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H Verdoux

Publications and source records attributed to H Verdoux.

103 records · Page 6Linked to original sources
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[Relationships between insight and medication adherence in subjects with psychosis].

BACKGROUND: Poor medication adherence in subjects with psychosis has a high prevalence and a negative impact on clinical outcome. Several studies have reported that a poor level of insight was a strong predictor of poor medi-cation adherence. However, few studies have investigated whether insight was associated with medication adherence, independently from other clinical and treatment characteristics. OBJECTIVE: To explore the link between insight and medi-cation adherence in subjects with psychosis, and to assess the impact of potential confounding factors on this association. METHOD: Subjects included in the study were patients aged 60 or less, consecutively admitted in a psychiatric ward, and presenting with at least one psychotic symptom (delusion or hallucination). Medication adherence was assessed using: 1) history of total discontinuation of treatment against medical advice over the 2 weeks before admission; 2) the 7-point rating scale developed by Kemp et al.; 3) the self-report questionnaire Drug Attitude Inventory (DAI). The Scale to assess Unawareness of Mental Disorder (SUMD) was used to measure level of insight. Assessment of symptoms was performed using the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS), and the Calgary Depression Scale (CDS). DSM IV diagnoses were assessed using the Diagnostic Interview for Psychosis (DIP). The associations between level of insight (SUMD scores) and the three measures of medication adherence were explored using the non-parametric Mann-Whitney and Spearman's tests. Logistic regression models giving Odds Ratios (ORs) and 95% confidence intervals (95% CI) were used to examine the impact of potential confounding variables on the associations between level of insight and medication adherence. RESULTS: 42 patients presenting with schizophrenia broadly defined (n=25) or psychotic mood disorder (n=17) were assessed. Significant associations were found between higher SUMD scores (ie poorer insight) and discontinuation of treatment before admission (z=- 2.6, p=0.009), poor medication adherence rated using the Kemp et al.'s scale (r=- 0.64; p=0.0001), and negative perception of treatment assessed using the DAI (r=- 0.405; p=0.009). The Kemp'scale score and the DAI score were categorised into poor vs. good according to the median for logistic regression analyses. Subjects were 1.7 times more likely (OR=1.7, 95% CI 1.1-2.5, p=0.01) to have discontinued their treatment, 1.9 times more likely (OR=1.9, 95% CI 1.3-2.8), p=0.0003) to have poor medication adherence rated with the Kemp's scale, and 1.8 times (OR=1.8, 95% CI 1.2-2.6, p=0.005) more likely to have a negative perception of the treatment for one point increase at the SUMD score (ie lower level of insight). The associations between SUMD score and the three measures of medication adherence were not modified after adjustment for demographic characteristics (age, gender, educational level, occupational status, marital status) and categorical diagnosis (schizophrenia broadly defined vs. psychotic mood disorder), severity of symptoms (SANS, SAPS, CDS scores), characteristics of the psychotropic treatment, diagnosis of substance or alcohol use disorder, age at onset, and number of previous admissions. CONCLUSION: The study demonstrates that medication adherence is associated with the level of insight, independently from other patient's demographic and clinical characteristics. The association between low level of insight and poor medication adherence should be confirmed using prospective studies carried out in ambulatory patients. These findings suggest that psycho-educational programs aimed at improving insight should be developed in order to improve medication adherence.

Adult↗
PubMedDate not supplied

[Irreversible neurologic sequelae caused by lithium].

Lithium therapy can induce acute toxic reactions especially during overdosage. Exceptionally, permanent neurologic sequelae persist after the acute toxic reaction. These sequelae are more often cerebellar symptoms. Dementia, parkinsonian syndromes, choreoathetosis, brain stem syndromes and peripheral neuropathies have also been described. They are defined as irreversible if they persist more than two months after the interruption of lithium treatment. These neurologic complications occur frequently after voluntary or accidental poisoning but they may be observed even if the serum lithium dosage is below toxic level. Risk factors other than overdose are not well identified. Neurologic lesions induced by lithium can occur in the first days of the treatment as well as after years of maintenance therapy. Age and psychiatric diagnosis do not seem to be correlated with an increased risk of lithium induced neurotoxicity. Sex may be a risk factor, because of an overrepresentation of women among the case reports. The lithium-neuroleptic combination is another possible (although controversial) risk factor precipitating the occurrence of irreversible neurologic sequelae. Haloperidol was first implicated, but it has been shown that others neuroleptics, in combination with lithium, can induce similar toxic reactions. Intercurrent somatic illness with pyrexia often precedes the acute toxic reaction, and special attention must be paid to patients treated by lithium when they become hyperthermic. Major surgery, concurrent treatment with diuretics, renal failure, low food intake or low-salt diet are more uncommon precipitating factors. Available pharmacological treatments have not yet proved to be helpful. Even when the lesions are irreversible, a functional improvement can be obtained by rehabilitation. Thirty one cases of irreversible neurologic sequelae are reviewed.

Female↗
PubMedDate not supplied

[Neuropsychiatric aspects of HIV infection and AIDS].

Neurotropism of H.I.V. has recently been recognized. More than one third of Aids patients have neurological complications (infections, tumors, multifocal progressive leuko-encephalopathy...) attributed to immunological failure. Necropsy reveals more frequent neuropathology (75%). "AIDS Dementia Complex" (A.D.C.) has been described. Neuropsychological impairment (and personality alteration) is frequent (20-40%) even in asymptomatic patients. H.I.V. infects the C.N.S. early in the course of viral infection and prior to the development of classical associated neurological abnormalities. Mental disorders are frequent: anxiety, depression, suicidal behavior, etc. They can be psychological reactions, although they are often already present before H.I.V. infection in "high risk groups". The signification of psychosis is discussed. Overview of literature.

AIDS Dementia Complex↗
PubMedDate not supplied

[Potentiation of antidepressive treatment by thyroid hormone therapy. Review of the literature].

The association of thyroid hormone and antidepressant has been proposed for about twenty years, mainly for refractory depression treatment. Review of ten trials made since 1969 does not bring positive arguments in favor of this association (most of these trials have poor or no methodology). It is necessary to undertake double-blind placebo controlled studies on refractory depressed inpatients, in order to ascertain the real usefulness of this association.

Antidepressive Agents↗
PubMedDate not supplied

[Clinical study of a population of patients hospitalized for eating disorders. Discussion of DSM III-R diagnostic criteria].

Patients consecutively referred for a clinical diagnosis of eating disorders to the Unit for Addictive Disorders at the University Hospital of Nantes were included in the study. The sample contained 95 patients (94 females, 1 male; mean age +/- SD: 24.1 +/- 6.5). All the patients were evaluated with the Computerized Multiple Diagnostic Instrument for Eating Disorders, which assesses diagnostic criteria for eating disorders from different international diagnostic classifications. Seven (7%) patients fulfilled the DSM III-R criteria for anorexia nervosa (AN) and 42 (44%) the DSM III-R criteria for bulimia nervosa. Two subgroups of bulimic patients were distinguished according to Body Mass Index [anorexia-bulimia (AB) if BMI was < 18 (n = 11, 12%) and normal weight bulimia (NWB) if BMI was > 18 (n = 31, 33%)]. Most patients (n = 46, 48%) did not fulfill DSM III-R criteria for AN or bulimia, and were given the residual DSM III-R diagnosis of eating disorder not otherwise specified (EDNOS). A comparison was made of the frequencies of the different weight control strategies displayed by the patients of the 4 subgroups. Vigorous exercise was more frequently used by AN patients than by patients of the 3 other subgroups. Vomiting was more frequent in bulimic patients, although this symptom was displayed by 29% of the AN patients and 24% of the EDNOS. Abuse of laxatives or diuretics was similar in the four subgroups. Use of diuretics was infrequent in the total sample of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[Obstetrical complications and schizophrenia. Comparative study of obstetric antecedents in schizophrenic and bipolar patients].

Information on pregnancy and birth complications was recorded for 46 patients with DSM III-R schizophrenia or bipolar disorder. The biological mothers of the patients were interviewed personally to obtain obstetric information. There were no significant differences between schizophrenic and bipolar patients in age at the assessment, distribution of sex, paternal social class, age of the mother at birth, and birth order. Biological mothers of schizophrenics had more often than mothers of bipolar patients an history of miscarriage, but this trend failed to reach statistical significance. Pregnancy complications and birth weight were not significantly different between schizophrenic and bipolar patients. Birth complications were scored according to the method described by Parnas et al. (1982). Three scores were obtained for each patient: a frequency score, a severity score, and a total score. All the scores were significantly higher in the schizophrenic than in the bipolar group (frequency score p < 0.011; severity score p < 0.015; total score p < 0.01). Surprisingly, birth complications were more severe in female than in male schizophrenics (p < 0.017). The two groups of patients could not be differentiated by specific birth complication. The schizophrenic patients with a history of birth complication and those without such an history did not differ in age at onset, age at first hospitalization, family history of schizophrenic or non-affective psychotic disorder, neuroleptic resistance, and type of schizophrenia. Because of the small number of subjects in each group a type II error cannot be excluded for these negative results.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
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[Comorbidity of bipolar and eating disorders. Epidemiologic and therapeutic aspects].

The frequent association of bulimia nervosa and affective disorders is well documented. Most studies on this topic have focused on the comorbidity of bulimia nervosa and unipolar depression. The literature on the comorbidity of eating disorders and bipolar disorder is more sparse. Nevertheless, an increased rate of bipolar disorder, especially bipolar II disorder, has been found by several epidemiological studies in patients with bulimia nervosa. This association might be more frequent in bulimic patients presenting with a severe chronic type of eating disorder. The relatives of bulimic patients also display an increased morbid risk for bipolar disorder. Although the comorbidity of bulimia and bipolar disorder does not appear coincidental, the nosological relationships between these two disorders are not perfectly clear. The possible relationships between seasonal affective disorders and bulimia nervosa have recently been suggested by some epidemiological studies, demonstrating that bulimia may display seasonal variations with winter worsening of bulimic symptoms. Eating symptoms are present in both winter depression and bulimia nervosa. The carbohydrate craving encountered in the former disorder could be compared to "binge eating" in bulimic patients. Epidemiological data suggest that winter depression is most frequently part of a bipolar II disorder. Few data are available concerning the therapeutic implications of the association of bulimia nervosa and bipolar disorder. Some case reports of concomitant remission of both disorders with anticonvulsivants or lithium salts have been published. However, there are no controlled studies. Anticonvulsivants or lithium salts might be indicated in some bulimic patients who do not present with a typical bipolar disorder, but who fulfill clinical criteria which are potentially predictive of a good response to such medications.

Anorexia Nervosa↗
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[Comparative study of substance dependence comorbidity in bipolar, schizophrenic and schizoaffective disorders].

Epidemiological studies such as the Epidemiological Catchment Area survey have shown that bipolar or schizophrenic patients are especially prone to display a comorbid substance use disorder. These studies have demonstrated that this comorbidity condition constitutes a major mental health problem owing to its high frequency. The aim of the present study was to assess the prevalence of a comorbid substance use disorder in a sample of psychotic patients, and to compare the pattern of street drug use in schizophrenic, schizoaffective and bipolar patients. Comorbidity of illicit substance use disorders was assessed with the Composite International Diagnostic Interview in 92 consecutive patients fulfilling the DSM III-R criteria for bipolar disorder (BP, n = 40), schizophrenia (S, n = 38) and schizoaffective disorder (SA, n = 14). The lifetime prevalence for any substance use was 25% in the total sample, and did not differ significantly between the three groups, although a higher prevalence was found in SA (BP: 20%, S: 23.7%, SA: 42.9%, NS). The current prevalence (previous six months) was 14.1%, in the total sample (BP: 17.5%, S: 7.9%, SA: 21.4%, NS). In the three diagnostic groups, the most commonly used drug was cannabis, followed by opiates and cocaine. These results do not confirm that schizophrenics might preferentially display abuse or dependence on psychostimulants, and highlight the possible role for the drug choice of the availability of the various illicit drugs in the geographical environment of the subject. Nearly half patients (47.8%) have a lifetime history of abuse or dependence on at least two different drugs. Age at onset of substance use disorder was earlier than or concomitant to that of schizophrenic and/or mood symptoms in most patients. This chronological pattern was the same in the three diagnostic groups. Clinical variables (age at onset, age at first hospitalization, number of hospitalizations) and sociodemographic variables (age, sex, educational level, marital and occupational status) did not significantly differ between patients with a lifetime history of drug abuse or dependence and those without. Patients presenting with a current abuse or dependence were younger than those without. These results confirm in a French sample of schizophrenic and/or mood disordered patients the high frequency of the comorbidity with substance use disorders.

Adult↗
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[Statistical results: which method of presentation to chose?].

Hypothesis testing and significance is currently the most widely used method in the medical literature to report statistical results. However, this method has several limitations. The main one is linked to the risk of misinterpretation of the p value. The arbitrariness of the 5 percent value used to determine whether a result is or not statistically significant is not always kept in mind, and the concept of statistical significance might therefore be confused with that of clinical or biological relevance. The misinterpretation pitfalls are mostly linked to the fact that the p value does not give precise indications on the strength of the association and its direction, or on the variability in the sample. Therefore, some experts claim that hypothesis testing and significance should be avoided in reporting statistical results, and that the method based upon estimation and confidence interval should be more widely used. By this latter method, it is possible to know the direction of the association and the effect size (i.e. the strength of the association). The precision of the estimation, i.e. the variability of the estimation in the sample, can be assessed by the width of the confidence interval: the narrower the confidence interval, the more precise the estimation. Therefore, the clinical relevance of the findings is easier to infere from such results than from those only reporting p values. However, the estimation and confidence interval method is not without its own limitations. This method is difficult to apply to non-parametric tests, and for some results, such as the comparison of mortality ratios, the p value is highly informative. On the other hand, the misinterpretation risk is not totally ruled out when estimation and confidence interval method is used. In the situations where both methods can be employed, there is not yet in the scientific community a definite consensus on which method is the best one to report statistical results, hence some experts suggest that both methods can be presented simultaneously, especially for clinical and epidemiological studies.

Confidence Intervals↗
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[Environmental and psychosocial aspects of genetic research in psychiatry].

Psychiatric disorders are thought to arise as a result of interactions between genetic vulnerability and environmental risk factors. However, research methods to actually investigate the pattern of hypothesized interactions have only recently been developed. In this article, we review the evidence that genes increase the risk for psychosis by making individuals more sensitive to environmental risk factors (genotype-environment interaction), or by making individuals more likely to select high-risk environments (genotype-environment correlation). It is likely that at least some of the impact of genes on the occurrence of psychosis is mediated through (sensitivity for ) environmental risk factors such as a dysfunctional early family rearing environment, paternal absence, use of cannabis, complications of birth and pregnancy, stressful life events and unknown environmental risk factors associated with urban life and membership of certain ethnic groups. With the advent of molecular genetics, further knowledge about possible genotype-environment interactions is urgently required in order to develop and improve strategies for the prevention and early treatment of psychosis.

Female↗