J.-M. Azorin

Pôle Universitaire Léonard de Vinci, Paris La Defense, Ile-de-France, France

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Publications (226)485.96 Total impact

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    ABSTRACT: The aim of our study was to investigate, in bipolar patients, the association between tobacco status (use and dependence) and history of suicide attempt, and to assess the possible role of inflammation as a missing link in the association between smoking status and history of suicide attempt. A total of 453 adult bipolar out-patients recruited in the French FondaMental Advanced Centres of Expertise for Bipolar Disorder were divided into two subgroups: 274 patients without past history of suicide attempt (non-SA), and 179 patients with a past history of suicide attempt (SA). Tobacco use and dependence, psychiatric and somatic comorbidities, history of childhood abuse, family history of suicide were assessed. Fasting blood tests yielded samples collected for the measurement of high sensitivity (hs-)CRP. The risk of suicide attempt increased with smoking dependence. Notably, bipolar patients with a history of suicide attempt were three times more likely to have severe tobacco dependence, independently of confounding factors. However, we failed to find arguments promoting the hypothesis of inflammatory markers (through hs-CRP measure) in the link between tobacco dependence and suicidal behavior. We found a significant association between severe tobacco dependence and history of suicide attempt, but not with level of CRP, independently of confusing factors. Longitudinal studies taken into account all these potential confusing factors are needed to confirm our results. Copyright © 2015 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 05/2015; 183. DOI:10.1016/j.jad.2015.04.038 · 3.71 Impact Factor
  • J M Azorin, M Adida, R Belzeaux
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    ABSTRACT: Literature suggests bipolars may differ in several features according to predominant polarity, but the role of temperaments remains controversial. The EPIDEP study was designed to identify bipolar patients among a large sample of major depressives. Only bipolars were included in the current study. Patients were subtyped as predominantly depressive (PD) and predominantly manic and hypomanic (PM) according to a broad (more episodes of a given polarity) and a narrow (2/3 of episodes of one polarity over the other) definition, and compared on their characteristics. Among 278 bipolars, 182 (79.8%) could be subtyped as PD and 46 (20.2%) as PM (broad definition); the respective proportions were of 111 (81.6%) and 25 (18.4%) using narrow definition. Expanding the definition added little in detecting differences between groups. Compared to PDs, PMs showed more psychosis, rapid cycling, stressors at onset, family history of affective illness, and manic first episode polarity; they also received more antipsychotics and lithium. The PDs showed more chronic depression, comorbid anxiety, and received more antidepressants, anticonvulsants and benzodiazepines. The following independent variables were associated with manic/hypomanic predominant polarity: cyclothymic temperament, first hospitalization≤25 years, hyperthymic temperament, and alcohol use (only for broad definition). Cross-sectional design, recall bias. Study findings are in accord with literature except for suicidality and mixicity which were related to predominant mania, and explained by higher levels of cyclothymic and hyperthymic temperaments. Temperaments may play a key role in the subtyping of bipolar patients according to predominant polarity, which warrants confirmation in prospective studies. Copyright © 2015 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 04/2015; 182:57-63. DOI:10.1016/j.jad.2015.04.037 · 3.71 Impact Factor
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    ABSTRACT: Dear editor,We have read with great interest the contribution of Leorides Severo-Duarte Guerra et al. [1]. The authors underlined the high lifetime prevalence of mood disorders and particularly bipolar disorders in patients seeking bariatric surgery in Brazil. It is worth noting that standardized evaluation enables to determine with more accuracy the prevalence of such disorders, but their research gives no information about the rates of underdiagnosed psychiatric disorders in such a population before this standardized evaluation. However, several studies have underlined that psychiatric disorders in community samples, in particular bipolar disorders, are frequently underdiagnosed and confused with major depressive disorders [2, 3]. This seems especially true in patients with obesity because major depressive episodes seem to be predictive of bipolar disorder in this specific population [4]. As a consequence, one hypothesis may be that a high proportion of psychiatric disorders is under ...
    Obesity Surgery 01/2015; 25(3). DOI:10.1007/s11695-014-1557-7 · 3.74 Impact Factor
  • L Encéphale 12/2014; 40. DOI:10.1016/S0013-7006(14)70124-1 · 0.60 Impact Factor
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    L Encéphale 12/2014; 40. DOI:10.1016/S0013-7006(14)70127-7 · 0.60 Impact Factor
  • L Encéphale 12/2014; 40. DOI:10.1016/S0013-7006(14)70129-0 · 0.60 Impact Factor
  • L Encéphale 12/2014; 40. DOI:10.1016/S0013-7006(14)70132-0 · 0.60 Impact Factor
  • L Encéphale 12/2014; 40. DOI:10.1016/S0013-7006(14)70131-9 · 0.60 Impact Factor
  • L Encéphale 12/2014; 40. DOI:10.1016/S0013-7006(14)70133-2 · 0.60 Impact Factor
  • L Encéphale 12/2014; 40. DOI:10.1016/S0013-7006(14)70128-9 · 0.60 Impact Factor
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    L Encéphale 12/2014; 40. DOI:10.1016/S0013-7006(14)70130-7 · 0.60 Impact Factor
  • J.-M. Azorin, R. Belzeaux, M. Adida
    L Encéphale 12/2014; 40. DOI:10.1016/S0013-7006(14)70122-8 · 0.60 Impact Factor
  • L Encéphale 12/2014; 40. DOI:10.1016/S0013-7006(14)70126-5 · 0.60 Impact Factor
  • L Encéphale 12/2014; 40. DOI:10.1016/S0013-7006(14)70123-X · 0.60 Impact Factor
  • L Encéphale 12/2014; 40. DOI:10.1016/S0013-7006(14)70125-3 · 0.60 Impact Factor
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    ABSTRACT: Mood and substance use disorders commonly co-occur, yet there is little evidence-based research to guide the pharmacologic management of these comorbid disorders. The authors review the existing empirical findings including current clinical pharmacotherapy practices for treating co-occurring mood and substance use disorders and call into question current clinical practices. The specific mood disorders reviewed are bipolar and major depressive disorders (either one co-occurring with a substance use disorder). The authors also highlight knowledge gaps that may serve as a basis for future research. Findings from the relatively small amount of available data indicate that pharmacotherapy for managing mood symptoms might be effective in patients with substance dependence, although results have not been consistent across all studies. In most studies, medications for managing mood symptoms did not appear to have an impact on the substance use disorder. Research has only begun to address optimal pharmacologic management of co-occurring disorders. In addition, current clinical treatment for drug dependence often exclude new pharmacotherapies approved by the French Haute Autorité de Santé for treating certain types of addiction. With new data becoming available, it appears that we need to revisit current practice in the pharmacological management of co-occurring mood and substance use disorders. Copyright © 2014 L’Encéphale. Published by Elsevier Masson SAS.. All rights reserved.
    L Encéphale 12/2014; 40 Suppl 3:S8-S13. · 0.60 Impact Factor
  • Eric Fakra, R Belzeaux, J M Azorin, M Adida
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    ABSTRACT: Epidemiologic studies show a frequent co-occurence of affective and eating disorders. The incidence of one disorder in patients suffering from the other disorder is well over the incidence in the general population. Several causes could explain this increased comorbidity. First, the iatrogenic origin is detailed. Indeed, psychotropic drugs, and particularly mood stabilizers, often lead to modification in eating behaviors, generally inducing weight gain. These drugs can increase desire for food, reduce baseline metabolism or decrease motor activity. Also, affective and eating disorders share several characteristics in semiology. These similarities can not only obscure the differential diagnosis but may also attest of conjoint pathophysiological bases in the two conditions. However, genetic and biological findings so far are too sparse to corroborate this last hypothesis. Nonetheless, it is noteworthy that comorbidity of affective and eating disorders worsens patients'prognosis and is associated with more severe forms of affective disorders characterized by an earlier age of onset in the disease, higher number of mood episodes and a higher suicidality. Lastly, psychotropic drugs used in affective disorders (lithium, antiepileptic mood stabilizers, atypical antipsychotics, antidepressants) are reviewed in order to weigh their efficacy in eating disorders. This could help establish the best therapeutic option when confronted to comorbidity. Copyright © 2014 L’Encéphale. Published by Elsevier Masson SAS.. All rights reserved.
    L Encéphale 12/2014; 40 Suppl 3:S46-50. · 0.60 Impact Factor
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    ABSTRACT: Anxiety disorders are frequently associated with affective disorders and represent one of the most important comorbidity in patients with bipolar disorder. Their prevalence is high, whatever the anxiety disorder, with nevertheless higher rates for generalized anxiety disorder (18.4 to 19.9 % for lifetime prevalence). Such high frequencies raise essential questions about the link between these groups of disorders, and if it is necessary to distinguish them or to consider their phenomenological overlap as resulting of common disease processes. The existence of comorbid anxiety disorder in bipolar disorder significantly worsens its evolution, inducing more severe episodes, shortening remission periods, favoring relapses and suicide as well as substance use, and reducing quality of life in comparison to bipolar patients without anxiety. The mechanisms that link the anxious symptomatology to mood dysregulation are still poorly understood, although it is likely that genetic factors play a key role, combined with other factors of vulnerability, including those involved in coping strategy to address ongoing distress. Despite the high impact of anxiety on the severity of bipolar disorder course, few randomized controlled trials examined treatments of comorbid anxiety disorders and only recent recommendations offer useful therapeutic perspectives. In this context, it seems necessary to better understand the features associated with the occurence of anxiety disorders in affective disorders, in order to better identify the mechanisms underlying such comorbidity, together with working to develop therapeutics that efficiently target them. Copyright © 2014 L’Encéphale. Published by Elsevier Masson SAS.. All rights reserved.
    L Encéphale 12/2014; 40 Suppl 3:S18-22. · 0.60 Impact Factor
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    ABSTRACT: Background It is unclear whether there is a direct link between economic crises and changes in suicide rates. Aims The Lopez-Ibor Foundation launched an initiative to study the possible impact of the economic crisis on European suicide rates. Method Data was gathered and analysed from 29 European countries and included the number of deaths by suicide in men and women, the unemployment rate, the gross domestic product (GDP) per capita, the annual economic growth rate and inflation. Results There was a strong correlation between suicide rates and all economic indices except GPD per capita in men but only a correlation with unemployment in women. However, the increase in suicide rates occurred several months before the economic crisis emerged. Conclusions Overall, this study confirms a general relationship between the economic environment and suicide rates; however, it does not support there being a clear causal relationship between the current economic crisis and an increase in the suicide rate.
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    ABSTRACT: Objective Identifying bipolar patients at high-suicide risk is a major health issue. To improve their identification, we compared dimensional and neuropsychological profile of bipolar patients with or without history of suicide attempt, taking into account suicidal severity (i.e. admission to intensive ward).MethodA total of 343 adult euthymic bipolar out-patients recruited in the French FondaMental Advanced Centres of Expertise for Bipolar Disorder were divided into three subgroups: 214 patients without history of suicide attempt, 88 patients with past history of non-severe suicide attempt and 41 patients with past history of severe suicide attempt. General intellectual functioning, speed of information processing, verbal learning and memory, verbal fluency and executive functioning were assessed.ResultsSevere suicide attempters had lower affective intensity and lability than non-severe attempters. Severe suicide attempters outperformed non-severe attempters for verbal learning and non-attempters for Stroop word reading part after adjustment for study centre, age, gender, educational level, antipsychotics use, depression score, anxious and addictive comorbidities.Conclusion Neuropsychological tasks commonly used to assess bipolar patients do not seem accurate to identify suicide attempters in euthymic patients. In the future, decision-making and emotional recognition tasks should be assessed. Moreover, clinical and neuropsychological profiles should be considered together to better define suicidal risk.
    Acta Psychiatrica Scandinavica 08/2014; 131(2). DOI:10.1111/acps.12326 · 5.55 Impact Factor

Publication Stats

2k Citations
485.96 Total Impact Points

Institutions

  • 2010–2014
    • Pôle Universitaire Léonard de Vinci
      Paris La Defense, Ile-de-France, France
  • 1988–2012
    • Aix-Marseille Université
      Marsiglia, Provence-Alpes-Côte d'Azur, France
  • 2001–2010
    • Assistance Publique Hôpitaux de Marseille
      • Pôle Psychiatrique
      Marsiglia, Provence-Alpes-Côte d'Azur, France
  • 1989–2004
    • French National Centre for Scientific Research
      Lutetia Parisorum, Île-de-France, France
  • 2003
    • University of California, San Diego
      • Department of Psychiatry
      San Diego, California, United States
  • 1998–2003
    • Hôpital Européen, Marseille
      Marsiglia, Provence-Alpes-Côte d'Azur, France
  • 1988–1992
    • Clinique médicale et pédagogique Dupré
      Île-de-France, France