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Biomedical subjects

J P Lepine

Publications and source records attributed to J P Lepine.

At least 19 recordsLinked to original sources
PubMed2002

Lithium: poisonings and suicide prevention.

This study concerns 81 cases of lithium poisoning and shows that deliberate intoxications are prevalent during the first 3 years of lithium treatment as well as in cases with a previous history of suicide attempt. Therapeutic intoxications could generally be avoided by education concerning hygiene and diet and careful monitoring in cases of intercurrent diseases.

Adult↗
PubMed2000

Social phobia: diagnosis and epidemiology, neurobiology and pharmacology, comorbidity and treatment.

Social phobia is a common disorder associated with significant psychosocial impairment, representing a substantial public health problem largely determined by the high prevalence, and the lifelong chronicity. Social phobia starts in early childhood or adolescence and is often comorbid with depression, other anxiety disorders, alcohol and substance abuse or eating disorders. This cascade of comorbidity, usually secondary to social phobia, increases the disability associated with the condition. The possibility that social phobia may be a trigger for later developing comorbid disorders directs attention to the need for early effective treatment as a preventive measure. The most recent drug class to be investigated for the psychopharmacological treatment of social phobia is the SSRI group for which there is growing support. The other drug classes that have been evaluated are monoamine oxidase inhibitors (MAOIs), benzodiazepines, and beta-blockers. The SSRIs represent a new and attractive therapeutic choice for patients with generalized social phobia. Recently the first, large scale, placebo-controlled study to assess the efficacy of drug treatment in generalized social phobia has been completed with paroxetine. Paroxetine was more effective in reducing the symptoms than placebo and was well tolerated. Many now regard SSRIs as the drugs of choice in social phobia because of their effectiveness and because they avoid the problems of treatment with benzodiazepines or classical MAOIs.

Adrenergic beta-Antagonists↗
PubMed1999

Anxiolytic and hypnotic use in 376 psychiatric inpatients. GERMED Neuropsychotropics Group.

This objectives of this study were three-fold: retrospectively evaluate anxiolytic/hypnotic consumption by psychiatric inpatients, identify the risk factors of prolonged intakes, and prospectively measure the impact of hospitalisation on the use of those drugs. Three hundred and seventy-six patients hospitalised in 11 psychiatric departments in the Paris region were studied using a structured interview for the anxiolytic/hypnotic treatments, DSM-III-R criteria, GHQ-12, HAD, Spiegel's questionnaire, COVI's anxiety scale and the CGI. Eighty-five per cent of the patients had taken one anxiolytic/hypnotic or more in the 3 months preceding hospitalisation. Hospitalisation induced little change in anxiolytic/hypnotic use: dosage frequency increased from 77% to 84% between the week preceding hospitalisation and that preceding discharge; 26% of consumers were taking at least two anxiolytics or two hypnotics in the first period vs. 23% in the second. The absence of withdrawal during hospitalisation was related to the high age and a diagnosis of depression rather than schizophrenia, to the existence of continuous intake over the 3 months preceding hospitalisation and to higher drug doses during the 7 days preceding hospitalisation. Prescription of treatment at the end of hospitalisation in previously non-user subjects was related to a higher HAD anxiety score at discharge.

Anti-Anxiety Agents↗
PubMed1999

Prevalence of suicide ideation and suicide attempts in nine countries.

BACKGROUND: There are few cross-national comparisons of the rates of suicide ideation and attempts across diverse countries. Nine independently conducted epidemiological surveys using similar diagnostic assessment and criteria provided an opportunity to obtain that data. METHODS: Suicide ideation and attempts were assessed on the Diagnostic Interview Schedule in over 40000 subjects drawn from the United States, Canada, Puerto Rico, France, West Germany, Lebanon, Taiwan, Korea and New Zealand. RESULTS: The lifetime prevalence rates/100 for suicide ideation ranged from 2.09 (Beirut) to 18.51 (Christchurch, New Zealand). Lifetime prevalence rates/100 for suicide attempts ranged from 0.72 (Beirut) to 5.93 (Puerto Rico). Females as compared to males had only marginally higher rates of suicidal ideation in most countries, reaching a two-fold increase in Taiwan. Females as compared to males had more consistently higher rates for suicide attempts, reaching a two- to three-fold increase in most countries. Suicide ideation and attempts in most countries were associated with being currently divorced/separated as compared to currently married. CONCLUSIONS: While the rates of suicide ideation varied widely by country, the rates of suicide attempts were more consistent across most countries. The variations were only partly explained by variation in rates of psychiatric disorders, divorce or separation among countries and are probably due to cultural features that we do not, as yet, understand.

Adolescent↗
PubMed1999

Anxiety and depressive disorders in fathers and mothers of anxious school-refusing children.

OBJECTIVE: To examine anxiety and depressive disorders in the mothers and fathers of children with anxious school refusal and to test for the existence of differences in familial aggregation between children suffering from school refusal related to separation anxiety disorder and those suffering from phobic disorder-based school refusal. METHOD: Using a blind standardized diagnostic evaluation (Schedule for Affective Disorders and Schizophrenia-Lifetime version, modified for the study of anxiety disorders; Diagnostic Interview for Genetic Studies; and Schedule for Affective Disorders and Schizophrenia for School-Age Children), the authors compared parental lifetime psychiatric illness for the 2 groups of anxious school refusers. RESULTS: Relationships between specific anxiety disorders in children and their parents revealed increased prevalence of simple phobia and simple and/or social phobia among the fathers and mothers of phobic school refusers, and increased prevalence of panic disorder and panic disorder and/or agoraphobia among the fathers and mothers of school refusers with separation anxiety disorder. Simple and/or social phobia in the father, simple phobia in the mother, and age of the father were associated with the group of phobic school refusers. CONCLUSIONS: The data show the high prevalence of both anxiety and depressive disorders in fathers and mothers of anxious school refusers. Significant differences were observed in familial aggregation considering the subgroups of anxious school-refusing children.

Adolescent↗
PubMed1996

Social phobia in general health care: an unrecognised undertreated disabling disorder.

BACKGROUND: This study explored the prevalence of social phobia (SP) in general health care, sociodemographic characteristics of patients with SP, the age at onset and severity of SP, its comorbidity with other psychiatric disorders, and the recognition by general practitioners. METHOD: The study was conducted in Paris as part of the WHO study on Psychological Problems in General Health Care. Among 2096 consecutive primary care patients, 405 were interviewed using the CIDI. DSM-III-R diagnoses, severity and disability were assessed. RESULTS: The one-month prevalence of SP is high (4.9) in primary care, although underdiagnosed by GPs. It has an early onset and leads to substantial disability. Patients with SP are at risk of developing further depression, alcoholism or suicidal behaviour. CONCLUSION: SP appears to be a true and frequently severe pathological condition. The awareness of GPs and the general population should be improved.

Adolescent↗
PubMed1995

Recurrent brief depression: clinical and epidemiological issues.

Initially based on empirical observations, the concept of RBD has led to operational diagnostic criteria allowing further studies in various and large populations. In line with the hypothesis of a continuum from normal sad mood to major depression, the spectrum of affective disorders is thus probably more in agreement with everyday clinical practice. Moreover, recurrent and so-called subthreshold conditions have been concurrently investigated in other fields of psychopathology. Nevertheless, many methodological problems and clinical implications of RBD still require further research. The question of a precise definition of the disorder, even if a consensus seems to be obtained about some key points, remains partially to be addressed, for example, concerning the problem of the reliability of assessment. The possibility of a seasonality of the episodes needs further investigations, as do the relationships between RBD and personality disorders such as borderline personality disorder. Finally, the important question of prophylactic treatment of RBD remains unsolved, as antidepressants have failed to demonstrate any efficacy and some neuroleptics have been proposed in particular conditions. Angst's prediction that clinical relevance, impairment, distress and public health impact of affective disorders could be related not only to the duration of an episode but also to the recurrence of episodes, possibly referring to a kindling model, has therefore been confirmed. His major contribution has been to underline, in various forms of affective disorders, the importance of conducting longitudinal clinical as well as epidemiologic studies to refine our psychopathological knowledge.

Comorbidity↗
PubMed1995

[Psychological trauma and mental disorders].

Fifty-eight female impatients consecutively hospitalized in the University Hospital Department of Psychiatry in Tours were interviewed with a clinician battery of instruments (among them, the SI-PTSD by Davidson). The diagnoses leading to hospitalization were: severe disorders of psychotic type (schizophrenic, schizophreniform, schizo-affective, schizoid and paranoid delusional disorders as well as bipolar disorder), borderline and narcissistic personalities for 7%, and other disorders for 53%. Among the results, we observed that 59% of these patients had experienced at least one major stressful event (rape 26%, other sexual assault 29%, physical assault 31%, seeing somebody dying in a violent way 8%, war scene 2%, injured in an accident 2%). As a consequence, 61% of the victims have suffered from PTSD and the diagnosis of PTSD was still present in 21%. In addition, in the victims, somatoform and dissociative disorders were significantly more frequent.

Adult↗
PubMed1994

Prevalence of recurrent brief depression in primary care.

Descriptions of mentally ill inpatients have strongly influenced current classifications of mental disorders. Primary care patients may therefore present a substantially different pathology. Some diagnoses, infrequent in psychiatric settings but common in the general population or in primary care, have been described, such as the concept of recurrent brief depression (RBD) proposed by Jules Angst. RBD refers to frequent but short-lasting (usually only a few days) severe depressive episodes. In parallel with a study organized by the World Health Organization aimed at defining the psychological disorders encountered in primary care, we investigated the prevalence of RBD, its severity, and comorbidity with major and well-defined disorders using a structured interview (CIDI). The current prevalence of RBD in a general practice population was found to be about 10%. The average duration of the episodes is 3-4 days. Ours results confirm the severity of this disorder; in particular, a history of suicide attempts is frequent (23.3%). Among RBD patients, 26% do not present any other psychiatric disorder. When a comorbidity is reported, depressive episodes (lasting at least two weeks, according to ICD-10) and generalized anxiety disorder are the main associated disorders. Our results are in favor of the existence of RBD as a separate and original nosological entity.

Adolescent↗
PubMed1994

Subsyndromal ("mixed") anxiety--depression in primary care.

OBJECTIVE: To determine in primary care settings the prevalence, clinical characteristics, and functional status of patients who have anxious and depressive symptoms who did not meet diagnostic criteria for major mood and anxiety diagnoses. DESIGN: Patients were screened with the General Health Questionnaire and interviewed if they exceeded the cutoff score of 5. Also, one patient whose score was below the cutoff was interviewed for every two patients whose scores were above the cutoff. SETTING: Five primary care sites in the United States, France, and Australia. PATIENT: Two hundred sixty-seven patients presenting to their primary care physicians for general medical care and follow-up. METHODS: Structured diagnostic interviews were conducted and ratings of anxiety, depression, and functional impairment were obtained by trained interviewers. RESULTS: After adjustments for sampling, 5% of the patients had symptoms of anxiety, depression, and functional impairment, without meeting formal criteria for a major DSM-III-R mood or anxiety disorder. This was comparable to the prevalence of diagnosable DSM-III-R mood disorders but only one-fourth the prevalence of diagnosable anxiety disorders. These patients who had subsyndromal symptoms had rates of lifetime psychiatric disorders and prior psychiatric treatment comparable to those of patients meeting criteria for major mood and anxiety disorders. CONCLUSION: The comparable rates of symptomatic distress, functional impairment, and prior psychiatric illness and treatment suggest that patients with subsyndromal anxiety and depressive symptoms warrant clinical recognition and possibly specific treatment.

Anxiety↗
PubMed1994

The DSM-IV field trial for mixed anxiety-depression.

OBJECTIVE: This field trial was designed to answer four questions. First, are patients presenting with anxious or depressed symptoms that are associated with significant impairment but do not meet DSM-III-R definitional thresholds for axis I anxiety or mood disorders? Second, is the impairment experienced by these patients simply the consequence of the severity of their medical conditions? Third, what percent of these patients present with depressive symptoms only, anxious symptoms only, and a mixture of both? Fourth, how should the operational criteria for the syndrome(s) presented by these patients be defined? METHOD: A total of 666 patients from five primary care medical sites and two outpatient mental health sites were administered a semistructured psychiatric interview. RESULTS: Patients presenting with affective symptoms that did not meet definitional thresholds for DSM-III-R axis I disorders were at least as common as patients with several of the already established anxiety and mood disorders in each of the seven sites, and their disorders were associated with significant distress or impairment. A nonspecific pattern of anxious and depressed symptoms was the modal presentation among these patients with currently subdefinitional threshold disorders, and they could be significantly differentiated in terms of current symptoms from patients presenting with a principal diagnosis of generalized anxiety disorder, major depressive episode, or panic disorder with agoraphobia. CONCLUSIONS: The authors recommend that a mixed anxiety-depression category be included in the DSM-IV appendix for proposed diagnostic categories that need further study. A criteria set is proposed.

Ambulatory Care↗
PubMed1993

Suicide attempts in patients with panic disorder.

In a clinical sample of 100 outpatients with panic disorder, 42% had a history of suicide attempt. Female sex and being single, divorced, or widowed were associated with an increased risk of suicide attempt. Thirty-one (73.8%) of the suicide attempts occurred after the first panic attack and 27 (64.3%) after the onset of panic disorder. Eighty-eight of these patients met DSM-III-R criteria for at least one other diagnosis in addition to panic disorder. Moreover, 52% had a history of major depressive episode and 31% had a lifetime diagnosis of alcohol and/or other substance abuse. Compared with those who did not attempt suicide, those who attempted suicide were significantly more likely to have suffered from major depressive episode and alcohol or other substance abuse in their lifetime. Among the 35 patients with no comorbidity with either major depression or addictive behaviors, 17.1% had a history of suicide attempt. All had suffered from depressive symptoms and/or a personality disorder. The same association was found in four of 19 patients suffering from panic disorder only with or without agoraphobia.

Adult↗
PubMed1993

Panic disorder in cardiac outpatients.

OBJECTIVE: Continuing the long history of interest in the relation of anxiety disorders to cardiovascular function and symptoms, this study investigated the level of anxiety and prevalence of panic disorder in cardiac patients and the possible associations between specific abnormal ECG results and a diagnosis of panic disorder. METHOD: Consecutive patients referred for ambulatory ECG recordings were assessed with the seven anxiety items of the Hospital Anxiety and Depression Scale. Then, 50 patients with scores higher than 8 (the anxious group) were interviewed with the Schedule for Affective Disorders and Schizophrenia--Lifetime Version Modified for the Study of Anxiety Disorders (SADS-LA). RESULTS: Of the 50 anxious patients (26 male and 24 female) interviewed with the SADS-LA, 62% (N = 31) met the DSM-III-R criteria for panic disorder. Patients with panic disorder had a higher mean maximal heart rate and a shorter P-R interval than patients without panic disorder. Unlike the patients without panic disorder, the patients with panic disorder showed no correlation between maximal heart rate and minimal P-R interval. CONCLUSIONS: The rate of panic disorder was high in the patients referred for ECG. Moreover, the prevalence of panic disorder was similar in the patients with and without ECG abnormalities, indicating that in anxious patients the presence of panic disorder does not rule out organic cardiac disease. On the other hand, the higher maximal heart rate and shorter P-R interval of the panic patients may be attributable to hypersensitivity of beta-adrenergic receptors in panic disorder.

Adult↗