Arlette Seghers

Socio-economic differences in psychiatric in-patient care

Objective:  We seek to investigate socio‐economic differences in psychiatric in‐patient care regarding admission, treatment and outcome.

Anxiety and depression, attention, and executive functions in hypothyroidism.

BACKGROUND Divergences in cognitive disturbances in hypothyroidism reported in the literature are a result of a methodological bias. METHODS By using a precise methodology, we examined attention and executive functions in hypothyroidism, verified the presence of anxiety and depressive symptoms in hypothyroidism, and examined the possible link between these symptoms and the cognitive disturbances (searching for attentional bias for words with a negative emotional valence). We administered a battery of cognitive tests to 23 participants who had undergone thyroidectomy for thyroid carcinoma: for the first time in an euthyroid state, then 3 weeks later (still in the euthyroid state) to assess the test/retest effect, and finally 4 weeks later in an hypothyroid state. We compared their performance with that of a group of 26 control participants who were also administered the same cognitive tests, also 3 times. RESULTS In hypothyroidism, the thyroid participants were more anxious and depressed than the controls and presented attentional and executive disturbances that reflected general slowing and difficulties in using their capacities of inhibition. However, they did not exhibit an attentional bias for words with a negative emotional valence. CONCLUSIONS Contrary to what was expected, symptoms of anxiety and not symptoms of depression interfered with the cognitive performance of participants in hypothyroidism.

Hypothyroidism and Major Depression: A Common Executive Dysfunction?

Little is known about the possible link between the cognitive disorders associated with hypothyroidism and those encountered in depression. This study examines attentional and executive functions as well as the intensity of anxiety and depressive symptoms in hypothyroidism and major depression and the possible link between these symptoms and cognitive disturbances. This study confirms the existence of psychomotor slowing associated with attentional and executive disturbance in major depression as well as in hypothyroidism. However, while depressed subjects manifested a conscious bias with material of negative emotional valence, no such bias was found in the hypothyroid subjects. While the hypothyroid state is accompanied by anxiety/depressive symptoms, it seems that the latter are too discrete for an attentional bias to be observed with material with a negative emotional valence.

Aripiprazole is effective in the treatment of Tourette's disorder

Tourettes disorder is a chronic neuropsychiatric disorder including multiple involuntary motor and vocal tics. We report the clinical case of a 23-yr-old girl with Tourettes disorder and a successful treatment of this condition with aripiprazole, a new antipsychotic drug with dopamine-2 (D2) receptor antagonism under hyperdopaminergic conditions and with D2 receptor agonism under hypodopaminergic conditions. After 3 wk treatment with 15 mg/d aripiprazole, both motor and vocal tics had almost completely disappeared. The treatment was well tolerated by the patient. The only reported side-effect was insomnia during the first 3 wk of treatment. This encouraging case report should justify long-term placebo-controlled trials to further establish the treatment of tics with aripiprazole in this life-long disorder with severe functional consequences.

Plasmatic vasopressin neurophysin in depression: basic levels and relations with HPA axis.

A decreased secretion of arginine vasopressin (AVP) has been implicated in depression. In order to further investigate this hypothesis, we studied the plasma level of the specific peptidergic carrier of AVP, vasopressin neurophysin (hNpI), in 26 depressed inpatients and 16 matched normal controls. On the other hand, AVP has also been involved in the pathophysiology of the cortisol postdexamethasone nonsuppression frequently observed in depression. Therefore, we investigated concomitantly hNpI and cortisol during a dexamethasone (DXM) suppression test. hNpI and cortisol were assessed by radioimmunoassay at 8 AM and 8 PM during 4 consecutive days. From days 2 to 3, 4 mg (DXM) was given orally. hNpI values were not affected by DXM administration. Compared with controls, patients showed higher pre- and post-DXM cortisol values and lower hNpI values. No difference in hNpI values was observed between DXM escapers or nonescapers. Our results are consistent with an impaired AVP secretion in depression and fail to support a role of AVP in the early cortisol escape.

An eight-week, open-label, uncontrolled, multicenter, phase IV study of remission rates in outpatients and inpatients with major depression treated with venlafaxine

Background: Venlafaxine is a structurally novel antidepressant that is believed to potentiate monoamine activity in the central nervous system. In preclinical studies, venlafaxine was shown to inhibit the neuronal uptake of serotonin and norepinephrine and, to a lesser degree, dopamine reuptake, but was without effect on monoamine oxidase (MAO) activity. Clinical trial results from similar to3000 patients suggest that venlafaxine is a safe and effective antidepressant with the potential to invoke an early onset of clinical activity. Objective: The purpose of this 8-week, open-label, uncontrolled, multi-center, Phase IV study was to examine the extent of remission and symptom relief in outpatients and inpatients with major depressive disorder treated with venlafaxine. Methods: This study was conducted at 12 centers across Belgium and Luxembourg. Consecutive, severely depressed inpatients and moderately depressed outpatients aged 18 to 70 years were eligible. Patients were administered open-label venlafaxine for 8 weeks. Dosing was initiated at venlafaxine 75 mg/d (37.5 mg BID), with dose adjustments made throughout the study, to a maximum daily dose of 375 mg for inpatients and 225 mg for outpatients. Results were measured using the Hamilton Depression (HAM-D) scale, the Montgomery-Asberg Depression Rating Scale (MADRS), and the Clinical Global Impression (CGI) scale. Results: A total of 149 consecutive patients (84 females, 65 males; mean age, 46.5 years; 88 outpatients, 61 inpatients) were enrolled; the intent-to-treat (ITT) population comprised 144 patients (84 outpatients, 60 inpatients); 111 patients (64 outpatients, 47 inpatients) completed the study. At the week 8 visit, 71.3% of patients (77/108) were considered to be responders according to the HAM-D scale; 73.8% (79/107) according to the MADRS; and 78.7% (85/108) according to the CGI scale. A sustained response was achieved in 33.3% of the ITT population (48/144), and at week 8, 50.8% of outpatients (32/63) and 37.8% of inpatients (17/45) were in remission according to the HAM-D scale. Venlafaxine was well tolerated at all doses, with the most frequently experienced adverse events (AEs) being nausea, sweating, and headache. Fewer inpatients than outpatients reported greater than or equal to 1 AE (57.4% [35/61] and 73.9% [65/88], respectively), despite receiving a higher maximum daily dose of venlafaxine. Conclusion: The results of this study indicate that venlafaxine was a tolerable and effective antidepressant in both outpatients and inpatients, with a significant proportion of patients achieving remission.

Safety, tolerability and efficacy of a rapid dose escalation of quetiapine in bipolar I mania: the FATIMA study

Objective: The FATIMA study (FAst TItration of quetiapine fumarate in bipolar I MAnia) evaluated the safety, tolerability and efficacy of a rapid dose escalation of quetiapine in acutely ill bipolar I patients experiencing a manic episode. Methods: In an open-label, phase II pilot study, 29 patients aged 18 years or older, hospitalised with a bipolar I manic episode, received quetiapine twice daily for 21 days. Quetiapine was administered at 200, 400, 600, then 800 mg/day on the first 4 days, with flexible dosing (400–800 mg/day) subsequently. The primary endpoint was the proportion of patient dropouts because of adverse drug reactions during the first 7 days. Secondary safety assessments included incidences of adverse drug reactions and significant changes in vital signs. Efficacy assessments included Young Mania Rating Scale (YMRS) and Clinical Global Impressions Severity of Illness (CGI-S) score changes from day 1 to day 21. Results: Twenty patients (69%) completed the study. No patients withdrew as a result of drug-related adverse events (AEs) during the first 7 days. Twenty-three patients reported 58 adverse events, and most of the adverse events were mild or moderate. No clinically relevant abnormalities in vital signs were reported. Mean YMRS and CGI-S scores decreased significantly from baseline to day 21 (p < 0.001). Response and remission rates were 78 and 70%, respectively, at the end of the study. Conclusion: Rapid dose escalation of quetiapine to 800 mg/day over 4 days was well tolerated and effective in reducing symptoms within 5 days in acutely ill bipolar I patients with a manic episode.