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Biomedical subjects

Y Lecrubier

Publications and source records attributed to Y Lecrubier.

At least 37 records · Page 2Linked to original sources
PubMed2000

Social phobia: diagnosis and epidemiology, neurobiology and pharmacology, comorbidity and treatment.

Social phobia is a common disorder associated with significant psychosocial impairment, representing a substantial public health problem largely determined by the high prevalence, and the lifelong chronicity. Social phobia starts in early childhood or adolescence and is often comorbid with depression, other anxiety disorders, alcohol and substance abuse or eating disorders. This cascade of comorbidity, usually secondary to social phobia, increases the disability associated with the condition. The possibility that social phobia may be a trigger for later developing comorbid disorders directs attention to the need for early effective treatment as a preventive measure. The most recent drug class to be investigated for the psychopharmacological treatment of social phobia is the SSRI group for which there is growing support. The other drug classes that have been evaluated are monoamine oxidase inhibitors (MAOIs), benzodiazepines, and beta-blockers. The SSRIs represent a new and attractive therapeutic choice for patients with generalized social phobia. Recently the first, large scale, placebo-controlled study to assess the efficacy of drug treatment in generalized social phobia has been completed with paroxetine. Paroxetine was more effective in reducing the symptoms than placebo and was well tolerated. Many now regard SSRIs as the drugs of choice in social phobia because of their effectiveness and because they avoid the problems of treatment with benzodiazepines or classical MAOIs.

Adrenergic beta-Antagonists↗
PubMed2000

Anxiety disorders in anorexia nervosa and bulimia nervosa: co-morbidity and chronology of appearance.

The objectives of the study were to assess lifetime prevalence of specific anxiety disorders, and their age of onset relative to that of eating disorders (ED), in a French sample of patients with anorexia nervosa (AN) or bulimia nervosa (BN). We assessed frequencies of seven anxiety disorders and childhood histories of separation anxiety disorder among 63 subjects with a current DSM-IV diagnosis of an ED, using the Composite International Diagnostic Interview (CIDI). Eighty-three percent of subjects with AN and 71% of those with BN had at least one lifetime diagnosis of an anxiety disorder. By far, the most frequent was social phobia (55% of the anorexics and 59% of the bulimics). When present, the co-morbid anxiety disorder had predated the onset of the ED in 75% of subjects with AN, and 88% of subjects with BN. Our results are consistent with those of studies conducted in other countries, and show that an anxiety disorder frequently exists before an ED. This has to be taken in consideration for successful treatment of patients with AN or BN.

Adult↗
PubMed2000

A European perspective on social anxiety disorder.

Epidemiologic surveys conducted across Europe indicate that the lifetime prevalence of social anxiety disorder in the general population is close to 7%. The disorder in adulthood rarely presents in its 'pure' form and 70-80% of patients have at least one other psychiatric disorder, most commonly depression. Social anxiety disorder is a risk factor for the development of depression and alcohol/substance use or dependence, especially in cases with an early onset (< 15 years). Individuals with social anxiety disorder have significant functional impairment, notably in the areas of initiation and maintenance of social/romantic relationships and educational and work achievement. The economic consequences of social anxiety disorder are considerable, with a high level of diminished work productivity, unemployment and an increased utilisation of medical services amongst sufferers. Effective treatment of social anxiety disorder would improve its course and its health and economic consequences.

Comorbidity↗
PubMed2000

Prevalence of subthreshold forms of psychiatric disorders in persons making suicide attempts in Hungary.

BACKGROUND: Suicide and suicide attempts have been associated to psychiatric illnesses; however, little is known about the role in suicide risk of those symptoms that do not meet the full criteria for a DSM-IV disorder. The aim of this study was to examine the prevalence of subthreshold psychiatric disorders among suicide attempters in Hungary. METHODS: Using a modified structured interview (Mini International Neuropsychiatric Interview) determining 16 Axis I psychiatric diagnoses and their subthreshold forms defined by the DSM-IV and a semistructured interview collecting background information, the authors examined 140 consecutive suicide attempters, aged 18-65 years. RESULTS: Eighty-three-point-six percent of the attempters had one or more current threshold diagnoses on Axis I and in addition more than three-quarters (78.6%) of the subjects had at least one subthreshold diagnosis. Six-point-four percent of the subjects (N = 9) had neither subthreshold nor threshold diagnoses at the time of their suicide attempts. Ten percent of the subjects (N = 14), not meeting the full criteria for any DSM-IV diagnoses, had at least one subthreshold diagnosis. In 68.6% of the subjects (N = 96), both subthreshold and threshold disorders were diagnosed at the time of their suicide attempts. The number of subthreshold and threshold diagnoses were positively and significantly related (chi2 = 5.12, df = 1, P < 0.05). Sixty-three-point-six percent of the individuals received two or more current threshold diagnoses on Axis I and 44.3% of the individuals (N = 62) had two or more subthreshold diagnoses at the time of their suicide attempts. LIMITATIONS: The subthreshold definitions in this study included only those forms of the disorders which required the same duration as the criteria DSM-IV disorder with fewer symptoms. Conclusions - Suicide attempts showed a very high prevalence of subthreshold disorders besides psychiatric disorders meeting the full criteria required according to the DSM-IV. Subthreshold forms of mental disorders need to be taken into account in suicide prevention.

Adolescent↗
PubMed2000

Depressive illness and disability.

Depression is a prevalent disorder that imposes a severe burden of functional disability. With the exception of advanced coronary artery disease, depression is more disabling than the many other chronic medical illnesses often encountered in primary care. Depressed patients also suffer reduced workplace productivity, take more days off work due to illness and are very high users of healthcare resources. Where depression is comorbid with anxiety, the burden of disability and cost increases considerably. Treatment of depressed patients results in a lower level of disability and increased workplace productivity. Moreover, reduced usage of healthcare resources can offset the costs of the treatment. Depression is frequently under-recognized or misdiagnosed in the primary care setting, and many patients do not receive appropriate treatment that could help relieve their disability. Improving the recognition and treatment of depression is essential to reduce the burden of disability, on depressed patients and on society as a whole.

Antidepressive Agents↗
PubMed2000

Generalized anxiety disorder (ICD-10) in primary care from a cross-cultural perspective: a valid diagnostic entity?

OBJECTIVE: Generalized anxiety disorder (GAD) is a common psychiatric disorder. The nosological status of this diagnostic entity was critically discussed because of the very high rate of comorbidity with other psychiatric disorders, the assumed low degree of social disability associated with GAD in the absence of other disorders, and an ambigious definition. METHOD: We explored the frequency and associated social disability of GAD, and examined whether the ICD-10 definition of GAD is appropriate. The analysis was based on the WHO study on 'Psychological Problems in Primary Care' conducted in a standardized manner in 14 countries. RESULTS: We found GAD (total and without another psychiatric disorder) to be common in primary care in nearly all countries (mean 1-month prevalence rate, 7.9%), with about 25% of these cases presenting with GAD in the absence of any comorbid psychiatric disorder. GAD in general, as well as non-comorbid GAD, are associated with social disability which is as severe as that in chronic somatic diseases. CONCLUSION: It remains questionable whether the current ICD-10 diagnosis of GAD defining 6 months as a minimum duration and requiring at least four associated symptoms for diagnosis is the most appropriate option. Using this definition, a substantial proportion of psychosocially disabled subjects characterized by anxiety, tension and worrying remain undetected, and are possibly therefore not adequately treated.

Anxiety Disorders↗
PubMed2000

Antidepressant selection: proceedings from a TCA/SSRI Concensus Conference.

OBJECTIVE: Despite significant advances in treatment choice, the use of antidepressants in clinical practice remains far from optimal. One aspect of antidepressant use, initial antidepressant selection, is the most immediately influential way to improve clinical outcomes. The purpose of this conference was to review the available literature on the two most common classes of antidepressants--the tricylic antidepressants (TCAs) and the selective serotonin reuptake inhibitors (SSRIs)--and come to consensus on recommendations for initial antidepressant selection. METHOD: A panel of experts in psychiatry and health services research was convened to systematically review and discuss the available literature on the TCAs and SSRIs in the treatment of depression and related affective disorders. RESULTS: The consensus group concluded that growing evidence suggests that TCAs are no longer justified as first-line antidepressant therapy in most settings. In addition, emerging differences in the tolerability profiles and breadth of indication of the SSRIs are important to consider when making an initial treatment choice. CONCLUSION: While the coming years will bring new treatment options, clinicians currently have the ability to improve clinical outcomes and the long-term prognosis of depression. The following pages provide information to make informed antidepressant choices, thereby providing a higher quality of antidepressant treatment for the patient in actual clinical practice.

Antidepressive Agents, Tricyclic↗
PubMed2000

Consensus statement on posttraumatic stress disorder from the International Consensus Group on Depression and Anxiety.

OBJECTIVE: To provide primary care clinicians with a better understanding of management issues in posttraumatic stress disorder (PTSD) and guide clinical practice with recommendations on the appropriate management strategy. PARTICIPANTS: The 4 members of the International Consensus Group on Depression and Anxiety were James C. Ballenger (chair), Jonathan R. T. Davidson, Yves Lecrubier, and David J. Nutt. Other faculty invited by the chair were Edna B. Foa, Ronald C. Kessler, Alexander C. McFarlane, and Arieh Y. Shalev. EVIDENCE: The consensus statement is based on the 6 review articles that are published in this supplement and the scientific literature relevant to the issues reviewed in these articles. CONSENSUS PROCESS: Group meetings were held over a 2-day period. On day 1, the group discussed the review articles and the chair identified key issues for further debate. On day 2, the group discussed these issues to arrive at a consensus view. After the group meetings, the consensus statement was drafted by the chair and approved by all attendees. CONCLUSION: PTSD is often a chronic and recurring condition associated with an increased risk of developing secondary comorbid disorders, such as depression. Selective serotonin reuptake inhibitors are generally the most appropriate choice of first-line medication for PTSD, and effective therapy should be continued for 12 months or longer. The most appropriate psychotherapy is exposure therapy, and it should be continued for 6 months, with follow-up therapy as needed.

Cost of Illness↗
PubMed2000

Is amisulpride an 'atypical' atypical antipsychotic agent?

Amisulpride is a novel antipsychotic with a pharmacological and clinical profile that differs from that of other atypical agents. Amisulpride is highly selective for dopamine D2/D3 receptor subtypes located in the limbic region, which is highly predictive of potent antipsychotic activity with a low potential to cause extrapyramidal symptoms (EPS). At the same time, its selective activity at presynaptic D2/D3 receptors is responsible for enhancing dopamine transmission, which predicts efficacy in the treatment of the negative symptoms of schizophrenia. Amisulpride thus has a unique profile: efficacy in controlling the symptoms of schizophrenia, whether predominantly positive or negative, combined with a low incidence of EPS. This profile is seen during both acute and chronic treatment. Amisulpride is therefore indeed an 'atypical atypical'--a flexible antipsychotic the use of which can be tailored to the changing needs of the patient. It is thus a suitable first-line choice for the treatment of schizophrenia.

Amisulpride↗
PubMed1999

CSF 5-HIAA levels are lower in impulsive as compared to nonimpulsive violent suicide attempters and control subjects.

BACKGROUND: We studied CSF 5-HIAA and HVA concentrations in violent suicide attempters and examined their relationship with depression, anxiety, and impulsivity. METHODS: CSF 5-HIAA and HVA concentrations were determined very shortly after hospital admission and compared to those of a matched control population. Clinical evaluation was performed concomitantly; the level impulsivity was evaluated by the Impulsivity Rating Scale (IRS). RESULTS: Twenty-three patients and 23 control subjects were included. According to the IRS, 14 patients were classified as impulsive, including all patients suffering from personality disorders, and 9 as nonimpulsive, with a main DSM-IIIR diagnosis of melancholia. CSF 5-HIAA concentrations in the suicide group were significantly lower than in control subjects. This difference was entirely due to the impulsive suicide attempters. There was an inverse correlation between the IRS score and CSF 5-HIAA (r = -.47, p = .02) and only a trend for HVA (r = -.41, p = .078) levels in the suicide group. CONCLUSIONS: This study of a group of violent suicide attempters distinguished a subgroup of patients diagnosed with personality disorder with high impulsivity scores and a subgroup of patients with the main diagnosis of severe depression. CSF 5-HIAA was significantly lower in impulsive violent attempters than in nonimpulsive violent attempters, therefore desintangling violence from impulsivity and linking this biologic abnormality to impulsivity.

Adult↗
PubMed1999

Treatment resistant depression: methodological overview and operational criteria.

A wide variety of definitions are used for Treatment Resistant Depression (TRD), considering various criteria and different concepts. Some of the key issues are: the diagnosis, the treatment adequacy in terms of dose and duration, the treatment response assessment and the number of failed therapeutic trials required. Systematic research has been characterizing the concept and criteria to define the different variables involved. Lack of consensus on these issues limits comparison across clinical trials and interpretation of treatment efficacy in the management of treatment resistant patients. Through reanalyzes of available data, we point out the limits of TRD definitions and propose conceptual and operational criteria for a collaborative research project on TRD. It appears that a number of variables commonly associated to treatment resistance are independent of patients characteristics and mainly refer to misdiagnosis and inadequate treatment. The proposed criteria are intended for therapeutic trials in TRD, combining the evaluation of treatment efficiency and the validation of the concept of TRD itself. Major depression with poor response to two adequate trials of different classes of antidepressants is proposed for an operational definition of TRD. Rationale for this definition is discussed in contrast to alternative definitions.

Antidepressive Agents↗
PubMed1999

Is severe depression a separate indication? ECNP Consensus Meeting September 20, 1996, Amsterdam. European College of Neuropsychopharmacology.

There is not an accepted definition of severe depression, but using cut-off scores on rating scales severe depression is considered to lie at one extreme of a continuum of severity. The evidence from epidemiological, biological, and clinical efficacy studies does not support severe depression as a separate illness category. A good response to antidepressants is seen in both moderate and severe depression. The available evidence supports the view that in most cases an effective antidepressant in moderate depression is likely to have efficacy in severe depression. Few studies have found differences between antidepressants in their efficacy in treating severe depression. Most evidence of differential efficacy derives from studies of clomipramine, which is perceived as a particularly potent antidepressant by many clinicians. Other tricyclic antidepressants do not appear to have an advantage in severe depression. Separate studies to demonstrate efficacy in severe depression are not necessary for the registration of a new antidepressant. However if efficacy in severe depression is demonstrated in separate studies this information could be included in the summary of product characteristics to provide guidance to clinicians.

Affective Disorders, Psychotic↗
PubMed1999

The prescribing of psychotropic drugs by primary care physicians: an international collaborative study.

Psychotropic drugs play a major role in primary care management of mental disorders. This study expands the existing data on prescribing practices using data from a 15-center, primary care epidemiologic survey. Questions to be addressed include the following: Which clinical and nonclinical factors are related to the prescribing of psychotropic drugs by primary care physicians? How do prescribing patterns vary across primary care centers? At each center, primary care patients were screened using the General Health Questionnaire, and a stratified random sample completed a standardized diagnostic assessment. For each patient completing the diagnostic assessment, the treating primary care physician provided data on clinical diagnosis and medications prescribed. Study results indicated that 11.5% of all practice attenders, 51.7% of cases who received a diagnosis of mental disorders by a physician, and 27.6% of cases who received a diagnosis using the Composite International Diagnostic Interview were treated with psychotropic medication because of their psychologic problems. Anxiolytics, hypnotics, and antidepressants each accounted for approximately 20% of all prescriptions. Prescription rates increased with the prominence of psychologic complaints, severity of mental disorder, severity of social disability, female gender, age older than 40 years, lower education, unemployment, and marital separation. Rates and type of drugs also varied among specific mental disorders; 19.3% of patients with brief recurrent depression but 55.0% with agoraphobia got any psychotropic drug. Antidepressant drugs were prescribed in 7.7% of anxiety disorders compared with 31.9% of depressive disorders. There were large differences between international centers. When comparing client-type centers with clinic-type centers, overall prescription rates were similar (51.2 vs. 52.9%), but significant differences were observed with respect to psychotropic polypharmacy (12.6% client, 6.3% clinic), tranquilizer medication (24.2 client, 32.9% clinic), and antidepressant medication (17.3 client, 8.9% clinic). Psychotropic drugs have an important role in the treatment of mental disorders by general practitioners. Prescription is associated with a number of clinical but also nonclinical factors that must be recognized when guidelines for international use are to be published. Recognition of mental disorders and selection of specific drug classes are important areas in which medical practice needs improvement.

Adult↗
PubMed1999

Amisulpride versus amineptine and placebo for the treatment of dysthymia.

Amisulpride, a selective antagonist for D2 and D3 dopamine receptors, acts preferentially on presynaptic receptors increasing dopaminergic transmission at low doses. In a multicentre, 3-month, placebo-controlled study, amisulpride (50 mg/day) was compared to amineptine (200 mg/day) in the treatment of primary dysthymia. A total of 323 patients were enrolled. Amisulpride and amineptine were found to be statistically superior to placebo (p < 0.0001) on the Clinical Global Impression (item 2): 63, 64 and 33% responders, respectively; improvement of Montgomery-Asberg Depression Rating Scale and Scale for the Assessment of Negative Symptoms scores following amisulpride or amineptine treatment was twice as high as with placebo (p < 0.0001). The adverse event profile of amisulpride was similar to that of placebo except for endocrine symptoms in female patients; amineptine showed mainly events linked to psychic activation (insomnia, nervousness). Results show that amisulpride can improve symptoms of chronic depression in dysthymia.

Amisulpride↗
PubMed1999

[Use of a structured diagnostic interview to identify depressive episodes in an epidemiologic study: a posteriori internal validation].

BACKGROUND: During these last years, many structured and standardized diagnostic interviews have been developed in order to identify psychiatric disorders in a standardized way. These tools enable a systematic investigation of these disorders according to international classifications. Their main drawback is to be long. To assess the care of depression, we used a shorter and more simple tool: the Mini International Neuropsychiatric Interview (MINI) to identify depressive subjects. METHOD: The study was conducted in the Gazel cohort from the French National Electricity and Gas Company. A stratified sample of 2394 civil servants selected in order to over-represent depressive subjects was asked to answer to the MINI interview through a phone interview. An epidemiological and statistical analysis was performed to test the MINI internal validity: prevalence of depressive disorders using different threshold of diagnosis (number of symptoms required to identify someone as depressive), frequency of different symptoms, variability between investigators and potential biases. RESULTS: Respondents to the phone interview (1108 civil servants) had more often presented depression markers for the last 5 years. Prevalence of depressive episodes changed little when we varied the threshold of diagnosis and did not stress any threshold problem. The variability between investigators was important, but the estimation of prevalence remained stable when we excluded extreme rates of prevalence. The choice of a classification system affected the prevalence estimation. Using the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) from the American Psychiatric Association, the prevalence of depressive episodes was lower and closer to the estimations shown in the literature than using the International Classification of Disease (ICD 10). Moreover, the stratification assigned very unbalanced weights to the stratification strata. By excluding depressive episodes observed in the stratum "control" (no depression "marker" from 1989 to 1994 in the database), the prevalence was very lower, whatever the classification was. Finally, factors which appeared linked to care of depression with the ICD definition remained the same when the DSM diagnosis definition was used, and relative risks were quite similar. CONCLUSION: The MINI appears to be a short and simple tool, suited to the epidemiological studies. This analysis does not highlight any failure in the internal consistency of the MINI. The remaining question is what the MINI really measures, particularly comparing to a psychiatrist's diagnosis.

Cross-Sectional Studies↗
PubMed1998

Differences between prescription and consumption of antidepressants and anxiolytics.

The rate of detection of depressed patients by general practitioners (GPs) is generally reported to be lower than 50%, with some studies giving a value as low as 14%. In addition, GPs tend to overdiagnose anxiety and underdiagnose depression. Patients are not necessarily aware of the psychological nature of the disorder and only one-fifth list psychological complaints as the reason for contact. We collected information on the prescription and consumption of drugs in order to assess the influence of recognition of depression by GPs and of other factors on the treatment received by patients. Our results, which are particularly important in the context of current discussions on the cost of mental healthcare treatments, indicate not only a need for GPs to improve their identification rates but also a need to make patients more aware of the nature of their psychological diagnoses. When spontaneous psychological complaints are presented, the identification rate increases very substantially, and when patients are well aware of their conditions, compliance increases. It is clear from our results that greater specific recognition of psychiatric patients accompanied by the prescription of a specific treatment would not substantially alter the direct costs of drug prescription. On the contrary, it would very probably lower many costs, since the proportion of specific treatment given to properly identified patients is very low at present.

Adult↗
PubMed1998

Is depression under-recognised and undertreated?

Most patients with a psychiatric disorder consult their general practitioner (GP) within one year. The majority of these patients are depressed or belong to the depressive spectrum. As other epidemiological studies, the World Health Organization (WHO) study conducted on 25916 primary care patients found a high prevalence of depressive episodes according to ICD10 (10.4%) and of dysthymics (2.1%). Among those, only 54% were recognised as having psychological problems by their GP. A specific diagnosis of depression was done in only 15%. When patients were identified as cases, 24 % were prescribed antidepressants while, when they were identified as depressed, antidepressant prescription was 43%. Factors influencing recognition were: reason for contact, sex, severity, disability, age, the existence of a physical disease. Interestingly, reasons for prescription (independently from recognition) were very similar.

Adolescent↗