Smoking and mental disability : A mixed observational study using a diverse sample of medical-social establishments and services / Tabagisme et handicap psychique : étude observationnelle mixte dans un échantillon diversifié d'établissements et de services médico-sociaux.

INTRODUCTION: A multi-center observational study was carried out in ten ESMS, using a mixed methodology (site visits, questionnaire survey, semi-directive group interviews with professionals and individual interviews with users). PURPOSE OF THE RESEARCH: The aim of this article is to describe the management and prevention of smoking in ESMS for people with mental health disorders, and to characterize and identify the smoking behaviors and representations of ESMS users and the professionals working there. RESULTS: The study made it possible to distinguish between ESMS in terms of the organization of smoking areas and tobacco prevention initiatives. It also revealed that 37 percent of respondents among the professionals said they smoked tobacco, with some of them explaining that they smoked with users and sometimes gave them cigarettes. With regard to prevention, there was a consensus among professionals that they should help users who wanted to stop smoking. Professionals were divided, however, on the need for more active prevention, citing the users' freedom and the fact that ESMS are places where people live. Among the users, 47 percent said they were smokers. Of the users who smoked, 55 percent said they wanted to stop. Interviews with the users revealed that twelve of them wanted to quit, with some asking for help and more assistance from professionals. CONCLUSIONS: This report suggests that intervention research could be developed in ESMS for people with mental health disorders, who could benefit from the smoking prevention actions identified in the facilities and services investigated.

Introduction: Une étude observationnelle multicentrique a été réalisée dans dix ESMS et mobilisait une méthodologie mixte (visite des structures, enquête par questionnaires, entretiens semi-directifs collectifs avec des professionnels et individuels avec des usagers). But de l'étude: Cet article vise à décrire la gestion et la prévention du tabagisme dans des établissements et services médico-sociaux (ESMS) accueillant des personnes avec un trouble psychique, et à caractériser et identifier les comportements tabagiques et les représentations de leurs usagers et professionnels. Résultats: L'étude a permis de distinguer les ESMS au regard de l'organisation des espaces du tabagisme et des actions de prévention du tabac. Elle a permis également de constater que 37 % des professionnels qui ont répondu déclaraient fumer du tabac, une partie d'entre eux expliquant fumer avec les usagers et leur donner parfois des cigarettes. Concernant la prévention, un consensus se dégageait chez les professionnels sur le fait d'aider les usagers qui souhaitaient arrêter. Les professionnels étaient cependant divisés à l'égard d'une prévention plus active, invoquant la liberté de l'usager et le fait que les ESMS sont des lieux de vie. 47 % des usagers se disaient fumeurs. 55 % des usagers fumeurs déclaraient vouloir arrêter. Les entretiens avec les usagers ont permis de constater que douze d'entre eux souhaitaient arrêter, une partie réclamant de l'aide et d'être davantage aidés par les professionnels. Conclusions: Cet état des lieux invite à développer des recherches interventionnelles dans les ESMS accueillant des personnes avec un trouble psychique qui pourraient tirer profit des actions de prévention du tabac repérées dans des structures enquêtées.

Neuroimaging evidence for structural correlates in adolescents resilient to polysubstance use: A five-year follow-up study.

Early initiation of polysubstance use (PSU) is a strong predictor of subsequent addiction, however scarce individuals present resilience capacity. This neuroimaging study aimed to investigate structural correlates associated with cessation or reduction of PSU and determine the extent to which brain structural features accounted for this resilient outcome. Participants from a European community-based cohort self-reported their alcohol, tobacco and cannabis use frequency at ages 14, 16 and 19 and had neuroimaging sessions at ages 14 and 19. We included three groups in the study: the resilient-to-PSU participants showed PSU at 16 and/or 14 but no more at 19 (n = 18), the enduring polysubstance users at 19 displayed PSU continuation from 14 or 16 (n = 193) and the controls were abstinent or low drinking participants (n = 460). We conducted between-group comparisons of grey matter volumes on whole brain using voxel-based morphometry and regional fractional anisotropy using tract-based spatial statistics. Random-forests machine-learning approach generated individual-level PSU-behavior predictions based on personality and neuroimaging features. Adolescents resilient to PSU showed significant larger grey matter volumes in the bilateral cingulate gyrus compared with enduring polysubstance users and controls at ages 19 and 14 (p<0.05 corrected) but no difference in fractional anisotropy. The larger cingulate volumes and personality trait "openness to experience" were the best precursors of resilience to PSU. Early in adolescence, a larger cingulate gyrus differentiated adolescents resilient to PSU, and this feature was critical in predicting this outcome. This study encourages further research into the neurobiological bases of resilience to addictive behaviors.

Imaging of monoamine oxidase-A in the human brain with [11C]befloxatone: quantification strategies and correlation with mRNA transcription maps.

INTRODUCTION: [C]Befloxatone is a highly specific, reversible, and selective radioligand for brain PET imaging of monoamine oxidase-A and can be quantified by a two-tissue compartment model (2TCM) and an arterial input function. The aims of the present study were the following: (a) to assess whether in-vivo protein concentration, as measured by [C]befloxatone total distribution volume (VT), is correlated with post-mortem mRNA expression; (b) to replicate in a population of tobacco smokers the results of a recent study on healthy nonsmokers, which showed that spectral analysis (SA) provides a highly accurate estimation of [C]befloxatone-VT at the voxel level; and (c) to validate the use of an input function that would not require arterial sampling. MATERIALS AND METHODS: Healthy male nonsmokers (n=7) and smokers (n=8) were imaged with PET and [C]befloxatone. Binding was quantified at the regional and voxel level with the Logan plot, multilinear analysis (MA1), and SA. VT values were compared with the reference values obtained by 2TCM at the regional level. [C]Befloxatone binding was compared with mRNA transcription maps from the Allen Human Brain Atlas. A less-invasive input function was obtained with a population-based input function (PBIF) scaled with arterialized venous samples. RESULTS: mRNA expression was highly correlated with in-vivo 2TCM-VT values both for nonsmokers (R=0.873; P<0.0001) and for smokers (R=0.851; P<0.0001). At the regional level, both Logan and MA1 showed a moderate negative bias (-5 to -10%) compared with the reference VT values. With the exception of a single outlying individual, SA showed little bias and variability (+4.4±3.5%). Although variability was higher than at the regional level, SA provided the most accurate VT estimations at the voxel level: all but one participant had an error of less than 20%. Parametric Logan and MA1 analyses gave highly biased or unusable results. PBIF provided good results in all participants in whom the arterialization of venous blood was successful (all errors of about 10% or less). CONCLUSION: [C]Befloxatone binding is strongly correlated with the values of mRNA transcription measured in post-mortem brains. At the voxel level, SA is the best available choice for [C]befloxatone quantification, although a higher variability must be expected. When an arterial input function is not technically feasible, a PBIF scaled with arterialized venous samples may provide an acceptable alternative, provided an optimal arterialization can be achieved.

Striatal and extrastriatal dopamine transporter in cannabis and tobacco addiction: a high-resolution PET study.

The dopamine (DA) system is known to be involved in the reward and dependence mechanisms of addiction. However, modifications in dopaminergic neurotransmission associated with long-term tobacco and cannabis use have been poorly documented in vivo. In order to assess striatal and extrastriatal dopamine transporter (DAT) availability in tobacco and cannabis addiction, three groups of male age-matched subjects were compared: 11 healthy non-smoker subjects, 14 tobacco-dependent smokers (17.6 ± 5.3 cigarettes/day for 12.1 ± 8.5 years) and 13 cannabis and tobacco smokers (CTS) (4.8 ± 5.3 cannabis joints/day for 8.7 ± 3.9 years). DAT availability was examined in positron emission tomography (HRRT) with a high resolution research tomograph after injection of [11C]PE2I, a selective DAT radioligand. Region of interest and voxel-by-voxel approaches using a simplified reference tissue model were performed for the between-group comparison of DAT availability. Measurements in the dorsal striatum from both analyses were concordant and showed a mean 20% lower DAT availability in drug users compared with controls. Whole-brain analysis also revealed lower DAT availability in the ventral striatum, the midbrain, the middle cingulate and the thalamus (ranging from -15 to -30%). The DAT availability was slightly lower in all regions in CTS than in subjects who smoke tobacco only, but the difference does not reach a significant level. These results support the existence of a decrease in DAT availability associated with tobacco and cannabis addictions involving all dopaminergic brain circuits. These findings are consistent with the idea of a global decrease in cerebral DA activity in dependent subjects.

Exposure to smoking cues during an emotion recognition task can modulate limbic fMRI activation in cigarette smokers.

Smoking cues (SCs) refer to smoking-associated environmental stimuli that may trigger craving and withdrawal symptoms, and predispose to relapse in smokers. Although previous brain imaging studies have explored neural responses to SCs, no study has characterized the effects of SCs on cerebral activity in smokers engaged in an attention-demanding cognitive task that is unrelated to smoking. Thirteen tobacco smokers and a demographically matched group of 13 healthy non-smokers participated in a fast event-related functional magnetic resonance imaging (fMRI) study that involved a visual task integrating SCs and neutral cues (NCs) during emotion recognition trials requiring a high level of attention. No significant SC-induced alterations were detected in smokers' behavioural performance. fMRI results show that non-smokers exhibited no difference between SC and NC trials; in contrast, smokers showed SC-induced widespread deactivations in a limbic, paralimbic and striatal network classically involved in addiction, and activation in the right dorsolateral prefrontal cortex. In addition, a correlation between deactivation of the right insula and the severity of smoking dependence (Fagerström test) was detected in smokers. These results suggest that the neural reactivity of smokers to SCs can be modified in the context of a cognitive challenge. This could reflect smokers' ability to inhibit cue-induced craving and may help in smoking cessation.

Cerebral monoamine oxidase A inhibition in tobacco smokers confirmed with PET and [11C]befloxatone.

The inhibition of cerebral monoamine oxidases (MAOs) by cigarette smoke components could participate to the tobacco addiction. However, the actual extent of this inhibition in vivo in smokers is still poorly known. We investigated cerebral MAO-A availability in 7 tobacco-dependent subjects and 6 healthy nonsmokers, using positron emission tomography (PET) and the MAO-A selective radioligand [C]befloxatone. In comparison to nonsmokers, smokers showed a significant overall reduction of [C]befloxatone binding potential (BP) in cortical areas (average reduction, -60%) and a similar trend in caudate and thalamus (-40%). Our findings confirm a widespread inhibition of cerebral MAO-A in smokers. This mechanism may contribute to tobacco addiction and for a possible mood-modulating effect of tobacco.