[Between deontology and ethics, does the institution become respectable?]. / Entre Déontologie et Ethique, l'Institution deviendrait-elle respectable?

Deontology draws one's inspiration from Ethics. From this occurrence it seems important to avoid confusion between the first and the second. Psychiatry belongs truly to medical training. Nevertheless considering freedom pathology is its main particularity. This is the reason why human freedom must, at all cost, be preserved. This one is essential whenever individual subjectivity is concerned. The fundamental reference remains Human Rights Convention; even if opposed to principle of reality, one is necessarily obliged to a conflictual accommodation.

Is phosphodiesterase inhibition a new mechanism of antidepressant action? A double blind double-dummy study between rolipram and desipramine in hospitalized major and/or endogenous depressives.

Unlike conventional antidepressants, rolipram (a new approach in the treatment of depression) stimulates both the presynaptic and the postsynaptic component of monoaminergic transmission. Several double blind trials are under way to assess the clinical efficacy and safety of this compound. The present study was a randomized, 4-week interindividual double blind double-dummy comparison with desipramine in inpatients with major (DSM-III) and/or endogenous (ICD-9) depressions. After a minimum washout period of three days the patients received either 0.50 mg rolipram or 25 mg desipramine orally t.i.d. for the first three days, then 0.75 mg rolipram or 50 mg desipramine t.i.d. until day 28. Rating tests were based principally on the AMDP-system and the HAMD scale. The study showed no differences between the two drugs as regards the efficacy, but a definite trend in favour of rolipram as regards the side effects and, in particular, anticholinergic effects.

[Preliminary results of a double-blind study between rolipram and desipramine in hospitalized patients with major depressive symptoms]. / Résultats préliminaires d'une étude en double aveugle entre le rolipram et la désipramine chez des déprimés majeurs hospitalisés.

Rolipram facilitates the postsynaptic neurotransmission of NA through a completely new mechanism of action, namely, an inhibition of the inactivation of the second messenger (the cyclic AMP) by phosphodiesterase. In the present study, Rolipram is compared to a classical tricyclic antidepressant which facilitates the NA transmission through an inhibition of its presynaptic reuptake: Desipramine. Preliminary results on 12 Rolipram patients vs. 9 Desipramine patients indicate that Rolipram has an antidepressant potency comparable to Desipramine with less anticholinergic and hypotensive side effects. This study also illustrates that a 14-factor AMDP profile gives much more information than a single total score such as the Hamilton score.

[Novel comparative profile of the clinical activity of antidepressive agents]. / Une physionomie comparée originale de l'activité clinique des antidépresseurs.

In order to develop practical criteria to guide in the selection of antidepressant medication according to depressive symptomatology, we propose a graphical representation of the clinical activity of 24 antidepressants according to a "star" model. Six parameters have been evaluated from 0 to 5 in comparison to reference drugs (rated 5) by 11 independent "blind" psychiatrists expert in pharmacotherapy. Three parameters were used as measures of therapeutic activity: antidepressant, psychostimulant, and anxiolytic, with iproniazide 75 mg/d, metamphetamine 15 mg/d, and diazepam 20 mg/d as reference drugs respectively. Three additional parameters assessed the level of side-effects: anticholinergic, sedative, and hypotensive, with atropine 0.75 mg/d, phenobarbital 200 mg/d, and iproniazide 75 mg/d as reference drugs respectively. The defined dose represented the standard maintenance daily dose for depressive outpatients. Mean values for each parameter, rounded off to the closest number, were used for the graphical representation. Results showed an excellent agreement among evaluators for the clinical profile of classical tricyclic and MAOI antidepressants, but serious divergences for the more recent drugs (e.g., viloxazine and mianserine), possibly reflecting more atypical or more variable clinical profile of these compounds.

[From therapy to teaching and from research to therapy]. / De la thérapeutique à l'enseignement et de la recherche à la thérapeutique.

Man can sometimes be the subject of experiment in medicine; in psychiatry, there are at least two situations when men, more so, a patient occupies legitimate the function of "experimental object". First the problem of clinical psychopharmacology is considered showing its necessity and legitimacy; one emphasizes the advantages and warrentee that the hospital is providing. Ethical regulations are discussed in relation to this practice and a sterilyzind formalism could be damageable as well as the ambiguity of the notion of informed conscript. The first conclusion is that the notion of therapeutic trial should replace clinical experiment meaning that the patient should be the first winner of this enterprise. Then the second situation of a hospitalized patient being the subject of teaching is discussed. The author describes its teaching technique based on the semiology of talking and the pathology of communication. Once again, its main concern is to render the patient first to benefit from this experimental situation, the remaining coming later.

Time-blind videotaped evaluation of injectable diazepam, lorazepam and placebo.

Eighteen inpatients suffering from a severe anxiety received in double-blind and crossover conditions iv and im injections of 10 mg diazepam, 5 mg lorazepam or saline t.i.d. during 5 days. The morning injections was made iv in a CCTV studio. Before injection and 20 mn after it, the patient filled out a 100 mm Visual Analogue Scale; his doctor-in-charge proceeded to a standard interview and to physiological measurements (tremor of hand, patellar reflexes, blood pressure, pulse rate). The videotaped interviews were randomly, i.e. time-blind, rated by two independent observers on 3 scales: the VAS, the Hamilton Anxiety Scale and an ad hoc Verbal and Non-Verbal Anxiety Scale (VNVA). The statistical analysis was completed by a logical analysis according to Lewis Carroll. The results demonstrate the superiority of lorazepam over diazepam on psychic anxiety, somatic anxiety, sleep and blood pressure, the only significant side-effect being drowsiness.

[On anxiety and anguish (author's transl)]. / De l'anxiété et de l'angoisse.

Psychopharmacology has confirmed psychiatry as a medical science; methodological rigor of the exact sciences is essential to psychopharmacological research. It does not however question speculative thought which remains one of the strong sources of psychiatry. The identification of new drugs with their elective properties and their unexpected action on psychopathology imposes a reappraisal of psychiatric concepts. This is true for some narrow concepts such as anxiety and anguish, which only exist in the French. The French psychiatry also determined its clinical limits at the beginning of this century, and it seems to lose it from time to time. Like any emotion, the anxious matrix is one non distinguishable from the unity of the existence. A phenomenological approach permits to confirm the intuition of language in showing that the living experience of anguish is different from the one of anxiety.