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M Bourgeois

Publications and source records attributed to M Bourgeois.

At least 379 records · Page 21Linked to original sources
PubMedDate not supplied

[Clinical case observations: lessons for empirical research].

Empirical studies of psychopathology are typically conducted in the goal of uncovering general characteristics of large samples of individuals. By contrast, the case study has remained a basic paradigm for understanding the causes of psychopathology as it is actually experienced by a given patient. However, by using case studies as an example, empirical researchers are rediscovering the importance of the individual. New data collection and analytic techniques have recently been applied to this effort, and considerable progress has been made to remove previous barriers to idiographic analyses. The present article describes these new applications, and discusses how empirical research can benefit from using case studies as a model for understanding the individual in a larger sample.

Humans↗
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[Evaluation of the incidence of hospitalization of patients with psychotic disorders].

The aim of this study was to assess the administrative incidence of psychotic disorders, i.e. the incidence of first hospitalization for such disorders. Consecutively first-admitted patients hospitalized in 4 departments of Bordeaux's psychiatric hospital were included. Patients fulfilled the following inclusion criteria: no previous psychiatric hospitalization; aged 60 years or less; at least one overt psychotic symptom; clear consciousness. Patients were drawn from a 250,000 inhabitants urban catchment area, with an at risk population of 161,698 inhabitants. DSM IV diagnoses were made using the Mini International Neuropsychiatric Instrument (MINI) as well as all available information collected from the patient, the relatives, and from any other informant. A complementary study was performed in the private psychiatric institutions and in the military Hospital of Bordeaux in order to assess the representativeness of the patients hospitalized in the state hospital. 59 patients were included during one year in the state hospital. The raw incidence rate was 0.37 per 1,000 (95% CI; 0.28-0.46). We used a direct standardization on age to calculate the incidence rates ratio to gender. Men were over-representated in the sample, with a standardized incidence ratio in men compared to women equal to 1.87 (95% CI; 1.25-2.8). Psychotic mood disorders had the highest incidence, with an incidence rate equal to 0.15 per 1,000 inhabitants (95% CI; 0.09-0.21). The incidence rate of DSM IV schizophrenia was lower than that of psychotic mood disorders, and was equal to 0.13 per 1,000 (95% CI; 0.08-0.18). Several studies conducted in European and North-American countries have recently suggested that the incidence of schizophrenia may have decreased in the past decades. Since few French studies on the incidence of such disorders have been carried out, it is not possible to assess whether the incidence of schizophrenia is or not decreasing in France. Further studies on the incidence of psychotic disorders are required in other French regions in order to assess the reproductibility of our results, and to have reference data on the incidence of psychotic disorders in the nineties.

Adolescent↗
PubMedDate not supplied

[Prognosis of short-term outcome in the first admission for psychosis].

The aim of the study was to assess the factors predicting the clinical and therapeutic outcome at discharge of first hospitalization in a population-based sample of patients presenting with psychotic symptoms. Factors predicting duration of the first hospital stay were examined using Cox proportional hazard regression. A family history of psychiatric hospitalization was the only variable independently predicting at trend level a longer hospitalization (HR = 0.54, 95% CI 0.28-1.07, p = 0.08). Since most subjects (92.5%) returned to an independent place of residence in the community after the hospital stay, factors predicting residential outcome were not assessed. Factors associated with persistence of psychotic symptoms, or prescription of antipsychotic drugs, at discharge, were examined using logistic regression models. Persistence of psychotic symptoms (whatever their intensity) was associated with a diagnosis of schizophrenia broadly defined (OR = 23.9, 95% CI 2.8-201.7, p = 0.003), with poor adjustment in the preceding year as measured by the Global Assessment of Functioning (GAF) scale (OR = 0.93, 95% CI 0.87-0.99, p = 0.04), and, at trend level, with older age at admission (OR = 1.1, 95% CI 0.99-1.21, p = 0.07). Prescription of antipsychotic drugs at discharge was independently predicted by low educational level (OR = 5.5, 95% CI 1.2-25.4, p = 0.03), low GAF score (OR = 0.94, 95% CI 0.90-0.99, p = 0.05), and, at trend level, by a diagnosis of schizophrenia broadly defined (OR = 4.1, 95% CI 0.80-23.4, p = 0.09). Univariate analyses showed that duration of psychosis before first admission was strongly associated with persistence of psychotic symptoms and with prescription of antipsychotic drugs at discharge. However, no association was found between duration of psychosis and outcome after adjustment.

Adolescent↗
PubMedDate not supplied

[Addiction and personality traits: sensation seeking, anhedonia, impulsivity].

This study presents the evaluation of three dimensional traits of personality (Sensation Seeking, Anhedonia, Impulsivity) among 65 patients admitted in a psychiatric ward, with or without addictive behaviors. Our objective is to establish that these personality traits are commun to all addictive behaviors and to test the hypothesis that high scores on the three scales are linked to a greater probability of presenting with addictive behaviors. The two most frequent types of addiction were alcoholism and drug abuse. The subjects presenting with one or several addictive behaviors had higher average scores on the three scales. Our results printed in the same direction for the subjects having shown an addictive behavior in their past history. The risk to present with an addictive behavior increased with the total scores of these self-report questionnaires. There was a significant relationship between 3 sub-dimensions on the Sensation Seeking Scale and addictive behavior. Each time sub-scores of boredom susceptibility, disinhibition and thrill and adventure rise by one, the risk to present with an addictive behavior is multiplied by 1.4 for the first two and by 1.3 for the third one. Subjects with high scores on the anhedonia and impulsivity scales respectively show a risk multiplied by 1.6 and 3.3 of developing an addictive behavior. These results of this transverse study confirm the link between addiction behavior and these three personality traits.

Adolescent↗
PubMedDate not supplied

[Predictive factors of suicide? an 8-year-long prospective longitudinal study of 200 psychiatric inpatients].

Suicide is the most dramatic complication of psychiatric disorders. Certain risk factors are generally accepted by practitioners. Mental disorders increase (tenfold) suicidal risk. However, this "statistically rare event" renders very difficult the definition of predictive factors. A personal prospective longitudinal study of 200 psychiatric inpatients followed up during an 8-year period found 5% of deaths by suicide. Amongst the various risk factors reputed predictive for suicide, only 2 were found statistically more frequent in the suicidal group: familial antecedents (1st degree relatives) of suicide and hospitalization in psychiatry. Impulsivity was also more frequent but could be imputed to the younger age of the suicide victims. Therefore, it was impossible to find determinants of suicide. This makes difficult preventive measures, excepted that psychiatric patients are at a much greater risk and should be diagnosed and correctly treated. There are also increasing legal aspects of responsibility for psychiatrists and psychiatric institutions in charge of these patients.

Adult↗
PubMedDate not supplied

[Short-term sequelae of lithium discontinuation].

It has long been considered that lithium therapy could be abruptly stopped because it was guessed that lithium salts did not induce withdrawal symptoms. However, several open and controlled studies have shown that lithium discontinuation was associated with a possible withdrawal syndromee and with an incontestable rebound effect. Lithium withdrawal symptoms have been described in some patients, but it is not easy to distinguish them from depressive or manic symptoms, because no specific somatic withdrawal symptoms have been observed. The most important risk related to lithium discontinuation is the early recurrence of bipolar illness. Especially, it has been shown that the risk of manic recurrences is increased in the first weeks after discontinuation of lithium therapy, and that this risk is higher than the one predicted by the natural history of the manic-depressive illness. Relapses can occur even when lithium is stopped only for a few days. Abrupt discontinuation of lithium seems to be associated with an increased risk of recurrence. The pathophysiology of this rebound effect is still unknown. In clinical practice, lithium discontinuation has to be gradual when possible. Further studies are needed to precise at what time the risk of lithium withdrawal syndromee develops after starting lithium therapy. It is also necessary to establish more precise clinical guidelines for lithium discontinuation.

Bipolar Disorder↗
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[Irreversible neurologic sequelae caused by lithium].

Lithium therapy can induce acute toxic reactions especially during overdosage. Exceptionally, permanent neurologic sequelae persist after the acute toxic reaction. These sequelae are more often cerebellar symptoms. Dementia, parkinsonian syndromes, choreoathetosis, brain stem syndromes and peripheral neuropathies have also been described. They are defined as irreversible if they persist more than two months after the interruption of lithium treatment. These neurologic complications occur frequently after voluntary or accidental poisoning but they may be observed even if the serum lithium dosage is below toxic level. Risk factors other than overdose are not well identified. Neurologic lesions induced by lithium can occur in the first days of the treatment as well as after years of maintenance therapy. Age and psychiatric diagnosis do not seem to be correlated with an increased risk of lithium induced neurotoxicity. Sex may be a risk factor, because of an overrepresentation of women among the case reports. The lithium-neuroleptic combination is another possible (although controversial) risk factor precipitating the occurrence of irreversible neurologic sequelae. Haloperidol was first implicated, but it has been shown that others neuroleptics, in combination with lithium, can induce similar toxic reactions. Intercurrent somatic illness with pyrexia often precedes the acute toxic reaction, and special attention must be paid to patients treated by lithium when they become hyperthermic. Major surgery, concurrent treatment with diuretics, renal failure, low food intake or low-salt diet are more uncommon precipitating factors. Available pharmacological treatments have not yet proved to be helpful. Even when the lesions are irreversible, a functional improvement can be obtained by rehabilitation. Thirty one cases of irreversible neurologic sequelae are reviewed.

Female↗
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[Neuropsychological sequelae of deportation to the Nazi concentration camps during the Second World War].

The essential neuropsychic consequences of the deportation to the nazi concentration camps of adults during the second world war are the "KZ syndrome", the survival syndrome (or persecution syndrome) and reactive schizophrenias. The "KZ syndrome" puts together a psychic asthenia, a progressive intellectual deterioration, anxiety, depressive mood and vegetative disturbances. It is brought about as a consequence of malnutrition and the psychic traumas suffered by those deported. It shows up mainly in the non-jewish deported. The survival syndrome is chronic, puts together anxiety, insomnia and nightmares, repetitive memories relative to the period of persecution, depressive symptoms, somatic complaints, neurovegetative disturbances and hypervigilance. It is observed mainly in those deported that are jewish. It is produced as a consequence of very severe psychic traumas suffered by the jewish deportees. Some reactive schizophrenias described in deported jews seem to be the direct consequence of psychic traumas of an extreme intensity.

Concentration Camps↗
PubMedDate not supplied

[Neuropsychiatric aspects of HIV infection and AIDS].

Neurotropism of H.I.V. has recently been recognized. More than one third of Aids patients have neurological complications (infections, tumors, multifocal progressive leuko-encephalopathy...) attributed to immunological failure. Necropsy reveals more frequent neuropathology (75%). "AIDS Dementia Complex" (A.D.C.) has been described. Neuropsychological impairment (and personality alteration) is frequent (20-40%) even in asymptomatic patients. H.I.V. infects the C.N.S. early in the course of viral infection and prior to the development of classical associated neurological abnormalities. Mental disorders are frequent: anxiety, depression, suicidal behavior, etc. They can be psychological reactions, although they are often already present before H.I.V. infection in "high risk groups". The signification of psychosis is discussed. Overview of literature.

AIDS Dementia Complex↗
PubMedDate not supplied

[A case of lycanthropy with deadly violence].

After a short historical review of the contemporary medical literature, the authors analyze a new and original observation of lycanthropy. He is a 28 years old man, imprisoned for deadly violence, who has been showing, for many years, the belief of being transformed into a werewolf during depersonalization episodes when he presents a lycanthropic behaviour. Our observation is closer to hysteria and mythomania on an antisocial personality, although it seems difficult to place the mental pathology of this alcoholic recidivist delinquent into a nosographical frame.

Adult↗