Jean-Michel Azorin

Aix-Marseille Université, Marsiglia, Provence-Alpes-Côte d'Azur, France

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Publications (85)260.89 Total impact

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    ABSTRACT: Bipolar disorder is associated with a high risk of suicide attempts and suicide death. The main objective of the present study was to identify and quantify the demographic and clinical correlates of attempted and completed suicide in people with bipolar disorder.
    Bipolar Disorders 10/2014; · 4.62 Impact Factor
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    ABSTRACT: The aim of this study was to estimate the prevalence of metabolic syndrome (MetS) and its components in a cohort of French patients with bipolar disorder; determine correlations with sociodemographic, clinical, and treatment-related factors; and investigate the gap between optimal care and effective care of the treated patients.
    The Journal of clinical psychiatry. 10/2014; 75(10):1078-85.
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    ABSTRACT: Objective: Deficit in facial affect recognition is a well-documented impairment in schizophrenia, closely connected to social outcome. This deficit could be related to psychopathology, but also to a broader dysfunction in processing facial information. In addition, patients with schizophrenia inadequately use configural information-a type of processing that relies on spatial relationships between facial features. To date, no study has specifically examined the link between symptoms and misuse of configural information in the deficit in facial affect recognition. Method: Unmedicated schizophrenia patients (n = 30) and matched healthy controls (n = 30) performed a facial affect recognition task and a face inversion task, which tests aptitude to rely on configural information. In patients, regressions were carried out between facial affect recognition, symptom dimensions and inversion effect. Results: Patients, compared with controls, showed a deficit in facial affect recognition and a lower inversion effect. Negative symptoms and lower inversion effect could account for 41.2% of the variance in facial affect recognition. Conclusion: This study confirms the presence of a deficit in facial affect recognition, and also of dysfunctional manipulation in configural information in antipsychotic-free patients. Negative symptoms and poor processing of configural information explained a substantial part of the deficient recognition of facial affect. We speculate that this deficit may be caused by several factors, among which independently stand psychopathology and failure in correctly manipulating configural information. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Neuropsychology 09/2014; · 3.58 Impact Factor
  • Jean-Michel Azorin, Raoul Belzeaux, Marc Adida
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    ABSTRACT: This review traces the history of negative symptom profiles in neuropsychiatry from their earliest emergence in the 19th century to the current psychiatric concepts and therapeutic approaches. Recent investigations performing exploratory and confirmatory factor analysis have suggested that negative symptoms are multidimensional, including evidence for at least two distinct negative symptom subdomains: diminished expression and amotivation. Preliminary studies have demonstrated the clinical validity of this distinction. Several potential pathophysiological validating factors based on brain imaging analysis of emotional experiences and expressions in individuals with schizophrenia are examined. Finally, the potential of different treatment strategies, including medications and various psychotherapeutic techniques, to most favorably treat each of these subdomains is discussed.
    CNS Neuroscience & Therapeutics 06/2014; · 4.46 Impact Factor
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    ABSTRACT: Previous studies have shown that major depressive patients may differ in several features according to gender, but the existence of a specific male depressive syndrome remains controversial.
    Journal of affective disorders. 06/2014; 167C:85-92.
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    ABSTRACT: Thought and language disturbances are crucial clinical features in Bipolar Disorders (BD), and constitute a fundamental basis for social cognition. In BD, clinical manifestations such as disorganization and formal thought disorders may play a role in communication disturbances. However, only few studies have explored language disturbances in BD at a neurophysiological level. Two main Event-Related brain Potentials (ERPs) have been used in language comprehension research: the N400 component, elicited by incongruous word with the preceding semantic context, and the Late Positive Component (LPC), associated with non-specifically semantic and more general cognitive processes. Previous studies provided contradictory results regarding N400 in mood disorders, showing either preserved N400 in depression or dysthymia, or altered N400 in BD during semantic priming paradigm. The aim of our study was to explore N400 and LPC among patients with BD in natural speech conditions. ERPs from 19 bipolar type I patients with manic or hypomanic symptomatology and 19 healthy controls were recorded. Participants were asked to listen to congruous and incongruous complete sentences and to judge the match between the final word and the sentence context. Behavioral results and ERPs data were analyzed. At the behavioral level, patients with BD show worst performances than healthy participants. At the electrophysiological level, our results show preserved N400 component in BD. LPC elicited under natural speech conditions shows preserved amplitude but delayed latency in difference waves. Small size of samples, absence of schizophrenic group and medication status. In contrast with the only previous N400 study in BD that uses written semantic priming, our results show a preserved N400 component in ecological and natural speech conditions among patients with BD. Possible implications in terms of clinical specificity are discussed.
    Journal of affective disorders 04/2014; 158:161-71. · 3.76 Impact Factor
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    Raoul Belzeaux, Jean-Michel Azorin, El Chérif Ibrahim
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    ABSTRACT: Although psychiatric disorders are frequently characterized by clinical heterogeneity, high recurrence, and unpredictable prognosis, studies of mRNA expression variations in blood cells from psychiatric patients constitute a promising avenue to establish clinical biomarkers. We report here, to our knowledge, the first genetic monitoring of a major depressive episode (MDE). The subject is a 51-year-old male, who was healthy at baseline and whose blood mRNA was monitored over 67 weeks for expression variations of 9 candidate genes. At week 20 the subject experienced a mild to moderate unexpected MDE, and oral antidepressant treatment was initiated at week 29. At week 36, the patient recovered from his MDE. After 6 months, antidepressant treatment was discontinued and the subject remained free of depressive symptoms. Genetic monitoring revealed that mRNA expression of SLC6A4/5HTT increased with the emergence of a depressive state, which later returned to basal levels after antidepressant treatment and during MDE recovery. PDLIM5, S100A10 and TNF mRNA showed also an interesting pattern of expression with regards to MDE evolution. This case demonstrated the applicability of peripheral mRNA expression as a way to monitor the natural history of MDE.
    BMC Psychiatry 03/2014; 14(1):73. · 2.23 Impact Factor
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    ABSTRACT: Antipsychotic drug side effects are common and can cause stigmatisation, decreased quality of life, poor adherence, and secondary morbidity and mortality. Systematic assessment of anticipated side effects is recommended as part of good clinical care, but is uncommon in practice and patients may not spontaneously report side effects. We aimed to develop a simple patient-completed checklist to screen systematically for potential antipsychotic side effects. The SMARTS checklist was developed over a series of group meetings by an international faculty of 12 experts (including psychiatrists, a general physician and a psychopharmacologist) based on their clinical experience and knowledge of the literature. The emphasis is on tolerability (i.e. assessment of side effects that 'trouble' the patient) as subjective impact of side effects is most relevant to medication adherence. The development took account of feedback from practising psychiatrists in Europe, the Middle East and Africa, a process that contributed to face validity. The SMARTS checklist assesses whether patients are currently 'troubled' by 11 well-established potential antipsychotic side effects. Patients provide their responses to these questions by circling relevant side effects. An additional open question enquires about any other possible side effects. The checklist has been translated into Italian and Turkish. The SMARTS checklist aims to strike a balance between brevity and capturing the most common and important antipsychotic side effects. It is appropriate for completion by patients prior to a clinical consultation, for example, in the waiting room. It can then form the focus for a more detailed clinical discussion about side effects. It can be used alone or form part of a more comprehensive assessment of antipsychotic side effects including blood tests and a physical examination when appropriate. The checklist assesses current problems and can be used longitudinally to assess change.
    Therapeutic advances in psychopharmacology. 02/2014; 4(1):15-21.
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    ABSTRACT: The aim of this study was to describe the phenomenology of mania and depression in bipolar patients experiencing a manic episode with mixed features as defined in the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In this multicenter, international on-line survey (the IMPACT study), 700 participants completed a 54-item questionnaire on demographics, diagnosis, symptomatology, communication of the disease, impact on life, and treatment received. Patients with a manic episode with or without DSM-5 criteria for mixed features were compared using descriptive and inferential statistics. Patients with more than 3 depressive symptoms were more likely to have had a delay in diagnosis, more likely to have experienced shorter symptom-free periods, and were characterized by a marked lower prevalence of typical manic manifestations. All questionnaire items exploring depressive symptomatology, including the DSM-5 criteria defining a manic episode as "with mixed features", were significantly overrepresented in the group of patients with depressive symptoms. Anxiety associated with irritability/agitation was also more frequent among patients with mixed features. Retrospective cross-sectional design, sensitive to recall bias. Two of the 6 DSM-5 required criteria for the specifier "with mixed features" were not explored: suicidality and psychomotor retardation. Bipolar disorder patients with at least 3 depressive symptoms during a manic episode self-reported typical symptomatology. Anxiety with irritability/agitation differentiated patients with depressive symptoms during mania from those with "pure" manic episodes. The results support the use of DSM-5 mixed features specifier and its value in research and clinical practice.
    Journal of affective disorders 01/2014; · 3.76 Impact Factor
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    ABSTRACT: Background Previous studies have shown that major depressive patients may differ in several features according to gender, but the existence of a specific male depressive syndrome remains controversial. Methods As part of the EPIDEP National Multisite French Study of 493 consecutive DSM-IV major depressive patients evaluated in at least two semi-structured interviews 1 month apart, 125 (27.7%) were of male gender, whereas 317 (72.3%) were female, after exclusion of bipolar I patients. Results Compared to women, men were more often married, had more associated mixed features, with more bipolar disorder NOS, more hyperthymic temperaments, and less depressive temperaments. Women had an earlier age at onset of depression, more depressive episodes and suicide attempts. A higher family loading was shown in men for bipolar disorder, alcohol use disorder, impulse control disorders and suicide, whereas their family loading for major depressive disorder was lower. Men displayed more comorbidities with alcohol use, impulse control, and cardiovascular disorders, with lower comorbidities with eating, anxiety and endocrine/metabolic disorders. The following independent variables were associated with male gender: hyperthymic temperament (+), alcohol use disorder (+), impulse control disorders (+), and depressive temperament (−). Limitations The retrospective design and the lack of specific tools to assess the male depressive syndrome. Conclusion Study findings may lend support to the male depression syndrome concept and draw attention to the role of hyperthymic temperament, soft bipolarity as well as comorbidities as determinants of this syndrome. The latter could help recognize an entity which is probably underdiagnosed, but conveys a high risk of suicide and cardiovascular morbidity.
    Journal of Affective Disorders. 01/2014; 167:85–92.
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    Marc Adida, Jean-Michel Azorin
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    ABSTRACT: Adjunctive use of methylphenidate, a central stimulant, has been considered as a potential therapeutic choice for patients with refractory unipolar, geriatric, or bipolar depression, and depression secondary to medical illness. We present a case of bipolar depression in which the patient responded significantly to augmentation with methylphenidate, without any side effects, after failure of adjunctive repetitive transcranial magnetic stimulation and electroconvulsive therapy. Mr U, a 56-year-old man with bipolar I disorder, had melancholic symptoms during his sixth episode of bipolar depression. After failure of repetitive transcranial magnetic stimulation and electroconvulsive therapy, he was treated with fluoxetine 80 mg/day, duloxetine 360 mg/day, mirtazapine 60 mg/day, and sodium valproate 1,000 mg/day, with no improvement. We added methylphenidate at a dose of 10 mg/day for one week, which resulted in mild clinical improvement, and then methylphenidate extended-release 20 mg/day for one week, with significant clinical improvement. He tolerated his medications well. His clinical recovery was stable over one year. The patient's antidepressants and methylphenidate were gradually tapered and finally discontinued after one year with no withdrawal syndrome. To date, he remains well on sodium valproate as monotherapy and is being followed up at our bipolar department. This case suggests that methylphenidate augmentation might be a therapeutic option when treating highly treatment-resistant patients with bipolar depression, even if they had not responded to adjunctive neuromodulation. In these clinical situations, physicians might be interested in prescribing methylphenidate because of its efficacy and safety.
    Neuropsychiatric Disease and Treatment 01/2014; 10:559-62. · 2.00 Impact Factor
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    ABSTRACT: In the past 20 years, much evidence has accumulated against the overly restrictive diagnostic concepts of hypomania in DSM-IV and DSM-IV-TR. We tested DSM-IV-TR and a broader modified version (DSM-IV-TRm) for their ability to detect bipolarity in patients who had been treated for bipolar disorders (BD) in psychiatric settings, and who now consulted general practitioners (GPs) for new major depressive episodes (MDE). Bipolact II was an observational, single-visit survey involving 390 adult patients attending primary care for MDE (DSM-IV-TR criteria) in 201 GP offices in France. The participating GPs (53.3±6.5 years old, 80.1% male) were trained by the Bipolact Educational Program, and were familiar with the medical care of depressive patients. Of the 390 patients with MDE, 129 (33.1%) were previously known as bipolar patients (ICD-10 criteria). Most of the latter bipolar patients (89.7%) had previously been treated with antidepressants. Only 9.3% of them met DMS-IV-TR criteria for BD. Conversely, 79.1% of the 129 bipolar patients met DMS-IV-TRm criteria for BD and showed strong associations with impulse control disorders and manic/hypomanic switches during antidepressant treatment. Limited training of participating GPs, recall bias of patients, and the study not being representative for untreated bipolar patients. Very few ICD-10 bipolar patients consulting French GPs for MDE met DSM-IV-TR criteria for bipolar diagnosis, which suggests that DSM-IV-TR criteria are insufficient and too restrictive for the diagnosis of BD. DSM-IV-TRm was more sensitive, but 20% of bipolar patients were undetected.
    Journal of affective disorders 10/2013; · 3.76 Impact Factor
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    ABSTRACT: OBJECTIVE The risk-benefit profile of antidepressant medications in bipolar disorder is controversial. When conclusive evidence is lacking, expert consensus can guide treatment decisions. The International Society for Bipolar Disorders (ISBD) convened a task force to seek consensus recommendations on the use of antidepressants in bipolar disorders. METHOD An expert task force iteratively developed consensus through serial consensus-based revisions using the Delphi method. Initial survey items were based on systematic review of the literature. Subsequent surveys included new or reworded items and items that needed to be rerated. This process resulted in the final ISBD Task Force clinical recommendations on antidepressant use in bipolar disorder. RESULTS There is striking incongruity between the wide use of and the weak evidence base for the efficacy and safety of antidepressant drugs in bipolar disorder. Few well-designed, long-term trials of prophylactic benefits have been conducted, and there is insufficient evidence for treatment benefits with antidepressants combined with mood stabilizers. A major concern is the risk for mood switch to hypomania, mania, and mixed states. Integrating the evidence and the experience of the task force members, a consensus was reached on 12 statements on the use of antidepressants in bipolar disorder. CONCLUSIONS Because of limited data, the task force could not make broad statements endorsing antidepressant use but acknowledged that individual bipolar patients may benefit from antidepressants. Regarding safety, serotonin reuptake inhibitors and bupropion may have lower rates of manic switch than tricyclic and tetracyclic antidepressants and norepinephrine-serotonin reuptake inhibitors. The frequency and severity of antidepressant-associated mood elevations appear to be greater in bipolar I than bipolar II disorder. Hence, in bipolar I patients antidepressants should be prescribed only as an adjunct to mood-stabilizing medications.
    American Journal of Psychiatry 09/2013; 170:1249-1262. · 14.72 Impact Factor
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    ABSTRACT: Previous studies have demonstrated that bipolar patients may differ in several features according to gender, but a number of the differences found remain controversial. The demographic, illness course, clinical, comorbidity and temperament characteristics of a total of 1090 consecutive DSM-IV bipolar I manic inpatients were compared according to gender. Bipolar illness in women was characterised by the predominance of depression, as indicated by a depressive polarity at onset, higher rates of mixed mania, more suicidal behaviour, and a greater number of temperaments with depressive propensities. In contrast, the manic component was found to predominate in men. Men also had an earlier onset of their illness. Women displayed more comorbidities with eating, anxiety, and endocrine/metabolic disorders, whereas men were more comorbid with alcoholism and other forms of substance abuse, neurological, and cancer disorders. The following independent variables were associated with male gender: being single (+), depressive temperament (-), excessive alcohol use (+), cyclothymic temperament (-), excessive other substance use (+), mood congruent psychotic features (+), and manic polarity at onset (+). The retrospective design and the sample being potentially not representative of the bipolar disorder population are limitations. Findings from this study tend to confirm most of the differences previously observed among bipolar men and women. Furthermore, these results draw attention to the risks that may be specifically linked to gender differences in bipolar I patients.
    Journal of affective disorders 09/2013; · 3.76 Impact Factor
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    ABSTRACT: Background Psychiatric practice is often faced with complex situations that pose serious moral dilemmas for mental health professionals. To some degree, all mental health professionals limit autonomous decision making on a person already impaired by illness. Ethical considerations become more complex when involuntary hospitalization or coercive measures serve to restore autonomy in patients with temporary mental incapacity. The ethical debate around involuntary hospitalization or coercive measures, and more globally around psychiatric care is concerned with whether deprivation of liberty can really be justified in order to help a patient regain his autonomy. On the other hand, patients’ opinions and views are increasingly being recognized as major indicators of how well health services and health systems are performing, as well as providing guidance for further service improvement. Little is known about the patients’ views of admissions to psychiatric hospitals from an ethical perspective. Objective The objective of our study, which is a part of a research project on the ethical references in institutional psychiatric practices is two-fold: To explore the experiences of hospitalized patients, and their perception of the effects of the hospitalization on their suffering and on restoring their psychological autonomy, then to offer possible ways to improve hospital care with a view to an ethical perspective. In this article, the principles based approach to biomedical ethics developed by Beauchamp and Childress is used, with a particular focus on autonomy, beneficence, and non-maleficence. Method The study was conducted in April and May 2010 in full-time hospital units in ten general psychiatry sectors at three hospital sites in Marseille. The study was based on a survey by questionnaire conducted with patients at the end of their hospital stay. The questionnaire consisting of 64 items sought to explore their viewpoints with respect to ethical principles: autonomy (free-will or agency), beneficence (to do good), non-maleficence (not to harm). A descriptive statistical analysis was conducted with SPSS 17.0 software. Data are presented as proportions for discrete variables and as means ± standard deviations for continuous variables. Results Among the 183 patients identified to participate in the survey, 14 refused. A total of 169 patients participated in the study. It showed that empowerment is promoted by the existence of milestones in treatment (more than 85%), freedom of movement (82%), information about the therapeutic plan (83%) and raising questions, especially about involvement in the direction of treatment (58%) and information about the mode of hospitalization (67%), the illness (71%) and the effects of medications (71%). Beneficence is respected at the level of availability of care providers (94%) as well as at the level of recognized beneficial and utilitarian effects (90%). However, hospitalization is an experience potentially loaded with negative affects (experienced as painful 50%, powerless 40%, fear 33%), even if it had protective effects in relation to one's self (86%) and others (53%) and is considered justified (87%). Conclusion In this study, the viewpoint of patients shows that the majority have a favorable perception of the hospital stay and the effects of the stay. These results suggest that attention must be paid to various information delivered during the stay and to the participation and empowerment of patients. This process would move in the direction of more active listening and greater autonomy, and could alleviate feelings of powerlessness, devaluation and the experience of the stay as a punishment. Thus, the process could have a positive impact on the relationship and acceptance of treatment in the future. Treatment teams could have an analytical tool in the form of a patient questionnaire, which would make it possible to approach the manner in which the arrangement of the proposed therapeutic process is perceived with the objective to adapt practice to a therapeutic and ethical intent. An important future research project would be an examination of whether following patients’ preferences using our questionnaire results in a better perception and a less aversive experience.
    Annales Médico-psychologiques revue psychiatrique 09/2013; 171(8):518–523. · 0.20 Impact Factor
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    ABSTRACT: Bipolar disorder (BD) has a multifactorial etiology with heterogeneous clinical presentations. Around 25% of BD patients may present with a depressive seasonal pattern (SP). However, there are limited scientific data on the prevalence of SP, its clinical manifestations, and any gender influence. Four hundred and fifty-two BD I and II cases (62% female), recruited from three French university-affiliated psychiatric departments, were assessed for SP. Clinical, treatment, and sociodemographic variables were obtained from structured interviews. One hundred and two (23%) cases met DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) criteria for SP, with similar frequency according to gender. Multivariate analysis showed a significant association between SP and BD II (odds ratio [OR] = 1.99, p = 0.01), lifetime history of rapid cycling (OR = 2.05, p = 0.02), eating disorders (OR = 2.94, p = 0.003), and total number of depressive episodes (OR = 1.13, p = 0.002). Seventy-one percent of cases were correctly classified by this analysis. However, when stratifying the analyses by gender, SP was associated with BD II subtype (OR = 2.89, p = 0.017) and total number of depressive episodes (OR = 1.21, p = 0.0018) in males but with rapid cycling (OR = 3.02, p = 0.0027) and eating disorders (OR = 2.60, p = 0.016) in females. This is the first study to identify different associations between SP and clinical characteristics of BD according to gender. The authors suggest that SP represents a potentially important specifier of BD. These findings indicate that seasonality may reflect increased severity or complexity of disorder.
    Chronobiology International 08/2013; · 4.35 Impact Factor
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    ABSTRACT: There is mounting evidence that current diagnostic systems inadequately recognize clinically relevant levels of hypomania in depressed patients, thereby leading to an under-diagnosis of bipolar disorders and the associated risk of treatment that is inappropriate or may actually worsen illness course. The Hypomania Checklist-32 revised version 2 (HCL-32-R2) is a self-rating scale for hypomanic symptoms specifically developed to address this problem. The goal of this study was to assess the transcultural validity of the HCL-32-R2. Measurement invariance of HCL-32-R2 responses from the multinational Bipolar Disorders: Improving Diagnosis, Guidance, and Education (BRIDGE) Study of 5635 patients with major depressive episodes (MDEs) was assessed by exploratory and confirmatory factor analysis across five cultural regions. Two previously identified factors were reproduced and explained 60% of the variance in test responses. Only three out of 32 items had cross-culturally variable factor loadings. Some moderate measurement invariance was also found with regard to age and gender. In discriminating unipolar from bipolar disorder, the HCL-32-R2 showed a sensitivity of 82% with a specificity of 57% when current DMS-IV criteria for bipolar disorder were used, and substantially higher specificity of 73% when evidence-based modified criteria were applied. The psychometric properties of the HCL-32-R2 were largely culture-independent. This finding replicates that of our previous international study and is a step towards validating the HCL-32-R2 as a broadly applicable screening instrument for hypomanic features, facilitating the detection of hidden bipolarity in depressed patients.
    Bipolar Disorders 07/2013; · 4.62 Impact Factor
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    ABSTRACT: BACKGROUND: Many studies have used admixture analysis to separate age-at-onset (AAO) subgroups in bipolar patients, but few have looked at the phenomenological characteristics of these subgroups, in order to find out phenotypic markers. METHODS: Admixture analysis was applied to identify the model best fitting the observed AAO distribution of a sample of 1082 consecutive DSM-IV bipolar I manic inpatients who were assessed for demographic, clinical, course of illness, comorbidity, and temperamental characteristics. RESULTS: The model best fitting the observed distribution of AAO was a mixture of three Gaussian distributions. We could identify three AAO subgroups: early, intermediate, and late age-at-onset (EAO, IAO, and LAO, respectively). Patients in the EAO subgroup were more often single young males exhibiting severe mania with psychotic features, a subcontinuous course of illness with substance use and panic comorbidity, more suicide attempts, and temperamental components sharing hypomanic features. Patients with LAO showed a less severe picture with more depressive temperamental components, alcohol use and comorbid general medical conditions. A less typical phenotype was present in IAO patients. LIMITATIONS: The following are the limitations of this study: retrospective design, and bias toward preferential enrollment of patients with manic predominant polarity. CONCLUSIONS: This study confirms that bipolar I disorder can be subdivided into three subgroups based on AAO distribution and shows that patients from these subgroups differ in phenotypes.
    Journal of affective disorders 06/2013; · 3.76 Impact Factor
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    ABSTRACT: The aim of this analysis was to identify Young Mania Rating Scale (YMRS) meaningful benchmarks for clinicians (severity threshold, minimal clinically significant difference [MCSD]) using the Clinical Global Impressions Bipolar (CGI-BP) mania scale, to provide a clinical perspective to randomized clinical trials (RCTs) results. We used the cohort of patients with acute manic/mixed state of bipolar disorders (N = 3459) included in the European Mania in Bipolar Longitudinal Evaluation of Medication (EMBLEM) study. A receiver-operating characteristic analysis was performed on randomly selected patients to determine the YMRS optimal severity threshold with CGI-BP mania score ≥ "Markedly ill" defining severity. The MCSD (clinically meaningful change in score relative to one point difference in CGI-BP mania for outcome measures) of YMRS, was assessed with a linear regression on baseline data. At baseline, YMRS mean score was 26.4 (±9.9), CGI-BP mania mean score was 4.8 (±1.0) and 61.7% of patients had a score ≥ 5. The optimal YMRS severity threshold of 25 (positive predictive value [PPV] = 83.0%; negative predictive value [NPV] = 66.0%) was determined. In this cohort, a YMRS score of 20 (typical cutoff for RCTs inclusion criteria) corresponds to a PPV of 74.6% and to a NPV of 77.6%, meaning that the majority of patients included would be classified as severely ill. The YMRS minimal clinically significant difference was 6.6 points. Copyright © 2013 John Wiley & Sons, Ltd.
    International journal of methods in psychiatric research. 03/2013;
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    ABSTRACT: Nonadherence is common among patients with schizophrenia, although the rates vary according to means of assessment and patient population. Failure to adhere to medication can have a major impact on the course of illness and treatment outcomes, including increasing the risk of relapse and rehospitalization. Understanding psychiatrists' perception of the causes and consequences of nonadherence is crucial to addressing adherence problems effectively. The Europe, the Middle East, and Africa (EMEA) Spanish Adherencia Terapéutica en la Esquizofrenia (ADHES) survey was conducted by questionnaire during January-March 2010 among psychiatrists treating patients with schizophrenia in 36 countries. The survey comprised 20 questions. In addition to recording the demographic details of the 4722 respondents (~12% response rate), it canvassed their preferred methods of assessing adherence, their perceptions of adherence rates, reasons for nonadherence, and strategies to improve adherence. Psychiatrists estimated that 53% of their patients with schizophrenia were partially/nonadherent during the previous month. They estimated only one-third of patients who deteriorated after stopping medication were able to attribute this to nonadherence. Psychiatrists assessed adherence most often by patient interview. Lack of insight was viewed as the most important cause of medication discontinuation, followed by patients feeling better and thinking their medication unnecessary, and experiencing undesirable side effects. Considerably fewer psychiatrists viewed insufficient efficacy, cognitive impairment, or drug/alcohol abuse as the most important reasons for their patients stopping medication. Psychiatrists throughout EMEA recognize the impact of partial/nonadherence to medication, with patient enquiry being the most commonly used means of assessment. There remains a need for more proactive management of patients with schizophrenia, particularly in increasing patient insight of their illness in order to improve adherence and minimize the consequences of relapse. Strategies focused on raising awareness of the importance of adherence are also warranted, with the aim of improving patient outcomes in schizophrenia.
    Patient Preference and Adherence 01/2013; 7:121-32. · 1.33 Impact Factor

Publication Stats

842 Citations
260.89 Total Impact Points

Institutions

  • 2008–2014
    • Aix-Marseille Université
      Marsiglia, Provence-Alpes-Côte d'Azur, France
  • 2013
    • University of Zurich
      Zürich, Zurich, Switzerland
  • 2003–2013
    • Assistance Publique Hôpitaux de Marseille
      • Pôle Psychiatrique
      Marsiglia, Provence-Alpes-Côte d'Azur, France
    • University of California, San Diego
      • Department of Psychiatry
      San Diego, California, United States
  • 2012
    • Università di Pisa
      Pisa, Tuscany, Italy
    • Creativ-Ceutical
      Letzeburg, Luxembourg, Luxembourg
  • 2008–2012
    • University College London
      • Mental Health Sciences Unit
      London, ENG, United Kingdom
  • 2011
    • University of Texas Health Science Center at San Antonio
      • Department of Psychiatry
      San Antonio, Texas, United States
    • Unité Inserm U1077
      Caen, Lower Normandy, France
  • 2009
    • Institut de Recherche sur les Phénomènes Hors Equilibre
      Marsiglia, Provence-Alpes-Côte d'Azur, France
  • 2007
    • University of Leipzig
      • Klinik und Poliklinik für Psychiatrie und Psychotherapie
      Leipzig, Saxony, Germany