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J Tignol

Publications and source records attributed to J Tignol.

89 records · Page 5Linked to original sources
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[Seizure threshold and ECT. Importance for good clinical practice of ECT. A review of literature].

To induce a seizure for electroconvulsive therapy (ECT), an electrical charge is delivered above seizure threshold. The means and criteria used to determine the electrical dosage are subject to debate. Nonetheless this is an important issue because effectiveness and side effects have been shown to be influenced by the electrical charge used. The objective is to review data available in the literature on seizure threshold and ECT and determine the eventual consequences for practical determination of stimulus dosing. A comprehensive review of the literature is based on the search of electronic databases (Medline, INSIT) and a manual search; 72 references out of a total of 96 selected were used for this review. Seizure threshold varies widely between subjects receiving ECT (600% mean variation), however a majority of subjects of all ages have a threshold below 150 mC. Only a few individuals have very high thresholds (400 to 800 mC). ECT has an anticonvulsive effect as threshold increases during a course of ECT. Many factors influence threshold and all are not known. Among those that have been documented are: the characteristics of the current used (longer stimulus duration with same dosage gives lower thresholds); electrode placement (bilateral gives higher thresholds than unilateral placement); age (explains 12 to 26% of threshold variance); gender (which inconsistently gives higher thresholds for males); and other factors such as anesthetic drugs, concurrent psychotropics, and some morphological characteristics. Different methods are used to determine an individually adapted dosage. Two are recommended: titration and age. The age method is based on the fact that age is an important factor influencing threshold. The titration method is based on the observation of a very important variation in threshold between individuals that is not explained by age. We discuss the pros and cons of each method.

Adult↗
PubMedDate not supplied

[Electroconvulsive therapy and benzodiazepine: antagonism or indifference? Review of the literature].

BACKGROUND: It is usually considered that the efficacy of electroconvulsive therapy is due to the induction of a seizure (20). Benzodiazepines are well known antiepileptics (11) and it is suggested that they should be withdrawn during electroconvulsive therapy (3). The purpose of our study was to determine the evidence that exists for this hypothesis in the literature. METHOD: We have reviewed the international literature on electroconvulsive therapy and benzodiazepines through the Medline and Pascal reference database, and performed a manual search of the major international journals. We have retained the references dealing with both benzodiazepine and electroconvulsive therapy. RESULTS: Up to June 1990, 16 references have been found (table I). Of these 16 references, 5 (6, 7, 12, 19, 25) are letters to the editor with no data reported. Six papers (1, 2, 8, 9, 14, 22) examine benzodiazepines as anesthetics and only focus on anesthetic variables, ignoring electroconvulsive therapy-treatment outcome. Only four studies (5, 17, 23, 24) actually examine the incidence of benzodiazepine use on electroconvulsive therapy. Of these, three studies (17, 23, 24) report the incidence of benzodiazepines used as tranquilizers or hypnotics on duration of the electroconvulsive therapy induced seizure. One is a retrospective study (24) showing a decrease in seizure duration due to benzodiazepine use. Of the two prospective studies one shows (23) no difference in seizure duration and the other one (17) a decrease. These studies, however, fail to actually examine how the antidepressive efficacy of electroconvulsive therapy is modified by benzodiazepine use. One recent study (5) measures the antidepressive efficacy of electro-convulsive therapy through the decrease of a validated depression scale. This is a randomized double-blind study examining a short acting benzodiazepine used as an anesthetic in lieu of methohexital. Electroconvulsive therapy efficacy does not appear impaired. CONCLUSION: From our review of the literature it appears that the supposed negative effect of benzodiazepines on the antidepressive action of electroconvulsive therapy has not been demonstrated. Further studies are necessary warranted.

Anti-Anxiety Agents↗
PubMedDate not supplied

[Peripheral neuropathies i- Waldenstrom's disease. Histological and ultrastructural studies of 5 cases].

In four cases it was the existence of peripheral neuropathy which led to the discovery of macroglobulinemia within an interval from 1 to 11 years. The treatment of the disease also markedly improved the peripheral neuropathy in three cases. Two patients died. Two of the biopsies of the peripheral nerve showed infiltration by atypical lymphocytes. Ultrastructural changes in the five cases were variable. Marked axonal involvement in the two cases with cellular infiltration. In one of these two cases it was combined with segmental demyelinization. This lesion was clearly predominant in the three other cases. In one of them demyelinization occurred in a very peculiar way with dilation of the internal part of the mesaxone going on in the most peripheral layers of the myelin. Discussion of the mechanisms of the involvement of the peripheral nervous parenchyma in Waldenström's disease. Cellular infiltrations, amorphous deposits, changes in the capillaries and macroglobuline may occur.

Adult↗
PubMedDate not supplied

[Benzodiazepines at the general hospital. An example of their use at the Périgueux Hospital Center].

The authors study prevalence and characteristics of BZD use in a general hospital (Périgueux, France). They try to point out the particularities of user's population (age, sex, psychiatric past, pathology at admission), the characteristics of prescription (nature, indication, dose, time of use), the place of BZD among the other anxiolytic and hypnosedative drugs employed. They come to the conclusion that strong prevalence of BZD use is not related to abusive prescription during hospitalization but to the lack of criticism concerning former prescriptions.

Adult↗
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Opiate withdrawal and electro-stimulation. Double blind experiments.

A rapid detoxification technique for heroin addicts is described. The technique uses an impulsional electric current developed by Limoge. The treatment is nonaggressive, very well tolerated by the addicts and leads to a good psychotherapeutic relationship with the medical staff. A successful physical detoxification is achieved in more than 80% of the cases (this figure is based on 400 patients treated by the method). The technique was subjected to two double-blind experiments. The first experiment tested the real efficacity of the electrical stimulation. The difference between the group of subjects stimulated and the unstimulated control group had a "p-value" which was significant at the 0,5% level. This leads us to believe that the electrical stimulation has a real positive effect. The second experiment reconfirmed the efficacity of the stimulation and showed that 24 hour continuous stimulation was not sufficient to produce a lasting effect. After about 50 hours stimulation a Naloxone test produced little or no reaction in the patients.

Adult↗
PubMedDate not supplied

[A problem detected by the AMDP rating of the Mar. case: the relation between phobia and obsession].

The rating of the videotaped interview of the Mar. case during three meetings of the French-speaking section of the AMDP has revealed the problem of the relationships between phobia and obsession. These ratings triggered a critical reflection based on the theoretical framework from the literature, on the clinical material (the videotaped interview) and on the pragmatic difficulties which appeared during the discussions of the ratings.

Aged↗
PubMedDate not supplied

[Assisted evaluation scale of quality of life].

The TEAQV (Tableau d'évaluation assistée de qualité de vie) is an instrument designed to standardize the collection of quality of life data among patients with chronic psychiatric or somatic diseases. This instrument is a two-part. 7 point-scale (0 = extremely bad; 6 = excellent), self-rated quantitative evaluation of quality of life at different time points in 4 areas (physical and psychological well-being, family relationships, professional activity). The first part is a one time retrospective lifetime evaluation whereas the second part is a current state evaluation that can be prospectively repeated. Time points are determined by important periods during the illness or treatment course. This instrument is administered by a trained interviewer in 5 to 10 minutes. The TEAQV has been used in different populations. Correlation coefficients between TEAQV current state and conventional scales were studies. Among 26 lung and heart-lung transplant patients, the correlation coefficients between TEAQV and the Sickness Impact Profile are: physical: -.622; psychological: -.406. Among 18, treated, opioid dependent patients, the correlation coefficients between TEAQV and the Addiction Severity Index are: physical: -.548; psychological: -.763; social professional: -.747; family: -.341. Our early results with the TEAQV suggest that it is an easy to use and beneficial instrument to assess quality of life.

Adaptation, Psychological↗
PubMedDate not supplied

[Descriptive studies of the use of the Addiction Severity Index in France].

The Addiction Severity Index (ASI) is an instrument that provides, in a 45-minutes semi-structured interview, a multidimensional assessment of substance abuse patients. It was designed in 1980 by A.T. McLellan et al., from Philadelphia PA, in North-America and introduced in France by our group in 1990. Over the past five years we have used it in different substance abuse populations including alcohol users. The goal of this paper is to review the adaptation procedure into French context and to present ASI data from different substance abuse sub-groups: opioïd dependent subjects seeking treatment and former heroïn addicted patients in maintenance treatment. After description of the ASI, presentation of the training procedure for its optimized use and methodological issues, we present for each opiate dependent group acceptability data, results of some of the ASI's 240 items and the severity scores. The Addiction Severity Index provides assessment of problem severity in seven functional areas in which substance abusers are commonly impaired and unable assessment of need for treatment. Objective and subjective patient data are collected in the following seven areas: medical, employment/ support, alcohol, drug use, legal, family/social relationship, and psychiatric. The ASI is both broad in the extent of its evaluation and yet easy to use for appropriately trained interviewers. Use of the ASI over the past five years allows us to underline the following characteristics: in the clinical setting the ASI unable a common descriptive analysis for need and adaptation for treatment of different patients populations; in the research setting the ASI is particularly suited for epidemiological studies of addiction and description, analysis or evaluation research.

Adult↗
PubMedDate not supplied

[Administration of high dose levothyroxine in treatment of rapid cycling bipolar disorders. Review of the literature and initial therapeutic application apropos of 6 cases].

INTRODUCTION: Rapid cycling among bipolar disorders was characterized in 1974 by Dunner and Fieve by at least 4 episodes per year, lithium resistance, female predominance. The idea of using thyroid hormones is based on frequent coexisting thyroid dysfunction. Thyroid hormones where first used in the forties, and more recently (table I) in open label and blind trials (Stancer et Persad, 1982; Bauer et Whybrow, 1990). OBJECTIVE: Open label study of levothyroxine in rapid cycling bipolar disorder. MATERIAL AND METHODS: Six subjects (4 females and 2 males, mean age 45.5 years at onset of bipolar disorder) meeting DMS III-R criteria for rapid cycling bipolar disorder were consecutively included in an open label study of levothyroxine. Subject characteristics are presented in table II. RESULTS: After almost two years follow-up results appear positive in 67% of cases (2 complete remissions, 2 partial remissions and 2 failures). CONCLUSION: Our cases, with data reported in the literature, support the potential efficacy of levothyroxine for treatment of rapid cycling bipolar disorder patients. We suggest a protocol for the good application of this potential new treatment (table III).

Adult↗
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[Adverse seizure reactions after electroconvulsive therapy. Study of personal cases and review of the literature].

OBJECTIVE: To determine what are the risk factors for the occurrence of unwanted seizures after an ECT session, and what is the best attitude regarding future ECT. METHOD: We have reviewed all the case reports published in the literature between 1946 and 1995 and have carried out a prospective case-control study of all incidental seizure type side effects among a group of 43 patients treated consecutively using the same procedure within the same institution in 1993. RESULTS: Results from the literature are presented in tables I to IV and results from our case-control study in tables V to VIII. Twenty seven seizure type side effects are reported in 22 published papers reporting the case of 24 patients. Most accidents occur during the first ECT and the occurrence of non convulsive seizures is greatly increased in case of coexisting EEG-monitoring. In our own study the overall incidence is 0.95%. Risk factors are neurologic disease, psychotropic medication, history of prolonged seizure during previous ECT. CONCLUSION: It appears that no unique risk factor but a summation of several risks (personal or family history of seizure, psychotropic medications, high energy level of electric stimuli) for specific subjects increases the risk for seizures after ECT. ECT can be resumed if necessary after occurrence of a post ECT seizure with addition of anti-epileptic medication.

Adolescent↗
PubMedDate not supplied

[Anxiety disorders in general practice: frequency--treatment. A survey of the Aquitaine Sentinel Network].

OBJECTIVE: This study, conducted in Aquitaine (Southwest France), was designed to assess both frequency and treatment of anxiety disorders in general practice patients. METHOD: The assessment was cross-sectional; a random sample of 312 patients was chosen and evaluated during the last week of Mai 1993, by 55 general practitioners who usually collaborate in the Aquitaine Sentinel Network, supported by the Department of Medical Statistics and Public Health of the University of Bordeaux. Anxiety disorders were assessed by the Composite International Diagnostic Interview and level of depression was self evaluated by the Beck Depression Inventory. The physicians reported current psychological and psychopharmacological treatments, and request for treatment of every patient tested. RESULTS: Frequency of anxiety disorders is concordant with available epidemiological data in French general population. There is no sex difference for anxiety disorders in this study, in opposition to what is known in the general population (2 = 1.47, p > .05). Women are more treated than men (drugs: chi(2) = 7.31 p < .01; psychotherapies: chi(2) = 7.58 p < .04) although they don't request for more treatment (chi(2) = .59 p M .05). Benzodiazepines and psychodynamic oriented therapies are the most used treatments for any anxiety disorders; specific treatments (antidepressive drugs, behavioral therapies) of anxiety are very rarely prescribed. CONCLUSION: This study shows the difference between the current theoretical knowledge in anxiety disorders, and the management of these disorders by the general practitioner. It suggests that patient's request, in opposition to what is often found in the literature, is not a determinant factor in treatment.

Adult↗
PubMedDate not supplied

[Effect of treatment with methadone on utilization of medical care by addicts seropositive for the AIDS virus. Results of a descriptive study, Bayonne, 1996].

Since two years, 80 patients received methadone maintenance treatment in Bayonne Médecins du Monde Center. In this population, 48% are HIV positive... The aim of this study is to determine the impact of methadone maintenance treatment on the medical status of a group of HIV positive subjects. In addition to the Addiction Severity Index collected data and quality of life evaluation by the TEAQV, the following data are collected: compliance to appointments HIV clinic, CD4 status, evolution of weight, observance of HIV medicine. Preliminary results are presented, showing precisely and confirming the good influence of methadone maintenance treatment on medical care of patients with HIV and AIDS. This kind of study, before and during the maintenance treatment (base line, third month and every six months) appears as a very important stake: for this patients with HIV and AIDS, in term of personal and medical status, for us, in term of methadone treatment impact, and health public care.

Adult↗