Moclobemide versus fluoxetine for a major depressive episode.

The efficacy and tolerability of moclobemide (300-600 mg daily) and fluoxetine (20-40 mg daily) were compared in a 6-week, double-blind study of 65 inpatients and 34 outpatients suffering from major depressive episodes (DSM III-R). No statistically significant differences between the two treatment groups were noted regarding efficacy (HDRS, CGI) or safety (adverse events, laboratory examination, vital signs). Moclobemide (300-600 mg daily) and fluoxetine (20-40 mg daily) would thus appear to be comparable both in antidepressant efficacy and tolerability. Doubling the low dosage in non-responders after 3 weeks resulted in a statistically significant improvement of CGI in the moclobemide group by comparison with the fluoxetine group at study end, suggesting that 600 mg moclobemide/day can still improve the patient's condition, while 40 mg fluoxetine/day does not. Sexual dysfunction was reported in two patients taking fluoxetine.

Psychophysiological correlates of suicidal behavior in depression. A preliminary study.

P300 and contingent negative variation (CNV) were recorded in depressive inpatients with and without history of suicide attempt. The results show a significant reduction of both P300 and CNV in patients who had attempted suicide as compared with patients who had not. Moreover, a significant correlation was found between the suicidal risk scale and CNV amplitude. Psychophysiological and biochemical implications are discussed.

[Zuclopenthixol acetate and haloperidol in acute psychoses. Results of the AMDP subgroup in a multicenter Belgian study]. / L'acétate de zuclopenthixol et l'halopéridol dans la psychose aigüe. Résultats du sous-groupe AMDP d'une étude multicentrique belge.

The efficacy of i.m. cis(Z)-clopenthixol in aggressive, agitated and delusional patients is well established but it necessitates, as for all other parenteral neuroleptics, several injections daily. Zuclopenthixol acetate is the first injectable neuroleptic characterized simultaneously by a short latency of action (2-3 h) and by a long duration of action (2-3 days). Within the frame of a Belgian multicentre study of zuclopenthixol acetate and haloperidol, a group of French-speaking psychiatrists added the AMDP scales to the basic protocol. The results of this AMDP subsample of 20 Acetate vs. 13 Haloperidol patients do not allow the demonstration of statistically significant differences between both neuroleptics because of the smallness and unbalance of the sample, but they indicate that both antipsychotics are very active and that a comprehensive rating scale such as the AMDP gives a much better differentiated clinical picture of a new drug than the total scores of short, so-called "economical" rating scales.

[Presentation of the AGP and observations on this evaluation system of symptomatology in gerontopsychiatry]. / Présentation du système AGP et réflexions suscitées par ce système d'évaluation de la sémiologie en gérontopsychiatrie.

The first part of the present paper concerns the presentation of the AGP-System. The authors formulate several remarks concerning some items of the 6 sheets of the System, and they stress its advantage over other scales in geriatric psychiatry. Nevertheless, the AGP-System is little used. Therefore, the authors consider that the integration into the AMDP-System of the two specific AGP scales could contribute to an increased success of the AGP-System.

[Cortisol suppression after dexamethasone administration in patients with dementia]. / Suppression du cortisol après dexaméthasone chez des patients déments.

Sixty-four nondepressed, carefully selected senile demented inpatients underwent two 1.0 mg overnight dexamethasone suppression tests (DSTs) separated by 7 days. These patients had been in a clinically stable and drug-free state for at least six months prior to testing. The Modified Ischemic Scale score and ICD-9 criteria for Alzheimer's disease were used to dichotomize subjects into Alzheimer's and multi-infarct types of dementia. Patients with vascular dementias were significantly more likely to evidence DST nonsuppression, furthermore, DSTs in this group were less reproducible from week to week than DSTs in Alzheimer's patients.

Open multicentre trial of zuclopenthixol in mania and schizophrenia based on the AMDP scales.

A total of 95 schizophrenic or manic patients received zuclopenthixol (cis(Z)-clopenthixol) either intramuscularly or orally during a period of 2 to 4 weeks in mean daily doses of 25 mg (i.m.) or 75 mg (p.o.). They were rated with the CGI, VAS, MSS, BPRS, and AMDP scales. Zuclopenthixol proved to be a potent antimanic, anti-aggressive and antidelusional neuroleptic already from the second day of injection. Very few anticholinergic and extrapyramidal side effects as well as little somnolence were seen and the local tolerance was excellent. The 14-factor AMDP profile proved valid, sensitive to change and highly differentiated.

Suppression of cortisol following dexamethasone in demented patients.

Sixty-four nondepressed, carefully selected senile demented inpatients underwent two 1-mg overnight dexamethasone suppression tests (DSTs) separated by 7 days. These patients were in a clinically stable and drug-free state for at least 6 months before testing. The Modified Ischemic Score and ICD-9 criteria for Alzheimer's disease were used to dichotomize subjects into Alzheimer's and multi-infarct types of dementia. Patients with vascular dementias were significantly more likely to evidence DST nonsuppression. Furthermore, DSTs in this group were less reproducible from week to week than DSTs in Alzheimer's patients.

[A scale inspired by AMDP, adapted for coronary patients]. / Une échelle inspirée de l'AMDP, adaptée aux coronariens.

In the aim of evaluating the goodness of the relaxation proposed to coronary patients, the authors have used their own scale which consists of a list of 51 items related to psychological attitudes. They have analyzed 156 scales by mean of principal components analysis followed by a Varimax rotation. So they have shown a good structural validity and have, in the same time, increased its sensitivity. For 53 paired patients rated by one of the authors before and after relaxation, the evolution of 10 factors has been analyzed by mean of a t test. This statistical procedure gives good results, particularly in the life adaptation (p less than 0.0001). All factors, but one related to "PATTERN A", are significantly changed. This last fact is interpreted in the way of defense mechanisms.

[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.

[Compatibility between AMDP scales and "Research Diagnostic Criteria" (RDC) for the diagnosis of endogenous depression]. / Compatibilité entre échelles AMDP et "Research Diagnostic Criteria" (RDC) dans le diagnostic de dépression endogène.

Research Diagnostic Criteria represent the most widely used system in research in biological psychiatry to select homogenous samples of patients with a defined psychiatric illness. The AMDP system represents the most complete system for documentation and quantification of psychopathology. On the conceptual point of view, it seems possible to use AMDP psychopathological and somatical scales to select patients who meet criteria of "major depressive disorder" of RDC. In fact, equivalents exist for most of the criteria. For an optimal correspondence, only two psychopathological reserve items--in place of little useful items--and two somatical reserve items could easily be included. A preliminary study has enabled to control the sense of this methodology. A more complete study that verifies the compatibility of both approaches and the ability to automatically select endogenous depressives from AMDP scales is ongoing.

[The necessity for standardized diagnosis in research in biological psychiatry. Attempted integration of "Research Diagnostic Criteria" into the AMDP system]. / De la nécessité du diagnostic standardisé dans la recherche en psychiatrie biologique. Essai d'intégration des "Research Diagnostic Criteria" dans le système AMDP.

Standardization of diagnosis is an essential preliminary in the clinical research in biological psychiatry. Between the different systems of nosographical selection, Research Diagnostic Criteria (RDC) are the most internationally diffused. After having recalled the spirit of RDC, we have looked for seven major illnesses (major and minor depressive disorders, endogenomorphic major depressive disorder, schizophrenia, manic disorder, panic disorder and generalized anxiety disorder) equivalents of RDC criteria in psychopathological and somatical items of AMDP system. With a minimum of modifications (adjonction of some reserve items for each illness), AMDP scales could become compatible. The verification of this theorical equivalence secondly makes it a duty to use jointly RDC and AMDP scales and to analyse both of them separately. After this methodological control, patients who meet RDC criteria could be automatically selected from AMDP scales.

[A semi-structured psychopathological interview conceived for the AMDP-3 scale and time-blind evaluation of videotapes (author's transl)]. / Un entretien psychopathologique semi-structuré adapté à l'échelle AMDP-3 et à l'évaluation vidéo en temps aveugle.

In the process of adapting the German AMDP Psychopathology Scale into French and of analyzing its interrater-reliability, free AMDP interviews were tape-recorded and played back. It became rapidly evident that such interviews are incompatible with a comprehensive and reliable evaluation of psychopathology: the collected information is incomplete and variable from one interviewer to the other and even from one interview to the other by the same interviewer, which is particularly invalidating in case of video ratings. The present semi-structured interview is based on 140 videotaped recordings of non-psychiatric patients, of depressives and psychotics. Formulation of questions is seldom imperative; their sequence is only suggested and may be modified according to the interviewer's style and to the patient's pathology. Have been avoided questions too dependent on setting (community, hospital) or likely to disclose the first-interview or retest nature of the recording, thus allowing time-blind evaluations. The mean duration of the interview is 28 mn (less than 30 mn in 70% of the cases) for 126 items.

[Schultz autogenic training and galvanic skin response in the systematic desensitization of a compulsive phobia]. / Training autogène de Schultz et électrodermographie dans la désensibilisation systématique d'une phobie d'impulsion.

A patient suffering suicidal phobia and resistant to antidepressants as well as electroconvulsive therapy was submitted to Wolpe's systematic desensitization associated with Schult's autogenic training. Ten sessions were sufficient to cure the patient. A follow-up period now extends to one year, without relapse. The concomitent measure of skin galvanic response by an electrodermograph appears a privileged psychophysiological control of such a therapy, i.a. allowing for detection of the avoidance of the anxiogenic evocation by the patient.