Introduction. - Data concerning the clinical and therapeutic characteristics of patients with schizophrenia treated by antipsychotic in naturalistic conditions are useful. Two national pharmacoepidemiological studies were conducted in France, a retrospective survey REALITE and a prospective study REALITE LT, to examine the use of loxapine, first in acute and chronic psychotic states and second in long-term treatment prescribed for patients with schizophrenia. Aim of study. The aim of REALITE LT is to specify the clinical characteristics of schizophrenic patients treated by loxapine for at least 4 months and the description of the methods of use of this antipsychotic medication during a 6-month follow-up in "real life" conditions.Aim of study. - The aim of REALITE LT is to specify the clinical characteristics of schizophrenic patients treated by loxapine for at least 4 months and the description of the methods of use of this antipsychotic medication during a 6-month follow-up in "real life" conditions.Design of study. - REALITE LT is an epidemiologic, observational, longitudinal, prospective (during a half-year period), multicenter and national study of the prescription of loxapine in routine clinical practice. For this study, 645 patients with schizophrenia treated by loxapine were recruited, assessed by PANSS, CGI, GAF, MeDra-SOC-PT for side effects and Girerd questionnaire for compliance; statistical analysis used SAS 9.2.Results. - Six hundred and forty-five adult patients were included and assessed at inclusion, month 3 and 6. These patients were mostly male (69%), with an average age of 41, inactive (68%), lonely with no child (79%), under psychiatric care for more than 5 years (81%), less than one third were inpatients. The subtypes of schizophrenia were paranoid (59%), disorganised (21%), undifferentiated or residual (10%), the outcome of psychotic illness was episodic (50%) or continuous (33%). The daily mean dosage of loxapine was 168,4 mg/d, in antipsychotic loxapine monotherapy (27%) or in combination with other antipsychotics (63%); it was often associated with psychotropic medications (anxiolytic [72%], antidepressant [21%], normothymic [19%]). The stability of the dosage of loxapine during the 6 months follow-up (60%) was associated with strict loxapine monotherapy or antipsychotic monotherapy (loxapine associated with other psychotropic medication). Safety, side effects and compliance were compared with previous studies.Discussion and conclusion. - These results are discussed, comparing the two pharmacoepidemiological studies REALITE and REALITE LT, loxapine is used in compliance with the two indications (smpc) and French guidelines (HAS, Haute Autorite de sante). (C) L'Encephale, Paris, 2011.

Une enquête pharmaco-épidémiologique observationnelle rétrospective a été mise en place, pendant 24 semaines, d’octobre 2004 à mars 2005, sur tout le territoire métropolitain (384 enquêteurs) afin de mieux cerner l’utilisation de la loxapine dans les états psychotiques aigus et chroniques. L’objectif de cette enquête nationale était de préciser ; à travers deux cohortes de patients adultes l’une « en phase aiguë » (prescription de loxapine dans les 4 semaines précédentes), l’autre dite « en phase de maintien » (prescription de loxapine depuis plus de 8 semaines), le profil clinique et thérapeutique de patients pris en charge par cet antipsychotique. La population recrutée (1 511 patients) présentait des données sociodémographiques identiques dans les deux groupes, les critères de sélection étaient adaptés aux données recueillies pour une analyse statistiquement pertinente soit 696 patients en phase aiguë et 633 patients en phase de maintien. Le groupe phase aiguë se composait de patients majoritairement connus (82 % d’antécédents psychotiques) sous forme de schizophrénie (47 %) ou de troubles de l’humeur (57 %), ayant déjà présenté des épisodes aigus (5,4 en moyenne) ; pour l’épisode actuel, la clinique était celle d’un état d’agitation (88 %), d’une durée moyenne de 15 jours ayant nécessité une hospitalisation (87 %), dont une hospitalisation sous contrainte (47,5 % en HDT et 40,8 % en HO) et une prescription de loxapine en monothérapie (56 %) à la dose moyenne quotidienne de 177,3 mg. Le groupe phase de maintien comprenait une population de patients connus (87,5 %), schizo-phrènes (63 %), présentant des symptômes psychotiques (dissociation 82 %, délire 74 %) ou thymiques (71 %) ayant nécessité une hospitalisation libre (78 %) sur une durée moyenne de 180 jours et une prescription de loxapine en monothérapie dans 28 % des cas à la dose moyenne quotidienne de 131,6 mg. L’association loxapine - halopéridol (21 %) était d’autant plus fréquente dans le second groupe que les troubles étaient anciens ; dans les autres cas la loxapine était associée aux principaux antipsychotiques de seconde génération : rispéridone (16 %), olanzapine (16 %), amisulpride (11 %). Pour l’ensemble de la population étudiée l’évaluation par la CGI retrouvait une amélioration clinique nette ou marquée et sans effet secondaire significatif dans plus de 80 % des cas.

A retrospective observational pharmaco-epidemiological survey was conducted during 24 weeks between October 2004 and March 2005 in metropolitan France (384 investigators) to more clearly define the use of loxapine in acute and chronic psychotic states. The objective of this national survey was to specify the clinical and therapeutic profile of patients managed by this antipsychotic in two cohorts of adult patients: one in "acute phase" (prescription of loxapine during the previous 4 weeks), the other in "maintenance phase" (prescription of loxapine for more than 8 weeks). The two groups of the recruited population (1,511 patients) presented identical sociodemographic data. Selection criteria were adapted to the data collected to ensure statistically relevant analysis: 696 patients in acute phase and 633 patients in maintenance phase. The acute phase group was predominantly composed of known patients (82% of patients had a psychotic history) with schizophrenia (47%) or mood disorders (57%) who had already presented acute episodes (an average of 5.4). The current episode consisted of a state of agitation (88%) lasting an average of two weeks, requiring hospitalization (87%), scheduled admission [HDT (admission at the request of another person) in 47.5% of cases and HO (statutory admission) in 40.8% of cases] and prescription of loxapine monotherapy (56%) at a mean daily dose of 177,3 mg. The maintenance phase group comprised a population of known patients (87.5%), schizophrenics (63%), presenting psychotic symptoms (dissociation 82%, delusions 74%) or mood disorders (71%) requiring voluntary hospitalization (78%) for a mean duration of 180 days and a prescription of loxapine monotherapy in 28% of cases at a mean daily dose of 131.6 mg. The loxapine-haloperidol combination (21%) was prescribed more frequently in the second group in the case of chronic disorders; in the other cases, loxapine was coprescribed with the main second generation antipsychotics: risperidone (16%), olanzapine (16%), amisulpride (11%). CGI assessment of the overall study population revealed a marked or very marked clinical improvement with no significant adverse effects in more than 80% of cases.

Medical information for the general public, patients and their families is a current Public Health priority. What information can be given to a patient suffering from schizophrenia, whose understanding and judgement capacities are supposedly affected by this mental disease? In the United States, 70% of psychiatrists inform patients of schizophrenia and diagnosis of schizophreniform disorder, while in Japan less than 30% do this. The lack of information given to the general public on the disease may contribute to reinforcing the difficulty in announcing the diagnosis. Indeed, the beliefs and attitudes of the patient, his/her family, the general population and health carers concerning the disease do not match up. However, the first two years seem to be a main issue for the subsequent evolution of the disease. No specific data on the attitude of French clinicians with respect to the announcement of the diagnosis is available. In the current legal context and in view of the advances in treatment, we have carried out a survey among French psychiatrists. It is an auto-questionnaire, transversal epidemiological, descriptive and analytical. The questionnaire was sent to a population of 12,958 psychiatrists. It comprised 48 questions: 7 referred to the socio-demographic and professional characteristics of the subjects, 22 to the attitude with respect to the announcement of the diagnosis to the patients, and the last 18 concerned the attitude with respect to the announcement of the diagnosis to the families. 1,691 questionnaires were returned by free post and analysed. The socio-demographic characteristics of the sample are close to those of French psychiatrists as a whole. The number of patients suffering from schizophrenia in the active files of the psychiatrists is 24% (+/- 21.4) on the entire sample. Approximately a third (37.8%) of psychiatrists deem it necessary to announce the schizophrenia diagnosis and approximately two thirds (69.5%) declare that they sometimes announce it. Among the patients suffering from schizophrenia in the active files of the psychiatrists who responded, approximately a third (34%) were informed of their diagnosis. The main reasons for not announcing the diagnosis are firstly the "reticence to give a diagnosis label" and secondly "the functional incapacity of the patient to understand the concept". The alternative diagnosis term most commonly used is "psychosis" (46.5%). However, 48.1% of practitioners state that the announcement of a specific diagnosis allows a better therapeutic combination. Depending on the proportion of patients suffering from schizophrenia in their active file presented in two categories (< 10% and > 10%), psychiatrists significantly most frequently announce the specific diagnosis (17.3% vs 25.3%, p < 10(-3). A statistically significant proportion of younger psychiatrists (44.4 vs 46.3, p < 10(-3) with fewer years of practice (14.1 vs 15.8), more often believe that it is necessary to announce the diagnosis. The rate of response (13.5%) for this type of survey seems high, which could indicate a high interest among psychiatrists with respect to this question. Our data showed the existence of a correlation between age, number of years in practice, type of practice and the proportion of patients suffering from schizophrenia in the active file on the one hand and the attitude of the psychiatrists with respect to the announcement of the diagnosis on the other hand. It is possible that the multi-disciplinary team work of public practice psychiatrists and the fact that they are more often confronted with schizophrenic disease facilitate the announcement of this diagnosis. In the survey population, the inability to give a diagnosis may be related to the questions of the practitioners about the capacity of the subjects to understand, the lack of precision of this diagnosis, the fear of disheartening the patients and the absence of curative treatment. The risk of suicide does not seem to be one

UNLABELLED:The notion of stabilization in schizophrenia has been investigated, in France, through a survey of 875 psychiatrists. This survey, which has been conducted on the 9th, 10th and 11th of December 1997, looked into the clinical, therapeutic and socio-demographic variables, and the means of patient management, which are used by psychiatrists to ascertain that their patients are stabilized. The data was collected by each psychiatrist by way of a questionnaire administered to his or her next three patients, either at the hospital or in private practice (2,464 questionnaires were completed). RESULTS:65% of the patients seen during this survey were considered stabilized by their psychiatrist (n = 1,597). The most common clinical presentation was of the paranoïd type. An insiduous onset of disease seems to be correlated with an absence of stabilization. Stabilization appears to be estimated at a given time rather than over a time period, since over half the patients who were considered stabilized had suffered at least one relapse over the last 2 years, and had been rehospitalized an average of 2.4 times over that period. In terms of drug therapy, they received 1.4 neuroleptic drugs, which does not differ markedly from the 1.5 neuroleptics administered to patients who were considered non stabilized. Co-prescriptions of anticholinergic medications, benzodiazepines and antidepressants were very common in these patients considered stabilized (49.9%, 39.8% and 24.8% respectively), which is similar to that observed in their non-stabilized counterparts (47.6%, 45%, 8% and 26.4%, respectively). Patient follow-up remained above an average of 1 patient visit per month (an average of 8.9 visit over the last 6 months), despite the fact that patients were considered stabilized. Two primary criteria were used by psychiatrists to determine that a patient was stabilized: treatment compliance and the absence of positive symptoms. However, 43% of the patients which were considered stabilized still presented with positive symptoms. Negative symptoms were also very prevalent in these patients (65%), as well as concomitant depressive signs (36%) and anxiety (64%). CONCLUSION:Even though the concept of stabilization remains difficult to define, it appears that schizophrenic patients are considered by their psychiatrist as stabilized on the grounds of good treatment compliance and decreased positive symptoms. Therefore, even in these so-called stabilized patients, enhancements are still possible, as symptoms remain present.

The notion of stabilization in schizophrenia has been investigated, in France, through a survey of 875 psychiatrists. This survey which has Seen conducted on the 9th, 10th and 11th of december 1997 looked into the clinical, therapeutic and socio-demographic variables, and the means of patient management, which are used by psychiatrists to ascertain that their patients are stabilized. The data was collected by each psychiatrist by way of a questionnaire administered to his or her next three patients, either at the hospital or in private practice (2464 questionnaires were completed). Results : 65 % of the patients seen during this survey were considered stabilized by their psychiatrist (n = 1 597). The most common clinical presentation was of the paranoid type. An insiduous onset of disease seems to be correlated with an absence of stabilization. Stabilization appears to be estimated at a given time rather than over a time period, since over half the patients who were considered stabilized had suffered at least one relapse over the last 2 years, and had been rehospitalized an average of 2.4 times over that period. In terms of drug therapy, they received 1.4 neuroleptic drugs, which does not differ markedly from the 1.5 neuroleptics administered to patients who were considered non stabilized Go-prescriptions of anticholinergic medications, benzodiazepines and antidepressants were very common in these patients considered stabilized (49,9 %, 39,8 % and 24,8 % respectively), which is similar to that observed in their non-stabilized counterparts (47,6 %, 45 %, 8 % and 26,4 %, respectively). Patient follow-up remained above an average of 1 patient visit per month (an average of 8.9 visits over the last 6 months), despite the fact that patients were considered stabilized Two primary criteria were used by psychiatrists to determine that a patient was stabilized : treatment compliance and the absence of positive symptoms. However, 43 % of the patients which were considered stabilized still presented with positive symptoms. Negative symptoms were also very prevalent in these patients (65 %), as well as concomitant depressive signs (36 %) and anxiety (64 %). Conclusion: Eventhough the concept of stabilization remains difficult lo define, ii appears that schizophrenic patients are considered by their psychiatrist as stabilized on the grounds of good treatment compliance and decreased positive symptoms. Therefore, even in these so-called stabilized patients, enhancements are still possible, as symptoms remain present.

Having reviewed the place of depressive complaint within contemporary nosography, the authors study the psychopathological aspect of clinical pictures called "dysthymias". The rapport of patients with their internal or external objects is deeply ambivalent and characterized by a link that Michael Balint calls "ocnophilic". Those patients also appear peculiar regarding their relationship with temporality, with what can be called: a "dictatorship of the present" reflecting their inability to be located in a "narrative" development. Some principles stem from these considerations, concerning therapeutic strategies as does a reminder of the difficulties in bringing about a genuine evolution.

Apres avoir resitue la plainte depressive dans les cadres nosographiques actuels, les auteurs etudient les particularites psychopathologiques de ces tableaux cliniques que l'on peut nommer dysthymiques. Le rapport du patient a ses objets internes ou externes est fondamentalement ambivalent et caracterise par un lien que Michael Balint qualifie d'ocnophile. La relation dysthymique a la temporalite apparait qualifiable comme dictature du present, traduisant l'incapacite de ces patients a se situer dans un deroulement narratif. De ces considerations decoulent quelques principes, pour une strategie therapeutique, et l'evocation de la difficulte a introduire une veritable evolution

Two sperm whale oils from the northern hemisphere and two from the southern hemisphere were fractionated. Triglyceride and wax esters were examined for fatty acids and alcohols with monoethylenic unsaturation bearing a methyl branch on an ethylenic carbon. The 7-methyl-7-hexadecenoic acid (0.37-1.37%) was accompanied by the corresponding alcohol (0.28-0.72%), but these materials were not accompanied by shorter chain homologues. The 7-methyl-6-hexadecenoic acid was relatively less important (0.23-0.68%), but was accompanied by 5-methyl-4-hexadecenoic acid (0.10-0.39%), and a partially identified C13 compound. Chromatographic properties on silver nitrate impregnated silicic acid TLC and on three GLC liquid phases are reported.

1.1. Critical examination of egg membrane lipid fatty acids showed essentially no nonadecenoic or heneicosanoic acids.2.2. A previous report of the occurrence of these acids was probably due to confusion with di-isobutyl and di-n-butyl phthalate esters.3.3. The phthalate esters were rapidly extracted from conventional screw caps on storage vials by diethyl ether, but less readily by other solvents.

The 22 : 1 alcohols in wax esters of some North Atlantic copepods, which amounted to 45% of total fatty alcohols, were found by oxidative fission to contain 80% of the ω11 isomer. This isomer proportion is discussed in terms of biosynthesis and the role of copepods in the food of capelin and other fish.