Showing papers by "Caroline Dubertret published in 2015"

Major depression and suicide attempts in patients with liver disease in the United States.

Abstract: BACKGROUND: Depression is common in patients with liver disease. Moreover, alcohol use is intricately linked with both major depression and liver disease, and has also been linked with suicidal behaviors, suggesting that the alcohol use may have an intermediate role in the relationship between liver disease and major depression or suicidal behaviors. AIM: This study presents nationally representative data on the prevalence of major depression in patients with liver disease in the United States and its association with suicide attempts. METHODS: Data were drawn from the 2001-2002 National Epidemiological Survey on Alcohol and Related Conditions (NESARC). The NESARC is a survey of 43,093 adults aged 18 years and older in the United States. Medically recognized liver diseases were self-reported, and diagnoses of major depression were based on the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version. RESULT: The prevalence of liver disease was estimated at 0.7%. Respondents with a liver disease reported 12-months rates of major depression (17.2%) that were significantly higher than among respondents without liver disease (7.0%; Adjusted OR:2.2; CI: 1.2-4.1). Lifetime rates of suicide attempts among participants with a major depression were also higher in participants with a liver disease (33.2%) than among respondents without liver disease (13.7%; OR: 3.1; CI: 1.3-7.6) CONCLUSIONS: Liver diseases are associated with major depression and suicide attempts among adults in the community. Adjustment for the amount of alcohol used or sociodemographic factors did not explained the observed association of liver disease with both major depression and suicide attempts. This article is protected by copyright. All rights reserved. Language: en

Comment améliorer les pratiques et interventions de soutien à l’insertion professionnelle des patients souffrant de schizophrénie en France ?

Abstract: Getting and keeping a job are not only one of the criteria of recovery from schizophrenia, but are also one of its main means. Indeed, recovery is partly defined by the ability to work. Despite the lack of data in France about employment of people with schizophrenia, it is widely acknowledged that the employment rate of people with schizophrenia remains quite low, and frequently it is only an employment in sheltered workshops, not on the regular work market. International research data show that it is possible to improve significantly this employment rate, with an appropriate support, that is precisely defined by the current researches, and that is quickly spreading in most developed countries. The aim of this paper is to present, on the basis of a broad current literature review, the key predictive factors of the return to work for people with schizophrenia, and the strategies to optimize vocational services. It will appear that there are several ways to improve practices and interventions in France to support work integration. To begin with individual factors of work integration, dependant on each person, the clinical state and the cognitive skills (in a broad sense, including social cognition and metacognition) are to be taken into account, and optimized by means of the association of a finely tuned pharmacological treatment and psychosocial interventions such as cognitive remediation adjusted to the person's specific needs. The other main kind of factors is environmental factors, particularly the kind of vocational support, which turns out to have a major impact not only on job acquisition, but importantly also on job tenure. The most effective vocational services are based on the "Place and train" model, and even more precisely on the Individual Placement and Support (IPS) model, that allows to the majority of people with a severe mental illness (more than 50%) to obtain a competitive employment after 6 to 18 months of individualized support. This approach is now widely recommended as "an evidence-based practice" of rehabilitation. It is important to promote in France the development of this kind of practice, already implemented as an experiment by few militant and involved associations. This development remains in France slow and delayed (compared to the practices in the other European countries) because of the lack of public funding. It implies an evolution of the social and medico-social practices, taking into account current research data, and assessing the outcomes of their practices in order to improve them. The employment specialist (sometimes called also the "job coach") turns out to play a key role, emphasized by current research, implying, among many other tasks, to coordinate the net of people supporting the work integration, including the clinical team, the employer and the colleagues of the workplace.

Louis Mourier, un service pionnier

Abstract: Resume Nommee agregee de psychiatrie chez Jean Delay a Sainte-Anne en 1968, il est alors propose a Therese Lemperiere d’etre chef de service dans un nouvel hopital de l’Assistance Publique qui ouvre ses portes a Colombes. Elle accepte, en venant a Louis-Mourier en novembre 1971, d’etre responsable du premier service de psychiatrie sectorise ouvert en hopital general. Elle permet que la psychiatrie soit reconnue comme discipline medicale forte. Le service dirige par Therese Lemperiere, non pense pour accueillir les patients psychiatriques, se construit en interaction forte avec les collegues hospitaliers universitaires, et devient l’ecole de la clinique psychiatrique qui beneficie a la fois a ses nombreux etudiants et aux patients du secteur.