1
|
Bastien G, Abboud A, McAnulty C, Elkrief L, Ledjiar O, Socias ME, Le Foll B, Bahji A, Brissette S, Marsan S, Jutras-Aswad D. Impact of Depressive Symptom Severity on Buprenorphine/Naloxone and Methadone Outcomes in People With Prescription-Type Opioid Use Disorder: Results From a Pragmatic Randomized Controlled Trial. J Dual Diagn 2024:1-12. [PMID: 38580298 DOI: 10.1080/15504263.2024.2329267] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
OBJECTIVE To evaluate the impact of depressive symptom severity on opioid use and treatment retention in individuals with prescription-type opioid use disorder (POUD). METHOD We analyzed data from a multi-centric, pragmatic, open-label, randomized controlled trial comparing buprenorphine/naloxone to methadone models of care in 272 individuals with POUD. Opioid use was self-reported every two weeks for 24 weeks using the Timeline Followback. Depressive symptom severity was self-reported with the Beck Depression Inventory at baseline, week 12 and week 24. RESULTS Baseline depressive symptom severity was not associated with opioid use nor treatment retention. At week 12, moderate depressive symptoms were associated with greater opioid use while mild to severe depressive symptoms were associated with lowered treatment retention. At week 24, moderate depressive symptoms were associated with greater opioid use. CONCLUSIONS Ongoing depressive symptoms lead to poorer outcomes in POUD. Clinicians are encouraged to use integrative approaches to optimize treatment outcomes. This study was registered in ClinicalTrials.gov (NCT03033732) on January 27th, 2017, prior to participants enrollment.
Collapse
Affiliation(s)
- Gabriel Bastien
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Anita Abboud
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Christina McAnulty
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Laurent Elkrief
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
| | - Omar Ledjiar
- Unité de recherche clinique appliquée, Centre hospitalier universitaire Ste-Justine, Montréal, Québec, Canada
| | - M Eugenia Socias
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, Faculty of Medicine, Medical Sciences Building, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Anees Bahji
- Department of Medicine and Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Suzanne Brissette
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Stéphanie Marsan
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Didier Jutras-Aswad
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
| |
Collapse
|
2
|
Riescher-Tuczkiewicz A, Elkrief L, Rautou PE. [Splanchnic vein thrombosis]. Rev Med Interne 2024; 45:17-25. [PMID: 37838484 DOI: 10.1016/j.revmed.2023.07.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/25/2023] [Indexed: 10/16/2023]
Abstract
Splanchnic vein thrombosis includes Budd-Chiari syndrome and portal vein thrombosis. These diseases share common features: (i) they are rare diseases and (ii) they can lead to portal hypertension and its complications. Budd-Chiari syndrome and portal vein thrombosis in the absence of underlying liver disease share many risk factors, the most common being myeloproliferative neoplasms. A rapid and comprehensive workup for thrombosis risk factors is necessary in these patients. Long-term anticoagulation is indicated in most patients. Portal vein thrombosis can also develop in patients with cirrhosis, and is associated with a worse course of cirrhosis. Indications for anticoagulation in patients with cirrhosis are increasing. Transjugular intrahepatic portosystemic shunt is a second-line procedure in this setting. Because of the rarity of these diseases, high-level evidence studies are rare. However, collaborative studies have provided a better understanding of their natural history and allowed to improve the management of these patients. This review focuses on the causes, diagnosis, and management of patients with Budd-Chiari syndrome, patients with portal vein thrombosis without underlying liver disease, and patients with cirrhosis and portal vein thrombosis.
Collapse
Affiliation(s)
- A Riescher-Tuczkiewicz
- Université Paris-Cité, Inserm, centre de recherche sur l'inflammation, UMR 1149, Paris, France.
| | - L Elkrief
- Université de Tours, service d'hépato-gastro-entérologie, CHRU de Tours, Tours, France
| | - P-E Rautou
- Université Paris-Cité, Inserm, centre de recherche sur l'inflammation, UMR 1149, Paris, France; Service d'hépatologie, AP-HP, hôpital Beaujon, DMU DIGEST, centre de référence des maladies vasculaires du foie, FILFOIE, ERN RARE-LIVER, Clichy, France
| |
Collapse
|
3
|
Payette O, Lespérance P, Jodoin VD, Longpré-Poirier C, Elkrief L, Richard M, Garel N, Miron JP. Intravenous ketamine for treatment-resistant depression patients who have failed to respond to transcranial magnetic stimulation: A case series. J Affect Disord 2023; 333:18-20. [PMID: 37075822 DOI: 10.1016/j.jad.2023.04.019] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/18/2023] [Accepted: 04/14/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND For individuals with treatment-resistant depression (TRD), transcranial magnetic stimulation (TMS) has become a well-established approach. In the past decade, intravenous (IV) racemic ketamine has also emerged as a potential treatment for TRD. Currently, little data is available on the clinical effects of IV racemic ketamine in TRD patients who experienced TMS-failure. METHODS Twenty-one (21) TRD patients who had failed to respond to a standard course of high-frequency left-dorsolateral prefrontal cortex TMS were subsequently scheduled to received IV racemic ketamine infusions. The IV racemic ketamine protocol consisted of 0,5 mg/kg infusions over 60 min, 3 times a week over 2 weeks. RESULTS Treatment was safe with minimal side-effects. Mean baseline MADRS score was 27.6 ± 6.4 (moderate depression), decreasing down to 18.6 ± 8.9 (mild depression) post-treatment. Mean percent improvement was 34.5 % ± 21.1 from baseline to post-treatment. Paired sample t-test showed significant MADRS score decrease pre- to post-treatment [t(20) = 7.212, p < .001]. Overall, four (4) patients (19.0 %) responded and two (2) of those achieved remission (9.5 %). LIMITATIONS Limitations of this case series include its retrospective and uncontrolled open-label nature, the lack of self-rating and standardized adverse events questionnaires, as well as follow-ups beyond the immediate treatment period. CONCLUSIONS Novel ways to increase the clinical effects of ketamine are being explored. We discuss potential combination approaches of ketamine with other modalities to augment its effects. Given the global burden of TRD, novel approaches are needed to curb the current mental health epidemic around the world.
Collapse
Affiliation(s)
- Olivier Payette
- Centre Hospitalier de l'Université de Montréal (CHUM) et Centre de Recherche du CHUM (CRCHUM), Université de Montréal, QC, Canada
| | - Paul Lespérance
- Centre Hospitalier de l'Université de Montréal (CHUM) et Centre de Recherche du CHUM (CRCHUM), Université de Montréal, QC, Canada; Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, QC, Canada
| | - Véronique Desbeaumes Jodoin
- Centre Hospitalier de l'Université de Montréal (CHUM) et Centre de Recherche du CHUM (CRCHUM), Université de Montréal, QC, Canada
| | | | - Laurent Elkrief
- Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, QC, Canada
| | - Maxime Richard
- Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, QC, Canada
| | - Nicolas Garel
- Department of Psychiatry, Faculty of Medecine, McGill University, Ludmer Research & Training Building, 1033 Av. des Pins, Montréal, Quebec H3A 1A1, Canada
| | - Jean-Philippe Miron
- Centre Hospitalier de l'Université de Montréal (CHUM) et Centre de Recherche du CHUM (CRCHUM), Université de Montréal, QC, Canada; Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, QC, Canada.
| |
Collapse
|
4
|
Elkrief L, Lin B, Marchi M, Afzali MH, Banaschewski T, Bokde ALW, Quinlan EB, Desrivières S, Flor H, Garavan H, Gowland P, Heinz A, Ittermann B, Martinot JL, Martinot MLP, Nees F, Orfanos DP, Paus T, Poustka L, Hohmann S, Fröhner JH, Smolka MN, Walter H, Whelan R, Schumann G, Luykx J, Boks MP, Conrod PJ. Independent contribution of polygenic risk for schizophrenia and cannabis use in predicting psychotic-like experiences in young adulthood: testing gene × environment moderation and mediation. Psychol Med 2023; 53:1759-1769. [PMID: 37310336 PMCID: PMC10106286 DOI: 10.1017/s0033291721003378] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/20/2021] [Accepted: 07/26/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND It has not yet been determined if the commonly reported cannabis-psychosis association is limited to individuals with pre-existing genetic risk for psychotic disorders. METHODS We examined whether the relationship between polygenic risk score for schizophrenia (PRS-Sz) and psychotic-like experiences (PLEs), as measured by the Community Assessment of Psychic Experiences-42 (CAPE-42) questionnaire, is mediated or moderated by lifetime cannabis use at 16 years of age in 1740 of the individuals of the European IMAGEN cohort. Secondary analysis examined the relationships between lifetime cannabis use, PRS-Sz and the various sub-scales of the CAPE-42. Sensitivity analyses including covariates, including a PRS for cannabis use, were conducted and results were replicated using data from 1223 individuals in the Dutch Utrecht cannabis cohort. RESULTS PRS-Sz significantly predicted cannabis use (p = 0.027) and PLE (p = 0.004) in the IMAGEN cohort. In the full model, considering PRS-Sz and covariates, cannabis use was also significantly associated with PLE in IMAGEN (p = 0.007). Results remained consistent in the Utrecht cohort and through sensitivity analyses. Nevertheless, there was no evidence of a mediation or moderation effects. CONCLUSIONS These results suggest that cannabis use remains a risk factor for PLEs, over and above genetic vulnerability for schizophrenia. This research does not support the notion that the cannabis-psychosis link is limited to individuals who are genetically predisposed to psychosis and suggests a need for research focusing on cannabis-related processes in psychosis that cannot be explained by genetic vulnerability.
Collapse
Affiliation(s)
- Laurent Elkrief
- Sainte-Justine Hospital Research Center, Montréal, Québec, Canada
- Département de psychiatrie et d'addictologie, Université de Montréal, Montréal, QC, Canada
| | - Bochao Lin
- Department of Translational Neuroscience, Brain Center University Medical Center, Utrecht University, Utrecht, the Netherlands
| | - Mattia Marchi
- Department Psychiatry, Brain Center University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giuseppe Campi, 287–41125 Modena, Italy
| | - Mohammad H Afzali
- Sainte-Justine Hospital Research Center, Montréal, Québec, Canada
- Département de psychiatrie et d'addictologie, Université de Montréal, Montréal, QC, Canada
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, 68159 Mannheim, Germany
| | - Arun L. W. Bokde
- Discipline of Psychiatry, School of Medicine and Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland
| | - Erin Burke Quinlan
- Centre for Population Neuroscience and Precision Medicine (PONS), Institute of Psychiatry, Psychology & Neuroscience, SGDP Centre, King's College London, United Kingdom
| | - Sylvane Desrivières
- Centre for Population Neuroscience and Precision Medicine (PONS), Institute of Psychiatry, Psychology & Neuroscience, SGDP Centre, King's College London, United Kingdom
| | - Herta Flor
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, Mannheim, Germany
- Department of Psychology, School of Social Sciences, University of Mannheim, 68131 Mannheim, Germany
| | - Hugh Garavan
- Departments of Psychiatry and Psychology, University of Vermont, 05405 Burlington, Vermont, USA
| | - Penny Gowland
- Sir Peter Mansfield Imaging Centre School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, United Kingdom
| | - Andreas Heinz
- Charité – Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charitéplatz 1, Berlin, Germany
| | - Bernd Ittermann
- Physikalisch-Technische Bundesanstalt (PTB), Abbestr. 2 - 12, Berlin, Germany
| | - Jean-Luc Martinot
- Institut National de la Santé et de la Recherche Médicale, INSERM Unit 1000 “Neuroimaging & Psychiatry”, University Paris Saclay, University Paris Descartes - Sorbonne Paris Cité; and Maison de Solenn, Paris, France
| | - Marie-Laure Paillère Martinot
- Institut National de la Santé et de la Recherche Médicale, INSERM Unit 1000 “Neuroimaging & Psychiatry”, University Paris Sud, University Paris Descartes; and AP-HP.Sorbonne Université, Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Paris, France
| | - Frauke Nees
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, 68159 Mannheim, Germany
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, Mannheim, Germany
| | | | - Tomáš Paus
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Centre Göttingen, von-Siebold-Str. 5, 37075, Göttingen, Germany
| | - Sarah Hohmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, 68159 Mannheim, Germany
| | - Juliane H. Fröhner
- Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany
| | - Michael N. Smolka
- Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany
| | - Henrik Walter
- Charité – Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charitéplatz 1, Berlin, Germany
| | - Robert Whelan
- School of Psychology and Global Brain Health Institute, Trinity College Dublin, Ireland
| | - Gunter Schumann
- Centre for Population Neuroscience and Precision Medicine (PONS), Institute of Psychiatry, Psychology & Neuroscience, SGDP Centre, King's College London, United Kingdom
- School of Psychology and Global Brain Health Institute, Trinity College Dublin, Ireland
- PONS Research Group, Dept of Psychiatry and Psychotherapy, Campus Charite Mitte, Humboldt University, Berlin and Leibniz Institute for Neurobiology, Magdeburg, Germany, and Institute for Science and Technology of Brain-inspired Intelligence (ISTBI), Fudan University, Shanghai, P.R. China
| | - Jurjen Luykx
- Department Psychiatry, Brain Center University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marco P. Boks
- Department Psychiatry, Brain Center University Medical Center Utrecht, Utrecht, the Netherlands
| | - Patricia J. Conrod
- Sainte-Justine Hospital Research Center, Montréal, Québec, Canada
- Département de psychiatrie et d'addictologie, Université de Montréal, Montréal, QC, Canada
| | | |
Collapse
|
5
|
Elkrief L, Bastien G, McAnulty C, Bakouni H, Hébert FO, Socias ME, Le Foll B, Lim R, Ledjiar O, Marsan S, Brissette S, Jutras-Aswad D. Differential effect of cannabis use on opioid agonist treatment outcomes: Exploratory analyses from the OPTIMA study. J Subst Use Addict Treat 2023; 149:209031. [PMID: 37003540 DOI: 10.1016/j.josat.2023.209031] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/09/2022] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Conflictual evidence exists regarding the effects of cannabis use on the outcomes of opioid agonist therapy (OAT). In this exploratory analysis, we examined the effect of recent cannabis use on opioid use, craving, and withdrawal symptoms, in individuals participating in a trial comparing flexible buprenorphine/naloxone (BUP/NX) take-home dosing model to witnessed ingestion of methadone. METHODS We analyzed data from a multi-centric, pragmatic, 24-week, open label, randomized controlled trial in individuals with prescription-type opioid use disorder (n = 272), randomly assigned to BUP/NX (n = 138) or methadone (n = 134). The study measured last week cannabis and opioid use via timeline-follow back, recorded at baseline and every two weeks during the study. Craving symptoms were measured using the Brief Substance Craving Scale at baseline, and weeks 2, 6, 10, 14, 18 and 22. The study measured opioid withdrawal symptoms via Clinical Opiate Withdrawal Scale at treatment initiation and weeks 2, 4, and 6. RESULTS The mean maximum dose taken during the study was 17.3 mg/day (range = 0.5-32 mg/day) for BUP/NX group and 67.7 mg/day (range = 10-170 mg/day) in the methadone group. Repeated measures generalized linear mixed models demonstrated that cannabis use in the last week (mean of 2.3 days) was not significantly associated with last week opioid use (aβ ± standard error (SE) = -0.06 ± 0.04; p = 0.15), craving (aβ ± SE = -0.05 ± 0.08, p = 0.49), or withdrawal symptoms (aβ ± SE = 0.09 ± 0.1, p = 0.36). Bayes factor (BF) for each of the tested models supported the null hypothesis (BF < 0.3). CONCLUSIONS The current study did not demonstrate a statistically significant effect of cannabis use on outcomes of interest in the context of a pragmatic randomized-controlled trial. These findings replicated previous results reporting no effect of cannabis use on opioid-related outcomes.
Collapse
Affiliation(s)
- Laurent Elkrief
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada; Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada
| | - Gabriel Bastien
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada; Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada
| | - Christina McAnulty
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada; Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada
| | - Hamzah Bakouni
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada; Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada
| | - François-Olivier Hébert
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada
| | - M Eugenia Socias
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia V6Z 2A9, Canada; Department of Medicine, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, Ontario M5S 2S1, Canada; Department of Pharmacology and Toxicology, Faculty of Medicine, Medical Sciences Building, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, 500 University Avenue, 5th floor, Toronto, Ontario M5G 1V7, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, Ontario M5T 1R8, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada; Waypoint Research Institute, Waypoint Centre for Mental Health Care, 500 Church Street, Penetanguishene, Ontario L9M 1G3, Canada
| | - Ron Lim
- Department of Medicine and Psychiatry, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada
| | - Omar Ledjiar
- Unité de recherche clinique appliquée, Centre hospitalier universitaire Ste-Justine, 3175 chemin de la Côte Ste-Catherine, Montréal, Québec H3T 1C5, Canada
| | - Stéphanie Marsan
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada; Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada
| | - Suzanne Brissette
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada; Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada
| | - Didier Jutras-Aswad
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada; Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada.
| |
Collapse
|
6
|
Payette O, Jodoin VD, Medjahed N, Massé-Leblanc C, Elkrief L, Longpré-Poirier C, Lespérance P, Miron JP. Intravenous ketamine for treatment-resistant depression in patients who have failed to respond to transcranial magnetic stimulation: a case series. Brain Stimul 2023. [DOI: 10.1016/j.brs.2023.01.491] [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] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
|
7
|
Richard M, Noiseux C, Desbeaumes Jodoin V, Blumberger DM, Sheen J, Mansouri F, Elkrief L, Longpré-Poirier C, Lespérance P, Miron JP. Prolonged intermittent theta burst stimulation in the treatment of major depressive disorder: a case series. Psychiatry Res 2022; 315:114709. [PMID: 35816923 DOI: 10.1016/j.psychres.2022.114709] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 04/22/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 11/29/2022]
Abstract
Intermittent theta burst stimulation (iTBS) using 600 pulses is an effective and FDA-cleared transcranial magnetic stimulation (TMS) protocol for major depressive disorder (MDD). Prolonged iTBS (piTBS) using 1,800 pulses could increase the effectiveness of TMS for MDD, but its real-world effectiveness is still debated. We assessed the safety, tolerability, and preliminary effectiveness of a 3x daily piTBS 1,800 pulses protocol delivered over 2 weeks in 27 participants. Only four participants (18.2%) achieved response, two of them achieving remission (9.1%). Five participants (18.5%) experienced tolerability issues. Future studies should focus on the neurophysiological effects of TBS protocols to determine optimal parameters.
Collapse
Affiliation(s)
- Maxime Richard
- Centre Hospitalier de l'Université de Montréal (CHUM) et Centre de Recherche du CHUM (CRCHUM), Université de Montréal, QC, Canada; Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, QC, Canada.
| | - Clémence Noiseux
- Centre Hospitalier de l'Université de Montréal (CHUM) et Centre de Recherche du CHUM (CRCHUM), Université de Montréal, QC, Canada
| | - Véronique Desbeaumes Jodoin
- Centre Hospitalier de l'Université de Montréal (CHUM) et Centre de Recherche du CHUM (CRCHUM), Université de Montréal, QC, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute at the Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Jack Sheen
- Institute of Medical Science, Faculty of Medicine, University of Toronto, ON, Canada
| | - Farrokh Mansouri
- Institute of Medical Science, Faculty of Medicine, University of Toronto, ON, Canada
| | - Laurent Elkrief
- Centre Hospitalier de l'Université de Montréal (CHUM) et Centre de Recherche du CHUM (CRCHUM), Université de Montréal, QC, Canada; Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, QC, Canada
| | - Christophe Longpré-Poirier
- Centre Hospitalier de l'Université de Montréal (CHUM) et Centre de Recherche du CHUM (CRCHUM), Université de Montréal, QC, Canada; Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, QC, Canada
| | - Paul Lespérance
- Centre Hospitalier de l'Université de Montréal (CHUM) et Centre de Recherche du CHUM (CRCHUM), Université de Montréal, QC, Canada; Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, QC, Canada
| | - Jean-Philippe Miron
- Centre Hospitalier de l'Université de Montréal (CHUM) et Centre de Recherche du CHUM (CRCHUM), Université de Montréal, QC, Canada; Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, QC, Canada.
| |
Collapse
|
8
|
Marchi M, Elkrief L, Alkema A, van Gastel W, Schubart CD, van Eijk KR, Luykx JJ, Branje S, Mastrotheodoros S, Galeazzi GM, van Os J, Cecil CA, Conrod PJ, Boks MP. Childhood maltreatment mediates the effect of the genetic background on psychosis risk in young adults. Transl Psychiatry 2022; 12:219. [PMID: 35650188 PMCID: PMC9160238 DOI: 10.1038/s41398-022-01975-1] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/29/2022] [Accepted: 05/10/2022] [Indexed: 11/09/2022] Open
Abstract
Childhood maltreatment (CM) and genetic vulnerability are both risk factors for psychosis, but the relations between them are not fully understood. Guided by the recent identification of genetic risk to CM, this study investigates the hypothesis that genetic risk to schizophrenia also increases the risk of CM and thus impacts psychosis risk. The relationship between schizophrenia polygenetic risk, CM, and psychotic-like experiences (PLE) was investigated in participants from the Utrecht Cannabis Cohort (N = 1262) and replicated in the independent IMAGEN cohort (N = 1740). Schizophrenia polygenic risk score (SZ-PRS) were calculated from the most recent GWAS. The relationship between CM, PRS, and PLE was first investigated using multivariate linear regression. Next, mediation of CM in the pathway linking SZ-PRS and PLE was examined by structural equation modeling, while adjusting for a set of potential mediators including cannabis use, smoking, and neuroticism. In agreement with previous studies, PLE were strongly associated with SZ-PRS (B = 0.190, p = 0.009) and CM (B = 0.575, p < 0.001). Novel was that CM was also significantly associated with SZ-PRS (B = 0.171, p = 0.001), and substantially mediated the effects of SZ-PRS on PLE (proportion mediated = 29.9%, p = 0.001). In the replication cohort, the analyses yielded similar results, confirming equally strong mediation by CM (proportion mediated = 34.7%, p = 0.009). Our results suggest that CM acts as a mediator in the causal pathway linking SZ-PRS and psychosis risk. These findings open new perspectives on the relations between genetic and environmental risks and warrant further studies into potential interventions to reduce psychosis risk in vulnerable people.
Collapse
Affiliation(s)
- Mattia Marchi
- grid.7548.e0000000121697570Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giuseppe Campi, 287 – 41125 Modena, Italy ,grid.5477.10000000120346234Department of Psychiatry, Brain Center University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Laurent Elkrief
- grid.14848.310000 0001 2292 3357Department of Psychiatry, Université de Montréal, CHU Sainte-Justine Hospital, Montréal, QC Canada ,grid.411418.90000 0001 2173 6322Center Hospitalier Universitaire Sainte-Justine Research Center, Montreal, QC Canada
| | - Anne Alkema
- grid.5477.10000000120346234Department of Psychiatry, Brain Center University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Willemijn van Gastel
- grid.5477.10000000120346234Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Chris D. Schubart
- grid.413202.60000 0004 0626 2490Department of Psychiatry, Tergooi Hospital, Blaricum, The Netherlands
| | - Kristel R. van Eijk
- grid.5477.10000000120346234Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Jurjen J. Luykx
- grid.5477.10000000120346234Department of Psychiatry, Brain Center University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Susan Branje
- grid.5477.10000000120346234Department of Youth and Family, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, The Netherlands
| | - Stefanos Mastrotheodoros
- grid.5477.10000000120346234Department of Youth and Family, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, The Netherlands ,grid.8127.c0000 0004 0576 3437Department of Psychology, University of Crete, Rethymno, Greece
| | - Gian M. Galeazzi
- grid.7548.e0000000121697570Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giuseppe Campi, 287 – 41125 Modena, Italy ,Department of Mental Health and Addiction Services, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Jim van Os
- grid.5477.10000000120346234Department of Psychiatry, Brain Center University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Charlotte A. Cecil
- grid.5645.2000000040459992XDepartment of Child and Adolescent Psychiatry, Erasmus Medical Center, Sophia Children’s Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands ,grid.5645.2000000040459992XDepartment of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Patricia J. Conrod
- grid.14848.310000 0001 2292 3357Department of Psychiatry, Université de Montréal, CHU Sainte-Justine Hospital, Montréal, QC Canada ,grid.411418.90000 0001 2173 6322Center Hospitalier Universitaire Sainte-Justine Research Center, Montreal, QC Canada
| | - Marco P. Boks
- grid.5477.10000000120346234Department of Psychiatry, Brain Center University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| |
Collapse
|
9
|
Elkrief L, Payette O, Foucault JN, Longpré-Poirier C, Richard M, Desbeaumes Jodoin V, Lespérance P, Miron JP. Transcranial magnetic stimulation and intravenous ketamine combination therapy for treatment-resistant bipolar depression: A case report. Front Psychiatry 2022; 13:986378. [PMID: 36213934 PMCID: PMC9532540 DOI: 10.3389/fpsyt.2022.986378] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/23/2022] [Indexed: 11/20/2022] Open
Abstract
About a third of patients suffering from major depression develop treatment-resistant depression (TRD). Although repetitive transcranial magnetic stimulation (rTMS) and intravenous ketamine have proven effective for the management of TRD, many patients remain refractory to treatment. We present the case of a patient suffering from bipolar TRD. The patient was referred to us after failure to respond to first-and second-line pharmacotherapy and psychotherapy. After minimal response to both rTMS and ketamine alone, we attempted a combination rTMS and ketamine protocol, which led to complete and sustained remission. Various comparable and complimentary mechanisms of antidepressant action of ketamine and rTMS are discussed, which support further study of this combination therapy. Future research should focus on the feasibility, tolerability, and efficacy of this novel approach.
Collapse
Affiliation(s)
- Laurent Elkrief
- Centre Hospitalier de l'Université de Montréal et Centre de Recherche du CHUM, Université de Montréal, Montreal, QC, Canada.,Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
| | - Olivier Payette
- Centre Hospitalier de l'Université de Montréal et Centre de Recherche du CHUM, Université de Montréal, Montreal, QC, Canada
| | - Jean-Nicolas Foucault
- Centre Hospitalier de l'Université de Montréal et Centre de Recherche du CHUM, Université de Montréal, Montreal, QC, Canada
| | - Christophe Longpré-Poirier
- Centre Hospitalier de l'Université de Montréal et Centre de Recherche du CHUM, Université de Montréal, Montreal, QC, Canada.,Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
| | - Maxime Richard
- Centre Hospitalier de l'Université de Montréal et Centre de Recherche du CHUM, Université de Montréal, Montreal, QC, Canada.,Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
| | - Véronique Desbeaumes Jodoin
- Centre Hospitalier de l'Université de Montréal et Centre de Recherche du CHUM, Université de Montréal, Montreal, QC, Canada
| | - Paul Lespérance
- Centre Hospitalier de l'Université de Montréal et Centre de Recherche du CHUM, Université de Montréal, Montreal, QC, Canada.,Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
| | - Jean-Philippe Miron
- Centre Hospitalier de l'Université de Montréal et Centre de Recherche du CHUM, Université de Montréal, Montreal, QC, Canada.,Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
| |
Collapse
|
10
|
Elkrief L, Spinney S, Vosberg DE, Banaschewski T, Bokde ALW, Quinlan EB, Desrivières S, Flor H, Garavan H, Gowland P, Heinz A, Brühl R, Martinot JL, Paillère Martinot ML, Nees F, Papadopoulos Orfanos D, Poustka L, Hohmann S, Millenet S, Fröhner JH, Smolka MN, Walter H, Whelan R, Schumann G, Pausova Z, Paus T, Huguet G, Conrod P. Endocannabinoid Gene × Gene Interaction Association to Alcohol Use Disorder in Two Adolescent Cohorts. Front Psychiatry 2021; 12:645746. [PMID: 33959052 PMCID: PMC8093566 DOI: 10.3389/fpsyt.2021.645746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/02/2021] [Indexed: 12/31/2022] Open
Abstract
Genetic markers of the endocannabinoid system have been linked to a variety of addiction-related behaviors that extend beyond cannabis use. In the current study we investigate the relationship between endocannabinoid (eCB) genetic markers and alcohol use disorder (AUD) in European adolescents (14-18 years old) followed in the IMAGEN study (n = 2,051) and explore replication in a cohort of North American adolescents from Canadian Saguenay Youth Study (SYS) (n = 772). Case-control status is represented by a score of more than 7 on the Alcohol Use Disorder Identification Test (AUDIT). First a set-based test method was used to examine if a relationship between the eCB system and AUDIT case/control status exists at the gene level. Using only SNPs that are both independent and significantly associated to case-control status, we perform Fisher's exact test to determine SNP level odds ratios in relation to case-control status and then perform logistic regressions as post-hoc analysis, while considering various covariates. Generalized multifactor dimensionality reduction (GMDR) was used to analyze the most robust SNP×SNP interaction of the five eCB genes with positive AUDIT screen. While no gene-sets were significantly associated to AUDIT scores after correction for multiple tests, in the case/control analysis, 7 SNPs were significantly associated with AUDIT scores of > 7 (p < 0.05; OR<1). Two SNPs remain significant after correction by false discovery rate (FDR): rs9343525 in CNR1 (pcorrected =0.042, OR = 0.73) and rs507961 in MGLL (pcorrected = 0.043, OR = 0.78). Logistic regression showed that both rs9353525 (CNR1) and rs507961 (MGLL) remained significantly associated with positive AUDIT screens (p < 0.01; OR < 1) after correction for multiple covariables and interaction of covariable × SNP. This result was not replicated in the SYS cohort. The GMDR model revealed a significant three-SNP interaction (p = 0.006) involving rs484061 (MGLL), rs4963307 (DAGLA), and rs7766029 (CNR1) predicted case-control status, after correcting for multiple covariables in the IMAGEN sample. A binomial logistic regression of the combination of these three SNPs by phenotype in the SYS cohort showed a result in the same direction as seen in the IMAGEN cohort (BETA = 0.501, p = 0.06). While preliminary, the present study suggests that the eCB system may play a role in the development of AUD in adolescents.
Collapse
Affiliation(s)
- Laurent Elkrief
- Department of Medicine, Université de Montréal, Montreal, QC, Canada
- Centre Hospitalier Universitaire Sainte-Justine Research Center, Montreal, QC, Canada
| | - Sean Spinney
- Centre Hospitalier Universitaire Sainte-Justine Research Center, Montreal, QC, Canada
- Department of Pediatrics, Université de Montréal, Montreal, QC, Canada
| | - Daniel E. Vosberg
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Arun L. W. Bokde
- Discipline of Psychiatry, School of Medicine and Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Erin Burke Quinlan
- Centre for Population Neuroscience and Precision Medicine (PONS), SGDP Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Sylvane Desrivières
- Centre for Population Neuroscience and Precision Medicine (PONS), SGDP Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Herta Flor
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Hugh Garavan
- Departments of Psychiatry and Psychology, University of Vermont, Burlington, VT, United States
| | - Penny Gowland
- Sir Peter Mansfield Imaging Centre School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom
| | - Andreas Heinz
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Campus Charité Mitte, Berlin, Germany
| | - Rüdiger Brühl
- Physikalisch-Technische Bundesanstalt, Berlin, Germany
| | - Jean-Luc Martinot
- Institut National de la Santé et de la Recherche Médicale, INSERM U1299 “Trajectoires développementales en psychiatrie,” Université Paris-Saclay, Ecole Normale supérieure Paris-Saclay, CNRS, Centre Borelli, Gif-sur-Yvette, France
| | - Marie-Laure Paillère Martinot
- Institut National de la Santé et de la Recherche Médicale, INSERM U A10 “Trajectoires développementales en psychiatrie,” Université Paris-Saclay, Ecole Normale supérieure Paris-Saclay, CNRS, Centre Borelli and AP-HP. Sorbonne Université, Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, Paris, France
| | - Frauke Nees
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | | | - Luise Poustka
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Centre Göttingen, Göttingen, Germany
| | - Sarah Hohmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Sabina Millenet
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Juliane H. Fröhner
- Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany
| | - Michael N. Smolka
- Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany
| | - Henrik Walter
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Campus Charité Mitte, Berlin, Germany
| | - Robert Whelan
- School of Psychology and Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Gunter Schumann
- Centre for Population Neuroscience and Precision Medicine (PONS), SGDP Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- PONS Research Group, Department of Psychiatry and Psychotherapy, Campus Charite Mitte, Humboldt University, Berlin, Germany
- Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - Zdenka Pausova
- Departments of Physiology and Nutritional Science, Hospital for Sick Children, Toronto, ON, Canada
| | - Tomáš Paus
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Departments of Psychology and Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Guillaume Huguet
- Centre Hospitalier Universitaire Sainte-Justine Research Center, Montreal, QC, Canada
- Department of Pediatrics, Université de Montréal, Montreal, QC, Canada
| | - Patricia Conrod
- Centre Hospitalier Universitaire Sainte-Justine Research Center, Montreal, QC, Canada
- Department of Pediatrics, Université de Montréal, Montreal, QC, Canada
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
| | | |
Collapse
|
11
|
Boks MP, He Y, Schubart CD, Gastel WV, Elkrief L, Huguet G, Eijk KV, Vinkers CH, Kahn RS, Paus T, Conrod P, Hol EM, de Witte LD. Cannabinoids and psychotic symptoms: A potential role for a genetic variant in the P2X purinoceptor 7 (P2RX7) gene. Brain Behav Immun 2020; 88:573-581. [PMID: 32330591 DOI: 10.1016/j.bbi.2020.04.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 10/16/2019] [Revised: 04/07/2020] [Accepted: 04/20/2020] [Indexed: 12/17/2022] Open
Abstract
To investigate the biological mechanisms underlying the higher risk for psychosis in those that use cannabis, we conducted a genome-wide environment-interaction study (GWEIS). In a sample of individuals without a psychiatric disorder (N = 1262), we analyzed the interactions between regular cannabis use and genotype with psychotic-like experiences (PLE) as outcome. PLE were measured using the Community Assessment of Psychic Experiences (CAPE). The sample was enriched for those at the extremes of both cannabis use and PLE to increase power. A single nucleotide polymorphism in the P2RX7 gene (rs7958311) was associated with risk for a high level of psychotic experiences in regular cannabis users (p = 1.10 x10-7) and in those with high levels of lifetime cannabis use (p = 4.5 × 10-6). This interaction was replicated in individuals with high levels of lifetime cannabis use in the IMAGEN cohort (N = 1217, p = 0.020). Functional relevance of P2RX7 in cannabis users was suggested by in vitro experiments on activated monocytes. Exposure of these cells to tetrahydrocannabinol (THC) or cannabidiol (CBD) reduced the immunological response of the P2X7 receptor, which was dependent on the identified genetic variant. P2RX7 variants have been implicated in psychiatric disorders before and the P2X7 receptor is involved in pathways relevant to psychosis, such as neurotransmission, synaptic plasticity and immune regulation. We conclude that P2RX7 plays a role in vulnerability to develop psychotic symptoms when using cannabis and point to a new pathway that can potentially be targeted by newly developed P2X7 antagonists.
Collapse
Affiliation(s)
- Marco P Boks
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Centre Utrecht, Utrecht University, The Netherlands
| | - Yujie He
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Centre Utrecht, Utrecht University, The Netherlands
| | - Chris D Schubart
- Department of Psychiatry, Tergooi Hospital, Blaricum, The Netherlands
| | | | - Laurent Elkrief
- Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Guillaume Huguet
- Department of Pediatrics, Université de Montréal, Montreal, Quebec, Canada; Center Hospitalier Universitaire Sainte-Justine Research Center, Montreal, Quebec, Canada
| | - Kristel van Eijk
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht University, The Netherlands
| | - Christiaan H Vinkers
- Department of Psychiatry, Amsterdam UMC (location VUmc), Amsterdam, The Netherlands; Department of Anatomy and Neurosciences, Amsterdam UMC (location VUmc), Amsterdam, The Netherlands
| | - René S Kahn
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Centre Utrecht, Utrecht University, The Netherlands; Department of psychiatry, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Tomás Paus
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital and Departments of Psychology and Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Patricia Conrod
- Center Hospitalier Universitaire Sainte-Justine Research Center, Montreal, Quebec, Canada; Department of Psychiatry, University of Montreal, Montréal, QC, Canada
| | - Elly M Hol
- Department of Translational Neuroscience, UMC Utrecht Brain Center, Utrecht University, The Netherlands; Neuroimmunology Research Group, Netherlands Institute for Neuroscience, An Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, Netherlands
| | - Lot D de Witte
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Centre Utrecht, Utrecht University, The Netherlands; Department of psychiatry, Icahn School of Medicine at Mount Sinai, New York City, USA.
| |
Collapse
|
12
|
Elkrief L, Belliveau J, D'Ignazio T, Simard P, Jutras-Aswad D. Assessing the current state of medical education on cannabis in Canada: Preliminary findings from Quebec. Paediatr Child Health 2020; 25:S29-S33. [PMID: 32581629 DOI: 10.1093/pch/pxaa015] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/10/2020] [Indexed: 11/12/2022] Open
Abstract
The legalization of recreational cannabis across Canada has revealed the importance of medical education on cannabis-related topics. A recent study has indicated that Canadian physicians report a significant gap in current versus desired knowledge regarding the therapeutic use of cannabis. However, the state of education on cannabis has never been studied in Canadian medical schools. This article presents the preliminary findings of a survey conducted to understand the perceptions of Quebec's medical students regarding cannabis-related teachings in their current curriculum. Overall, students reported very low to low levels of exposure to, knowledge of, and comfort levels with cannabis-related subjects. The majority of students reported that they felt that their medical curricula did not prepare them to face cannabis-related issues in their future practices. Strategies need to be developed for improving medical school curriculum regarding cannabis-related issues. These findings provide potential key strategies to improve curricula.
Collapse
Affiliation(s)
- Laurent Elkrief
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Quebec.,Faculty of Medicine, Université de Montréal, Montréal, Quebec
| | - Julien Belliveau
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Quebec.,Faculty of Medicine, Université de Montréal, Montréal, Quebec
| | - Tara D'Ignazio
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Quebec.,Faculty of Medicine, Université de Montréal, Montréal, Quebec
| | - Philippe Simard
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Quebec.,Faculty of Medicine, Université de Montréal, Montréal, Quebec
| | - Didier Jutras-Aswad
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Quebec.,Department of Psychiatry and Addiction, Université de Montréal, Montréal, Quebec
| |
Collapse
|
13
|
Elkrief L, Ronot M, Andrade F, Dioguardi Burgio M, Issoufaly T, Zappa M, Roux O, Bissonnette J, Payancé A, Lebrec D, Francoz C, Soubrane O, Valla D, Durand F, Vilgrain V, Castera L, Rautou PE. Non-invasive evaluation of portal hypertension using shear-wave elastography: analysis of two algorithms combining liver and spleen stiffness in 191 patients with cirrhosis. Aliment Pharmacol Ther 2018; 47:621-630. [PMID: 29322599 DOI: 10.1111/apt.14488] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [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] [Received: 09/05/2017] [Revised: 09/28/2017] [Accepted: 12/05/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Two algorithms based on sequential measurements of liver and spleen stiffness using two-dimensional shearwave elastography (2D-SWE) have been recently proposed to estimate clinically significant portal hypertension (hepatic venous pressure gradient [HVPG] ≥10 mm Hg) in patients with cirrhosis, with excellent diagnostic accuracy. AIM To validate externally these algorithms in a large cohort of patients with cirrhosis. METHODS One hundred and ninety-one patients with stable cirrhosis (Child-Pugh class A 39%, B 29% and C 31%) who underwent liver and spleen stiffness measurements using 2D-SWE at the time of HVPG measurement were included. Diagnostic accuracy of the 2 algorithms was assessed by calculating sensitivity, specificity, positive and negative predictive values. RESULTS The first algorithm, using liver stiffness <16.0 kilopascals (kPa) and then spleen stiffness <26.6 kPa, was used to rule-out HVPG ≥10 mm Hg. In our population, its sensitivity and negative predictive value were 95% and 63% respectively. The second algorithm, using liver stiffness >38.0 kPa, or liver stiffness ≤38.0 kPa but spleen stiffness >27.9 kPa, was used to rule-in HVPG ≥10 mm Hg. In our population, its specificity and positive predictive value were 52% and 83% respectively. Restricting the analyses to the 74 patients without any history of decompensation of cirrhosis or to the 65 patients with highly reliable liver stiffness measurement did not improve the results. CONCLUSION In our population, diagnostic accuracies of non-invasive algorithms based on sequential measurements of liver and spleen stiffness using 2D-SWE were acceptable, but not good enough to replace HVPG measurement or to base clinical decisions.
Collapse
Affiliation(s)
- L Elkrief
- Service d'Hépatologie et Gastroentérologie, Hôpitaux Universitaires de Genève, Suisse, Switzerland.,Service d'Hépatologie, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Clichy, France
| | - M Ronot
- Service de radiologie, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Clichy, France.,UMR 1149, Inserm, Université Paris Diderot Paris 7, Centre de Recherche sur l' Inflammation (CRI), Paris
| | - F Andrade
- Service d'Hépatologie, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Clichy, France
| | - M Dioguardi Burgio
- Service de radiologie, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Clichy, France.,UMR 1149, Inserm, Université Paris Diderot Paris 7, Centre de Recherche sur l' Inflammation (CRI), Paris
| | - T Issoufaly
- Service d'Hépatologie, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Clichy, France
| | - M Zappa
- Service de radiologie, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Clichy, France.,UMR 1149, Inserm, Université Paris Diderot Paris 7, Centre de Recherche sur l' Inflammation (CRI), Paris
| | - O Roux
- Service d'Hépatologie, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Clichy, France.,UMR 1149, Inserm, Université Paris Diderot Paris 7, Centre de Recherche sur l' Inflammation (CRI), Paris
| | - J Bissonnette
- Service d'Hépatologie, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Clichy, France
| | - A Payancé
- Service d'Hépatologie, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Clichy, France
| | - D Lebrec
- Service d'Hépatologie, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Clichy, France.,UMR 1149, Inserm, Université Paris Diderot Paris 7, Centre de Recherche sur l' Inflammation (CRI), Paris
| | - C Francoz
- Service d'Hépatologie, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Clichy, France.,UMR 1149, Inserm, Université Paris Diderot Paris 7, Centre de Recherche sur l' Inflammation (CRI), Paris
| | - O Soubrane
- UMR 1149, Inserm, Université Paris Diderot Paris 7, Centre de Recherche sur l' Inflammation (CRI), Paris.,Service de chirurgie digestive, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Clichy, France
| | - D Valla
- Service d'Hépatologie, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Clichy, France.,UMR 1149, Inserm, Université Paris Diderot Paris 7, Centre de Recherche sur l' Inflammation (CRI), Paris
| | - F Durand
- Service d'Hépatologie, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Clichy, France.,UMR 1149, Inserm, Université Paris Diderot Paris 7, Centre de Recherche sur l' Inflammation (CRI), Paris
| | - V Vilgrain
- Service de radiologie, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Clichy, France.,UMR 1149, Inserm, Université Paris Diderot Paris 7, Centre de Recherche sur l' Inflammation (CRI), Paris
| | - L Castera
- Service d'Hépatologie, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Clichy, France.,UMR 1149, Inserm, Université Paris Diderot Paris 7, Centre de Recherche sur l' Inflammation (CRI), Paris
| | - P-E Rautou
- Service d'Hépatologie, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Clichy, France.,UMR-970, Paris Cardiovascular Research Center - PARCC, INSERM, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| |
Collapse
|
14
|
Harrar V, Elkrief L, Bouskila J, Kucera R, Fink-Jensen A, Bouchard JF, Palmour R, Ptito M. Effects of Prenatal Alcohol Exposure on the Visual System of Monkeys Measured at Different Stages of Development. ACTA ACUST UNITED AC 2017; 58:6282-6291. [DOI: 10.1167/iovs.17-22181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Vanessa Harrar
- School of Optometry, University of Montreal, Montreal, Quebec, Canada
| | - Laurent Elkrief
- School of Optometry, University of Montreal, Montreal, Quebec, Canada
- Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Joseph Bouskila
- School of Optometry, University of Montreal, Montreal, Quebec, Canada
- Departments of Psychiatry and of Human Genetics, McGill University, Montreal, Quebec, Canada
- Behavioural Science Foundation, St Kitts
| | - Ryan Kucera
- School of Optometry, University of Montreal, Montreal, Quebec, Canada
| | - Anders Fink-Jensen
- Laboratory of Neuropsychiatry, Psychiatric Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | | | - Roberta Palmour
- Departments of Psychiatry and of Human Genetics, McGill University, Montreal, Quebec, Canada
- Behavioural Science Foundation, St Kitts
| | - Maurice Ptito
- School of Optometry, University of Montreal, Montreal, Quebec, Canada
- Behavioural Science Foundation, St Kitts
- Laboratory of Neuropsychiatry, Psychiatric Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
15
|
Calmy A, van Delden C, Giostra E, Junet C, Rubbia Brandt L, Yerly S, Chave JP, Samer C, Elkrief L, Vionnet J, Berney T. HIV-Positive-to-HIV-Positive Liver Transplantation. Am J Transplant 2016; 16:2473-8. [PMID: 27109874 DOI: 10.1111/ajt.13824] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [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: 04/01/2016] [Revised: 04/08/2016] [Accepted: 04/09/2016] [Indexed: 01/25/2023]
Abstract
Most countries exclude human immunodeficiency virus (HIV)-positive patients from organ donation because of concerns regarding donor-derived HIV transmission. The Swiss Federal Act on Transplantation has allowed organ transplantation between HIV-positive donors and recipients since 2007. We report the successful liver transplantation from an HIV-positive donor to an HIV-positive recipient. Both donor and recipient had been treated for many years with antiretroviral therapy and harbored multidrug-resistant viruses. Five months after transplantation, HIV viremia remains undetectable. This observation supports the inclusion of appropriate HIV-positive donors for transplants specifically allocated to HIV-positive recipients.
Collapse
Affiliation(s)
- A Calmy
- HIV Unit, Geneva University Hospitals, Geneva, Switzerland
| | - C van Delden
- Transplant Infectious Diseases Unit, Geneva University Hospitals, Geneva, Switzerland
| | - E Giostra
- Division of Transplantation, Geneva University Hospitals, Geneva, Switzerland
| | - C Junet
- Private Practice, Geneva, Switzerland
| | - L Rubbia Brandt
- Division of Pathology, Geneva University Hospitals, Geneva, Switzerland
| | - S Yerly
- Virology Laboratory, Geneva University Hospitals, Geneva, Switzerland
| | - J-P Chave
- Private Practice, Lausanne, Switzerland
| | - C Samer
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - L Elkrief
- Division of Transplantation, Geneva University Hospitals, Geneva, Switzerland
| | - J Vionnet
- Division of Gastroenterology and Division of Transplantation, CHUV, Lausanne, Switzerland
| | - T Berney
- Division of Transplantation, Geneva University Hospitals, Geneva, Switzerland
| | | |
Collapse
|
16
|
Payancé A, Bissonnette J, Roux O, Elkrief L, Gault N, Francoz C, Nekachtali O, Soubrane O, Lebrec D, Valla D, Durand F, Rautou PE. Lack of clinical or haemodynamic rebound after abrupt interruption of beta-blockers in patients with cirrhosis. Aliment Pharmacol Ther 2016; 43:966-73. [PMID: 26932599 DOI: 10.1111/apt.13577] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 12/29/2015] [Accepted: 02/12/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Beta-blockers may have to be interrupted in patients with cirrhosis. The concept of a rebound after interruption of beta-blockers is based on an animal study and on isolated case reports of variceal bleeding. AIM To determine if a rebound occurs in patients with cirrhosis following abrupt interruption of beta-blockers. METHODS We prospectively included all consecutive patients with cirrhosis undergoing right heart and hepatic vein catheterisation. Four groups were defined: 'no beta-blockers' including patients not receiving beta-blockers; '≤1 day', '2-3 days' and '≥4 days' classified according to the time patients had interrupted beta-blockers before catheterisation. Results were expressed as median (interquartile range). RESULTS A total of 150 patients were included. Among the 25 patients in the groups '2-3 days' and '≥4 days', median duration of beta-blockers interruption was 4 (3-6) days. No gastrointestinal bleeding occurred during that period, nor during the following month. Hepatic venous pressure gradient was not different among patients in usually treated with beta-blockers. After adjustment, beta-blockers interruption was not associated with hepatic venous pressure gradient. Cardiac index was higher in the '≥4 days' group [4.6 L/min/m(2) (3.5-5.1)] than in the '≤1 day' group [3.4 (2.6-4.0); P = 0.001] or in the '2-3 days' group [3.1 (2.7-3.7); P = 0.007], but not different from the 'no beta-blockers' group. CONCLUSIONS Abrupt interruption of beta-blockers is associated neither with an apparent increase in the risk of variceal bleeding nor with a haemodynamic rebound. Thus, interruption of beta-blockers in patients with cirrhosis may not require particular dosing or surveillance.
Collapse
Affiliation(s)
- A Payancé
- Service d'Hépatologie, Hôpital Beaujon, APHP, Clichy, France.,DHU Unity, Hôpital Beaujon, APHP, Clichy, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - J Bissonnette
- Service d'Hépatologie, Hôpital Beaujon, APHP, Clichy, France
| | - O Roux
- Service d'Hépatologie, Hôpital Beaujon, APHP, Clichy, France.,DHU Unity, Hôpital Beaujon, APHP, Clichy, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - L Elkrief
- Service d'Hépatologie, Hôpital Beaujon, APHP, Clichy, France
| | - N Gault
- DHU Unity, Hôpital Beaujon, APHP, Clichy, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Département Epidémiologie et Recherche Clinique, Hôpital Beaujon, APHP, Clichy, France
| | - C Francoz
- Service d'Hépatologie, Hôpital Beaujon, APHP, Clichy, France.,DHU Unity, Hôpital Beaujon, APHP, Clichy, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,CRI UMR1149, Clichy, France
| | - O Nekachtali
- Service d'Hépatologie, Hôpital Beaujon, APHP, Clichy, France
| | - O Soubrane
- DHU Unity, Hôpital Beaujon, APHP, Clichy, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,CRI UMR1149, Clichy, France.,Service de chirurgie hépato-biliaire et transplantation, Hôpital Beaujon, APHP, Clichy, France
| | - D Lebrec
- Service d'Hépatologie, Hôpital Beaujon, APHP, Clichy, France.,DHU Unity, Hôpital Beaujon, APHP, Clichy, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,CRI UMR1149, Clichy, France
| | - D Valla
- Service d'Hépatologie, Hôpital Beaujon, APHP, Clichy, France.,DHU Unity, Hôpital Beaujon, APHP, Clichy, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,CRI UMR1149, Clichy, France
| | - F Durand
- Service d'Hépatologie, Hôpital Beaujon, APHP, Clichy, France.,DHU Unity, Hôpital Beaujon, APHP, Clichy, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,CRI UMR1149, Clichy, France
| | - P-E Rautou
- Service d'Hépatologie, Hôpital Beaujon, APHP, Clichy, France.,DHU Unity, Hôpital Beaujon, APHP, Clichy, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM, U970, Paris Cardiovascular Research Center - PARCC, Paris, France
| |
Collapse
|
17
|
Pasquet B, Elkrief L, Rautou PE, Tubach F, Moreau R, De Rycke Y, Gault N. Effet de la norfloxacine sur la survie des malades atteints de cirrhose Child-Pugh C : essai contrôlé randomisé avec prise en compte des risques compétitifs. Rev Epidemiol Sante Publique 2016. [DOI: 10.1016/j.respe.2016.03.098] [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] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
18
|
Bochatay L, Elkrief L, Spahr L. [When should we give albumin in patients with cirrhosis?]. Rev Med Suisse 2015; 11:1596-1601. [PMID: 26502620] [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
The beneficial effects of the use of albumin, either alone or combines with other treat- ments, have been demonstrated in patients with various complications of cirrhosis. Therefore, albumin should be administred in patients with spontaneous bacterial peritonitis in association with antibiotics, and in association with terlipressin in patients with type 1 hepatorenal syndrome. Albumin use reduces the occurrence of paracentesis-related circulatory dysfunction, in patients with large ascites undergoing paracentesis. So far, the beneficial effect of albumin has not been demonstrated, neither for infections other than spontaneous bacterial peritonitis nor for hepatic encephalopathy. This article provides an overview of the data evaluating the effects of albumin in patients with cirrhosis.
Collapse
|