Competing Motivations: Proactive Response Inhibition Toward Addiction-Related Stimuli in Quitting-Motivated Individuals.

We examined whether addiction-related cues impact proactive inhibition (the restraint of actions in preparation for stopping) in individuals who are motivated to quit gambling or cannabis use. In Study 1, treatment-seeking individuals with cannabis use disorder and matched controls performed a stop-signal task that required them to inhibit categorizing cannabis or neutral pictures, and within varying levels of stop-signal probability. In Study 2, two groups of individuals, who applied to a voluntary self-exclusion program toward gambling, performed the stop-task following relaxation or gambling craving induction, with results compared to non-gamblers. Study 1 showed that despite being less efficient in proactive inhibition, individuals with cannabis use disorder exhibited heightened proactive inhibition toward cannabis cues. In Study 2, proactive inhibition toward gambling cues was heightened in gamblers after craving, but the degree of proactive adjustment decreased as a function of induced changes in gambling-related motivation. Present findings demonstrate that exposure to addiction-related cues can modulate proactive inhibition in individuals who are motivated to restrict their addictive behaviors.

[Short-term and long-term effects of cannabis use]. / Effets à court et à long terme de la consommation de cannabis.

Cannabis is used worldwide. So, it is necessary to stay especially concerned by the medical and social consequences of its use. For a long time, it was seen as a " soft drug ", in reference to the apparent low medical risk related to its use. However, the psycho-social consequences of cannabis use albeit of major importance are commonly neglected. Furthermore, danger for the health does exist, both from psychiatry and somatic medicine points of view. The danger is growing especially due to the apparition on the market of more potent presentations of cannabinoids.

Le cannabis est une drogue très largement utilisée dans le monde, ce qui justifie que l'on soit particulièrement attentif aux conséquences médicales et sociales de son usage. Il bénéficie de longue date d'une réputation de " drogue douce ", principalement en raison du faible nombre de conséquences médicales graves lors de sa consommation. C'est méconnaître les conséquences psychosociales majeures liées à son usage, en particulier chez les plus jeunes. De plus les conséquences pour la santé ne sont pas absentes, qu'elles soient psychiatriques ou somatiques. Elles deviennent chaque jour plus fréquentes tant en raison d'une absence de perception du danger que de l'apparition sur le marché de nouvelles formes de cannabis plus dosées et infiniment plus puissantes.

[Self-help program: a new tool to facilitate the access to treatment for problem gamblers]. / Programme self-help: un nouvel outil pour faciliter l'accès au traitement des joueurs excessifs.

Shame, fear of stigmatization, denial, accessibility to and the cost of treatment program may explain why only a small proportion of problem gamblers sought clinical treatment. In the hope to overcome these barriers, the Gambling Clinic and Other Behavioral Addictions of C.H.U. Brugmann (Brussels) has developed its own self-help program for excessive gamblers. Our goals were to foster readiness to change gambling behaviors and when appropriate to facilitate the transition from self-help program to classical face-to-face clinical intervention. In a sample of 172 problem gamblers who participated, 40% had never sought help (e.g., clinical treatment) and/or never attempted quit gambling. Interestingly, for some, internet-based self-help treatment preceded their determination for seeking a traditional face-to-face therapeutic setting. Those results led us to discuss this program as a valid clinical tool within a broader health care setting in excessive gamblers.

[Doping, sport and addiction--any links?]. / Dopage, pratique sportive et addiction--quels liens?

Sport is widely encouraged as it is beneficial for health. However, high-performance sport is more and more associated to rather suspicious practices; doping is one of the best example. From a physician point of view, the use of doping agents is obviously a major concern because taking such products often induce serious adverse effects on health. The present manuscript aims to inform physicians about the most frequent doping practices. It also points out that intensive sport can generate an "addictive" behavior sharing with "common"addictions a loss of practice control, a lack of interest in other activities and even a sport's practice detrimental to athlete's health. Analysis of the doping issue needs to take this reality into account as some doping products display an established " addictive" effect.

[A case of central pontine and extrapontine myelinolysis, without hyponatremia, during alcohol withdrawal with favorable outcome]. / Un cas clinique de myélinolyse centropontine et extrapontine, sans hyponatrémie, au décours d'un sevrage alcoolique et d'évolution favorable.

Central pontine and extra-pontine myelinolysis (CPM/EPM) is a rare neurological disorder, well documented for more than 50 years but whose pathogenesis remains obscure. The existence of predisposing factors occurs in the most cases; chronic alcohol abuse is one of the most commonly encountered, among many others. Alcohol withdrawal represents an additional vulnerability factor, being responsible for electrolyte imbalances which are not always demonstrable but are certainly involved in the development of CPM and/or EPM. CPM/EPM may be responsible for severe morbidity and is potentially life-threatening. The diagnosis of CPM/ EPM remains mostly clinical and is confirmed by magnetic resonance imaging of the brain. It should be considered in the setting of any unexplained neurological symptoms during the course of alcohol withdrawal or for any patient with chronic alcohol abuse, as promptly as possible, given the potentially fatal outcome.

[Munchausen's syndrome: a factitious disorder? A case report]. / Le syndrome de Munchausen: un trouble factice? Présentation d'un cas clinique.

Munchausen's syndrome is classified as a chronic factitious disorder with predominant physical signs and symptoms. Several symptoms are specific to this disorder, such as travelling and pseudologia fantastica. Others symptoms, such as multiple physical complaints with no organic substrate, are shared with somatoform disorders. We report a case showing how difficult it is to diagnose a Munchausen syndrome. We discuss also the opportunity to classify such a syndrome as a factitious disorder. Indeed, several authors suggest classifying Munchausen syndrome as a subtype of somatoform disorders, as those two disorders share a lot of characteristics.

[Treatment of depression with transcranial magnetic stimulation]. / La stimulation magnétique transcrânienne dans le traitement de la dépression.

Major depression disorder is a frequent psychiatric condition with serious consequences. Many patients don't respond to usual psychopharmacological and/or psychotherapeutic treatments. This observation has stimulated the research of alternative treatment options. Repeated transcranial magnetic stimulation (rTMS) is a recent therapeutic tool with few side effects. Its efficacy relies on stimulation of cortical networks through the application of a magnetic field on the skull. rTMS has been approved as a full therapeutic option for major depressive disorder by the FDA in 2008. It could therefore be routinely used in the future and complete the usual treatments in this condition. Our paper reviews what is currently known about the clinical use of rTMS in major depressive disorder.

[Factorial study of the psychopathological factors of morbid obesity in the adolescent]. / Étude factorielle des composantes psychopathologiques de l'obésité sévère chez l'adolescent.

BACKGROUND: The prevalence of paediatric obesity is high in most countries. Added to this, the degree of paediatric obesity is also on the rise. It is however to be noted that although the psychological causes of the problem are well known, they remain difficult to assess. Facing the great number of adolescents suffering from severe obesity, who are looking for treatment and failing to find one, this survey aims at facts-finding and analyses of the psychological and psychopathological origin and associated severity of obesity, and of the parameters that can lead to a successful treatment. METHODS: This survey has been carried out among 125 adolescents suffering from grade 2 obesity. To lose weight, the adolescents were treated during 1 year at the boarding dietary department of the "Institut Médical Pédiatrique Clairs-Vallons" in Belgium. The evaluation consists in a type CFTMEA-R-2000 psychopathological diagnosis including previous traumatic factors, taking into consideration the information regarding weight, weight evolution over one year and a quality assessment of the compliance of the patient with the treatment. These data have been submitted to the SPADN statistical program in order to carry out an analysis taking into account the various connections. RESULTS: Our results have underlined that the severity of the obesity in our population can be coupled with pathological family environment factors such as mental illness, care deficiencies, child abuse and, as a result, the presence of a psychopathological diagnosis. The same can be said in cases of lesser compliance with the treatment by the patient and his family, although in the short term the weight loss is greater. Likewise, a less severe obesity and a better compliance with the treatment can be coupled with the absence of both psychopathological diagnosis and pathological family environment. CONCLUSION: In our sample population, the psychological and psychopathological factors tend to be linked with a more severe obesity, and less good compliance with the treatment on both individual and family accounts. As a result, obesity could be considered as a way for the patient to adapt him/herself or compensate in front of traumatic family experiences. The isolation from the family seems therefore indispensable for any change in the adolescent, but then raises the problem of long term care after hospitalisation. If obesity is an adaptation process, the loss of weight could then have deeper psychological implications, implying a more complex follow-up of the patient.

[Perception of training in doctor-patient communication for students at faculty of medicine]. / La perception de l'apprentissage à la communication médecin-patient de l'étudiant en Faculté de Médecine.

Doctor-patient communication is the heart of any medical practice. The technology of medicine today is focused on knowledge, its application and know-how, rather than skills of being, of knowing and of knowing when to do nothing. In 2005, Belgian High Council of Health emphasizes a quantitative and qualitative reduction of communication aspects within the initial medical training. The aim of our study is to investigate Belgian and foreign students perception of how the doctor-patient communication was taught during their studies. A questionnaire was sent by email to 300 Belgian and foreign Universities. We obtained 13.6% of answers of 99 students belonging to 41 Faculties from 22 countries. 55.6% of respondents thought to be well trained in the doctor-patient communication. 85.9% of students received theoretical courses out of which only 64.6% have the opportunity to enhance their apprenticeship by practical work. Majority of respondents required more practical work in learning to communicate. All of them agree on that they would like more applied practical communication incorporated into their curriculum. Like wise the society that calls for doctors with increased communication skills and communication researchers who emphasize the central role of the doctor-patient communication in the clinical and therapeutic approach, students are also seeking longitudinal transdisciplinary learning, including more practical practices.

[General practitioner burnout: risk factors]. / Le burn-out du médecin généraliste: hypothèses etiologiques.

This paper aims to review current knowledge on risk factors leading to burn-out of general practitioners, who are particularly concerned by burn-out, as 50% of them are being more or less affected. This article is based on bibliographic research covering literature between 1975 and 2010, using PUB MED software, medical books and articles. 44 articles were selected as dealing well with the aspects of the burn-out reviewed here. It seems established that stress precedes burnout symptoms. Theories investigating relationships between stress and work are presented. Exogenic stress (load and organization of work, emotional interaction with the patient, constraints, lack of recognition, conflicts between private and professional life) interacts with endogenous stress (idealism, (too much) acute feeling of responsibility, mood disorder, difficulty in collaborating, character, personality). Burn-out symptoms would appear preferentially when these two stresses coexist. Despite the wealth of publications, there is still a lack of knowledge of the causes of burn-out, requiring therefore increased research efforts, in order to improve the implementation of preventive measures, beneficial to the doctors as well as to their patients.

[Creation of a body satisfaction and global self-perception questionnaire: the QSCPGS. Norms and first validation]. / Création d'un questionnaire de satisfaction corporelle et de perception globale de soi: le QSCPGS. Recherche de normes et début de validation.

INTRODUCTION: A review of the literature finds that everything concerning the body is a source of self-questioning. However, if a feeling of comfort or of discomfort is perceived within the body, it is difficult to quantify and to define this perception. This is because this feeling is multifactorial and characterized by behaviors and symptoms that are not explicit. METHOD: To resolve this perception, we created a self-reported questionnaire allowing for the estimation of "body satisfaction and global self-perception". RESULTS: We present here the normative values collected with 788 subjects: 541 "non clinical" subjects and 247 "clinical subjects" consisting of inpatients hospitalized for major depressive disorder. In the "non clinical" group, the results show a good stability of scores. However, the female participants of this group have values (39.1) significantly (p<0.03) lower than the male participants (44.8). The evolution according to age showed a peak in physical satisfaction and of global self-perception between the age of 30 and 50. The score of this QSCPGS is very significantly (p<0.0001) higher in the "non clinical" group (43) than in the "clinical group" (-2); this confirms the good validity of the criterion. Finally, the average gains in the total score of the QSCPGS after a relaxation session with 34 depressed subjects are 23.7 (-12.2 before and 11.5 after). DISCUSSION: This very significant advantage indicates that this questionnaire is sensitive to changes connected with a therapeutic intervention. The QSCPGS can thus be useful for the evaluation of body satisfaction or dissatisfaction as well as the mood associated with it; thus, it permits one to clarify the concept of well-being within "non clinical subjects" and to record the modifications provided by therapy, both at a physical level and a level of global self-perception. Future studies must now be submitted in different study groups such as: diverse pathologies, high level sportsmen, (etc.), this will allow us to gather information that will help establish specific therapies or effective preventative measures.

Spatiotemporal brain signal associated with high and low levels of proactive motor response inhibition.

Proactive motor response inhibition is used to strategically restrain actions in preparation for stopping. In this study, we first examined the event related potential (ERP) elicited by low and high level of proactive response inhibition, as assessed by the stop-signal task. Corroborating previous studies, we found an increased amplitude of the contingent negative variation (CNV) in the high level of proactive inhibition. As the main goal of the present study, swLORETA was used to determine the neural generators characterising CNV differences between low and high levels of proactive inhibition. Results showed that the higher level of proactive inhibition involved numerous generators, including within the middle and medial frontal gyrus. Importantly, we observed that the lower level of proactive inhibition also involved a specific neural generator, within the frontopolar cortex. Altogether, present findings identified the specific brain sources of ERP signals involved in the later phase of motor preparation under low or high levels of proactive motor response inhibition.

Processing of proenkephalin is tissue-specific.

Most neuropeptides are synthesized as large precursor proteins. These precursors undergo a maturation process involving several proteolytic events that generate the biologically active peptides. The enzymatic mechanisms underlying this processing are still largely unknown. The processing of the precursor protein proenkephalin was studied in two different bovine tissues, the hypothalamus and adrenal medulla. The high molecular weight enkephalin-containing peptides that accumulate in these two tissues were found to be different, indicating the existence of two processing pathways for this neuropeptide precursor.

[Drug dependence on benzodiazepines and antidepressants]. / Assuétudes aux benzodiazépines et aux antidépresseurs.

Since years, the concepts of drug abuse and drug dependence changed, due to new knowledge coming from the neurosciences. Specifically, the role of a brain structure called "reward circuit" was emphasized. Therefore, the diagnosis criteria for abuse and dependence on drugs are presently defined mostly from a behavioral point of view: both in animal models and in clinical situations, it was stressed the importance of drug-seeking behavior and of the loss of control of the consumption. The occurrence of a pharmacological dependence is in fact of concern for only some of addictive drugs. According to these new criteria, dependence on benzodiazepines or antidepressants is certainly not frequent, even if withdrawal manifestations can occur after a long-term exposition. Furthermore, it is important to keep in mind the risk for non-medical use of benzodiazepines in persons with illicit drug use.

Alcoholism leads to early perceptive alterations, independently of comorbid depressed state: an ERP study.

INTRODUCTION: Alcoholism is associated with a deficit in the processing of emotional facial expressions (EFE) and with a delayed P3b component, partially mediated by earlier perceptive deficits (P100, N170). Since alcohol dependence often occurs with depression, we aim at investigating whether classical event-related potentials (ERP) alterations observed in alcoholism are modulated or not by depression. METHODS: Four groups (controls; alcoholics; depressed; alcoholics-depressed) of 12 participants performed two different discrimination tasks, a gender and an emotional one. They had to decide as quickly as possible about the gender or the emotion displayed by facial stimuli during an ERP recording session (32 channels). Reaction times (RTs), P100, N100, N170 and P3b were recorded. RESULTS: At the behavioural level, control participants discriminated EFE (but not gender) more rapidly than the three other groups. At the ERP level, the differences observed on RTs for emotional task were neurophysiologically indexed by a delayed P3b component. This delay was associated with earlier ERP alterations (P100, N100, N170), but only in participants suffering from alcohol dependence, in association or not with depression. DISCUSSION: On the one hand, individuals with alcoholism, associated or not with a comorbid depression, were impaired in the processing of EFE. This deficit was neurophysiologically indexed by early perceptive (P100, N100, N170) and decisional (P3b) alterations. On the other hand, non-alcoholic patients with depression only exhibited P3b impairment. These results lead to potential implications concerning the usefulness of the ERP for the differential diagnosis in psychiatry, notably concerning the comorbidities in alcoholism.

EEG Dynamics and Neural Generators in Implicit Navigational Image Processing in Adults with ADHD.

In contrast to childhood ADHD that is characterized by inattention, impulsivity and hyperactivity, most adults with ADHD predominantly exhibit inattention. We used a new oddball paradigm using implicit navigational images and analyzed EEG dynamics with swLORETA inverse modeling of the evoked potential generators to study cortical processing in adults with ADHD and age-matched controls. In passive observation, we demonstrated that P350 amplitude, alpha-beta oscillation event-related synchronization (ERS) anticipation, and beta event-related desynchronization (ERD) were significantly smaller in ADHD. In the active condition, P100 duration was reduced and N140 amplitude increased for both deviant and frequent conditions in the ADHD. Alpha ERS and delta-theta ERS were reduced in the ADHD in the deviant condition. The left somatosensory area (BA2) and the right parietal lobe (BA31, BA40) contributed more to the P100 generators in the control than in the ADHD group, while the left frontal lobe (BA10) contributed more to the P100 generators in the ADHD. The left inferior parietal lobe (BA40) contributed more to the N140 generators in the control than the ADHD group while the right posterior cingulate (BA30) contributed more to the N140 generators in the ADHD. These findings reinforce the notion that earlier cortical stages of visual processing are compromised in adult ADHD by inducing the emergence of different even-related potential generators and EEG dynamics in ADHD. Considering that classical approaches for ADHD diagnosis are based on qualitative clinical investigation possibly biased by subjectivity, EEG analysis is another objective tool that might contribute to diagnosis, future neurofeedback or brain stimulation therapies.

Is the P300 deficit in alcoholism associated with early visual impairments (P100, N170)? An oddball paradigm.

OBJECTIVE: Studies exploring chronic alcoholism with event-related potentials (ERPs) have shown delayed latency and reduced amplitude of the P300, a long-lasting positive potential reflecting decisional processing. This P300 deficit in alcoholism is generally interpreted as a disturbance in central nervous system inhibition or in memory/attention. The present study aimed at identifying if this electrophysiological deficit is already present on earlier components, and advances a new hypothesis concerning the interpretation of the P300 alteration. METHODS: Patients suffering from alcoholism and matched healthy controls had to detect, in an oddball paradigm, emotional faces among a succession of neutral faces. Behavioral performance and ERP data (recorded from 32 electrodes) were analyzed. RESULTS: In line with previous studies, data showed that alcoholism led to a P300 deficit. Moreover, we observed for the first time that this deficit begins at earlier visual (P100) and face-processing (N170) stages, and we found high positive correlations between P100, N170 and P300 for amplitude and latency values, suggesting cumulative deficits on the cognitive continuum. CONCLUSIONS: We suggest that the P300 deficit observed in chronic alcoholism could be linked to earlier visuo-spatial deficits rather than being an impairment of the specific processes linked to the P300. SIGNIFICANCE: These results call for reconsidering the interpretation of P300 impairments at a fundamental and clinical level, and shows that earlier ERP components must be taken into account in future studies.

[Evidence of a modification of the profile of addictive drugs consumption through the study of patients consulting a psychiatric emergency room]. / Mise en evidence d'une modification des habitudes de consommation de substances psychoactives au travers du suivi d'une activité d'urgence psychiatrique.

The consumption of psychoactive drugs is frequently the reason of consultation in a psychiatric emergency unit. We present here the evolution over time of the consumption pattern of patients consulting the psychiatric emergency unit of the Brugmann University Hospital. Major modifications were observed during this period. Mainly, problematic consumption of opiates was progressively overwhelmed by this of cannabis, psychostimulants and recently synthesis drugs. We suggest that this reflects the situation of psychoactive drugs consumption in the general population. This implicates a modification of prevention and treatment attitudes in drug consuming persons.

Early visual components (P100, N170) are disrupted in chronic schizophrenic patients: an event-related potentials study.

INTRODUCTION: On the basis of the Positive and Negative Syndrome Scale (PANSS), fourteen schizophrenic patients and 7 normal controls were confronted with pictures from the Ekman & Friesen series in an event-related potentials study. PROCEDURE: Participants were confronted with a visual face-detection task, in which they had to detect, as quickly as possible, deviant faces amongst a train of standard stimuli (neutral faces). Deviant faces changed either on identity (different identity, neutral expression), or on emotion (same identity, happy, fearful or sad expression). RESULTS: Schizophrenics exhibited a decrease in amplitude of the face N170, recorded around 170 ms at occipito-temporal sites; this was observed as well for emotional as for identity faces, which suggests a global involvement of face processing. Moreover, this decrease of the face-N170 was positively correlated to positive, but not negative, symptoms of schizophrenia. Finally, the amplitude of P100 was also decreased, which suggests that the N170 decrement would result from a more global deficit in visual processing deficit. DISCUSSION: It is suggested that, in schizophrenics, an involvement of early visual processing might underlie the decreased amplitudes and the higher onset latencies of later P300 and N400 components.

[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.