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J M Leger

Publications and source records attributed to J M Leger.

59 records · Page 4Linked to original sources
PubMed1976

[Psychotic manifestations complicating surgical operation in the ocular region].

The authors report ten observations as well as the results of an investigation conducted by ophtalmologists and psychiatrists with intention of better understanding clinical, physiological and psychological problems, provoked by occurance of complications stemming from psychoses which are the result of ophtamological complications. They conclude that it is necessary to form accurate distinctions with regard to the total manifestations of the malady "black patch delirium". They emphasize the fact that its manifestations are not an appanage of the aged ; they especially insist upon not only the role of visual disorientation but also of the social factors which are united with restrictions, beyond those of motor, control and biological imvalances. With regard to etiopathology they acknowledge a need for a combination of organogenic and psychodynamic models to account for each case ; a certain number of communal points can be found : subjects (declined in physical and metal capacities), there is a rapid weaking of the external comportment, resulting in an imptiness, which must be compensated for by a fantasy life or some other physiopathological mecanisms.

Age Factors↗
PubMedDate not supplied

[Causes and consequences of elderly's agitated and aggressive behavior].

Agitation and aggressiveness are frequent in the elderly and often related to dementia. As a result of the ageing of the general population this is becoming a major public health concern. No or little epidemiological data, during primary health care, about symptoms, co-morbidity, nor medical and social consequences of elderlys' disruptive behavior have been gathered or published in the French literature. Thus, in order to describe these disorders, a survey in cooperation with general practitioners (GP) was conducted. A representative sample of 212 French GP's, all with preferential geriatric activity were asked to conduct a study by including retrospectively their two most recent patients older than 65, who had exhibited agitation and/or aggressiveness. From this cross sectional study, 410 patients (female: 61%, male: 39%) were included. The mean age was 81 years (sd: 7.65). The patients suffered from change in verbal behavior (80%), verbal aggressiveness (71%), physical agitation (60%), wandering (48%), and/or physical aggressiveness (31%). The average of disruptive behavior symptoms per patient was 2.9. The symptoms appeared progressively in 81% of patients, the mean duration was two years and it was the first episode in 40% of patients. Disruptive behaviors may be explained in view of organic illness in 62% of patients (cardiovascular disease: 37%, neurologic: 12%, diabetes: 7%, dehydratation: 5%), dementia (Alzheimer disease: 20%, vascular dementia: 18%, mixed dementia: 14%). In 54% of patients disruptive behavior may be explained in view of depression: 34%, and anxiety disorder: 31%. A triggering factor was observed in 57% of cases (psychosocial stress: 39%). Somatic consequences of the symptoms were frequently identified: decrease of alimentary intake: 39%, weight loss: 27%, dehydratation: 11%, falls: 32%, and irregular medication intake: 31%. Limitation of daily life activities: 85%, and family life: 97% were also noted. Acceptability of patient's symptoms by the family was good (no discomfort or transitory and mild irritability) in 61% of cases, and very bad (reactions of exhaustion, hospitalization requirement) in 13%. This study carried out during primary care, showed that the elderly's disruptive behaviors cause severe medical consequences and familial and social distress.

Age Factors↗
PubMedDate not supplied

[Value of tiapride for agitation in the elderly. Review of published studies].

Among elderly disruptive behavior agitation and aggressiveness are frequent and often related to dementia. They are known for increasing the risk of patients' institutionalization and causing distress to families and care givers. When a drug prescription is required, physicians have to take into account the high sensitivity of elderly. Tiapride is an atypical neuroleptic which acts preferentially on D2 and D3 dopaminergic receptors. Several papers concerning results of clinical trials conducted in Europe and Japan have been published and reviewed in this article. The interest of tiapride in the treatment of elderly agitation and aggressiveness has been assessed in four double blind clinical trials including more than 700 patients. The efficacy of tiapride (aggressiveness, agitation, delusion and wandering) was demonstrated in a trial versus placebo (p = 0.027) including 324 patients treated for 28 days with 75 to 150 mg/d. Furthermore the superiority of tiapride (175 to 450 mg/d) on chlorpromazine (18 to 112.5 mg/d) was shown in two trials where 262 patients were treated for four weeks, and a recent survey highlighted that tiapride (400 mg/d) is as efficient as melperone (100 mg/d), the only neuroleptic to be indicated in treatment of elderly agitation and aggressiveness in Germany. Besides, 30 open clinical trials including around 1,000 patients have been conducted and have shown homogeneous and positive results. In the two trials versus chlorpromazine, the safety of tiapride was better, with especially less drowsiness, extrapyramidal symptoms, and dry mouth. Compared to lorazepam, in healthy subjects, tiapride caused less memory impairment. European and Japanese open studies confirmed the safety of tiapride in the elderly. In conclusion, tiapride at doses of 100 to 300 mg/d, appeared to be a therapy of elderly agitation and aggressiveness, at less as efficient as the other drugs used in this indication. Furthermore, the safety of tiapride is an advantage compared to benzodiazepines and neuroleptics.

Aged↗