[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.

[Psychiatric emergencies : specific phenomenon.]. / Les urgences psychiatriques : Phénomène spécifique.

In as much as it is situated at a crossroads, emergency psychiatric practice provides a remarkable observation point in relation to a number of new facts: the recession, unemployment, the lack of health, the growth and development of the autonomy of the para-psychiatric professions, deinstitutionalization, the poorly-defined extension of the field of psychiatry. The réponse, even the site of this response, to demands for urgent service, its ties to medicine and to society, represent major questions. The essential reasons for providing emergency psychiatric care remain the curtailment of pathology, the early assumption of care, the reduction of errors in diagnosis and the teaching of psychiatry in the medical milieu. Although seemingly evident, these affirmations deserve to be evaluated, to be the subject of epidemiological and démographie research. Beginning with the new problems posed by the economic recession, and in the face of the situation of medicine and psychiatry, the author describes two critical situations concerning the current organization of emergency care: the saturation of transitory units and the connections between the specialties.

[Open trial of sultopride in psychiatric emergencies]. / Expérimentation ouverte du sultopride aux urgences psychiatriques.

The effectiveness of sultopride in acute psychiatric syndromes with prominent agitation was tested in patients seen in the emergency department of a general hospital. Among 32 patients, 26 were given a single injection of 200 mg and 6 had two injections. Seven items were evaluated at ten minute intervals for one hour. Results showed excellent control of agitation and anxiety but little effect on delirium, hallucinations and depression. Furthermore, the patients' unwillingness to be cared for can be overcome by this agent and diagnosis, therapy and orientation can be established. These good results are partly achieved as early as 20 minutes after the injection. Psychomotor agitation thus appears to be the choice indication of sultopride.