[Sexual dysfunction induced by antidepressants and antipsychotics].

The interest in sexual dysfunction induced by psychotropic drugs has increased considerably in recent years because of the new-generation antidepressants (AD) and antipsychotics (AP) being put into medical practice. These drugs are widely used to treat not only depression and schizophrenia, but also anxiety and affective disorders. Other, additional indications for the use of antidepressants are appetite disorders, premenstrual syndrome, chronic pain, etc. Neuroleptics are administered to treat resistant depressions, aggressiveness, impulsivity, and alcoholism. Impaired sexual functioning due to AD and AP lowers quality of life in patients and increases the risk of their refusing treatment, the result of which is a phenomenon associated with the occurrence of recurrent mental illnesses. There are few scientific data on the nature and prevalence of sexual dysfunctions induced by these medications. This topic is universally underestimated as it is rarely touched upon by specialists during their consultations. The aim of the review is to show the side effects of AP and AD on the sexual sphere, to compare different classes of the drugs, and to propose possible management strategies to correct these undesirable effects.

[Neuroleptic malignant syndrome and general paralysis: a clinical case]. / Le cas clinique du mois. Syndrome malin des neuroleptiques et paralysie générale.

Described in 1960 by Jean Delay in relation to the use of haloperidol, neuroleptic malignant syndrome remains relatively rare, and poorly known by the medical profession. The emergence of the atypical antipsychotic agents and preventive measures which have become general in recent years in hospital departments using dopamine receptor antagonists has not altered the prognosis, which remains potentially fatal in approximately a quarter of cases. This article proposes a descriptive summary of this syndrome in terms of clinical and biological diagnostics as well as of evolution, epidemiology, differential diagnosis and treatment. It describes the case of a patient affected by general paralysis having developed a neuroleptic malignant syndrome, thus the hypothesis what the neuroleptic malignant syndrome preferentially arises in subjects having underlying organic or metabolic problems and provides food for thought regarding the main medical and psychiatric overlaps, the use of dopaminergic agents and the behaviour to be adopted when dealing with a patient presenting with inaugural psychiatric symptomatology.

[Suicide of young adults: psychiatric and psychosocial comorbidity]. / Le suicide des jeunes adultes. Comorbidité psychiatrique et psychosociale.

This paper is concerned with a specific population of young adults who were admitted to the Patrick Dewaere Center, a crisis unit dedicated to suicidal young adults aged 15 to 35. We analysed data from a group of 885 patients hospitalized from July 1996 to November 2003. The psychiatric and psychosocial comorbidity of these young suicidal adults was outlined from data contained in the "Minimum Psychiatric Summary" (MPS). Several observations were made: There was a high prevalence of adaptation disorders (67.3%) contrasting with a rather low proportion of major depressive disorders. There was also a very high prevalence of personality disorders 80%), particularly, histrionical or borderline personality disorders. Diffuse, atypical somatic complaints, mainly related to sleep and appetite, that often failed to yield a precise medical diagnosis, were most frequent. A close relationship between suicide and psychosocial problems was apparent and attested the importance of the quality of social links. The value of short hospitalization among this generally active population was evidenced.

[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.

[Novel comparative profile of the clinical activity of antidepressive agents]. / Une physionomie comparée originale de l'activité clinique des antidépresseurs.

In order to develop practical criteria to guide in the selection of antidepressant medication according to depressive symptomatology, we propose a graphical representation of the clinical activity of 24 antidepressants according to a "star" model. Six parameters have been evaluated from 0 to 5 in comparison to reference drugs (rated 5) by 11 independent "blind" psychiatrists expert in pharmacotherapy. Three parameters were used as measures of therapeutic activity: antidepressant, psychostimulant, and anxiolytic, with iproniazide 75 mg/d, metamphetamine 15 mg/d, and diazepam 20 mg/d as reference drugs respectively. Three additional parameters assessed the level of side-effects: anticholinergic, sedative, and hypotensive, with atropine 0.75 mg/d, phenobarbital 200 mg/d, and iproniazide 75 mg/d as reference drugs respectively. The defined dose represented the standard maintenance daily dose for depressive outpatients. Mean values for each parameter, rounded off to the closest number, were used for the graphical representation. Results showed an excellent agreement among evaluators for the clinical profile of classical tricyclic and MAOI antidepressants, but serious divergences for the more recent drugs (e.g., viloxazine and mianserine), possibly reflecting more atypical or more variable clinical profile of these compounds.

[Factor analysis of the French revision of the AMDP rating scales. Results of an international study of 388 cases]. / Analyse factorielle de la révision française de l'échelle AMDP. Résultats d'une étude internationale de 388 cas.

A total of 388 patients from 10 Belgian and French Centers were evaluated with the 1981 revision of the psychopathological and somatic scales of the AMDP System. Principal components factor analyses indicate that the somatic items contribute little to the structure. A 10-factors solution of the psychopathological items generate the following factors after orthogonal rotation: Obsessions-Phobias, Dramatization, Anxiety, Depression, Retardation, Organicity, Dissociation, Delusions, Mania, Dysphoria. This structure is similar to the analyses of the previous German edition except for Anxiety (due to additional French items) and Dramatization (which replaces the German factor on Hypochondriasis). The correlations between raw factor scores and item scores of the BPRS and of a similar AMDP-derived scale contribute to the validation of the AMDP factors and to the justification of a 13-item AMDP Syndromic Scale.