Coralie Lazignac

Effect of Nicotine Replacement Therapy on Agitation in Smokers With Schizophrenia: A Double-Blind, Randomized, Placebo-Controlled Study

OBJECTIVE The authors conducted a randomized, placebo-controlled study of nicotine replacement therapy for the reduction of agitation and aggression in smokers with schizophrenia. METHOD Participants were 40 smokers 18-65 years of age admitted to a psychiatric emergency service with a diagnosis of schizophrenia confirmed by the Mini International Neuropsychiatric Interview. Patients were screened for agitation with the excited component subscale of the Positive and Negative Syndrome Scale (PANSS) and for nicotine dependence with the Fagerström Test for Nicotine Dependence. A score of at least 14 on the PANSS excited component subscale and at least 6 on the Fagerström test were required for study eligibility. Participants in the nicotine replacement group received a 21-mg nicotine transdermal patch, and those in the placebo group were treated with a placebo patch. Participants received usual care with antipsychotics. The Agitated Behavior Scale and other agitation measures were administered at baseline and again at 4 and 24 hours. RESULTS At baseline, participants were at least moderately agitated, and 28% reported aggressive behavior in the previous week. The mean Agitated Behavior Scale score for the nicotine replacement group was 33% lower at 4 hours and 23% lower at 24 hours than for the placebo group. Participants with lower levels of nicotine dependence responded better than those with higher levels of dependence. CONCLUSIONS The drug-placebo difference in this study was similar to that obtained in trials of parenteral antipsychotics in similar populations. This finding suggests that in patients with schizophrenia, smoking status should be included in the assessment of agitation and nicotine replacement included in the treatment of those who are smokers.

Are psychiatric residents still interested in psychoanalysis? A brief report.

In spite of the efficacy of the psychodynamic psychotherapies, the number of young psychiatric residents interested in psychodynamic therapies is decreasing. Our psychoanalytical group, Genden (Genève—Denver), explored the possible reasons for psychiatric residents’ hesitation to get psychoanalytic training. Five psychoanalytical psychotherapists met weekly for a year in order to debate that question, focusing on personal feedbacks from all of our 100 residents in psychiatry working with us for at least 4 years. Following the residents’ responses, our focus group proposed ten commonsense feedbacks for psychoanalysts regarding stimulating young psychiatric residents’ interest in psychoanalytic approaches.

A Naturalistic Study of Consecutive Agitated Emergency Department Patients Treated With Intramuscular Olanzapine Prior to Consent

1. Zayfert C, Deviva JC, Becker CB, Pike JL, Gillock KL, Hayes SA: Exposure utilization and completion of cognitive behavioral therapy for PTSD in a “real world” clinical practice. J Trauma Stress 2005; 18:637–645 2. Bryant RA, Sackville T, Dang ST, Moulds M, Guthrie R: Treating acute stress disorder: an evaluation of cognitive behavior therapy and counseling techniques. Am J Psychiatry 1999; 156: 1780–1786 3. Bradley R, Greene J, Russ E, Dutra L, Westen D: A multidimensional meta-analysis of psychotherapy for PTSD. Am J Psychiatry 2005; 162:214–227

Recurrence of post-traumatic stress disorder and antiretrovirals

This is the first report of a patient who experienced a recurrence of PTSD repeatedly after 2 attempts to initiate antiretrovirals including efavirenz for HIV infection. After recurrence of PTSD, the patient showed an important decrease in viral load and a higher CD4 level despite a bad compliance to antiretrovirals.

S08-02 The interest of an international research network focusing on emergency psychiatry for improving the quality of care

This communication focus on the critical points about the quality of care in emergency psychiatry: rapid diagnose, management of the psychotherapeutic and pharmacologic treatments effective in emergency. The interest of an international research network in emergency psychiatry is emphasized starting from several clinical experiences (United States, Switzerland, Belgium, France, Luxembourg, Romania).