[Phototherapy: clinical and therapeutic evaluation of a 2-year experience]. / Photothérapie: bilan clinique et thérapeutique d'une expérience de deux ans.

The concept of seasonal periodicity in psychiatry has been studied for thirty years in different domains, particularly in that affective disorders. It seems to be established that winter seasonal depressions are correlated to a particular vulnerability to the decrease in ambient light; this led directly to the development of phototherapy as primary treatment of SAD, simultaneously to the development of the clinical concept. Since the first demonstration by Rosenthal of the efficacy of phototherapy in SAD, numerous studies have confirmed that bright light provides rapid and effective treatment for this type of disorder. Phototherapy has been used at the Centre Psychothérapique des Hôpitaux Civils de Colmar for five years in three ways: as an alternative treatment to medication, in addition to antidepressive medication, and as primary treatment of seasonal depression. We describe the evaluation protocol of this treatment, which was established in collaboration with the Psychiatric Clinic of the University of Basel. The principal inclusion criterion for this study was the presence or regular phases of depression or loss of energy in autumn and winter; the regularity of the appearance of symptoms in winter was predominant over the severity of the symptoms, their seasonal occurrence being the most important predictive factor in favour of phototherapy. Our prospective study enabled us to include, over a period of two years, 18 subjects presenting very different symptomatology. Though the sample was heterogeneous, the results of treatment efficacy are satisfactory: we note effectively a decrease of 67.5% in the modified Hamilton scale even though strict criteria for seasonality (Seasonal Screening Questionary, Rosenthal's Criteria) were not always respected. These data should lead us to widen the indication for phototherapy, particularly in patients presenting mood disorders which are not exclusively seasonal, and support the accumulating experimental data for the selective antidepressive effect of light.

Explicit memory, repetition priming and cognitive skill learning in schizophrenia.

Explicit memory and two forms of implicit memory, repetition priming and cognitive skill learning, were examined in twenty-four schizophrenic patients and twenty-four normal control subjects previously matched for sex, age, and educational level. Two explicit tasks, free recall and frequency monitoring, and two implicit tasks, word completion and the Tower of Toronto puzzle, a variant of the Tower of Hanoi puzzle, were selected. The performance of schizophrenic patients was impaired in both explicit tasks, whereas repetition priming was intact; in the Tower of Toronto puzzle, a deficit was observed in problem solving, but not in skill learning. This dissociation between explicit and implicit memory is not entirely consistent with the hypothesis of a deficiency in effort-demanding information processing. It could be better accommodated by a model of a disturbance in the internal representation of context.

Double-blind placebo-controlled study of milnacipran in hospitalized patients with major depressive disorders.

Fifty-eight inpatients with a DSM-III diagnosis of major depressive disorder participated in a 5-week double-blind trial of milnacipran and placebo. Milnacipran was superior to placebo on all measures of depression. The first index of milnacipran superiority was the difference of dropouts due to treatment failure between milnacipran (10.3%) and placebo (55.2%). All patients were evaluated up to day 14. The improvement with milnacipran was statistically significant at day 14. Side effects were identical for milnacipran and placebo.

[Continuous ambulatory peritoneal dialysis in schizophrenia. Experimentation in 3 cases]. / La dialyse péritonéale continue ambulatoire chez les schizophrènes. Expérimentation dans trois cas.

The authors report their experience in using Continuous Ambulatory Peritoneal Dialysis (C.A.P.D.), in the treatment of chronic schizophrenia. This attempt refers to studies which confirm any role of endorphins in the origin of schizophrenia. Consecutively to american authors who found endorphins (molecular weight 3 300) in the dialysat of hemodialysed schizophrenics, they choose C.A.P.D. This continue technic of dialysis is more efficient than hemodialysis in removal of substances which molecular weight is between 1 500 and 5 000. This technic was used in 3 chronic schizophrenics: the disease has developed since 6 to 17 years and all the previous treatments failed. The duration of C.A.P.D. was 3 to 6 months. The only complication was one episode of inflammation of the peritoneum during 14 months of dialysis. Followed by the same staff with the AMDP 3 scale, the psychiatric evolution includes: --improvement and relapse in 2 patients (but we have to consider the difficulties of socioprofessional rehabilitation of these long term patients); --"clinical recovery" (17 months) in the third patient. The incidence of mothering and institutionalism is not negligible. Dosage of Met-enkephalin and beta-endorphin by radioimmunoassay in the drained dialysat did not show any difference between schizophrenics and the reference chronic renal patient. The results obtained with C.A.P.D. are not very satisfactory so far. But further research especially on the role of endorphins in schizophrenia and on their analysis technics in the body fluids perhaps will allow to treat schizophrenia again by dialysis.