Estudo clínico e biológico em deprimidos tratados com amineptina / Clinical and biological study in depressed women inpatients treated by amineptine

A resposta do GH, TSH e da PRL ao TRH foi estudada em 10 pacientes mulheres hospitalizadas antes e depois de 21 dias de tratamento pela amineptina. A eliminação urinária do MHPG (total, glucuronídeo, sulfato), 5 HIAA e HVA também foram estudados um dia antes dos dois testes TEH e após 5 dias de um regime pobre em tiramina. Nenhuma conclusão foi possível a partir do GH, TSH, PRL, HVA e 5 HIAA. O MHPG total foi diminuído significativamente com o tratamento, devido à redução da fração glucuronídeo. Esta ação no metabolismo da noradrenalina tem uma origem periférica. Nenhuma correlação foi possível entre o MHPG e outros resultados clínicos e biológicos. A redução do glucuronídeo não foi verificada em nove mulheres deprimidas tratadas com desimipramina durante 21 dias. A redução do MHPG glucuronídeo parece resultar da ação da amineptina

[Amineptin dependence. Detection of patients at risk. Report of 8 cases]. / Dépendance à l'amineptine. Détection de sujets à risques. A propos de huit cas.

The authors relate eight cases of amineptine dependency collected between 1980 and 1988 in 7 women and 1 man treated in the CHU of Besançon (France). The pharmacodependency appeared to be limited mainly to an abuse and a psychic dependence, i.e. a compulsive need to use the drug on a periodic (two cases) or continuing (six cases) basis in order to experience its psychomotor stimulant like effect. The used dosages ranged between 1,000 and 2,500 mg per day. The daily dose was divided into little doses, every hour for example. The induction modality was progressive during weeks or months and a stable dose period was then encountered. In one patient only, we observed a progressive increase of the dose without stabilisation of the dose. The withdrawal of amineptine was obtained without problem except in 2 cases where we observed clinical manifestations of anxiety, psychomotor agitation or bulimia during one day. Four years after the beginning, amineptine dependence was still present in 2 patients. In 4 patients we obtained an interruption of the amineptine pharmacodependency for one to three years. We did not see again the two remaining patients. In two cases, the main diagnosis, according to DSM III, was a major personality disorder (borderline). In the six other cases the diagnosis was a bipolar affective disorder (including four cases with only hypomanic episodes only). In these six patients the main characteristic of their affective illness was the association with other psychiatric disorders, especially personality disorders, such as borderline personality in one case and atypical personality with uncontrolled behavior as the main feature, in the 5 other patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[Compliance, subdosage and overdosage of antidepressive agents in the first prescription in a hospital milieu]. / Observance, sous-dosage et surdosage des antidépresseurs lors de la première prescription en milieu hospitalier.

It is common clinical experience that depressed patients comply poorly with their treatment schedules. In a retrospective study, the authors studied the compliance with the tricyclic antidepressant treatment (TCA) in 1,023 in-patients and evaluated the frequency of the plasma levels under or above the therapeutic range, following a first prescription of TCA. To describe the adherence to the TCA regimen, the investigators have classified patients as either "compliant" or "bad compliant" on the basis of two different arbitrary dividing points: plasma levels of tertiary OR secondary amine lower than 20 ng/ml, or plasma levels of tertiary AND secondary amine lower than 20 ng/ml. The antidepressant plasma levels were measured, on steady state conditions, using a gas chromatographic method. The incidence of bad compliance ranged between about 2.5 and 10%, depending on the criteria used, the incidence of plasma levels under or above the therapeutic window ranged respectively between 26 and 54%-4 and 24%. The results from this study should encourage TCA plasma level measurements.

Estudo clinico e bilogico em deprimidos tratados com amineptina

A resposta do GH, TSH e da PRL ao TRH foi estudada em 10 pacientes mulheres hospitalizadas antes e depois se 21 dias de tratamento pela amineptina. A eliminacao urinaria do MHPG (total, glucuronideo, sulfato), 5 HIAA e HVA tambem foram estudados um dia antes dos dois testes TEH e apos 5 dias de um regime pobre em tiramina. Nenhuma conclusao foi possivel a partir do GH, TSH, PRL, HVA e 5HIAA. O MHPG total foi diminuido significativamente com o tratamento, devido a reducao da fracao glucuroideo. Esta acao no metabolismo da noradrenalina tem uma origem periferica. Nenhuma correlacao foi possivel entre o MHPG e outros resultados clinicos e biologicos. A reducao do MHPG glucuronideo nao foi verificada em nove mulheres deprimidas tratadas com desimipramina durante 21 dias. A reducao do MHPG glucuronideo parece resultar da acao da amineptina.

[Perphenazine enanthate. Results of a 1-year open multicenter study]. / Enanthate de perphénazine. Résultats d'une étude ouverte multicentrique d'un an.

The results of a one-year, open multicenter trial of perphenazine enanthate, a sustained-release neuroleptic drug, are reported. 240 patients (62% suffering from schizophrenia) were included in the study and 144 were followed during the 12-month period. The usual adverse reactions associated with sustained-release neuroleptic drugs were observed. Total and partial BPRS ratings showed that improvement (expressed as a percentage) after 12 months' treatment was similar for systematized chronic delusions, paranoid schizophrenia and hebephrenia. However, the onset of therapeutic activity was different in these three groups of patients. Maximum therapeutic activity, as defined by the BPRS rating, was obtained within 4 months in chronic delusions whereas schizophrenia improved more progressively. Such patients therefore require prolonged treatment before the therapeutic activity of a sustained-release neuroleptic drug can be assessed.

Desipramine dose prediction based on 24-hour single-dose levels: feasibility and validity.

The authors present a prospective study of a rapid desipramine dose adjustment on the basis of a 24-hour plasma concentration after a single 150 mg dose. For this, they use a prediction table constructed from data in the literature showing strong correlation between steady-state plasma levels and 24-hour single-dose levels. Despite the fact that desipramine action is not always linear, the method appears to be feasible and valid. In an attempt to reach a 150 ng/ml level, the authors obtained steady-state levels ranging from 85 to 317 ng/ml, with 14 of the 19 patients in the range between 125 and 250 ng/ml. Moreover, 11 of the 19 patients received a daily dose of 250 mg or more desipramine from the third day of treatment onward; in ten of these cases, this dose had been adapted.

Amitriptyline: linear or nonlinear kinetics in every day practice?

The linearity of the (AMT) kinetics of amitriptyline has been tested in 135 depressed dosed twice daily by measuring plasma. Their (AMT) and nortriptyline (NT) levels under steady-state conditions. The AMT concentration/dose ratios at low and high dosages were not significantly different and there was a linear relationship between the dose ratios and the concentration ratios. No change in the metabolic ratio (AMT/NT) was observed between the two dosages. Although the results are consistent with linear AMT kinetics, there may have been nonlinear kinetics in some patients as the ratio between the concentration/dose ratios in them at low and high dosages was greater than one. Those patients were characterized by a low concentration/dose ratio at low dosage. No clinical adverse effect appeared in the study.

Debrisoquine oxidative phenotyping and psychiatric drug treatment.

The debrisoquine/sparteine phenotype was determined in 51 patients with depression, who were subdivided into 3 groups in terms of their drug treatment. Log (MR) for each group was compared. Patients treated with benzodiazepines had the same distribution of log (MR) as the healthy population, but the distribution was shifted towards higher values in patients treated with neuroleptics and antidepressants. It appears that the phenotypic expression of debrisoquine oxidation may be modified by drugs whose metabolism follows the same route as debrisoquine. The debrisoquine test must be carefully interpreted in patients receiving several drugs in the same time.

Salazar: estudo de sua personalidade / Salazar's personality study

Os autores estudaram a personalidade de Salazar e concluem que os traços obsessivos predominam na sua personalidade. O estudo grafológico chega à mesma conclusäo. Ambos os métodos estäo de acordo quanto a uma mudança de comportamento no fim de sua vida

Salazar: estudo de sua personalidade

Os autores estudaram a personalidade de Salazar e concluem que os tracos obsessivos predominam na sua personalidade. O estudo grafologico chega a mesma conclusao. Ambos os medicos estao de acordo quanto a uma mudanca de comportamento no fim de sua vida.

Biotransformation of amitriptyline in man: interaction with phenothiazines.

The biotransformation modification of amitriptyline by phenothiazines has been studied in 65 depressive inpatients. Thirty-four of them were treated with oral amitriptyline and 31 with a combination of amitriptyline and phenothiazine. Urinary and plasmatic results showed a decrease in hydroxylated metabolites of amitriptyline (OHAMTc and OHAMT) in patients with added phenothiazine.