Biomedical subjects

P Huguelet

Publications and source records attributed to P Huguelet.

14 recordsLinked to original sources

PubMed2001

Cognitive function in euthymic bipolar I disorder.

Recent reports have suggested the presence of persistent cognitive impairments in patients diagnosed with Bipolar Disorder even after prolonged euthymic phases. In this work, various domains of cognitive function were examined in asymptomatic patients diagnosed with Bipolar I Disorder (BDI) in comparison with healthy subjects. Fifteen otherwise healthy BDI patients with a prior history of psychosis during mania completed a neuropsychological testing battery after a prolonged asymptomatic remission. Their scores were compared to those of individually matched healthy subjects with unpaired two-tailed t-tests at P<0.01. Relationships between cognitive performance measures and clinical variables related to illness severity were also examined with Pearson correlations, P<0.05. We detected poorer performance on measures of verbal learning, executive functioning and motor coordination in BDI patients compared to control volunteers. Scores on tests of executive functioning were negatively correlated with the number of episodes of mania and depression. Social and occupational scores were also associated with a poorer performance on measures of verbal learning and executive function. Euthymic BDI patients, therefore, demonstrate reductions in specific cognitive domains even after prolonged asymptomatic phases. Some of these deficits appear to be associated with a more severe course of illness and poorer social and occupational functioning.

Adult↗

PubMed2001

Cyclic AMP-mediated signaling components are upregulated in the prefrontal cortex of depressed suicide victims.

The components of cyclic AMP signaling cascade (catalytic (Calpha) subunit of cyclic AMP-dependent protein kinase (PKA) and cyclic AMP response element binding protein (CREB)) were quantitated by Western blotting in the prefrontal cortex of depressed suicide victims (n=23) and their matched controls (n=14). There was a significant increase in the levels of CREB, both in total (tCREB; 121+/-8% (mean+/-S.E.M.), P<0.02) and phosphorylated (pCREB; 128+/-9%, P<0.01) forms, but not in PKA Calpha levels (109+/-9%, ns), in brains of depressed suicides compared to those in control subjects. The increases in CREB were specifically observed in antidepressant drug-free subjects (tCREB: 137+/-11%, P<0.01; pCREB: 136+/-12%, P<0.02; n=9), but not in the antidepressant-treated subjects (tCREB: 108+/-18%, ns; pCREB: 111+/-17%, ns; n=8). There were significant correlations between the levels of PKA and those of tCREB and pCREB in the prefrontal cortex of depressed suicides. These results indicate that the components of cyclic AMP signaling are upregulated in a coordinated manner in brains of depressed suicides and that this alteration is not related to antidepressant treatment.

Adult↗

PubMed2001

Vesicular monoamine transporter concentrations in bipolar disorder type I, schizophrenia, and healthy subjects.

BACKGROUND: Previous analyses of vesicular monoamine transporter (VMAT2) binding in euthymic bipolar disorder type I (BDI) patients have shown increases of this presynaptic marker in the thalamus and ventral midbrain. To assess the diagnostic specificity of those findings, we compared VMAT2 concentrations between euthymic BDI patients, patients diagnosed with schizophrenia (SCH), and age-matched healthy volunteers. METHODS: Binding sites for VMAT2 were quantified with (+)-alpha-[11C]DTBZ (dihydrotetrabenazine) and positron emission tomography. Fifteen euthymic BDI and 12 SCH patients and 15 group-matched healthy controls were studied. [11C]DTBZ tracer transport and binding potentials were examined in the thalamus and ventral midbrain with factorial analyses of variance and post hoc Tukey's honestly significantly different tests. RESULTS: Analysis of variance detected diagnosis effects in binding potentials in both brain regions. Binding of VMAT2 in the thalamus was higher in BDI patients than in control subjects and SCH patients. Conversely, ventral brainstem binding was nearly identical between BDI and SCH patients and were higher than in the control group. CONCLUSIONS: The patterns of regional VMAT2 expression, and by extension, the concentration of monoaminergic synaptic terminals, differ between BDI, SCH, and a control group. These findings may relate to both similarities and differences in the presentation or clinical course of these syndromes and require further examination.

Adult↗

PubMed2000

A study of visual and auditory verbal working memory in schizophrenic patients compared to healthy subjects.

Impaired working memory (WM) performance is considered as a central feature of schizophrenia. Divided into two components, verbal and spatial, WM has been shown to involve frontal and parietal regions. Verbal WM can be tested either visually or aurally. The present study aimed to test schizophrenic patients in both visual and auditory verbal WM in order to assess a possible distinct pattern of alteration of these two modalities. Twenty-four schizophrenic patients and 24 healthy controls were compared with 2-back continuous visual and auditory verbal WM testing. Both groups were also tested on a neuropsychological battery including Wisconsin Card Sorting Test (WCST). Schizophrenic patients were less efficient in both verbal WM tests. When taking age and educational level as covariates and both WM modalities as dependent variables, there was no differential effect of modalities across groups. In further exploratory analyses, partial correlations brought association between verbal WM and psychosocial adaptation, WCST and length of illness. These results suggest a similar pattern of alteration of both modalities of verbal WM in schizophrenic patients. The implications of this finding are discussed.

Adolescent↗

PubMed2000

High vesicular monoamine transporter binding in asymptomatic bipolar I disorder: sex differences and cognitive correlates.

OBJECTIVE: It has been hypothesized that anomalies in monoaminergic function underlie some of the manifestations of bipolar disorder. In this study the authors examined the possibility that trait-related abnormalities in the concentration of monoaminergic synaptic terminals may be present in patients with asymptomatic bipolar disorder type I. METHOD: The concentration of a stable presynaptic marker, the vesicular monoamine transporter protein (VMAT2), was quantified with (+)[(11)C]dihydrotetrabenazine (DTBZ) and positron emission tomography. Sixteen asymptomatic patients with bipolar I disorder who had a prior history of mania with psychosis (nine men and seven women) and individually matched healthy subjects were studied. Correlational analyses were conducted to examine the relationship between regional VMAT2 binding, cognitive function, and clinical variables. RESULTS: VMAT2 binding in the thalamus and ventral brainstem of the bipolar patients was higher than that in the comparison subjects. VMAT2 concentrations in these regions correlated with performance on measures of frontal, executive function. In addition, sex differences in VMAT2 binding were detected in the thalamus of the bipolar patients; the male patients had higher binding than the women. No sex differences in binding were observed in the healthy comparison group. CONCLUSIONS: These initial results suggest that higher than normal VMAT2 expression and, by extension, concentration of monoaminergic synaptic terminals, may represent a trait-related abnormality in patients with bipolar I disorder and that male and female patients show different patterns. Also, VMAT2 concentrations may be associated with some of the cognitive deficits encountered in euthymic bipolar disorder.

Adult↗

PubMed1997

Factors associated with multiple admissions to a public psychiatric hospital.

The purpose of this study was to identify the psychiatric and social factors associated with multiple admissions, especially for psychotic patients. Demographic and diagnostic information (based on the DSM-III-R) was collected on a computerized database for all patients admitted to the only psychiatric hospital in Geneva, Switzerland. Patients who had had at least three admissions over a period of 1 year were compared with a control group drawn from the total clinic population. In 1994, a total of 1575 patients were hospitalized, and 18% of these patients were readmitted for the third or more time. The principal diagnoses were psychotic disorders (25%), affective disorders (35%) and substance-related disorders (24%). The predictors of multiple admissions for psychotic patients were a comorbidity of substance-related disorder, longer duration of illness, female sex, younger age and poorer psychosocial adjustment during the past year. These results highlight the usefulness of a computerized psychiatric database. Indeed, early identification of the types of psychiatric patient who are likely to be readmitted is necessary to enable the planning and implementation of specific programmes of ambulatory care to prevent rehospitalization.

Adult↗

PubMed1995

The use of the Expressed Emotion Index as a predictor of outcome in first admitted schizophrenic patients in a French speaking area of Switzerland.

A 5 year prospective study of 44 first admission schizophrenic patients was conducted in Geneva, in order to evaluate the prognostic value of Expressed Emotion (EE). The predictive power of the EE index was tested on 3 variables of outcome: relapse rates, social adaptation and hospital stays. The EE index and the outcome measures tended to be associated. After the third year, patients living with high EE relatives were significantly more maladjusted and relapsed more than those living with low EE relatives. At intake, the patients presenting more premorbid features lived in high EE households. Our results show that initial measure of EE in a first episode cohort is predictive of outcome over a five-year period. This may not be causal, as it cannot be excluded that poorer premorbid functioning alone may result in poorer outcome, and may also elicit high EE in the relative.

Expressed Emotion↗

PubMed1995

[Stability and predictive role of emotions, expressed by families in the development of a cohort of schizophrenic patients in the course of 5 years].

A prospective study of 44 first admission schizophrenic patients was conducted in Geneva, in order to evaluate the prognostic value of Expressed Emotion (EE), as well as its stability. The predictive power of the EE index was tested on three variables of outcome: relapse rate, social adaptation and hospital stay. At intake, the patients presenting more premorbid features lived in high EE households. The EE index and the outcome measures tended to be associated. After the third year, patients living with high EE relatives were significantly more maladjusted and relapsed more than those living with low EE relatives. The EE index was stable during the five years. Our results show that initial measure of EE in a first episode cohort is predictive of outcome over a five year period. This may not be causal as it cannot be excluded that poorer premorbid functioning alone may result in poorer outcome, and may also elicit high EE in relative.

Adult↗

PubMedDate not supplied

Stability of DSM-III-R diagnoses: study of a case register.

We studied the diagnostic stability and the factors associated with it in 1,443 psychiatric patients with multiple admissions for a period of 45 months. We successively considered the whole population, the psychotic and then the schizophrenic patients. Demographic and DSM-III-R diagnostic information was collected on a computerized database. During the observation period, 1,443 patients were hospitalized twice or more. Diagnostic stability ranged from 34 to 86%. Psychotic disorder was the most stable, whereas adjustment and anxiety disorders were the least stable. Among schizophrenic patients, higher stability appeared for residual and disorganized types (83 and 71%, respectively). Statistical analysis did not show any variable associated with change, apart from the diagnoses themselves. The reasons that could explain changes are discussed, as well as the clinical consequences of these shifts.

Adult↗

PubMedDate not supplied

Relationship between subjective cognitive symptoms and frontal executive abilities in chronic schizophrenic outpatients.

The aim of this study was to investigate the relationship between executive abilities and subjective basic symptoms in a group of outpatients with schizophrenia. Fifty patients underwent a neuropsychological testing battery. Basic symptoms were assessed using the Frankfurt Complaint Questionnaire. Using Pearson's product-moment correlations or partial correlations calculated by regression procedure, cognitive performance was not related to subjective experience. When patients were divided into two groups, with and without 'hypofrontality', as assessed by the neuropsychological testing, we did not find any significant difference in basic symptoms rating. Thus, it is likely that basic symptoms and neurocognitive functioning are unrelated in schizophrenic outpatients, probably because the expression of subjective experience and cognitive impairment is less pronounced than in inpatients. Also, subjective self-perceived basic symptoms and neurocognitive functioning may be unrelated, because these concepts are based on different theoretical backgrounds.

Adult↗

PubMedDate not supplied

[Four year follow-up of social adjustment of a cohort of schizophrenic patients].

Sixty-seven first episode schizophrenic patients (PSE-Catego criteria) have been included in this study in order to evaluate their prognosis and the factors predictive of their evolution. Potential predictive factors consisted of anamnestic and demographic data, scores on the Disability Assessment Schedule (DAS-WHO) and relatives' Expressed Emotion index (EE), measured by the Camberwell Family Interview (CFI). The outcome was assessed monthly by the Global Assessment Scale (GAS/DSM III-R). At four years, 39 patients (58%) were still being followed. 33% of the patients presented a good evolution (EGF > or = 51) and 67% of the patients a bad evolution (EGF < 51). Four factors predictive of the psychosocial adaptation were extracted using regression analysis: premorbid psychosocial evolution, EE, sex and psychiatric family history. These 4 factors predicted correctly 85% of cases. Moreover, the monthly follow-up of these patients pointed to three types of evolution: the patients presenting a good and stable evolution (22%), those presenting a bad and stable evolution (33%) and those presenting an oscillating evolution which fluctuated between good and bad periods (44%). However, no predictive factors of the psychosocial adaptation of these oscillating patients could be identified through the statistical analysis. These results take all their importance regarding the treatment of schizophrenic patients, for whom the therapeutic plans which have to be settled should take into account their prognosis in the most precise manner. Moreover, the predictive value of EE on psychosocial adaptation for a 4 years period is confirmed.

Adolescent↗

PubMedDate not supplied

[Neuroimaging and neurobiology of obsessive compulsive disorder: review of recent developments in research].

Morphological and functional changes seen in obsessive-compulsive disorder (OCD) are reviewed. OCD and neurology are closely linked: some neurological diseases involving basal ganglia are sometimes associated with OCD symptoms; conversely, OCD patients often present neurological soft signs. Structural neuroimaging has shown reduced caudate nucleus volume among OCD patients. Functional neuroimaging demonstrated repeatedly an activation of the caudate nucleus and orbitofrontal cortex areas which reversed after treatment. Recent studies showed a correlation between induced OCD symptoms and an increase of the blood flow of the right caudate nucleus and the orbitofrontal cortex. A circuit linking the orbital cortex, the striatum and the thalamus is probably involved in OCD symptoms. However, it is not yet possible to find a causal lesion for this trouble.

Brain↗

PubMedDate not supplied

[Patient education about neuroleptic treatment, can it reduce costs? A pilot study].

Costs generated by chronically mentally ill are very high. Concerning direct costs (hospitalisations, outpatient services, medications), they are estimated from 120,000 to 160,000 french francs per year. Indirect costs (social security, gain lost) are assessed as being at least three times more than direct costs. Trimestrial costs, charged to insurance, of the first fourteen patients who followed the UCLA medication management module, have been retrospectively calculated on the base of the number of consultations, days at the hospital and community day center during the previous and following year of the introduction of the program. The intervention lasts 3 months with two weekly sessions of 1 h 30. The medication module aims the following goals: 1) Obtaining information about antipsychotic medication; 2) Knowing correct self-administration and evaluation of medication; 3) Identifying side effects of medication; and 4) Negotiating medication issues with health-care providers. The mean trimestrial costs curve goes down following the application of the program and this reduction continues 9 months after the end of the intervention. The small numbers of patients and the absence of control group do not allow to draw conclusions about these results. However, these data provide support to formulate an hypothesis about the effect of the module on medication compliance.

Adult↗

PubMedDate not supplied

[Effect of a coordinated management program on the outcome of a cohort of ambulatory psychiatric patients].

This study describes a one year follow-up study of 53 ambulatory patients treated with case management oriented care. These patients, characterized by a chronic evolution for an average of 10 years, presented after a one year period a significant improvement of different symptomatic parameters (positive and negative psychotic symptoms). Psychosocial adaptation was also improved for their dependency, their activity and the amount of their social contacts. These results underline the usefulness of case management, which permits an optimal use of available therapeutic facilities. Moreover, the setting of such a program allows a more specifical treatment of this category of patients.

Adult↗