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Marie-Claire C, Courtin C, Bellivier F, Gard S, Leboyer M, Scott J, Etain B. Methylomic biomarkers of lithium response in bipolar disorder: a clinical utility study. Int J Bipolar Disord 2023; 11:16. [PMID: 37119343 PMCID: PMC10148930 DOI: 10.1186/s40345-023-00296-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/14/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND Response to lithium (Li) is highly variable in bipolar disorders (BD). Despite decades of research, no clinical predictor(s) of response to Li prophylaxis have been consistently identified. Recently, we developed epigenetic Methylation Specific High-Resolution Melting (MS-HRM) assays able to discriminate good responders (GR) from non-responders (NR) to Li in individuals with BD type 1 (BD-I). This study examined whether a combination of clinical and epigenetic markers can distinguish NR from other types of Li responders. METHODS We recorded clinical variables that are potentially associated with Li response in 64 individuals with BD-I. MS-HRM assays were performed on DNA isolated from peripheral blood. We used backward stepwise logistic regression analyses, followed by receiver operating characteristic (ROC) curve analysis to estimate the performance of the clinical variables, alone then in combination with the epigenetic biomarkers, to identify GR and partial responders (PaR) vs NR. RESULTS Polarity at onset, psychotic symptoms at onset and family history of BD classified correctly 70% of individuals according to their Li response (PaR + GR = 86%; NR = 35%). When combined with the epigenetic biomarkers, these three clinical variables plus alcohol misuse (and one DMR: Differentially Methylated Region) correctly classified 86% of individuals, improving the prediction of PaR + GR (93%) and of NR (70%). The ROC analysis demonstrated an improvement in the area under the curve from 0.75 (clinical variables alone) to 0.87 (combination of clinical and epigenetic markers). CONCLUSIONS Combining clinical predictors and DNA methylation markers of Li response may have greater utility in clinical practice than relying on clinical characteristics alone.
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Affiliation(s)
- C Marie-Claire
- Inserm UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Université Paris Cité, 4 Avenue de l'observatoire, 75006, Paris, France.
| | - C Courtin
- Inserm UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Université Paris Cité, 4 Avenue de l'observatoire, 75006, Paris, France
| | - F Bellivier
- Inserm UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Université Paris Cité, 4 Avenue de l'observatoire, 75006, Paris, France
- Département de Psychiatrie et de Médecine AddictologiqueHôpitaux Lariboisière-Fernand Widal, GHU APHP.Nord Université de Paris, 75010, Paris, France
- Fondation Fondamental, 94010, Créteil, France
| | - S Gard
- Fondation Fondamental, 94010, Créteil, France
- Centre Hospitalier Charles Perrens, Pôle de Psychiatrie Générale et Universitaire, Bordeaux, France
| | - M Leboyer
- Fondation Fondamental, 94010, Créteil, France
- Translational Neuro-Psychiatry, Université Paris Est Créteil, INSERM U955, IMRB, Créteil, France
- Département Médico-Universitaire de Psychiatrie et d'Addictologie (DMU IMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - J Scott
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, NE4 5PL, UK
| | - B Etain
- Inserm UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Université Paris Cité, 4 Avenue de l'observatoire, 75006, Paris, France
- Département de Psychiatrie et de Médecine AddictologiqueHôpitaux Lariboisière-Fernand Widal, GHU APHP.Nord Université de Paris, 75010, Paris, France
- Fondation Fondamental, 94010, Créteil, France
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Fatone S, Caldwell R, Angelico J, Stine R, Kim KY, Gard S, Oros M. Comparison of Ischial Containment and Subischial Sockets on Comfort, Function, Quality of Life, and Satisfaction With Device in Persons With Unilateral Transfemoral Amputation: A Randomized Crossover Trial. Arch Phys Med Rehabil 2021; 102:2063-2073.e2. [PMID: 34214499 DOI: 10.1016/j.apmr.2021.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 05/20/2021] [Accepted: 05/27/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare comfort and functional performance of the Northwestern University Flexible Subischial Vacuum (NU-FlexSIV) Socket with the ischial containment (IC) socket in persons with unilateral transfemoral amputation. DESIGN Randomized crossover trial with two 7-week periods. SETTING Private prosthetic clinics and university research laboratory. PARTICIPANTS A total of 30 enrolled (N=30); 25 participants completed the study with full (n=18) or partial data (n=7). INTERVENTIONS Two custom-fabricated sockets (IC and NU-FlexSIV), worn full-time for 7 weeks, with testing at 1, 4, and 7 weeks after socket delivery. MAIN OUTCOME MEASURES The primary outcome was change in Socket Comfort Score (SCS) at 7 weeks. Secondary outcomes at 7 weeks included the Orthotic and Prosthetic Users' Survey (OPUS) to assess lower extremity functional status, health-related quality of life, and satisfaction with device, as well as the 5-Times Rapid Sit-to-Stand Test, Four Square Step Test, and T-Test of Agility to assess functional performance. RESULTS At 7 weeks, the mean SCS for IC (7.0±1.7) and NU-FlexSIV (8.4±1.1) Sockets were significantly different (P<.001; 95% confidence interval, 0.8-2.3). Results from a linear mixed-effects model, accounting for data from all time points, indicated that the SCS was 1.7 (SE=0.45) points higher for the NU-FlexSIV Socket (P<.001). For the secondary outcomes, only OPUS satisfaction with device was significantly better in the NU-FlexSIV Socket after accounting for all data points. CONCLUSIONS The results suggest that after 7 weeks' accommodation, the NU-FlexSIV Socket was more comfortable and led to greater satisfaction with device than the IC socket in persons with unilateral transfemoral amputation and K3/K4 mobility. Other patient-reported outcomes and function were no different between sockets.
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Affiliation(s)
- Stefania Fatone
- Department of Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, Chicago, IL.
| | - Ryan Caldwell
- Department of Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, Chicago, IL; Scheck and Siress Prosthetics and Orthotics, Chicago, IL; Hanger Clinic, Austin, TX
| | - John Angelico
- Scheck and Siress Prosthetics and Orthotics, Chicago, IL; Hanger Clinic, Austin, TX
| | | | - Kwang-Youn Kim
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Steven Gard
- Department of Physical Medicine and Rehabilitation, Northwestern University, Feinberg School of Medicine, Chicago, IL; Jesse Brown VA Medical Center, Chicago, IL
| | - Michael Oros
- Scheck and Siress Prosthetics and Orthotics, Chicago, IL; Hanger Clinic, Austin, TX
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Godin O, Leboyer M, Belzeaux R, Bellivier F, Loftus J, Courtet P, Dubertret C, Gard S, Henry C, Llorca PM, Schwan R, Passerieux C, Polosan M, Samalin L, Olié E, Etain B, Henry C, Olié E, Leboyer M, Haffen E, Llorca PM, Barteau V, Bensalem S, Godin O, Laouamri H, Souryis K, Hotier S, Pelletier A, Drancourt N, Sanchez JP, Saliou E, Hebbache C, Petrucci J, Willaume L, Bourdin E, Bellivier F, Carminati M, Etain B, Maruani J, Marlinge E, Meyrel M, Antoniol B, Desage A, Gard S, Jutant A, Mbailara K, Minois I, Zanouy L, Bardin L, Cazals A, Courtet P, Deffinis B, Ducasse D, Gachet M, Henrion A, Molière F, Noisette B, Olié E, Tarquini G, Belzeaux R, Correard N, Groppi F, Lefrere A, Lescalier L, Moreau E, Pastol J, Rebattu M, Roux B, Viglianese N, Cohen R, Schwan R, Kahn J, Milazzo M, Wajsbrot‐Elgrabli O, Bougerol T, Fredembach B, Suisse A, Halili B, Pouchon A, Polosan M, Galliot A, Grévin I, Cannavo A, Kayser N, Passerieux C, Roux P, Aubin V, Cussac I, Dupont M, Loftus J, Medecin I, Dubertret C, Mazer N, Portalier C, Scognamiglio C, Bing A. Non-alcoholic fatty liver disease in a sample of individuals with bipolar disorders: results from the FACE-BD cohort. Acta Psychiatr Scand 2021; 143:82-91. [PMID: 33011976 DOI: 10.1111/acps.13239] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 09/02/2020] [Accepted: 09/21/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Non-Alcoholic fatty liver disease (NAFLD) is becoming the most common liver disease in Western populations. While obesity and metabolic abnormalities are highly frequent in bipolar disorders (BD), no studies have been performed to estimate the prevalence of NALFD in individuals with BD. The aim of our study is to estimate the prevalence of NAFLD and to identify the potential associated risk factors in a large sample of BD individuals. METHODS Between 2009 and 2019, 1969 BD individuals from the FACE-BD cohort were included. Individuals with liver diseases, Hepatitis B or C, and current alcohol use disorders were excluded from the analyses. A blood sample was drawn from participants. Screening of NAFLD was determined using fatty liver index (FLI). Individuals with FLI> 60 were considered as having NAFLD. RESULTS The prevalence of NAFDL in this sample was estimated at 28.4%. NAFLD was observed in 40% of men and 21% of women. NAFLD was independently associated with older age, male gender, sleep disturbances, and current use of atypical antipsychotics or anxiolytics. As expected, the prevalence of NALFD was also higher in individuals with overweight and in those with metabolic syndrome. CONCLUSIONS This study reinforces the view that individuals with BD are highly vulnerable to metabolic and cardiovascular diseases. The prevalence of NAFLD in individuals with BD was two times higher than the prevalence reported in the general population. The regular screening of the MetS in individuals with BD should be therefore complemented by the additional screening of NAFLD among these vulnerable individuals.
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Affiliation(s)
- Ophelia Godin
- Fondation FondaMental, Créteil, France.,Inserm U955, IMRB, Laboratoire Neuro-Psychiatrie Translationnelle, Université Paris Est Créteil, Créteil, France.,AP-HP, HU Henri Mondor, Département Medico-Universitaire de Psychiatrie et d'Addictologie (DMU ADAPT), Fédération Hospitalo-Universitaire de Médecine de Precision (FHU IMPACT), Créteil, France.,Fondation FondaMental, Créteil, France
| | - Marion Leboyer
- Fondation FondaMental, Créteil, France.,Inserm U955, IMRB, Laboratoire Neuro-Psychiatrie Translationnelle, Université Paris Est Créteil, Créteil, France.,AP-HP, HU Henri Mondor, Département Medico-Universitaire de Psychiatrie et d'Addictologie (DMU ADAPT), Fédération Hospitalo-Universitaire de Médecine de Precision (FHU IMPACT), Créteil, France.,Fondation FondaMental, Créteil, France
| | - Raoul Belzeaux
- Fondation FondaMental, Créteil, France.,Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, Marseille, France.,INT-UMR7289, CNRS Aix-Marseille Université, Marseille, France
| | - Frank Bellivier
- Fondation FondaMental, Créteil, France.,Assistance Publique des Hôpitaux de Paris (AP-HP), GHU Saint-Louis - Lariboisière - Fernand Widal, DMU Neurosciences, Département de Psychiatrie et de Médecine Addictologique, INSERM UMRS 1144, Université de Paris, Paris, France
| | - Joséphine Loftus
- Fondation FondaMental, Créteil, France.,Pôle de Psychiatrie, Centre Hospitalier Princesse Grace, Monaco, France
| | - Philippe Courtet
- Fondation FondaMental, Créteil, France.,Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France.,PSNREC, Univ Montpellier, INSERM, CHU Montpellier, Montpellier, France
| | - Caroline Dubertret
- Fondation FondaMental, Créteil, France.,AP-HP, Groupe Hospitalo-universitaire Nord, DMU ESPRIT, Service de Psychiatrie et Addictologie, Hopital Louis Mourier, Colombes, France.,Inserm U1266, Faculté de Médecine, Université de Paris, Paris, France
| | - Sebastien Gard
- Fondation FondaMental, Créteil, France.,Centre Expert Troubles Bipolaires, Service de Psychiatrie Adulte, Hôpital Charles-Perrens, Bordeaux, France
| | - Chantal Henry
- Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, Paris, France
| | - Pierre-Michel Llorca
- Fondation FondaMental, Créteil, France.,CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Raymund Schwan
- Fondation FondaMental, Créteil, France.,Inserm U1114, Centre Psychothérapique de Nancy, Université de Lorraine, Nancy, France
| | - Christine Passerieux
- Fondation FondaMental, Créteil, France.,Service Universitaire de Psychiatrie d'Adultes, Centre Hospitalier de Versailles, Le Chesnay, Université Paris-Saclay, UVSQ, Inserm, CESP, Team "DevPsy", Villejuif, France
| | - Mircea Polosan
- Fondation FondaMental, Créteil, France.,Grenoble Institut des Neurosciences (GIN) Inserm U 1216, CHU de Grenoble et des Alpes, Université Grenoble Alpes, Grenoble, France
| | - Ludovic Samalin
- Fondation FondaMental, Créteil, France.,CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Emilie Olié
- Fondation FondaMental, Créteil, France.,INT-UMR7289, CNRS Aix-Marseille Université, Marseille, France
| | - Bruno Etain
- Fondation FondaMental, Créteil, France.,Assistance Publique des Hôpitaux de Paris (AP-HP), GHU Saint-Louis - Lariboisière - Fernand Widal, DMU Neurosciences, Département de Psychiatrie et de Médecine Addictologique, INSERM UMRS 1144, Université de Paris, Paris, France
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Samalin L, Godin O, Olié E, Etain B, Henry C, Pelletier A, Poinso F, Encely L, Mazer N, Roux P, Loftus J, Gard S, Bennabi D, Polosan M, Schwitzer T, Aubin V, Schwan R, Passerieux C, Bougerol T, Dubertret C, Aouizerate B, Haffen E, Courtet P, Bellivier F, Leboyer M, Llorca PM, Belzeaux R. Evolution and characteristics of the use of valproate in women of childbearing age with bipolar disorder: Results from the FACE-BD cohort. J Affect Disord 2020; 276:963-969. [PMID: 32745833 DOI: 10.1016/j.jad.2020.07.078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 05/19/2020] [Accepted: 07/05/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Valproate is associated with teratogenic and neurodevelopmental effects. Several agencies have restricted the conditions of its prescription in bipolar disorders (BD). We aimed to assess the evolution of valproate prescription and the clinical profile of BD women of childbearing age receiving valproate. METHODS Based on a large national cohort, we included all BD women 16-50 years old. Sociodemographic, clinical and pharmacological data were recorded. Logistic regression analyses were used to describe variables associated with valproate prescription. RESULTS Of the 1018 included women 16-50 years old, 26.9% were treated with valproate with a mean daily dosage of 968 mg. The prevalence of BD women using valproate was 32.6% before May 2015 and 17.3% after May 2015 (p<0.001), the date of French regulatory publication of restriction of valproate prescription. The multivariate analysis revealed that the inclusion period after May 2015 (OR=0.54, CI 95% 0.37-0.78, p=0.001), the age lower than 40 years (OR=0.65, CI 95% 0.43-0.98, p=0.040) and the number of lifetime mood episodes (OR=0.98, CI 95% 0.95-0.99, p=0.040) were the variables negatively associated with the use of valproate. LIMITATIONS Study could be underpowered to determine a clinical profile associated with valproate prescription. CONCLUSIONS The regulatory change in BD women of childbearing age had a significant impact on valproate prescription, even if the prescription rate remains high. Important efforts are needed to help clinicians and patients to improve quality of care in BD women of childbearing age.
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Affiliation(s)
- L Samalin
- Fondation Fondamental, Créteil, France; Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, EA 7280, Clermont-Ferrand, France.
| | - O Godin
- Fondation Fondamental, Créteil, France; INSERM U955, Équipe de Psychiatrie Translationnelle, Université Paris-Est Créteil, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - E Olié
- Fondation Fondamental, Créteil, France; Department of Emergency Psychiatry and Acute Care, CHU de Montpellier, PSNREC, University Montpellier, INSERM, Montpellier, France
| | - B Etain
- Fondation Fondamental, Créteil, France; AP-HP, GH Saint-Louis - Lariboisière - Fernand Widal, Pôle Neurosciences Tête et Cou, Département de Psychiatrie et de Médecine Addictologique, INSERM UMRS 1144, Université de Paris, Paris, France
| | - C Henry
- Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie and Neurosciences, Université Descartes, Paris, France
| | - A Pelletier
- Fondation Fondamental, Créteil, France; AP-HP, DMU IMPACT, Psychiatry and Addictology of Mondor University Hospital, University Paris-Est-Créteil, Créteil, France
| | - F Poinso
- Pôle de Psychiatrie, APHM, Marseille, France; INT-UMR7289, CNRS Aix-Marseille Université, Marseille, France
| | - L Encely
- Pôle de Psychiatrie, APHM, Marseille, France; INT-UMR7289, CNRS Aix-Marseille Université, Marseille, France
| | - N Mazer
- Fondation Fondamental, Créteil, France; AP-HP, Groupe Hospitalo-universitaire AP-HP Nord, DMU ESPRIT, Service de Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, Inserm U1266, Faculté de Médecine, Université de Paris, France
| | - P Roux
- Fondation Fondamental, Créteil, France; Centre Hospitalier de Versailles, Service Universitaire de psychiatrie d'adulte et d'addictologie, Le Chesnay, EA 4047 HANDIReSP, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin-en-Yvelines, Equipe « PsyDev », CESP, Université Paris-Saclay, Inserm, 94807 Villejuif, France
| | - J Loftus
- Fondation Fondamental, Créteil, France; Department of Psychiatry, Princess-Grace Hospital, Monaco, Monaco
| | - S Gard
- Fondation Fondamental, Créteil, France; Department of Psychiatry, Princess-Grace Hospital, Monaco, Monaco
| | - D Bennabi
- Fondation Fondamental, Créteil, France; Department of Clinical Psychiatry, CIC-1431 INSERM, CHU de Besançon, EA481 Neurosciences, University Bourgogne Franche-Comté, France
| | - M Polosan
- Fondation Fondamental, Créteil, France; CHU Grenoble Alpes, Grenoble Institut Neurosciences, Inserm, U1216, University of Grenoble Alpes, Grenoble, France
| | - T Schwitzer
- Fondation Fondamental, Créteil, France; Centre Psychothérapique de Nancy, Pôle Hospitalo-universitaire de Psychiatrie d'Adultes du Grand Nancy, Laxou F-54520, France
| | - V Aubin
- Fondation Fondamental, Créteil, France; Department of Psychiatry, Princess-Grace Hospital, Monaco, Monaco
| | - R Schwan
- Fondation Fondamental, Créteil, France; Centre Psychothérapique de Nancy, Pôle Hospitalo-universitaire de Psychiatrie d'Adultes du Grand Nancy, Laxou F-54520, France
| | - C Passerieux
- Fondation Fondamental, Créteil, France; Centre Hospitalier de Versailles, Service Universitaire de psychiatrie d'adulte et d'addictologie, Le Chesnay, EA 4047 HANDIReSP, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin-en-Yvelines, Equipe « PsyDev », CESP, Université Paris-Saclay, Inserm, 94807 Villejuif, France
| | - T Bougerol
- Fondation Fondamental, Créteil, France; CHU Grenoble Alpes, Grenoble Institut Neurosciences, Inserm, U1216, University of Grenoble Alpes, Grenoble, France
| | - C Dubertret
- Fondation Fondamental, Créteil, France; AP-HP, Groupe Hospitalo-universitaire AP-HP Nord, DMU ESPRIT, Service de Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, Inserm U1266, Faculté de Médecine, Université de Paris, France
| | - B Aouizerate
- Fondation Fondamental, Créteil, France; Department of Clinical and Academic Psychiatry, Charles-Perrens Hospital, Bordeaux, France; NutriNeuro, UMR INRA 1286, University of Bordeaux, Bordeaux, France
| | - E Haffen
- Fondation Fondamental, Créteil, France; Department of Clinical Psychiatry, CIC-1431 INSERM, CHU de Besançon, EA481 Neurosciences, University Bourgogne Franche-Comté, France
| | - P Courtet
- Fondation Fondamental, Créteil, France; Department of Emergency Psychiatry and Acute Care, CHU de Montpellier, PSNREC, University Montpellier, INSERM, Montpellier, France
| | - F Bellivier
- Fondation Fondamental, Créteil, France; AP-HP, GH Saint-Louis - Lariboisière - Fernand Widal, Pôle Neurosciences Tête et Cou, Département de Psychiatrie et de Médecine Addictologique, INSERM UMRS 1144, Université de Paris, Paris, France
| | - M Leboyer
- Fondation Fondamental, Créteil, France; AP-HP, DMU IMPACT, Psychiatry and Addictology of Mondor University Hospital, University Paris-Est-Créteil, Créteil, France
| | | | - P M Llorca
- Fondation Fondamental, Créteil, France; Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, EA 7280, Clermont-Ferrand, France
| | - R Belzeaux
- Fondation Fondamental, Créteil, France; Pôle de Psychiatrie, APHM, Marseille, France; INT-UMR7289, CNRS Aix-Marseille Université, Marseille, France
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5
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Godin O, Leboyer M, Mazroui Y, Aouizerate B, Azorin JM, Raoul B, Bellivier F, Polosan M, Courtet P, Dubertret C, Henry C, Kahn JP, Loftus J, Olié E, Passerieux C, Costagliola D, Etain B, Llorca P, Barteau V, Bensalem S, Laaidi M, Laouamri H, Souryis K, Hotier S, Pelletier A, Drancourt N, Sanchez J, Saliou E, Hebbache C, Petrucci J, Willaume L, Bourdin E, Carminati M, Etain B, Marlinge E, Meheust J, Antoniol B, Desage A, Gard S, Jutant A, Mbailara K, Minois I, Zanouy L, Abettan C, Bardin L, Cazals A, Deffinis B, Ducasse D, Gachet M, Henrion A, Martinerie E, Molière F, Noisette B, Tarquini G, Belzeaux R, Correard N, Consoloni JL, Groppi F, Lescalier L, Montant J, Rebattu M, Viglianese N, Cohen R, Milazzo M, Wajsbrot-Elgrabli O, Bougerol T, Fredembach B, Garçon S, Grignon P, Perrin A, Galliot A, Grévin I, Cannavo A, Kayser N, Roux P, Aubin V, Cussac I, Dupont M, Medecin I, Mazer N, Portalier C. Trajectories of functioning in bipolar disorders: A longitudinal study in the FondaMental Advanced Centers of Expertise in Bipolar Disorders cohort. Aust N Z J Psychiatry 2020; 54:985-996. [PMID: 32779531 DOI: 10.1177/0004867420945796] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE We aimed at identifying distinct trajectories of functioning and at describing their respective clinical characteristics in a cohort of individuals with bipolar disorders. METHODS We included a sample of 2351 individuals with bipolar disorders who have been followed-up to 3 years as part as the FondaMental Advanced Centers of Expertise in Bipolar Disorders cohort. Global functioning was measured using the Functioning Assessment Short Test. We used latent class mixed models to identify distinct longitudinal trajectories of functioning over 3 years. Multivariable logistic regression models were used to identify the baseline factors that were associated with the membership to each trajectory of functioning. RESULTS Three distinct trajectories of functioning were identified: (1) a majority of individuals (72%) had a stable trajectory of mild functional impairment, (2) 20% of individuals had a stable trajectory of severe functional impairment and (3) 8% of individuals had a trajectory of moderate functional impairment that improved over time. The membership to a trajectory of stable severe versus stable mild functional impairment was associated with unemployment, a higher number of previous hospitalizations, childhood maltreatment, a higher level of residual depressive symptoms, higher sleep disturbances, a higher body mass index and a higher number of psychotropic medications being prescribed at baseline. The model that included these seven factors led to an area under the curve of 0.85. CONCLUSION This study enabled to stratify individuals with bipolar disorders according to three distinct trajectories of functioning. The results regarding the potential determinants of the trajectory of severe functional impairment needs to be replicated in independent samples. Nevertheless, these potential determinants may represent possible therapeutic targets to improve the prognosis of those patients at risk of persistent poor functioning.
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Affiliation(s)
- Ophelia Godin
- Fondation FondaMental, Créteil, France.,Université Paris Est Créteil, Inserm U955, IMRB, Laboratoire Neuro-Psychiatrie Translationnelle, Créteil, France.,AP-HP, HU Henri Mondor, Departement Medico-Universitaire de Psychiatrie et d'Addictologie (DMU ADAPT), Federation Hospitalo-Universitaire de Médecine de Precision (FHU IMPACT), Paris, France
| | - Marion Leboyer
- Fondation FondaMental, Créteil, France.,Université Paris Est Créteil, Inserm U955, IMRB, Laboratoire Neuro-Psychiatrie Translationnelle, Créteil, France.,AP-HP, HU Henri Mondor, Departement Medico-Universitaire de Psychiatrie et d'Addictologie (DMU ADAPT), Federation Hospitalo-Universitaire de Médecine de Precision (FHU IMPACT), Paris, France
| | - Yassin Mazroui
- Laboratoire de Probabilités, Statistiques et Modélisation (LPSM), Sorbonne Université, Paris, France
| | - Bruno Aouizerate
- Fondation FondaMental, Créteil, France.,Centre Expert Troubles Bipolaires, Service de Psychiatrie Adulte, Hôpital Charles-Perrens, Bordeaux, France
| | - Jean-Michel Azorin
- Fondation FondaMental, Créteil, France.,Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, Marseille, France.,CNRS Aix-Marseille Université, Marseille, France
| | - Belzeaux Raoul
- Fondation FondaMental, Créteil, France.,Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, Marseille, France.,CNRS Aix-Marseille Université, Marseille, France
| | - Frank Bellivier
- Fondation FondaMental, Créteil, France.,Assistance Publique des Hôpitaux de Paris (AP-HP), GHU Saint-Louis-Lariboisière-Fernand Widal, DMU Neurosciences, Département de Psychiatrie et de Médecine Addictologique, INSERM UMRS 1144, Université de Paris, Paris, France
| | - Mircea Polosan
- Fondation FondaMental, Créteil, France.,Université Grenoble Alpes, CHU de Grenoble et des Alpes, Grenoble Institut des Neurosciences (GIN) Inserm U1216, Grenoble, France
| | - Philippe Courtet
- Fondation FondaMental, Créteil, France.,Département Urgence et Post-urgence Psychiatrique, CHU Montpellier, INSERM U1061, Université de Montpellier, Montpellier, France
| | - Caroline Dubertret
- Fondation FondaMental, Créteil, France.,AP-HP, Groupe Hospitalo-Universitaire Nord, DMU ESPRIT, Service de Psychiatrie et Addictologie, Hopital Louis Mourier, Colombes, Inserm U1266, Faculté de Médecine, Université de Paris, Paris, France
| | - Chantal Henry
- Fondation FondaMental, Créteil, France.,Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, Paris, France
| | - Jean-Pierre Kahn
- Fondation FondaMental, Créteil, France.,Université de Lorraine, CHRU de Nancy et Pôle de Psychiatrie et Psychologie Clinique, Centre Psychothérapique de Nancy, Nancy, France
| | - Josephine Loftus
- Fondation FondaMental, Créteil, France.,Pôle de Psychiatrie, Centre Hospitalier Princesse Grace, Monaco, France
| | - Emilie Olié
- Fondation FondaMental, Créteil, France.,Département Urgence et Post-urgence Psychiatrique, CHU Montpellier, INSERM U1061, Université de Montpellier, Montpellier, France
| | - Christine Passerieux
- Fondation FondaMental, Créteil, France.,Service Universitaire de Psychiatrie d'Adultes, Centre Hospitalier de Versailles, Le Chesnay, Université Paris-Saclay, UVSQ, Inserm, CESP, Team 'DevPsy', Villejuif, France
| | - Dominique Costagliola
- INSERM, Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Bruno Etain
- Fondation FondaMental, Créteil, France.,Assistance Publique des Hôpitaux de Paris (AP-HP), GHU Saint-Louis-Lariboisière-Fernand Widal, DMU Neurosciences, Département de Psychiatrie et de Médecine Addictologique, INSERM UMRS 1144, Université de Paris, Paris, France
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Loftus J, Scott J, Vorspan F, Icick R, Henry C, Gard S, Kahn JP, Leboyer M, Bellivier F, Etain B. Psychiatric comorbidities in bipolar disorders: An examination of the prevalence and chronology of onset according to sex and bipolar subtype. J Affect Disord 2020; 267:258-263. [PMID: 32217226 DOI: 10.1016/j.jad.2020.02.035] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 02/05/2020] [Accepted: 02/18/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Bipolar Disorder (BD) is frequently comorbid with other psychiatric disorders. However, few studies systematically examine which disorders are more likely to occur pre- or post-BD onset. We examine the prevalence and Age At Onset (AAO) of psychiatric conditions in adults with BD. METHODS A structured clinical interview was used to assess lifetime history and AAO of alcohol and cannabis misuse, suicide attempts, anxiety and eating disorders in a French sample of euthymic patients with BD (n = 739). Regression analyses were used to test for statistically significant associations between rates and AAO of comorbidities in BD groups stratified by sex or subtype. RESULTS Prevalence of alcohol and cannabis misuse was associated with male sex and BD-I subtype; whilst most anxiety and eating disorders were associated with female sex. The AAO of most comorbid conditions preceded that of BD, except for panic disorder, agoraphobia and alcohol misuse. Few variations were observed in AAO of comorbidities according to groups. LIMITATIONS All assessments were retrospective, so estimates of prevalence rates and especially exact AAO of some comorbidities are at risk of recall bias. CONCLUSIONS Sex and BD subtype are associated with different rates of comorbid disorders. However, there were minimal between group differences in median AAO of comorbidities. By describing the chronological sequence of comorbidities in BD we were able to demonstrate that a minority of comorbidities typically occurred post-onset of BD. This is noteworthy as these disorders might be amenable to interventions aimed at early secondary prevention.
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Affiliation(s)
- J Loftus
- Centre Expert Trouble Bipolaire, Hospital Princesse Grace, Monaco; Fondation Fondamental, Créteil, France
| | - J Scott
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Université de Paris, Paris, France
| | - F Vorspan
- Université de Paris, Paris, France; AP-HP, GH Saint-Louis-Lariboisière-Fernand-Widal, Département de Psychiatrie et de Médecine Addictologique, DMU Neurosciences, Paris, France; Inserm UMRS 1144, Paris, France
| | - R Icick
- Université de Paris, Paris, France; AP-HP, GH Saint-Louis-Lariboisière-Fernand-Widal, Département de Psychiatrie et de Médecine Addictologique, DMU Neurosciences, Paris, France; Inserm UMRS 1144, Paris, France
| | - C Henry
- Fondation Fondamental, Créteil, France; Institut Pasteur, Unité Perception et Mémoire, Paris, France; Université Paris-Est-Créteil, Creteil, France; Département Médico-Universitaire Psychiatrie et Addictologie, DMU IMPACT, AP-HP, Hôpitaux Universitaires H. Mondor, Créteil, France
| | - S Gard
- Fondation Fondamental, Créteil, France; Hôpital Charles-Perrens, Centre Expert Trouble Bipolaire, Service de psychiatrie adulte, Pôle 3-4-7, Bordeaux, France
| | - J P Kahn
- Fondation Fondamental, Créteil, France; Université de Lorraine, CHRU de Nancy, Nancy, France and Fondation Santé des Etudiants de France (FSEF), Paris, France
| | - M Leboyer
- Fondation Fondamental, Créteil, France; Université Paris-Est-Créteil, Creteil, France; Département Médico-Universitaire Psychiatrie et Addictologie, DMU IMPACT, AP-HP, Hôpitaux Universitaires H. Mondor, Créteil, France; INSERM U955, Equipe 15 Psychiatrie Translationnelle, Creteil, France
| | - F Bellivier
- Fondation Fondamental, Créteil, France; Université de Paris, Paris, France; AP-HP, GH Saint-Louis-Lariboisière-Fernand-Widal, Département de Psychiatrie et de Médecine Addictologique, DMU Neurosciences, Paris, France; Inserm UMRS 1144, Paris, France
| | - B Etain
- Fondation Fondamental, Créteil, France; Université de Paris, Paris, France; AP-HP, GH Saint-Louis-Lariboisière-Fernand-Widal, Département de Psychiatrie et de Médecine Addictologique, DMU Neurosciences, Paris, France; Inserm UMRS 1144, Paris, France.
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7
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Etain B, Godin O, Boudebesse C, Aubin V, Azorin J, Bellivier F, Bougerol T, Courtet P, Gard S, Kahn J, Passerieux C, Leboyer M, Henry C. Sleep quality and emotional reactivity cluster in bipolar disorders and impact on functioning. Eur Psychiatry 2020; 45:190-197. [DOI: 10.1016/j.eurpsy.2017.06.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/29/2017] [Accepted: 06/29/2017] [Indexed: 12/24/2022] Open
Abstract
AbstractObjective:Bipolar disorders (BD) are characterized by sleep disturbances and emotional dysregulation both during acute episodes and remission periods. We hypothesized that sleep quality (SQ) and emotional reactivity (ER) defined clusters of patients with no or abnormal SQ and ER and we studied the association with functioning.Method:We performed a bi-dimensional cluster analysis using SQ and ER measures in a sample of 533 outpatients patients with BD (in remission or with subsyndromal mood symptoms). Clusters were compared for mood symptoms, sleep profile and functioning.Results:We identified three clusters of patients: C1 (normal ER and SQ, 54%), C2 (hypo-ER and low SQ, 22%) and C3 (hyper-ER and low SQ, 24%). C1 was characterized by minimal mood symptoms, better sleep profile and higher functioning than other clusters. Although highly different for ER, C2 and C3 had similar levels of subsyndromal mood symptoms as assessed using classical mood scales. When exploring sleep domains, C2 showed poor sleep efficiency and a trend for longer sleep latency as compared to C3. Interestingly, alterations in functioning were similar in C2 and C3, with no difference in any of the sub-domains.Conclusion:Abnormalities in ER and SQ delineated three clusters of patients with BD and significantly impacted on functioning.
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Munuera C, Weil F, Minois I, Zanouy L, Gard S, Roux P, M'Bailara K. [Exploring Early Maladaptative Schema (EMS) in adults with bipolar disorder: A systematic review of the scientific literature]. Encephale 2019; 46:65-77. [PMID: 31767255 DOI: 10.1016/j.encep.2019.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/10/2019] [Accepted: 09/16/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Clinical heterogeneity during euthymic states is a crucial issue in bipolar disorders. Indeed, actual data are not sufficient to understand why some patients are unharmed by subthreshold symptoms and have functional impairments whereas others have a functional remission but have subthreshold symptoms. Based on the Ball model, cognitive and schematic vulnerability interact with genetic vulnerability and trigger affective symptoms with the intervention of stressful life events. Furthermore, according to this model, adjustment and adaptation to illness assessed by functional outcome and illness experience are associated with this cognitive and schematic vulnerability. So, theoretical arguments support that childhood adversity and temperamental deregulation characterize patients with bipolar disorders. Thus, the aim of this study is to systematically review studies of Early Maladaptive Schemas in bipolar disorder, to determine whether Early Maladaptive Schemas have specificity in bipolar disorder in comparison with other populations, and to identify which Early Maladaptive Schemas could be activated. The challenge of this review is to identify if the taking of early maladaptive schemas into account could allow us to better identify, understand and manage bipolar disorders. METHODS This systematic review was led according to the Preferred Reporting Items for Systematic review and Meta-Analysis statement on the electronic databases Cochrane, PsycArticles, Psychology and Behavioral Sciences Collection, PsycInfo, PubMed, ScienceDirect and Scopus with « early maladaptive schemas » AND « bipolar disorder » as keywords. Only studies meeting eligibility criteria concerning publication status, language, population and outcomes were included after several screenings on basis of title, abstract and full-text. Then, we carried out data extraction in accordance with criteria defined in principle (about characteristics of participants, objectives, materiel and methods, principle results and bias). RESULTS Among 39 records identified, a total of 10 studies met eligibility criteria for inclusion in this review. Synthesizing findings across the studies revealed three important topics. First, early maladaptive schemas appear as potential cognitive characteristics that clinicians have to investigate in clinical practice. Indeed, patients with bipolar disorders present greater activation of the early maladaptive schemas in comparison with people who have no disorder. This point supports the first part of Ball's theoretical model that considers schemas as a vulnerability to bipolarity. Secondly, early maladaptive schemas are relevant to distinguish bipolar disorders from unipolar depression and borderline personality disorder. A greater and a lower activation are respectively identified among bipolar disorders. Thirdly, supporting the second part of Ball's model, early maladaptive schemas play a key role in recovery regarding their impact on the course of bipolarity, in particular on suicidality and functional impairment. Finally, these dysfunctional schemas allow us to understand the clinical heterogeneity of bipolar disorder, and among others, about the type of bipolarity. These results have several implications, but there are some limits in this systematic review. First, no French study has been done. Then, reduced sample sizes in these studies increased the risk to conclude wrongly to an activation difference between groups. Furthermore, probably due to the variety of methods and populations, we could not identify an homogeneous pattern of early activated maladaptive schemas. Overall, scientific approaches used in these studies are based on statistical models using mean and standard deviation. These types of statistical analyses are the main limit because they cannot represent the heterogeneity of early maladaptive schemas profiles. CONCLUSIONS Schema theory proves to be a relevant approach in bipolar disorders, and early maladaptive schemas appear to be important to take into account in clinical practice. Nevertheless, in order to propose schemas therapy appropriately, it is necessary to specify if early maladaptive schemas are activated and to specify therapeutic indications because of clinical heterogeneity. Moreover, data do not yet allow us to understand the disparity of profiles during the inter-episode period. Indeed, a French research perspective is being considered that will prefer a person-oriented approach.
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Affiliation(s)
- C Munuera
- Laboratoire de psychologie, EA4139, Université de Bordeaux, 3(ter) place de la Victoire, 33076 Bordeaux, France
| | - F Weil
- Réseau des Centres Expert des Troubles Bipolaires, Fondation FondaMental, 40, rue de Mesly, 94000 Créteil, France; Service Universitaire de Psychiatrie d'Adultes, Centre Hospitalier de Versailles, 177, rue de Versailles, 78157 Le Chesnay, France; Laboratoire HANDIReSP, EA4047, Université de Versailles Saint-Quentin-En-Yvelines, 2, avenue de la Source de la Bièvre, 78180, Montigny-le-Bretonneux, France
| | - I Minois
- Centre Hospitalier Charles Perrens, Pôle 3-4-7, Bordeaux, 121, rue de la Béchade, 33076 Bordeaux, France; Réseau des Centres Expert des Troubles Bipolaires, Fondation FondaMental, 40, rue de Mesly, 94000 Créteil, France
| | - L Zanouy
- Centre Hospitalier Charles Perrens, Pôle 3-4-7, Bordeaux, 121, rue de la Béchade, 33076 Bordeaux, France; Réseau des Centres Expert des Troubles Bipolaires, Fondation FondaMental, 40, rue de Mesly, 94000 Créteil, France
| | - S Gard
- Centre Hospitalier Charles Perrens, Pôle 3-4-7, Bordeaux, 121, rue de la Béchade, 33076 Bordeaux, France; Réseau des Centres Expert des Troubles Bipolaires, Fondation FondaMental, 40, rue de Mesly, 94000 Créteil, France
| | - P Roux
- Réseau des Centres Expert des Troubles Bipolaires, Fondation FondaMental, 40, rue de Mesly, 94000 Créteil, France; Service Universitaire de Psychiatrie d'Adultes, Centre Hospitalier de Versailles, 177, rue de Versailles, 78157 Le Chesnay, France; Laboratoire HANDIReSP, EA4047, Université de Versailles Saint-Quentin-En-Yvelines, 2, avenue de la Source de la Bièvre, 78180, Montigny-le-Bretonneux, France
| | - K M'Bailara
- Laboratoire de psychologie, EA4139, Université de Bordeaux, 3(ter) place de la Victoire, 33076 Bordeaux, France; Centre Hospitalier Charles Perrens, Pôle 3-4-7, Bordeaux, 121, rue de la Béchade, 33076 Bordeaux, France; Réseau des Centres Expert des Troubles Bipolaires, Fondation FondaMental, 40, rue de Mesly, 94000 Créteil, France.
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9
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Nepomuceno A, Major MJ, Stine R, Gard S. Effect of foot and ankle immobilization on able-bodied gait as a model to increase understanding about bilateral transtibial amputee gait. Prosthet Orthot Int 2017; 41:556-563. [PMID: 28318394 DOI: 10.1177/0309364617698521] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The anatomical foot-ankle complex facilitates advancement of the stance limb through foot rockers and late-stance power generation during walking, but this mechanism is altered for persons with bilateral transtibial amputation when using passive prostheses. OBJECTIVES To study the effects of bilateral foot and ankle immobilization on able-bodied gait to serve as a model for understanding gait of persons with bilateral transtibial amputation and associated compensatory mechanisms. STUDY DESIGN Comparative analysis. METHODS Nine able-bodied persons walked at self-selected slow, normal, and fast speeds. They performed trials unaltered and when fitted with bilateral foot and ankle-immobilizing casts. Data from 10 individuals with bilateral transtibial amputation walking at self-selected fast speeds were used for qualitative comparison. RESULTS The average speeds for the able-bodied fast speed cast and normal speed no-cast trials were similar and were compared with bilateral transtibial amputation data. The able-bodied cast condition data more closely matched bilateral transtibial amputation data than the no-cast data. Ankle range-of-motion and power generation at pre-swing in the cast condition were markedly decreased, while trunk lateral flexion and transverse rotation range-of-motion and peak hip power generation increased. CONCLUSION Results suggest that the absence of active ankle range-of-motion and power generation contributes to the development of characteristic compensatory gait mechanisms displayed by persons with bilateral transtibial amputation. Clinical relevance This study helps to improve understanding of compensatory mechanisms resulting from reduced foot and ankle joint motion to inform lower limb prosthesis design and function for improving gait quality of individuals with bilateral transtibial amputation.
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Affiliation(s)
- Antonia Nepomuceno
- 1 Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA.,2 Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University Prosthetics-Orthotics Center, Chicago, IL, USA
| | - Matthew J Major
- 2 Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University Prosthetics-Orthotics Center, Chicago, IL, USA.,3 Department of Veterans Affairs, Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Rebecca Stine
- 3 Department of Veterans Affairs, Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Steven Gard
- 1 Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA.,2 Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University Prosthetics-Orthotics Center, Chicago, IL, USA.,3 Department of Veterans Affairs, Jesse Brown VA Medical Center, Chicago, IL, USA
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10
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Etain B, Lajnef M, Henry C, Aubin V, Azorin JM, Bellivier F, Bougerol T, Courtet P, Gard S, Kahn JP, Passerieux C, Leboyer M. Childhood trauma, dimensions of psychopathology and the clinical expression of bipolar disorders: A pathway analysis. J Psychiatr Res 2017; 95:37-45. [PMID: 28777981 DOI: 10.1016/j.jpsychires.2017.07.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 05/23/2017] [Accepted: 07/17/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND This study aims at testing for paths from childhood abuse to clinical indicators of complexity in bipolar disorder (BD), through dimensions of affective dysregulation, impulsivity and hostility. METHOD 485 euthymic patients with BD from the FACE-BD cohort were included from 2009 to 2014. We collect clinical indicators of complexity/severity: age and polarity at onset, suicide attempt, rapid cycling and substance misuse. Patients completed questionnaires to assess childhood emotional, sexual and physical abuses, affective lability, affect intensity, impulsivity, motor and attitudinal hostility. RESULTS The path-analysis demonstrated significant associations between emotional abuse and all the affective/impulsive dimensions (p < 0.001). Sexual abuse was moderately associated with emotion-related dimensions but not with impulsivity nor motor hostility. In turn, affect intensity and attitudinal hostility were associated with high risk for lifetime presence of suicide attempts (p < 0.001), whereas impulsivity was associated with a higher risk of lifetime presence of substance misuse (p < 0.001). No major additional paths were identified when including Emotional and Physical Neglect in the model. CONCLUSIONS This study provides refinement of the links between early adversity, dimensions of psychopathology and the complexity/severity of BD. Mainly, dimensions of affective dysregulation, impulsivity/hostility partially mediate the links between childhood emotional to suicide attempts and substance misuse in BD.
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Affiliation(s)
- B Etain
- AP-HP, GH Saint-Louis - Lariboisière - Fernand Widal, Pôle Neurosciences, Paris, France; Université Paris Diderot, UMR-S 1144, Paris, France; Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Fondation Fondamental, Créteil, France.
| | - M Lajnef
- Inserm, U955, Equipe Psychiatrie Translationnelle, Créteil, France
| | - C Henry
- Fondation Fondamental, Créteil, France; Inserm, U955, Equipe Psychiatrie Translationnelle, Créteil, France; Université Paris Est, Faculté de Médecine, Créteil, France; AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie et d'Addictologie, Créteil, France; Institut Pasteur, Unité Perception et Mémoire, Paris, France
| | - V Aubin
- Fondation Fondamental, Créteil, France; Service de Psychiatrie, Centre Hospitalier Princesse-Grace, Avenue Pasteur, Monaco
| | - J M Azorin
- Fondation Fondamental, Créteil, France; Pôle de Psychiatrie, Hôpital Sainte Marguerite, Assistance Publique Hôpitaux de Marseille, France; Aix-Marseille Université, CNRS, CRN2M UMR 7286, Marseille, France
| | - F Bellivier
- AP-HP, GH Saint-Louis - Lariboisière - Fernand Widal, Pôle Neurosciences, Paris, France; Université Paris Diderot, UMR-S 1144, Paris, France; Fondation Fondamental, Créteil, France
| | - T Bougerol
- Fondation Fondamental, Créteil, France; Clinique Universitaire de Psychiatrie, CHU de Grenoble, Grenoble, France
| | - P Courtet
- Fondation Fondamental, Créteil, France; Département d'Urgence et Post Urgence Psychiatrique, CHRU Montpellier, INSERM U1061, Université Montpellier 1, Montpellier, France
| | - S Gard
- Fondation Fondamental, Créteil, France; Centre Expert Trouble Bipolaire, Pôle de Psychiatrie Générale Universitaire, Centre Hospitalier Charles Perrens, Bordeaux, France
| | - J P Kahn
- Fondation Fondamental, Créteil, France; Université de Lorraine, CHU de Nancy et Pôle 6 de Psychiatrie et Psychologie Clinique, Centre Psychothérapique de Nancy, 1 rue du Docteur Archambault, Laxou Cedex, France
| | - C Passerieux
- Fondation Fondamental, Créteil, France; Université de Versailles Saint-Quentin, Centre Hospitalier de Versailles, Service de Psychiatrie Adulte, Le Chesnay, France
| | - M Leboyer
- Fondation Fondamental, Créteil, France; Inserm, U955, Equipe Psychiatrie Translationnelle, Créteil, France; Université Paris Est, Faculté de Médecine, Créteil, France; AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie et d'Addictologie, Créteil, France
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Reinkensmeyer DJ, Blackstone S, Bodine C, Brabyn J, Brienza D, Caves K, DeRuyter F, Durfee E, Fatone S, Fernie G, Gard S, Karg P, Kuiken TA, Harris GF, Jones M, Li Y, Maisel J, McCue M, Meade MA, Mitchell H, Mitzner TL, Patton JL, Requejo PS, Rimmer JH, Rogers WA, Zev Rymer W, Sanford JA, Schneider L, Sliker L, Sprigle S, Steinfeld A, Steinfeld E, Vanderheiden G, Winstein C, Zhang LQ, Corfman T. How a diverse research ecosystem has generated new rehabilitation technologies: Review of NIDILRR's Rehabilitation Engineering Research Centers. J Neuroeng Rehabil 2017; 14:109. [PMID: 29110728 PMCID: PMC5674748 DOI: 10.1186/s12984-017-0321-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 10/26/2017] [Indexed: 01/14/2023] Open
Abstract
Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a "total approach to rehabilitation", combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970's, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program.
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Affiliation(s)
| | | | | | - John Brabyn
- The Smith-Kettlewell Eye Research Institute, San Francesco, USA
| | | | | | | | | | - Stefania Fatone
- Northwestern University Prosthetics-Orthotics Center, Evanston, USA
| | - Geoff Fernie
- Toronto Rehabilitation Institute, Toronto, Canada
| | - Steven Gard
- Northwestern University Prosthetics-Orthotics Center, Evanston, USA
| | | | | | | | | | - Yue Li
- Toronto Rehabilitation Institute, Toronto, Canada
| | | | | | | | | | | | - James L. Patton
- Rehabilitation Institute of Chicago, University of Illinois at Chicago, Chicago, USA
| | | | - James H. Rimmer
- Lakeshore FoundationUniversity of Alabama-Birmingham, Birmingham, USA
| | | | - W. Zev Rymer
- Rehabilitation Institute of Chicago, Chicago, USA
| | | | | | | | | | - Aaron Steinfeld
- Robotics Institute, Carnegie Mellon University, Pittsburgh, USA
| | | | | | | | | | - Thomas Corfman
- National Institute on Disability, Independent Living, and Rehabilitation Research, Washington, DC, USA
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12
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Ducasse D, Jaussent I, Guillaume S, Azorin JM, Bellivier F, Belzeaux R, Bougerol T, Etain B, Gard S, Henry C, Kahn JP, Leboyer M, Loftus J, Passerieux C, Olié E, Courtet P. Affect lability predicts occurrence of suicidal ideation in bipolar patients: a two-year prospective study. Acta Psychiatr Scand 2017; 135:460-469. [PMID: 28260234 DOI: 10.1111/acps.12710] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of our study was to investigate, in bipolar patients, whether affect lability was associated with suicidal ideation incidence during 2-year follow-up, and which subtype of affect lability was associated with suicidal ideation. METHOD A total of 319 euthymic or mildly depressed bipolar outpatients recruited in the French FondaMental Advanced Centres of Expertise for Bipolar Disorder were divided into two subgroups according to the occurrence of suicidal ideation during a 2-year follow-up. Affect lability was assessed by the French version of the Affect Lability Scale. RESULTS Bipolar patients with high affect lability were more likely to report suicidal ideation during follow-up, even after adjustment for age, study level, rapid cycling, current depression level, anxiety disorder, and lifetime history SA (OR = 2.47; 95% CI [1.15-5.30], P = 0.01). The risk of suicidal ideation increased with the level of affect lability. More specifically, the propensity to switch from neutral to elation affect, from anxious to depressive affect (or inversely), and from neutral to anger affect predicted suicidal ideation. CONCLUSION Reducing affective lability could become a new therapeutic target of suicidal prevention in bipolar disorder.
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Affiliation(s)
- D Ducasse
- CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, Montpellier, France.,Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France.,Fondation FondaMental, Créteil, France
| | - I Jaussent
- Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France
| | - S Guillaume
- CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, Montpellier, France.,Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France.,Fondation FondaMental, Créteil, France
| | - J M Azorin
- Fondation FondaMental, Créteil, France.,AP HM, Psychiatric Pole, Sainte Marguerite, Marseille, France
| | - F Bellivier
- Fondation FondaMental, Créteil, France.,Hospital Saint-Louis - Lariboisière - Fernand Widal, AP-HP, Paris, France
| | - R Belzeaux
- Fondation FondaMental, Créteil, France.,AP HM, Psychiatric Pole, Sainte Marguerite, Marseille, France
| | - T Bougerol
- Fondation FondaMental, Créteil, France.,Academic Hospital of Grenoble, Grenoble, France
| | - B Etain
- Fondation FondaMental, Créteil, France.,Université Paris-Est, Hopital Henri Mondor, DHU PePSY and AP-HP, Créteil, France
| | - S Gard
- Fondation FondaMental, Créteil, France.,Charles Perrens Hospital, Bordeaux, France
| | - C Henry
- Fondation FondaMental, Créteil, France.,Université Paris-Est, Hopital Henri Mondor, DHU PePSY and AP-HP, Créteil, France
| | - J P Kahn
- Fondation FondaMental, Créteil, France.,Brabois Hospital, Academic Hospital of Nancy, Vandoeuvre Les Nancy, France
| | - M Leboyer
- Fondation FondaMental, Créteil, France.,Université Paris-Est, Hopital Henri Mondor, DHU PePSY and AP-HP, Créteil, France
| | - J Loftus
- Fondation FondaMental, Créteil, France.,Department of Psychiatry, Princesse-Grace Hospital, Monaco
| | - C Passerieux
- Fondation FondaMental, Créteil, France.,Academic Hospital of Versailles, Le Chesnay, France
| | | | - E Olié
- CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, Montpellier, France.,Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France.,Fondation FondaMental, Créteil, France
| | - P Courtet
- CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, Montpellier, France.,Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France.,Fondation FondaMental, Créteil, France
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13
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Etain B, Lajnef M, Brichant-Petitjean C, Geoffroy PA, Henry C, Gard S, Kahn JP, Leboyer M, Young AH, Bellivier F. Childhood trauma and mixed episodes are associated with poor response to lithium in bipolar disorders. Acta Psychiatr Scand 2017; 135:319-327. [PMID: 27987204 DOI: 10.1111/acps.12684] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Reliable predictors of response to lithium are still lacking in bipolar disorders (BDs). However, childhood trauma has been hypothesized to be associated with poor response to lithium. METHODS We included 148 patients with BD, euthymic when retrospectively and clinically assessed for response to lithium and childhood trauma using reliable scales. RESULTS According to the 'Alda scale', the sample consisted in 20.3% of excellent responders, 49.3% of partial responders and 30.4% of non-responders to lithium. A higher level of physical abuse significantly correlated with a lower level of response to lithium (P = 0.009). As compared to patients not exposed to any abuse, patients with at least two trauma abuses (emotional, physical or sexual) were more at risk of belonging to the non-responders group (OR = 4.91 95% CI (1.01-27.02)). Among investigated clinical variables, lifetime presence of mixed episodes and alcohol misuse were associated with non-response to lithium. Multivariate analyses demonstrated that physical abuse and mixed episodes were independently associated with poor response to lithium (P = 0.005 and P = 0.013 respectively). CONCLUSIONS Childhood physical abuse might be involved in a poor future response to lithium prophylaxis, this effect being independent of the association between clinical expression of BD and poor response to lithium.
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Affiliation(s)
- B Etain
- Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, France.,AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris cedex, France.,Inserm, U1144, Paris, France.,Fondation FondaMental, Créteil, France.,Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College of London, London, UK
| | - M Lajnef
- INSERM, U955, Psychiatrie Translationnelle, Créteil, France
| | - C Brichant-Petitjean
- Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, France.,AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris cedex, France.,Inserm, U1144, Paris, France
| | - P A Geoffroy
- Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, France.,AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris cedex, France.,Inserm, U1144, Paris, France.,Fondation FondaMental, Créteil, France
| | - C Henry
- Fondation FondaMental, Créteil, France.,INSERM, U955, Psychiatrie Translationnelle, Créteil, France.,Faculté de médecine, Université Paris Est, Créteil, France.,AP-HP, Hôpitaux Universitaires Albert Chenevier-Henri Mondor, DHU PePSY, Pôle de Psychiatrie, Créteil, France.,Institut Pasteur, Unité Perception et Mémoire, Paris, France
| | - S Gard
- Fondation FondaMental, Créteil, France.,Université Hôpital Charles Perrens, Centre Expert Trouble Bipolaire, Service de Psychiatrie Adulte, Pôle 3-4-7, Bordeaux, France
| | - J P Kahn
- Fondation FondaMental, Créteil, France.,Pôle de Psychiatrie et Psychologie Clinique (54G06), Centre Psychothérapique de Nancy, Laxou, France.,Université de Lorraine, Nancy, France
| | - M Leboyer
- Fondation FondaMental, Créteil, France.,INSERM, U955, Psychiatrie Translationnelle, Créteil, France.,Faculté de médecine, Université Paris Est, Créteil, France.,AP-HP, Hôpitaux Universitaires Albert Chenevier-Henri Mondor, DHU PePSY, Pôle de Psychiatrie, Créteil, France
| | - A H Young
- Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College of London, London, UK
| | - F Bellivier
- Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, France.,AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris cedex, France.,Inserm, U1144, Paris, France.,Fondation FondaMental, Créteil, France
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14
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Aas M, Henry C, Bellivier F, Lajnef M, Gard S, Kahn JP, Lagerberg TV, Aminoff SR, Bjella T, Leboyer M, Andreassen OA, Melle I, Etain B. Affective lability mediates the association between childhood trauma and suicide attempts, mixed episodes and co-morbid anxiety disorders in bipolar disorders. Psychol Med 2017; 47:902-912. [PMID: 27894372 DOI: 10.1017/s0033291716003081] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Many studies have shown associations between a history of childhood trauma and more severe or complex clinical features of bipolar disorders (BD), including suicide attempts and earlier illness onset. However, the psychopathological mechanisms underlying these associations are still unknown. Here, we investigated whether affective lability mediates the relationship between childhood trauma and the severe clinical features of BD. METHOD A total of 342 participants with BD were recruited from France and Norway. Diagnosis and clinical characteristics were assessed using the Diagnostic Interview for Genetic Studies (DIGS) or the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). Affective lability was measured using the short form of the Affective Lability Scale (ALS-SF). A history of childhood trauma was assessed using the Childhood Trauma Questionnaire (CTQ). Mediation analyses were performed using the SPSS process macro. RESULTS Using the mediation model and covariation for the lifetime number of major mood episodes, affective lability was found to statistically mediate the relationship between childhood trauma experiences and several clinical variables, including suicide attempts, mixed episodes and anxiety disorders. No significant mediation effects were found for rapid cycling or age at onset. CONCLUSIONS Our data suggest that affective lability may represent a psychological dimension that mediates the association between childhood traumatic experiences and the risk of a more severe or complex clinical expression of BD.
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Affiliation(s)
- M Aas
- NORMENT,KG Jebsen Centre for Psychosis Research,Institute of Clinical Medicine,University of Oslo,Norway
| | - C Henry
- AP-HP,Hôpitaux Universitaires Henri Mondor,Pôle de Psychiatry,DHU Pepsy,Créteil,France
| | | | - M Lajnef
- Inserm,U955,Equipe Psychiatrie Translationnelle,Créteil,France
| | - S Gard
- Fondation Fondamental,Créteil,France
| | - J-P Kahn
- Fondation Fondamental,Créteil,France
| | - T V Lagerberg
- NORMENT,KG Jebsen Centre for Psychosis Research,Institute of Clinical Medicine,University of Oslo,Norway
| | - S R Aminoff
- NORMENT,KG Jebsen Centre for Psychosis Research,Institute of Clinical Medicine,University of Oslo,Norway
| | - T Bjella
- NORMENT,KG Jebsen Centre for Psychosis Research,Institute of Clinical Medicine,University of Oslo,Norway
| | - M Leboyer
- AP-HP,Hôpitaux Universitaires Henri Mondor,Pôle de Psychiatry,DHU Pepsy,Créteil,France
| | - O A Andreassen
- NORMENT,KG Jebsen Centre for Psychosis Research,Institute of Clinical Medicine,University of Oslo,Norway
| | - I Melle
- NORMENT,KG Jebsen Centre for Psychosis Research,Institute of Clinical Medicine,University of Oslo,Norway
| | - B Etain
- Fondation Fondamental,Créteil,France
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15
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Etain B, Lajnef M, Loftus J, Henry C, Raust A, Gard S, Kahn JP, Leboyer M, Scott J, Bellivier F. Association between childhood dimensions of attention deficit hyperactivity disorder and adulthood clinical severity of bipolar disorders. Aust N Z J Psychiatry 2017; 51:382-392. [PMID: 27066819 DOI: 10.1177/0004867416642021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Clinical features of attention deficit hyperactivity disorder can be frequently observed in cases with bipolar disorders and associated with greater severity of bipolar disorders. Although designed as a screening tool for attention deficit hyperactivity disorder, the Wender Utah Rating Scale could, given its factorial structure, be useful in investigating the early history of impulsive, inattentive or mood-related symptoms among patients with bipolar disorders. METHODS We rated the Wender Utah Rating Scale in 276 adult bipolar disorder cases and 228 healthy controls and tested its factorial structure and any associations with bipolar disorder phenomenology. RESULTS We confirmed a three-factor structure for the Wender Utah Rating Scale (' impulsivity/temper', ' inattentiveness' and ' mood/self-esteem'). Cases and controls differed significantly on Wender Utah Rating Scale total score and sub-scale scores ( p-values < 10-5). About 23% of bipolar disorder cases versus 5% of controls were classified as ' WURS positive' (odds ratio = 5.21 [2.73-9.95]). In bipolar disorders, higher Wender Utah Rating Scale score was associated with earlier age at onset, severity of suicidal behaviors and polysubstance misuse; multivariate analyses, controlling for age and gender, confirmed the associations with age at onset ( p = 0.001) and alcohol and substance misuse ( p = 0.001). CONCLUSION Adults with bipolar disorders who reported higher levels of childhood symptoms on the Wender Utah Rating Scale presented a more severe expression of bipolar disorders in terms of age at onset and comorbidity. The Wender Utah Rating Scale could be employed to screen for attention deficit hyperactivity disorder but also for ' at-risk behaviors' in adult bipolar disorder cases and possibly for prodromal signs of early onset in high-risk subjects.
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Affiliation(s)
- Bruno Etain
- 1 Faculté de Médecine, Université Paris-Est Créteil, Créteil, France.,2 Inserm U955, Equipe Psychiatrie Translationnelle, Créteil, France.,3 AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie et d'Addictologie, Créteil, France.,4 Fondation Fondamental, Créteil, France
| | - M Lajnef
- 1 Faculté de Médecine, Université Paris-Est Créteil, Créteil, France
| | - J Loftus
- 4 Fondation Fondamental, Créteil, France.,5 Centre Expert Trouble Bipolaire, Hospital Princesse Grace, Monaco
| | - C Henry
- 1 Faculté de Médecine, Université Paris-Est Créteil, Créteil, France.,2 Inserm U955, Equipe Psychiatrie Translationnelle, Créteil, France.,3 AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie et d'Addictologie, Créteil, France.,4 Fondation Fondamental, Créteil, France
| | - A Raust
- 3 AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie et d'Addictologie, Créteil, France
| | - S Gard
- 4 Fondation Fondamental, Créteil, France.,6 Service de Psychiatrie Adulte, Hôpital Charles Perrens Bordeaux, Bordeaux, France
| | - J P Kahn
- 4 Fondation Fondamental, Créteil, France.,7 CHU de Nancy-Hôpitaux de Brabois, Service de Psychiatrie et Psychologie Clinique, Vandoeuvre Les Nancy, France
| | - M Leboyer
- 1 Faculté de Médecine, Université Paris-Est Créteil, Créteil, France.,2 Inserm U955, Equipe Psychiatrie Translationnelle, Créteil, France.,3 AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie et d'Addictologie, Créteil, France.,4 Fondation Fondamental, Créteil, France
| | - J Scott
- 8 Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - F Bellivier
- 4 Fondation Fondamental, Créteil, France.,9 AP-HP, GH Saint-Louis-Lariboisière-Fernand-Widal, Pôle Neurosciences, Paris, France.,10 Université Paris Diderot, UMR-S 1144, Paris, France
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16
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Abstract
BACKGROUND Reduced-stiffness components are often prescribed in lower-limb prostheses, but their efficacy in augmenting shock absorption has been inconclusive. OBJECTIVES To perform a systematic variation of longitudinal prosthetic stiffness over a wide range of values and to evaluate its effect on shock absorption during gait. STUDY DESIGN Repeated-measures crossover experiment. METHODS Twelve subjects with a unilateral transtibial amputation walked at normal and fast self-selected speeds. Longitudinal prosthetic stiffness was modified by springs within a shock-absorbing pylon: normal (manufacturer recommended), 75% of normal (medium), 50% of normal (soft), and rigid (displacement blocked). The variables of interest were kinematic (stance-phase knee flexion and pelvic obliquity) and kinetic (prosthetic-side ground reaction force loading peak magnitude and timing). RESULTS No changes were observed in kinematic measures during gait. A significant difference in peak ground reaction force magnitudes between medium and normal ( p = 0.001) during freely selected walking was attributed to modified walking speed ( p = 0.008). Ground reaction force peaks were found to be statistically different during fast walking, but only between isolated stiffness conditions. Thus, altering longitudinal prosthesis stiffness produced no appreciable change in gait biomechanics. CONCLUSION Prosthesis stiffness does not appear to substantially influence shock absorption in transtibial prosthesis users. Clinical relevance Varying the level of longitudinal prosthesis stiffness did not meaningfully influence gait biomechanics at self-selected walking speeds. Thus, as currently prescribed within a transtibial prosthesis, adding longitudinal stiffness in isolation may not provide the anticipated shock absorption benefits. Further research into residual limb properties and compensatory mechanisms is needed.
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Affiliation(s)
- Erin Boutwell
- Northwestern University Prosthetics-Orthotics Center, Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois USA,Department of Biomedical Engineering, McCormick School of Engineering and Applied Science, Northwestern University, Evanston, Illinois USA,Jesse Brown VA Medical Center, Department of Veterans Affairs, Chicago, Illinois USA
| | - Rebecca Stine
- Northwestern University Prosthetics-Orthotics Center, Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois USA,Jesse Brown VA Medical Center, Department of Veterans Affairs, Chicago, Illinois USA
| | - Steven Gard
- Northwestern University Prosthetics-Orthotics Center, Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois USA,Department of Biomedical Engineering, McCormick School of Engineering and Applied Science, Northwestern University, Evanston, Illinois USA,Jesse Brown VA Medical Center, Department of Veterans Affairs, Chicago, Illinois USA
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17
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Icick R, Gard S, Barde M, Carminati M, Desage A, Guillaume S, Scott J, Bellivier F. Physical and mental health burden in cases of bipolar disorder classified as current, former, or non-tobacco smokers. J Affect Disord 2017; 208:406-413. [PMID: 27810725 DOI: 10.1016/j.jad.2016.09.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 08/31/2016] [Accepted: 09/22/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Tobacco smoking increases the global burden of bipolar disorder (BD). We examined markers of physical and mental health that are associated with tobacco smoking, controlling for confounders that have not always been considered in previous studies of BD. METHODS Over 600 individuals with BD I or II referred to the French Network for bipolar disorder (FACE-BD) who completed standardized assessments, and could be reliably classified as current (CS) or former smokers (FS), were compared with those who were never smokers (NS) on: BD symptom load and psychiatric comorbidities; prevalence of alcohol and substance use disorders (ASUD); medication usage; functioning and physical health parameters. The bivariate and multivariate analyses took into account age and gender. RESULTS 300 cases (49%) were CS, 78 (13%) FS and 238 (39%) had never smoked. Rates were similar across genders regardless of BD subtype. Compared with NS, CS were more likely to have an ASUD (Odds Ratio (OR) 5.18), BD I (OR 2.09), and lower abdominal obesity (OR 0.97), and FS were more likely to have an ASUD (OR 6.32) and higher abdominal obesity (OR 1.03). LIMITATIONS The sample comprised of white Europeans; the FS subgroup was relatively small and we did not apply any statistical correction for the bivariate analyses. CONCLUSIONS The increased risk of physical and mental health burden in CS and FS compared to NS represents avoidable morbidity in BD. This study offers support to the argument that individuals with BD should be routinely offered support to prevent or stop tobacco smoking.
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Affiliation(s)
- R Icick
- FondaMental Foundation, F-94000 Créteil, France; Paris Diderot Univeristy, Inserm UMR-S 1144, Paris F-75013, France; Paris Descartes University, Inserm UMR-S1144, Paris F-75006, France; Inserm U 1144, F-75006 Paris, France; Assistance Publique - Hôpitaux de Paris, GH Saint-Louis - Lariboisière - F. Widal, Department of Psychiatry and Addiction Medicine, Paris F-75010, France.
| | - S Gard
- FondaMental Foundation, F-94000 Créteil, France; CH Charles Perrens, F-33076 Bordeaux, France
| | - M Barde
- FondaMental Foundation, F-94000 Créteil, France; Assistance Publique - Hôpitaux de Paris, GH Saint-Louis - Lariboisière - F. Widal, Department of Psychiatry and Addiction Medicine, Paris F-75010, France
| | - M Carminati
- FondaMental Foundation, F-94000 Créteil, France; Assistance Publique - Hôpitaux de Paris, GH Saint-Louis - Lariboisière - F. Widal, Department of Psychiatry and Addiction Medicine, Paris F-75010, France
| | - A Desage
- CH Charles Perrens, F-33076 Bordeaux, France
| | - S Guillaume
- FondaMental Foundation, F-94000 Créteil, France; Montpellier 1 University, Inserm U1061, Montpellier, France; CH Lapeyronie, F-34000, Montpellier, France
| | - J Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle, UK; Centre for Affective Disorders, IPPN, London, UK
| | - F Bellivier
- FondaMental Foundation, F-94000 Créteil, France; Paris Diderot Univeristy, Inserm UMR-S 1144, Paris F-75013, France; Paris Descartes University, Inserm UMR-S1144, Paris F-75006, France; Inserm U 1144, F-75006 Paris, France; Assistance Publique - Hôpitaux de Paris, GH Saint-Louis - Lariboisière - F. Widal, Department of Psychiatry and Addiction Medicine, Paris F-75010, France
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18
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Aubert E, Jaussent I, Olié E, Ducasse D, Azorin JM, Bellivier F, Belzeaux R, Bougerol T, Etain B, Gard S, Henry C, Kahn JP, Leboyer M, Loftus J, Passerieux C, Lopez-Castroman J, Courtet P. Effect of early trauma on the sleep quality of euthymic bipolar patients. J Affect Disord 2016; 206:261-267. [PMID: 27517134 DOI: 10.1016/j.jad.2016.07.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 06/20/2016] [Accepted: 07/09/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Poor quality of sleep is frequent in euthymic bipolar patients and conveys worse clinical outcomes. We investigated the features of euthymic bipolar patients associated with poor sleep quality, with a focus on the effect of childhood trauma. METHOD 493 euthymic patients with DSM-IV-defined bipolar disorders were recruited in FondaMental Advanced Centers of Expertize for Bipolar Disorders (FACE-BD) between 2009 and 2014. Clinical variables were recorded. Subjective sleep quality and history of childhood trauma were respectively measured by the Pittsburgh Sleep Quality Index (PSQI) and the Childhood Trauma Questionnaire (CTQ). RESULTS Poor sleepers were older, less professionally active, had significantly higher anxiety levels, took more anxiolytic drugs and did endorse more suicide attempts and suicidal ideas than good sleepers after adjusting for anxiety levels and age. Emotional abuse was associated with poor sleep quality after adjustment for BMI, age, professional activity, and bipolar disorders (BD) type (OR=1.83; 95% CI [1.30; 3.10]; p=0.02). However, this association was lost after adjustment for anxiety levels, anxiolytic treatment and suicide ideation/attempts. LIMITATIONS The main limitation was the type of sleep assessment, which only measured the subjective part of sleep complaints. CONCLUSION A history of emotional abuse might underlie sleep problems in many bipolar patients but anxiety seems to act as a confounding factor in this relationship. New studies are needed to elucidate the role of childhood maltreatment on poor sleep among bipolar patients.
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Affiliation(s)
- E Aubert
- CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France; Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France.
| | - I Jaussent
- Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France
| | - E Olié
- CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France; Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France
| | - D Ducasse
- CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France; Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France
| | - J M Azorin
- FondaMental Foundation, Créteil, France; AP HM, Psychiatric Pole, Sainte Marguerite, Marseille, France
| | - F Bellivier
- FondaMental Foundation, Créteil, France; Hospital Saint-Louis - Lariboisière - Fernand Widal, AP-HP, Paris, France
| | - R Belzeaux
- FondaMental Foundation, Créteil, France; AP HM, Psychiatric Pole, Sainte Marguerite, Marseille, France
| | - T Bougerol
- FondaMental Foundation, Créteil, France; Academic Hospital of Grenoble, Grenoble, France
| | - B Etain
- FondaMental Foundation, Créteil, France; Université Paris-Est, Hopital Chenevier and AP-HP, Créteil, France
| | - S Gard
- FondaMental Foundation, Créteil, France; Charles Perrens Hospital, Bordeaux, France
| | - C Henry
- FondaMental Foundation, Créteil, France; Université Paris-Est, Hopital Chenevier and AP-HP, Créteil, France
| | - J P Kahn
- FondaMental Foundation, Créteil, France; Brabois Hospital, Academic Hospital of Nancy, Vandoeuvre Les Nancy, France
| | - M Leboyer
- FondaMental Foundation, Créteil, France; Université Paris-Est, Hopital Chenevier and AP-HP, Créteil, France
| | - J Loftus
- FondaMental Foundation, Créteil, France; Department of Psychiatry, Princesse-Grace Hospital, Monaco
| | - C Passerieux
- FondaMental Foundation, Créteil, France; Academic Hospital of Versailles, Le Chesnay, France
| | - J Lopez-Castroman
- CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France; Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France
| | - Ph Courtet
- CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France; Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France
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Major MJ, Raghavan P, Gard S. Assessing a low-cost accelerometer-based technique to estimate spatial gait parameters of lower-limb prosthesis users. Prosthet Orthot Int 2016; 40:643-8. [PMID: 25733407 DOI: 10.1177/0309364614568411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 11/21/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND AIM Inexpensive methods for characterizing lower-limb prosthetic gait allow clinicians to monitor gait quality. This study assessed an established method for estimating step length using a low-cost accelerometer to estimate distance walked in lower-limb prosthesis users and explore the use of subject-specific correction factors. TECHNIQUE A three-axis accelerometer was attached to participants using straps. Validity and test-retest reliability of step length was assessed in able-bodied individuals using a motion capture system. Validity of distance walked was assessed with lower-limb prosthesis users. A regression equation was developed for prosthesis users to estimate a correction factor that minimized error. DISCUSSION The system demonstrated excellent reliability and minimal mean error for both participant groups, but subject-specific correction factors did not provide substantial benefit. Estimate variability was high, suggesting the need for further refinement. Estimating distance walked and step length from low-cost accelerometers may be a valid, clinically accessible method for characterizing prosthetic gait. CLINICAL RELEVANCE The use of a low-cost accelerometer may provide valid means for estimating step length and distance walked of lower-limb prosthesis users in a clinical environment for monitoring patient outcomes.
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Affiliation(s)
- Matthew J Major
- Northwestern University Prosthetics-Orthotics Center, Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Pooja Raghavan
- Northwestern University Prosthetics-Orthotics Center, Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Steven Gard
- Northwestern University Prosthetics-Orthotics Center, Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA Jesse Brown VA Medical Center, Chicago, IL, USA
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Boutwell E, Stine R, Gard S. Impact testing of the residual limb: System response to changes in prosthetic stiffness. ACTA ACUST UNITED AC 2016; 53:369-78. [PMID: 27272982 DOI: 10.1682/jrrd.2014.10.0234] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 05/15/2015] [Indexed: 11/05/2022]
Abstract
Currently, it is unknown whether changing prosthetic limb stiffness affects the total limb stiffness and influences the shock absorption of an individual with transtibial amputation. The hypotheses tested within this study are that a decrease in longitudinal prosthetic stiffness will produce (1) a reduced total limb stiffness, and (2) reduced magnitude of peak impact forces and increased time delay to peak force. Fourteen subjects with a transtibial amputation participated in this study. Prosthetic stiffness was modified by means of a shock-absorbing pylon that provides reduced longitudinal stiffness through compression of a helical spring within the pylon. A sudden loading evaluation device was built to examine changes in limb loading mechanics during a sudden impact event. No significant change was found in the peak force magnitude or timing of the peak force between prosthetic limb stiffness conditions. Total limb stiffness estimates ranged from 14.9 to 17.9 kN/m but were not significantly different between conditions. Thus, the prosthetic-side total limb stiffness was unaffected by changes in prosthetic limb stiffness. The insensitivity of the total limb stiffness to prosthetic stiffness may be explained by the mechanical characteristics (i.e., stiffness and damping) of the anatomical tissue within the residual limb.
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Affiliation(s)
- Erin Boutwell
- Northwestern University Prosthetics-Orthotics Center, and Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
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21
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Zissimopoulos A, Fatone S, Gard S. Effects of ankle-foot orthoses on mediolateral foot-placement ability during post-stroke gait. Prosthet Orthot Int 2015; 39:372-9. [PMID: 24878846 DOI: 10.1177/0309364614534294] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 04/10/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Accurate and precise mediolateral foot placement is important for balance during gait, but is impaired post stroke. Mediolateral foot placement may be improved with ankle-foot orthosis use. OBJECTIVE The purpose of this study was to determine whether an ankle-foot orthosis improves mediolateral foot-placement ability during post-stroke ambulation. STUDY DESIGN Crossover trial with randomized order of conditions tested. METHODS The accuracy and precision of mediolateral foot placement was quantified while subjects targeted four different randomized step widths. Subjects were tested with and without their regular non-rigid ankle-foot orthosis in two separate visits (order randomized). RESULTS While ankle-foot orthosis use corrected foot and ankle alignment (i.e. significantly decreased mid-swing plantar flexion, p = 0.000), effects of ankle-foot orthosis use on hip hiking (p = 0.545), circumduction (p = 0.179), coronal plane hip range of motion (p = 0.06), and mediolateral foot-placement ability (p = 0.537) were not significant. CONCLUSION While ankle-foot orthosis-mediated equinovarus correction of the affected foot and ankle was not associated with improved biomechanics of walking (i.e. proximal ipsilateral hip kinematics or mediolateral foot-placement ability), it may affect other aspects of balance that were not tested in this study (e.g. proprioception, cerebellar, vestibular, and cognitive mechanisms). CLINICAL RELEVANCE Studies that investigate the effect of ankle-foot orthosis on gait can help advance stroke rehabilitation by documenting the specific gait benefits of ankle-foot orthosis use. In this study, we investigated the effect of ankle-foot orthosis use on mediolateral foot-placement ability, an aspect of gait important for maintaining balance.
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Affiliation(s)
- Angelika Zissimopoulos
- Prosthetics-Orthotics Center, Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, USA Department of Biomedical Engineering, Northwestern University, Evanston, USA
| | - Stefania Fatone
- Prosthetics-Orthotics Center, Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, USA Jesse Brown VA Medical Center, Department of Veterans Affairs, Chicago, USA
| | - Steven Gard
- Prosthetics-Orthotics Center, Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, USA Jesse Brown VA Medical Center, Department of Veterans Affairs, Chicago, USA
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Ducasse D, Jaussent I, Guillaume S, Azorin JM, Bellivier F, Belzeaux R, Bougerol T, Etain B, Gard S, Henry C, Kahn JP, Leboyer M, Loftus J, Passerieux C, Courtet PH, Olié E. Increased risk of suicide attempt in bipolar patients with severe tobacco dependence. J Affect Disord 2015; 183:113-8. [PMID: 26001671 DOI: 10.1016/j.jad.2015.04.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 04/22/2015] [Accepted: 04/22/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND The aim of our study was to investigate, in bipolar patients, the association between tobacco status (use and dependence) and history of suicide attempt, and to assess the possible role of inflammation as a missing link in the association between smoking status and history of suicide attempt. METHODS A total of 453 adult bipolar out-patients recruited in the French FondaMental Advanced Centres of Expertise for Bipolar Disorder were divided into two subgroups: 274 patients without past history of suicide attempt (non-SA), and 179 patients with a past history of suicide attempt (SA). Tobacco use and dependence, psychiatric and somatic comorbidities, history of childhood abuse, family history of suicide were assessed. Fasting blood tests yielded samples collected for the measurement of high sensitivity (hs-)CRP. RESULTS The risk of suicide attempt increased with smoking dependence. Notably, bipolar patients with a history of suicide attempt were three times more likely to have severe tobacco dependence, independently of confounding factors. However, we failed to find arguments promoting the hypothesis of inflammatory markers (through hs-CRP measure) in the link between tobacco dependence and suicidal behavior. CONCLUSIONS We found a significant association between severe tobacco dependence and history of suicide attempt, but not with level of CRP, independently of confusing factors. Longitudinal studies taken into account all these potential confusing factors are needed to confirm our results.
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Affiliation(s)
- D Ducasse
- CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France; Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France.
| | - I Jaussent
- Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France
| | - S Guillaume
- CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France; Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France
| | - J M Azorin
- FondaMental Foundation, Créteil, France; AP HM, Psychiatric Pole, Sainte Marguerite, Marseille, France
| | - F Bellivier
- FondaMental Foundation, Créteil, France; Hospital Saint-Louis - Lariboisière - Fernand Widal, AP-HP, Paris, France
| | - R Belzeaux
- FondaMental Foundation, Créteil, France; AP HM, Psychiatric Pole, Sainte Marguerite, Marseille, France
| | - T Bougerol
- FondaMental Foundation, Créteil, France; Academic Hospital of Grenoble, Grenoble, France
| | - B Etain
- FondaMental Foundation, Créteil, France; Université Paris-Est, Hopital Chenevier and AP-HP, Créteil, France
| | - S Gard
- FondaMental Foundation, Créteil, France; Charles Perrens Hospital, Bordeaux, France
| | - C Henry
- FondaMental Foundation, Créteil, France; Université Paris-Est, Hopital Chenevier and AP-HP, Créteil, France
| | - J P Kahn
- FondaMental Foundation, Créteil, France; Brabois Hospital, Academic Hospital of Nancy, Vandoeuvre Les Nancy, France
| | - M Leboyer
- FondaMental Foundation, Créteil, France; Université Paris-Est, Hopital Chenevier and AP-HP, Créteil, France
| | - J Loftus
- FondaMental Foundation, Créteil, France; Department of Psychiatry, Princesse-Grace Hospital, Monaco
| | - C Passerieux
- FondaMental Foundation, Créteil, France; Academic Hospital of Versailles, Le Chesnay, France
| | - P H Courtet
- CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France; Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France
| | - E Olié
- CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France; Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France
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Gard S, Christofilopoulos P, Ménétrey J. [Femoroacetabular impingement: rehabilitation and return to sport]. Rev Med Suisse 2015; 11:1450-1455. [PMID: 26398975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Femoroacetabular impingements (FAI) are quite frequent among young athletes. An early detection is essential in order to prevent more labral and cartilage damage. Conservative treatment should not focus on forcing the full range of motion but on restoring a good muscle balance around the joint and a better lower limb dynamic stability and control. The patient should be educated to master the end of hip range of motion during his activities. If the outcome is not satisfactory, a surgical treatment is offered. The post-operative treatment protocol is tailored to the type of repair, following several stages, from neuromuscular control to strengthening up to the return to sport. FAI prevention should be more studied in order to protect the hip of the growing athlete.
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Etain B, Aas M, Bellivier F, Melle I, Henry C, Gard S, Kahn J, Leboyer M. Childhood Trauma and the Clinical Expression of Bipolar Disorders and Psychosis. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)30065-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Olié E, Seyller M, Beziat S, Loftus J, Bellivier F, Bougerol T, Belzeaux R, Azorin JM, Gard S, Kahn JP, Passerieux C, Leboyer M, Etain B, Henry C, Courtet P. Clinical and neuropsychological characteristics of euthymic bipolar patients having a history of severe suicide attempt. Acta Psychiatr Scand 2015; 131:129-38. [PMID: 25131519 DOI: 10.1111/acps.12326] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Identifying bipolar patients at high-suicide risk is a major health issue. To improve their identification, we compared dimensional and neuropsychological profile of bipolar patients with or without history of suicide attempt, taking into account suicidal severity (i.e. admission to intensive ward). METHOD A total of 343 adult euthymic bipolar out-patients recruited in the French FondaMental Advanced Centres of Expertise for Bipolar Disorder were divided into three subgroups: 214 patients without history of suicide attempt, 88 patients with past history of non-severe suicide attempt and 41 patients with past history of severe suicide attempt. General intellectual functioning, speed of information processing, verbal learning and memory, verbal fluency and executive functioning were assessed. RESULTS Severe suicide attempters had lower affective intensity and lability than non-severe attempters. Severe suicide attempters outperformed non-severe attempters for verbal learning and non-attempters for Stroop word reading part after adjustment for study centre, age, gender, educational level, antipsychotics use, depression score, anxious and addictive comorbidities. CONCLUSION Neuropsychological tasks commonly used to assess bipolar patients do not seem accurate to identify suicide attempters in euthymic patients. In the future, decision-making and emotional recognition tasks should be assessed. Moreover, clinical and neuropsychological profiles should be considered together to better define suicidal risk.
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Affiliation(s)
- E Olié
- Department of Emergency Psychiatry, CHRU, Montpellier, France; INSERM U1061, Montpellier, France; Fondamental Foundation, Foundation of Scientific Cooperation, France
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Boutwell E, Stine R, Gard S. A novel in vivo impact device for evaluation of sudden limb loading response. Med Eng Phys 2015; 37:151-5. [DOI: 10.1016/j.medengphy.2014.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 10/10/2014] [Accepted: 10/18/2014] [Indexed: 10/24/2022]
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M’Bailara K, Desage A, Zanouy L, Minois I, Bouteloux M, Jutant A, Gard S. Hypo- et hyper-réactivité émotionnelle : 2 profils de dysrégulation émotionnelle associés à une altération du fonctionnement chez des patients normothymiques ayant reçu un diagnostic de trouble bipolaire. Eur Psychiatry 2014. [DOI: 10.1016/j.eurpsy.2014.09.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
La réactivité émotionnelle est définie par l’intensité émotionnelle avec laquelle un individu réagit à son environnement. Il est désormais admis que les patients ayant reçu un diagnostic de trouble bipolaire ont, en moyenne, une réactivité émotionnelle de base plus intense que les sujets n’ayant pas la pathologie [1–3]. Afin d’affiner cette observation, il paraît maintenant important de déterminer s’il existe différents profils de dysrégulation émotionnelle (hyporéactivité émotionnelle versus hyperréactivité émotionnelle). Les liens entre émotion et adaptation n’étant plus à démontrer, affiner la description des profils de dysrégulation émotionnelle peut être un levier pour mieux saisir les différences de fonctionnement entre les patients. En effet, le niveau de handicap associé aux troubles bipolaires semble variable et les déterminants de cette variabilité sont encore peu connus. L’objectif de cette étude est de tester le lien entre profils de réactivité émotionnelle et niveau de fonctionnement chez des patients normothymiques ayant reçu un diagnostic de troubles bipolaires. Cette étude a été réalisée auprès de 67 patients normothymiques et ayant reçu un diagnostic de trouble bipolaire. La réactivité émotionnelle a été évaluée avec la Multidimensional Assessment of Thymic State (MATHYS) et le fonctionnement avec le FAST. Les résultats montrent que la distribution des scores de fonctionnement diffère entre les groupes (test de Kruskall-Wallis 11,7 ; ddl = 2 ; p = 0,003). À la fois, les patients présentant une hypo-réactivité (MATHYS < 16) et ceux présentant une hyper-réactivité émotionnelle (MATHYS > 24) ont un niveau de fonctionnement général altéré, avec une perturbation particulière pour les dimensions autonomie, activité professionnelle, fonctionnement cognitif et relations interpersonnelles. Il existe donc différents profils de dysrégulation émotionnelle chez les patients. Tenir compte de ces profils paraît pertinent pour orienter certains patients vers un travail de régulation émotionnelle en termes de réduction de l’intensité émotionnelle alors que d’autres mériteraient de davantage réagir à leur environnement.
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M’Bailara K, Gard S, Rouan E, Chive M, Zanouy L, Minois I, Bouteloux M, Jutant A, Desage A. Poids de l’évolution des représentations sur les stratégies d’adaptation des patients et des familles confrontées au trouble bipolaire. Eur Psychiatry 2014. [DOI: 10.1016/j.eurpsy.2014.09.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Vivre au quotidien avec un trouble bipolaire ou vivre avec un patient atteint d’un trouble bipolaire génère un stress familial intense [1]. Les recommandations de la Haute Autorité de santé (HAS) et le développement parallèle de l’éducation thérapeutique du patient proposent 3 axes prioritaires de prise en charge des aidants familiaux : l’information sur le trouble, l’aide dans la gestion du trouble au quotidien et le soutien psychologique. Dans ce contexte, les programmes de psychoéducation familiale constituent un dispositif pertinent pour répondre à la question complexe de la place des familles dans la prise en charge : comment inclure les aidants dans le soin tout en leur garantissant de ne pas devenir des soignants [2] ? Des nombreuses études ont pointé le bénéfice d’une telle prise en charge sur l’évolution de la pathologie [3,4]. Ainsi dans le cas des troubles bipolaires, la psychoéducation a un impact sur le nombre d’épisodes dépressifs et maniaques, sur leur durée et leur intensité. À l’heure actuelle peu de travaux nous renseignent sur les mécanismes qui permettent une telle amélioration et en particulier sur les processus favorisant les modifications de stratégies des personnes dans la gestion du trouble bipolaires. Un des leviers essentiel à évaluer concerne la représentation de la maladie. En effet, l’éducation thérapeutique place d’emblée la personne au cœur du dispositif en s’appuyant sur ses connaissances et sa représentation de la maladie et ne peut se réduire à l’instruction. Notre objectif est donc d’évaluer le poids de l’évolution des représentations sur les stratégies d’adaptation des patients et des familles confrontées au trouble bipolaire. Cette étude a été effectuée auprès de patients ayant reçu un diagnostic de trouble bipolaires et de leur famille pris en charge dans un programme de psychoéducation de 12 séances (sur 6 mois). Nos résultats offrent des pistes de compréhension des processus en jeu au cours d’une psychoéducation multifamiliale.
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Aas M, Etain B, Bellivier F, Henry C, Lagerberg T, Ringen A, Agartz I, Gard S, Kahn JP, Leboyer M, Andreassen OA, Melle I. Additive effects of childhood abuse and cannabis abuse on clinical expressions of bipolar disorders. Psychol Med 2014; 44:1653-1662. [PMID: 24028906 DOI: 10.1017/s0033291713002316] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Previous studies of bipolar disorders indicate that childhood abuse and substance abuse are associated with the disorder. Whether both influence the clinical picture, or if one is mediating the association of the other, has not previously been investigated. METHOD A total of 587 patients with bipolar disorders were recruited from Norway and France. A history of childhood abuse was obtained using the Childhood Trauma Questionnaire. Diagnosis and clinical variables, including substance abuse, were based on structured clinical interviews (Structured Clinical Interview for DSM-IV Axis I disorders or French version of the Diagnostic Interview for Genetic Studies). RESULTS Cannabis abuse was significantly associated with childhood abuse, specifically emotional and sexual abuse (χ 2 = 8.63, p = 0.003 and χ 2 = 7.55, p = 0.006, respectively). Cannabis abuse was significantly associated with earlier onset of the illness (z = -4.17, p < 0.001), lifetime history of at least one suicide attempt (χ 2 = 11.16, p = 0.001) and a trend for rapid cycling (χ 2 = 3.45, p = 0.06). Alcohol dependence was associated with suicide attempt (χ 2 = 10.28, p = 0.001), but not with age at onset or rapid cycling. After correcting for possible confounders and multiple testing, a trend was observed for an interaction between cannabis abuse and childhood abuse and suicide attempt (logistic regression: r 2 = 0.06, p = 0.039). Significant additive effects were also observed between cannabis abuse and childhood abuse on earlier age at onset (p < 0.001), increased rapid cycling and suicide attempt (logistic regression: r 2 = 0.03-0.04, p < 0.001). No mediation effects were observed; childhood abuse and cannabis abuse were independently associated with the disorder. CONCLUSIONS Our study is the first to demonstrate significant additive effects, but no mediation effects, between childhood abuse and cannabis abuse on increased clinical expressions of bipolar disorders.
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Affiliation(s)
- M Aas
- KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Norway
| | - B Etain
- AP-HP, Hôpital H. Mondor - A. Chenevier, Pôle de Psychiatry, Créteil, France
| | | | - C Henry
- AP-HP, Hôpital H. Mondor - A. Chenevier, Pôle de Psychiatry, Créteil, France
| | - T Lagerberg
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - A Ringen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - I Agartz
- KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Norway
| | - S Gard
- Fondation Fondamental, Créteil, France
| | - J-P Kahn
- Fondation Fondamental, Créteil, France
| | - M Leboyer
- AP-HP, Hôpital H. Mondor - A. Chenevier, Pôle de Psychiatry, Créteil, France
| | - O A Andreassen
- KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Norway
| | - I Melle
- KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Norway
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Etain B, Jamain S, Milhiet V, Lajnef M, Boudebesse C, Dumaine A, Mathieu F, Gombert A, Ledudal K, Gard S, Kahn JP, Henry C, Boland A, Zelenika D, Lechner D, Lathrop M, Leboyer M, Bellivier F. Association between circadian genes, bipolar disorders and chronotypes. Chronobiol Int 2014; 31:807-14. [DOI: 10.3109/07420528.2014.906445] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Abstract
BACKGROUND One intervention often used to address physical impairments post stroke is an ankle-foot orthosis. Ankle-foot orthoses may improve walking speed, stride length, and gait pattern. However, effects on balance, crucial for safe ambulation, are thus far inconclusive. One aspect of balance shown to contribute to functional ability is self-efficacy. Self-efficacy, defined as the belief in one's ability to succeed in particular situations, has been shown to be more strongly associated with activity and participation (as defined by the International Classification of Functioning, Disability, and Health) than physical performance measures of gait or balance. OBJECTIVES We investigated whether self-efficacy, or balance confidence when referred to in the context of balance capabilities, is improved with ankle-foot orthosis use. STUDY DESIGN Repeated measures study design. METHODS Balance confidence was measured using the Activities-specific Balance Confidence Scale in 15 persons with chronic poststroke hemiplegia, with and without their regular ankle-foot orthosis. RESULTS Activities-specific Balance Confidence Scale scores were significantly higher (p ≤ 0.01) for the ankle-foot orthosis condition compared to no ankle-foot orthosis. CONCLUSIONS One mechanism by which ankle-foot orthosis use may influence balance is improved balance confidence. Future work should explore the specific mechanisms underlying this improvement in self-efficacy. Clinical relevance Self-efficacy may be an important factor to consider when evaluating functioning post stroke. Rehabilitative interventions that improve balance confidence may help restore participation and overall functioning in pathological populations, particularly in the fall-prone poststroke population. Study results provide evidence for improvements in balance confidence with ankle-foot orthosis use.
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Affiliation(s)
- Angelika Zissimopoulos
- 1Northwestern University Prosthetics-Orthotics Center, Dept. of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Chicago, IL, USA
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Zissimopoulos A, Stine R, Fatone S, Gard S. Mediolateral foot placement ability during ambulation in individuals with chronic post-stroke hemiplegia. Gait Posture 2014; 39:1097-102. [PMID: 24582515 DOI: 10.1016/j.gaitpost.2014.01.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 12/12/2013] [Accepted: 01/22/2014] [Indexed: 02/02/2023]
Abstract
Mediolateral (ML) foot placement is an effective way to redirect the lateral trajectory of the body center of mass (BCoM) during ambulation, but has only been partly characterized in the chronic post-stroke population despite their increased risk for falling [1]. During able-bodied gait, the locomotor system coordinates lower limb swing phase kinematics such that an appropriate ML foot placement occurs upon foot contact. Muscle weakness and abnormal motor patterns may impair foot placement ability post-stroke. The purpose of this study was to characterize ML foot placement ability during post-stroke ambulation by quantifying ML foot placement accuracy and precision, for the both sound and affected feet. Age matched able-bodied individuals were recruited for comparison. All participants were instructed to target step widths ranging from 0 to 45% leg length, as marked on the laboratory floor. Results of this study confirmed that ML foot placement accuracy and precision were significantly lower for the post-stroke group as compared to the control group (p=0.0). However, ML foot placement accuracy and precision were not significantly different between the affected and sound limbs in the post-stroke group. The lowest accuracy for post-stroke subjects was observed at both extreme step width targets (0 and 45%). Future work should explore potential mechanisms underlying these findings such as abnormal motor coordination, lower limb muscle strength, and abnormal swing phase movement patterns.
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Affiliation(s)
- Angelika Zissimopoulos
- Northwestern University Prosthetics-Orthotics Center, Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Chicago, IL, USA; Northwestern University, Department of Biomedical Engineering, Evanston, IL, USA.
| | - Rebecca Stine
- Jesse Brown VA Medical Center, Department of Veterans Affairs, Chicago, IL, USA
| | - Stefania Fatone
- Northwestern University Prosthetics-Orthotics Center, Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Chicago, IL, USA
| | - Steven Gard
- Northwestern University Prosthetics-Orthotics Center, Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Chicago, IL, USA; Northwestern University, Department of Biomedical Engineering, Evanston, IL, USA; Jesse Brown VA Medical Center, Department of Veterans Affairs, Chicago, IL, USA
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Mathieu F, Etain B, Daban C, Raymond R, Raust A, Cochet B, Gard S, M'Bailara K, Desage A, Kahn JP, Wajsbrot-Elgrabli O, Cohen RF, Azorin JM, Leboyer M, Bellivier F, Scott J, Henry C. Affect intensity measure in bipolar disorders: a multidimensional approach. J Affect Disord 2014; 157:8-13. [PMID: 24581821 DOI: 10.1016/j.jad.2013.12.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 12/19/2013] [Accepted: 12/19/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Emotional dysregulation, characterized by high levels of both arousal and intensity of emotional responses, is a core feature of bipolar disorders (BDs). In non-clinical populations, the 40-item Affect Intensity Measure (AIM) can be used to assess the different dimensions of emotional reactivity. METHODS We analyzed the factor structure of the AIM in a sample of 310 euthymic patients with BD using Principal Component Analysis and examined associations between AIM sub-scale scores and demographic and illness characteristics. RESULTS The French translation of the AIM demonstrated good reliability. A four-factor solution similar to that reported in non-clinical samples (Positive Affectivity, Unpeacefulness [lack of Serenity], Negative Reactivity, Negative Intensity), explained 47% of the total variance. Age and gender were associated with Unpeacefulness and Negative reactivity respectively. 'Unpeacefulness' was also positively associated with psychotic symptoms at onset (p=0.0006), but negatively associated with co-morbid substance misuse (p=0.008). Negative Intensity was positively associated with social phobia (p=0.0005). LIMITATIONS We cannot definitively exclude a lack of statistical power to classify all AIM items. Euthymia was carefully defined, but a degree of 'contamination' of the self-reported levels of emotion reactivity may occur because of subsyndromal BD symptoms. It was not feasible to control for the possible impact of on-going treatments. CONCLUSIONS The AIM scale appears to be a useful measure of emotional reactivity and intensity in a clinical sample of patients with BD, suggesting it can be used in addition to other markers of BD characteristics and sub-types.
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Affiliation(s)
- F Mathieu
- Inserm, UMR-S958 - Génétique des Diabètes, Site Villemin, Paris, France.
| | - B Etain
- Inserm, U955, Créteil, France; AP-HP, Hôpital H. Mondor - A. Chenevier, Pôle de Psychiatry, Créteil, France; Fondation Fondamental, Créteil, France
| | - C Daban
- Inserm, U955, Créteil, France; AP-HP, Hôpital H. Mondor - A. Chenevier, Pôle de Psychiatry, Créteil, France
| | | | - A Raust
- Inserm, U955, Créteil, France; AP-HP, Hôpital H. Mondor - A. Chenevier, Pôle de Psychiatry, Créteil, France
| | - B Cochet
- AP-HP, Hôpital H. Mondor - A. Chenevier, Pôle de Psychiatry, Créteil, France
| | - S Gard
- Fondation Fondamental, Créteil, France; Hôpital Charles Perrens, Service de Psychiatrie Adulte, Pôle 3-4-7, Bordeaux, France; Laboratoire de Psychologie EA 4139, Université Victor Segalen, Bordeaux, France
| | - K M'Bailara
- Fondation Fondamental, Créteil, France; Hôpital Charles Perrens, Service de Psychiatrie Adulte, Pôle 3-4-7, Bordeaux, France; Laboratoire de Psychologie EA 4139, Université Victor Segalen, Bordeaux, France
| | - A Desage
- Fondation Fondamental, Créteil, France; Hôpital Charles Perrens, Service de Psychiatrie Adulte, Pôle 3-4-7, Bordeaux, France; Laboratoire de Psychologie EA 4139, Université Victor Segalen, Bordeaux, France
| | - J P Kahn
- Fondation Fondamental, Créteil, France; Service de Psychiatrie et Psychologie Clinique, CHU de Nancy, Hôpitaux de Brabois, Vandoeuvre Les Nancy, France
| | - O Wajsbrot-Elgrabli
- Fondation Fondamental, Créteil, France; Service de Psychiatrie et Psychologie Clinique, CHU de Nancy, Hôpitaux de Brabois, Vandoeuvre Les Nancy, France
| | - R F Cohen
- Fondation Fondamental, Créteil, France; Service de Psychiatrie et Psychologie Clinique, CHU de Nancy, Hôpitaux de Brabois, Vandoeuvre Les Nancy, France
| | - J M Azorin
- Fondation Fondamental, Créteil, France; Pôle Universitaire de Psychiatrie, Hôpital Ste Marguerite, Marseille, France
| | - M Leboyer
- Inserm, U955, Créteil, France; AP-HP, Hôpital H. Mondor - A. Chenevier, Pôle de Psychiatry, Créteil, France; Fondation Fondamental, Créteil, France; Université Paris Est, Faculté de Médecine, Créteil, France
| | - F Bellivier
- Inserm, U955, Créteil, France; Fondation Fondamental, Créteil, France; APHP, Hôpital Fernand Widal, Pôle Addictologie-Toxicologie-Psychiatrie, Paris, France
| | - J Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK; Centre for Affective Disorders, Institute of Psychiatry, London, UK
| | - C Henry
- Inserm, U955, Créteil, France; AP-HP, Hôpital H. Mondor - A. Chenevier, Pôle de Psychiatry, Créteil, France; Fondation Fondamental, Créteil, France; Université Paris Est, Faculté de Médecine, Créteil, France
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Olié E, Franck N, Gard S, Llorca PM, Maurel-Raymondet M, Nuss P, Orth JP, Rousselet AV, Sorbara F, Lukasiewicz M, Mathieu B, Vega C, Courtet P. Évaluation de l’intérêt d’un Serious game chez des patients souffrant de troubles bipolaires inclus dans un programme de psychoéducation. Eur Psychiatry 2013. [DOI: 10.1016/j.eurpsy.2013.09.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
IntroductionLa psychoéducation du trouble bipolaire favorise l’adhésion thérapeutique et le maintien de l’euthymie à 2 ans [1]. Au terme d’un tel programme, les patients peuvent avoir besoin d’aide pour perpétuer la mise en place des apprentissages concernant l’observance thérapeutique, les routines de vie quotidienne, l’évitement des toxiques et le repérage des prodromes thymiques. Le Serious Game BIPOLIFE®, jeu centré sur un avatar souffrant de trouble bipolaire évoluant dans des situations de la vie courante, s’articule aussi autour de ces cibles.
ObjectifsÉvaluer la qualité de l’observance thérapeutique par la Medication Adherence Rating Scale (MARS) [2], les indicateurs de routine de vie et de recours aux soins psychiatriques à 1 et 4 mois de la dernière séance de psychoéducation chez les patients utilisant BIPOLIFE® vs. suivi habituel.MéthodologieÉtude pilote multicentrique randomisée contrôlée à 2 bras (durée : 24 mois) incluant des sujets euthymiques (score de dépression MADRS ≤ 12 et de manie YMRS ≤ 8 depuis 3 mois), bénéficiant d’un programme de psychoéducation. Les patients du groupe « intervention » se connecteront au site BIPOLIFE®, de manière hebdomadaire, pendant un mois (durée de connexion libre). À l’inclusion (dernière séance de psychoéducation), 1 et 4 mois, seront évalués l’attitude vis-à-vis du traitement, la qualité du sommeil, l’indice de masse corporelle, le périmètre ombilical, la consommation de toxiques, le fonctionnement psychosocial et le recours aux soins psychiatriques.PerspectivesProposer BIPOLIFE® en add-on de la psychoéducation pour renforcer les compétences acquises lors du programme et le maintien de l’euthymie.
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Boudebesse C, Lajnef M, Geoffroy PA, Bellivier F, Nieto I, Gard S, Olié E, Azorin JM, Kahn JP, Bougerol T, Passerieux C, Aubin V, Milhiet V, Folkard S, Leboyer M, Henry C, Etain B. Chronotypes of Bipolar Patients in Remission: Validation of the French Version of the Circadian Type Inventory in the FACE-BD Sample. Chronobiol Int 2013; 30:1042-9. [DOI: 10.3109/07420528.2013.798330] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Martin R, Gard S, Besson C, Ménétrey J. [Return to sport after anterior cruciate ligament reconstruction]. Rev Med Suisse 2013; 9:1426-1431. [PMID: 23971328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Despite continuous advances in techniques for anterior cruciate ligament reconstruction (ACLR), return to play (RTP) after surgery remains a challenge. More than one-third of the patients are unable to return to their preinjury sport level, for most because of a fear to sustain another injury. And when a RTP is attempted, up to 20% will tear their graft and a similar % will sustain an ACL tear on the opposite side. We believe that these failures result from an incomplete recovery. Based on a literature review and on our experience, we suggest 6 objective criteria to allow a safer RTP. They rely on laxity, strength, neuromuscular function, and psychological evaluations. Rehabilitation after ACLR should focus on the deficits identified by these tests and on they specific needs of the sport that the athlete plans to return to.
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Affiliation(s)
- R Martin
- Swiss olympic medical center, Unité d'orthopédie et traumatologie du sport, Service de chirurgie orthopédique et traumatologie de l'apparell moteur, HUG, Faculté de médecine et Université de Genève, Genève.
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Drancourt N, Etain B, Lajnef M, Henry C, Raust A, Cochet B, Mathieu F, Gard S, Mbailara K, Zanouy L, Kahn JP, Cohen RF, Wajsbrot-Elgrabli O, Leboyer M, Scott J, Bellivier F. Duration of untreated bipolar disorder: missed opportunities on the long road to optimal treatment. Acta Psychiatr Scand 2013; 127:136-44. [PMID: 22901015 DOI: 10.1111/j.1600-0447.2012.01917.x] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Duration of untreated illness represents a potentially modifiable component of any diagnosis-treatment pathway. In bipolar disorder (BD), this concept has rarely been systematically defined or not been applied to large clinically representative samples. METHOD In a well-characterized sample of 501 patients with BD, we estimated the duration of untreated bipolar disorder (DUB: the interval between the first major mood episode and first treatment with a mood stabilizer). Associations between DUB and clinical onset and the temporal sequence of key clinical milestones were examined. RESULTS The mean DUB was 9.6 years (SD 9.7; median 6). The median DUB for those with a hypomanic onset (14.5 years) exceeded that for depressive (13 years) and manic onset (8 years). Early onset BD cases have the longest DUB (P < 0.0001). An extended DUB was associated with more mood episodes (P < 0.0001), more suicidal behaviour (P = 0.0003) and a trend towards greater lifetime mood instability (e.g. rapid cycling, possible antidepressant-induced mania). CONCLUSION Duration of untreated bipolar disorder (DUB) will only be significantly reduced by more aggressive case finding strategies. Reliable diagnosis (especially for BD-II) and/or instigation of recommended treatments is currently delayed by insufficient awareness of the early, polymorphous presentations of BD, lack of systematic screening and/or failure to follow established guidelines.
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Affiliation(s)
- N Drancourt
- AP-HP, Hôpital H. Mondor - A. Chenevier, Pôle de Psychiatry, Créteil, France
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Etain B, Mathieu F, Liquet S, Raust A, Cochet B, Richard JR, Gard S, Zanouy L, Kahn JP, Cohen RF, Bougerol T, Henry C, Leboyer M, Bellivier F. Clinical features associated with trait-impulsiveness in euthymic bipolar disorder patients. J Affect Disord 2013; 144:240-7. [PMID: 22901401 DOI: 10.1016/j.jad.2012.07.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 06/30/2012] [Accepted: 07/01/2012] [Indexed: 01/10/2023]
Abstract
BACKGROUND A strong association has been reported between trait-impulsiveness and bipolar disorder (BD). Much attention has been focused on this association, but subgroup analysis has generated conflicting results, raising questions about the role of trait-impulsiveness in suicidal behavior and substance misuse in bipolar patients. METHOD We compared Barratt Impulsiveness Scale-10 scores between 385 euthymic bipolar patients and 185 healthy controls. We then investigated possible association between impulsiveness scores and the following clinical characteristics: suicide attempt (SA), lifetime alcohol/cannabis misuse, rapid cycling and mixed episodes. RESULTS Bipolar patients and healthy controls had significantly different BIS-10 total score and subscores (motor, attentional and nonplanning impulsiveness) (all p values <0.0001). No association was observed between BIS-10 total score, personal history of SA, number of SA, age at first SA and history of violent SA. Higher BIS-10 total scores were associated with alcohol misuse (p=0.005), cannabis misuse (p<0.0001), with an additive effect for these two substances (p=0.005). Higher BIS-10 total scores were also associated with rapid cycling (p=0.006) and history of mixed episodes (p=0.002), with an additive effect of these two variables (p=0.0006). LIMITATIONS We used only one clinical measurement of impulsiveness and did not carry out cognitive assessment. CONCLUSION This study demonstrates that trait-impulsiveness may be considered as a dimensional feature associated with BD and with a more severe clinical expression of the disease, characterized by a history of substance misuse, rapid cycling and mixed episodes. We found no association between impulsiveness and SA characteristics in bipolar patients, confirming some previous negative results.
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Affiliation(s)
- B Etain
- Inserm, U955, Créteil 94000, France.
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Icick R, Guillaume S, Gard S, Desage A, Barde M, Henry C, Bellivier F. 803 – Correlates of cannabis use disorders among bipolar outpatients enrolled in the bipolar expert centers french network. Eur Psychiatry 2013. [DOI: 10.1016/s0924-9338(13)75989-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Sportiche S, Brichant-Petitjean C, Etain B, Henry C, Kahn JP, Gard S, Bellivier F. 1732 – Characteristics associated with lithium response in bipolar I and II disorders. Eur Psychiatry 2013. [DOI: 10.1016/s0924-9338(13)76712-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Boutwell E, Stine R, Hansen A, Tucker K, Gard S. Effect of prosthetic gel liner thickness on gait biomechanics and pressure distribution within the transtibial socket. ACTA ACUST UNITED AC 2012; 49:227-40. [PMID: 22773525 DOI: 10.1682/jrrd.2010.06.0121] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Prosthetic gel liners are often prescribed for persons with lower-limb amputations to make the prosthetic socket more comfortable. However, their effects on residual limb pressures and gait characteristics have not been thoroughly explored. This study investigated the effects of gel liner thickness on peak socket pressures and gait patterns of persons with unilateral transtibial amputations. Pressure and quantitative gait data were acquired while subjects walked on liners of two different uniform thicknesses. Fibular head peak pressures were reduced (p = 0.04) with the thicker liner by an average of 26 +/- 21%, while the vertical ground reaction force (GRF) loading peak increased 3 +/- 3% (p = 0.02). Most subjects perceived increased comfort within the prosthetic socket with the thicker liner, which may be associated with the reduced fibular head peak pressures. Additionally, while the thicker liner presumably increased comfort by providing a more compliant limb-socket interface, the higher compliance may have reduced force and vibration feedback to the residual limb and contributed to the larger vertical GRF loading peaks. We conclude that determining optimal gel liner thickness for a particular individual will require further investigations to better identify and understand the compromises that occur between user perception, residual-limb pressure distribution, and gait biomechanics.
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Affiliation(s)
- Erin Boutwell
- Northwestern University Prosthetics-Orthotics Center for Education and Research, Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
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M’bailara K, Cosnefroy O, Desage A, Gard S, Zanouy L, Minois I, Henry C. Group-based trajectory modeling a good model to explore sub-groups of recovery during acute bipolar mood episodes. Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)71943-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Group-based trajectory modeling (GBTM) is a statistical method created to explore the heterogeneity of clinical groups based on their longitudinal outcomes by identifying distinct trajectories of change. This model can be applied to assess heterogeneity in responses to treatment. This pilot study explored the relevance of the GBTM associated with the dimensional evaluation of mood (MATHYS) to define trajectory of recovery in acute bipolar mood episodes on a short period of time during a naturalistic study.MethodThe sample consisted in 118 bipolar patients and all patients were recruited during an acute phase: 56% had a major depressive episode, 26% a manic or hypomanic episode, and 18% a mixed state using the DSM-IV criteria. Patients were assessed four times with MATHYS during a three weeks follow-up period. It is an observational study and treatment was prescribed as usual. We applied the GBTM method and MATHYS total score to define trajectories of recovery.ResultsThis method allows identifying 4 trajectories of recovery. At Baseline, two of them started with a score of inhibition but with quite different evolutive profiles (stable inhibition versus improvement). The two others trajectories started with a score of activation (mild versus moderate) and showed a linear improvement of symptoms but with a more rapid recovery for the patients with the higher activation at baseline.ConclusionWhen considering the diagnosis of patients belonging in each trajectory, there model seems particular relevant to explore the high heterogeneity in response to treatment in bipolar patients during an acute depressive episode.
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Abstract
In two out of three large urban epidemics of poliomyelitis the virus of this disease has been detected in samples of sewage. From one of the sites it was found repeatedly. Both positive sites were located in the vicinity of isolation hospitals, and we believe that the findings indicate that this virus can be transported, for short distances at least, through the medium of flowing sewage.
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Affiliation(s)
- J R Paul
- Departments of Medicine and Pediatrics, Yale University School of Medicine, New Haven
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Abstract
1. In the feces of approximately two-thirds of normal mice 6 weeks of age an agent in all respects similar to the virus of mouse encephalomyelitis can be recovered. 2. In isolated mice, fed on sterile food and water, excretion of virus has been shown to persist up to 53 days after isolation. 3. In normal mice known to be virus carriers virus has been demonstrated in the gastro-intestinal tract but not in the central nervous system, thoracic or abdominal viscera, or any organs of the head. 4. The source of the virus excreted in the feces has been shown to be located in all probability in the intestinal wall. 5. Evidence is presented that the virus can invade the animal organism, as virus has been demonstrated in the mesenteric lymph glands.
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Affiliation(s)
- M Theiler
- Laboratories of the International Health Division of The Rockefeller Foundation, New York
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Abstract
1. The two strains of virus named GD VII and FA, respectively, accidentally discovered during experiments with yellow fever, have been shown to be immunologically related to each other, as well as to the virus of mouse encephalomyelitis. 2. Infection of the central nervous system can be produced with both strains by intracerebral, intranasal, or intraperitoneal inoculations. The cardinal symptom produced by the GD VII strain of virus by all three methods of inoculation is a flaccid paralysis of the limbs. The symptoms produced by the FA strain are referable to lesions of the brain when infection is produced by intracerebral and intranasal inoculation. Following intraperitoneal inoculation of the FA strain of virus, however, a flaccid paralysis is usually produced. 3. By the use of graded collodion membranes the particle size of the virus of mouse encephalomyelitis has been shown to be from 9 to 13 mµ 4. The stability of the virus at different hydrogen ion concentrations has been tested. It has been found that there are two optima of stability, one at about pH 8.0 and the other at pH 3.3. 5. The virus is readily inactivated at 37°C. by 1 per cent hydrogen peroxide. 6. Of organic solvents tested, ether had no action, whereas ethyl alcohol in 20 per cent concentration almost completely inactivated the virus after 45 minutes in the cold. 7. The virus can be precipitated by means of ammonium sulfate. 8. With increasing age mice acquire a relative resistance to the virus. 9. Immunity to a subsequent intracerebral inoculation can be produced by intraperitoneal, as well as intranasal, administrations of relatively large amounts of virus. 10. Mice infected by the intracerebral inoculation of a relatively avirulent virus acquire a high degree of immunity to a subsequent inoculation of a highly virulent strain. 11. The course of infection in mice following intracerebral, intranasal, and intraperitoneal inoculation of the FA strain of virus has been studied.
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Affiliation(s)
- M Theiler
- Laboratories of the International Health Division of The Rockefeller Foundation, New York
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Abstract
In a study of mouse encephalomyelitis the following observations were made:— 1. A definite relationship exists between the amount of virus inoculated intracerebrally and the length of the incubation period. 2. The reciprocal of the incubation period was found to be approximately proportionate to the logarithm of the amount of virus inoculated. The relationship can, therefore, be given a simple mathematical form. 3. This fact provides a basis for a new method for measurement of the activity of mouse encephalomyelitis virus.
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Affiliation(s)
- S Gard
- Laboratories of the International Health Division of The Rockefeller Foundation, New York
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Brennan S, Sly PD, Gangell CL, Sturges N, Winfield K, Wikstrom M, Gard S, Upham JW. Alveolar macrophages and CC chemokines are increased in children with cystic fibrosis. Eur Respir J 2009; 34:655-61. [DOI: 10.1183/09031936.00178508] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Douglas TA, Brennan S, Gard S, Berry L, Gangell C, Stick SM, Clements BS, Sly PD. Acquisition and eradication of P. aeruginosa in young children with cystic fibrosis. Eur Respir J 2008; 33:305-11. [PMID: 19010992 DOI: 10.1183/09031936.00043108] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
When do infants and young children with cystic fibrosis acquire infection with Pseudomonas aeruginosa? Can this be eradicated when first detected? Children <6 yrs of age participated in an annual bronchoalveolar lavage (BAL)-based microbiological surveillance programme in Perth, Australia. When P. aeruginosa was detected, an eradication programme using combination treatment with i.v., oral and nebulised antibiotics was undertaken. Repeat BAL was performed 3 months following treatment, to assess eradication success. P. aeruginosa was detected in 33 (28.4%) children; median (range) age at detection was 30.5 (3.3-71.4) months. P. aeruginosa was mucoid at detection in six (18.2%) out of 33 patients and associated with respiratory symptoms in 16 (48.5%) out of 33 children. In total, 26 children underwent eradication therapy, with P. aeruginosa eradicated in 20 (77%) out of 26 following one eradication cycle and in three (total 88%) additional children following a second cycle. Eradication was associated with a significant decrease in neutrophil elastase and interleukin-1beta in BAL fluid 12 months post eradication. Eradication of Pseudomonas aeruginosa infection is achievable in young children with cystic fibrosis for up to 5 yrs using combination i.v., oral and nebulised antibiotic therapy and is associated with reduced pulmonary inflammation 12 months post eradication.
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Affiliation(s)
- T A Douglas
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia Perth, Western Australia
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Abstract
This study examined the effect of sagittal trunk posture on the gait of able-bodied subjects. Understanding the effect of trunk posture on gait is of clinical interest since alterations in trunk posture often occur with age or in the presence of spinal pathologies, such as lumbar flatback. Gait analysis was conducted on 14 adults walking at self-selected slow, normal, and fast walking speeds while maintaining three trunk postures: upright, and with 25+/-7 degrees and 50+/-7 degrees of trunk flexion from the vertical. During trunk-flexed gait, subjects adopted a crouch posture characterized by sustained knee flexion during stance and an increase in ankle dorsiflexion and hip flexion angles. During stance, these kinematic adaptations produced a posterior shift in the positions of the trunk and pelvis, which helped to offset the anterior shift in the trunk mass that occurred with trunk flexion. In this way, kinematic adaptations may have been used to maintain balance by shifting the body's center of mass to a position similar to that of upright walking. These changes in lower limb joint kinematics created a phase lag in the position of the hip joint center relative to that of the ankle joint center in the sagittal plane. Alterations in the sagittal alignment of the hip and ankle joint positions were associated with a phase lag in the vertical position, velocity, and acceleration of the body's center of mass (BCOM) relative to upright walking. Since the vertical ground reaction force (GRF(v)) is proportional to the vertical acceleration of the BCOM, significant changes were also seen in the GRF(v) during trunk-flexed gait. In summary, kinematic adaptations necessary to maintain dynamic balance altered the trajectory and acceleration of the BCOM in the vertical direction, which was reflected in the GRF(v). The results of this study may help clinicians better understand the nature and impact of compensatory mechanisms in patients who exhibit trunk-flexed postures during gait.
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Affiliation(s)
- Devjani Saha
- Northwestern University Prosthetics Research Laboratory & Rehabilitation Engineering Research Program, Chicago, IL 60611, United States.
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Gard S. [Tendinopathies: the most effective physiotherapeutic treatments]. Rev Med Suisse 2007; 3:1788-91. [PMID: 17850007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Tendinopathy, a current injury often falsely named tendinitis, is a lesion due to an excess load of the tendon with impairment of its collagen fibers. The repair of tendinous fibers requires many weeks; the treatment is a determining factor. There are numerous physiotherapy treatments. We have chosen the most usual ones, controlled their evidence of effectiveness according to the literature and shown which techniques with proven efficacy should be used in every tendinopathy treatment: cold, stretching, eccentric training. If these give no satisfactory results, shock waves could be useful. Ultrasonic therapy is worthless although widely used. Serious studies on other techniques are lacking. An evidence based physiotherapy is of prime importance for the future.
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Affiliation(s)
- S Gard
- Physio des Voisins 15, rue des Voisins, 1205 Genève.
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