[Psychostimulants for late life depression]. / Intérêt et usage des psychostimulants dans le traitement de la dépression du sujet âgé.

OBJECTIVES: The use of psychostimulants in the treatment of depressive disorders is receiving renewed interest. Recent publications suggest a particular interest of psychostimulants in the treatment of depression in the elderly. The aim of this article is to review the literature on the role of psychostimulants in the treatment of depression in older adults. METHODS: The literature review focused on efficacy and tolerability studies of psychostimulants in the treatment of depression for the elderly that were published between 1980 and 2016. The only inclusion criterion applied was an average age of the sample studied greater than or equal to 60 years. RESULTS: Overall, 12 trials were selected: 3 controlled trials and 9 uncontrolled trials. Of the 3 controlled trials, one compared parallel groups and the other two were cross-tests. Among the psychostimulants, methylphenidate was the most studied molecule. The trials demonstrate an efficacy of this molecule in particular as an add-on therapy in old-age depression but for the most part with a level of proof that remains insufficient. CONCLUSIONS: The small size of the samples and the methodological limitations of the studies obviate the possibility of extracting definitive conclusions concerning the place of psychostimulants in the treatment of depression in the elderly. Further studies are required in particular in the treatment of resistant depressive episodes.

Mental health and substance use among self-employed lawyers and pharmacists.

BACKGROUND: Self-employed workers experience occupational stress and may suffer from various mental health disorders. AIMS: To assess the mental health, substance use and risk factors for psychological distress in a sample of self-employed lawyers and pharmacists. METHODS: A cross-sectional study, using self-completion postal questionnaires, of lawyers and pharmacists. The General Health Questionnaire-28 (GHQ-28) was used as a measure of current mental health, and some additional questions evaluated alcohol, tobacco and psychotropic drug use and somatic morbidity. A multiple regression model was used to analyse the respective impact of the different risk factors on psychological suffering. RESULTS: A total of 1282 lawyers and 1153 pharmacists participated representing response rates of 36 and 35%, respectively. According to the GHQ-28 score, the rate of psychological distress was high in the sample overall, especially in lawyers (52 versus 47% in pharmacists, P < 0.05). According to the mean number of drinks per day, 16% of the lawyers and 13% of the pharmacists reported alcohol misuse, and lawyers were twice as likely as pharmacists to smoke (26 versus 13%, P < 0.001). Higher GHQ-28 scores were associated in lawyers with female gender, being widowed or divorced, smoking and using anxiolytic medication and in pharmacists with being younger, smoking, alcohol abuse and anxiolytic and hypnotic use. CONCLUSIONS: In our sample of these self-employed groups, both pharmacists and lawyers reported a high rate of psychological distress.

[Hysterical mutism]. / Le mutisme hystérique.

BACKGROUND: Conversion disorders comprise many clinical pictures, including hysterical mutism. Hysterical mutism has emerged as a clinical entity that remains difficult to diagnose, and whose treatment is poorly codified. Hysterical mutism is a disorder of the vocal function without changing the integrity of the body, resulting in loss of voice. Identified at all times, hysterical mutism entered the medical field in the late nineteenth century, under the direction of Jean-Martin Charcot (Salpêtrière School). Since then, although the disorder has emerged as a clinical entity, it remains little known. METHOD: A systematic review of the literature. We performed electronic literatures search of relevant studies using Medline, SUDOC, and BIUM. Search terms used were mutism, functional aphonia, conversion disorder, hysteria. RESULTS: The epidemiology of hysterical mutism is difficult to assess. The first limitation is the lack of consensensual diagnostic criteria. An estimate of its frequency may be advanced through registries consultation of otolaryngology-head and neck surgery. Through a literature review, emerges a rare disorder, about 5% of functional dysphonia. The sex-ratio is in favour of women. Regarding age of onset of disorder, functional aphonia mainly concerns adults with an average around the age of 30-40 years. The onset of the disorder typically involves a sudden onset and a recent stressful event. The duration of the disorder is difficult to specify. It appears that this dysfunction is rapidly reversible and that the majority of patients are in remission of this disorder within three months. The recurrence of dysfunction seems to be frequent. The existence of psychiatric comorbidity did not appear to be the rule. The natural history of this disorder is not known making it tricky to evaluate the efficiency of therapeutic approaches. CONCLUSION: Today the term hysterical mutism does not appear as an entity in either international classification. It belongs to the category of conversion disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Identified as a medical entity described by the school of the Salpêtrière, this disorder has raised little interest. The medicalization of the condition remains difficult because of the importance of stigma associated with it, which contributes to the rejection rather than support of patients with mutism. To better understand this disorder and improve the care of patients who suffer, renewed interest is warranted.

[Depressive symptoms in pathomimia: comorbidity or psychiatric factitious disorder?]. / Symptômes dépressifs et pathomimie : comorbidité ou trouble psychiatrique factice ?

BACKGROUND: The factitious disorders, more commonly known as pathomimia, are mainly expressed as organic symptoms voluntarily induced by the patient. Patients suffering from these disorders do not seek to obtain immediate secondary benefits, contrary to simulation. They send the physician a challenge, sometimes by means of self-mutilation, or exposure to a vital risk. Their objective is to raise the interest and the mobilization of the medical community. The patient will develop intense relationships with the medical staff, technically mobilized as well as emotionally, as far as the factitious character of the disorder is uncovered. In some cases, factious disorders are conditions in which a person acts as if he or she has a psychiatric disorder, by deliberately exhibiting psychiatric symptoms. Most often described are factitious acute psychotic disorders, mourning, affective disorders and post-traumatic stress disorders. Psychiatric factitious disorders are difficult to diagnose, but they share common diagnosis criteria with other pathomimias. These subjects may suffer from pathomimia because of the occurrence of other psychiatric symptoms, such as pathological personalities, adaptation disorders, abuse and/or dependence on alcohol or other substances, or depressive disorders. This paper describes three clinical cases of pathomimia, diagnosed after hospitalization in a psychiatric unit for depressive symptoms, as a correlate to their factitious or authentic character. METHOD: Three case reports, describing patients with pathomimia hospitalized in a department of psychiatry for depressive disorders. RESULTS: The first case was a 57 year-old man considered as suffering from a bipolar disorder hospitalized for a depressive syndrome. The symptoms described and reported are those of a factitious disorder. The patient interrupted the medical care by asking to be discharged from the hospital. The second case was a young woman hospitalized following a suicide attempt. She has a history of multiple somatic and psychiatric factitious disorders. On admission she had depressive symptoms, more likely linked with a pathological personality, rather than with a major depressive episode. The third case presented a Munchausen syndrome. He was hospitalized for depressive symptoms. He had a comorbid major depressive episode. The prescription of antidepressants led to a significant clinical improvement. CONCLUSION: These three cases indicate that a real depressive syndrome may be observed with a patient suffering from pathomimia. Therefore, a neutral and complete psychiatric evaluation is necessary so as to not deprive these patients from the opportunity for an adapted treatment.

Trypanosoma cruzi: the development of estrus cycle and parasitemia in female mice maintained with or without male pheromones.

Female BALB/c or C57B1/6 mice, kept in small groups of three or five animals with or without male odor, all had a similar progesterone and corticosterone level, mean number of estrus and duration of estrus cycle. However, if males were kept in the same room, the mean duration of the estrus cycle was longer for both strains; and C57B1/6 females had a significantly higher number of estrus than BALB/c mice and showed a tendency to synchronize the estrus cycle within a group. After infection of females of both mouse strains with vector-derived metacyclic trypomastigotes of Trypanosoma cruzi, anestrus with intense phlegm production occurred during the acute phase of infection and this was positively correlated with higher parasitemia. Within individual groups of BALB/c mice, the female with the relatively highest corticosterone and progesterone level had the lowest parasitemia. In groups kept separate from male pheromones, one or two females in each group developed high parasitemias.

Experimental Chagas disease: the influence of sex and psychoneuroimmunological factors.

The effects of gender and psychoneuroimmunological factors resulting from the social environment and status of males were investigated with regard to the concentrations of testosterone and corticosterone and the course of Trypanosoma cruzi infection in mice. Hormone concentrations varied considerably; and only testosterone concentrations showed a tendency to be higher in dominant males. Females kept singly developed lower and more similar parasitaemias than males kept singly or together with a female. This difference was significant when comparing groups of females or males. Within groups of male mice, parasitaemia was strongly correlated with the social position, being high in inferior males and low in dominant ones. The importance of these findings is that they clearly prove that chronic social stress in males strongly affects the course of infection with T. cruzi.

Trypanosoma cruzi: skin-penetration kinetics of vector-derived metacyclic trypomastigotes.

In order to investigate the natural route of infection of nude and normal BALB/c mice with Trypanosoma cruzi via the skin, a drop of vector faeces/urine containing metacyclic trypomastigotes was placed onto the puncture site of a bite from Triatoma infestans. The periods of exposure, i.e. until removal of flagellates from the skin, and the time elapsed until surgical removal of the skin around the puncture were varied. After 15 min of exposure, T. cruzi developed in all nude mice without surgery, and in four of 10 mice if the puncture region of the skin was removed directly after exposure. In a shaved puncture region, 5 min of exposure were sufficient to infect all normal BALB/c mice without surgery and one of four mice with direct removal of the puncture region. Longer periods of exposure or time until removal of the skin only sometimes resulted in higher infection rates. Prepatent periods and the development of parasitaemia varied irrespective of the period of exposure or the period until skin removal at the puncture site. The importance of these findings is that they clearly prove that T. cruzi can rapidly invade the host via the puncture site of the bite of the vector and that at least some parasites are immediately transported away from this site.

Ultrastructural changes on various Trypanosoma spp. after a 30-year storage period in liquid nitrogen.

Four Trypanosoma species were examined for damage following prolonged storage in liquid nitrogen (-196 degrees C). The stabilates were successfully recovered after a cryopreservation period of approximately 30 years. The structure of specimens was studied by means of light microscopy and scanning (SEM) and transmission (TEM) electron microscopy. All of the species tested--T. evansi, T. equinum, T. brucei, and T. congolense--proved to be infective to mice. However, as compared with controls, the trypomastigote bloodstream forms, which had been frozen and later recovered, showed clear differences. Formerly deep-frozen organisms usually appeared to have shrunk as a result of solution effects, which occur during freezing and thawing. Ultrastructural changes such as separation of the cytoplasm from the pellicle, the occurrence of large vacuoles in the cytoplasm and karyoplasm, a loss of cytoplasmatic ribosomes, membrane injuries, enlargement of the flagellar pocket, and denaturation of chromatin became obvious. The extent of the ultrastructural alterations appeared to be much greater after a cryopreservation period of approximately 30 years than those previously reported after a 13-year storage period. These changes, however, did not result in a complete loss of infectivity to mice.