39 results on '"Samalin L"'
Search Results
2. Comprendre les conduites suicidaires : définition et facteurs de risque
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Patoz, M.-C. and Samalin, L.
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- 2022
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3. [French Expert advice on the management of valproate in childbearing and pregnant women with bipolar disorder]
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Samalin, L, Arnould, A, Boudieu, L, Henry, C, Haffen, E, Drapier, D, Anmella, G, Pacchiarotti, I, Vieta, E, Belzeaux, R, Llorca, P. M., Institut Pascal (IP), Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne (UCA)-Institut national polytechnique Clermont Auvergne (INP Clermont Auvergne), Université Clermont Auvergne (UCA)-Université Clermont Auvergne (UCA), CHU Clermont-Ferrand, GHU AP-HP Centre Université de Paris, Centre d'Investigation Clinique de Besançon (Inserm CIC 1431), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS BFC)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red Salud Mental [Madrid] (CIBER-SAM), Institut de Neurosciences de la Timone (INT), Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Ce projet a reçu le support institutionnel de l’Association française de psychiatrie biologique et neuropsychopharmacologie.Les travaux de recherche du Dr Anmella sont soutenus par une bourse Rio Hortega 2021 (CM21/00017) financée par l'Instituto de Salud Carlos III (ISCIII) et cofinancée par le Fondo Social European Plus (FSE+).Les travaux de recherche du Dr Pacchiarotti sont soutenus par des bourses FIS 2018 et 2021 (PI18/01001, and PI21/00169) financées par l'Instituto de Salud Carlos III (ISCIII).
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Valproate ,Bipolar Disorder ,[SDV]Life Sciences [q-bio] ,Valproic Acid ,Guidelines ,Perinatal ,Recommandations professionnelles ,Childbearing ,Pregnancy ,Recurrence ,Femme en âge de procréer ,Périnatalité ,Humans ,Female ,Anticonvulsants ,Trouble bipolaire ,Pregnant Women ,Child ,Antipsychotic Agents - Abstract
National audience; INTRODUCTION: The perinatal period is associated with high risk of relapses in women with untreated bipolar disorder (BD) and can have significant consequences on foetal and child development. Valproate is an effective mood stabilizer in BD but it is also the anticonvulsant associated to the highest risks of neurodevelopmental disorders and congenital malformations. The National Agency for the Safety of Medicines and Health Products (ANSM) changed the conditions of use and prescription of valproate in France in 2015. Its prescription is now contraindicated (i.e., not to be prescribed) in women able to have children unless alternative treatments are ineffective or not tolerated. Moreover, valproate could only be prescribed if the protocol of a specific pregnancy prevention program is followed. METHODS: A panel of experts from the French Association for Biological Psychiatry and Neuropsychopharmacology (AFPBN) provided consensus-based recommendations for switching and discontinuation of valproate in women with BD. The development of these recommendations consisted of an adaptation to French clinical practice based on a European expert opinion published in 2019. The experts discussed five real-world clinical situations in light of the scientific evidence and their clinical experience (a. Stable BD patient with valproate monotherapy who is planning pregnancy, b. Stable BD patient with valproate polytherapy who is planning pregnancy, c. Unstable BD patient with frequent relapses and valproate polytherapy who is planning pregnancy, d. Stable BD patient treated with valproate and unexpected pregnancy, e. Unstable BD patient treated with valproate and unexpected pregnancy) and developed, through several rounds of exchange drafts, a French version of clinical recommendations. RESULTS: First of all, some factors need to be considered for establishing personalized practical recommendations for a safe and effective switching or discontinuation of valproate in any clinical situations: planned pregnancy or unplanned pregnancy or current pregnancy, the existence or not of a pregnancy risk minimization program and a complete treatment history. Other factors that should be considered are the predominant polarity, the severity, the stability, the comorbidities associated with BD, the beliefs toward treatments, the family situation and the preference of the patient. The modalities for switching or discontinuation of valproate in women with BD were related to the clinical situation. First-line therapeutic alternatives such as lithium, lamotrigine, quetiapine, olanzapine or aripiprazole were preferred for patients suffering from a clinically stable BD considering pregnancy or pregnant. In patients suffering from clinically unstable BD, to reach stability was considered first. A shared decision-making should be systematically implemented and the patient must be fully informed of the risks related to an in-utero exposure to valproate, and the risks of the discontinuation/switch that is considered. CONCLUSION: Although the adaptation to French practice of the recommendations from the European expert opinion highlighted some differences in the criteria taken into consideration to guide the therapeutic decision, this expert advice will guide the clinician for switching and discontinuation of valproate in BD women able to have children or pregnant.
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- 2022
4. A smartphone application of personalized psychoeducation: how does it work ?
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Hidalgo-Mazzei, D. and Samalin, L.
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- 2018
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5. Décision médicale partagée : quels outils en pratique ?
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Samalin, L.
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- 2018
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6. Quelles innovations thérapeutiques dans la prise en charge du trouble bipolaire ?
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Samalin, L., Roux, P., Hidalgo-Mazzei, D., and Etain, B.
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- 2018
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7. Modalités d’initiation de la formulation trimestrielle de palmitate de palipéridone en pratique clinique : résultats de l’étude française en vie réelle OPTIMUS
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Gary, C., Déal, C., Boursicot-Beuzelin, J., Guillon, P., Falissard, B., Giordana, J.Y., Fakra, E., Samalin, L., and Bouju, S.
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- 2019
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8. Étude rétrospective de la trajectoire du trouble bipolaire en fonction de l’ordre et du délai d’apparition avec un trouble lié à l’usage d’alcool
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Aubin, V., Belzeaux, R., Biseul, I., Brousse, G., Gard, S., Godin, O., Guillaume, S., Icick, R., Loftus, J., and Samalin, L.
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- 2019
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9. Trajectoire du trouble bipolaire en fonction de sa séquence d’installation avec les troubles liés à l’usage d’alcool dans la cohorte des centres experts du réseau fondamental : identifier des cibles thérapeutiques
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Aubin, V., Belzeaux, R., Biseul, I., Brousse, G., Gard, S., Godin, O., Guillaume, S., Icick, R., Loftus, J., and Samalin, L.
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- 2019
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10. BI ou pas trop BI : quels marqueurs pour différencier les troubles bipolaires des troubles dépressifs majeurs ?
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Murru, A., Belzeaux, R., N’Diaye, K., and Samalin, L.
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- 2019
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11. Recommandations Formalisées d’Experts de l’Association Française de Psychiatrie Biologique et Neuropsychopharmacologie sur le dépistage et prise en charge du trouble bipolaire : mise à jour 2014
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Samalin, L., Guillaume, S., Courtet, P., Abbar, M., Lancrenon, S., Llorca, P-M, Neuro-Psycho Pharmacologie des Systèmes Dopimanégiques sous-corticaux (NPsy-Sydo), CHU Clermont-Ferrand-Université Clermont Auvergne [2017-2020] (UCA [2017-2020]), Centre Hospitalier Sainte Anne [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Neuropsychiatrie : recherche épidémiologique et clinique (PSNREC), Université Montpellier 1 (UM1)-Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Sylia Stat Lancrenon S.A.S., and Université Montpellier 1 (UM1)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)
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Adult ,Male ,Psychotropic Drugs ,Troubles bipolaires ,Psychopharmacology ,Bipolar disorder ,Recommandations ,Middle Aged ,Guidelines ,Long-Term Care ,Risk Assessment ,Pharmacotherapy ,Psychopharmacologie ,[SDV.MHEP.PSM]Life Sciences [q-bio]/Human health and pathology/Psychiatrics and mental health ,Acute Disease ,Chronic Disease ,Humans ,Drug Therapy, Combination ,Female ,France ,Biological Psychiatry ,Societies, Medical - Abstract
International audience; As part of a process to improve the quality of care, the French Society for Biological Psychiatry and Neuropsychopharmacology developed in 2010 formal consensus guidelines for the treatment of bipolar disorder. The evolution of therapeutic options available in France for the treatment of bipolar disorder has justified the update of this guideline. The purpose of this work was to provide an updated and ergonomic document to promote its use by clinicians. This update focuses on two of the six thematic previously published (acute treatment and long-term treatment). Aspects of the treatment of bipolar patients sparking debate and questions of clinicians (use of antidepressant, place of the bitherapy, interest of long-acting antipsychotics…) were also covered. Finally, we proposed graded recommendations taking into account specifically the risk-benefit balance of each molecule.
- Published
- 2015
12. Euthymia is not always euthymia: Clinical status of bipolar patients after 6 months of clinical remission
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Samalin, L., De chazeron, I., Reinares, M., Torrent, C., Bonnin, C.D.M., Hidalgo, D., Murru, A., Pacchiarotti, I., Bellivier, F., Llorca, P.M., and Vieta, E.
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- 2016
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13. Serious game : un nouvel outil pédagogique dans la prise en charge des patients souffrant de schizophrénie
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Samalin, L.
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- 2015
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14. Recommandations professionnelles en psychiatrie : quelles méthodologies, quels enjeux ?
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Samalin, L.
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- 2013
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15. [Psychopharmacotherapeutic guidelines : a challenge during health crisis]
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Javelot H, Samalin L, Weiner L, Meyer G, Fossati P, emmanuel haffen, Pm, Llorca, haffen, emmanuel, Etablissement Public de Santé Alsace Nord [EPSAN], Laboratoire de pharmacologie et toxicologie neurocardiovasculaire (LPTNC), Université de Strasbourg (UNISTRA), Neuro-Psycho Pharmacologie des Systèmes Dopimanégiques sous-corticaux (NPsy-Sydo), CHU Clermont-Ferrand-Université Clermont Auvergne [2017-2020] (UCA [2017-2020]), CHU Strasbourg, Laboratoire de Psychologie des Cognitions (LPC), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Université Pierre et Marie Curie - Paris 6 (UPMC), Laboratoire de Neurosciences Intégratives et Cliniques - UFC (UR 481) (NEURO), Université de Franche-Comté (UFC), and Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)
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MESH: Pandemics ,MESH: Humans ,Psychotropic drugs ,MESH: Psychotropic Drugs ,MESH: Coronavirus Infections ,SARS-CoV-2 ,Mental Disorders ,[SDV]Life Sciences [q-bio] ,Pneumonia, Viral ,education ,COVID-19 ,Guidelines ,[SDV] Life Sciences [q-bio] ,Betacoronavirus ,MESH: Pneumonia, Viral ,Humans ,MESH: Betacoronavirus ,MESH: COVID-19 ,MESH: Mental Disorders ,MESH: SARS-CoV-2 ,Coronavirus Infections ,Pandemics ,COVID 19 ,health care economics and organizations - Abstract
The construction of pharmacological guidelines is a complex endeavor, and this is all the truer amidst a health crisis such as the current SARS-CoV-2 pandemic. In psychiatric settings, guidelines have to consider the handling of other drugs (i.e., psychotropic medications), that have been suggested as potentially prophylactic for COVID-19. These dialectics are discussed here, and the methodological foundations used for the elaboration of guidelines are put forward.Réaliser des recommandations pharmacothérapeutiques est une démarche complexe, plus encore dans une période de crise sanitaire, comme celle que nous traversons avec la pandémie liée au SARS-CoV-2. En psychiatrie, les préconisations formulées se doivent de rappeler la légitime prudence à adopter dans le maniement des psychotropes, dans un contexte qui, par ailleurs, présente certaines de ces médications comme potentiellement prophylactiques de la COVID-19. Ces enjeux contradictoires sont débattus, les concepts méthodologiques de l’élaboration des recommandations sont rappelés.
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- 1970
16. [Validated care programs for patients with functional neurological disorders].
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Rauline G, Hingray C, Carle-Toulemonde G, Hubsch C, El Hage W, Conejero I, Samalin L, Garcin B, and Gharib A
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- Humans, Delayed Diagnosis, Dissociative Disorders, Psychotherapy, Transcranial Direct Current Stimulation, Conversion Disorder diagnosis, Conversion Disorder therapy
- Abstract
Functional neurological disorder (FND) is a common cause of persistent and disabling neurological symptoms. Diagnostic delay may lead to no treatment, inappropriate treatment or even iatrogenic symptoms. Yet, several treatments significantly reduce physical symptoms and improve functioning in FND patients even though not all patients respond to the currently available treatments. This review aims to describe the range of evidence-based rehabilitative and/or psychological therapeutic approaches available for FND patients. The most effective treatments are multidisciplinary and coordinated; using an outpatient or inpatient setting. Building a network of FND-trained healthcare professionals around the patient is an essential aspect of optimal patient management. Indeed, a supportive environment coupled with a collaborative therapeutic relationship improves understanding of FND and appears to help patients engage in appropriate treatments. Patients need to be invested in their own care and have to understand that recovery may depend on their commitment. The conventional treatment combines psychoeducation, physical rehabilitation and psychotherapy (cognitive and behavioral therapy, hypnosis, psychodynamic interpersonal therapy). Early referral of patients to physical therapy is recommended; however, the optimal parameters of treatment, duration and intensity are unknown and seem to vary with the severity and chronicity of symptoms. The goal is to minimize self-awareness by diverting attention or by stimulating automatically generated movements with non-specific and gradual exercises. The use of compensatory technical aids should be avoided as much as possible. Psychotherapeutic management should encourage self-evaluation of cognitive distortions, emotional reactions and maladaptive behaviors while empowering the patient in managing symptoms. Symptom management can use anchoring strategies to fight against dissociation. The aim is to connect to the immediate environment and to enrich one's sensoriality. The psychological interventions should then be adapted to the individual psychopathology, cognitive style and personality functioning of each patient. There is currently no known curative pharmacological treatment for FND. The pharmacological approach rather consists of progressively discontinuing medication that was introduced by default and that could lead to undesirable side effects. Finally, neurostimulation (transcranial magnetic stimulation, transcranial direct current stimulation) can be effective on motor FND., (Copyright © 2023 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)
- Published
- 2023
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17. [Recommandations to facilitate the discontinuation of valproate in women of childbearing age].
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Samalin L and Belzeaux R
- Subjects
- Female, Humans, Anticonvulsants adverse effects, Valproic Acid adverse effects, Bipolar Disorder drug therapy
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- 2023
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18. [Interest of hypnosis with a paradigm's use in anorexia nervosa: A case report].
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Méry R, Flaudias V, Guillaume S, Geneste J, Llorca PM, and Samalin L
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- Humans, Anorexia Nervosa therapy, Hypnosis
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- 2022
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- View/download PDF
19. [Psychopharmacotherapeutic guidelines : a challenge during health crisis].
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Javelot H, Samalin L, Weiner L, Meyer G, Fossati P, Haffen E, and Llorca PM
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- COVID-19, Humans, Mental Disorders drug therapy, SARS-CoV-2, Betacoronavirus, Coronavirus Infections, Pandemics, Pneumonia, Viral epidemiology, Psychotropic Drugs therapeutic use
- Abstract
The construction of pharmacological guidelines is a complex endeavor, and this is all the truer amidst a health crisis such as the current SARS-CoV-2 pandemic. In psychiatric settings, guidelines have to consider the handling of other drugs (i.e., psychotropic medications), that have been suggested as potentially prophylactic for COVID-19. These dialectics are discussed here, and the methodological foundations used for the elaboration of guidelines are put forward.
- Published
- 2020
20. Utilisation des objets connectés en recherche clinique.
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Dhainaut JF, Huot L, Bouchara Pomar V, Dubray C, Augé P, Barthélémy P, Belghiti J, Bureau S, Cassagnes J, Deblois S, Di Palma M, Dorsay G, Duchossoy L, Durand-Salmon F, Escudier T, Fiorini M, Franc S, Gelpi O, Laporte S, Lavallée E, Lethiec F, Meunier JP, Peyret O, Samalin L, and Vicaut E
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- 2018
- Full Text
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21. [Comparison of medical and economic benefits of antipsychotics in the treatment of schizophrenia in France].
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Druais S, Doutriaux A, Cognet M, Godet A, Lançon C, Levy P, Samalin L, and Guillon P
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- Ambulatory Care economics, Cohort Studies, Cost-Benefit Analysis, Delayed-Action Preparations, France, Health Status, Humans, Markov Chains, Models, Economic, National Health Programs economics, Patient Compliance, Quality-Adjusted Life Years, Recurrence, Antipsychotic Agents economics, Antipsychotic Agents therapeutic use, Schizophrenia drug therapy, Schizophrenia economics
- Abstract
Introduction: The course of schizophrenia can vary widely, and patients experience remission phases alternating with relapse episodes, which generally lead to hospitalisation and have a significant impact on the burden of disease. The prevalence of schizophrenia in France is estimated to be approximately 600,000 people, with an incidence of 10,000 new patients per year. Patients with schizophrenia represent the largest group of hospitalised patients in French public institutions and specialised centres, and the French authorities recognise that the management of schizophrenia is a major public health concern. The Haute Autorité de Santé (HAS) and most of the evidence-based guidelines for the maintenance treatment of schizophrenia recommend long-acting injectable (LAI) antipsychotics to be used predominantly in the prevention of relapse for non-compliant patients; however, in clinical practice, the use of LAIs remains low., Objective: This analysis aimed to estimate and to compare the cost-effectiveness of the most common antipsychotic strategies in France in the management of schizophrenia., Methods: A Markov model was developed to simulate the progression of a cohort of patients with schizophrenia through four health states (stable treated, stable non-treated, relapse and death) and considered up to three lines of treatment to account for changes in treatment management. Antipsychotics including aripiprazole LAI (ALAI), olanzapine LAI (OLAI), paliperidone LAI (PLAI), risperidone LAI (RLAI), haloperidol decanoate (HD) and oral olanzapine (OO) were compared in terms of costs and clinical outcomes. Thus, costs, quality-adjusted life-years (QALYs) and number of relapses were assessed over five years based on three-month cycles from a French health insurance perspective with a discount rate of 4 %. Patients were considered to be stabilised after clinical decompensation and would enter the model at an initiation phase, followed by a prevention of relapse phase if successful. Data (e.g. relapse or discontinuation rates) for the initiation phase came from randomised clinical trials, whereas relapse rates in the prevention phase were derived from hospitalisation risks based on French real-life data in order to capture adherence effects. Safety and utility data were derived from international publications. Additionally costs were retrieved from French health insurance databases and publications. Robustness of results was assessed through deterministic and probabilistic sensitivity analyses., Results: First and second generations of LAIs were found to have similar costs over five years; i.e. approximately € 55,000, except for PLAI which was associated with a discounted cost of € 50,880. Oral antipsychotics were found to be less costly (i.e. OO cost € 50,379 after five years) but associated with a lower number of QALYs gained and relapse avoided. PLAI and RLAI were associated with the greatest number of QALYs gained; i.e. PLAI dominated ALAI, OLAI and HD and was associated with an incremental costs-effectiveness ratio (ICER) of € 2411 per QALY gained versus OO. Finally, PLAI and OLAI were associated with the lowest number of relapses; i.e. PLAI dominated RLAI, ALAI and HLAI and was associated with an ICER of € 1782 per avoided relapse compared to OO. OO and HD were found to have led to the highest number of relapses., Conclusion: This analysis, to the best of our knowledge, is the first of its kind to assess the cost-effectiveness of antipsychotics based on French observational data. PLAI was associated with the highest probability of being the optimal treatment from the French health insurance perspective., (Copyright © 2016. Published by Elsevier Masson SAS.)
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- 2017
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22. [Long-term efficacy and safety of lurasidone in the treatment of schizophrenia].
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Samalin L, Honciuc M, and Llorca PM
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- Adult, Antipsychotic Agents adverse effects, Female, Humans, Lurasidone Hydrochloride adverse effects, Male, Antipsychotic Agents therapeutic use, Lurasidone Hydrochloride therapeutic use, Schizophrenia drug therapy
- Abstract
Lurasidone is a new second-generation antipsychotic approved in March 2014 by the European Medicines Agency for the treatment of schizophrenia. Lurasidone has demonstrated its efficacy in long-term studies. It has been shown to reduce significantly the risk of relapse in comparison with placebo in patients with schizophrenia. In comparator study, lurasidone was noninferior to quetiapine XR in risk for relapse. In open-label studies, lurasidone was associated with sustained improvement in efficacy measures observed and well-tolerated inpatients with schizophrenia who had switched to lurasidone from another antipsychotic. Available evidence showed also that lurasidone might be involved in the long-term improvement of cognitive performance in schizophrenic patients. Lurasidone differs from the other second-generation antipsychotics by a good tolerability profile, in particular in terms of metabolic and cardiovascular profiles. Lurasidone seems to have a moderate link with the occurrence of akathisia and extrapyramidal symptoms. Although lurasidone long-acting formulation is lacking, the long-term profile of lurasidone appears compatible with a good acceptability and consequently a good compliance to treatment of patients with schizophrenia.
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- 2015
- Full Text
- View/download PDF
23. [French Society for Biological Psychiatry and Neuropsychopharmacology task force. Formal consensus for the treatment of bipolar disorder: an update (2014)].
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Samalin L, Guillaume S, Courtet P, Abbar M, Lancrenon S, and Llorca PM
- Subjects
- Acute Disease, Adult, Chronic Disease, Drug Therapy, Combination, Female, France, Humans, Long-Term Care, Male, Middle Aged, Psychotropic Drugs adverse effects, Risk Assessment, Biological Psychiatry, Bipolar Disorder drug therapy, Psychopharmacology, Psychotropic Drugs therapeutic use, Societies, Medical
- Abstract
As part of a process to improve the quality of care, the French Society for Biological Psychiatry and Neuropsychopharmacology developed in 2010 formal consensus guidelines for the treatment of bipolar disorder. The evolution of therapeutic options available in France for the treatment of bipolar disorder has justified the update of this guideline. The purpose of this work was to provide an updated and ergonomic document to promote its use by clinicians. This update focuses on two of the six thematic previously published (acute treatment and long-term treatment). Aspects of the treatment of bipolar patients sparking debate and questions of clinicians (use of antidepressant, place of the bitherapy, interest of long-acting antipsychotics…) were also covered. Finally, we proposed graded recommendations taking into account specifically the risk-benefit balance of each molecule., (Copyright © 2014 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)
- Published
- 2015
- Full Text
- View/download PDF
24. [Short-term efficacy and safety of lurasidone in the treatment of schizophrenia].
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Samalin L, Ben Gharbia M, Garnier M, and Llorca PM
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- Antipsychotic Agents adverse effects, Dose-Response Relationship, Drug, Double-Blind Method, Humans, Isoindoles adverse effects, Lurasidone Hydrochloride, No-Observed-Adverse-Effect Level, Psychiatric Status Rating Scales, Randomized Controlled Trials as Topic, Schizophrenia diagnosis, Thiazoles adverse effects, Treatment Outcome, Antipsychotic Agents therapeutic use, Isoindoles therapeutic use, Schizophrenia drug therapy, Schizophrenic Psychology, Thiazoles therapeutic use
- Abstract
Lurasidone is a new second-generation antipsychotic approved in October 2010 by the Food and Drug Administration and in March 2014 by the European Medicines Agency for the treatment of schizophrenia. Like other second-generation antipsychotics, lurasidone is an antagonist of D2 dopamine and 5HT2A serotonin receptors, but differs from the other second-generation antipsychotics in its action profile for certain receptors. Lurasidone is the second-generation antipsychotic with the greatest affinity for 5HT7 receptors and has a low affinity for α1 and α2C-adrenergic and 5HT2C serotonin receptors, and no affinity for histaminergic H1 or muscarinic M1 receptors. Lurasidone has demonstrated its efficacy in several short-term studies in acute schizophrenia with significantly reducing total scores of Positive and Negative Syndrome Scale (PANSS) and Brief Psychiatric Rating Scale (BPRS) compared with placebo. Early improvement was observed by days 3-7 for the 80-160 mg/day doses. Two studies with several methodological limitations showed that lurasidone might be involved in the improvement of cognitive performance in schizophrenic patients. Post hoc analysis of four pooled short-term studies showed significantly better effects on improving depressive symptoms associated with schizophrenia in patients treated with lurasidone as compared to patients treated with placebo. Lurasidone differs from the other second-generation antipsychotics by a good tolerability profile, in particular in terms of metabolic and cardiovascular profiles. Although results of the preclinical studies suggested that lurasidone had a low potential for causing clinically significant extrapyramidal symptoms, these were observed with a higher frequency than expected. It seems to have a significant though moderate link with the occurrence of akathisia, extrapyramidal symptoms, and hyperprolactinemia during initiation of treatment. This new tolerance profile greatly broadens the scope of second-generation antipsychotics and supports the view of some authors that the term second-generation antipsychotic is now outdated. Other therapeutic perspectives of lurasidone have been assessed, in particular in bipolar depression., (Copyright © 2014 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)
- Published
- 2014
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25. [Aripiprazole long-acting for the maintenance treatment of schizophrenia.]
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Samalin L, Charpeaud T, and Llorca PM
- Abstract
Antipsychotics are the cornerstone for the maintenance treatment of schizophrenia patients. Their long-acting formulations are helpful for preventing relapses through improvement of adherence to medication and a better pharmacokinetic coverage. However, their use is often reserved for refractory or non-observant clinical forms because of limitations among both clinicians and patients. The development of a new formulation of long-acting injectable aripiprazole administered every 4 weeks is a new option. Two randomized controlled trials vs. placebo and vs. oral aripiprazole respectively show a superiority and non-inferiority in terms of relapse prevention. Meanwhile, a mirror-image study demonstrates fewer hospitalizations. The safety profile is comparable to the oral formulation, particularly in terms of metabolic and neurological side-effects. As mentioned in various professional recommendations, long-acting injectable antipsychotics, so long-acting injectable aripiprazole, are one of the major strategies of the maintenance treatment for patients with schizophrenia., (Copyright © 2014. Published by Elsevier Masson SAS.)
- Published
- 2014
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26. [Efficacy of aripiprazole for the treatment of schizophrenia: what dose is required?].
- Author
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Charpeaud T, Samalin L, and Llorca PM
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- Aripiprazole, Dose-Response Relationship, Drug, Double-Blind Method, Evidence-Based Medicine, Hostility, Humans, Piperazines adverse effects, Psychiatric Status Rating Scales, Psychomotor Agitation diagnosis, Psychomotor Agitation drug therapy, Psychomotor Agitation psychology, Quinolones adverse effects, Randomized Controlled Trials as Topic, Schizophrenia diagnosis, Treatment Outcome, Piperazines administration & dosage, Quinolones administration & dosage, Schizophrenia drug therapy, Schizophrenic Psychology
- Abstract
Objective: Problem of the choice of antipsychotic dose is a key issue in clinical practice. It determines the efficacy and safety of treatment. Aripiprazole is recommended at a dose of between 10 and 15 mg/day in the treatment of schizophrenia, with a dose range considered to be effective, between 10 and 30 mg/day. This wide therapeutic range prompted us to investigate the existence of a possible dose-effect relationship for aripiprazole in the treatment of schizophrenia., Method: We conducted a literature review from PubMed and EMBASE database, with the keywords: aripiprazole, schizophrenia. We limited it to studies published in English and French, with the main objective to assess the efficacy of aripiprazole in patients with schizophrenia. We selected only randomized clinical trials, double-blind, controlled against placebo or against an active comparator. Studies in which aripiprazole was studied added to another antipsychotic were not retained., Results: Twenty-two randomized, double-blind, controlled studies were selected. Three studies assessed the efficacy of aripiprazole on agitation symptoms in patients with schizophrenia and for which a dose of aripiprazole between 1 and 15mg showed significant efficacy compared to placebo. Seven clinical trials focused on the effect of aripiprazole short term (less than 12weeks). For the primary endpoint (PANSS scores), aripiprazole was superior to placebo or equivalent to active comparators (risperidone, olanzapine or haloperidol). These short-term studies revealed a range of effective doses from 10 mg/day to 20 mg/day. Five studies, lasting between 16 and 52 weeks, with a primary endpoint being the time to discontinuation for any cause for two studies, the time before relapse in one study, and the improvement in PANSS scores for the two other studies. On these different endpoints, aripiprazole was effective at average doses between 15 and 28.1 mg/day. The safety of aripiprazole was particularly favourable in these trials. Finally, we listed seven post-hoc analyses. In support of these long-term analyses on different endpoints, aripiprazole showed significant efficacy at higher doses (20 and 30 mg/day) than those used in the agitation treatment., Conclusions: No study was designed to compare aripiprazole doses in schizophrenia. Nevertheless, efficacy on agitation and hostility components had been observed for doses of 10mg/day, or lower; whereas the antipsychotic effect in acute or maintenance phase appeared optimal for doses ranging from 10 to 25 mg/day. Only one study retained a minimum effective dose of 10mg/day on the PANSS scores. This literature review reveals an effective dose range between 10 and 25 mg/day for aripiprazole in schizophrenia. Less than 10 mg/day did not show significant efficacy on symptoms of schizophrenia, apart from a specific short-term effect on agitation, at very low doses (starting at 1mg). Optimization of treatment, at doses above 25 mg/day, cannot be the subject of evidence-based recommendations., (Copyright © 2014 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)
- Published
- 2014
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27. [French Society for Biological Psychiatry and Neuropsychopharmacology task force: Formal Consensus for the prescription of depot antipsychotics].
- Author
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Samalin L, Abbar M, Courtet P, Guillaume S, Lancrenon S, and Llorca PM
- Subjects
- Administration, Oral, Adult, Anticonvulsants adverse effects, Anticonvulsants therapeutic use, Antipsychotic Agents administration & dosage, Antipsychotic Agents adverse effects, Bipolar Disorder diagnosis, Bipolar Disorder drug therapy, Bipolar Disorder psychology, Delayed-Action Preparations, Drug Therapy, Combination, Female, France, Humans, Injections, Intramuscular, Male, Medication Adherence, Middle Aged, Psychotic Disorders diagnosis, Psychotic Disorders psychology, Quality Improvement, Schizophrenia diagnosis, Schizophrenia drug therapy, Schizophrenia, Paranoid diagnosis, Schizophrenia, Paranoid drug therapy, Schizophrenia, Paranoid psychology, Schizophrenic Psychology, Secondary Prevention, Antipsychotic Agents therapeutic use, Psychotic Disorders drug therapy, Societies, Medical
- Abstract
Background: Compliance is often partial with oral antipsychotics and underestimated for patients with serious mental illness. Despite their demonstrated advantages in terms of relapse prevention, depot formulations are still poorly used in routine. As part of a process to improve the quality of care, French Association for Biological Psychiatry and Neuropsychopharmacology (AFPBN) Task Force elaborated a Formal Consensus for the prescription of depot antipsychotics in clinical practice., Methods: The Task Force recommends as first-line choice, the use of long-acting injectable (LAI) second-generation antipsychotics in patients with schizophrenia, schizoaffective disorder and delusional disorder. They can be considered as a second-line option as a monotherapy to prevent manic recurrence or in combination with mood stabilizer to prevent depressive recurrence in the maintenance treatment of bipolar disorder. LAI second-generation antipsychotics can also be used after a first episode of schizophrenia. Depot neuroleptics are not recommended during the early course of schizophrenia and are not appropriate in bipolar disorder. They are considered as a second-line option for maintenance treatment in schizophrenia., Results: LAI formulations should be systematically proposed to any patients for whom maintenance antipsychotic treatment is indicated. LAI antipsychotics can be used preferentially for non-compliant patients with frequent relapses or aggressive behaviors., Conclusion: A specific information concerning the advantages and inconveniences of the LAI formulations, in the framework of shared-decision making must be delivered to each patient. Recommendations for switching from one oral/LAI form to another LAI and for using LAI antipsychotics in specific populations (pregnant women, elderly patients, subjects in a precarious situation, and subjects having to be treated in a prison establishment) are also proposed., (Copyright © 2013 L’Encéphale. Published by Elsevier Masson SAS.. All rights reserved.)
- Published
- 2013
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28. [Mixed states].
- Author
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Llorca PM, Charpeaud T, and Samalin L
- Subjects
- Arousal, Attention, Bipolar Disorder classification, Bipolar Disorder therapy, Cognition Disorders classification, Cognition Disorders diagnosis, Cognition Disorders psychology, Cognition Disorders therapy, Comorbidity, Cyclothymic Disorder classification, Cyclothymic Disorder diagnosis, Cyclothymic Disorder psychology, Cyclothymic Disorder therapy, Diagnosis, Differential, Diagnostic and Statistical Manual of Mental Disorders, Humans, Prognosis, Psychomotor Disorders classification, Psychomotor Disorders diagnosis, Psychomotor Disorders psychology, Psychomotor Disorders therapy, Suicidal Ideation, Affect, Bipolar Disorder diagnosis, Bipolar Disorder psychology
- Abstract
The issue of mixed states has an important place in the debate on psychiatric nosography since the end of 19th century. The current definition of mixed states according to the DSM- IV, as a thymic episode of bipolar disorder type I, is probably somewhat too restrictive in clinical practice. Due to the clinical heterogeneity of bipolar disorder, the mixed states will define within a dimensional approach, likely in the next DSM- V. As the evolution, the prognosis or the therapeutic strategies differ from what is applied in other thymic episodes, this transition from "mixed state" to manic or depressive episodes "with mixed features" may be relevant in practice., (Copyright © 2012 L’Encéphale. Published by Elsevier Masson SAS.. All rights reserved.)
- Published
- 2012
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29. [Treatment initiation in psychotic and manic episodes: French attitudes collected by Focus Group].
- Author
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Benoit M, Bellivier F, Llorca PM, Millet B, Passamar M, Schwan R, Marty L, Cailhol L, Giordana B, Naudet F, Samalin L, Tadri M, Yon L, Hacques E, and Moreau-Mallet V
- Subjects
- Adult, Adverse Drug Reaction Reporting Systems, Aged, Antimanic Agents adverse effects, Antipsychotic Agents adverse effects, Bipolar Disorder diagnosis, Bipolar Disorder psychology, Drug Administration Schedule, Drug Interactions, Drug Therapy, Combination, Evidence-Based Medicine, Female, Humans, Male, Medication Adherence, Middle Aged, Practice Guidelines as Topic, Psychotic Disorders diagnosis, Psychotic Disorders psychology, Schizophrenia diagnosis, Antimanic Agents administration & dosage, Antipsychotic Agents administration & dosage, Bipolar Disorder drug therapy, Focus Groups, Psychotic Disorders drug therapy, Schizophrenia drug therapy, Schizophrenic Psychology
- Abstract
An accurate treatment of first episodes in schizophrenia and bipolar disorders has a significant impact on compliance and prognosis. However, existing therapeutic guidelines may be poorly respected and may concern only typical clinical situations. Medical attitudes in clinical practice have been collected and structured on the basis of small interactive meetings (Focus Group [FG]), and a synthesis of practical attitudes has been compared with updated guidelines. The FG method applied to treatment initiation in schizophrenia and bipolar disorder is seen as complementary to evidence-based guidelines. It reveals that, in a reflexive manner, clinical attitudes are often more diverse and frequently consider first treatments after global evaluation, taking more into account external factors such as clinicians' experience, patient's history and willingness, clinical setting, and environment. A symptomatic approach is sometimes preferred, and a better alliance is always considered as a main objective. The FG method could be a supplementary support to continuous medical education., (Copyright © 2012 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)
- Published
- 2012
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30. [Asenapine in bipolar disorder: efficacy, safety and place in clinical practice].
- Author
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Samalin L, Tixeront C, and Llorca PM
- Subjects
- Adult, Anticonvulsants adverse effects, Anticonvulsants therapeutic use, Antimanic Agents adverse effects, Antimanic Agents therapeutic use, Antipsychotic Agents adverse effects, Benzodiazepines adverse effects, Benzodiazepines therapeutic use, Bipolar Disorder diagnosis, Bipolar Disorder psychology, Dibenzocycloheptenes, Double-Blind Method, Drug Therapy, Combination, Female, Heterocyclic Compounds, 4 or More Rings adverse effects, Humans, Male, Olanzapine, Psychiatric Status Rating Scales statistics & numerical data, Psychometrics, Randomized Controlled Trials as Topic, Treatment Outcome, Antipsychotic Agents therapeutic use, Bipolar Disorder drug therapy, Heterocyclic Compounds, 4 or More Rings therapeutic use
- Abstract
Asenapine is a new second-generation antipsychotic (SGA) approved in September 2010 by the European Medicines Agency for the treatment of bipolar disorder. It was significantly more effective than placebo in acute mania or mixed episodes as monotherapy or adjunctive therapy to mood stabilizers (lithium or valproate). Early improvement was seen at day-2 (significant difference with placebo) and was strongly associated with week-3 response and remission. These suggest that the observation of an early improvement in the first week may be clinically an useful tool for individual treatment adjustment during the early course of treatment. Post-hoc analyses of asenapine studies showed significantly better effects on improving depressive symptoms associated with manic symptoms, and physical health related quality of life dimensions as compared to placebo. Asenapine differs from the other SGAs by a good tolerability profile, in particular in terms of metabolic profile. However, it seems to have a significant though moderate link with the occurrence of sedation. This new tolerance profile greatly broadens the scope of SGAs and supports the view of some authors that the term SGA is now outdated. Other therapeutic perspectives of asenapine are being assessed, in particular in specific population (pediatric and elderly patients)., (Copyright © 2012 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)
- Published
- 2012
- Full Text
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31. [Helping the "hard-core" smokers].
- Author
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Perriot J, Underner M, Peiffer G, Le Houezec J, Samalin L, Schmitt A, de Chazeron I, and Doly-Kuchcik L
- Subjects
- Algorithms, Humans, Motivation physiology, Nicotine therapeutic use, Practice Guidelines as Topic, Smoking epidemiology, Smoking genetics, Tobacco Use Disorder epidemiology, Tobacco Use Disorder etiology, Tobacco Use Disorder genetics, Tobacco Use Disorder therapy, Helping Behavior, Smoking therapy, Smoking Cessation methods
- Abstract
Smoking cessation specialists are frequently confronted with smokers who have great difficulty in stopping smoking, and who are either motivated to stop or are forced to stop for health, economic or statutory reasons. These smokers are composed of a mixed population but they have in common a heavy dependence on tobacco and a significant level of cigarette consumption. They are exposed to serious morbidity induced by their uncontrollable smoking. Other factors unfavourable to the attempt to stop smoking are often present: anxiety-depressive disorders, socioeconomic difficulties or the use of psychoactive substances. They constitute a priority target for smoking cessation clinics, which must optimise and diversify proposals to improve their interventions. This review describes these highly dependent smokers unable to stop, and suggests medical treatments and therapeutic combinations to assist the practitioners trying to help the "hard-core" smokers., (Copyright © 2012 SPLF. Published by Elsevier Masson SAS. All rights reserved.)
- Published
- 2012
- Full Text
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32. [Methodological approach to inter "guideline" variability in the management of bipolar disorders].
- Author
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Samalin L and Llorca PM
- Subjects
- Antimanic Agents adverse effects, Antipsychotic Agents adverse effects, Antipsychotic Agents therapeutic use, Bipolar Disorder diagnosis, Bipolar Disorder psychology, Consensus, Drug Therapy, Combination, Evidence-Based Medicine, Guideline Adherence, Humans, Lithium Carbonate adverse effects, Lithium Carbonate therapeutic use, Psychiatric Status Rating Scales statistics & numerical data, Psychometrics, Randomized Controlled Trials as Topic, Risk Assessment, Treatment Outcome, Valproic Acid adverse effects, Valproic Acid therapeutic use, Antimanic Agents therapeutic use, Bipolar Disorder drug therapy, Practice Guidelines as Topic
- Abstract
Introduction: In recent decades, an increasing number of pharmacologic agents have become available in bipolar disorder treatment. These therapeutic advances provide a new challenge for clinicians in the choice of medication for patients with bipolar disorder. In this context, tools have been developed for making medical decisions in the management of bipolar disorder: guidelines., Methods: Guidelines for bipolar disorder were compared on the basis of their construction methodology (evidence-based treatment guidelines or consensus-based treatment guidelines), results and recommendations for clinical practice., Results: There are differences between guidelines for treating bipolar disorder. For the American Psychiatric Association (APA), the severity of the manic episode is a primary endpoint of the decision-making tree for the choice of therapy. On the other hand, the National Institute for Health and Clinical Excellence (NICE) ruled that the choice of the initial treatment, in the case of manic episode, should be based first on the current patient's treatment (history of anti-manic therapy) while the World Federation of Societies of Biological Psychiatry (WFSBP) emphasizes the clinical classification of the type of mania. The sequencing of medication in the guidelines may vary according to the construction methodology, the date of elaboration, the geocultural context and experts' position. Recent guidelines consider the last randomized controlled trials (RCT) as those of aripiprazole in the treatment of mania, recommending it in first line as anti-manic agent. The recent updated WFSBP guidelines changed in its construction methodology taking into account the negative studies or those showing non-superiority compared to placebo. Thus, a recent study of non-superiority of lithium monotherapy compared to placebo in the treatment of bipolar depression downgraded lithium from level of evidence B to D. During recent years, a large number of RCT have demonstrated superior efficacy (particularly in mania treatment) of lithium or valproate combined with second-generation antipsychotic compared with lithium or valproate monotherapy. Consequently, according to geocultural context or experts' position, some guidelines recommended medication combinations in first line (Canadian Network for Mood and Anxiety Treatment) and other guidelines considered monotherapy in first line (except for particular cases) to promote tolerance and good therapeutic alliance (WFSBP). Malhi et al. recommended a sequencing of medication based on the benefit risk ratio for the management of each phase of bipolar disorder. These differences between guidelines may cause difficulties for clinicians in choosing clinical practice guidelines., Conclusion: While there are a large number of guidelines for bipolar disorder, the recommendations may vary depending on multiple factors. It seems interesting to conduct a comparative study of guidelines for bipolar disorder on the basis of a validated scale (AGREE) or completed by other items such as date of elaboration and number of proposed recommendations. However, the methodological understanding of guidelines remains the central element for practitioners in their choice of guidelines. Thus, the initial objective of guidelines "to develop statements to assist clinician and patient decisions about the most appropriate health care for specific clinical situations" could be implemented in clinical practice., (Copyright © 2011 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)
- Published
- 2012
- Full Text
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33. [Lithium and anticonvulsants in bipolar depression].
- Author
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Samalin L, Nourry A, and Llorca PM
- Subjects
- Anticonvulsants adverse effects, Antimanic Agents adverse effects, Antipsychotic Agents adverse effects, Antipsychotic Agents therapeutic use, Bipolar Disorder diagnosis, Bipolar Disorder psychology, Clinical Trials as Topic, Drug Interactions, Drug Therapy, Combination, Drug-Related Side Effects and Adverse Reactions, Humans, Lamotrigine, Lithium Carbonate adverse effects, Secondary Prevention, Treatment Outcome, Triazines adverse effects, Triazines therapeutic use, Valproic Acid adverse effects, Valproic Acid therapeutic use, Anticonvulsants therapeutic use, Antimanic Agents therapeutic use, Bipolar Disorder drug therapy, Lithium Carbonate therapeutic use
- Abstract
For decades, lithium and anticonvulsants have been widely used in the treatment of bipolar disorder. Their efficacy in the treatment of mania is recognized. These drugs have been initially evaluated in old and methodologically heterogeneous studies. Their efficacy in bipolar depression has not always been confirmed in more recent and methodologically more reliable studies. Thus, lithium's efficacy as monotherapy was challenged by the study of Young (2008) that showed a lack of efficacy compared with placebo in the treatment of bipolar depression. In two recent meta-analyses, valproate has shown a modest efficacy in the treatment of bipolar depression. As for lithium, valproate appeared to have a larger antimanic effect for acute phase and prophylaxis of bipolar disorder. In contrast, lamotrigine is more effective on the depressive pole of bipolar disorder with better evidence for the prevention of depressive recurrences. The guidelines include these recent studies and recommend lamotrigine as a first-line treatment of bipolar depression and for maintenance treatment. Because of more discordant data concerning lithium and valproate, these two drugs are placed either as first or as second line treatment of bipolar depression. The different safety/efficacy ratios of mood stabilizers underlie the complementarity and the importance of combination between them, or with some second-generation antipsychotics, in the treatment of patients with bipolar disorder., (Copyright © 2011 L’Encéphale. Published by Elsevier Masson SAS.. All rights reserved.)
- Published
- 2011
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34. [Antidepressants in bipolar disorder].
- Author
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Courtet P, Samalin L, and Olié E
- Subjects
- Affect drug effects, Antipsychotic Agents adverse effects, Antipsychotic Agents therapeutic use, Bipolar Disorder diagnosis, Bipolar Disorder psychology, Drug Therapy, Combination, Humans, Risk Assessment, Treatment Outcome, Antidepressive Agents adverse effects, Antidepressive Agents therapeutic use, Bipolar Disorder chemically induced, Bipolar Disorder drug therapy
- Abstract
Whereas mania defines the bipolar disorder, depression is the major challenge of treatment. In general, depressions are more frequent, longer, with a major prognostic impact in terms of disability and suicide. How should we treat a patient with bipolar depression? Antidepressants are the treatment of choice for depression, but not in the bipolar disorder. In this context, we have traditionally accepted that antidepressants are effective but they were inducing a significant risk of destabilization of the bipolar disorder, because of the transitions to mania and rapid cycling. Current data reconsider both the two aspects of this risk-benefit ratio. The effectiveness of antidepressants finally seems very limited, especially after the more recent studies with a robust methodology. Manic switches and rapid cycling may not be increased, particularly with new antidepressants and mood stabilizer combinations. The current literature reminds us that these course's modalities are inherent to the disease, with numerous risk factors, and among them, exposure to antidepressants. Who are the bipolar patients who only get the benefits of antidepressant treatment? Research will tell. They are in any case limited. How to navigate in our treatment strategies ? By choosing first drugs that demonstrated efficacy in bipolar depression. When the situation is more complex, "primum non nocere" should lead to support the prescription of the antidepressant in association with mood stabilizer., (Copyright © 2011 L’Encéphale. Published by Elsevier Masson SAS.. All rights reserved.)
- Published
- 2011
- Full Text
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35. [The contributions of the evidence-based medicine or how to optimize the management of major depressive disorder].
- Author
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Llorca PM, Charpeaud T, Nourry A, and Samalin L
- Subjects
- Antidepressive Agents adverse effects, Combined Modality Therapy, France, Guideline Adherence, Humans, Meta-Analysis as Topic, Placebo Effect, Psychotherapy, Randomized Controlled Trials as Topic, Antidepressive Agents therapeutic use, Depressive Disorder, Major drug therapy, Evidence-Based Medicine
- Abstract
In the early 1980s, Evidence-Based Medicine (EBM) has been developed in the Department of Clinical Epidemiology at McMaster Medical School in Canada to meet the ever-increasing need to integrate publications in clinical practice. In this approach, we cannot ever consider that the evidence will replace clinical experience. The quality of scientific data is prioritized taking into account the methodological characteristics of studies. It takes time to learn and practice the method, which is often difficult in daily practice. The concept of "management recommendations" covers multiple realities. It can rely on the results of clinical trials (randomized, controlled or not…), the trends from the meta-analysis that attempt to "simplify" the field of literature or the Clinical Practice Guidelines. Meta-analysis should be used with caution. They do not preclude the need to use the data "sources", but they help the comparability of results and synthesis work. However it should be aware that this is a work of interpretation. The controversy over the action of antidepressants compared to placebo in depression according to the severity of the episode shows that a result depends on the included studies, the statistical technique used, but also how the results are reported. The international literature produced many recommendations in the management of depression. It is useful to refer to it as the meta-analysis because they provide an overall view of the current state of knowledge. We can regret the lack of recent French recommendations that could articulate the specifics of the French practice and data from the literature. The use of guidelines in clinical practice remains low in all fields of medicine. However improving the consideration of the recommendations is an important issue because it is associated with improved patient care. It remains to develop a collective strategy to implement them. The Evidence-Based Medicine is a major change in the everyday clinical practice. It may be insufficiently known and understood, seems too complex, time-consuming and therefore inapplicable. We have to mobilize our efforts to improve our practices., (Copyright © 2011 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)
- Published
- 2011
- Full Text
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36. [Bipolar depression and suicidal behavior].
- Author
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Guillaume S, Courtet P, and Samalin L
- Subjects
- Antimanic Agents therapeutic use, Bipolar Disorder drug therapy, Bipolar Disorder psychology, Comorbidity, Depressive Disorder, Major drug therapy, Depressive Disorder, Major mortality, Depressive Disorder, Major psychology, Diagnosis, Differential, Humans, Lithium Carbonate therapeutic use, Risk Factors, Stress, Psychological complications, Suicidal Ideation, Suicide psychology, Suicide, Attempted prevention & control, Suicide, Attempted psychology, Suicide Prevention, Bipolar Disorder mortality, Cause of Death, Suicide statistics & numerical data, Suicide, Attempted statistics & numerical data
- Abstract
Suicide is a frequent and tragic consequence of bipolar depression. The prevention of suicidal behavior (SB) need an assessment of vulnerability traits related related to SB (personal suicide history, impulsive traits...), characteristics of depression (mixed depression, subtype of bipolar disorder...), psychiatric comorbidities and stressors psycho-social. Meanwhile, the characteristics of suicidal behavior (ie: severe or multiple attempts) suggest a diagnosis of bipolar disorder rather than major depressive disorder. In addition to a correct screening of bipolar disorders and assessment of suicidal behavior, the removal of lethal means, networking and treatment of depression reduces the risk of suicidal behavior. Finally, lithium may have a particular interest in subjects at high risk of suicide., (Copyright © 2011 L’Encéphale. Published by Elsevier Masson SAS.. All rights reserved.)
- Published
- 2011
- Full Text
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37. [Guidelines for the biological treatment of bipolar depression].
- Author
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Samalin L, Charpeaud T, and Guillaume S
- Subjects
- Affect drug effects, Antimanic Agents adverse effects, Drug Substitution, Drug Therapy, Combination, Humans, Long-Term Care, Antimanic Agents therapeutic use, Bipolar Disorder drug therapy, Evidence-Based Medicine, Practice Guidelines as Topic
- Abstract
Numerous guidelines for the treatment of bipolar disorder have been published in the recent years. A review focusing on recent international and French guidelines the last 5 years on the management of bipolar depression was conducted. The comparison of guidelines showed differences in the choice of initial treatment: monotherapy (in first line: quetiapine and lamotrigine) or polypharmacotherapy (in first line: combination olanzapine/fluoxetine). All guidelines recommend in patients with inadequate response a therapeutic strategy in two steps. An initial clinical stage seeking the causes of poor therapeutic response and a second therapeutic stage trying to optimize the current treatment, to change treatment or to consider a co-therapy. In first line, the prophylactic drugs recommended are: lithium, valproate, quetiapine; olanzapine, risperidone (and long-acting formulation) and aripiprazole mainly for the prevention of manic episodes; lamotrigine limited to prevention of depressive episodes. The duration of treatment before patient reassessment and that of maintenance therapy are not consensual. The development of second-generation antipsychotics in bipolar depression is an interesting development for our therapeutic armamentarium and has been incorporated in recent guidelines., (Copyright © 2011 L’Encéphale. Published by Elsevier Masson SAS.. All rights reserved.)
- Published
- 2011
- Full Text
- View/download PDF
38. [Screening and management of bipolar disorders: results].
- Author
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Llorca PM, Courtet P, Martin P, Abbar M, Gay C, Meynard JA, Baylé F, Hamon M, Lançon C, Thibaut F, Thomas P, Lancrenon S, Guillaume S, and Samalin L
- Subjects
- Adolescent, Adult, Aged, Antimanic Agents adverse effects, Bipolar Disorder psychology, Female, France, Humans, Middle Aged, Pregnancy, Psychotropic Drugs adverse effects, Secondary Prevention, Young Adult, Antimanic Agents therapeutic use, Bipolar Disorder diagnosis, Bipolar Disorder drug therapy, Mass Screening, Psychotropic Drugs therapeutic use
- Published
- 2010
- Full Text
- View/download PDF
39. [Screening and management of bipolar disorders: methodology].
- Author
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Llorca PM, Courtet P, Martin P, Abbar M, Gay C, Meynard JA, Baylé F, Hamon M, Lançon C, Thibaut F, Thomas P, Lancrenon S, Guillaume S, and Samalin L
- Subjects
- Adolescent, Adult, Aged, Antimanic Agents adverse effects, Bipolar Disorder psychology, Female, France, Humans, Practice Guidelines as Topic, Pregnancy, Psychotropic Drugs adverse effects, Antimanic Agents therapeutic use, Bipolar Disorder diagnosis, Bipolar Disorder drug therapy, Evidence-Based Medicine, Mass Screening, Psychotropic Drugs therapeutic use
- Published
- 2010
- Full Text
- View/download PDF
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