Risk factors associated to tobacco and alcohol use in a large French cohort of pregnant women.

Tobacco and/or alcohol use during pregnancy is a major public health concern. The aim of our study was to identify risk factors associated to maternal alcohol and tobacco use assessed by maternal self-reports combined with biological measurements in meconium samples of cotinine and ethylglucuronide which reflect fetal exposure to tobacco and alcohol, respectively, during the 3rd trimester of pregnancy. We conducted a prospective study in three maternity hospitals in a large urban area during consecutive weeks (2010 and 2011). Maternal sociodemographic and clinical characteristics were assessed after delivery, using the French version of the Addiction Severity Index. Cotinine and ethylglucuronide were measured in meconium samples. Seven hundred and twenty-four women were included, and 645 meconium samples collected. Using multivariate analyses, we found that not being married or having a smoking partner predicts maternal tobacco use. In contrast, a decreased risk was associated with higher education level and wanted pregnancy. The risk for alcohol use increased when the mother had been in conflict with any relative or her partner for a long time throughout her life, as well as in case of previous treatment for any mental or emotional disorder. Using multivariate analyses and cotinine presence in meconium samples, the risks were similar except for marital status, which was not associated to cotinine presence. Community education and prevention programs should urgently be improved for all women of childbearing age with a special focus on those with past histories of mental or emotional disorders and addictive disorders. Smoking cessation should be recommended to both parents.

A case of female hypersexuality and child abuse and a review.

Mother-son incest as well as female pedophilic disorder remain underrecognized and misdiagnosed. This is the case of a female child abuser who suffered from hypersexual disorder and mental retardation and whose son was viewed as a substitute transitional sexual partner. Our clinical case shared some common features with female sex offenders previously described in the literature but the association of sexual gratification and hypersexuality without pedophilic fantasies is quite uncommon in female child abusers.

Pharmacologic treatment of sex offenders with paraphilic disorder.

Sexual offending is both a social and a public health issue. Evidence demonstrates that a combination of pharmacological and psychotherapeutic approaches may reduce or even eliminate deviant sexual behavior in sex offenders with paraphilic disorders. In this article, we will review pharmacological treatment options for sex offenders with paraphilias. Both serotonin selective reuptake inhibitors (SSRIs) and antiandrogen treatments have been used with reported success in decreasing recidivism. SSRIs have been used in mild types of paraphilias and juvenile paraphilias. Antiandrogen treatments seem to be effective in severe sex offenders with paraphilic disorders in order to reduce victimization. Combined pharmacological and psychotherapeutic treatment is associated with better efficacy. Imaging studies may improve the knowledge of paraphilic disorders and the mechanisms of action of current treatments. In spite of existing evidence, there is a need for independent, large-scale and good quality studies assessing the long-term efficacy and tolerance of treatments.

[Schizophrenia: research perspectives]. / Grands axes de recherche sur la schizophrénie.

Current data and perspectives for schizophrenia research were reviewed in this paper. Increased incidence of schizophrenia is correlated to perinatal environmental factors, recent immigration, urban life and cannabis. Determining endophenotypes seems to be a promising strategy in the field of molecular genetics. Side effects and efficacy of treatments for schizophrenia could, now, be better predicted by the use of pharmacogenetic studies. Functional neuroimaging studies have described hypoactivations of certain brain areas supporting the hypothesis of a dysfunction of inner speech during auditory and verbal hallucinations. Dopaminergic and glutamatergic systems are disturbed in schizophrenia. These data contribute to a better understanding of the disease and may help to decrease the stigma that surrounds schizophrenia.

Assessment of tobacco, alcohol and cannabinoid metabolites in 645 meconium samples of newborns compared to maternal self-reports.

Prenatal psychoactive substance exposure has significant impact on neonatal health and child development and the development of reliable biomarkers is critical. Meconium presents several advantages for detecting prenatal exposure to psychoactive substances, as it is easy to collect and provides a broad time frame of exposure (third trimester). The aim of our study was to compare the prevalence of alcohol, tobacco and/or cannabis use during the third trimester of pregnancy (using maternal self-reports) with the results of meconium testing of their metabolites in newborns (cotinine, ethyl-glucuronide (EtG) and cannabinoid metabolites). Among all deliveries (993) that occurred in all maternities in Rouen (Normandy) during a defined time period (5 consecutive weeks in August, 2010 and August, 2011), 724 mothers were included and 645 meconium samples were collected. Maternal self-reports, using the Addiction Severity Index (5th edition), and meconium samples were collected within 72 h of delivery. Cotinine detection appears highly correlated to maternal self-reports (Kappa value: 0.79; [95%CI: 0.73-0.85]). Moreover, detection in meconium seems more accurate in the prediction of neonatal consequences of prenatal tobacco exposure as compared to maternal self-reports. In contrast, we have found a lower concordance between maternal self-reports and meconium testing for EtG and cannabinoid metabolites (Kappa value: 0.13; [95%CI: 0.04-0.22] and: 0.30; [95%CI: -0.03-0.63], respectively); however the total number of EtG- and cannabinoid-positive meconium samples was small. Interestingly, meconium samples with the highest levels of EtG mainly corresponded to negative maternal self-reports. Fetal exposure to alcohol, tobacco or cannabis may also considerably differ as displayed in our pairs of dizygotic twins. Finally, a polyconsumption of these psychoactive substances was not frequently observed according to meconium testing. In conclusion, cotinine detection appears as a valuable meconium biomarker. EtG measurement in meconium samples seems interesting if there is any risk of high fetal exposure, whereas assessment of prenatal cannabis exposure, using meconium testing, needs to be improved.

[Do antidepressant treatments influence self-harm and aggressive behaviors?]. / Les médicaments antidépresseurs influencent-ils les passages à l'acte auto- et hétéroagressifs ?

Depression is a frequent disorder with a lifetime prevalence of 25% in women and 12% in men. General practitioners are responsible for the majority of antidepressant prescriptions in France. Antidepressant treatments decrease the suicide risk in adult patients with a depressive disorder or suicidal behavior. However, antidepressant treatment is not recommended in children or adolescents. Indeed, an increase risk of suicide has been reported in this population in previous studies, especially when antidepressant treatment is started. The treatment of adolescents with major depression or suicidal behaviors must be preferentially conducted by a specialized care team. A clinical evaluation must be done very carefully before the onset of antidepressant treatment. In some specific clinical contexts, antidepressant treatments may be used to decrease levels of impulsiveness and aggressiveness. However, the efficacy of antidepressant treatment on violent behaviors is still not clearly determined by scientific literature owing to lack of studies with a high level of evidence. In a few cases of patients, activation syndromes may appear at the beginning of antidepressant treatments, with akathisia, nervousness, anxiety, insomnia and agitation. These reactions may be risk factors for acting out. Alcohol, cocaine or benzodiazepines when concomitantly consumed with antidepressant treatment may increase the risk for acting out. Whenever benzodiazepines are needed in a patient with a high suicide risk, the dosage used must be enough to avoid desinhibition and to obtain anxiolytic and sedative effects.

Psychosis in a cocaine-dependent patient with ADHD during treatment with methylphenidate.

OBJECTIVE: The objective was to report a case of experienced psychosis during the treatment with methylphenidate (MPH) in a cocaine-dependent adult treated for attention-deficit/hyperactivity disorder (ADHD) with comorbid cocaine dependence. CONCLUSION: ADHD is a frequent comorbidity in substance use disorder (SUD) patients. MPH may be effective in treating ADHD symptoms in SUD patients, thus preventing possible adverse outcomes. Cocaine-induced psychosis may be a risk factor for development of psychosis in the presence of a concurrent treatment with MPH.

Attention deficit hyperactivity disorder is associated with a more severe pattern of cocaine consumption in cocaine users from French West Indies.

OBJECTIVE: Attention deficit hyperactivity disorder (ADHD) is a frequent comorbidity in patients with substance use disorder. The aim of this cross-sectional study was to evaluate the consequences of ADHD comorbidity in cocaine users seeking treatment in Martinique. METHODS: During 15 months, all patients seeking treatment for cocaine dependence in a specialized center were assessed using the ADHD DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition-Text Revision) criteria and the French version of the Wender Utah Rating Scale. RESULTS: Forty-six (44 men and 2 women) cocaine abusers were included. Among them, 10 (21.7%) patients met DSM-IV-TR full criteria for adult ADHD. Patients with ADHD spend significantly more money (3 fold) on cocaine per week than those without ADHD, which means that they use a higher dose. All patients with ADHD used cocaine in a pipe, which allowed a greater absorption compared to smoking cocaine in a joint or snorting cocaine powder; in contrast, only 53% of the subjects without ADHD used cocaine in a pipe. CONCLUSIONS: Our study shows that cocaine users seeking treatment in Martinique with reported ADHD have a more severe pattern of cocaine consumption and the prevalence of ADHD's comorbidity in cocaine users is proximately equal to values previously found in the literature.