A multidimensional approach to impulsivity in Parkinson's disease: measurement and structural invariance of the UPPS Impulsive Behaviour Scale.

BACKGROUND: Poor impulse control is a common feature in patients with Parkinson's disease (PD). However, before testing whether patients with PD and controls differ in impulsivity, one must assess whether impulsivity measures are invariant across groups. Consequently, we examined (a) the measurement and structural invariance of a scale assessing changes in four dimensions of impulsivity (urgency, lack of premeditation, lack of perseverance and sensation seeking) among patients with PD and controls; and (b) whether the four impulsivity traits relate differentially to risky decisions by patients. METHOD: Close relatives of 78 patients with idiopathic PD and 96 control participants were given the short Urgency-Premeditation-Perseverance-Sensation seeking Impulsive Behaviour Scale (UPPS), which assesses changes in four dimensions of impulsivity. Participants also completed the Game of Dice Task (GDT), a laboratory measure of risk taking. RESULTS: Multigroup confirmatory factor analyses supported measurement invariance across groups, whereas structural invariance was not confirmed. Patients with PD showed greater variability and higher impulsivity than controls. Furthermore, patients with impulse control disorders (ICDs) demonstrated even greater levels of sensation seeking than patients without ICDs. Finally, lower premeditation and greater perseverance were significantly associated with greater risk taking in patients with PD, and higher agonist dopaminergic doses with less risky choices on the GDT. CONCLUSIONS: The questionnaire appears to function comparably across patients and controls. Thus, group comparisons on the questionnaire can be considered valid. Mean differences between groups on the dimensions of impulsivity may reflect executive impairments and/or abnormal reward processing in patients with PD, which may lead to risky behaviours.

Neurobehavioral and self-awareness changes after traumatic brain injury: Towards new multidimensional approaches.

Neurobehavioral and self-awareness changes are frequently observed following traumatic brain injury (TBI). These disturbances have been related to negative consequences on functional outcomes, caregiver distress and social reintegration, representing therefore a challenge for clinical research. Some studies have recently been conducted to specifically explore apathetic and impulsive manifestations, as well as self-awareness impairments in patients with TBI. These findings underlined the heterogeneity of clinical manifestations for each behavioral disturbance and the diversity of psychological processes involved. In this context, new multidimensional approaches taking into account the various processes at play have been proposed to better understand and apprehend the complexity and dynamic nature of these problematic behaviors. In addition, the involvement of social and environmental factors as well as premorbid personality traits have increasingly been addressed. These new multidimensional frameworks have the potential to ensure targeted and effective rehabilitation by allowing a better identification and therefore consideration of the various mechanisms involved in the onset of problematic behaviors. In this context, the main objective of this position paper was to demonstrate the interest of multidimensional approaches in the understanding and rehabilitation of problematic behaviors in patients with TBI.

[Acute schistosomiasis: lessons learned from a cohort of 42 exposed travelers]. / Schistosomiase aiguë au retour de voyage. Enseignements tirés d'une cohorte de 42 voyageurs exposés.

Acute schistosomiasis is a regularly encountered disease in travelers. Because of the temporal delay, its unspecific presentation and the spontaneous resolution, acute schistosomiasis can easily remain unrecognized by physicians who are not familiar with tropical pathologies. In December 2011, a female traveler was admitted to the hospital with undetermined fever after having returned from Madagascar where she bathed in fresh water. Acute schistosomiasis was diagnosed and infection was suspected among other travelers of her group. Seroconversion was confirmed among 78% of participants. This article intends to clarify the preventive and diagnostic strategies based on the lessons learned from this cluster of 42 travelers exposed to schistosomiasis.

[Yellow fever: new recommendations]. / Fièvre jaune: nouvelles recommandations.

Indication for yellow fever vaccination is not always easy to assess. The decision to immunize is not only based on the actual risk of the disease in a specific location, but also on public health considerations in the visited country (in order to respectively avoid epidemics in endemic countries or the introduction of the virus in zones where the vectors mosquitoes are present) and on travelers' risk factors for severe or even fatal vaccine adverse events. WHO has recently published new recommendations regarding vaccination against yellow fever after concluding that one dose of vaccine generates a life-long protection. This article tends to clarify the strategy to adopt in 2013 using cases frequently encountered in the practice of travel medicine.

Feasibility and initial efficacy of a cognitive-behavioural group programme for managing anger and aggressiveness after traumatic brain injury.

This study assesses the feasibility of a cognitive-behavioural group programme for treating anger and aggressiveness after a traumatic brain injury (TBI). Five feasibility criteria were considered: demand, implementation, practicality, acceptability and initial efficacy. A self-report questionnaire of aggressiveness (AQ-12) was administered before the intervention (T1), one week following the intervention (T2) and at a four months follow-up (T3). Ten patients with moderate to severe chronic TBI completed the programme through eight once-a-week sessions. The analysis of the feasibility outcomes suggests that: (1) The recruitment, the process of grouping participants and the characterisation of anger and aggressiveness at baseline need to be re-evaluated and improved for future designs. (2) The use of specific strategies for bypassing cognitive and other behavioural dysfunctions related to TBI is crucial for the success of this intervention and merits special attention. (3) The high retention rate, the convenient meeting schedule, cost advantages and the good acceptability by participants are positive arguments for the implementation of a larger trial. (4) The significant reduction of AQ-12 scores at T3 and the high effect size constitute a change in the expected direction and support the initial efficacy of the programme.

[Dyspepsia and Helicobacter pylori: should it be treated?]. / Dyspepsie et Helicobacter pylori: faut-il le traiter?

Epigastric pains are currently one of the most frequent reasons of clinic visits in ambulatory medicine, generating high direct and indirect costs each year. Corresponding to pains in the epigastric area, they result from different underlying diseases such as gastro-esophageal reflux, dyspepsia and peptic ulcers. If the role of Helicobacter pylori is well defined in the pathogenesis of gastro-duodenal ulcers, its implication in dyspepsia is less clear. The Maastricht IV Consensus recommends to test and treat Helicobacter pylori among patients with dyspepsia and no alarm symptoms.