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Biomedical subjects

Yasser Khazaal

Publications and source records attributed to Yasser Khazaal.

At least 19 recordsLinked to original sources
PubMed2007

Naltrexone-assisted rapid methadone discontinuation: a pilot study.

Slow downtitration as a methadone discontinuation method is time-consuming and associated to high dropout rates. Whereas ultra-rapid opiate detoxification methods have recently gained some popularity, they are expensive and may be associated with particular problems in methadone patients. In the present study, a 3-day detoxification procedure accelerated with a unique dose of naltrexone was used in 10 methadone-substituted patients. Whereas the treatment resulted in a shortened withdrawal syndrome, which was satisfactorily controlled by the drugs used, a two-phase course was observed, some symptoms reappearing between the end of day 2 and the beginning of day 3. The first phase of withdrawal symptoms was attributed to the antagonistic effect of naltrexone, which possibly also improved under the weakening of naltrexone. The second phase of withdrawal symptoms may be related to falling methadone plasma levels.

Adult↗
PubMed2006

Eating and weight related cognitions in people with Schizophrenia : a case control study.

BACKGROUND: Patients with antipsychotic-induced weight gain (WG) regularly report on unsuccessful dietary trials, which suggests strong biological weight gain drive that is extremely hard to overcome with thoughts, such that behaviour doesn't change despite some intent to change. The purpose of the present study was to assess cognitions specifically related to restrained eating in severely overweight patients with schizophrenia treated with antipsychotic drugs. METHODS: Forty outpatients with schizophrenia and 40 controls without psychiatric disability were included. Both groups were composed of one subgroup severely overweight (defined as a BMI > 28), and a comparison sample (BMI<28). The revised version of the Mizes Anorectic cognitive questionnaire (MAC-R) was used in this cross-sectional case-control study. RESULTS: Gender was significantly related to eating disorders cognition, women scoring higher than men. Patients with schizophrenia in general scored higher on the MAC-R total scale and on the MAC-R subscale 2, the latter score representing rigid weight regulation and fear of weight gain. When comparing the two groups of subjects with BMI < 28, it appeared that patients with schizophrenia also scored higher on MAC-R total scale, the subscales 2 and 3, the latter subscale 3, indicating altered self control and self-esteem. CONCLUSION: As is the case in weight gain of subjects without schizophrenia, the present results suggest that the cognitive distortions, as assessed by the MAC-R, may play an important role in weight gain also in patients with schizophrenia, and in weight gain associated with antipsychotic pharmacotherapy. Particular attention to these processes may help to improve the management of antipsychotic drugs induced weight gain.

Journal Article↗
PubMed2006

A card game for the treatment of delusional ideas: a naturalistic pilot trial.

BACKGROUND: "Michael's game" is a card game which aims at familiarizing healthcare professionals and patients with cognitive behavioral therapy of psychotic symptoms. This naturalistic study tests the feasibility and the impact of the intervention in various naturalistic settings. METHOD: Fifty five patients were recruited in seven centers. They were assessed in pre and post-test with the Peters Delusion Inventory--21 items (PDI-21). RESULTS: Forty five patients completed the intervention significantly reducing their conviction and preoccupation scores on the PDI-21. CONCLUSION: This pilot study supports the feasibility and effectiveness of "Michael's game" in naturalistic setting. Additional studies could validate the game in a controlled fashion.

Adult↗
PubMed2006

Binge eating symptomatology in overweight and obese patients with schizophrenia: a case control study.

OBJECTIVE: The purpose of this study was to assess whether severe overweight schizophrenic treated patients differ from controls and from pairs in binge eating symptomatology. METHOD: Current body mass index (BMI) and the binge eating status were assessed cross-sectionally in 40 schizophrenic outpatients and 40 non-psychiatric controls. In each group half of the subjects were severe overweight (BMI > or = 28) or obese. RESULTS: Pearson Chi-square analysis shows a higher number of subjects with binge symptomatology in the group of patients with schizophrenia having BMI > or = 28 (Pearson Chi-square = 8.67, p = 0.034). Among subjects with BMI > or = 28, 60% of patients with schizophrenia and 30% of controls have binge eating symptomatology. CONCLUSION: This result may odds to the understanding of weight gain associated with antipsychotics and underscores the importance of assessing binge eating behaviour during treatment and prevention of obesity in this population.

Journal Article↗
PubMed2006

Topiramate in the treatment of compulsive sexual behavior: case report.

BACKGROUND: Among the multiple mechanisms of action of topiramate, AMPA/kainate antagonism may be particularly interesting for the treatment of disorders characterized by conditioned cognitive and behavioral cue reactivity. CASE PRESENTATION: We report the case of a patient consulting primarily for obesity and cue triggered snacking, who responded well on topiramate at doses up to 50 mg. Coincidentally he reported on an improvement of compulsive nonparaphilic sexual behaviors (consumption of prostitution), which was also strongly triggered by environmental cues. Both addictive behaviors (snacking and consumption of prostitution) reoccurred after discontinuation of topiramate and again responded reintroduction of the drug. CONCLUSION: The present case report of topiramate's effect on comorbid obesity and nonparaphilic addiction could be interpreted as a further indication that topiramate acts on the common pathway underlying conditioned behaviors and seems to be a treatment of behavioral disorders associated with environmental cues.

Adult↗
PubMed2006

Worsening of obsessive-compulsive symptoms under methadone tapering.

There is data supporting the hypothesis that the endogenous opioid system may play a role in the pathophysiology of Obsessive Compulsive Disorder (OCD). The authors report a case of worsening of OCD during methadone tapering, which seems to confirm the role of the opioid system in the pathophysiology of OCD. The possible involvement of the cortico-limbic-basal-ganglia-thalamic circuit in the observed phenomenon is discussed.

Adult↗
PubMed2006

Topiramate for smoking cessation.

Due to its AMPA (alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid)/kainate antagonism, topiramate would be particularly interesting in addiction treatment. Flexible-dose topiramate was prescribed to 13 smokers (10 smokers who wanted to stop smoking, and three who received topiramate for other reasons). Six out of 13 smokers were abstinent at 2 months and two more subjects had reduced their cigarette consumption by >50%. With one exception, temporary reduction of the number of smoked cigarettes preceded definitive abstinence at month 2. Three more subjects who achieved a momentary reduction had, however, to interrupt the treatment due to intolerable side-effects. Controlled trials are needed to confirm these preliminary observations.

Adult↗
PubMed2006

[Psychoeducational and cognitive behavioral treatments of bipolar disorder].

UNLABELLED: Bipolar disorder is a severe mood disorder characterized by recurrence of mania and depression. Despite the use of mood stabilizers, a significant proportion of bipolar patients experience relapse, psychosocial impairment and persistent symptoms. A significant part of patients show poor adhesion to the pharmacological treatment. This article aims to provide an overview of research focusing on psychoeducational and cognitive-behavioral treatment (CBT) of bipolar patients. METHOD: Studies were identified through Medline searches between 1971 and 2005. RESULTS: Studies on bipolar patients suggest that psychoeducational interventions may improve treatment adherence, illness knowledge, ability to cope with early manic symptoms and tend to reduce the risk of manic relapses. CBT tends to diminish depressive symptoms, improve treatment adherence and reduce the risk of depressive and manic relapses. Most psychoeducational and CBT studies share a common medical model of the illness, thereby making clear distinctions of impact of each intervention difficult. Few studies focused on patients with problems with mood stabilizers adherence. It is now important to develop specific interventions for those patients. CONCLUSION: According to these studies, bipolar patients are likely to benefit from psychoeducational or CBT interventions added to usual pharmacotherapy. In order to overcome limitations of existing research, future studies should adjust for the effect of pharmacological treatment, the type and severity of psychopathology at baseline, the acceptance of and the adaptability to the illness and it's awareness.

Adaptation, Psychological↗
PubMed2005

Mirtazapine in drug-induced excessive sweating.

Excessive sweating is a well-known side effect of a selective serotonin reuptake inhibitor treatment, but little is known about the impact of sweating on treatment discontinuation or the general quality of life of patients. In this case report, we present a patient suffering from excessive sweating induced by escitalopram. When mirtazapine was administered as an additional treatment, a dose-dependent reduction of drug-induced excessive sweating was observed. Taking into account the particular serotonin antagonistic properties of mirtazapine, its eventual influence on the regulation of body temperature and diaphoresis in the central nervous system is discussed.

Citalopram↗
PubMed2005

Local back massage with an automated massage chair: general muscle and psychophysiologic relaxing properties.

OBJECTIVES: The objective of the present study was to test massage applied with an automated massage chair on the back muscles with regard to the effects on the tension of other muscles or on the neurovegetative tone, and to compare three different automated massage techniques. METHODS: Ten healthy volunteers participated in the study. The experiment consisted of an initial 5-minute period of relaxation without massage, and 5-minute periods of three different massage programs (roll-stretch massage, shiatsu massage, and beat massage). Subjects were randomized as to the presentation order. The following physiologic data were collected: frontalis and gastrocnemius electromyogram (EMG) activity, skin conductance, and peripheral skin temperature. Judgments of valence and arousal were registered using the pencil and- paper version of the five-point Self-Assessment Manikin. RESULTS: Roll-stretch and shiatsu massage were rated by participants as more pleasant than the relaxation period without massage or the beat massage. Whereas the four conditions were similar with regard to the mean frontal EMG values (reflecting primarily affective states), they differed regarding the gastrocnemius EMG (relating more to a general level of tension), roll-stretch massage, and shiatsu massage, resulting in less muscle tension than the control condition. Shiatsu massage was associated with significantly lower skin conductance than the control condition, whereas beat massage increased it significantly. A significant increase of skin temperature was found during the roll-stretch massage compared to the no-massage condition. CONCLUSIONS: Automated roll-stretch massage and shiatsu massage applied on the back can rapidly induce measurable relaxation in distant muscles not directly massaged, and is accompanied by signs of neurovegetative calming. Back massage applied by an automated massage chair may be an efficient and inexpensive general relaxation approach, and is especially interesting for patients who dislike to be touched.

Adult↗
PubMed2005

[Depersonalization--current data].

OBJECTIVE: Depersonalization is a fascinating clinical phenomenon referring to a self-consciousness disorder, characterized by emotional detachment from one's own feelings, thoughts, or actions. This article intends to summarize the current literature in this area. METHOD: Using the Medline data base, we reviewed literature addressing the clinical, etiology, nosology, physiopathology, and treatment of depersonalization. CONCLUSIONS: Derealization means that perception of the world and of external reality are altered. These 2 phenomena are often associated. They are not specific to any psychiatric entity and are reported in many different psychiatric syndromes. Many factors, including use of different substances, are involved in their onset. The physiopathology is still little known. However, some conceptual models suggest partial amygdala inhibition combined with activation of other amygdaloid structures. A serotoninergic functioning impairment is indicated in different pharmacologic studies. Different psychotropic drugs, especially serotoninergic antidepressants, have been proposed for pharmacotherapy; however, there are no conclusive randomized studies, and the contribution of psychotherapy in treating these patients is still questioned.

Amygdala↗
PubMed2004

Escitalopram/reboxetine combination in depressed patients with substance use disorder.

Acting pharmacologically on different transmitter systems has been suggested to have some advantages in patients with substance abuse and may possibly address a larger spectrum of symptoms. One major drawback of using antidepressants addressing several neurotransmitters is that the relative activities on the different neurotransmitters cannot individually be adjusted. Combining antidepressants targeting different neurotransmitter systems may allow adapting the effect on each neurotransmitter system corresponding to patients' response and tolerance. Three cases of patients presenting a substance use disorder with comorbid major depression episodes are presented, who were treated with a reboxetine/escitalopram combination and who showed a rapid response of their depressive syndrome.

Adult↗
PubMed2004

Topiramate in opiate withdrawal- comparison with clonidine and with carbamazepine/mianserin.

UNLABELLED: There are some rationales for developing anticonvulsants for the treatment of substance abuse. The blockade of the AMPA/kainate subtype of glutamate receptor by topiramate may be of particular interest, as preclinical studies of withdrawal from opioids suggest that whilst AMPA-receptor antagonists may not be able to prevent tolerance or dependence from developing, they may ameliorate both physical and emotional consequences of withdrawal. METHODS: Ten consecutively admitted patients treated with topiramate were compared in a retrospective naturalistic drug utilization observation study with 10 consecutively admitted patients treated with clonidine and with 10 consecutively admitted patients treated with a carbamazepine/ mianserin combination. RESULTS: In 9 cases of the clonidine group and in 7 carbamazepine/mianserin treated patients the dose had been reduced, whereas this occurred in only 2 topiramate treated patients (p < 0.01). Patients in the topiramate group received less p.r.n. myorelaxant medication than the two other groups, and there was a significant difference between the three groups with regard to p.r.n. analgesics (p < 0.05), topiramate and clonidine treated patients receiving fewer analgesics than the carbamazepine/mianserin group. CONCLUSIONS: Compared to clonidine and carbamazepine/mianserin, a detoxification scheme using high initial and then decreasing doses of topiramate appeared to be appropriate for most patients and as associated with less analgesic and myorelaxant comedication, indicating a more promising efficacy at the used doses.

Adrenergic alpha-Agonists↗
PubMed2004

Anticonvulsant drugs in the treatment of substance withdrawal.

Although detoxification cannot, in itself, be considered a treatment for addiction, it is one of the most pivotal phases. In order to facilitate entry into recovery and/or rehabilitation programs, a detoxification treatment has to be experienced as easy and safe by the patient. In consideration of the many inconveniences related to standard withdrawal treatments, there is an interest in developing alternative pharmacological strategies. The main rationales for using anticonvulsants in substance-abuse patients are their lack of addiction potential, evidence support a role of kindling mechanisms in withdrawal syndromes and their efficacy in comorbid psychiatric disorders. The available data currently support the utilization of carbamazepine as a treatment for detoxification from benzodiazepines, alcohol and opiates, and as a useful agent to reduce cocaine consumption. The use of valproate is well corroborated for alcohol detoxification and it seems to be a promising treatment for the reduction of cocaine use; however, it has been found to be ineffective against benzodiazepine withdrawal symptoms. Some preliminary data suggest that lamotrigine could be useful in opiate and cocaine dependence. Gabapentin shows potential as a treatment for cocaine dependence, and some case reports have stimulated interest in this agent for alcohol and benzodiazepine detoxification. Due to its particular pharmacological profile, topiramate is one of the most interesting newer anticonvulsants. It has been found to be efficacious in opiate and possibly benzodiazepine detoxification and also has theoretical potential as a preventive therapy.

Alcohol Withdrawal Delirium↗
PubMed2004

[How hypervigilance and hyperreactivity clinically described in anxiety expressed physiologically?].

Anxious people often show a particular attentional focus towards potentially threatening stimuli. Like any other emotion, anxiety goes along with physiological reactions, which may be more or less noticeable, and may impair behavior and physical wellness. In view of the psychophysiological reactions related with anxiety and anxiety disorders, it seems important to examine potential correlations between psychophysiological activity and the phenomena of hypervigilance. In fact, selective psychophysiological activation has repeatedly been found as a reaction to pathology-specific threatening stimuli in patients with anxiety disorders, whereas their psychophysiological responses appeared often to be blunted when they were submitted to neutral stimuli.

Anxiety Disorders↗
PubMed2004

[Are anxiety disorders associated to a particular addiction to smoking? Stress, anxiety and nicotine addiction].

This paper describes the relationship between several types of anxiety disorders and tobacco use. Possible explanations of those relationships are presented. Nicotine probably modulates the function of pathways involved in stress response and anxiety in the normal brain, which results in alterations of anxiety levels. Anxiety disorders do not seem to be related to a particular form of tobacco consumption. However, smoking is more frequent in these patients and seems to be implicated in some of their coping strategies. Understanding neurobiological and behavioral mechanisms underlying the association between smoking and anxiety disorders may improve physician's ability to assist smokers in their efforts to quit.

Adaptation, Psychological↗