Consensus on the Practical Use of Amisulpride, an Atypical Antipsychotic, in the Treatment of Schizophrenia.

Clinical expectations in schizophrenia treatment have greatly increased since the introduction of new atypical antipsychotics, but the choice of therapeutic strategy has become more complex and reference guidelines are scarce. This paper summarizes the consensus of a broad range of professionals after long-term commercialization in France of an atypical antipsychotic, amisulpride. Participants were from psychiatric hospitals, private clinics, out-patients settings and research; all were experienced with the drug. Discussions focused on the practical use of amisulpride, as, in addition to the double-blind trials information, it may be useful for psychiatrists of other countries to intuitively understand the therapeutic properties of amisulpride. The topics selected include acute psychotic episodes, short- and long-term follow-up, feasibility of treating the initial phase, the elderly and switching treatments. The French experience emphasizes the central role of amisulpride as a first-line treatment of schizophrenia.

[Drug abuse experience and neuroleptic prescriptions at the onset of schizophrenia]. / Expérience toxicomaniaque et prescription neuroleptique dans les schizophrénies débutantes.

In the first stage of schizophrenia, patients without acute symptoms often react to the prescription of neuroleptics by reservations or a refusal. In ten young schizophrenics who were hospitalized in order to initiate therapy with neuroleptics, subjective deterioration was often coincident with objective improvement of symptoms. The use of hashish as a self-administered medication at the onset of the symptoms and the ingestion of neuroleptics were experienced by the patients in a similar fashion. The decision to prescribe neuroleptics at the onset of schizophrenia should not rest only on the presence of behavioural symptoms, some of which will have to remain untreated.

Activation by stress of the habenulo-interpeduncular substance P neurons in the rat.

Substance P levels were significantly decreased in the ventro-tegmental area and the interpeduncular nucleus of rats submitted for 20 min to electric foot-shocks. Substance P levels in the substantia nigra and in the prefrontal cortex were not affected. These results are discussed in light of the selective activation of the mesocortico-prefrontal dopaminergic neurons induced by this stress situation.

Increased utilization of dopamine in the nucleus accumbens but not in the cerebral cortex after dorsal raphe lesion in the rat.

Dihydroxyphenylacetic acid (DOPAC) and dopamine (DA) levels were estimated in the frontal cortex, the nucleus accumbens and the striatum of the rat after electrolytical lesion of the dorsal raphe nucleus. The efficiency of this lesion was tested by measuring the decline in serotonin (5-HT) levels in the striatum. 5-HT levels were reduced by 90% when compared to those of sham-operated rats 11 days after the lesion. As revealed both by the increase in DOPAC levels and in the DOPAC/DA ratio, the rate of DA utilization was markedly increased in the nucleus accumbens, slightly enhanced in the striatum and in contrast remained unaffected in the frontal cerebral cortex 4 days after the lesion. Changes in DOPAC levels in the nucleus accumbens were also seen 11 and 30 days after the lesion but they were less pronounced than those observed at 4 days. These results suggest that neurons originating from the dorsal raphe and projecting to the ventro-tegmental area are regulating the activity of the meso-nucleus accumbens dopaminergic neurons but not that of the meso-cortical dopaminergic neurons.