Orbitofrontal sulcal patterns in catatonia.

BACKGROUND: Catatonia is a psychomotor syndrome frequently observed in disorders with neurodevelopmental impairments, including psychiatric disorders such as schizophrenia. The orbitofrontal cortex (OFC) has been repeatedly associated with catatonia. It presents with an important interindividual morphological variability, with three distinct H-shaped sulcal patterns, types I, II, and III, based on the continuity of the medial and lateral orbital sulci. Types II and III have been identified as neurodevelopmental risk factors for schizophrenia. The sulcal pattern of the OFC has never been investigated in catatonia despite the role of the OFC in the pathophysiology and the neurodevelopmental component of catatonia. METHODS: In this context, we performed a retrospective analysis of the OFC sulcal pattern in carefully selected homogeneous and matched subgroups of schizophrenia patients with catatonia (N = 58) or without catatonia (N = 65), and healthy controls (N = 82). RESULTS: Logistic regression analyses revealed a group effect on OFC sulcal pattern in the left (χ2 = 18.1; p < .001) and right (χ2 = 28.3; p < .001) hemispheres. Catatonia patients were found to have more type III and less type I in both hemispheres compared to healthy controls and more type III on the left hemisphere compared to schizophrenia patients without catatonia. CONCLUSION: Because the sulcal patterns are indirect markers of early brain development, our findings support a neurodevelopmental origin of catatonia and may shed light on the pathophysiology of this syndrome.

[Drug use and treatment misuse: Key points on polydrug use]. / Usages de drogues et mésusages de médicaments : repères utiles sur la polyconsommation.

Problematic use of psychoactive drugs, be it legal, on prescription, or not, remains a broad phenomenon when taken as a whole, with an increasingly large spectrum of used products. The polysubstance drug use is an expanding new trend. Although its epidemiological analysis is complex, needing further research, certain patterns of drug combinations can be found, allowing to identify clusters of users associated to more specific medical and social risks. Managing polysubstance users involves assessing each drug use, but also the connections between drugs and the patient's expectations for each of them. Complications, as well as psychiatric and somatic comorbidities are to be taken into account. The therapeutic tools for polysubstance drug use, mainly pharmacological, are still often limited to the sum of specific tools for each product. Prevention is crucial but has to adapt to the identified use clusters, and the gender. Notably, a good knowledge of chronic pain management and prescribed drug dependency risks is required to prevent polysubstance drug use involving opioids.