[Bipolar depression: a review of current therapeutic strategies]

It is now acknowledged that depressive symptoms dominate the natural history of bipolar affective disorder. Treating bipolar depression therefore represents a major therapeutic issue that has paradoxically been understudied compared to the treatment of acute manic or hypomanic episodes. Thanks to a computerized and manual bibliographic search, we reviewed the literature pertaining to the somatic treatments of bipolar depression. It is initially advisable to implement or optimize the thymoregulator treatment by carrying out a blood titration and by adjusting the therapeutic rates as well as possible towards the upper recommended levels. In the second place, the adjunction of another mood stabilizer may be necessary to obtain euthymia while preventing a mood switch to mania. Atypical antipsychotics may have some efficacy in treating bipolar depression, but further evidence is needed. Antidepressants are generally prohibited due to the risk of induction of mania or rapid cycling. Their use is generally limited to severe cases in which the association of at least two mood stabilizers has failed.

Single-file diffusion of interacting particles in a finite-sized channel

We study the dynamics of charged macroscopic particles (millimetric steel balls) confined in a linear channel of finite length, sufficiently narrow to avoid particles crossing. We show that their individual response to thermal fluctuations strongly depends either on their position in the channel or the local potential they experience. Three different dynamical regimes are identified. At small times, a "free regime" takes place, with the outermost particles exhibiting the highest diffusion coefficient. This effect results from an "echo" of the thermal fluctuations reflected by the channel wall. Then, forbidden crossing induces a correlated regime similar to single file diffusion. Surprisingly, the corresponding mobility increases with the local potential. Lastly, the finite length of the channel induces the saturation of fluctuations. We show that those behaviors may be described heuristically with the help of models for N hard-core interacting particles diffusing in a finite channel of length L, provided that we replace the uniform interparticle distance L/N by a characteristic distance (k(B)T/K)(1/2) built upon the temperature T and the stiffness K of the local potential. It provides a very satisfactory estimate for the fluctuations sizes, whereas they are greatly overestimated assuming hard-core interactions.

Single-file diffusion of macroscopic charged particles

In this paper, we study a macroscopic system of electrically interacting metallic beads organized as a sequence along an annulus. A random mechanical shaking mimics the thermal excitation. We exhibit non-Fickian diffusion (single-file diffusion) at large time. We measure the mobility of the particles and compare it to theoretical expectations. We show that our system cannot be accurately described by theories assuming only hard-sphere interactions. Its behavior is qualitatively described by a theory extended to more realistic potentials [M. Kollmann, Phys. Rev. Lett. 90, 180602 (2003)]. A correct quantitative agreement is shown and we interpret the discrepancies by the violation of the assumption of overdamped dynamics, which is a key point in the theory. We recast previous results on colloids with known interaction potentials and compare them quantitatively to the theory. Focusing on the transition between ordinary and single-file diffusions, we exhibit a dimensionless crossover time that is of order 1 both for colloids and our system, although the time and length scales differ by several orders of magnitude.

Treatment response in major depression: effects of personality dysfunction and prior depression

BACKGROUND

The impact of personality dysfunction on the outcome of treatment for depression remains debated.

AIMS

To examine the relationship between the number of prior depressive episodes, personality dysfunction and treatment response for depression.

METHOD

In a large sample (n = 8229) of adult out-patients with a major depressive episode (DSM-IV), personality dysfunction was assessed using the Standardised Assessment of Personality - Abbreviated Scale (SAPAS). Potential predictors of treatment response at 6 weeks were examined via structural equation modelling.

RESULTS

The amount of personality dysfunction and number of prior episodes of depression were both associated with poor response to treatment. Once personality dysfunction was controlled for, the number of prior episodes of depression was not associated with treatment response.

CONCLUSIONS

Personality dysfunction is associated with impaired short-term response to antidepressant treatment in major depression. The apparent detrimental effect of prior depression on treatment response may be accounted for by pre-existing personality dysfunction.

Clinical correlates of atypical depression and validation of the French version of the Scale for Atypical Symptoms (SAS)

BACKGROUND

The 8-item "Scale for Atypical Symptoms" (SAS) and its structured interview, the SIGH-SAD, have been developed to assess atypical symptoms of depression in winter depression. Although they are commonly used, no validation study has yet been conducted.

METHODS

270 consecutive depressed inpatients were assessed prospectively. Pearson's correlation coefficients between fulfilment of Liebowitz criteria for atypical depression and both the SAS score and the atypical balance [ratio of the AS score to the total score on the Hamilton Depression Rating Scale 29-item (HDRS-29)] were calculated. The SAS was evaluated against Liebowitz criteria using binary logistic regression. A ROC curve was performed with the atypical balance against the fulfilment of Liebowitz criteria.

RESULTS

18.5% of patients met the criteria for atypical depression. The presence of an atypical depression was significantly correlated with both the atypical score (r=0.42) and the atypical balance (r=0.51). The logistic regression showed that a higher score on the SAS, the absence of a somatic syndrome (ICD-10) and a lower HDRS-21 score were independent predictors of an atypical depression while age, gender and bipolarity were not. The ROC curve showed that an atypical balance of 29% was the optimal threshold for the diagnosis of atypical depression (sensitivity=0.86, specificity=0.79).

LIMITATION

Patients with bipolar I and II were not distinguished.

CONCLUSION

Atypical depression is relatively frequent in hospitalised patients. The concurrent validity of the French version of the SAS and its structured interview, the SIGH-SAD is satisfactory.

[Locally advanced (neglected) breast cancer: the reality? Relevance of two cases and reflection how to optimise the multidisciplinary approach]

The standard treatment for breast cancer patients with untreated locally advanced breast cancer is neo-adjuvant chemotherapy or hormonal treatment. In some cases, this treatment is followed by surgery and/or radiotherapy when the multidisciplinary approach is present. In some cases of patients presenting metastatic diseases, the radiotherapy is forgotten or proposed late when the local disease is extremely advanced with symptoms and decreased quality of life. Two cases of extremely advanced non operable T4 stage breast cancer are reported and the importance of multidisciplinary approach is discussed. The place and the right time of radiotherapy in this multidisciplinary strategy is reported.