[Eole-Réseau LIENS: telephone based assistance and referral advice for primary care professionals confronted with mental health issues in their patients]. / Eole-Réseau LIENS: Service d'appui et d'orientation téléphonique pour les professionnels confrontés à des personnes souffrant de problèmes de santé mentale.

Eole-LIENS is an available telephone line for first-line professionnels facing, in their daily practice, patients or users in psychological trouble. This service proposes a dialogue with a third party allowing a support, a help to the handling of the situation, a finer orientation towards the institutions existing in the network.

[Hard use of soft drugs]. / De l'usage dur de drogues douces.

The concept of "soft drugs" is unclear and refers more to the behaviour of consumers than to the specific pharmacological properties of substances. However, "soft drugs" is often understood as "safe drugs." However, it is of major importance to underline that all drugs can induce major loss of the control of consumption, what is the crucial point of addictive behaviour. This is due to a sensitization of the so-called" brain reward system"; moreover, there is cross-sensitization between drugs. Only cannabis and alcohol are frequently thought to be associated to a long-term safe consumption. In our experience, this reputation is broadly usurped. Indeed, we observed that even when they do not have major health problems, cannabis consumers present major alterations of social functioning. In another way, we have shown that heavy alcohol consumers without neurological complications have frequently frontal dysfunction, clinically correlated to major alterations of executive functions.

Supervisory attentional system in nonamnesic alcoholic men.

BACKGROUND: Many studies have shown that recently detoxified alcoholic persons perform poorly on tasks thought to be sensitive to frontal lobe damage, supporting the hypothesis that the frontal lobes are highly vulnerable to chronic alcohol consumption. However, it appeared that most of the executive tasks used in these studies also involved nonexecutive components, and these tasks had been shown to be impaired as a result of nonfrontal lobe lesions. In this study, we examined further the "frontal lobe vulnerability" hypothesis using executive tasks, proved to be associated with frontal lobe functioning, that allowed us to distinguish the relative importance of executive and nonexecutive processes. METHOD: Thirty recently detoxified asymptomatic male alcoholic inpatients and 30 control subjects were tested for planning, inhibition, rule detection, and coordination of dual task, as well as the speed of processing and nonexecutive functions (such as short-term memory storage). RESULTS: Alcoholics performed worse than controls in almost all tasks assessing executive functions. However, they were not slower than the controls and showed normal results for nonexecutive functions. CONCLUSIONS: Chronic alcohol consumption seems to be associated with severe executive function deficits, which are still present after a protracted period of alcohol abstinence. These data support the idea that the cognitive deficits in recently detoxified sober alcoholic subjects are due, at least partly, to frontal lobe dysfunctioning.

Increase of neurophysin II serum levels in chronic alcoholic patients: relationship with alcohol consumption and alcoholism blood markers during withdrawal therapy.

Neurophysin II (hNpII) but not hNpI serum levels were higher than normal (greater than 2.85 ng/ml) in 9 of 20 patients admitted to the metabolic ward for alcohol withdrawal therapy; a normalization was observed within the first week of alcohol withdrawal. The higher levels of hNpII were felt to reflect alcohol impregnation for the following reasons: 1) on admission, levels of most of the alcoholism blood markers were higher in the group of patients with high hNpII levels than in the group with normal hNpII levels; 2) hNpII levels were correlated with most of the alcoholism blood markers, mainly gamma-glutamyl transpeptidase (r = 0.63, P less than 0.001) in the 20 patients of the study; 3) patients with high hNpII levels admitted to greater alcohol and less anxiolytic drug intake immediately before admission. The physiopathological meaning and hypothetical psychological consequence of this hNpII increase remain to be defined.

Divergent responses to fluoxetine from two compulsive, food-related conditions: bulimia nervosa and compulsive water drinking.

BACKGROUND: The association of compulsive water drinking with bulimia nervosa is rarely encountered. Nevertheless similar behavior patterns could involve a common pathophysiological mechanism. METHODS: A case report with the association of those two disorders is described. Treatment with fluoxetine was introduced to alleviate the compulsive aspects of those disorders. RESULTS: Fluoxetine had a positive effect on bulimia nervosa but none on compulsive water drinking. CONCLUSIONS: The different response to pharmacologic treatment could mean that bulimia nervosa and compulsive water drinking are based on different physiological mechanisms.

Mild to moderate sleep respiratory events: one negative night may not be enough.

STUDY OBJECTIVES: Reports on the reproducibility of apnea-hypopnea indexes (AHIs) across sequential polysomnography (PSG) sessions are conflicting, leading to a lack of clear recommendations on the optimal use of this technique: is one night of monitoring sufficient or is a second night required in order to safely reject the diagnosis? DESIGN: Retrospective comparison of two consecutive nights. SETTING: Sleep unit of a tertiary-care facility. PATIENTS: Two hundred forty-three subjects with suspected sleep apneas. INTERVENTIONS: Two sequential PSG sessions in a sleep unit. MEASUREMENTS AND RESULTS: Using analysis of covariance for repeated measures, with age and body mass index as covariates and gender as a cofactor, a classic first-night effect was found for sleep variables. In addition, a night effect was demonstrated for sleep respiratory variables. Moreover, the high variability of AHIs showed that many patients had their condition diagnosed on only one of the two nights, and more often on the second night than on the first. The gain in detection by adding a second night when the results of testing on the first were negative was between 15% and 25%, according to the AHI obtained on night 1. CONCLUSIONS: Considering the disability associated with sleep apnea/hypopnea syndrome, as well as its global cost for society, the present study shows that it is worth performing two consecutive PSG sessions or at least a second one when the result of the first one is negative in all patients admitted for apnea detection.

Correlations using the NREM-REM sleep cycle frequency support distinct regulation mechanisms for REM and NREM sleep.

Polysomnograms of most homeothermic species distinguish two states, rapid eye movement (REM) and non-REM (NREM) sleep. These alternate several times during the night for reasons and following rules that remain poorly understood. It is unknown whether each state has its own function and regulation or whether they represent two facets of the same process. The present study compared the mean REM/NREM sleep ratio and the mean number of NREM-REM sleep cycles across 3 consecutive nights. The rationale was that, if REM and NREM sleep are tightly associated, their ratio should be comparable whatever the cycle frequency in the night. Twenty-six healthy subjects of both sexes were recorded at their home for 4 consecutive nights. The correlation between the REM/NREM sleep ratio and the number of cycles was highly significant. Of the two sleep components, REM sleep was associated to the number of cycles, whereas NREM sleep was not. This suggests that the relationship between REM sleep and NREM sleep is rather weak within cycles, does not support the concept of NREM-REM sleep cycles as miniature units of the sleep process, and favors the concept of distinct mechanisms of regulation for the two components.

Critical analysis of the theories advanced to explain short REM sleep latencies and other sleep anomalies in several psychiatric conditions.

One of the most consistent and most studied sleep modifications in several psychiatric conditions is the shortening of the rapid eye movement (REM) sleep latency. While its clinical usefulness is still to be proven and its meaning relatively obscure, the appearance of a short REM latency continues to be a daily fact in sleep laboratories. Many theories compete to explain what is observed, the most important being the circadian rhythm hypotheses, the homeostatic model and the reciprocal interaction model. These three are summarised and their pros and cons are exposed in a systematic manner. Points of conflict, possible convergences and limitations are discussed in the light of recent developments on the general theories of sleep regulation.

The first-night effect may last more than one night.

The first-night effect in sleep polysomnographic studies is usually considered to last for one night. However, a few observations have indicated that variables associated to rapid eye movement sleep take longer to stabilize. Notwithstanding, current opinion holds that second nights of recording can be used without restriction for research and clinical purposes. The goal of this study was to describe the dynamics of habituation to polysomnography in optimal conditions. Twenty-six young, carefully screened, healthy subjects were recorded in their home for four consecutive full polysomnographies. Repeated measures ANOVA were applied. Between the two first nights, while there were no differences in sleep duration in non-rapid eye movement sleep, marked modifications in corresponding spectral power were observed. The dynamics of adaptation of rapid eye movement sleep appeared to be a process extending up to the fourth night. Similar dynamics in NREMS and REMS homeostasis have been observed in sleep deprivation studies, and it appears that the same mechanisms may be responsible for the FNE. The longer habituation process of REMS in particular has important implications for sleep research in psychiatry.

Personality profile and drug of choice; a multivariate analysis using Cloninger's TCI on heroin addicts, alcoholics, and a random population group.

As personality may predispose, precipitate or perpetuate substance abuse and/or dependence, and as it is considered to remain stable across the years in a given subject, potential links with the drug of choice may help screen future patients before drug consumption. The present study compared three groups: 42 patients with heroin dependence (mean age: 31.2; standard deviation (SD): 5.5; 10 females), 37 patients with alcohol dependence (mean age 44.2; SD: 9.1; 9 females) and 83 subjects from a random population sample (mean age: 38.8; SD: 6.9; 20 females). Personality was measured by Cloninger's Temperament and Character Inventory (TCI). Pillai's MANCOVA with age as a covariate and gender as a cofactor was highly significant. Univariate ANOVA analyses using TCI dimensions as dependent variable showed most variables to vary in parallel for the two patient groups in comparison with controls. Post-hoc tests showed heroin patients to score higher in Novelty-Seeking and Self-Directedness than alcohol patients. Sub-dimensions Exploratory Excitability, Fear of the Uncertain, Responsibility, Congruent Second Nature and Transpersonal Identification were also significantly different in the two patient samples. Logistic regression showed Exploratory Excitability to segregate up to 76% of heroin patients from alcohol patients. In conclusion, personality profiles were linked to some preferential choice of drug and personality screening might be tested in preventive strategies.

Age and gender effects on the diagnostic power of the DST.

Among 365 major and 158 minor depressive inpatients, the dexamethasone suppression test (DST) yielded an overall diagnostic sensitivity of 50%, a specificity of 85%, and a confidence level of 88%. Age was significantly correlated with the post-dexamethasone cortisol levels in the whole sample (r = 0.11; P less than 0.01); however, this low relationship disappeared when all subgroups defined by gender or diagnostic were considered. Gender did not appear to influence DST results; however, among the patients between 30 and 39 years, the diagnostic performance of the DST was significantly lower among female as compared to male patients, suggesting possible interferences with endocrine variables.

Previous anesthesia can temporarily overshadow the expression of a withdrawal syndrome in opiate dependent rats.

We hypothesized that induction of opiate antagonist-precipitated withdrawal under anesthesia can decrease the expression of later withdrawal signs. Three groups of morphine-dependent rats were compared in different experimental conditions of withdrawal precipitation using naloxone. We showed that anesthesia can temporarily overshadow the expression of withdrawal signs, but that some signs can be delayed and increased in intensity. This can be explained by a parallel and temporary effect of anesthesia on arousal and pain threshold. This carries important implications on the use of anesthesia in detoxification procedures.

Interference with withdrawal signs of naloxone-induced opiate withdrawal under anesthesia is anesthetic-specific in opiate-dependent rats.

We hypothesized that interference of opiate antagonist-precipitated withdrawal signs under anesthesia is anesthetic-specific. Three groups of morphine-dependent rats were compared in different experimental conditions using a protocol of rapid withdrawal induction by an antagonist under anesthesia. We observed that ketamine and midazolam have different effects on the expression of withdrawal. This brings specific insights into the pharmacological basis of therapy with induction of opiate antagonist.

Shorter REM latency associated with more sleep cycles of a shorter duration in healthy humans.

A significant association between rapid eye movement (REM) sleep latency and the number of non-REM/REM sleep cycles was found 15 years ago in a large retrospective study. The present prospective study further explored this intra-sleep relationship and analyzed the links between these two variables and the mean cycle duration. It was based on a carefully selected group of healthy control subjects whose sleep was polysomnographically recorded at home for 4 sequential nights. The latency of REM sleep was inversely correlated with the number of cycles and positively correlated with the mean cycle duration, both in individual nights and on means of 4 nights. The present study demonstrated that variations in the number of cycles or the mean cycle duration between the nights are far less important than the substantial differences observed between subjects. Present outcomes support the study of sleep cycle periods and frequencies in those psychiatric disorders where REM sleep latencies have been found to be shorter, and they suggest that these variables be included in sleep studies in which cycles are compared with each other.

Impaired emotional facial expression recognition in alcoholism compared with obsessive-compulsive disorder and normal controls.

Emotional facial expression (EFE) decoding skills have been shown to be impaired in recovering alcoholics (RA). The aim of the present study is to replicate these results and to explore whether these abnormalities are specific to alcoholism using two control groups: non-patient controls (NC) and patients with obsessive-compulsive disorder (OC). Twenty-two alcoholic patients at the end of their detoxification process (RA) were compared to 22 OC and 22 NC matched for age, sex and education level. They were presented with 12 photographs of facial expressions portraying different emotions: happiness; anger; and fear. Each emotion was displayed with mild (30%) and moderate (70%) intensity levels. Each EFE was judged on 8 scales labeled happiness, sadness, fear, anger, disgust, surprise, shame and contempt. For each scale, subjects rated the estimated intensity level. RA were less accurate in EFE decoding than OC and NC, particularly for anger and happiness expressions. RA overestimated the emotional intensity for mild intensity level expressions compared with both OC and NC while no significant differences emerged for moderate intensity level expressions. Deficits in EFE decoding skills seem to be specific to RA when compared with OC. Comparison with other psychopathological groups is still needed. Possible consequences of EFE decoding deficits in RA include distorted interpersonal relationships.

Deficits in recognition of emotional facial expression are still present in alcoholics after mid- to long-term abstinence.

OBJECTIVE: Emotional facial expression (EFE) decoding skills play a key role in interpersonal relationships. Decoding errors have been described in several pathological conditions, including alcoholism. The aim of this study was to investigate whether EFE decoding skill deficits persist after abstention from alcohol of at least 2 months. METHOD: Alcoholic patients abstinent for at least 2 months (n = 25) were compared with 25 recently detoxified patients and with 25 normal controls matched for age, gender and educational level. Subjects were presented with 40 photographs of facial expressions portraying happiness, anger, sadness, disgust and fear. Each emotion was displayed with neutral, mild, moderate and strong emotional intensity. Each facial expression was judged successively on eight scales labeled happiness, sadness, fear, anger, disgust, surprise, shame and contempt. For each scale, subjects rated the estimated intensity level. A complementary scale assessed the self-estimated difficulty in performing the task. RESULTS: Recently detoxified alcoholics were significantly less accurate than controls, making more EFE labeling errors and overestimating the intensity of the portrayed emotions. Deficits in decoding accuracy for anger and disgust were present in mid- to long-term abstinent patients; intensity overestimation was present in the former and absent in the latter. CONCLUSIONS: Deficits in decoding accuracy for anger and disgust, and to a lesser degree sadness, persist with an abstinence of 2 months and beyond. Right frontotemporal regions and cingulate could be implicated. These deficits may contribute to the social skills deficits frequently encountered in alcoholic patients.

Sleep in detoxified alcoholics: impairment of most standard sleep parameters and increased risk for sleep apnea, but not for myoclonias--a controlled study.

OBJECTIVE: To assess recently alcohol-abstinent chronic alcoholic patients for selected parameters indicative of sleep quality. METHOD: Patients (n = 24, 14 male), abstinent 3-6 weeks, and healthy controls (n = 20) were admitted to a clinical sleep unit. Measurements included sleep respiratory events and periodic limb movements, using strict methodology. RESULTS: Clear signs of sleep deterioration and a high prevalence of apneic/hypopneic episodes were observed. Apneas were found at the same frequency for men and women; this has not been described before. No periodic limb movement was found. CONCLUSIONS: Considering the high degree of morbidity and mortality observed in sleep apneic syndrome, systematic screening for sleep apneas is recommended for alcoholics seeking help.

Alcoholism and emotional reactivity: more heterogeneous film-induced emotional response in newly detoxified alcoholics compared to controls--a preliminary study.

Alcoholics are thought to be characterized by irregular emotional responses, having trouble reaching an optimal level of emotional arousal. They therefore may use alcohol to restore emotional homeostasis. This study investigated whether recently detoxified alcoholics show different emotional responses as compared to controls. Film excerpts were used to induce emotions in 14 newly detoxified alcoholics (9 men, 5 women) and matched controls in a standardized laboratory setting. Subjective emotional (questionnaires) and physiological measures were employed. Depression and cognitive deterioration were controlled. Based on subjective ratings, alcoholics displayed greater variability of emotion; they displayed also fewer or no physiological arousal changes. Subjective emotional responses were exceedingly high or low. These differences were not accounted for by depression or cognitive deterioration. We hypothesize that alcohol could be used to restore an optimal level of emotional arousal. This homeostatic function of alcohol is yet to be clearly assessed.

Psychosis, migration and social environment: an age--and--gender controlled study.

PURPOSE: Adverse social experiences are frequently invoked to explain the higher rate of psychosis among migrant groups. The aim of the present study was to establish the socio-environmental factors distinguishing migrant psychotic patients from autochthonous patients. SUBJECTS AND METHOD: We conducted a cross-sectional survey involving 341 migrant psychotic patients matched for age and gender with 341 autochthonous psychotic patients. RESULTS: Migrant patients lived more often with their parental family, were less often enrolled with a referral psychiatrist, presented a lower rate of employment, a lower percentage of alcohol misuse and of suicide attempts. DISCUSSION: Our findings add to the growing body of results showing that more attention needs to be focused on socio-environmental variables in psychosis research. However, several limitations have to be taken into account, particularly with regard to selection biases and age of onset of the psychotic illness. CONCLUSION: Our results are compatible with the hypothesis that unemployment is a contributing factor in the risk for psychosis among migrant groups. Migrants' families are an important keystone in the mental health care process of their sick relatives. Our service models need to be adapted with the aim to make the treatment easier for migrant patients.

Psychiatric disorders and social characteristics among second-generation Moroccan migrants in Belgium: an age-and gender-controlled study conducted in a psychiatric emergency department.

PURPOSE: Clinically, one of the most consistent clinical findings among migrant patients is an increase in the rate of psychosis. The aim of the present study was to confirm this finding in Belgium by comparing second-generation Moroccan migrant patients with Belgian patients, matched for the variables of age and gender. SUBJECTS AND METHOD: We conducted a cross-sectional survey on 272 patients admitted in a psychiatric emergency unit during the year 1998. We used univariate and multivariate analyses to compare the two subgroups. RESULTS: Multivariate analyses showed that migrant patients lived more often with their parental family and that they presented a higher rate of admission for psychotic disorders and a lower rate of employment. DISCUSSION: Our findings add to the growing body of results showing increased incidence of psychosis among immigrants to European countries, but several factors have to be taken into account, particularly with regard to selection biases and differences in help-seeking behaviour and in family perception of the mental illness. CONCLUSION: Our results are compatible with the hypothesis that unemployment is a contributing factor in the risk for psychosis among migrant groups. Further studies would be needed to better explain some of our results, particularly the role played by the families of migrant patients.