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Biomedical subjects

J Besson

Publications and source records attributed to J Besson.

At least 19 recordsLinked to original sources

Learning the structure of correlated synaptic subgroups using stable and competitive spike-timing-dependent plasticity.

Synaptic plasticity must be both competitive and stable if ongoing learning of the structure of neural inputs is to occur. In this paper, a wide class of spike-timing-dependent plasticity (STDP) models is identified that have both of these desirable properties in the case in which the input consists of subgroups of synapses that are correlated within the subgroup through the occurrence of simultaneous input spikes. The process of synaptic structure formation is studied, illustrating one particular class of these models. When the learning rate is small, multiple alternative synaptic structures are possible given the same inputs, with the outcome depending on the initial weight configuration. For large learning rates, the synaptic structure does not stabilize, resulting in neurons without consistent response properties. For learning rates in between, a unique and stable synaptic structure typically forms. When this synaptic structure exhibits a bimodal distribution, the neuron will respond selectively to one or more of the subgroups. The robustness with which this selectivity develops during learning is largely determined by the ratio of the subgroup correlation strength to the number of subgroups. The fraction of potentiated subgroups is primarily determined by the balance between potentiation and depression.

Action Potentials↗

[Addictions].

This year reviews on the addictions emphasizes five aspects, on a bio-psycho-social perspective: (1) The relationship between methadone and cardiotoxicity. (2) The introduction of Eye Movement Desensibilization and Reprocessing (EMDR). (3) The apparition of a possible specific pharmacotherapy for excessive gambling. (4) A better knowledge of the relationship between cannabis and psychoses. (5) Resistance to treatment in the doctor-patient relationship.

Cannabis↗

Opioid antagonist detoxification under anaesthesia versus traditional clonidine detoxification combined with an additional week of psychosocial support: a randomised clinical trial.

BACKGROUND: While detoxification under anaesthesia accelerates the detoxification procedure, there is a lack of randomised clinical trials evaluating its effectiveness compared to traditional detoxification procedures, and a lack of data on long-term abstinence. METHODS: Prospective randomised clinical trial. Analysis by intention to treat and per protocol. SETTING: Specialised substance abuse unit in a psychiatric teaching hospital and an intensive care unit of a general hospital. PARTICIPANTS: Seventy patients with opiate mono-dependence requesting detoxification: 36 randomised to RODA (treatment as allocated received by 26) and 34 randomised to classical clonidine detoxification (treatment as allocated received by 21). MAIN OUTCOME MEASURES: Successful detoxification, safety and self-reported abstinence at 3, 6 and 12 months after detoxification. RESULTS: Socio-demographics were similar in both groups at baseline. No complications were reported during or after anaesthesia. According to the intention to treat analysis, 28/36 (78%) RODA patients and 21/34 (62%) of the clonidine group successfully completed the detoxification process (p=0.14). In the intention to treat analysis, 30% of RODA patients were abstinent after 3 months compared to 14% in the clonidine group (p=0.11). No difference was found at 6 and 12 months (both groups showed less than 5% abstinence after 12 months). The per-protocol analysis showed similar results with no statistical differences either for ASI mean scores or for the SF36 questionnaire. CONCLUSION: Although the detoxification success rate and abstinence after 3 months were slightly better for the RODA procedure compared to clonidine treatment, these differences were not statistically significant and disappeared completely after 6 and 12 months.

Adult↗

Prevalence of methadone injection in three Swiss cities.

OBJECTIVE: Intravenous methadone is associated with increased risk of morbidity and mortality. A previous report from a methadone center in Fribourg, Switzerland, found a high prevalence (43%) of patients who injected oral methadone. We therefore wished to assess the prevalence of methadone injection among patients in oral methadone programs in 3 other Swiss cities--Lausanne, Geneva, and La Chaux-de-Fonds. METHOD: Subjects were randomly selected and interviewed by assistant psychologists who were not on the staff of the study centers. Participation was voluntary and anonymous. RESULTS: 164 patients participated in the study (n = 58 in Lausanne, 52 in Geneva, and 54 in La Chaux-de-Fonds). The prevalence of methadone injection was low (5%) and did not differ significantly between the cities. DISCUSSION: Less liberal policies cannot explain the lower prevalence of methadone injection in these three centers than in Fribourg. The high prevalence of methadone injection there is probably related to its separate methadone injection program: patients in oral methadone programs may be more likely to injection methadone when other patients authorized to do so. IN CONCLUSION: Although the 5% prevalence of methadone injection found in the 3 cities surveyed is low, it is not negligible. These results suggest that information on the risks associated with injection of methadone syrup should be provided to all methadone maintenance. This information is especially necessary when maintenance therapy is provided in the same center, or city as injectable methadone maintenance.

Adolescent↗

Ultra-rapid opiate detoxification using deep sedation and prior oral buprenorphine preparation: long-term results.

BACKGROUND: New methods of ultra-rapid opiate detoxification (URD) under intravenous sedation have been criticized because of limited data on safety and long-term follow-up. Premedication with buprenorphine has been advocated to improve safety by decreasing vomiting. Prior research has not explored URD in socially impaired patients. METHOD: Sixteen patients were detoxified with URD and prospectively evaluated over at least 30 months. Data of this procedure were compared with those of our previous study without buprenorphine preparation (Drug Alcohol Depend. 52(3) (1998) 243). The 16 patients were followed up by a general practitioner (GP) before and after URD. The GPs also supervised the 7-day course of buprenorphine treatment prescribed for the 16 patients prior to URD. RESULTS: During the procedure, only one episode of vomiting occurred instead of 13 out of 20 in our previous study. Post-procedure, only two patients experienced moderate withdrawal symptoms, such as persistent nausea, abdominal cramps and vomiting lasting from 24 to 48 h, in comparison with most patients in the previous study without buprenorphine. After a period of at least 30 months (36.0+/-6.38), the 16 patients were still alive and were regularly monitored by their GP. Only two of the 16 never relapsed after URD and reported total opiate abstinence. Fourteen patients relapsed; 12 of these were prescribed a licensed methadone substitution program and two were still using heroin. CONCLUSION: In this small sample, the data indicated that URD with buprenorphine preparation was safe and that it markedly decreased post-procedure morbidity. No patient died over a minimum 30-month follow-up period. Furthermore, the procedure was employed with socially impaired patients. In the long term, a few patients were still free of opiates, while the majority opted for a methadone maintenance program, showing that URD can serve as one possible step in a long-term treatment program.

Adult↗

[Rapid induction of withdrawal with opiate antagonists under anesthesia: an alternative to treatment of opiate dependence?].

Rapid induction of withdrawal by opiate antagonists under anesthesia is an opiate detoxification technique. This technique is useful to reduce intensity and duration of withdrawal. Therefore, this technique represents an alternative strategy in the treatment of opiate addicted patients. This paper attempts to present a brief history of this technique, and a critical review of related issues.

Anesthesia, General↗

Involuntary treatment of alcohol-dependent patients: a study of 17 consecutive cases of civil commitment.

AIM: To investigate the baseline and follow-up characteristics of a group of alcohol-dependent patients being treated under civil commitment. METHODS: This study involved a cross-sectional comparative analysis of baseline characteristics and a follow-up survey of a group of committed alcoholic patients. The study was undertaken in the Alcohol Unit of a 1,000-bed general and university hospital. The study included 17 consecutive cases of civil commitment (representing 15 patients, of whom 2 were committed twice) and a comparative group of 34 randomly selected age- and sex-matched patients. Baseline characteristics of the cases (at the time of commitment) and of patients from the comparative group were collected from medical records, including sociodemographic data, medical condition, patterns of drinking and number and dates of previous treatments for alcohol-related problems. A structured follow-up interview of the cases provided information on their medical condition, social status, patterns of alcohol use, type and duration of residential treatment as well as their perceptions of commitment. RESULTS: During a 4-year period, our Unit referred 23 cases of alcohol-dependent patients (out of 367) to the Guardianship Authority, requesting civil commitment. On 17 occasions, patients were committed to residential treatment, including 2 patients who underwent commitment on two separate occasions, thus representing a total of 15 different patients. In comparison with age- and sex-matched patients seen at the Unit, the cases were characterized by multiple medical, social and psychological alcohol-related impairments. At the time of follow-up, 14 out of 15 patients were alive, among whom 10 agreed to be interviewed. Eight of these reported complete abstinence, whereas 9 considered their alcohol problem as less severe than before. The average duration of commitment was 29 weeks. The majority of patients retrospectively considered the measure as having been justified and useful. The patients' satisfaction with the decision to commit was higher among women than among men. Health-related quality of life at the time of follow-up, as assessed by the MOS 36-Item Short Form Health Survey questionnaire, was good on average and better than that usually reported by other cohorts of alcoholics undergoing treatment. CONCLUSIONS: The usefulness of residential civil commitment of certain severely impaired alcohol-dependent patients is underscored. This study suggests that civil commitment not only may save the lives of endangered patients but could also be a health-promoting measure that may sometimes allow for recovery from dependence. Unexpectedly, this measure was retrospectively well accepted by many patients, who considered the commitment decision as having been justified and useful.

Alcoholism↗

[Dependence: all similar, all different. Point of view of a practitioner, point of view of a specialist].

Psycho-active substances dependent patients are similar in the mechanisms of addiction, but are individually very different and need a diversified approach. This paper is showing a general practitioner's point of view and the one of an addiction specialist regarding common clinical problems in such patients. The question of the treatment matching and of the level of care are discussed through an instrument for a rapid evaluation.

Diagnosis, Differential↗

[Smoking in psychiatry, a neglected problem].

The prevalence of smoking and the associated health risk are especially high in psychiatric patients. Smoking prevention has, however, been neglected until now in psychiatry. Nicotine withdrawal may be associated with some difficulties in psychiatric patients. Existing programs for the prevention and treatment of tobacco dependence do not take into account these special problems.

Comorbidity↗

A French translation of the obsessive-compulsive drinking scale for craving in alcohol-dependent patients: a validation study in Belgium, France, and Switzerland.

The Obsessive-Compulsive Drinking Scale (OCDS) is an instrument developed to measure cognitive aspects of alcohol craving. The aim of this study was to validate the French translation of the OCDS according to the international methodology as published by Hunt and coworkers (see text), including forward-backward translations, patient interviews (9 patients), patient's perception of acceptability (15 patients), and final validation within a treatment program (50 patients). All 74 patients were native French-speaking alcohol-dependent patients from Belgium, France, and Switzerland. The derived aggregated total (TOT) score and both subscores corresponding to the obsessive (OB) and compulsive (CP) dimensions were shown to be asymptomatically normal. Good internal consistencies were found, with Cronbach alpha: TOT = 0.88; OB = 0. 82; CP = 0.79. The test-retest procedure was used to examine intrarater reliability (r = 0.81). The construct validity was examined with linear correlation of the two main components: r(OB, CP) = 0.62; r(OB, TOT) = 0.86; r(CP, TOT) = 0.92. Principal-components analysis revealed two main factors: the first factor representing the total scale score, while the obsessive and compulsive subscale scores were distributed along factor two. The translated scale seems to be psychometrically as valid as the original English scale and confirms the psychometric properties of the OCDS.

Adult↗

Stage of change of cigarette smoking in alcohol-dependent patients.

Despite the heavy burden of tobacco-related problems in alcohol-dependent patients, little effort has been directed toward reducing the prevalence of smoking in these patients. It seems reasonable to develop nicotine addiction treatments for alcohol-dependent patients based on the smoker's stage of change. To assess the stage of change for tobacco consumption and possible quitting barriers in alcohol-dependent patients, 88 consecutively admitted inpatients of a Swiss university-affiliated alcohol withdrawal clinic were interviewed with a semistructured schedule. More than half of the alcohol-dependent smokers (50.7%) considered the possibility of smoking cessation or had already decided to stop, although the majority (83.1%) were highly dependent smokers. Positive reinforcers were factors influencing motivation both to stop smoking as well as to continue smoking, whereas negative reinforcers had no influence. As recovering alcoholic patients are often interested in smoking cessation and the introduction of nicotine treatment interventions has been shown not to jeopardize the outcome of alcohol treatment, alcohol treatment programs should include counseling for smoking cessation. Education and training for staff is essential, as their beliefs and habits remain an important barrier.

Adult↗

[Alcoholism from the systemic viewpoint].

In this paper we attempt to view the phenomenon alcohol abuse and dependence within the family or partnership and to describe the important impact of alcoholism on social relation. Understating the role of alcohol in the familial structure may help to draw conclusions for competence and effectiveness of individual or familial psychotherapeutic interventions.

Adult↗

Inhibition of CYP2E1 by chlormethiazole as measured by chlorzoxazone pharmacokinetics in patients with alcoholism and in healthy volunteers.

BACKGROUND: Chlormethiazole has been shown in in vitro studies, with use of rat and human liver microsomes, to specifically inhibit cytochrome P4502E1 (CYP2E1)-mediated activity by inhibition of the rate of CYP2E1 gene transcription. It is known that CYP2E1 is involved in the activation of many low-molecular-weight toxins and carcinogens and may be involved in the development of alcohol-induced liver disease. METHODS: The pharmacokinetics of a single oral dose of 250 mg chlorzoxazone, a marker of the activity of CYP2E1, were measured in five healthy drug-free volunteers and in 16 patients with alcoholism receiving 1.2 gm or 2.4 gm chlormethiazole per day for 1, 2, or 3 days. The patients were starting an alcohol-withdrawal program and were supposed to have an induced CYP2E1 activity. RESULTS: The results suggest that chlormethiazole strongly decreased chlorzoxazone clearance in the patients with alcoholism compared with clearance in the control subjects (3.98 +/- 1.8 L/hr versus 12.7 +/- 5.6 L/hr; p < 0.005), prolonged the elimination half-life (3.91 +/- 1.23 hours versus 1.12 +/- 0.34 hours; p < 0.001), and caused a threefold increase in the area under the concentration versus time curve of chlorzoxazone (73.0 +/- 35.5 mg.hr/L versus 21.3 +/- 13.7 mg.hr/L; p < 0.005). They also suggest that chlormethiazole significantly decreased the area under the concentration versus time curve of the metabolite 6-hydroxy-chlorzoxazone (4.56 +/- 1.27 mg.hr/L versus 7.1 +/- 1.84 mg.hr/L; p < 0.05). CONCLUSION: Chlormethiazole administration seems to result in a marked reduction of CYP2E1 activity in subjects with high CYP2E1 activity and could at least partially explain the claimed hepatoprotective action of this drug.

Administration, Oral↗

Combined efficacy of acamprosate and disulfiram in the treatment of alcoholism: a controlled study.

This study presents the results of a multicenter investigation of the efficacy of acamprosate in the treatment of patients with chronic or episodic alcohol dependence. One hundred eighteen patients were randomly assigned to either placebo or acamprosate, and both groups were stratified for concomitant voluntary use of disulfiram. Treatment lasted for 360 days, with an additional 360-day follow-up period. The primary efficacy parameters evaluated were: relapse rate and cumulative abstinence duration (CAD). Results were analyzed according to Intention-To-Treat principles using chi2, t, and multiple regression analyses where appropriate. After 30 days on study medication, 40 of 55 (73%) acamprosate-treated patients were abstinent, compared with 26 of 55 (43%) placebo-treated patients (p = 0.019). The treatment advantage remained throughout the study medication period and was statistically significant until day 270 (p = 0.028). Twenty-seven percent of patients on acamprosate and 53% of patients on placebo had a first drink within the first 30 days of the study. The mean CAD was 137 days (40% abstinent days) for the patients treated with acamprosate and 75 days (21% abstinent days) for the placebo group (p = 0.013). No adverse interaction between acamprosate and disulfiram occurred, and the subgroup who received both medications had a better outcome on CAD than the those on only one or no medication. Acamprosate was well tolerated. Diarrhea was the only significant treatment-induced effect. It was concluded that acamprosate was a useful and safe pharmacotherapy in the long-term treatment of alcoholism. Concomitant administration of disulfiram improved the effectiveness of acamprosate.

Acamprosate↗

[New drugs in the treatment of alcoholism].

Pharmacotherapy of alcoholism is improving rapidly with the introduction of new agents. New knowledge about the neurobiology of alcoholism is necessary for the clinician, who has to establish the diagnosis. Useful pharmacological agents for the treatment of alcohol dependence can be classified into four groups: (1) agents for the treatment of the withdrawal syndrome, (2) aversive agents, (3) therapeutic agents for comorbidity, (4) new agents to reduce craving for alcohol or prevent relapse. These new agents derive from research in four directions, based on neurobiological hypotheses: (a) the glutamatergic hypothesis with acamprosate, (b) the opioid hypothesis with naltrexone, (c) the serotonergic hypothesis with the new antidepressants, and (d) other hypotheses, including dopaminergic, peptidic etc. Of these new agents, acamprosate has undergone most study in controlled clinical trials around Europe. Its efficacy has been demonstrated statistically, it is well tolerated and does not interact with alcohol. Acamprosate can be associated with disulfiram therapy. Future perspectives for treatment and research are discussed, in particular with regard to therapeutic associations.

Acamprosate↗