[Psychoeducation for overweight patients with psychiatric disorders: The Wellness program developed in Quebec]. / L'éducation thérapeutique du patient pour les clientèles psychiatriques présentant un surpoids : l'exemple du programme « Wellness ¼ développé au Québec.

OBJECTIVES: Patients with severe psychiatric disorders such as psychosis, bipolar disorder, and depression have a greater risk of suffering from being overweight or from obesity than the general population. This can in part be explained by medication-induced weight gain related to the use of antipsychotics, antidepressants and mood stabilizers. Fortunately, non-pharmacological interventions targeting modifications in lifestyle behaviors exist to help patients deal with weight gain and weight management. The main objective of this study is to assess the effectiveness of one of these interventions developed in Quebec (Canada), the Wellness Program. MATERIALS AND METHODS: The 12-week program, consisting of two to three weekly individual and group sessions, was administered to patients diagnosed with a severe psychiatric disorder (i.e. Psychotic Disorders, Bipolar Disorders, Major Depressive Disorder) and referred to a general hospital for significant weight problems. Topics of program sessions included: physical conditioning, nutrition, meal cooking, psychoeducation, motivation, relaxation training, and optional walking sessions. A total of 47 participants took part in this study and either initially received the intervention (n=31) or were placed in a waitlist control group and later received the intervention (n=16). The effectiveness of the program was measured using objective anthropometric (weight, Body Mass Index, waist circumference) and clinical (psychiatric symptoms, medication adherence, quality of life) variables from both experimental and control groups. Assessments were conducted at the end of the 12-week intervention and at a 3-month follow-up. RESULTS: After three months of active intervention, there were no significant differences between the two groups for most of the variables studied. Patients in the experimental group did show greater improvements in weight loss, Body Mass Index and waist circumference compared to the control group, but these positive changes were not statistically significant given the small sample size of the study. However, the results obtained at follow-up three months after the end of the program showed a significant impact of the program, albeit small, on weight, Body Mass Index, waist circumference and on some aspects of quality of life in the experimental group. CONCLUSION: Non-pharmacological interventions targeting healthy lifestyle behaviors and weight management, such as the Wellness Program, seem effective in improving anthropometric variables and quality of life in patients with severe psychiatric disorders such as psychosis and mood disorders. Given the potential clinical benefits, implementation in clinical settings and widespread dissemination is recommended. Indeed, these programs have the potential to limit weight gain associated with medications used to treat psychiatric disorders and to improve quality of life for these patients.

Neuroleptic dosing and neuroleptic plasma levels in schizophrenia: determining the optimal regimen.

OBJECTIVE: To recommend dose range and therapeutic plasma concentration for several neuroleptics, and to discuss conditions under which neuroleptic plasma levels are clinically useful. METHOD: Neuroleptic drug therapy is a major component of the acute and maintenance treatment of schizophrenia. However, there is no consensus on what constitutes an appropriate or optimal dose of antipsychotic drug in individual patients. Low-dose medication has the potential to improve psychosocial function and reduces the frequency of side effects but can lead to an increase in positive symptoms and schizophrenic relapse. High doses may be associated with behavioural toxicity, symptom exacerbation, a worsening of secondary deficit symptoms, impaired social functioning and increased adverse effects such as acute extrapyramidal symptoms and tardive dyskinesia. Numerous clinical studies have attempted to determine the degree of correlation between dose, neuroleptic blood levels, and clinical response. RESULTS: To date, this approach has met with only limited success: neuroleptic dose overall appears to be a poor predictor of clinical outcome, and the suggested therapeutic plasma level concentrations of some antipsychotic drugs cannot be regarded as established by any means. Furthermore, the ability to conduct neuroleptic plasma levels is not readily accessible in the usual clinical setting. In the acute treatment phase, titrating the dose until the onset of minimal cogwheel rigidity or hypokinesia (neuroleptic threshold dose) has met with some success and is preferable to standard dosing as a means of individualizing pharmacotherapy. During the maintenance phase, a slow and gradual dosage reduction with adjunctive psychosocial and psychotherapeutic intervention is the preferred strategy. CONCLUSION: Reinforcing patient and physician compliance is a key element in achieving an optimal treatment regimen.

Reliability of best-estimate diagnosis in genetic linkage studies of major psychoses: results from the Quebec pedigree studies.

OBJECTIVE: Diagnostic classification and reliability are critical in genetic linkage studies of schizophrenia and bipolar disorder. To establish an optimal diagnostic procedure, the authors drew 13 methodological elements from 38 major linkage studies and workshop reports. They determined reliability for a consensus best-estimate diagnostic method based on these 13 features. METHOD: Each of 59 subjects from several large multiplex pedigrees, densely affected by either schizophrenia or bipolar disorder, received a best-estimate diagnosis from unblind diagnosticians in the field and also from a panel of four research psychiatrists who were blind to the proband's and relatives' clinical status. The best estimate was based on personal diagnostic interviews, all available medical records, and family history data. RESULTS: The diagnostic concordance between the field team and the blind psychiatric board yielded 78% to 90% agreement for the whole sample (kappa = 0.83-0.88) and 71% to 87% agreement for the subjects given field diagnoses (kappa = 0.76-0.83). The diagnoses made by the unblind field diagnosticians were biased toward a greater severity (or certainty) level in the diagnostic hierarchy (schizophrenic or bipolar) and more consistency with the most prevalent diagnosis affecting the pedigree. CONCLUSION: Since several previous linkage studies used diagnoses made by diagnosticians who were not blind to the status of the probands and the relatives or did not use a consensus best-estimate diagnosis, further reliability studies of different aspects of the best-estimate method and of its effect on linkage studies are needed. Such research is imperative given the serious impact of diagnostic misclassifications on genetic linkage results.

[Use of low doses of bromocriptine in chronic schizophrenia resistant to neuroleptics. A preliminary study]. / Utilisation de faibles posologies de bromocriptine dans la schizophrénie chronique résistante aux neuroleptiques. Une étude préliminaire.

In this work, we report the efficiency of bromocriptine (1.25 and 2.5 mg/day) in 9 neuroleptic resistant chronic schizophrenics. Following an initial four-week placebo period, the subjects successively received bromocriptine (1.25 mg/day), placebo and bromocriptine (2.5 mg/day). The 2 bromocriptine treatments significantly improved the global psychiatric symptomatology and different scores and factors related to the more specific schizophrenic symptomatology. An escape phenomenon seems to occur during the 4th week of the first bromocriptine treatment (1.25 mg/day) but is not observed with the second treatment (2.5 mg/day). All patients improved.

You drive me crazy: a case report of acute psychosis and neurocysticercosis.

Cysticercosis is a parasitic disease endemic in several developing countries where people consume raw or insufficiently cooked pork. The authors present a clinical picture of an organic psychosis in a 24 year old female with CNS cysticercosis. The neuroradiologic follow-up of this patient pre and post treatment with praziquantel is presented. The implications of this case with regard to the pathophysiology of schizophrenia and schizophrenia-like psychoses is discussed.

Vitamin E in the treatment of tardive dyskinesia: a double-blind placebo-controlled study.

The authors compared vitamin E with placebo in a double-blind randomized crossover study of 27 patients with tardive dyskinesia. Each treatment period lasted for 6 weeks. Vitamin E showed no differences from placebo in the treatment of tardive dyskinesia.

Enhanced sensitivity to cholecystokinin tetrapeptide in panic disorder. Clinical and behavioral findings.

We studied the action of cholecystokinin tetrapeptide (CCK-4) in patients with panic disorder and normal controls. Subjects received, in random order, one injection of CCK-4 and one injection of placebo (saline) on two separate days in a double-blind crossover design. Two doses of CCK-4, 50 and 25 micrograms, were administered to two different samples of subjects. The panic rate with 50 micrograms of CCK-4 was 100% (12/12) for patients and 47% (7/15) for controls. The panic rate with 25 micrograms of CCK-4 was 91% (10/11) for patients and 17% (2/12) for controls. Nine percent of patients compared with 0% of controls panicked with placebo. These findings concur with previous reports of a panicogenic effect of CCK-4 and suggest that patients with panic disorder are more sensitive to the panicogenic effect of the peptide than are normal controls.

Double-blind comparison of the effects of clonazepam and lorazepam in acute mania.

A double-blind comparison of clonazepam and lorazepam was conducted in 24 patients with acute mania. Patients received either clonazepam or lorazepam alone for 14 days. Treatment with lorazepam produced marked improvement in symptomatology, while treatment with clonazepam failed to demonstrate a significant therapeutic effect. Sixty-one percent of patients responded to treatment with lorazepam, with 38.5% achieving remission. This compares to an 18.2% response rate and 0% remission rate in patients treated with clonazepam. These findings support the usefulness of lorazepam in the treatment of acute mania.

Tardive dyskinesia: legal and preventive aspects.

Tardive dyskinesia is a complication associated with long term neuroleptic drug treatment that can be the object of litigation. Such litigation has occurred recently in the United States, where awards of considerable value have been granted to plaintiffs. Circumstances that can lead to TD litigation are presented as well as guidelines for the prescription of neuroleptics, the prevention of litigation and of the syndrome itself. Five lawsuits associated with TD serve as a backdrop for the discussion.

[Tardive dyskinesia: a current review]. / Dyskinésie tardive: mise a jour.

Tardive Dyskinesia (TD) is a neurological syndrome associated with long-term use of antipsychotic drug treatment (APD). Its significant prevalence (estimated 15-20%) and potential irreversibility are a major concern in psychiatry. The clinical picture is characterized by involuntary repetitive movements of choreoathetotic and dystonic nature varying in location and intensity. The individual outcome of TD is unpredictable but recent long-term studies give reason for prudent optimism. All neuroleptics are involved in the disorder, numerous risk factors have been suggested; advancing age is the only one which has a clearly definite role. Even though several hypotheses have been suggested, the pathophysiology of the disorder remains a mystery. Informed consent is discussed in this update with regard to the legal implications of the disorder. Because of lack of effective treatment, prevention of TD is essential. The present treatment of choice is gradual reduction (and ideally discontinuance) of APD treatment when possible.