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1.
Artigo em Inglês | MEDLINE | ID: mdl-34826559

RESUMO

BACKGROUND: Tobacco smoking has been associated with suicide, impulsivity and depression in non-clinical populations with differences across sexes. OBJECTIVE: To determine the role of tobacco smoking in Treatment-Resistant Depression (TRD) according to sex in a precision-medicine approach. METHOD: The FACE-TRD cohort is a national cohort of TRD patients recruited in 13 resistant depression expert centers between 2014 and 2021 and followed-up at 6 months. A standardized one-day long comprehensive battery was carried out, including trained-clinician and patient-reported outcomes, and patients were reevaluated at 6 months on their smoking and psychiatric hospitalization outcomes. RESULTS: 355 TRD participants were included (222 women). The smoking rate was much higher in TRD women compared to the French general population (34% vs 24%) while it was comparable for men (approximately 29%). In multivariate analyses, compared to non-smoking women, female smokers had significantly increased number of lifetime psychiatric hospitalizations (standardized beta B = 0.232, p = 0.014) and electro-convulsive therapy (adjusted odds ratio (aOR) = 2.748, p = 0.005), increased suicidal ideations (aOR = 4.047, p = 0.031), history of suicide attempt (aOR = 1.994, p = 0.033), and increased impulsivity (B = 0.210, p = 0.006) and were more frequently treated by benzodiazepines (aOR = 1.848, p = 0.035) and third- or fourth-line TRD treatments (antipsychotics aOR = 2.270, p = 0.006, mood stabilizers aOR = 2.067 p = 0.044). Tobacco smoking at baseline was predictive of psychiatric hospitalization within 6 months in persistent smoking women (aOR = 2.636, p = 0.031). These results were not replicated in men, for whom tobacco smoking was only associated with increased clinician-rated and self-reported depressive symptoms (respectively B = 0.207, p = 0.022 and B = 0.184, p = 0.048). The smoking cessation rate at 6 months was higher in women than in men (12% vs. 7%). No patient was administered nicotine substitute or varenicline at the two timepoints. INTERPRETATION: Combining these results and those of the literature, we recommend that active tobacco cessation should be promoted in TRD to improve depression, suicide and impulsivity especially in women. Female smokers appear as a specific population with heavier mental health outcomes that should be specifically addressed.


Assuntos
Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Medicina de Precisão , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar Tabaco , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nicotina/efeitos adversos , Fatores Sexuais , Ideação Suicida , Tentativa de Suicídio/estatística & dados numéricos , Inquéritos e Questionários
2.
Presse Med ; 45(3): 350-9, 2016 Mar.
Artigo em Francês | MEDLINE | ID: mdl-26995510

RESUMO

Non-selective and irreversible MAOI have become as third or fourth-line strategy for the management of treatment-resistant depression. Non-selective and irreversible MAOI requires careful monitoring of drug interactions and dietary restrictions. Nutritional supplements such as omega-3 have been found to produce beneficial effects in the management of treatment-resistant depression when administered in combination with the ongoing antidepressant treatment. The glutamate antagonist ketamine has been found to produce beneficial effects in the management of treatment-resistant depression while administered alone. Dopamine and/or norepinephrine agonists, such as methylphenidate, modafinil or pramipexole, have been found to produce beneficial effects in the management of treatment-resistant depression when administered in combination with the ongoing antidepressant treatment.


Assuntos
Agonistas alfa-Adrenérgicos/uso terapêutico , Antidepressivos/uso terapêutico , Estimulantes do Sistema Nervoso Central/uso terapêutico , Transtorno Depressivo/tratamento farmacológico , Suplementos Nutricionais , Agonistas de Dopamina/uso terapêutico , Antagonistas de Aminoácidos Excitatórios/uso terapêutico , Ketamina/uso terapêutico , Inibidores da Monoaminoxidase/uso terapêutico , Antidepressivos/farmacocinética , Método Duplo-Cego , Interações Medicamentosas , Resistência a Medicamentos , Quimioterapia Combinada , Ácidos Graxos Ômega-3/uso terapêutico , Ácido Fólico/uso terapêutico , Interações Alimento-Droga , Humanos , Inibidores da Monoaminoxidase/farmacocinética , Ensaios Clínicos Controlados Aleatórios como Assunto , S-Adenosilmetionina/uso terapêutico
3.
World Neurosurg ; 80(3-4): S31.e1-8, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-22469523

RESUMO

Because of its reversibility and adaptability, deep brain stimulation (DBS) has recently gained interest in psychiatric disorders, such as obsessive-compulsive disorders (OCD) and depression. In OCD, DBS is now an alternative procedure to lesions of fascicles such as the anterior capsule, which links the orbitofrontal cortex, the cingulum, and the thalamus, and has been applied to new target such as the nucleus accumbens, with promising results. However, a recent interest has been developed toward the subthalamic nucleus (STN), a key structure of the basal ganglia that connects the motor, limbic, and associative systems. It is known from patients with Parkinson disease that STN-DBS can have significant effects on mood and cognition. Those transient effects are usually seen as "side effects" in Parkinson disease, but are clues to the underappreciated role that STN plays in the limbic circuitry, a role whose precise details are as yet unknown and under active investigation. We present the rationale supporting the use of nonmotor STN as a therapeutic target to treat OCD. In particular, we discuss the recent experience and preliminary results of our group after 6 months of nonmotor STN-DBS in patients with severe OCD.


Assuntos
Estimulação Encefálica Profunda/métodos , Procedimentos Neurocirúrgicos/métodos , Transtorno Obsessivo-Compulsivo/terapia , Núcleo Subtalâmico/cirurgia , Adulto , Idade de Início , Animais , Estimulação Encefálica Profunda/efeitos adversos , Feminino , Humanos , Comportamento Impulsivo/psicologia , Comportamento Impulsivo/cirurgia , Masculino , Procedimentos Neurocirúrgicos/efeitos adversos , Transtorno Obsessivo-Compulsivo/patologia , Transtorno Obsessivo-Compulsivo/psicologia , Seleção de Pacientes , Núcleo Subtalâmico/patologia , Falha de Tratamento , Resultado do Tratamento
4.
Int Psychogeriatr ; 24(3): 496-502, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21835072

RESUMO

BACKGROUND: The medical care of elderly patients with psychotic disorders is a matter of major concern. The aim of the study was to investigate health conditions and treatment of elderly patients with psychotic disorders in France. METHODS: The SAGE (Schizophrenia AGEd) study (observational, cross-sectional) was a survey conducted among 123 physicians in France, regarding prescriptions of antipsychotic drugs in elderly patients (≥60 years) suffering from psychotic disorders. The survey was based on a questionnaire addressing the mental and somatic health management of the patients. RESULTS: Data from 930 patients (mean age: 70.4 years) were collected. Most patients (58.5%) suffered from schizophrenia, 20.8% had delusional disorder and 20.6% hallucinatory chronic psychosis (very-late-onset schizophrenia-like psychosis). 70.8% of them were outpatients, while 29.2% were inpatients. The severity of psychotic symptoms was assessed in 97.8% of patients, but cognitive function was only evaluated in 41.6%. Some 46.5% of patients were treated with atypical antipsychotics alone, 36.2% with classical antipsychotics alone and 17.3% received a combination of both, atypical and classical antipsychotics; 36.3% patients were given antiparkinsonian medication, of whom only 17.8% as preventive treatment; 51.1% of patients had somatic comorbidities, particularly cardiovascular disorders (34.0%). Evaluation of renal and/or liver function to adjust the dose of treatment was done in only 32.1% of patients. Over the previous 12 months, almost half of the patients had had no ECG, glycemia or creatininemia investigated and HDL-cholesterol and triglycerides were available for less than one-third of them. CONCLUSIONS: Antipsychotic and antiparkinsonian drug prescriptions in French aged psychotic patients follow only partially the clinical guidelines and recommendations of consensus conferences. Moreover, cognitive, cardiac and metabolic aspects are not fully managed as expected.


Assuntos
Antipsicóticos/uso terapêutico , Transtornos Psicóticos/tratamento farmacológico , Transtornos Psicóticos/epidemiologia , Esquizofrenia/tratamento farmacológico , Esquizofrenia/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Antiparkinsonianos/efeitos adversos , Antiparkinsonianos/uso terapêutico , Antipsicóticos/efeitos adversos , Doenças Cardiovasculares/epidemiologia , Doença Crônica , Comorbidade , Estudos Transversais , Quimioterapia Combinada , Feminino , França , Fidelidade a Diretrizes , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Inquéritos Epidemiológicos , Humanos , Masculino , Programas de Rastreamento/estatística & dados numéricos , Entrevista Psiquiátrica Padronizada , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente/estatística & dados numéricos , Revisão da Utilização de Recursos de Saúde
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