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Johnson TF, Beckerman AP, Childs DZ, Webb TJ, Evans KL, Griffiths CA, Capdevila P, Clements CF, Besson M, Gregory RD, Thomas GH, Delmas E, Freckleton RP. Revealing uncertainty in the status of biodiversity change. Nature 2024; 628:788-794. [PMID: 38538788 PMCID: PMC11041640 DOI: 10.1038/s41586-024-07236-z] [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: 11/23/2022] [Accepted: 02/26/2024] [Indexed: 04/06/2024]
Abstract
Biodiversity faces unprecedented threats from rapid global change1. Signals of biodiversity change come from time-series abundance datasets for thousands of species over large geographic and temporal scales. Analyses of these biodiversity datasets have pointed to varied trends in abundance, including increases and decreases. However, these analyses have not fully accounted for spatial, temporal and phylogenetic structures in the data. Here, using a new statistical framework, we show across ten high-profile biodiversity datasets2-11 that increases and decreases under existing approaches vanish once spatial, temporal and phylogenetic structures are accounted for. This is a consequence of existing approaches severely underestimating trend uncertainty and sometimes misestimating the trend direction. Under our revised average abundance trends that appropriately recognize uncertainty, we failed to observe a single increasing or decreasing trend at 95% credible intervals in our ten datasets. This emphasizes how little is known about biodiversity change across vast spatial and taxonomic scales. Despite this uncertainty at vast scales, we reveal improved local-scale prediction accuracy by accounting for spatial, temporal and phylogenetic structures. Improved prediction offers hope of estimating biodiversity change at policy-relevant scales, guiding adaptive conservation responses.
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Affiliation(s)
- T F Johnson
- School of Biosciences, Ecology and Evolutionary Biology, University of Sheffield, Sheffield, UK.
| | - A P Beckerman
- School of Biosciences, Ecology and Evolutionary Biology, University of Sheffield, Sheffield, UK
| | - D Z Childs
- School of Biosciences, Ecology and Evolutionary Biology, University of Sheffield, Sheffield, UK
| | - T J Webb
- School of Biosciences, Ecology and Evolutionary Biology, University of Sheffield, Sheffield, UK
| | - K L Evans
- School of Biosciences, Ecology and Evolutionary Biology, University of Sheffield, Sheffield, UK
| | - C A Griffiths
- School of Biosciences, Ecology and Evolutionary Biology, University of Sheffield, Sheffield, UK
- Swedish University of Agricultural Sciences, Department of Aquatic Resources, Institute of Marine Research, Lysekil, Sweden
| | - P Capdevila
- School of Biological Sciences, Biosciences, University of Bristol, Bristol, UK
- Departament de Biologia Evolutiva, Ecologia i Ciències Ambientals, Universitat de Barcelona (UB), Barcelona, Spain
- Institut de Recerca de la Biodiversitat (IRBio), Universitat de Barcelona (UB), Barcelona, Spain
| | - C F Clements
- School of Biological Sciences, Biosciences, University of Bristol, Bristol, UK
| | - M Besson
- School of Biological Sciences, Biosciences, University of Bristol, Bristol, UK
- Sorbonne Université, CNRS, Biologie Intégrative des Organismes Marins, BIOM, Banyuls-sur-Mer, France
| | - R D Gregory
- RSPB Centre for Conservation Science, The Lodge, Sandy, UK
- Centre for Biodiversity & Environment Research, Department of Genetics, Evolution and Environment, University College London, London, UK
| | - G H Thomas
- School of Biosciences, Ecology and Evolutionary Biology, University of Sheffield, Sheffield, UK
| | - E Delmas
- School of Biosciences, Ecology and Evolutionary Biology, University of Sheffield, Sheffield, UK
- Habitat, Montreal, Quebec, Canada
- Institut des Sciences de la Forêt Tempérée, Université du Québec en Outaouais, Ripon, Quebec, Canada
| | - R P Freckleton
- School of Biosciences, Ecology and Evolutionary Biology, University of Sheffield, Sheffield, UK
- Debrecen Biodiversity Centre, University of Debrecen, Debrecen, Hungary
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Souche A, Besson M, Desmeules J, Piguet V, Cedraschi C. [Therapeutic alliance and cognitive behavioral group therapy]. Rev Med Suisse 2023; 19:1236-1239. [PMID: 37341316 DOI: 10.53738/revmed.2023.19.832.1236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
In cognitive-behavioral group therapy, the therapeutic alliance with the psychotherapists and between the patients in the group, allows patients to develop coping strategies. These include cognitive and behavioral efforts aimed to control, reduce or tolerate specific demands, whether internal or external, experienced as threatening, exhausting or exceeding the patient's resources. This adaptive mechanism lowers the intensity of anxiety, favors control of fear and reinforces the motivation and energy invested in the process of change. We describe the importance of therapeutic alliance in group therapy with patients suffering from chronic pain. These processes will be illustrated with clinical vignettes.
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Affiliation(s)
- Alain Souche
- Service de pharmacologie et toxicologie cliniques, Centre multidisciplinaire de la douleur, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Marie Besson
- Service de pharmacologie et toxicologie cliniques, Centre multidisciplinaire de la douleur, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Jules Desmeules
- Service de pharmacologie et toxicologie cliniques, Centre multidisciplinaire de la douleur, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Valérie Piguet
- Centre Jean-Violette, Traitement de la douleur, Rue Jean-Violette 3, 1205 Genève
| | - Christine Cedraschi
- Service de pharmacologie et toxicologie cliniques, Centre multidisciplinaire de la douleur, Hôpitaux universitaires de Genève, 1211 Genève 14
- Service de médecine interne de réhabilitation, Hôpital Beau-Séjour, Hôpitaux universitaires de Genève, 1211 Genève 14
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Gloor Y, Lloret-Linares C, Bosilkovska M, Perroud N, Richard-Lepouriel H, Aubry JM, Daali Y, Desmeules JA, Besson M. Drug metabolic enzyme genotype-phenotype discrepancy: High phenoconversion rate in patients treated with antidepressants. Biomed Pharmacother 2022; 152:113202. [PMID: 35653884 DOI: 10.1016/j.biopha.2022.113202] [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] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 11/02/2022] Open
Abstract
Cytochromes from the P450 family (CYP) play a central role in the primary metabolism of frequently prescribed antidepressants, potentially affecting their efficacy and tolerance. There are however important differences in the drug metabolic capacities of each individual resulting from a combination of intrinsic and environmental factors. This variability can present an important risk for patients and increases the difficulty of drug prescription in clinical practice. Pharmacogenetic studies have uncovered a number of alleles defining the intrinsic metabolizer status, however, additional factors affecting cytochrome activity can modify this activity and result in a phenoconversion. The present study investigates the discrepancy between the genetically predicted and actually measured activities for the six most important liver cytochromes (CYP1A2, CYP2B6, CYP2C9, CYP2C19, CYP2D6 and CYP3A4) in a cohort of patients under antidepressant treatment, previously shown to have a high proportion of patients with low metabolizing activities. We now performed the genetic characterization of this cohort to determine the extent of the genetic versus environmental contribution in these decreased activities. For all enzyme tested, we observed an important rate of phenoconversion, affecting between 33 % and 65 % of the patients, as well as a significant (p < 1E-06) global reduction in the effective but not predicted activities of CYP2D6, CYP2C9 and CYP2C19 compared to the general population. Our results highlight the advantages of phenotyping versus genotyping as well as the increased risk of treatment failure or adverse effect occurrence in a polymedicated population.
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Affiliation(s)
- Y Gloor
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency, Geneva University Hospitals (HUG), Geneva, Switzerland.
| | - C Lloret-Linares
- Department of Nutritional and Metabolic Diseases, Ramsay Générale de Santé, Pays de Savoie Private Hospital, Annemasse, France
| | - M Bosilkovska
- Clinical Pharmacology and Toxicology, Department of Anaesthetics Pharmacology and Intensive Care, University of Geneva, Geneva, Switzerland
| | - N Perroud
- Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University of Geneva, Geneva, Switzerland; Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - H Richard-Lepouriel
- Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University of Geneva, Geneva, Switzerland; Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - J-M Aubry
- Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, University of Geneva, Geneva, Switzerland
| | - Y Daali
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency, Geneva University Hospitals (HUG), Geneva, Switzerland; Clinical Pharmacology and Toxicology, Department of Anaesthetics Pharmacology and Intensive Care, University of Geneva, Geneva, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland (ISPSO), University of Geneva, Geneva, Switzerland
| | - J A Desmeules
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency, Geneva University Hospitals (HUG), Geneva, Switzerland; Clinical Pharmacology and Toxicology, Department of Anaesthetics Pharmacology and Intensive Care, University of Geneva, Geneva, Switzerland; Institute of Pharmaceutical Sciences of Western Switzerland (ISPSO), University of Geneva, Geneva, Switzerland
| | - M Besson
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency, Geneva University Hospitals (HUG), Geneva, Switzerland; Clinical Pharmacology and Toxicology, Department of Anaesthetics Pharmacology and Intensive Care, University of Geneva, Geneva, Switzerland
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Galani V, Besson M, Le Hénaff C, Chytas V, Prada P. [When the discontinuation of psychotropic drugs is necessary: clinical manifestations and therapeutic approach]. Rev Med Suisse 2022; 18:276-281. [PMID: 35188352 DOI: 10.53738/revmed.2022.18.769.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The reduction or suspension of psychotropic treatment may be necessary for various medical reasons. This can have serious consequences for patients, including clinical manifestations, both physical and psychological. These manifestations, which are often unpleasant, can compromise care during hospitalization and undermine the therapeutic alliance. Their early detection, readjustment of treatment, when necessary, as well as regular communication with the patient and among specialists are important tips to take into account from caregivers.
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Affiliation(s)
- Vasiliki Galani
- Service de psychiatrie de liaison et d'intervention de crise, Département de santé mentale et de psychiatrie, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Marie Besson
- Service de pharmacologie et de toxicologie cliniques, Centre multidisciplinaire de la douleur, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Catherine Le Hénaff
- Service de psychiatrie de liaison et d'intervention de crise, Département de santé mentale et de psychiatrie, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Vasileios Chytas
- Service de psychiatrie de liaison et d'intervention de crise, Département de santé mentale et de psychiatrie, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Paco Prada
- Service de psychiatrie de liaison et d'intervention de crise, Département de santé mentale et de psychiatrie, Hôpitaux universitaires de Genève, 1211 Genève 14
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5
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Rodieux F, Ivanyuk A, Besson M, Desmeules J, Samer CF. Hydromorphone Prescription for Pain in Children-What Place in Clinical Practice? Front Pediatr 2022; 10:842454. [PMID: 35547539 PMCID: PMC9083226 DOI: 10.3389/fped.2022.842454] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/25/2022] [Indexed: 11/13/2022] Open
Abstract
While morphine is the gold standard treatment for severe nociceptive pain in children, hydromorphone is increasingly prescribed in this population. This review aims to assess available knowledge about hydromorphone and explore the evidence for its safe and effective prescription in children. Hydromorphone is an opioid analgesic similar to morphine structurally and in its pharmacokinetic and pharmacodynamic properties but 5-7 times more potent. Pediatric pharmacokinetic and pharmacodynamic data on hydromorphone are sorely lacking; they are non-existent in children younger than 6 months of age and for oral administration. The current data do not support any advantage of hydromorphone over morphine, both in terms of efficacy and safety in children. Morphine should remain the treatment of choice for moderate and severe nociceptive pain in children and hydromorphone should be reserved as alternative treatment. Because of the important difference in potency, all strategies should be taken to avoid inadvertent administration of hydromorphone when morphine is intended.
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Affiliation(s)
- Frédérique Rodieux
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - Anton Ivanyuk
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - Marie Besson
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jules Desmeules
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland (ISPSO), School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
| | - Caroline F Samer
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Abstract
Gabapentinoids and opioids have in common that they are used in medicine in the treatment of pain, and by addicts in recreational use. In recent years, in the context of the "opioid epidemics", gabapentinoids, which had a reputation for low risk of abuse, have been increasingly prescribed. This was accompanied by increasingly frequent abuses, the patients most at risk being those suffering from opiate addiction. However, gabapentinoids increase the risks associated with opioids or other sedatives, due to a synergy of central depressant effects. This leads to reconsider the framework of their prescription and the management of chronic pain.
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Affiliation(s)
- Michel Hofmann
- Department of Psychiatry, Service of psychiatric specialties, Mood disorder unit, Geneva University Hospitals, Rue de Lausanne 20, CH-1201, Geneva, Switzerland; Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Psychopharmacology Unit, Geneva University Hospitals, Geneva, Switzerland.
| | - Marie Besson
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Psychopharmacology Unit, Geneva University Hospitals, Geneva, Switzerland; Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Intensive care and Pharmacology, Multidisciplinary Pain Center, Geneva University Hospitals, Geneva, Switzerland
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7
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Ing Lorenzini K, Desmeules J, Rollason V, Bertin S, Besson M, Daali Y, Samer CF. CYP450 Genotype-Phenotype Concordance Using the Geneva Micrococktail in a Clinical Setting. Front Pharmacol 2021; 12:730637. [PMID: 34512355 PMCID: PMC8427306 DOI: 10.3389/fphar.2021.730637] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/13/2021] [Indexed: 12/15/2022] Open
Abstract
Pharmacokinetic variability is a major source of differences in drug response and can be due to genetic variants and/or drug-drug interactions. Cytochromes P450 are among the most studied enzymes from a pharmacokinetic point of view. Their activity can be measured by phenotyping, and/or predicted by genotyping. Depending on the presence of drugs and/or diseases that can affect their in vivo activity, both approaches can be complementary. In 2014, the Geneva cocktail using dried blood spots was validated in healthy volunteers for CYP450 phenotyping. Since its clinical implementation, it has been used in approximately 500 patients in various clinical situations. Our study aims to report the concordance between CYP450 genotype and phenotype in real-life patients. The prospectively collected data from patients who were genotyped and/or phenotyped between January 2014 and December 2020 were reviewed. A total of 537 patients were genotyped and/or phenotyped for CYP450 during this period, and 241 underwent simultaneous genotyping and phenotyping allowing for genotype/phenotype concordance assessment. Genotyping correctly predicted poor metabolizer phenotypes for most CYPs isoenzymes studied, whereas agreement was more variable for intermediate, normal, and ultrarapid metabolizers. Discrepancies between the phenotype predicted on the basis of genotyping and the measured phenotype were not always explained by concurrent medication (phenotypic switch). Therefore genotyping and phenotyping tests are complementary approaches when aiming to individualize drug therapy. In the 537 patients, the majority of clinical situations were observed with analgesic/anesthetic drugs (n = 187), followed by antidepressants (n = 153), antineoplastics (n = 97), and immunosuppressants (n = 93). Inefficacy (or low drug levels) and adverse drug reaction (or high drug levels) were the main reasons for testing. Genotype and/or phenotype results explained or at least contributed to the clinical event in 44% of cases.
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Affiliation(s)
- Kuntheavy Ing Lorenzini
- Division of Clinical Pharmacology and Toxicology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Jules Desmeules
- Division of Clinical Pharmacology and Toxicology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Victoria Rollason
- Division of Clinical Pharmacology and Toxicology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Stéphane Bertin
- Division of Clinical Pharmacology and Toxicology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Marie Besson
- Division of Clinical Pharmacology and Toxicology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Youssef Daali
- Division of Clinical Pharmacology and Toxicology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Caroline F Samer
- Division of Clinical Pharmacology and Toxicology, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
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Meszaros EP, Stancu C, Costanza A, Besson M, Sarasin F, Bondolfi G, Ambrosetti J. Antibiomania: a case report of clarithromycin and amoxicillin-clavulanic acid induced manic episodes separately. BMC Psychiatry 2021; 21:399. [PMID: 34380446 PMCID: PMC8359544 DOI: 10.1186/s12888-021-03397-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 07/28/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Antibiomania is a rare but recognized side effect with yet unclear definite pathogenesis although multiple hypotheses have been proposed. The novelty of this case is the suspected pharmacodynamic drug-drug interaction between clarithromycin and amoxicillin-clavulanic acid. CASE PRESENTATION We present the occurrence of a brief manic episode concerning a 50-year-old man with no psychiatric history, first started on amoxicillin-clavulanic acid therapy and then switched to clarithromycin for left basal pneumonia. Shortly after the antibiotic prescription, he presented psychiatric symptomatology (logorrhea, elevated mood, irritability, increase in physical activity and delusions). The antibiotic was stopped and the patient received lorazepam (2.5 mg p.o.) to treat psychomotor agitation. Approximately 12 h after clarithromycin cessation, amelioration was already observed, supporting the diagnosis of a clarithromycin-induced manic episode. Amoxicillin-clavulanic acid was then reintroduced because of the pneumonia and psychiatric symptoms reemerged. This second antibiotic was also stopped, and 1 week later, the patient was symptom-free. CONCLUSION The emergence of psychiatric side effects related to antibiotherapy, which is a common treatment, can greatly impact a patient's quality of life. Early recognition and intervention could substantially influence the administered medical care and recovery. Moreover, given the widespread use of antibiotics including in combination, we thought our case report might be clinically useful as a clinical reminder relevant to the use of antibiotic combinations.
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Affiliation(s)
- Edith Paula Meszaros
- Departments of Emergency and Psychiatry, Emergency Psychiatric Unit (UAUP), Geneva University Hospitals (HUG), Geneva, Switzerland.
| | - Catheline Stancu
- grid.8591.50000 0001 2322 4988Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Alessandra Costanza
- grid.8591.50000 0001 2322 4988Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Marie Besson
- grid.150338.c0000 0001 0721 9812Unit of Psychopharmacology, Department of Pharmacology and Toxicology, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - François Sarasin
- grid.8591.50000 0001 2322 4988Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland ,grid.150338.c0000 0001 0721 9812Department of Emergency, Emergency Medicine Unit, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Guido Bondolfi
- grid.8591.50000 0001 2322 4988Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland ,grid.150338.c0000 0001 0721 9812Department of Psychiatry, Service of Liaison Psychiatry and Crisis Intervention (SPLIC), Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Julia Ambrosetti
- grid.150338.c0000 0001 0721 9812Departments of Emergency and Psychiatry, Emergency Psychiatric Unit (UAUP), Geneva University Hospitals (HUG), Geneva, Switzerland
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Lonchampt S, Gerber F, Aubry JM, Desmeules J, Kosel M, Besson M. Prevalence of Polypharmacy and Inappropriate Medication in Adults With Intellectual Disabilities in a Hospital Setting in Switzerland. Front Psychiatry 2021; 12:614825. [PMID: 34248693 PMCID: PMC8267250 DOI: 10.3389/fpsyt.2021.614825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/07/2020] [Accepted: 05/18/2021] [Indexed: 01/06/2023] Open
Abstract
Background: Polypharmacy and inappropriate prescription are frequent in vulnerable and multi-morbid populations. Adults with intellectual disability (ID) are at risk of being polymedicated because they often present with multiple comorbidities and challenging behaviors. Aim: The objective of this study was thus to evaluate the prevalence of potentially inappropriate medications (PIM) and polypharmacy in a hospital unit dedicated to adults with ID. Methods: A 10-month prospective observational study took place at a hospital unit specializing in the care of adults with ID in Geneva, Switzerland. Once a week, health and prescription data were collected and screened for PIM according to preset definitions. Results: Fourteen patients consented to participate, leading to 20 hospitalization events assessed during the study. Hospitalizations lasted 12.8 weeks on average. ID severities ranged from mild to profound, all degrees of severity being equally represented. One hundred percent of the patients were polymedicated (defined as five drugs or more prescribed simultaneously). A mean number of 9.4 drugs were prescribed per week, including 5.3 psychotropic drugs. The number of prescribed drugs remained stable throughout the hospitalizations. Antipsychotics were the most prescribed drug class (19% of all prescribed drugs), followed by benzodiazepines (13%) and laxatives (12%). A total of 114 PIM were recorded with an average of 5.7 PIM per hospitalization. Conclusions: This study showed that polypharmacy and inappropriate prescription are very common in adults with ID, even though the literature and expert positions advocate for deprescription in these patients. Specific prescribing and deprescribing guidelines are needed for that specific population.
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Affiliation(s)
- Sophie Lonchampt
- Psychopharmacology Unit, Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Intensive Care, Pharmacology and Emergency, Geneva University Hospitals, Geneva, Switzerland
- Unit for Treatment and Assessment of In and Out Patients With Learning Disabilities and Autism Spectrum Disorders, Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Science, School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
| | - Fabienne Gerber
- Unit for Treatment and Assessment of In and Out Patients With Learning Disabilities and Autism Spectrum Disorders, Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Michel Aubry
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Jules Desmeules
- Faculty of Science, School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Intensive Care and Pharmacology, Geneva University Hospitals, Geneva, Switzerland
| | - Markus Kosel
- Unit for Treatment and Assessment of In and Out Patients With Learning Disabilities and Autism Spectrum Disorders, Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Marie Besson
- Psychopharmacology Unit, Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Intensive Care, Pharmacology and Emergency, Geneva University Hospitals, Geneva, Switzerland
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10
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Souche A, Piguet V, Besson M, Bourezg A, Desmeules J, Cedraschi C. [Activity, decentration and cognitive restructuring in cognitive-behavioural therapy - practice-based aspects]. Rev Med Suisse 2021; 17:1204-1207. [PMID: 34160916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Decentration and cognitive restructuring are used in cognitive-behavioural therapy (CBT) with patients suffering from chronic pain and are reinforced by group work. They can also be useful to the general practitioner. Clinical vignettes summarize the role of group CBT in identifying realistic and meaningful activities. They stress decentration and cognitive restructuring as key therapeutic tools in group CBT. Using them with patients suffering from chronic pain is complex and challenging when it comes to allow the patients to overcome the impossibility to function 'as before' while figuring out how to cope 'as for now'.
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Affiliation(s)
- Alain Souche
- Service de pharmacologie et toxicologie cliniques, Centre multidisciplinaire de la douleur, HUG, 1211 Genève 14
| | - Valérie Piguet
- Service de pharmacologie et toxicologie cliniques, Centre multidisciplinaire de la douleur, HUG, 1211 Genève 14
- Centre Jean-Violette, Traitement de la douleur, Rue Jean-Violette 3, 1205 Genève
| | - Marie Besson
- Service de pharmacologie et toxicologie cliniques, Centre multidisciplinaire de la douleur, HUG, 1211 Genève 14
| | - Ali Bourezg
- Service de pharmacologie et toxicologie cliniques, Centre multidisciplinaire de la douleur, HUG, 1211 Genève 14
| | - Jules Desmeules
- Service de pharmacologie et toxicologie cliniques, Centre multidisciplinaire de la douleur, HUG, 1211 Genève 14
| | - Christine Cedraschi
- Service de pharmacologie et toxicologie cliniques, Centre multidisciplinaire de la douleur, HUG, 1211 Genève 14
- Service de médecine interne de réhabilitation, Hôpital Beau-Séjour, HUG, 1211 Genève 14
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11
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Sergentanis I, Vibert V, Costanza A, De Néris M, Besson M, Kosel M, Bondolfi G, Ambrosetti J. [About the use of ketamine in emergency psychiatric settings]. Rev Med Suisse 2021; 17:303-306. [PMID: 33586375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Ketamine and its S-enantiomer, esketamine, have shown to be promising molecules for use in psychiatry. Widely investigated for the treatment of drug-resistant depression, they could be used in emergency conditions, due to their rapid onset of action, in two main conditions : 1) psychomotor agitation, and 2) acute suicidal ideation and behavior (suicidal crisis). In particular, intranasal administration offers a non-invasive, safe and very easy to administer option. An effect begins a few hours to a day after intake and lasts for about a week. These molecules present an innovative option for the future and their specific use in psychiatric emergencies.
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Affiliation(s)
- Ioannis Sergentanis
- Unité d'accueil et d'urgences psychiatriques, Service des urgences, Département de médecine aiguë, HUG, 1211 Genève 14
| | - Vincent Vibert
- Unité d'accueil et d'urgences psychiatriques, Service des urgences, Département de médecine aiguë, HUG, 1211 Genève 14
| | - Alessandra Costanza
- Département de psychiatrie, Faculté de médecine, UNIGE, 1211 Genève 4
- Struttura complessa di psichiatria (S.P.D.C.), Azienda Ospedaliera Nazionale « Santi Antonio e Biagio e Cesare Arrigo », Via Venezia 16, 15121 Alessandria, Italie
| | - Mélanie De Néris
- Service de psychiatrie de liaison et d'intervention de crise, HUG, 1211 Genève 14
| | - Marie Besson
- Unité de psychopharmacologie clinique, Département de médecine aiguë, HUG, 1211 Genève 14
| | - Markus Kosel
- Unité de psychiatrie du développement mental, Service des spécialités psychiatriques, HUG, 1211 Genève 14
| | - Guido Bondolfi
- Service de psychiatrie de liaison et d'intervention de crise, HUG, 1211 Genève 14
| | - Julia Ambrosetti
- Unité d'accueil et d'urgences psychiatriques, Service des urgences, Département de médecine aiguë, HUG, 1211 Genève 14
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Abstract
Since the endocannabinoid system is involved in immune function, the effect of cannabinoid intake on infectious conditions is questioned for several years and is of particular interest in the COVID 19 pandemia. Some data suggest that the immunomodulatory effect of cannabinoids may affect the course and severity of SARS-CoV-2 infection. Given the large number of cannabinoids consumers in the community, this commentary presents the current knowledge on the potential impact of cannabinoids and endocannabinoids on bacterial and viral infection courses namely SARS-CoV-2 disease. Practical recommendations, which can be drawn from the literature, are given.
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Affiliation(s)
- Myriam El Biali
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Barbara Broers
- Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
| | - Marie Besson
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Jules Demeules
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
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13
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Lonchampt S, Gerber F, Aubry JM, Desmeules J, Besson M, Kosel M. TOP-ID: a Delphi technique-guided development of a prescription and deprescription tool for adults with intellectual disabilities. BMJ Open 2020; 10:e039208. [PMID: 33148748 PMCID: PMC7643515 DOI: 10.1136/bmjopen-2020-039208] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 09/22/2020] [Accepted: 10/11/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Adults with an intellectual disability (AWID) are often polymedicated because of somatic and psychiatric health problems. Besides, they may display challenging behaviours, leading to off-label prescription of psychotropic drugs, without efficacy and with numerous adverse effects. In this context, a prescription/deprescription tool (Tool for Optimising Prescription in Intellectual Disability/TOP-ID) was developed to improve the care of AWID. This paper describes how TOP-ID was designed. DESIGN Four-step consensus-based process involving a review of the literature, eight semistructured interviews and a two-round Delphi process. SETTING Seventeen general practices and university and general hospitals from Belgium, France and Switzerland. PARTICIPANTS Eighteen French-speaking physicians from different domains of expertise participated in the Delphi process. PRIMARY AND SECONDARY OUTCOME MEASURES For the Delphi iteration process, consensus was defined as at least a 65% agreement between the experts. RESULTS Two rounds were needed for the Delphi process. Eighty-one items of the tool were submitted to 18 out of 35 recruited French-speaking experts during the first round. Sixty-nine per cent of the items reached a rate of agreement of 65% or more in that round. Thirteen questions were reformulated and resubmitted for the second Delphi iteration round. All of the statements reached a rate of agreement of 65% or more in the second round. CONCLUSION TOP-ID is the first prescription-deprescription tool developed specifically for AWIDs in French. It is intended to help prescribers document patient care in order to reduce prescription errors and to improve safety. The next steps of the project include the development of an electronic version of TOP-ID and a utility study.
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Affiliation(s)
- Sophie Lonchampt
- Psychopharmacology Unit, Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology and Intensive care, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
- Unit for Intellectual Disabilities and Autism in Adults, Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
- School of Pharmaceutical Sciences of Geneva and Lausanne, Faculty of Science, University of Geneva, Geneva, Switzerland
| | - Fabienne Gerber
- Unit for Intellectual Disabilities and Autism in Adults, Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Jean-Michel Aubry
- Division of Psychiatric Specialties, Department of Psychiatry and Mental Health, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Jules Desmeules
- School of Pharmaceutical Sciences of Geneva and Lausanne, Faculty of Science, University of Geneva, Geneva, Switzerland
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Marie Besson
- Psychopharmacology Unit, Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology and Intensive care, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
- Multidisciplinary Pain Center, Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Intensive care and Pharmacology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Markus Kosel
- Unit for Intellectual Disabilities and Autism in Adults, Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
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14
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Rollason V, Lloret-Linares C, Lorenzini KI, Daali Y, Gex-Fabry M, Piguet V, Besson M, Samer C, Desmeules J. Evaluation of Phenotypic and Genotypic Variations of Drug Metabolising Enzymes and Transporters in Chronic Pain Patients Facing Adverse Drug Reactions or Non-Response to Analgesics: A Retrospective Study. J Pers Med 2020; 10:E198. [PMID: 33121061 PMCID: PMC7711785 DOI: 10.3390/jpm10040198] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/22/2020] [Accepted: 10/24/2020] [Indexed: 12/11/2022] Open
Abstract
This retrospective study evaluates the link between an adverse drug reaction (ADR) or a non-response to treatment and cytochromes P450 (CYP), P-glycoprotein (P-gp) or catechol-O-methyltransferase (COMT) activity in patients taking analgesic drugs for chronic pain. Patients referred to a pain center for an ADR or a non-response to an analgesic drug between January 2005 and November 2014 were included. The genotype and/or phenotype was obtained for assessment of the CYPs, P-gp or COMT activities. The relation between the event and the result of the genotype and/or phenotype was evaluated using a semi-quantitative scale. Our analysis included 243 individual genotypic and/or phenotypic explorations. Genotypes/phenotypes were mainly assessed because of an ADR (n = 145, 59.7%), and the majority of clinical situations were observed with prodrug opioids (n = 148, 60.9%). The probability of a link between an ADR or a non-response and the genotypic/phenotypic status of the patient was evaluated as intermediate to high in 40% and 28.2% of all cases, respectively. The drugs in which the probability of an association was the strongest were the prodrug opioids, with an intermediate to high link in 45.6% of the cases for occurrence of ADRs and 36.0% of the cases for non-response. This study shows that the genotypic and phenotypic approach is useful to understand ADRs or therapeutic resistance to a usual therapeutic dosage, and can be part of the evaluation of chronic pain patients.
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Affiliation(s)
- Victoria Rollason
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Emergency Medicine and Intensive Care, Geneva University Hospitals, 1205 Geneva, Switzerland; (K.I.L.); (Y.D.); (V.P.); (M.B.); (C.S.); (J.D.)
- Faculty of Medicine, Geneva University, 1206 Geneva, Switzerland
| | - Célia Lloret-Linares
- Ramsay Générale de Santé, Hôpital Privé Pays de Savoie, Maladies Nutritionnelles et Métaboliques, 74000 Annemasse, France;
| | - Kuntheavy Ing Lorenzini
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Emergency Medicine and Intensive Care, Geneva University Hospitals, 1205 Geneva, Switzerland; (K.I.L.); (Y.D.); (V.P.); (M.B.); (C.S.); (J.D.)
- Faculty of Medicine, Geneva University, 1206 Geneva, Switzerland
| | - Youssef Daali
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Emergency Medicine and Intensive Care, Geneva University Hospitals, 1205 Geneva, Switzerland; (K.I.L.); (Y.D.); (V.P.); (M.B.); (C.S.); (J.D.)
- Faculty of Medicine, Geneva University, 1206 Geneva, Switzerland
| | - Marianne Gex-Fabry
- Division of Psychiatric Specialties, Department of Psychiatry and Mental Health, Geneva University Hospitals, 1226 Thônex, Switzerland;
| | - Valérie Piguet
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Emergency Medicine and Intensive Care, Geneva University Hospitals, 1205 Geneva, Switzerland; (K.I.L.); (Y.D.); (V.P.); (M.B.); (C.S.); (J.D.)
| | - Marie Besson
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Emergency Medicine and Intensive Care, Geneva University Hospitals, 1205 Geneva, Switzerland; (K.I.L.); (Y.D.); (V.P.); (M.B.); (C.S.); (J.D.)
- Faculty of Medicine, Geneva University, 1206 Geneva, Switzerland
| | - Caroline Samer
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Emergency Medicine and Intensive Care, Geneva University Hospitals, 1205 Geneva, Switzerland; (K.I.L.); (Y.D.); (V.P.); (M.B.); (C.S.); (J.D.)
- Faculty of Medicine, Geneva University, 1206 Geneva, Switzerland
| | - Jules Desmeules
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Emergency Medicine and Intensive Care, Geneva University Hospitals, 1205 Geneva, Switzerland; (K.I.L.); (Y.D.); (V.P.); (M.B.); (C.S.); (J.D.)
- Faculty of Medicine, Geneva University, 1206 Geneva, Switzerland
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15
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Papachristou C, Premand Parisien N, Besson M, Bartolomei J. Sialorrhée sous clozapine. Swiss Arch Neurol Psychiatr Psychother 2020. [DOI: 10.4414/sanp.2020.03149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | | | - Marie Besson
- Service de Pharmacologie et Toxicologie cliniques, Hôpitaux Universitaires de Genève
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16
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Aubin PA, Rigumye LO, Kosel M, Besson M, Favrod-Coune T. [Drug management of behavioral disorders in people with developmental and intellectual disability]. Rev Med Suisse 2020; 16:1786-1789. [PMID: 32997447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Behavioral disorders in people with developmental and intellectual disability are frequent but their management is rarely taught. This article is to help primary physicians prescribe drug treatment. We will also discuss the key elements of two of the most commonly used classes of drugs, taking into account the patient's co-morbidities, contraindications and the main side effects.
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Affiliation(s)
- Paul-Alexandre Aubin
- Service de médecine de premier recours, Département de médecine de premier recours, HUG, 1211 Genève 14
| | - Lloyd Orphée Rigumye
- Service de médecine de premier recours, Département de médecine de premier recours, HUG, 1211 Genève 14
| | - Markus Kosel
- Département de psychiatrie, Belle-Idée Les Alpes, 1226 Thônex
| | - Marie Besson
- Unité de psychopharmacologie clinique, Département de médecine aiguë, Belle-Idée, 1226 Thônex
| | - Thierry Favrod-Coune
- Service de médecine de premier recours, Département de médecine de premier recours, HUG, 1211 Genève 14
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17
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El Biali M, Besson M. [Why using antidepressants in chronic pain ? Practical prescription recommendations]. Rev Med Suisse 2020; 16:1350-1353. [PMID: 32672012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The use over the last 50 years of antidepressants having both serotonergic and noradrenergic properties, as the first line for the management of neuropathic pain or chronic pain syndromes, is based on a twofold rationale: on the one hand, a plausible analgesic mechanism of action independent of the effect on mood, on the other hand, efficacy data in humans and animals. Their prescription should be part of a multimodal approach to pain. The dose to reach the analgesic effect, which on average occurs within four weeks after the initiation of treatment, is sometimes lower than the dose required to achieve the antidepressant effect. The choice of antidepressant will rely on the profile of adverse effects and other expected secondary benefits in the case of comorbidities.
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Affiliation(s)
- Myriam El Biali
- Unité de gérontopharmacologie clinique, Service de pharmacologie et toxicologie cliniques, Département de médecine aiguë, HUG, 1211 Genève 14
| | - Marie Besson
- Unité de psychopharmacologie clinique et Centre multidisciplinaire d'évaluation et de traitement de la douleur, Service de pharmacologie et toxicologie cliniques, Département de médecine aiguë, HUG, 1211 Genève 14
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18
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Matthey A, Daali Y, Curtin F, Poncet A, Desmeules J, Besson M. GABAergic modulation of secondary hyperalgesia: A randomized controlled 4-way crossover trial with the α2-subunit preferring GABA positive allosteric modulator, N-desmethyl-clobazam in healthy volunteers. Eur J Pain 2020; 24:1094-1106. [PMID: 32171038 DOI: 10.1002/ejp.1554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/28/2020] [Accepted: 03/03/2020] [Indexed: 11/10/2022]
Abstract
The antihyperalgesic and sedative effects of the α2-subunit preferring GABAA positive allosteric modulator (GAM), N-desmethyl-clobazam (NDMC), 20 and 60 mg, were assessed in a randomized, placebo and active-controlled (clonazepam 1,5 mg), 4-way crossover study, in healthy volunteers, using the ultraviolet B-induced experimental pain model. Single (20, 40, 60 mg) and repeated doses (20 mg over 15 days) of NDMC pharmacokinetics were evaluated. Thirty-two subjects participated in the study. Primary outcome parameter was maximal change in the area of cutaneous UVB irradiation-induced secondary hyperalgesia (ASH). ASH decreased under all treatments. Mean (SD) relative change was 79 (22)%, 83 (24)%, 77 (30)% and 92 (16)% for placebo, NDMC20, NDMC60 and clonazepam, respectively. Neither absolute change nor relative change in ASH was significantly different between NDMC60 and placebo (mean difference = 2.3 cm2 [95% CI 4.0-8.5], p = .462 and 0.4% [-11.9 to 12.6], p = .952, respectively). An overall treatment effect was found on level of sedation. Compared to placebo, sedation was higher under clonazepam (mean difference = 39 mm [30-49] on a visual analogue scale, p < .001) while NDMC was free of sedative effect. NDMC pharmacokinetics after single doses showed poor absorption, but was linear. Steady-state plasma concentrations of NDMC20 were attained within 14 days, with low between-subjects variability. Mean steady-state concentration (CS-S , SD) reached 209 (22) ng/ml. NDMC absence of sedative effect and its overall well-characterized safety coming from years of utilization as a metabolite from clobazam, raise the prospect of dose escalating trials in patients to quantify its clinical utility. SIGNIFICANCE: This article, presenting the Phase I data of the new antihyperalgesic compound, α2-subunit GABAA positive allosteric modulator, N-desmethyl-clobazam (NDMC) is exploring the modulation of a new target in the treatment of neuropathic pain. Based on these results and on its preclinical properties NDMC would qualify as a good tool compound to seek confirmation of the clinical utility of selective GABA allosteric modulators in neuropathic pain patients.
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Affiliation(s)
- Alain Matthey
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Center, Geneva University Hospitals, Geneva, Switzerland
| | - Youssef Daali
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Center, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - François Curtin
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Center, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Antoine Poncet
- Division of Clinical Epidemiology, Geneva University Hospitals, Geneva, Switzerland
| | - Jules Desmeules
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Center, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Marie Besson
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Center, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, Geneva University, Geneva, Switzerland
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19
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Lonchampt S, Gerber F, Aubry JM, Desmeules J, Kosel M, Besson M. Pain interventions in adults with intellectual disability: A scoping review and pharmacological considerations. Eur J Pain 2020; 24:875-885. [PMID: 32060971 DOI: 10.1002/ejp.1547] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/31/2020] [Accepted: 02/09/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE Having to deal on a daily routine with prescriptions in adults with intellectual disability (ID), we systematically reviewed the literature on the specificities of pain interventions in that population, focusing on medication and trying to gather practical information on appropriate pain treatments. Given the scarcity of the literature on the topic, we also discussed the pharmacological considerations to be taken into account when prescribing analgesic drugs in that vulnerable population. DATABASES AND DATA TREATMENT Articles on pain and ID were searched in the Medline and Google scholar electronic databases using the key words "Intellectual Disability," "Developmental Disability" and specific keywords for pharmacological and non-pharmacological pain interventions. Preset outcomes about pharmacological treatment specificity, efficacy and safety were then collected. RESULTS One hundred and fifty-two articles were found and 16 were retained based on our inclusion and exclusion criteria. Of the 16 articles, five were topical reviews. Among the 11 remaining articles, five discussed pharmacological interventions, four considered non-pharmacological interventions and two discussed both. As anticipated, the literature matching our specific outcomes about the pharmacological treatment of pain was scarce and for the most part not designed to answer the questions of specificity, efficacy and safety of pain treatment in adults with ID. CONCLUSION The specificity of analgesic treatments in adults with ID is a totally unexplored domain. In the absence of clinical guidelines, pharmacological facts-such as inter-individual variability in drug response, pharmacokinetic and pharmacodynamic interactions, frequent co-morbidities and ease of administration-must be systematically integrated, when prescribing in the population of adults with ID. SIGNIFICANCE This review synthesizes the state of research on pain interventions in adults with ID and is one of the rare articles addressing the specificities of analgesic prescriptions in this population.
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Affiliation(s)
- Sophie Lonchampt
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Psychopharmacology Unit, Geneva University Hospitals, Geneva, Switzerland.,Division of Psychiatric Specialties, Department of Psychiatry and Mental Health, Unit for Intellectual Disabilities and Autism in Adults, Geneva University Hospitals, Geneva, Switzerland
| | - Fabienne Gerber
- Division of Psychiatric Specialties, Department of Psychiatry and Mental Health, Unit for Intellectual Disabilities and Autism in Adults, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Michel Aubry
- Division of Psychiatric Specialties, Department of Psychiatry and Mental Health, Geneva University Hospitals, Geneva, Switzerland
| | - Jules Desmeules
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - Markus Kosel
- Division of Psychiatric Specialties, Department of Psychiatry and Mental Health, Unit for Intellectual Disabilities and Autism in Adults, Geneva University Hospitals, Geneva, Switzerland
| | - Marie Besson
- Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Psychopharmacology Unit, Geneva University Hospitals, Geneva, Switzerland.,Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Intensive care and Pharmacology, Multidisciplinary Pain Center, Geneva University Hospitals, Geneva, Switzerland
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20
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de Néris M, Costanza A, Besson M, Greiner C, Prada P, Ambrosetti J. [Suicidal crisis and suicide prevention : psychopharmacological aspects]. Rev Med Suisse 2020; 16:314-317. [PMID: 32049453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Suicide is a common cause of death in Switzerland. It often occurs during a period of crisis marked by a disruption of the subject's intrapsychic, interpersonal or social balance. The management of this crisis is crucial and essentially psychotherapeutic. Drug therapy may be necessary for the management of acute symptoms or for the prevention of long-term suicidal risk. Benzodiazepines and atypical antipsychotics are often used for acute symptoms such as anxiety or sleep disorders while other molecules are recognized in reducing long-term suicidal risk. Some disorders, such as borderline personality disorder, account for more frequent suicidal behaviors. The pharmacological management of these specific situations is discussed.
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Affiliation(s)
- Mélanie de Néris
- Service de psychiatrie de liaison et d'intervention de crise, HUG, 1211 Genève 14
| | - Alessandra Costanza
- Département de psychiatrie, Faculté de médecine, Université de Genève, 1211 Genève 4
- Struttura Complessa di Psichiatria (S.P.D.C.), Azienda Ospedaliera Nazionale « Santi Antonio e Biagio e Cesare Arrigo », Via Venezia, 16, 15121 Alessandria, Italie
| | - Marie Besson
- Unité de psychopharmacologie clinique, Département de médecine aiguë, HUG, 1211 Genève 14
| | - Christian Greiner
- Service de psychiatrie de liaison et d'intervention de crise, HUG, 1211 Genève 14
| | - Paco Prada
- Service de psychiatrie de liaison et d'intervention de crise, HUG, 1211 Genève 14
| | - Julia Ambrosetti
- Service des urgences, Département de médecine aiguë, HUG, 1211 Genève 14
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Gloor Y, Mouterde M, Matthey A, Poloni E, Chabert J, Simona A, Bovet L, Besson M, Piguet V, Cedraschi C, Pickering G, Kosek E, Ehret G, Desmeules J. P192 - Identification of genetic determinants for central pain sensitization in fibromyalgia patients. Drug Metab Pharmacokinet 2020. [DOI: 10.1016/j.dmpk.2020.04.193] [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: 10/23/2022]
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22
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Barbier L, Nault JC, Dujardin F, Scotto B, Besson M, de Muret A, Bourlier P, Zucman-Rossi J, Salamé E, Bacq Y. Natural history of liver adenomatosis: A long-term observational study. J Hepatol 2019; 71:1184-1192. [PMID: 31419515 DOI: 10.1016/j.jhep.2019.08.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/31/2019] [Accepted: 08/06/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Liver adenomatosis (LA) is characterized by the presence of at least 10 hepatocellular adenomas (HCAs), but the natural history of this rare liver disorder remains unclear. Thus, we aimed to reappraise the natural history and the risk of complications in a cohort of patients with at least 10 HCAs. METHODS We analyzed the natural history of 40 patients with LA, excluding glycogen storage disorders, in a monocentric cohort. Pathological examination was performed, with immunostaining and molecular biology carried out on surgical specimens or liver biopsies. RESULTS Forty patients (36 female) were included with a median follow-up of 10.6 (1.9-26.1) years. Six (15%) patients had familial LA, all with germline HNF1A mutations. Median age at diagnosis was 39 (9-55) years. Thirty-three (94%) women had a history of oral contraception, and 29 (81%) women had a pregnancy before LA diagnosis. Overall, thirty-seven (93%) patients underwent surgery at diagnosis. Classification of HCAs showed 46% of patients with HNF1A-mutated HCA, 31% with inflammatory HCA, 3% with sonic hedgehog HCA, 8% with unclassified HCA. Only 15% of the patients demonstrated a "mixed LA" with different HCA subtypes. Hepatic complications were identified in 7 patients: 1 patient (3%) died from recurrent hepatocellular carcinoma after liver transplantation; 6 (15%) had hemorrhages, of which 5 occurred at diagnosis, with 1 fatal case during pregnancy, and 2 occurred in male patients with familial LA. Four patients (10%) had repeated liver resections. Finally, 4 (10%) patients developed extrahepatic malignancies during follow-up. CONCLUSIONS The diversity in HCA subtypes, as well as the occurrence of bleeding and malignant transformation during long-term follow-up, underline the heterogeneous nature of LA, justifying close and specific management. In patients with germline HNF1A mutation, familial LA occurred equally frequently in males and females, with a higher rate of bleeding in male patients. LAY SUMMARY Liver adenomatosis is a rare disease characterized by the presence of 10 or more hepatocellular adenomas that may rarely be of genetic origin. Patients with liver adenomatosis have multiple adenomas of different subtypes, with a risk of bleeding and malignant transformation that justify a specific management and follow-up.
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Affiliation(s)
- Louise Barbier
- Digestive Surgery and Liver Transplantation, Tours University Hospital, University of Tours, FHU SUPORT, Tours, France.
| | - Jean-Charles Nault
- Inserm UMR-1162, Génomique fonctionnelle des Tumeurs solides, Université Paris Descartes, Université Paris Diderot, Université Paris 13, Labex Immuno-Oncology, Paris, France; Liver Unit, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, APHP, Bondy, France
| | - Fanny Dujardin
- Pathology, Tours University Hospital, University of Tours, Tours, France
| | - Béatrice Scotto
- Radiology, Tours University Hospital, University of Tours, Tours, France
| | - Marie Besson
- Radiology, Tours University Hospital, University of Tours, Tours, France
| | - Anne de Muret
- Pathology, Tours University Hospital, University of Tours, Tours, France
| | - Pascal Bourlier
- Digestive Surgery and Liver Transplantation, Tours University Hospital, University of Tours, FHU SUPORT, Tours, France
| | - Jessica Zucman-Rossi
- Liver Unit, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, APHP, Bondy, France; Hôpital Européen Georges Pompidou, HEGP, F-75015, Assistance Publique-Hôpitaux de Paris, APHP, Paris, France
| | - Ephrem Salamé
- Digestive Surgery and Liver Transplantation, Tours University Hospital, University of Tours, FHU SUPORT, Tours, France
| | - Yannick Bacq
- Department of Hepatology and Gastroenterology, University Hospital of Tours, Tours, France
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23
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O'Connor JJ, Fobert EK, Besson M, Jacob H, Lecchini D. Live fast, die young: Behavioural and physiological impacts of light pollution on a marine fish during larval recruitment. Mar Pollut Bull 2019; 146:908-914. [PMID: 31426235 DOI: 10.1016/j.marpolbul.2019.05.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/16/2019] [Accepted: 05/16/2019] [Indexed: 06/10/2023]
Abstract
Artificial light at night (ALAN) is a recently acknowledged form of anthropogenic pollution of growing concern to the biology and ecology of exposed organisms. Though ALAN can have detrimental effects on physiology and behaviour, we have little understanding of how marine organisms in coastal areas may be impacted. Here, we investigated the effects of ALAN exposure on coral reef fish larvae during the critical recruitment stage, encompassing settlement, metamorphosis, and post-settlement survival. We found that larvae avoided illuminated settlement habitats, however those living under ALAN conditions for 10 days post-settlement experienced changes in swimming behaviour and higher susceptibility to nocturnal predation. Although ALAN-exposed fish grew faster and heavier than control fish, they also experienced significantly higher mortality rates by the end of the experimental period. This is the first study on the ecological impacts of ALAN during the early life history of marine fish.
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Affiliation(s)
- J J O'Connor
- School of BioSciences, University of Melbourne, Parkville, VIC 3010, Australia; Institute for Pacific Coral Reefs, IRCP, 98729, Moorea, French Polynesia.
| | - E K Fobert
- School of BioSciences, University of Melbourne, Parkville, VIC 3010, Australia
| | - M Besson
- PSL Research University: EPHE-UPVD-CNRS, USR3278 CRIOBE, BP 1013, 98729 Papetoai, Moorea, French Polynesia; Observatoire Océanologique de Banyuls-sur-Mer, UMR7232, Université Pierre et Marie Curie Paris, 1 avenue du Fontaulé, 66650 Banyuls-sur-Mer, France
| | - H Jacob
- PSL Research University: EPHE-UPVD-CNRS, USR3278 CRIOBE, BP 1013, 98729 Papetoai, Moorea, French Polynesia; International Atomic Energy Agency, Environment Laboratories, 4a, Quai Antoine 1er, Principality of Monaco, Monaco
| | - D Lecchini
- Institute for Pacific Coral Reefs, IRCP, 98729, Moorea, French Polynesia; PSL Research University: EPHE-UPVD-CNRS, USR3278 CRIOBE, BP 1013, 98729 Papetoai, Moorea, French Polynesia; Laboratoire d'Excellence "CORAIL", Moorea, French Polynesia
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24
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Lloret-Linares C, Bosilkovska M, Daali Y, Gex-Fabry M, Heron K, Bancila V, Michalopoulos G, Perroud N, Richard-Lepouriel H, Aubry JM, Desmeules J, Besson M. Phenotypic Assessment of Drug Metabolic Pathways and P-Glycoprotein in Patients Treated With Antidepressants in an Ambulatory Setting. J Clin Psychiatry 2019; 79. [PMID: 29570971 DOI: 10.4088/jcp.16m11387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 12/07/2016] [Accepted: 08/30/2017] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Drug-metabolizing enzymes (DMEs), such as cytochrome P450 (CYP) enzymes, and transporters have emerged as major determinants of variability in drug metabolism and response. This study investigated the association between CYP and P-glycoprotein activities and plasma antidepressant concentration in an outpatient clinical setting. Secondary outcomes were antidepressant efficacy and tolerance. We also describe phenotypes in patients treated with antidepressants and evaluate the tolerance of a minimally invasive phenotyping approach. METHODS From January 2015 to August 2015, 64 patients on a stable antidepressant regimen underwent a simultaneous assessment of steady-state antidepressant concentration and DME (CYP1A2, CYP2B6, CYP2C9, CYP2C19, CYP2D6, CYP3A) and P-glycoprotein transporter activity using a cocktail phenotyping approach. Psychiatric diagnoses were in accordance with DSM-5. RESULTS We observed a high proportion of subjects (> 20%) with reduced activity of CYP2C19, CYP2D6, CYP3A4, and P-glycoprotein. As expected, higher CYP activity for major metabolic pathways was associated with lower concentration of the parent compound (CYP2C19 and escitalopram, P = .025; CYP2D6 and fluoxetine, P < .001; CYP2C19 and sertraline, P = .001), higher concentration of the metabolite (CYP2D6 and O-desmethylvenlafaxine, P = .007), and higher metabolite-to-parent drug ratio (CYP2C19 and escitalopram, P = .03; CYP2D6 and fluoxetine, P < .001; CYP2C19 and sertraline, P = .048; CYP2B6 and sertraline, P = .006). Phenotyping also highlighted the relevance of a minor metabolic pathway for venlafaxine (CYP3A4). Insufficient response and adverse reactions to antidepressants were not significantly associated with plasma antidepressant concentration, DME, or P-glycoprotein activity. Tolerance of the phenotypic test in ambulatory settings was found to be excellent. CONCLUSIONS The phenotypic assessment of DMEs and a transporter is a valuable, well-tolerated method to explore the interindividual variability in drug disposition in clinical settings. The method is able to account for the inhibitory activity of antidepressants themselves and for polymedication, which is frequent in this population of refractory depressed patients. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02438072.
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Affiliation(s)
- Célia Lloret-Linares
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland.,INSERM UMR-S1144, Paris, France
| | - Marija Bosilkovska
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Youssef Daali
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Marianne Gex-Fabry
- Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Kyle Heron
- Department of Experimental Psychology, University of Bristol, and Somerset Partnership NHS Foundation Trust, Bristol, United Kingdom
| | - Victor Bancila
- Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Giorgio Michalopoulos
- Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Nader Perroud
- Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Hélène Richard-Lepouriel
- Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Michel Aubry
- Division of Psychiatric Specialties, Department of Mental Health and Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Jules Desmeules
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Marie Besson
- Psychopharmacology Unit, Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Gabrielle Perret-Gentil 4, 1211 Genève 4, Switzerland. .,Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
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25
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Réocreux R, Girel É, Clabaut P, Tuel A, Besson M, Chaumonnot A, Cabiac A, Sautet P, Michel C. Reactivity of shape-controlled crystals and metadynamics simulations locate the weak spots of alumina in water. Nat Commun 2019; 10:3139. [PMID: 31316059 PMCID: PMC6637198 DOI: 10.1038/s41467-019-10981-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/17/2019] [Indexed: 12/04/2022] Open
Abstract
The kinetic stability of any material in water relies on the presence of surface weak spots responsible for chemical weathering by hydrolysis. Being able to identify the atomistic nature of these sites and the first steps of transformation is therefore critical to master the decomposition processes. This is the challenge that we tackle here: combining experimental and modeling studies we investigate the stability of alumina in water. Exploring the reactivity of shape-controlled crystals, we identify experimentally a specific facet as the location of the weak spots. Using biased ab initio molecular dynamics, we recognize this weak spot as a surface exposed tetra-coordinated Al atom and further provide a detailed mechanism of the first steps of hydrolysis. This understanding is of great importance to heterogeneous catalysis where alumina is a major support. Furthermore, it paves the way to atomistic understanding of interfacial reactions, at the crossroad of a variety of fields of research. Gaining atomistic level understanding of alumina/water interfaces is key to unraveling alumina decomposition processes. Here the authors combine the experimental synthesis of shape-controlled γ-Al2O3 samples with metadynamics simulations to identify the surface weak spots responsible for alumina decomposition.
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Affiliation(s)
- R Réocreux
- Univ Lyon, Ens de Lyon, CNRS UMR 5182, Université Claude Bernard Lyon 1, Laboratoire de Chimie, 69342, Lyon, France.,Thomas Young Centre and Department of Chemical Engineering, University College London, Roberts Building, Torrington Place, London, WC1E 7JE, UK
| | - É Girel
- Direction Catalyse et Séparation, IFP Energies nouvelles, Rond-point de l'échangeur de Solaize, BP 3, 69360, Solaize, France.,Institut de Recherches sur la Catalyse et l'Environnement de Lyon, IRCELYON, CNRS UMR 5256-Univ. Lyon 1, 2, avenue Albert Einstein, 69626, Villeurbanne, France
| | - P Clabaut
- Univ Lyon, Ens de Lyon, CNRS UMR 5182, Université Claude Bernard Lyon 1, Laboratoire de Chimie, 69342, Lyon, France
| | - A Tuel
- Institut de Recherches sur la Catalyse et l'Environnement de Lyon, IRCELYON, CNRS UMR 5256-Univ. Lyon 1, 2, avenue Albert Einstein, 69626, Villeurbanne, France
| | - M Besson
- Institut de Recherches sur la Catalyse et l'Environnement de Lyon, IRCELYON, CNRS UMR 5256-Univ. Lyon 1, 2, avenue Albert Einstein, 69626, Villeurbanne, France
| | - A Chaumonnot
- Direction Catalyse et Séparation, IFP Energies nouvelles, Rond-point de l'échangeur de Solaize, BP 3, 69360, Solaize, France
| | - A Cabiac
- Direction Catalyse et Séparation, IFP Energies nouvelles, Rond-point de l'échangeur de Solaize, BP 3, 69360, Solaize, France
| | - P Sautet
- Department of Chemical and Biomolecular Engineering, University of California Los Angeles, Los Angeles, CA, 90095, USA. .,Department of Chemistry and Biochemistry, University of California Los Angeles, Los Angeles, CA, 90095, USA.
| | - C Michel
- Univ Lyon, Ens de Lyon, CNRS UMR 5182, Université Claude Bernard Lyon 1, Laboratoire de Chimie, 69342, Lyon, France.
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26
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Galova A, Berney P, Desmeules J, Sergentanis I, Besson M. A case report of cholinergic rebound syndrome following abrupt low-dose clozapine discontinuation in a patient with type I bipolar affective disorder. BMC Psychiatry 2019; 19:73. [PMID: 30782143 PMCID: PMC6381751 DOI: 10.1186/s12888-019-2055-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 02/11/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Rebound cholinergic syndrome is a rare, but well known unwanted phenomenon occurring after abrupt clozapine discontinuation. There have been previous reported cases of cholinergic rebound in the literature; however, these reports described cholinergic rebound following cessation of high doses of clozapine in patients diagnosed with schizophrenia. Here, we report a case of rebound cholinergic syndrome and catatonia in a male patient three days after abrupt discontinuation of 50 mg of clozapine prescribed for type I bipolar affective disorder. CASE PRESENTATION A 66-year old male of Spanish origin, treated for type I bipolar affective disorder for 15 years and for Crohn disease, was brought to the emergency department because of a sudden onset of mutism, dysphagia and trismus. He was described catatonic and presented hypertension, tachycardia and tachypnea. His body temperature was normal and the laboratory tests were unremarkable at presentation. A head CT and an EEG were in the normal range. While reviewing his history, it appeared the he was on clozapine 50 mg a day, first introduced 2 months ago, during a previous hospitalization for a manic episode resistant to other mood stabilizers. For an unknown reason, the patient's psychiatrist stopped clozapine three days before the admission and replaced it by risperidone 5 mg and quetiapine 200 mg daily. A cholinergic rebound syndrome was then evoked. The patient's ability to speak recovered dramatically and fast after the intravenous administration of 2.5 mg of biperiden supporting the diagnosis. Risperidone and quetiapine were also stopped. The patient fully recovered in 20 days after the reintroduction of 50 mg of clozapine and 2.5 mg of biperiden daily. CONCLUSIONS This case report underscores that cholinergic rebound syndrome may occur in patients suffering from bipolar affective disorders, being on clozapine as a mood stabilizer. The low dose clozapine does not preclude severe manifestations of the phenomenon. Progressive tapering should therefore be adopted in any case.
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Affiliation(s)
- Andrea Galova
- 0000 0001 0721 9812grid.150338.cPsychopharmacology Unit, Clinical pharmacology and toxicology division, Acute Medicine Department, Geneva University Hospital, Geneva, Switzerland
| | - Patricia Berney
- 0000 0001 0721 9812grid.150338.cPsychopharmacology Unit, Clinical pharmacology and toxicology division, Acute Medicine Department, Geneva University Hospital, Geneva, Switzerland
| | - Jules Desmeules
- 0000 0001 0721 9812grid.150338.cClinical pharmacology and toxicology division, Acute Medicice Department, Geneva University Hospital, Geneva, Switzerland
| | - Ioannis Sergentanis
- 0000 0001 0721 9812grid.150338.cLiaison Psychiatry and Crisis Intervention Unit, Psychiatry department, Geneva University Hospital, Geneva, Switzerland
| | - Marie Besson
- Psychopharmacology Unit, Clinical pharmacology and toxicology division, Acute Medicine Department, Geneva University Hospital, Geneva, Switzerland.
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27
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Mancera KF, Besson M, Lisle A, Allavena R, Phillips CJ. The effects of mining machinery noise of different amplitudes on the behaviour, faecal corticosterone and tissue morphology of wild mice ( Mus musculus ). Appl Anim Behav Sci 2018. [DOI: 10.1016/j.applanim.2018.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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28
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Regnault H, Emambux S, Lecomte T, Doat S, Dhooge M, Besson M, Dubreuil O, Moryoussef F, Silvain C, Bachet JB, Tougeron D. Clinical outcome of portal vein thrombosis in patients with digestive cancers: A large AGEO multicenter study. Dig Liver Dis 2018; 50:285-290. [PMID: 29183764 DOI: 10.1016/j.dld.2017.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 06/22/2017] [Revised: 10/31/2017] [Accepted: 11/01/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Management of portal vein thrombosis (PVT) in cancer patients remains discussed. AIMS The objective of this multicenter retrospective study was to investigate the management and outcome of PVT in patients with digestive cancers other than hepatocellular carcinoma (HCC). METHOD Main inclusion criteria were trunk or branch PVT in patients with locally advanced or metastatic digestive cancers. Predictive factors of bleeding and overall survival (OS) were evaluated in univariate and multivariate analysis. RESULTS Between 2012 and 2016, 118 patients with PVT and digestive cancers were identified. The majority had a pancreatic cancer (50%). Sixty-six percent of patients had trunk PVT location. Endoscopic screening of portal hypertension was performed in only 7 patients (1%) and 5 had esophageal varices. Gastrointestinal bleeding occurred in 22 patients (19%) and 12 patient deaths (17%) were related to a gastrointestinal hemorrhage. Metastatic disease (HR=2.83 [95%CI 1.47-5.43], p<0.01) and gastrointestinal hemorrhage (HR=1.68 [95%CI 1.01-2.78], p=0.04) were associated with OS in multivariate analysis. Only trunk PVT location was significantly associated with gastrointestinal hemorrhage in multivariate analysis (HR=5.56 [95%CI 1.18-26.32], p=0.03). CONCLUSION A high rate of variceal bleeding leading to death was found in this cohort. Endoscopic screening and the efficacy of prophylactic treatment of variceal bleeding remain to be evaluated in a prospective study.
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Affiliation(s)
- Hélène Regnault
- Department of Hepatogastroenterology, Pitié Salpêtrière Hospital, Paris, France; Sorbonne University, UPMC University, Paris VI, France
| | - Sheik Emambux
- Department of Oncology, Poitiers University Hospital, Poitiers, France
| | - Thierry Lecomte
- Department of Hepatogastroenterology and Digestive Oncology, Tours University Hospital, Tours, France; Université François-Rabelais de Tours, CNRS, GICC UMR, Tours, France
| | - Solene Doat
- Department of Hepatogastroenterology, Pitié Salpêtrière Hospital, Paris, France; Sorbonne University, UPMC University, Paris VI, France
| | - Marion Dhooge
- Department of Gastroenterology, Cochin Hospital, Paris, France
| | - Marie Besson
- Department of Radiology, Tours University Hospital, Tours, France
| | | | - Frederic Moryoussef
- Department of Hepatogastroenterology, Pitié Salpêtrière Hospital, Paris, France; Sorbonne University, UPMC University, Paris VI, France
| | - Christine Silvain
- Department of Gastroenterology, Poitiers University Hospital, Poitiers, France; Laboratory of Inflammation, tissus épithéliaux et cytokines (LITEC), Poitiers University, France
| | - Jean-Baptiste Bachet
- Department of Hepatogastroenterology, Pitié Salpêtrière Hospital, Paris, France; Sorbonne University, UPMC University, Paris VI, France.
| | - David Tougeron
- Department of Oncology, Poitiers University Hospital, Poitiers, France; Department of Gastroenterology, Poitiers University Hospital, Poitiers, France; Laboratory of Inflammation, tissus épithéliaux et cytokines (LITEC), Poitiers University, France
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29
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Galani V, Prada P, Besson M. [Psychotropic and liver enzyme's perturbation, conduct to hold]. Rev Med Suisse 2018; 14:331-334. [PMID: 29412527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Drug-induced liver injury (DILI) represents a complex clinical problem, both in terms of diagnosis and of therapeutic approach. When the suspected treatment is a psychotropic drug, the role of the liaison psychiatrist is not limited to the re-adaptation of the drug treatment. In this article, with a clinical case as an example, we will discuss the issues to deal with facing a perturbation of liver enzymes in a patient on psychotropic treatment. The risk and benefit assessment of a therapeutic window, as well as the overall care of the patient at the general hospital will be detailed.
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Affiliation(s)
- Vasiliki Galani
- Service de psychiatrie de liaison et d'intervention de crise, Département de santé mentale et de psychiatrie, HUG, 1211 Genève 14
| | - Paco Prada
- Service de psychiatrie de liaison et d'intervention de crise, Département de santé mentale et de psychiatrie, HUG, 1211 Genève 14
| | - Marie Besson
- Unité de psychopharmacologie clinique, Service de pharmacologie et toxicologie cliniques, Département d'anesthésiologie, pharmacologie et soins intensifs, HUG, 1211 Genève 14
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30
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Jolimaitre E, Delcroix D, Essayem N, Pinel C, Besson M. Dihydroxyacetone conversion into lactic acid in an aqueous medium in the presence of metal salts: influence of the ionic thermodynamic equilibrium on the reaction performance. Catal Sci Technol 2018. [DOI: 10.1039/c7cy02385e] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Different Lewis acid aluminium complexes catalyse the successive reactions to convert dihydroxyacetone into lactic acid in an aqueous medium.
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Affiliation(s)
- E. Jolimaitre
- IRCELYON
- Institut de Recherches sur la Catalyse et l'Environnement de Lyon
- UMR5256 CNRS-Université Lyon 1
- F-69626 Villeurbanne Cedex
- France
| | | | - N. Essayem
- IRCELYON
- Institut de Recherches sur la Catalyse et l'Environnement de Lyon
- UMR5256 CNRS-Université Lyon 1
- F-69626 Villeurbanne Cedex
- France
| | - C. Pinel
- IRCELYON
- Institut de Recherches sur la Catalyse et l'Environnement de Lyon
- UMR5256 CNRS-Université Lyon 1
- F-69626 Villeurbanne Cedex
- France
| | - M. Besson
- IRCELYON
- Institut de Recherches sur la Catalyse et l'Environnement de Lyon
- UMR5256 CNRS-Université Lyon 1
- F-69626 Villeurbanne Cedex
- France
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31
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Lloret-Linares C, Daali Y, Chevret S, Nieto I, Molière F, Courtet P, Galtier F, Richieri RM, Morange S, Llorca PM, El-Hage W, Desmidt T, Haesebaert F, Vignaud P, Holtzmann J, Cracowski JL, Leboyer M, Yrondi A, Calvas F, Yon L, Le Corvoisier P, Doumy O, Heron K, Montange D, Davani S, Déglon J, Besson M, Desmeules J, Haffen E, Bellivier F. Exploring venlafaxine pharmacokinetic variability with a phenotyping approach, a multicentric french-swiss study (MARVEL study). BMC Pharmacol Toxicol 2017; 18:70. [PMID: 29115994 PMCID: PMC5678760 DOI: 10.1186/s40360-017-0173-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 10/09/2017] [Indexed: 12/18/2022] Open
Abstract
Background It is well known that the standard doses of a given drug may not have equivalent effects in all patients. To date, the management of depression remains mainly empirical and often poorly evaluated. The development of a personalized medicine in psychiatry may reduce treatment failure, intolerance or resistance, and hence the burden and costs of mood depressive disorders. The Geneva Cocktail Phenotypic approach presents several advantages including the “in vivo” measure of different cytochromes and transporter P-gp activities, their simultaneous determination in a single test, avoiding the influence of variability over time on phenotyping results, the administration of low dose substrates, a limited sampling strategy with an analytical method developed on DBS analysis. The goal of this project is to explore the relationship between the activity of drug-metabolizing enzymes (DME), assessed by a phenotypic approach, and the concentrations of Venlafaxine (VLX) + O-demethyl-venlafaxine (ODV), the efficacy and tolerance of VLX. Methods/design This study is a multicentre prospective non-randomized open trial. Eligible patients present a major depressive episode, MADRS over or equal to 20, treatment with VLX regardless of the dose during at least 4 weeks. The Phenotype Visit includes VLX and ODV concentration measurement. Following the oral absorption of low doses of omeprazole, midazolam, dextromethorphan, and fexofenadine, drug metabolizing enzymes activity is assessed by specific metabolite/probe concentration ratios from a sample taken 2 h after cocktail administration for CYP2C19, CYP3A4, CYP2D6; and by the determination of the limited area under the curve from the capillary blood samples taken 2–3 and 6 h after cocktail administration for CYP2C19 and P-gp. Two follow-up visits will take place between 25 and 40 days and 50–70 days after inclusion. They include assessment of efficacy, tolerance and observance. Eleven french centres are involved in recruitment, expected to be completed within approximately 2 years with 205 patients. Metabolic ratios are determined in Geneva, Switzerland. Discussion By showing an association between drug metabolism and VLX concentrations, efficacy and tolerance, there is a hope that testing drug metabolism pathways with a phenotypical approach would help physicians in selecting and dosing antidepressants. The MARVEL study will provide an important contribution to increasing the knowledge of VLX variability and in optimizing the use of methods of personalized therapy in psychiatric settings. Trial registration ClinicalTrials.govNCT02590185 (10/27/2015). This study is currently recruiting participants.
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Affiliation(s)
- Célia Lloret-Linares
- Inserm, U1144, F-75006, Paris, France. .,Université Paris Diderot, UMR-S 1144, F-75013, Paris, France. .,Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Therapeutic Research Unit, F-75010, Paris, France.
| | - Youssef Daali
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Sylvie Chevret
- Service de Biostatistiques et Information Médicale, Hôpital Saint-Louis, AP-HP, ECSTRA Team, Inserm UMR-1153, Université Paris Diderot, 1 rue Claude Vellefaux, 75010, Paris, France
| | - Isabelle Nieto
- Department of Psychiatry and Addiction Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital F. Widal, F-75010, Paris, France
| | | | | | | | - Raphaëlle-Marie Richieri
- Pôle psychiatrie, addictologie, pédopsychiatrie, Assistance Publique des hôpitaux de Marseille, Marseille, France
| | - Sophie Morange
- APHM, Aix Marseille Univ, Institut Paoli-Calmettes, INSERM, CIC Hôpital Conception, Marseille, France
| | - Pierre-Michel Llorca
- Service Psychiatrie et Addictologie de l'Adulte CMP B, Centre Hospitalier Universitaire, Rue Montalembert, Clermont-Ferrand, France
| | - Wissam El-Hage
- Inserm U930, Université François Rabelais de Tours, Tours, France.,Inserm CIC 1415, Tours, France.,Clinique Psychiatrique Universitaire, CHRU de Tours, Tours, France
| | - Thomas Desmidt
- Inserm U930, Université François Rabelais de Tours, Tours, France.,Clinique Psychiatrique Universitaire, CHRU de Tours, Tours, France
| | - Frédéric Haesebaert
- PsyR2 Team, U 1028, INSERM and UMR 5292, CNRS, Center for Neuroscience Research of Lyon (CRNL), CH Le Vinatier, Lyon-1 University, Bron, France.,Centre Interdisciplinaire de Recherche en Réadaptation et en Intégration Sociale (CIRRIS), Centre de Recherche de l'Institut Universitaire en Santé Mentale (CRIUSM), Université Laval, QC, Québec, Canada
| | - Philippe Vignaud
- PsyR2 Team, U 1028, INSERM and UMR 5292, CNRS, Center for Neuroscience Research of Lyon (CRNL), CH Le Vinatier, Lyon-1 University, Bron, France
| | - Jerôme Holtzmann
- Service Hospitalo-Universitaire de Psychiatrie. CHU Grenoble-Alpes, La Tronche, France
| | - Jean-Luc Cracowski
- Unité de Pharmacologie Clinique, Centre d'Investigation Clinique de Grenoble, INSERM CIC1406, CHU de Grenoble, Grenoble, France
| | - Marion Leboyer
- AP-HP, pole de psychiatrie des HU Henri Mondor, Equipe psychiatrie translationnelle, Créteil, France.,Inserm U955 and foundation FondaMental, Créteil, France
| | - Antoine Yrondi
- Service de psychiatrie et psychologie médicale CHU Toulouse-Purpan, Toulouse, France.,Toulouse NeuroImaging Center, ToNIC, University of Toulouse, Inserm, UPS, Toulouse, France
| | - Fabienne Calvas
- Inserm CIC 1436, CHU Toulouse, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Liova Yon
- Inserm, Clinical Investigation Center 1430 and Henri Mondor University Hospital, AP-HP, Créteil, France
| | - Philippe Le Corvoisier
- Inserm, Clinical Investigation Center 1430 and Henri Mondor University Hospital, AP-HP, Créteil, France
| | - Olivier Doumy
- Centre Expert Dépression Résistante, Centre Référence Pathologies Anxieuses et Dépression (CERPAD), Centre Hospitalier Charles Perrens, Bordeaux, France
| | - Kyle Heron
- Department of Experimental Psychology, University of Bristol, UK and Somerset Partnership NHS Foundation Trust, Bristol, UK
| | - Damien Montange
- Department of Pharmacology, CHRU Besançon, Univ. Bourgogne-Franche-Comté, EA3920, Besançon, France
| | - Siamak Davani
- Department of Pharmacology, CHRU Besançon, Univ. Bourgogne-Franche-Comté, EA3920, Besançon, France
| | - Julien Déglon
- Unit of Toxicology, CURML, University Hospitals of Lausanne, Lausanne, Switzerland.,Unit of Toxicology, CURML, University Hospitals of Geneva, Geneva, Switzerland
| | - Marie Besson
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Jules Desmeules
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Emmanuel Haffen
- Department of Clinical Psychiatry, University Hospital of Besançon, Besançon, France
| | - Frank Bellivier
- Inserm, U1144, F-75006, Paris, France.,Université Paris Diderot, UMR-S 1144, F-75013, Paris, France.,Department of Psychiatry and Addiction Medicine, Assistance Publique-Hôpitaux de Paris, Hôpital F. Widal, F-75010, Paris, France
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Desnoyer A, Blanc AL, Pourcher V, Besson M, Fonzo-Christe C, Desmeules J, Perrier A, Bonnabry P, Samer C, Guignard B. PIM-Check: development of an international prescription-screening checklist designed by a Delphi method for internal medicine patients. BMJ Open 2017; 7:e016070. [PMID: 28760793 PMCID: PMC5642656 DOI: 10.1136/bmjopen-2017-016070] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES Potentially inappropriate medication (PIM) occurs frequently and is a well-known risk factor for adverse drug events, but its incidence is underestimated in internal medicine. The objective of this study was to develop an electronic prescription-screening checklist to assist residents and young healthcare professionals in PIM detection. DESIGN Five-step study involving selection of medical domains, literature review and 17 semistructured interviews, a two-round Delphi survey, a forward/back-translation process and an electronic tool development. SETTING 22 University and general hospitals from Canada, Belgium, France and Switzerland. PARTICIPANTS 40 physicians and 25 clinical pharmacists were involved in the study.Agreement with the checklist statements and their usefulness for healthcare professional training were evaluated using two 6-point Likert scales (ranging from 0 to 5). PRIMARY AND SECONDARY OUTCOME MEASURES Agreement and usefulness ratings were defined as: >65% of the experts giving the statement a rating of 4 or 5, during the first Delphi-round and >75% during the second. RESULTS 166 statements were generated during the first two steps. Mean agreement and usefulness ratings were 4.32/5 (95% CI 4.28 to 4.36) and 4.11/5 (4.07 to 4.15), respectively, during the first Delphi-round and 4.53/5 (4.51 to 4.56) and 4.36/5 (4.33 to 4.39) during the second (p<0.001). The final checklist includes 160 statements in 17 medical domains and 56 pathologies. An algorithm of approximately 31 000 lines was developed including comorbidities and medications variables to create the electronic tool. CONCLUSION PIM-Check is the first electronic prescription-screening checklist designed to detect PIM in internal medicine. It is intended to help young healthcare professionals in their clinical practice to detect PIM, to reduce medication errors and to improve patient safety.
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Affiliation(s)
- Aude Desnoyer
- Department of Pharmacy, Hôpitaux Universitaires de Genève, Geneva, Switzerland
- Department of Pharmacy, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Anne-Laure Blanc
- Department of Pharmacy, Hôpitaux Universitaires de Genève, Geneva, Switzerland
- Department of Pharmacy, Hôpitaux de l’Est Lémanique, Vevey, Switzerland
| | - Valérie Pourcher
- Department of Infectious and Tropical Diseases, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- UMR996—Inflammation, Chemokines and Immunopathology, Inserm, Clamart, France
| | - Marie Besson
- Department of Clinical Pharmacology and Toxicology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | | | - Jules Desmeules
- Department of Clinical Pharmacology and Toxicology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
- Section of Pharmaceutical Sciences, Université de Genève, Université de Lausanne, Geneva, Switzerland
| | - Arnaud Perrier
- Department of General Internal Medicine, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Pascal Bonnabry
- Department of Pharmacy, Hôpitaux Universitaires de Genève, Geneva, Switzerland
- Section of Pharmaceutical Sciences, Université de Genève, Université de Lausanne, Geneva, Switzerland
| | - Caroline Samer
- Department of Clinical Pharmacology and Toxicology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Bertrand Guignard
- Department of Pharmacy, Hôpitaux Universitaires de Genève, Geneva, Switzerland
- Department of Clinical Pharmacology and Toxicology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
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Chalopin T, Barillot I, Biny JP, Arbion F, Besson M, Santiago-Ribeiro M, Piver E, Herault O, Gyan E, Benboubker L. Primary solitary plasmacytoma of the liver - successful treatment with fractionated stereotactic radiotherapy (Cyberknife®): a case report. J Med Case Rep 2017; 11:193. [PMID: 28716071 PMCID: PMC5514462 DOI: 10.1186/s13256-017-1358-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 06/19/2017] [Indexed: 11/29/2022] Open
Abstract
Background Solitary plasmacytoma of the liver is a very rare and aggressive form of plasma cell dyscrasia. To the best of our knowledge, very few cases have been reported without systemic disease. We reported a rare case of hepatic solitary plasmacytoma that successfully responded to fractionated stereotactic radiotherapy. Case presentation A 64-year-old white French man had monoclonal gammopathy of the immune globulin G lambda type; he developed a cholestasis and cytolysis with the discovery of a subscapular nodule. A biopsy showed plasma cells and, for several reasons, the decision was made to use the fractionated stereotactic radiotherapy strategy. After 20 months, he is asymptomatic and the immune globulin G component has completely disappeared. Conclusion We suggest considering Cyberknife® radiosurgery as an option for the treatment of hepatic solitary plasmacytoma.
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Affiliation(s)
- Thomas Chalopin
- Department of Hematology, University Hospital of Tours, Tours, France. .,Centre Hospitalier Universitaire de Tours, Hôpital Bretonneau, 2 boulevard Tonnellé, 37044, Tours cedex 9, France.
| | - Isabelle Barillot
- Department of Radiation Oncology (CORAD), University Hospital of Tours, Tours, France
| | - Jean-Paul Biny
- Anatomopathology Center of Origet, Saint-Cyr sur Loire, France
| | - Flavie Arbion
- Department of Anatomopathology, University Hospital of Tours, Tours, France
| | - Marie Besson
- Department of Medical Imaging, University Hospital of Tours, Tours, France
| | | | - Eric Piver
- Department of Biochemistry, University Hospital of Tours, Tours, France
| | - Olivier Herault
- Department of Biologic Hematology, University of Tours, Tours, France
| | - Emmanuel Gyan
- Department of Hematology, University Hospital of Tours, Tours, France
| | - Lotfi Benboubker
- Department of Hematology, University Hospital of Tours, Tours, France
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Cayet S, Pasco J, Dujardin F, Besson M, Orain I, De Muret A, Miquelestorena-Standley E, Thiery J, Genet T, Le Bayon AG. Diagnostic performance of contrast-enhanced CT-scan in sinusoidal obstruction syndrome induced by chemotherapy of colorectal liver metastases: Radio-pathological correlation. Eur J Radiol 2017; 94:180-190. [PMID: 28712693 DOI: 10.1016/j.ejrad.2017.06.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/25/2017] [Accepted: 06/26/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE Sinusoidal obstruction syndrome (SOS) is a likely side effect of colorectal liver metastases (CRLM) chemotherapy. This study aimed to assess computed tomography scan (CT-scan) performance for SOS diagnosis for patients receiving neoadjuvant chemotherapy (NC) prior to CRLM surgery, comparing obtained results with pathological gold standard. METHODS Preoperative CT-scans of 67 patients who had received a NC prior to liver resection for CRLM from 2011 to 2016 were retrospectively analysed. Positive diagnosis and severity of SOS were established after consensual review of the slides by three pathologists. Preoperative CT-scans were separately interpreted by two radiologists and evocative signs of SOS were sought, defined according to a literature review and operators experience. In order to identify SOS predictors, univariate analysis and multivariate logistic regression were used to study CT-scan signs and pathological results correlation. RESULTS Twenty-nine patient (43%) had an SOS, 22 (33%) were low-grade and 7 (10%) were high-grade. All patient had received a median of 6 cures (3-27) containing Oxaliplatin for 53 (79%) of them. In univariate analysis, hepatic heterogeneity (p<0.001), puddle-like or micronodular appearance (p<0.001), peripheral distribution of heterogeneity (p=0.085), clover-like sign (p=0.02), splenomegaly (p=0.0026), spleen volume increase ≥30% (p=0.04) or splenic length increase ≥15% (p=0.04), as well as the subjective impression of the observer (P<0.001) were significantly associated with SOS diagnosis. In multivariate analysis, clover-like sign (OR 1.87, 95% CI 1.18-2.95, p=0.0081), increase in spleen volume ≥30% (OR 1.29, 95% CI 1.01-1.64, p=0.04), and the peripheral distribution of heterogeneity (OR 1.53, 95% CI 1.21-1.94, p<0.001) were independent SOS predictors. The area under the ROC curve was 0.804. The inter-observer agreement for SOS diagnosis was moderate (Kappa=0.546). CONCLUSION CT-scan can detect suggestive signs of SOS in patients receiving chemotherapy for CRLM. By integrating clinical and biological information into CT-scan data, it may be fruitful to create a positive diagnostic and severity score for chemotherapy-induced SOS.
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Affiliation(s)
- Sophie Cayet
- University Hospital center of Tours, General Radiology Department, Trousseau Hospital, Tours, France.
| | - Jeremy Pasco
- University Hospital center of Tours, Clinical Data Center, Bretonneau Hospital, Tours, France.
| | - Fanny Dujardin
- University Hospital center of Tours, Histopathology department, Trousseau Hospital, Tours, France.
| | - Marie Besson
- University Hospital center of Tours, General Radiology Department, Trousseau Hospital, Tours, France.
| | - Isabelle Orain
- University Hospital center of Tours, Histopathology department, Trousseau Hospital, Tours, France.
| | - Anne De Muret
- University Hospital center of Tours, Histopathology department, Trousseau Hospital, Tours, France.
| | | | - Julien Thiery
- University Hospital center of Tours, Visceral and Transplantation Surgery Department, Trousseau Hospital, Tours, France.
| | - Thibaud Genet
- University Hospital center of Tours, Cardiology Department, Trousseau Hospital Tours, France; EA4245 CDG Fédération Hospitalo-universitaire SUPPORT, Medicine University of Tours, Tours, F-37000, France.
| | - Anne-Gwenn Le Bayon
- University Hospital center of Tours, General Radiology Department, Trousseau Hospital, Tours, France.
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Val-Laillet D, Besson M, Guérin S, Coquery N, Randuineau G, Kanzari A, Quesnel H, Bonhomme N, Bolhuis JE, Kemp B, Blat S, Le Huërou-Luron I, Clouard C. A maternal Western diet during gestation and lactation modifies offspring's microbiota activity, blood lipid levels, cognitive responses, and hippocampal neurogenesis in Yucatan pigs. FASEB J 2017; 31:2037-2049. [DOI: 10.1096/fj.201601015r] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/17/2017] [Indexed: 11/11/2022]
Affiliation(s)
- David Val-Laillet
- Institut National de la Recherche Agronomique (INRA)Unité de Recherche 1341Alimentation et Adaptations DigestivesNerveuses et Comportementales (ADNC)Saint‐GillesFrance
| | - Marie Besson
- Institut National de la Recherche Agronomique (INRA)Unité de Recherche 1341Alimentation et Adaptations DigestivesNerveuses et Comportementales (ADNC)Saint‐GillesFrance
| | - Sylvie Guérin
- Institut National de la Recherche Agronomique (INRA)Unité de Recherche 1341Alimentation et Adaptations DigestivesNerveuses et Comportementales (ADNC)Saint‐GillesFrance
| | - Nicolas Coquery
- Institut National de la Recherche Agronomique (INRA)Unité de Recherche 1341Alimentation et Adaptations DigestivesNerveuses et Comportementales (ADNC)Saint‐GillesFrance
| | - Gwénaëlle Randuineau
- Institut National de la Recherche Agronomique (INRA)Unité de Recherche 1341Alimentation et Adaptations DigestivesNerveuses et Comportementales (ADNC)Saint‐GillesFrance
| | - Ameni Kanzari
- Institut National de la Recherche Agronomique (INRA)Unité de Recherche 1341Alimentation et Adaptations DigestivesNerveuses et Comportementales (ADNC)Saint‐GillesFrance
| | - Hélène Quesnel
- INRAUnité Mixte de Recherche (UMR) 1348Physiologie Environnement et Génétique pour l'Animal et les Systèmes d’Élevage (PEGASE)Saint‐GillesFrance
- Agrocampus OuestUMR 1348 PEGASERennesFrance
| | - Nathalie Bonhomme
- INRAUnité Mixte de Recherche (UMR) 1348Physiologie Environnement et Génétique pour l'Animal et les Systèmes d’Élevage (PEGASE)Saint‐GillesFrance
- Agrocampus OuestUMR 1348 PEGASERennesFrance
| | - J. Elizabeth Bolhuis
- Adaptation Physiology GroupDepartment of Animal SciencesWageningen University ResearchWageningenThe Netherlands
| | - Bas Kemp
- Adaptation Physiology GroupDepartment of Animal SciencesWageningen University ResearchWageningenThe Netherlands
| | - Sophie Blat
- Institut National de la Recherche Agronomique (INRA)Unité de Recherche 1341Alimentation et Adaptations DigestivesNerveuses et Comportementales (ADNC)Saint‐GillesFrance
| | - Isabelle Le Huërou-Luron
- Institut National de la Recherche Agronomique (INRA)Unité de Recherche 1341Alimentation et Adaptations DigestivesNerveuses et Comportementales (ADNC)Saint‐GillesFrance
| | - Caroline Clouard
- Adaptation Physiology GroupDepartment of Animal SciencesWageningen University ResearchWageningenThe Netherlands
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Lecchini D, Dixson DL, Lecellier G, Roux N, Frédérich B, Besson M, Tanaka Y, Banaigs B, Nakamura Y. Habitat selection by marine larvae in changing chemical environments. Mar Pollut Bull 2017; 114:210-217. [PMID: 27600273 DOI: 10.1016/j.marpolbul.2016.08.083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 08/25/2016] [Accepted: 08/30/2016] [Indexed: 06/06/2023]
Abstract
The replenishment and persistence of marine species is contingent on dispersing larvae locating suitable habitat and surviving to a reproductive stage. Pelagic larvae rely on environmental cues to make behavioural decisions with chemical information being important for habitat selection at settlement. We explored the sensory world of crustaceans and fishes focusing on the impact anthropogenic alterations (ocean acidification, red soil, pesticide) have on conspecific chemical signals used by larvae for habitat selection. Crustacean (Stenopus hispidus) and fish (Chromis viridis) larvae recognized their conspecifics via chemical signals under control conditions. In the presence of acidified water, red soil or pesticide, the ability of larvae to chemically recognize conspecific cues was altered. Our study highlights that recruitment potential on coral reefs may decrease due to anthropogenic stressors. If so, populations of fishes and crustaceans will continue their rapid decline; larval recruitment will not replace and sustain the adult populations on degraded reefs.
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Affiliation(s)
- D Lecchini
- EPHE, PSL Research University, UPVD-CNRS, USR3278 CRIOBE, F-66360 Perpignan, France; Laboratoire d'Excellence CORAIL, Moorea, French Polynesia.
| | - D L Dixson
- School Marine Science and Policy, University of Delaware, Newark, USA
| | - G Lecellier
- Laboratoire d'Excellence CORAIL, Moorea, French Polynesia; University of Versailles-Saint, Versailles, France
| | - N Roux
- EPHE, PSL Research University, UPVD-CNRS, USR3278 CRIOBE, F-66360 Perpignan, France; Equipe Biologie Intégrative de la Métamorphose BIOM UMR7232 CNRS-UPMC Observatoire Océanologique de Banyuls sur mer, Banyuls sur mer, France
| | - B Frédérich
- Laboratoire de Morphologie Fonctionnelle et Evolutive, AFFISH Research Center, Liege, Belgium
| | - M Besson
- EPHE, PSL Research University, UPVD-CNRS, USR3278 CRIOBE, F-66360 Perpignan, France; Molecular Zoology Team, Institut de Génomique Fonctionnelle de Lyon, Université Lyon 1, CNRS UMR 5242, Ecole Normale Supérieure de Lyon, Lyon, France
| | - Y Tanaka
- Sesoko Station, Tropical Biosphere Research Center, University of the Ryukyus, Sesoko, Japan
| | - B Banaigs
- EPHE, PSL Research University, UPVD-CNRS, USR3278 CRIOBE, F-66360 Perpignan, France
| | - Y Nakamura
- Graduate School of Kuroshio Science, Kochi University, Kochi, Japan
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Ralvenius WT, Acuña MA, Benke D, Matthey A, Daali Y, Rudolph U, Desmeules J, Zeilhofer HU, Besson M. The clobazam metabolite N-desmethyl clobazam is an α2 preferring benzodiazepine with an improved therapeutic window for antihyperalgesia. Neuropharmacology 2016; 109:366-375. [PMID: 27392635 PMCID: PMC4981430 DOI: 10.1016/j.neuropharm.2016.07.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 05/27/2016] [Accepted: 07/04/2016] [Indexed: 12/14/2022]
Abstract
Data from genetically modified mice suggest that benzodiazepine (BDZ)-site agonists with improved selectivity for α2-subtype GABAA receptors (α2GABAAR) are potentially useful for the treatment of neuropathic pain. Subtype-selective compounds available for preclinical tests in rodents support this concept but have not been approved for human use, hindering proof-of-concept studies in patients. We recently proposed that N-desmethyl clobazam (NDMC), the main metabolite of the licensed BDZ clobazam (CBZ), is responsible for most of the antihyperalgesia observed in mice after CBZ administration. In order to assess a potentially favorable pharmacological profile of NDMC, we analyzed differences in the GABAAR subtype specificity of CBZ, NDMC and diazepam (DZP) in recombinant receptors. DZP and CBZ potentiated sedating α1GABAARs and antihyperalgesic α2GABAARs with similar efficacies, whereas NDMC preferred α2GABAARs over α1GABAARs across a wide concentration range. In vivo, DZP and NDMC reduced neuropathic pain at doses between 3 and 30 mg/kg. At these doses, DZP had strong locomotor sedating effects while NDMC caused no or only weak sedation. Sedative effects of NDMC became apparent when the action of NDMC was restricted to α1GABAARs. However, when GABAAR point-mutated mice were studied that allow the analysis of antihyperalgesia and sedation in isolation, we found that, compared to DZP, NDMC had a significantly improved therapeutic window, consistent with its more favorable α2/α1 in vitro activity ratio. Given that NDMC should share the safety profile of its parent compound CBZ, it should be well-suited for proof-of-concept studies in human volunteers or patients.
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Affiliation(s)
- William T Ralvenius
- Institute of Pharmacology and Toxicology, University of Zurich, Winterthurerstrasse 190, CH-8057 Zurich, Switzerland
| | - Mario A Acuña
- Institute of Pharmacology and Toxicology, University of Zurich, Winterthurerstrasse 190, CH-8057 Zurich, Switzerland
| | - Dietmar Benke
- Institute of Pharmacology and Toxicology, University of Zurich, Winterthurerstrasse 190, CH-8057 Zurich, Switzerland
| | - Alain Matthey
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Center, Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, University of Geneva, 4 rue Gabrielle-Perret-Gentil, CH-1211 Geneva, Switzerland
| | - Youssef Daali
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Center, Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, University of Geneva, 4 rue Gabrielle-Perret-Gentil, CH-1211 Geneva, Switzerland
| | - Uwe Rudolph
- Laboratory of Genetic Neuropharmacology, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215, USA
| | - Jules Desmeules
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Center, Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, University of Geneva, 4 rue Gabrielle-Perret-Gentil, CH-1211 Geneva, Switzerland
| | - Hanns Ulrich Zeilhofer
- Institute of Pharmacology and Toxicology, University of Zurich, Winterthurerstrasse 190, CH-8057 Zurich, Switzerland; Institute of Pharmaceutical Sciences, Swiss Federal Institute of Technology (ETH) Zurich, Vladimir-Prelog-Weg 10, CH-8093 Zürich, Switzerland; Drug Discovery Network Zurich (DDNZ), CH-8057 Zurich, Switzerland.
| | - Marie Besson
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Center, Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, University of Geneva, 4 rue Gabrielle-Perret-Gentil, CH-1211 Geneva, Switzerland
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Lloret-Linares C, Rollason V, Lorenzini KI, Samer C, Daali Y, Gex-Fabry M, Aubry JM, Desmeules J, Besson M. Screening for genotypic and phenotypic variations in CYP450 activity in patients with therapeutic problems in a psychiatric setting, a retrospective study. Pharmacol Res 2016; 118:104-110. [PMID: 27378571 DOI: 10.1016/j.phrs.2016.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/23/2016] [Accepted: 07/01/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This retrospective study aimed to assess to what extent an adverse drug reaction (ADR), an abnormal therapeutic drug monitoring (TDM) or a non-response, was attributable to an abnormal cytochrome P450 activity in a psychiatric setting. METHOD We collected the results of investigations performed in these situations related to psychotropic drugs between January 2005 and November 2014. Activities of different cytochrome P450 were assessed by genotyping and/or phenotyping. Two experienced clinical pharmacologists assessed independently the possible association between the event and the results of the investigations. RESULTS One hundred and thirty eight clinical or biological situations had a complete assessment of all major metabolic pathways of the target drug. A majority of clinical or biological situations were observed with antidepressants (n=93, 67.4%), followed by antipsychotics (n=28, 20.3%), benzodiazepines and hypnotics (n=13, 9.4%), and psychostimulants (n=4, 2.9%). Genotype and/or phenotype determination was mainly performed because of ADRs (n=68, 49.3%) or non-response (n=46, 33.3%). Inter-rate reliability of the scoring system between the pharmacologists was excellent (kappa=0.94). The probability of an association between ADR, TDM or non-response and metabolic status was rated as intermediate to high in 34.7% of all cases, with proportions of 30.4% and 36.7%, for non-response and ADR respectively. CONCLUSION When indicated by clinical pharmacologists, ADR, TDM or non-response may be attributable to a variation of the metabolic status with an intermediate to high probability in 34.7% of patients, based on the congruent assessment made by two clinical pharmacologists. Further studies assessing the clinical relevance of prospective explorations and clarifying the appropriate method according to the clinical context are needed.
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Affiliation(s)
- Célia Lloret-Linares
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland; INSERM UMR-S1144, Paris, France
| | - Victoria Rollason
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Kuntheavy Ing Lorenzini
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Caroline Samer
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Youssef Daali
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Marianne Gex-Fabry
- Division of Psychiatric Specialties, Department of Psychiatry and Mental Health, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Michel Aubry
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Jules Desmeules
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Marie Besson
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland.
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Piguet V, D'Incau S, Besson M, Desmeules J, Cedraschi C. [It is not only about cost ... when it comes to generic medication]. Rev Med Suisse 2016; 12:1230-1233. [PMID: 27506067] [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: 06/06/2023]
Abstract
The aim of this qualitative study was to explore patients' representations regarding generics in patients suffering from non-specific disabling chronic musculoskeletal pain, as these patients are confronted with the issue of the prescription and/or substitution of original formulations with generics. Patients' representations suggest that they might be confident in taking a generic medication: when the generic medication is prescribed by the physician and each prescription is discussed, i.e., the patient is prescribed the generic version of a given medication and not a generic medication. Economic arguments are not sufficient to accept substitution. Negative representations require attention and need be considered.
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Abstract
Why is vocal music the oldest and still the most popular form of music? Very possibly because vocal music involves an intimate combination of speech and music, two of the most specific, high-level skills of human beings. The issue we address is whether people listening to a song treat the linguistic and musical components separately or integrate them within a single percept. Event-related potentials were recorded while musicians listened to excerpts from operas sung a capella. Excerpts were ended by semantically congruous or incongruous words sung either in or out of key. Results clearly demonstrated the independence of lyrics and tunes, so that an additive model of semantic- and harmonic-violations processing predicted the data extremely well. These results are consistent with a modular organization of the human cognitive system and open new perspectives in the search for the similarities and differences between language and music processing.
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Affiliation(s)
- M. Besson
- Center for Research in Cognitive Neuroscience, C.N.R.S., Marseille, France
| | - F. Faïta
- University of Bordeaux II, Bordeaux, France
| | - I. Peretz
- University of Montreal, Montreal, Canada
| | - A.-M. Bonnel
- Center for Research in Cognitive Neuroscience, C.N.R.S., Marseille, France
| | - J. Requin
- Center for Research in Cognitive Neuroscience, C.N.R.S., Marseille, France
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41
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Canel L, Zisimopoulou S, Besson M, Nendaz M. Topiramate-induced severe heatstroke in an adult patient: a case report. J Med Case Rep 2016; 10:95. [PMID: 27075033 PMCID: PMC4831160 DOI: 10.1186/s13256-016-0835-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 02/12/2016] [Indexed: 11/11/2022] Open
Abstract
Background Heatstroke is a life-threatening condition defined by failure of heat load dissipation, resulting in a core temperature higher than 40 °C (104 °F) associated with neurological dysfunction. Topiramate may cause anhidrosis, potentially resulting in heatstroke, as reported especially in children. Case presentation A 57-year-old Caucasian man was admitted to the emergency room in a febrile comatose state. After a complete workup ruling out the usual etiologies of such a condition, we assumed the hypothesis of a heatstroke caused by topiramate, recently prescribed for essential tremor. Conclusions Topiramate-related heatstroke has been described in children but must be recognized in adults as well. Outcomes may range from total clinical recovery to persistent neurological dysfunction or death. The prescription of topiramate and the follow-up of adult patients under this medication should include an evaluation of hypohidrosis, especially in contexts of high temperature.
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Affiliation(s)
- Lucie Canel
- Department of Internal Medicine, HUG Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
| | - Sofia Zisimopoulou
- Department of Community Medicine, HUG Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Marie Besson
- Department of Clinical Pharmacology and Toxicology, HUG Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Mathieu Nendaz
- Department of Internal Medicine, HUG Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
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Belin-Rauscent A, Daniel ML, Puaud M, Jupp B, Sawiak S, Howett D, McKenzie C, Caprioli D, Besson M, Robbins TW, Everitt BJ, Dalley JW, Belin D. From impulses to maladaptive actions: the insula is a neurobiological gate for the development of compulsive behavior. Mol Psychiatry 2016; 21:491-9. [PMID: 26370145 DOI: 10.1038/mp.2015.140] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [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: 04/06/2015] [Revised: 07/15/2015] [Accepted: 08/10/2015] [Indexed: 02/06/2023]
Abstract
Impulsivity is an endophenotype of vulnerability for compulsive behaviors. However, the neural mechanisms whereby impulsivity facilitates the development of compulsive disorders, such as addiction or obsessive compulsive disorder, remain unknown. We first investigated, in rats, anatomical and functional correlates of impulsivity in the anterior insular (AI) cortex by measuring both the thickness of, and cellular plasticity markers in, the AI with magnetic resonance imaging and in situ hybridization of the immediate early gene zif268, respectively. We then investigated the influence of bilateral AI cortex lesions on the high impulsivity trait, as measured in the five-choice serial reaction time task (5-CSRTT), and the associated propensity to develop compulsivity as measured by high drinking levels in a schedule-induced polydipsia procedure (SIP). We demonstrate that the AI cortex causally contributes to individual vulnerability to impulsive-compulsive behavior in rats. Motor impulsivity, as measured by premature responses in the 5-CSRTT, was shown to correlate with the thinness of the anterior region of the insular cortex, in which highly impulsive (HI) rats expressed lower zif268 mRNA levels. Lesions of AI reduced impulsive behavior in HI rats, which were also highly susceptible to develop compulsive behavior as measured in a SIP procedure. AI lesions also attenuated both the development and the expression of SIP. This study thus identifies the AI as a novel neural substrate of maladaptive impulse control mechanisms that may facilitate the development of compulsive disorders.
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Affiliation(s)
- A Belin-Rauscent
- Department of Pharmacology, University of Cambridge, Cambridge, UK.,Behavioral and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - M-L Daniel
- Inserm CIC-1402, Université de Poitiers, Poitiers, France
| | - M Puaud
- Department of Pharmacology, University of Cambridge, Cambridge, UK.,Behavioral and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - B Jupp
- Behavioral and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK.,Department of Psychology, University of Cambridge, Cambridge, UK
| | - S Sawiak
- Behavioral and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - D Howett
- Department of Pharmacology, University of Cambridge, Cambridge, UK
| | - C McKenzie
- Department of Pharmacology, University of Cambridge, Cambridge, UK
| | - D Caprioli
- Behavioral Neuroscience Branch, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA
| | - M Besson
- Neurobiologie Intégrative des Systèmes Cholinergiques, Institut Pasteur, Paris, France
| | - T W Robbins
- Behavioral and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK.,Department of Psychology, University of Cambridge, Cambridge, UK
| | - B J Everitt
- Behavioral and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK.,Department of Psychology, University of Cambridge, Cambridge, UK
| | - J W Dalley
- Behavioral and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK.,Department of Psychology, University of Cambridge, Cambridge, UK.,Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - D Belin
- Department of Pharmacology, University of Cambridge, Cambridge, UK.,Behavioral and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
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Lloret-Linares C, Bellivier F, Haffen E, Aubry JM, Daali Y, Heron K, Berney P, Desmeules J, Besson M. Markers of Individual Drug Metabolism: Towards the Development of a Personalized Antidepressant Prescription. Curr Drug Metab 2016; 16:17-45. [PMID: 26152128 DOI: 10.2174/138920021601150702160728] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 03/05/2015] [Accepted: 03/28/2015] [Indexed: 11/22/2022]
Abstract
The development of a personalized psychopharmacotherapy could potentially reduce treatment failure associated with drug intolerance or resistance, and therefore the burden and costs of affective disorders. An important challenge in realising this potential will be to identify suitable markers of an individual's metabolic response to specific pharmaceuticals. In the absence of suitable markers related directly to drug mechanism, the drug-metabolizing enzymes and transporters have emerged as major determinants of variability in drug metabolism and response. In keeping with this emergent general pharmacological trend, numerous studies concerning the relationship between antidepressants, their metabolism, transport, pharmacokinetic properties, efficacy and tolerability have now been published. These studies are reviewed in this article. The studies considered here frequently support a link between enzyme/transporter activity and/or the pharmacokinetic parameters of antidepressants. However, the majority of studies explored the variability of tricyclic antidepressants, which are less often prescribed today. Furthermore only a few studies have been conducted in naturalistic clinical conditions, seeking to determine whether the systematic assessment of the variability may improve the management of 'real-world' patients. Nonetheless recent studies have yielded promising results regarding the potential benefits of determining drug metabolism variability which might encourage additional large-scale prospective systematic studies be set up to assess the relevance of this approach in everyday practice.
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Affiliation(s)
- Celia Lloret-Linares
- Division of clinical pharmacology and toxicology, Geneva university hospitals, University of Geneva, Switzerland.
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44
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Besson M, Komen H, Aubin J, de Boer IJM, Poelman M, Quillet E, Vancoillie C, Vandeputte M, van Arendonk JAM. Economic values of growth and feed efficiency for fish farming in recirculating aquaculture system with density and nitrogen output limitations: a case study with African catfish (Clarias gariepinus). J Anim Sci 2015; 92:5394-405. [PMID: 25414104 DOI: 10.2527/jas.2014-8266] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In fish farming, economic values (EV) of breeding goal traits are lacking, even though they are key parameters when defining selection objectives. The aim of this study was to develop a bioeconomic model to estimate EV of 2 traits representing production performances in fish farming: the thermal growth coefficient (TGC) and the feed conversion ratio (FCR). This approach was applied to a farm producing African catfish (Clarias gariepinus) in a recirculating aquaculture system (RAS). In the RAS, 2 factors could limit production level: the nitrogen treatment capacity of the biofilter or the fish density in rearing tanks at harvest. Profit calculation includes revenue from fish sales, cost of juveniles, cost of feed, cost of waste water treatment, and fixed costs. In the reference scenario, profit was modeled to zero. EV were calculated as the difference in profit per kilogram of fish between the current population mean for both traits (µt) and the next generation of selective breeding (µt+Δt) for either TGC or FCR. EV of TGC and FCR were calculated for three generations of hypothetical selection on either TGC or FCR (respectively 6.8% and 7.6% improvement per generation). The results show that changes in TGC and FCR can affect both the number of fish that can be stocked (number of batches per year and number of fish per batch) and the factor limiting production. The EV of TGC and FCR vary and depend on the limiting factors. When dissolved NH3-N is the limiting factor for both µt and µt+Δt, increasing TGC decreases the number of fish that can be stocked but increases the number of batches that can be grown. As a result, profit remains constant and EVTGC is zero. Increasing FCR, however, increases the number of fish stocked and the ratio of fish produced per kilogram of feed consumed ("economic efficiency"). The EVFCR is 0.14 €/kg of fish, and profit per kilogram of fish increases by about 10%. When density is the limiting factor for both µt and µt+Δt, the number of fish stocked per batch is fixed; therefore, extra profit is obtained by increasing either TGC, which increases the annual number of batches, or by decreasing FCR, which decreases annual feed consumption. EVTGC is 0.03 €/kg of fish and EVFCR is 0.05-0.06 €/kg of fish. These results emphasize the importance of calculating economic values in the right context to develop efficient future breeding programs in aquaculture.
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Affiliation(s)
- M Besson
- Animal Breeding and Genomics Centre, Wageningen University, P.O. Box 338, NL-6700 AH Wageningen, the Netherlands AgroParisTech, UMR1313 Génétique animale et biologie intégrative, 16 rue Claude Bernard, F-75231 Paris 05, France INRA, UMR1313 Génétique animale et biologie intégrative, Allée de Vilvert, F-78350 Jouy-en-Josas, France
| | - H Komen
- Animal Breeding and Genomics Centre, Wageningen University, P.O. Box 338, NL-6700 AH Wageningen, the Netherlands
| | - J Aubin
- INRA, Agrocampus Ouest Rennes, UMR1069 Sol Agronomie Spatialisation, 65 rue de Saint Brieuc, F-35042 Rennes, France
| | - I J M de Boer
- Animal Production Systems group, Wageningen University, P.O. Box 338, NL-6700 AH Wageningen, the Netherlands
| | - M Poelman
- IMARES, Wageningen UR, Korringaweg 5, NL-4401 NT Yerseke, the Netherlands
| | - E Quillet
- INRA, UMR1313 Génétique animale et biologie intégrative, Allée de Vilvert, F-78350 Jouy-en-Josas, France
| | - C Vancoillie
- Fishion Breeding, Breedijk 13, NL-5705 CJ Helmond, the Netherlands
| | - M Vandeputte
- INRA, UMR1313 Génétique animale et biologie intégrative, Allée de Vilvert, F-78350 Jouy-en-Josas, France IFREMER, Chemin de Maguelone, F-34250 Palavas-les-Flots, France
| | - J A M van Arendonk
- Animal Breeding and Genomics Centre, Wageningen University, P.O. Box 338, NL-6700 AH Wageningen, the Netherlands
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45
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Perogamvros L, Pépin JL, Thorens G, Mégevand P, Claudel E, Espa F, Besson M, Cervena K, Janssens JP, Lador F. Baclofen-Associated Onset of Central Sleep Apnea in Alcohol Use Disorder: A Case Report. Respiration 2015; 90:507-511. [PMID: 26390141 DOI: 10.1159/000439542] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 08/18/2015] [Indexed: 04/13/2024] Open
Abstract
A 61-year-old patient with alcohol use disorder (AUD) was referred for suspicion of sleep apnea syndrome (SAS). He had incurred three road accidents attributed to sleepiness over the previous year, shortly after initiation of high-dose (100 mg b.i.d.) treatment with baclofen, a molecule increasingly used in the management of AUD. Polysomnography revealed a severe central SAS (CSAS) with an apnea-hypopnea index (AHI) of 81.6/h. Baclofen was suggested as a possible cause of the CSAS, and after its withdrawal, a second polysomnography was done, showing the disappearance of the central apneas and a shift to severe obstructive SAS (AHI 43.9/h), for which a positive airway pressure (CPAP) treatment was initiated. A third polysomnography was performed under CPAP after reintroduction of baclofen (50 mg b.i.d.) by the patient, showing reappearance of the CSAS (AHI 42.1/h). This case report illustrates the deleterious effect of baclofen on breathing physiology during sleep. Since it is typically prescribed off label at high doses to a population of patients potentially using other substances that inhibit the ventilatory drive, this possible adverse effect is a major concern. When considering the use of baclofen in patients with AUD, the potential for sleep-disordered breathing should be weighed and carefully monitored.
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46
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Piguet V, D’Incau S, Besson M, Desmeules J, Cedraschi C. Prescribing Generic Medication in Chronic Musculoskeletal Pain Patients: An Issue of Representations, Trust, and Experience in a Swiss Cohort. PLoS One 2015; 10:e0134661. [PMID: 26237036 PMCID: PMC4523195 DOI: 10.1371/journal.pone.0134661] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 07/13/2015] [Indexed: 11/18/2022] Open
Abstract
Objective Parallel to an ever stronger advocacy for the use of generics, various sources of information report concerns regarding substitution. The literature indicates that information regarding substitution is not univocal. The aim of this qualitative study was to explore patients’ representations regarding generics in patients suffering from non-specific disabling chronic musculoskeletal pain, as these patients are confronted with the issue of the prescription and/or substitution of original formulations with generics. Methods Qualitative methods were selected because the aim was to access the range of patients' representations and to consider their conceptions. Standardized face-to-face semi-structured interviews were used, and transcripts were submitted to content analysis. Results Patients’ representations suggest that they might be confident in taking a generic medication: when he/she has an understanding of generics as resulting from a development process that has become part of the public domain; the generic medication is prescribed by the physician; each prescription is discussed, i.e., the patient is prescribed the generic version of a given medication and not a generic medication. Discussion Economic arguments are not sufficient to justify substitution, and may even raise issues calling upon cognitive dissonance. Even in non-life-threatening diseases, negative cues require attention and need be de-emphasized - in particular lower price as an indication of lower quality, and generic status as contradictory with advocating individualization of medication.
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Affiliation(s)
- Valérie Piguet
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Center, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- * E-mail:
| | - Stéphanie D’Incau
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Marie Besson
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Center, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Jules Desmeules
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Center, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Christine Cedraschi
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Center, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- Division of General Medical Rehabilitation, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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47
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Piguet V, D’Incau S, Besson M, Desmeules J, Cedraschi C. Generic Medication In Chronic Musculoskeletal Pain Patients: An Issue of Representations, Trust, and Experience. Clin Ther 2015. [DOI: 10.1016/j.clinthera.2015.05.070] [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: 11/25/2022]
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48
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Poncet A, Gencer B, Blondon M, Gex-Fabry M, Combescure C, Shah D, Schwartz PJ, Besson M, Girardin FR. Electrocardiographic screening for drug-induced long qt to reduce sudden cardiac death in Psychiatric patients: a cost-effectiveness analysis. Clin Ther 2015. [DOI: 10.1016/j.clinthera.2015.05.032] [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: 10/23/2022]
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49
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Poncet A, Gencer B, Blondon M, Gex-Fabry M, Combescure C, Shah D, Schwartz PJ, Besson M, Girardin FR. Correction: Electrocardiographic Screening for Prolonged QT Interval to Reduce Sudden Cardiac Death in Psychiatric Patients: A Cost-Effectiveness Analysis. PLoS One 2015; 10:e0133108. [PMID: 26172274 PMCID: PMC4501759 DOI: 10.1371/journal.pone.0133108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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50
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Besson M, Samer C, Rollason V, Dayer P, Desmeules J. Providing Quality Therapeutics in Switzerland: Role of the Stakeholders and Recent Incentives for Further Improvements. Clin Ther 2015; 37:1588-92. [PMID: 26049714 DOI: 10.1016/j.clinthera.2015.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 12/12/2014] [Revised: 03/18/2015] [Accepted: 05/06/2015] [Indexed: 11/26/2022]
Abstract
Quality therapeutics play an important role in Switzerland's health care and economy. Switzerland holds a key position in the world of research and development, as well as in drug production. Recently, new emphasis has been placed on promoting clinical research and maintaining Switzerland's position as a center of excellence in the field. Recent revisions to the law regarding medical trials in human research allow for better allocation of regulatory resources and simplified procedures for drugs already authorized in Switzerland. The country has its own regulatory agency, the Swiss Agency for Therapeutic Products (Swissmedic), which is a public institution of the Swiss government. Swissmedic is responsible for ensuring safety in medicines, particularly regarding authorizations and market surveillance in the sector of medicinal products and medical devices. Although the centralized authorization procedure of the European Union for medicines does not apply to Switzerland, there are mutual recognition mechanisms between the Swiss medicine regulatory authority and the European Medicines Agency. Swissmedic is also in charge of postmarketing safety and oversees the national pharmacovigilance center, which collaborates closely with the World Health Organization center in Uppsala. In addition, university hospital-based clinical pharmacologists, who are involved in basic science and clinical research, regulatory affairs, ethics committees, and pharmacovigilance, promote quality therapeutics. This article discusses the role of the various stakeholders and the recent efforts made to provide a better allocation of resources aimed at further improving quality therapeutics in Switzerland.
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Affiliation(s)
- Marie Besson
- Psychopharmacology Unit, Division of Clinical Pharmacology and Toxicology, University Hospital of Geneva, Geneva, Switzerland.
| | - Caroline Samer
- Division of Clinical Pharmacology and Toxicology, University Hospital of Geneva, Geneva, Switzerland
| | - Victoria Rollason
- Division of Clinical Pharmacology and Toxicology, University Hospital of Geneva, Geneva, Switzerland; Clinical Research Center, University Hospital and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - Pierre Dayer
- Division of Clinical Pharmacology and Toxicology, University Hospital of Geneva, Geneva, Switzerland; Medical Direction, University Hospital of Geneva, Geneva, Switzerland
| | - Jules Desmeules
- Division of Clinical Pharmacology and Toxicology, University Hospital of Geneva, Geneva, Switzerland; Clinical Research Center, University Hospital and Faculty of Medicine of Geneva, Geneva, Switzerland
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