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Biomedical subjects

J Adès

Publications and source records attributed to J Adès.

At least 37 records · Page 2Linked to original sources
PubMed1999

[Behçet's disease and factitious manic-depressive psychosis: a case of Münchausen syndrome].

BACKGROUND: Munchausen syndrome is frequently observed in men unlike other factitious conditions. The patient presents a characteristic triad: apparently acute but factitious disorders, migration from hospital to hospital resulting in unnecessary explorations and treatments, and fabulated medical history. CASE REPORT: A 57-year-old man was hospitalized in the psychiatric unit for alleged insomnia, psychomotor excitation and multiple hallucinatory phenomena. The factitious nature of the patientís condition was rapidly suspected in light of the large number of previous unconfirmed medical conditions and a rather unbelievable history. DISCUSSION: Unlike the classical description of Munchausen's syndrome, this patient had no history of surgery. This unusual aspect should not exclude the clinical diagnosis as for some patients, the invasive nature of certain explorations may be a valid substitute for surgery.

Behcet Syndrome↗
PubMed1999

Genetic factors in anorexia nervosa.

Anorexia nervosa is a severe and complex disorder with incompletely known vulnerability factors. It is generally recognized that anorexia nervosa is a familial disorder, but the majority of twin studies have shown that the concordance rate for monozygotic twins is higher (on average 44%) than for dizygotic twins (on average 12.5%). This difference in concordance rates shows that genetic factors, more than common familial environment, may explain why the 'anorexia nervosa' phenotype runs in families. In order to estimate the heritability in the broad sense of anorexia nervosa according to published familial and twin studies, we first assessed the intrapair correlation between monozygotic and dizygotic twins, and secondly calculated the deviation threshold of relatives of affected probands from the relative mean. In this review, we obtained an estimation of the heritability at 0.72 according to all published controlled familial studies (six references quoted in MEDLINE(R)), and 0.71 for all published twin studies (59 references quoted in MEDLINE(R)). This estimation is close to the ones previously proposed, between 0. 5 and 0.8. Familial and twin studies may also help to define the boundaries of the phenotype, shedding light on the complex relationship between anorexia nervosa on the one hand, and bulimia nervosa, mood disorders, and alcoholism on the other. Demonstrating the importance of genetic factors in anorexia nervosa, and more specifically for anorexia of the restrictive type, requires not only prospective and adoption studies (which are still lacking), but also genetic polymorphisms analyses, which began very recently.

Anorexia Nervosa↗
PubMed1999

Study of impulse-control disorders among alcohol-dependent patients.

BACKGROUND: Impulse-control disorders (ICDs) include intermittent explosive disorder, kleptomania, trichotillomania, pyromania, and pathological gambling. Several studies have suggested that the incidence of pathological gambling is substantially higher in alcoholics than in the general population. The rate of co-occurrence of other ICDs and alcohol dependence has never been systematically investigated. In our study, we assessed the frequency of all ICDs in a population of alcohol-dependent patients. We also examined the possibility that the presence of an ICD can correspond to earlier onset and more severe forms of alcoholism, which have a greater association with antisocial personality. METHOD: All patients hospitalized at our psychiatric unit for detoxification between January and August 1997 met DSM-IV criteria for alcohol dependence and were included in this study. Diagnosis of alcohol dependence was confirmed with the Mini-International Neuropsychiatric Interview. ICDs were investigated using the Minnesota Impulsive Disorders Interview. All patients completed the Michigan Alcoholism Screening Test. RESULTS: Among the 79 patients included in the study, 30 (38.0%) met criteria for an ICD. Included in the study were 19 cases of intermittent explosive disorder, 7 cases of pathological gambling, 3 cases of kleptomania, and 1 case of trichotillomania. Patients with co-occurring ICDs were significantly younger than patients without an ICD (mean age = 40.7 vs. 44.5 years; p = .03). Patients with co-occurring pathological gambling were significantly younger at the onset of alcohol dependence than patients without ICDs (mean age = 19.5 vs. 25.9 years; p = .0008). Pathological gamblers had significantly longer duration of alcohol dependence compared with patients without ICDs (26.0 vs. 17.9 years; p = .02). Patients with co-occurring intermittent explosive disorder had the shortest duration of alcohol dependence of all patients (9.9 years). Prevalence of antisocial personality disorder was no different in patients with or without co-occurring ICDs. CONCLUSION: Thirty-eight percent of the alcohol-dependent patients studied presented with an ICD. Patients with ICDs were younger than those without an ICD. The presence of an ICD was not associated with a specific form of alcohol dependence or with antisocial personality. Co-occurrence of pathological gambling, however, was associated with lower age at onset of alcohol dependence, a higher number of detoxifications, and a longer duration of alcohol dependence than was absence of an ICD.

Adult↗
PubMed1998

Impulse-control disorders in alcoholics are related to sensation seeking and not to impulsivity.

Impulse-control disorders (ICD) include intermittent explosive disorder, kleptomania, trichotillomania, pyromania and pathological gambling. Several studies have suggested that the incidence of pathological gambling and impulsive violent behavior is substantially higher in alcohol-dependent patients than in the general population. The association between ICD and alcoholism, as well as personality characteristics such as sensation seeking and impulsivity, has never been systematically studied. The present study compared the levels of impulsivity and sensation seeking in age- and sex-matched groups of alcohol-dependent patients with concomitant ICD (ICD+, n = 30), alcohol-dependent patients without ICD (ICD-; n = 30) and control subjects (n = 30). All the alcohol-dependent patients (ICD+ and ICD-) were hospitalized for alcohol detoxification. Diagnoses of ICD were based on DSM-IV criteria and the Minnesota Impulsive Disorders Interview. All patients completed the Zuckerman Sensation-Seeking Scale (SSS) and the Barratt Impulsiveness Rating Scale (BIS). Mean scores on the SSS general factor, the SSS disinhibition subscale, and the SSS experience-seeking scale were significantly higher in ICD+ patients than in either ICD- patients or control subjects. By contrast, total scores and subscale scores on the BIS showed no significant differences among the three groups. Thus, it appears that measures of sensation seeking, rather than impulsivity, are relevant in distinguishing between alcohol-dependent patients with and without concomitant impulse control disorders.

Adult↗
PubMed1998

Lack of association between anorexia nervosa and D3 dopamine receptor gene.

BACKGROUND: Evidence from family and twin studies suggests a genetic contribution to the etiology of anorexia nervosa. Different genes could contribute to the vulnerability to anorexia nervosa, but dopamine could be more specifically implicated in anorexia nervosa because of pharmacologic, endocrine, and neurobiological specificities. The dopamine receptor D3 (DRD3) may be of additional interest, since it is specifically located in the limbic area, an area implicated in reward and reinforcement behavior. METHODS: We performed an association study between 39 patients with severe (requiring hospitalization and with young age at onset) anorexia nervosa (DSM-III-R), and 42 controls, with the Bal I polymorphism in exon I of the DRD3 gene. RESULTS: There was no significant difference between patients with anorexia nervosa and controls in allele frequencies or genotype count. The association was still negative between subgroups separated according to family history of anorexia nervosa or comorbid mood disorders. CONCLUSIONS: Despite the fact that the number of patients tested is small, there is good evidence that the Bal I DRD3 polymorphism does not play a major role in the genetic component of anorexia nervosa. It would be useful to test polymorphisms of the other genes coding for dopamine receptors.

Adolescent↗
PubMed1998

Genetics and anorexia nervosa: a review of candidate genes.

Anorexia nervosa is a severe disorder which seems likely to have a multifactorial aetiology. However, several studies have stressed that genetic factors play a significant role. Epidemiological studies have shown that the lifetime risk for first-degree relatives of a patient with an eating disorder is 6% compared to 1% among relatives of controls, and a twin study performed on 34 pairs of twins has shown a higher concordance rate in monozygotic twins (55%) compared to dizygotic twins (7%). The vulnerability component of anorexia nervosa that can be attributed to genetic influences has been estimated from twin studies to be around 70%. Despite this, few genetic studies have been performed testing the role of candidate genes which code for proteins potentially implicated in the aetiopathogenesis of the disorder. In this review, genes encoding components of the dopamine, serotonin, opiate, and noradrenaline systems are assessed for their role in anorexia nervosa. Attention is paid to psychological dimensions, clinical symptoms, co-morbidity frequency, pharmacological data, and biological measures that characterize anorexia nervosa.

Animals↗
PubMed1997

Study of compulsive buying in depressed patients.

BACKGROUND: Compulsive buying is defined by the presence of repetitive impulsive and excessive buying leading to personal and familial distress. Patients with this disorder also suffer from mood disorder in 50% to 100% of the cases studied, and antidepressants help to decrease the frequency and the severity of uncontrolled buying. To define the correlation between compulsive buying and depression, we assessed this behavior among 119 inpatients answering to DSM-III-R criteria for major depressive episode. Additionally, we evaluated for comorbidity in the patients suffering from compulsive buying and in those free from this disorder. Impulsivity and sensation seeking were also compared in the two groups. METHOD: Diagnosis of compulsive buying was made using standardized criteria and a specific rating scale. Diagnosis of depression and assessment of comorbidity were investigated using the Mini International Neuropsychiatric Interview and a modified version of the Minnesota Impulsive Disorders Interview. All patients answered the Zuckerman Sensation-Seeking Scale and the Barrat Impulsivity Rating Scale. RESULTS: The prevalence of the disorder was 31.9%; 38 of the 119 depressed patients were diagnosed as compulsive buyers. Patients from the compulsive buying group were younger in age, more often women than men, and more frequently unmarried. They presented more often than others with recurrent depression (relative risk = 1.4), disorders associated with deficits in impulse control such as kleptomania (relative risk = 8.5) or bulimia (relative risk = 2.8), benzodiazepine abuse or dependence disorder (relative risk = 4.7), and two or more dependence disorders (relative risk = 1.99). Subscores for experience seeking using the Zuckerman Sensation-Seeking Scale were significantly higher (p = .04) and scores of impulsivity were much higher (p < .0001) than corresponding scores in the group without compulsive buying behavior. CONCLUSION: Compulsive buying is frequent among depressed patients. In most cases, the behavior is associated with other impulse control disorders or dependence disorders and a high level of impulsivity.

Adult↗
PubMed1997

Antidepressant discontinuation: a review of the literature.

Sudden or tapered withdrawal from treatment with antidepressants, including monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs), and serotonin selective reuptake inhibitors (SSRIs), can produce phenomena consisting of somatic and psychological symptoms. The literature about these discontinuation phenomena consists mainly of case reports and a limited number of controlled prospective studies. The symptoms are generally mild and transient for the TCAs and the SSRIs but may be serious for the MAOIs. They are much more common with a shorter acting SSRI, such as paroxetine, than with the longer acting agent fluoxetine. Because the symptoms of antidepressant discontinuation include changes in mood, affect, appetite, and sleep, they are sometimes mistaken for signs of a relapse into depression. Thus, it is important to directly question patients about new symptoms that occur during antidepressant discontinuation to optimally manage treatment discontinuation.

Antidepressive Agents↗
PubMed1996

[Alcoholism: value of a search for familial antecedents].

Alcoholism is a complex disorder, with clinical and etiological heterogeneity. The clinical symptoms used for the diagnostic of alcoholism are based on worldwild standard criteria, such as DSM (American Psychiatric Association) or ICD (World Health Organisation). Good agreement between clinicians for the diagnostic of alcoholism can be obtained with these classifications. The diagnostic of alcoholism with such international criteria is mainly based on the cognitive and behavior consequences of alcohol consumption. In order to cope with the heterogeneity of alcoholism, one should analyse the different aspects of alcoholism pathogenesis. One important aspect is its high frequency within some families, as many studies show a direct correlation between the risk for alcoholism and familial frequency of alcoholism. More recent studies tried to detect which clinical aspects of alcoholism are more frequently observed in alcoholic patients with a positive familial history. Those studies also analysed the impact of a familial history of co-morbid psychiatric disorders on the general risk for alcoholism and the specific risk for alcoholism and co-morbid psychiatric disorders. Most clinicians interested in alcoholism look for familial history of alcoholism or psychiatric disorders, but this information is frequently incomplete and partially used. The research on familial history of alcoholism is nevertheless facilitated, and more valid, with the recent clinical tools such as standard clinical questionnaires. The detection of a familial history can be in many aspects useful for establishing clinical subtypes, predicting specific (psychiatric, social or medical) complications, or helping to find the most relevant treatment modality.

Alcoholism↗
PubMed1996

Phenomenology and psychopathology of uncontrolled buying.

OBJECTIVE: Uncontrolled buying, defined by the presence of repetitive impulsive and excessive buying that leads to personal and familial distress, is a psychiatric disorder that has only recently been recognized. This review focuses on the prevalence, clinical features, and etiology of this disorder. METHOD: All published articles on the topic were collected and reviewed. The literature concerning the typology of normal consumerism was also reviewed. RESULTS: The prevalence of the disorder in the general population is reported to be 1.1%. The main clinical features of uncontrolled buying are impulsivity and repetition of buying, the invasive need to buy, unsuccessful attempts to control spending, and the existence of tangible negative consequences of buying (marked distress, interference with social or occupational functioning, or financial problems). Uncontrolled buying may be related to obsessive-compulsive disorder, depression, addiction, or impulsivity. CONCLUSIONS: In most cases, uncontrolled buying can be understood as "compensatory buying" that temporarily alleviates depressive symptoms and can thus be associated with the results of antidepressant treatment in cases in which uncontrolled buying is symptomatically associated with depression.

Adult↗
PubMed1995

Lack of association between alcohol-dependence and D3 dopamine receptor gene in three independent samples.

Numerous studies on the involvement of dopamine receptors in the genetics of alcoholism focused on associations between a polymorphism of the D2 dopamine receptor (DRD2) gene and alcohol dependence. However, the results of these studies are conflicting. Another receptor, the D3 dopamine receptor (DRD3), may be of additional interest since it is specifically located in the limbic area, and in particular in the nucleus accumbens which plays a significant role in the reward process of addiction behavior. We thus tested the association in three independent samples of alcoholic patients, with different origins and various inclusion criteria. No difference in the DRD3 gene polymorphism emerged between controls and alcoholic patients, regardless of their origin, inclusion criteria, or presence or absence of the DRD2 TaqI A1-allele. Despite the fact that more information could have been considered and that association studies provide limited information, there is good evidence that this DRD3 polymorphism does not play a major role in the genetic component of alcoholism.

Alcoholism↗
PubMed1994

[Addictive behavior in the elderly].

Alcohol and drug abuse are the two main addictions in the elderly subject. Prevalence of alcohol dependency is 14% in those over 65 years of age and 17% in elderly psychiatric patients. The distribution of alcoholism between the sexes becomes equal with age. After 65 years of age, the sex-ratio is 1 female to 1.3 male subjects. The elderly alcoholic population consists of both subjects having become alcoholics at a young age and those in whom alcoholic behaviour appeared at a late age. In one third of elderly alcoholics such dependency appeared after 60 years of age. The main risk factors for alcoholism in the elderly subject are lonliness, death of the spouse and the presence of an invalid or bedridden spouse. In the elderly, tolerance to and dependence on alcohol are rare and appear late. Somatic complications are particularly severe (cirrhosis, liver cancer, gastritis, acute pancreatitis and myocardial involvement). Psychiatric complications include anxiety, depression and especially suicide. Alcoholism is the third most frequent cause of organic cerebral dementia, following Alzheimer disease and vascular dementia. Drug dependency is very often linked to alcoholism and consists of tranquillizers and less often of antalgics.

Aged↗
PubMed1994

Cost of anxiety disorders: impact of comorbidity.

The aim of this study was to assess the relative impact of co-mobidity and of symptom severity on the costs of caring for patients with generalized anxiety disorders (GAD). One thousand and forty-two patients with GAD according to DSM III-R were observed by psychiatrists using a cross-sectional methodology. Demographic, clinical, therapeutic as well as health care utilization data were collected at a single point in time. Patients were stratified according to prevalence of co-morbidity. An economic analysis was performed based on a societal perspective. Hospitalizations and losses of productivity were the two major components of costs both in patients with and without co-morbidity. On the other hand costs of pharmaceuticals remain a marginal component of costs associated with GAD in the two groups. Controlling for confounding variables, the prevalence of health care utilisation was found to be significantly higher in patients with co-morbidity for hospitalization, laboratory tests, medications and absenteeism from work. Most of cost components were found to be significantly higher in patients with co-morbidity. The relative risk of health care utilization was higher in patients with co-morbidity, past history of anxiety, high level of anxiety as well as in older patients. Overall our findings suggest that both co-morbidity and symptom severity play a role in cost generation in GAD patients.

Absenteeism↗
PubMed1993

[Psychiatric emergencies in acute alcoholic intoxication].

Acute alcohol ingestion can lead to psychiatric emergencies. The main syndromes observed are states of agitation, acute anxiety episodes and suicide or attempted suicide. States of agitation are mainly due to simple or pathological inebriety. Any case of acute alcoholic intoxication requires a full clinical examination and a simple laboratory work-up. Behavioral disorders linked to pathological inebriety can be improved by moderate doses of sedatives such as benzodiazepine, carbamate, tetrabamate or neuroleptic drugs for the most agitated states. States of anxiety generally regress with non-neuroleptic tranquilizers, and attempted suicide mainly requires close surveillance or intensive care.

Alcoholic Intoxication↗
PubMed1993

A spin label study of the membrane effect of various psychoactive drugs in human erythrocytes.

The effect of psychoactive agents with different clinical actions: three sedative neuroleptics (trifluoperazine, alimemazine tartrate, chlorpromazine), an anticholinergic agent (trihexyphenidyl hydrochloride), two tricyclic antidepressants (imipramine, desipramine) and lithium carbonate on the rotational correlation frequency (V+) of the spin label 16NS has been comparatively investigated in whole human erythrocytes. V+ was about 40% increased by the three neuroleptics, the anticholinergic agent and the antidepressant molecules at 0.2 mM. By contrast, lithium did not induce any significant change in V+ at the same concentrations. It can be suggested that the increase in "membrane fluidity", observed with a wide variety of drugs, is a non specific effect, unrelated to the psychotropic action, that can be ascribed to the amphiphilic properties of the tested drugs.

Electron Spin Resonance Spectroscopy↗