Jacques Wauthy

Psychological evolution and assessment in patients undergoing orthotopic heart transplantation

BACKGROUND Orthotopic heart transplantation (OHT) is a major surgical intervention inducing distress and anxiety. Psychiatric evaluation of organ transplant candidates is now routinely proposed. This study purposed to assess the psychological evolution in patients having received psychological and/or psychiatric assistance before and during 1-6 postoperative months. METHODS Twenty-two consecutive transplant candidates were psychically evaluated as part of the preoperative protocol. In the waiting period, 1 and 6 months after OHT, they were asked to fill out the following questionnaires: the General Health Questionnaire, the Spielbergers State-Trait Anxiety Inventory, the Beck Depression Inventory, the Perceived Social Support Scale, the Toronto Alexithymia Scale and the Personal Reaction Inventory. RESULTS A DSM-IV Axis I diagnosis was found in nine patients (41%); four patients (18%) presented with an Axis II diagnosis. One month after OHT, scores of depression, anxiety and general health significantly improved, while scores of social support, alexithymia and social desirability did not differ. In the sixth postoperative month, all psychological scores remained stable. CONCLUSIONS A high prevalence of preoperative psychopathology was reported in 22 candidates who received OHT. Surgical intervention obviously improved the quality of life after cardiac transplantation. If the impact of psychological and/or psychiatric aid remains difficult to appraise, these results emphasize the positive impact of surgery on psychological status and the appropriateness of the psychosomaticians social support intervention on patients facing the transplant process.

Hormonal and temperature responses to flesinoxan in normal volunteers: an antagonist study

RATIONALE Flesinoxan is a highly potent and selective 5-HT1A agonist. In a recent study, in normal volunteers, flesinoxan induced a significant and dose-dependent increase in adrenocorticotropic hormone (ACTH), cortisol, prolactin (PRL), growth hormone (GH) and a decrease in body temperature. OBJECTIVES In order to better define the role of 5-HT receptor subtypes in response to flesinoxan, we assessed the influence of 5-HT1A and 5-HT2 antagonists on hormonal and temperature responses to flesinoxan. METHODS Hormonal and temperature responses were studied in 6 volunteers with or without pretreatment with pindolol (30 mg p.o.), a 5-HT1A antagonist, or ritanserin (10 mg p.o.), a selective 5-HT2 antagonist, using a double-blind crossover design. RESULTS Pindolol significantly antagonized ACTH, PRL, GH and temperature responses to flesinoxan and ritanserin exhibited similar activity on PRL and ACTH responses. CONCLUSIONS These results show the role of 5-HT1A mechanisms in the PRL, ACTH, GH, and temperature responses to flesinoxan, and the role of 5-HT2 mechanisms in PRL and ACTH responses. Therefore, they confirm the interest of flesinoxan as a 5-HT neuroendocrine probe.

Relationship between alpha2-adrenergic function and suicidal behavior in depressed patients

The current main neurochemical theories of the biological correlates of suicidal behavior involve serotonergic and, to a lesser extent, dopaminergic systems. Few data are available about the possible implication of the noradrenergic function. In the present study, we assessed the growth hormone response to clonidine, a selective alpha 2-adrenergic agonist, in 15 DSM-III-R major depressive inpatients with a history of suicide attempts, compared with 15 age- and gender-matched major depressive inpatients without a history of suicidal behavior. Mean (+/- SD) growth hormone peak responses to clonidine were significantly lower in the group of suicide attempters than in the control group: 2.93 +/- 3.01 ng/ml vs. 8.28 +/- 8.15 ng/ml. Therefore, these results suggest that a blunted growth hormone response to clonidine could be a biological correlate of suicidal behavior.

Memory disturbances and dexamethasone suppression test in major depression

Assessed the relationships between hypothalamo-pituitary-adrenal (HPA) activity and memory performance using 16 inpatients (mean age 45.9 yrs) with major depressive syndrome and a memory profile developed by A. Rey (1966). Within 2 wks following hospital admission, HPA assessments (both basal and post dexamethasone suppression test [DST] cortisol levels) and the memory profile were administered. Results suggest that HPA assessments including both basal and post-DST cortisol levels are better correlated with memory processes than isolated post-DST levels.

Transsexualism and Connection with Reality: Rorschach Data

From a formal point of view, transsexualism presents the characteristics of delusion: despite the anatomical evidence, and without letting themselves be inf luenced by the contradiction that sets their conviction against their perception, transsexuals assert that the reality is not what they feel. A real sense of feminine identity is not denied by the fact of having a penis; the absence of a penis in no way alters the certainty of being a man. It is understandable that particular attention has been paid to the question of possible psychosis in efforts to account for such a delusional belief. This possibility is especially plausible given the fact that delusion focused on sexual identity is a classic theme in schizophrenia, and, until recently, a psychiatrist would immediately think of this possibility when confronted with a question of transsexualism. This is one of the reasons why sex-change candidates are so regularly subjected to psychodiagnostic tests. Today there remains little doubt that transsexualism bears no particular relationship to schizophrenia. Most transsexuals present no symptoms of schizophrenia, even though they are focusing on a limited aspect of reality in the same way as a delusional psychotic might do. This has given rise to the notion of a focused delusion, which is sometimes used to convey the presence of a limited and circumscribed element of psychotic behavior in a person who does not otherwise display psychotic functioning. Thus, there would seem to be something like a nucleus of psychotic thinking, a center of resistance impervious to counter-arguments, not subject to the rules of logic, and operating on the basis of distinctive mechanisms, which brings to mind the Freudian notion of perversion with mechanisms of splitting of the ego, disavowal of castration, and the creation of a fetish.

The flesinoxan/5-HT1A receptor challenge in major depression

The prevailing neurochemical theory about biological correlates of suicidal behavior focuses on the serotonergic system. In this study, we assessed the cortisol, ACTH, GH, prolactin and temperature responses to flesinoxan, a5-HT1A agonist, in 30 DSM-III-R major depressed inpatients subgrouped into suicide attempters (n = 15) and nonattempters (n = 15). The patients were assessed after a drug-free period of at least 3 weeks. A subsample of 16 patients completed the Buss-Durkee Hostility Inventory as a measure of impulsive aggressive behavior. Mean delta cortisol responses to flesinoxan were significantly lower in the group of depressed patients with a history of suicide attempts than in the group without history of suicidal behavior: for the delta cortisol values 14.5 +/- 16.3 micrograms/l vs 101 +/- 94 micrograms/l (F = 8.9, df = 5.25, p = 0.006). There was also a very significant difference between suicide attempters and nonattempters for the temperature (delta T degrees) responses to flesinoxan: 0.20 +/- 0.24 degrees C vs. 0.60 +/- 0.24 degrees C (F = 18.1, df = 5.25, p = 0.0003). Hormonal and temperature responses to flesinoxan were not correlated with BDHI irritability or assault subscale scores. The results of the present study support the implication of the serotonergic system, particularly 5-HT1A receptors, in the control of self-directed aggressive behavior. Moreover, in depressed patients, serotonergic abnormalities do not appear to be related to aggressive behavior.