Showing papers by "David Cohen published in 2011"
TL;DR: It is stressed that credence should be given to parents' intuition as they recognize, long before diagnosis, the pathological process through the interactive pattern with their child, when studying interactive patterns.
Abstract: Background
To assess whether taking into account interaction synchrony would help to better differentiate autism (AD) from intellectual disability (ID) and typical development (TD) in family home movies of infants aged less than 18 months, we used computational methods.
Methodology and Principal Findings
First, we analyzed interactive sequences extracted from home movies of children with AD (N = 15), ID (N = 12), or TD (N = 15) through the Infant and Caregiver Behavior Scale (ICBS). Second, discrete behaviors between baby (BB) and Care Giver (CG) co-occurring in less than 3 seconds were selected as single interactive patterns (or dyadic events) for analysis of the two directions of interaction (CG→BB and BB→CG) by group and semester. To do so, we used a Markov assumption, a Generalized Linear Mixed Model, and non negative matrix factorization. Compared to TD children, BBs with AD exhibit a growing deviant development of interactive patterns whereas those with ID rather show an initial delay of development. Parents of AD and ID do not differ very much from parents of TD when responding to their child. However, when initiating interaction, parents use more touching and regulation up behaviors as early as the first semester.
Conclusion
When studying interactive patterns, deviant autistic behaviors appear before 18 months. Parents seem to feel the lack of interactive initiative and responsiveness of their babies and try to increasingly supply soliciting behaviors. Thus we stress that credence should be given to parents' intuition as they recognize, long before diagnosis, the pathological process through the interactive pattern with their child.
114 citations
TL;DR: Examining the developmental trajectories showed that PDD-NOS corresponded to a group of heterogeneous pathological conditions including prodromic forms of later AD, remitted or less severe forms of AD, and developmental delays in interaction and communication.
Abstract: We reviewed the stability of the diagnosis of pervasive developmental disorder not otherwise specified (PDD-NOS). A Medline search found eight studies reiterating a diagnostic assessment for PDD-NOS. The pooled group included 322 autistic disorder (AD) and 122 PDD-NOS cases. We used percentage of individuals with same diagnose at Times 1 and 2 as response criterion. The pooled Relative Risk was 1.95 (p < 0.001) showing that AD diagnostic stability was higher than PDD-NOS. When diagnosed before 36 months PDD-NOS bore a 3-year stability rate of 35%. Examining the developmental trajectories showed that PDD-NOS corresponded to a group of heterogeneous pathological conditions including prodromic forms of later AD, remitted or less severe forms of AD, and developmental delays in interaction and communication.
66 citations
TL;DR: The case of a 17-year-old girl referred for an acute mania with psychotic features and a clinical picture deteriorated to a catatonic state is described, positive diagnosis of anti-NMDA-receptor encephalitis suggested specific treatment.
Abstract: Anti-NMDA-Receptor encephalitis is a severe form of encephalitis that was recently identified in the context of acute neuropsychiatric presentation. Here, we describe the case of a 17-year-old girl referred for an acute mania with psychotic features and a clinical picture deteriorated to a catatonic state. Positive diagnosis of anti-NMDA-receptor encephalitis suggested specific treatment. She improved after plasma exchange and immunosuppressive therapy. Post-cognitive sequelae (memory impairment) disappeared within 2-year follow-up and intensive cognitive rehabilitation.
65 citations
TL;DR: The authors found that language skills in AD and SLI rely on different mechanisms, while PDD-NOS show an intermediate profile sharing some characteristics of both Autistic Disorder (AD) and Specific Language Impairment (SLI).
64 citations
TL;DR: The results showed that all LIC have difficulties in reproducing intonation contours because they achieved significantly lower recognition scores than TD children on almost all studied intonations, which suggests a more pronounced pragmatic impairment in AD and PDD-NOS children.
Abstract: This study presents a preliminary investigation into the automatic assessment of language-impaired children's (LIC) prosodic skills in one grammatical aspect: sentence modalities. Three types of language impairments were studied: autism disorder (AD), pervasive developmental disorder-not otherwise specified (PDD-NOS), and specific language impairment (SLI). A control group of typically developing (TD) children that was both age and gender matched with LIC was used for the analysis. All of the children were asked to imitate sentences that provided different types of intonation (e.g., descending and rising contours). An automatic system was then used to assess LIC's prosodic skills by comparing the intonation recognition scores with those obtained by the control group. The results showed that all LIC have difficulties in reproducing intonation contours because they achieved significantly lower recognition scores than TD children on almost all studied intonations (p <; 0.05). Regarding the “Rising” intonation, only SLI children had high recognition scores similar to TD children, which suggests a more pronounced pragmatic impairment in AD and PDD-NOS children. The automatic approach used in this study to assess LIC's prosodic skills confirms the clinical descriptions of the subjects' communication impairments.
55 citations
TL;DR: The ultimate goal of the present document is to provide direction in defining and measuring the appropriate use—avoiding not only underuse but also overuse and misuse—and proper application of cardiovascular technology and to describe how appropriate use measures and structure/safety measures might be developed for the purposes of quality improvement and public reporting.
Abstract: Consistent with the growing national focus on healthcare quality, the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) have taken a leadership role over the past decade in developing measures of the quality of cardiovascular care by convening a joint ACCF/AHA Task Force on Performance Measures. The Task Force is charged with identifying the clinical topics appropriate for the development of performance measures and with assembling writing committees composed of clinical and methodological experts in collaboration with appropriate subspecialty societies. The Task Force has also created methodology documents that offer guidance in the development of process, outcome, composite, and efficiency measures. Cardiovascular performance measures using existing ACCF/AHA methodology are based on Class I or Class III guidelines recommendations, usually with Level A evidence. These performance measures, based on evidence-based ACCF/AHA guidelines, remain the most rigorous quality measures for both internal quality improvement and public reporting. However, many of the tools for diagnosis and treatment of cardiovascular disease involve advanced technologies, such as cardiac imaging, for which there are often no underlying guideline documents. Because these technologies affect the quality of cardiovascular care and also have the potential to contribute to cardiovascular health expenditures, there is a need for more critical assessment of the use of technology, including the development of quality and performance measures in areas in which guideline recommendations are absent. The evaluation of quality in the use of cardiovascular technologies requires consideration of multiple parameters that differ from other healthcare processes. The present document describes methodology for development of 2 new classes of quality measures in these situations, appropriate use measures and structure/safety measures. Appropriate use measures are based on specific indications, processes, or parameters of care for which high level of evidence data and Class I or Class III guideline recommendations may be lacking but are addressed in ACCF appropriate use criteria documents. Structure/safety measures represent measures developed to address structural aspects of the use of healthcare technology (e.g., laboratory accreditation, personnel training, and credentialing) or quality issues related to patient safety when there are neither guidelines recommendations nor appropriate use criteria. Although the strength of evidence for appropriate use measures and structure/safety measures may not be as strong as that for formal performance measures, they are quality measures that are otherwise rigorously developed, reviewed, tested, and approved in the same manner as ACCF/AHA performance measures. The ultimate goal of the present document is to provide direction in defining and measuring the appropriate use-avoiding not only underuse but also overuse and misuse-and proper application of cardiovascular technology and to describe how such appropriate use measures and structure/safety measures might be developed for the purposes of quality improvement and public reporting. It is anticipated that this effort will help focus the national dialogue on the use of cardiovascular technology and away from the current concerns about volume and cost alone to a more holistic emphasis on value.
52 citations
TL;DR: A developmental hypothesis focusing on the possible implication of motherese impoverishment during the course of parent–infant interactions as a possible co‐factor is described and the methodological approach used to develop a computerized algorithm to detect motheree in home videos is described.
Abstract: Autism is a well-defined clinical syndrome after the second year of life, but information on autism in the first two years of life is still lacking. The study of home videos has described children with autism during the first year of life as not displaying the rigid pattern typical of later symptoms. Therefore, developmental/environmental factors are claimed in addition to genetic/biological ones to explain the onset of autism during maturation. Here we describe (1) a developmental hypothesis focusing on the possible implication of motherese impoverishment during the course of parent-infant interactions as a possible co-factor; (2) the methodological approach we used to develop a computerized algorithm to detect motherese in home videos; (3) the best configuration performance of the detector in extracting motherese from home video sequences (accuracy = 82% on speaker-independent versus 87.5% on speaker-dependent) that we should use to test this hypothesis.
46 citations
TL;DR: Stenting is an economically attractive alternative to endarterectomy for patients at high surgical risk and over 98 percent of bootstrap estimates <$50,000/QALY gained.
Abstract: Objectives: To evaluate the cost-effectiveness of carotid stenting vs. carotid endarterectomy using data from the SAPPHIRE trial. Background: Carotid stenting with embolic protection has been introduced as an alternative to carotid endarterectomy for prevention of cerebrovascular and cardiovascular events among patients at increased surgical risk. Methods: Between August 2000 and July 2002, 310 patients with an accepted indication for carotid endarterectomy but at high risk of complications were randomized to and subsequently underwent either carotid stenting (n = 159) or endarterectomy (n = 151). Clinical outcomes, resource use, costs, and quality of life were assessed prospectively for all patients over a 1-year period. Life expectancy, quality-adjusted life expectancy, and health care costs beyond the follow-up period were estimated for patients alive at 1 year, based on observed clinical events during the first year of follow-up. Results: Although initial procedural costs were significantly higher for stenting than for endarterectomy (mean difference: $4,081/patient; 95% CI, $3,849–$4,355), mean post-procedure length of stay was shorter for stenting (1.9 vs. 2.9 days; P < 0.001) with significant associated cost offsets. As a result, initial hospital costs were just $559/patient higher with stenting (95% CI, $3,470 less to $2,289 more). Neither follow-up costs after discharge nor total 1-year costs differed significantly. The incremental cost-effectiveness ratio for stenting compared with endarterectomy was $6,555 per quality-adjusted life year (QALY) gained, with over 98 percent of bootstrap estimates <$50,000/QALY gained. Conclusions: Although carotid stenting with embolic protection is more costly than carotid endarterectomy, by commonly accepted standards, stenting is an economically attractive alternative to endarterectomy for patients at high surgical risk. © 2011 Wiley-Liss, Inc.
43 citations
TL;DR: Elderly patients with severe aortic stenosis undergoing medical management have limited long-term survival and incur substantial costs to the Medicare Program, which has important implications for policy makers interested in better understanding the cost-effectiveness of emerging treatment options such as transcatheter aortsic valve replacement.
36 citations
TL;DR: These unadjusted observational findings provide support for the continued use of DES in routine practice but highlight the important impact of prolonged dual antiplatelet use on the cost-effectiveness of this technology.
Abstract: Background—Drug-eluting stents (DES) reduce the need for repeat target revascularization (TVR) compared with bare metal stents (BMS) but are more costly. The objective was to evaluate the cost-effectiveness of DES versus BMS. Methods and Results—We evaluated clinical outcomes and costs of care over 3 years in 1147 undergoing BMS before the availability of DES and 1247 DES patients at Wake Forest University Baptist Medical Center from 2002 to 2005. Costs for index stenting, TVR, and clopidogrel use were assessed. The 2 groups were well matched for baseline characteristics. Index stenting costs were $1846 higher per patient for DES versus BMS ($1737 more to $1950 more). At 3 years, absolute TVR rates were 15.2 per 100 DES patients and 24.1 per 100 BMS patients, and as a result, cumulative TVR-related costs were $2065 less per patient for DES versus BMS ($3001 less to $1134 less). Including the cost of clopidogrel, the incremental cost-effectiveness ratio per TVR avoided with DES was $4731 through 1 year, $4...
TL;DR: VDBL in an adolescent population with severe mental illness is lower than current recommendations of optimal level for bone health regardless of treatment or disease type, and vitamin D supplementation is recommended.
Abstract: Background: To protect against osteoporosis, keeping the vitamin D blood level (25[OH]D; VDBL) above 30 ng/mL is recommended. It is established that regular intake of vitamin D, calcium intake, and physical exercise contribute to maximizing bone mineral mass during childhood and adolescence. Recent articles suggest that patients with schizophrenia treated with antipsychotics have low VDBL and may have a higher risk of hip fractures in their later years than the general population. Objectives: To evaluate whether adolescent psychiatric inpatient VDBL is lower than the 30-ng/mL optimal threshold and to document low-VDBL risk factors. Method: We determined the VDBL of all consecutive inpatients from three adolescents units in 2009 (N = 136). Univariate analyses explored the influence on VDBL of (1) well-documented risk factors (e.g., age, gender, ethnic origin, body mass index, or season) and (2) suspected risk factors (e.g., disease type or antipsychotic treatment). Results: All but six patients ha...
TL;DR: In the EVENT Registry, minor surgery was performed in 2% of patients in the first year after DES implantation, which was slightly higher than the background rate of ischemic events in the study population.
TL;DR: Among unselected patients undergoing PCI, bivalirudin use during PCI was associated with a lower risk of bleeding at all comparator ACT levels without an increase in ischemic outcomes.
Abstract: Background—Prior randomized trials have shown reduced bleeding with bivalirudin compared with unfractionated heparin (UFH) in patients undergoing percutaneous coronary intervention (PCI). However, it is not known if this benefit is also present when UFH doses are more tightly controlled (as measured by activated clotting time, ACT). Methods and Results—Patients enrolled in the EVENT (Evaluation of Drug-Eluting Stents and Ischemic Events) registry, were divided into 3 groups, based on the antithrombotic drug used during PCI (UFH monotherapy, UFH+glycoprotein IIb-IIIa receptor inhibitor [GPI], or bivalirudin alone). Propensity score matching was used to adjust for measured covariates (89 variables) and to compare bivalirudin versus UFH monotherapy and bivalirudin versus UFH+GPI groups. The UFH groups were stratified based on ACT achieved (optimal ACT defined as 250–300 for UFH monotherapy and 200–250 when GPI was also used). The primary bleeding outcome was in-hospital composite bleeding, defined as events ...
TL;DR: The PDD-NOS group had difficulty processing emotional stimuli in general and more easily identified happy compared to angry or neutral faces and vocalizations, and had a strong discrepancy between emotional and neutral human stimuli processing.
TL;DR: In this article, the authors explore specificities des troubles psychiatriques presentes par les jeunes pris en charge par l'aide sociale a l'enfance (ASE), and des facteurs de risque auxquels ils sont confrontes.
Abstract: Resume Les enfants et adolescents pris en charge par l’aide sociale a l’enfance (ASE) constituent une population a haut risque de developper une pathologie psychiatrique. A travers une etude clinique realisee dans les unites d’hospitalisation d’un service de psychiatrie de l’enfant et de l’adolescent, nous avons explore les specificites des troubles psychiatriques presentes par les jeunes pris en charge par l’ASE, et des facteurs de risque auxquels ils sont confrontes. Les resultats montrent davantage de troubles des conduites chez les jeunes pris en charge par l’ASE, et au niveau des variables dimensionnelles, plus de traits caracterisant l’organisation limite, soit davantage d’impulsivite, de labilite emotionnelle, d’hostilite et de troubles des relations. Les facteurs de risque environnementaux et familiaux retrouves de facon significative dans le groupe ASE sont les conflits familiaux, les parents isoles, les pathologies psychiatriques des parents, les ruptures repetees dans les lieux de vie. La gravite et la prevalence elevees de troubles psychiatriques chez les jeunes pris en charge par l’ASE et necessitant des soins hospitaliers specialises montrent l’impact des interactions avec l’environnement sur le developpement de la psychopathologie chez l’enfant et l’insuffisance de moyens de prevention adaptes.
TL;DR: Regardless of analytic approach, CVD is the primary contributor to overall mortality during the first 30 days after PCI, whereas rates of CVD and non-CVD are remarkably similar after the first month after PCI.
TL;DR: The results of this exploratory study suggest that wet sheet packs may be effective in relieving auto/hetero aggressive behaviors in children and adolescents hospitalized in a psychiatric setting.
Abstract: Objective: To explore the effectiveness of wet sheet packs on auto/hetero aggressive behaviors in children and adolescents hospitalized in a psychiatric setting. Method: We reviewed the charts of all patients (N=8) who received packing therapy in the context of resistance to behavioral interventions, milieu therapy and medications from 2005-2009. We scored the level of auto/hetero aggressive behaviors per patient for each day they were hospitalized. Inter rater reliability was good (Intraclass correlations=0.91). We used a mixed generalized linear model to assess whether the following explanatory variables (time, typical and atypical antipsychotics, mood stabilizer, sedative drug, stimulant and wet sheet pack) influenced the course of aggression over time, the dependant variable. Results: Using univariate analysis, the only variables that were found to be associated with a significant decrease in auto/hetero aggressive score were time (p=8 10 -3 ), atypical antipsychotics (p=.027) and packing therapy (p=10 -9 ). Effect of packing therapy remained significant after adjustment for atypical antipsychotics (p=1.8 10 -9 ) and for time (p=.0017). Conclusion: In addition to atypical antipsychotics and milieu therapy, the results of this exploratory study suggest that wet sheet packs may be effective in relieving auto/hetero aggressive behaviors.
TL;DR: In this article, the reliability and diagnostic efficiency of the Diagnostic Inventory for Disharmony (DID) were explored and its concurrent validity with the Vineland Adaptive Behavior Scales (VBAS) and its concordance with Multiplex Complex Developmental Disorder (MCDD) and PDD-NOS.
TL;DR: The results of published evaluations of the cost-effectiveness of oral antiplatelet strategies for use across a range of clinical conditions and treatment settings are reviewed and support the use of aspirin for primary prevention in high-risk patients and for secondary prevention in all patients with previous cardiovascular events.
Abstract: Cardiovascular disease is both highly prevalent and exceedingly costly to treat. Several novel antiplatelet agents have been found to be effective in reducing the morbidity and mortality associated with cardiovascular disease. Understanding both the economic and the clinical implications of these novel therapies is particularly important. In this article, the results of published evaluations of the cost-effectiveness of oral antiplatelet strategies for use across a range of clinical conditions and treatment settings are reviewed. The results of these studies support the use of aspirin for primary prevention in high-risk patients and for secondary prevention in all patients with previous cardiovascular events. Although the optimal duration of dual antiplatelet therapy after an event remains uncertain, favorable cost-effectiveness estimates have been demonstrated for aspirin plus clopidogrel versus aspirin alone after a myocardial infarction or percutaneous coronary intervention. Moreover, prasugrel has been shown to be more cost-effective than clopidogrel for patients with an acute coronary syndrome and planned percutaneous coronary intervention. As novel antiplatelet agents emerge and existing agents are tested in different patient populations, the evaluation of the relative economic efficiency of these oral antiplatelet treatment strategies will continue to be instrumental to optimally inform clinical and health-policy decision-making.
TL;DR: In this paper, the authors explore les troubles langagiers et psychopathologiques presentes par des jeunes pris en charge par l'aide sociale a l'enfance (ASE) and hospitalises.
Abstract: Resume Les enfants et adolescents pris en charge par l’aide sociale a l’enfance (ASE) constituent une population a haut risque de developper une pathologie psychiatrique et un trouble du langage oral ou ecrit. A travers une etude clinique cas–temoin realisee dans les unites d’hospitalisation d’un service de psychiatrie de l’enfant et de l’adolescent, nous avons explore les troubles langagiers et psychopathologiques presentes par des jeunes pris en charge par l’ASE, et hospitalises (n = 104). Apres un screening des aptitudes langagieres, les enfants presentant au moins un score inferieur a deux deviations standard aux normes ont beneficie d’un protocole individuel evaluant le langage oral, les prerequis du langage ecrit et les performances en lecture et orthographe. Nos resultats montrent, chez les jeunes confies a l’ASE, une faiblesse du langage elabore, un deficit significatif en conscience phonologique et une fragilite des voies d’assemblage et d’adressage de la lecture. En outre, nous avons retrouve une association significative entre les troubles du langage et le genre (garcon), le retard mental et les troubles envahissants du developpement. Si les troubles externalises sont frequemment assoc ies aux troubles du langage ecrit, cette association est surtout portee par le genre. Enfin, nous avons observe qu’un jeune confie a l’ASE avait 3,5 fois (95 %CI : 1,03–12,05, p = 0,038) moins de chance de beneficier d’une orthophonie pour un trouble du langage associe. En conclusion, ces resultats soulignent l’impact d’un milieu defavorise sur les acquisitions du langage ecrit et l’influence conjointe des troubles psychiatriques associes et de l’insuffisance de mesures de prise en charge adaptees chez des jeunes carences.
Journal Article•
Journal Article•
07 Jul 2011
TL;DR: In this paper, the authors report results of perceptual experiments aimed to explore the human ability to recognize emotional expressions through the visual and auditory channel, investigating if one channel is more effective than the other to infer emotional information.
Abstract: The present work reports results of perceptual experiments aimed to explore the human ability to recognize emotional expressions through the visual and auditory channel, investigating if one channel is more effective than the other to infer emotional information and if this effectiveness is affected by the cultural context and in particular by the language. To this aim American, French, and Italian subjects were involved in a comparative analysis of subjective perceptions of emotional states dynamically portrayed by visual and vocal cues, exploiting a cross-modal database of verbal and non-verbal American video clips. What should make the difference is that while one group of participants is native speaker of the language and belongs to the same cultural context of the video-clips used as stimuli (the American English), the other two are not. Results showed that emotional information is affected by the communication mode and that language plays a role.
TL;DR: In this paper, the authors present a categorisation of maladies neurometaboliques (MNM) which are atypicites dans la semiologie schizophrenique.
Abstract: Resume La recherche d’une pathologie organique associee est un element essentiel de la prise en charge de tout patient en psychiatrie. Les pathologies du spectre des schizophrenies, dont la prevalence approche le 1 % de la population generale, sont associees a des troubles organiques multiples. Une recherche exhaustive et systematique etant peu envisageable, il est important de se concentrer sur les pathologies traitables et de connaitre des signes d’appels organiques, mais surtout psychiatriques, en particulier des atypicites dans la semiologie schizophrenique. Cet article se concentre sur les maladies neurometaboliques (MNM), en prenant l’exemple de la maladie de Niemann Pick de type C (NPC). Les MNM sont essentiellement des pathologies genetiques de deficit enzymatique, ce qui signifie que les perturbations metaboliques apparaissent des la naissance, meme si elles sont cliniquement presentes que plus tard dans la vie. Un grand nombre d’entre elles expriment des signes psychiatriques (deficit intellectuel, troubles schizophreniformes ou autres) souvent atypiques. Dans un certain nombre de cas, ces signes peuvent apparaitre avant les signes organiques et ne constituer que le seul point d’appel diagnostique. Pour les MNM traitables, l’enjeu majeur est donc la detection precoce par les psychiatres, et singulierement les psychiatres d’enfant et d’adolescent. Nous presentons succinctement la categorie des MNM puis le NPC avant de proposer un outil clinique psychiatrique et une conduite a tenir simple pour aider les psychiatres a evoquer ces pathologies et permettre des explorations complementaires.
TL;DR: Among unselected patients undergoing elective PCI with bivalirudin as the planned anticoagulant, clopidogrel pretreatment was common but was not associated with a reduced risk of ischemic complications.
Abstract: Although clopidogrel pretreatment benefits patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndromes, these benefits are less well established among patients undergoing elective PCI—in particular, when they are treated with the direct thrombin inhibitor, bivalirudin. We used data from the multicenter Evaluation of Drug Eluting stents and ischemic Events registry to assess the association between clopidogrel pretreatment and PCI-related complications among patients undergoing elective PCI with bivalirudin as the antithrombotic regimen. The primary end point was the composite of in-hospital death or myocardial infarction. From January 2005 and December 2007, 4,681 patients underwent elective PCI at 55 United States centers, and 1,913 (41%) received bivalirudin as the planned anticoagulant. Clopidogrel pretreatment was used in 923 patients (48%). The incidence of in-hospital death or myocardial infarction was similar among patients who did and did not receive clopidogrel pretreatment (5.5% vs 5.8%, p = 0.83). This result was unchanged in propensity-adjusted analyses (adjusted odds ratio for pretreatment 0.91, 95% confidence interval 0.60 to 1.39, p = 0.66). Also, no differences were seen in the in-hospital bleeding events (1.0% vs 1.0%, p = 0.94) or 1-year ischemic complications between the 2 treatment groups (7.5% vs 8.3%, p = 0.26). In conclusion, among unselected patients undergoing elective PCI with bivalirudin as the planned anticoagulant, clopidogrel pretreatment was common but was not associated with a reduced risk of ischemic complications.
TL;DR: It can be concluded that there are no discrepancies between psychodynamic views and experimental data, whether one tests psychotherapeutic approaches, discusses data from other fields such as psychopharmacology, or designs experiments based on psychodynamic theory.
Abstract: The question of whether a psychodynamic view is compatible with experimental research is still a challenging issue—especially for child and adolescent psychopathology—despite the influence of psychoanalytic theory in this field until the 1980s. In this article, is explored the relationship between psychodynamic theory and experimental research using examples of evidence-based studies in the fields of (i) psychotherapeutic intervention assessment, (ii) placebo response in children and adolescents, (iii) unconscious lasting traumatic effects in children and adolescents, (iv) psychodynamic-oriented psychological testing. There are now a sufficient number of evidence-based studies to support the use of psychodynamic therapy in mental disorders, particularly in personality disorder and anxious/depressive disorder. In addition, placebo responses in children and adolescents with internalizing disorders are significantly higher in major depression compared to obsessive–compulsive disorder or other anxiety disorders, which highlights differential psychopathologies regarding the experience of loss. Also, using an experimental task, psychoanalysts are able to identify, without explicit knowledge and above the level of chance, healthy adults whose siblings had experienced cancer during childhood. This experiment suggests that implicit information regarding a participant’s history is conveyed in interpersonal exchanges that can be intuitively perceived by judges experienced in listening to free associations from a psychodynamic perspective. Finally, psychodynamic-oriented psychological testing may predict the transition to schizophrenia in adolescents with a history of manic/mixed episodes. It can be concluded that there are no discrepancies between psychodynamic views and experimental data, whether one tests psychotherapeutic approaches, discusses data from other fields such as psychopharmacology, or designs experiments based on psychodynamic theory.
TL;DR: The potential to eliminate the risk of restenosis, a benign complication, would have substantial value for patients undergoing PCI and this association followed a quadratic effect.
Abstract: Background—Percutaneous coronary intervention (PCI) remains limited by the risk of restenosis. Patients' perceptions of the health benefits and value of avoiding restenosis are incompletely known. Methods and Results—We used a contingent valuation approach to assess the willingness to pay (WTP) for a hypothetical treatment that eliminates the risk of restenosis among 270 PCI patients. Patients were provided with a scenario describing a baseline 10% or 20% probability of restenosis in the year following the procedure, which could lead to repeat PCI or, more rarely, bypass surgery, without any increase in mortality. Six different “take it or leave it” bids ($500, $1000, $1500, $2000, $2500, and $3000) and both risk levels were randomly assigned. Multiple logistic regression was used to identify independent predictors of a positive response to the WTP question. Using nonparametric methods, the median WTP to eliminate the risk of restenosis was estimated at $2802. As expected, higher income was independently ...
TL;DR: Among the subgroup of patients with established cardiovascular disease in the CHARISMA trial, adding clopidogrel to aspirin increases life expectancy at a cost generally considered acceptable in Canada.