[Aggressiveness and violence in daily ophthalmology practice: Descriptive analysis of a survey sent to residents and assistants in Grand Est and Bourgogne-Franche-Comté]. / Agressivité et violence au cours de l'exercice professionnel en ophtalmologie : analyse descriptive d'un questionnaire adressé aux internes et assistants des régions Grand Est, Bourgogne-Franche-Comté.

INTRODUCTION: The goal of this study was to estimate the prevalence of workplace violence in a population of young ophthalmologists in France and to characterize these situations. METHODS: We conducted an epidemiological descriptive, cross-sectional, multi-center study based on an anonymous questionnaire. We submitted a questionnaire to all ophthalmology residents and fellows (n=157) in the Grand Est and Bourgogne-Franche-Comté regions between December 2020 and March 2021. RESULTS: The overall response rate was 76.4% (n=120, 55% female and 45% male) of whom 81.6% reported having faced aggression at least once. For 50.9% of participants, aggression had occurred several times per year. These situations occurred during the first year of residency in 64.3% of cases. They mainly consisted of verbal aggression (98.8%) by a patient or their relatives (43.7% and 29.8%). The main complaints voiced by these individuals concerned the wait time (40%) and the feeling of lack of competence or improper medical care (26.8%). Fifty-seven percent of people who faced these situations thought about it for at least a week, and 20.4% of those exposed felt anxiety at work after the incident. CONCLUSION: We found high prevalence of verbal aggression in professional ophthalmology practice. Although these situations were mainly verbal aggression without significant consequences, they sometimes lead to anxiety in the aftermath. We should prepare medical students to manage them, through appropriate theoretical and practical training, such as medical simulation described in this article.

Assessment of neuropsychological impairments in regular cannabis users.

BACKGROUND: Cannabis is the most widely used illicit drug in the world. It is responsible for cognitive dysfunction of memory, speed of information processing, attention, and executive functions. Cognitive performance depends on the level of study, tolerance, and duration of abstinence from cannabis use. This study analyses cognitive function in a large population of regular cannabis consumers taking into account level of education. METHODS: A battery of neuropsychological tests using the Cambridge Neuropsychological Test Automated Battery was performed on a population of 58 cannabis users categorized into two groups according to their level of education with a threshold of 12 years of study, and 25 non-users. RESULTS: In Attention Switching Task percent correct trials, significant differences were found between the group of cannabis smokers with less than 12 years of study and the non-smoker group (P=0.022), and between the cannabis users with more than 12 years of study and the non-smoker group (P=0.008). A significantly lower performance in the Rapid Visual Information Processing (Mean latency, Probability of hit, Total hits, Total misses, Correct rejections) was found in the cannabis users with less than 12 years of study compared with the non-user group. CONCLUSION: In our population, chronic cannabis users presented divided and sustained attention and working memory disorders. Rapid Visual Information Processing performance may be influenced by education level in cannabis smokers.

Mindfulness-based relapse prevention for cannabis regular users: Preliminary outcomes of a randomized clinical trial.

Mindfulness-based approaches have shown their effectiveness in caring for patients with substance use disorders (SUD). Mindfulness-based relapse prevention (MBRP) integrates practices from mindfulness-based interventions and cognitive-behavioral relapse prevention (RP) approaches. This article presents the preliminary results of a study that measures the effectiveness of an MBRP protocol for volunteer cannabis users willing to reduce or stop their consumptions. Twenty cannabis users were randomly assigned to either receive an eight-week outpatient MBRP program or treatment as usual (TAU). Cannabis use was assessed weekly through the timeline follow back (TLFB). Eighty percent of individuals received MBRP treatment and 60% of individuals received TAU completed treatment. Preliminary results did not find significant difference at the end of treatment (week 8) regarding the number of joints smoked. Despite the absence of any significant difference between the two groups, the contribution of mindfulness in the caring of SUD seems encouraging and promising. Many MBRP group participants reported qualitative changes in the way they consumed. This study will be continued in order to evaluate the effectiveness of MBRP on a larger number of subjects.

[Specific effect of exercise training on depression in COPD patients]. / Impact spécifique du réentraînement à l'exercice sur les symptômes de dépression dans la broncho-pneumopathie chronique obstructive : expérience du Réseau insuffisance respiratoire de Lorraine.

INTRODUCTION: Depression is a common comorbidity in COPD patients, worsening their quality of life and their current level of physical activity. Respiratory rehabilitation is therefore highly recommended for COPD patients but only few of them have access to that kind of program. In real life, exercise training is often the only therapeutic activity provided to patients. METHODS: The aim of this study was to evaluate the specific effect of exercise training on the level of depression (using Beck Depression inventory short form (BDI-SF)) and quality of life in COPD patients [using the Saint George's Respiratory Questionnaire (SGRQ)]. Five hundred and fifteen COPD patients were enrolled in home-based exercise training programs. 421 programs were completed and the data was available for 182 patients (SGRQ, BDI-SF et TE) at T0 and T12. RESULTS: Dyspnoea (mMRC), SGRQ, BDI-SF scores and TE were significantly improved by the exercise training: mMRC 2,7±0,9 vs. 2,3±1,2; SGRQ 45±15 vs 34±18; BDI-SF 4,2±5,1 vs. 2,7±4,3; TE 6,4±5,4 vs. 17,2±12,8 respectively at T0 and T12. The improvement of TE was significantly correlated to that of the SGRQ scores (r=0,4; P<0,001) and of the BDI-SF scores (r=-0,24; P=0,001). CONCLUSION: This home-based exercise training program improved dyspnoea, quality of life, depression and exercise capacity. The improvement of the TE and BDI-SF scores were correlated.

Evolution and characteristics of the use of valproate in women of childbearing age with bipolar disorder: Results from the FACE-BD cohort.

BACKGROUND: Valproate is associated with teratogenic and neurodevelopmental effects. Several agencies have restricted the conditions of its prescription in bipolar disorders (BD). We aimed to assess the evolution of valproate prescription and the clinical profile of BD women of childbearing age receiving valproate. METHODS: Based on a large national cohort, we included all BD women 16-50 years old. Sociodemographic, clinical and pharmacological data were recorded. Logistic regression analyses were used to describe variables associated with valproate prescription. RESULTS: Of the 1018 included women 16-50 years old, 26.9% were treated with valproate with a mean daily dosage of 968 mg. The prevalence of BD women using valproate was 32.6% before May 2015 and 17.3% after May 2015 (p<0.001), the date of French regulatory publication of restriction of valproate prescription. The multivariate analysis revealed that the inclusion period after May 2015 (OR=0.54, CI 95% 0.37-0.78, p=0.001), the age lower than 40 years (OR=0.65, CI 95% 0.43-0.98, p=0.040) and the number of lifetime mood episodes (OR=0.98, CI 95% 0.95-0.99, p=0.040) were the variables negatively associated with the use of valproate. LIMITATIONS: Study could be underpowered to determine a clinical profile associated with valproate prescription. CONCLUSIONS: The regulatory change in BD women of childbearing age had a significant impact on valproate prescription, even if the prescription rate remains high. Important efforts are needed to help clinicians and patients to improve quality of care in BD women of childbearing age.

[Retinal investigations in patients with major depressive disorder, bipolar disorder or schizophrenia: A review of the literature]. / Étude de la structure et de la fonction rétinienne chez les patients atteints de trouble dépressif sévère, de trouble bipolaire ou de schizophrénie : une revue de la littérature.

Major depressive disorder, bipolar disorder and schizophrenia are currently among the most common psychiatric disorders, known to constitute a serious public health issue in terms of morbidity, mortality and functional handicap. Their pathophysiology is still unclear, but there is now increasing evidence supporting the existence of abnormalities of neurotransmission. As the retina is an extension of the central nervous system, it may be an interesting site of study which might provide a better understanding of the pathophysiology of psychiatric disorders. Several studies have demonstrated retinal abnormalities, with abnormal cone and rod responses on electroretinography (ERG), suggesting a process of functional neuronal loss, structurally supported by a decrease in the retinal nerve fiber layer thickness (RNFL) on optical coherence tomography (OCT), which suggests involvement of the molecular signal pathways of neurotransmission. These tests could be useful tools for diagnosing and monitoring psychiatric disorders. This article is an overview of the literature on retinal abnormalities observed in patients with major depressive disorder, bipolar disorder or schizophrenia, and discusses how they could be pathophysiologic markers.

[Screening tools for cannabis use disorders and their adaptation to DSM-5: A literature review]. / Les outils de repérage pour les troubles de l'usage du cannabis et leur adaptation au DSM-5 : une revue de littérature.

OBJECTIVES: Cannabis use is widespread in France, particularly among adolescents and young adults, and can induce severe somatic, psychiatric and social consequences. Early identification and appropriate care of cannabis use disorders thus constitute a major public health issue. Standardized questionnaires based on patient self-reporting are recognized as the best option for identifying cannabis use disorders because of their reliability and simplicity. METHODS: We conducted a narrative literature review on cannabis use assessment tools on PubMed and selected cannabis-specific questionnaires, validated for adolescent and/or adult populations, from scientific articles in English or French between 1995 and 2010. RESULTS: Sixteen questionnaires were found according to the inclusion criteria. The CAGE-cannabis, the CAST, the CUDIT and its revised version the CUDIT-R, the PUM and the SDS are the only ones that have good characteristics for a short screening tool adapted to daily clinical practice, namely to be brief (fewer than 10 questions) and quick handover (less than 10minutes). Only the CAST has been validated in French, and the CUDIT-R is currently being validated. In the DSM-5, diagnoses of abuse or addiction have been grouped into a single diagnosis of cannabis use disorders with different levels of severity. It is relevant that tools used for screening take into account these new diagnostic concepts. The CUDIT-R is currently the only one to be validated based on DSM-5 diagnostic criteria. CONCLUSION: Among the many questionnaires available, few are suited for daily clinical practice in France because of their complexity, their long duration or the absence of a validated French translation. The CUDIT-R has good psychometric characteristics, is simple to use, and has been validated according to the criteria of DSM-5. These questionnaires are obviously not a substitute for a clinical diagnosis and must be followed by a specialist's evaluation. However, they remain an interesting mediation, encouraging a patient's awareness and commitment to care.

Study of retinal structure and function in patients with major depressive disorder, bipolar disorder or schizophrenia: A review of the literature.

Major depressive disorder, bipolar disorder and schizophrenia are currently among the most common psychiatric disorders, known to constitute a serious public health issue in terms of morbidity, mortality and functional handicap. Their pathophysiology is still unclear, but there is now increasing evidence supporting the existence of abnormalities of neurotransmission. As the retina is an extension of the central nervous system, it may be an interesting site of study which might provide a better understanding of the pathophysiology of psychiatric disorders. Several studies have demonstrated retinal abnormalities, with abnormal cone and rod responses on electroretinography (ERG), suggesting a process of functional neuronal loss, structurally supported by a decrease in the retinal nerve fiber layer thickness (RNFL) on optical coherence tomography (OCT), which suggests involvement of the molecular signal pathways of neurotransmission. These tests could be useful tools for diagnosing and monitoring psychiatric disorders. This article is an overview of the literature on retinal abnormalities observed in patients with major depressive disorder, bipolar disorder or schizophrenia, and discusses how they could be pathophysiologic markers.

Free viewing exploration in schizophrenia: Review of evidence from laboratory settings to natural environment.

Several studies have investigated visual processing impairment in schizophrenia. The literature on visual exploration has described restricted scanning in schizophrenia patients. This gaze behavior is characterized by increased fixation duration, a reduced scan path length and avoidance of salient features of the face with emotional content. The aim of this paper is to give an insight on the latest update on scan path deficit. Abnormal gaze exploration was replicated in various visual stimuli. This review describes gaze patterns with stimuli that imply minimal to high cognitive process: figures, objects, faces, and scenes. Interestingly, schizophrenia patients have shown cognitive flexibility by modulating gaze scanning when they are involved in an active assignment. We will also consider scanning abnormalities in real-life environment and discuss the potential therapeutic use of eye tracking in schizophrenia. The therapeutic application of eye tracking in schizophrenia is a young emerging field in psychiatry research. The recent remediation program is based on the reorientation of visual attention on the salient features of faces. For now, this program has shown encouraging results. Further studies are needed to explore behavior in real-world situations to complement laboratory measurements to move toward a full understanding of the mechanisms underlying atypical scanning in patients with schizophrenia.

The effect of interactions between genetics and cannabis use on neurocognition. A review.

BACKGROUND: Cannabis is one of the most widely-used drugs in industrialized countries. It is now well established that cannabis use impacts neurocognition. In the intoxication period time episodic memory, working memory and attention are impacted and impulsivity is increased. The long-term effects of cannabis use tend to be similar. Various internal factors, such as sex differences, modulate this impact. It is unclear whether genetic variations can also influence the impact of cannabis on neurocognition. We set out to examine the impact of genetic variations on neurocognition in cannabis users. METHOD: We conducted a search via the PubMed, Web of Science, and ScienceDirect databases to identify studies measuring neurocognition and assessing genotypes in the context of cannabis use. RESULTS: We included 13 articles. We found that working memory, verbal and visual memory and sustained attention are more impacted during intoxication in subjects with the Val COMT allele. COMT gene could also modulate sustained attention in regular use. The CNR1, AKT1, DBH and 5-HTT/SLC6A4 genes may also modulate effects. CONCLUSION: Most of these genes are linked to schizophrenia. A fuller understanding of their impact on the effects of cannabis on neurocognition would thus help elucidate the mechanisms linking cannabis and psychosis. However, evidence is still scant, and more research is needed.