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Biomedical subjects

Michel Reynaud

Publications and source records attributed to Michel Reynaud.

At least 19 recordsLinked to original sources
PubMed2007

Prevalence and factors associated with alcohol and drug-related disorders in prison: a French national study.

BACKGROUND: Most studies measuring substance-use disorders in prisons focus on incoming or on remand prisoners and are generally restricted to drugs. However, there is evidence that substance use initiation or continuation occurs in prison, and that alcohol use is common. The aim of this study is 1) to assess prevalence of both drug and alcohol abuse and dependence (DAD/AAD) in a national randomised cohort of French prisoners, short or long-term sentence 2) to assess the risk factors associated with DAD/AAD in prison. a stratified random strategy was used to select 1) 23 prisons among the different types of prison 2) 998 prisoners. Diagnoses were assessed according to a standardized procedure, each prisoner being assessed by two psychiatrists, one junior, using a structured interview (MINI 5 plus), and one senior, completing the procedure with an open clinical interview. At the end of the interview the clinicians met and agreed on a list of diagnoses. Cloninger's Temperament and Character Inventory (TCI) was also used. RESULTS: More than a third of prisoners presented either AAD or DAD in the last 12 months. Cannabis was the most frequent drug and just under a fifth of prisoners had AAD. AAD and DAD were clearly different for the following: socio-demographic variables, childhood history, imprisonment characteristics, psychiatric comorbidity and Cloninger's TCI. Profiles of AAD in prison are similar to type II alcoholism. CONCLUSION: Regular screening of AAD/DAD in prison, and specific treatment programmes taking into account differences between prisoners with an AAD and prisoners with a DAD should be a public health priority in prison.

Adolescent↗
PubMed2006

Brain morphometry and cognitive performance in detoxified alcohol-dependents with preserved psychosocial functioning.

The extent of structural brain damage and related cognitive deficits has been little described in alcohol-dependent individuals with preserved social functioning. Thus, we investigated the relationship between regional alterations, executive performance, and drinking history. Volumes of gray and white matter were assessed using magnetic resonance imaging voxel-based morphometry in healthy men and in detoxified alcohol-dependent men with good psychosocial functioning. Their executive performance was assessed using neuropsychological tests. Regression analyses were carried out in the regions in which volume differences were detected. Decreases in gray matter were detected bilaterally in alcohol-dependents in the dorsolateral frontal cortex (up to 20% lower), and to a lesser extent in the temporal cortex, insula, thalamus, and cerebellum. Decreases in white matter volume were widespread, being up to 10% in corpus callosum. The degradation of neuropsychological performance correlated with gray matter volume decreases in the frontal lobe, insula, hippocampus, thalami and cerebellum, and with white matter decrease in the brainstem. An early age at first drinking was associated with decreased gray matter volumes in the cerebellum, brainstem (pons), and frontal regions. Regional alteration in gray and white matter volume was associated with impairment of executive function despite preserved social and somatic functioning in detoxified patients. Besides involving frontal regions, these findings are consistent with a cerebello-thalamo-cortical model of impaired executive functions in alcohol-dependent individuals.

Alcoholism↗
PubMed2006

Impact of practitioner's training in the management of alcohol dependence: a quasi-experimental 18-month follow-up study.

BACKGROUND: In many European countries, medical education on alcohol remains inadequate in terms of both quantity and quality. The expansion of GP training and care protocols would improve the management and outcome of alcoholic patients. Our purpose was to assess the impact of a multifaceted intervention by trained GPs in the management of alcohol-dependent patients. RESULTS AND DISCUSSION: Trained GPs proved better i) in the attempt at abstinence, with 67% patients becoming sober vs. 47% in a comparison sample and ii) in repeat attempt at abstinence in the event of relapse, with an average 2.99 vs. 1.31 attempts per patient. There were no differences in terms of i) relapses, which involved about three in four patients, and ii) prolonged abstinence, which averaged two months. Overall, patients managed by trained GPs remained abstinent 103 days during the 18-month follow-up period vs 68 days for the comparison sample (p = 0.016). METHODS: This 18-month follow-up study had a quasi-experimental design with 24 volunteer trained GPs and a comparison sample of a representative sample of 24 GPs. All GPs included their own already existing DSM-IV alcohol-dependent patients. Patients with depression or anxiety comorbidities were included. Participants were 126 patients in the trained sample and 122 in the comparison sample. The two patient samples were evenly-balanced, averaging 47 years old and 80% males. In the trained sample, consultations were scheduled and management (medication, biological workup) was protocolized, whereas the comparison sample representing standard practice had no obligations. CONCLUSION: Medical education can sharply improve the management of alcohol-dependent patients and short-term outcome. Trained GPs lead more patients to attempt abstinence and more often than in standard practice. However, a strict medical approach remains limited in the maintenance of medium-term abstinence (over two months), providing a strong argument for multidisciplinary management of alcohol-dependent patients.

Alcoholism↗
PubMed2006

Development and validation of a method for the quantitation of Delta9 tetrahydrocannabinol in human plasma by high performance liquid chromatography after solid-phase extraction.

A high performance liquid chromatography (HPLC) procedure for the determination of Delta9 tetrahydrocannabinol (THC) in human plasma is described. A two-step solid-phase extraction on CN cartridges was coupled with a reversed phase HPLC system. THC was eluted using a mobile phase composed of methanol, acetonitrile and tetrabutylammonium perchlorate solution (0.005 M, pH 3.2), through a C18 Nucleosil column and detected at a wavelength of 215 nm. Calibration curve was linear over the range 5-100 ng/ml with a lower limit of quantification validated at 5 ng/ml. Extraction recovery using the developed extraction procedure was higher than 85%. This method is presently used for the quantification of THC in plasma samples from regular cannabis smokers.

Calibration↗
PubMed2006

Predictive factors of the number and the dose of anti-psychotics in a cohort of schizophrenic patients.

BACKGROUND: Anti-psychotic prescription in schizophrenia is characterised in Europe by frequent associations and high doses. Nevertheless, few longitudinal epidemiological studies have explored anti-psychotic prescriptions. AIM: (1) To describe the evolution of prescription patterns across time; (2) to determine risk factors for prescription of high doses of anti-psychotics and for anti-psychotic combinations. MATERIALS AND METHODS: Three thousand four hundred seventy three subjects were included in 1993. Data collected in 1993 and subsequently in 1996 and 1999, provided information on demographics, clinical status and prescription. In 1996, the response rate was 68.5% and 56.7% in 1999. RESULTS: The number of anti-psychotics prescribed slightly decreased across time, while doses remained high for one-third of the patients. The factors predicting dose were: dose at previous evaluation, class of anti-psychotic and clinical severity. The factors predicting the number of anti-psychotics were: previous number and class of anti-psychotic and clinical severity. CONCLUSION: Higher dosage and combinations were related more to physicians' habits than to patient characteristics, as is frequently observed in chronic disease.

Adult↗
PubMed2005

Dose-effect relation between daily ethanol intake in the range 0-70 grams and %CDT value: validation of a cut-off value.

AIM: To evaluate the ability to infer alcohol consumption using the %CDT (carbohydrate deficient transferrin) immunoassay (Axis Shield). METHODS: One hundred and eighty-three healthy subjects (143 men, 40 women) undergoing a routine medical check-up at their workplace declared frequency and quantity of alcohol consumption covering the last 4 weeks. Seven sub-groups were made up from this population, according to daily ethanol intake and by increments of 10 g from 0 to 70 g/day. A reference group that consisted of 133 healthy teetotallers (74 men, 59 women) was recruited by occupational medicine in the same conditions as the 183 subjects of the study. Percentage CDT and gamma glutamyl transferase (GGT) were assayed on a fasting blood sample. RESULTS: There was a proportional dose-response effect of daily ethanol intake on %CDT values in the range of 0-70 g per day. A threshold effect on %CDT values for patients having an alcohol intake of over 40 g per day was found, an effect which was not observed for GGT activity. CONCLUSION: The kit has clinical usefulness, and the value of 2.6% proposed by the manufacturer for the cut-off for hazardous drinking in both sexes has been validated.

Adult↗
PubMed2005

[Systematic use in hospitals of a alcohol problems detecting questionnaire. The CAGE (cut down, annoyed, guilty, eye opener) questionnaire].

OBJECTIVES: The CAGE questionnaire is considered a useful tool for detecting alcohol problems, especially in clinical populations. Its sensitivity exceeds 75% and its specificity 90%. Our objective was to assess performance of the French version of the CAGE (DETA) in identifying patients who meet the DSM-IV criteria and to discuss its usefulness in hospitals. METHODS: Data come from study of hospital morbidity in the Auvergne district of central France in 1998. Alcohol problems were diagnosed by physicians using the DSM-IV alcohol abuse or dependency criteria. For each diagnostic category, we calculated the performance of the CAGE questionnaire at a cut-off of 2 (CAGE 2+) and of 1 (CAGE 1+). RESULTS: The study included 5,452 patients--48.5% of them men--in acute- and intermediate-care facilities. CAGE 2+ had a sensitivity of 77% and a specificity of 94% among the diagnosed patients. It was more sensitive for patients diagnosed as alcohol-dependent than for alcohol abusers (61% vs 84%), but specificity was identical for both groups (94%). These results are similar to the properties of the English version. For a cut-off of 1 the CAGE had a sensitivity of 88% and a specificity of 87%. CONCLUSION: The French version of CAGE is a useful screening tool for alcohol abuse and dependance. Its systematic use in hospitals is desirable: a positive response to any item should attract the physician's attention and lead to further investigation.

Adult↗
PubMed2005

Reports on defense styles in depression.

INTRODUCTION: 'State effect' of depression on personality makes its assessment during depression difficult. Many clinicians do not only refer to the patient, but use additional information sources, especially reports from close informants. Our hypothesis was that an informant could assess the defensive functioning of the depressed patient. The objective of this study was to investigate the validity of the informants' assessment of defense styles in depressed patients. METHODS: Sixty-three inpatients with DSM-IV major depression as primary diagnosis were included. They were administered the Defense Style Questionnaire (DSQ) at admission (D0) and 28 days after treatment (D28) according to their current state. At the same time, informants rated an adapted version of the DSQ (INF-DSQ), according to the patient's current (D0 and D28) and premorbid defensive functioning (D0). Otherwise, severity of depression was assessed using the 17-item Hamilton Depression Rating Scale at D0 and D28. RESULTS: Agreement between patient's and informant's DSQ scores was moderate, both at D0 and D28, even if comparison of mean defense scores does not show significant difference. Mature defense scores significantly increased between D0 and D28, whereas immature defense scores significantly decreased, with both the DSQ and INF-DSQ. During the episode, informants are able to discriminate premorbid from current D0 defenses, but not from current D28 defenses. CONCLUSION: Even if this study has strong limitations, our results argue for the interest of close informants to assess premorbid personality. Before it could be validated, the INF-DSQ should be further studied in other subgroups of patients, especially its ability to give accurate descriptions of patient's premorbid defenses during an acute episode.

Adaptation, Psychological↗
PubMed2005

[Acute and chronic cognitive disorders caused by cannabis use].

Cannabis is currently the most commonly used illegal psychoactive substance amongst young people aged between 15 and 24, and it seems that 5% of this age group is addicted to it. Many research teams focused particularly on the cognitive disorders caused by cannabis use. Amongst the cognitive functions considered, memory-related, attention-related, psychomotor and motivation-related functions were proved deteriorated by acute and chronic cannabis use; a very important point, especially among teenagers, as possible alteration at the social and academic level could be the outcome. However studies on long-term and persistent cognitive effects haven't provided convergent conclusions. Methodological differences could partly affect these observations. Therefore it seems necessary to develop studies with larger samples.

Adolescent↗
PubMed2005

[Treatment of cannabis dependence].

Cannabis is the most regularly used illicit drug in the world. Yet, until recently, there existed no therapeutic intervention for the users of this product. This was due to the fact that cannabis has always been considered a substance that doesn't lead to dependence and thus didn't necessitate a management plan for quitting. The results of the first studies in the domain of cannabis dependence suggest that this pathology responds to the same types of treatments for alcohol and tobacco dependence.

Adolescent↗
PubMed2004

The use of biological laboratory markers in the diagnosis of alcohol misuse: an evidence-based approach.

BACKGROUND: A large number of patients seen in clinical practice have an underlying alcohol problem. There is a pressing need for accurate methods to diagnose alcohol over-consumption objectively. Our aim was to determine how best to use biological markers to objectify alcohol problems in patients with clinical suspicion of alcohol misuse. METHODS: A 6-month longitudinal multicenter trial was conducted, using four study groups (alcohol abusers, alcohol-dependents, healthy controls and consulting controls). CDT, GGT and MCV were measured. Statistical analyses used a computer learning system that created classification systems displayed in decision trees. RESULTS: In 379 subjects the marker that best discriminated those with alcohol problems from controls was CDT. GGT then helped to differentiate between alcohol abuse and alcohol dependence in cases of high CDT. MCV, age and gender provided no extra information. DISCUSSION: We recommend CDT as a first-line biological marker to confirm or disprove suspected alcohol misuse. High CDT plus GGT above normal points to alcohol dependence, while high CDT plus GGT below normal is evidence of alcohol abuse.

Adolescent↗
PubMed2004

Multicenter validation study of the %CDT TIA kit in alcohol abuse and alcohol dependence.

BACKGROUND: Carbohydrate-deficient transferrin (CDT) and gamma-glutamyl transferase (GGT) are used as biomarkers of alcohol misuse. The aim of this study was to evaluate, in terms of sensitivity and specificity, the performance of the new Bio-Rad %CDT TIA kit and GGT assay for identifying alcohol abuse and alcohol dependence (according to the DSM-IV criteria). METHODS: An open multicenter study (30 centers) over 3 months, including patient groups of "abusers," "dependents," and controls, was conducted in France. RESULTS: In alcohol abuse, the sensitivity of GGT was 0.56, and that of CDT was 0.80; in alcohol dependence, the sensitivity of GGT was 0.86, and that of CDT was 0.91. The specificity of GGT was 0.77, and that of CDT was 0.83. The association of GGT with CDT increased sensitivity for alcohol abuse to 0.90 and for alcohol dependence to 0.99, but it appreciably decreased specificity (0.63). CONCLUSIONS: %CDT is the better screening marker for alcohol abuse and dependence, but GGT is still a useful marker for the detection of alcohol dependence. As an assay method, the second-generation Bio-Rad %CDT immunoassay can be recommended for routine CDT measurement.

Adult↗
PubMed2003

Defense styles, impulsivity and suicide attempts in major depression.

BACKGROUND: The aim of our study was to identify if defense mechanisms are associated with impulsivity and lifetime suicide attempts in depressed patients. SAMPLING AND METHODS: The Defense Style Questionnaire, the Impulsivity Rating Scale and the Impulse Control Scale were used in 77 depressed inpatients. RESULTS: Impulsivity was correlated positively with immature and neurotic styles and negatively with mature style. Some but not all defense mechanisms were relevant in this respect. The number of lifetime suicide attempts was positively correlated not only with impulsivity, but also with immature style and to a lesser extent with neurotic style. Several defense mechanisms were involved in these correlations: undoing, projection, passive aggression, acting out, splitting and somatization. CONCLUSIONS: Like impulsivity, defense styles may be relevant to discriminate recurrent suicide attempters in depression. Prospective assessment of defense styles and suicide attempts in depression is needed.

Adolescent↗
PubMed2003

[Diagnosis of drug addictions].

The recognition of harmful drug use or the dependence on psychoactive substances is aided above all by simple, systematic history taking on the consumption (frequency and quantity) of tobacco, alcohol and illicit products, as an integrated part of the social history. The diagnosis of alcohol addiction takes into account the declared consumption of alcohol, using standard questionnaires (DETA/CAGE and AUDIT) and biological markers to confirm or objectify the diagnosis. The diagnosis of cannabis addiction is made by a clinical evaluation of harmful usage and dependence, the frequency and the quantity of consumption, and the search for complications. It is possible to make use of an auto-questionnaire. Urinary screening can be used to help orientate the history taking. These tests are only of interest in the context of a project of healthcare that has been freely consented to. The diagnosis of tobacco addiction takes into account the significance of the dependence that can be quantified, thanks to Fagerström's test (or more simply by the short Fagerström test). The expired CO level is an objective test of tobacco intoxication and its consequences on respiratory function. It is a good instrument of measurement of motivation. The continine level is still a little known test. The practitioner must also evaluate the factors of severity: certain modalities of consumption, certain personality characteristics or the presence of psychiatric pathology, certain family characteristics or social environments. Finally, he should evaluate the level of motivation for change.

Diagnosis, Differential↗
PubMed2003

[Psychiatric emergencies in drug addiction].

The practitioner is very frequently confronted by emergencies in drug-addicted patients also having psychiatric symptomatology. In this article the authors will address emergencies related to alcohol (notably intoxication, pre-DTs and the encephalopathies); emergencies related to cannabis (notably intoxication, psychotic states and panic attacks); and emergencies related to other psycho-active substances (overdoses, drug-withdrawal, psychiatric complications related to cocaine or amphetamines). In the domain of drug addiction, as in psychiatry, the practitioner must give as much importance to the organisation of the long-term healthcare plan for the drug addict, ulterior to the management of the immediate emergency. For example, whereas 90% of subjects presenting to the emergency department for acute alcoholic intoxication have a pathological consumption of alcohol (abuse or dependance), management of the alcoholism is proposed in only 2% of them.

Diagnosis, Dual (Psychiatry)↗
PubMed2003

General practitioners and alcohol use disorders: quantity without quality.

BACKGROUND: General medical practitioners are essential for the prevention, diagnosis, and management of alcohol use disorders. Studies to examine medical practice in this field, however, are very rare. METHOD: A cross-sectional study involving 2010 patients seen by a sample of 145 general practitioners in the Auvergne region of central France was conducted on a given day in May 1998. The purpose of the study was to evaluate the prevalence of alcohol use disorders (using the DSM-IV diagnostic criteria for alcohol abuse or dependence and the CAGE questionnaire) and so to estimate the proportion of nonsomatic alcohol-related care dispensed. RESULTS: Sixteen percent of patients consulting their general practitioner had an alcohol problem, 27% of men and 5% of women. On average, a quarter of these patients had not been previously identified by the physician. Diagnosis seemed particularly difficult in women: 11% of women aged between 36 and 45 had an alcohol-related problem that went unidentified in 60% of cases. Care for alcohol-related health problems was therefore seriously inadequate. In one third of cases, patients with a diagnosed alcohol-related problem were not followed up by the physician for that problem. Two thirds received no medication, and in more than 80% of cases the physician did not refer to a specialist or prescribe admission to a specialized hospital ward. CONCLUSIONS: These results underline the diagnostic and therapeutic difficulties experienced by general practitioners. This study has led to the establishment of a pilot health care network for patients suffering from alcohol use disorders. This network involves voluntary doctors who have been trained and are better paid for their services. Care protocols have been established to which these practitioners have to adhere.

Adolescent↗
PubMed2003

[Cognitive disorders and chronic use of cannabis].

Cannabis is by far the illegal substance the most widely used by youth aged 12-25 years. One out of five persons living in France has already tried it once in his lifetime. Although the psychiatric symptoms as well as the cognitive and acute or chronic behavioral effects linked to repeated use of cannabis are well documented in the literature, search for persistent cognitive effects amongst chronic users has not provided convincing evidence because of methodological biases. The issue is nevertheless most crucial, especially amongst teenagers, due to the potential risks of deteriorated academic, social and occupational performance. The longer the exposure to the effects of the substance, the greater the risk of complications. Based on data reported in the literature, we report the cognitive effects associated with chronic use of cannabis as well as its social and educational consequences.

Adolescent↗