Biskin R.S.,Sir Mortimer B Davis Jewish General Hospital |
Biskin R.S.,McGill University
Canadian Journal of Psychiatry | Year: 2015
Borderline personality disorder (BPD) has historically been seen as a lifelong, highly disabling disorder. Research during the past 2 decades has challenged this assumption. This paper reviews the course of BPD throughout life, including childhood, adolescence, and adulthood. BPD can be accurately identified in adolescence, and the course of the disorder, in adolescence and adulthood, is generally similar, with reductions in symptoms over time. Functional recovery is less consistent, and further research on factors or treatments that may improve the long-term functional outcome of patients with BPD is warranted. © 2015, Canadian Psychiatric Association. All rights reserved.
Desmarais J.E.,McGill University |
Looper K.J.,McGill University |
Looper K.J.,Sir Mortimer B Davis Jewish General Hospital
Maturitas | Year: 2010
Objective: Tamoxifen, a medication used in the treatment of breast cancer, often induces menopausal symptoms. Certain medications and natural supplements taken or prescribed to alleviate tamoxifen-induced hot flashes and depressive states in women with breast cancer interact with tamoxifen. This paper reviews potentially problematic interactions and offers treatment recommendations. Methods: Medline (1950-June 1, 2010), Embase Classic + Embase (1947-June 1, 2010) and PsycINFO (1967-June 1, 2010) were searched through Ovid. The word "tamoxifen" was searched with "depression" and then with "menopaus*" and "symptoms", with "treatment" as a limit. "Tamoxifen" was later searched with the MeSH terms "drug interaction" or "drug incompatibility". Results: Venlafaxine is efficacious for the treatment of hot flashes and depression and safe to use in combination with tamoxifen. Gabapentin is also efficacious in treating tamoxifen-induced hot flashes and, since it does not interact with cytochrome P450 system, is likely safe to use in patients using tamoxifen. Desvenlafaxine and pregabalin may be alternatives to venlafaxine and gabapentin, respectively, although desvenlafaxine has not yet been studied in this population. Paroxetine, fluoxetine and bupropion are strong CYP2D6 inhibitors which should be avoided in tamoxifen users. Fluvoxamine and nefazodone both inhibit CYP3A, which could potentially affect the metabolism of tamoxifen. Clonidine can be an alternative agent but may carry significant side effects. Evidence of medicinal products for the treatment of tamoxifen-induced hot flashes is equivocal at best. Conclusions: Clinicians should remain cautious about using strong inhibitors and/or inducers of cytochrome 2D6 and 3A4 concomitantly with tamoxifen. Use of natural menopausal supplements and diets rich in isoflavones should not be encouraged in tamoxifen users until more data is available. There are however safe treatments for hot flashes and depression in tamoxifen users. © 2010 Elsevier Ireland Ltd. All rights reserved.
Paris J.,Sir Mortimer B Davis Jewish General Hospital |
Paris J.,McGill University
Canadian Journal of Psychiatry | Year: 2013
Psychiatry has long been prone to fads. The main reason is that mental illness is poorly understood and can be difficult to treat. Most diagnostic fads have involved the extension of well-known categories into broader spectra. The most prominent treatment fads have involved the overuse of pharmacological interventions and a proliferation of methods for psychotherapy. The best antidote to fads is a commitment to evidence-based psychiatry.
Mallette F.A.,Sir Mortimer B Davis Jewish General Hospital |
Mallette F.A.,McGill University |
Richard S.,Sir Mortimer B Davis Jewish General Hospital |
Richard S.,McGill University
Cell Research | Year: 2012
Efficient DNA damage sensing and repair is crucial to preserve genomic integrity and failure to detect or repair DNA breaks can cause mutations, contributing to the formation of tumors. One key protein required for mediating DNA repair is the tumor suppressor 53BP1. Recent studies now demonstrate the crucial role of K48-linked ubiquitination and protein degradation for 53BP1 recruitment at sites of DNA damage. © 2012 IBCB, SIBS, CAS All rights reserved.
Huiart L.,Institute Paoli Calmettes |
Huiart L.,French Institute of Health and Medical Research |
Dell'Aniello S.,Sir Mortimer B Davis Jewish General Hospital |
Suissa S.,Sir Mortimer B Davis Jewish General Hospital |
Suissa S.,McGill University
British Journal of Cancer | Year: 2011
Background:Non-compliance with oral treatment in oncology is an emerging health issue. For breast cancer (BC) patients, few data are available on compliance and persistence to tamoxifen in younger women and to aromatase inhibitors (AIs) as compared with tamoxifen in older women.Methods:We constituted a cohort of 13 479 women with BC who received at least one prescription of tamoxifen or AI between 1998 and 2008, in the United Kingdom General Practice Research Database. Days covered by medication and treatment discontinuation were studied. Time to treatment discontinuation was calculated using Kaplan-Meier estimates.Results:Overall, 18.9% (95% CI: 15.1-23.0) of women on AIs as compared with 31.0% (95% CI: 29.6-32.2) of women on tamoxifen had discontinued their treatments within the first 5 years (P0.001). This rate raised to 50.7% (95% CI: 43.0-57.9) among the 416 women under 40 years receiving tamoxifen as initial hormonal therapy. Among older women, treatment discontinuation was less frequent for AIs as compared with tamoxifen (P0.001). Among women on AI therapy, 14% of them (n374) had switched treatments. Conclusion:Among older women, the real-life patterns of use of AI show high rates of compliance. In younger women, tamoxifen is prematurely discontinued for half of patients. © 2011 Cancer Research UK All rights reserved.
Azoulay L.,Sir Mortimer B Davis Jewish General Hospital |
Azoulay L.,McGill University |
Dell'Aniello S.,Sir Mortimer B Davis Jewish General Hospital |
Gagnon B.,McGill University |
And 3 more authors.
Cancer Epidemiology Biomarkers and Prevention | Year: 2011
Background: Several in vitro studies have indicated that metformin may reduce the risk of prostate cancer; however, epidemiologic studies have been inconclusive. The objective of this study was to determine whether metformin decreases the risk of prostate cancer in patients with type 2 diabetes. Methods: A nested case-control analysis was conducted within a population-based cohort from the UK General Practice Research Database. The cohort included patients over the age of 40 who were prescribed a first oral hypoglycemic agent (OHA) between 1988 and 2009. Cases of prostate cancer were matched up to ten controls on year of birth, date of cohort entry, and duration of follow-up. Adjusted rate ratios (RR) were estimated using conditional logistic regression. Results: The cohort included 63,049 incident users of OHAs, in which 739 cases of prostate cancer were matched to 7,359 controls. Metformin use did not decrease the risk of prostate cancer (RR: 1.23, 95% CI: 0.99-1.52). In secondary analyses, prostate cancer risk was found to increase as a function of the number of metformin prescriptions received (one to seven prescriptions: RR: 1.05, 95% CI: 0.80-1.37; seven to eighteen prescriptions: RR: 1.29, 95% CI: 0.99-1.69; eighteen to thirty-six prescriptions: RR: 1.37, 95% CI: 1.04-1.81; more than thirty-six prescriptions: RR: 1.40, 95% CI: 1.03-1.89). Conclusion: The results of this study indicate that metformin does not reduce the risk of prostate cancer in patients with type 2 diabetes. Impact: The secondary analyses need to be interpreted with caution given the inverse association between type 2 diabetes and prostate cancer. ©2010 AACR.
Tritt S.M.,University College London |
Ryder A.G.,Concordia University at Montréal |
Ryder A.G.,Sir Mortimer B Davis Jewish General Hospital |
Ring A.J.,Concordia University at Montréal |
Pincus A.L.,Pennsylvania State University
Journal of Affective Disorders | Year: 2010
Background: Although relations between depressive and narcissistic pathologies have been proposed in both psychoanalytic and phenomenological literatures, empirical research generally fails to confirm this link. Common measures of narcissism, however, emphasize grandiose rather than vulnerable traits, and include both adaptive and maladaptive features. We therefore assessed the relation between narcissistic personality and depressive temperament (DT) using a recently developed measure designed to assess a wide range of pathological narcissistic (PN) traits. We also examined the distinctiveness of the association between DT and PN controlling other temperaments. Method: The Pathological Narcissism Inventory (PNI; Pincus et al., 2009), the Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Auto-questionnaire (TEMPS-A; Akiskal et al., 2005), and a modified Schedule of Fatigue and Anergia (SOFA; Hadzi-Pavlovic et al., 2000), were administered to 228 university students. Results: Principal component analyses yielded two components of PN: Component 1 items reflect narcissistic vulnerability-negative affect when narcissistic needs are not met; Component 2 items reflect narcissistic grandiosity-positive affect related to self-enhancement. Component 1 significantly predicted DT, an effect that remained after controlling for Component 2 and other temperaments in the TEMPS-A and SOFA. A similar effect was observed for the anxious temperament. Limitations: Our study is limited by the use of a homogenous, non-clinical university student sample unscreened for clinical depression, and by reliance on self-report questionnaires. Conclusions: Contrary to past research, DT is associated with narcissistic disturbance, in particular with the avoidance of narcissistic injury, when the PNI is used. Clinical intervention targeting this avoidance might help patients with a DT develop self-esteem that is not overly dependant upon recognition from others. © 2009 Elsevier B.V. All rights reserved.
Schiffrin E.L.,Sir Mortimer B Davis Jewish General Hospital |
Schiffrin E.L.,Lady Davis Institute for Medical Research
Journal of Cellular and Molecular Medicine | Year: 2010
This review addresses the use of the different antihypertensive agents currently available and some in development, and their effects on the vasculature. The different classes of agents used in the treatment of hypertension, and the results of recent large clinical trials, dosing protocols and adverse effects are first briefly summarized. The consequences on blood vessels of the use of antihypertensive drugs and the differential effects on the biology of large and small arteries resulting in modulation of vascular remodelling and dysfunction in hypertensive patients are then described. Large elastic conduit arteries exhibit outward hypertrophic remodelling and increased stiffness, which contributes to raise systolic blood pressure and afterload on the heart. Small resistance arteries undergo eutrophic or hypertrophic inward remodelling, and impair tissue perfusion. By these mechanisms both large and small arteries may contribute to trigger cardiovascular events. Some antihypertensive agents correct these changes, which could contribute to improved outcome. The mechanisms that at the level of the vascular wall lead to remodelling and can be beneficially affected by antihypertensive agents will also be addressed. These include vasoconstriction, growth and inflammation. The molecular pathways contributing to growth and inflammation will be summarily described. Further identification of these signalling pathways should allow identification of novel targets leading to development of new and improved medications for the treatment of hypertension and cardiovascular disease. © 2010 The Author Journal compilation © 2010 Foundation for Cellular and Molecular Medicine/Blackwell Publishing Ltd.
Lipman M.L.,Sir Mortimer B Davis Jewish General Hospital |
Schiffrin E.L.,Sir Mortimer B Davis Jewish General Hospital
Current Cardiology Reports | Year: 2012
There appears to be a broad consensus among professional health organizations that a blood pressure (BP) of 130/80 mm Hg or less is the recommended therapeutic BP target for subjects with diabetes mellitus. This review focuses on key studies that have examined the relationship between BP reduction and its impact on diabetic complications. An attempt is being made to identify the BP level at which maximum protection against diabetic complications is conferred, and below which further reduction no longer delivers a benefit that exceeds risk. Specific attention has been accorded to data contributing to establishing ideal BP goals in diabetic patients with nephropathy. On the basis of recent studies, it would appear that a BP below 140/90 mm Hg should be recommended for all diabetic individuals, and around 135/85 mm Hg for most. BP should be closer to, but not below, 130/80 mm Hg for those subjects at the highest cardiovascular risk. For those diabetic subjects at highest risk for stroke, lower BP may provide greater protection against stroke as shown in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. In younger individuals with diabetes and hypertension of shorter duration, it may be possible to lower BP below 130/80 mm Hg without untoward side effects and in fact with cardiovascular benefit, but this remains to be demonstrated. The ideal BP goal in diabetic patients with nephropathy remains questionable, and for now, the recommended target must be considered the same as that for the general diabetic population. © Springer Science+Business Media, LLC 2012.
Vanounou T.,Sir Mortimer B Davis Jewish General Hospital |
Garfinkle R.,Sir Mortimer B Davis Jewish General Hospital
Annals of Surgical Oncology | Year: 2016
Peritoneal spread from colorectal cancer is second only to the liver as a site for metastasis. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is a well-established treatment option for patients with peritoneal carcinomatosis (PC) of colorectal origin. However, due to concerns regarding both its clinical benefit and high cost, its universal adoption as the standard of care for patients with limited peritoneal dissemination has been slow. The purpose of this review was to clarify the clinical utility and cost effectiveness of CRS-HIPEC in the treatment of colorectal PC using the framework of value-based medicine, which attempts to combine both benefit and cost into a single quantifiable metric. Our comprehensive review of the clinical outcomes and cost effectiveness of CRS-HIPEC demonstrate that it is a highly valuable oncologic therapy and a good use of healthcare resources. © 2016, Society of Surgical Oncology.