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Hélène Verdoux

Publications and source records attributed to Hélène Verdoux.

At least 19 recordsLinked to original sources
PubMed2007

The current state of adult mental health care in France.

Since the 1960s, French public mental health services are organised in "sectors", each sector catering for a mean population of 54,000 inhabitants. Although this organisation was aimed at insuring equal access to care whatever the place of residence, there are still huge disparities in number of staff and bed resources from one sector to another. The reduction in the number of hospital beds started later in France than in most other European countries, and was really effective in the 1990s. In 2000, there were 9.4 beds for 10,000 inhabitants aged over 20 years. Hospital-based care has still an overwhelming importance, and is associated with a marked under-development of community services and lack of sheltered housing for the most disabled patients. With more than 13,000 registered psychiatrists in France, the density of psychiatrists is one of the highest in the world. However, French psychiatry has currently to face a structural crisis due to the reduction in public health budgets, as well as to the reduction of 30% in the number of French psychiatrists over the next two decades. The numerous national programmes aimed at renovating French mental health services, published over the last decade, have not yet kept their promises.

France↗
PubMed2006

Psychotic disorders among homeless subjects attending a psychiatric emergency service.

BACKGROUND: Homelessness is an increasing problem among subjects with severe mental illnesses and little is known about the characteristics of homeless subjects with psychosis using emergency psychiatric services. The aims of the present study were to assess the frequency of psychotic disorders among subjects attending a psychiatric emergency service and to explore the clinical and demographic characteristics of these subjects and the management proposed by the emergency staff. METHODS: All homeless patients (n=104) consecutively attending a psychiatric emergency service were included over a 6-month period. Patients were categorised according to ICD-10 diagnoses as presenting with psychotic disorder (schizophrenia and other non-affective psychotic disorders) versus other disorders. A random sample of matched non-homeless controls (n=71) was included over the same period. RESULTS: Nearly one out of three homeless subjects (32.7%) presented with a psychotic disorder, a higher proportion than that found in non-homeless subjects (15.7%). Compared to non-homeless subjects with psychosis, homeless subjects with psychosis were more likely to be male and to present with drug use disorder. The likelihood of being hospitalised after attending the psychiatric emergency services did not significantly differ between the two groups. Compared to homeless subjects with other psychiatric disorders, homeless subjects with psychosis were more likely to be single, to have a history of psychiatric hospitalisation and presented less frequently with anxiety or depressive symptoms motivating admission. CONCLUSION: Most homeless subjects with psychosis attending a psychiatric emergency service were already identified as suffering from a severe mental illness, suggesting that homelessness was a consequence of a break in contact with mental health services. Since homelessness is incompatible with the adequate management of psychosis, strategies have to be developed in mental health organisations in combination with outside partnerships, to drastically reduce the frequency of this condition in subjects with psychosis.

Adult↗
PubMed2006

[Screening programs for early detection of psychosis?].

Programs for the early detection of psychosis are currently underway in most developed countries. Their aim is to improve the outcome of subjects with psychotic disorders, but neither their feasibility nor their usefulness was assessed before their implementation. The postulate underlying these programs - that early treatment improves the prognosis of psychosis - has not yet been demonstrated. The absence of effective and adequately specific screening tests implies that a substantial number of the subjects evaluated may be incorrectly diagnosed with and treated for psychoses (false positives). Development of facilities specializing in the assessment and care of subjects with early psychosis often implies a decrease in funding for facilities caring for patients with chronic psychoses. Educational and information campaigns aimed at the general public and health professionals, on the other hand, may help reduce the stigma associated with psychosis and improve access to care for subjects in early stages of psychosis. Risk/benefit and cost/benefit analyses of programs for the early detection of psychosis must be evaluated before promoting their development.

Anxiety↗
PubMed2006

Schizophrenia: who is at risk? Who is a case?

It is now almost unanimously acknowledged that schizophrenia is of multifactorial origin (i.e. that the clinical expression of the vulnerability induced by genetic factors depends on the interactions between this genetic liability and environmental risk factors). The list of putative environmental risk factors keeps on lengthening, including perinatal events with potential harmful neurodevelopmental impact, or later risk factors such as substance use or social factors. Although research on genetic and environmental risk factors for schizophrenia is of major importance to elucidate the etiology of the disorder, the usefulness of this body of knowledge with respect to prevention should be considered cautiously. Indeed, there is a huge gap between determining who is at increased risk for the disease and predicting who will actually develop schizophrenia amongst all subjects at increased risk. How a case of schizophrenia is defined is another major issue for etiological research and also for prevention. A growing body of evidence suggests the existence of a symptomatic continuum between subjects from the general population and subjects with clinical psychosis with respect to the occurrence of psychotic experiences. Thus, establishing a boundary between psychosis and normality is, by its very essence, an arbitrary process. Creating a new diagnostic category of "prodromal psychosis" is moving the boundary to include subjects with less severe symptoms. This strategy has major clinical implications because the question "who is a case?" is often equivalent in clinical practice to the question "who needs treatment?".

Forecasting↗
PubMed2005

A survey of general practitioners' knowledge of symptoms and epidemiology of schizophrenia.

OBJECTIVE: To explore general practitioners' (GPs) knowledge of the symptoms and epidemiology of schizophrenia, and the GPs' characteristics associated with level of knowledge. METHOD: Survey questionnaires exploring practice in patients with early psychosis were mailed to all GPs in South-Western France (N=3829). GPs were asked to fill out questions anonymously on the symptoms and epidemiology of schizophrenia. RESULTS: The response rate was 23.6%. GPs had a fair theoretical knowledge of schizophrenia symptoms, but underestimated the prevalence and the risk of suicide. Recent attendance at a continuing medical education (CME) course on schizophrenia was the main predictor of level of knowledge on epidemiological figures, although its impact was relatively modest. Regarding risk factors, the implication of genetic factors was considered as null or modest by more than half of the GPs, while a large proportion of them stated that mother-baby interactional disturbances were frequently implicated in the aetiology of the disorder. CONCLUSION: GPs' level of knowledge on the public health impact and risk factors for schizophrenia needs to be improved in order to promote the delivery of accurate and de-stigmatising information to primary care patients.

Adult↗
PubMed2005

How do general practitioners manage subjects with early schizophrenia and collaborate with mental health professionals? A postal survey in South-Western France.

OBJECTIVE: This study was conducted to explore how general practitioners (GPs) manage subjects with early psychosis and collaborate with psychiatrists in the care of such patients. METHODS: Survey questionnaires exploring practice in patients with early psychosis were mailed to all GPs in South-Western France (n=3,829). RESULTS: The response rate was 23.6%. Half of GPs responding to the survey had actually diagnosed a possible case of schizophrenia during the previous year. In such cases, the most frequent decision was to refer the patient to a psychiatrist, despite the difficulties of convincing the patient and obtaining a rapid referral. According to GPs' answers, the relationships between primary care and the mental health team were characterised by a lack of communication: less than one out of three GPs had regular contact with a mental health team, and a large majority reported that they never or rarely had information about the diagnosis and treatment of subjects referred for early schizophrenia. Having regular contacts with mental health services had a major impact on GPs' management of subjects with early schizophrenia, in particular on reducing delays to obtain a psychiatric consultation and on level of information on diagnosis and treatment after referral. CONCLUSION: Promotion of networking between primary care and mental health services is required to reduce delayed access to care in subjects with early schizophrenia.

Adult↗
PubMed2005

Cognitive predictors of psychosocial functioning outcome in schizophrenia: a follow-up study of subjects participating in a rehabilitation program.

The aims of this prospective study were to explore in subjects with psychosis participating in a rehabilitation program whether cognitive performances at baseline predicted (i) psychosocial functioning over a 15-16 month follow-up; (ii) improvement in psychosocial functioning over the rehabilitation program. Visuo-spatial tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) were administered to assess cognitive performance in 55 subjects with schizophrenia spectrum disorders who completed a rehabilitation program. The Multnomah Community Ability Scale (MCAS) was used to measure dimensions of community functioning. One subscale of the Client's Assessment of Strengths, Interests, and Goals (CASIG) provided a measure of subjective quality of life (QoL). Improvement was defined as a 15% or more increase in psychosocial scores between baseline and follow-up. Worse baseline sustained attention predicted better self-rated quality of life, and better baseline visual memory predicted better community functioning over the rehabilitation follow-up period, in particular, higher autonomy in activities of daily living, and less physical and psychiatric symptoms that could interfere with rehabilitation. Baseline cognitive performances predicted community functioning improvement during the follow-up period: visual memory predicted improvement in daily living autonomy and in social competence; sustained attention predicted improvement in behavioral problems (such as medication compliance, collaboration with treatment providers or impulse control) and social competence; planning performances predicted improvement in social competence. These cognitive functions could be specifically targeted in a rehabilitation program aimed at enhancing functioning in those particular dimensions.

Adult↗
PubMed2005

A decision analysis model to assess the feasibility of the early detection of psychosis in the general population.

The objective was to evaluate the feasibility of early detection of psychosis in the general population. Decision analysis was used to compare the effectiveness of early detection to that of detection as usual to prevent the occurrence of adverse outcomes (death, hospitalization, or unemployment) over 5 years in a hypothetical cohort of subjects aged from 15 to 34 years old. Decision analysis was based upon optimistic models with several assumptions favoring early detection. Sensitivity analyses were used to explore how the findings were affected by varying the different probabilities. Early detection would be effective in preventing the occurrence of adverse outcomes only if detection tests with high specificity (>88%) were available and if a high number of subjects were screened. The numbers needed to screen would be 20,000 subjects to prevent one death, 641 to prevent one hospitalization, and 847 to prevent one unemployment. A temporary conclusion of this decision analysis is that more specific screening instruments have to be developed and that further studies have to be carried out in unselected populations to establish the feasibility and effectiveness of early detection of psychosis.

Adolescent↗
PubMed2005

Impact of substance use on the onset and course of early psychosis.

The strong comorbidity between psychosis and substance use is already identifiable in early psychosis, raising the question of the direction of the association between substance use and psychosis onset. It has long been considered that this association was explained by the self-medication hypothesis. This hypothesis has been recently challenged by several prospective studies carried out in population-based samples, showing a dose-response relationship between cannabis exposure and risk of psychosis. This association was independent from potential confounding factors such as exposure to other drugs and pre-existence of psychotic symptoms. As a large percentage of subjects from the general population is now exposed to this drug, even a small increase in the risk of adverse effects may have significant deleterious consequences for the health of the population. Hence, reducing exposure to cannabis may contribute to prevention of some incident cases of psychosis. Regarding prognosis, persistent substance misuse after the onset of psychosis has a deleterious impact on clinical outcome. Therapeutic programs for subjects with dual diagnosis should be implemented early in the course of psychosis to maximise their impact on the course of illness.

Adolescent↗
PubMed2005

Prospective, multicentre, randomized, double-blind study of the efficacy of escitalopram versus citalopram in outpatient treatment of major depressive disorder.

Pre-clinical studies, active-control clinical trials and meta-analyses indicate that escitalopram (S-citalopram) might be more effective than citalopram, the racemic mixture of S- and R-citalopram. The present study aimed to confirm the superior efficacy of escitalopram over citalopram. A double-blind, randomized clinical trial was performed in which general practitioners and psychiatrists compared fixed doses of escitalopram (20 mg/day) with citalopram (40 mg/day) over 8 weeks in outpatients with major depressive disorder (MDD) [baseline Montgomery-Asberg Depression Rating Scale (MADRS) score > or =30]. Primary efficacy parameter was change from baseline to last assessment in the MADRS total score. Out of 138 (aged 44.1+/-10.9 years; initial MADRS score 36.3+/-4.8) and 142 (aged 46.2+/-11.1 years; initial MADRS score 35.7+/-4.4) evaluable patients who were randomized to escitalopram and citalopram, respectively, six and 15 withdrew prematurely (P=0.05). The MADRS score decreased more in the escitalopram than in the citalopram arm (-22.4+/-12.9 versus -20.3+/-12.7; P<0.05). There were more treatment responders with escitalopram (76.1%) than with citalopram (61.3%, P<0.01). Adjusted remitter rates were 56.1% and 43.6%, respectively (P<0.05). Tolerability was similar in both groups. This randomized double-blind trial confirms that escitalopram has a superior effect to citalopram in MDD.

Adolescent↗
PubMed2005

Atypical antipsychotics: from potassium channels to torsade de pointes and sudden death.

Syncope and sudden death are features of schizophrenia that can be attributed to ischaemic heart disease, the use of antipsychotics (because of proarrhythmia or other reasons such as pharyngeal dyskinesia) or the psychiatric disease itself. Cases have been described with most antipsychotics and have led to the withdrawal, temporary suspension from the market or restricted use of antipsychotics, such as sultopride, droperidol, sertindole or thioridazine. Reviewing the available data shows that all antipsychotics tested affect the cardiac potassium channel, with the concentration that produces 50% inhibition (IC50) ranging from 1 nmol/L (haloperidol) to 6 micromol/L (olanzapine). Experimental in vitro or in vivo electrophysiological studies have shown a dose-dependent increase in the duration of the action potential with various degrees of indicators of serious arrhythmogenicity. However, this does not always translate clinically into an increased duration of the QT interval or increased risk of torsade de pointes or sudden death in clinical trials or pharmacoepidemiological studies. In turn, QT prolongation in clinical trials does not always translate to an increased risk of torsade de pointes or sudden death. The reasons for these apparent discrepancies are unclear and could be related to insufficiently powered field studies, low plasma and tissue drug concentrations with reference to in vitro data or drug effects on other receptors or ion channels that have a protective effect. Alternatively, risks that were not apparent from preclinical or clinical data could be related to the use of the drug in high-risk patients, metabolic interactions or other factors that would only be encountered in large postmarketing populations. The assessment of cardiovascular safety, both preclinical and during premarketing clinical trials, needs to be supported by appropriately powered pharmacoepidemiology studies.

Animals↗
PubMed2004

The crucial role of sustained attention in community functioning in outpatients with schizophrenia.

The aim was to explore the pattern of associations between visual cognitive performance and community functioning in a sample of outpatients with schizophrenia participating in a rehabilitation program. Visuo-spatial tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) were administered to assess cognitive performances in 88 subjects. The Multnomah Community Ability Scale (MCAS) was used to measure dimensions of community functioning. Our results showed that the sustained attention score was significantly associated with the global community functioning score and with two specific dimensions: "adjustment to living" and "behavioral problems". No association was found between other cognitive indices and MCAS scores. Since the sustained attention task mainly involves the executive component of working memory, these findings suggest that attentional control processes are limiting factors for community functioning in schizophrenia outpatients. Measures of such processes could serve as key indices of disability in clinical practice. Attention and working memory training may be helpful to improve community functioning in subjects with schizophrenia.

Adult↗
PubMed2004

Self-assessed cognitive dysfunction and objective performance in outpatients with schizophrenia participating in a rehabilitation program.

OBJECTIVE: To explore the pattern of associations between self-assessed and objective neuropsychological performance in a sample of outpatients with schizophrenia participating in a rehabilitation program. METHOD: The Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS) [Compr. Psychiatry 44 (2003) 331] was used to assess cognitive complaints in 73 subjects with schizophrenia. Visuo-spatial tests of the Cambridge Neuropsychological Test Automated Battery (CANTAB) [Cogn. Neuropsychiatry 3 (1998) 45] were administered as objective measures. RESULTS: Cognitive complaints in several cognitive domains were mainly correlated with a true difficulty in memory. Higher SSTICS attention scores, i.e. increased complaints, were associated with poorer CANTAB explicit visual memory and planning performances. Higher SSTICS executive functioning scores were associated with poorer CANTAB explicit visual memory scores. CONCLUSION: These findings suggest that outpatients with schizophrenia express some cognitive difficulties. However, the cognitive nature of these subjective complaints does not strictly correspond with objective performances. These results also suggest that theoretical constructs of cognitive functions do not always have ecological validity. Thus, subjective cognitive complaints should be taken into account in assessment of patient well-being, but cannot be used as a substitute to objective cognitive measures. The simultaneous use of subjective and objective measures of cognitive dysfunction may provide a more complete picture of individual rehabilitation targets in patients with schizophrenia.

Adult↗
PubMed2004

[Cannabis use and risk of psychosis, an etiological link?].

CANNABIS TO TREAT PSYCHOSIS: The nature of the link between cannabis use and psychosis remains to be clarified. Cross-sectional epidemiological studies have shown that individuals with psychosis use cannabis more often than other individuals in the general population. It has long been considered that this association was explained by the self-medication hypothesis, postulating that cannabis is used to self-medicate psychotic symptoms. This hypothesis has been recently challenged. PSYCHOTIC DISORDERS ENHANCED BY CANNABIS: Several prospective studies carried out in population-based samples, showed that cannabis exposure was associated with an increased risk of psychosis. A dose-response relationship was found between cannabis exposure and risk of psychosis, and this association was independent from potential confounding factors such as exposure to other drugs and pre-existence of psychotic symptoms. The brain mechanisms underlying the association have to be elucidated; they may implicate deregulation of cannabinoid and dopaminergic systems. A RISK FACTOR NOT TO BE NEGLECTED: Cannabis exposure may be a risk factor for psychotic disorders by interacting with a pre-existing vulnerability for these disorders. If further studies confirm that cannabis is a risk factor for psychosis, its impact on the population's mental health may not be negligible considering the growing number of adolescents exposed to this substance.

Cannabis↗
PubMed2004

Is the intensity of Schneiderian symptoms related to handedness and speech disorder in subjects with psychosis?

OBJECTIVE: To explore the links between Schneiderian first-rank symptoms (FRS), handedness and speech disorder in subjects with psychosis. METHODS: A Schneiderian score was calculated by summing seven items of the Scale for the Assessment of Positive Symptoms (SAPS) exploring first-rank symptoms in 33 hospitalized patients presenting with psychotic symptoms. Speech disorder was rated using the Scale for the Assessment of Thought, Language and Communication Disorders (TLC). Handedness was assessed using the Edinburgh Handedness Inventory. RESULTS: Higher Schneiderian score was independently predicted by reduced right-hand preference and by lower TLC score. The associations between Schneiderian score and lateralisation or speech disorder were independent from level of psychotic and depressive symptoms, and from categorical diagnosis. CONCLUSION: The present study adds further support to the hypothesis that loss of normal cerebral asymmetry may be implicated in the emergence of FRS.

Adolescent↗