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BACKGROUND: One of the challenges in bipolar disorder (BD) lies in early detection of the illness and its recurrences, to improve prognosis. Sleep disturbances (SD) have been proposed as reliable predictive markers of conversion. While preliminary studies have explored the relationship between SD and the onset of mood episodes, the results remain heterogeneous and a few have specifically examined patients' perception of prodromal symptoms and their progression until the episode occurs. Identifying prodromes represents a crucial clinical challenge, as it enables early intervention, thereby reducing the severity of BD. Therefore, the objective of this study is to better characterize and evaluate the progressive nature of SD as prodromal symptoms of mood episodes, and patients' perception of it. METHODS: Patients diagnosed with BD, either hospitalized or seeking treatment for a (hypo)manic or depressive episode benefited from standardized questionnaires, structured interviews, and self-report questionnaires to evaluate SD prior to the current episode, as well as sociodemographic and clinical information. RESULTS: Out of the 41 patients included, 59% spontaneously reported SD prior to the episode, appearing 90 days before depression and 35 days before mania (pre-indexed/spontaneous reports: 51.22% insomnia complaints, 4.88% hypersomnolence complaints, 7.32% parasomnias, 2.44% sleep movements). After inquiry about specific SD, the percentage of patients reporting prodromal SD increased significantly to 83%, appearing 210 days before depression and 112.5 days before mania (post-indexed reports: 75.61% presented with insomnia complaints appearing 150 days before depression and 20 days before mania, 46.34% had hypersomnolence complaints appearing 60 days before depression, 43.9% had parasomnias appearing 210 days before depression and 22.5 days before mania, 36.59% had sleep movements appearing 120 days before depression and 150 days before mania). Of note, bruxism appeared in 35% of patients before mania, and restless legs syndrome in 20% of patients before depression. CONCLUSION: This study highlights the very high prevalence of SD prior to a mood episode in patients with BD with differences between depressive and manic episodes. The more systematic screening of sleep alterations of the prodromal phase improved the recognition and characterization of different symptoms onset by patients. This underscores the need for precise questioning regarding sleep patterns in patients, to better identify the moment of transition toward a mood episode, referred to as "Chronos syndrome". The study emphasizes the importance of educating patients about the disorder and its sleep prodromal symptoms to facilitate early intervention and prevent recurrences.
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INTRODUCTION: Psychomotor activity stands out as a crucial symptom in characterizing behaviors associated with depression. This study aims to explore the potential of actigraphy as a tool for digital phenotyping in characterizing symptoms of psychomotor agitation and retardation, which are clinically challenging dimensions to capture, in patients diagnosed with major depressive episode (MDE) according to DSM-5 criteria. METHODS: We compared rest-activity circadian rhythm biomarkers measured by the Motion Watch 8 actigraphy between 58 (78.4%) patients with MDE and psychomotor retardation (PMR), and 16 (21.6%) patients with MDE and psychomotor agitation (PMA), according to DSM-5 criteria. RESULTS: Actigraphy allowed to objectively report PMA through heightened activity over a 24-h period, while PMR manifests as reduced activity during the most active 10 h. Lower rest-activity rhythm (RAR) amplitude in PMR was accompanied by increased irregularities in intra- and inter-day rhythms. Interestingly, actigraphy emerges as an objective tool to measure the characteristics of the active and rest periods, free from the confounding effects of sleep disturbances. Indeed, no differences in sleep disturbances were identified between patients exhibiting psychomotor agitation and those displaying PMR. CONCLUSION: Digital phenotyping through actigraphy may aid in distinguishing psychomotor retardation and psychomotor agitation allowing for a more precise characterization of the depression phenotype. When integrated with clinical assessment, measurements from actigraphy could offer additional insights into activity rhythms alongside subjective assessments and hold the potential to augment existing clinical decision-making processes in psychiatry.
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Insomnia is the most frequent sleep disorder and a public health concern that increased during the Covid 19 pandemic. Fully restrictive lockdowns during Covid are interesting periods to examine the impact of environmental and behavioural changes on the emergence of insomnia symptoms. In this cross-sectional study we aimed to (1) determine the main factors associated with insomnia symptoms during a Covid-19 fully restrictive lockdown examining the associated daily life alterations and (2) create a predictive model of insomnia symptoms. We used the data drawn from the "Covid-RythmE" study that reached volunteers from the general French population through an online survey during the last 2 weeks of the 2 month full lockdown. Associations with insomnia symptoms were tested and significant associations were entered in a Backward Stepwise Logistic Regression (BSLR) to assess the best combination to classify individuals with or without insomnia symptoms. From the 1624 participants, 50.64% suffered from mild to severe insomnia symptoms as assessed by the ISI. The best combination for explaining insomnia symptoms with 74.26% of accuracy included: age (OR = 1.15), females (OR = 1.26), smaller home sizes (OR = 0.77), environmental noises (OR = 1.59), anxiety symptoms (OR = 1.24), depressive symptoms (OR = 1.15), regularity of sleep-wake schedules (OR = 1.25), exposure to screen during the morning (OR = 1.13), and LED light during the evening (OR = 1.17). Thus, lifestyle schedule and exposure to natural synchronizers such as light, are primordial in considering in insomnia physiopathology, prevention and treatment, as well as the associated mental health status.
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COVID-19 , Trastornos del Inicio y del Mantenimiento del Sueño , Femenino , Humanos , COVID-19/epidemiología , Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , Estudios Transversales , SARS-CoV-2 , Depresión/epidemiología , Depresión/etiología , Depresión/diagnóstico , Control de Enfermedades Transmisibles , Ansiedad/epidemiología , Ansiedad/etiología , Ansiedad/diagnósticoRESUMEN
Non-24-h sleep-wake rhythm disorder is quite rare in sighted patients and frequently associated with psychiatric disorders. We report the case of a 46-year-old man with autism spectrum disorder (ASD) and agoraphobia who had been referred for a suspicion of obstructive sleep apnea syndrome (OSAS). Polysomnography and arterial blood gas confirmed moderate OSAS associated with hypoventilation. Continuous positive airway pressure (CPAP) was started on fixed mode with excellent results. At follow-up, his CPAP report data revealed an irregular sleep-wake rhythm with a progressive offset of sleep schedule and wake time delayed from 1 h from day to day. Melatonin (or agonist) is efficacious and safe for long-term treatment in ASD and circadian rhythm sleep-wake disorder (CRSWD) with light therapy and wakefulness promoting medication. This case underlines the importance to sensitise psychiatrists to sleep and CRSWD, and also that CPAP data offer a possible objective alternative to sleep diary.
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Trastorno del Espectro Autista , Melatonina , Apnea Obstructiva del Sueño , Trastornos del Sueño del Ritmo Circadiano , Trastornos del Sueño-Vigilia , Masculino , Humanos , Persona de Mediana Edad , Presión de las Vías Aéreas Positiva Contínua , Sueño , Trastornos del Sueño del Ritmo Circadiano/terapia , Trastornos del Sueño del Ritmo Circadiano/tratamiento farmacológico , Melatonina/uso terapéutico , Apnea Obstructiva del Sueño/terapia , Apnea Obstructiva del Sueño/tratamiento farmacológico , Ritmo CircadianoRESUMEN
This psychometric pilot study aims to evaluate a new multidimensional simple scale, named the nightmare severity index (NSI) - close to the existing insomnia (ISI) and hypersomnia (HSI) severity indexes. The NSI encompasses all main dimensions of nightmare disorder, evaluating four subdimensions: frequency, emotional impact, diurnal impact, and nocturnal impact of nightmares. The NSI was completed by a total of 102 patients. The majority of the population consisted of women (64%) and outpatient individuals (76%) diagnosed with mood disorders such as depression (31%) and bipolar disorder (41%). Comorbidity with post-traumatic stress disorder (PTSD) was prevalent (44%), and psychotropic medications were commonly used (47%). Internal validity analyses indicated that the NSI was well suited for exploratory factor analysis. All items demonstrated satisfactory correlations with the factors, and the questionnaire exhibited good internal consistency (Cronbach's alpha >0.7). Higher NSI scores were observed among individuals experiencing nightmare symptoms considering the DSM-5/ICSD-3 criteria. In summary, the NSI proves to be a promising and valuable tool for clinical practice, demonstrating good acceptability, internal validity, and the ability to assess nightmare severity.
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BACKGROUND AND OBJECTIVES: Nitrous oxide (N2 O) has euphoric properties, which are associated with an alarming increasing misuse. A lack of data exists regarding medical students. The objectives are: (i) evaluate the prevalence of N2 O use and N2 O use disorder (NUD) among French medical students, (ii) assess whether education about addictions has an impact on consumption, (iii) draw up clinical profiles of N2 O users with or without NUD, (iv) identify factors associated with use and NUD. METHODS: A cross-sectional study among medical students at Université de Paris, using an online questionnaire. RESULTS: Out of the 981 medical students (29% of the total medical students) who completed the questionnaire, 80% had used N2 O. 19% had a mild use disorder, 4% moderate, and 1% severe. N2 O use was significantly associated with the use of poppers (p < .0005), alcohol (p < .0005), and cocaine (p = .004). Factors significantly associated with NUD were alcohol use disorder (p = .017), male gender (p = .006), and being part of a student association (p = .0130). DISCUSSION AND CONCLUSION: This survey shows a high prevalence of N2 O use and NUD among medical students. It could be explained by the N2 O pharmacokinetic profile or by a perception of "harmlessness." We also identified associated risk factors that may be useful to better identify and treat students seeking help. SCIENTIFIC SIGNIFICANCE: This is the first study to evaluate the use of this product among medical students. The evaluation of factors impacting use and dependence is also new in this population, which is at risk of misuse of substances.
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Alcoholismo , Conducta Adictiva , Estudiantes de Medicina , Humanos , Masculino , Óxido Nitroso/efectos adversos , Estudios Transversales , Conducta Adictiva/epidemiología , Alcoholismo/epidemiologíaRESUMEN
Prior research suggests that sleep disturbances are associated with increased risk of suicide. However, sleep disturbances are associated with a wide range of psychiatric disorders, and it is unknown whether this association is independent of psychopathology. In a large nationally representative prospective survey, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), we used structural equation modeling to examine the shared and specific effects of three sleep complaints (i.e., trouble falling asleep, early morning awakening, and hypersomnia) on the 3-year occurrence of attempting suicide. Because psychiatric disorders increase the risk of suicide attempt almost exclusively through a general psychopathology factor representing their shared effect, covariates included that factor, prior history of suicide attempt, and a wide range of sociodemographic and clinical characteristics. The 3-year prevalence rate of suicide attempt was 0.6% (n = 241). Compared with participants who did not attempt suicide between the two waves, those who did reported significantly more frequently having trouble falling asleep (44.6% vs. 16.6%), early morning awakening (38.9% vs. 12.7%), and hypersomnia (35.0% vs. 10.7%). Following adjustments, effects of sleep complaints on this risk were significant and exerted almost exclusively through a general sleep complaints factor representing the shared effect across all sleep complaints. There were no residual associations of any individual sleep complaint with attempting suicide above that association. Sleep complaints are associated with an increased risk of attempting suicide independently of psychopathology, and should be included in suicide risk assessments as these symptoms may provide targets for reducing the risks of suicidal behaviors.
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Trastornos Mentales , Humanos , Trastornos Mentales/epidemiología , Estudios Prospectivos , Sueño , Ideación Suicida , Intento de SuicidioRESUMEN
The full 2-month lockdown to fight the coronavirus disease 2019 (COVID-19) pandemic in 2020 led to substantial disruption of daily life and routines. The present study aimed to comprehensively identify the lockdown's effects on sleep, daily rhythms and emotions of the French population. A survey was published online during the last week of the 2-month full lockdown and 1,627 individuals completed the online survey. The survey was self-administered and included standardised questionnaires. Sleep schedules were delayed during lockdown in more than half of the participants. New severe delayed sleep phase affected 10% of participants with sleep schedules delayed by ≥3 hr during the lockdown compared to before. A significant decrease in exposure to morning (p < 0.001) and evening natural light (p < 0.001), a significant increase in screen exposure time (with a significant screen exposure >3 hr during the evening for 45% of the participants during lockdown versus 18% before lockdown, p < 0.001), an increase in substance use for one-quarter of participants, a poorer sleep quality in 56% of participants, and less regular sleep schedules in 48% of participants were observed. We also found a poorer sleep quality in women than men during lockdown (p = 0.004). The French full lockdown had a severe impact on sleep quality, sleep-wake rhythms, and sleep behaviours. The implementation of public health strategies for the prevention and care of sleep-wake cycles during lockdown are therefore essential.
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COVID-19 , COVID-19/prevención & control , Ritmo Circadiano , Control de Enfermedades Transmisibles , Femenino , Humanos , Masculino , SARS-CoV-2 , SueñoRESUMEN
OBJECTIVE: To provide a qualitative view and quantitative measure of sleep disturbances across and between early stages - clinical ultra high-risk and first episode - of psychotic and bipolar disorders. METHODS: Electronic databases (PubMed, Cochrane, Embase, PsychINFO) were searched up to March 2021 for studies comparing sleep measures between individuals with an early stage and controls. Standard mean deviations (Cohen's d effect sizes) were calculated for all comparisons and pooled with random-effects models. Chi-square tests were used for direct between-subgroups (ultra high-risk vs first episode) comparisons of standard mean deviations. The effects of age, sex ratio, symptoms and treatment were examined in meta-regression analyses. RESULTS: A database search identified 13 studies that contrasted sleep measures between individuals with an early stage (N = 537) and controls (N = 360). We observed poorer subjective sleep quality (standard mean deviation = 1.32; 95% confidence interval, [1.01, 1.62]), shorter total sleep time (standard mean deviation =-0.44; 95% confidence interval, [-0.67, -0.21]), lower sleep efficiency (standard mean deviation = -0.72; 95% confidence interval, [-1.08, -0.36]), longer sleep onset latency (standard mean deviation = 0.75; 95% confidence interval, [0.45, 1.06]) and longer duration of wake after sleep onset (standard mean deviation = 0.49; 95% confidence interval, [0.21, 0.77]) were observed in early stages compared to controls. No significant differences were observed for any of the reported electroencephalographic parameters of sleep architecture. No significant between-subgroups differences were observed. Meta-regressions revealed a significant effect of the age and the antipsychotic status on subjective measures of sleep. CONCLUSION: The early stage population presents with significant impairments of subjective sleep quality continuity, duration and initiation. Systematic assessments of sleep in early intervention settings may allow early identification and treatment of sleep disturbances in this population.
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Trastorno Bipolar , Trastornos del Inicio y del Mantenimiento del Sueño , Trastornos del Sueño-Vigilia , Trastorno Bipolar/complicaciones , Humanos , Polisomnografía , Sueño , Trastornos del Sueño-Vigilia/epidemiologíaRESUMEN
BACKGROUND: 3,4-Methylenedioxy-N-methylamphetamine (MDMA) is increasing being used by youth in Europe and in France, but characteristics of its use are unknown. Objectives: The aim was to characterize MDMA use in a sample of French medical students. Methods: Cross-sectional study of Paris VII medical students (N = 592) with an online self-reporting questionnaire. Results: 592 students completed the online questionnaire. 21.5% (n = 127) had experimented with MDMA. Use of MDMA was associated with male sex (p < 0.001), older age (p < 0.001), left the parent's home (p < 0.01), and belonging to a fraternity (p < 0.05). Most experimenters (90.7%) used MDMA in a club or during a music festival. Among users, 42.5% used it more than once a year and less than once a month. During the use, users drank alcohol (90.6%), smoked tobacco (70.9%), smoked cannabis (42.0%) or used cocaine (20.5%). In the days after the use, some smoked tobacco (40.9%), smoked cannabis (29.1%), drank alcohol (22.0%), used cocaine (1.6%) and also took benzodiazepines (5.5%). According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, criteria, the prevalence of MDMA use disorder was 8.5% in our sample and 40.9% among MDMA users. As compared with students who never experienced MDMA, fewer users thought that occasional intake could be dangerous (66.9% vs 83.9%, p < 0.001) and that MDMA could be addictive (74.0% vs 90.3%, p < 0.001). Conclusions: Other studies focusing on drug consumption among students are necessary to define specific public health strategies of prevention and harmful reduction.
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N-Metil-3,4-metilenodioxianfetamina , Estudiantes de Medicina , Trastornos Relacionados con Sustancias , Adolescente , Anciano , Estudios Transversales , Europa (Continente) , Francia/epidemiología , Humanos , Masculino , Prevalencia , Trastornos Relacionados con Sustancias/epidemiologíaRESUMEN
AIMS: As low rates of thiamine are thought to be implicated in alcohol-related cognitive disorders, we wanted to assess patients with alcohol use disorders (AUD) during detoxification for their nutritional status and test if vitamins blood levels were associated with a surrogate of cognitive impairment. METHODS: We performed a retrospective chart review of medical records of 94 consecutive patients hospitalized for alcohol detoxification in a specialized addiction medicine department. Nutritional status was assessed with Body Mass Index (BMI). Vitamins blood levels were available for 80 patients, but thiamine only for 52 patients. The Montreal Cognitive Assessment (MoCA) score was used to screen for cognitive impairment at Day 10 of entry and was available in 59 patients. A binary logistic regression was performed to identify factors associated with MoCA scores below the threshold (26 points). RESULTS: The mean BMI was 23.28 ± 3.78 kg/m2 and 8.79% of weighted patients qualified for malnutrition. The mean MoCA score was 22.75 ± 4.88 points, and 66% of tested patients were below the threshold of suspected cognitive impairment. No low blood thiamine level was found. In multivariate analysis, BMI, but not vitamins blood rates, was significantly associated with a pathological MoCA screening test. CONCLUSION: Clinical examination is more sensitive than biomarkers to determine malnourished AUD patients who are at-risk for cognitive impairment. Malnourished patients with AUD should receive a full neuropsychological testing. SUMMARY: This retrospective chart review study screened for cognitive disorders during alcohol inpatient detoxification with the MoCA test. Body mass index, but not vitamins blood rates, was associated with a pathological MoCA. Clinical examination is more sensitive than biomarkers to determine malnourished AUD patients who are at-risk for cognitive impairment.
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Alcoholismo/fisiopatología , Alcoholismo/rehabilitación , Estado Nutricional , Adulto , Anciano , Alcoholismo/epidemiología , Avitaminosis/epidemiología , Índice de Masa Corporal , Trastornos del Conocimiento/epidemiología , Trastornos del Conocimiento/etiología , Trastornos del Conocimiento/psicología , Femenino , Humanos , Pacientes Internos , Masculino , Desnutrición/epidemiología , Desnutrición/psicología , Persona de Mediana Edad , Pruebas Neuropsicológicas , Prevalencia , Estudios Retrospectivos , Tiamina/sangre , Deficiencia de Tiamina/epidemiología , Vitaminas/sangreRESUMEN
OBJECTIVE/INTRODUCTION: The present trial informs clinicians about switching conditions with the antidepressant agomelatine after the failure of a treatment with either paroxetine or venlafaxine. METHODS: The total number of discontinuation-emergent symptoms, according to the Discontinuation-Emergent Signs and Symptoms checklist, was compared in double-blind conditions after 3 switching options: immediate substitution or initiation of agomelatine (25 mg/day p.o.) with either a short- or long-tapering of the previous drug. Secondary objectives included tolerability and safety assessments and the early clinical benefit after the switch. RESULTS: For all switching options, a withdrawal syndrome was observed 1 week after cessation of the selective serotonin reuptake inhibitor (SSRI)/serotonin-norepinephrine reuptake inhibitor (SNRI) treatment. Psychic symptoms were the most frequently reported, and somatic symptoms were comparatively few. Early discontinuation symptoms after cessation of SSRI/SNRI treatment did not prejudice the antidepressant benefits of agomelatine over 8 weeks. CONCLUSIONS: Both abrupt and start-taper switching with agomelatine are options in everyday practice for those patients who have not responded to either paroxetine or venlafaxine. However, regardless of the switching strategy, the present double-blind study shows that early discontinuation symptoms that arise upon cessation of SSRI/SNRI can alter the patients' perception of the clinical benefit of the new antidepressant. Both practitioners and patients must be warned about these early discontinuation symptoms to prevent the symptoms from being confounded with a lack of therapeutic benefit of the new treatment.
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Acetamidas/uso terapéutico , Antidepresivos/uso terapéutico , Ciclohexanoles/uso terapéutico , Trastorno Depresivo Mayor/tratamiento farmacológico , Sustitución de Medicamentos , Paroxetina/uso terapéutico , Acetamidas/administración & dosificación , Adulto , Anciano , Antidepresivos/administración & dosificación , Ciclohexanoles/administración & dosificación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Paroxetina/administración & dosificación , Clorhidrato de VenlafaxinaRESUMEN
BACKGROUND: There is emerging evidence that the psychobiological mechanisms underlying behavioral addictions such as internet and videogame addiction resemble those of addiction for substances of abuse. OBJECTIVES: Review of brain imaging, treatment and genetic studies on videogame and internet addiction. METHODS: Literature search of published articles between 2009 and 2013 in Pubmed using "internet addiction" and "videogame addiction" as the search word. Twenty-nine studies have been selected and evaluated under the criteria of brain imaging, treatment, and genetics. RESULTS: Brain imaging studies of the resting state have shown that long-term internet game playing affected brain regions responsible for reward, impulse control and sensory-motor coordination. Brain activation studies have shown that videogame playing involved changes in reward and loss of control and that gaming pictures have activated regions similarly to those activated by cue-exposure to drugs. Structural studies have shown alterations in the volume of the ventral striatum possible as result of changes in reward. Furthermore, videogame playing was associated with dopamine release similar in magnitude to those of drugs of abuse and that there were faulty inhibitory control and reward mechanisms videogame addicted individuals. Finally, treatment studies using fMRI have shown reduction in craving for videogames and reduced associated brain activity. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Videogame playing may be supported by similar neural mechanisms underlying drug abuse. Similar to drug and alcohol abuse, internet addiction results in sub-sensitivity of dopamine reward mechanisms. Given the fact that this research is in its early stage it is premature to conclude that internet addiction is equivalent to substance addictions.
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Conducta Adictiva/tratamiento farmacológico , Conducta Adictiva/genética , Encéfalo/fisiopatología , Internet , Juegos de Video/efectos adversos , Juegos de Video/psicología , Conducta Adictiva/fisiopatología , Conducta Adictiva/psicología , Encéfalo/metabolismo , Toma de Decisiones/fisiología , Dopamina/metabolismo , Humanos , Inhibición Psicológica , Neuroimagen , Recompensa , Trastornos Relacionados con Sustancias/metabolismo , Trastornos Relacionados con Sustancias/fisiopatología , Transmisión Sináptica/genética , Transmisión Sináptica/fisiología , Resultado del Tratamiento , Adulto JovenRESUMEN
New psychoactive substances (NPS) have completely modified the drug scene and the current landscape of addiction. Synthetic substances, such as substituted or synthetic cathinones, also known as « legal highs ¼, are often produced and used to mimic the effects of controlled drugs such as cocaine, methylenedioxymethamphetamine (MDMA, ecstasy), and methamphetamine. The overwhelming majority of synthetic cathinones are produced in China and South East Asian countries. The Internet has emerged as the new marketplace for NPS, playing a major role in providing information on acquisition, synthesis, extraction, identification, and substance use. All these compounds are intentionally mislabeled and sold on-line under slang terms such as bath salts, plant food, plant feeders and research chemicals. They are sometimes labeled « not for human use ¼ or « not tested for hazards or toxicity ¼. The rapid spread of NPS forces member countries of the European Union to adapt their response to the potential new dangers that may cause. To date, not only health actors but also the general public need to be clearly informed and aware of dangers resulting from NPS spread and use. Here, we review the major clinical effects of synthetic cathinones to highlight their impact on public health. A literature search was conducted from 2009 to 2014 based on PubMed, Google Scholar, Erowid, and governmental websites, using the following keywords alone or in combination: "new psychoactive substances", "synthetic cathinones", "substituted cathinones", "mephedrone", "methylone", "MDPV", "4-MEC", "addiction", and "substance use disorder".
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Alcaloides/síntesis química , Alcaloides/farmacología , Drogas Ilícitas/síntesis química , Drogas Ilícitas/farmacología , Psicotrópicos/farmacología , Trastornos Relacionados con Sustancias/epidemiología , Alcaloides/efectos adversos , Drogas de Diseño/química , Consumidores de Drogas , Humanos , Drogas Ilícitas/efectos adversos , Psicotrópicos/efectos adversos , Psicotrópicos/síntesis químicaRESUMEN
An acute substance induced psychotic disorder is a cause to raise with a state of agitation in an acute delusional clinical setting. Patients are most often seen in hospital emergency rooms. Rapid diagnosis must be made. An integrated therapeutic management should be considered. Both psychiatric and addiction problems must be taken into account.
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Trastornos Psicóticos/etiología , Trastornos Relacionados con Sustancias/complicaciones , Enfermedad Aguda , Humanos , Trastornos Psicóticos/psicología , Trastornos Relacionados con Sustancias/diagnósticoRESUMEN
Delirium tremens (DT) is a specific type of delirium occurring in patients who are in alcohol withdrawal states. It has a high mortality of about 8%. Hence, it is important for clinicians to be able to predict it. Treatment of DT is best achieved by the use of intravenous diazepam administered at frequent intervals while closely monitoring the patient during the procedure. Refractory DT is defined by a high requirement of intravenous diazepam with poor control of withdrawal symptoms. Once the acute phase medically controlled, the patient should be managed for his addiction to alcohol.
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Delirio por Abstinencia Alcohólica , Anticonvulsivantes/uso terapéutico , Diazepam/uso terapéutico , Delirio por Abstinencia Alcohólica/diagnóstico , Delirio por Abstinencia Alcohólica/tratamiento farmacológico , Delirio por Abstinencia Alcohólica/epidemiología , Anticonvulsivantes/administración & dosificación , Diazepam/administración & dosificación , Fluidoterapia , Humanos , Inyecciones Intravenosas , Pacientes Internos , Prevalencia , Factores de Riesgo , Resultado del TratamientoRESUMEN
INTRODUCTION: Cannabis currently stands as the most prevalent illicit substance used by adolescents in France. Its use is associated with an elevated risk of developing psychiatric disorder, affecting neuro-cognitive development, or leading to psycho-social challenges in the long run. Cognitive-behavioral therapies (CBT) have emerged as a preferred approach for treating cannabis use disorders (CUD) in adults. METHODS: This review is grounded in a systematic search of the PubMed scientific database for randomized controlled trials focusing on CBT treatment for adolescents (12-18 years old) with CUD. RESULTS: Nine studies met the inclusion criteria. Currently, several variants of CBT-based treatments are available for adolescents, differing in duration based on the intended objectives (ranging from 3 to 24 weeks). These CBT therapies are often complemented by motivational interviewing or family therapy. Only two studies draw comparisons between CBT and alternative therapeutic approaches. DISCUSSION: The current scientific literature in this field is limited, and the study designs display heterogeneity. However, abbreviated treatment courses appear to have value, especially within the adolescent population. These courses offer treatment advantages and may enhance treatment adherence among these young patients, who may face challenges in maintaining consistent follow-up. Additionally, involving parents in psychotherapeutic care seems to have a positive impact. CONCLUSION: CBT in adolescents with CUD appears to be a promising approach to assist with maintaining abstinence and managing emotions. However, given the diverse study designs found in the literature, conducting research with standardized treatments on larger patient cohorts would be valuable.
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Terapia Cognitivo-Conductual , Abuso de Marihuana , Humanos , Adolescente , Terapia Cognitivo-Conductual/métodos , Abuso de Marihuana/terapia , Abuso de Marihuana/psicología , Niño , Ensayos Clínicos Controlados Aleatorios como Asunto/métodosRESUMEN
BACKGROUND: Cognitive impairments are common in patients with AUD and worsen the prognosis of addiction management. There are no clear guidelines for screening cognitive impairments in hospitalized patients with AUD. METHODS: Fifty-seven patients with an AUD history who were admitted to an acute hospital and assessed by the addiction care team were included. Those patients were screened for cognitive impairments using the Montreal Cognitive Assessment (MoCA) test. We collected clinical information regarding addiction history, comorbidities, and current treatments. Chi-square tests, t-tests, and Mann-Whitney tests were performed to determine factors associated with a pathological MoCA score (<26). RESULTS: A pathological MoCA score was positively associated with spatial-temporal disorientation, difficulty in recalling addiction history, patient underreporting of AUD and a date of last alcohol consumption lower than 11 days ago, and negatively associated with a reason for hospitalization due to alcohol-related health issues. No medication was associated with cognitive impairments. CONCLUSIONS: Clinical elements from assessment by the addiction care team allow for relevant indication for screening cognitive impairments.