[Somatic care in psychiatry : barriers perceived by patients and health professionals]. / Soins de santé somatiques en psychiatrie : barrières perçues par les patients et les professionnels de la santé.

Disparities in access to, use of and delivery of somatic health care contribute to widening gaps in morbidity and mortality between psychiatric patients and the general population. We conducted a qualitative semi-structured interview study with psychiatric patients and health professionals from different psychiatric care settings to understand these poor physical health outcomes. Optimal somatic follow-up of patients with severe mental illness seems to be hampered by (1) provider-related elements (attitude, training, experiences); (2) organisational aspects (equipment, infrastructure, staff, pharmacy, communication networks); (3) psychiatric patient-related elements and (4) financial barriers.There is an urgent need for integrated somatic and psychiatric health care systems and for cultural change. Psychiatrists and somatic health care providers continue to view the mental and physical health of their patients as mutually exclusive responsibilities. A range of system changes will improve the quality of somatic health care for these vulnerable patients.

Les disparités dans l'accès, l'utilisation et la prestation des soins de santé somatiques contribuent à creuser les écarts de morbidité et mortalité entre patients psychiatriques et la population générale. Nous avons mené une étude qualitative par entretiens semi-structurés auprès de patients psychiatriques et de professionnels de santé de différents lieux de soins psychiatriques afin de comprendre ces mauvais résultats en matière de santé physique. Le suivi somatique optimal des patients atteints d'une maladie mentale sévère semble entravé par des éléments : (1) liés aux prestataires de soins (attitude, formation, expériences); (2) en relation avec des aspects organisationnels (équipement, infrastructure, personnel, pharmacie, réseaux de communication); (3) inhérents aux caractéristiques des patients psychiatriques et (4) représentés par des obstacles financiers. Il est urgent de mettre en place des systèmes de soins de santé somatiques et psychiatriques intégrés et d'entamer un changement culturel. Les psychiatres et les prestataires de soins somatiques continuent de considérer la santé mentale et la santé physique de leurs patients comme des responsabilités mutuellement exclusives. Un changement de paradigme tendant vers une meilleure intégration permettra d'améliorer la qualité des soins de santé somatiques pour ces patients vulnérables.

Real-World Treatment Patterns, Outcomes, Resource Utilization and Costs in Treatment-Resistant Major Depressive Disorder: PATTERN, a Retrospective Cohort Study in Belgium.

OBJECTIVE: Treatment-resistant depression (TRD), a subgroup of major depressive disorder (MDD) that does not adequately respond to treatment, has a substantial impact on the quality of life of patients and is associated with higher medical and mental health care costs. This study aimed to report real-world treatment patterns, outcomes, resource utilization, and costs in the management of TRD by psychiatrists in Belgium. METHODS: We conducted a retrospective, non-interventional cohort study of patients ≥ 18 years, with diagnosed MDD who are treatment-resistant, defined as not responding to two different antidepressant treatments in the current moderate to severe major depressive episode (MDE). Data obtained from medical records of patients included patient health state (MDE, response, remission, and recovery) and resource use (number of consultations and emergency room visits, non-drug and drug interventions, and hospitalizations). RESULTS: One hundred and twenty-five patients were enrolled in nine sites, with an average observation period of 34 months. During the MDE, 89.7% of patients were treated with selective serotonin reuptake inhibitors, 63.2% with serotonin-norepinephrine reuptake inhibitors, and 60.8% with anti-psychotics. Twenty-four percent of patients did not respond to any treatment; 76% responded, of whom 61% experienced a relapse; 28% of patients reached recovery, of whom 31.4% experienced recurrence. The average yearly direct cost of a TRD patient is €9012, mainly driven by hospitalization in the MDE. The observed absenteeism relates to a high indirect cost, representing 70% of the total MDE cost. CONCLUSION: TRD is associated with a high unmet need and economic burden for patients and society, with highest costs in the MDE health state driven by absenteeism.

A prospective, multicentre, open-label study to evaluate the effectiveness of aripiprazole in the treatment of a broad range of patients with schizophrenia.

PURPOSE: The aim of this study is to evaluate the effectiveness of 12-week treatment with aripiprazole in a broad range of patients suffering from schizophrenia by using a variety of physicians, caregivers and patients scales. SUBJECTS AND METHODS: A total of 361 in- or outpatients who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for schizophrenia received open-label aripiprazole (10-30 mg per day) in this 12-week, prospective, multicentre, uncontrolled study. The primary endpoint was the Clinical Global Impression-Improvement (CGI-I) scale which measured effectiveness of study medication, including efficacy, safety and tolerability. A variety of physician-, patient- and caregiver-rated parameters were measured to gain a complete view of the effectiveness of aripiprazole. RESULTS: The effectiveness of aripiprazole treatment was demonstrated in a broad range of schizophrenia patients (CGI-I score of 3.0; 95% confidence interval: 2.8, 3.2: last observation carried forward [LOCF]) as the upper bound of the 95% CI was less than 4 (score of "no change"). Both patient and caregiver PGI-I scores (LOCF: 95% CI: 2.79, 3.09 and, 95% CI: 2.74, 3.17, respectively) corroborate this finding. Aripiprazole had a positive effect on disease severity by study end, as assessed by an increase of the (physician-rated) CGI-S scores, with 57.3% of patients having improved disease, one-third maintaining their condition (30.8%) and 11.3% with worsening symptoms (LOCF). The Investigator Assessment Questionnaire (IAQ) showed a great improvement (>50% of patients). Patients reported significantly improved quality of life and overall, 71% of patients and 67% of caregivers preferred aripiprazole to their previous antipsychotic medication (LOCF; P<0.0001 over time). CONCLUSION: Aripiprazole was effective in a broad range of patients with schizophrenia.

Cognitive deficits in patients with chronic fatigue syndrome compared to those with major depressive disorder and healthy controls.

OBJECT: Chronic fatigue syndrome (CFS) patients report usually cognitive complaints. They also have frequently comorbid depression that can be considered a possible explanation for their cognitive dysfunction. We evaluated the cognitive performance of patients with CFS in comparison with a control group of healthy volunteers and a group of patients with MDD. PATIENTS AND METHODS: Twenty-five patients with CFS, 25 patients with major depressive disorder (MDD), and 25 healthy control subjects were given standardized tests of attention, working memory, and verbal and visual episodic memory, and were also tested for effects related to lack of effort/simulation, suggestibility, and fatigue. RESULTS: Patients with CFS had slower phasic alertness, and also had impaired working, visual and verbal episodic memory compared to controls. They were, however, no more sensitive than the other groups to suggestibility or to fatigue induced during the cognitive session. Cognitive impairments in MDD patients were strongly associated with depression and subjective fatigue; in patients with CFS, there was a weaker correlation between cognition and depression (and no correlation with fatigue). CONCLUSIONS: This study confirms the presence of an objective impairment in attention and memory in patients with CFS but with good mobilization of effort and without exaggerated suggestibility.

Major depression is associated with impaired processing of emotion in music as well as in facial and vocal stimuli.

BACKGROUND: The processing of emotional stimuli is thought to be negatively biased in major depression. This study investigates this issue using musical, vocal and facial affective stimuli. METHODS: 23 depressed in-patients and 23 matched healthy controls were recruited. Affective information processing was assessed through musical, vocal and facial emotion recognition tasks. Depression, anxiety level and attention capacity were controlled. RESULTS: The depressed participants demonstrated less accurate identification of emotions than the control group in all three sorts of emotion-recognition tasks. The depressed group also gave higher intensity ratings than the controls when scoring negative emotions, and they were more likely to attribute negative emotions to neutral voices and faces. LIMITATIONS: Our in-patient group might differ from the more general population of depressed adults. They were all taking anti-depressant medication, which may have had an influence on their emotional information processing. CONCLUSIONS: Major depression is associated with a general negative bias in the processing of emotional stimuli. Emotional processing impairment in depression is not confined to interpersonal stimuli (faces and voices), being also present in the ability to feel music accurately.

Belgian Schizophrenia Outcome Survey - results of a 2-year naturalistic study in patients stabilised on monotherapy with olanzapine, risperidone or haloperidol.

OBJECTIVES: This Schizophrenia Outcome Survey compared medical costs, psychopathology and adverse events in outpatients for 2 years following hospitalisation for an acute schizophrenic episode. METHODS: Adults stabilised with haloperidol, olanzapine or risperidone entered this observational study or=1 EPS; 69% (p<0.013), 40 and 44%, respectively, had >or=1 sexual problem (NS). Mean weight gain was 0.4 (NS), 2.6 (p<0.05) and 2.6 kg (p<0.05), respectively. CONCLUSIONS: In this naturalistic study, treatment allocation might have introduced a bias in the interpretation of efficiency results, but olanzapine and risperidone caused less EPS than haloperidol during 2 years of outpatient follow-up.

[Functional somatic complaints in the emergency service and 4 year outcome]. / Plaintes somatiques fonctionnelles dans un service des urgences et leur devenir à 4 ans.

The article presents the clinical profile of 72 somatizations taking in charge by a psychiatric team in a emergency room. They represent mood disorders (37.5%), psychotic disorders (11%) and anxiety disorders (20%). The psychiatric antecedents are very poor. Their outcome after 4 years is good on the health sickness rating scale of Luborsky in 35% and very bad in 25%, particularly for symptomatic score. After their taking in charge in the emergency room, these patients go not much in psychiatric hospitals and in psychiatric consultations. This observation gives to this first intervention in the emergency room a very important rule.

[Therapy for couples in their sixties]. / Couples en thérapie "autour de la soixantaine".

There is small interests in marital therapy for 60 years and more, for which a, at least, partially specific approach seems us necessary. After reviewing the weak literature regarding this topic the authors present six marital therapy in this age group. They propose in their conclusions a five points model of care: brief taking in charge or "coevolution", psychiatric approach, "problem solving", specific crisis of this ages, speaking about sexual life.

Serum myoglobin concentration as an index of myocardial damage after cardiac surgery.

We assessed serum myoglobin concentration as an index of myocardial damage after cardiothoracic surgery in a dog model and man. Experimentally, we compared 12 dogs subject to left thoracotomy either with or without coronary artery ligation to cause an infarct. Serial blood sampling for 24 hours after surgery showed that the times taken for the myoglobin peak concentrations to appear distinguished the two groups without overlap. These times were 2.4 +/- 0.4 hours after surgery without ligation compared with 9.8 +/- 0.8 hours in the ligated group (P less than 0.001). Clinically, serial sampling was performed over 48 hours in 20 patients having undergone cardiac surgery involving cardiopulmonary bypass. A further 80 patients were investigated for 12 hours. Myoglobin was compared with the activities of creatine kinase, 2-hydroxybutyrate dehydrogenase and glutamate-oxaloacetate transaminase in relation to electrocardiographic criteria of myocardial damage. A myoglobin peak greater than 800 micrograms/1 appearing later than 6 hours after starting bypass was found in those patients suffering myocardial damage. The appearance times and activities of the enzymes tested were widely scattered and difficult to interpret. We conclude that blood samples taken at approximately 3 and 6 hours after starting bypass should suffice to characterise both peak myoglobin and its time of appearance which together form a sensitive index of myocardial damage. However, this conclusion is limited by the low incidence of myocardial damage (3%) in this group of patients.