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.

[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.

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.

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.

Reasons for Attempted Suicide in Europe: Prevalence, Associated Factors, and Risk of Repetition.

To examine the prevalence of specific reasons for attempted suicide, factors associated with them, and whether reasons for attempted suicide influence risk of repetition. As part of the Monitoring Suicide in Europe (MONSUE) project, data on 4,683 suicide attempters from nine European countries were collected. Independence tests were used to study the influence of age, gender, and other factors on reported reasons. We examined risk of repetition using logistic regression analysis. Interpersonal conflict was common for all patients except those widowed, living alone, or retired. Mental health problems were prevalent among over 45 year-olds, patients unable to work, and patients with a history of at least three suicide attempts. Financial difficulties were cited more often by patients who were 45-64 years old, divorced or separated, living with children only, and unemployed. Close bereavement/serious illness and own physical illness were associated with those over 65 years of age. Two reasons for suicide attempt, interpersonal conflict and mental health problems, were associated with increased risk of repetition independent of other factors. Suicide attempters have a multitude of problems of varying prevalence depending on age, gender, and other factors. They present a range of clinical profiles that require a multidisciplinary response.

[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.

Does more sleep matter? Differential effects of NREM- and REM-dominant sleep on sleepiness and vigilance.

We investigated effects of NREM and REM predominant sleep periods on sleepiness and psychomotor performances measured with visual analog scales and the psychomotor vigilance task, respectively. After one week of stable sleep-wake rhythms, 18 healthy sleepers slept 3hours of early sleep and 3hours of late sleep, under polysomnographic control, spaced by two hours of sustained wakefulness between sleep periods in a within subjects split-night, sleep interruption protocol. Power spectra analysis was applied for sleep EEG recordings and sleep phase-relative power proportions were computed for six different frequency bands (delta, theta, alpha, sigma, beta and gamma). Both sleep periods presented with similar sleep duration and efficiency. As expected, phasic NREM and REM predominances were obtained for early and late sleep conditions, respectively. Albeit revealing additive effects of total sleep duration, our results showed a systematic discrepancy between psychomotor performances and sleepiness levels. In addition, sleepiness remained stable throughout sustained wakefulness during both conditions, whereas psychomotor performances even decreased after the second sleep period. Disregarding exchanges for frequency bands in NREM or stability in REM, correlations between outcome measures and EEG power proportions further evidenced directional divergence with respect to sleepiness and psychomotor performances, respectively. Showing that the functional correlation pattern changed with respect to early and late sleep condition, the relationships between EEG power and subjective or behavioral outcomes might however essentially be related to total sleep duration rather than to the phasic predominance of REM or NREM sleep.

[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.

Emotional facial expression processing in depression: data from behavioral and event-related potential studies.

Behavioral literature investigating emotional processes in depressive populations (i.e., unipolar and bipolar depression) states that, compared to healthy controls, depressive subjects exhibit disrupted emotional processing, indexed by lower performance and/or delayed response latencies. The development of brain imaging techniques, such as functional magnetic resonance imaging (fMRI), provided the possibility to visualize the brain regions engaged in emotional processes and how they fail to interact in psychiatric diseases. However, fMRI suffers from poor temporal resolution and cognitive function involves various steps and cognitive stages (serially or in parallel) to give rise to a normal performance. Thus, the origin of a behavioral deficit may result from the alteration of a cognitive stage differently situated along the information-processing stream, outlining the importance of access to this dynamic "temporal" information. In this paper, we will illustrate, through depression, the role that should be attributed to cognitive event-related potentials (ERPs). Indeed, owing to their optimal temporal resolution, ERPs can monitor the neural processes engaged in disrupted cognitive function and provide crucial information for its treatment, training of the impaired cognitive functions and guidelines for clinicians in the choice and monitoring of appropriate medication for the patient.

[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.

[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.

[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.

How cognitive assessment through clinical neurophysiology may help optimize chronic alcoholism treatment.

Alcohol dependence constitutes a serious worldwide public health problem. The last few decades have seen many pharmacological studies devoted to the improvement of alcoholism treatment. Although psychosocial treatments (e.g. individual or group therapy) have historically been the mainstay of alcoholism treatment, a successful approach for alcohol dependence consists in associating pharmacologic medications with therapy, as 40-70% of patients following only psychosocial therapy typically resume alcohol use within a year of post-detoxification treatment. Nowadays, two main pharmacological options, naltrexone and acomprosate, both approved by the US Food and Drug Administration, are available and seemingly improve on the results yielded by standard techniques employed in the management of alcoholism. However, insufficient data exist to confirm the superiority of one drug over the other, and research is ongoing to determine what type of alcohol-dependent individual benefits the most from using either medication. Available data on the application of both drugs clearly suggest different practical applications. Thus, a fundamental question remains as to how we can identify which alcoholic patients are likely to benefit from the use of naltrexone, acamprosate or both, and which are not. The aim of the present manuscript is to suggest the use of cognitive event-related potentials as an interesting way to identify subgroups of alcoholic patients displaying specific clinical symptoms and cognitive disturbances. We propose that this may help clinicians improve their treatment of alcoholic patients by focusing therapy on individual cognitive disturbances, and by adapting the pharmaceutical approach to the specific needs of the patient.

Major depression is associated with impaired processing of emotion in music as well as in facial and vocal stimuli.

BACKGROUND: The processing of emotional stimuli is thought to be negatively biased in major depression. This study investigates this issue using musical, vocal and facial affective stimuli. METHODS: 23 depressed in-patients and 23 matched healthy controls were recruited. Affective information processing was assessed through musical, vocal and facial emotion recognition tasks. Depression, anxiety level and attention capacity were controlled. RESULTS: The depressed participants demonstrated less accurate identification of emotions than the control group in all three sorts of emotion-recognition tasks. The depressed group also gave higher intensity ratings than the controls when scoring negative emotions, and they were more likely to attribute negative emotions to neutral voices and faces. LIMITATIONS: Our in-patient group might differ from the more general population of depressed adults. They were all taking anti-depressant medication, which may have had an influence on their emotional information processing. CONCLUSIONS: Major depression is associated with a general negative bias in the processing of emotional stimuli. Emotional processing impairment in depression is not confined to interpersonal stimuli (faces and voices), being also present in the ability to feel music accurately.

[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.

[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.

Chronic alcoholism: insights from neurophysiology.

INTRODUCTION: Increasing knowledge of the anatomical structures and cellular processes underlying psychiatric disorders may help bridge the gap between clinical signs and basic physiological processes. Accordingly, considerable insight has been gained in recent years into a common psychiatric condition, i.e., chronic alcoholism. MATERIAL AND METHODS: We reviewed various physiological parameters that are altered in chronic alcoholic patients compared to healthy individuals--continuous electroencephalogram, oculomotor measures, cognitive event-related potentials and event-related oscillations--to identify links between these physiological parameters, altered cognitive processes and specific clinical symptoms. RESULTS: Alcoholic patients display: (1) high beta and theta power in the resting electroencephalogram, suggesting hyperarousal of their central nervous system; (2) abnormalities in smooth pursuit eye movements, in saccadic inhibition during antisaccade tasks, and in prepulse inhibition, suggesting disturbed attention modulation and abnormal patterns of prefrontal activation that may stem from the same prefrontal "inhibitory" cortical dysfunction; (3) decreased amplitude for cognitive event-related potentials situated along the continuum of information-processing, suggesting that alcoholism is associated with neurophysiological deficits at the level of the sensory cortex and not only disturbances involving associative cortices and limbic structures; and (4) decreased theta, gamma and delta oscillations, suggesting cognitive disinhibition at a functional level. DISCUSSION: The heterogeneity of alcoholic disorders in terms of symptomatology, course and outcome is the result of various pathophysiological processes that physiological parameters may help to define. These alterations may be related to precise cognitive processes that could be easily monitored neurophysiologically in order to create more homogeneous subgroups of alcoholic individuals.