Effects of antipsychotics on the clinical and psychosocial behavior of patients with schizophrenia.

With the arrival of atypical antipsychotic drugs, questions have arisen as to their efficacy, compared with classical antipsychotics, and their impact on the clinical and psychosocial behavior of schizophrenic patients. This paper reviews the development of antipsychotic drugs from the prototype chlorpromazine in the 1950s to the atypical antipsychotics--clozapine, risperidone, olanzapinein--in the 1990s. Particular attention is given to the medications' effect on positive and negative symptoms and on patients' quality of life. Experience to date with the atypical antipsychotic drugs is that they are as effective as traditional treatments, with a possibly greater action in treating negative symptoms and with a lower extrapyramidal side effects profile. For comprehensive treatment of schizophrenia, the author advocates a polydimensional approach encompassing psychopharmacology, psychotherapy, psychosocial interventions (particularly with family members), and vocational training.

The efficacy and tolerability of venlafaxine and paroxetine in outpatients with depressive disorder or dysthymia.

A 24-week, double-blind, randomized trial was performed to compare the efficacy and tolerability of venlafaxine and paroxetine in patients with major depression or dysthymia. Outpatients aged 18-70 years with a baseline score of 17 on the 21-item Hamilton Depression Rating Scale (HAM-D) were eligible. Patients were randomly assigned to venlafaxine, 37.5 mg, in the morning and evening or paroxetine, 20 mg, in the morning and placebo in the evening, which could be increased to venlafaxine, 75 mg twice daily, or paroxetine, 20 mg twice daily, after 4 weeks. Efficacy was assessed with the 21-item HAM-D, the Montgomery-Asberg Rating Scale, the Hamilton Anxiety Rating Scale, and the Clinical Global Impressions Scale. Forty-one patients were randomized to venlafaxine and 43 to paroxetine. At week 6, a response was observed in 55% of patients on venlafaxine and 29% on paroxetine (P = 0.03). At week 12, significantly (P = 0.011) more patients in the venlafaxine group had a HAM-D remission score of 8 or less (59% versus 31%). Discontinuation for any reason occurred in 16 (39%) patients on venlafaxine and 11 (26%) on paroxetine. The most common adverse events were nausea (28%), headache (18%) and dry mouth (15%) with venlafaxine and headache (40%) and constipation (16%) with paroxetine. Venlafaxine was effective and well tolerated for the treatment of patients with mild to moderate depression or dysthymia. A consistently higher proportion of patients had a response or remission on venlafaxine than on paroxetine.

[Patterns of the use of electroconvulsive therapy in Barcelona]. / Patrones de uso de la terapéutica electroconvulsiva en Barcelona.

BACKGROUND: To study the prevalence of use and the characteristics of current utilization of electroconvulsive therapy (ECT) in Barcelona. METHODS: A descriptive study was carried out in August of 1993. A structured interview designed by the authors was administered to psychiatrists in 20 hospitals, including general hospitals with Department of Psychiatry and psychiatric hospitals. RESULTS: In 12 hospitals of the sample (60%) ECT was practised. The most frequent indication was depression (83%) followed by schizophrenia (17%). In all these hospitals pharmacological treatment was simultaneously used and the application of electrodes was bilateral. Most of them used stimulation by sinusoidal wave, thiopental was used as anesthetic agent, the duration of seizures was not evaluated, EEG monitoring was not performed and treatment in a surgeon's room was not applied. In 10 hospitals written consent was obtained. CONCLUSIONS: ECT was used in general hospitals with psychiatric department of Barcelona, Spain, with high coincidence in indications but not in the technical aspects.

[Interactions between depression and anxiety (author's transl)]. / Interactions entre dépression et angoisse.

At present anxiety and depression are being considered as different syndromes. However, the depressive syndromes are associated with a sever or less grave component of anxiety. In this communication distinctions between anxiety and depression as nuclear or accompanying syndrome, respectively, as well as some of their more frequent pathogenetic mechanisms are established. Finally, the most appropriate psychodrugs for each one of the depression-anxiety association forms, depending on their nuclear syndrome, are mentioned.

[Clinical evaluation of new antidepressive agents]. / Evaluation clinique des nouveaux antidépresseurs.

The second generation of antidepressants have been developed with the goal to reduce cardio-toxic effects and to further a more specific action on neurotransmitter systems. However some standardized actual parameters, clinical, biological and pharmacological may be accepted as reasonable elements in evaluating the therapeutic effects. Among them we will distinguish the diagnostic instruments which define categories of affective disorders; rating scales to assess gravity, the type of clinical test, duration of the test and finally those biological variables which should be an integral part of the evaluation of new antidepressants.

[Evolution, capabilities and limits of psychopharmacology]. / Evolution, pouvoir et limites de la psychopharmacologie.

Evolution of psychopharmacology is discussed from the viewpoint of the growth of the number of psychotropic drugs, their use and the rate of scientific reports related to them. Power is discussed from the standpoint of economic perspectives, although it is not the only aim. On the other hand, the influence of the psychopharmacological "boom" on the development of the specialty is analyzed. The limits of psychopharmacology achieve their maximum extent when they are combined with the study of psychological, social and cultural factors and determinants and, hence, to other therapeutic methods.

The "Melancholia Rating Scale": a useful instrument for the assessment of affective disorders. Validity and reliability of the Spanish adaptation.

This instrument has been constructed with the purpose of quantifying the severity of depressive states, i.e. to identify the depressive patient and to measure the response to treatment with an antidepressant. Type of instrument: Ordinal rating scale, 11 items, 5 grades. Eleven variables are assessed: Activity (motor); Activity (verbal); Retardation (intellectual); Anxiety (psychic); Suicidal impulses; Lowered mood; Self-depreciation and guilt feelings; Emotional retardation; Sleep disturbances; Tiredness and pain; Work and interests. Tests were done to verify concurrent validity with the Hamilton Depression Scale (HDS); some data on inter-observer reliability are given.