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

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

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

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

Effectiveness of Repetitive Transcranial Magnetic Stimulation on Fibromyalgia Patients Responding to a First Repetitive Transcranial Magnetic Stimulation Induction Course After Six Months of Maintenance Treatment: A Randomized Pilot-Controlled Study.

BACKGROUND: Fibromyalgia is a chronic painful condition without real, effective treatment. The administration of repetitive transcranial magnetic stimulation (rTMS) has been shown to have a therapeutic effect on pain, but there are still questions about the maintenance of its effect over time. Continuation of the treatment upon clinical response through maintenance sessions is promising and merits further exploration. MATERIALS AND METHODS: We conducted a randomized, parallel-group, controlled study involving 78 patients to evaluate the effect of rTMS vs sham stimulation after a three-week induction treatment and six months of maintenance treatment (three-week periodicity) on 22 patients who presented a clinical response to the induction treatment. The clinical response was defined as a ≥30% decrease of the baseline visual analog scale (VAS) for pain and a score for the Patient Global Impression of Change (PGIC) >5. The clinic global impression, fibromyalgia impact questionnaire, symptom severity score, and Beck's depression inventory were also studied. RESULTS: A significant clinical response to treatment with rTMS was observed after the induction phase and maintained over six months, particularly as measured by the PGIC parameter of pain, as well as of the intensity of fatigue and depression, with an absence of adverse effects induced by this method. CONCLUSION: A three-week rTMS treatment, characterized by a reduction in pain, as evaluated by VAS, should be continued with the administration of rTMS maintenance sessions for an additional six months to maintain the best possible long-term effects.

Sensory processing in depression: Assessment and intervention perspective.

Few studies have examined sensory processing in mood disorders, including depression. The interactions between sensory inputs and adaptive behaviour have yet to be clarified in this pathology. We assessed sensory profiles among people with major depressive disorder (MDD) with the Adult/Adolescent Sensory Profile scale and determined whether sensory processing patterns were associated with clinical variables such as anxiety, depression, psychomotor retardation or self-esteem. We compared 25 participants with MDD (MDD group) and 25 healthy controls (HC group) to identify sensory processing patterns (low registration, sensation seeking, sensory sensitivity and sensation avoiding). The Hamilton Depression Rating Scale and Clinical Outcomes in Routine Evaluation scale were used to assess depressive symptomatology. Both groups completed the Hamilton Anxiety Rating Scale, Frontal Assessment Battery and Rosenberg Self-Esteem Inventory. The MDD group significantly differed from the HC group in each sensory processing patterns. They had higher low registration (p < 0.001), sensory sensitivity (p < 0.001) and sensation avoidance (p < 0.001) and lower sensation seeking (p = 0.005) than HC. Extreme sensory processing patterns in MDD patients were linked to depressive symptomatology, including anxiety. Sensory processing disorders should be assessed and taken into account when developing nondrug treatment strategies.

BDNF levels and liver stiffness in subjects with alcohol use disorder: Evaluation after alcohol withdrawal.

Background: Brain-derived neurotrophic factor (BDNF) plays a key role in the processes of withdrawal and addiction in alcohol use disorder (AUD), and is also involved in liver homeostasis. The role of BDNF in liver damage and its link with liver stiffness are not known. We hypothesize that serum BDNF levels are linked to changes in hepatic elasticity, both of which depend on variations in alcohol consumption.Objectives: We aimed to study the evolution of BDNF levels and changes in the liver stiffness (LS) of AUD subjects, within two months following withdrawal.Methods: We measured LS by FibroScan® (as an indicator of the degree of liver fibrosis), gamma glutamyl transferase (GGT) levels (as a nonspecific but sensitive marker of liver status) and serum BDNF levels of 62 alcohol-dependent subjects without previously identified liver complications. Measures were obtained at the time of withdrawal (M0) and two months later (M2). Results: BDNF levels increased after alcohol withdrawal and small variations of LS were observed. BDNF values increased significantly according to fibrosis stages measured by LS (p = .028 at M0), and were predicted by GGT levels in a regression model (p = .007 at M0 and p = .003 at M2).Conclusion: In AUD, BDNF levels were associated with measured LS when divided into fibrosis risk categories. Changes in LS and BDNF levels after alcohol withdrawal may be related to changes in homeostatic mechanisms, in addition to those of liver status.

Painful Life Events in Psychiatric Disorders: A Quantitative and Qualitative Analysis.

We reported in a previous study the painful events experienced in the past in subjects with schizophrenia or major depression, in comparison to controls, and related them to the experimental pain sensitivity, anxiety, and the diagnosis. We present here the detailed analysis of these past painful events, with the aim of determining whether schizophrenic, depressive and control groups are qualitatively (type of painful events experienced, emotional or sensory components associated with pain) and quantitatively (duration, severity, and intensity) comparable concerning their past painful experiences. The questionnaire used relies on memory and feelings and will provide an indication about the way pain is experienced and memorized in daily life. The reported history of pain was not the same in the three groups. Depressed subjects differed from the others by the number of reported painful events. Painful events of everyday life, such as trauma without fracture and wounds, were the most highly reported painful events for all groups. Surprisingly, the daily pain events are associated to affective component of pain perception. Other kinds of event were differently reported between the groups. Experience of pain appears to be memorized and reported differently depending on the psychiatric disorder and type of event. The characteristics of each individual, their previous experience, contribute to the expression of psychiatric disorders, including in the field of pain. Past pain experience should be taken into account when attending someone for pain.

Determinants of Blood Brain-Derived Neurotrophic Factor Blood Levels in Patients with Alcohol Use Disorder.

BACKGROUND: Blood brain-derived neurotrophic factor (BDNF) levels are influenced by both addiction and mood disorders, as well as somatic conditions, gender, and genetic polymorphisms, leading to widely varying results. Depressive symptoms and episodes are frequently observed in patients with alcohol use disorder, and vary widely over time, making it a challenge to determine which aspects are specifically involved in variations of serum BDNF levels in this population. METHODS: We assessed 227 patients with alcohol dependence involved in a detoxification program, at baseline and after a follow-up of 6 months, for the Alcohol Use Disorders Identification Test score, the length of alcohol dependence, and the number of past detoxification programs. The Beck Depression Inventory and information on current tobacco and alcohol use, suicidal ideation, body mass index, age, gender, and psychotropic treatments were also collected. Serum BDNF (ELISA) and 2 genetic polymorphisms of the BDNF gene (Val33Met and rs962369) were analyzed. RESULTS: The presence of the Met allele, 2 markers of the history of alcohol dependence (gamma glutamyl transferase and the number of past treatments in detoxification programs), and the presence of a depressive episode (but not depressive score) were significantly associated with the 2 blood levels of BDNF at baseline and after 6 months. After controlling for baseline BDNF levels, the presence of the Met allele and an ongoing depressive episode were the only variables associated with changes in BNDF levels after 6 months. CONCLUSIONS: Low serum BDNF levels are associated with characteristics related to alcohol consumption and mood disorders, and variants of the BDNF gene in alcohol use disorder patients. The factors that most strongly influenced changes in serum BDNF levels following treatment in an alcohol detoxification program were variants of the BDNF gene and ongoing depression.

Past Pain Experience and Experimentally induced Pain Perception.

Many intercurrent factors may be involved in the modulation of the pain message and its expression, such as the previous experience of pain built along the life. In this study, we aimed to determine whether susceptibility to experimentally induced pain is differentially influenced by the individual previous painful experience in subjects with schizophrenia (SC) major depression (MD), and controls (C). METHODS: The SC (30), MD (32) and C (30) groups participated in experimental pain tests (application of pressure and induction of ischemia) after a semi-structured interview to make an inventory of the previous painful experiences, and the evaluation of anxiety either with autonomic (heart rate, blood pressure) or psychological (Hospital Anxiety Depression scale HAD) measures, and catastrophism. RESULTS: The reported pain intensities, severities, duration, of the previous pain events, and the number of previous painful events were equivalent in the three groups, except for the number of painful events experimented before the last six months which was lower in the MD group. Experimental pain sensitivity was influenced by the diagnosis, the HAD scores or the number and intensities of previous lived painful events. CONCLUSION: The lack of a past experience of pain was comparable for the different groups, suggesting that psychiatric disorders do not affect the experience of pain associated with daily life or past events. For each subject, the reported previous experience of pain influences the present feeling of pain.

Snapshot of the supports of communication used by patients at a French psychiatric hospital: a digital or social division?

BACKGROUND: The role of information and communications technology is becoming increasingly prevalent in daily life and in the organization of medical care: are some people being left out? AIMS: To evaluate access to and the uses of communication resources by psychiatric patients, focusing on the means of communication (e.g. mobile phones and computers), access and frequency of internet use. METHODS: A questionnaire was distributed, over a period of 1 week, to inpatients or day hospitalised patients aged over 12 years in all care units. RESULTS: Access to and the uses of modern communication resources were lower than in the general population. Among places and means of internet consultation, the personal computer was most often cited, but only by 34%, and the use of mobile phones is still not widespread. Finally, day hospitalised subjects, the elderly, or subjects being treated in the psychosis care sector use internet and technology the least. CONCLUSIONS: Some differences exist between this population with mental illness and the general population on the use of new communication technologies. The possibility of integrating these techniques in individualized psychiatric care requires prior equipment and/or updates.

A prospective hospital study of alcohol use disorders, comorbid psychiatric conditions and withdrawal prognosis.

BACKGROUND: The objective of this study was to describe the profile and alcoholic status of a population with alcohol use disorders (AUD) requesting help from a psychiatric hospital to stop drinking, as well as their clinical outcome and care consumption over the 2 years following the request. METHODS: The visits were conducted at baseline (M0) and at 6, 12, 18 and 24 months (M6, M12, M18, M24). Demographic, clinical and psychometric data [Beck Depression Inventory (BDI), AUDIT questionnaire, Global Assessment of Functioning (GAF) scale], and information regarding the use of psychiatric care and therapeutics were collected. RESULTS: The 330 subjects included were mostly male, aged 45.2 ± 10.2 years with an employment rate of 55.4 %, living alone (69.1 %), with a psychiatric comorbidity (60.9 %), especially depressive, and with few somatic complications. Their global functioning was poor (GAF score 49.14 ± 15.6), and less than 10 % were addicted to another substance. The abstinence rate at 24 months was 41.4 %, but only 23 % (20) abstained continuously between M0 and M24, and 66.7 % (58) intermittently. The likelihood of abstinence at M24 was greater for females aged over 60 years. The BDI score decreased significantly between M0 and M24. In all, 56.2 % of the participants were re-hospitalized after weaning, but were not integrated in long-term medical care. CONCLUSIONS: Abstinence after alcohol withdrawal fluctuated over time indicating the need for long-term support. The treatment of AUD should not target total, continuous abstinence. Prognostic profiles combining socio-demographic, clinical and biological indicators must be established.

Serum BDNF and pro-BDNF levels in alcohol use disorders according to depression status: An exploratory study of their evolution two months after withdrawal.

Background: Alcohol use disorders (AUDs) are complex pathologies with a myriad of molecular actors involved in both disease progression and remission. Brain-derived neurotrophic factor (BDNF) is suspected to be one such actor due to its neurotrophic effects. The BDNF precursor, pro-BDNF, has different effects, as it mainly promotes neuronal apoptosis. Both forms also play a role in depression and depressive episodes (DE). The aim of this exploratory study was to compare serum BDNF and pro-BDNF levels in patients with AUDs after withdrawal and according to DE status with those of controls without AUDs or DE. Materials and methods: Ninety-nine AUD patients and 40 controls were included. Questionnaires were used to assess both alcohol and psychiatric domains: the severity of hazardous alcohol consumption was assessed using Alcohol Use Disorders Identification Test (AUDIT), craving was assessed using Obsessive and Compulsive Drinking Scale (OCDS), anxiety was assessed with Hamilton Anxiety Rating Scale (HAM-A) and depression with Montgomery-Åsberg Depression Rating Scale (MADRS). Blood samples were collected during two visits: at the time of alcohol withdrawal (M0) and two months later (M2). ELISAs to measure serum BDNF and pro-BDNF levels were performed. AUD patients were categorized according to depression status at M2. Forty-five patients remained abstinent whereas 54 relapsed. BDNF serum levels rose after alcohol withdrawal, but pro-BDNF levels did not vary between M0 and M2. Results: AUD subjects without DE at M2 had higher BDNF levels at both M0 and M2 than AUD subjects with DE at M2. AUD subjects showed lower MADRS and OCD scores at M2 than at M0. AUD subjects without DE had lower BDNF levels at M0 than controls but not at M2, regardless of abstinence maintenance. Conclusion: BDNF serum levels were reduced in AUD patients compared to controls and were further reduced in patients with both AUDs and DE. Alcohol withdrawal treatment was sufficient to induce an increase in serum BDNF levels after 2 months, regardless of whether abstinence was maintained during this time period.

The body interior in anorexia nervosa: from interoception to conceptual representation of body interior.

Background: Body image disorders are well documented in anorexia nervosa (AN); however, knowledge of interoceptive awareness (IA) in this population remains poor. This descriptive study investigated whether and how the representation of the interior of the body may have an impact on IA. Methods: The representations and knowledge of the body interior were evaluated with a drawing task in 34 women with AN and 34 healthy controls (HCs). A lexicometric analysis was performed on the vocabulary used to describe the drawn body parts in a structured interview. It was assumed that the conceptual representation of the body interior could be affected by or influence IA. Thus, the relationship between IA, measured with the heartbeat task and the ischemia-induction test, and the drawings was explored. Other scales, such as those of body shape, awareness or satisfaction, were used to assess affective representations of the body. Results: The drawing, lexicometric and IA results were similar in the two groups. No correlations were found among IA, body representation scores and representation level of body interior. Only the representation of bones by the AN group was significantly different. Discussion: Increased visual attention to the skeleton or greater awareness of bone health could explain the stronger representation of bones in the AN group. The psychophysical therapy received by some AN participants (73%) did not seem to have influenced IA. Our results do not support a relationship between IA and the representation of the body interior.Clinical trial registration:https://clinicaltrials.gov/, identifier NCT03988218.

BDNF CpG methylation and serum levels covary during alcohol withdrawal in patients with alcohol use disorder: A pilot study.

OBJECTIVES: Brain-derived neurotrophic factor (BDNF) levels vary in various conditions including alcohol use disorder (AUD). We aimed to identify drivers of these variations. METHODS: Twelve patients with AUD were assessed at hospitalisation for alcohol withdrawal and four months later. We looked for associations between the change in serum BDNF levels and (1) length of abstinence, (2) anxiety (Hamilton Anxiety Scale) and depression (Beck-Depression Inventory), (3) one functional BDNF genotype (rs6265) and (4) methylation levels of 12 CpG sites within the BDNF gene (located in exons I, IV and IX). RESULTS: While abstinence remained, serum BDNF level increased. This increase correlated with the variation of methylation levels of the BDNF gene, and more specifically of exon I. We found no significant effect of length of abstinence, rs6265, depression or anxiety on serum BDNF level. CONCLUSIONS: Epigenetic regulation of the BDNF gene may be involved in variations of BDNF blood level associated with alcohol abstinence.

Distinct Predictors of Clinical Response after Repetitive Transcranial Magnetic Stimulation between Bipolar and Unipolar Disorders.

Background: Repetitive transcranial magnetic stimulation (rTMS) has been shown to be therapeutically effective for patients suffering from drug-resistant depression. The distinction between bipolar and unipolar disorders would be of great interests to better adapt their respective treatments. Methods: We aimed to identify the factors predicting clinical improvement at one month (M1) after the start of rTMS treatment for each diagnosis, which was preceded by a comparison of the patients' clinical conditions. We used the data collected and the method employed in a previous publication on 291 patients. Results: Although the bipolar group had fewer responders, these patients seemed to better maintain their post-rTMS improvement on anxiety and perception of the severity of their illness than those in the unipolar group. For the bipolar group, young age coupled with low number of medications and high fatigue was shown to be the best combination for predicting improvement at M1. The duration of current depressive episode, which was previously demonstrated for whole group, combined with being attached was shown to favor clinical improvement among the patients in unipolar group. Conclusion: We were able to define a combination of specific factors related to each diagnosis for predicting the patients' clinical response. This could be extremely useful to predict the efficacy of rTMS during routine clinical practice in neuromodulation services.

Comparison of withdrawal symptom intensity between hypnosis and nicotine-replacement-therapies: A pilot study.

Smoking cessation is a global public health issue. Nicotine dependence is a dynamic process that is not limited to physical dependence. Hypnosis can be helpful in the global management of smoking cessation. We explored this effect by comparing the effects of hypnosis and nicotine-replacement therapies (NRT) on tobacco withdrawal.Thirty participants were included in this comparative-randomized pilot study in parallel controlled groups after ethical validation. Participants were recruited by a general practitioner and had standardized consultations with addiction and hypnosis specialists and adapted treatment. The evolution of withdrawal symptoms was compared using the Cigarette Withdrawal Scale-21 for one month after smoking cessation in an adult tobacco-addict population wishing to stop smoking and receiving either NRT or hypnosis, both supported by motivational interviews. Craving intensity (French version of the Tobacco Craving Questionnaire), nicotine dependence (Fagerström), tobacco consumption, anxiety (Hamilton scale), and depression (Montgomery-Asberg scale) were also evaluated. Hypnosis appeared to have an influence on reducing the number of smoked cigarettes, whereas NRT appeared to influence markers of both physical and psychic dependence. A complementarity of hypnosis and NRT may be a viable therapeutic alternative to reduce the intensity of withdrawal symptoms after voluntary smoking cessation. A study on a larger population with a longer follow-up is needed to assess the advantages of each method to quit smoking.

Brain-derived neurotrophic factor serum levels in alcohol-dependent subjects 6 months after alcohol withdrawal.

BACKGROUND: Diagnosing alcohol dependence is based on clinical signs and on the measured levels of biological markers of alcohol consumption. However, these markers are neither sufficiently sensitive and nor specific enough to definitively determine alcohol dependence. The neuroadaptive changes associated with alcohol dependence involve markers such as brain-derived neurotrophic factor (BDNF), which regulate neuronal plasticity. Serum levels of BDNF have been reported to decrease during alcohol dependence and may be restored to normal soon after alcohol is withdrawn. However, the long-term relationship between serum BDNF levels and abstinence status is unknown. METHODS: We investigated serum BDNF levels in 101 abstinent and relapsing alcohol-dependent subjects at the moment of hospitalization for alcohol withdrawal (M0) and 6 months later (M6) and compared them to the serum BDNF levels of 41 nondependent subjects. The BDNF levels of the alcohol-dependent subjects were compared to their serum gamma glutamyl transferase (GGT) levels, mean corpuscular volume (MCV) values, and their score on the Beck Depression Inventory (BDI) questionnaire. RESULTS: Forty-four percent of the alcohol-dependent participants remained abstinent during the 6 months following alcohol detoxification. Serum BDNF levels of the abstinent group at M6 were significantly higher than those of the original group of alcohol-dependent subjects at M0 (p = 0.034). Only the abstinent group had higher BDNF levels than the control group (p < 0.001). Serum BDNF levels increased to a greater extent in the abstinent group than in the nonabstinent group (p = 0.016). No correlations were found between serum BDNF levels and GGT level, MCV value, or BDI score. CONCLUSIONS: Our data confirm that serum BDNF levels do not correlate with either chronic alcohol consumption or peripheral toxicity but may be linked to neuronal aspects of alcohol consumption and dependence. The increased serum levels of BDNF may reflect the concomitant activation of BDNF synthesis that accompanies the neuronal remodeling triggered by alcohol withdrawal and suggests that BDNF synthesis may have a role in the long-term maintenance of abstinence. Monitoring the serum BDNF levels of alcoholics undergoing treatment could help to characterize alcohol dependence profiles and predict relapse.

Factors for Maintaining Abstinence at 2 and 6 Months After Alcohol Withdrawal.

OBJECTIVES: Relapse rates in subjects with an alcohol use disorder who have undergone alcohol detoxification are high, and risk factors vary according to the studied population and the context in which withdrawal occurred. Subjects being treated in psychiatric settings require increased monitoring at the moment of detoxification and during follow-up. It is thus important to identify specific risk factors for relapse in such patients. The objective of this study was to determine factors associated with maintenance of abstinence 2 months after alcohol withdrawal (M2) and to characterize factors associated with later relapses 6 months after withdrawal (M6) among those who were abstainers at M2. METHODS: We conducted an ancillary study of a specific psychiatric cohort of subjects with an alcohol use disorder who were followed after withdrawal, by analyzing clinical and biological data collected at M2 and M6. RESULTS: The specific factors predictive of future relapse were age, intensity of craving, number of standard glasses consumed, psychiatric comorbidity (depression), and employment and family/marital status. Substance use (other than the use of tobacco) decreased the likelihood of abstinence at M2, whereas a depressive state at the time of alcohol withdrawal increased the likelihood of abstinence at M2. Consumption of other substances and a greater intensity of craving at the time of alcohol withdrawal decreased the likelihood of abstinence at M6. CONCLUSIONS: The results of this study highlight the importance of identifying craving, multiple substance use, and psychiatric comorbidities (depression) during comprehensive interviews in follow-up after alcohol withdrawal. In caring for patients after alcohol detoxification, priority should be given to factors that have been shown to enhance the beneficial effects of abstinence, such as mood enhancement.

Acceptability of Pharmacogenetic Testing among French Psychiatrists, a National Survey.

Psychiatric disorder management is based on the prescription of psychotropic drugs. Response to them remains often insufficient and varies from one patient to another. Pharmacogenetics explain part of this variability. Pharmacogenetic testing is likely to optimize the choice of treatment and thus improve patients' care, even if concerns and limitations persist. This practice of personalized medicine is not very widespread in France. We conducted a national survey to evaluate the acceptability of this tool by psychiatrists and psychiatry residents in France, and to identify factors associated with acceptability and previous use. The analysis included 397 observations. The mean acceptability score was 10.70, on a scale from 4 to 16. Overall acceptability score was considered as low for 3.0% of responders, intermediate for 80.1% and high for 16.9%. After regression, the remaining factors influencing acceptability independently of the others were prescription and training history and theoretical approach. The attitude of our population seems to be rather favorable, however, obvious deficiencies have emerged regarding perceived skills and received training. Concerns about the cost and delays of tests results also emerged. According to our survey, one of the keys to overcoming the barriers encountered in the integration of pharmacogenetics seems to be the improvement of training and the provision of information to practitioners.

Predictors of clinical response after rTMS treatment of patients suffering from drug-resistant depression.

Repeated transcranial magnetic stimulation (rTMS) is a therapeutic brain-stimulation technique that is particularly used for drug-resistant depressive disorders. European recommendations mention the effectiveness of 30 to 64%. The failure rate of treatment is high and clinical improvement is visible only after a certain period of time. It would thus be useful to have indicators that could anticipate the success of treatment and more effectively guide therapeutic choices. We aimed to find predictive indicators of clinical improvement at 1 month after the start of rTMS treatment among the data collected during the care of patients with drug-resistant depression included in the Neuromodulation Unit of the Esquirol Hospital in Limoges since 2007. In total, 290 patients with a pharmaco-resistant depressive episode, according to the Hamilton Depression Rating Scale (HDRS) (score ≥8), before treatment who underwent a complete course of rTMS treatment and did not object to the use of their collected data were included. The clinical response in routine practice, corresponding to a decrease in the HDRS score of at least 50% from inclusion, was determined and complemented by interquartile analysis. A combination of factors predictive of clinical response during care, such as a short duration of the current depressive episode associated with a higher HDRS agitation item value (or a lower perceived sleepiness value) and a higher number of previous rTMS treatments, were identified as being useful in predicting the efficacy of rTMS treatment in routine clinical practice, thus facilitating the therapeutic choice for patients with drug-resistant depression.

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

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