Psychological health in central hypersomnias: the French Harmony study.

BACKGROUND: A large observational French study of central hypersomnia, including narcolepsy with cataplexy (C+), without cataplexy (C-) and idiopathic hypersomnia (IH), was conducted to clarify the relationships between the severity of the condition, psychological health and treatment response. METHODS: 601 consecutive patients over 15 years of age suffering from central hypersomnia were recruited on excessive daytime sleepiness, polysomnography and Multiple Sleep Latency Test (MSLT) results. 517 (47.6% men, 52.4% women) were finally included: 82.0% C+, 13.2% C- and 4.8% IH. Face to face standardised clinical interviews plus questionnaires (Epworth Sleepiness Scale (ESS), short version Beck Depression Inventory (S-BDI), Pittsburgh Sleep Quality Index (PSQI) and 36-item Short Form Health Survey (SF-36)) were performed. Patients affected with a different diagnosis and with and without depressive symptoms were compared. RESULTS: Mean ESS and body mass index were higher in C+ compared with C-/IH patients. Half of the patients (44.9%) had no depressive symptoms while 26.3% had mild, 23.2% moderate and 5.6% severe depressive symptoms. C+ patients had higher S-BDI and PSQI and lower SF-36 scores than C-/IH patients. Depressed patients had higher ESS scores than non-depressed patients, with no difference in age, gender, duration of disease or MSLT parameters. Finally, C+ patients treated with anticataplectic drugs (38.7%) had higher S-BDI and lower SF-36 scores than C+ patients treated with stimulants alone. CONCLUSION: Our data confirmed the high frequency of depressive symptoms and the major impact of central hypersomnias on health related quality of life, especially in patients with cataplexy. We recommend a more thorough assessment of mood impairment in central hypersomnias, especially in narcolepsy-cataplexy.

[Cutaneous pulpar temperature and cold test. Predictive specificity and sensitivity in pharmaco-clinical studies]. / Température cutanée pulpaire et test au froid. Spécificité et sensibilité prédictives en pharmacoclinique.

The aim of this study was to measure the cutaneous pulpar temperature of the fingers and assess its evolution after one minute of controlateral hand immersion in a water bath at 4 degrees C and during 10 minutes after cooling. This test was carried out in 347 subjects (120 M, 227 F) divided in 5 groups: 117 healthy volunteers (49 M, 68 F) without any vascular diseases, 46 patients (5 M, 41 F) with acrocyanosis, 87 patients (19 M, 68 F) with Raynaud's phenomenon, 31 patients (24 M, 7 F) with peripheral arterial occlusive disease and 66 patients (23 M, 43 F) with other vascular diseases (high blood pressure and coronary disease). The mean initial temperature (TO) analysis in each group, showed that 2 groups, acrocyanosis and especially Raynaud's group, had a finger temperature significantly lower than the control group (27.4 +/- 4.8 degrees C 25.3 +/- 4.9 degrees C versus 30.5 +/- 4.9, p < 0.02). The cooling test showed 3 different cutaneous temperature reactions: subjects without any modification during and after immersion, subjects with a temperature decreasing after immersion and a normal rewarming after 10 minutes and subjects with a decreasing without any total recovery after 10 minutes. In the subjects with cold hands (initial temperature < 30 degrees C), this cooling test can isolate all patients with a temperature decreasing without any rewarming after 10 minutes with a specificity at 100% (no normal subject with cold hands were abnormal to this test).(ABSTRACT TRUNCATED AT 250 WORDS)

[Utilization of theta/alpha spectral range as an indicator of vigilance: pharmacological applications during repeated sleep latency tests]. / Utilisation du rapport des puissances spectrales thêta/alpha comme indice de vigilance: applications en pharmacologie lors de tests itératifs d'endormissement.

Three successive double-blind, cross-over vs placebo trials with amphetamine 10 mg, amineptine 200 mg, clonidine 150 mcg were made in 12 x 3 healthy volunteers by means of a multiple sleep latency test (MSLT) associated with quantitative EEG. Data were evaluated by a 3-way ANOVA for repeated measurement. The aim of the study was to find out the most efficient parameters from theta/alpha ratio to exhibit a "time effect", i.e. the physiological variation of vigilance during the daytime and a "drug effect", i.e. a stimulant or sedative effect. The best parameter was the difference between the maximum and the minimum values of the theta/alpha ratio during the recording session. The time after which the theta/alpha doubled and the time after which the subject was the most relaxed (theta/alpha minimum) exhibited significant variations due to time effect and only sedative drug effect. The results of the other classical parameters from MSLT, visual analogue scales and sleep questionnaires were discussed as was the use of parameters from quantified EEG in order to make up homogeneous groups of healthy volunteers.

[The AMDP scales in a phase II evaluation of psychotropic drugs]. / Les échelles AMDP dans l'évaluation de psychotropes en phase II.

Four multicentre double blind trials (two studies comparing placebo to a marketed activating drug and two comparing placebo to a new drug with central adrenergic modulating properties) were pooled, totalling 77 placebo Ss, 30 reference drug Ss and 73 study drug Ss. The AMDP-4 and -5 scales were filled out at day 0 and 7 by trained raters. Four statistical analyses were performed on the pre- vs. postdrug differences: an analysis of variance, a principal components factor analysis, a discriminant analysis and a cluster analysis. The results indicate that 9 out of the 14 AMDP factor scores significantly decrease within 1 week while the factor Mania-Agitation increases, without differences between both active compounds; on the item level, the "inhibition of drive" is specifically improved by the study drug; the discriminant analysis confirms that the two most improved items are "Inhibition of drive" and "Hopelessness". Three factor scores significantly improve on placebo (Depression, Retardation, Psycho-organic Symptoms), which points to the necessity of placebo-controlled studies in clinical trials of new drugs.