Encephale
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Meta-analysis is being increasingly used in therapeutic and clinical research to synthetize data from terminated clinical trials. Meta-analysis provides a powerful tool to objectively combine data in a quantitative manner, unlike the classical general review of literature, which is qualitative and subjective by definition, and thus not reproducible, and also the simple data pooling, methods which neglects the statistical heterogeneity between studies. The two most known objectives of meta-analysis are, to provide an objective decision when the trial results have produced contradictory or non-significant results, and to give a better estimation of the magnitude of the treatment effect. ⋯ The results of several of these meta-analyses are to be interpreted with the potential biases in mind, especially the publication bias and selection bias. Clinicians must be aware of the difficulties encountered in the choice of outcome criteria, and in deciding how to deal with patients that withdraw from treatment early (intention to treat analysis is the least biased solution for this problem.). Meta-analysis can therefore be helpful in establishing medical references in psychiatry, and to organize consensus conferences, but the limits of this method must be clearly recognized.
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Review Comparative Study
[Treatment of generalized anxiety: new pharmacologic approaches].
First defined as a residual diagnostic category in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), Generalized Anxiety Disorder (GAD) was until recently one of the least studied and least clearly conceptualized of the anxiety disorders. The clinical definition of GAD has however improved up to the fourth edition of the DSM where the disorder is now characterized as a chronic state of apprehensive expectation and uncontrollable worry concerning multiple daily life events or activities and accompanied with at least 3 symptoms belonging to a list of six common manifestations of psychic or motor tension. Clinical research demonstrating the stability and the specificity of somatic symptoms clearly support the validity of the diagnosis of GAD despite possible difficulties in the differential diagnosis with other chronic conditions or axis II disorders such as dysthymia or mixed anxiety-depressive disorder. ⋯ Despite the potential interest of these new treatments of GAD, recent years have shown that the development of new anxiolytic drugs often appears limited by high-rates of placebo response in numerous clinical trials. This phenomenon may be related--in part--to the increasingly sophisticated designs used in such trials, such as extensive diagnostic workups, repeated evaluations and inclusion criteria selecting the less severe types of anxiety. As emphasized by other authors, much more research needs to be done to establish what effects various ways of conducting a trial have on the trial's results in order to facilitate the emergence of new psychopharmacological approaches in the treatment of GAD.
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[Cognition disorders in HIV infection. Validation of a brief neuropsychological evaluation battery].
The objective of our study was the elaboration and the validation of a brief neuropsychological battery sensitive to the main cognitive and psychomotor deficits in HIV+ patients with HIV encephalopathy and cognitive impairment associated with seropositivity. We evaluated the sensitivity of this brief battery with respect to a large neuropsychological battery of standardized tests. ⋯ The brief battery (BB) testing 6 cognitive functions could be considered as a sensitive, practical instrument for rapid detection of cognitive impairment in HIV+ patients, with a few rate of false positive or negative diagnosis. However, it is not adequate for determining whether psychiatric or/and organic brain pathology is at the origin of the deficit. Evaluation and follow-up of a possible anxio-depressive component has to be considered together before concluding.
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Various pharmacologic agents have been reported to be effective in treating negative symptoms of schizophrenia. European schools of psychiatry and especially the French one assumed the opinion that part of negative symptoms of schizophrenia do respond to neuroleptics. In light of effects of reserpine and some phenothiazines on negative schizophrenia, various pharmacologic agents have been studied focusing on these properties. ⋯ Symptoms were assessed by means of 18 item Brief Psychiatric Rating Scale, Positive and Negative Syndrome Scale and Extrapyramidal Symptom Rating Scale (ESRS). Improvement in negative symptoms was significantly correlated to improvement in positive ones and to scores in ESRS. Many open studies concerning anti-depressants and other drugs have been published; however controlled studies are necessary to confirm these data.