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.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.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.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.
This is a case report of a manic-depressive case type II in a melancholic phase (Bipolar affective disorder, depressed) benefiting from a joined drug treatment according to nosological criteria of biological psychiatry (DSM III, RDC) and family sessions on the basis of psychodynamic and systemic criteria according to the logic of family theories. This case illustrates strategies belonging to various frames of reference and their articulation around a particular case.
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Ce travail se propose d'interroger les repercussions du mode d'admission dans un service de psychiatrie, sur la duree de l'hospitalisation et la maniere de quitter l'unite de soins. La question peut etre formulee autrement: une entree urgente dans un service psychiatrique implique-t-elle une sortie precipitee ? Les informations enregistrees dans deux services de psychiatrie bruxellois, implantes assez differemment, sont analysees. Elles couvrent les hospitalisations d'une annee. Quatre criteres ont ete retenus pour etudier les sejours hospitaliers: le mode d'admission, le diagnostic, le type de sortie et la duree d'hospitalisation. Des differences entre les deux unites de soins sont soulignees et des hypotheses sont avancees.
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.
Divergences in cognitive disturbances in hypothyroidism reported in the literature are a result of a methodological bias.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.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.Contrary to what was expected, symptoms of anxiety and not symptoms of depression interfered with the cognitive performance of participants in hypothyroidism.
