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J L Terra

Publications and source records attributed to J L Terra.

At least 19 recordsLinked to original sources
PubMed2006

[Is the suicidal risk assessment scale RSD of predictive value?].

INTRODUCTION: A part (60% to 70%) of those who are going to act out their suicide consult a doctor the month before. Studies have shown the need to improve the practitioner's capacity to diagnose depression. The assessment of the suicidal risk is crucial. The search for suicidal risk factors helps to define the populations at risk. However, it doesn't provide information concerning the possibility of acting out in the short term. And how does one react when faced with those who do not present any of the risk factors? Psychometric instruments attempt to help the therapist in his/her reasoning. SUICIDAL RISK ASSESSMENT: Among them, the suicidal risk assessment scale RSD should be mentioned. Its objective is to estimate the seriousness of the suicidal risk, with 11 levels. It is built around a possible will to commit suicide rather than a single assessment of the frequency of suicidal ideas. Its construction in hierarchical order permits the progressive assessment of the suicidal risk, in the form of a semi-structured interview. Hence, the suicidal risk assessment scale RSD looks for the existence of death wishes (levels 1-2), of suicide ideations and its frequency (levels 3-4-5), and of a passive desire to die (level 6). Level 7 shows the onset of a decision making process, except that the patient is still inhibited by various important factors in his/her life. More often, the fear of inflicting immense suffering to his/her loved ones or for religious beliefs, is found. From level 8, determination has made way to hesitation. An active death wish exists, and although the plan remains undefined, the act is decided on. At level 9 the methods of application are developed and a plan is established. The ultimate level exists when there is a start in the preparation of the act of suicide (level 10). This hierarchical order has been confirmed by some epidemiological studies. METHOD: The inclusion of the suicidal risk assessment scale RSD in a double-blind, placebo-controlled study, which tested the efficacy of fluvoxamine in reducing the risk of recurrence of depression over 18 months, appears of particular interest. In this multicentre study, patients of both sexes were included, aged between 18 and 70 years, presenting a major depressive episode with a MADRS equal to a minimum of 25, and having had a minimum of two episodes of major depression within the last five years. RESULTS: The resulting analysis carried out on 103 patients showed a satisfactory concurrent validity between the suicidal risk assessment scale RSD and the items "suicide" of the MADRS (rho=0.79; p=0.0001) and the Hamilton Depression Scale (rho=0.70; p=0.0001), and fairly satisfactory concurrent validity with the depression degree assessed by the MADRS overall score (rho=0.40; p=0.0001). The short-term follow-up under treatment revealed enhanced sensitivity of the RSD versus the MADRS. The improvement in suicidal risk, assessed by the RSD, was faster than the improvement in depression, which is interesting from a clinical point of view. The medium-term follow-up tested the predictive validity of RSD and confirmed a greater level of suicidal risk from a score of 7 on the RSD, with the death by suicide of 2 subjects among the 15 who exhibited a score between 7 and 10 on the RSD on inclusion. On the other hand, no acting out, no attempted suicides, and no suicides were noted in the group of 88 subjects whose RSD was lower or equal to 6 on inclusion (p=0.02 using Fisher's exact test). CONCLUSION: Thus, the RSD appears of interest, from a clinical point of view, by providing a -diagnostic, or a scientific approach.

Adult↗
PubMed2002

[Are new data collection systems needed to achieve public health and research goals for the prevention of suicide?].

Evaluation of suicide prevention programs, both on the local and national level, is a methodological challenge. In September 2000, France initiated a nation program for suicide prevention. But, as was noted in the Prémutan report and more recently the FNORS report, very few of the hundreds of preventive measures taken annually are evaluated. In addition to this assessment challenge, new data, particularly concerning the different phases of the suicide process, are needed to design new programs, define their objectives with precision, and assure their implementation. For example, if the objective is to improve prevention in men aged 25-54 years who suffer from a state of depression, alcohol abuse, impulsive personality disorders, and life events implicating loss, the necessary information is currently unavailable or sparse. The lack of data and research in this domain can be grouped into several categories: lack of proper definition and quantification of the objectives; insufficient study of the mechanisms by which prevention measures are effective: lack of monitoring tools providing information on the rate of implementation of planned actions. These arguments demonstrate the need for collecting new information to develop a dynamic prevention program. Such data collection should be synchronized, conducted by a wide range of actors, and concern multiple actions. Without a coherent information system, it is doubtful the current impetus for the prevention of suicide can be sustained.

Adult↗
PubMed2001

Evaluation of 60 continuous quality improvement projects in French hospitals.

OBJECTIVE: To evaluate the feasibility of implementing continuous quality improvement (CQI) projects in French health care organizations. DESIGN: The French Ministry of Health issued two calls for CQI projects (in 1995 and 1996). ANAES was commissioned to monitor and evaluate the projects, and to provide advice. SETTING: ANAES in collaboration with French public hospitals. STUDY PARTICIPANTS: A jury selected 64 projects from 483 submissions. The first series of projects related to safety issues (e.g. blood transfusions), the second related chiefly to patient management. INTERVENTIONS: ANAES instructed project leaders in process analysis (modified four-step FOCUS-PDCA model), convened regular meetings between leaders and performed on-site visits. MAIN OUTCOME MEASUREMENTS: Objective outcomes: goal achievement, extension of projects to other topics and departments, allocation of resources. Subjective outcomes: changes in attitudes. Statistics were obtained from two questionnaires completed by project leaders. RESULTS: Four projects were discontinued; 82% (49 out of 60) met more than half their objectives. The CQI method was adopted by other departments in 65% and 50% (1st and 2nd series respectively) of cases. Hospital management often chose to provide continued support (81%/88%), offer training (59%/80%), create a CQI unit (62%/73%), and allocate a budget (61%/65%). A positive impact on staff attitudes was noted in over 75% of projects. CONCLUSION: ANAES' co-ordinated initiative to acquaint a hard core of French public hospitals with CQI proved successful. Identification of the factors for success and of potential hurdles helped pave the way for the national hospital accreditation procedure currently underway.

Attitude of Health Personnel↗
PubMed2000

Assessing the impact of a consensus conference on long-term therapy for schizophrenia.

OBJECTIVE: Our aim was to assess the impact of six recommendations regarding drug prescription on the clinical practices of French psychiatrists. The recommendations were part of the conclusions of a consensus conference entitled "Long-term therapy of schizophrenia" (Paris, January 1994). METHODS: The impact of the conference was assessed on the basis of awareness of the existence of the conference, knowledge of its conclusions, and actual changes in clinical practice. We performed: a) a survey of a representative sample of 396 psychiatrists 2 years after the conference; and b) an analysis of changes in drug prescriptions in a cohort of 2,407 patients with schizophrenia under treatment at the time of the conference. RESULTS: Overall, 78% of interviewed psychiatrists were aware of the existence of the conference and 70% of its conclusions. Declared prescription practices conformed with conference conclusions about 60% (10%-95%) of the time. No difference in practices was noted between psychiatrists who were aware of the recommendations and those who were not. Single neuroleptic prescriptions increased in the cohort study in line with the main conference recommendation. The increase was small, but significant from 51.1% to 56.4%, and mainly concerned patients recently put on treatment. Contrary to recommendations, prescriptions of anticholinergics plus neuroleptics inexplicably rose from 48.2% to 54.3%. CONCLUSION: Small changes in prescription habits occurred in the wake of the consensus conference, but we cannot really ascribe them to a direct impact of the conference. Despite the great pains we took in disseminating the conclusions of the conference as widely as possible, it is clear that a more forceful action plan (e.g., including continuous medical education) is required.

Adolescent↗
PubMed1999

[Symptomatic and concurrent depressions].

The symptomatic and concurrent depressions description need to resort to comorbidity and symptomatic co-occurrence concepts. Patients with depressive symptoms or in a major depressive episode may also be suffering from another nonmood psychiatric disorders as alcoholism, anxiety or eating disorders. Many general medical conditions which are link with depression are illustrated with the examples of cancer, coronary artery disease, endocrinologic diseases, dementia, stroke and chronic fatigue syndrome. When depression and another psychiatric or medical conditions occur together, it is important to provide to the practitioner guidelines for the decision to treat one of the two disorders. This paper contains an example of decisional algorithm.

Alcoholism↗
PubMed1998

Quality of life assessment in psychiatry: the Subjective Quality of Life Profile (SQLP)--first results of a new instrument.

This article describes early results of a new instrument for measuring quality of life--the French Subjective Quality of Life Profile (SQLP) questionnaire. This 36-item, self-administered questionnaire has been previously validated in a large sample population with somatic disorders. It is characterized by its multidimensional pattern and subjective approach (i.e., the degree of satisfaction with various domains of life, the degree of change anticipated and the importance attributed to these domains). The SQLP was tested with three psychiatric patient samples: people with depression, psychosis or substance abuse. Preliminary findings indicate that the questionnaire is useful in describing psychiatric patients, their characteristics, and explaining some of their changes.

Adult↗
PubMed1998

Fluvoxamine prevents recurrence of depression: results of a long-term, double-blind, placebo-controlled study.

This double-blind placebo-controlled study specifically tested the efficacy of fluvoxamine, at a dose of 100 mg a day, in reducing the risk of new episodes of depression. Out of 436 patients treated openly with fluvoxamine 283 patients fulfilled stringent criteria to define responders at 6 weeks. A total of 204 patients maintained their remission throughout a continuation treatment period of 18 weeks and then entered the prophylactic study. They were randomly assigned to receive either fluvoxamine 100 mg a day or placebo for 1 year. There were significantly fewer recurrences of new episodes of depression in the fluvoxamine group compared with the placebo group (p < 0.001). The significant advantage for fluvoxamine was also seen in the Kaplan-Meier analysis of time to recurrence (p < 0.001). The clear-cut efficacy of 100 mg of fluvoxamine and the good tolerability and side-effect profile demonstrated in this study support the view that fluvoxamine is particularly suitable for maintenance or prophylactic treatment.

Adolescent↗
PubMed1997

[The psychiatrist's point of view on the treatment of morbid obesity by gastroplasty].

The surgical treatment of pathological obesity has been rapidly developing in France over recent years. The growing demand for operation raises a number of questions concerning the indications and the factors predictive of success. Patients are increasingly referred for a psychiatrist's or psychologist's opinion in order to detect psychiatric contraindications and to select patients who are able to comply with their weight reduction programme with the help of the operation and who are able to obtain a lasting improvement in their quality of life. The author starts by describing the explicit demand formulated by candidates for gastroplasty, characterized by a high degree of information and motivation. In view of the uncertainties concerning the right advice to be given to this population, an open prospective study was conducted among 109 gastroplasty candidates. Evaluation of somatic and psychological parameters was performed before the operation and at 6 months, 1 year, 2 years and 5 years. The preliminary results are based on 98 operated patients. The mean BMI (Body Mass Index) decreased from an initial value of 42.08 +/- 0.7 kg/m2 to 29.96 +/- 6.68 kg/m2 at one year. The frequency of vomiting decreased with successive evaluations, but nevertheless constituted the major disadvantage of the operation. Evaluation of depression scores, using the MADRS (Montgomery and Asberg Depression Rating Scale), did not reveal any depressogenic effect of gastroplasty. The other assessment instruments (visual analogue scales and Subjective Quality of Life Profile) indicated a favourable change in numerous dimensions of quality of life. Although it is too early to define any predictive criteria, the author proposes a list of empirical criteria in line with those reported in the literature and defines the role of psychiatrists before and after the operation.

Biological Psychiatry↗
PubMed1996

No season-of-birth effect in schizophrenic patients from a tropical island in the Southern Hemisphere.

The distribution of birth rates was examined in 668 schizophrenic patients born in Réunion, a tropical French island in the Southern Hemisphere, and compared with that in the general local population. We failed to observe a significant season-of-birth effect, either in the total sample of schizophrenic patients or in subgroups categorized by gender, age, or family history of schizophrenia. Seasonal factors do not appear to affect the yearly distribution of births among schizophrenic patients on Réunion Island. It is nevertheless possible that environmental factors which are seasonal in countries with more contrasting climates have a continuous effect, throughout the whole year, in subtropical areas. Conversely, these findings provide some evidence against the hypothesis that there is an age-incidence artifact in seasonal studies from countries in the Northern Hemisphere.

Adult↗
PubMed1996

Increased serum levels of neuron-specific enolase in epileptic patients and after electroconvulsive therapy--a preliminary report.

Serum neuron-specific enolase (NSE) levels were studied by an enzymo-immunoassay method in 2 groups of patients: a group of epileptic patients, and a group of patients with refractory major depression after electroconvulsive therapy (ECT). In patients without organic neurological disease (n = 274) the mean serum NSE level (+/- S.D.) was 8.4 +/- 3.4 micrograms/l. No correlation with sex or age was observed. No significant difference was observed between epileptic patients without seizure or major electroencephalogram (EEG) abnormality, and a reference group. Significant increases were observed in 32 samples collected from patients with interictal EEG without spikes and waves before the 7th day after a seizure, in whom mean NSE was 21.5 +/- 9.4 micrograms/l, and in 26 samples from 4 patients without seizures but with spikes and waves in the interictal EEG, whose mean NSE was 20.6 +/- 11.5 micrograms/l. The increases of serum NSE levels in epileptic patients seem therefore to be linked to seizures and/or to EEG abnormalities. The consequences of these observations for the survey of epileptic patients, and for the diagnosis of cerebral tumors (mainly neuroblastoma) or for monitoring treatment after surgical resection, are discussed. In only 1 patient out of 6, an increase in serum NSE levels was observed with a peak about 12 h after ECT. No significant correlation with the ECT features (length of seizures, one- or two-sided electrodes) was observed.

Adult↗
PubMed1992

Relationship between symptoms rated with the Positive and Negative Syndrome Scale and brain measures in schizophrenia.

The Positive and Negative Syndrome Scale (PANSS) was used to rate clinical symptoms in 42 inpatients with schizophrenia before they were examined by computed tomography. Significantly higher mean size of lateral and third ventricles, and higher mean cortical atrophy were found in schizophrenic patients compared with healthy control subjects. Ventricular enlargement and cortical atrophy were significantly related to low scores on the Composite subscale of the PANSS. Positive correlations were observed mainly with negative items such as blunted affect, emotional withdrawal, difficulties in abstract thinking, passive-apathetic social withdrawal, and lack of spontaneity of conversation. Additional positive correlations were observed with two items from the General Psychopathology subscale (mannerisms and disorientation). Inverse correlations were found with most positive items. These results suggest a relationship between brain structural abnormalities and the symptomatology of schizophrenia recorded with PANSS.

Adult↗
PubMed1991

[Depressive disorders. Sociodemographic factors predicting therapeutic response].

The choice of an antidepressant according to the possible course of depression is a fundamental step in the treatment approach. Socio-demographic factors are considered in order to predict the outcome of depression receiving an adequate treatment. Only a few studies deal with this topic, probably because of the role the same factors play in the occurrence of depression. The influence of age, sex, marital status, socio-economic level and life events on compliance with treatment is considered as well as main clinical issues such as treatment resistance, risk of chronicity and of suicide. Generally speaking, socio-demographic factors do not constitute a major parameter when selecting an antidepressant. They are useful to identify patients at risk requiring special therapeutic measures. The poor prognosis of depression in males after 65 has must be emphatized, as well as the negative influence of life events occurring during the course of endogenous depression. Conversely, a decrease in the number of life events or a life event experiencing a new start in life, play an important role in the improvement of depression according to Brown. Those factors remain in the background of the pathological process and of its evolution, acting indirectly, with a poor association power. Moreover, most of those predictors have been determined a posteriori.

Aging↗
PubMedDate not supplied

[Management of suicidal adolescents: a clinical audit in 76 hospitals].

We describe the implementation and results of a clinical audit of the management of suicidal adolescents in hospital that was carried out as part of the French national suicide prevention programme. The ANAES definition of a clinical audit is: "an assessment method using defined criteria that compares care practices with accepted standards and measures the quality of these practices and the results of care with a view to improving them". Standards for the audit were derived from the clinical practice guidelines published by ANAES (French National Agency for Accreditation and Evaluation in Health) in November 1998. They comprised 15 criteria covering ressources available and procedures implemented: patient management in hospital (9 criteria), contacts made with the patient's environment outside hospital (2 criteria) and preparation for discharge from hospital (4 criteria). Participation in the audit was voluntary. Overall, 76 hospitals from the 10 regions of France with a suicide prevention programme took part in the audit and made 1,554 observations. The number of observations per hospital ranged from 1 to 42. Compliance with the criteria was > 80 % for 5 criteria, 50-80 % for 3 criteria, and < 50 % for 7 criteria. A total of 26 hospitals, proposed a structured improvement plan, ie, scheduled, ordered and ranked measures with a definition of responsibilities and follow-up. Of these 26 hospitals, 15 had implemented the three ANAES recommendations (setting up a working group for the project, using a grid to analyse results, drafting a structured report) whereas only 5 of the 50 hospitals that did not come up with an improvement plan had done so. An operational outcome thus seems related to compliance with the audit method. Three years after the audit was set up, 17 hospitals took part in a second round. Improvements were noted for 12 criteria, mainly for those giving poor results in the first round. However, these improvements concerned few hospitals (eg just 4 hospitals for the criterion with the worst result in the first round). A worsening of compliance was noted for 3 criteria. In conclusion, hospitals were found to comply with guidelines relating to the management of suicidal adolescents in hospital. However, compliance with guidelines relating to making contact with the patient's environment outside hospital and preparing for discharge was less good. Although the hospitals taking part in the audit endorsed our method, our experience showed that, to be effective, clinical audits need methodological support and a well-defined time schedule.

Adolescent↗