[Catatonia education in France: A cross-sectional study]. / L'enseignement du syndrome catatonique en France : enquête nationale et état des lieux.

OBJECTIVES: Catatonia is a transnosographic syndrome described by K. Kahlbaum in 1874. Catatonia can be life-threatening due to its complications and in case of malignant catatonia. Safe and effective treatments have been identified (benzodiazepines and electro-convulsive-therapy). The prevalence of this syndrome is important and represents about 10% of inpatients in an acute psychiatric ward. However, this syndrome appears to remain under-diagnosed and poorly known. We were, therefore, interested in the current knowledge of French psychiatry residents and young psychiatrists as well as the education they had received about catatonia. METHODS: A questionnaire was submitted to French psychiatry residents and young psychiatrists with fewer than 5 years of experience. It included questions about knowledge of the symptoms, complications, causes and treatments of catatonia. Participants were also asked about their confidence in the management of a patient with catatonia and about the number of catatonic patients they had already met. The type of lecture and teaching about catatonia was also assessed. RESULTS: Among the 376 psychiatrists that completed the questionnaire, 37.5% never had received any specific teaching about catatonia. Concerning the 62.5% who benefited from a specific lecture, this was mainly delivered as part of psychiatry DES. Heterogeneity in the education delivery on the French territory had been highlighted. In addition, participants' knowledge of catatonic syndrome seems incomplete. However, knowledge of catatonic symptoms and first intention treatments was significantly better among respondents who were part of the "with education" group. The confidence in catatonia recognition and management, as well as the number of catatonic patients they met, are also significantly higher in the group "with education". CONCLUSION: Specific education seems to improve the knowledge of young doctors and their ability to diagnose and treat catatonic patients. This education remains poorly provided and heterogeneous on the French territory. Catatonia deserves a place in the teaching program of the psychiatry DES, thus to become systematic.

Type A competitiveness traits correlate with downregulation of c-Fos expression in patients with type 1 diabetes.

AIM: Type A personality has been associated with increased survival in people with type 1 diabetes (T1D). Systemic low-grade inflammation may play a critical role, as suggested in recent reports, although the links between the inflammatory circulating transcriptome and Type A remain unknown. This prompted our exploration of the potential associations between Type A personality and c-Fos gene expression, a candidate gene closely linked to inflammatory processes, in T1D. METHODS: Type A personality was assessed by Bortner questionnaire in patients with T1D, and two subscales - 'speed' and 'competitiveness' - were used to measure these specific dimensions of Type A. Expression of the c-Fos gene was assessed by a quantitative real-time polymerase chain reaction technique. RESULTS: This pilot study included 20 men with T1D. Multivariable analyses showed an independent inverse association between Type A competitiveness score and c-Fos expression, while a regression model adjusted for age, body mass index and HbA1c levels revealed a significant inverse relationship between c-Fos transcripts and Type A competitiveness (P = 0.003). CONCLUSION: This strong association between Type A competitiveness and reduced c-Fos expression is in line with recent data suggesting a psychobiological influence of the Type A profile in T1D via inflammatory pathways.

Mast cells' involvement in inflammation pathways linked to depression: evidence in mastocytosis.

Converging sources of evidence point to a role for inflammation in the development of depression, fatigue and cognitive dysfunction. More precisely, the tryptophan (TRP) catabolism is thought to play a major role in inflammation-induced depression. Mastocytosis is a rare disease in which chronic symptoms, including depression, are related to mast cell accumulation and activation. Our objectives were to study the correlations between neuropsychiatric features and the TRP catabolism pathway in mastocytosis in order to demonstrate mast cells' potential involvement in inflammation-induced depression. Fifty-four patients with mastocytosis and a mean age of 50.1 years were enrolled in the study and compared healthy age-matched controls. Depression and stress were evaluated with the Beck Depression Inventory revised and the Perceived Stress Scale. All patients had measurements of TRP, serotonin (5-HT), kynurenine (KYN), indoleamine 2,3-dioxygenase 1 (IDO1) activity (ratio KYN/TRP), kynurenic acid (KA) and quinolinic acid (QA). Patients displayed significantly lower levels of TRP and 5-HT without hypoalbuminemia or malabsorption, higher IDO1 activity, and higher levels of KA and QA, with an imbalance towards the latter. High perceived stress and high depression scores were associated with low TRP and high IDO1 activity. In conclusion, TRP metabolism is altered in mastocytosis and correlates with perceived stress and depression, demonstrating mast cells' involvement in inflammation pathways linked to depression.

Potential influence of Type A personality on plasma C-reactive protein levels in people with diabetes.

AIM: Type A personality, although classically known as a factor linked to increased vascular risk, has recently been associated with increased survival in patients with diabetes. As low-grade inflammation predicts a poor outcome, the present study explored the potential associations between Type A and plasma levels of C-reactive protein (CRP) in diabetes. METHODS: Type A personality was assessed by the Bortner questionnaire in people with diabetes. The association between Type A and plasma CRP levels was examined by multivariable linear regression, and structural equation modelling (SEM) was performed to determine the impact of the major clinical, biological and psychological confounders. RESULTS: The study included 626 participants with type 1 and type 2 diabetes from the Diabetes and Psychological Profile study. Multivariable analyses showed an independent inverse association between Type A score and CRP levels. The structural model adjusted for age, gender, diabetes type and duration, body mass index (BMI), smoking status, alcohol abuse, oral antidiabetic and statin treatments, HbA1c levels, lipids, perceived stress, anxiety and depression revealed significant associations between CRP and Type A (ß=-0.135, 95% CI: -0.242, -0.028; P=0.014), BMI (ß=0.194, 95% CI: 0.038, 0.350; P=0.015) and HDL cholesterol (ß=-0.132, 95% CI: -0.245, -0.020; P=0.014). CONCLUSION: Our present study data indicate that Type A personality is independently associated with lower CRP levels. This lower level of inflammation might explain the better clinical outcomes associated with Type A personality in patients with diabetes.

[Evolution in styles of romantic and interpersonal attachment in depressed adult women during hospitalization]. / Évolution des styles d'attachement romantique et interpersonnel au cours de l'hospitalisation chez des femmes adultes déprimées.

INTRODUCTION/OBJECTIVE: Bowlby (1984) regarded attachment as a model of psychological vulnerability to depression. Since then, a large number of studies have considered vulnerability to depression in light of the idea of attachment style. Attachment styles correspond to two dimensions observed in relationships (anxiety and avoidance) evoking ideally the internal operating models of self and other respectively, as first described by Bowlby (1984). Two types of adult attachment styles are evaluated in our study: romantic attachment (Hazan and Shaver, 1987) and interpersonal attachment (Bartholomew and Horowitz, 1991). The existing literature indicates that depression is associated with the insecure attachment styles, in both romantic an interpersonal relationships. Nevertheless, a question remains concerning the nature of the link between attachment style and depression: are attachment styles stable and independent of the depression or are they modified as the depression evolves? The aim of the present study was to investigate the relationships between attachment and depression in adult women hospitalized for depression; following up the evolution in their romantic and interpersonal attachment styles from the beginning to the end of their hospitalization. METHODOLOGY: The study population consisted of 50 women hospitalized for an episode of major depression (Axis I, DSM IV). Individuals exhibiting bipolar disorders and other pathologies linked to depression were not included in the population. Sixty-eight percent of the depressed women in our population had previously experienced depressive episodes and 42% of them also exhibited a personality disorder (Axis II, DSM IV). The clinical group participated in two psychological investigations, one at the beginning (T1) and one at the end of the hospitalization (T2), including each time a clinical interview during which the depression as well as the romantic (ECR, 1998) and interpersonal (RQ, 1991) attachment styles were evaluated. STUDY RESULTS: Our findings showed that depression is positively correlated with the "avoidant" dimension of the romantic attachment style and negatively with the "secure" dimension of the interpersonal attachment style. Between the beginning and the end of hospitalization, only the "secure" and "fearful" dimensions of the interpersonal attachment styles were modified, whereas the styles of romantic attachment remained stable. In terms of the links between attachment styles and the evolution of depression during hospitalization (between T1 and T2), we noted that an increase in security of attachment was correlated with a decrease in the depressive symptomatology. Conversely, the other romantic and interpersonal attachment styles were not linked with the evolution of the depressive symptomatology. DISCUSSION/CONCLUSION: Our results confirm that romantic and interpersonal styles of attachment constitute factors of vulnerability to depression. But more importantly, these findings open up new perspectives in terms of the nature of the relationships between attachment styles and depression. They provide matter for discussion concerning the stability or the change in romantic and interpersonal attachment styles. Indeed, we have revealed the stable and independent nature of romantic attachment styles in relation to depressive symptomatology. On the contrary, security in the interpersonal attachment style was shown to be a factor of change, associated with the evolution of the depressive symptomatology in progress. In the quest to take combined account of romantic and interpersonal attachment styles and their links with the evolution of depression, the present study results in a new understanding of depression, viewed from the perspective of the model of attachment in adults.

[Genetic testing in asymptomatic minors: a survey among French geneticists]. / Les tests génétiques présymptomatiques chez le mineur: enquête auprès des généticiens français et position du groupe français de génétique prédictive.

Since their introduction, genetic tests have been carefully considered, with special attention to the release of information about the test and test results, the confidentiality of genetic information, the request and its motivation, and the psychological impact of the test. Careful consideration is needed when family members at risk are asymptomatic children or adolescents. Cautious reflection is warranted on whether and under which conditions genetic testing should be performed. Here, we report on the results of a survey conducted in France among 50 geneticists questioned on their opinions and practices concerning presymptomatic testing in three groups of diseases: those for which a medical benefit exists during childhood (e.g., retinoblastoma), diseases with onset during childhood for which there are no immediate medical consequences (e.g., type II/III spinal muscular atrophy), and those with onset during adulthood for which there is no medical benefit during childhood (e.g., Huntington disease). Guidelines are proposed: presymptomatic testing should not be performed in a minor without individual and direct information, all requests for presymptomatic genetic testing concerning a disease with onset in adulthood should be postponed, and all presymptomatic test requests for a minor should be addressed to a multidisciplinary team.

[Subjective quality of life profile in patients with multiple sclerosis]. / Profil de qualité de vie subjective chez les sujets atteints de sclérose en plaques.

OBJECTIVES: This study aimed to assess subjective quality of life in patients with multiple sclerosis regarding the criteria of satisfaction and importance attached to various domains of life. METHOD: Sixty-one subjects took part in this study. The psychological evaluation consisted of a clinical interview and three questionnaires: subjective quality of life profile (PQVS), State-Trait anxiety inventory (STAI), Beck depression inventory (BDI). RESULTS: The results show a low level of general satisfaction of subjective quality of life. Fatigue and pain are the most unsatisfactory domains of life while the relationships with close relations and medical staff are perceived as the most satisfactory and important domains of life. Some differences are observed between men and women regarding the satisfaction of conjugal life and fatigue perception. The subjective quality of life seems mainly correlated to anxiety, depression and to the level of handicap. CONCLUSIONS: Our results emphasize the necessity of taking into account the subjective perception of the disease which can lead in an appropriated treatment. These results underline the place of anxious and depressive disorders associated with multiple sclerosis, which seem to have a certain impact on the subjective quality of life.

[Alexithymia and links with depression and anxiety in multiple sclerosis]. / Alexithymie et liens avec la dépression et l'anxiété dans la sclérose en plaques.

OBJECTIVES: This study evaluates the prevalence of alexithymia in multiple sclerosis and examines the links between alexithymia, depression and anxiety. METHOD: Sixty-one subjects aged between 18 and 60 years and suffering from multiple sclerosis took part in the study. The psychological assessment consisted of an interview with a psychologist and three questionnaires: the Toronto Alexithymia Scale (TAS), the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory (BDI). RESULTS: The prevalence of alexithymia was 42.5%, 34.4% for depression and 44.3% for anxiety (high and moderate level). The alexithymic subjects were more depressed and anxious. Results indicated positive correlations between anxiety (state and trait), depression and alexithymia scores. The various dimensions of alexithymia were found to be diversely correlated with anxiety and depression. CONCLUSIONS: Our results point out the importance of anxiety in multiple sclerosis and the specificity of alexithymia.

[Styles of attachment and social support perceived in depressed women]. / Styles d'attachement et soutien social perçu chez des femmes déprimées.

RESULTS: This study, inspired by the attachment model and research in the field of social support, attempts to reveal the link between styles of attachment, social support and depressive vulnerability. AIM OF THE STUDY: It investigates current styles of attach-ment and the quality of social support perceived by 35 hospitalized, depressed subjects compared to 35 control subjects who exhibited no pathology. After giving their consent, each subject took part in an in-depth psychological investigation consisting of a recorded clinical interview and various clinical scales. METHOD: The study presents only the responses to the Perception of Relations questionnaire which distinguishes between four styles of attachment (secure, detached, preoccupied and disorganized) and the Social Support Questionnaire (SSQ6) which contains two dimensions: social availability and social satisfaction. The results were subjected to statistical analyses: a comparative analysis between the two groups and a correlational analysis between the dimensions of social support and the dimensions of style of attachment. On the one hand, the study reveals that the social network is perceived to be less available by depressed subjects, together with the absence of a current intimate relationship with other people, the absence of people to confide in, and a relationship between this absence and the large number of losses experienced by depressed subjects, in particular the loss of figures of attachment (father and mother). On the other hand, depressed subjects tend to exhibit a preoccupied, disorganized style of attachment which is characterized by negative models of the self. DISCUSSION: The discussion addresses the way these styles of attachment should be understood: do they represent the consequence of the depressive pathology or an older relational style?

[Pre-implantation apposition grafts for edentuous anterior maxillary. Retrospective study of 36 patients]. / La greffe d'apposition à visée pré-implantaire pour édentation maxillaire antérieure.

INTRODUCTION: Apposition grafting is a method of choice for reconstruction of the anterior maxillary. The purpose of this work was to evaluate the success rate, the degree of bone resorption and the osteointegration of these grafts. MATERIAL AND METHODS: We reviewed retrospectively 36 cases of pre-maxillary bone apposition in patients operated from 1998 to 2002. Autografts were used for all patients. The harvesting site was parietal for 24 patients, intraoral for 8 and iliac for 4. RESULTS: There was two graft failures. The success rate was 94.5%. Partial resorption with effect on implantation was noted in 3 patients. Eighty implants were inserted successfully in 234 grafted sites with on average 2.4 implants per graft. Three implants were removed. Implant survival was 96.2%. DISCUSSION: This study demonstrated that the premaxillary apposition technique using autologous grafts provides sufficient bone volume to enable optimal implant insertion and stability.

[Stability of grafts and implants after bone grafting of the maxillary sinus. Retrospective analysis of 44 patients]. / Stabilité du greffon et des implants après greffe osseuse du sinus maxillaire.

OBJECTIVES: We assessed the reliability of maxillary bone grafting and implant stability, comparing our results with reports in the literature. MATERIAL AND METHODS: This retrospective series included 44 patients who underwent maxillary sinus bone grafting between 1998 and 2002. An analogous graft was used for 31 patients and a combination autologous-bone substitute graft for 13. One hundred twelve dental implants were positioned at the grafting site (2.5 implants per graft). We assessed recipient site morbidity, bone graft integration and stability, and stability of the implants. RESULTS: Bone grafting was successful in 97.8% of patients. There was one failure. Two of the 112 implants failed. DISCUSSION: Our results are comparable with those in the literature. This study demonstrated the reliability of maxillary bone grafting with equivalent results using autologous bone and combination autologous bone-bone substitute.

[Coronal approach. Surgical technique]. / La voie coronale. Technique chirurgicale.

Many indications in maxillo-facial surgery require a coronal approach. We recall the main anatomic features and describe the surgical technique.

[Anterolateral thigh free flap. Surgical technique]. / Le lambeau libre antéro-latéral de cuisse. Technique chirurgicale.

The anterolateral thigh free flap is a cutaneous or fasciocutaneous flap vascularised by one or several perforating arteries arising from the descending branch of the lateral circonflex femoral artery. Venous drainage occurs via the perforators or a similar route to the deep femoral system or the femoral vein. This flap is commonly used in Asia (China, Japan) where for certain teams, it replaces the classical radial forearm flap or the rectus abdominis myocutaneous flap for the reconstruction of head and neck defects after tumor ablation. We briefly describe the anatomy and vascularization of this flap and present the harvesting technique as well as the properties of the flap.

[Development of the maxilla in patients with complete unilateral cleft palate surgically treated by a periosteal transplantation technic. A retrospective study of 15 surgical cases with an 18 year follow-up]. / L'évolution du maxillaire chez les sujets porteurs de fente unilatérale totale opérés par la technique de la greffe périostée. Etude rétrospective de 15 cas opérés avec 18 ans de recul.

PURPOSE: The aim of this study was to assess retrospectively the long-term growth of the maxilla in subjects with unilateral total cleft treated initially with the tibial periosteal graft technique. PATIENTS AND METHODS: The study group included 15 patients with a mean 18 years follow-up (range 15-20 years). All patients had been operated on by the same surgeon. Only patients in stage DP3, one to two years after peak growth were retained for review. Delaire's architectural analysis was used to study anteroposterior and vertical growth of the maxilla. Transverse growth was studied with the Mars occlusal score. Bone generation induced by the periosteum was studied using the Björk Holmgren analysis. The quality of the palatine and nasal repair was studied using Pruzansky's criteria. RESULTS: Anteroposterior and vertical growth led to a normal maxilla in 53.3% of the cases and a moderate to severe retromaxilla (> 5 mm) in 46.7%. Complete symmetry was achieved for the nasal fossae in 20% of the cases and marked asymmetry was noted in 26%. The height of the nasal fossae was symmetrical in 60% of the cases with marked asymmetry in 26%. Mean production of alveolar bone reached 58% of the height of the alveolar bone filling. It was good in 46.6% of the cases, fair in 26.7% and weak in 26.7%. The occlusal score evidenced crossed occlusion in 33.3% of the cases for a hemisection and in 46.7% of the cases for an anterior section. Normal occlusion was achieved in 20%. The quality of palatine repair was found to be good with a normal mucosa in 86.7% of the cases. A fistula was present in 13.3%. CONCLUSION: The preoperative objectives of periosteal graft repair of unilateral complete clefts were achieved. This technique provides a closed scar-free palate. Nasal repair favored the development of an ample and functional airway. The periosteal graft produced bone in the anterior portion allowing a harmonious premaxillary region and stable nose support.

[Description and classification of extra-oral implants]. / Description et classification des implants extra-oraux.

There is no universal extra-oral implant (EOI) that provides an answer to all clinical situations. We present briefly the two main categories of extra-oral implants currently available, endo-osseous implants and juxta-osseous implants, comparing the advantages and disadvantages of each. We also discuss the new developments currently under experimentation in extra-oral implantology.