scale. In spite of weak inclusion scores in MADRS, patients taking tianeptine also showed significant improvement, greater than with placebo. The percentage of patients with a reduction equal to or greater than 50% of their MADRS score was significantly more important in tianeptine group. These results could be the illustration of the decrease in associated depressive symptoms or the result of an improvement of symptoms common to MADRS and psychasthenia scales. The same favorable results were obtained in symptoms of anxiety scored by HARS. In term of safety, tianeptine is equivalent to a placebo if we consider somatic complaints expressed by the patients, global improvement evaluated by the patient and the investigator, weight and blood pressure. Interruption of treatment for side-effects concerns the placebo group only (3 versus 0). This excellent safety is particularly well-adapted to the treatment of these out-patients.

[A scale to assess psychasthenia]. / Une échelle pour évaluer la psychasthénie.

"Psychasthenia exists--we meet it every day". Despite this affirmation, Pierre Janet's views remain unappreciated by international psychiatry. Psychasthenia is not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM III-R). This pathology, described by Janet as both benign and terrible, is presently broken into many diagnostic categories with respect to the principal symptomatology of the patient. When a mood disorder is present, these patients can have diagnostic criteria for major depression or dysthymia. Patients with prevalent anxiety, phobia or obsessive-compulsive symptoms, must also be classified in having anxiety disorders. When somatic complaints are major symptoms, the patient's disease can be, on the whole, attributed to a somatoform disorder. This scale is a global evaluation of psychasthenia. It is made up of three lists of items. The first concerns asthenia or fatigue sine materia. The items in this group allow an evaluation of the physical and mental characteristics of asthenia associated with an inability of acting. Difficulties in mental concentration are measured by items in the second list. Mental processes are associated with doubts and waverings. They are interrupted by interferences caused by obsessions with recurrent and persistent ideas, impulses or images. Physical symptoms without organic pathology or a pathophysiologic mechanism constitute the neurasthenic part of psychasthenia. In the third list, somatic complaints are spelled out in a check-list of these potential symptoms. This scale can be used as a help in the diagnosis. Items 2, 3, 5, 25, 26 and 29 have a specific reference to the history of the disorder.(ABSTRACT TRUNCATED AT 250 WORDS)

[Role of tianeptine in the prevention of depression relapse and recurrence. First estimations]. / Rôle de la tianeptine dans la prévention des rechutes et récidives dépressives. Premières estimations.

The potential activity of tianeptine in the prevention of depressive relapses or recurrences was evaluated in the course of a long-term multicenter study. Five hundred and ten patients were treated for a one-year period. During the first six months, 22 percent of patients responders to the treatment relapsed into depression or had a methodological equivalent of depressive relapse (a MADRS score equal to or higher than 25). This percentage of depressive relapses is comparable to those obtained with other antidepressants. After six months of treatment, 7 percent of patients with a stabilized recovery recurred into depression or had a methodological equivalent of depressive recurrence (a MADRS score equal to or higher than 25). An analysis compared this percentage with those obtained in the course of other studies. These percentages are classically more important. The role of diagnoses of depression was analysed. Percentages of depressive relapses and recurrences were also evaluated in the sub-sample of patients treated with tianeptine alone.

[Legislative draft amendments regarding psychiatry]. / Sur les projets de réformes législatives visant la psychiatrie.

Simultaneously the Government presents to the Parliament very important amendments to the Penal Law (concerning especially the responsibilities of mentally ill) and of the Public Health Code related to the hospitalisation of psychiatric patients. The proposed disposals without consultation of the specialists raise up numerous and fundamental objections coming from all the organisations of psychiatrists. After reviewing the major nonations of the amendments, the author request the advice of the National Academy of Medicine.

The neuroleptics: a historical survey.

The history of the neuroleptic drugs has been marked by various milestones: some have been successes, others have been associated with complications and side effects, especially when the drugs have been misused. At the Paris meeting in 1955, it was confirmed that neuroleptics were indicated in chronic psychoses. In 1963, a new form of long-acting neuroleptic was introduced which appeared useful for non-compliant patients. However, following the introduction of the American concept of "CPZ- equivalent" which is opposed to the European distinction between sedative and "disinhibitory" neuroleptics, the problem of the development of tardive dyskinesia became serious. The antipsychotic actions of the neuroleptics in some psychoses eventually led to the so-called "dopaminergic theories" of schizophrenia, which are still under discussion. It should be underlined that the specific antimanic action of neuroleptics, which is included in the early definition, has been prematurely neglected. In fact, mania is the opposite of depression and, in general, the antidepressants are "anti-neuroleptic". The neurobiological studies of the neuroleptics resulted in the differentiation of the compounds according to their action on different parts of the dopamine system, especially on the mesolimbic and mesocortical structures. This was particularly useful in the efforts to avoid extrapyramidal side effects. The clarification of the role of the D1 and D2 dopamine receptors has been important in understanding the development of tardive dyskinesias. There are now some 50 different neuroleptic drugs, in about a dozen chemical families, which can be classified by an "automatic" statistical method.

[Caffeine and EEG mapping: effects of visuo-spatial task in healthy volunteers]. / Caféine et cartographie EEG: effets d'une tache visuospatiale chez des volontaires sains. Stratégie d'analyse des données électropharmacologiques.

A group of 10 subjects, normal volunteers (6 men, 4 women), mean age 27.2 years, right-handers, has been selected for a double-blind study of caffeine effects (400 mg per os) versus placebo. One week delay separated the two EEG sessions quantified by spectral analysis. During each session (16 EEG channels, common reference), each subject was recorded four times: 2.5 min, in eyes-closed condition, under diffuse attention, followed by 2.5 min, during a visuo-spatial task ("eyes open" condition: presentation of a picture). These two EEG recordings were obtained before the oral administration and repeated 1 hr after the administration of caffeine or placebo. Individual and group results presented globally: 1) an increase in mean frequencies of alpha activity in "eyes closed" condition, and of delta activity in "eyes open" condition; 2) a decrease of alpha activity amplitudes (both RMS and % values) in both conditions; 3) a decrease of total RMS amplitudes in "eyes closed" condition; 4) an increase of relative % amplitudes for beta 2% fast activity in the "eyes open condition". These results characterize the psycho-stimulant effects of caffeine, especially over the left temporal area which was confirming an initial statistical hypothesis of specific cerebral local activation. The non-parametric permutation tests of Fisher, were not always reaching statistical significance for the same EEG channel quantified by one of the 17 analyzed spectral parameters, except on the left temporal area. During the visuo-spatial task, the decrease in alpha amplitudes (RMS and %) was also statistically significant, but over larger areas: over left and right temporal, central and parietal regions. In both conditions, eyes closed and eyes open, the alpha RMS amplitude was also decreased over the right anterior frontal area.

Position of tianeptine among antidepressive chemotherapies.

The advent of a new antidepressant is always received with both interest and scepticism by clinicians. No new compound has yet been shown to be more efficient than imipramine in the treatment of depression. In determining the position of a compound among the antidepressants, four levels are to be considered: (a) Chemical family: Tianeptine is a tricyclic compound of dibenzothiazepine type. It is the only representative of this subgroup. (b) Biochemical activities: Tianeptine increases the presynaptic uptake of serotonin after single as well as repeated administration; but this action is not linked to any effect on the 5-HT post-synaptic systems. Electrophysiological modifications are observed in the locus coeruleus (noradrenergic) at 2.5 times higher doses; nevertheless, the essential action involves the serotoninergic systems. Tianeptine has no affinity for alpha 1 adrenergic and H1 antihistaminic receptors; this affinity is responsible in a large part for the sedative anxiolytic properties of antidepressants. Tianeptine has no affinity for the muscarinic receptors. It has secured its place among the non-anticholinergic antidepressants. The mechanism of action or the therapeutic profile cannot be inferred from this original biochemical profile. (c) In clinical trials, the double-blind trials confirm the antidepressant efficacy in essentially neurotic depressive syndromes, similar to that of imipramine, nomifensine, amitriptyline. They do not show a shorter onset time of antidepressant activity. The therapeutic profile appears to be neither stimulating nor sedative. Some arguments are in favor of an anxiolytic activity. Others favor a more psychotonic profile. Tianeptine can be classified among the mid-position antidepressants. (d) With respect to clinical acceptability, tianeptine has no anticholinergic effect and no cardiovascular effect.

[Treatment with tianeptine of depressive disorders in drug addicts under withdrawal. Assessment of efficacy and study of dependence]. / Traitement par la tianeptine des syndromes dépressifs des toxicomanes sevrés. Appréciation de l'efficacité et recherche de dépendance.

The study concerns the use of a new antidepressant, tianeptine, as a treatment of depressive and/or amotival syndrome, in 30 drug addicts, detoxified from opiates. From a thymoanaleptic point of view, 85% of the patients exhibit a positive result after 28 days of treatment with 37.5 mg/day. These good results are confirmed by the evolution of the Hamilton Depression Rating Scale global score, which significantly decreases from D0 to D14 and from D14 to D28. The acceptability of the antidepressant is good. Anticholinergic side-effects are very uncommon. Tianeptine appears devoid of any obvious psychostimulant or sedative effect. The drug compliance, estimated by counting the tablets, is very satisfying: there is no tendency to a spontaneous increase of dosing. The follow-up of the patients after drug cessation has not shown any symptoms suggesting psychological or physical dependence towards the drug. During this study in subjects particularly predisposed to the abuse of psychoactive drugs, tianeptine has not induced anything suggesting the possibility of drug abuse or tolerance.