Changes in cocaine consumption are associated with fluctuations in self-reported impulsivity and gambling decision-making.

BACKGROUND: In cross-sectional studies, cocaine users generally display elevated levels of self-reported and cognitive impulsivity. To what extent these impairments are stable v. variable markers of cocaine use disorder, and, thus, are pre-existing or drug-induced, has not yet been systematically investigated. METHOD: We conducted a longitudinal study with cocaine users who changed or maintained their consumption intensity, measuring self-reported impulsivity with the Barratt Impulsiveness Scale (BIS-11), and cognitive impulsivity with the Rapid Visual Processing task (RVP), Iowa Gambling task (IGT), and Delay Discounting task (DD) at baseline and at 1-year follow-up. We assessed 48 psychostimulant-naive controls and 19 cocaine users with decreased, 19 users with increased, and 19 users with unchanged cocaine intake after 1 year as confirmed by hair analysis. RESULTS: Results of linear multilevel modelling showed significant group × time interactions for the BIS-11 total score and the IGT total card ratio. Increasers showed a trend for elevated scores, whereas decreasers exhibited reduced self-reported impulsivity scores within 1 year. Surprisingly, increasers' IGT performance was improved after 1 year, whereas decreasers' performance deteriorated. By contrast, neither RVP response bias B" nor DD total score showed substantial group × time interactions. Importantly, BIS-11 and DD revealed strong test-retest reliabilities. CONCLUSION: Self-reported impulsivity (BIS-11) and decision-making impulsivity (IGT) covary with changing cocaine use, whereas response bias and delay discounting remain largely unaffected. Thus, self-reported impulsivity and gambling decision-making were strongly state-dependent in a stimulant-using population and may be suitable to monitor treatment success, whereas delay of gratification was confirmed as a potential endophenotype of stimulant addiction.

Evidence-based definitions of bipolar-I and bipolar-II disorders among 5,635 patients with major depressive episodes in the Bridge Study: validity and comorbidity.

The definitions of bipolar-I (BP-I) and bipolar-II (BP-II) disorders are currently under revision by the APA and by the WHO. We provide evidence of a revised set of criteria for bipolar disorders and major depressive disorder (MDD) which could serve to strengthen the construct and predictive validity of both disorders and enable more incisive studies of treatments and courses of both disorders. In the diagnostic Bridge Study of 5,635 patients with major depressive episodes from 18 countries (Europe, North Africa, Near East and Far East) leading psychiatrists in each country assessed a pre-specified group of symptoms, illness course, family history and duration of episodes; these data allowed tests of several definitions of bipolarity. The primary revised specifier diagnosis of BP-I disorder included manic episodes based on an additional category A criterion (increased activity/energy) and did not apply any exclusion criteria. The revised BP-II disorders included hypomanic episodes of 1-3 days. Family history and illness course validators (history of mania/hypomania among first degree relatives, 2 or more lifetime episodes and first symptoms having occurred before age 30) discriminated clearly between patients with bipolar-I or bipolar-II disorders meeting bipolarity specifier criteria and those with MDD. Specifier definitions provided better discrimination between MDD and the two bipolar subgroups. Patterns of concurrent comorbidities also differed significantly between patients meeting criteria for MDD compared with those meeting bipolar specifier criteria. Comorbidity patterns differed between bipolar-I and bipolar-II patients. This study provides evidence for the validity of modified (specifier) BP-I and BP-II definitions that incorporate illness course and family history which reduce ambiguities of major depressive episodes between bipolar-I and bipolar-II disorders and MDD.

The role played by depression associated with somatic symptomatology in accounting for the gender difference in the prevalence of depression.

PURPOSE: A variety of studies suggest the existence of a distinct phenotype of somatic depression, i.e., depression accompanied by significant somatic symptomatology. Previous research suggests that the gender difference in the prevalence of depression is primarily due to a difference in somatic depression. The aim of this study was to compare the gender difference in the prevalence of somatic depression and of depression not accompanied by significant somatic symptomatology (labelled "pure" depression) in two representative samples, the National Comorbidity Survey-Replication (NCS-R) and the Zurich Study. METHOD: The gender difference in lifetime somatic depression was compared to that of pure depression based on analyses weighted back to the general population in two representative samples. The NCS-R analyses involved a narrow definition of somatic depression with items from the DSM criteria for depression--appetite, sleep, and fatigue. The analysis of the Zurich study added headaches, body image issues, and breathing difficulties to the criteria and comparison to atypical depression. RESULTS: In both samples, the gender difference in depressive prevalence was due to a large difference in somatic depression with other phenotypes showing little or no gender difference. The gender differences were found to be due to the somatic symptoms rather than the number of symptoms and were much larger for somatic than for atypical depression. CONCLUSION: The gender difference in the prevalence of depression results from the higher prevalence among women of a specific phenotype, somatic depression.

Diagnostic criteria for bipolarity based on an international sample of 5,635 patients with DSM-IV major depressive episodes.

To assess the clinical validity of individual DSM-IV criteria for hypomania. In an international sample of 5,635 patients with major depressive episodes (Bridge Study), DSM-IV criteria for hypomania (stem questions, number and quality of symptoms, duration and exclusion criteria) were systematically assessed and their validity analysed on the basis of clinical data including family history, course, and other clinical characteristics. Three stem questions for hypomania, irritability, elevated mood and the added question of increased activity, showed comparable validity. The results support the current DSM-IV requirement for a higher symptom threshold (4 of 7 hypomanic symptoms) in cases of irritable mood. Longer durations of hypomanic episodes were associated with higher scores on all validators. The results did not support the DSM-IV durational requirements for hypomanic episodes (4 days) and manic episodes (7 days). Brief hypomanic episodes of 1, 2 or 3 days were valid and would meet validity criteria for inclusion. The three exclusion criteria in DSM-IV (hypomania due to the use of antidepressants or of other substances, or to other medical conditions) were found to exclude patients with bipolar depression and should therefore not be retained. These results support several revisions of the DSM-IV concept of hypomanic episodes: specifically, the inclusion of increased activity as a gate question, the inclusion of 1 or 2 to 3-day episodes and the elimination of all exclusion criteria.

Subjective distress predicts treatment seeking for depression, bipolar, anxiety, panic, neurasthenia and insomnia severity spectra.

OBJECTIVE: To examine correlates of mental health treatment seeking such as gender, diagnosis, impairment, distress and mastery. METHOD: Longitudinal epidemiological data from the Zurich Study of common psychiatric syndromes, including unipolar and bipolar depression, panic, anxiety, neurasthenia and insomnia, were utilized. In longitudinal Generalized Estimating Equations, treatment seeking was regressed on measures of subjective distress and impairment, childhood family problems, mastery and number of comorbid diagnoses. RESULTS: Approximately half of all treated participants across all six syndromes suffered from subthreshold disorders. Meeting full or subthreshold diagnostic criteria was associated with treatment seeking for insomnia. Being female was associated with treatment seeking for depression. The only variable highly and consistently associated with treatment seeking, across all syndromes, was subjective distress. Treated participants reported high levels of distress, work and social impairment in both diagnostic and subthreshold groups. CONCLUSION: Subjective distress may be a better indicator of treatment seeking than symptom count.

Acute psychological effects of 3,4-methylenedioxymethamphetamine (MDMA, "Ecstasy") are attenuated by the serotonin uptake inhibitor citalopram.

3,4-Methylenedioxymethamphetamine (MDMA, "Ecstasy") is a recreational drug that has been shown to release serotonin (5-HT) and dopamine (DA) in animals. The effect of MDMA on 5-HT release can be blocked by 5-HT uptake inhibitors such as citalopram, suggesting that MDMA interacts with the 5-HT uptake site. It is unknown whether this mechanism is also responsible for the psychological effects of MDMA in humans. We investigated the effect of citalopram pretreatment (40 mg iv) on the psychological effects of MDMA (1.5 mg/kg po) in a double-blind placebo-controlled psychometric study in 16 healthy human volunteers. MDMA produced an emotional state with heightened mood, increased self-confidence and extroversion, moderate derealization, and an intensification of sensory perception. Most of these effects were markedly reduced by citalopram. This finding suggests that the psychological effects of MDMA are mediated via action at the 5-HT uptake site to increase 5-HT release through the carrier, as expected from animal studies.

Psychological and cardiovascular effects and short-term sequelae of MDMA ("ecstasy") in MDMA-naïve healthy volunteers.

3, 4-methylenedioxymethamphetamine (MDMA, "Ecstasy") is a recreational drug reported to produce a different psychological profile than that of classic hallucinogens and stimulants. It has, therefore, been tentatively classified into a novel pharmacological class termed entactogens. This double-blind placebo-controlled study examined the effects of a typical recreational dose of MDMA (1.7 mg/kg) in 13 MDMA-naïve healthy volunteers. MDMA produced an effective state of enhanced mood, well-being, and increased emotional sensitiveness, little anxiety, but no hallucinations or panic reactions. Mild depersonalization and derealization phenomena occurred together with moderate thought disorder, first signs of loss of body control, and alterations in the meaning of percepts. Subjects also displayed changes in the sense of space and time, heightened sensory awareness, and increased psychomotor drive. MDMA did not impair selective attention as measured by the Stroop test. MDMA increased blood pressure moderately, with the exception of one subject who showed a transient hypertensive reaction. This severe increase in blood pressure indicates that the hypertensive effects of MDMA, even at recreational doses, should not be underestimated, particularly in subjects with latent cardiovascular problems. Most frequent acute somatic complaints during the MDMA challenge were jaw clenching, lack of appetite, impaired gait, and restless legs. Adverse sequelae during the following 24 hours included lack of energy and appetite, feelings of restlessness, insomnia, jaw clenching, occasional difficulty concentrating, and brooding. The present findings are consistent with the hypothesis that MDMA produces a different psychological profile than classic hallucinogens or psychostimulants.

3,4-Methylenedioxymethamphetamine (MDMA) modulates cortical and limbic brain activity as measured by [H(2)(15)O]-PET in healthy humans.

[H(2)(15)O]-Positron Emission Tomography (PET) was used to examine regional cerebral blood flow (rCBF) after administration of a single oral dose of the serotonin realeaser and uptake inhibitor MDMA (1.7 mg/kg) or placebo to 16 MDMA-naïve subjects. Psychological changes were assessed by psychometric rating scales. MDMA produced distributed changes in regional blood flow including increases in ventromedial frontal and occipital cortex, inferior temporal lobe and cerebellum; and decreases in the motor and somatosensory cortex, temporal lobe including left amygdala, cingulate cortex, insula and thalamus. Concomitant with these changes, subjects experienced heightened mood, increased extroversion, slight derealization and mild perceptual alterations. MDMA also produced increases in blood pressure and several side effects such as jaw clenching, lack of appetite and difficulty concentrating. These results indicate that a distributed cluster of brain areas underlie the various effects of MDMA in humans.

Psychological and physiological effects of MDMA ("Ecstasy") after pretreatment with the 5-HT(2) antagonist ketanserin in healthy humans.

MDMA (3,4-methylenedioxymethamphetamine, "Ecstasy") mainly releases serotonin and dopamine. In animals, pretreatment with 5-HT(2) antagonists has been shown to attenuate neurochemical and behavioral effects of MDMA. In humans, the role of 5-HT(2) receptors in the action of MDMA has not been studied. We investigated the effect of pretreatment with the 5-HT(2A/C) antagonist ketanserin (50 mg p.o.) on subjective responses to MDMA (1.5 mg/kg p.o.) in 14 healthy volunteers using a double-blind placebo-controlled within-subject design. Subjective effects were rated by psychometric rating scales. Physiological effects measured were blood pressure, heart rate, and body temperature. Adverse effects were assessed during the sessions, and after one and three days. Ketanserin attenuated MDMA-induced perceptual changes, emotional excitation, and acute adverse responses but had little effect on MDMA-induced positive mood, well-being, extroversion, and short-term sequelae. Body temperature was lower under MDMA plus ketanserin compared to MDMA alone. The results suggest a contributing role for 5-HT(2) receptors in the action of MDMA in humans.

Gender differences in the subjective effects of MDMA.

RATIONALE: 3.4-Methylenedioxymethamphetamine (MDMA) mainly releases serotonin (5-HT) and is contained in the recreational drug Ecstasy. 5-HT is known to play an important role in mood and anxiety disorders, for which there is a female preponderance. To date, there are no systematic data on gender differences in the subjective effects of MDMA. OBJECTIVES: The present work analyzed the pooled data from three controlled studies on the psychological and physiological effects of MDMA in healthy volunteers with no or minimal MDMA experience. A particular focus of the analyses were possible gender differences. METHODS: A total of 74 subjects (54 male, 20 female) participated in all three studies. MDMA in oral doses ranging from 70-150 mg (1.35-1.8 mg/kg) was administered under double-blind placebo-controlled conditions. Subjective peak changes were assessed by standardized psychometric rating scales. Physiological measures were blood pressure, heart rate, and peripheral body temperature. Adverse drug effects were assessed during the experimental session and after 24 h. RESULTS: Psychoactive effects of MDMA were more intense in women than in men. Women especially had higher scores for MDMA-induced perceptual changes, thought disturbances, and fear of loss of body control. The dose of MDMA positively correlated with the intensity of perceptual changes in women. Acute adverse effects and sequelae were also more frequent in female than in male subjects. In contrast, men showed higher increases in blood pressure than woman. CONCLUSIONS: The fact that equal doses of MDMA per kilogram body weight produce stronger responses in women compared to men is consistent with an increased susceptibility of women to the 5-HT-releasing effects of MDMA. Our results also indicate that increasing doses of MDMA produce more hallucinogen-like perceptual alterations, particularly in women.

Mood state and brain electric activity in ecstasy users.

Resting EEG during open and closed eyes and subsequent mood ratings were obtained from 15 Ecstasy users and 14 Ecstasy-naive controls. Absolute spectral power on the scalp, and the three-dimensional, intracerebral distribution of neuroelectric activity using low resolution brain electromagnetic tomography (LORETA) were computed. LORETA revealed global increases of theta, alpha 1 and beta 2/3 power during eyes open in Ecstasy users, and spectral analyses revealed a right-posterior increase of alpha 2 power (confirmed by LORETA) and increased beta band activity during open eyes. Ecstasy users had higher levels of state depressiveness, emotional excitability and a trend-level increase in state anxiety. The observed differences may be related to regular exposure to Ecstasy or other illicit drugs, or may be pre-existing.

Functional hemispheric asymmetry and belief in ESP: towards a "neuropsychology of belief".

30 right-handed subjects were given a lateralized tachistoscopic lexical-decision task. Subjects' belief in extrasensory perception (ESP) was assessed with a single six-point scale; 16 subjects were designated as believers in ESP and 14 subjects as nonbelievers. Believers in ESP did not exhibit a hemispheric asymmetry for the task while nonbelievers exhibited the expected right visual-field/left-hemisphere dominance documented in the literature. Believers' lack of asymmetry was not caused by an impaired left-hemisphere performance but rather by a significantly enhanced lexical-decision accuracy in the left visual field/right hemisphere compared to nonbelievers. These results are compatible with previous studies indicating a correlation between belief in ESP and a bias for right-hemisphere processing. Moreover, the results are relevant for a discussion of an association between paranormal beliefs and schizotypy: highly schizotypal individuals are not only particularly prone to believe in ESP but are also known to show an attenuation of hemispheric asymmetries in lateralized verbal tasks due to an enhanced contribution of the right hemisphere. We suggest that the neurological basis of delusion-like beliefs may involve a release of right-hemisphere function from left-hemisphere control and sketch the focus of research for a future "neuropsychology of belief."

[Volvulus of the colon. Apropos of 37 cases]. / Les volvulus du côlon. A propos de 37 cas.

A retrospective study of 37 case reports of patients with volvulus of the colon was carried out to define diagnostic and therapeutic strategies. The group comprised 22 men and 15 women, mean age 69 +/- 4 years (range 26-88 years), the volvulus being located in the sigmoid colon (n = 23), ascending colon (n = 13) or transverse colon (n = 1). The diagnosis, suggested by the straight abdominal film in almost all cases, was confirmed by a barium enema in 70% of cases. Treatment was surgical in 30 patients (81%) including 12 as emergency operations. Mortality was 5.4% (2 cases), and morbidity high (43% including fatal complications) the majority of adverse reactions being respiratory. Volvulus of the ascending colon was treated by hemicolectomy in 9 cases with no mortality or relapse. In patients with sigmoid volvulus, a "medical" reduction was performed in 7 patients, with success in 5 cases, one recurrence and no mortality, ideal sigmoidectomies in 14 cases resulting in one recurrence and no mortality. Right hemicolectomy appears to be the technique of choice even for urgent cases, there being no contraindications to a one-stage re-establishment of continuity. Inversely, an urgent intervention should at all costs be avoided in cases of sigmoid volvulus, a "medical" reduction (radiology, intubation, endoscopy) allowing preparation of the patient for a deferred ideal sigmoidectomy. Obviously, failure to reduce the volvulus or signs of colon necrosis require urgent surgery and raise the problem of whether or not to re-establish colon continuity.

[Splenectomy for hematologic disease in patients over 70 years of age. Apropos of 38 cases]. / Splénectomie pour maladie hámatologique au-delà de 70 ans. A propos de 38 cas.

A retrospective series of 38 splenectomies performed in patients over 70 for haematology diseases is reported. There were no post-operative deaths and 8 patients (21%) had complications which resolved favourably. Paradoxically, mortality and morbidity were lower in elderly patients although the difference was not statistically significant. No factor predictive of post-operative outcome was found. It was concluded that age is not a contraindication although the clinical situation is a predominant factor in patient selection.

[Cholelithiasis in patients over 75 years of age. Apropos of 147 cases]. / La lithiase biliaire des sujets de plus de 75 ans. A propos de 147 cas.

The authors perform a retrospective study of a series of 147 patients aged 75 and more, who were treated for gallstone. AMong them, 104 had conventional surgery and 43 a nonsurgical treatment. The noticeable elements produced by this analysis are: the frequency of common bile duct lithiasis and of severe septic complication in elderly patients, the frequency of previous gallstone, sometimes remote in time, a significantly higher mortality when the treatment is non-surgical (p less than 0.001), mainly due to the septic complications of the lithiasis. the influence of the diathesis on mortality, and finally, the greater inocuity of the right infracostal approach in view of respiratory complications.

[Sigmoido-uterine fistula of diverticular origin. Review of the literature apropos of a case]. / Les fistules sigmoïdo-utérines d'origine diverticulaire. Revue de la littérature à propos d'un cas.

The authors report one case of sigmoid-uterine fistula of diverticular origin with a favorable outcome after an ideal colectomy associated with subtotal hysterectomy. They emphasize the rarity of this complication, due to the resistance of the uterine tissue. Its diagnosis is primarily clinical, and other examinations are required only to establish the etiological diagnosis. Surgery must be curative, ideally in one stage including the treatment of the diverticular disease and that of its gynecological consequences, which may vary according to the local conditions.

[Mesenteric-portal thrombosis after hematologic splenectomy]. / Thrombose mésentérico-portale après splénectomie hématologique.

Venous thrombosis of the portal system following splenectomy for haematological diseases is uncommon, being reported with an incidence of 0.2 to 6%. Diagnosis may be difficult and the clinical presentation varies greatly. We report 4 cases, included in a consecutive series of 350 splenectomies for hematological diseases. Case 1: a man of 22 years, operated on for autoimmune hemolytic anemia developed severe and generalized abdominal pain 20 days after splenectomy. The coeliac arteriography showed a thrombosis of the portal system. The laparotomy revealed segmentary small bowel necrosis. Outcome after intestinal resection was uneventful. Case 2: a man of 56 years, operated on for essential thrombocythemia had the laboratory findings of acute hepatic failure 28 days after splenectomy. Doppler ultrasonography revealed a portal vein thrombosis. He was treated with heparin. Case 3: a man of 69 years, operated on for acquired idiopathic anemia, developed asthenia and fever 23 days after splenectomy. The ultrasonography showed a portal vein thrombosis. He was successfully treated with heparin. Case 4: a man of 20 years, operated on for Minkowsky-Chauffard hemolytic anemia developed a severe and generalized abdominal pain and fever 13 days after splenectomy. The CT-scan showed a thrombosis of the portal system. Outcome after thrombectomy and regional thrombolysis was uneventful. The aim of this presentation is to review the pathophysiological diagnosis, therapeutic and prophylactic aspects of this serious complication of splenectomy.

[Predictive factors of nodular recurrence after thyroidectomy for goiter]. / Facteurs prédictifs de récidive nodulaire après thyroïdectomie pour goitre.

We report a retrospective series of 44 recurrences of nodular goitre following 430 partial thyroidectomies over a 10 years period. There were 40 women and 4 men with a mean age of 43 and 37 years respectively. Twenty-four recurrences were from our institution (6%) and 20 were referred to us. The median follow-up of primary thyroidectomies was 8.5 years for patients with recurrence and 4 years for patients free of recurrence (p < 10(-6)). The incidence of recurrence was analysed in a statistical and actuarial model considering clinical intra-operative and post-operative variables. The following risk-factors for recurrence were found: age < 50 years (p < 0.01), family history of goitre (p < 0.04), unilateral multinodularity (p < 0.0002), diffuse and bilateral distribution of nodules (p < 0.02), atypical resections with conservation of isthmus (p < 0.0001), scintigraphically "warm" nodules (p < 0.001). Interestingly, sex, heterogeneous thyroid parenchyma without macroscopic nodules and the use of post-operative levothyroxine did not modify the risk of recurrence. Thirty-three patients were non symptomatic. Thirty-four patients underwent re-operation. Three primary non suspected carcinomas were found. There was no mortality related to re-operation. There were not definitive vocal cord paralysis or hypocalcemia. There was no significant difference in vocal or parathyroid morbidity when total thyroidectomy for primitive goitre was compared to total thyroidectomy as re-operation. Long-term and periodic follow-up is necessary to detect non-symptomatic recurrences in a high-risk population. Total thyroidectomy is the treatment of choice for bilateral multinodular goitre.(ABSTRACT TRUNCATED AT 250 WORDS)

[Obstruction of the small intestine caused by bridles and adherences. Analysis of 157 operated cases]. / Les occlusions du grêle par brides et adhérences. Analyse sur 157 cas opérés.

We retrospectively studied a series of 157 patients who were operated for post-operative occlusion of the small bowel. Our aim was to analyze the clinical and operative aspects with particular emphasis of the factors predicting intestinal necrosis. We also reviewed the literature. There were 103 females and 54 males with a mean age of 61 and 51 years respectively (p < 0.01). Patients with neoplasia, hernia or irradiated bowel syndrome were excluded. Perioperative variables were analyzed and compared with the incidence of intestinal necrosis and post-operative morbidity and mortality. Data were compared with the chi 2 test. The most frequent prior surgery was appendectomy (33%) and pelvic operations (25%). The mean latency period was 15 years and 5 patients (3%) developed immediate post-operative occlusion (mean 7 days). The preoperative interval was 24 hours on the average. The pathologies involved were: bridles 48%, bridles + adherences 35%, adherences 17%. No clinical sign could distinguish between these three categories, but strangulation was more frequent in patients with bridles (p < 0.003). The following factors were significantly related to intestinal necrosis: signs of abdominal defence (p < 0.0002), white-cell-count > 16000 (p < 0.002), systolic hypotension (p < 10(-7)) and the lack of a history of occlusion (p < 0.04). Mortality was 6% (all at age > 70 years). Age was the only factor significantly related to morbidity-mortality. Emergency surgery shoulder be performed for patients at risk of intestinal necrosis, especially elderly patients.

[Acute cholecystitis in the elderly]. / La cholécystite aiguë chez le sujet âgé.

We retrospectively studied 150 patients aged over 65 years who had been operated for acute cholecystitis in order to define the surgical results and evaluate this treatment as a function of age. The patients were divided into two groups. Group I included patients between the age of 65 and 79 years, n = 99 (53 males and 46 females). Group II included patients aged 80 years and over, n = 51 (14 males and 37 females). The data were compared with the chi 2 test and the Kruskall and Wallis test. Associated affections were observed in 69 patients in group I and in 36 patients in group II (NS). The clinical picture was similar in the 2 groups with manifestations of pain in the right hypochondral region (group I, n = 97; group II, n = 50), fever (group I, n = 73; group 2, n = 38) and abdominal defence (group I, n = 62; group II, n = 35). Echography revealed the diagnosis in almost all cases in both groups. There was no statistical difference between the two groups in terms of mean operative delay and length of hospital stay. Age increased significantly the risk of exploration of the main bile duct (group I, n = 14; group II, n = 15, p < 0.05). Nevertheless, this exploration did not affect post-operative follow-up. Mortality was 6.7% with 4 deaths in group I and 6% in group II (NS). Post-operative complications were observed in 36 patients in group I and 28 in group II (p < 0.05) (43% overall including deaths).(ABSTRACT TRUNCATED AT 250 WORDS)