[Endoscopic management of broncho-pleural fistula in a patient with acute respiratory distress syndrome after pneumonectomy]. / Prise en charge endoscopique d'une fistule bronchopleurale chez un patient en syndrome de détresse respiratoire aiguë après pneumonectomie.

We report the management of endobronchial a patient admitted to the ICU for respiratory distress in the consequences of an surgical recovery of his left pneumonectomy complicated by bronchopleural fistula as part of a bronchial carcinoma non-small cell type adenocarcinoma. Endobronchial treatment by gluing of the fistula may be an alternative to surgery. We discuss its indication in the treatment of bronchial fistula.

[Perception of atypical antipsychotics' side effects through speech analysis of schizophrenic patients. TALK Study]. / Analyse de discours de patients schizophrènes et perception des effets indésirables de différents antipsychotiques atypiques. Étude TALK.

OBJECTIVE: Patients with schizophrenia often become non-adherent following negative treatment experiences as antipsychotics'side-effects. The objective of this study was to propose an alternative measure of patients'perception of atypical antipsychotics'side-effects on weight, as weight is a major concern reported by patients. METHOD: We used a computer-assisted method called Alceste, which is a pragmatic analysis of speech. We selected three groups of ten patients respectively treated by three different atypical antipsychotics: aripiprazole, olanzapine and risperidone. Participants were administered an interview. All speeches were retranscribed and structured in a set of texts, called a corpus. Regarding antipsychotic treatment, we constituted three corpuses of ten speeches. We analyzed separately the three corpuses with the software Alceste. RESULTS: Our findings revealed the presence of a specific class dealing with treatment and illness in the speech of patients, regardless of their treatment. We found weight-related words in all three-treatment groups. The examination of the context of use showed this notion was differently employed in each treatment group: if weight was statistically associated with the notion of loss in the aripiprazole group, the reverse was found (notion of gain) in the two other treatment groups. CONCLUSION: Our findings are valuable because they contribute to validate this speech analysis method. Actually our results, which are mathematically obtained through speech analysis, are convergent with those objectively observed by clinicians. Thus we hypothesize the Alceste-software is a relevant tool to evaluate the perceptions of antipsychotic side-effects.

[Aripiprazole induced Parkinsonism: A case report]. / Syndrome parkinsonien sous aripiprazole : à propos d'un cas.

INTRODUCTION: Aripiprazole is an atypical antipsychotic with a pharmacological profile, different from other atypical antipsychotics. It is a high-affinity partial agonist at the dopamine D2 and serotonin 5-HT1A receptors and an antagonist at serotonin 5-HT2 receptors. It is associated with a good safety and tolerability profile including extrapyramidal side-effects. CASE-REPORT: We report on a 37 year-old female patient with paranoid schizophrenia who developed Parkinsonian symptoms after one month of aripiprazole 10mg per day. She had been admitted to our unit for a psychotic episode with delusions of persecution and grandiosity. It was her second hospitalization. During the first hospitalization, seven years earlier, she had been treated with haloperidol. We do not have any information about the tolerability of that treatment. At the start, she received olanzapine with good tolerability but without efficacy on psychotic symptoms. After 4 weeks, we switched from olanzapine to risperidone 6 mg per day. After a few days, the patient developed severe Parkinsonian symptoms. We reduced the dose to 4 mg per day without any effect on the extrapyramidal symptoms.We decided to discontinue risperidone and to introduce aripiprazole 10mg per day. After one month, the patient developed severe Parkinsonian symptoms including hypertonia, akinesia, and shuffling gait. After reduction of the dose of Aripiprazole to 5mg per day, all the Parkinsonian symptoms had disappeared within 5 days without any other medication. DISCUSSION: Few reports of Parkinsonian symptoms with aripiprazole have been published in the adult population. There is one report of Parkinsonian symptoms, associated with hypersalivation without akathisia, in a patient treated with 30 mg per day of aripiprazole. All the symptoms disappeared after a switch to olanzapine. The other cases have been reported when aripiprazole was associated with anti-depressant serotonin specific reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors. One report has been published of a 16 year-old girl who had already developed extrapyramidal symptoms with olanzapine and risperidone. Another has been published concerning a 3 year-old child who had taken a half tablet of aripiprazole 15 mg. CONCLUSION: We hypothesise that cytochrome P450 2D6 is implicated in this case-report because it is active in metabolizing aripiprazole. This patient could have been deficient in this enzyme, thus failing to metabolize aripiprazole at a normal rate.

[Clinical and socio-demographic profile of patients with schizophrenia according to the antipsychotic treatment prescribed]. / Analyse du profil socio-démographique et clinique de patients schizophrènes en fonction du traitement neuroleptique reçu.

INTRODUCTION: Data concerning the characteristics of patients with schizophrenia and their treatment in day hospitals are scarce. Guidelines for clinical practice are, however, regularly published. Recommendations from the 1994 Consensus Conference underline the necessity of antipsychotic monotherapy in the long term treatment of schizophrenia. In the US the Schizophrenia Patient Outcome Research Team (PORT) published in 1999 treatment recommendations concerning the use of antipsychotics in the acute phase and in maintenance. For maintenance, the recommended dose should be between 300 and 600 mg/day (CPZ equivalents) (recommendation n 4). AIM OF THE STUDY: The aim of this study is to establish the socio-demographic and clinical profile of patients according to the dose of antipsychotic medication prescribed. The study also examines the use of antipsychotic polypharmacy. DESIGN: of the study. For this study, 116 patients treated in 12 different day hospital units were recruited. Inclusion criteria were: a DSM IV diagnosis of schizophrenia, being treated in a day hospital and having received antipsychotic medication for at last 2 months. Instruments were the MINI for a standardized diagnosis of schizophrenia, the CGI and the PANSS. Prescribed doses were transformed in chlorpromazine (CPZ) equivalents, in order to establish comparisons between patients. RESULTS: The population sample was composed of 72 male (61.5%) and 44 female (38.5%) patients. The mean age was 36.4 years old. The mean education level was 11.3 years. A large majority (n=103, 88%) of patients was celibate, 65 patients (55.6%) lived on their own, the others lived with their family (45 patients, 38.5%) or with a spouse (7 patients, 6%). A large majority of patients (75.6%) received some form of state allowance. Only 1.7% were receiving a salary. The mean antipsychotic dose was 660 mg/day and 68% of patients were treated with an atypical antipsychotic (amisulpride, clozapine, olanzapine, risperidone). Thirty-two percent of patients were treated with doses between 600 and 1,000 mg/day and 24% with doses above 1,000 mg/day. When comparing patients according to the dose level they were receiving (<300 mg/day; 300 to 599 mg/day; and 600 to 999 mg/day;>1,000 mg/day), there was no significant difference between groups for socio-demographic variables. Patients treated with doses below 300 mg/day had a better psychosocial profile and were more often treated with loxapine, haloperidol and risperidone. Patients treated with doses above 1,000 mg/day were more often receiving clozapine. There was still a substantial number of patients treated with conventional antipsychotics in the above 1,000 mg/day range. Patients receiving an antipsychotic monotherapy were more often treated with clozapine or olanzapine and presented a higher rate of positive symptoms. DISCUSSION: These results are discussed in comparison with present guidelines concerning the treatment of patients with schizophrenia.

[Neuroleptic drug utilization among schizophrenic outpatients]. / Utilisation des neuroleptiques chez les patients ambulatoires souffrant de schizophrénie.

BACKGROUND: Our objective was to describe and compare neuroleptic drug utilization patterns among French schizophrenic outpatients in public and private care settings. METHODS: A cross sectional survey was carried out by a random sample of 61 public and 112 private psychiatrists who registered for one month all schizophrenic adult outpatients treated with a neuroleptic drug. Among registered patients, each psychiatrist was to include a maximum of 18 patients (public setting) or 9 patients (private setting). Statistical analysis was weighted to take into account for psychiatrist activity level, assessed by patient registration. RESULTS: Psychiatrists included 934 patients in the public care setting and 927 patients in the private care setting. Patients were (mean+/-sd) 40.1+/-12.1 years old, 60.9% men. The patients' social and clinical characteristics were less favorable in the public setting than in the private setting: no professional activity (78.9% vs 65.1%), living in institution (7.2% vs 3.7%), under legal protection (35.1% vs 14.5%), drug abuse (9.6% vs 5.6%). An atypical neuroleptic was prescribed for 63.0% of patients and a classic neuroleptic for 49.7%, an association of neuroleptics for 22.0%. In both settings, the most prescribed neuroleptics were olanzapine (28.0%) and risperidone (18.6%) with a higher mean daily dosage in the public care setting. At least one neuroleptic treatment change (drug and/or dosage) occurred during the previous year for 44.9% and 39.2% patients, in public and private settings, respectively. In both settings, reasons for changes were mainly lack of efficacy (55.1%) and side effects (49.8%). CONCLUSION: Public and private care populations were different but not as much as expected. In both settings, atypical neuroleptics were the predominant drugs used in the treatment of schizophrenia outpatients. The high frequency of drug change for lack of efficacy or side effects demonstrates the difficulties with the use of the present neuroleptic armamentarium.

[The subjective quality of life of patients with schizophrenia: influence of psychopathology and patients' expectations. A comparative study]. / Influence de la psychopathologie et des attentes sur la qualité de vie subjective des patients schizophrènes: une étude comparative.

Most studies on the quality of life (Qol) of patients with schizophrenia deal with objective living conditions and how they are perceived by hospitalized patients. The few studies that compare Qol for patients treated in part time services with the Qol of ambulatory patients do not show any significant difference in terms of subjective Qol. Some stu-dies evaluate the influence of psychopathology and needs (or expectations) on the subjective Qol in these groups of patients. Available data indicate that the general well-being is influenced by psychopathology (positive, negative or depressive symptoms) and unmet needs in ambulatory patients. They also show that subjective Qol in certain life domains (social relations, family relations, leisure, health, law and security) is influenced by negative symptoms, anxiety and depression in patients treated in part-time services. The aim of this study is to compare the objective and subjective Qol of patients with schizophrenia treated in part time services (day hospital and day care center) to the Qol of out-patients treated on a purely ambulatory basis (out patient clinic). We studied the Qol of 2 groups of 30 patients with schizophrenia (ICD 10 criteria) treated in various centers. The first group was made of ambulatory patients, the second one was constituted of patients treated in a day hospital or a day care center. Patients were matched for age, duration of illness, number of hospitalizations. The instruments used for rating were the following: Clinical Global Impression (CGI), Global Assessment of Functioning (GAF), Positive And Negative Symptoms Scale (PANSS), Drug Attitude Inventory (DAI-10). The Qol was measured with a french version of the Lancashire Quality Of Life Profile (LQOLP) (Salomé, Germain, Petitjean, Demant and Boyer, 2000). This instrument measures the objective Qol as well as the subjective Qol. It does possess satisfying psychometric properties and offers the possibility to establish Qol profiles. All Qol ratings were carried out by a clinician who was not involved in the treatment of the patients. When the 2 groups are compared our results indicate that ambulatory patients are less symptomatic, have a better level of functioning and a better objective Qol in such domains as: finances, living situation, family relations and health. There is no significant difference in terms of anxiety and depression as measured by the respective items of the PANSS. Patients treated in part-time services present higher scores of positive symptoms. Our results indicate that there is no significant difference for subjective Qol variables between the two groups, except for general well-being, that tends to be higher in ambulatory patients. When exploring the influence of clinical data on the Qol in each group, we find negative correlations in ambulatory patients between various domains of subjective Qol and illness severity (law and security, family relations, social relations, general well-being), global functioning (family relations, social relation, health) and positive symptoms (living conditions, law and security, family relations, social relations, health). In this same group, the subjective Qol for family relations is significantly correlated with several expectations in terms of Qol improvement (leisure, social relations, family relations, transport, work). In these patients, the subjective Qol for social relations is also significantly correlated with their expectations in terms of Qol improvement (work, money, lodging, affective relations, transport). There is no significant correlation between subjective Qol and expectations in patients treated in part-time services. Our results indicate that part time services treat schizophrenic patients with a lower level of global functioning and a higher level of symptom severity compared with ambulatory patients. These results confirm other studies that show no significant difference between these 2 groups in terms of subjective Qol. The subjective Qol in the field of relations (family and social) in ambulatory patients seems particularly sensitive to illness severity, positive symptoms and global functioning level. This has also been reported by other studies. In patients treated in part-time services, the subjective Qol, particularly for living conditions and security, seems sensitive to anxiety and depression. This has also been shown by other studies. Finally, our results underline the importance of patients' expectations in terms of subjective Qol, particularly in the field of relations (family and social) for ambulatory patients.

Consensus on the Practical Use of Amisulpride, an Atypical Antipsychotic, in the Treatment of Schizophrenia.

Clinical expectations in schizophrenia treatment have greatly increased since the introduction of new atypical antipsychotics, but the choice of therapeutic strategy has become more complex and reference guidelines are scarce. This paper summarizes the consensus of a broad range of professionals after long-term commercialization in France of an atypical antipsychotic, amisulpride. Participants were from psychiatric hospitals, private clinics, out-patients settings and research; all were experienced with the drug. Discussions focused on the practical use of amisulpride, as, in addition to the double-blind trials information, it may be useful for psychiatrists of other countries to intuitively understand the therapeutic properties of amisulpride. The topics selected include acute psychotic episodes, short- and long-term follow-up, feasibility of treating the initial phase, the elderly and switching treatments. The French experience emphasizes the central role of amisulpride as a first-line treatment of schizophrenia.

["Polydipsia, intermittent hyponatremia and psychoses" syndrome: a diagnosis and therapeutic management of a case]. / Le syndrome "polydipsie, hyponatrémie intermittence et psychoses": diagnostic et conduite thérapeutique à propos d'un cas.

Polydipsia can be defined as an impulsive behavior leading to absorption of large amounts of water (4 to 20 litres a day), without any underlying organic disease. Its prevalence in a population of chronic psychiatric patients can be as high as 6 to 17%. Schizophrenia represents 80% of cases reported. Some patients with polydipsia may develop hyponatremia, leading to a PIP syndrome (Polydipsia intermittent hyponatremia and psychosis). Hyponatremia or water intoxication appears when three conditions are present: an abnormal regulation of thirst, an inappropriate ADH secretion and/or an excessive renal sensitivity to ADH, with an increased sensitivity of the central nervous system to hyponatremia. The clinician must first identify patients at risk to develop water intoxication and start treatment before any severe physical complication occurs. Pharmacological treatments aiming at an increase of renal free-water excretion--do not show a constant efficacy in the correction of hyponatremia, they have no action on polydipsia. The new atypical neuroleptics such as clozapine and risperidone seem to open new perspectives in the treatment of polydipsia. Controlled studies should be performed in this field.

Cross-cultural study of schizophrenia.

Researchers have used a variety of approaches to assess schizophrenic disorders across cultures. Of the possible ways of studying cultural variations, the one most typically employed involves the accumulation of data in geographically isolated settings and indigenous situations. Another method is through comparative studies of people of various backgrounds living in the same social and geographical environment. This opportunity is provided by immigrants of diverse origins living in the same community. Ninety schizophrenic patients (according to DSM-III-kappa criteria) participated in this study, aged between 18 and 35 years. Three groups were constituted. The first population consisted of second-generation North Africans living and raised in France, the second of native French patients, and the third population consisted of schizophrenic patients living and being raised in North Africa (Algeria), their native country. This study showed that, for the symptoms evaluated, schizophrenic patients from Maghreb have few clinical differences from patients of French origin. Thus, cultural origins do not seem to be of major influence. These results are in concordance with those of the International Pilot Study of Schizophrenia based on a larger international population.

[A contribution of brain imaging techniques to the diagnosis of psychiatric emergencies]. / Apports des techniques d'imagerie cérébrale au diagnostic de certaines urgences psychiatriques. A propos de deux observations.

This study was performed in the psychiatric emergency unit of René-Dubos General Hospital (Pontoise, France). Two cases of female patients with motor deficiencies suggesting a diagnosis of conversion disorder because of preceding psychological stressors and lability of symptoms, are presented. In both cases, the diagnosis was reconsidered after the use of RMI for multiple sclerosis in one case, HIV related encephalopathy in the other. Recent studies have shown that organic diseases with a psychiatric presentation represent 1,2 to 4% of patients examined in emergency setting. Criteria for the diagnosis of conversion disorders are discussed (they are classified as dissociative disorders in ICD-10 and as somatoform disorders in DMS-IV). A diagnosis of conversion disorder should not be made before a thorough clinical and neurological evaluation has been performed.

Antibodies for the immunochemistry of the human beta 3-adrenergic receptor.

Based on the amino acid sequence deduced from the recently cloned human beta 3-adrenergic receptor (hu beta 3AR) gene, polyclonal antibodies were prepared against synthetic peptides, corresponding to regions of hu beta 3AR presumed to be exposed at the outer or the inner side of the membrane on the basis of the putative three-dimensional structure of the previously characterized beta 1 and beta 2 adrenergic receptors. Affinity-purified antibodies directed against N-terminal, extracellular or intracellular loops and C-terminal peptides reacted specifically with the hu beta 3AR and not with either the human beta 1 or beta 2 adrenergic receptor. Using these antibodies, it was demonstrated that the receptor is present at the surface of Chinese Hamster Ovary (CHO) cells transfected with the hu beta 3AR gene; in addition, the presence of the receptor protein was established in a human tissue (gall bladder). Immuno-affinity chromatography of solubilized CHO hu beta 3AR-containing cell membranes allowed the isolation of hu beta 3AR protein with an overall yield of 30%. The degree of purity of the receptor was more than 80%, as assessed by N-terminal sequencing of the protein eluted from the column. Sequence analysis demonstrated the absence of a methionine residue at the N-terminal position, and suggested that the side chain of the asparagine residue at position 7 is glycosylated.

[Chronic crisis or recurrence of emergencies]. / Crise chronique ou répétition de l'urgence.

The authors have studied the characteristics of a group of chronic crisis patients among those who were treated in the psychiatric emergency unit of René-Dubos General Hospital (Pontoise, France). The population was defined as patients who visited the unit four times or more during one year (from 01/07/1991 to 30/06/1992). These 70 patients represent 4.3% of the total number of individuals who were treated in the emergency setting during the same year. 1568 patients were treated as out patients, or hospitalized for a short time, not exceeding 48 hours). Two sub groups can be distinguished. The first one is composed of patients who repeat their visits during a total period of less than 3 months. The second sub group is composed of repeaters who are seen regularly but for a longer period of time. The socio demographic and clinical characteristics (DSM-III R) of the two sub groups are discussed.

High level functional expression of human beta 1-adrenergic receptor in baculovirus-infected cells screened by a rapid in situ procedure.

A novel screening assay for the identification of baculovirus infected cells expressing membrane receptors was developed by using a replica transfer technique. Sf9 cells were cotransfected with wild type baculoviral DNA and the transfer vector pVL941-beta 1 containing the coding region of the human beta 1-adrenergic receptor gene. Infected cells embedded in agarose were incubated with [125I]-iodocyanopindolol and transferred onto filters that were subsequently autoradiographed. This procedure resulted in the isolation of recombinant baculoviruses that expressed beta 1-adrenergic receptors. Binding assays carried out with [125I]-ICYP indicated that more than 600,000 receptors were expressed per cell, the highest level noted so far for this receptor in genetically engineered cells. Sf9 cells expressing the beta 1-AR were analysed by ligand binding, competition experiments, adenylyl cyclase stimulation and photoaffinity labeling. These cells express a homogenous population of receptors and display the known pharmacological properties of beta 1-AR in human tissues.