Meralgia paresthetica syringectica.
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Adult↗
Biomedical subjects
M Auriacombe
Publications and source records attributed to M Auriacombe.
Transcutaneous electrical stimulation with Limoge current potentiates morphine analgesia and attenuates opiate abstinence syndrome.
Transcutaneous electrostimulation is a somewhat controversial technique used in the management of the opiate withdrawal syndrome. We report an animal study of a particular transcutaneous electrostimulation called transcutaneous cranial electrostimulation, based on a technique used for many years on heroin addicts for the rapid severance of their addiction, which has been validated in a clinical setting by a double-blind trial. This technique involves the application of an intermittent high-frequency current (Limoge's current). Our experimental data show that this transcutaneous cranial electrostimulation increases morphine analgesia by threefold on the tail flick latency measure and produces a 48% attenuation of the abstinence syndrome observed after abrupt cessation of morphine administration. These results were obtained using a double-blind paradigm.
Animals↗
[Continuity in the neuroleptic treatment in patients with schizophrenia. Current data].
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Antipsychotic Agents↗
A naturalistic follow-up study of French-speaking opiate-maintained heroin-addicted patients: effect on biopsychosocial status.
The purpose of this study was to evaluate the impact of opiate maintenance pharmacotherapy (OMP) on the biopsychosocial status of opiate-addicted patients in a cultural environment (France) that is not favorable to OMP and where methadone is not available. Buprenorphine and laudanum (opium tincture), which, to our knowledge, has not been reported previously in the scientific literature for OMP, were used in this study of a group of 18 opioid-dependent subjects. At time of initiation of OMP, mean age was 33 years, sex ratio male: female was 14:4, average duration of drug use was 11.2 years. Six patients received laudanum p.o., 15 g daily; 12 patients received buprenorphine sublingual 2 to 4 mg daily. This group of patients was selected because of persistent relapse and impairment after an average of 5.7 drug-free-oriented treatments over a period of 6.8 years. Initial evaluation and follow-up were made by way of a 150-min semi-structured interview using the Lifetime Retrospective Evaluation Score Table (LREST) and the Addiction Severity Index (ASI). Results showed that body weight and scores for physical and psychological health, socioprofessional status, and family relationships improved significantly after 14 months of OMP. These results show that highly impaired opiate-addicted patients doing poorly in drug-free treatment can respond to OMP even though methadone is not available and the idea of OMP is not favored.
Adult↗
Cochrane Drugs and Alcohol Group: the development of systematic reviews of treatment outcome.
- The aim of the Cochrane Collaboration is to promote review processes which address all aspects of health care and which can be viewed by clinicians to guide their day-to-day clinical practice. Recently, a Cochrane review group on drugs and alcohol has been developed. The Cochrane Review Group Editorial base is in Rome, Italy. There is an international editorial board with editors in the UK, Italy, France, Australia and the USA. So far, the group has published five reviews addressing treatment for opioid, cocaine and alcohol dependence. Additional reviews and protocols are in progress. A growing number of titles are registered with the group. Interested readers and potential reviewers and/or referees can contact the Cochrane Drugs and Alcohol Group Coordinator in Rome at the e-mail address: dacochrane@asplazio.it
Alcoholism↗
[Addiction and personality].
Within the field of substance abuse, it is now widely admitted that the addictive personality does not exist. No one personality type is predisposed to addiction. The predisposition to drug dependence involves many different factors: psychological, social, familial, biological. None of these factors can be the sole determinant of drug dependence. Keeping that in mind, it is of interest to review the recent data on the relationship between personality traits or disorders and opiate and cocaine dependence. Using DSM and ICD categorical assessment, no single personality disorder emerged, instead a range of personality disorders has been evaluated in opiate and cocaine dependent subjects. Every type of personality disorders (PD) existed but cluster BPD were the most common (especially antisocial personality disorder in opiate addicts). However, it is noteworthy that a large minority to a majority of subjects did not display any king of PD. The implication of these results is that antisocial PD is probably over-diagnosed in drug dependence clinical settings. The studies reviewed failed to demonstrate that personality disorders were strong predictors of outcome in opiate or cocaine dependence. However, opiate dependent PD subjects entering treatment had more severe problems and lower retention rate than non PD subjects. But the amount of improvement was not significantly different between PD subjects and non PD subjects. This demonstrated that substance dependent PD patients could benefit from treatment whose intensity and duration must be adjusted. There is good support for the idea that Sensation Seeking trait is a vulnerability factor to substance abuse. But after dependence develops, sensation seeking is probably irrelevant to continued use of the drugs. This break between the psychopathology of vulnerability of substance abuse and the psychopathology of dependence raises the question of the existence of dramatically different factors involved in both phases of addiction.
Behavior, Addictive↗
[Quantitative evaluation of sharing practices of materials at risk for infectious virus contamination by intravenous opiate users seeking treatment--application of the RAB(Risk for AIDS Behavior) self-administered questionnaire].
The objective of this study was to quantify the occurrence of AIDS risk related sharing activities in i.v. opiate users seeking treatment using a self administered questionnaire. Subjects were recruited among first time consultants of an outpatient clinic and assessed using the Risk for AIDS Behavior questionnaire (RAB), a self administered questionnaire that assesses both needle-sharing and unprotected sexual activity; the Beck Depression Inventory (BDI) a self administered questionnaire that assesses depressive symptoms; and the Addiction Severity Index (ASI), a 45-min, structured interview that provides assessments of problem severity in seven functional areas commonly impaired among drug abusers. Among the 102 patients who came in for treatment, all 66 subjects reporting i.v. drug abuse agreed to participate. The study was based on the data collected from these 66 subjects of whom 49 were males (74%) and mean age +/- SD was 31 +/- 5. Fifty-eight-percent of theses subjects reported having shared needles or related paraphernalia over the past 6 months. Despite informational campaigns on the risks of sharing and despite the well spread knowledge of such a risk, most i.v. opiate users seeking treatment report having shared at least once over the previous 6 months.
Acquired Immunodeficiency Syndrome↗
[Lethal catatonia: clinical aspects and therapeutic intervention. A review of the literature].
Lethal catatonia continues to occur and represents a nonspecific syndrome associated with diverse organic as well as functional conditions. From this perspective, neuroleptic malignant syndrome may be conceptualized as a neuroleptic-induced toxic or iatrogenic form of organic lethal catatonia. Neuroleptics appear ineffective in the treatment of lethal catatonia and should be stopped whenever this disorder is suspected. Existing data suggest that ECT is a safe and effective treatment for lethal catatonia. ECT also appears effective in the treatment of neuroleptic malignant syndrome.
Antipsychotic Agents↗
[Case study--relationship between prevalence of shyness, social phobia and avoidant personality in male sexual disorders].
UNLABELLED: Social phobia, avoidant personality disorder and shyness are very akin disorders, despite the fact that the first two are mental disorders, whereas the third is found mainly in lay or psychological literature. The relationship between these disorders and male sexual disorders can only be hypothesized from clinical studies and psychopathological theories. Social phobia, avoidant personality disorder, and shyness, share a probable indirect responsibility in sexual disorders because they impair the ability of subjects to meet partners. There are only a few direct studies of the negative impact of shyness on sexual behavior. OBJECTIVE: The objective of this study was to compare males with sexual disorders to non-sexual disorder males on diagnosis of social phobia, avoidant personality disorder and shyness. METHODS: We conducted a case-control study comparing a group of male patients seeking care for sexual disorders (n = 87) and a control group of male subjects without sexual disorder (n = 87), regarding the diagnosis of social phobia, avoidant personality disorder and shyness. Diagnoses were appreciated with a structured diagnostic interview (CIDI for the diagnosis of social phobia) or a list of criteria (DSM IV criteria for avoidant personality disorder) and through standardized scales (Fear Questionnaire, CBSHY, Cottraux male sexual problems questionnaire). Severity of shyness was evaluated through visual analog scales. RESULTS: We found strong significant statistical differences between cases and controls regarding the percentage in each group of social phobia, avoidant personality disorder and shyness. For shyness, the mean score at CBSHY was 16.2 (+/- 12.63) for the cases and 6.07 (+/- 6.67) for the controls (p < 0.0001), whereas the percentage of cases with a score of > 19.5 was 41.4% vs 6.9% for the controls (p < 0.001); 27.6% of the cases had a CIDI diagnosis of social phobia vs 8% of the controls (p < 0.001); 31% of the cases implemented DSM IV criteria for the diagnosis of avoidant personality disorder vs 6.9% of the cases (p < 0.001). CONCLUSION: Our results are in favor of one or several factors in common between social phobia, avoidant personality disorder and shyness, which would be strongly related to male sexual disorders.
Adult↗
[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↗
[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↗
[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↗
[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↗
[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↗
[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↗