Zolpidem test and catatonia.

WHAT IS KNOWN AND OBJECTIVE: There is no consensus regarding treatment of catatonia and the main recent therapeutic progress has been the development of the zolpidem diagnostic and therapeutic test. We report on the use of this test in one of our patients. CASES SUMMARY: Mr. S. suffered from a paranoid schizophrenia. Three episodes of catatonia are described to illustrate the effect of zolpidem in a patient for whom lorazepam was ineffective or inadequate. WHAT IS NEW AND CONCLUSION: Zolpidem with appropriate testing appears to be a credible alternative to electroconvulsive therapy or increased lorazepam dosing and allows continuation of antipsychotic administration.

[Acute psychotic disorders related to bupropion: review of the literature]. / Troubles psychotiques aigus liés au bupropion: revue de la littérature.

RATIONALE AND OBJECTIVES: Bupropion, or amfebutamone, is an atypical antidepressant also used during tobacco cessation. From a structural standpoint, it resembles amphetamine drugs with psychostimulant effects, and endogenous monoamines. From a pharmacological standpoint, bupropion, and two of its most important active metabolites, inhibit dopamine and norepinephrine reuptake. It has recently been discovered that bupropion may act as a non-competitive cholinergic nicotinic receptor antagonist, and that it may inhibit the activation of reward systems triggered by nicotine. Buproprion's efficacy as a smoking cessation aid has been demonstrated by numerous clinical trials that have compared its effects with those of placebo and other nicotinic substitutes. In 2001, buproprion SR received marketing authorization in France as a smoking cessation aid, under the name ZYBAN®. Tobacco addiction indeed remains a major public health issue. Among patients with psychiatric conditions, chronic tobacco consumption is frequent. The development of non-nicotinic drugs may therefore enhance therapeutic possibilities. However, the psychotropic effects of these molecules should be taken into account. We have recently reported the case of a patient with schizoaffective disorder, who presented two acute bupropion-induced psychotic episodes. We have also undertaken an exhaustive bibliographical research on this subject. The aim of the present study is to present the information available to us, in order to suggest aetiopathogenic hypotheses and therapeutic proposals. DATA SOURCES: The following databases were consulted on a regular basis, with no date restriction: Medline, Cochrane and Elsevier. The present study identified 22 cases of psychotic conditions associated with buproprion, as well as randomized and pharmacovigilance studies published in English, from December 1985 to November 2008. Since 2002, there have been three published case-reports on patients who underwent a tobacco cessation program. DATA SYNTHESIS: Psychotic disorders associated with buproprion appear after an average of 10 days of 300 mg/d bupropion intake. In about two third of cases, the patients have no history of psychiatric conditions. In one third of cases, they have a history of thymic disorders. In our review, auditory, visual or cenaesthetic hallucinations frequently occur (85% of the reported cases), and are sometimes characterized by single episodes and/or are rationalized. Some of them occur along with delusional episodes (mystical, paranoid, etc.). The patients are restless, confused, but seldom exhibit dissociative and thymic symptoms. DISCUSSION AND CONCLUSIONS: From an aetiopathogenic, clinical and evolutive standpoint, buproprion-induced psychotic episodes share many similarities with acute organic or toxic psychosis (notably induced by amphetamines). The hypothesis of a dopaminergic hyper-reactivity should be analyzed. Moreover, most of these patients were taking other medication, and the possibility of a dopaminergic potentialization prior to buproprion intake could be suggested. In such cases, bupropion should be discontinued and complete remission is expected within an average of 10 days. Even though neuroleptic drugs are still frequently used in these cases, benzodiazepines could become a valid alternative, according to the model of amphetamine-induced acute psychosis.

[Non-functional or silent endocrine tumors of the pancreas. Apropos of a case of cystic form]. / Les tumeurs endocrines "non fonctionnelles" ou silencieuses du pancréas. A propos d'une observation à forme kystique.

The authors report a new case of silent cystic pancreatic endocrine tumour discovered by chance on abdominal ultrasonography. This tumour was treated surgically by simple enucleation-resection. On the basis of the histological appearance and the absence of metastases, this tumour was considered to be benign, but only the long-term course will confirm the diagnosis.

Long-term results obtained with the Bankart method for the treatment of recurring anterior instability of the shoulder.

This review of cases was the product of a multicentric study the results of which were discussed during the Round Table discussion on the treatment of recurring anterior instability of the shoulder for the Spring Session of the S.OF.C.O.T 90. It is the purpose of this study to evaluate the long-term results obtained with Bankart capsuloplasty. Fifty-three patients were reviewed with a long-term follow-up of more than 10 years. Their performance in sports and during everyday life was evaluated. The procedure may be the cause of mild joint stiffness in external and internal rotation, but it is distinguished for its scarce tendency to provoke arthrosis and for its excellent results in relieving pain, as compared to other procedures such as the Latarjet method. Thus, its results in terms of stability are comparable to those obtained with other methods. In this series the results seem to be correlated with sports activity, age and the side operated on. The worst results were obtained in very young amateur athletes and in non-dominant shoulders. Long-term follow-up showed that results were stable in time, with no functional progression or decline in sports activity.