David Misdrahi - Academia.edu (original) (raw)

Papers by David Misdrahi

Research paper thumbnail of Évaluation de l’observance et de l’alliance thérapeutiques chez des patients psychotiques traités par rispéridone orale et en relais vers une forme injectable à libération prolongée de la rispéridone

Revue d'Épidémiologie et de Santé Publique, 2009

Objectifs.-Décrire les prescriptions médicamenteuses des sujets atteints de maladie d'Alzheimer (... more Objectifs.-Décrire les prescriptions médicamenteuses des sujets atteints de maladie d'Alzheimer (MA) « en vie réelle », en particulier des médicaments spécifiques antidémentiels et les psychotropes. Méthode.-L'étude française multicentrique « Plan de soin et d'aide spécifique à la MA » (Plasa), conduite en centres hospitaliers généraux et universitaires, testait l'efficacité d'un plan de soins sur la perte d'autonomie dans la MA de stade léger à modéré vivant à domicile et bénéficiant du soutien d'un aidant. La moitié des patients (n = 574) était randomisée pour recevoir un suivi appliquant les recommandations de ce plan, l'autre moitié (n = 557) bénéficiait du suivi habituel du centre. Les médicaments prescrits et pris en automédication étaient recueillis par l'interrogatoire (aidant) et les ordonnances apportées par le patient, codés selon la classification ATC. Résultats.-Entre 2003 et 2005, 1118 patients participaient à la visite initiale.

Research paper thumbnail of Factors influencing compulsory admission in first-admitted subjects with psychosis

Social psychiatry and psychiatric epidemiology, 2004

There is a growing body of evidence that patients with early psychosis have undesirable pathways ... more There is a growing body of evidence that patients with early psychosis have undesirable pathways to care, yet few studies have explored the factors related to compulsory admission in patients with psychosis. The aim of the present study was to examine the demographic and clinical factors and pathways to care influencing compulsory admission in first-admitted subjects with psychosis. Pathways to care, clinical and demographic characteristics, were assessed using multiple sources of information in 86 subjects with psychosis first admitted in two hospitals of South-Western France. Characteristics independently associated with compulsory admission were explored using logistic regressions. Nearly two-thirds of the subjects (61.6%) were compulsorily admitted. Compulsory admission was independently predicted by being a male (adjusted OR = 3.2, 95 % CI 1.2-8.6, p = 0.02), having a diagnosis of schizophrenia broadly defined (adjusted OR = 2.8, 95 % CI 1.02-7.4, p = 0.04) and absence of depre...

Research paper thumbnail of Validation of a Psycho-Sensory hAllucinations Scale (PSAS) in schizophrenia and Parkinson's disease

Schizophrenia research, 2015

If hallucinations are the most common of schizophrenic symptoms, they have been described in othe... more If hallucinations are the most common of schizophrenic symptoms, they have been described in other pathologies such as Parkinson's disease (PD) but may differ considerably in their phenomenology. However, no multi-modal clinical scale with a transnosographic approach has been developed today. The purpose of this study was to create and validate a new tool for the hetero-assessment of all sensory modalities of hallucinations schizophrenia (SCZ) and in PD. Scale items were generated by literature review and validated by medical board. A study was then made to evaluate psychometric properties of the Psycho-Sensory hAllucinations Scale (PSAS) that include four domains (auditory, visual, olfactory and gustatory, cenesthetic modalities) and one specific item 'guardian angel'. It was then validated in 137 patients: 86 PD (53.5% male; mean age=53.3years) and 51 SCZ (64.7% male; mean age=38.5years). Factorial analysis of the PSAS found four factors. The PSAS showed good internal ...

Research paper thumbnail of Facteurs prédictifs de l’observance en transplantation rénale : étude observationnelle française

Néphrologie & Thérapeutique, 2011

Patients et méthodes.-Étude rétrospective monocentrique portant sur 200 transplantations rénales ... more Patients et méthodes.-Étude rétrospective monocentrique portant sur 200 transplantations rénales de donneurs décédés réalisées consécutivement entre mars 2009 et février 2011. Chaque LC a été ensemencé parallèlement sur gélose au sang et dans des flacons à hémocultures aéro et anaérobies (BacT/ALERT ® )

Research paper thumbnail of P11-4 Filières d’accès aux soins dans les premiers épisodes psychotiques

Revue d'Épidémiologie et de Santé Publique, 2004

Research paper thumbnail of Pathways to care in early psychosis

Schizophrenia Research, 2003

In view of recent criticism of observed rates of antipsychotic polypharmacy in schizophrenia, thi... more In view of recent criticism of observed rates of antipsychotic polypharmacy in schizophrenia, this study assessed the prevalence and correlates of antipsychotic co-prescribing in a large cohort of patients meeting DSM-IV criteria for schizophrenia. We evaluated 223 patients between 18 and 65 years of age meeting DSM-IV criteria for schizophrenia as established by a Structured Clinical Interview (SCID-IV). Demographic and medication utilization data were obtained from the medical record. Data were analyzed using t-tests for group comparisons and stepwise regression analysis for correlates of antipsychotic polypharmacy. Analysis of the data revealed that second generation antipsychotics(SGAs) were used in 80.7% of patients, and 35.0% were treated with a first generation antipsychotic agent (FGA). The most commonly prescribed antipsychotics were risperidone (30.0%), clozapine (27.8%), olanzapine (24.7%), and oral FGAs (19.7%), followed by decanoate FGAs (15.2%) and quetiapine (11.7%). Antipsychotic polypharmacy was observed in 35.0% of subjects, involving an FGA plus SGA in 54.5%, two SGAs in 35.3% and two FGAs in 10.2% (oral plus decanoate formulation) of cases. Among SGAs, quetiapine was prescribed the least as a single antipsychotic treatment (23.1% vs. 59.6% for clozapine, 58.2% for risperidone and 52.7% for olanzapine, p=.001 ). In 78% of patients, antipsychotics were also combined with other psychotropic medications. These included mood stabilizers (44.4%), antidepressants (40.3%), anxiolytics/hypnotics (23.8%) and anticholinergics (29.6%). Finally, antipsychotic polypharmacy was associated with duration of illness (p=.004) and reduced concomitant use of mood stabilizers, antidepressants or anxiolytics/hypnotics (p=.02), but not with anticholinergic use (p=0.33). These data suggest that the rate of antipsychotic polypharmacy is significant even in patients with a research diagnosis of schizophrenia. Moreover, the introduction of SGAs into routine clinical practice is still associated with high rates of antipsychotic co-prescribing. The best predictor of polypharmacy in this population was duration of illness, which may suggest that these patients are more severely ill, or which could be related to other factors that remain to be determined.

Research paper thumbnail of Pathways to care of first-admitted subjects with psychosis in South-Western France

Psychological Medicine, 2004

A limited number of studies have assessed the pathways to care of patients with first-episode psy... more A limited number of studies have assessed the pathways to care of patients with first-episode psychosis. The aim of the study was to describe the pathways to care of subjects with psychosis between onset of psychosis and first admission, and to examine the demographic and clinical factors influencing access to care. Number and type of helping contacts since onset of first psychotic symptoms were assessed using multiple sources of information in 86 subjects with psychosis first-admitted in two hospitals of South-Western France. Characteristics independently associated with long delays between onset of symptoms and first helping contact, first treatment and first admission were explored using logistic regressions. Twelve per cent of subjects were first admitted without any previous helping contact. The patients were seen by a median of two helpers (maximum 7). For most patients (70%), the first helping contact was a health care professional, and the same proportion of patients had a first contact with a GP or a psychiatrist. The type of first contact was not predicted by demographic or clinical characteristics. Subjects with poor pre-morbid functioning or at-risk behaviour were more likely to have a delayed access to care. The delay in access to care may not be totally attributed to inadequate management by health professionals, but may be a characteristic of the disease itself, at least in part independent of the organization of the health system.

Research paper thumbnail of Pratiques de prescription des traitements antipsychotiques dans les premières hospitalisations pour épisode psychotique : étude sur une cohorte de patients hospitalisés dans deux hôpitaux girondins

L'Encéphale, 2007

ABSTRACT

Research paper thumbnail of Définition de l’état aigu dans la schizophrénie : enquête réalisée auprès des psychiatres français

L'Encéphale, 2005

ABSTRACT

Research paper thumbnail of Quels rapports bénéfices/risques des antidépresseurs au long cours ?

Research paper thumbnail of Towards a reconceptualization of mixed states, based on an emotional-reactivity dimensional model

Journal of Affective Disorders, 2007

Background: DSM-IV criteria for mixed states may be too restrictive and may actually exclude pati... more Background: DSM-IV criteria for mixed states may be too restrictive and may actually exclude patients who do not meet the full criteria for a manic and depressive state. Using this DSM-IV definition, many patients who are considered depressed may have mixed features, which can explain why some bipolar depressive states can worsen with antidepressants and can be improved by mood stabilizers or atypical antipsychotics. A dimensional approach not exclusively focused on the tonality of affect would help to define a broader entity of mixed states. The aim of this study was to apply a dimensional model to bipolar episodes and to assess the overlap between the groups defined using this model and using categorical diagnosis. Method: We assessed 139 DSM-IV acutely ill bipolar I patients with MAThyS (Multidimensional Assessment of Thymic States by Henry et al. in press), a scale that assesses five quantitative dimensions exploring excitatory and inhibition processes, and that is not focused on tonality of mood but on emotional reactivity. We studied the relationship between clusters defined by statistical analyses and DSM-IV bipolar mood states. Results: This study showed the existence of three clusters. Cluster 1 was characterized by an inhibition in all dimensions and corresponded to the depressive cluster (more than 90% of patients met the criteria for DSM-IV Major Depressive Episode (MDE)). Cluster 2 showed a general excitation and was mainly DSM-IV manic or hypomanic patients (90%). Cluster 3 (Mixed) was more complex and the diagnosis included MDE (56%) in most of the cases associated with manic or hypomanic symptoms, mixed states (18%) defined by DSM-IV criteria, and manic or hypomanic states (25%). Emotional reactivity was relevant to distinguish Cluster 1 (Depressive), exhibiting emotional hypo-reactivity, from Cluster 2 (Manic) and 3 (Mixed), characterized by emotional hyperreactivity. Sadness was reported equally in all three clusters. Conclusion: A dimensional approach using the concept of emotional reactivity seems appropriate to define a broad mixed state entity in patients who would be diagnosed with MDE according to DSM-IV. Further studies are needed to test the relevance of this model in therapeutic strategies.

Research paper thumbnail of DSM-IV mental disorders and neurological complications in children and adolescents with human immunodeficiency virus type 1 infection (HIV-1)

European Psychiatry, 2004

- To study the types of psychiatric problem encountered in children infected with the human immun... more - To study the types of psychiatric problem encountered in children infected with the human immunodeficiency virus (HIV) and their relationship to central nervous system disorder and the severity of infection. - 17 HIV-infected children presenting with psychiatric problems were included. Mental disorders were evaluated according to DSM-IV criteria. Neurological disorders and progressive encephalopathy (presence or absence) diagnosis were evaluated by clinical and radiological examination. The severity of infection was assessed by the percentage of CD4 lymphocytes. - The most frequent diagnoses were major depression (MDD: 47%) and attention deficit hyperactivity disorder (ADHD: 29%). Major depression diagnosis was significantly associated with neuroimaging or clinical neurological abnormalities (p < 0.01). In contrast, no association was found between hyperactivity diagnosed according to DSM-IV criteria and central nervous system disorder. Percentage of CD4 lymphocytes were close to 0 for more than 80% of children presenting with psychiatric complications. - The very low % of CD4 lymphocytes of these children suggest that the appearance of a psychiatric complication should be regarded as a factor indicating severe HIV infection. Depressive disorders may be a clinical form of encephalopathy.

Research paper thumbnail of Efficiency and safety of oxcarbazepine in mood disorders: A naturalistic study exploring the interest of plasma dosages

European Psychiatry, 2008

Objective. e To investigate whether measurement of plasma levels can predict tolerance to oxcarba... more Objective. e To investigate whether measurement of plasma levels can predict tolerance to oxcarbazepine (OXC).

Research paper thumbnail of P.3.e.015 Psychometric proprieties from the French translation of the “Medication Adherence Rating Scale” (MARS)

European Neuropsychopharmacology, 2008

Research paper thumbnail of The 4-Point ordinal Alliance Self-report: a self-report questionnaire for assessing therapeutic relationships in routine mental health

Comprehensive Psychiatry, 2009

The quality of the relationship between patient and therapist can be considered a cornerstone of ... more The quality of the relationship between patient and therapist can be considered a cornerstone of psychiatric practice. Nonadherence is one of the leading problems affecting antipsychotic effectiveness in schizophrenic patients and represents a poor prognostic factor for schizophrenia. Among the factors influencing adherence, the clinician's style of communication and the therapeutic relationship (TR) are recognized as key points. The measures of TR have been broadly explored in psychotherapy process but have received little attention in the treatment of severe mental illness in the context of routine mental health. Our objective was to build a self-rating scale easy to use in clinical psychiatric practice to assess TR, including drug-taking aspects and the relationship with the clinician on a day-to-day basis. A secondary objective was to assess the scale's validity and the association between TR and adherence. The study was conducted with 92 consenting inpatients who met specified criteria for schizophrenia and schizoaffective disorders (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). Assessments of TR were obtained by the 4-Point ordinal Alliance Self-report and an 8-cm visual analog scale completed by the patient 1 week before discharge, after the remission of acute symptomatology. Adherence behavior was estimated with a new valid and reliable questionnaire called the Medication Adherence Rating Scale. Factor analysis was performed. Internal consistency was assessed by calculating Cronbach alpha, which revealed a highly satisfactory value (alpha = .91). After oblique rotation was run, 2 understandable factors were extracted that we termed empathy experienced and psychoeducation. Therapeutic relationship with the clinician can be considered a prerequisite for positive treatment course and outcome. The detection of subpopulations characterized by determinants of poor TR could be the first step toward improving schizophrenia prognosis linked to poor adherence.

Research paper thumbnail of Insight et schizophrénie : quels rôles dans le risque suicidaire ?

Annales Médico-psychologiques, revue psychiatrique, 2011

Suicide is the leading cause of premature death in patients with schizophrenia. Suicide risk is i... more Suicide is the leading cause of premature death in patients with schizophrenia. Suicide risk is increased during the early stages of the disease, especially the first year after diagnosis. In this population, the coexistence of a mood disorder is an identified risk factor for suicide. Results from literature are consensual about the association between a good level of insight and

Research paper thumbnail of Pattern of health service utilization and predictors of readmission after a first admission for psychosis: a 2-year follow-up study

Acta Psychiatrica Scandinavica, 2006

Pattern of health service utilization and predictors of readmission after a first admission for p... more Pattern of health service utilization and predictors of readmission after a first admission for psychosis: a 2-year follow-up study Cougnard A, Parrot M, Grolleau S, Kalmi E, Desage A, Misdrahi D, Brun-Rousseau H, Verdoux H. Pattern of health service utilization and predictors of readmission after a first admission for psychosis: a 2-year follow-up study.

Research paper thumbnail of Medication adherence and psychotic disorder

Background: Maintaining antipsychotic therapy in psychosis is important in preventing relapse. Lo... more Background: Maintaining antipsychotic therapy in psychosis is important in preventing relapse. Long-acting depot preparations can prevent covert non-adherence and thus potentially contribute to better patient outcomes.

Read this original research and sign up to receive Patient Preference and Adherence journal here: https://www.dovepress.com/articles.php?article_id=23691

Research paper thumbnail of Évaluation de l’observance et de l’alliance thérapeutiques chez des patients psychotiques traités par rispéridone orale et en relais vers une forme injectable à libération prolongée de la rispéridone

Revue d'Épidémiologie et de Santé Publique, 2009

Objectifs.-Décrire les prescriptions médicamenteuses des sujets atteints de maladie d'Alzheimer (... more Objectifs.-Décrire les prescriptions médicamenteuses des sujets atteints de maladie d'Alzheimer (MA) « en vie réelle », en particulier des médicaments spécifiques antidémentiels et les psychotropes. Méthode.-L'étude française multicentrique « Plan de soin et d'aide spécifique à la MA » (Plasa), conduite en centres hospitaliers généraux et universitaires, testait l'efficacité d'un plan de soins sur la perte d'autonomie dans la MA de stade léger à modéré vivant à domicile et bénéficiant du soutien d'un aidant. La moitié des patients (n = 574) était randomisée pour recevoir un suivi appliquant les recommandations de ce plan, l'autre moitié (n = 557) bénéficiait du suivi habituel du centre. Les médicaments prescrits et pris en automédication étaient recueillis par l'interrogatoire (aidant) et les ordonnances apportées par le patient, codés selon la classification ATC. Résultats.-Entre 2003 et 2005, 1118 patients participaient à la visite initiale.

Research paper thumbnail of Factors influencing compulsory admission in first-admitted subjects with psychosis

Social psychiatry and psychiatric epidemiology, 2004

There is a growing body of evidence that patients with early psychosis have undesirable pathways ... more There is a growing body of evidence that patients with early psychosis have undesirable pathways to care, yet few studies have explored the factors related to compulsory admission in patients with psychosis. The aim of the present study was to examine the demographic and clinical factors and pathways to care influencing compulsory admission in first-admitted subjects with psychosis. Pathways to care, clinical and demographic characteristics, were assessed using multiple sources of information in 86 subjects with psychosis first admitted in two hospitals of South-Western France. Characteristics independently associated with compulsory admission were explored using logistic regressions. Nearly two-thirds of the subjects (61.6%) were compulsorily admitted. Compulsory admission was independently predicted by being a male (adjusted OR = 3.2, 95 % CI 1.2-8.6, p = 0.02), having a diagnosis of schizophrenia broadly defined (adjusted OR = 2.8, 95 % CI 1.02-7.4, p = 0.04) and absence of depre...

Research paper thumbnail of Validation of a Psycho-Sensory hAllucinations Scale (PSAS) in schizophrenia and Parkinson's disease

Schizophrenia research, 2015

If hallucinations are the most common of schizophrenic symptoms, they have been described in othe... more If hallucinations are the most common of schizophrenic symptoms, they have been described in other pathologies such as Parkinson's disease (PD) but may differ considerably in their phenomenology. However, no multi-modal clinical scale with a transnosographic approach has been developed today. The purpose of this study was to create and validate a new tool for the hetero-assessment of all sensory modalities of hallucinations schizophrenia (SCZ) and in PD. Scale items were generated by literature review and validated by medical board. A study was then made to evaluate psychometric properties of the Psycho-Sensory hAllucinations Scale (PSAS) that include four domains (auditory, visual, olfactory and gustatory, cenesthetic modalities) and one specific item 'guardian angel'. It was then validated in 137 patients: 86 PD (53.5% male; mean age=53.3years) and 51 SCZ (64.7% male; mean age=38.5years). Factorial analysis of the PSAS found four factors. The PSAS showed good internal ...

Research paper thumbnail of Facteurs prédictifs de l’observance en transplantation rénale : étude observationnelle française

Néphrologie & Thérapeutique, 2011

Patients et méthodes.-Étude rétrospective monocentrique portant sur 200 transplantations rénales ... more Patients et méthodes.-Étude rétrospective monocentrique portant sur 200 transplantations rénales de donneurs décédés réalisées consécutivement entre mars 2009 et février 2011. Chaque LC a été ensemencé parallèlement sur gélose au sang et dans des flacons à hémocultures aéro et anaérobies (BacT/ALERT ® )

Research paper thumbnail of P11-4 Filières d’accès aux soins dans les premiers épisodes psychotiques

Revue d'Épidémiologie et de Santé Publique, 2004

Research paper thumbnail of Pathways to care in early psychosis

Schizophrenia Research, 2003

In view of recent criticism of observed rates of antipsychotic polypharmacy in schizophrenia, thi... more In view of recent criticism of observed rates of antipsychotic polypharmacy in schizophrenia, this study assessed the prevalence and correlates of antipsychotic co-prescribing in a large cohort of patients meeting DSM-IV criteria for schizophrenia. We evaluated 223 patients between 18 and 65 years of age meeting DSM-IV criteria for schizophrenia as established by a Structured Clinical Interview (SCID-IV). Demographic and medication utilization data were obtained from the medical record. Data were analyzed using t-tests for group comparisons and stepwise regression analysis for correlates of antipsychotic polypharmacy. Analysis of the data revealed that second generation antipsychotics(SGAs) were used in 80.7% of patients, and 35.0% were treated with a first generation antipsychotic agent (FGA). The most commonly prescribed antipsychotics were risperidone (30.0%), clozapine (27.8%), olanzapine (24.7%), and oral FGAs (19.7%), followed by decanoate FGAs (15.2%) and quetiapine (11.7%). Antipsychotic polypharmacy was observed in 35.0% of subjects, involving an FGA plus SGA in 54.5%, two SGAs in 35.3% and two FGAs in 10.2% (oral plus decanoate formulation) of cases. Among SGAs, quetiapine was prescribed the least as a single antipsychotic treatment (23.1% vs. 59.6% for clozapine, 58.2% for risperidone and 52.7% for olanzapine, p=.001 ). In 78% of patients, antipsychotics were also combined with other psychotropic medications. These included mood stabilizers (44.4%), antidepressants (40.3%), anxiolytics/hypnotics (23.8%) and anticholinergics (29.6%). Finally, antipsychotic polypharmacy was associated with duration of illness (p=.004) and reduced concomitant use of mood stabilizers, antidepressants or anxiolytics/hypnotics (p=.02), but not with anticholinergic use (p=0.33). These data suggest that the rate of antipsychotic polypharmacy is significant even in patients with a research diagnosis of schizophrenia. Moreover, the introduction of SGAs into routine clinical practice is still associated with high rates of antipsychotic co-prescribing. The best predictor of polypharmacy in this population was duration of illness, which may suggest that these patients are more severely ill, or which could be related to other factors that remain to be determined.

Research paper thumbnail of Pathways to care of first-admitted subjects with psychosis in South-Western France

Psychological Medicine, 2004

A limited number of studies have assessed the pathways to care of patients with first-episode psy... more A limited number of studies have assessed the pathways to care of patients with first-episode psychosis. The aim of the study was to describe the pathways to care of subjects with psychosis between onset of psychosis and first admission, and to examine the demographic and clinical factors influencing access to care. Number and type of helping contacts since onset of first psychotic symptoms were assessed using multiple sources of information in 86 subjects with psychosis first-admitted in two hospitals of South-Western France. Characteristics independently associated with long delays between onset of symptoms and first helping contact, first treatment and first admission were explored using logistic regressions. Twelve per cent of subjects were first admitted without any previous helping contact. The patients were seen by a median of two helpers (maximum 7). For most patients (70%), the first helping contact was a health care professional, and the same proportion of patients had a first contact with a GP or a psychiatrist. The type of first contact was not predicted by demographic or clinical characteristics. Subjects with poor pre-morbid functioning or at-risk behaviour were more likely to have a delayed access to care. The delay in access to care may not be totally attributed to inadequate management by health professionals, but may be a characteristic of the disease itself, at least in part independent of the organization of the health system.

Research paper thumbnail of Pratiques de prescription des traitements antipsychotiques dans les premières hospitalisations pour épisode psychotique : étude sur une cohorte de patients hospitalisés dans deux hôpitaux girondins

L'Encéphale, 2007

ABSTRACT

Research paper thumbnail of Définition de l’état aigu dans la schizophrénie : enquête réalisée auprès des psychiatres français

L'Encéphale, 2005

ABSTRACT

Research paper thumbnail of Quels rapports bénéfices/risques des antidépresseurs au long cours ?

Research paper thumbnail of Towards a reconceptualization of mixed states, based on an emotional-reactivity dimensional model

Journal of Affective Disorders, 2007

Background: DSM-IV criteria for mixed states may be too restrictive and may actually exclude pati... more Background: DSM-IV criteria for mixed states may be too restrictive and may actually exclude patients who do not meet the full criteria for a manic and depressive state. Using this DSM-IV definition, many patients who are considered depressed may have mixed features, which can explain why some bipolar depressive states can worsen with antidepressants and can be improved by mood stabilizers or atypical antipsychotics. A dimensional approach not exclusively focused on the tonality of affect would help to define a broader entity of mixed states. The aim of this study was to apply a dimensional model to bipolar episodes and to assess the overlap between the groups defined using this model and using categorical diagnosis. Method: We assessed 139 DSM-IV acutely ill bipolar I patients with MAThyS (Multidimensional Assessment of Thymic States by Henry et al. in press), a scale that assesses five quantitative dimensions exploring excitatory and inhibition processes, and that is not focused on tonality of mood but on emotional reactivity. We studied the relationship between clusters defined by statistical analyses and DSM-IV bipolar mood states. Results: This study showed the existence of three clusters. Cluster 1 was characterized by an inhibition in all dimensions and corresponded to the depressive cluster (more than 90% of patients met the criteria for DSM-IV Major Depressive Episode (MDE)). Cluster 2 showed a general excitation and was mainly DSM-IV manic or hypomanic patients (90%). Cluster 3 (Mixed) was more complex and the diagnosis included MDE (56%) in most of the cases associated with manic or hypomanic symptoms, mixed states (18%) defined by DSM-IV criteria, and manic or hypomanic states (25%). Emotional reactivity was relevant to distinguish Cluster 1 (Depressive), exhibiting emotional hypo-reactivity, from Cluster 2 (Manic) and 3 (Mixed), characterized by emotional hyperreactivity. Sadness was reported equally in all three clusters. Conclusion: A dimensional approach using the concept of emotional reactivity seems appropriate to define a broad mixed state entity in patients who would be diagnosed with MDE according to DSM-IV. Further studies are needed to test the relevance of this model in therapeutic strategies.

Research paper thumbnail of DSM-IV mental disorders and neurological complications in children and adolescents with human immunodeficiency virus type 1 infection (HIV-1)

European Psychiatry, 2004

- To study the types of psychiatric problem encountered in children infected with the human immun... more - To study the types of psychiatric problem encountered in children infected with the human immunodeficiency virus (HIV) and their relationship to central nervous system disorder and the severity of infection. - 17 HIV-infected children presenting with psychiatric problems were included. Mental disorders were evaluated according to DSM-IV criteria. Neurological disorders and progressive encephalopathy (presence or absence) diagnosis were evaluated by clinical and radiological examination. The severity of infection was assessed by the percentage of CD4 lymphocytes. - The most frequent diagnoses were major depression (MDD: 47%) and attention deficit hyperactivity disorder (ADHD: 29%). Major depression diagnosis was significantly associated with neuroimaging or clinical neurological abnormalities (p < 0.01). In contrast, no association was found between hyperactivity diagnosed according to DSM-IV criteria and central nervous system disorder. Percentage of CD4 lymphocytes were close to 0 for more than 80% of children presenting with psychiatric complications. - The very low % of CD4 lymphocytes of these children suggest that the appearance of a psychiatric complication should be regarded as a factor indicating severe HIV infection. Depressive disorders may be a clinical form of encephalopathy.

Research paper thumbnail of Efficiency and safety of oxcarbazepine in mood disorders: A naturalistic study exploring the interest of plasma dosages

European Psychiatry, 2008

Objective. e To investigate whether measurement of plasma levels can predict tolerance to oxcarba... more Objective. e To investigate whether measurement of plasma levels can predict tolerance to oxcarbazepine (OXC).

Research paper thumbnail of P.3.e.015 Psychometric proprieties from the French translation of the “Medication Adherence Rating Scale” (MARS)

European Neuropsychopharmacology, 2008

Research paper thumbnail of The 4-Point ordinal Alliance Self-report: a self-report questionnaire for assessing therapeutic relationships in routine mental health

Comprehensive Psychiatry, 2009

The quality of the relationship between patient and therapist can be considered a cornerstone of ... more The quality of the relationship between patient and therapist can be considered a cornerstone of psychiatric practice. Nonadherence is one of the leading problems affecting antipsychotic effectiveness in schizophrenic patients and represents a poor prognostic factor for schizophrenia. Among the factors influencing adherence, the clinician's style of communication and the therapeutic relationship (TR) are recognized as key points. The measures of TR have been broadly explored in psychotherapy process but have received little attention in the treatment of severe mental illness in the context of routine mental health. Our objective was to build a self-rating scale easy to use in clinical psychiatric practice to assess TR, including drug-taking aspects and the relationship with the clinician on a day-to-day basis. A secondary objective was to assess the scale's validity and the association between TR and adherence. The study was conducted with 92 consenting inpatients who met specified criteria for schizophrenia and schizoaffective disorders (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). Assessments of TR were obtained by the 4-Point ordinal Alliance Self-report and an 8-cm visual analog scale completed by the patient 1 week before discharge, after the remission of acute symptomatology. Adherence behavior was estimated with a new valid and reliable questionnaire called the Medication Adherence Rating Scale. Factor analysis was performed. Internal consistency was assessed by calculating Cronbach alpha, which revealed a highly satisfactory value (alpha = .91). After oblique rotation was run, 2 understandable factors were extracted that we termed empathy experienced and psychoeducation. Therapeutic relationship with the clinician can be considered a prerequisite for positive treatment course and outcome. The detection of subpopulations characterized by determinants of poor TR could be the first step toward improving schizophrenia prognosis linked to poor adherence.

Research paper thumbnail of Insight et schizophrénie : quels rôles dans le risque suicidaire ?

Annales Médico-psychologiques, revue psychiatrique, 2011

Suicide is the leading cause of premature death in patients with schizophrenia. Suicide risk is i... more Suicide is the leading cause of premature death in patients with schizophrenia. Suicide risk is increased during the early stages of the disease, especially the first year after diagnosis. In this population, the coexistence of a mood disorder is an identified risk factor for suicide. Results from literature are consensual about the association between a good level of insight and

Research paper thumbnail of Pattern of health service utilization and predictors of readmission after a first admission for psychosis: a 2-year follow-up study

Acta Psychiatrica Scandinavica, 2006

Pattern of health service utilization and predictors of readmission after a first admission for p... more Pattern of health service utilization and predictors of readmission after a first admission for psychosis: a 2-year follow-up study Cougnard A, Parrot M, Grolleau S, Kalmi E, Desage A, Misdrahi D, Brun-Rousseau H, Verdoux H. Pattern of health service utilization and predictors of readmission after a first admission for psychosis: a 2-year follow-up study.

Research paper thumbnail of Medication adherence and psychotic disorder

Background: Maintaining antipsychotic therapy in psychosis is important in preventing relapse. Lo... more Background: Maintaining antipsychotic therapy in psychosis is important in preventing relapse. Long-acting depot preparations can prevent covert non-adherence and thus potentially contribute to better patient outcomes.

Read this original research and sign up to receive Patient Preference and Adherence journal here: https://www.dovepress.com/articles.php?article_id=23691