[Results of the French cohort of the European observational study FINDER: quality of life of patients treated with antidepressants]. / Résultats de la cohorte française de l'étude observationnelle européenne FINDER : qualité de vie de patients traités par antidépresseurs.

OBJECTIVES: To describe health-related quality of life (HRQoL), pain, clinical outcomes and treatment patterns in French patients with depression treated by general practitioners and psychiatrists. METHODS: Factors Influencing Depression Endpoints Research (FINDER) is a European longitudinal observational, naturalistic, multicentre study to determine the HRQoL (SF-36 and EQ-5D) and to assess outcomes of depression and anxiety (Hospital Anxiety and Depression Scale [HADS]), and pain (VAS) in a population of depressed patients initiating antidepressant treatment. Clinical diagnosis of depression was based on physician's clinical judgment. Physicians decided at their own discretion and clinical practice to initiate pharmacological treatment for depression. Adult patients with a first or new episode of depression were enrolled between May 2004 and September 2005, and followed up for 6 months. Across Europe, 437 physicians observed 3468 patients. RESULTS: In France, 606 patients (approximately 17% of the whole sample) were enrolled by 57 psychiatrists and 46 general practitioners. These patients were (mean ± SD) 45.6 ± 13.0 years old, 69% female and 39% having had a previous depressive episode in the last 2 years. According to the patient-rated HADS score greater or equal to 11, most patients (75%) were classified as cases of depression as well as cases of anxiety (84%); 51% of patients rated their overall pain severity (based on VAS cut-off of 30 mm) as moderate/severe, with 65% of these patients reporting no medical explanation for their pain. The majority (81%) of the patients were prescribed selective serotonin reuptake inhibitors (SSRI). During the 6-month follow-up, the majority of the patients (73%) remained on the same antidepressant at the same dose during the course of treatment. Between baseline and 6-month endpoint, French patients improved their mean scores (SD) on the SF-36 physical score by+3.5 (9.0) (P<0.001) and mental score by+20.6 (14.2) (P<0.001); on the EQ-5D Health State Index by+0.37 (0.32) (P<0.001) and the EQ-5D VAS by+32.3 (25.0) (P<0.001); on the HADS depression score by-8.1 (6.0) (P<0.001) and HADS anxiety score by-6.9 (5.0) (P<0.001). Patients with moderate/severe pain at baseline improved their overall pain on a mean VAS score by-34.1 (28.7) (P<0.001). CONCLUSIONS: More than half of the French patients enrolled in the study experienced pain associated with depression. During follow-up, patients improved all of their outcome measurements (physical and mental SF-36 scores, depression and anxiety HADS scores, pain VAS, EQ-5D Health State Index and VAS) and most patients remained on the same antidepressant at the same dose.

Presence and predictors of pain in depression: results from the FINDER study.

BACKGROUND: Patients with depression often experience pain. There is limited understanding of the relation between pain and other symptoms (depressive, anxious and non-painful somatic symptoms). This exploratory study assesses pain severity and interference of pain with functioning in a clinically depressed population and investigates the relation between the different groups of symptoms. METHODS: FINDER was a 6-month prospective, observational study investigating health-related quality of life of outpatients with depression initiating antidepressant treatment. Patients completed ratings on the Hospital Anxiety and Depression Scale (HADS), Somatic Symptom Inventory (SSI-28), and overall pain severity and interference of pain with functioning using Visual Analogue Scales (VAS) at baseline and at 3 and 6 months. Regression analyses identified factors associated with overall pain severity and interference of pain with functioning, at baseline and over the observation period. RESULTS: Of 3468 eligible patients at baseline, 56.3% experienced moderate to severe pain and 53.6% had moderate to severe pain-related interference with functioning. At 6 months of follow-up, these proportions decreased to 32.5% and 28.1%, respectively. Higher baseline SSI-somatic scores (non-painful) were strongly associated with greater pain severity and greater pain-related interference with functioning at baseline and over 6 months. Certain socio-demographic (increasing age, being unemployed) and depression-related factors (more previous episodes, longer duration of current episode) were also significantly associated with greater pain severity and interference over 6 months, while higher baseline severity of depression (HADS-D) and further education were associated with less severe pain or pain-related interference with functioning over 6 months. CONCLUSIONS: Over half of depressed patients in this study experienced moderate to severe pain. Painful somatic symptoms appear to be closely related to non-painful somatic symptoms, more than to depressive or anxious symptoms suggesting that painful and non-painful somatic symptoms can be considered as one group of 'somatic symptoms,' all of them associated with depressive and anxious symptoms.

[Primary Human Immunodeficiency Virus infection revealed by psychiatric symptoms]. / Primo-infection par le VIH révélée par une symptomatologie psychiatrique.

INTRODUCTION: Any atypical psychiatric disorder, especially if associated with somatic manifestations and when any psychiatric antecedents are missing, should lead to search for an organic pathology, and notably a Human Immunodeficiency Virus (HIV) infection. In the case of Primary Human Immunodeficiency Virus Infection (PHI), which is often symptomatic, the diagnosis is seldom made, probably because of atypical or non specific manifestations. Therefore, it is essential to consider such a diagnosis, because it may have important clinical and public health consequences (stopping the contamination chain). CASE-REPORT: We present the case of a 38 year-old homosexual man from West Indies, in whom the diagnosis of PHI had been made on the basis of psychiatric symptoms evoking a Major Depressive Episode with a doubt on the presence of psychotic symptoms. To our knowledge, this is the first report of psychiatric PHI found in scientific literature. Clinical presentation was atypical: the patient had no psychiatric history (except probably a schizotypical personality, according to his family), symptoms were atypical (sudden onset and fast improvement) associated with somatic symptoms (fever, headache, sound intolerance), the latter possibly due to a meningo-encephalitis, which had been underestimated and attributed to dehydration in a period when France was faced with an important and unexpected heatwave. Blood samples were performed on admission and revealed a thrombopenia and presence of HIV P24 antigen, testifying a contamination by HIV 2 to 4 weeks earlier, this possibility having been confirmed by the patient. Further analyses found a Western-Blot partially positive test and an HIV viral load of 315 711 Eq copies/mL. DISCUSSION: The main question about this report is the primary or secondary nature of psychiatric symptoms towards HIV infection, given that in this patient mood alteration could have possibly occurred, before HIV contamination, due to particularities of his personal and professional life. We can also question whether the neurological manifestations of PHI might be changed by a schizotypical personality. Further reports are required to answer these questions.

[Weight gain and antipsychotic drug treatment]. / Prise de poids et traitement antipsychotique.

Like the classical neuroleptic drugs, most of the new antipsychotic agents can cause weight gain in patients receiving long-term treatment. However, it remains difficult to rank the different compounds according to their propensity to cause this unwanted side-effect. Recent data suggest that weight gain appears to be essentially related to an increase in appetite in these patients. Thus, it is a fact that the patients' diet represents the main predictive factor for weight gain, independently of the antipsychotic compound prescribed. In contrast to the other and often more disabling side-effects of these treatments, overweight can be effectively prevented by simple hygienic and dietetic measures. It would therefore be advisable to discuss the possibility of this side-effect of antipsychotic treatment with the patient, and to suggest appropriate preventive measures, as part of the therapeutic partnership.

The measurement of retardation in depression.

The description of clinical features helps to distinguish between depressive illness and nondepressive psychic pain and enables the clinician to decide whether prescription of an antidepressant is beneficial. Psychomotor retardation is probably a central feature of depression, and this review discusses the methods available for measuring it. The Salpêtrière Retardation Rating Scale (SRRS) specifically measures psychomotor retardation; the scale and applications are described. Means of measuring motor and speech activity and an experimental approach for understanding the process underlying psychomotor retardation are reviewed. Comparison of the SRRS and other rating scale scores demonstrates that retardation is related to depression severity and therapeutic change and is a good criterion for prediction of therapeutic effect. The SRRS has been used to show that selective antidepressants target specific clinical dimensions of depression depending on the patient subgroup treated. Measures of motor and speech activity are sensitive to therapeutic response. Choice Reaction Time and Simple Reaction Time tasks are particularly suited for examining psychomotor retardation because they test the decision process while avoiding motivation and attention interference. Psychomotor retardation is a constant and probably central feature of depression. Means available for measuring it can be used to assess the effects of antidepressants on specific clinical dimensions.

[Deficit in selective attention and its evolution in depression]. / Le déficit de l'attention sélective et son évolution au cours de la dépression.

Selective attention was measured in 34 depressed patients and 34 controls using a computerized version of the Stroop test, that included a manipulation of the stimulus onset asynchrony (SCA) in order to explore the efficacy of cognitive inhibition as a function of depression and of clinical amelioration of degression after therapy. Clinical tests included a measure of psychomotor slowing [Echelle de Ralentissement de Widlöcher (ERD), the Hamilton (Psychiatric Rating Scale for Depression (HAMD), and the Brief Psychiatric Rating Scale (BPRS)]. Selective attention was measured with the Stroop test, which includes four measures: Word, Color, Color-Word, and Color-Word minus Color, or interference. All of these measures were deficient in the depressed patients, particularly Stroop interference. Even when additional time was given to inhibit the Stroop distractor in the SOA condition, depressed subjects still showed significantly inferior performance. After four weeks of anti-depressive treatment, fifteen of the patients were retested, and showed significant improvement on all the Stroop measures, particularly on Stroop interference. The improvement in performance on the attentional measures was comparable in magnitude to that seen on the clinical scales, and suggests that the interference measure can be a sensitive indicator of clinical status in depressed patients.

[Decision trees in psychiatric therapy]. / Les apports des arbres de décision en thérapeutique psychiatrique.

The main objective of decision analysis is to offer a theoretical representation of choices made in an environment of uncertainty. This technique is currently under development in a great variety of fields, particularly in medicine, where aid in decision making is the topic of much research. Psychiatry, in turn, is very much concerned by these new developments which could be of particular interest to therapeutics-an area where the large number of studies and date are in great contrast with the lack of consensus concerning the various solutions proposed to patients. Decision analysis utilizes different techniques among which are decision trees. The technique of decision trees goes far beyond a simple graphic representation of reasoning in the form of a chart. Its basic principles is to measure the uncertainty associated with decision making in the hopes of better understanding the rationale of decisions while optimizing the gain versus cost ratio. The goal is to calculate, within a series of decisions, the weight of their importance expressed in terms of usefulness or unpleasantness. In psychiatric therapeutics, only three studies have been published which incorporate the technique of decision trees. Two of these deal with treating depression (Schulberg et al., 1989; Koenig et al., 1993) while the third deals with schizophrenia (Hatcher, 1995). The limits of these techniques are, on one hand, due to their feasibility in that their complexity renders them inapplicable when a great number of variables have to be taken into account or when the amount of necessary data is still insufficient. Moreover, the use of these techniques remains relatively restricted as their expansion depends upon their acceptance by clinical physicians. Also, their use raises questions as to what extent it is possible to rationalize decisions in psychiatry. From a larger perspective, one must consider that these techniques may eventually furnish certain elements which could be integrated to help further the field of decision-making representations for clinical use. These decision-making techniques are still in the experimental stages and remains difficult to apply to clinical practice. However they appear to be of a great interest, not only in communicating knowledge both in teaching and training, but in research as well. They allow us to view the results of epidemiological studies and clinical research from a more global perspective; to make evident the grey areas of our science and to determine new priorities in research.

[Charcot and hysteria]. / Charcot et l'hystérie.

Charcot's work on hysteria has always been controversial. All his attitudes, whether on the theory of the ovary, the hysteroepileptic seizure or the use of hypnosis, have always been charicatured, misunderstood and separated from the wider context of his overall approach. Rereading Charcot's works shows that he developed his approach progressively over a period of more than 20 years before coming to his psychological model of hysteria. This model explains the formation of the symptom and the hysterical conversion via a mechanism of being ignorant of the motor representation. This concept has never been disproven and remains the only theory explaining the formation of the hysteria symptom. Based on Charcot's fundamental contribution, Freud and Janet further developed their work on the psychopathology of hysteria.

Circadian pattern of motor activity in major depressed patients undergoing antidepressant therapy: relationship between actigraphic measures and clinical course.

The 24-hour motor activity pattern was evaluated in 26 inpatients with major depression at treatment onset and after 4 weeks of antidepressant therapy. Clinical state, depression, and psychomotor retardation, as well as motor activity level and circadian rhythm, were simultaneously assessed. Treatment responders and nonresponders were also considered. Diurnal hypoactivity and reduced 24-hour rhythm amplitude were found at treatment onset. Activity level increased significantly on discharge. The rest-activity cycle for each depressed patient fit a cosine function of 24-hour periodicity. Data tended to show no phase shift but a large intragroup phase variability. Preliminary findings of a negative correlation between basic activity level and clinical improvement, and a trend toward responders having a lower activity level than nonresponders, suggest that activity could be used to predict therapeutic response.

[Significance of studies of motor activity in depression]. / Intérêt des études actométriques dans la dépression.

Actometry is a technique that enables continuous monitoring of spontaneous motor activity. This technique can be applied to the study of depression either by studying qualitative motor activity patterns or by measuring quantitative motor parameters. We present here the results of a quantitative actometric analysis. 13 depressive in-patients were evaluated both clinically by depression scales and by actometry before and after trimipramine treatment. Correlation analysis was made between actometric and clinical rating scores at different moments of the treatment. Some actometric parameters appear to be specific indices of depression and psychomotor retardation. Future prospects for the use of actometric techniques in depression are discussed.

Long-term treatment with different calcium- and calmodulin-antagonists induces changes in rat brain alpha-adrenoceptors.

1. The binding characteristics (Bmax and Kd) of the alpha-adrenoceptor radioligand [3H] WB4101 in crude membrane fraction (fraction P2) from cerebral cortex were studied after 13-day oral treatment of male Wistar rats with the Ca(2+)-antagonists nifedipine (20 mg/kg), verapamil (50 mg/kg), flunarizine (10 mg/kg) and with the calmodulin-antagonist trifluoperazine (TFP) (3 mg/kg). 2. A significant reduction of the binding sites (Bmax) for [3H] WB4101 was established after the three Ca(2+)-antagonists as well as after TFP treatment. 3. Different changes in the affinity constant (Kd) of brain adrenoceptors were observed depending on the type of the Ca2+ or CaM-antagonist used: nifedipine did not change the Kd value, verapamil and TFP decreased whereas flunarizine increased the Kd value. 4. Relationships between Ca ions and alpha-adrenoceptor functions are suggested.