Association between burnout and stigma in physicians.

BACKGROUND: Physicians suffering from burnout are more likely to develop depression, substance dependence, and cardiovascular diseases, which can affect their practices. Stigmatization is a barrier to seeking treatment. This study aimed to understand the complex links between burnout among medical doctors and the perceived stigma. METHODS AND FINDINGS: Online questionnaires were sent to medical doctors working in five different departments of the Geneva University Hospital. The Maslach Burnout Inventory (MBI) was used to assess burnout. The Stigma of Occupational Stress Scale in Doctors (SOSS-D) was used to measure the three stigma dimensions. Three hundred and eight physicians participated in the survey (response rate: 34%). Physicians with burnout (47%) were more likely to hold stigmatized views. Emotional exhaustion was moderately correlated with perceived structural stigma (r = 0.37, P < .001) and weakly correlated with perceived stigma (r = 0.25, P = 0.011). Depersonalization was weakly correlated with personal stigma (r = 0.23, P = 0.04) and perceived other stigma (r = 0.25, P = 0.018). CONCLUSION: These results suggest the need to adjust for existing burnout and stigma management. Further research needs to be conducted on how high burnout and stigmatization impact collective burnout, stigmatization, and treatment delay.

Narrative enhancement and cognitive therapy (NECT) to improve social functioning in people with serious mental illness: study protocol for a stepped-wedge cluster randomized controlled trial.

BACKGROUND: Self-stigma is highly prevalent in serious mental illness (SMI) and is associated with poorer clinical and functional outcomes. Narrative enhancement and cognitive therapy (NECT) is a group-based intervention combining psychoeducation, cognitive restructuring and story-telling exercises to reduce self-stigma and its impact on recovery-related outcomes. Despite evidence of its effectiveness on self-stigma in schizophrenia-related disorders, it is unclear whether NECT can impact social functioning. METHODS: This is a 12-centre stepped-wedge cluster randomized controlled trial of NECT effectiveness on social functioning in SMI, compared to treatment as usual. One hundred and twenty participants diagnosed with schizophrenia, bipolar disorder or borderline personality disorder will be recruited across the 12 sites. The 12 centres participating to the study will be randomized into two groups: one group (group 1) receiving the intervention at the beginning of the study (T0) and one group (group 2) being a control group for the first 6 months and receiving the intervention after (T1). Outcomes will be compared in both groups at T0 and T1, and 6-month and 12-month outcomes for groups 1 and 2 will be measured without a control group at T2 (to evaluate the stability of the effects over time). Evaluations will be conducted by assessors blind to treatment allocation. The primary outcome is personal and social performance compared across randomization groups. Secondary outcomes include self-stigma, self-esteem, wellbeing, quality of life, illness severity, depressive symptoms and personal recovery. DISCUSSION: NECT is a promising intervention for reducing self-stigma and improving recovery-related outcomes in SMI. If shown to be effective in this trial, it is likely that NECT will be implemented in psychiatric rehabilitation services with subsequent implications for routine clinical practice. TRIAL REGISTRATION: ClinicalTrials.gov NCT03972735 . Trial registration date 31 May 2019.

[Evaluation of HBA1C measurement on Architect CI8200 (Abbott Diagnostic). Comparison with HPLC D-10 Bio-Rad assay]. / Evaluation d'une technique de détermination de l'HBA 1C sur Architect CI8200 (Abbott Diagnostic). Comparaison avec la technique HPLC D-10 Bio-Rad.

The aim of this study is to present an evaluation of HbA(1c) Assay on Architect CI8200 (Abbott Diagnostic). The measurement includes Hb assay by colorimetry and HbA(1c) by immunoturbidimetry. The percentage of HbA(1c) is the report HbA(1c)/complete Hb with a conversion coefficient. Repetability (n = 30; CV: 1.15-1.91%) and reproductibility (n = 30; CV: 2.09-2.64%) are good. Abbott results cannot be returned above 12%. Comparison between HbA(1c) Abbott and HbA(1c) Bio-Rad is performed on 161 patients samples ranging from 4.7 and 12%. Results show a correlation coefficient of 0.9847 (N = 161) with a regression equation: [Abbott] = 1.02x [Bio-Rad]-0,636]. Differences between two methods are normally distributed. 95% of differences lie between limits (-0.61%; +0.61%). Such differences are clinically important and interchangability of two measurements can't be possible now because lack of agreement. We hope that IFCC standardization will reduce these differences. Presence of a jaundice and carbamylation of haemoglobin do not interfer with Abbott assay. Hemoglobin variants are not detected. Therefore, monitoring of diabetic patients with HbA(1c) is possible only if hemoglobinopathy has been identified before.

Frequency of dysphoria and mixed states.

BACKGROUND: Mixed states are a complex entity in the field of mood disorders. Dysphoria has been advocated as an important clinical dimension of mixed states. The objective of this work is to study the frequency of dysphoria within a population of patients with DSM-IV major depressive and/or manic episodes and to determine if it may help establish diagnostic criteria for subthreshold cases of depressive or manic mixed states. SAMPLING AND METHODS: A total of 165 patients were assessed using the Mini International Neuropsychiatric Interview complemented by a section defining dysphoria as a constellation of 3 among 4 symptoms (inner tension, irritability, aggressive behavior and hostility). RESULTS: When classifying patients according to the number of symptoms of the opposite polarity, changes in the frequency of dysphoria revealed a clear contrast between the 2 opposite manic and depressive poles and the full mixed state (DSM-IV definition). The frequency of dysphoria was 17.5% in pure depression, 22.7% in pure mania and 73.3% in full mixed state. Two threshold effects were identified: (1) the frequency of dysphoria increased from 17.5 to 61.1% (p = 0.002) when the number of manic symptoms in DSM-IV depressed patients increased from 0 to 1, and (2) dysphoria increased from 14.3 to 69.2% (p = 0.057) when the number of depressive symptoms increased from 2 to 3 in DSM-IV manic patients. CONCLUSION: Dysphoria is strongly but not necessarily associated with mixed states. When used as a clinical marker for mixed states, dysphoria confirms the modern delimitations of sub-threshold mixed states by specifying the required number of symptoms of the opposite polarity (which could be lower for depressive mixed states than for manic mixed states). The study has limitations related to the inclusion of patients who are not drug-free, to the definition of dysphoria and to the sample size.

Chronic Diarrhea in L-Amino Acid Decarboxylase (AADC) Deficiency: A Prominent Clinical Finding Among a Series of Ten French Patients.

Aromatic L-amino acid decarboxylase (AADC) deficiency is an autosomal recessive inborn error of metabolism, affecting catecholamines and serotonin biosynthesis. Cardinal signs consist in psychomotor delay, hypotonia, oculogyric crises, dystonia, and extraneurological symptoms. PATIENTS AND METHODS: We present a retrospective descriptive multicentric study concerning ten French children with a biochemical and molecular confirmed diagnosis of AADC deficiency. RESULTS: Clinical presentation of most of our patients was consistent with the previous descriptions from the literature (hypotonia (nine children), autonomic signs (nine children), sleep disorders (eight children), oculogyric crises (eight children), motor disorders like hypertonia and involuntary movements (seven children)). We described however some phenotypic particularities. Two patients exhibited normal intellectual abilities (patients already described in the literature). We also underlined the importance of digestive symptoms like diarrhea, which occurred in five among the ten patients. We report in particular two children with chronic diarrhea, complicated by severe failure to thrive. Vanillactic acid (VLA) elevation in urines of one of these two patients led to suspect the diagnosis of AADC deficiency, as in two other patients from our population. CONCLUSION: Some symptoms like chronic diarrhea were atypical and have been poorly described in the literature up to now. Diagnosis of the AADC deficiency is sometimes difficult because of the phenotypic heterogeneity of the disease and VLA elevation in urines should suggest the diagnosis.

In vitro modulation and relationship between N-myc and HLA class I RNA steady-state levels in human neuroblastoma cells.

Neuroblastoma cell lines and tumors are characterized by low HLA class I expression. The majority of neuroblastoma cell lines and a high percentage of disseminated tumors display amplification of the nuclear protooncogene N-myc. An inverse correlation between HLA class I expression and N-myc amplification and overexpression has been recently described in neuroblastomas (NBs). In this study we have shown that cytokines (recombinant gamma-interferon, recombinant alpha-tumor necrosis factor), differentiation agents (dibutyryl cyclic AMP, phorbol myristate acetate) and growth factors (nerve growth factor, epithelial growth factor) were able to influence the growth rate and surface expression of HLA class I molecules as well as of a tumor-associated antigen on 2 representative NB cell lines. Induced decreased growth rate in NB cells was not always related to decreased N-myc expression. Analysis at the mRNA level revealed that both N-myc and HLA class I RNA steady-state levels could be modulated by several substances, including recombinant gamma-interferon, phorbol myristate acetate, dibutyryl cyclic AMP, and epithelial growth factor and were not necessarily linked. An inverse correlation between N-myc and HLA mRNA levels was observed only after exposure of NB cells to recombinant alpha-tumor necrosis factor. We conclude that N-myc and HLA class I RNA steady-state levels can be modulated independently and suggest that they are not necessarily inversely regulated.

Resting-state functional connectivity of emotion regulation networks in euthymic and non-euthymic bipolar disorder patients.

BACKGROUND: Previous functional magnetic resonance imaging studies in bipolar disorder (BD) have evidenced changes in functional connectivity (FC) in brain areas associated with emotion processing, but how these changes vary with mood state and specific clinical symptoms is not fully understood. METHODS: We investigated resting-state FC between a priori regions of interest (ROIs) from the default-mode network and key structures for emotion processing and regulation in 27 BD patients and 27 matched healthy controls. We further compared connectivity patterns in subgroups of 15 euthymic and 12 non-euthymic patients and tested for correlations of the connectivity strength with measures of mood, anxiety, and rumination tendency. No correction for multiple comparisons was applied given the small population sample and pre-defined target ROIs. RESULTS: Overall, regardless of mood state, BD patients exhibited increased FC of the left amygdala with left sgACC and PCC, relative to controls. In addition, non-euthymic BD patients showed distinctive decrease in FC between right amygdala and sgACC, whereas euthymic patients showed lower FC between PCC and sgACC. Euthymic patients also displayed increased FC between sgACC and right VLPFC. The sgACC-PCC and sgACC-left amygdala connections were modulated by rumination tendency in non-euthymic patients, whereas the sgACC-VLPFC connection was modulated by both the current mood and tendency to ruminate. CONCLUSION: Our results suggest that sgACC-amygdala coupling is critically affected during mood episodes, and that FC of sgACC play a pivotal role in mood normalization through its interactions with the VLPFC and PCC. However, these preliminary findings require replication with larger samples of patients.

[Body contouring surgery after massive weight loss]. / Chirurgie de la silhouette chez l'ancien obèse.

After massive weight loss, former obese patients have adipose and cutaneous excess, the skin has lost all its elasticity. Functional and psychological consequences can be significant. Between January 2000 and January 2005, 122 patients underwent some kind of plastic surgery following massive weight loss. In more than 90% of thecases, patients underwent abdominoplasty, associated with liposuction, breast surgery, thighs or arms dermolipectomy or facelift. Multiple simultaneous body contouring surgeries on a single patient is often performed because it's convenient and does not increase morbidity, as long as operative time and blood loss is limited. Overall patient's satisfaction is good, and a favorable impact on quality of life is demonstrated.

The analysis of peculiar urinary (and other) calculi: an endless source of challenge.

The exact composition of calculi is clinically important, but many specimens are not examined, with resultant loss of important information. We describe the incidence and nature of false stones, peculiar calculi and crystals growing on surprising materials. We studied 3100 calculi (97% urinary, 2% digestive and 1% others). Fourier transform infrared spectroscopy was used to identify calculi by detailed comparison with libraries of reference spectra. We also used UV-visible spectroscopy, nuclear magnetic resonance and gas chromatography-mass spectrometry for specific situations. Among 3100 calculi, 154 (5%) had an unusual composition; 101 specimens (3.3%) were false calculi or artifacts, 31 (1%) contained drugs or metabolites and 22 (0.7%) corresponded to crystallizations around other materials. The findings contribute to immediate patient management and to advances in scientific and medical knowledge. We conclude that the analysis of all calculi must be carried out, to determine their composition, and an efficient strategy must be used.

Monoclonal antibodies to gamma-interferon treated LAN-1 cells detect modulation of ganglioside GD2 exposure on human neuroblastoma cells.

A panel of 8 new Mabs have been produced against neuroblastoma cells (LAN-1) previously treated with IFN-gamma. All selected Mabs from 2 different fusions have been shown to detect epitopes on the GD2 ganglioside molecules highly expressed on all cells of neural crest origin including neuroblastoma, glioblastoma and melanoma. Our results imply that modulation of GD2 exposure on NB cells is dependent on culture conditions and moreover that IFN-gamma increases the surface expression of GD2 and thereby enhances their immunogenicity.

Follow-up study of 67 first episode schizophrenic patients and their involvement in religious activities.

We studied the characteristics of religious practice in a cohort of 67 first admission schizophrenic patients over 5 years. Thirty percent of these patients were involved in religious activities, either with an established religion or in a marginal group. They were mostly women, who had a good premorbid psychosocial adaptation and tended not to be substance abusers. Their social adaptation was improved at year 5. They were as compliant with their ambulatory treatment as the other patients. However, when controlling for the inclusion characteristics, a similar outcome was shown between the group of practicing patients and the nonpracticing group. Religious activity may not be by itself the cause of this favorable outcome, as it is probable that only the patients who are less symptomatic and relatively well adapted could actually join a religious movement. The fact that many schizophrenic patients find an occupation and relationships in religious activities that they would not find elsewhere should encourage the psychiatric community target its occupational goals.

Lithium augmentation in venlafaxine non-responders: an open study.

Thirteen major depressive patients not responding to a 4-week venlafaxine 300 mg treatment were eligible for a 4-week open trial of lithium addition. Two patients had to stop lithium for a possible moderate serotonin syndrome and five patients became responders, including one dramatic response and two semi-rapid responses.

[Four year follow-up of social adjustment of a cohort of schizophrenic patients]. / Evolution durant quatre ans de l'adaptation psychosociale d'une cohorte de patients schizophrènes.

Sixty-seven first episode schizophrenic patients (PSE-Catego criteria) have been included in this study in order to evaluate their prognosis and the factors predictive of their evolution. Potential predictive factors consisted of anamnestic and demographic data, scores on the Disability Assessment Schedule (DAS-WHO) and relatives' Expressed Emotion index (EE), measured by the Camberwell Family Interview (CFI). The outcome was assessed monthly by the Global Assessment Scale (GAS/DSM III-R). At four years, 39 patients (58%) were still being followed. 33% of the patients presented a good evolution (EGF > or = 51) and 67% of the patients a bad evolution (EGF < 51). Four factors predictive of the psychosocial adaptation were extracted using regression analysis: premorbid psychosocial evolution, EE, sex and psychiatric family history. These 4 factors predicted correctly 85% of cases. Moreover, the monthly follow-up of these patients pointed to three types of evolution: the patients presenting a good and stable evolution (22%), those presenting a bad and stable evolution (33%) and those presenting an oscillating evolution which fluctuated between good and bad periods (44%). However, no predictive factors of the psychosocial adaptation of these oscillating patients could be identified through the statistical analysis. These results take all their importance regarding the treatment of schizophrenic patients, for whom the therapeutic plans which have to be settled should take into account their prognosis in the most precise manner. Moreover, the predictive value of EE on psychosocial adaptation for a 4 years period is confirmed.

[Translation and validation of a French version of the Young Mania Rating Scale (YMRS)]. / Traduction et validation française de l'échelle de manie de Young (YMRS).

Both the Young Mania Rating Scale (YMRS) and the Mania Assessment Scale (MAS) have been widely used during the last decade for the evaluation of severity of mania in clinical trials. For both scales good inter-rater reliability, validity and sensitivity to change have been reported. The French version of the MAS has been validated. To our know-ledge, the YMRS has not yet been translated into French and validated. The main objective of the present study was to validate a French version of the YMRS and to test its use in manic patients entering a study on the effectiveness of valproic acid and olanzapine combination. After translating the items in French, we tested this version of the YMRS on two samples of psychiatric patients recruited in a ward of adult inpatients (18 to 65 Years old) at the Department of Psychiatry, Geneva University Hospital. The first sample included 18 (hypo) manic inpatients (10 males, 8 females). Mean age was 37.0 (standard deviation 10.1). Interviews were video taped and assessed by three different judges on both scales (YMRS and MAS). The second sample included 20 inpatients (5 males, 15 females) who provided written informed consent to enter a study on the association of valproic acid and olanzapine in the treatment of mania. Mean age was 40.0 (standard deviation 11.3). Patients were followed over four weeks and assessed on both scales (YMRS and MAS) every seven days (day 0, 7, 14, 21 and 28). On day 7, patients were assessed during a joint interview by two of three judges who independently administered both scales in permuted order. On days 0, 14, 21 and 28, patients were evaluated by one of the same three raters. Inter-rater reliability was assessed by comparing item scores and total scores assigned by different judges with intra-class correlation coefficient ICC (2,1). Three judges were considered for patients in sample 1. Two judges were considered for patients in sample 2 (day 7 assessment). Concurrent validity with the MAS was analysed in sample 2 on days 0, 7, 14, 21 and 28 using Spearman rank-order correlation coefficient. Sensitivity to change was assessed in sample 2 by comparing total score at inclusion and at last observation using Wilcoxon signed ranks test. For both the MAS and YMRS, intraindividual change was calculated as the difference between total scores at inclusion and discharge (last observation carried forward approach). The relationship between changes on the two scales was analysed through Spearman correlation coefficient. Significance level was set to 0.05 for each test. Ranges of YMRS total scores were 2 to 32 in sample 1 and 1 to 28 in sample 2, indicating symptom severity from euthymic to moderately manic. Inter-rater reliability was very good for the total scores in both samples, both for the MAS and the YMRS (ICC>0.89). When considering YMRS individual items, correlation coefficient varied from 0.61 to 0.96 in the first sample. In the second sample, 9 of 11 items displayed values above 0.63. The remaining two items, increased motor activity and energy and Language-thought disorder, presented modest inter-rater reliability (ICC=0.54 and 0.50 respectively). This was largely attributable to a single patient, who was perceived very differently by the two judges (scores 0-2 for increased motor activity and energy; 1-4 for Language-thought disorder). When this patient was excluded, intra-class correlation coefficients were above 0.69 for both items. Overall, inter-rater reliability of the YMRS items was in the same range as for the MAS items (0.61-0.96 vs 0.61-0.93 in sample 1; 0.50-0.93 vs 0.54-0.83 in sample 2). Correlation between the two instruments was very high and statistically significant at each weekly assessment (rs>0.91, p<0.001) except for day 21 which displayed a somewhat lower correlation (rs=0.75, p<0.01). This latter result was attributed to a reduced spread of values and number of patients on day 21. YMRS and MAS total scores as a function of time in patients receiving combined treatment with olanzapine and valproic acid (sample 2) show that for both at for both scales, total scores significantly decreased from day 0 to last observation (Wilcoxon signed ranks test, p<0.001), with median decrease of 18 points both on the YMRS (range 9-32) and MAS (range 10-33). Median relative decrease was 67% for the YMRS and 69% for the MAS. When analysing the relationship between intraindividual changes on the YMRS and MAS, highly significant correlation was observed (Spearman rs=0.93, p<0.001), showing that the two scales were virtually interchangeable in assessing treatment efficacy. In conclusion, the YMRS is a simple and easy-to-use instrument for measuring severity of manic symptoms The newly translated French version was satisfactory in terms of inter-rater reliability, concurrent validity with the MAS, and sensitivity to change in patients receiving treatment for manic symptoms. This should allow its future use for international comparison studies.

[Digitalis intoxication during the neonatal period: role of dehydration]. / Intoxication digitalique en période néonatale: rôle de la déshydratation.

BACKGROUND: Despite the great progress which has been made in the treatment of acute digitalis intoxication by digoxin-immune Fab, it still remains a severe complication of cardiotonic therapy. CASE REPORT: A neonate with ventricular septal defect and large left-to-right shunt was treated with digitalis and diuretics at the usual starting doses. An intensive phototherapy was also required because of a hyperbilirubinemia due to glucose-6-phosphate dehydrogenase deficiency. Toxic digoxin accumulation (plasma level 14 ng/mL) was diagnosed three days after the initiation of treatment by the presence of sinus bradycardia and bursts of ventricular fibrillation. Intravenous administration of digoxin-specific antibody Fab fragments (Digidot) was effective, with a rapid improvement of the digitalis poisoning. CONCLUSION: Because of the particularities concerning drug distribution, metabolism and elimination of drugs in the neonatal period, the digoxin therapeutic index is narrow. This case report suggests the involvement of phototherapy and diuretics, which might induce a significant decrease in extracellular water and drug distribution volumes, ultimately promoting the occurrence of an intoxication.

[Mycoplasma pneumoniae meningoencephalitis]. / Méningoencéphalite à Mycoplasma pneumoniae.

BACKGROUND: Severe central nervous system diseases, such as encephalitis, have been reported in association with Mycoplasma pneumoniae infections. CASE REPORT: After an ENT infection, a 9-year-old boy with Down's syndrome developed encephalitis revealed by an acute alteration in consciousness. Head computed tomography showed, after 2 weeks, an infiltration in the basal ganglia region. The diagnosis of Mycoplasma pneumoniae encephalitis was made; recovery was complete in a few weeks. CONCLUSION: Mycoplasma pneumoniae infection should be considered in all cases of acute encephalopathy; yet the pathogenesis of the disorder is unknown and the treatment uncertain.

[Stability and predictive role of emotions, expressed by families in the development of a cohort of schizophrenic patients in the course of 5 years]. / Stabilité et rôle pronostique de l'émotion exprimée des familles dans l'évolution d'une cohorte de patients schizophrènes suivis durant cinq ans.

A prospective study of 44 first admission schizophrenic patients was conducted in Geneva, in order to evaluate the prognostic value of Expressed Emotion (EE), as well as its stability. The predictive power of the EE index was tested on three variables of outcome: relapse rate, social adaptation and hospital stay. At intake, the patients presenting more premorbid features lived in high EE households. The EE index and the outcome measures tended to be associated. After the third year, patients living with high EE relatives were significantly more maladjusted and relapsed more than those living with low EE relatives. The EE index was stable during the five years. Our results show that initial measure of EE in a first episode cohort is predictive of outcome over a five year period. This may not be causal as it cannot be excluded that poorer premorbid functioning alone may result in poorer outcome, and may also elicit high EE in relative.

[Mitochondrial neurogastrointestinal encephalopathy disease]. / L'encéphalomyopathie neuro-gastro-intestinale mitochondriale : un tableau d'anorexie mentale atypique.

Mitochondrial neurogastrointestinal encephalopathy disease (MNGIE) is a rare autosomal-recessive syndrome, resulting from mutations in the TYMP gene, located at 22q13. The mutation induces a thymidine phosphorylase (TP) deficit, which leads to a nucleotide pool imbalance and to instability of the mitochondrial DNA. The clinical picture regroups gastrointestinal dysmotility, cachexia, ptosis, ophthalmoplegia, peripheral neuropathy, and asymptomatic leukoencephalopathy. The prognosis is unfavorable. We present the case of a 14-year-old Caucasian female whose symptoms started in early childhood. The diagnosis was suspected after magnetic resonance imaging (MRI), performed given the atypical features of mental anorexia, which revealed white matter abnormalities. She presented chronic vomiting, postprandial abdominal pain, and problems gaining weight accompanied by cachexia. This diagnosis led to establishing proper care, in particular an enteral and parenteral nutrition program. There is no known specific effective treatment, but numerous studies are in progress. In this article, after reviewing the existing studies, we discuss the main diagnostic and therapeutic aspects of the disease. We argue for the necessity of performing a cerebral MRI given the atypical features of a patient with suspected mental anorexia (or when the clinical pattern of a patient with mental anorexia seems atypical), so that MNGIE can be ruled out.

Screening for bipolar disorder among outpatients with substance use disorders.

BACKGROUND: Comorbidity of bipolar disorder and alcohol or substance abuse/dependence is frequent and has marked negative consequences on the course of the illness and treatment compliance. The objective of this study was to compare the validity of two short instruments aimed at screening bipolar disorders among patients treated for substance use disorders. METHODS: The Mood Disorder Questionnaire (MDQ) and the Hypomania Checklist-32 (HCL-32) were tested with reference to the mood section of the Structured Clinical Interview for DSM-IV axis I disorders (SCID) in 152 patients, recruited in two outpatient clinics providing specialized treatment for alcohol and opiate dependence. RESULTS: According to the SCID, 33 patients (21.7%) had a diagnosis within the bipolar spectrum (two bipolar I, 21 bipolar II and 10 bipolar not otherwise specified). The HCL-32 was more sensitive (90.9% vs. 66.7%) and the MDQ more specific (38.7% vs. 77.3%) for the whole sample. The MDQ displayed higher sensitivity and specificity in patients treated for alcohol than for opiate dependence, whereas the HCL-32 was highly sensitive but poorly specific in both samples. Both instruments had a positive predictive value under 50%. CONCLUSIONS: Caution is needed when using the MDQ and HCL-32 in patients treated for substance use disorders.

Phenomenology of mixed states: a principal component analysis study.

OBJECTIVES: To contribute to the definition of external and internal limits of mixed states and study the place of dysphoric symptoms in the psychopathology of mixed states. METHODS: One hundred and sixty-five inpatients with major mood episodes were diagnosed as presenting with either pure depression, mixed depression (depression plus at least three manic symptoms), full mixed state (full depression and full mania), mixed mania (mania plus at least three depressive symptoms) or pure mania, using an adapted version of the Mini International Neuropsychiatric Interview (DSM-IV version). They were evaluated using a 33-item inventory of depressive, manic and mixed affective signs and symptoms. RESULTS: Principal component analysis without rotation yielded three components that together explained 43.6% of the variance. The first component (24.3% of the variance) contrasted typical depressive symptoms with typical euphoric, manic symptoms. The second component, labeled 'dysphoria', (13.8%) had strong positive loadings for irritability, distressing sensitivity to light and noise, impulsivity and inner tension. The third component (5.5%) included symptoms of insomnia. Median scores for the first component significantly decreased from the pure depression group to the pure mania group. For the dysphoria component, scores were highest among patients with full mixed states and decreased towards both patients with pure depression and those with pure mania. CONCLUSIONS: Principal component analysis revealed that dysphoria represents an important dimension of mixed states.