Effects of smoking on sleep architecture and ventilatory parameters including apneas: Results of the Tab-OSA study.

Background: The interaction between smoking and sleep seems appears to be bidirectional, but few studies evaluated the impact of smoking and its cessation on objective sleep parameters. In this context, this new study aimed to assess the impact of smoking and its cessation on sleep architecture and on ventilatory sleep parameters, particularly the presence of sleep apnea syndrome (apnea-hypopnea index (AHI)≥15). Methods: Patients hospitalized for polysomnographic sleep exploration were compared according to their smoking status: active smokers (AS), former smokers (FS), non-smokers (NoNi). Psychiatric and non-psychiatric co-morbidities and treatment or substance use were taken into account in the analyses. Results: A total of 170 participants were included (N = 37 FS, 39 AS, 86 NoNi). A significant decrease in the mean nocturnal O2 saturation was observed for FS and AS compared to NoNi. No differences were found regarding AHI. Regarding sleep architecture, we observed a significant decrease in the slow wave sleep duration for AS compared to NoNi, and interestingly not between FS and NoNi. Conclusion: This study suggests that current smokers suffer from alterations in both sleep architecture and ventilatory parameters, the later appears to persist even after smoking cessation.

Diurnal symptoms of sleepiness and dysfunction predict future suicidal ideation in a French cohort of outpatients (FACE-DR) with treatment resistant depression: A 1-year prospective study about sleep markers.

BACKGROUND: Patients suffering from treatment-resistant depression (TRD) are at risk of suicide. Sleep and circadian rhythm alterations are widely recognized as core symptoms of major depressive disorder and are associated with suicidal ideation. Thus, sleep and circadian rhythm alterations may be targeted to prevent suicide. METHODS: Patients were recruited from a prospective cohort of the French network of TRD expert centers. Mood, sleep and circadian rhythms were assessed at baseline; suicidal risk was assessed both at baseline and during a one-year follow-up with standardized subjective questionnaires. RESULTS: Excessive daytime sleepiness (adjusted odds ratio aOR = 1.7(1-3.3), p = 0.04) and daytime dysfunction (aOR = 1.81(1.16-2.81), p = 0.0085) increased the risk of suicidal thoughts over the one-year follow-up period in patients with TRD after adjustment on age, gender, depression, trauma, anxiety, impulsivity, current daily tobacco smoking and body mass index. Hypnotics intake is associated with a reduced risk of suicidal ideation at one-year follow-up after the same adjustments (OR = 0.73(0.56-0.95), p = 0.019). Other associations between sleep quality or circadian rhythms and suicidal ideations at either baseline or one year did not remain significant in multivariate analyses after the same adjustments. LIMITATIONS: Sleep assessments were based on self-reported questionnaires rather than objective measures. CONCLUSIONS: Daytime sleepiness and dysfunction are predictors of suicidal ideations, whereas hypnotics intake is associated with a reduced risk of suicidal ideations. Diurnal symptoms of sleep disturbances are therefore red flags to target for preventing suicide in depressed patients, and hypnotics seem efficient in preventing suicide for patients with TRD.

Sleep Complaints Among Adults With Major Depressive Episode Are Associated With Increased Risk of Incident Psychiatric Disorders: Results From a Population-Based 3-Year Prospective Study.

Objective: Sleep alterations have been suggested as a cause and consequence of psychiatric disorders. In this context, we evaluated the incidence of psychiatric disorders following sleep complaints in adults with major depressive episode (MDE).Methods: In a large, nationally representative 3-year prospective survey, the National Epidemiologic Survey on Alcohol and Related Conditions conducted in 2001-2002 (Wave 1) and 2004-2005 (Wave 2), we used structural equation modeling to examine shared and specific effects of trouble falling asleep, early morning awakening, and hypersomnia on incidence of common comorbid DSM-IV disorders among patients with MDE. The analyses adjusted for sociodemographic and clinical characteristics, including sedative or tranquilizer use.Results: Among participants with MDE at Wave 1, 3-year incidence rates were dysthymia = 2.9%, general anxiety disorder = 8.2%, panic disorder = 3.4%, social anxiety disorder = 4.0%, specific phobia = 3.0%, alcohol use disorder = 8.1%, nicotine dependence = 6.2%, cannabis use disorder = 2.7%, and other drug use disorder = 4.9%. Participants with 3-year incident psychiatric disorders commonly had trouble falling asleep (67.6% for cannabis use disorder to 76.4% for panic disorder), early morning awakening (43.3% for cannabis use disorder to 55.6% for dysthymia), and hypersomnia (51.3% for nicotine use disorder to 72.1% for social anxiety disorder). The effects of the incident general psychopathology factor, representing mechanisms related to incidence of all psychiatric disorders, were exerted almost exclusively through a factor representing shared effect across all sleep complaints. Sleep complaints were associated with increased risk of incident psychiatric disorders, independent of sociodemographic and clinical characteristics.Conclusions: These findings suggest that sleep complaints should be clinically assessed in all psychiatric disorders, as these prodromal symptoms might constitute transdiagnostic biomarkers and therapeutic targets for prevention.

MDMA Use by Paris Medical Students: Prevalence and Characteristics.

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.

Impact of a computer-assisted Screening, Brief Intervention and Referral to Treatment on reducing alcohol consumption among patients with hazardous drinking disorder in hospital emergency departments. The randomized BREVALCO trial.

OBJECTIVE: To assess the impact of a computer-assisted Screening, Brief Intervention, and Referral to Treatment (SBIRT) on daily consumption of alcohol by patients with hazardous drinking disorder detected after systematic screening during their admission to an emergency department (ED). DESIGN: Two-arm, parallel group, multicentre, randomized controlled trial with a centralised computer-generated randomization procedure. SETTING: Four EDs in university hospitals located in the Paris area in France. PARTICIPANTS: Patients admitted in the ED for any reason, with hazardous drinking disorder detected after systematic screening (i.e., Alcohol Use Disorder Identification Test score ≥5 for women and 8 for men OR self-reported alcohol consumption by week ≥7 drinks for women and 14 for men). INTERVENTIONS: The experimental intervention was computer-assisted SBIRT and the comparator was a placebo-controlled intervention (i.e., a computer-assisted education program on nutrition). Interventions were administered in the ED and followed by phone reinforcements at 1 and 3 months. MAIN OUTCOME MEASURE: The primary outcome was the mean number of alcohol drinks per day in the previous week, at 12 months. Results From May 2005 to February 2011, 286 patients were randomized to the computer-assisted SBIRT and 286 to the comparator intervention. The two groups did not differ in the primary outcome, with an adjusted mean difference of 0.12 (95% confidence interval, -0.88 to 1.11). CONCLUSIONS: There was no additional benefit of the computer-assisted alcohol SBIRT as compared with the computer-assisted education program on nutrition among patients with hazardous drinking disorder detected by systematic screening during their admission to an ED.

Characteristics of online compulsive buying in Parisian students.

BACKGROUND: Online compulsive buying is a little-studied behavioral disorder. AIMS: To better understand its clinical aspects by focusing on (i) prevalence rate, (ii) correlation with other addictions, (iii) influence of means of access, (iv) motivations to shop to the internet and (v) financial and time-consuming consequences. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: 200 students in two different centers of Paris Diderot University - Paris VII. MEASUREMENTS: Brief self-questionnaires, to screen online compulsive buying, internet addiction, alcohol and tobacco use disorders, to rate frequency of online purchase by private-sale websites, by advertising banners, by mobile phone or to avoid stores, to rate motivations like "more discreet", "lonelier", "larger variety of products", "more immediate positive feelings", and "cheaper" and to assess the largest amount of online purchasing and the average proportion of monthly earnings, and time spent, both day and night. FINDINGS: Prevalence of online compulsive buying was 16.0%, while prevalence of internet addiction was 26.0%. We found no significant relationship with cyberdependence, alcohol or tobacco use disorders. Online compulsive buyers accessed more often shopping online by private-sale websites (56.2% vs 30.5%, p<0.0001) or by mobile phone (22.5% vs 7.9%, p=0.005) and preferred online shopping because of exhaustive offer (p<0.0001) and immediate positive feelings (p<0.0001). Online compulsive buyers spent significantly more money and more time in online shopping. CONCLUSION: Online compulsive buying seems to be a distinctive behavioral disorder with specific factors of loss of control and motivations, and overall financial and time-consuming impacts. More research is needed to better characterize it.

Phenomenology and psychopathology of excessive indoor tanning.

Excessive indoor tanning, defined by the presence of an impulse towards and repetition of tanning that leads to personal distress, has only recently been recognized as a psychiatric disorder. This finding is based on the observations of many dermatologists who report the presence of addictive relationships with tanning salons among their patients despite being given diagnoses of malignant melanoma. This article synthesizes the existing literature on excessive indoor tanning and addiction to investigate possible associations. This review focuses on the prevalence, clinical features, etiology, and treatment of this disorder. A literature review was conducted, using PubMed, Google Scholar, EMBASE and PsycINFO, to identify articles published in English from 1974 to 2013. Excessive indoor tanning may be related to addiction, obsessive-compulsive disorder, impulse control disorder, seasonal affective disorder, anorexia, body dysmorphic disorder, or depression. Excessive indoor tanning can be included in the spectrum of addictive behavior because it has clinical characteristics in common with those of classic addictive disorders. It is frequently associated with anxiety, eating disorders, and tobacco dependence. Further controlled studies are required, especially in clinical psychopathology and neurobiology, to improve our understanding of excessive indoor tanning.

Excessive indoor tanning as a behavioral addiction: a literature review.

BACKGROUND: Socially valorized, excessive indoor tanning can lead to dependence. This finding is based on the observations of many dermatologists, who report repeated failures in preventing their patients from visiting tanning cabins, despite the announcement of a diagnosis of malignant melanoma. OBJECTIVE: The objective of this paper is to show that excessive indoor tanning can be included in the spectrum of addictive behavior. This review focuses on the clinical features, diagnosis, prevalence, etiology, treatment, prevention, and psychopathology of this disorder. METHODS: A review of the medical literature was conducted using PubMed and Google Scholar and using the following key words alone or in combination: tanning, addiction, dependence, tanning bed, sun exposure, and solarium. We selected 41 English-language articles from 1974 to 2013. RESULTS: Many excessive indoor tanners meet symptom criteria adapted from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) substance abuse and dependence criteria. Trial studies suggest that there may be a physiological basis, consisting of dependence on opioids, for excessive indoor tanning behaviors. CONCLUSION: Excessive indoor tanning can be included in the spectrum of addictive behaviors, although other models may be proposed. Further controlled studies must be performed, especially in neurobiology and imaging, to improve our understanding of tanning dependence.

[Psychological and social impact of online gambling]. / Impact social et psychologique des jeux d'argent en ligne chez les jeunes adultes.

The arrival of online betting has important implications for pathological gambling New gamblers are easily recruited online, especially among young people who are highly involved in web-mediated activities. In addition, gamblers used to betting in "real life" settings can now play their favorite games at any time of the day or night. Negative economic, social and psychological consequences of this new phenomenon are beginning to appear. We present original data from a study conducted in a French University, showing a 7% prevalence of online gambling This activity was associated with male gender, alcohol consumption and smoking. New prevention messages and new means of early diagnosis are needed.

Prevalence of exercise dependence and other behavioral addictions among clients of a Parisian fitness room.

AIM OF THE STUDY: Exercise dependence is an inadequate pattern of exercise leading to clinically significant negative consequences. Subjects present loss of control of their physical activity, tolerance, and withdrawal symptoms when they do not practice sport. We studied the prevalence of exercise dependence among clients of a Parisian fitness room. We also assessed alcohol and nicotine use disorders, 2 other "socially tolerated" behavioral addictions (compulsive buying and Internet addiction), and 2 disorders related to anxiety focused on the body (bulimia and hypochondria). METHOD: All clients of the fitness room 18 years and older were invited to participate in the study. Three hundred subjects were included; 125 (42%) presented diagnostic criteria of exercise dependence. Unsurprisingly, exercise dependents spent more hours each day in the fitness center practicing (2.1 vs 1.5 hours per day). They went to the fitness center more often each week (3.5 vs 2.9 days per week). Exercise addicts smoked less; alcohol consumption was equivalent in both groups. Compulsive buying was significantly more frequent in exercise dependents (63% vs 38%), which means they scored higher in the compulsive buying scale (5.4 vs 4.1). Prevalence of hypochondria was equivalent in both groups, but scores in the Whiteley Index of Hypochondria were higher (4.1 vs 3) in the exercise-dependent group. Bulimia was significantly more frequent among exercise dependents (70% vs 47%), who also presented a higher number of bulimic episodes each week (2.5 vs 1.3). Subjects with exercise dependence spent more time on their computer each day (3.9 vs 2.4 hours per day). We found no difference regarding time spent using Internet, the number of e-mails sent or received, and their time at speaking on a cellular phone. CONCLUSION: Our results lead to systematically study the addictive relation to exercise among regular clients of the fitness rooms. Exercise addicts are exposed to negative consequences for their excess of physical activity. Exercise addiction is also associated to compulsive buying, bulimia, and, in a lesser extent, hypochondria.

Study of impulse control disorders among women presenting nicotine dependence.

Objective. Impulse control disorders (ICDs) include intermittent explosive disorder, kleptomania, trichotillomania, pyromania and pathological gambling. Several studies have showed an association between ICDs and alcohol use disorders. The rate of co-occurrence ICDs and nicotine dependence has never been investigated. We thus assessed the frequency of all ICDs in a population of nicotine-dependent women compared to non-smoking women. We also checked criteria of two other impulsive behaviours, compulsive buying and bulimia. Methods. Five hundred consecutive patients were assessed by a general practitioner in Paris (France). One hundred and twenty-seven women presenting the DSM-IV-R criteria for nicotine dependence were included. They were compared to 127 women consulting the same practitioner but who did not smoke. Diagnosis of ICD (pyromania, kleptomania, trichotillomania, intermittent explosive disorder, pathological gambling) and of bulimia was based on DSM-IV criteria and a modified version of the Minnesota Impulsive Disorders Interview (MIDI). Diagnosis of compulsive buying was made with the McElroy et al. criteria and a specific questionnaire. Cigarette smoking was studied using the Fagerström questionnaire and the DSM-IV-R criteria for nicotine dependence. Alcohol use disorders were assessed with the DSM-IV-R criteria for dependence and the CAGE and the MAST questionnaires. Results. Thirteen patients presented trichotillomania, 22 explosive intermittent disorder and 12 pathological gambling. All these diagnoses were equally frequent in the nicotine-positive and nicotine-negative groups. We found no case of pyromania. Compulsive buying was the most frequent impulse control disorder. It was significantly more frequent in the nicotine-positive group than in the nicotine-negative group (58 vs. 39 cases, P=0.01). Scores of the compulsive buying scale were higher in the nicotine-positive group (4.07 vs. 2.9, P=0.01). None of the patients presented an association of two or more ICDs. Patients from the nicotine-positive group drunk higher quantities of alcohol each day, consumed alcohol more frequently each week and were more often intoxicated each week with alcohol. Their mean MAST scores of alcohol abuse disorders were higher. Conclusion. A total of 45.6% of the nicotine-dependent women presented compulsive buying and 23.6% bulimia. Compulsive buying was significantly more frequent among nicotine-dependent subjects than controls. Other impulse control disorders were as frequent among nicotine-dependent women as in controls. A total of 8.6% presented explosive intermittent disorder, 4.7% pathological gambling and 5% trichotillomania. Nicotine dependence in women was also associated with a higher level of alcohol consumption. These results indicate the possible need to systematically screen nicotine-dependent women, regardless of their motivation for consultation, for alcohol dependence, bulimia and compulsive buying.

Alcohol dependence among elderly French inpatients.

OBJECTIVE/METHODS: The authors compared groups of heavier and lighter drinkers in a geriatric hospital inpatient unit in France, using questionnaire measures of alcohol dependence, sociodemographic characteristics, and cognitive status. RESULTS: Alcohol consumption is more frequent in men than in women; 9% of the geriatric patients (3% of women and 18% of men) show symptoms of alcohol dependence. Alcohol dependence is also associated with benzodiazepine treatment and nicotine dependence. CONCLUSION: Elderly male patients hospitalized in the geriatric unit and receiving benzodiazepines should thus be identified as a population at risk for alcohol dependence, and medical practitioners should be alert to the possibility of overprescribing benzodiazepines past the acute withdrawal stage.

Screening for domestic violence among patients admitted to a French emergency service.

OBJECTIVE: The authors assessed the prevalence of domestic violence among patients examined in the emergency service of a general hospital. They compared the socio-demographic status and psychiatric comorbidity of victims of domestic violence and other patients. METHOD: An assessment was made on 126 consecutive patients received by the emergency service of Bichat-Claude Bernard hospital (Paris, France). Assessment of domestic violence was made through the use of a specific questionnaire. RESULTS: The prevalence rate of domestic violence was 18% among patients examined by the emergency service. Thirty-five percent of the cases were physical violence, 22% sexual violence, 17% psychological violence and 26% multiple forms of domestic violence. Domestic violence had been going on for less than 1 month in only one case. In 74% of the cases, violence lasted for more than 1 year. No differences were found in terms of socio-demographic characteristics (age, marital status, rate of unemployment, sex ratio) and psychiatric comorbidity between victims of domestic violence and others. CONCLUSION: Patients seen in an emergency service must be identified as a population at risk for domestic violence (18%). These situations can be identified only by a systematic assessment using a standardized questionnaire.