Lower leptin level at discharge in acute anorexia nervosa is associated with early weight-loss.

OBJECTIVE: Predictive values of acute phase metabolic abnormalities of anorexia nervosa (AN) have seldom been studied. As early postrestoration weight loss is associated with poor outcome, discharge biologic parameters were assessed to detect an association with 2-month follow-up weight loss as a proxy to poor outcome. METHOD: Fasting plasma levels of leptin, acyl-ghrelin, obestatin, PYY, oxytocin and BDNF were measured in 26 inpatients, at inclusion, at discharge and 2 months later. A body mass index less than 18 2-month postdischarge was considered a poor outcome. RESULTS: Nineteen patients (73%) had a fair outcome and seven (27%) had a poor one with a mean loss of 0.69 versus 4.54 kg, respectively. Only discharge leptin levels were significantly higher in fair versus poor outcome patients (14.1 vs. 7.0 ng/ml, p = 0.006). The logistic regression model using discharge leptin, acyl-ghrelin, obestatin, oxytocin, PYY and BDNF levels as predictors of outcome disclosed a nearly significant effect of leptin (p < 0.10). Receiver operating characteristic analysis showed 11.9 ng/ml was the best value of threshold. Neither clinical variables differed according to outcome. CONCLUSION: Leptin level may be a biomarker of early weight relapse after acute inpatient treatment of AN. Its clinical usefulness in monitoring care in AN should further be determined.

Risky decision-making in suicide attempters, and the choice of a violent suicidal means: an updated meta-analysis.

BACKGROUND: Studies showed disadvantageous decision-making in suicide attempters. The present meta-analysis aims to examine the stability of these findings and related questions. METHODS: EMBASE and Pubmed databases were searched for studies published between 01/01/2000 and 01/01/2020 with an additional search through bibliographical references. English or French articles published in peer-reviewed journals, reporting quantitative task-based measures of decision-making in suicide attempters were included: 3,582 records were identified, 33 full-text articles screened, and 21 articles finally included. RESULTS: All studies were conducted in mood disorders; 18 used the Iowa Gambling Task (IGT) and 3 the Cambridge Gamble Task (CGT). With the IGT, suicide attempters showed riskier choices than patient controls (Hedges' g=-0.28 95%CI (-0.44 - -0.12)) and healthy controls (g=-0.54 (-0.83 - -0.25)) with no significant difference between control groups. The difference between suicide attempters and patient controls was not related to age group, mood disorder type, author, or research center while an effect of time of publication was found (p=0.006). Poorer performance was also found in suicide attempters compared to patient controls when using the CGT (g=-0.57 95%CI (-0.82 - -0.31)). Suicide attempters who used a violent means showed poorer IGT performance than those who used a non-violent means (3 studies). LIMITATION: Limited number of studies outside mood disorders. No data to calculate a gender effect. CONCLUSION: The present meta-analysis confirmed riskier decision-making in suicide attempters. Although group differences appear to be of modest effect size in general, they were particularly marked in the subgroup of those who used a violent suicidal means.

Unexpected Association of Desacyl-Ghrelin with Physical Activity and Chronic Food Restriction: A Translational Study on Anorexia Nervosa.

Anorexia nervosa (AN) is a severe metabopsychiatric disorder characterised by caloric intake restriction and often excessive physical exercise. Our aim is to assess in female AN patients and in a rodent model, the co-evolution of physical activity and potential dysregulation of acyl-(AG) and desacyl-(DAG) ghrelin plasma concentrations during denutrition and weight recovery. AN inpatients were evaluated at inclusion (T0, n = 29), half-(T1) and total (T2) weight recovery, and one month after discharge (T3, n = 13). C57/Bl6 mice with access to a running wheel, were fed ad libitum or submitted to short-(15 days) or long-(50 days) term quantitative food restriction, followed by refeeding (20 days). In AN patients, AG and DAG rapidly decreased during weight recovery (T0 to T2), AG increased significantly one-month post discharge (T3), but only DAG plasma concentrations at T3 correlated negatively with BMI and positively with physical activity. In mice, AG and DAG both increased during short- and long-term food restriction. After 20 days of ad libitum feeding, DAG was associated to persistence of exercise alteration. The positive association of DAG with physical activity during caloric restriction and after weight recovery questions its role in the adaptation mechanisms to energy deprivation that need to be considered in recovery process in AN.

[Novel insight into suicidal behavior]. / Nouvelles perspectives sur les conduites suicidaires.

Novel insight into suicidal behavior. This article presents four short examples of new insights into suicidal acts and innovative treatments. These include the results of cognitive neuroscience studies that have identified hypersensitivity to rejection, exclusion, and injustice signals in suicide attempters, as well as persisting trend for risky choices and insufficient cognitive control. These processes may be future therapeutic targets. Moreover, several studies showed on early suicidal trajectories, as well as residual epigenetic scars, as a result of childhood abuse. The people who were victims of these events may require specific intervention. In addition, artificial intelligence is a source of hope to account for the etiological and phenotypic complexity of suicidal behavior, and to establish more precise algorithms of medical decision-making. Ethical issues are raised at the same time. Finally, ketamine is today an innovative treatment (pending authorization) for the rapid reduction of suicidal ideation and a more effective crisis management.

Nouvelles perspectives sur les conduites suicidaires. Nous présentons dans cet article quatre courts exemples de nouvelles pistes de compréhension des actes suicidaires et de traitements innovants. Il s'agit notamment des résultats des études de neurosciences cognitives qui ont identifié une hypersensibilité aux signaux de rejet, d'exclusion et d'injustice chez les suicidants, ainsi qu'une tendance persistante aux choix risqués et à un contrôle cognitif insuffisant. Ces processus pourraient être des cibles thérapeutiques futures. Plusieurs études ont en outre mis en évidence les trajectoires suicidaires précoces ainsi que les cicatrices épi génétiques résiduelles des maltraitances dans l'enfance. Les personnes ayant été victimes de ces événements pourraient nécessiter des prises en charge particulières. Par ailleurs, l'intelligence artificielle est une source d'espoir pour rendre compte de la complexité étiologique et phénotypique des conduites suicidaires, et établir des algorithmes plus précis de décision médicale. Des questions éthiques sont parallèlement soulevées. Enfin, la kétamine représente aujourd'hui un traitement innovant (en attente d'AMM) pour la réduction rapide des idées suicidaires et une prise en charge de la crise plus performante.

Propofol-interrupted tinnitus later suppressed by amantadine: a case-report.

Tinnitus is a frequent condition without consistently effective remediation. Mr V. was a 64 year old man with Behcet's disease, a generalized systemic relapsing vasculitis. Tinnitus appeared in 1998 and he had been both aware and distressed by his tinnitus 80% of his awake time. After his last colonoscopic examination, he mentioned a transient interruption of his tinnitus. Mr V. only received propofol, an anesthesic drug that selectively down-regulates glutamatergic synaptic transmission. Amantadine, another glutamate antagonist, was later prescribed and durably suppressed tinnitus. Systematically inquiry about post-anesthesia effects on tinnitus may help decide if amantadine may be tried on an individual basis.

Why do people with eating disorders drop out from inpatient treatment?: the role of personality factors.

Dropout rates from inpatient treatment for eating disorders are very high and have a negative impact on outcome. The purpose of this study was to identify personality factors predictive of dropout from hospitalization. A total of 64 adult patients with anorexia nervosa consecutively hospitalized in a specialized unit were included; 19 patients dropped out. The dropout group and the completer group were compared for demographic variables, clinical features, personality dimensions, and personality disorders. There was no link between clinical features and dropout, and among demographic variables, only age was associated with dropout. Personality factors, comorbidity with a personality disorder and Self-transcendence dimension, were statistically predictive of premature termination of hospitalization. In a multivariate model, these two factors remain significant. Personality traits (Temperament and Character Inventory personality dimension and comorbid personality disorder) are significantly associated with dropout from inpatient treatment for anorexia nervosa. Implications for clinical practice, to diminish the dropout rate, will be discussed.

Treating the cause of illness rather than the symptoms: parental causal beliefs and treatment choices in autism spectrum disorder.

OBJECTIVES: To explore the relationship between causal beliefs on autism (CBA) and treatment choices. DESIGN AND METHODS: A cross-sectional design was employed. Parents of a child with autism spectrum disorder (ASD) were asked to complete the Lay-Beliefs about Autism Questionnaire (LBA-Q) and answer questions about treatments used. Only items inquiring about a cause of autism were retained for analysis. Series of forward stepwise logistic regressions were performed with each treatment as dependent variable and the scores given to each of the CBA items as independent variables. RESULTS: 78 parents were included. The most strongly held causal beliefs were brain abnormalities and genetic factors. Parents who had more beliefs in the causal role of very early traumatic experiences were less likely to use behavior therapy and PECS. Higher beliefs in illness during pregnancy increased the odds of medication use. Stronger beliefs on the role of food allergy were associated with higher use of detoxification treatments, special diets, and vitamins. On the contrary, these beliefs reduced the odds of drug use. CONCLUSIONS: Causal beliefs are associated with treatment choices. Such preliminary results highlight the value of continued studies, not only to establish the causal nature of these associations, but also to demonstrate the utility of modifying such beliefs for both parents' and child's benefits. Identifying parents' beliefs about their child's illness may be an important step in formulating interventions facilitating appropriate care.

Predictors of dropout from inpatient treatment for anorexia nervosa: data from a large French sample.

Dropout from anorexia nervosa inpatient treatment programs is frequent and is linked to a poorer outcome. This study aimed to identify predictive factors for dropout among anorexia nervosa inpatients. Between 1988 and 2004, 601 consecutive female inpatients with anorexia, restrictive (AN-R) or binge/purging (AN-B/P) subtype (Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV)), were assessed at admission (clinical, socio-demographic, and psychological data). A stepwise logistic model was developed. Dropout rates were respectively 50.0% and 56.2% for AN-R and AN-B/P. Seven predictive factors were identified in multivariate analysis: having one or more children, low desired body mass index (BMI), a low minimum BMI, high scores on the SCL-90 paranoid ideation and the Morgan and Russell eating behavior subscales, and low educational status. Early dropouts had a particular profile: lower desired BMI, higher score on SCL90 paranoid subscale, and more impulsive behaviors (alcohol use, suicide attempts). Dropout appeared as a multifactorial event. In clinical practice, certain factors could serve as warning messages reflecting the severity of the illness (high EDI score and low minimum BMI); while others could be targeted before hospitalization (having at least one child and low desired BMI).

Treatment choices in autism spectrum disorder: the role of parental illness perceptions.

A cross-sectional design was employed. Parents of a child with Autism Spectrum Disorder (ASD) were asked to complete a modified version of the Revised Illness-Perception Questionnaire (IPQ-RA) and answer questions about information-seeking activities and treatments used. Internal consistency, construct validity, and factor structure were assessed. Multivariate logistic regressions were performed. Eighty-nine parents having a child with ASD took part in the study. Five subscales of the IPQ-R were replicated. Causes were split into personal, external and hereditary factors. The most highly rated main cause was a genetic cause. Perception of seriousness of the disease was associated with the use of educative methods and unpredictable course of disorder associated with drug use. A higher sense of personal control was associated with reduced use of nutritional or pharmaceutical treatments. Attendance to training programs was associated with higher hereditary beliefs and lower perception of cyclical timeline. The IPQ-RA captures components of representations of autism and provides a reliable mean for exploring illness concept in parents of a child with ASD. Some illness dimensions may prevent parents from having the opportunity to modify their concept of autism. Such measure may be useful for assessing the modification of potentially malleable beliefs with psychoeducational interventions.

Role of the ghrelin/obestatin balance in the regulation of neuroendocrine circuits controlling body composition and energy homeostasis.

Ghrelin and obestatin are two peptides isolated from the gastrointestinal tract and encoded by the same preproghrelin gene. They convey to the central nervous system informations concerning the nutritional status and/or the energy stores. Ghrelin, mostly acting through the GH secretagogue receptor GHS-R, is a potent GH secretagogue, an orexigenic peptide and a long-term regulator of energy homeostasis. Obestatin was initially described for its anorexigenic effects and its binding to the G protein-coupled receptor 39 (GPR39). However, the role of obestatin is still controversial and the nature of the obestatin receptor remains an open question. This review is focussed on the possible implication of the ghrelin/obestatin system in psychiatric diseases with particular emphasis on eating disorders.

Factors associated with suicidal behaviors in a large French sample of inpatients with eating disorders.

OBJECTIVE: The objective of the present study was to identify factors associated with suicidal behaviors among patients with eating disorders. METHOD: A large database including sociodemographic and clinical characteristics of 1,009 consecutive patients hospitalized for an eating disorder in Paris, France, was examined. Data gathered upon admission to hospital were analyzed to identify factors associated with a history of suicide attempt or current suicidal ideation, among the whole sample as well as among each subtype of eating disorder. RESULTS: Among the whole sample, the factor most strongly associated with suicide attempt or suicidal ideation was the diagnostic category, with the highest odds ratio for bulimia nervosa followed by anorexia nervosa of the binging/purging subtype. Among diagnostic subgroups, the strongest factors were drug use, alcohol use, and tobacco use. CONCLUSION: Suicide risk should be monitored carefully among patients with eating disorders, paying particular attention to combinations of risk factors.

Anxiety and depression prevalence rates in age-related macular degeneration.

PURPOSE: To estimate the prevalence rates of depression and anxiety in patients with wet age-related macular degeneration (AMD) and the relationship with visual acuity and to develop a simple algorithm for depression screening. METHODS: This cross-sectional, prospective, observational, multicenter study was performed in France, Germany, and Italy. Retina specialists at 10 centers per country each enrolled 12 consecutive patients with wet ARMD. Patients were stratified into four severity groups by using best eye (BE) and worst eye (WE) visual acuity (VA) thresholds (BE:VA 20/40 and WE:VA 20/200). Patients rated themselves on the Hospital Anxiety and Depression Scale (HADS). Analysis of variance was performed to estimate the effect of VA severity levels on HADS scores adjusted on age, gender, and country. RESULTS: Patients (females 60%) were recruited, with a mean age of 77 years and 2.3 years' disease duration. Mean BE:VA at inclusion was 0.49 logMar (logarithm of the minimum angled of resolution) and WE:VA 1.0 logMar. The prevalence of severe depression increased from 0% (BE:VA > or = 20/40+WE:VA > or = 20/200) to 7.6% (BE:VA < 20/40+WE:VA < 20/200), whereas anxiety was unrelated to VA loss. Moreover, total depression scores were strongly associated with VA severity (P = 0.006), but not total anxiety scores (P = 0.840). Responses to two HADS items ("I still enjoy things I used to enjoy"; "I can enjoy a good book or radio or television program") identified 95% of severely to moderately depressed patients. CONCLUSIONS: Self-rated depression in patients with AMD was associated with VA severity level. It should, therefore, be relatively easy for ophthalmologists to implement the screening procedure and refer identified patients to psychiatrists for proper assessment and treatment.

Family trios analysis of common polymorphisms in the obestatin/ghrelin, BDNF and AGRP genes in patients with Anorexia nervosa: association with subtype, body-mass index, severity and age of onset.

Anorexia nervosa (AN) affects 0.3% of young girls with a mortality of 6%/decade and is strongly familial with genetic factors. Ghrelin is an upstream regulator of the orexigenic peptides NPY and AgRP and acts as a natural antagonist to leptin's effects on NPY/AgRP-expressing neurons, resulting in an increase in feeding and body weight. Obestatin which counteracts ghrelin action on feeding is derived from the same propeptide than ghrelin. BDNF has been involved in body weight regulation and its Val66Met polymorphism associated with AN. We therefore re-investigated the association between AN and the Leu72Met and Gln90Leu polymorphisms of the prepro-ghrelin/obestatin gene, the Ala67Thr polymorphism of AgRP and the Val66Met polymorphism of BDNF taking into account clinical subtypes (restrictive--ANR--and bingeing/purging--ANB--subtypes). Family trios study of these 4 single nucleotide polymorphisms were performed in 114 probands with AN and both their parents recruited in two specialized French centres. A transmission disequilibrium was observed for the Leu72Met SNP of the preproghrelin gene and for the Ala67Thr SNP of the AgRP gene. When stratified by clinical subtype, these two polymorphisms were preferentially transmitted for the trios with a bingeing/purging proband. An excess of transmission of the Gln90Leu72 preproghrelin/obestatin haplotype in patients with AN was observed. These results do not provide evidence for a preferential transmission of the 66Met allele of BDNF but support the hypothesis that ghrelin and AGRP polymorphisms confers susceptibility to AN. Further simultaneous analysis of genetic variants of the biological determinants of energy metabolism and feeding behaviour in very large populations should contribute to the understanding of the high degree of heritability of eating disorders and to the description of pathophysiological patterns leading to life-threatening conditions in a highly redundant system.

[Obsessive-compulsive symptoms treatment in: schizophrenia]. / Le traitement des symptômes obsessionnels-compulsifs dans la schizophrénie.

Obsessive-compulsive symptoms (OCSs) frequently occur in schizophrenia and seem to worsen prognosis. Many case studies suggest that OCSs appear or worsen with an atypical antipsychotic agent treatment (that is, with risperidone, olanzapine, and clozapine). Therefore, family or personal history of OCS should be investigated before initiating such treatment, and OCS onset should be monitored during treatment. Clozapine is involved in most such cases. When OCSs appear with clozapine, dosage can be reduced and a serotonin reuptake inhibitor treatment added. Current studies suggest that patients with schizophrenia and OCSs should benefit from treatment with an antipsychotic and an antiobsessive medication. Two controlled trials deal with OCS treatment in schizophrenia: the first, with clomipramine; and the second, with fluvoxamine. Both have proven their efficacy, but these trials include a small number of patients with heterogeneous characteristics.

[Standardized and clinical evaluation of defense mechanisms: a critical review of 6 quantitative tools]. / L'evaluation normalisée et clinique des mécanismes de défense: revue critique de 6 outils quantitatifs.

BACKGROUND: The defense mechanisms (DM) concept goes back to the foundation of psychoanalysis and is one of its theoretical cornerstones. Recently, with the introduction of this notion in an experimental item of categorical classification, DMs have become a new field in research and scientific communication. The increasing number of studies taking DMs into account matches the development of clinical evaluation scales that are easier to use than projective tests. To our knowledge, there is no comparative analysis of these tools. OBJECTIVE: We aimed first to describe the operating mode and metrological qualities of the most recent scales and then to highlight the benefits and limitations of these clinical evaluation tools. Finally, this article aims to help clinicians choose a tool that is most convenient for their protocol. METHOD: We introduce the following tools through a literature review: Defense Mechanism Inventory, Defense Mechanism Profile, Defense Style Questionnaire (DSQ), Defense Mechanism Rating Scale, Life Style Index, and Response Evaluation Measure. CONCLUSION: Using clinical scales includes many limitations associated with the DM concept. Nevertheless, their feasibility and validity warrant their use. The DSQ stands out for its many qualities, but the other tools specificities are yet to be considered in regard to the chosen protocols.

Sensation seeking in a French population of pathological gamblers: comparison with regular and nongamblers.

To test the hypothesis that pathological gamblers in the French general population who play games available in cafés score lower on sensation seeking than regular and nongamblers, the Zuckerman's Sensation Seeking Scale was administered to 57 diagnosed pathological gamblers, 40 regular gamblers, and a control group of 97 nongamblers. Whereas pathological gamblers did not obtain a significantly lower Sensation Seeking mean than the regular and nongamblers groups, analysis indicated that those pathological gamblers seek different and multiple forms of games to reduce boredom, but they do not necessarily seek excitement-generating activities. One possible interpretation is that the types of games investigated in this study are "passive" forms of games that required low involvement from the gamblers.

Frequency of hospitalisations and inpatient care costs of manic episodes: in patients with bipolar I disorder in France.

BACKGROUND: Bipolar disorder is a chronic illness that may involve multiple relapses and result in substantial psychosocial impairment. However, very few recent studies have investigated the economic burden of the disease. OBJECTIVE: To assess the frequency of hospitalisation and the inpatient care costs associated with manic episodes in patients with bipolar I disorder in France. METHOD: A cost-of-illness study was conducted based on available data using a hospital payer perspective. The lifetime prevalence of manic episodes was estimated from published epidemiological data using a random-effects meta-analysis. Data were obtained by a computerised literature search using the main scientific and medical databases. Additional epidemiological references were identified from published studies and textbooks. Data on frequency of hospitalisation and length of stay were collected from a large psychiatric university hospital. Data on unit costs for inpatient care were obtained from the accounting system of the largest hospital group in Paris, France for the year 1999. RESULTS: Extrapolating from international data on the average prevalence of bipolar I disorder, the proportion of rapid cycling patients and the average cycle duration, we estimated the annual number of manic episodes in patients with bipolar I disorder to be around 265,000 in France. Based on hospital data in Paris, the proportion of manic episodes that require hospitalisation was estimated to be around 63%. The average length of stay was 32.4 days and the hospitalisation-related costs were estimated to be around 8.8 billion French francs (Euro 3 billion) [1999 values]. CONCLUSION: Our study highlights the lack of medical and economic data on the frequency and hospitalisation-related costs of manic episodes in patients with bipolar I disorder in France. As the lifetime prevalence of bipolar I disorder may be as high as 3% among adults, further studies are required in order to provide representative national data and to allow economic evaluations of costs related to bipolar I disorder in France.