[Comparative study of 2 groups of bipolar manic-depressive patients treated with lithium or with carbamazepine].
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Adult↗
Biomedical subjects
F Rouillon
Publications and source records attributed to F Rouillon.
[Prevalence and risk factors of suicide and attempted suicide].
Suicide provocates 0.5 to 1% of the deaths in France. Every year, more than 12,000 people die by suicide. In France, the annual incidence rate of suicide is 21/100,000. Among young people (15 to 24) suicide rate is 13.9/100,000 in men and 4.2/100,000 in women. Methods of suicide are hanging (38%), firegun (23%), overdose (13%) and drowning (10%). Among the suicides, most subjects are unmarried, live alone and more often in Paris. Suicide is more frequent during the day than during the night, in the beginning of the week, in summer and in spring. Suicide rates in France are comparable to those observed in United States and Great Britain. Suicide appears to be closely related to psychiatric morbidity. Most frequent psychiatric diagnosis in patients who commit suicide are depression (64%), alcoholism (15%), schizophrenia (3%) and anxiety (3%). 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. Depressives older than 50 and patients with history of attempted suicide have a greater risk of suicide. Among schizophrenics, frequency of suicide is 10 to 13%. Suicide are more frequent during the first ten years of the illness. In patients presenting panic disorder, frequency of suicide is variable according to the authors, between 30% and 3%. Attempted suicide are much more frequent than suicide. The annual rate is 162/100,000 in men and 265/100,000 in women.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[Adjustment disorders: apropos of an epidemiologic survey. Epidemiology and Psychiatry Group].
An epidemiologic survey performed in France in 1990 allowed us to analyze the epidemiologic characteristics of adjustment disorders (AD). AD were defined according to the DSM III-R guidelines. AD are strongly correlated to personality disorders. The study population was young (mean age: 39 years) and predominantly female (60.3%). Marriage or life with a partner, living in the country or in small towns, liberal profession and a high level of schooling are the most significant social and demographic characteristics that emerge from this study. These patients tend to have multiple medical contacts, seeing many doctors but consuming little medication (25% of them). Comorbidity with associated personality disorders (15%) and dependency behaviors (alcohol, drugs) are frequent (9.3%), although no causative link was found between these disorders. Alcoholism may have a tendency to protect against AD. There is no seasonal factor. The patients mostly see private physicians; their geographic distribution is the inverse of the distribution of alcoholism. Numerous social and demographic risk factors for AD were found. Among the personal psychiatric history, disorders of feeding behavior and early adjustment problems were prominent. The family history often shows the existence of mental disorders in the parents. The treatment history points to a lesser consummation of psychotropic drugs, mostly limited for two classes, i.e. antidepressants (50%) and tranquilizers (40.9%), although a different pattern of behaviour was found according to the clinical types of AD. The present therapeutic approach is recent and based on psychotherapy. It differs little according to the clinical forms, with the possible exception of co-prescribed medication. This study has thus allowed us to observe the epidemiologic characteristics of AD. Adjustment disorders appear to be frequent, but their particularities do not differentiate them significantly from other types of mental disorders.
Adjustment Disorders↗
[Survey for participation in therapeutic trials in psychiatry].
In collaboration with the Sofres Institute, a two-phase population survey was conducted in 1991. During the first phase, 10,000 households representative of the French population and regularly surveyed by the Sofres Institute answered five questions by mail. The purpose was to identify subgroups regularly receiving psychotropic drugs and followed up by a physician. They were identified according to whether they used any of some 30 neuroleptic and antidepressant drugs, the most frequently prescribed in their class. According to their answers returned by post, the subjects were classified into three groups: regular psychotropic drug users followed by general practitioners, regular psychotropic drug users followed by specialists (these subjects being considered possibly more severely ill), and non users of these drugs, subjects considered as controls. In the second phase, a random sample of these groups received a detailed questionnaire including 14 questions related to clinical trials. In addition the same questionnaire was given to hospitalised patients in three different psychiatric units. Out of total of 958 subjects who received the detailed questionnaire, 712 answered (a 74% response rate). Results indicate that a majority of the subjects (50% to 74% depending on the subgroups) have already heard about the need for clinical trials to test new drugs. However, less than 20% of these subjects are aware of a recent French law protecting patient rights in clinical trials. This awareness appears to be quite insufficient A large number of subjects do not know whether they have been part of a clinical trial in the past.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[Clinical and epidemiologic study of "generalized anxiety" in general practice].
Recent studies have shown that 16 to 43% of general practice attenders express minor psychiatric disorders (Barrett et al. 1988). The present survey was carried out among a sample of 1,177 patients seen by 121 private general practitioners through out France. Its purpose was: to rate the point-prevalence of general anxiety disorders (GAD) according to DSM III criteria, to evaluate sociodemographic and clinical status of patients with a GAD, to identify the anxiety symptoms that were the most frequently exhibited in a primary-care practice. 181 patients (15.4%) were assessed a GAD diagnosis. 217 patients (18.4%) were assessed a "secondary anxiety" diagnosis ie anxiety associated with an affective disorder (14.8%), phobia (2.5%), panic disorder (1%). Patients with a GAD were predominantly female, between the age of 35-50 years. They tended to be widowed, separated or divorced and of an average socio-economic level. They also had more previous psychiatric disorders. The GAD appeared to start at the middle age of the life (36 years), to be chronic (lasting over one year) in half of the cases, and to be recurrent. The somatic expression of anxiety was frequent (21%) but 34% of the patients expressed directly their psychological distress. Psychotropic drugs were prescribed to 75% of the subjects. Benzodiazepines were prescribed in 34% of the cases. More surprisingly, antidepressive drugs were prescribed more often when a GAD was diagnosed. This results confirm the high point-prevalence rate of anxiety disorders in general practice.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[Controlled study of treatment of residual depression by clomipramine versus placebo].
The choice of a new treatment strategy for a patient suffering from residual depression in sometimes difficult; in reality, any change in the prescription involves a risk of losing any benefit, even partial, that has recently been obtained; consequently, can one be sure that a new antidepressant treatment will be beneficial? To attempt to find the answer to this question, the Laboratories Ciba-Geigy have conducted a controlled study versus placebo to evaluate the efficacy of clomipramine in residual depression which has been progressing for more than a year. 207 patients were pre-included in the 7-day wash-out phase and treated with placebo. During this period, a clinical examination and laboratory work-up made it possible to exclude patients with a curable cause of partial resistance to antidepressants (e.g., hypothyroidism) or who were "placebo-responders". After this run-in, 181 patients were included if they complied with the criteria characterizing a major depressive episode in partial remission (according to the DSM III-R), present for at least one year and treated throughout this period with at least two antidepressants at effective dosages. In addition, these patients had to have a score between 15 and 25 on the Montgomery and Asberg Depression Rating Scale (MADRS). The patients included were randomized into two groups, receiving either an clomipramine 75 tablet or a placebo tablet for two weeks; the dosage could be increased to two tablets as at D14 if necessary and maintained for the next six weeks. The only authorized concomitant treatments were tranquillizers (lorazepam or bromazepam) and/or non-barbiturate hypnotics (zopiclone or flunitrazepam).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Therapeutic management of schizophrenic patients and its cost].
The purpose of this study was to observe the treatment of patients suffering from schizophrenic disorders and to assess the cost of this treatment in medical and social terms. The survey based on a questionnaire was sent to 6,000 French psychiatrists practising both in the hospital sector and in the ambulatory sector, whether acting through the national health service or privately. The psychiatrists who accepted to answer (N = 494) described all the treatment and assistance undergone by the last patient suffering from schizophrenia, as defined by the DSM III-R, seen either during a consultation or when hospitalized during the previous year. The clinical, epidemiological and therapeutic information collected for 356 patients treated as out-patients (72%) and 138 hospitalized patients (28%) in the public (49%) or private (51%) sectors underwent medical and economic modelling. The most frequent forms of schizophrenia encountered were paranoid type (48.6%) and those which developed chronically without severe exacerbation (32%). The average length of time between the date of the survey and the first symptoms is on average 11 +/- 8 years and the average length of time between the date of the survey and the first symptoms is on average 11 +/- 8 years and the average length of time between the first hospitalization is 9.5 +/- 8 years. This means that the time between the first symptoms and the first hospitalization is 25 +/- 4 months on average. The average number of previous full-time hospitalizations is 4 and the patients spent 22 months (+/- 48) in hospital on a full-time basis and 26 months (+/- 39) as day patients in hospital, from the start of their disorders. 27% of patients had at least one previous suicide attempt and 28% had already committed a medico-legal act.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[The serotonin syndrome: review of the literature and description of an original study].
In animals the occurrence of a behavioural syndrome consisting of hyperactivity, stereotyped movements and increase of temperature has been induced by MAOIs, 5-HT precursors (L-tryptophan) and 5-HT reuptake inhibitors. Most of these manifestations were specifically blocked by a pretreatment with an inhibitor of serotonin synthesis. In humans, the association of myoclonus, diarrhea, confusion, hypomania, agitation, hyperreflexia, shivering, incoordination, fever and diaphoresis, when patients are treated with serotoninergic agents, could constitute a "serotonin syndrome". Such cases of serotonin syndrome were reported after treatments with L-tryptophan, MAOIs, serotonin reuptake inhibitors and tricyclics alone or in association. The authors prospectively evaluated all the "serotonin-related" symptoms in 38 depressed inpatients fulfilling DSM III-R criteria of major depression. 16 (42%) out of 38 patients presented at least one symptom of serotonin syndrome. In 14 cases tremor and myoclonus occurred simultaneously and 10 patients presented at the same time tremor, myoclonus, diaphoresis and shivering. Except for two patients, symptoms were transient, lasted less than one week and disappeared with the pursuit of the treatment. Most often, serotonin syndrome thus corresponds to a reaction induced by a combination of serotoninergic agents at high dosages. In very rare cases, a toxic and potentially fatal interaction can occur between MAOIs, tricyclics and selective serotonin reuptake inhibitors at therapeutic dosages. Serotonin syndrome also provides an heuristic model of the putative mode of action of antidepressants. Serotonin-related symptoms are the physical and objective expression of the antidepressant-induced increase in serotonin. The specificity of serotonin-related syndrome also needs to be discussed since most of the symptoms, such as tremor and diaphoresis, are not in all cases related to an increase in serotonin.
Akathisia, Drug-Induced↗