Showing papers by "David Cohen published in 2007"

Psychiatric manifestations revealing inborn errors of metabolism in adolescents and adults

Abstract: Inborn errors of metabolism (IEMs) may present in adolescence or adulthood as a psychiatric disorder. In some instances, an IEM is suspected because of informative family history or because psychiatric symptoms form part of a more diffuse clinical picture with systemic, cognitive or motor neurological signs. However, in some cases, psychiatric signs may be apparently isolated. We propose a schematic classification of IEMs into three groups according to the type of psychiatric signs at onset. Group 1 represents emergencies, in which disorders can present with acute and recurrent attacks of confusion, sometimes misdiagnosed as acute psychosis. Diseases in this group include urea cycle defects, homocysteine remethylation defects and porphyrias. Group 2 includes diseases with chronic psychiatric symptoms arising in adolescence or adulthood. Catatonia, visual hallucinations, and aggravation with treatments are often observed. This group includes homocystinurias, Wilson disease, adrenoleukodystrophy and some lysosomal disorders. Group 3 is characterized by mild mental retardation and late-onset behavioural or personality changes. This includes homocystinurias, cerebrotendinous xanthomatosis, nonketotic hyperglycinaemia, monoamine oxidase A deficiency, succinic semialdehyde dehydrogenase deficiency, creatine transporter deficiency, and α and β mannosidosis. Because specific treatments should be more effective at the ‘psychiatric stage’ before the occurrence of irreversible neurological lesions, clinicians should be aware of atypical psychiatric symptoms or subtle organic signs that are suggestive of an IEM. Here we present an overview of IEMs potentially revealed by psychiatric problems in adolescence or adulthood and provide a diagnostic strategy to guide metabolic investigations.

Policy and Practice: The Dilemma.

Abstract: The relations between policy and practice embody a dilemma. Policies aim to solve problems, yet the key problem solvers are those who have the problem. Governments devise instruments to encourage implementation, but they help only if used well by those with the problem, whose capability is often weak. The realization of policy in practice thus depends on the fit between capabilities that support implementation and aims. The more aims outstrip capabilities, the less likely is effective implementation. When Title 1 of the 1965 Elementary and Secondary Education Act began, capabilities were modest: the program's instruments were limited, and neither practitioners nor workers in the environment knew much about school improvement. Yet Title 1 became a viable program in the 1970s because its aims were defined in ways that were achievable, given the capability that was possible. Title 1 later was made the chief lever for national standards‐based reform policies, but capability was far from what would be required...

Animal models relevant to schizophrenia and autism: validity and limitations.

Abstract: Development of animal models is a crucial issue in biological psychiatry. Animal models provide the opportunity to decipher the relationships between the nervous system and behavior and they are an obligatory step for drug tests. Mouse models or rat models to a lesser extent could help to test for the implication of a gene using gene targeting or transfecting technologies. One of the main problem for the development of animal models is to define a marker of the psychiatric disorder. Several markers have been suggested for schizophrenia and autism, but for the moment no markers or etiopathogenic mechanisms have been identified for these disorders. We examined here animal models related to schizophrenia and autism and discussed their validity and limitations after first defining these two disorders and considering their similarities and differences. Animal models reviewed in this article test mainly behavioral dimensions or biological mechanisms related to autistic disorder or schizophrenia rather than providing specific categorical models of autism or schizophrenia. Furthermore, most of these studies focus on a behavioral dimension associated with an underlying biological mechanism, which does not correspond to the complexity of mental disorders. It could be useful to develop animal models relevant to schizophrenia or autism to test a behavioral profile associated with a biological profile. A multi-trait approach seems necessary to better understand multidimensional disorders such as schizophrenia and autism and their biological and clinical heterogeneity. Finally, animal models can help us to clarify complex mechanisms and to study relationships between biological and behavioral variables and their interactions with environmental factors. The main interest of animal models is to generate new pertinent hypotheses relevant to humans opening the path to innovative research.

The state of education policy research

Abstract: Contents: Part I: Introduction to Education Policy Research. S.H. Fuhrman, D.K. Cohen, F. Mosher, Preface and Acknowledgments. R. Floden, Philosophical Issues in Education Policy Research. Part II: The Making and Effects of Education Policy. L.M. McDonnell, The Politics of Education: Influencing Policy and Beyond. S.H. Fuhrman, M.E. Goertz, E.H. Weinbaum, Educational Governance in the U.S.: Where Are We? How Did We Get Here? Why Should We Care? D.K. Cohen, S.L. Moffitt, S. Goldin, Policy and Practice. P.T. Hill, New Political Economy of Public Education: Policy and Research. J.R. Henig, As Moths to a Flame: Education Policy Research and the Controversial Issues of Race. J.P. Spillane, The Making and Effects of Education Policy: Commentary. Policy, Politics, Institutions, and Markets. Part III: Policy as Resource Allocation. L. Barrow, C.E. Rouse, Causality, Causality, Causality: The View of Education Inputs and Outputs From Economics. W.N. Grubb, The Elusiveness of Educational Equity: From Revenues to Resources to Results. H.F. Ladd, Policy as Resource Allocation: Commentary. Part IV: Across the Sectors. W.S. Barnett, D.J. Ackerman, Boundaries With Early Childhood Education: The Significance of the Early Childhood Frontier for Elementary and Secondary Education. M.W. Kirst, Separation of K-12 and Postsecondary Education Policymaking: Evolution, Impact, and Research Needs. J.L. Aber, Across the Sectors: Commentary. Border Crossings: On the Relations Between the Major Age-Graded Education Systems in the United States. Part V: The Role of Education Research. F. Mosher, Knowledge and Policy. B. Neufeld, Learning, Teaching, and Keeping the Conversation Going: The Links Between Research, Policy, and Practice. R.E. Slavin, N.A. Madden, A. Datnow, Research In, Research Out: The Role of Research in the Development and Scale-Up of Success for All. C.H. Weiss, The Role of Education Research: Commentary. Can We Influence Education Reform Through Research? Part VI: Policy and Professionals. R.M. Ingersoll, Misdiagnosing the Teacher Quality Problem. T.B. Corcoran, The Changing and Chaotic World of Teacher Policy. A.R. Odden, A. Milanowski, H.G. Heneman III, Policy and Professionals: Commentary. Part VII: In Conclusion. S.H. Fuhrman, D.K. Cohen, F. Mosher, Conclusion: A Review of Policy and Research in Education.

Should the use of selective serotonin reuptake inhibitors in child and adolescent depression be banned

Abstract: BACKGROUND: European and US pharmaceutical agencies have recently warned against the use of selective serotonin reuptake inhibitors (SSRIs) in child and adolescent depression. This came as a surprise to many practitioners, who had made treatment decisions based on data from pharmaceutical trials using adult samples. METHOD: The author reviews the recent literature relevant to the use of SSRIs in youth depression, including psychiatricclinical trials, pharmacology and drug safety data. Recommendations and rationales for the use of SSRIs in this context are offered. RESULTS: Ten publications, comprising a total of 2,046 patients, evaluated the efficacy of four SSRIs (fluoxetine, paroxetine, sertraline and citalopram) in child and adolescent depression. It is noted that an additional 6 trials (with a total of 1,234 patients) were not reported by the industry because of a lack of efficacy or problematic side effects, including suicidal behaviors. Meta-analyses revealed no data supporting the use of SSRIs, except for fluoxetine. To formulate recommendations for clinical practice, it is necessary to examine specific issues such as (1) the link between SSRIs, depression and suicidal risk; (2) SSRI age-related specific effects, and (3) the high placebo response in child and adolescent depression. CONCLUSION: An SSRI prescription is still a second-line option in severe and resistant forms of youth depression. However, in children and adolescents only specialists well trained in child and adolescent psychiatry should prescribe SSRIs. Language: en

Comorbidity with ADHD Decreases Response to Pharmacotherapy in Children and Adolescents with Acute Mania: Evidence from a Metaanalysis:

Abstract: Objective:To assess whether comorbid attention-deficit hyperactivity disorder (ADHD) influences response to treatment in young patients with acute mania.Methods:We conducted a metaanalysis of 5 open trials of 100, 35, 41, 60, and 37 children and adolescents. The pooled group included 273 children and adolescents with bipolar disorder (BD), divided into 2 subgroups: those with (n = 132), and those without (n = 141), ADHD comorbidity.Results:There was a moderate and significant reduction in relative risk (RR) favouring treatment response in children and adolescents with BD but without ADHD comorbidity (RR 0.822; 95%CI, 0.69 to 0.97; P = 0.021). The negative effect of ADHD comorbidity on treatment response was more significant in studies including adolescents only or subjects with BD I only.Conclusion:These findings suggest that children and adolescents with BD and ADHD tend to be less responsive to drugs used in treatment of acute mania.

Cotard's syndrome in adolescents and young adults is associated with an increased risk of bipolar disorder

Abstract: Objectives: To assess the effect of age at onset on the phenomenology of Cotard's syndrome (CS) as a recent study reported a high rate of occurrence of bipolar disorder (BD) in adolescents and young adults with CS followed up for ≥2 years. Methods: We reviewed all cases of CS reported since it was first described. A statistical analysis was carried out to determine the effect of age at onset on CS phenomenology. Results: We found 138 cases including 21 cases aged 25 years or younger. In these younger CS patients, BD was more frequent, and the risk of associated BD was increased nine times (p < 0.0001). Within the BD sub-group (n = 27), admixture analysis identified two sub-groups with mean ages at onset of 18.7 years [standard deviation (SD) = 3.2] and 50.5 years (SD = 11.7). Conclusions: Young people with CS should be monitored carefully for the onset of BD, and families should be educated about this risk. Treatment with mood stabilizers can be helpful for those who develop BD. Within BD associated with CS, early versus late onset should be distinguished.

Treatments in child and adolescent bipolar disorders

Abstract: The existence of bipolar disorder in adolescents is now clearly established. However, whether bipolarity exists in children is more controversial. We reviewed the literature on acute and prophylactic treatment of bipolar disorder in youths. The guidelines for the treatment of bipolar disorder in children and adolescents are generally similar to those applied in adult practice. But no evidence-based data support the use of mood stabilisers or antipsychotics since we only found two placebo-randomised controlled trials testing the efficacy of lithium in the paediatric literature. Therefore, we support the view that prescriptions should be limited to the most typical cases. In fact, the use of mood stabilisers or antipsychotics in the treatment of bipolar disorder in children and adolescents appears to be of limited use when a comorbid condition, such as attention deficit hyperactivity disorder, occurs unless aggressive behaviour is the target symptom.

Transformations des représentations de l'autisme et de sa prise en charge

Abstract: 1 Objectif : mettre en evidence les constructions sociales et culturelles de l'autisme en analysant les transformations de ses representations de 1943 a 2007 2 Methode : l'etude ethnographique realisee associe des observations dans des services accueillants des enfants autistes, des entretiens avec des parents et des professionnels, ainsi qu'une analyse des publications scientifiques et des politiques publiques 3 Resultats et discussion : depuis 1993, date de la publication de la CIM-10 (classification internationale des maladies), l'autisme, maladie rare, incurable, associee souvent a un retard mental, est devenu un syndrome aux contours flous classe dans la categorie des troubles envahissants du developpement (TED), qui inclut aussi bien des enfants severement handicapes sans langage que des personnes presentant de bonnes capacites langagieres mais des difficultes d'interactions sociales L'elargissement des criteres diagnostiques va de pair avec une augmentation de la frequence de l'autisme Evaluee entre 2 et 5 cas pour 10 000 dans les annees 1990, elle serait aujourd'hui de 1/150 Ces changements ne se sont pas generalises de la meme maniere dans tous les pays, et notamment en France, ou la denomination TED n'est apparue qu'en 2000 dans la classification francaise 4 Conclusion : les associations de parents contribuent a faire evoluer les representations et influencent les politiques publiques En participant a la promotion des approches educatives et comportementales, elles modifient le domaine des interventions en autisme mais favorisent aussi, paradoxalement, le desinvestissement des pouvoirs publics qui diminuent leur implication a long terme dans la prise en charge des personnes autistes

Drug-eluting stents.

Abstract: Our interest in the systematic review by Suzanne Ligthart and colleagues of published studies evaluating the cost-effectiveness of drug-eluting stents[1][1] was not dispassionate, as we are coauthors of 4 of the 19 published studies cited. We have several concerns about the analysis in this review