[Long-term antidepressant drug treatment in Champagne]. / Les traitements anti-dépresseurs au long cours en Champagne.

Bibliography in hands, the authors initialed the long term imipraminic antidepressive treatments in the french literature. Formerly, Prien explained them in English-in both cases for unipolar depressive expressions of periodic manic depressive illness-and Siegwald in French for neuroleptics by schizophrenias. The actual extension of concept of depression and drug's treatment, under medico-industrial banner, ends in a medical ethic's problem.

[Lithium therapy and drinking water]. / Lithiothérapie et eaux de boissons.

ain causes of failure and giving up in psychotropic lithiotherapics because of instable lithiemy to the same patient or functional acute renal insufficiency, are principaly mistaken diets, those mistaken concerning the amount, the quality and the way of taking drinking water and other beverages. Lithium salt, taken either in two times, morning and evening, or in one, must be absorbed at the end of a solid meal with at least 25 cl. of water. The patient must absorb at least 1.5 l. of water per day, and up to 3 l. in case of physical efforts or heat. The pH of this water and it ionic compound should be stable, as close as possible to the plasma's, without additives that could change its taste. This includes cooking water and infusions. Physicopharmacological explanations.

[Benzodiazepine drug ingestion and evaluation of after care]. / Ingestions médicamenteuses aux benzodiazépines et évaluation de la vigilance.

Voluntary drug ingestion with benzodiazepine represent today the most frequent method of attempt of autolysis. One must note the difficulties the doctor may find in front such problems to judge the reliability of interviews made in such difficult conditions. Residual disturbances of superior functions, more precisely of vigilance during the period with follow the suicidal action must not be overlooked. Thanks to a clinical scale easily used the residual disturbances have been put in evidence on a sample of 20 subjects who had been admitted with this aim in view in a university ward specialized in psychiatric emergencies. The possibility of continuity within middle range care must allow an improvement of minimum care of such pathologies.

[Hyperparathyroidism with lithium]. / Hyperparathyroïdie sous lithium.

Lithium has proved to be a highly effective preventive measure in mood disorders and an increasing number of patients are receiving long-term lithium carbonate therapy. Among other biologically and clinically important effects of lithium, the possible induction of hyperparathyroidism was first suggested in 1973 by Garfinkel et al. About thirty other case reports have since been described, but they could simply have represented the coincidental occurrence of primary hyperparathyroidism and lithium carbonate treatment in the same patients. Eleven cross-sectional studies of calcium metabolism in patients treated with lithium carbonate have been reported. Evidence of a causal relationship of lithium to hyperparathyroidism can lead to a loss of effectiveness of lithium in controlling the affective symptoms. Interestingly, coexistence with hypothyroidism is not uncommon. Low serum phosphate, high serum chloride are also observed. Bone mineral content may decrease. In addition, several studies have shown that lithium treatment increases serum magnesium level. Unusual metabolic features are associated with hyperparathyroidism and long-term lithium treatment: low urinary calcium excretion, absence of nephrolithiasis, and normal urinary cyclic AMP excretion. Lithium inhibition of PTH sensitive adenylcyclase in the kidney would explain these features. In vitro studies suggested that lithium is a potent inhibitor of several hormone responsive adenylcyclase systems. It is possible that the tissue susceptibility to adenylcyclase inhibition in an individual may decide the nature of endocrine dysfunction seen during lithium treatment. Information about the time course with which abnormalities may develop is derived from longitudinal studies. Several months to several years are needed for lithium inducing primary hyperparathyroidism. In vitro studies provide strong evidence that lithium can induce a shift in the set-point for inhibition of PTH secretion by calcium and a direct stimulation of PTH secretion. The extent to which we can extrapolate these data to the clinical situation is discussed. In vivo data from Shen an Seely are compatible with these two mechanisms. These alterations should cause parathyroid hyperplasia. The possibility that a generalized parathyroid stimulus might lead to formation of a single adenima is not proved. Several recommendations regarding parathyroid function in patients receiving lithium have been suggested. Measurement of total calcium and serum proteins or of serum calcium ion values when available should be performed before therapy is begun. If elevated values are obtained, lithium treatment should be deferred and evaluation for hyperparathyroidism performed. Serum calcium should be monitored periodically during lithium treatment. Sustained hypercalcemia or true hyperparathyroidism require parathyroidectomy. If hypercalcemia is mild without complication and psychiatric symptoms well controlled, perhaps surgery should not be employed.

[Lithium in the treatment of refractory depression]. / Le lithium dans le traitement des dépressions résistantes.

The definition of treatment-resistant depression is variously interpreted. There is no agreement of different authors on its meaning. The present vagueness of criteria for the diagnosis of a refractory depression contrasts with the many studies reporting potentiation of antidepressants by lithium. De Montigny in 1981, after early works by Zall and by Lingjaerde, initiated this approach that still remains poorly understood in terms of biochemical mechanisms. A review of the controlled studies shows that the delay of antidepressant action varies and the term "lithium potentiation" does not seem totally relevant. From a pharmacological point of view, several types of data suggest a synergic potentiation rather than a true potentiation. This effect applies to all classes of antidepressants and improves about 50% of patients who did not respond positively to an adequate treatment received during 4 to 6 weeks. Many questions remain unanswered particularly concerning the lithium levels, factors predicting a positive response and the strategy for the maintenance treatment. Studies are necessary in order to compare the relevance of this potentiation technique with the mere substitution by another antidepressant and to understand the biochemical mechanisms underlying the synergic effect.

[Recurrent depression without lithium therapy. A lost chance]. / Rechute dépressive sans lithothérapie. Perte de chance.

By four patients hospitalized for a depressive recurrent the favorable element of clinic evolution was a lithotherapy then bring the effect very rapidly (three to seven days) grace using gluconate of lithium. The lithium being antidepressant, the absence of lithotherapy tentative in the course of major depressive status recurrent is a loss of chance for patients.

[Non-verbal clinical psychiatric aspects]. / La clinique psychiatrique non verbale.

Mimic, involuntary movements, agitation or immobility, are parts of description, comprehension and evaluation of any human behaviour, normal or not: they were included in the classic european psychiatries. They almost disappear from the actual scales of evaluation, or from the training through scales. It seems possible to complete such scales, exclusively verbal, by scales of behaviours-suicidal attempt being a good instance of such behaviours.

[The lithium test, test of endogenous criteria]. / Le test au lithium, test d'endogénéités.

The lithium-test (Li-T) requests hospitalisation of the patient, administration of Li to obtain a plasma/level of at the lust 0, 8 mEq/l, since the third to the eight day. It improve depressions, acute delusions, pseudo-dementias: the field of the lithiodépendent endogenic diseases as to be enlarged. The Li-T may distinguish between this lithiodependence of the other, non-lithiodépendent, in dysthymic psychotic disorders.

[Indications of lithium plasma levels in professional practice. Average of a 7-year follow-up]. / Indications et taux plasmatiques du lithium en pratique sectorielle. Recul moyen à 7 ans.

With a mean follow-up duration of 7 years, the retrospective analysis of 57 charts of lithiotherapy shows that: Better results are observed when the lithium blood level reactus 0.87 mmoles/l. In that case, the best lithiotherapy indication is the major recurrent long cycles depression. We also propose as lithiotherapy indication in order of efficacy: 1--The maniac-depressive psychosis (P.M.D.) in its mixed form. 2--The schizo-affective troubles. The curative and preventive lithium efficacy is on favour of the diagnosis of recurrent endogenous psychiatric disease.

[Value of karyotype in psychiatry: the 3-D syndrome (dysthymia-dysgonosomia-deterioration). First clinical, cytogenetic, anatomical correlation]. / Intérêt du caryotype en psychiatrie: le syndrome 3-D (dysthymie-dysgonosomie-détérioration). Première confrontation clinique, cytogénétique et anatomique.

The systematic study of the karyotype in Adult Psychiatry reveals among the group of periodical psychoses the existence of the 3-D Syndrome, marked by long clinical cycles, a course towards a dementia, the presence of a X-dysgonosomy with mosaicism, a relative and better clinical response with the use of lithium than with the use of tricyclic antidepressants. These characteristics discriminate the 3-D syndrome from the periodical manic depressive psychosis, which neither includes the course towards a dementia nor does it include until now identified cellular abnormalities. From the anatomical point of view the brain is quasi-normal, when the ultimate phase is a dementia. The 3-D Syndrome seems to be linked with a phenomenon of chromosomal instability. The caryotype takes a part among the usual biological tests in psychiatry.

[Relations between intelligence and perversion. Small essay on ethics]. / Rapports de l'intelligence et du caractère pervers. Etique essai d'éthique.

Excepted vegetarians, everybody let kill and may kill for self-defence. The killed-one suffers and dies. Perversity is to kill or to let suffer without personnal life's saving's necessity--for the treasure of the "perverse subject". We think that such subjects must not be considered as non responsible, excepted when they present a mental retardation. The sexual perversions are probably not the most dangerous: the most are subjects using a personnal high level of intelligence to domination and destruction, including in the sexual behaviours.

[Biomedical researches: for whom? for what? how?]. / Recherches bio-médicales: pour qui? pour quoi? comment?

The law of December 20th 1988 provides for the protection of those people who lend themselves to clinical research, both patients and healthy subjects. The ex-expert clinicians are confronted with new drugs and protocols of experimentation enacted by industry. Grey areas still exist, authors try to limit them for want of being able to through light on them, today.

[Evaluation of the risk factors of suicide in patients treated for mental disorders. Review of the literature from 1978 to 1988]. / Evaluation des facteurs de risque de suicide chez les malades mentaux traités. Revue de la littérature de 1978 à 1988.

Research on suicide risk factors among psychiatric patients has developed considerably over the last 10 years. The methodological problems are numerous. Tentatives of global prediction have been unsuccessful in describing one complete and specific picture of the mentally ill suicide, whereas lawsuits against psychiatrists are frequent after patients' suicides. Through the analysis of 37 publications from 1978 to 1988 the authors review the main suicide risk factors identified among treated psychiatric patients.

[Standardized symptomatologic inventory adapted to psychiatric emergency]. / Inventaire séméiologique standardisé adapté à l'urgence psychiatrique.

Clinical psychiatry, particularly in the case of hospital emergency, begins with the patient's benevolent observation. It goes on with the verbal communication, subordinated itself to linguistic problems. There are now daily cross-cultural practising and education in France. This is the presentation of a standardized inventory and of its instructions for use, created in connection with a multicentric currently analysed survey. The inventory can be used without major difficulty by non clinicians and general practitioners.

[Lithium as founding the concept of endogenous mental disease]. / Le lithium fonde le concept de maladie mentale endogène.

The abnormal life--potentially the death--of the cell can be restored by a metalloid--lithium--which is nearly as common as sodium in the mineral world. This established fact grounds indirectly, contrary to apparent and scientific logic, the concept of endogenous brain disease which was until then an abstract concept because of a lack of objective evidence. Seven case reports are described.

[Suicidal alcoholic patients: profile, risk factors and review of the literature from 1955 to 1988]. / Le patient alcoolique suicidaire: profil, facteurs de risque et revue de la littérature de 1955 à 1988.

Alcoholism and suicide are two Public Health problems which are linked at the epidemiological and clinical levels. Research over suicide risk factors among alcoholic subjects has developed mainly among medicalized psychiatric populations. Suicide occurs late among alcoholic patients, and affects particularly men and socially isolated subjects. The main risk factors relate to the decrease of the socio-economic status. loss of job and of income-, to the interpersonal loss--i.e. family bereavement or breach of relation, to the existence of a suicidal ideation often communicated or of suicidal antecedents, to a degradation of the physical state or the presence of some affections like gastro-duodenal ulcer. The identified factors are of little specificity. It is difficult to assess their interrelations and their respective true values. The reliable prediction of a later suicide remains presently impossible. Progress in analytic research over the alcoholic patients' suicide could result from the standardization of populations and of studied factors and from the use of multivariate analysis statistical methods.