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Grillault Laroche D.,Hopital University Paul Brousse | Gaillard A.,University of Sainte-Anne
Psychiatry Research | Year: 2016

The prevalence of OCS and OCD is higher in schizophrenic patients than in the general population. These disorders are sometimes induced by AAPs. There is higher frequency of OCS and greater severity in patients treated with antipsychotics with predominant anti-serotoninergic profiles opposed to those with predominant dopaminergic blockade. Induced OCS may be due to complex neuromodulation involving many serotonin, dopamine and glutamate receptors and several subtypes. Concerning connectivity, AAPs differentially influence the BOLD signal, depending on the intensity of D2 receptor blockade. The OFC could play a significant role, on account of its involvement in inhibitory control. There is a paradox: AAPs are efficient as augmentation to SSRI in treatment resistant OCD, some of them such as risperidone or aripiprazole have favourable effects in schizoptypic OCD, but AAPs cause induced OCS in schizophrenic patients. When prescribing AAPs, we should inform patients about this potential side effect and assess systematically OCS with Y-BOCS assessment after 1 month of treatment. Afterwards there are different strategies: Aripiprazole in combination can reduce OCS induced by clozapine, SSRI are slightly effective and CBT shows a few encouraging results. OCS are sometimes dose-dependent, so we also recommend prescribing the minimum effective dose and gradual introduction. © 2016 Elsevier Ireland Ltd


Samuel D.,Hopital University Paul Brousse | Duclos-Vallee J.-C.,Hopital University Paul Brousse
Nature Reviews Gastroenterology and Hepatology | Year: 2015

Liver transplantations for patients who are co-infected with HIV and HCV have always posed a challenge and still do, according to the results of a new study. This article discusses the factors that contribute to an increased risk of poor transplantation outcomes and how new treatment options might affect patient survival. © 2015 Macmillan Publishers Limited. All rights reserved.


Mebarki S.,rue La Condamine | Trivalle C.,Hopital University Paul Brousse
NPG Neurologie - Psychiatrie - Geriatrie | Year: 2012

Many drugs possessing anticholinergic properties are often prescribed in geriatrics, which exposes elderly people to a risk of developing side effects such as delirium, urinary retention or falls. Although some anticholinergic drugs are known to be potentially inappropriate by geriatricians, others like furosemide or warfarine, that are frequently prescribed, present anticholinergic features. There are three different clinical scales in the literature to measure the anticholinergic content of various frequently used drugs. The purpose of this article is to present the existing medication scales and to evaluate their interest in clinical practice. © 2012 Elsevier Masson SAS.


Reynaud M.,Hopital University Paul Brousse
Annales Medico-Psychologiques | Year: 2010

The relations between amorous passion and addiction have long been noted. Recent advances in neurobiology have allowed us to reexamine the relations between these two states and to better understand their clinical symptoms. Methods: We compare clinical, neuropsychological, neurobiological and neuroimaging data in love passion versus substance addictions. Results: The clinical description of the amorous state includes: unrestrained desire and sexual pleasure; feeling of euphoria; powerful motivation to the " object of his love" ; a cognitive mechanism characterised by a focalised attention, pervasive memories, intrusive thoughts; emotional exacerbation and emotional dependence with need for the other, aroused by his absence. Criteria for love addiction (differing from love passion), including the notion of suffering and continued behaviour despite adverse consequences, inspired from the DSM-IV criteria could be evaluated. The neurophysiological model for all addictions can be applied to love addicts: the desired object is overrated. The rewarding value and its memory trigger a major motivation: simple desire has become a need; cortical control has become insufficient. For love as well as addictions, dopamine codes the value of pleasure. Love and drugs are potent pleasure modulators of dopamine flux. Oxytocin pathways, clearly implicated in love attachment, are also an important pathway towards understanding the mechanisms of dependence. Imagery data on various drug addictions and imagery data on sexual desire, orgasm and amorous relationships, enable their mechanisms and activated circuits to be compared and their similarities analysed. Conclusion: Love and addictions are comprised of liking, wanting and needing. Refining of clinical, neurobiological and neuro-imaging studies will further elucidate these similarities and should provide a better understanding and improved treatment of these states. © 2010 Elsevier Masson SAS.


Fodil M.,Hopital University Paul Brousse | Fillette A.,Hopital University Paul Brousse | Trivalle C.,Hopital University Paul Brousse
NPG Neurologie - Psychiatrie - Geriatrie | Year: 2013

In geriatrics, it is frequent to crush tablets so that patients presenting problems of swallowing and/or of the behaviour may take the medicine more easily. This may, however, significantly alter the effectiveness of drugs, their pharmacokinetics and even lead to toxic effects for both patients and caregivers. All classes of drugs are concerned. To avoid potential iatrogenic and professional risks, it is important to first make sure of the dosage formulation, because some drugs prohibit tampering. We propose a simplified list of drugs for which it is forbidden to crush together with some practical recommendations. © 2012.


Guardia D.,UDSL | Rolland B.,CHULille | Karila L.,Hopital University Paul Brousse | Cottencin O.,UDSL
Current Pharmaceutical Design | Year: 2011

Lifetime prevalence estimates for binge eating disorder (BED) and bulimia nervosa (BN) are 3.5% and 1.5% among women and 2.0% and 0.5% among men, respectively. Night eating syndromes (NES) affect 1.1%-1.5% of the general population. All of these disorders induce an impaired quality of life and significant disability. Symptom overlaps are reported between substance use disorders and eating disorders such as BED, BN and NES. A growing body of evidence suggests that γ-amino-butyric acid (GABA) and glutamate modulation pathways might be useful targets in the treatment of alcohol and substance use disorders. Their involvement in the reward process and in the regulation of food intake could be the source of new pharmacological strategies for the treatment of eating disorders. We review published data on the efficacy and safety of drugs targeting the GABA and glutamate modulation pathways for the treatment of BED, BN and NES. Preliminary results indicate that baclofen and topiramate are effective in reducing binge eating, craving and weight gain. However, the potential clinical drug-placebo difference is not detected for acamprosate and lamotrigine. Limitations of these studies are discussed. In view of these data, first- and second-line pharmacological interventions are proposed. © 2011 Bentham Science Publishers Ltd.


PubMed | Humanitas University, Hospital Italiano Of Buenos Aires, Hopital University Paul Brousse and University of Geneva
Type: Review | Journal: Liver cancer | Year: 2016

The recent advent of more effective chemotherapy and the development of surgical procedures have expanded the pool of resectable patients with colorectal liver metastases (CLM). Two-stage hepatectomy (TSH), associated liver partition and portal vein ligation for staged hepatectomy (ALPPS), and ultrasound-guided enhanced one-stage hepatectomy (e-OSH) are the surgical solutions proposed for these patients, but the range of indications for these procedures vary from institution to institution.The advantages and disadvantages of each approach are herein discussed. Patients who drop out between the staged operations of TSH limit its success rate, although predictive scores may help with patient selection and thereby optimize the results. Safety and oncological suitability are concerns to be addressed when considering ALPPS. These concerns notwithstanding, ALPPS has introduced an innovative concept in surgery: the monosegmental remnant liver. Studies involving e-OSH have proven the oncological suitability of tumor exposure once the CLM is detached from major intrahepatic vessels. This finding could expand the indications for e-OSH, although the technical challenges that it entails limit its spread among the surgical community. The liver-first approach involves the clearance of tumors from the liver before the colorectal primary is tackled. This approach fully justifies the complexity of e-OSH.Predictive scores limiting the interstage dropout of TSH, partial and monosegmental ALPPS, and R1 vascular e-OSH justified by solid long-term results represent new insights that could help refne the patient assignment to each of these approaches. Additionally, liver transplantation is an emerging treatment for CLM that should be taken into account.


PubMed | Hopital University Paul Brousse
Type: Comment | Journal: Nature reviews. Gastroenterology & hepatology | Year: 2015

Liver transplantations for patients who are co-infected with HIV and HCV have always posed a challenge and still do, according to the results of a new study. This article discusses the factors that contribute to an increased risk of poor transplantation outcomes and how new treatment options might affect patient survival.


PubMed | Kumamoto University and Hopital University Paul Brousse
Type: Journal Article | Journal: The British journal of surgery | Year: 2016

Although associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been increasingly adopted by many centres, the oncological outcome for colorectal liver metastases compared with that after two-stage hepatectomy is still unknown.Between January 2010 and June 2014, all consecutive patients who underwent either ALPPS or two-stage hepatectomy for colorectal liver metastases in a single institution were included in the study. Morbidity, mortality, disease recurrence and survival were compared.The two groups were comparable in terms of clinicopathological characteristics. ALPPS was completed in all 17 patients, whereas the second-stage hepatectomy could not be completed in 15 of 41 patients. Ninety-day mortality rates for ALPPS and two-stage resection were 0 per cent (0 of 17) versus 5 per cent (2 of 41) (P = 0891). Major complication rates (Clavien grade at least III) were 41 per cent (7 of 17) and 39 per cent (16 of 41) respectively (P = 0999). Overall survival was significantly lower after ALPPS than after two-stage hepatectomy: 2-year survival 42 versus 77 per cent respectively (P = 0006). Recurrent disease was more often seen in the liver in the ALPPS group. Salvage surgery was less often performed after ALPPS (2 of 8 patients) than after two-stage hepatectomy (10 of 17).Although major complication and 90-day mortality rates of ALPPS were similar to those of two-stage hepatectomy, overall survival was significantly lower following ALPPS.


PubMed | Kumamoto University, Hopital University Paul Brousse and University Paris - Sud
Type: Journal Article | Journal: The oncologist | Year: 2016

The purpose of this study was to determine the optimal definition and elucidate the predictive factors of early recurrence after surgery for colorectal liver metastases (CRLM).Among 987 patients who underwent curative surgery for CRLM from 1990 to 2012, 846 with a minimum follow-up period of 24 months were eligible for this study. The minimum p value approach of survival after initial recurrence was used to determine the optimal cutoff for the definition of early recurrence. The predictive factors of early recurrence and prognostic factors of survival were analyzed.For 667 patients (79%) who developed recurrence, the optimal cutoff point of early recurrence was determined to be 8 months after surgery. The impact of early recurrence on survival was demonstrated mainly in patients who received preoperative chemotherapy. Among the 691 patients who received preoperative chemotherapy, recurrence was observed in 562 (81%), and survival in patients with early recurrence was significantly worse than in those with late recurrence (5-year survival 18.5% vs. 53.4%, p < .0001). Multivariate logistic analysis identified age 57 years (p = .0022), >1 chemotherapy line (p = .03), disease progression during last-line chemotherapy (p = .024), >3 tumors (p = .0014), and carbohydrate antigen 19-9 >60 U/mL (p = .0003) as independent predictors of early recurrence. Salvage surgery for recurrence significantly improved survival, even in patients with early recurrence.The optimal cutoff point of early recurrence was determined to be 8 months. The preoperative prediction of early recurrence is possible and crucial for designing effective perioperative chemotherapy regimens.In this study, the optimal cutoff point of early recurrence was determined to be 8 months after surgery based on the minimum p value approach, and its prognostic impact was demonstrated mainly in patients who received preoperative chemotherapy. Five factors, including age, number of preoperative chemotherapy lines, response to last-line chemotherapy, number of tumors, and carbohydrate antigen 19-9 concentrations, were identified as predictors of early recurrence. Salvage surgery for recurrence significantly improved survival, even in patients with early recurrence. For better selection of patients who could truly benefit from surgery and should also receive strong postoperative chemotherapy, the accurate preoperative prediction of early recurrence is crucial.

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