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Biomedical subjects

J M Chignon

Publications and source records attributed to J M Chignon.

At least 19 recordsLinked to original sources
PubMed2000

[Factor analysis of french translation of the Barratt impulsivity scale (BIS-10)].

Though the concept of impulsiveness is controversial, there are many attempts being made to measure this dimension. In this context, only psychometric measures are widely considered valid and are routinely in use. Barratt developed the first scale that specifically measured impulsiveness. Subsequently, various refinements have improved the validity of results. We have translated, without any significant problems, the tenth validated version of this scale (BIS 10) into French, and we have completed a factorial analysis. The scale was coupled with a self-administered questionnaire designed to assess anxiety. A sample of 280 subjects between the ages of 18 and 79 years (average age, 36.9) were recruited from the general population. Subject age was found to have a weak but nevertheless significant correlation with the impulsiveness rating. A principal component analysis (PCA) resulted in the first 9 factors explaining 55.6% of the variance. Another PCA of these factors allowed the identification of a second tier of 3 second order factors; these were closely related to Barratt's ranking. Our study confirms results from the scale's initial analysis--results which could not be subsequently reproduced. To our knowledge, this is the first French translation of an instrument that specifically measures impulsiveness and the first in which a factorial structure has been tested in the general population.

Adult↗
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↗
PubMed1994

[Treatment of depression: methods and stages].

According to recent epidemiological studies, the lifetime prevalence of major depression ranges between 10 and 20%. However, informations concerning the course of depressive illness remain limited. It appears that only about one-quarter, or even less, of all depressives are affected once in their lifetime. Today, it could be assumed that 75-80% of depressive cases are recurrent. Many antidepressive treatments are available today, including first generation and second-generation antidepressants, psychotherapies, and sismotherapies. While antidepressants are similar in terms of drug or efficacy, onset of action, and latency to treatment response, their potential side effect and toxicity profiles are quite different. These factors must be weighed before treatment of depression is begun in an effort to prescribe the compound that is most beneficial i.e., clinically effective while exhibiting the fewest negative aspects. Determination of patients with an "at-risk" profile for drug side effects is best done by a careful analysis of their medical history, comorbidity with other axis I and axis II disorders and concomitant drug therapies. In fact, it appears that depressive patients with coexisting anxiety are often prone to side effects either with tricyclic compounds and SSRI's. In these patients these medications should therefore be introduced at a low dose and slowly increased. Otherwise, because of the frequent comorbidity of depression and alcoholic disorders, the clinician should make very effort to obtain a detailed history of the patient's substance use. If the patient is found to have a substance use disorder, a program to secure abstinence should be regarded as a priority in the treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Antidepressive Agents↗
PubMed1993

Suicide attempts in patients with panic disorder.

In a clinical sample of 100 outpatients with panic disorder, 42% had a history of suicide attempt. Female sex and being single, divorced, or widowed were associated with an increased risk of suicide attempt. Thirty-one (73.8%) of the suicide attempts occurred after the first panic attack and 27 (64.3%) after the onset of panic disorder. Eighty-eight of these patients met DSM-III-R criteria for at least one other diagnosis in addition to panic disorder. Moreover, 52% had a history of major depressive episode and 31% had a lifetime diagnosis of alcohol and/or other substance abuse. Compared with those who did not attempt suicide, those who attempted suicide were significantly more likely to have suffered from major depressive episode and alcohol or other substance abuse in their lifetime. Among the 35 patients with no comorbidity with either major depression or addictive behaviors, 17.1% had a history of suicide attempt. All had suffered from depressive symptoms and/or a personality disorder. The same association was found in four of 19 patients suffering from panic disorder only with or without agoraphobia.

Adult↗
PubMed1993

Panic disorder in cardiac outpatients.

OBJECTIVE: Continuing the long history of interest in the relation of anxiety disorders to cardiovascular function and symptoms, this study investigated the level of anxiety and prevalence of panic disorder in cardiac patients and the possible associations between specific abnormal ECG results and a diagnosis of panic disorder. METHOD: Consecutive patients referred for ambulatory ECG recordings were assessed with the seven anxiety items of the Hospital Anxiety and Depression Scale. Then, 50 patients with scores higher than 8 (the anxious group) were interviewed with the Schedule for Affective Disorders and Schizophrenia--Lifetime Version Modified for the Study of Anxiety Disorders (SADS-LA). RESULTS: Of the 50 anxious patients (26 male and 24 female) interviewed with the SADS-LA, 62% (N = 31) met the DSM-III-R criteria for panic disorder. Patients with panic disorder had a higher mean maximal heart rate and a shorter P-R interval than patients without panic disorder. Unlike the patients without panic disorder, the patients with panic disorder showed no correlation between maximal heart rate and minimal P-R interval. CONCLUSIONS: The rate of panic disorder was high in the patients referred for ECG. Moreover, the prevalence of panic disorder was similar in the patients with and without ECG abnormalities, indicating that in anxious patients the presence of panic disorder does not rule out organic cardiac disease. On the other hand, the higher maximal heart rate and shorter P-R interval of the panic patients may be attributable to hypersensitivity of beta-adrenergic receptors in panic disorder.

Adult↗
PubMed1993

[Cardiovascular pathology and panic disorder].

The relationship between anxiety and cardiovascular function and symptoms has long been of interest, culminating in the recent emphasis on the modulation of cardiovascular response in patients with panic disorder. The relationship between panic disorder and mitral valve prolapse remains controversial. Panic disorder appears to be significantly associated with increased incidence of cardiovascular morbidity. The detection and treatment of panic disorder in patients with cardiovascular risk or diseases could have an important impact on prognosis and quality of life of the patients.

Cardiovascular Diseases↗
PubMed1993

[Panic disorder and alcoholism: effects of comorbidity].

Both epidemiological and clinical studies have demonstrated a high prevalence of panic disorder among alcoholic patients. In contrast, little attention has been given to studying alcohol abuse and/or dependence in patients suffering from panic disorder. One hundred and fifty-five consecutive referrals for treatment for panic disorder were interviewed using a modified version of the Schedule for Affective Disorders and Schizophrenia--Lifetime Version, modified for the study of anxiety disorders. Thirty-two patients (20.7%) had a lifetime history of alcohol abuse and/or dependence. Although the lifetime comorbidity rate of either agoraphobia and/or social phobia seems without any influence on the risk of alcohol-related disorder, alcoholic patients suffering from panic disorder appear to be more likely to have a history of depression and other addictive disorders. The majority of patients with primary alcoholism were male, and those who became alcoholics after they developed panic disorder were more likely to be female. The comparison between patients with primary and secondary alcoholism did not indicate any difference in the comorbidity rate with other psychiatric disorders nor the severity of panic disorder.

Adult↗
PubMedDate not supplied

[The use of therapeutic isolation and confinement in psychiatry. A prospective study].

Despite recent developments in psychopharmacology and a better understanding of agitation patterns in psychiatric patients, the use of seclusion and restraint procedures remains a matter of daily practice. Little or no time is spent on its teaching in a formal way. There is almost no literature on these issues, and it has grown only since legal procedures initiated by patients, which forced practitioners to spend some time analysing these methods. Facing this problem, we realized a prospective study at the CHS de la Savoie, in Chambéry, so as to clarify the current modes of these procedures. This study was led among 460 secluded patients, during one year. 11 data were studied, such as the duration of the seclusion, the reason and the medical history, the desire of the patient to be liberated ... The review or awareness of certain variables may give clinicians a better perspective on the use of procedures which, unfortunately, continue to be the cause of deaths in psychiatric practice.

Adolescent↗
PubMedDate not supplied

[Behavior dyscontrol scale: validation and initial results].

The numerous recent trials devoted to disruptive behavior disorders indicate the renewed interest of clinicians for these so-called dimensions and call for revision of the instruments with which they are evaluated. The present paper provides a brief review of the currently used scales for rating impulsivity. A new scale for evaluating the behavioural dyscontrol is proposed. The items of this scale are selected a priori according to clinical experience with patients suffering from lack of behavioural control. The Behaviour Dyscontrol Scale (BDS) includes, in the initial version, 4 parts. The first part concerns the generalized lack of control (G-BDS). This is a questionnaire of 24 items. The second part is constituted by a questionnaire which lists a number of specific behaviours where impulsivity has a central role (S-BDS). Part III is constituted with 4 Visual Analogue Scales for evaluating handicap linked to dyscontrol. Part IV is constituted by 3 Visual Analogue Scales concerning the physician global impression about the lack of general control in cognitions, emotions and behaviours. For validation, 166 patients (111 females and 55 males), either hospitalized or ambulatory, and 35 controls (16 females and 19 males) were included in this study. Mean age of patients was 38.5 (SD = 10.5) years. The patients population is subdivided in 4 subgroups, anxious, depressed, abusers and bulimics according to DSM III-R criteria. Patients and controls global scores were significantly different at the G-BDS (p less than 10(-4)) and not at S-BDS.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Panic disorder and alcoholism].

Relationships between alcoholism and anxiety disorder are well known by clinicians. Studies have recently shown that the prevalence of alcohol abuse or dependence is very high in patients with panic disorder with or without agoraphobia (Thyer et al., 1986; Bibb and Chambless, 1986). The aims of this study were to determine the prevalence and comorbidity of alcohol abuse and dependence in a population of panic outpatients who were consecutive referrals for treatment of panic disorder (PD) in an anxiety clinic. Patients were interviewed with the Schedule for Affective Disorders and Schizophrenia-Lifetime Version Modified for the study of anxiety disorders (SADS-LA) which is a standardized and semi-structured interview allowing to make diagnoses according to RDC, DSM III and DSM III-R criteria. One hundred and three panic patients (39 males and 64 females) were included in the study. Their mean age was 38.5 years (SD: 11.6). In this sample, 24.3% met the DSM III-R criteria for alcohol abuse and 8.7% those for alcohol dependence. Among these patients, 26.2%, abused of benzodiazepines and 16.5% of them of other substances. We found a high comorbidity rate. In fact, 6.8% of the patients met diagnostic criteria for PD alone, 31.0% for one more diagnosis, 29.1% for two more and 33.0% for three or more besides PD. In this study, we found an association between alcohol abuse and the presence of a lifetime diagnosis of major depressive episode and/or other addictive behaviors. Otherwise, alcohol abuse did not occur more often in patients suffering from panic disorder associated with agoraphobia and/or social phobia.

Adult↗
PubMedDate not supplied

[Effect of antidepressant treatment on sense of dyscontrol: preliminary studies].

Cumulative data in the field of phenomenology, neurobiology and psychopharmacology indicate "discontrol" as a dimension probably linked to serotonin central activity and frequently observed in major depression and other related disorders. A new questionnaire for evaluating this dimension is proposed: Behavioral Discontrol Scale (BDS). The BDS was constructed in 1990 and validated through multiple clinical studies: the first validation study included 166 patients (subdivided in 4 subgroups, anxious, depressed, alcohol abusers and bulimics fulfilling DSM III-R criteria) and 35 controls. The second validation study concerned a large clinical population suffering from major depression according tho DSM III-R criteria (n = 1360 patients). The episodes classified as psychogenic or neurotic and characterised as "agitated, anxious, impulsive and/or suicidal"' showed the highest scores on discontrol (p < 0.001). Following these initial studies, the present study was conducted to evaluate prospectively the sensitivity of BDS to change under different antidepressant treatments (serotonergic versus other agents). Preliminary data were obtained within a group of 62 outpatients suffering from major depression (DSM III-R criteria), treated naturalisticly and followed on a 4 weeks period. Results showed that discontrol is sensitive to change, especially in the fluoxetine group (decrease at day 28 by 35% vs 23% and 24% in other groups, p = 0.17). Changes of discontrol scores was shown to be related to benzodiazepine (BZD) combination to antidepressant treatment. In fact, in the group "with BZD" (n = 42), the magnitude of BDS score variation was less important than in the group "without BZD" (n = 19): respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[Social adjustment and depression: value of the SAS-SR (Social Adjustment Scale Self-Report)].

The Social Adjustment Scale Self-Report (SAS-SR) is a simple and inexpensive method, which allows the routine assessment of the patient's social adjustment, especially in the case of depression. Compared with other scales based on an interview with the patient, the SAS-SR is more sensitive to change in the patient's clinical status. The SAS-SR is a useful method as part of the detection of even mild depressions, regular aftercare evaluation of out-patients or as an outcome measure in longitudinal studies. A French version of the SAS-SR is now available and is currently under evaluation in a large-scale randomized therapeutic trial.

Chronic Disease↗