Double-blind comparison of fluoxetine versus clomipramine in the treatment of obsessive compulsive disorder.

There is evidence of the clinical efficacy and safety of clomipramine and the newer selective serotonin reuptake inhibitors (SSRIs) for the treatment of obsessive-compulsive disorder (OCD). In the present study, we have compared the efficacy and safety of 40 mg/day of fluoxetine and 150 mg/day of clomipramine in patients with OCD, diagnosed according to DSM-IIIR. A total of 55 patients entered this 8-week, double-blind controlled study. Efficacy for both drugs was comparable. The primary efficacy criterion, the Y-BOCS Total score, did not show any significant differences between treatment arms. Response rate was higher with clomipramine, using a 25% decrease in Y-BOCS Total score as response threshold, but there were no significant differences between treatment arms using a 35% threshold. Overall safety and tolerability were good for both drugs, being slightly better for fluoxetine.

Clomipramine test: serum level determination in three groups of psychiatric patients.

Concentrations of clomipramine, a specific and potent serotonin uptake inhibitor, are measured in 67 psychiatric patients and 12 normal volunteers. The psychiatric patients are grouped according to the DSM III R criteria namely; pathological gamblers, obsessive compulsives and sufferers of panic disorders. Before and 30, 60, 90 and 120 min after an intravenous infusion of the drug (12.5 mg in 10 min), serum samples are collected to evaluate the concentrations of cortisol, prolactine and growth hormone. Simultaneously the clomipramine concentration of these samples is determined and these results only are reported in this communication. Very different drug concentrations are observed in individual patients receiving the same amount of drug, indicating a substantial inter-individual variability of drug metabolism. No statistical differences (Newman-Keules test) between the clomipramine concentrations from the patients of the three psychiatric groups and the normal group are observed. Neither are statistical correlations observed when clomipramine concentrations from all individuals (n = 79) are related with the age, sex or consumer behaviour (cigarette smoking, alcohol and coffee intakes) of the patients.

Localized cutaneous leishmaniasis (chiclero's ulcer) in Mexico: sensitivity and specificity of ELISA for IgG antibodies to Leishmania mexicana mexicana.

Sera from 223 human beings were assayed by enzyme-linked immunosorbent assay for immunoglobulin G antibodies to Leishmania mexicana mexicana promastigotes. 76% of 74 sera from patients with chiclero's ulcer gave positive reactions at a titre of 1:40; the positivity rate was lower in patients with long-standing infections. False positive reactions were obtained with only 7% of 56 sera from healthy individuals with positive Montenegro tests and with 6 of 7 sera from patients with Chagas disease. It is concluded that this method would be a useful contributory diagnostic method in cases of suspected chiclero's ulcer.

[Psychosis and cannabis consumption: study of the psychopathologic differences and risk factors]. / Psicosis y consumo de cannabis: estudio de las diferencias psicopatológicas y los factores de riesgo.

The consumption of Cannabis has been related with different psychiatric disorders. However the role of this drug in the etiology of disorders has not yet precisely been established. It has been discussed that the existence of an Induced Psychosis is brought about by the consumption of Cannabis. The objective of our study is to determine if there exists specific characteristics in the psychotic disorders manifested after the Cannabis consumption in comparison with a group of Psychotics non consumers. We also defined the risk factors that influence the appearance of the psychopathologic troubles.

[Refractory depression: therapeutic alternatives]. / Depresiones resistentes: alternativas terapéuticas.

A group of 89 patients admitted to the Psychiatric Unit of a General Hospital, with diagnosis of depression according to ICD-9 criteria and randomly chosen were studied. 26 of them (29.2%) were resistant depressions and 63 (7.82%) responded to treatment. Both groups were composed retrospectively in order to analyse resistance or lack of response to a first treatment with tricyclic or tetracyclic antidepressants in effective dosages. We considered: the personality type; the associated somatic pathology; prolonged social stress; period of evolution of the disorder; previous treatments; type of disorder uni or bipolar; familial morbidity; diagnosis reconsideration; analysis of therapeutic compliance; side effects and intolerance. We observed a statistically significant difference with regard to prophylactic treatment (38.4% resistant versus 98.3% non-resistant, p less than 0.0001); a greater suspicion of psycho-organicity in the resistant group (p less than 0.05); a longer interval of time for the resistant group between the beginning of the disorder and the beginning of treatment in our service (F: 1.45, t: 2.58, p less than 0.01). The alternatives used with our patients are analysed and we propose schedules for tackling this kind of problem.

[Hysterical psychosis: clinical aspects and disease course]. / Psicosis histéricas: aspectos clínico-evolutivos.

30 patients admitted to our psychiatric service with the initial diagnosis of psychogenic psychosis, dissociative psychosis or hysterical pseudo-psychosis are studied anamnestically and in their catamnesis (average follow up 5.1 years). The objective of the study was to see if these disorders are independent nosologic entities or are masking other ones, such as affective, schizophrenic or neurotic disorders. In this study we found a greater percentage of women (3/1) with a previous hysterical personality in more than 50%; many of the patients were hospitalised in order to clarify the diagnosis; in 70% we found psychogenic triggers; a greater predominance of an abrupt onset of the disorder (which would favour the concept of reaction); 60% had fluctuating symptoms (not so common in endogenous psychosis). In almost 100% there was a complete remission during the hospitalization period (average 22.7 days), which would bring them closer to the present concept of brief reactive psychosis. With a follow up of an average of five years, the diagnosis is maintained in 93.3% of the cases. The majority of the patients fulfilled the criteria for hysterical psychosis as defined by Hollender and Hirsch. We think that these disorders are well delimited, both clinically and nosologically, not having received up until now an exact placing in modern classification systems (DSM-III, ICD-10, etc.).

[Personality and triggering life events in the affective psychoses]. / Personalidad y acontecimientos vitales desencadenantes en las psicosis afectivas.

60 bipolar patients and 30 patients with recurrent major depression, both fulfilling DSM-III criteria, were studied in terms of sociodemographic profile, personal and family antecedents, clinical psychopathology, personality type and triggers of the first episodes. We found a greater frequency in the bipolar group of personality disorders of the hypomanic, cyclothymic and sociopathic types; the melancholic-anancastic being more associated with unipolar depression. The bipolar patients in our study had a higher socioeconomical and cultural level compared with the unipolar patients. More than 50% of the depressive episodes of each group had unfavourable life event triggers; 45% of the manic episodes also had previous unfavourable life events; 44% of the patients of this later group, exhibited a previous hypomanic, sociopathic or cyclothymic personality.

Elimination of serum proteins and potential virus contaminants during hepatitis B vaccine preparation.

As first generation hepatitis B vaccines are derived from human plasma, detailed information is required concerning the elimination of hepatitis B virus and other potential transmissible infectious agents during vaccine preparation. To demonstrate the safety of a hepatitis B vaccine, the efficiency of each of the six main steps used in the preparation process to remove or destroy pathogens was determined for representatives of major groups of animal viruses. Infectivity of all the tested viruses was reduced 10(5)-fold to a factor of 10(9)-fold by the first and last steps, namely PEG fractionation and formalin treatment. The four successive zonal ultracentrifugations decreased virus infectivity by at least 10(7)-fold. Five of these steps tend also to purify the hepatitis B surface antigen (HBsAg) which increases the HBsAg: protein ratio by at least 10(5)-fold. Considering the high degree of purity obtained, checked on each batch, it is concluded that the procedure consistently eliminates any potential virus with a ide safety margin.