Encephale
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Review Comparative Study
[Antidepressants and their onset of action: a major clinical, methodological and pronostical issue].
Although antidepressant medications are effective in about 50-70% of patients with major depressive disorder (MDD), they have a delayed onset of therapeutic effect. This latency is one of the current major limitations of these medications, in that it prolongs the impairments associated with depression, leaves patients vulnerable to an increased risk of suicide, increases the likelihood that a patient will prematurely discontinue therapy, and increases medical costs associated with severe depression. It is becoming increasingly clear that differences may exist between antidepressants and some evidence suggests that some antidepressant agents may begin to work faster than others. ⋯ Thus, current data do not clearly support claims that one drug reduces the symptoms of depression faster than another, though the existing literature suggests that escitalopram displays some superiority in terms of rapidity of action. Given the potential benefits of early-acting antidepressant treatments, the possibility of superior speed of onset of escitalopram presented here merits further study in adequately designed, prospective clinical trials. A definitive demonstration of early onset of action awaits the results of appropriately designed and powered clinical studies, which may include (1) a prospective definition of early onset of action, (2) more focused assessments of core emotional symptoms and cognitive deficits of depression by using specific and sensitive tools, (3) a data-analytic approach capable of capturing the dynamic nature of symptomatic change (for example, survival analysis), and (4) strategies to minimize biases and heterogeneity of response.
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Many clinical practice guidelines (CPG) have been published in reply to the development of the concept of "evidence-based medicine" (EBM) and as a solution to the difficulty of synthesizing and selecting relevant medical literature. Taking into account the expansion of new CPG, the question of choice arises: which CPG to consider in a given clinical situation? It is of primary importance to evaluate the quality of the CPG, but until recently, there has been no standardized tool of evaluation or comparison of the quality of the CPG. An instrument of evaluation of the quality of the CPG, called "AGREE" for appraisal of guidelines for research and evaluation was validated in 2002. ⋯ Globally, two CPG are considered as strongly recommended: "the quick reference guide of the APA practice guideline for the treatment of patients with schizophrenia" and "the T-MAP".
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The aim of the study was to evaluate the relative contributions of peers and parental influences and adolescents' own beliefs about use, in the prediction of cannabis use. ⋯ As our sample was non-clinical, a first limitation of our findings is that they may not be transposable to patient populations. Another limitation of our study is linked to its cross-sectional design, which prevents the attribution of causal explanations for the associations found. One of the study's strengths is that it assesses potentially important variables not evaluated in previous studies, such as the number of peers opposed to cannabis use and positive and negative expectations of use. The results of the present study suggested that the number of peers using cannabis, father's present or past cannabis use and participants' positive expectations of cannabis use were risk factors for use, whereas the number of peers opposed to cannabis use and the negative expectations of use were protective factors. Parental attitudes toward use did not appear to influence adolescents' cannabis use. In conclusion, our results may have some implications for prevention interventions. They add weight to the view that normalisation of non-use by peers facilitates abstinence. The absence of influence of parental attitudes toward use suggests that parental disapproval of use is not effective in preventing use, whereas the example of father's use or non-use influences adolescent use. The quite low correlation between positive and negative expectancies suggests that prevention interventions presenting information concerning the effects of cannabis use should focus on both reducing positive expectancies and enhancing negative expectancies.
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Insight is more than frequently altered in schizophrenia, rupture of treatment being one the most known consequences of this impairment. Two different types of scales can be used to assess consciousness: self-questionnaires directly filled-in by the patient or questionnaires assessed by a psychiatrist after an interview. AIM OF THE STUDIES: The goal of this study was first to assess insight in schizophrenic patients with these two different types of scales and then try to find a link between insight impairment and schizophrenic symptoms. The self-questionnaire was the Marks et al. Self Appraisal of Illness Questionnaire (SAIQ) [Schizophr Res 45 (2000) 203-11], 17 items finally giving four scores (consciousness of illness, consequences of schizophrenia, need for treatment and worrying about illness) plus a total score of insight. The other questionnaire was the Amador Scale for assessment of Unawareness of Mental Disease [Amador XF, Strauss DH. The scale to assess unawareness of mental disorder (SUMD). Columbia University and New-York State Psychiatric Institute;1990], consisting in an interview with a psychiatrist who finally assesses four dimensions (consciousness of illness, symptoms, need for treatment and consequences of illness) plus a total score. In addition to these scores, Amador's scale gives the opportunity to score attribution a patient gives to illness for his symptoms. ⋯ Considering symptom attribution, being unconscious of a symptom and being enable to attribute it to schizophrenia were linked, which could refer to Frith's theory of schizophrenia [Frith CD. Neuropsychologie de la schizophrénie. Psychiatrie ouverte. Paris: PUF;1996 (208p.)] and attribution impairment as a main dysfunction. The two different types of scales seem to be effective. The significant correlation between them suggests they assess the same dimension. This preliminary study will be followed by a validation study of the french translation of the SAIQ.
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Many studies have shown that the strategies used to cope with chronic pain play a very important role in the adjustment to the pathology and to its effects (emotional distress, physical and psychosocial impairment, and quality of life). Among the methods assessing coping with pain, the most widely used instrument at present is the coping strategies questionnaire (CSQ) developed by Rosenstiel and Keefe, [Pain 17 (1983) 33-44]. This questionnaire is composed of 48 items distributed in eight subscales each including six items: diverting attention, reinterpreting pain sensations, coping self-statements, ignoring pain sensations, praying and hoping, catastrophizing, increasing activity level, and increasing pain behaviour. Most studies examining the factor structure of the CSQ have used the scores of its eight prior theoretically derived scales rather than the 48 items. Three studies, Tuttle et al. [Rehab Psychol 36 (1991) 179-187], Swartzmann et al. [Pain 54 (1994) 311-316; Robinson et al. [Clin J Pain 13 (1997) 43-49] have examined the factor structure of the CSQ from the 48 original items on the questionnaire and have yielded five or six factors. A structural confirmatory analysis showed the superiority of the six-factor model [Clin J Pain 13 (1997) 156-162]: distraction, catastrophizing, ignoring pain sensations, distancing from pain, coping self-statements and praying. The present study aimed at measuring the internal consistency and the construct validity of the French version of the CSQ. ⋯ The present study indicates that the internal consistency and the construct validity of the French version of the CSQ were adequate, and contributes to demonstrate the stability of the factor structure of the CSQ across samples. The 21-item French adaptation of the CSQ (CSQ-F) appears to be a very interesting tool because it facilitates the use of this questionnaire, not only for research but also in the clinical assessment of the patients suffering from chronic pain.