Elie-Georges Hantouche

Suicidal behaviour in a French Cohort of major depressive patients: Characteristics of attempters and nonattempters

BACKGROUND Epidemiological and clinical studies indicate that major depressive disorder is the leading cause of suicidal behaviour and that bipolar II subjects carry the highest risk. Identification of risk factors is therefore essential to prevent suicide in this population. METHODS As part of the EPIDEP National Multisite French Study of 493 consecutive DSM-IV major depressive patients evaluated in at least two semi-structured interviews 1month apart, 155 (33.7%) were classified as suicide attempters, and 295 (66.3%) as nonattempters, after exclusion of bipolar I patients. RESULTS Compared to nonattempters, attempters had a longer duration of illness, longer delays before seeking help and correct diagnosis and a higher number of previous episodes; they were more frequently rapid cyclers, with fewer free intervals between episodes. Lifetime suicide attempts were associated with more comorbid bulimia and substance abuse. Bipolar II spectrum disorders, depressive, cyclothymic and irritable temperaments were overrepresented in attempters, as well as family history of both affective disorder and suicide attempts. The following independent variables were associated with lifetime suicide attempts: higher number of previous depressive episodes, multiple hospitalizations, cyclothymic temperament, rapid cycling and earlier age at onset. LIMITATIONS Retrospective design, recall bias, lack of sample homogeneity, and insufficient assessment of hypomanic features during index depression. CONCLUSIONS In major depressive disorders, family history, age at onset, illness course, comorbidity and cyclothymic temperament alongside other indices of bipolarity may help predict suicidal behaviour. Longer delays to seeking help and diagnosis in attempters emphasize the importance of early recognition of bipolar spectrum disorders.

Characteristics of depressive patients according to family history of affective illness: Findings from a French national cohort.

BACKGROUND Literature is scarce about the characteristics of mood disorder patients with a family history (FH) of affective illness. The aim of the current study was to compare the prominent features of depressive patients with a FH of mania (FHM), those of depressive patients with a FH of depression (FHD), and those of depressive patients with no FH of affective illness (FHO). METHODS As part of the EPIDEP National Multisite French Study of 493 consecutive DSM-IV major depressive patients evaluated in at least two semi-structured interviews 1 month apart, 45 (9.1%) were classified as FHM, 210 (42.6%) as FHD, and 238 (48.3%) as FHO. RESULTS The main characteristics of FHM patients were a cyclothymic temperament, the presence of mixed features and diurnal variations of mood during depression, early sexual behaviour, a high number of mood episodes and hypomanic switches, high rates of suicide attempts and rapid cycling; diagnosis of bipolar disorder was more frequent in this group as well as comorbid obsessive compulsive disorder, posttraumatic stress disorder, bulimia, attention deficit/hyperactivity disorder and impulse control disorders. The FHD patients had more depressive temperament, generalized anxiety disorder, and anorexia nervosa. Compared to FHO, FHM and FHD showed an earlier age at onset, more comorbid anxiety disorders, as well as more psychotic features. LIMITATIONS The following are the limitations of this study: retrospective design, recall bias, and preferential enrolment of bipolar patients with a depressive predominant polarity. CONCLUSIONS In light of genetic studies conducted in affective disorder patients, our findings may support the hypothesis of genetic risks factors common to affective disorders and dimensions of temperament, that may extend to comorbid conditions specifically associated with bipolar or unipolar illness.

Drug treatment of mania: 6 month prospective follow-up in a naturalistic multi-site survey

Results At the end of follow-up, we observed a global stability for diagnosis in 93% of patients and for the choice of primary anti-manic drug therapy in 74%. In case of changing primary treatment, almost half of changes were done within the same drug family and half toward a switch to another family. At D180, the switch rate from MS to AP was 5% and from AP to MS 14.5%. The global rate of treatment modifications (including changing of dose) was 44% at D15, 42% at D30, 34% at D60, 35% at D90, 32% at D180, and the major reason for modifications was partial efficacy (respectively 17.5%, 15%, 9.4%, 12.2% and 9.4%). Intolerance was the second reason (respectively 8%, 6.3%, 7%, 4.2% and 3.8%).

Lifetime comorbid anxiety in mania: structure factor, links with mixity and role of instable temperament

., 2003). It involved training 317French psychiatrists working in different sites representa-tive of all France. The study actually succeeded in recruit-ing 1090 cases admitted for acute mania (DSM-IVcriteria). Mixed Mania, as defined by the presence of 2items from the checklist of depressive symptoms, CLDS(10 items) was observed in 30% of the entire population.Lifetime comorbid anxiety disorders were assessed byusing the DSM-IV criteria, and the AMDP Anxiety Scale ofBobon. The full TEPMS-A French version (84 items, Han-touche