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Biomedical subjects

E Fombonne

Publications and source records attributed to E Fombonne.

64 records · Page 4Linked to original sources
PubMed1989

[A study of prescriptions for psychotropic drugs at a French psychiatric hospital].

The prescribing habits were studied in a psychiatric hospital which provides services for one district of Paris. The sample consisted of 175 inpatients. A mean of 2.1 psychotropic drugs was prescribed per patient, and more than two-thirds received two psychotropic drugs or more. Almost one-half had a PRN order. Major tranquilizers were frequently used in patients not having a psychotic disorder and were associated to anticholinergic drugs in 55% of the cases. Factors associated with drug prescriptions were diagnosis, age and unit of treatment. Our results are similar to those of previous studies on excessive polypharmacy. The discussion draws attention on the need to obtain data on the rationale for prescribing and the response to treatment. Emphasis is placed on the potential usefulness of studying drug prescriptions for psychiatric practice.

Adolescent↗
PubMed1989

A follow-up study of childhood psychosis.

A cohort of 227 children having attended the same day treatment facility during their childhood was followed-up in adult life. A questionnaire was designed to collect data on various aspects of social and personal adjustment. The length of the follow-up period is 17 years. Information was obtained on 99 subjects whose mean age was 27-years. Of these, 55 had been admitted to the facility for childhood psychosis, and the remaining 44 subjects served as a comparison group. The results show that, in adulthood, the psychotic children fare significantly worse than the controls for employment, autonomy, marriage and the need for continuing medical care. Although non significant, a trend is found in the same direction for educational attainment and medication consumption. We then looked at the clinical and therapeutic variables in the childhood of the psychotic group which were the strongest predictors of adjustment in adulthood. We found that those children who had been admitted at a younger age, whose length of stay in the day treatment hospital had been longer, who scored lower on IQ tests and who had been discharged towards other specialised institutions, were less well adjusted. The results of this study must be interpreted with caution in light of the important attrition during the follow-up period. The discussion then focuses on case definition issues. Emphasis is placed on the need for careful diagnostic assessment and for the use of precise diagnostic assessment and for the use of precise diagnostic criteria. Further, our result on the prognostic significance of IQ level suggests that the assessment of cognitive functioning in autistic and psychotic children is key information which should be more systematically taken into account both in clinical practice and in future research projects.

Adult↗
PubMed1986

Comparative study of four evaluation criteria in a clinical trial with schizophrenic patients.

In order to compare the level of agreement between four evaluation criteria, data from an 18-month clinical trial with 181 schizophrenic patients were reanalyzed. In that study, assessments of the subjects were carried out with two psychiatric rating scales, Brief Psychiatric Rating Scale and Nurses' Observation Scale for Inpatient Evaluation (BPRS and NOSIE), and two clinical evaluations (psychiatrist and nurse). Results show that there was total agreement on the four outcome measures for only half of the subjects. After further analyses, we observed that the best agreement was between the two clinical assessments. The NOSIE had poor agreement with the other criteria and appeared less sensitive to moderate levels of improvement in the patients' clinical status. These results are discussed with respect to reliability and validity issues.

Adult↗
PubMed1983

Comparison of six treatments of ascites in patients with liver cirrhosis. A clinical trial.

UNLABELLED: A national multicenter study (34 centers) compared six treatments in 328 patients with cirrhotic ascites. Excluded were patients with g.i. bleeding within the last six months, chronic encephalopathy, cancer, tuberculosis or the following complications persisting after three weeks: acute encephalopythy, fever greater than 38 degrees C, infected ascites or biochemical abnormalities: blood urea greater than 8 mmol/l, natremia less than 130 mmol/l, kaliemia less than 2.5 or greater than 5.5 mmol/l, WBC greater than 12000 mm3, total bilirubin greater than 85.5 mumol/l. In each center patients were randomized into two treatment groups, each center using 2 of 6 proposed treatments: (1) Spironolactone and 500 mg Na p.d (77 patients), (2) Spironolactone + furosemide or Moduretic (amiloride + hydrochlorothiazide) and 500 mg Na p.d (80 patients), (3) Spironolactone + Furosemide or Moduretic and unrestricted sodium diet (86 patients), (4) Concentrated ascites reinfusion and 500 mg Na p.d. (36 patients), (5) Unmodified ascites reinfusion and 500 mg Na p.d. (23 patients), (6) Slow ascites drainage and 500 mg Na p.d. (31 patients). Statistical analysis methods were X2, variance analysis and Spotvoll-Stoline and Dunn-Sidak tests. Before treatment, there was no significant difference between the 6 groups. RESULTS: After one month of treatment, no difference was found in the frequency of total or partial regression of ascites, complications of cirrhosis, mortality, acceptability of treatment. Mechanical treatments induced more rapid weight loss but more frequent recurrence; comparison of groups 2 and 3 did not confirm any benefit associated with unrestricted Na diet. Duration of treatment and hospitalization were shorter in group 4 than in groups 3 and 6.

Amiloride↗
PubMedDate not supplied

Prevalence of pervasive developmental disorders in the British nationwide survey of child mental health.

The prevalence of pervasive developmental disorders (PDD) is not well established and needs monitoring. We investigated the prevalence of PDDs in the 1999 nationwide British survey of child and adolescent mental health. A randomized stratified sample of children (n = 12,529) aged 5-15 was generated from Child Benefit Records. Trained interviewers interviewed parents and youths aged 11 or older with a standardized diagnostic interview (Development and Well-Being Assessment) and questionnaire data (Strengths and Difficulties Questionnaire) were obtained from teachers and parents who also completed self-report measures of psychological distress. A team of experienced clinicians using all data sources achieved final diagnostic determination. A total of 10,438 (83%) interviews were conducted. There were two girls with Rett syndrome (weighted prevalence: 3.8/10,000 girls) and 27 children with other PDDs (weighted prevalence: 26.1/10,000). Compared to children with a psychiatric disorder other than PDD, social but not behavioural problems were more frequent in the PDD group. Parents of children with PDDs had higher rates of psychological distress than those from the two comparison groups. Consistent with other recent surveys, PDD rates are higher than those reported 30 years ago. The burden associated with PDDs is very high.

Adolescent↗
PubMedDate not supplied

Prevalence of obsessive-compulsive disorder in the British nationwide survey of child mental health.

Obsessive-compulsive disorder (OCD) is a disorder that appears to be under-diagnosed and under-treated, despite the evidence for effective treatments. There are variable estimates of OCD prevalence in the under-16s and published rates give little indication of age trends. The aim of this study was to establish the prevalence and associates of OCD in young people aged 5-15 years. The method was a nationwide (UK) epidemiological study of rates of psychiatric disorder in 5-15 year olds (1999 British Child Mental Health Survey): 10,438 children were assessed. Twenty-five children with OCD were identified (weighted overall prevalence 0.25%; 95% CI 0.14-0.35), with prevalence rising exponentially with increasing age. Compared with normal controls, children with OCD were more likely to be from lower socio-economic class and of lower intelligence. Only three of these children had been seen by specialist children's services. Although OCD is rare in young children, the rate increases towards the adult rates at puberty. Children with OCD have additional psychosocial disadvantage. The majority of the childhood cases identified in this survey appear to have been undetected and untreated.

Adolescent↗
PubMedDate not supplied

[Use of ROC analysis in psychiatry].

The fundamental principles of ROC analysis are described. This method provides a means to assess the overall discriminant power of psychiatric rating scales for the full range of their scores. For each cut-off, an instrument has a sensitivity (true positive rate) and a specificity (true negative rate). High values of these coefficients are desirable although they are inversely related. ROC curves can be obtained by plotting the false positive rate and the true positive rate for different thresholds of the rating scale. The curves which would be obtained with a perfect, a worthless and a typical instrument are drawn to illustrate various situations found in ROC analysis. Among the several indices proposed, the area under the curve (AUC) is the most commonly used index to assess the overall discriminant power of an instrument. To calculate this area, the non parametric trapezoidal method is advocated. The area under the curve varies between 0.50 which corresponds to the chance line up to 1.0, a value associated with perfect accuracy. This parameter can be interpreted as the probability of classifying correctly the subjects of a pair where one is normal and one is diseased. Then, the appropriate statistic to compare several ROC indices is provided for the general case of independent observations. When the observations are paired, the standard error of the difference between two areas needs to be corrected.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMedDate not supplied

[Sensitivity, specificity and predictive values of methods of evaluation in psychiatry].

Clinical assessments, psychological examinations, biological parameters and other indices are commonly used in psychiatry to measure disease status. These evaluation tools are not perfect and, in general, they will fail to perfectly discriminate "cases" from normal controls. When a gold standard is available, their performances can be evaluated. If the results of a measurement are tabulated with true disease status in a contingency table, the proportions of cases and normals correctly identified (sensitivity and specificity) are useful coefficients of validity of the instrument studied. It is shown that unbiased estimates of the prevalence rate cannot however be derived directly from the proportion of sample respondents identified by a test. Practical examples with a psychiatric rating scale are provided which illustrate the importance and magnitude of this bias. Formulas are subsequently given which permit the calculation of the "true" prevalence rate from the proportion of screen positives when the sensitivity and the specificity of the test are known. The proportion of true cases among those individuals identified by a test is another important property of psychiatric measures, particularly for screening purposes. It is also called the positive predictive value and, like sensitivity and specificity, predictive values are probabilities for which high values are desirable. However, this critical characteristic of a test depends on the prevalence rate, the sensitivity and the specificity of the test used. Using an example, major changes in the probability of a screen positive individual to be truly diseased are shown to depend upon varying levels of the base rate of the disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗