Biomedical subjects

Marc Auriacombe

Publications and source records attributed to Marc Auriacombe.

10 recordsLinked to original sources

PubMed2006

Social phobia and premature ejaculation: a case-control study.

In a previous case-control study, we found marked differences between a group of patients with male sexual disorders and a control group without any sexual disorder regarding the percentage of social phobia (SP) in each group. On this basis, our aim in this study was to test the hypothesis that premature ejaculation (PE) as a specific sexual disorder and SP might be strongly related, by comparing subjects with PE to a control group without any sexual disorder regarding the diagnosis of SP. Subjects with PE were recruited at private practice sexology settings in France. Control subjects were recruited among inpatients in a surgical ward. Diagnosis of SP was made with the Composite International Diagnostic Interview. Diagnosis of PE was clinician-rated according to DSM-IV criteria. Eighty-five subjects with PE only were compared to 93 control subjects without any sexual disorder. Forty (47%) subjects with PE versus 8 (9%) controls were diagnosed with SP (chi(2)=3.35, df=1, P=.001). Logistical analysis showed that SP and PE were strongly associated (odds ratio=10.97, 95% CI=4.49-26.06; chi(2)=28.28, df=1, P=.0001). This study is the first to show a clear relationship between SP and PE. Although requiring confirmation by further studies, this finding has immediate clinical consequences given that SP and PE can be treated by the same medication, a selective serotonin-reuptake inhibitor (SSRI). Moreover, since SP is a likely risk factor for PE, this might argue for preventive action on both disorders in children.

Adult↗

PubMed2006

[Benzodiazepine withdrawal in subjects on opiate substitution treatment].

INTRODUCTION: Benzodiazepines are the most widely used psychotropic agents in the world. Abuse and dependence are reported in the general population and among drug misusers, including those dependent on heroine. Benzodiazepine use by heroine users increases their risk of overdose, not only from heroin but also substitution drugs such as methadone and more recently buprenorphine. Hence, detoxification from benzodiazepines is desirable. OBJECTIVE: The objective of this paper was to review the literature and determine the best benzodiazepine detoxification procedure for opiate-dependent individuals receiving substitution treatment. METHODS: Relevant studies were sought through systematic searches of Medline and Toxibase (a database focusing on substance abuse). RESULTS: There were fewer controlled studies than expected about benzodiazepine detoxification, and all of them excluded subjects who misused opiates or were in opiate substitution treatment. The best evidence supports a procedure where the patient is switched to a long-lasting benzodiazepine and the dose then tapered by 25% of the initial dose each week. Diazepam is the drug most often used in the framework. In opiate users, diazepam may raise special problems of misuse, as suggested by clinical and epidemiologic studies. Nonetheless, diazepam is the only benzodiazepine found to be effective for this withdrawal in controlled studies and some studies indicate that unprescribed diazepam use in heroin users is sometimes motivated by the desire to alleviate withdrawal symptoms and discomfort. CONCLUSION: Although diazepam appears to have potential for abuse, the available data does not rule out its therapeutic interest for benzodiazepine withdrawal in patients on opiate substitution treatment in an adequate treatment setting. Specific studies of this population are needed.

Anticonvulsants↗

PubMed2005

Selective serotonin re-uptake inhibitors and the risk of bleeding.

Despite their safety, selective serotonin re-uptake inhibitors (SSRIs) are associated with bleeding. The authors critically reviewed the medical literature on SSRIs to identify subgroups of patients at risk of bleeding complications. The authors performed a literature search using MEDLINE from 1966 to 1st September 2004 using; 'haemorrhage, serotonin uptake inhibitors and antidepressive agents' as search terms and followed up on citations in each paper that was relevant to SSRI associated bleeding. The authors reviewed 7 retrospective analytical studies and 24 case reports of bleeding in 43 different people. Analytical studies support an association between SSRI consumption and upper gastrointestinal (GI) bleeding and perioperative bleeding. Little evidence links SSRI use with intracerebral haemorrhage. The risk of GI bleeding appeared to be highest among patients consuming SSRIs with NSAIDs. Combining aspirin or NSAIDs with SSRIs may further increase the risk of bleeding. Clinicians should caution patients about combining SSRIs with aspirin or NSAIDs. Pharmacotherapy to reduce the risk of GI bleeding should be considered in high risk patients.

Adult↗

PubMed2004

French field experience with buprenorphine.

In most European countries, methadone treatment is provided to only 20-30% of opiate abusers who need treatment due to regulations and concerns about safety. To address this need in France, all registered medical doctors since 1995 have been allowed to prescribe buprenorphine (BUP) without any special education or licensing. This led to treating approximately 65,000 patients per year with BUP, about ten times more than with more restrictive methadone policies. French physician compensation mechanisms, pharmacy services, and medical insurance funding all minimized barriers to BUP treatment. About 20% of all physicians in France are using BUP to treat about half of the estimated 150,000 problem heroin users. Daily supervised dosing by a pharmacist for the first six months resulted in significantly better treatment retention (80% vs 46%) and lower heroin use. Intravenous diversion of BUP may occur in up to 20% of BUP patients and has led to various infections and relatively rare overdoses in combination with sedatives. Opiate overdose deaths have declined substantially (by 79%) since BUP was introduced in 1995. Newborn opiate withdrawal in mothers treated with buprenorphine compared to methadone was reported to be less frequent, less severe, and of shorter duration. Although some of the public health benefits seen during the time of buprenorphine expansion in France might be contingent upon characteristics of the French health and social services system, the French model raises questions about the value of tight regulations on prescribing BUP imposed by many countries throughout the world.

Adult↗

PubMed2003

[Substitution therapy in drug addictions].

In France, so called "substitution treatments" for addiction are nicotine substitutes for tobacco dependence and buprenorphine, and methadone for opiate dependence. The word "substitution" participates to the uncertainty as to the objective of such treatments. From an addiction psychiatry perspective, these treatments are of interest as pharmacological treatments for maintenance of abstinence. In such a perspective they are not changing one substance of dependence for another. The goal is to reduce craving by low potential reinforcement medications. Conditions for success are a clarification of treatment goal with the patients, adequate dosing, and time. All medical doctors may prescribe buprenorphine for treatment of opiate dependence. Supervised daily dispensing in pharmacies is useful to increase compliance and collaboration, and avoid misuse and diversion. For tobacco dependence, nicotine patch must be clearly differentiated from other nicotine substitutes like gums and inhalers that have significant reinforcing effects. Because the patch is accessible without medical prescription, many patients are not sufficiently medically supervised and dropout frequently. For patients that cannot initially accept the behavioral changes associated to the goal of abstinence, it is legitimate to truly substitute them with less dangerous reinforcing substances. This possibility exists in France only for tobacco use that can be substituted to inhaled or chewed nicotine. It is possible that some reported misuse of buprenorphine and methadone are inadequate attempts to increase the reinforcing effects of these medications.

Buprenorphine↗

PubMed2003

Borna disease virus RNA in immunocompromised patients in southwestern France.

Borna disease virus (BDV) is a neurotropic RNA virus with a wide host range. Human infections, although controversial, have been described in Europe, Asia, and the United States. The present study investigated the existence of BDV infections in immunocompromised human beings, namely, 82 human immunodeficiency virus (HIV)-infected and 80 therapeutically immunosuppressed patients. BDV p40 RNAs were detected in peripheral white blood cells with reverse transcription-nested PCR and hybridization in, respectively, 11 (13.41%) and 1 (1.25%) of the two groups of patients. BDV p24 RNAs were identified in only one of those. BDV RNA was detected in the absence of any neuropsychiatrical illness, suggesting that BDV infections may occur in asymptomatic carriers. The severity and particularity of cellular immunosuppression could explain the significantly increased detection of BDV RNA in HIV-infected patients.

Base Sequence↗

PubMed2003

A critical review of selective serotonin reuptake inhibitor-associated bleeding: balancing the risk of treating hepatitis C-infected patients.

BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) are increasingly being used to treat interferon-associated side effects in patients receiving hepatitis C virus (HCV) therapy. Because there is an increased risk of bleeding in HCV-infected patients who have developed cirrhosis and either portal hypertension or hepatic failure or both, we critically reviewed the literature on SSRI-associated bleeding. DATA SOURCES AND STUDY SELECTION: We performed a MEDLINE search of literature from 1966 to the present using hemorrhage, SSRI, and antidepressants as search terms and followed up on relevant citations. We reviewed 6 retrospective studies, 5 of which were case-control studies, and 18 case reports of bleeding in 37 people. Our review is supplemented with a case report of a possible connection between SSRI treatment and a fatal gastrointestinal bleed in an HCV-infected man. DATA SYNTHESIS: Bleeding events in 12/18 reports (67%) describing 19/24 people (79%) were closely associated with the use of SSRIs. CONCLUSION: Combining aspirin or nonsteroidal anti-inflammatory drugs with SSRIs for the treatment of interferon-associated neuropsychiatric side effects increases the risks of hemorrhage in patients with HCV who have developed cirrhosis and either portal hypertension or hepatic failure or both. We recommend that clinicians exercise caution when prescribing medications that can promote spontaneous bleeding to patients with multiple risk factors for internal hemorrhage.

Analgesics↗

PubMed2003

[Development of diagnosis criteria for physical activity abuse and dependence: a qualitative study].

AIM: The purpose of this work was to search for criteria of physical activity abuse and dependence, patterned after abuse and dependence criteria for psychoactive substances described in DSM IV and CIM10, and to determine whether these criteria could be found in individuals practising sports. This preliminary work was designed as the first step in the search for a possible physical activity dependence syndrome. METHODS: Operational criteria for physical activity abuse and dependence were defined by using the DSM IV and CIM 10 criteria for psychoactive substances abuse and dependence as a pattern. We searched for these criteria among a group of 8 persons (4 men and 4 women, aged 17-25 years) who practised 7 different sports. The subjects participated in a qualitative interview during which the defined criteria were not mentioned directly. The script of the interview was analyzed with a pre-established grid in order to search for the operational diagnostic criteria. RESULTS: All of the defined operational criteria except two concerning physical activity abuse were identified in the interview scripts. All of the participants fulfilled at least one of the defined criteria. The importance of physical activity dependence criteria spontaneously mentioned by the participants was notable; abuse criteria were found less often. DISCUSSION: Based on the findings of this qualitative study, the development of diagnostic criteria for physical activity abuse or dependence patterned after psychoactive abuse and dependence criteria appears to be a realistic possibility. The operational criteria we defined were found in all of the participants in this study, irrespective of the sports they practised. Although a large number of dependence criteria were found for each participant, this study was not designed to determine the number of participants for whom the diagnosis of physical activity dependence could be retained. This would require search for notions such as duration of the manifestations, changing functional behavior, or clinically significant suffering in order to identify the pathological nature of the behavior. Other studies are now needed to determine whether individual subjects who present a sufficient number of criteria simultaneously can be identified as presenting physical activity abuse or dependence.

Adolescent↗

PubMed2002

[Is buprenorphine a potential alternative to methadone for treating pregnant drug users? Inventory of clinical data in the literature].

In this review of the literature, we collected 102 case reports of newborns exposed in utero to buprenorphine between 1996 and 2000. Reported data show that infants born to a mother taking buprenorphine are delivered at term and have a birth weight close to infants not exposed to these substances. The published data also showed that observations have varied concerning the frequency, intensity, and duration of the withdrawal syndrome in newborns exposed in utero to buprenorphine.

Buprenorphine↗

PubMed1990

Transcranial electrical stimulation with high frequency intermittent current (Limoge's) potentiates opiate-induced analgesia: blind studies.

Transcutaneous cranial electrical stimulation (TCES) with high frequency (166 kHz) intermittent current (100 Hz: Limoge current) has been used for several years in cardiac, thoracic, abdominal, urological and micro-surgery. The main benefits are a reduced requirement for analgesic drugs, especially opiates, and a long-lasting postoperative analgesia. We have confirmed these clinical observations in rats using the tail-flick latency (TFL) test to measure pain threshold. TCES was not found to modify the pain threshold in drug-free rats, but it potentiated morphine-induced analgesia (systemic injection). To obtain a maximal effect, the stimulation must be initiated 3 h before the drug injection and be maintained throughout the duration of its pharmacological action. TCES potentitation was found to depend on the dose of the drug, the intensity of the current and the polarity of electrodes. These findings were confirmed by blind tests of the efficiency of TCES on several opiate analgesic drugs currently used in human surgery (morphine, fentanyl, alfentanil and dextromoramide). The analgesic effect of these 4 opiates (TFL as % of baseline without or with TCES) were respectively: 174%, 306%; 176%, 336%; 160%, 215%; and 267%, 392%. The results were obtained not only after systemic opiate treatment, but also after intracerebroventricular injection of morphine (10 micrograms; analgesic effect 152%, 207% with TCES) suggesting that TCES potentiation of opiate-induced analgesia is centrally mediated.

Alfentanil↗