Tritiated imipramine binding sites in affective disorders and schizophrenia. Influence of circannual variation.

We have investigated platelet [3H]imipramine binding in normal controls and patients with primary endogenous depression (unipolar and bipolar) or schizophrenia. Absolute Bmax values did not differ between subgroups. However, when circannual variation of binding was taken into account by expressing results as percentages of normalised values derived from the multiple linear regression of Bmax values as a function of time of sampling, schizophrenic patients were found to have higher Bmax than normal controls. There was no significant difference between depressed patients and controls, nor between patients exhibiting plasma cortisol suppression and non-suppression after the dexamethasone suppression test. A significant negative correlation was found between relative Bmax values and cerebrospinal 5-HIAA levels in depressed patients.

Effects of ECT on sleep and CSF biogenic amines in affective illness.

The effects of electroconvulsive therapy (ECT) on sleep and cerebrospinal fluid (CSF) 5-hydroxyindoleacetic acid (5HIAA) and homovanillic acid (HVA) were studied in 11 male patients suffering from major depressive disorders severe enough to require ECT. Total sleep time and sleep efficiency index increased significantly after ECT, while the number of awakenings, the ratio wake/total sleep time, and the time of intermittent awake decreased, indicating that sleep continuity improved after treatment. Sleep architecture was also favorably influenced by ECT as shown by a significant increase in time of stage 2 and rapid eye movement (REM) sleep. REM latency and REM density also normalized after ECT. CSF 5HIAA increased significantly after ECT, but this was not the case for CSF HVA. These results demonstrate a positive effect of ECT on sleep EEG and CSF neurochemical markers for depressive illness.

ACTH, cortisol and growth hormone 24-hour profiles in major depressive illness.

Circadian rhythms of ACTH, cortisol and growth hormone have been studied in eighteen major depressives (eight unipolar and ten bipolar) as well as in eight normal controls. Both unipolar and bipolar depressed patients secreted more growth hormone than normal men. This hypersecretion occurred during waking hours rather than during sleep. An early sleep GH increase was found in all but one of the normal men, but was absent in seven of the eight unipolar depressed patients, who had instead a presleep increase. No consistent disturbance of the temporal association between sleep onset and GH secretion was found in bipolar depressed patients. Both unipolar and bipolar depressed patients had higher 24 h mean cortisol levels than normal men, but no significant difference was found for 24 h ACTH levels. An early timing of the nadir of ACTH-cortisol secretion which was observed in our depressed patients also suggest that disorders of circadian time keeping may characterize major endogenous depression.

CSF levels of neurotransmitters in Alzheimer-type dementia. Effects of ergoloid mesylate.

The cerebrospinal fluid level of homovanilic acid (HVA), 5 hydroxyindolacetic acid (5HIAA) and 3 methoxy-4-hydroxy phenylglycol (MHPG) was determined twice at 12 to 15-day intervals in 23 patients with Alzheimer-type dementia (ATD). No correlation was found with the degree of dementia as assessed by psychometric testing. In most of the patients, the CSF levels of 5HIAA, MHPG and to a lesser extent HVA were found to be rather stable within a period of 2 weeks. The observation of a decrease in the concentration of HVA but not of 5HIAA or MHPG in 10 out of 12 patients treated with ergoloid mesylate may therefore be of interest in elucidating the mechanism of action of this drug in ATD.

Diurnal hypersecretion of growth hormone in depression.

A 24-h profile of plasma GH concentrations was obtained together with polygraphic recordings of sleep in 16 men suffering from a major depressive disorder (8 unipolar and 8 bipolar) and in 8 age- and sex-matched normal men. None of the patients had any physical illness. All were studied after a drug-free period of at least 15 days. Blood was sampled every 15 min. The amount of GH released in every significant secretory spike was estimated using a computer program. Both unipolar and bipolar depressed patients secreted more GH than normal men (mean +/- SD, 441 +/- 189 micrograms/24 h for unipolar depressed men; 357 +/- 143 micrograms/24 h for bipolar depressed men vs. 172 +/- 101 micrograms/24 h for normal men (P less than 0.01). This hypersecretion occurred during waking hours rather than during sleep. The increase in daytime GH release was more marked in unipolar depressed patients. During sleep, depressed patients and normal men secreted similar amounts of GH despite an overall reduction in slow wave stages in depressed patients. An early sleep GH increase was found in all but one of the normal men, but was absent in seven of the eight unipolar depressed patients, who had, instead, a presleep increase in between 2100-0000 h. No consistent disturbance of the temporal association between sleep onset and GH secretion was found in bipolar depressed patients.

Sleep and neuroendocrine disturbances in catatonia. A case report.

Sleep EEG investigations were performed in a 31-year-old catatonic male patient before and after electroconvulsive therapy and 3 months after recovery. The dexamethasone suppression test was also performed longitudinally together with measurements of CSF 5-HIAA, HVA and 24-h urinary MHPG. A normal male control aged 32 was also investigated. Sleep analysis showed reduced REM latency and increased REM activity and density during the catatonic phase before treatment when compared to the age-matched control. REM latency remained shortened after recovery following ECT treatment and 3 months after recovery. Dexamethasone suppression test, abnormal before treatment normalized with clinical improvement during ECT. Urinary MHPG values were low in the catatonic state and did not change after ECT treatment. CSF HVA and 5-HIAA were also low in the pretreatment period and increased during the 3 months follow-up period. There results indicate that some cases of catatonic behavior may be linked to affective disorders.

Circannual variations in the density of tritiated imipramine binding sites on blood platelets in man.

We demonstrate a circannual variation in the density of binding sites of 3H-imipramine on human platelets of normal controls and depressed patients. These results imply further reassessment of previously published data on 3H-imipramine binding studies in affective disorders.

[Reflections on supervision problems in a team of psychotherapists]. / Réflexions sur les problèmes de supervision au sein d'une équipe de psychothérapeutes

The author presents some thoughs on the experience resulting from a 3 year individual supervision in the "Centre de Guidance Infantile" (Child Guidance Center) of the University of Louvain. The aim of the supervision is essentially the formation for child and adolescent psychotherapy. This supervision is done inside the Center, to be consistant, but this structure is causing some problems of interference : problems of responsability from the supervisors to the Center, to the patients ; problems of authority for the supervised ; problems of affective relationships between supervisors and supervised. To resolve these difficulties, the supervisors have established spontaneously regulations enabling them to limit as much as possible these interferences.

[Indications for individual child psychotherapy in a Guidance Center]. / Les indications de psychothérapie individuelle d'enfant dans un centre de guidance

The aim of this article is to describe how we conceptualise in practical indications of individual psychotherapy in the frame of the consultation of a guidance center. We will not review the literature concerned with this subject. We shall start with the study of the following factors : parents, family, reality features (distance, time, money...). Then, we study the positive and negative features in the child. We explain first all we consider to be the main obstacles in the psychic structure of the child. Then we describe in detail the favorable elements to the psychotherapeutic work. We also recall cases who, without being impossible to treat, require a big experience from the therapist, because of complexity and demand. They are sometimes treated in our unit, according to the disponibility of the therapists. In conclusion, we indicate that the choice of psychotherapy depends not only from the sick child and his familial milieu, but also from the therapist who will involve himself in this type of treatment.