Frédéric Limosin

Cancer Mortality in Patients With Schizophrenia: An 11-year Prospective Cohort Study

Schizophrenia has been associated with a rate of premature mortality that is 2 to 3 times higher than that in the general population. Although the role of cancer in this excess mortality remains unclear, previous incidence or mortality studies found contradictory results.

Prenatal exposure to influenza as a risk factor for adult schizophrenia

Objective:  Several, but not all epidemiological studies, have demonstrated a positive correlation between exposure to the virus during the second trimester of pregnancy and an increased risk to the infants for subsequently developing schizophrenia. The present study is the first be designed in France to examine the risk of gestational exposure to the influenza virus and subsequent development of schizophrenia.

Ten-year prospective follow-up study of the mortality by suicide in schizophrenic patients

This ten-year follow-up study examined the prevalence and the most relevant baseline predictors of suicide in schizophrenic patients. In 1993, 3470 patients meeting the ICD-10 criteria for schizophrenia were assessed. We used national death certificate data to identify patients that had died by suicide for each year included in the study. In this way, we calculated standardized mortality ratios, adjusting for age and sex relative to the general population. We used Coxs proportional hazards models to investigate potential sociodemographic and clinical risk factors. There were 141 suicides in the cohort during the follow-up period, corresponding to a risk of suicide that was approximately 16 times higher than that of the general population. Women had slightly higher standardized mortality ratios than men. Suicide was the cause of death in more than half (53.9%) of deaths occurring during the first year of follow-up and nearly one-third (31.8%) of those occurring in the ten-year period of the study. There were four significant baseline predictors of suicide remaining in the final logistic regression model: male gender, drug abuse, previous suicide attempts, and short duration of illness. Sex, age, history of suicide attempt should be particularly considered in the assessment of suicide risk in schizophrenic patients. Our findings also emphasize the need for detection and effective management of associated comorbid drug abuse.

Does long-acting injectable risperidone make a difference to the real-life treatment of schizophrenia? Results of the Cohort for the General study of Schizophrenia (CGS)

OBJECTIVE The primary aim of this study was to compare the impact of risperidone long-acting injectable (R-LAI) to other antipsychotics on rates of hospitalisation in real-life settings. METHOD The Cohort for the General study of Schizophrenia (CGS) followed 1859 patients diagnosed with schizophrenia (DSM-IV) from 177 psychiatric wards of public and private hospitals across France over a mean period of 12months. These patients were ambulatory or had been hospitalised for less than 93days at study entry. Recruitment was stratified for long-acting second-generation antipsychotic use. A multivariate Poisson regression adjusted for confounding with propensity scores and allowing for autocorrelation was used for the calculation of relative rates of hospitalisation with 95% confidence intervals. RESULTS The mean age of participants was 37.65years, 68.3% were male and 36.7% were hospitalised for less than 93days at study entry. Altogether, participants accumulated 796 hospital stays (53.4 per 100 person-years). R-LAI patients were slightly younger and had been hospitalised more often in the past 12months compared to non-R-LAI users. The adjusted Poisson regression analysis showed R-LAI use to be associated with a lower rate of future hospitalisation: 0.66 [0.46-0.96] compared to non-R-LAI use, and 0.53 [0.32-0.88] compared to use of other LAIs. CONCLUSION Use of R-LAI was associated with lower rates of hospitalisation compared to non-use of R-LAI.

Impulsiveness as the intermediate link between the dopamine receptor D2 gene and alcohol dependence.

Objectives Reinforcement and reward processes have been proposed as being an intermediate link between the risk for alcohol dependence and the gene coding for the dopamine receptor D2 (DRD2). This hypothesis remains open to speculation, and personality traits such as impulsiveness, a core dimension in addictive disorders, should also be taken into account. For instance, recent evidence in rats showed that DRD2 antagonists might increase impulsivity in decreasing the value of delayed rewards. Methods Considering the pro‐impulsiveness role of ethanol observed in clinical practice and epidemiological studies, we analysed the Barratt impulsiveness scores in a sample of 92 alcohol‐dependent French patients (57 men and 35 women), according to the TaqI A polymorphism of the DRD2 gene. Results A2/A2 and A1/A2 genotypes were significantly associated with a higher global impulsiveness than A1/A1 genotype (P = 0.02 and P =0.03, respectively). Conclusions We propose that reward‐related impulsiveness may constitute a risk factor for alcohol dependence, and that this core temperament could be partly mediated by the DRD2 gene.

Mental disorders and risk of suicide attempt: a national prospective study

Most mental disorders, when examined independently, are associated with an elevated risk for suicide attempt. However, mental disorders often co-occur, and that co-occurrence is well explained by models where specific mental disorders are understood as manifestations of latent dimensions of psychopathology. To date, it remains unclear whether the risk of suicide attempt is due to specific mental disorders, to specific dimensions of psychopathology (that is, internalizing and externalizing dimensions), to a general psychopathology factor or to a combination of these explanations. In a large nationally representative prospective survey, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), we used structural equation modeling to examine the shared and specific effects of Axis I and Axis II disorders on the occurrence of suicide attempts in the general population and among individuals with a lifetime history of suicidal ideation. Effects of mental disorders on the risk of suicide attempt were exerted almost exclusively through a general psychopathology factor representing the shared effect across all mental disorders. Effects of remitted psychiatric disorders on the risk of suicide attempt were fully mediated by current mental disorders. Similar patterns of associations were found in individuals with suicidal ideation. These results held when using different approaches to modeling psychiatric comorbidity. Our findings underscore the importance of adopting dimensional approaches to comorbidity in the study of suicidal behavior. Because mental disorders increase the risk of suicide attempt through a general psychopathology liability, this dimension should be considered as an important therapeutic target to substantially advance suicide prevention.

Manic episode with psychotic symptoms in a patient with Parkinson's disease treated by subthalamic nucleus stimulation: improvement on switching the target.

Manic symptoms have been reported as adverse effects of bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) in patients with Parkinsons disease. In previous reports, manic symptoms were described as transient, not associated with psychotic features, and improved spontaneously or with medical adjustments. The medial part of the STN seems to play a key role in the occurrence of these manic symptoms. We report the case of a manic episode with psychotic symptoms in a patient with Parkinsons disease treated by STN DBS, which improved with a change in the stimulated target. This case demonstrates the efficacy of switching the stimulation target against a manic episode with psychotic features secondary to DBS.

Body mass index and prevalence of obesity in a French cohort of patients with schizophrenia.

Objective:  To evaluate the distributions of body mass index in a large sample of patients with schizophrenia, and to examine the association between body weight and antipsychotic drugs.

Association Between Dopamine Receptor D1 Gene Dde I polymorphism and Sensation Seeking in Alcohol-Dependent Men

BACKGROUND Among genetic and biopsychological factors involved in alcohol-dependence vulnerability, dopamine receptor subtypes genes and temperaments dimensions, such as sensation seeking, have been particularly incriminated. Moreover, it is suggested that higher levels of sensation seeking could be associated with a modification of sensitivity to dopamine in postsynaptic receptors. METHODS We investigated whether the DRD1 DdeI polymorphism could be associated with the sensation-seeking level among a sample of 72 alcohol-dependent male and female patients. Analyses of variance were performed to test for an effect between the DRD1 DdeI genotypes and sensation-seeking scores according to the 40-item Zuckerman scale. RESULTS When comparing the DRD1 DdeI genotypes and the Zuckerman scores, we found a significant association only in men (p = 0.01). CONCLUSIONS That is the first report of a male limited association between the DRD1 gene polymorphism and sensation-seeking score in alcohol-dependent subjects.

The A9 allele of the dopamine transporter gene increases the risk of visual hallucinations during alcohol withdrawal in alcohol-dependent women

Previous studies have found an association between the A9 allele (nine-copy repeat) of the dopamine transporter (DAT) gene and two complications of alcohol withdrawal, namely delirium tremens (DT) and alcohol withdrawal seizures (AWS). Most of these studies only included male alcohol-dependent patients. Even those that included a small proportion of women did not look at the effect of gender. We compared the frequency of the A9 allele in 64 French Caucasian alcohol-dependent women with a history of alcohol withdrawal complications. Women carrying the A9 allele had more visual hallucinations during withdrawal than those without this allele (P = 0.03). However, women with the A9 allele were not more susceptible to DT or AWS than those without (P = 0.48 and P = 1.00, respectively). Our results suggest that the A9 allele of the DAT gene is involved in vulnerability to alcohol withdrawal complications in women, but that these complications differ from those associated with this polymorphism in alcohol-dependent men.