[Risk of incarceration of persons undergoing psychiatric care. A retrospective longitudinal study on the French department of Oise using information from a psychiatric hospital discharge database]. / Le risque d'incarcération des personnes suivies en psychiatrie. Une étude longitudinale rétrospective dans le département français de l'Oise à partir du Recueil d'informations médicalisé en psychiatrie.

INTRODUCTION: Compared to the general population, persons with mental disorders are overrepresented in prison. In a study carried out in Picardy (northern France) in 2017, a quarter of those entering prison had had contact with a psychiatric service prior to their incarceration. Since to our knowledge no work on this subject has been published in France, we conducted a retrospective study, the main objective of which was to propose an estimate measure of incarceration likelihood in people with mental disorders. METHODS: Using data from a psychiatric hospital discharge database (Recueil d'informations médicalisé en psychiatrie, RimP), we searched for patients aged 18 and older who had received psychiatric care (except for those who were incarcerated at baseline) at the Oise psychiatric hospital in 2015-2016 and identified those who had also been registered by the psychiatric care tool (DSP) in liaison with the same hospital. As a marker of incarceration, registration was the event to be investigated. Survival analyses (Kaplan-Meier), first simple and then stratified by age, gender, past history, main diagnosis and intensity of care outside of prison were carried out to calculate likelihood of incarceration. A multivariate Cox model was used in order to identify the factors associated with incarceration. RESULTS: Among the 25,029 patients monitored in the Oise psychiatric hospital in 2015-2016, 126 had experienced incarceration during the 12 months following their inclusion in the study, i.e. an incarceration probability of 0.45% (95 % confidence interval: 0.37-0.55%). The incarcerated patients were younger (36.6 years in average versus 44.7-Pt-test<0.0001), more often male (96.8% versus 43.7% - P<0.0001), and had a more frequent history of detention (11.1% versus 0.6% - P <0.0001) and psychiatric care (20.6% versus 10.1% - P<0.0001) than the general population. The probability of incarceration at 12 months for the population followed in the psychiatry unit was 3.2 times higher than the detention rate of the general population in Oise over the same period. CONCLUSION: Our study confirms the pronouncedly high incarceration rate of people with mental disorders. Scheduled to begin in 2020, coding in the RimP of a single nationwide patient identifier for all the procedures and stays described will allow the generalized measurement by means of the proposed indicator throughout France.

[Supervised off-label prescribing of methylphenidate in adult ADHD]. / Prescriptions hors AMM supervisées de méthylphénidate dans le TDAH de l'adulte.

OBJECTIVE: Off-label prescription is a common practice in psychiatry, raising health and economic concerns. Collegial consultation could allow a framed prescription of treatments that are not authorized in specific indications. Attention Deficit Hyperactivity in adult populations (ADHD) is a striking example of a pathology where off-label prescription is frequent. First considered to be a childhood disorder, the awareness of this condition in adults is increasing, leading to the development of new clinical practices and treatments. However, the adult ADHD diagnosis and its management are still emerging in France despite a high prevalence. Treatment of adult ADHD relies on methylphenidate prescription, but the initiation of this drug is not authorized in adult populations. Methylphenidate is a central nervous system stimulant that is structurally close to amphetamine and acts as a norepinephrine and dopamine reuptake inhibitor. Due to these pharmacological properties, neuropsychiatric and cardiovascular side-effects could occur. Furthermore, its addictive potential has led France to classify it as a psychoactive drug, dispensed via secured prescription. The first prescription and the one-year follow-up are restricted to neurologists, paediatrics, psychiatrists and sleep disorders specialists at hospital. The objective of this article is to propose a multidisciplinary framework for the off-label prescription of methylphenidate in adult ADHD. METHODS: The Multidisciplinary Advice Consultation for Exceptional Addiction Treatments (Consultation d'Avis Multidisciplinaire de Traitements d'Exception en Addictologie CAMTEA) was first set up in Lille for the prescription of baclofen in alcohol dependence and was then extended to topiramate in binge eating disorder. This procedure has been adapted to the particularities of ADHD in adult populations, the differential diagnosis (bipolar disorder, depressive disorder, anxious disorder, personality disorder, substance use disorder) and the co-morbidities requiring a full psychiatric and neuropsychological assessment. Moreover, a particular attention has been paid to the monitoring of neuropsychiatric, cardiovascular and misuse risk because of the potential side-effects of methylphenidate. RESULTS: The proposed prescription framework is structured into several specialized consultations. A first psychiatric evaluation aims to diagnose adult ADHD, using the French version of the Diagnostisch Interview Voor ADHD 2.0 questionnaire (DIVA 2.0), and to assess the quality of life impact with the Weiss Functional Inventory Rating Scale (WIFRS). It also searches for the presence of differential diagnosis or co-morbidities. The second appointment consists of a pharmacological evaluation that aims to search for contraindications and potential drug interaction. A neuropsychological evaluation based on standardized tests (Weschler Adulte Intelligence Scale [WAIS IV], Conner's Continuous Performance Test 3 [CPT] and the Minnesota Multiphasic Personnality Inventory [MMPI]) is also required to evaluate neurocognitive disabilities and personality features. Once the parameters of the different assessments have been collected, the synthesis is presented during a multidisciplinary meeting in order to assess the risk-benefit ratio for each patient. Several specialties are involved in this multidisciplinary meeting: psychiatry, addictology, general medicine, addictovigilance, pharmacovigilance and neuropsychology. One strategy among three possibilities can be decided: (1) contraindication to treatment with methylphenidate, (2) attention deficit disorder that does not require medication management, and (3) indication of treatment with methylphenidate with the choice of the pharmacological form (immediate or prolonged release). A biological check-up and an electrocardiogram are carried out systematically before any treatment. If the decision is made to initiate treatment, it is started at the lowest dosage and followed by a titration phase. A weekly follow-up is carried out during the titration phase in order to assess treatment efficacy and safety. After treatment stabilization, the general practitioner can carry out the renewal, and the patient will be reassessed within the framework of the multidisciplinary consultation every 3 months. CONCLUSION: When an off-label prescription is being considered, it must comply with the basic rules of good clinical practice, and the benefit/risk ratio should be constantly reassessed. The proposed multidisciplinary framework, adapted to the characteristics of adult ADHD and the pharmacological properties of methylphenidate, appears to be an interesting strategy to meet the requirements of the good clinical practice. The complementary assessments carried out and the collegial framework allow enhancing the patient's follow-up and minimize the drug risk, particularly in the psychiatric, addictive and cardiovascular adverse events. Finally, this framework could also help the monitoring of other off-label treatments for ADHD, such as atomoxetine or guanfacine.

[Can we consider the journalist an actor in suicide prevention?] / Peut-on faire du journaliste un acteur de la prévention du suicide ?

INTRODUCTION: After more than 50 years of dedicated research, media coverage of suicide is now well known to have a significant influence on the suicide epidemiology. This influence is supposed to result from two opposite effects. The Werther effect (WE) refers to the robust increase of suicide rates following the publication of a suicide story. This specific kind of mass cluster implies a suggestion process, i.e. imitation of the depicted death by vulnerable persons. In contract, the preventive potential of medias has been labeled the "Papageno effect" (PE). Although more recently discovered and far less known, PE predicts that journalists can help prevent suicidal behaviors beyond a simple WE reduction. Because PE and WE directly bridge journalistic productions to suicidal events, several national and international health organisms (including the World Health Organization) started to see the media as new prevention opportunities. In this paper, we intend to assess the extent to which journalists can be considered as public health actors in the specific field of suicide prevention. METHODS: Based on a critical review of the so-called Media effect studies, we explore the opportunities, limits and constraints of collaborating with media professionals for public health actions. For that purpose, we focus on the main strategy employed so far, namely providing recommendations for more cautious coverage of suicide. An overview of the efficacy of these recommendations serves not only as a starting point for understanding how public health and journalistic perspectives can confront, but also how they can be combined in a fertile way. RESULTS: Numerous suicide prevention organisms developed strategies in order to assist journalists in reporting suicide stories in a safer way. As a formal support to these strategies, around 30 national or international guides have been produced around the word, with the shared aim of reducing WE and, eventually, promoting PE. The recommendations about articles' style and content that compose these guides were shown to be similar across the countries. They mostly meet public health concerns, rest on the available knowledge about the two effects' determinants and thus advocate for a less quantitatively and qualitatively prominent coverage. However, the way the guides were produced and implemented shows considerable variations. While most countries solely edited and/or distributed the recommendations with no complementary measures, several organisms associated their publication with promotion actions towards the journalists and general public. Evidence for the impact of the guides' publication on suicide rates, although encouraging, are seriously limited by methodological considerations. As a consequence, their efficacy is more often assessed in terms of media compliance to the recommendations. The extent to which media items respect the guidelines depends considerably on the way journalists are invited - or not - to resort to them. While the strategy seems inefficient when limited to a simple publication, the quality of suicide portrayal significantly improves when the guides are part of a whole prevention campaign dealing with suicide coverage. Moreover the journalist's implication at each step of the process seems a crucial point for its success. DISCUSSION: Media professionals are submitted to their own codes, constraints and missions which do not necessarily fit with public health concerns. If considered as prescriptions to reduce the suicide rates, journalists might see recommendations for a more cautious coverage to be a threat to their independence, thus accounting for their non-compliance. On the other hand, a real collaborative approach based on shared skills and knowledge could help sensitize journalists to a responsibility that PE and WE inevitably give them. Under these conditions, recommendations can become a precious resource to help media professional when facing a sensitive issue and finally contribute to fight against suicide.

[Determine the patient's position towards psychiatric care: a simple tool to estimate the alliance and the motivation]. / Déterminer la position du patient envers les soins psychiatriques avec le questionnaire Touriste-Plaignant-Client (TPC) : un outil simple pour évaluer l'alliance et la motivation.

OBJECTIVES: For the brief systemic therapy (BST), the evaluation of the patient's position towards the care is a prerequisite to psychotherapy. Three positions of the patient are described. The "tourist's" position: the patient claims to have no problem and doesn't suffer. Someone asks him to make an appointment, sometimes with threats. The "complaint's" position: the patient claims to suffer, but attributes the responsibility of this suffering to others. These two positions are not good for beginning a therapy. The "customer's" position differs from both previous positions. The "customer" considers that he has a psychological problem which depends on him and he is motivated in the resolution of it. In theory, the "customer" is more motivated and the therapeutic alliance is better. It is for this reason that the BST estimates the position of the patient at first, to bring the patient to the "customer's" position. The objective of this study is to assess an interview which identifies the patient's position towards the care, and to validate the theoretical elaborations of the brief systemic therapy. METHOD: The study concerns the follow-up of outpatients who consult a psychiatrist for the first time. The evaluation of the patients checks their position towards care using the Tourist-Complaint-Customer (TCC) inventory, how they suffer, the therapeutic alliance (scale Haq-2) and the compliance during care. The evaluation by the psychiatrists checks the suffering perceived, the motivation perceived and the diagnoses according to the DSM. RESULTS: The typology of these patients is made up of one half "complaint", a quarter of "tourist" and a quarter of "customer". The "customer's" position is correlated with the therapeutic alliance and the motivation perceived by the psychiatrist. The motivation perceived by the psychiatrist is correlated with the therapeutic alliance. These results correspond to the theoretical elaborations of the BST. CONCLUSION: the TCC inventory provides information on the motivation and the therapeutic alliance. If the patient is in "tourist" or "complaint" position, we recommend that the psychiatrist "work" to bring the patient to "customer" position. The evaluation of the position of the patient is simple and rich in information. We recommend that it be given a place in the daily practice of psychiatry.

Effectiveness of a French Program to Prevent Suicide Reattempt (VigilanS).

AIM: Brief contact interventions (such as letters, green cards, telephone calls or postcards) for reducing suicide reattempt (SR) and suicide have been evaluated since the 1980s, but results have been inconsistent. VigilanS is one of these programs that has benefited patients hospitalized for suicide attempt (SA) after discharge in 2 departments of northern France since 2015. The purpose of this study is to demonstrate its effectiveness in reducing SR. METHODS: Patients exposed to VigilanS in 2016 were recruited from the medical administrative database of the program, and the nonexposed patients from a database of the medico-surgical ward outside the scope of the program. First, a Cox model was used to compare the probability of SR during the 12-month follow-up period between the 2 groups. Second, a propensity score using the variables sex, age, source, SA history and SA method was used to match the VigilanS-exposed and the nonexposed patients. A Cox model propensity score adjusted analysis was reiterated on the matched data. RESULTS: The exposed and nonexposed groups included 3,068 and 3,694 individuals, respectively. In the bivariate analyses, the cumulative probability of SR at 12 months was significantly lower in the exposed group (6.0%, 95% confidence interval (CI): 5.5-6.5%) than in the nonexposed group (16.8%, 95% CI: 15.9-17.7%; p < 0.001). In the Cox model, the hazard ratio of SR was 0.38 in the exposed patients (95% CI: 0.36-0.40, p < 0.001). After matching, the cumulative probability of SR at 12 months was 5.2% in exposed versus 22.2% in nonexposed patients (p < 0.001). In the propensity score-adjusted Cox model, the hazard ratio of SR in the exposed patients was 0.19 (95% CI: 0.14-0.24, p < 0.001). CONCLUSION: The results suggest the effectiveness of this real-life program for reducing SR. However, VigilanS only benefits a portion of the patients hospitalized for SA and therefore could be extended.

[Suicide risk and suicide attempt in North Pas de Calais Region. Lessons from the survey Mental Health in General Population]. / Risque suicidaire et tentative de suicide en Nord-Pas de Calais. Enseignements de l'enquête santé mentale en population générale.

The Santé Mentale en Population Générale Survey (Mental Health in General Population Survey (MHGP)) is a multicentre international research and action project initiated by the World Health Organisation Collaboration Centre for research and training in mental health. Its aims are to assess the prevalence of the major mental health disorders in the general adult population and from this to record perceptions associated with "mental illness", "madness" and "depression" together with different means of assistance and specialist or lay care. In this work we present the analysis of data on risks of suicide and past history of suicide attempts in the Nord pas de Calais region. We present the qualitative features of these phenomena and correlations with socio-economic, cultural and psychopathological factors, which are discussed in terms of both protective and vulnerability factors. Risk of suicide is present in 15% of the Nord pas de Calais population and is divided into 10.44% slight risk, 2.37% moderate risk and 2.2% high risk. A comparison with data from the MHGP survey in other regions reveals the high risk of suicide in the NPDC region. A risk of suicide is present is 13% of the population in other SMPG survey regions, broken down into 9.1% low risk, 2.1% medium risk and 1.7% high risk. Compared to the 2.2% high risk figure for NPDC, the population in this category is 21% larger. In terms of risk and protective factors, a bivariate analysis of socio-economic and cultural factors confirms the classical risk factors of sex, marital, occupational and educational status and income. The odds-ratio for these socio-economic and cultural factors can be calculated from logistic regression and the protective factors ranked in decreasing order from religion (Muslim versus other religions), martial status (marked versus separated), age (over 58 years old), occupational status (working or retired versus unemployed), income (more than 1300 euros versus less than 840 euros), sex (men versus women) and immigration. For mental illness, the bivariate analysis confirms that the risk of suicide is significantly higher regardless of the mental disorder in question. Logistic regression categorises the mental illnesses as risk factors in the following order: depression, psychotic disorders, anxiety, alcohol abuse disorders, other drugs and insomnia. Suicide attempts have been made by 9.7% of the study population. This figure should be compared with the 8% of the study population in other regions in the survey and represents 29% more attempts. For the risk and protective factors the results of the bivariate analysis of socio-economic on cultural and psychopathological factors are superimposeable on those found for risk of suicide. The ranking of protective factors obtained from logistic regression places age in first position followed in decreasing order by religion, martial status, income, employment status and finally sex and immigration. The same ranking of mental illnesses by logistic regression places depression as the greatest risk factor followed by anxiety, psychotic disorders, alcohol abuse disorders, drugs and insomnia.

Calcitonin levels do not decrease with weaning in chronic alcoholism.

OBJECTIVE: Alcohol might increase calcitonin but this assertion is mainly based on the acute effect of the drug in small animals and humans. The aim of this study was to investigate the effect of chronic alcoholic intoxication on plasma calcitonin (CT) levels. DESIGN: 20 smoking male subjects admitted to be weaned from chronic daily alcohol consumption >100 g were included after informed consent. Blood was sampled upon admission (T0) and after 5 (T5) and 21 (T21) days of alcohol weaning to measure mean erythrocyte volume, gamma-glutamyltransferase (GGT), calcium, gastrin, and CT levels. The control group consisted of 30 male subjects with daily alcohol consumption <20 g. MAIN OUTCOME: The characteristics of the alcohol group were as follows (mean +/- SD): age 41.2 +/- 13 years old; mean erythrocyte volume: 96.0 +/- 4.2 microm(3) (N: 85-95); calcium level: 94.7 +/- 3.7 mg/L (N: 85-105); gastrinemia: 59.3 +/- 14.9 ng/mL (N: <120). At T0 and T21, three alcoholic subjects had CT levels above 10 pg/mL, usually considered as the normal cut-off value. There was no correlation between CT and the different biochemical parameters at T0, T5, and T21. There was no difference between CT levels at the different stages in the alcohol group (T0: 6.4 +/- 3.6 pg/mL; T5: 6.5 +/- 5.3 pg/mL; T21: 8.4 +/- 5.6), although GGT significantly decreased with weaning duration (T0: 248 +/- 354 IU/L; T5: 211 +/- 290 IU/L; T21: 79 +/- 90 IU/L; ANOVA, p <0.05). But a significant difference was found between mean CT levels in the alcohol group and in the control group (3.1 +/- 0.7 pg/mL, p <0.0001). CONCLUSIONS: This study suggests that mean CT levels of chronically alcoholic smoking male subjects are higher than those of an age- and sex-matched control group. However, most alcoholic patients exhibited CT levels <10 pg/mL. No decrease in CT levels was noted over a short period of alcohol weaning. As CT measurement is currently recommended in thyroid nodule assessment, this finding may be important to know how to decipher borderline values of CT.

[Short- and long-term consequences of prenatal exposure to cannabis]. / Conséquences à court et long terme d'une exposition prénatale au cannabis.

OBJECTIVE: Cannabis is one of the most commonly used drugs by pregnant women. The objective of this review of literature was to examine the association between cannabis use during pregnancy and effects upon growth, cognitive development (memory, attention, executive functions...) and behavior of newborns, children and teenagers. MATERIAL AND METHODS: We searched for articles indexed in the medline database from 1970 to 2005. The following terms were used in the literature search: cannabis/marijuana, pregnancy, fetal development, newborn, prenatal exposure, neurobehavioral deficits, cognitive deficits, executive functions, cannabinoids, reproduction. Most of the articles were published in English. RESULTS: Cannabis use during pregnancy is related to diverse neurobehavioral and cognitive outcomes, including symptoms of inattention, impulsivity, deficits in learning and memory, and a deficiency in aspects of executive functions. It seems difficult to identify complications, such as lower birth weight, only attributable to cannabis as opposed to the multiple perinatal complications associated with tobacco smoking. CONCLUSION: In addition to alcohol and cigarettes, information should be given to women about the potentially harmful effects on fetal development, newborns, children and teenagers of smoking cannabis. Therefore, it seems necessary to develop prevention programs on this subject.

[Delusional melancholia and multiple lacunar infarcts of the basal ganglia]. / Mélancolie délirante et lacunes multiples des noyaux gris centraux.

A 72 years-old man presented with melancholia with delusions, possibly resulting from multiple lacunar infarcts in the basal ganglia. This case is akin to the syndrome of psychic akinesia and compulsive activity, resulting from lenticular nucleus lesions or frontal lobe lesions. We suggest that melancholia could be a consequence of a certain type of stereotyped mental activity and we would compare this stereotyped mental activity to stereotyped verbal activity in aphasia. Cognitive impairment might then be a cause of depression.

[Mood disorders and right hemisphere infarction]. / Troubles de l'humeur et infarctus de l'hémisphère droit.

Persistent depression of mood following stroke and acute psychiatric disturbances in conjunction with infarcts in the right hemisphere has been well reported. Sometimes its psychiatric features were most salient although neurological signs could not be elicited. We treated two patients with infarcts in the right hemisphere. The first developed depression with melancholia, the second a bipolar disorder. We question whether aprosodia or mood neglect may give a melancholic profile of depression following right hemisphere damage.

[Progressive cannabis-induced arteritis: a clinical thromboangiitis obliterans sub-group?]. / L'artérite progressive cannabique, un sous-type clinique de la thromboangéite oblitérante?

INTRODUCTION: Since the end of the nineteen-nineties, cannabis is not only incriminated in the onset of thromboangiitis obliterans but also in inducing artheromatous lesions in young subjects. OBSERVATION: A young, Caucasian, 18 year-old man was referred for cannabis withdrawal in the treatment of arteritis of the left leg. DISCUSSION: Cannabis is by far the illicite psychoactive substance most consumed by the 15-25 year-olds. Data in the literature, notably since the end of the nineteen-nineties, show that cannabis is accused of provoking arterial disease similar to that which is found in Buerger's disease (or thromboangiitis obliterans) in young subjects of whichever sex.

[A case of delusional melancholia: "a variant of loss of psychological self-activation"?]. / Un cas de mélancolie délirante: "variante de perte de l'autoactivation psychique"?

A 62 year-old man presented with melancholia with delusions, possibly resulting from lenticular lesion in the left and frontal damages in the right. Atypical signs of our observation led us to consider our patient not as suffering of affective disorder. We suggest that melancholia could be a consequence of a certain type of stereotyped mental activity, and we would compare this stereotyped mental activity to mental compulsive activity described in "loss of psychic self activation" of D. Laplane. In this perspective our observation would be a variant of "Loss of psychic self-activation". Heuristic value of this concept is discussed.

[Alcohol, chronobiology and sleep]. / Alcool, chronobiologie et sommeil.

Chronobiology is the scientific discipline of biologic rhythm study. Applications of the emerging concepts of chronobiology are now use in several fields of clinical medicine. Alcohol related disorders seems to be clarified with the main concepts of chronobiology. Thus chronopharmacology (specially chronokinetics and time-related differences in drug effects) clears up variations of blood alcohol levels and toxicity of ethanol during the 24 h, chronesthesy explains the action of ethanol on biological rhythms of hormone secretions and sleep, and the concept of chronopathology seems to be apply to alcohol dependence. We review in this article some applications in alcohol related disorders of the main concepts of chronobiology.

The effect of alcohol consumption on the circadian control of human core body temperature is time dependent.

The few controlled studies dealing with the action of alcohol on core body temperature in humans have focused on the effect of a single dose of ethanol and reported that it has a hypothermic effect. No studies report the effects of repeated ethanol intake over a 24-h period, a pattern of consumption much closer to the clinical condition of chronic alcoholism. We therefore designed a trial in which alcohol was repeatedly and regularly administered, with a total dose of 256 g. Nine healthy male volunteers (mean age 23.3 +/- 2.9 yr; range 21-30) each served as his own control. The circadian temperature rhythm was studied by a single-blind, randomized, crossover study that compared a 26-h alcohol session to a 26-h placebo session. The trial controlled for so-called masking effects known to affect temperature. The volunteers were in bed; the ambient temperature was maintained between 20 and 22 degrees C. Meals were standardized. And light was controlled during the night. All sessions took place between November and April. The two sessions were separated by 2 to 5 wk. Rectal temperature was monitored every 20 min throughout the trial. We found the standard hypothermic effect of alcohol in the early hours of the trial, during the daytime, but our principal result is that alcohol consumption induced a very significant hyperthermic effect (+0.36 degrees C) during the night and thereby reduced the circadian amplitude of core body temperature by 43%. The dramatic decrease of the amplitude of circadian temperature rhythm that we observed may explain, at least in part, some clinical signs observed in alcoholic patients, including sleep and mood disorders. We suggest that jet lag, shift work, and aging, which are known to alter body temperature, are aggravated by alcohol consumption.

The effects of ethanol on the glycosylation of human transferrin.

Appearance of a hyposialylated transferrin fraction in the plasma during chronic alcohol exposure is a well-known phenomenon, and it represents the best available marker of chronic alcohol consumption. The mechanisms of its appearance are still not well understood and are extremely complex, involving biosynthesis and catabolism alterations, although the only structural abnormality described corresponds to the loss of an entire glycan chain. We analyzed and compared the oligosaccharides present on the different isoforms of purified transferrin isolated from control and patients with severe alcohol abuse by fluorescent carbohydrate electrophoresis and matrix-assisted laser desorption ionization mass spectrometry. Our data indicate that the major modification observed is the loss of an entire oligosaccharide chain; we also demonstrate that there is a modification of terminal sialylation. Carbohydrate-deficient transferrin (CDT) is the result of multiple alterations of glycosylation. These results give a partial explanation to the poor sensitivity of the measurement of CDT and its controversial use as a marker of chronic alcohol consumption.