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T Bougerol

Publications and source records attributed to T Bougerol.

At least 37 records · Page 2Linked to original sources
PubMed1991

[Schizophrenia: diagnosis, classification, course and prognosis].

Schizophrenia is a chronic mental illness usually considered as one of the most disabling. Its clinical manifestations are characterized by a mental splitting which is a loss of the unity and cohesion of mental activity. A paranoid state or psychomotor disturbance are, sometimes, associated with this mental splitting. The course of the disease may be continuous or oscillating with acute exacerbations. The outcome of schizophrenia is often characterized by a chronic defect state but may be quite good for one half of the patients.

Adolescent↗
PubMed1991

[Semiological and psychological predictive factors of response to antidepressive agents].

Since the discovery of the first antidepressive compounds, very few progress have been made for the efficacy of these drugs. All the antidepressants, even the more recent of them, are efficient only in 60 to 75% of the depressive disorders treated. Many studies have been conducted to define clinical or psychological predictive factors of the response to antidepressants. Emphasis was carry mostly on the clinical characteristics of the depressive disorder and the importance of "endogenous" features for the response to treatment, have been well established. Some works have also emphasized the importance of personality disorders and environmental disturbances for the issues of treatment. More recent works aim to define the characteristics of the best responders to more selective antidepressive compounds. But, it is still very difficult today to define precisely what are the clinical or psychological features which are specifically responsive to antidepressive drugs.

Antidepressive Agents↗
PubMed1988

[Visual evoked potentials and attention processes in depression].

The study of the attention process during depression has been realized with the recording of visual evoked potential (VEP) by simple pattern reversal checkerboard and in sequences where a rare stimulus appears randomly, with or without task. The recordings obtained on fifty patients have been compared to the VEP obtained on fifteen reference subjects. The results indicate that some perturbations, characteristic of the depressive state, should happen at the both levels of attentional selection, early (P1 and N1 components) and late (P3 component). The responses of the depressive patients appear to reflect rather an intervention of automatic attention process.

Adult↗
PubMedDate not supplied

[Potentializing of tricyclics and serotoninergics by thyroid hormones in resistant depressive disorders].

In response to the increase of resistant depressive disorders and in spite of improved treatments, numerous studies were conducted in the last thirty Years aiming at assessing the pre-morbid thyroid state of depressed patients resistant to well conducted tricyclic treatments. "Minimal" thyroid abnormalities were evidenced as well as central thyroid disorders which may not be detected by peripheral-i.e plasmatic- dosages. Regarding the premorbid thyroid status, the hypothesis of subclinical hypothyroidism was considered by many Authors. It is marked by four grades including T3 and T4 decreased levels, basal TSH concentration abnormalities as well as increased TSH response to TRH stimulation, and the presence of antimicrosomal and antithyroglobulin antibodies. Although, there are different views on the existence or not of these abnormalities, we'll focus our attention on a metaanalysis including six studies. It shows in a population with a resistant depression, 52% of patients with subclinical hypothyroidism, against 8 to 17% in patients with simple depression and 5% in the overall population.Similarly, antithyroid antibody levels (group IV hypothyroidism) were significantly higher in depressed patients (9% to 20% against 7,5% in the overall population). For many Years, a central hypothyroidism was hypothesized on the basis of an exhausted T3-T4 transference mechanism and a lowered TRH hypothalamic biodisponibility.In the last Years, new data emerged on the role of transthyretin, a cerebral carrier T4 protein, whose concentration in the CSF was found significantly lower in depressed patients than in a control group, the lowest levels being observed in the most severely depressed. This decreased level of transthyretin would result in a lower central T4 biodisponibility-hence, in view of a T4-T3 desiodation insufficiency, a T3 deficit is observed. A low transthyretin level associated or not to subclinical hypothyroidism could be a factor of depressive vulnerability on one hand, of resistance to tricyclic treatment on the other one. Conversely, subclinical hypothyroidism could be a predictive factor of a good response to a potentializing strategy. The pharmacological mechanisms involved in this potentializing phenomenon are now well known: they consist in an interaction between depression, adrenergic receptors and thyroid hormones biodisponibility. The decreased norepinephrine level observed in depressive patients is associated, in case of increased thyroid hormones biodisponibility, with a higher sensitivity of adre-nergic receptors, mostly betaadrenergic. This seems to underly the recovery process. According to some Authors, the serotoninergic system might be involved in the potentialization of tricyclics by thyroid hormones. We know that in animals with hypothyroidism, the serotonin synthesis is decreased and that the administration of T3 increases the brain levels of serotonin and its 5HIA catabolite. In addition, T3 could correct the down-regulation induced by serotoninergics on beta-adrenergic receptors. On the basis of numerous studies carried out on the potentializing of tricyclics, we suggest practical modalities of treatment - which until today did not materialize in every day practice in the absence of a clear consensus based on statistically reliable data: after four to six weeks of inefficient tricyclic or serotoninergic treatment on a correct dosage testified by plasmatic dosages, it is recommended to initiate a T3 treatment on a effective posology (25 to 50 micrograms per day), which must be reached in 2 or 3 days, except in case of rare and transitory side effects (sweating, shaking, tachycardia, nervousness, anxiety). If the treatment is not rapidly efficient, it must be discontinued in case there is no improvement after 3 weeks. Until today, there is no consensus about the duration of a T3 treatment. It is important to take into account the predictive criteria of good or bad response to a T3 potentialization, since they have direct consequences on the management of depressed patients. For example, a high degree of chronic evolution with resistance to numerous treatments, associated disorders according to the DSM IV axis I and a comorbidity of addiction, point to a bad prognosis of a potentialization treatment. In addition, we'll examine the few recent studies on the potentializing of serotoninergic antidepressant drugs by thyroid hormones.

Animals↗
PubMedDate not supplied

[Vulnerability to schizophrenia. III: Importance and limits of the Identical Pairs Continuous Performance Test].

Since several investigations have shown attentional deficits both in patients with schizophrenia and in subjects at high risk for schizophrenia, these deficits could be valuable vulnerability markers for schizophrenia. The aim of this study was to investigate wether non psychotic relatives of schizophrenic probands have deficits in sustained attention as measured by the Continuous Performance Test, Identical Pairs (CPT-IP) version. The study subjects were 25 schizophrenic probands, 50 of their first-degree relatives and 46 normal controls. For each subject, attention was assessed during 6 experimental conditions (2 standard, 2 slow, 2 easy conditions) of visual stimuli (digit-numbers and shapes). In each of the six conditions, the value of the sensitive index d' in the first-degree relative group was at an intermediate level between the patient and control groups. Moreover, in the standard shape condition, the d' value was significantly lower in the schizophrenic and in the relative groups than in the control group. This deficit was all the more interesting since it was not explained by a deficit in general intellectual abilities or by psychopathology such as anxiety or depression. Furthermore, the schizophrenic patients made more random errors in the standard and in the slow number conditions than both other groups. All groups improved their performance when the stimulus duration increased and when the processing load decreased. As a conclusion, this investigation seems: 1) to confirm the existence of an attentional deficit in the first-degree relatives of patients with schizophrenia; 2) to demonstrate the interest of the CPT-IP to detect this deficit. It must be emphasized that in order to detect the deficit, one only needs to explore the standard shape condition and that under such circumstances, the CPT-IP test has the advantage of being less time consuming than tests used in previous studies.

Adult↗
PubMedDate not supplied

[Apropos of using patient isolation in psychiatry: point of view of nurses].

Seclusion continues to be used in the care of acutely disturbed psychiatric patients despite often emotionally charged debate about its appropriateness within mental health services. Powerful legal and moral arguments about the use of seclusion emphasize an urgent need to critically examine its role in the care of mentally ill people. This paper examines the use of seclusion on psychiatric departments in the management of acutely disturbed patients: 36 psychiatric nurses working in 6 departments in a specialized hospital (the CHS de la Savoie, in Chambery) were interviewed in relation to their perceptions of the role of seclusion. Data were analysed using grounded theory methodology revealing the core conceptual category "controlling" and two sub-categories "watching out for" and "watching over". Seclusion was found to be used as an adjunctive treatment in the care of individuals considered to be "out of control". Clinicians expressed comfort with the use of seclusion, citing a strict protocol that provided parameters for its use. While expert therapeutic interventions were described by clinicians, they are contextualized within a framework of power and control--a framework that stands in stark contrast to contemporary philosophies of nursing care, providing impetus for a reconsideration of the use of constraining practices in the care of mentally ill people.

Adult↗
PubMedDate not supplied

[Restraint and seclusion in psychiatry: review and prospects].

In this article, the authors reviewed the literature published since 1965 concerning restraint and seclusion. They synthesized the contents of the articles reviewed using the categories of indications and contraindications; rates of seclusion and restraint as well as demographic, clinical, and environmental factors that affect these rates; effects on patients and staff; implementation; and training. The literature on restraint and seclusion supports the following: 1) Seclusion and restraint are basically efficacious in preventing injury and reducing agitation; 2) It is nearly impossible to operate a program for severely symptomatic individuals without some form of seclusion or physical or mechanical restraint; 3) Demographic and clinical factors have limited influence on rates of restraint and seclusion; 4) Training in prediction and prevention of violence, in self-defense, and in implementation of restraint and/or seclusion is valuable in reducing rates and untoward effects; 5) Studies comparing well-defined training programs have potential usefulness.

Humans↗
PubMedDate not supplied

[Characteristics of patients hospitalized in a specialized hospital center after after attempted suicide].

Authors have counted, during a period of one year, the totality of patients having been admitted to the Centre Hospitalier Spécialisé de la Savoie (Chambéry) following a volunteer medicinal intoxication; 227 patients have been thus included, this type of acting out concerning third more women than men. The higher impact is found in young adults (20-40 years). Professional inactivity appears as a favoring factor, while the way of life (bachelor or in couple) does not seem to have consequence on the frequency of occurrence of the suicidal attempts. Relapses are numerous, and happen in most cases during the year. Concerning used medicines, they have been generally prescribed by a practitioner or a psychiatrist. The prominent fact is the presence of a very short period between the prescription, the deliverance of the medicine and the acting out. Plurimedicinal intoxications are increasingly frequent, with often concurrent absorption of alcohol. The diminution of the use of barbiturics in ambulatory medicine to the profit of other molecules, and especially the benzodiazepines, has reduced the frequency of their use in volunteers medicinal intoxications. Benzodiazepines are the most employed medicines in this type of acting out. This epidemiological and toxicological study confirms that used substances during volunteer medicinal intoxication are a reflection of the general medicinal consumption.

Adult↗
PubMedDate not supplied

[Why psychotic patients are not drug compliant?].

Improving patient's compliance with antipsychotics is a major issue in psychosis management. As the point is to convince patients to take their drugs, we have to better understand why they should want or not want to do that. Compliance is actually a complex behavior, involving many psychosocial factors. Thus, we conducted a survey to assess compliance rate and to investigate determinant compliance factors of psychotic outpatients (according to CIM-10 diagnosis). Method - Investigated factors were selected according both to biomedical researches and to psychosocial theories (Health Belief Model). Around 20 influential factors, described in publication, were investigated. The questionnaire design conformed to sociological survey's rules. More, in order to promote patients frankness, the investigator was independent of the medical team. We processed the answers of 63 patients (61% men, average age 40 years), having presented with psychotic disorders for an average of 10 years, without addictive comorbidity (CIM-10). Results - The compliance rate was only 47%. Biomedical factors related to patients (sex, age, social way of life, professional state, and study level), as well as those related to treatment (complexity, duration, side effects occurring), don't affect compliance behavior. The psychosocial factors investigation reveals more interesting results. If the patient trusts his medicines, and do not subscribe to drug's negative beliefs , compliance rate is significantly improved (p=0,0062). It appears to be the survey's best factor for a good compliance, but it concerns only 29% of the investigated patients. When patients aknowledge the whole positive effects of their medicines, compliance is also inclined to improved (p=0,075). But compliance significantly decreases when patients felt that adverse effects are difficult to undergo or unbearable (p=0,04). It also inclined to decrease when family or friends have a negative opinion or are hostile to the pharmacological treatment. None of the other factors influence patient's compliance. Conclusion - These results demonstrate that convincing psychotic patients to be compliant is mandatory. As determinant compliance factors appear to be complex psychosocial ones, it also demonstrates that information procedure needs to be extensively structured.

Adolescent↗
PubMedDate not supplied

[Psychosurgical treatment of malignant OCD: three case-reports].

Surgery can be proposed for some patients affected by psychiatric diseases such as severe, disabling and refractory affective disorders (depression), OCD and chronic anxiety states. It can be performed after a period of evolution of minimum 5 Years and after all other classical treatments have failed. For the last Years, different stereotactic techniques have been used: capsulotomy, cingulotomy, subcaudate tractotomy and limbic leukotomy, performed by radiofrequency thermolesions or radiosurgery (g rays). In the case of OCD, these procedures are supposed to affect some of the neural circuits between the frontal lobes and different structures of the limbic system, considered as central to OCD symptoms. As they cause smaller cerebral lesions than earlier surgical techniques (mostly open surgery techniques), modern stereotactic approaches have less clinical side effects, primarily less deficit in emotional reactivity and motivation. This type of treatment offers some hope to patients seriously disabled by OCD. These surgeries and especially their main side effects are mentioned briefly in this Article. The most current indications for psychosurgery are severe OCD and chronic major depressive disorder. The level of stress should be significant and assessed by clinical and social functioning scale scores (for the OCD: Y-BOCS>25, GAF>50). Patients affected by demential disorders, sociopathic or paranoiac personality disorder, substance abuse should be excluded as well as patients aged 65 Years over and less than 18 Years. Several studies evaluating the results of the surgical treatment showed significant improvement in 54% of cases. and a moderate improvement in 27% of them. These results seem unchanged a few Years later in 56% of cases. Despite the lack of controlled trials of neurosurgery and several bias in published reports, evidence suggests that the condition of intractable OCD patients may improve after this surgery. Although capsulotomy and cingulotomy are mainly used, the superiority of any of these four surgical techniques has not been established yet. In this Article, we reported 3 "malignant" OCD cases treated by different psychosurgery techniques: 2 of the cases showed a clinical improvement, whereas the third did not -benefit from surgery. All of them were suffering of OCD since childhood with a gradual clinical impairment, unless the -second patient who presented a severe impairment following an accident causing a ten-day coma. In all three cases social consequences of OCD were important: negative socio-professional and family-life consequences and depressive complication with suicide risk. All patients remained unresponsive or showed a very transient reaction to the other forms of therapy, including varied pharmacotherapy (potentiation pharmacotherapy strategies included), intensive psychotherapy, behavioural therapy and electro-convulsive therapy. Pre- and post-operative assessment included neurological, radiological, psychometric and neuropsychological examination. The free and informed consent of the patient was always required before surgery, notifying the nature of the procedure, the potential risks and outcome. The first patient benefited of a bilateral anterior cingulotomy by thermocoagulation in stereotactic conditions, followed, four years later, by a second complementary one because of a relapse which occurred a few months after the first intervention. A clinical improvement was noticed over a period of two years, though it was not sufficient according to the patient. The second patient benefited of a stereotactic cingulotomy associated with a limbic leucotomy: it was initially efficient on OCD as well as on thymic symptoms. Nevertheless the positive evolution on OCD is not perceived by the patient and has not been assessed until now by clinical rating scales. Anterior cingulotomy is undergone in the third case, who showed a significant improvement. Despite clomipramine administered secondary to the surgery, a slight relapse of obsessive ideas was noticed six months later. The postoperative side effects were transient and regressive after a few months; they were observed especially in the case of tractotomy (oedema and transient frontal syndrome). On the whole, morbidity seemed more important with extensive lesions, whereas recurrence rate may be higher with smaller lesions. We did not observe any consequences on personality or on cognitive functions of these patients. No additional -deficits were observed after surgery. Further research is needed in order to determine the optimal site and size of the lesions in terms of efficacy and safety. Although psychosurgery is still controversial from an ethical view point, this treatment appears to be an ultimate solution for these severe disabled patients. Psychosurgery is a safe and relatively effective treatment which should be carried out by an expert multidisciplinary team in these disorders; surgery should be considered as part of an entire treatment program including an appropriate psychiatric rehabilitation part. Research in this field is currently focused on MRI-guided basal ganglia stimulation techniques which would allow to target specific structures in a reversible way.

Brain↗
PubMedDate not supplied

[Erythrocyte membrane transport of tyrosine and tryptophan and plasma level of MHPG in depressive disorders].

Both plasma MHPG level and red blood cell membrane transports (TM) of L-tyrosine (L-TYR) and L-tryptophan (L-TRY) were evaluated in 29 depressed patients and compared to 16 control subjects. On the basis of MHPG plasmatic levels, we were able to define two subgroups in the depressed population showing a biological homogeneity: in the first one, both MHPG level and TYR TM decreased, while in the second one neither of these indices were disturbed. These biological features were not related to the nosographic subgroups. Bipolar depressed subjects showed a decrease in both MHPG and TYR TM; unipolar depressed subjects exhibited a decrease in both MHPG and TYR TM associated to an increase in TRY TM, whereas no change was found in dysthymic disorders. The time course of MHPG and MT were desynchronized if followed during the antidepressant treatment. At day 7, MHPG level increased significantly, while clinical improvement showed a normalisation of MHPG and TYR TM.

Adult↗