Epidemiology of alcohol use disorder in the general population of Togo and Benin: the ALCOTRANS study.

INTRODUCTION: Access to data concerning mental health, particularly alcohol use disorders (AUD), in sub-Saharan Africa is very limited. This study aimed to estimate AUD prevalence and identify the associated factors in Togo and Benin. METHODS: A cross-sectional study was conducted between April and May 2022, targeting individuals aged 18 years and above in the Yoto commune of Togo and the Lalo commune of Benin. Subjects were recruited using a multi-stage random sampling technique. AUD diagnoses were made using the MINI adapted to DSM-5 criteria. Our study collected sociodemographic information, data on psychiatric comorbidities, stigmatization, and assessed cravings, using a series of scales. The association between AUD and various factors was analyzed using multivariable logistic regression. RESULTS: In Togo, 55 of the 445 people investigated had AUD (12.4%; [95% CI: 9.5-15.7%]). Among them, 39 (70.9%) had severe AUD and the main associated comorbidities were suicidal risk (36.4%), and major depressive disorder (16.4%). Associated factors with AUD were male gender (aOR: 11.3; [95% CI: 4.8-26.7]), a higher Hamilton Depression Rating Scale (HDRS) score (aOR: 1.2; [95% CI: 1.1-1.3]) and a lower Stigma score measured by the Explanatory Model Interview Catalogue (EMIC) (aOR: 0.9; [95% CI: 0.8-0.9). The stigma scores reflect perceived societal stigma towards individuals with AUD. In Benin, 38 of the 435 people investigated had AUD (8.7%; [95% CI: 6.4-11.7]), and the main associated comorbidities were suicidal risk (18.4%), tobacco use disorder (13.2%) and major depressive episode (16.4%). Associated factors with AUD were male gender (aOR: 6.4; [95% CI: 2.4-17.0]), major depressive disorder (aOR: 21.0; [95% CI: 1.5-289.8]), suicidal risk (aOR: 3.7; [95% CI: 1.2-11.3]), a lower Frontal Assessment Battery (FAB) score (aOR:0.8; [95% CI: 0.8-0.9]) and a lower perceived stigma score (by EMIC )(aOR: 0.9; [95% CI: 0.8-0.9]). CONCLUSION: In these communes of Togo and Benin, AUD prevalence is notably high. A deeper understanding of the disease and its local determinants, paired with effective prevention campaigns, could mitigate its impact on both countries.

Alcohol Use Disorder in the General Population in Sub-Saharan Africa.

INTRODUCTION: Alcohol use disorder (AUD) is one of the major risk factors for population health worldwide. In some regions, this disorder remains underdiagnosed. This is particularly the case in sub-Saharan Africa, where data on this disease in the general population remains scarce. The aim of this review was to describe the characteristics of AUD in sub-Saharan Africa. METHODS: We have conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Web of Science, African Journals Online, African Index Medicus, PsycINFO, Cochrane, and Scopus were investigated. Studies were included if they were conducted in a general population using a validated assessment tool. RESULTS: A total of 16 articles were selected and were conducted in 8 sub-Saharan African countries. The prevalence of AUD ranged from 0.1% to 33.2% in Nigeria. The most commonly used screening tool was the Alcohol Use Disorders Test (AUDIT), and among the factors associated with the AUD, we find mainly male gender, low income, Catholic religion, and the presence of a psychiatric comorbidity. CONCLUSION: In sub-Saharan Africa, too few studies have investigated the AUD in the general population with validated diagnostic tools. Prevalence data seem to vary widely between and even within countries. The main factors associated with AUD are those found in the Western literature. The wide variety of assessment tools used to screen for AUD makes it difficult to compare prevalences across countries.

Repetitive Behaviors in Alzheimer's Disease: A Systematic Review and Meta-Analysis.

BACKGROUND: Repetitive behaviors (RBs) are a well-known symptom of Alzheimer's disease (AD); however, they have been little studied and have not been the subject of any specific literature review. OBJECTIVE: To conduct a systematic review of all studies to document RBs in AD. METHODS: An extensive literature search combining five databases and a meta-analysis were conducted to investigate the frequency, nature, and cognitive correlates of RBs in AD. RESULTS: Ten studies were included in the review. Seven studies out of ten investigated the frequency of RBs in patients with AD, which ranged from 52.3% to 87%. A meta-analysis showed an overall frequency of 66.3% (95% CI: 55.5; 77.1) of patients exhibiting RBs in AD, but important heterogeneity was observed between studies. Three studies investigated the predominant nature of RBs in AD. Verbal RBs, complex behavioral stereotypies, and simple motor stereotypies have been identified to different degrees depending on the level of dementia. Most verbal RBs are underpinned by episodic memory impairment, while simple motor stereotypies and complex behavioral stereotypies are mostly underpinned by executive dysfunction. CONCLUSIONS: The current review seems to suggest that there are two types of mechanisms underpinning RBs involved in AD. The first is observed especially in the mild stages of the disease and is mediated by episodic memory impairment. The second occurs later and is mediated by executive impairment. Additional studies should be conducted to improve the knowledge about RBs in AD and thus improve their management.Systematic review registration number: PROSPERO 2022: CRD42022310027.

Effectiveness of the Therapeutic Community Model in Addiction Treatment: A Retrospective Pilot Study in French Prisons.

BACKGROUND: In France, addiction care in prison usually consists of nurses' interventions, medical care and socio-educational programs, but new alternatives have arisen, namely the therapeutic community (TC) model. This pilot study aims to evaluate the effectiveness of this prison-based TC in comparison with classic and socio-educational care offered in French prisons. METHODS: To compare these three types of prison-based care, two detention centers' files were screened for use of multiple drugs, willingness to participate and absence of psychiatric comorbidities incompatible with group therapy. A custom questionnaire was built based on the fifth version of the Addiction Severity Index. It investigates medical status, employment and support, primary addiction status, legal status, social/familial status and psychiatric status through various items. RESULTS: Our sample only consisted of male repeat offenders with a mean age of 37.7 ± (9.1) years. Primary addiction status improvement was observed for all care studied but was more important in TC than in classic care. Self-esteem and social/familial status saw significant improvement throughout TC care. CONCLUSIONS: The TC model represents an alternative to classic and socio-educational care in French prisons. More studies are needed to assess the extent of the benefits provided on both the medical side and economic side.

Epidemiology of Epilepsy in Low- and Middle-Income Countries: Experience of a Standardized Questionnaire over the Past Two Decades.

INTRODUCTION: Epilepsy affects >50 million people worldwide, with 80% of them living in low- and middle-income countries (LMICs). Studies with a standardized methodology are required to obtain comparable data on epilepsy and implement health policies in order to reduce the treatment gap and improve the diagnosis and management of epilepsy. In 2000, following the guidelines of the International League Against Epilepsy (ILAE), the "questionnaire for investigation of epilepsy in tropical countries" (IENT questionnaire) was developed to promote epidemiological surveys on epilepsy using a standard methodology. This study aims to describe how, when, where, and why the IENT questionnaire has been used through epidemiological studies on epilepsy over the last 2 decades and to acquire users' opinions about the tool. METHODS: Studies that used the IENT questionnaire were searched through international and local bibliographic databases, including the gray literature. An online survey was carried out, including a snowball effect. Original research studies were included. Characteristics of the studies and populations and general information on the instrument and its use were collected. RESULTS: Eighty-two documents were selected referring to 61 studies that were mostly carried out on the African continent (n = 54). Most of them aimed to determine the prevalence (n = 31) and associated factors (n = 28) of epilepsy in LMICs. Among the 61 studies, 35 were population-based, and 30 included both adults and children. A methodological heterogeneity was found between studies, and in cases where the IENT questionnaire alone did not ensure complete data collection, other tools were used concomitantly (n = 40). DISCUSSION/CONCLUSION: Over the last 2 decades, the IENT questionnaire has been continuously used in different LMICs. This result favors its promotion and updating, with the inclusion of new topics related to epilepsy (e.g., comorbidities, quality of life, and stigma), current ILAE guidelines, and digital versions.

Inventory and Analysis of Controlled Trials of Mobile Phone Applications Targeting Substance Use Disorders: A Systematic Review.

Background: Less than 20% of people with addictions have access to adequate treatment. Mobile health could improve access to care. No systematic review evaluates effectiveness of mobile health applications for addiction. Objectives: First aim was to describe controlled trials evaluating the effectiveness of smartphone applications targeting substance use disorders and addictive behaviors. Secondly, we aimed to understand how the application produced changes in behavior and craving management. Method: A systematic review based on PRISMA recommendations was conducted on MEDLINE, CENTRAL, and PsycINFO. Studies had to be controlled trials concerning addictive disorders (substance/behavior), mobile application-based interventions, assessing effectiveness or impact of those applications upon use, published after 2008. Relevant information was systematically screened for synthesis. Quality and risk of bias were evaluated with JADAD score. Results: Search strategy retrieved 22 articles (2014-2019) corresponding to 22 applications targeting tobacco, alcohol, other substances and binge eating disorder. Control groups had access to usual treatments or a placebo-application or no treatment. Eight applications showed reduced use. Most of the applications informed about risks of use and suggestions for monitoring use. Twelve applications managed craving. Discussion: Heterogeneity limited study comparisons. Duration of studies was too short to predict sustainable results. A reduction of craving seemed related to a reduction in use. Conclusion: There is a lack of robust and comparable studies on mHealth applications for addiction treatment. Such applications could become significant contributors in clinical practice in the future so longer-termed double-blind studies are needed. Targeting craving to prevent relapse should be systematic.

BDNF and pro-BDNF in serum and exosomes in major depression: Evolution after antidepressant treatment.

BACKGROUND: The study of clinically related biological indicators in Major Depression (MD) is important. The Brain Derived Neurotrophic Factor (BDNF) appears to play an important role in MD, through its neurotrophic effect, and its levels are significantly decreased. The variation in the serum levels of its precursor proBDNF, which has opposite effects, is not known. Their distribution between serum and exosomes and their evolution during antidepressant treatment is also not known, and may be important in modulating their effects. The aim of this study is to evaluate whether serum and exosome mBDNF and proBDNF levels are altered in patients with MD during antidepressant treatment compared to controls, and their association with clinical improvement and clinical variables. MATERIALS AND METHODS: 42 MD subjects and 40 controls were included. Questionnaires to assess the severity of depression and cognitive impairment and blood samples were collected during the three visits at D0 (inclusion) and 3 and 7 weeks after the start of antidepressant treatment. Assays for mBDNF and proBDNF levels were performed in serum and exosomes by ELISA. RESULTS: MD subjects had decreased serum and exosomal BDNF levels and increased proBDNF levels at D0 compared to controls. BDNF and pro-BDNF vary in an inverse manner in both serum and exosomes during antidepressant treatment. No relationship of BDNF and proBDNF levels to clinical improvement and depression scales was found. CONCLUSION: We demonstrated an evolution of those molecules either in serum or in exosomes after MD treatment. These transport vesicles could have a role in the regulation of BDNF.