[Acute psychosis and Behçet's disease: a case report]. / Trouble psychotique aigu et maladie de Behçet: à propos d'un cas.

BACKGROUND: Behçet's disease is a multisystem vasculitis of unknown origin. The prevalence of the disease varies widely and is high in the Eastern Mediterranean Basin, North Africa, Iran and Japan. Many clinical features of Behçet's disease have been described and the international study group for Behçet's disease has defined a set of diagnostic criteria. These require the presence of recurrent oral ulcers plus two of the following: recurrent genital ulcerations, typical defined eye lesions, typical defined skin lesions or a positive pathergy test (a skin hypersensitivity reaction to a non-specific physical insult; when positive, the response consists of a papule or pustule that develops after 24 to 48 hours at the site of a needle prick to the skin). Although not included in these diagnostic criteria, there are some other features commonly seen in patients with Behçet's disease: thrombophlebitis, oligo-arthritis, gastrointestinal ulcerations and neurological involvement. Neuro-Behçet is well described in Behçet's disease, with variable prevalence rates between 5.3 and 35%. This prevalence is probably affected by the type of study (retrospective or prospective) and regional and ethnic variations in disease expression. Psychiatric symptoms usually occur as incidental findings in some patients with neurological disease; they are misdiagnosed and mistreated. CASE-REPORT: The patient described here developed acute psychotic symptoms without parenchymal cerebral involvement, and negative symptoms during Behçet's disease. Two hypotheses were evoked: schizophrenia associated with Behçet's disease versus psychiatric syndrome induced by vasculitis. Such a case has not been reported in the literature. We describe the case of a 31-year-old Haitian female, admitted because of an acute psychosis. She developed hallucination, misrecognition, psychomotor hyperactivity and delusion about her million childbirths. The patient had three years history of mistreated Behçet's disease, in particular recurrent oral ulcers, iritis and cardiovascular manifestations. She also had a history of uterine tumour, rectal carcinoid tumour and recurrent pleurisies. One year ago, she presented breast lymphangitis, anxiety, unusual thought content, hostility, suspiciousness, and poor impulse control: cranial computerised tomography scan was normal. After ten days of hospitalization, she complained of oral and genital aphta and no neurological sign was found. The cerebral angiographic magnetic resonance imaging showed a thrombophlebitis of the left lateral sinus without parenchymal involvement. Haloperidol, Heparin, Colchicine, Cyclophosphamide and Prednisone were introduced. Six months after, delirium and Behçet's symptoms had disappeared with the following treatment: Risperidone, Alprazolam, Zolpidem, Colchicine, Prednisone, and Azathioprine. The patient has developed enduring negative symptoms: blunted affect, social withdrawal, difficulty in abstract thinking, lack of spontaneity and flow of conversation and poor rapport. They are still present. This patient had two acute psychotic symptoms without parenchymal pattern. After treatment, she had persistent negative symptoms and psychosocial deterioration. This evolution is commonly seen in schizophrenia. DISCUSSION: Retrospective analysis of this patient's course suggests that -psychiatric episodes were always associated with physical manifestations. However, pleurisies, lymphangitis, uterine and rectal tumours have never been described in Behçet's disease. This vasculitis occurs less frequently in the Caribbean than in Mediterranean, Middle East or Japan. It seemed that this patient had a psychotic syndrome and a chronic relapsing multisystem disorder, more complex than Behçet's disease. A prospective study would be useful to characterize psychiatric patterns of Behçet's disease and establish their relationships with physical manifestations, especially neurological involvement.

Parenteral loxapine in severely disturbed schizophrenic patients.

Loxapine is a tricyclic antipsychotic drug of the dibenzoxapine class. An uncontrolled open trial of this compound has been performed by intramuscular route in 28 patients previously refractory to other neuroleptic drugs. These patients received 50 to 200 mg loxapine daily by intramuscular route. Clinical evaluation, BPRS, NOISE and biological evaluation were performed before and at the 8th day of the treatment. Global clinical evaluation and statistical analysis of BPRS showed the high efficacy of loxapine with a sedative effect during the initial phase and a disinhibiting and "hallucinolytic" character at a later stage. Tolerance to the preparation appeared good both locally and systematically with the possible exception of transient effects upon body temperature.

[Neurotic inhibition]. / L'inhibition dans la constellation névrotique.

Inhibition is a normal neuro-physiologic regulation phenomenon which antagonizes the dangerous aspects of excitation and which facilitates the adaptation of man to his surroundings. Inhibition becomes neurotic: -- when it fails in its normative-connection with excitation. -- when accompanied by anxiety, -- when the subject cannot control it, -- however without blocking all the psychic functions as the psychotic inhibition does. Accompanying symptoms diversify its ways of expression. Contemporary to trauma in neurasthenia, it proceeds from early trauma in psychasthenia and in hystero-phobic neuroses. For some authors, it may be innate, perhaps hereditary. It appears particularly severe, because it lasts when the symptomatology has disappeared during the analytic therapy and it seems to resist more than the excitation to chemotherapies.

[Tardive dyskinesia induced by neuroleptics. A review of the literature]. / Les dyskinésies tardives des neuroleptiques. Revue de la littérature.

Neuroleptics can induce not only early but also tardive extrapyramidal side effects. The former were described as early as in the beginning of the therapeutic era; the latter, known as tardive dyskinesia, are essentially made of bucco-linguomasticatory dyskinesia, sometimes accompanied by other extrapyramidal symptoms, among others choreo-athetoid movements of the limbs. This complication was most often reported in elderly people, when a long-lasting neuroleptic treatment is withdrawn; but it can also appear in young people and after a neuroleptic treatment of only a few weeks duration. The trouble occurs or is worsened when neuroleptics are withdrawn and is reduced when dosage is increased; it responds to the theoretical model of denervation supersensitivity. Symptoms may be reduced by blocking the dopaminergic receptor, or by reducing dopaminergic transmission, or, may be, by increasing cholinergic activity. Now, treatment is first and foremost prevention.

[Alcoholism and depression (author's transl)]. / Alcoolisme et dépression.

Alcoholism and depression have always been in intricated. A lot of studies try presently to precise this relation:--Clinical studies about episodic alcoholism.--Genetical studies showing a debatable relation between alcoholism and unipolar depression.--Biological studies essentialy attesting a depressive action of ethanol among the serotoninergic system: ethanol would deviate the serotonin metabolism. Likewise it would induce a depletion of catecholamines in the brain. More, biochemical researches point out an inheritance of ethanol preference which would be correlated with a decrease of the brain level of serotonin. Is is a genetical transmission of alcoholism: these perturbations could manifest themselves by the ethanol dependence, or by depressive trends?

[Value of pharmacokinetic data during the treatment of psychoses with haloperidol]. / Intérêt des données pharmacocinétiques au cours des traitements des psychoses par l'halopéridol.

Pharmacokinetic data of psychotropic drugs should allow a better understanding of therapeutic results and side effects. The different factors influencing liberation, absorption, protein binding, distribution, metabolism and excretion are reviewed. Then, the principal pharmacokinetic data of haloperidol are exposed with a special emphasis on the lack of information about the correlations between plasma levels and clinical effects. The role of pharmacokinetic informations in the interpretation of responses to treatment is detailed, wishing that the monitoring of haloperidol plasma levels will be more developped in a next future.

[Loxapine succinate: a new neuroleptic]. / Le succinate de loxapine: un nouveau neuroleptique.

Commercialized in the U.S.A. a few years ago, the loxapine succinate appears to be interesting among neuroleptic compounds. Used in 28 chronic schizophrenics, 19 of which were neuroleptic resistent patients, the parenteral route proved to be anti-psychotic and sedative in 26 patients. The usual daily dosages were between 100 and 200 mg. The local and general tolerances were good. The side effects were mild and essentially vegetative. The therapeutic efficiency seems to be better at the same dosages with the oral form than with the parenteral form.

[Trial of verification of the thymoanaleptic action of hypothalamic thyrostimulin (thyrotropin releasing factor of TRF) in melancholic states]. / Essai de vérification de l'action thymoanaleptique de la thyrostimuline hypothalamique (thyrotropine releasing factor ou TRF) dans les états mélancoliques

After the studies conducted by PRANGE and KASTIN in 1972, we tried to verify whether T.R.F. had a real thymo-analeptic effect and if a repeated administration could cure a depressive state. We used T.R.F. either intra-venously -- in slow perfusion or directly -- (1 mg per day) or p.o. (30 mg per day) on 18 mono or bipolar melancolic patients. The treatment lasted from 8 to 21 days. We have observed 4 good results obtained between the second and the sixth day, all among bipolar melancolic patients. In the other cases the results were negative. In all cases the tolerance was very good. These results, though very limited, present very interesting perspectives about a physiological substance whose site and actions are known with a relative precision.

[Pharmacopsychoses during drug addiction]. / Les pharmacopsychoses au cours des toxicomanies

Widespread use of certain drugs (amphetamines, L.S.D., hypnotics) in France, allowed us to observe more than 200 cases of acute or chronic psychoses among addicts. Sometimes these are transitory outburst but the occurrence of a delusional psychosis with long range evolution raises a difficult diagnosis problem in relation to functional psychoses. The emphasis should be put on respective roles of the drug and of a predisposed mental state. Circumstances of beginning, apparently direct relationship between drug taking and pathological symptoms, therapy efficiency, absence of earlier pathological traits (as in many of our patients) and relapse when intoxication starts again, are in favour of a pharmacological origin of the troubles.

[Pharmacoclinical value of the study of lithium cycles during 24 hours]. / Intérêt pharmacoclinique de l'étude des cycles lithiémiques de 24 heures

One cannot base a posology only upon morning lithiemy which turns out to be an unreliable criterion. It is useful to appreciate therapy equilibration through lithiemic cycle i.e. and every two hours dosage among patients on lithium carbonate or gluconate. Certain patients with quite an insufficient lithiemic morning level may be well equilibrated during day time. Lithiemy variations during the day are constantly reliable with the same patient. The study of nycthemeral variations among lithium salts treated patients allows us to understand some pathological subphenomena : intermittent tremor, subconfusional transitory onsets. Lastly lithiemic cycles allow comparison between lithiemy variations in manic or depressive relapses.

[Cannabis]. / Le cannabis.

Cannabis produces a resin, the psychotropic effects of which are known since the High Antiquity. It induces euphoria, a feeling of pleasant dreaminess. Nevertheless, psychiatric disturbances such as psychomotor deficiency states or acute oniroïd states were described in heavy users countries. These psychiatric disorders put the accent on the starting or catalysing role of cannabis on the premorbid personality. The experimental studies of cannabis on the premorbid personality. The experimental studies of cannabis and its active substance (delta-g-tetrahydrocanabinol) bring information on this problem.

[Progressive exhaustion of the psychotropic effect of T.R.H. Clinical and neuroendocrinologic study]. / L'épuisement progressif de l'effet psychotrope de la T.R.H. Etude clinique et neuroendocrinienne

The progressive exhaustion of the psychotropic effect of T.R.H. clinical and neuroendocrinological study. The study of a complicated clinical case permitted us to use T.R.H. because of the ineffectiveness of other psychotropic agents the patient (male, aged 38) was given previously. A major and atypical depressive state with severe anorexia was lasting from several months. T.R.H. was administered 3 times per day (at 8 h. 11 h and 14 h) as an intravenous injection of 0.5 mg of T.R.H. lasting 1 min. (total dose per day: 1.5 mg). From the 1st to 7th day the patient showed a market improvement) in the depression symptoms, followed by a light degradation observed from the 7th to 10th day. During a third phase, he showed wild improvement which was maintened stable from the 10th to the 21st day. Then, there was a progressive return to the state prior to T.R.H. period till the 30th day. This phase lasted up to the end of the therapeutic trial of T.R.H. These fluctuations of the depressive state were not found to be correalted with significant plasma-T.R.H. changes and seem to happen when changes in catecholamines and/or serotonin were not observed, according to methods used. Independently of various theoritical approaches concerning the mechanism of psychotropic T.R.H. action, it seems that its effect is exhausted progressively and rapidly.