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Biomedical subjects

J Spagnoli

Publications and source records attributed to J Spagnoli.

11 recordsLinked to original sources
PubMed2000

Plasma concentrations of the enantiomers of methadone and therapeutic response in methadone maintenance treatment.

Methadone is a 50:50 mixture of two enantiomers and (R)-methadone accounts for the majority of its opioid effect. The aim of this study was to determine whether a blood concentration of (R)-methadone can be associated with therapeutic response in addict patients in methadone maintenance treatment. Trough plasma concentrations of (R)-, (S)- and (R,S)-methadone were measured in 180 patients in maintenance treatment. Therapeutic response was defined by the absence of illicit opiate or cocaine in urine samples collected during a 2-month period prior to blood sampling. A large interindividual variability of (R)-methadone concentration-to-dose-to-weight ratios was found (mean, S.D., median, range: 112, 54, 100, 19-316 ng x kg/ml x mg). With regard to the consumption of illicit opiate (but not of cocaine), a therapeutic response was associated with (R)- (at 250 ng/ml) and (R,S)-methadone (at 400 ng/ml) but not with (S)-methadone concentrations. A higher specificity was calculated for (R)- than for (R,S)-methadone, as the number of non-responders above this threshold divided by the total number of non-responders was higher for (R,S)-methadone (19%) than for (R)-methadone (7%). The results support the use of therapeutic drug monitoring of (R)-methadone in cases of continued intake of illicit opiates. Due to the variability of methadone concentration-to-dose-to-weight ratios, theoretical doses of racemic methadone could be as small as 55 mg/day and as large as 921 mg/day to produce a plasma (R)-methadone concentration of 250 ng/ml in a 70-kg patient. This demonstrates the importance of individualizing methadone treatment.

Adult↗
PubMed1999

INTERMED--an assessment and classification system for case complexity. Results in patients with low back pain.

STUDY DESIGN: Cross-sectional investigation and follow-up of patients with low back pain. OBJECTIVES: To evaluate the capacity of the INTERMED--a biopsychosocial assessment and classification system for case complexity--to identify patients with a chronic, disabling course of low back pain and to predict treatment outcome. SUMMARY OF BACKGROUND DATA: An impressive number of biologic and nonbiologic factors influencing the course of low back pain have been identified. However, the lack of a concise, comprehensive, reliable and validated classification system of this heterogeneous patient population hampers preventive and therapeutic progress. METHODS: The INTERMED was used to assess patients with low back pain, who participated in a functional rehabilitation program (n = 50) and patients with low back pain who applied for disability compensation (n = 50). Patients of the rehabilitation program were observed to assess the effects of treatments. RESULTS: The INTERMED distinguished between patients in different phases of disability and provided meaningful information about the biopsychosocial aspects of low back pain. In hierarchical cluster analysis two distinct clusters emerged that differed in the degree of case complexity and treatment outcomes. CONCLUSIONS: This first application of the INTERMED indicates its potential utility as a classification system for patients with low back pain.

Adult↗
PubMed1998

Ultra-rapid opiate detoxification using deep sedation with oral midazolam: short and long-term results.

The present study describes an ultra-rapid opiate detoxification method using direct transition from heroin or methadone to oral naltrexone after deep sedation with oral midazolam in conjunction with ondansetron and clonidine treatment. Twenty patients were detoxified with the method. No serious events occurred, but two out of three patients vomited during the acute phase of deep sedation, which involves some risks. Withdrawal symptoms were still present 24 h after detoxification and 80% of the patients relapsed during a 6-month follow-up.

Administration, Oral↗
PubMed1998

The French version of the Defense Style Questionnaire.

BACKGROUND: Bond et al. developed the Defense Style Questionnaire (DSQ), a self-questionnaire that aims at empirically measuring conscious derivatives of defense mechanisms. The original analysis yielded 4 factors called Defense Styles (DS). DSQ discriminates between mature and immature defense styles. OBJECTIVES: Determine if the French version of DSQ has (a) face validity, (b) a similar structure to the original version, (c) internal consistency, (d) grouping of defense mechanisms into clinically pertinent defense styles, (e) evidence of nonpatients using more mature defense styles, (f) correlation with Defensive Functioning Scale (DFS) (DSM-IV) [2]. METHODS: Reliability and validity study on 82 control subjects and 140 patients, 59 among them evaluated for defensive level. RESULTS: Factor analysis of controls sample yielded 4 factors ranging from immature to mature defense styles. DSQ scores on factor I (maladaptive style) are significantly higher in outpatients than in controls. Maladaptive style score correlates with clinical evaluation of defensive level of functioning (DFS). CONCLUSION: Psychometric features of the French version are similar to the original scale, although minor differences in individual defense mechanisms are present. Factor I (maladaptive defense style) remains more stable than other factors, accounts for most of variance contribution, has high internal consistency and applies to behaviors, i.e. conscious derivatives of defense mechanisms that can be easily identified. The French version of DSQ is (a) an easy and economical way to rate immature defense style in populations of 'neurotic' and borderline patients and (b) further provides a hierarchical grouping of defense mechanisms in defense styles.

Adult↗
PubMed1997

[Mortality and birthdays].

The authors study the date of death in relationship, in the annual cycle, to date of birth of every person who died of natural causes in Switzerland between 1st January, 1969 and 31st December, 1992 (N = 12,275,033). They highlight a maximal mortality (17% over expected) on the actual anniversary of birth with the entire population, a slightly lower figure being found under 80 years of age, higher over this age. They tie this phenomenon to the classical group of "anniversary reactions", in which problems of identity probably play a role. An uncertainty hangs nevertheless over the value of these findings, which are not confirmed by any published material, and even denied by some.

Adjustment Disorders↗
PubMed1991

Psychotherapeutic treatments evaluated with two instruments: clinical questionnaire and semantic differential.

We evaluated about 100 psychotherapeutic treatments on the Freudian model with two independent instruments: a clinical questionnaire (assessed globally and intuitively) and a semantic differential (processed through various mathematic analyses). The results obtained with the two instruments were compared, and we also compared the semantic evolution of patients with that of normal subjects. Both instruments show an undeniable average improvement among patients. The semantic differential also shows that the various 'zones' tested by the inducive words are neither equally affected by neurosis nor equally modified by treatment.

Adult↗
PubMed1988

Application of Osgood's Semantic Differential to the study of psychotherapeutic treatments.

Osgood's Semantic Differential was applied to a group of 35 neurotic patients at initial and final stage of individual psychoanalytical psychotherapy. When compared to 'normal' subjects who had not undergone treatment but were examined under the same conditions, neurotic subjects showed, between test and retest, more conspicuous semantic changes, several of which--although not all--brought them closer to normal subjects.

Adolescent↗
PubMedDate not supplied

"INTERMED": a method to assess health service needs. II. Results on its validity and clinical use.

The validity and clinical use of a recently developed instrument to assess health care needs of patients with a physical illness, called INTERMED, is investigated. The INTERMED combines data reflecting patients' biological, psychological, and social characteristics with information on health care utilization characteristics. An example of a patient population in which such an integral assessment can contribute to the appropriateness of care, are patients with low back pain of degenerative or unknown origin. It supports the validity and the clinical usefulness of the INTERMED when clinically relevant subgroups in this heterogeneous population can be identified and described based on their INTERMED scores. The INTERMED was utilized in a group of patients (N = 108) having low back pain who vary on the chronicity of complaints, functional status, and associated disability. All patients underwent a medical examination and responded to a battery of validated questionnaires assessing biological, psychological, and social aspects of their life. In addition, the patients were assessed by the INTERMED. It was studied whether it proved to be possible to form clinically meaningful groups of patients based on their INTERMED scores; for this, a hierarchical cluster analysis was performed. In order to clinically describe them, the groups of patients were compared with the data from the questionnaires. The cluster analysis on the INTERMED scores revealed three distinguishable groups of patients. Comparison with the questionnaires assessing biological, psychological, and social aspects of disease showed that one group can be characterized as complex patients with chronic complaints and reduced capacity to work who apply for a disability compensation. The other groups differed explicitly with regard to chronicity, but also on other variables. By means of the INTERMED, clinically relevant groups of patients can be identified, which supports its use in clinical practice and its use as a method to describe case mix for scientific or health care policy purposes. In addition, the INTERMED is easy to implement in daily clinical practice and can be of help to ease the operationalization of the biopychosocial model of disease. More information on its validity in different patient populations is necessary.

Analysis of Variance↗
PubMedDate not supplied

[Subjective perception of the effect of neuroleptics by outpatient schizophrenic patients: a cross-sectional study].

UNLABELLED: Subjective response to neuroleptics is essential to long term observance of treatment and quality of life of patients. Numerous factors (pharmacological, relational and psychopathological) are responsible of this subjective response. Objectives of this study are: (a) to examine psychometric features of the french version of the Drug Attitude Inventory (DAI-30) [13] and (b) to explore pharmacological, relational and psychopathological factors related to this subjective response. SUBJECTS AND METHODS: 78 subjects were rated (self rated response rate 61% (n = 48)) for (a) subjective response to neuroleptics, (b) compliance, (c) therapeutic alliance, (d) symptoms (e) severity of disorder. RESULTS: Factor analysis yielded 2 main clinically relevant factors, similar to the original version: (I) global subjective response and (II) specific subjective response. Internal consistency is high. Correspondance analysis showed two important dimensions in the treatment of schizophrenic patients: (I) Recovery--aggravation, (II) Therapeutic ambition--positive or negative symptoms. CONCLUSION: French version of DAI-30 seems to have a similar structure and psychometric features as the original version. It shows concordance with the degree of compliance. Pharmacological factors are not the only factors implicated in subjective response, but are still to be identified. Limitations of our study are: (a) nonhomogenous indication for treatment, (b) small rate and degree of non compliance in our sample. Relationships between therapeutic ambition, type of symptoms and treatment outcome should be further studied.

Adult↗