PubMed Health⌕ Search

Biomedical subjects

J Ades

Publications and source records attributed to J Ades.

30 records · Page 2Linked to original sources
PubMed1981

[Organic illness and depression (author's transl)].

Depression constitutes a major health problem. Its prevalence in any one year is about 3 per cent of the general population. Most depressed patients are seen by general practitioners, and represent approximately 10 to 18 per cent of their patients. Depression should be present in about 20 per cent of the inpatients in general medicine departments. Depression and organic pathology are very often associated, thus leading to diagnosis mistakes and delays in medical care. Depressions masked by somatic symptoms frequently provoked such mistakes. Depressions occurring during and after medical illnesses, and more specifically chronic illnesses, are often completely neglected. These depressions hinder the patient's readaptation and impair his recovery although they would, in the majority of cases, be accessible to chemotherapeutic and/or psychotherapeutic treatment.

Adjustment Disorders↗
PubMed1981

[An open study of Mianserin (author's transl)].

The authors present a synthesis of 277 observations collected in France from open studies of mianserin. The product has shown positive results in 65 per cent of the patients considered, based on the global clinical judgement of the prescriber at the beginning and the end of a 28 days open study. The data from Hamilton's scale for depression and Beck's Inventory, even though concerning a smaller number of patients, seem to provide similar results. The improvement appears from the first week, and seems to concern the overall depressive mood, anxiety, psychomotor inhibition, and sleep. The evaluation of the respective results for each target-symptom is made difficult due to the lack of precise data concerning the associated psychotropic drugs. Tolerance has generally been good; there have only been five drop-outs as a result of unpleasant side effects.

Adolescent↗
PubMed1979

[The problems posed to the general practitioner by depression (author's transl)].

Given the high incidence of depression, it is necessary and desirable that as many cases as possible should be treated by general practitioners. However, general practitioners are on the whole ill-prepared to meet the needs of depressed patients. In the last few years a big effort has been made in certain countries to improve the psychiatric training of general practitioner and to enable him the better to detect and treat depression. Communication between psychiatrists and general practitioners is made difficult by the lack of a common language and terms used should be defined clearly. Some of the problems in practice are diagnostic in nature: detect of the depressive syndrome, of the minor or masked forms; differential diagnosis of depression and anxiety. The commonest problems in treatment are: selection of drug, monitoring of side-effects, duration of treatment. The general practitioner needs information also on such questions as: how to evaluate the risk of suicide; when to call in the specialist; how far to use supportive psychotherapy. Some types of depression are particularly likely to come to the general practitioner: depression masked by physical symptoms, depression associated with or secondary to physical disease, depression in the elderly.

Antidepressive Agents, Tricyclic↗
PubMedDate not supplied

[Genetic epidemiology and psychiatry (I): scope and limitations of familial studies. Case of panic disorder].

Genetics epidemiology shed new light on multifactorial disorders for which genes are partly involved, for example on numerous psychiatric diseases. Nevertheless, each epidemiological technic has it's caracteristics and limitations. This review discuss the impact of aggregation studies, on the bases of an example, namely all aggregation studies on panic disorder. We detected through Medline thirteen studies, comparing 3,700 relatives of 780 probands affected with panic disorder, with 3,400 relatives of 720 unaffected controls. It is computed that relatives of patients with panic disorder have an increased risk (10.7%) for panic disorder than relatives of controls (1.4%), relatives from affected probands having a high relative risk (6.8) for panic disorder according to the meta-analysis. On the basis of these 13 aggregation studies, there is an important attribuable risk (78.3%) of "having a familial history of panic disorder" in the risk for panic disorder. Furthermore, the estimated heritability is 73% (73% of the total variance would be explained by additive genetic effects), if Reich's conditions are fulfilled for a valid estimation of the heritability on the basis of aggregation families. These studies can also be used to highlight the variability of expression according to gender, to show the relevance of quantitative approaches (versus the qualitative approach which is nearly systematically used), to underline the informations raised by experimental technics (such as panic disorder induced by lactate), and to raise the potential existence of phenocopies. Lastly, aggregation studies on panic disorder can help to understand the high comorbidity of this disorder, with other anxiety disorders and mood disorder.

Female↗
PubMedDate not supplied

[Psychiatric disorders induced by drug dependence other than alcohol].

Most of psychoactive substances abuse or dependence disorders are associated to another psychiatric disorders. Depression, anxiety and psychotic disorders are the more frequent comorbid disorders. Psychiatric comorbidity is induced by acute consumption of psychoactive agents, chronic consumption or withdrawal. Psychiatric disorders are more frequent when patient are assessed immediately after the withdrawal. Main biological factors implicated in the pathophysiology of psychiatric disorders associated to dependence disorders are: increase in norepinephrine activity, during withdrawal, activation of locus coeruleus, kinding induced by repeated withdrawals. Psychotic disorders in opiate dependent patients can be induced by withdrawals. These psychotic disorders are more often described after methadone discontinuation. Consumption of cocaine can provocate paranoid delusions. Phenylcyclidine provocates sensorial distortion or delusive disorders resembling schizophrenia. Flash backs, following withdrawal realized brief and transient psychotic disorders. They can occur up to one year after the end of the intoxication. The occurrence of depression in dependent patients is frequent. Depressed patients are at risk for suicide. Retrospective studies showed that near of 40% of the subjects died from suicide have presented alcohol or drug abuse or dependence. Withdrawal from opiates provocates depression. Clinical picture included apathy, blunting of the affects, sadness and loss of interest. Cocaine consumption provocates manic-like disinhibition at the beginning of the intoxication. Long term consumption and withdrawal increase the risk of depression.

Humans↗
PubMedDate not supplied

[Psychiatric and psychological aspects of premenstrual syndrome].

Numerous, but heterogeneous studies have been performed about premenstrual syndrome, with finally a lack of credibility and interest among practitioners. More recently with the diagnosis criteria generalization, psychiatrists were more concerned about this syndrome, because of anxiety and mood symptoms involved in social impairment and need of medical care. In 1983 in the United States, the National Institute of Mental Health conference devoted to this topic proposed the first diagnosis criteria, requiring a prospective and daily assessment of the symptoms. In 1987, the American Psychiatric Association, in the DSM III-R, introduced the Late Luteal Phase Dysphoric Disorder diagnosis that became in 1994 in the DSM IV the Premenstrual Dysphoric Disorder, with the same diagnosis criteria. In the literature, prevalence rates are very heterogeneous according to the diagnosis criteria used and to the populations studied. One of the most relevant criteria is the induced impairment, such as avoidance of social activities, or search for medical care. Lifetime prevalence is thus estimated between 75 and 85% if considering the report of one or several symptoms, between 10 and 15% in case of medical care request, and between 2 and 5% in case of social activities interruption. To distinguish isolated complaints from a disabling disorder, self-questionnaires are the best way of assessment in a so complex and changing disease. Most of the epidemiological studies found a positive correlation between the premenstrual dysphoric symptoms and the lifetime major depressive disorder diagnosis. However, recent prospective studies failed to find an association between premenstrual syndrome and an increased risk of major depression. On the other hand, some studies showed that the premenstrual period is a risk period for associated psychiatric disorders exacerbations, as the obsessive-compulsive disorder, more severe alcohol intakes in case of alcoholism, symptoms increase in schizophrenics, or higher rates of suicide attempts. The most widely studied and frequently blamed etiopathogenic hypothesis is the serotonin dysregulation. Serotonin is particularly involved in expression of irritability and anger, but also in occurrence of depressive symptoms and specific food cravings, precisely found in the premenstrual dysphoric disorder. Among their different effects, estrogens increase the density of serotonin receptors and enhance the sensitivity to serotonin agonists. Moreover, some studies found a significantly different response to d-fenfluramine, a serotonin agonist, in women with premenstrual dysphoric disorder. In psychoanalytical theories the premenstrual syndrome was associated to a "femininity complex", to an ambivalent pregnancy desire, and to unconscious conflicts relating to sexual preference. In this context, Karen Horney, who took a great interest in the premenstrual period, was radically opposed to the Freudian theory of feminine sexuality, in particular the negation of the female sex. For Karen Homey, the "desire of penis" is more expressive of the woman's spite not to share the sexual, but also political, social and cultural benefits fallen to men. To understand the premenstrual period feelings it is also necessary to take into account the personal history of the woman and the psychosocial factors involved, as the social and cultural beliefs, and the mother-daughter communication. Medical cares are necessary when symptoms constitute a severe and disabling disorder. Among non-psychiatric treatments, progesterone was the most widely prescribed treatment, but relating to recent performed studies, it failed to prove its efficiency in such an indication. In the same way, the efficiency of the contraceptive pill was not demonstrated. The most prescribed psychiatric treatments are serotonin re-uptake inhibitors and benzodiazepines. First studies showing serotonin re-uptake inhibitors efficiency in premenstrual dysphoric disorder were performed in the beginning of the nineties, with clomipramine and fluoxetine, and later fluvoxamine, paroxetine, sertraline and citalopram. Studies having compared the efficiency of antidepressants according to their serotonin activity (paroxetine or sertraline versus maprotiline, that is a selective noradrenaline re-uptake inhibitor), showed that serotonin re-uptake inhibitors were significantly more efficient on all symptoms than maprotiline, that was not more efficient than placebo. Low doses of clomipramine (10 to 50 mg per day) seem to be sufficient and it appears also preferable to prescribe an intermittent treatment because of a possible tolerance effect, susceptible to be warned by phases free of treatment. Alprazolam was the most studied benzodiazepine in this indication. Most studies were positive, using daily posologies of 0.25 to 4 mg during the 6 days preceding the menses, with improvement of irritability, anxiety and depressive mood. The general practitioner frequently carries out psychological support, in particular in case of mild symptoms without consequences. Nevertheless, underestimate a more severe psychological suffering is a risk, firstly because there is no systematic interrelationship between the somatic symptoms intensity and the psychological distress, and secondly because premenstrual period is a special emotionally moment to put in evidence psychological or relational disruption. All kinds of psychotherapy can be relevant, even though the training of relaxation techniques is particularly suitable in such an indication. In conclusion, and in spite of the generalization of the diagnosis criteria in the international psychiatric classifications as the DSM, the premenstrual syndrome remains a complex and polymorphous disorder. The premenstrual syndrome was considered for a long time like a somatic disease, but now the psychiatric symptoms severity justifies most often the medical cares. In order to distinguish some isolated and mild complaints, of a disabling disorder, the standardized prospective auto-assessment is the most relevant method. Finally, intermittent prescription of serotonin re-uptake inhibitors appears to be the most effective treatment, the previously used hormonal treatments not having made proof of their efficiency in such an indication.

Adult↗
PubMedDate not supplied

[Panic disorder and alcoholism].

Relationships between alcoholism and anxiety disorder are well known by clinicians. Studies have recently shown that the prevalence of alcohol abuse or dependence is very high in patients with panic disorder with or without agoraphobia (Thyer et al., 1986; Bibb and Chambless, 1986). The aims of this study were to determine the prevalence and comorbidity of alcohol abuse and dependence in a population of panic outpatients who were consecutive referrals for treatment of panic disorder (PD) in an anxiety clinic. Patients were interviewed with the Schedule for Affective Disorders and Schizophrenia-Lifetime Version Modified for the study of anxiety disorders (SADS-LA) which is a standardized and semi-structured interview allowing to make diagnoses according to RDC, DSM III and DSM III-R criteria. One hundred and three panic patients (39 males and 64 females) were included in the study. Their mean age was 38.5 years (SD: 11.6). In this sample, 24.3% met the DSM III-R criteria for alcohol abuse and 8.7% those for alcohol dependence. Among these patients, 26.2%, abused of benzodiazepines and 16.5% of them of other substances. We found a high comorbidity rate. In fact, 6.8% of the patients met diagnostic criteria for PD alone, 31.0% for one more diagnosis, 29.1% for two more and 33.0% for three or more besides PD. In this study, we found an association between alcohol abuse and the presence of a lifetime diagnosis of major depressive episode and/or other addictive behaviors. Otherwise, alcohol abuse did not occur more often in patients suffering from panic disorder associated with agoraphobia and/or social phobia.

Adult↗