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Biomedical subjects

F Rouillon

Publications and source records attributed to F Rouillon.

At least 37 records · Page 2Linked to original sources
PubMed1998

The use of lithium to augment antidepressant medication.

Lithium is one of the most studied agents used to augment the pharmacologic effect of antidepressant drugs, particularly in refractory depression. We reviewed 22 case reports, 22 open trials, 5 open comparison studies, and 9 placebo-controlled studies of lithium augmentation and 6 studies in which antidepressants were added to, or coadministrated with, lithium. The efficacy of the augmentation therapeutic strategy is supported by these analyses, involving 969 patients. The optimal dose and the most effective blood levels of lithium are unclear, but a reasonable strategy would be to start with low doses (600-900 mg/day) and, if necessary, to increase the doses to obtain a level in accordance with the usual therapeutic range of blood levels (0.8-1.2 mEq/L). Some patients respond quickly, but others need a long and combined treatment; it is thus advantageous to prescribe lithium for at least 3 to 6 weeks. Despite the fact that the mechanism of action of lithium augmentation is still unknown, all refractory depressed patients can potentially be treated by lithium augmentation, particularly bipolar patients, to obtain full prophylactic effect as soon as possible.

Adult↗
PubMed1997

Further epidemiological evidence for anticipation in schizophrenia.

Anticipation describes an inheritance pattern within a pedigree in which disease severity increases, and/or age at onset decreases, in successive generations. This phenomenon has been described in different samples of schizophrenic subjects, and could explain many inconsistencies in the inheritability of schizophrenia. Anticipation is, however, subject to numerous and significant biases, partially controlled by different methodologies used in different studies. We analyzed the anticipation effect on an original sample of schizophrenic patients (n = 57) who had at least one other schizophrenic in their family belonging to another generation (father/mother, uncle/aunt, son/daughter). We tested the anticipation effect according to previously published methodologies, such as percentages of parent-child pairs showing negative versus positive anticipation, comparison of anticipation limited to parent-child or uncle-nephew pairs, anticipation analysis on the basis of families with unilineal origins only, and comparison of the age at onset-survival distribution of the two generations. The 31 schizophrenic subjects who belonged to the younger generation had a significantly earlier age at onset (24.58 years) than the 26 schizophrenic subjects who belonged to the older generation (36.46 years). Whatever the method used to control biases, we significantly found earlier age at onset for schizophrenic patients from the younger generation. There is strong evidence for the existence of the anticipation effect in schizophrenia in our sample, as well as in various others, which may elucidate numerous inconsistencies in clinical and epidemiological data which characterize schizophrenia. Looking for expanded trinucleotide repeats is thus the next step to detect the gene(s) that are potentially involved.

Adult↗
PubMed1997

Some aspects of the cost of schizophrenia in France.

This study aimed to investigate how patients with schizophrenia were treated and to evaluate the cost of treatment in medical and social terms in France. The study was questionnaire-based. 6000 French hospital and community psychiatrists in the public and private sectors received the questionnaire. The 494 psychiatrists who responded described the treatment prescribed for, and social assistance provided to, the last patient consulting for schizophrenia-as defined by the criteria of the third edition (revised) of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R)-either as an outpatient or as an impatient in the last year. The clinical, epidemiological and therapeutic data collected on 356 (72%) patients receiving outpatient treatment and 138 (28%) patients receiving impatient treatment in the public (242 patients; 49%) or private (252 patients; 51%) sectors were processed by medical and economic modelling. The mean (+/-standard deviation) time from symptom onset to study entry was 11 +/- 8 years, while the mean time from first hospital admission to study entry was 9.5 +/- 8 years. The mean time from symptom onset to initial hospitalisation was 25 +/- 4 months. 224 patients had been hospitalised in a psychiatric ward at least once in the previous year (45%). The average duration of hospitalisation was 82 +/- 96 days. During the year of the study, 122 patients received part-time treatment in a day hospital or intermediate facility (e.g. occupational therapy centres, therapeutic workshops and therapeutic apartments), 39 (8%) on a daily basis and 83 (17%) one or more times a week; medical care lasted 130 +/- 137 days and 107 +/- 89 days, respectively. The annual complete cost of medical management of the 477 evaluable patients in the study was F27471511 (1992 values). The overall annual treatment cost (medical and social) was F1533724 for medication (5.6% of the complete cost), F2600673 for visits (9.5%), F8285900 for intermediate facilities (30.1%) and F15051214 (54.8%) for hospitalisation. The social allowance cost was F10926000. The average annual costs of medical care and social allowance per patient with schizophrenia were respectively estimated at F54970 and F22905. The annual cost of medical management of schizophrenia in France was thus F12.37 billion ($US2.34 billion).

Adult↗
PubMed1997

[Epidemiology of bipolar disorders. Current studies].

The prevalence of bipolar disorder over a lifetime, which is similar to that for one year since this is a chronic disease, is around 1% of the general population. Estimates of incidence vary (0.3 to 3 cases per 10000). This general morbidity corresponds quite closely to that found in institutions, since patients presenting with bipolar disorders are not necessarily in care. Bipolar disorder affects men and women in equal proportions, and independently of ethnic and cultural background or of socio-economic status. It is nevertheless more prevalent in urban than in rural areas, and is more common in subjects who are divorced, separated or have never married than in married subjects who have never divorced. It mainly affects younger subjects, with the mean age of onset being about 20 years. Furthermore, it appears to be more common in subjects born since 1930-1940. Finally, it is often associated with other mental disorders, particularly alcoholism and drug dependence.

Adolescent↗
PubMed1996

[Chronic fatigue syndrome].

Fatigue is one of the most common medical complaints. Sometimes, fatigue is chronic, unexplained and induces significant distress or impairment in social, occupational or other important areas of functioning. This condition was described as neurasthenia by Beard at the end of the 19th Century; more recently the United States Centers for Disease Control and Prevention (CDC) suggested to call it "Chronic Fatigue Syndrome" (SFC). Both are considered as physical diseases and share certain therapeutic measures. Pathophysiology is still unknown and may involve viral agents, immunological processes or psychiatric disorders. Similarly most of the treatments which have been properly evaluated seem to be more or less inefficacious.

Fatigue Syndrome, Chronic↗
PubMed1996

Cross-cultural study of schizophrenia.

Researchers have used a variety of approaches to assess schizophrenic disorders across cultures. Of the possible ways of studying cultural variations, the one most typically employed involves the accumulation of data in geographically isolated settings and indigenous situations. Another method is through comparative studies of people of various backgrounds living in the same social and geographical environment. This opportunity is provided by immigrants of diverse origins living in the same community. Ninety schizophrenic patients (according to DSM-III-kappa criteria) participated in this study, aged between 18 and 35 years. Three groups were constituted. The first population consisted of second-generation North Africans living and raised in France, the second of native French patients, and the third population consisted of schizophrenic patients living and being raised in North Africa (Algeria), their native country. This study showed that, for the symptoms evaluated, schizophrenic patients from Maghreb have few clinical differences from patients of French origin. Thus, cultural origins do not seem to be of major influence. These results are in concordance with those of the International Pilot Study of Schizophrenia based on a larger international population.

Adolescent↗
PubMed1996

Anticipation in schizophrenia: new light on a controversial problem.

OBJECTIVE: Anticipation, recently found in several neuropsychiatric disorders, is an inheritance pattern within a pedigree in which disease severity increases or age at onset decreases in successive generations. Demonstration of genetic anticipation in schizophrenia could be of heuristic value, since unstable trinucleotide repeat DNA is known to be the biological basis of anticipation. However, to overcome one of the major ascertainment biases that might mimic anticipation--namely, the fact that patients in different generations are not interviewed at the same age, resulting in a greater chance of finding a later age at onset in the older generation--a new method of investigating anticipation was used. METHOD: The study subjects were 97 systematically ascertained schizophrenic patients belonging to 24 families with at least two generations affected who were identified during a 1-year prevalence study in a limited geographical area of Reunion Island (Indian Ocean). A method of calculating expected age at onset according to age at interview was used in the analyses. RESULTS: In the younger generation of patients, the observed age at onset (21.80 years) was earlier than the expected age at onset (24.95 years), demonstrating anticipation, even when five additional biases that can mimic this genetic effect--the proband effect, the presence of an affected father or mother, the bilineality of the illness, the fertility effect, and the cohort effect--were taken into account. CONCLUSIONS: Evidence for anticipation was demonstrated in this group of schizophrenic patients. This may help the search for pathological genes implicated in the genesis of schizophrenia.

Adult↗
PubMed1996

[Pharmaco-epidemiologic study of the use of antidepressant drugs in the general population].

The objective of this study was to evaluate the mode of prescription and the users of antidepressant agents. It consisted of an initial phase (survey of the general population), aimed at selecting a representative sample of antidepressants users by a mail questionnaire, without asking prescribers in order to avoid the bias inherent to such an approach. Results showed a current incidence of use of 2.75 % for the 8 main antidepressants, i.e. more than one million adults in France. The distribution of antidepressants showed Prozac in first place, followed by Anafranil, and Laroxyl, then Stablon, Athymil, Survector and Ludiomil. In more than 50 % of cases, antidepressants have been taken for a year or more, continuously of intermittently. They were prescribed by a general practitioner in 60 % of cases and a psychiatrist in 30 %. A second survey phase (telephone) undertaken by psychiatrists and involving a sample of this population enabled determination of the pathophysiological profile of consumers at the time of prescription of antidepressant treatment, using a validated diagnostic tool, the MINI. Taking all drugs together, results showed that prescription was within Marketing Authorization approved indications in about 65 % of cases (existence of depression 61 %, dysthymia 3 %, OCD 1 %). This study shows that, in 23 % of cases, antidepressants are not used in patients with one of the psychiatric diseases identified by the MINI but nevertheless suffering from pathophysiological symptoms (subsyndronic syndrome). It can be concluded that, in some subjects, antidepressants are used in non-identified disorders. It must also be recognized that, with 3 % of users, the population of individuals treated by antidepressants is less than that of patients suffering, in the general population, from depression (5 to 10 % per year, according to studies).

Adult↗
PubMed1996

[Suicide and psychotropic drugs].

Suicide provocates 0.5 to 1% of the deaths in France. Suicide appears to be closely related to psychiatric morbidity. History of depression is associated with a 30-fold increase in suicide risk. Globally, the annual incidence of suicide among depressives is 1% and 15% of the depressives die by suicide. When depressive symptoms are retrospectively assessed, it appears that 45 to 70% of patients who committed suicide presented depression. Suicide is the main complication of untreated depression. Patients who commit suicide take the more easily available medications. The decrease in the prescription of barbiturates has been associated with a decrease of the frequency of self-poisoning with barbiturates. In the same time, neuroleptics, antidepressants and benzodiazpines, more often prescribed, induced more lethality by suicide. The number of deaths by millions of prescriptions variates, with the antidepressants, between 13 and 166. They correspond to 0.005% of death each year among patients taking antidepressants. In daily practice, the prescription of antidepressants, which alleviates depressive symptoms, usually prevents suicidal risk among depressives. In some rare cases, antidepressants and other psychoactive agents are used by the patients, in overdosage, to commit suicide. According to the results of all controlled studies of antidepressants, suicide attempts are more frequent among patients taking antidepressants (1.7% of the cases) than among patients receiving placebo (0.8%). These data may be related to methodological bias which are discussed here. They do not initiate to restrain the prescription of antidepressants to depressed patients but to provide more frequent consultations and even to hospitalize depressives at high risk for suicide.

Antidepressive Agents↗
PubMed1996

[Epidemiology of panic disorder].

The prevalence of panic disorder in the general population is 2,3% over a person's whole life, and 0,5-1% per year. International studies have yielded more widely varying estimates of the prevalence of panic attacks (4-12%). The proportion of patients consulting their doctors for panic disorder is also highly variable; the frequency is a function of the medical specialty (being highly represented in cardiology and the emergency services). In psychiatry, panic disorder represents the main diagnosis in one patient out of 10 or 20. Panic disorder is more common in women than men, and in young or middle-aged subjects and those living alone (separated, widowed or divorced). In socio-economic terms, it is the socio-educational level rather than income or profession that appears to be the determining factor. Lastly, residence (urban/rural) and the fact of belonging to a particular socio-cultural group seem to play little part. As with many mental disorders, two predisposing factors have been found to operate: a genetic element, as shown by family and twin studies, and an element relating to psychoaffective development (traumatic events in childhood, separation anguish, etc.). Panic disorder is commonly associated as a comorbid trait with other neurotic and anxiety disorders, depression, alcoholism and drug abuse. These associations represent poor prognostic factors associated with chronicity, attempted suicide and social handicap. Prospective studies of overall outcome have shown complete remission rates of 10-20% at 3 or 5 years. However, if the occasional occurrence of a few panic attacks is regarded as acceptable, the prognosis can be regarded as good for two-thirds of affected subjects.

Adolescent↗
PubMed1995

[The long-term course of depression (epidemiology and clinical aspects)].

Depression recurs in three quarters of cases; it is therefore necessary to undertake long-term studies in order to understand the clinical and epidemiological implications. Current classifications schematically distinguish depressive episodes according to their more or less permanent and complete semiological expression (at least five symptoms over at least two weeks for a major depressive episode, versus at least two criteria for the greater part of the time over at least two years) or their time-scale (isolated or recurrent episodes; recurrent brief depressive episodes...). The terminology of therapeutic strategies is based on the temporal definitions of the depressive process. Thus one speaks of curative treatment during the acute phase of the illness (two months), maintenance treatment during recurrence (four to six months), and prophylaxis against later possible recurrences (more than six months). Epidemiological findings emphasize the importance not only of recurrence of depression (50% in the year following an index episode), but also that of becoming chronic (20%), of partial remissions (15 to 20%), and the "bipolarisation" of a unipolar illness (10 to 15%). Finally, certain risk factors for recurrence have been identified. The most important of these is a large number of previous depressive episodes.

Adult↗
PubMed1994

[Mood regulator agents (excluding lithium)].

Several anti-epileptic drugs have been shown to have a thymoregulatory effect and are thus alternatives to lithium treatment. They are mainly carbamazepine and, to a lesser degree, valproate (the use of clonazepam is only anecdotal in this indication). Their indications and contraindications are different from those of lithium, and they are highly useful in treatment. In addition, prescription is easy and tolerance good as long as precautions are respected and laboratory surveillance affords early detection of rare liver or blood complications.

Anticonvulsants↗