Nicolas Zdanowicz

Efficacy and tolerance of venlafaxine in depressed patients switched from prior antidepressant treatment

A large-scale, naturalistic trial was conducted in 1020 patients, 688 of whom switched to venlafaxine from other antidepressant medications, primarily because of lack of efficacy with their prior antidepressant (86.3% patents). A significant decrease from baseline in Hamilton Rating Scale for Depression (HAM-D) and Montgomery Asberg Depression Rating Scale (MADRS) scores occurred at each study visit (weeks 2-6). An increasing percentage of patients were classified as responders over the course of the study (>50% by week 6), with approximately 20% of patients in early remission and approximately 40% classed as having a sustained response. A higher percentage of patients previously treated with selective serotonin reuptake inhibitors (SSRIs) were classified as responders at week 6 than those treated with tricyclic antidepressants or combination or other antidepressant medication. One-way analyses of variance of the final change from baseline revealed that these differences were statistically significant for bot h HAM-D and MADRS scores. The same result held for the subset of patients switched due to lack of efficacy. Amongst specific SSRIs, the final change from baseline revealed no significant differences between the SSRIs for HAM-D or MADRS scores. Venlafaxine was safe and well tolerated and switching patents to venlafaxine from other antidepressants did not affect the incidence or type of adverse events. No evidence of serotonin discontinuation syndrome was seen during the study. In conclusion, venlafaxine was effective as switch therapy for patients with previous antidepressant treatment.

Overuse of emergency care in psychiatry

In an open study relating psychiatric emergencies in a general hospital, the authors observe that only in 30% of cases does the reason for emergency referral of patients by their general practitioner involve the concept of danger. In view of the results of this study, it would seem beneficial, if one wishes to reduce the number of psychiatric admissions, to improve the training of general practitioners in general psychiatry and in the treatment of mood disorders in particular.

ADOLESCENCE AND DIAGNOSTICS

The major diagnostic categories (schizophrenia, borderline disorder, depression) are reviewed and the difficulties in applying this “adult” classification to adolescence are noted. The reasons for these are numerous, i.e., history of the discovery of diseases, the similarities in psychodynamic functioning between the pathological and the “normal” in adolescence, and prognosis which varies depending on age. How, then, does one distinguish between the pathological and the normal at this age, and is the concept of crisis at all useful?

Induction of a schizophreniform disorder by a spinal cord stimulator.

Received July 10, 1998; revised July 22, 1998; accepted August 20, 1998. From the Department of Psychosomatic Medicine and the Interdisciplinary Clinic on Pain, Universite Catholique de Louvain, Cliniques de Mont-Godinne, Yvoir, Belgium. Address correspondence and reprint requests to Dr. Zdanowicz, Universite Catholique de Louvain, Cliniques de Mont-Godinne, Department of Psychosomatic Medicine, 55330 Yvoir, Belgium. Copyright 1999 The Academy of Psychosomatic Medicine. In pain clinics—especially in teaching hospitals—before proceeding to spinal cord stimulation and/or implantation, a psychiatric and psychometric assessment is usually recommended to identify “at-risk patients,” that is, essentially patients showing schizophrenia and other psychotic disorders, lack of compliance, and/or other psychopathological abnomalities related to pain disorders. In some cases (as in schizotypical disorders), it remains somewhat difficult to ascertain such prognostic evaluations: may we deprive the patient of a pain-relief technique because of a hypothetical psychotic breakdown? The present case outlines the difficulty of applying such guidelines in practice and especially pinpoints the “floating point” problems encountered about whether accepting or rejecting indications of spinal cord stimulation. In this case, the patient does not really meet the full criteria for any Cluster A personality disorder, according to DSM-IV.

Comparisons between psychotropic drugs: must the risk of side effects dictate our practices?

Abstract Objectives: Recently, SOHO and CATIE’s studies in the field of schizophrenic disorders asserted that molecules apparently showing the most side-effects are not only the most effective but also lead to the least changes in treatments. Can we generalise this assertion to other domains of pharmacological treatments, such as in mood and anxiety disorders ? And, more generally, do we possess information about comparison between different types of molecules in these different fields. Methods: Review of the literature (medline – psycinfo – psycarticles) addressing these three psychiatric disorders, and comparing efficacy of treatments, or cost-effectiveness studies. Results: Although there is a plethora of publications about the efficacy of given molecules vs. placebo, studies comparing molecules are scarce, and studies on cost-effectiveness in natural environments are even more scarce. Independently of the type of disorders under study, the last few years’ efforts to completely limit side effects seem to have resulted in a loss of efficacy. Moreover, the previously held hypothesis suggesting that the fewer the side effects, the lesser the need to change treatment has not been confirmed. The duration of a treatment is more dependent upon its efficacy than on other variables. Conclusions: Clinicians cannot determine the absence of noxiousness of a molecule as their primary criterion of choice. In contrast, they should carefully balance side effects and efficacy. In Psychiatry, there is a lack of studies about costeffectiveness in natural environments.

La dimension familiale du processus suicidaire, une étude empirique

A retrospective study was carried out on 44 patients with major depression to study familial characteristics and to determine whether this patient population could be prospectively characterized. Two groups were differentiated: the first consisted of suicidal depressive patients, and the second consisted of non-suicidal depressive patients. A discriminant analysis was then made on two variables: health locus of control for the depressive patient, and the adaptability and cohesion factors for the existing couple, the original family and the nuclear family. This analysis provided a psychological profile of the suicidal patient and his family based on the individuals health locus of control, and indicated certain psychological and familial predisposing factors. The results showed that the family has a considerable influence on the health of a suicidal depressive subject compared to that of a non-suicidal depressive individual. The capacity for adaptability is less and the attitudes are more rigid in the former subjects family than in the latter individuals family. These results have been discussed

S04-03 - Training young psychiatrists in Belgium

Introduction For the last dozen years, there has been a reduction of candidates for specialization in Psychiatry. Furthermore, we receive complaints from the units where they work as young psychiatrists after training. Although, five years ago the examination-selection to this specialisation became a federal contest which prioritises grades obtained during their medical studies, this does not alone account for this development. Method The authors teach in the Faculty of Medicine, but are also involved in the selection process, and in the process of accompanying candidates as they master Psychiatry. Based on their experiences and meetings with colleagues in other universities, they formulate hypotheses to explain this phenomenon. Results In addition to the reduction of numbers of candidates for specialisation, the complaints regard their competences in three domains: Pharmacotherapies, Psychoterapies, and their leadership style which is qualified as authoritarian. We believe DSM II and subsequent versions had important effects on how psychiatry is taught. While trying to free the DSM from the influence of Psychoanalysis and not wanting to reduce training to merely learning statistical diagnostics and pharmacotherapeutic guidelines, training in Psychiatry has become «a little of everything and nothing precise». The result of this lack of content is young psychiatrists, lacking in self confidence and not sure enough of their references to establish a leadership style other than authoritarian. Conclusion During medical studies, we need to reinforce the courses of physio-pharmaco-therapy, Psychotherapy, and comparative psychopathologie and add training in team management.