Anomalies du sommeil et de la regulation neuroendocrinienne dans la depression.

In a series of investigations we explored 24 hour neuroendocrine profiles as well as sleep patterns in a sample of monozygotic and dizygotic normal twins as well as in a group of depressed and schizophrenic patients. Our results indicate that genetic factors influence some sleep variables, mainly the slow wave sleep. They also indicate that a disorder of circadian time-keeping (a phase advance of the biological clock) characterizes some forms of affective illness.English AbstractJournal ArticleTwin Studyinfo:eu-repo/semantics/publishe

Cimetidine-induced mania

The authors report a case of a typical manic syndrome following the administration of cimetidine. They discuss the risk factors related to the neuropsychiatric toxicity of cimetidine and suggest a possible role of histamine control in the pathophysiology of affective disturbances and possibly mania.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Vortioxetine :What place in the management of major depression?

Vortioxetine is indicated for the treatment of moderate to severe major depressive episodes. The clinical action of Vortioxetine is mediated by selective blockade of serotonin reuptake and modulation of serotonin receptor activity. Although Vortioxetine appears to be more effective than placebo in the management of major depression, its place in the treatment of this pathology is unclear. Indeed, the lack of randomized controlled trials comparing Vortioxetine with first-line treatments for major depression (such as selective serotonin reuptake inhibitors) severely limits the interpretation of currently available data in the literature. However, given its potential pro-cognitive action, Vortioxetine may therefore be a treatment of choice in the management of cognitive symptoms associated with major depression, which justifies additional studies.info:eu-repo/semantics/publishe

The dexamethasone suppression test in affective illnesses and schizophrenia: Relationship with psychotic symptoms

The authors studied the dexamethasone suppression test (DST) on a series of 112 inpatients including 65 patients with major depressive disorder (21 bipolars: 4 with, 17 without psychotic symptoms; 44 unipolars: 13 with, 31 without psychotic symptoms), 15 patients with depressive disorder, 10 schizoaffective and 22 schizophrenic patients. Using different diagnostic criteria, they confirm the best performances of the DST in depression for the diagnosis of a major depressive disorder, primarily endogenous. They also examined the potential influence of psychotic symptoms, suicidal behavior and family history of affective illness on the DST. The only significant difference found is in the cortisol plasma level at 4 p.m. in bipolar patients with psychotic symptoms. That fact and the high rate of abnormality of the DST in schizoaffective and schizophrenic patients indicate that psychotic symptoms per se may play a role in a dysregulation of the hypothalamo-pituitary adrenal axis.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Further investigation of the dexamethasone suppression test in affective illnesses: Relationship to clinical diagnosis and therapeutic response

The authors have studied the performances of the Dexamethasone Suppression Test (DST) in 107 hospitalized patients diagnosed according to the Research Diagnostic Criteria (RDC) and Feighner's criteria. The best performances of the DST are obtained for the diagnosis of primary depressed patients, suffering from a major depressive disorder. With the combination of these two diagnostic criteria, we found a sensitivity of 81%, a specificity of 81% and the diagnostic confidence of a positive test is 93%. Our study also shows 90% of abnormal DST results in schizoaffective disorder, depressed type, and no significant difference of the mean cortisol plasma levels at 4 p.m. after dexamethasone administration between depressed schizoaffective patients and major depressives. The finding of a better therapeutic response to antidepressive treatments in DST nonsuppressor patients than in suppressors is of interest for the predictive value of the DST in relation to treatment response.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

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Prise en charge de l'insomnie :Recommandations pour la pratique en médecine générale

In Belgium, poor sleep complaints are numerous and frequent in the general population. Of these complaints, one of the most important is insomnia. Acute onset and chronicity of insomnia can be explained by different models based on genetic criteria, neurophysiological, neuroendocrine, neuroimmunological and neuroimaging. Insomnia can be associated with a lot of somatic and psychiatric comorbidities. The diagnosis of insomnia is primarily a clinical diagnosis based on medical history and physical examination. Different tools can help us in our approach, such as self-questionnaires and sleep diaries while additional tests (polysomnography and actigraphy) should be reserved for research of associated sleep disorders and for unclear situations. The management of insomnia can be non-drug treatment (exercise, light therapy, acupuncture and self-treatment cognitive behavioral therapy) but also drug treatment (benzodiazepine, Z-DRUGS, melatonin, antidepressants, herbal medicines, neuroleptics and antihistaminics). Each of these approaches has advantages and disadvantages that must be considered when choosing treatment. The aim of this review is to allow general practitioners to better understand the mechanisms of insomnia and to have recommendations for the diagnosis and treatment of insomnia.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Excessive daytime sleepiness in adolescents: Current treatment strategies

The complaints of excessive daytime sleepiness are very common among adolescents. In addition, in this particular subpopulation, the presence of excessive daytime sleepiness is associated with negative impact on school performances, interpersonal difficulties (school friends or family), extracurricular activities, health and driving. In adolescents with complaints of excessive daytime sleepiness, it is important to perform a complete clinical assessment including systematic clinical interview, physical examination, sleep diaries, use of specific questionnaires and possible confirmatory tests. In adolescents, the main causes of excessive daytime sleepiness are sleep deprivation, inadequate sleep hygiene, insomnia disorders, circadian rhythm disorders, chronic somatic pathologies, psychiatric disorders, movement disorders related to sleep, respiratory disorders related to sleep, parasomnias, hypersomnia disorders and use of drugs or medications. Given the multiple aetiologies of excessive daytime sleepiness in adolescents, the implementation of targeted therapeutic strategies is essential in order to allow optimal management of this symptom and better prevention of its negative consequences. The aim of this review is therefore to provide health care professionals caring for adolescents with excessive daytime sleepiness complaints the currently recommended therapeutic strategies for the main aetiologies of excessive daytime sleepiness in this particular subpopulation.SCOPUS: re.jinfo:eu-repo/semantics/publishe