[Influence of heredity, sex and season on the type of episode of bipolar disorder]. / Influence de l'hérédité, du sexe et de la saison sur le type d'épisode dans le trouble bipolaire.

The aim of this work was to investigate if sex, age, family history, season and hypothyroidism have any influence on the type of episodes (manic, depressive, mixed) seen in bipolar patients. This retrospective study concerns a sample of 208 patients with a diagnosis of bipolar disorder (type I or II), who were admitted in one of two psychiatric centers between July 1996 and June 2000. The sex-ratio was 2.8 females for 1 male. Sex, family history and hypothyroidism were not associated with any type of episode. A higher percentage of depressive episodes was observed in the patients who were older than 50 and the average age of depressive patients was higher than that of other patients. There was no seasonal pattern in this study and the season did not influence the type of episode. The results indicate no influence of sex, season, family history and hypothyroidism on the type of episode presented. On the opposite, age seems to favour depression episode.

Controlled comparison of milnacipran and fluoxetine in major depression.

The efficacy and the tolerance of milnacipran (100 mg/day), a second generation antidepressant which equipotently inhibits both noradrenaline and serotonin reuptake, was compared to fluoxetine (20 mg/day), a selective serotonin reuptake inhibitor, in two parallel groups of, respectively, 97 and 93 major depressive outpatients. The duration of the study was 6 weeks, with assessments every 2 weeks by means of the Montgomery and Asberg depression scale (MADRS), the Hamilton depression scale, the clinical global impressions (CGI), and a checklist of symptoms and side-effects. Results showed significant superiority of fluoxetine over milnacipran on most rating instruments: MADRS (P = 0.01) including five individual items, Hamilton depression scale (P = 0.002) including ten individual items, CGI of severity (P = 0.01) and therapeutical index (P = 0.002). On visual analogue scales assessing the clinical profile of the compounds, fluoxetine was rated as exhibiting more psychostimulating activity than milnacipran (P = 0.0008). The tolerance of the two antidepressants was very similar, with the exception of symptoms of dizziness which were more frequently reported with milnacipran (P = 0.01). These differences in efficacy favoring fluoxetine could result from the selection of a dose of milnacipran below the optimal therapeutic dose for this type of psychiatric patients or to the administration of the compounds in single daily intakes, whereas milnacipran possesses a plasma elimination half-life of only 7 h.

[Assessment of the clinical activity of fluoxetin (Prozac) according of the "Stars of Liège" model]. / Evaluation de l'activité clinique de la fluoxétine (Prozac) selon "les étoiles de Liège".

Ten psychiatrists have independently rated the clinical profile of fluoxetin (Prozac) at the daily dose of 20 mg according to a "Stars of Liège" model comprising three parameters of therapeutic activity (antidepressant, psychostimulant and anxiolytic) and three parameters of side-effects (anticholinergic, sedative and hypotensive). Each parameter, graduated from 0 to 5 (no, very weak, weak, moderate, potent, very potent effect) was rated by each investigator according to his personal experience with at least 10 patients. Mean ratings given to fluoxetine show a moderate antidepressant effect, equal to amitriptyline (Rédomex, Tryptizol 75 mg/d, clomipramine (Anafranil 75 mg/d and nialamide (Niamide 100 mg/d, weak psychostimulating and anxiolytic effects, a very weak sedative effect and a lack of anticholinergic and hypotensive effects. Digestive side-effects of moderate intensity were also noted as well as a very weak anorexia. The important variability between investigators in the rating of the clinical profile of fluoxetine suggests that more experience is needed in order to define better its physiognomy.

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.

[Open study of clotiazepam (Clozan) in ambulatory anxious patients centered on a multifactorial evaluation using the AMDP and on a study of the rebound effect]. / Etude ouverte du clotiazépam (Clozan) chez des patients anxieux ambulatoires centrée sur une évaluation multifactorielle par l'AMDP et sur l'étude de l'effet rebond.

The efficacy and tolerance of the first thienodiazepine, clotiazepam, is well established but its clinical spectrum and the possibility of a rebound effect upon its cessation needed further research. Moreover, the validity of the AMDP Anxiety scale had been tested but not yet its sensitivity to change. Clotiazepam was given in an "open" design to 42 anxious outpatients at the dosage of 3 X 5 to 3 X 10 mg daily during 1 month, followed by a 1-week "single blind" placebo period. No other psychotropic drug was needed in 74% of the cases. A battery of observer rating scales (CGI, VAS, HAMA, BPRS, AMDP-4 and -5, AMDP-AT) confirmed the anxiolytic and tensiolytic efficacy of clotiazepam as well as its excellent tolerance. The 13-factor AMDP profile proved superior to short scales in the sample description and in the illustration of the clinical spectrum of the drug. Both the HAMA and the AMDP-AT were sensitive to change but the HAMA more significantly than the AMDP-AT.

[Scales, factor analysis and subscales of the French-language AMDP system]. / Les échelles, analyses factorielles et sous-échelles de l'AMDP francophone.

The 4th and 5th forms of the AMDP-System consist of a Psychopathology Scale (100 + 15 items) and of a Somatic Scale (40 + 7 items); the total duration of the interview and filling out is 45 to 60 mn. On the basis of a decade of research done or initiated in Liège, the French-speaking section of the AMDP has contributed to the System with several improvements: the inclusion of write-in or "reserve" items to the standard scales, esp. on anxiety (generating Anxiety and Dramatization factors missing in the German version as well as an Anxiety Subscale); modifications of the somatic scale (adopted in the 1979 German revision); modification of the item scaling from 0-3 to 0-4, the category "severe" being subdivided in "severe" and "extremely severe" (adopted in all other translations); elaboration and preliminary validation of a BPRS-like Syndromic Scale (AMDP-SY); inclusion of a semi-structured interview for the AMDP-4 and of a standardized interview for the AMDP-5. A multicentre Franco-Belgian factor analysis and several drug trials in France and Belgium confirm the validity, sensitivity and factorial stability of the AMDP scales. The subscales (Mania-Depression, Anxiety, Schizophrenia) are potentially useful but need further research except for the Anxiety subscale, which has been validated in Belgium and Spain and is free of somatic symptoms, an advantage in psychosomatics (e.g. cancer research).

Open multicentre trial of zuclopenthixol in mania and schizophrenia based on the AMDP scales.

A total of 95 schizophrenic or manic patients received zuclopenthixol (cis(Z)-clopenthixol) either intramuscularly or orally during a period of 2 to 4 weeks in mean daily doses of 25 mg (i.m.) or 75 mg (p.o.). They were rated with the CGI, VAS, MSS, BPRS, and AMDP scales. Zuclopenthixol proved to be a potent antimanic, anti-aggressive and antidelusional neuroleptic already from the second day of injection. Very few anticholinergic and extrapyramidal side effects as well as little somnolence were seen and the local tolerance was excellent. The 14-factor AMDP profile proved valid, sensitive to change and highly differentiated.

[Preliminary construction and validation of an anxiety scale derived from the French version of the AMDP, the AMDP-AT]. / Construction et validation préliminaire d'une échelle d'anxiété extraite de l'AMDP francophone, l'AMDP-AT.

The authors have applied to 493 Belgian and French patients the French version of the AMDP Psychopathology and Somatic scales, made of 140 items from the original German version and of 22 items specific to its French adaptation, among others anxiety items. By applying a principal components factor analysis to this sample, a 17-items. Anxiety Scale was extracted from the 162-items complete scales. This new scale is characterized by a predominence of tension/irritability items over somatic items as compared to the Hamilton Anxiety Scale. On 116 cases, the correlation between both scales is .59 (p less than .0001). A cut-off score for anxiety and an inclusion score for drug trials are suggested on the basis of statistical data.

[Acute porphyria and psychiatry. Updating our knowledge]. / Porphyries aiguës et psychiatrie. Actualisation des connaissances.

On the occasion of a clinical case of acute porphyria, the authors review the present knowledge on the biochemistry, pathophysiology, clinical picture, diagnosis and therapy of this group of disorders. They stress their importance in psychiatry and present two lists of authorized vs contra-indicated drugs in these disorders.

[Effects of time variables (time-blind, time gap) on quantitative evaluation of psychopathology]. / Influences de variables temporelles (time-blind, time gap) sur l'évaluation quantitative de la psychopathologie.

Are the objectivity and sensibility of quantitative psychopathology influenced by certain methodological conditions (time-blind evaluation or not, chronological order or random order, suppression of the time gap between two evaluations or not)? Different evaluations of AMDP videotaped interviews were not able to demonstrate systematic effects of these temporal conditions on the evaluation itself. Other variables (monotony, order of sequences, verbal inertia, contingencies) might well play a greater role. Within the methodological limits of the present study, the time-blind evaluation was the most sensitive.

[Computerized letter to the attending physician. Practical application of the AMDP (Association of Methodology and Documentation in Psychiatry)]. / La lettre informatisée au médecin traitant une application pratique de l'amdp.

The authors have elaborated a micro-computerized program which enables --on the basis of the Psychopathology Form (plus optionally the Somatic Form) of the AMDP-System and of an open-language diagnosis and treatment --to print out instantly a semi-standardized letter and a syndromic profile of 10 or 13 factors. This realization is favorably acknowledged by general practitioners and medical inspectors thanks to its speed of transmission, to its brevity and to the clarity of the syndromic reduction of the clinical picture. Other advantages lie in the greater validity of factor scores as compared to items scores, the standardization and readability of the clinical files, and the extension of the AMDP data bank.