[The psychopathological dimension of female alcoholism]. / La dimension psychopathologique de l'alcoolisme féminin.

In France, as in other countries, more and more women are affected by alcoholism. Progress needs to be made in the early detection and management of their physical and psychological dependence on alcohol, as well as their psychopathological comorbidities.

[A microcytic sideroblastic anemia successfully treated with B6 vitamin]. / Une anémie microcytaire sidéroblastique carentielle traitée efficacement par de la vitamine B6.

INTRODUCTION: Sideroblastic anemia is a rare cause of microcytic anemia, which is characterized by ring sideroblasts on bone marrow aspirate. This anemia can be congenital or acquired. CASE REPORT: We report the case of an alcoholic 49-year-old man who presented with a severe microcytic sideroblastic anemia related to pyridoxine (B6 vitamin) deficiency. Acid folic deficiency was associated. The blood count normalized within one month after vitamin supplementation. CONCLUSION: Pyridoxine deficiency must be sought in sideroblastic anemia in patients at risk.

The difficulties of pseudo-Cushing's syndrome (or "non-neoplastic hypercortisolism").

Pseudo-Cushing's syndrome covers different pathological conditions responsible for mild-to-moderate ACTH-dependent hypercortisolism, related not to an ACTH-secreting tumor but rather to CRH and/or AVP hypothalamic secretion through activation of various neural pathways, in patients generally displaying excess central adiposity. It is better termed "non-neoplastic hypercortisolism" (NNH). The main conditions implicated in NNH comprise: neuropsychiatric disorder, alcohol abuse, insulin-resistant obesity, polycystic ovary syndrome, and end-stage kidney disease. Glucocorticoid resistance is one differential diagnosis, as are some cases of primary adrenal disease with incompletely suppressed ACTH. Differentiating between NNH and mild-to-moderate Cushing's disease can be a real challenge. Clinical analysis, based on thorough history taking and screening for catabolic signs is essential; useful explorations include midnight serum or salivary cortisol and Dex/CRH and ddAVP stimulation response. Pituitary MRI suffers from limitations regarding both sensitivity and specificity, while bilateral inferior petrosal sinus sampling cannot distinguish between pituitary ACTH secretion by a tumor or by normal cells stimulated by endogenous CRH. Definitive diagnosis of functional etiology requires demonstrating that treatment of the underlying condition restores normal secretion of ACTH and cortisol, but this is not always possible. Lingering diagnostic uncertainty has to be accepted in certain patients, who will have to be followed up for some time before diagnosis can be considered more or less definitive.

Investigating a theatre-based intervention for Indigenous youth with fetal alcohol spectrum disorder: Exploration d'une intervention basée sur le théâtre auprès de jeunes Autochtones atteints du syndrome d'alcoolisme fœtal.

BACKGROUND: Theatre-based interventions use artistic media to facilitate social and emotional awareness and have therapeutic benefits for persons with developmental disabilities and mental health problems. The role of these interventions with Indigenous youth who have emotional, behavioural, and cognitive sequelae related to fetal alcohol spectrum disorder (FASD) has not been explored. PURPOSE: The purpose of this study was to explore the experiences and acceptability of a theatre-based approach for facilitating social communication and engagement in youth with FASD. METHOD: Participants were three Indigenous youth with FASD. A qualitative exploration of the experiences and acceptability of the intervention was conducted via focus groups held 2 weeks post-program participation with the participants, their caregivers, and program facilitators. The transcripts were analyzed using an inductive thematic approach. FINDINGS: Our results identified perceived postintervention improvements in participants' development of self-esteem, social skills, and emotional awareness. IMPLICATIONS: A theatre-based arts intervention has the potential to support improvements in social skills for youth with FASD.

Virtual Morris task responses in individuals in an abstinence phase from alcohol.

The present study was aimed at examining spatial learning and memory, in 33 men and 12 women with alcohol use disorder (AUD) undergoing ethanol detoxification, by using a virtual Morris task. As controls, we recruited 29 men and 10 women among episodic drinkers without a history of alcohol addiction or alcohol-related diseases. Elevated latency to the first movement in all trials was observed only in AUD persons; furthermore, control women had longer latencies compared with control men. Increased time spent to reach the hidden platform in the learning phase was found for women of both groups compared with men, in particular during trial 3. As predicted, AUD persons (more evident in men) spent less time in the target quadrant during the probe trial; however, AUD women had longer latencies to reach the platform in the visible condition during trials 6 and 7 that resulted in a greater distance moved. As for the probe trial, men of both groups showed increased virtual locomotion compared with the women of both groups. The present investigation confirms and extends previous studies showing (i) different gender responses in spatial learning tasks, (ii) some alterations due to alcohol addiction in virtual spatial learning, and (iii) differences between AUD men and AUD women in spatial-behaviour-related paradigms.

[Representation of psychotropic medicines and alcohol use disorder]. / Représentation des psychotropes et maladie alcoolique.

An elderly person's use of alcohol can conceal undernutrition, cognitive decline due to dementia or depression. Caregivers have an important role to play with these patients in distress. It is necessary to help them regain their self-esteem and to support their will to live to restore the relationship with others.

Saying goodbye to the hero: Jung, Liber Novus and conversion from addiction.

Two chapters in Liber Novus throw fresh light on Jung's epistemology of addiction. Taking these as a starting point, the nature of the challenges that patients confront in leaving addiction behind are explored. It is suggested that an archetypal process of separation is constellated at the point of quitting as the precursor to a life without the object of the addiction. A short account is given of Jung's part in the inception of Alcoholics Anonymous and the potential role of a 'conversion experience' as an initiation into psychological reorientation away from the negative individuation experienced by the hero. The case of a patient addicted to heroin illustrates the contribution of an analytic approach in an NHS setting, along with other workers in a rehabilitation centre. Certain challenges of working with addicted people are outlined, including arousal of the psychotherapist's rescue fantasies.

Age and gender as independent predictors of violence under the influence of alcohol in Zurich, Switzerland.

Violent behaviour associated with alcohol consumption is frequently reported by different media. Clinical data analysing the correlation between alcohol intoxication, age, gender and violence are scarce. The aim of this study was to evaluate the influence of age, gender and blood alcohol content on violent behaviour under the influence of alcohol under central European conditions. Three hundred patients admitted to the emergency department were included into this study in the time period from January 01. to December 31. 2009. The inclusion criteria were a blood alcohol content (BAC) of ≥10 mmol/l, any traumatic injury and an age ≥16 years. Violence was defined as an evitable act committed by others leading to patient's hospitalisation. The data were compared with Wilcoxon and χ2-test for proportions. The data were considered as significant if p<0,05. Predictive quality was evaluated by using receiver operating characteristic (ROC) curve. Independent predictors were analyzed by logistic regression analysis. The average age was 36,9±16,9 years (range: 16-84 years), 259 (86%) males and 41 (24%) females. There was a significant difference in gender (odds ratio for gender male 2,88; CI 95%: 1,24-6,67; p<0,001) and age dependent (odds ratio for each year of age 0,94; CI 95%: 0,93-0,96; p<0,0001) violence with no correlation to blood alcohol content found. Logistic regression analysis revealed male gender and young age as an independent predictor for violence. These results clarify the relationship between alcohol, age, gender and violence and have important implications for municipal-level alcohol policies.

Les comportements violents associés à l'alcoolisme sont fréquemment rapportés dans différentes médias. Les données cliniques analysant la corrélation entre l'intoxication alcoolique, l'âge, le genre et la violence sont rares. Le but de la présente étude était d'évaluer l'influence de l'âge, du genre et de la concentration sanguine d'alcool sur le comportement violent sous l'influence de l'alcool, ceci dans des conditions rencontrées en Europe centrale. 300 malades hospitalisés dans le Département d'urgences de l'Hôpital universitaire de Zürich ont été inclus pendant une période allant du 1.1.2009 au 31.1.2009. Les critères d'inclusion consistaient en une alcoolémie ≥10 mmol/l, une atteinte traumatique de n'importe quelle nature et un âge ≥16 ans. La violence était définie comme un acte évitable commis par d'autres et ayant conduit à l'hospitalisation du malade. Les résultats ont été comparés par un test de Wilcoxon et de chi-carré. Une différence a été considérée comme significative à partir d'un p<0,05. La valeur prédictive a été évaluée sur la base d'une courbe ROC. Les facteurs prédictifs indépendants ont été recherchés à l'aide d'une analyse de régression logistique. L'âge moyen était de 36,9±16,9 (intervalle: 16­84 ans). Il y avait 259 (86%) hommes et 41 femmes (24%). Il y a vait une différence significative entre les genres (odds ratio pour les hommes=2,88; intervalle de confiance 95%: 0,93­0,96; p<0,0001) en ce qui concerne la violence, mais pas de différence du point de vue de l'alcoolémie. L'analyse de régression logistique a mis en évidence le genre masculin et le jeune âge comme des facteurs prédictifs indépendants. Ces résultats clarifient la relation entre l'alcool, l'âge, le genre et la violence. Ils ont ainsi d'importantes implications au niveau municipal pour l'attitude à avoir face à l'alcool.

[Diagnosis of an increased serum level of ferritin]. / Démarche diagnostique devant une hyperferritinémie.

The discovery of a hyperferritinemia is most of the time fortuitous. The diagnostic approach aims at looking for the responsible etiology and at verifying if an iron hepatic overload is present or not. Three diagnostic steps are proposed. The clinical elements and a few straightforward biological tests are sufficient at first to identify one of the four main causes: alcoholism, inflammatory syndrome, cytolysis, and metabolic syndrome. None of these causes is associated with a significant iron hepatic overload. If the transferring saturation coefficient is raised (>50%) a hereditary hemochromatosis should be discussed. Secondly, less common disorders will be discussed. Among these, only the chronic hematological disorders either acquired or congenital are at risk of iron hepatic overload. Thirdly, if a doubt persists in the etiologic research, and the serum ferritin level is very high or continues to rise, it is essential to verify that there is no iron hepatic overload. For that purpose, the MRI with study of the iron overload is the main test, which will guide the therapeutic attitude. Identification of more than a single etiology occurs in more than 40% of the cases.

[Acute pancreatitis: an overview of the management]. / Actualités sur la prise en charge de la pancréatite aiguë

Over the past decades, the incidence and the number of hospital admissions for acute pancreatitis have increased in the Western countries. The two most common etiological factors of acute pancreatitis are gallstones (including small gallstones or microlithiasis) and alcohol abuse. Acute pancreatitis is associated with a significant mortality (4-10%) and 25% in case of pancreatic necrosis, especially. Edematous pancreatitis is benign and oral feeding can be restarted once abdominal pain is decreasing and inflammatory markers are improving. Enteral tube feeding should be the primary therapy in patients with predicted severe acute pancreatitis who require nutritional support. Enteral nutrition in acute pancreatitis can be administered via either the nasojejunal or nasogastric route. In case of necrosis, preventive antibiotics are not recommended. The single indication is infected necrosis confirmed by fine needle aspiration. The incidence trends of acute pancreatitis possibly reflect a change in the prevalence of main etiological factors (e.g. gallstones and alcohol consumption) and cofactors such as tobacco, obesity and genetic susceptibility. Priority is to search for associated causes, especially in cases with atypical symptoms. In case of first acute pancreatitis in patients older than 50 years, the presence of a tumor (benign or malignant) has to be specifically ruled out, using CT-scan, MRI and endoscopic ultrasound.

[Unexplained, subclinical chronically elevated transaminases]. / Élévation modérée, persistante et inexpliquée des transaminases.

Unexplained, subclinical chronically elevated transaminases is mainly a marker of non-alcoholic fatty liver disease, metabolic syndrome, alcoholism and diabetes, which are very common situations but viral hepatitis and iatrogenic origin must also be considered. Before looking for hepatic or genetic rare diseases, it is worth considering hypertransaminasemia as a clue for muscular disease, particularly in paediatric settings, and creatine phosphokinase is a specific marker. Then, patient history, examination and appropriate biologic requests can permit the identification of less frequent disorders where isolated hypertransaminasemia is possibly the unique marker of the disease for a long while: hemochromatosis, celiac disease, autoimmune hepatitis, Wilson's disease, α1-anti-trypsine deficiency, thyroid dysfunctions, Addison's disease. Liver biopsy should be performed only in patients with aspartate aminotransferases upper the normal range or alanine aminotransferases higher than twice the normal range after 6 months delay with dietetic corrections.

A construção narrativa da família em crianças com familiares alcoólicos: contributos de um estudo qualitativo / Narrative constructions of family in children with alcoholic family members: contributes of a qualitative investigation / La construction narratif de la famille par les enfants qui ont des gens alcooliques dans leurs familles: conclusion d'une étude qualitative / La construcción narrativa de la familia en niños con familiares alcohólicos: conclusiones de un estudio cualitativo

No presente artigo descreve-se um estudo cujo objetivo se centra na identificação e compreensão dos significados e sentidos, narrativamente construídos e organizados por crianças com e sem familiares alcoólicos, relativamente à sua família. Esta investigação enquadra-se na necessidade atual de aprofundar o estudo do consumo de álcool e do seu impacto a nível familiar, principalmente no desenvolvimento das crianças. Foi utilizada uma metodologia qualitativa, recorrendo-se à realização de entrevistas analisadas de acordo com a Grounded Analysis. As entrevistas decorreram com 11 crianças com idades compreendidas entre os 4 e os 10 anos de idade, inseridas nas atividades lúdico-pedagógicas de um projeto social. Seis destas crianças possuem familiares que sofrem de alcoolismo e cinco não. Os resultados apontam para a existência de diferenças entre os discursos dos dois grupos de crianças que constituíram a amostra, sendo que as crianças com familiares alcoólicos manifestaram uma concepção diferente da família, que envolve relações conflituosas e problemas de vários tipos(AU)

With this article we aim to analyse narrative meanings about family, by children with and without alcoholic family members. This investigation underlines the lack of studies about alcohol consumption and its impact to familial environment, mostly on children development. A qualitative design was used, oriented by Grounded Analysis. Data were collected through a semi-structured interview. 11 participants, with ages between 4 and 10 years old that take part of a portuguese social project, were interviewed, six of them have an alcoholic family member and five don't. The results demonstrate the existence of differences between the discourses of the two groups of children that constitute the sample. In fact, family concept of children with alcoholic family members is negative, and reflects various problems and conflicts(AU)

Dans cet article nous décrivons une étude qui a comme sujet l'identification et la compréhension des sens et des significations sur la famille, par des enfants qui avaient et qui n'avaient pas des gens alcooliques dans la famille. Cette investigation a une raison d'être, le besoin actuel d'approfondir l'étude sur la consommation d'alcool, son impact au niveau familial et son influence sur le développement des enfants. On a utilisé une méthode qualitative en se servant de la réalisation de certaines entrevues qui ont été analysées selon la Grounded Analysis. Les entrevues ont été faites à 11 enfants à l'âge entre 4 et 10 ans, qui faisaient partie des activités d'un projet social, 6 d'entre eux avaient des gens alcooliques dans leur famille, les autres 5 n'en avaient pas. Les deux groupes d'enfants démontrèrent une différence au niveau du discours, ceux qui en avaient dans leurs familles des gens alcooliques montrèrent, d'une certaine manière, une conception plus négative de la famille, qui montre plusieurs problèmes et des conflits familiers(AU)

En el presente artículo, describe se un estudio cuyo objetivo se centra en la identificación y comprensión de los significados y sentidos, narrativamente construidos y organizados, por niños con y sin familiares alcohólicos, relativamente à su familia. Esta investigación encuadrase en la necesidad actual de profundar el estudio del consumo del alcohol y de su impacto a nivel familiar, principalmente a nivel del desarrollo de los niños. Fue utilizada una metodología cualitativa, recorriéndose à la realización de entrevistas analizadas de acuerdo con el Grounded Analysis. Las entrevistas descorrieran con 11 niños con edades comprendidas entre los 4 y los 10 años de edad, insertadas en las actividades lúdico-pedagógicas de un proyecto social. Seis de estos niños posean familiares que sufren de alcoholismo y cinco no. Los resultados apuntan para la existencia de diferencias entre los discursos de los grupos de niños que constituyeron la muestra, siendo que los niños con familiares alcohólicos manifestaron una concepción diferente de la familia, que envuelve relaciones conflictivas y problemas de varios tipos(AU)

A construção narrativa da família em crianças com familiares alcoólicos: contributos de um estudo qualitativo / Narrative constructions of family in children with alcoholic family members: contributes of a qualitative investigation / La construction narratif de la famille par les enfants qui ont des gens alcooliques dans leurs familles: conclusion d'une étude qualitative / La construcción narrativa de la familia en niños con familiares alcohólicos: conclusiones de un estudio cualitativo

No presente artigo descreve-se um estudo cujo objetivo se centra na identificação e compreensão dos significados e sentidos, narrativamente construídos e organizados por crianças com e sem familiares alcoólicos, relativamente à sua família. Esta investigação enquadra-se na necessidade atual de aprofundar o estudo do consumo de álcool e do seu impacto a nível familiar, principalmente no desenvolvimento das crianças. Foi utilizada uma metodologia qualitativa, recorrendo-se à realização de entrevistas analisadas de acordo com a Grounded Analysis. As entrevistas decorreram com 11 crianças com idades compreendidas entre os 4 e os 10 anos de idade, inseridas nas atividades lúdico-pedagógicas de um projeto social. Seis destas crianças possuem familiares que sofrem de alcoolismo e cinco não. Os resultados apontam para a existência de diferenças entre os discursos dos dois grupos de crianças que constituíram a amostra, sendo que as crianças com familiares alcoólicos manifestaram uma concepção diferente da família, que envolve relações conflituosas e problemas de vários tipos

With this article we aim to analyse narrative meanings about family, by children with and without alcoholic family members. This investigation underlines the lack of studies about alcohol consumption and its impact to familial environment, mostly on children development. A qualitative design was used, oriented by Grounded Analysis. Data were collected through a semi-structured interview. 11 participants, with ages between 4 and 10 years old that take part of a portuguese social project, were interviewed, six of them have an alcoholic family member and five don't. The results demonstrate the existence of differences between the discourses of the two groups of children that constitute the sample. In fact, family concept of children with alcoholic family members is negative, and reflects various problems and conflicts

Dans cet article nous décrivons une étude qui a comme sujet l'identification et la compréhension des sens et des significations sur la famille, par des enfants qui avaient et qui n'avaient pas des gens alcooliques dans la famille. Cette investigation a une raison d'être, le besoin actuel d'approfondir l'étude sur la consommation d'alcool, son impact au niveau familial et son influence sur le développement des enfants. On a utilisé une méthode qualitative en se servant de la réalisation de certaines entrevues qui ont été analysées selon la Grounded Analysis. Les entrevues ont été faites à 11 enfants à l'âge entre 4 et 10 ans, qui faisaient partie des activités d'un projet social, 6 d'entre eux avaient des gens alcooliques dans leur famille, les autres 5 n'en avaient pas. Les deux groupes d'enfants démontrèrent une différence au niveau du discours, ceux qui en avaient dans leurs familles des gens alcooliques montrèrent, d'une certaine manière, une conception plus négative de la famille, qui montre plusieurs problèmes et des conflits familiers

En el presente artículo, describe se un estudio cuyo objetivo se centra en la identificación y comprensión de los significados y sentidos, narrativamente construidos y organizados, por niños con y sin familiares alcohólicos, relativamente à su familia. Esta investigación encuadrase en la necesidad actual de profundar el estudio del consumo del alcohol y de su impacto a nivel familiar, principalmente a nivel del desarrollo de los niños. Fue utilizada una metodología cualitativa, recorriéndose à la realización de entrevistas analizadas de acuerdo con el Grounded Analysis. Las entrevistas descorrieran con 11 niños con edades comprendidas entre los 4 y los 10 años de edad, insertadas en las actividades lúdico-pedagógicas de un proyecto social. Seis de estos niños posean familiares que sufren de alcoholismo y cinco no. Los resultados apuntan para la existencia de diferencias entre los discursos de los grupos de niños que constituyeron la muestra, siendo que los niños con familiares alcohólicos manifestaron una concepción diferente de la familia, que envuelve relaciones conflictivas y problemas de varios tipos