[Calcium carbasalate-metoclopramide combination versus dihydroergotamine in the treatment of migraine attacks]. / Association carbasalate calcique-métoclopramide versus di-hydroergotamine dans le traitement de la crise de migraine.

In this randomised, double-blind, cross-over study the association of calcium carbasalate+metoclopramide was compared with oral dihydroergotamine mesilate in the treatment of migraine attacks. 155 patients suffering from migraine, with or without aura were analysed; the main efficacy criteria being the evolution of the headache intensity: disappearance of headache 2 hours after administration or incomplete improvement (severe to moderate headache reduced to slight headache). There was a significantly greater reduction in headache intensity following administration of CSC-METO (p < 0.001), the percentage of patients showing recovery or improvement two hours after administration being 64.5% with CSC-METO compared to 43.5% with DHE. A significantly more marked improvement following administration of CSC-METO was also observed for nausea, photophobia, phonophobia, use of analgesic treatment, impact on normal activities and overall assessment by the patient and physician. The frequency of undesirable events was weak and identical for both treatments.

[Three cases of matricide]. / A propos de trois observations de matricide.

The matricide is defined as the murder of the mother by her son or her daughter. The term of parricide is also used. Matricide is not a specific mental disease. The study of three original cases leads to classify two of them as psychiatric disorders, legal authority is applicable to the last. The first category contains a wide spectrum of psychiatric diagnosis and could be successfully controlled by treatment. Those cases fall in the article 64 of the French Law at the moment of the murder. The second category consists of perverse individuals responsible of their actions and hardly curable by treatment. These cases are abandoned to Justice. The "parricide" represents 2.54% of murders, the matricide 0.68%.

Clinical subtypes and age at onset in schizophrenic siblings.

This study examines the concordance of clinical subtypes and age at onset of schizophrenia in 42 sibships of multiply affected schizophrenic patients. Subtypes were defined by four major diagnostic systems (DSM-III, DSM-III-R, ICD-10, and Tsuang-Winokur criteria) and rated both for the first hospitalization and long-term diagnosis. When a sibship method was used, no concordance for subtypes was found in siblings. Age at onset, analyzed as a continuous variable with the intraclass correlation method, was found to be correlated in siblings. This finding suggest that the search for continuous traits distributed in families of schizophrenic patients might constitute an alternative to discrete category-based family studies.

[Familial forms of schizophrenia. Cytogenetic study]. / Formes familiales de schizophrénie. Etude cytogénétique.

As a preliminary step in the search for chromosomal location of a susceptibility gene predisposing to schizophrenia, cytogenetic screening of patients might be useful. Search for chromosomal aberrations has successfully directed and accelerated the identification of several disease genes, such as the Duchenne muscular dystrophy gene, retinoblastoma, Burkitt's lymphoma and chronic myeloïd leukemia. Although karyotypes abnormalities do not account for a large portion of cases of Schizophrenia, the two candidate regions predisposing to this disease resulted from observation of chromosomal abnormalities. First, the identification of a partial trisomy of the 5q11-q13 region (Basset et al., 1988) led Sherrington et al. (1988) to report a positive linkage with markers localized on the long arm of chromosome 5, which has not yet been replicated (Kauffman et al., 1989; Kennedy et al., 1988; St Clair et al., 1989). Second, on the basis of frequent cytogenetic abnormalities of the sex chromosome (DeLisi, 1985) in addition to epidemiological observations, Crow (1988) suggested that there could be a locus for psychosis within the pseudoautosomal region, a data which has been recently confirmed (Collinge et al., 1991). With the hypothesis that such aberrations could be more frequent among schizophrenics who have at least one affected first-degree relative, we undertook cytogenetic screening on a sample recruited from consecutive psychiatric admissions to a Psychiatric facility (Hôpital Saint Paul) involving patients living in a limited geographical area on the island of La Réunion, a French Department in the Indian Ocean.(ABSTRACT TRUNCATED AT 250 WORDS)

[Amisulpride, neuroleptic and antinegative action]. / L'amisulpride, neuroleptique et antidéficitaire.

Amisulpride (Solian), a substituted benzamide derivative, is distinguished pharmacologically by its marked affinity for dopamine D2 receptors and its higher affinity for limbic and hippocampic as compared with striatal dopamine receptors. The originality of this molecule lies in its observed 2 opposed actions at 2 distinct dose levels. High amisulpride doses, antidopaminergic, inhibit, in animals, the hyperdopaminergic symptomatology considered equivalent to positive schizophrenia, whereas low doses, dopamine-releasing and activating, improve hypodopaminergic symptomatology of negative schizophrenia. The ratio of about 300 between activating and inhibiting doses demonstrates the clear dose-related dissociation of effects, this ratio being, furthermore, much higher than that of other neuroleptics possessing bipolar activity. In contrast to conventional neuroleptics, amisulpride possesses only weak sedative activity and practically lacks cataleptigenic effects. This twofold action has been confirmed in clinical practice by open and double-blind studies, demonstrating in each case the rapidity of action (by the end of the 1st week) and very good tolerance, notably neurological, of amisulpride. Clinical studies (5 open and 4 double-blind) in patients with psychosis and positive symptomatology, have demonstrated that high doses of amisulpride (Solian 200) are effective against overall positive symptomatology at doses of 600 to 1,200 mg/day, doses of less than 300 mg/day being ineffective or aggravating. Improvement is obtained without "damping effect", amisulpride being as effective as haloperidol in this indication with a significantly better tolerance. In patients with negative schizophrenia (4 open and 3 double-blind studies) the effective dosage of amisulpride (Solian 50) is about 150 mg/day, doses above 300 mg being ineffective or aggravating. Improvement is marked and occurs in all negative symptomatology.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clonidine versus a placebo trial in manic disorder]. / Essai "clonidine contre placebo" dans la manie.

Clonidine efficacy was evaluated in 24 manic inpatients, hospitalised in a locked ward. This is a double blind and randomized study. The duration of the trial was 14 days, and the daily dose of clonidine was 0.225 mg/day during the first week, increased to 0.450 mg/day during the second week, in the case of incomplete improvement. There was a trend for a better efficacy of clonidine over placebo, but this did not reach significant, due to an important amelioration of many patients under placebo. The effects of the hospitalisation in a locked ward are discussed.

[Obsessive-compulsive neurosis explored using positron emission tomography. Apropos of a case]. / Névrose obsessionnelle explorée par caméra à positons. A propos d'un cas.

Regional cerebral glucose metabolic rates were studied during three sessions of positron emission tomography in an obsessive-compulsive patient. Changes in whole cortex metabolism, apparently related to the clinical relapses, were found. These preliminary findings are discussed in the light of the available literature.

[Depressions resistant to tricyclic antidepressive treatment and hypothyroidism]. / Dépressions resistant aux traitements antidépresseurs tricycliques et hypothyroïdie.

The relationship between thyroid disorders and depression is well known. This type of endocrine disease is mainly observed in patients with depression resistant to appropriate antidepressor therapy. Three clinical forms of this association may be distinguished: hypothyroidism in a patient with depression but without a previous psychiatric history; a relapse of depression in a manico depressive patient who has developed hypothyroidism; the finding of slight thyroid dysfunction (increased TSH response after injection of TRH) in a patient with depression. The frequency of the association of hypothyroidism and resistant depression underlines the need to perform thyroid function tests in all depressed patients who do not respond normally to appropriate antidepressor therapy. The precise mechanism of the resistance of depressive symptoms to tricyclic antidepressors is unclear. Several arguments point to an effect of triiodothyronine on central noradrenergic receptors. In practice, significant hypothyroidism implies substitute therapy. Minor thyroid dysfunction (abnormal TRH test alone) may require the association of tricyclic antidepressors and thyroid hormone although the indications and precise dosages of this drug association have not been established.

[Renal clearance technic for individualizing lithium dosage in routine hospital care]. / La méthode de la clairance rénale pour l'individualisation des posologies du lithium en routine hospitalière.

Lithium has a narrow therapeutic index and exhibits a wide pharmacokinetic variability. Individual dosage regimen adjustment is necessary to warrant the efficacy and safety of long-term treatment. We propose the "renal clearance method" for rapid determination of the lithium carbonate daily dose for chronic therapy. After the first intake of drug by a manic-depressive patient, a four-hour trial is performed. It involves two blood samplings and two urine collections, in which lithium and creatine are assayed. Comparison of observed creatinine with a value predicted according to age, morphological characteristics, sex and serum creatinine of the patients allows the interpretation of conflicting results. The estimation of lithium and creatinine clearances of each patient is performed using a computerized or manual method which unfolds a decision procedure. The daily dosage (1.5 to 6 250 mg tablets in two or three daily intakes) is deduced from the according lithium renal clearance (0.4 to over 2 l/h) by means of a nomogram established in previous studies on about 50 patients. The clearance method has been investigated in routine hospital care on a 40 patients sample. The range of satisfactory lithium serum levels during patients monitoring was 0.6-0.9 mmol/l. Accurate dosage regimen forecasting is obtained in 92% of the patients. The percentage observed in a subset of 13 patients with the C24 method, which relies on a unique blood sample 24 hours after the first dose, was much lower (54%). The renal clearance method appears as a robust and reliable technique for individual lithium dosage regimen adjustment in routine care.

[Plasma levels of desmethylclomipramine and clomipramine at steady-state in the morning. Correlative analysis and prediction of theoretical blood clomipramine]. / Taux plasmatiques de desméthylclomipramine et de clomipramine au "steady-state', le matin. Analyse corrélative et prévision d'une clomipraminémie théorique.

Clomipramine (CMI) was administered to eight patients, either as an antidepressive drug or, in two patients, as an antalgic drug (average age: 54 y.; average body surface area: 1,71 m2). These patients were treated with 20 to 150 mg, every day, for various lengths of time: min.; one week: max.; 7 years, till the day before the determination of plasma levels. The samples were drawn on patients, fasting, in the morning. Plasma levels of CMI, Desmethylclomipramine (DCMI) and Cortisol were dosed by means of High Performance Liquid Chromatography with U. V. detection.

[Drug combinations in the treatment of depression]. / Des associations médicamenteuses dans le traitement des dépressions.

Four types of combination therapy may be used in the treatment of depression: anxiolytics and antidepressants, neuroleptics and antidepressants, co-administration of two or more antidepressants, association of antidepressants with drugs correcting antidepressant-induced side-effects. First, the pros and cons of these combinations are described as they appear in daily practice. In the second part, the theoretical reasons for supporting or contraindicating such combinations are discussed in the light of pharmacological data. The value of recent molecules such as nomifensin, viloxazin, amineptin and mianserin which interact with a minimum number of neurotransmitters is stressed.