[Atypical depression as a risk factor for obstructive sleep apnea syndrome in young adults]. / La dépression majeure à caractéristique atypique comme facteur de risque du syndrome d'apnées obstructives du sommeil chez le jeune adulte.

OBJECTIVES: In the literature, several studies have investigated the particular relationship between major depression and obstructive sleep apnoea syndrome (OSAS). However, most of these studies have focused primarily on middle-aged to elderly individuals (≥40 years) which means that this problem has been little studied in young adults (<30 years). Nevertheless, in young adults the prevalence of major depression (particularly its atypical subtype) is not negligible, which seems to justify carrying out additional investigations in order to allow a better understanding of the potential role played by major depression in the pathophysiology of OSAS in this particular subpopulation. The aim of this study was therefore to empirically investigate the prevalence of OSAS in young adults and to study the risk of OSAS associated with major depression in this particular subpopulation. METHODS: Polysomnographic and demographic data from 264 young adults were collected from the Erasme Hospital Sleep Laboratory (Brussels, Belgium) database to enable our analyses. During their two-night stay (including a first night of habituation and a night of polysomnography) at the Sleep Laboratory, these individuals underwent a complete somatic assessment (including blood test, electrocardiogram, daytime electroencephalogram and urinalysis), a systematic psychiatric assessment by a unit psychiatrist and an assessment of their complaints related to sleep. These different steps made it possible to systematically diagnose all somatic pathologies, psychiatric disorders according to the diagnostic criteria of the DSM-IV-TR and sleep pathologies according to the diagnostic criteria of the AASM. This allowed the selection of young adults included in our study based on our inclusion and exclusion criteria. Polysomnographic recordings from our Sleep Laboratory were visually scored according to AASM criteria. An obstructive sleep apnoea-hypopnoea index ≥5/hour was used for the diagnosis of OSAS. At the statistical level, in order to allow our analyses, we subdivided our sample of young adults into two groups: a control group without OSAS (n=215) and a patient group with OSAS (n=49). After checking the normal distribution of our data, normally distributed data were analysed with t-tests whereas asymmetrically or dichotomously distributed data were analysed with Wilcoxon tests or Chi2 tests. Univariate regression models were used to study the risk of OSAS associated with major depression (categorized: absent, typical, atypical) in young adults and potential confounding factors. In multivariate regression models, the risk of OSAS associated with major depression (categorized: absent, typical, atypical) in young adults was adjusted only for confounding factors significantly associated with OSAS during univariate analysis. These confounding factors were introduced in a hierarchical manner in the various multivariate regression models constructed. RESULTS: The prevalence of OSAS in our population of young adults was 18.6 %. During univariate analyses, atypical depression [OR 2.51 (95% CI 1.18-5.32), p-value=0.014], male gender [OR 4.53 (95% CI 2.20-9.34), P-value <0.001], presence of snoring [OR 2.51 (95% CI 1.33-4.75), P-value=0.005], presence of at least one cardio-metabolic alteration [OR 2.26 (95% CI 1.19-4.28), P-value=0.012], body mass index>30 kg/m2 [OR 4.55 (95% CI 2.07-10.03), P-value <0.001] and ferritin ≥150 µg/L [OR 3.28 (95% CI 1.69-6.36), P-value<0.001] were associated with increased risk of OSAS in our population of young adults. After adjusting for these major confounding factors associated with OSAS (gender, body mass index, cardio-metabolic alterations, ferritin level, and snoring) in the four models studied, multivariate regression analyses confirmed that unlike typical depression, atypical depression [OR 3.09 (95% CI 1.26-7.54), P-value=0.019] was a risk factor for OSAS in young adults. CONCLUSIONS: In our study, we demonstrated that the prevalence of OSAS was 18.6 % in young adults referred to the Erasme Hospital Sleep Laboratory. In addition, we have shown that unlike typical depression, atypical depression was associated with an increased risk of OSAS in young adults, which seems to justify more systematic research of this pathology in young adults suffering from atypical depression in order to allow the establishment of adapted therapeutic strategies and avoid the negative consequences associated with the co-occurrence of these two pathologies.

Link Between Anhedonia and Depression During Early Alcohol Abstinence: Gender Matters.

AIMS: The aim of the present study was to evaluate the relation between anhedonia and depression in alcohol use disorders (AUD) during detoxification: Is trait anhedonia measured at the beginning of detoxification predictive of depressive symptoms observed at the end? Does state anhedonia recover during detoxification as depression does? Gender differences that have been previously observed for depression in AUD were also explored. METHODS: 81 AUD inpatients were tested at T1 (day 1) and T2 (day 14-18) of withdrawal with the trait Physical Anhedonia Scale, the state anhedonia Snaith-Hamilton Pleasure Scale, the Beck depression inventory and the Spielberger State Anxiety Inventory and compared to 34 control participants, matched for age and gender. RESULTS: AUD patients scored significantly higher than controls on depression, anxiety and state and trait anhedonia when they just entered the detoxification unit. Depression, anxiety and state anhedonia decreased between T1 and T2 in AUD patients. In women, state anhedonia at T1 was predictive of depressive symptoms at T2 over and above anxiety and depression at T1. CONCLUSION: In AUD, state anhedonia recovers during detoxification, concurrently to other affective-related symptoms. However, in women, trait anhedonia predicts the level of depression at the end of detoxification, above and beyond anxiety. This finding stresses the importance of addressing anhedonia in the treatment of AUD and emphasizes the need for targeted interventions within clinical settings in this gender. Clinical consequences are discussed.

[Elderly's suicide attempt]. / Tentative de suicide de la personne âgée.

Suicide attempts among the elderly (more than 65 years old) is a topic that is scarcely studied despite its prevalence. In recent years, researchers from all over the world started to study and publishing about this phenomenon. Several research studies tried to single out elderly people's suicide risk factors, focusing particularly on neurobiological alterations linked to the aging process. Some prevention techniques have already been developed and produced convincing results. Through this literature review, we set out to give both a general and summarized view on suicide and suicide attempts among the elderly.

La tentative de suicide des personnes âgées de 65 ans et plus est un sujet encore peu étudié. Ce n'est pourtant pas un fait rare. Depuis plusieurs années, divers groupes de chercheurs à travers le monde ont commencé à étudier et à publier sur le sujet. Plusieurs études tentent de cibler les facteurs de risque du suicide du senior, notamment au niveau d'altérations neurobiologiques liées à l'âge. Des techniques de préventions ont déjà été développées et montrent des résultats probants. Au travers de cette revue de littérature, nous avons voulu donner une vision globale et résumée du suicide et de la tentative de suicide des seniors.

Beat note stabilization in dual-polarization DFB fiber lasers by an optical phase-locked loop.

A fully fibered microwave-optical source at 1.5 µm is studied experimentally. It is shown that the beat note between two orthogonally polarized modes of a distributed-feedback fiber laser can be efficiently stabilized using an optical phase-locked loop. The pump-power-induced birefringence serves as the actuator. Beat notes at 1 GHz and 10 GHz are successfully stabilized to a reference synthesizer, passing from the 3 kHz free-running linewidth to a stabilized sub-Hz linewidth, with a phase noise as low as -75 dBc/Hz at 100 Hz offset from the carrier. Such dual-frequency stabilized lasers could provide compact integrated components for RF and microwave photonics applications.

[The alexithymia questionnaire for children (AQC): Psychometric properties in a sample of 105 adolescents hospitalized in an adolescent psychiatric department]. / Le questionnaire d'alexithymie pour enfants (QAE) : étude sur une population clinique de 105 adolescents hospitalisés en pédopsychiatrie.

OBJECTIVE: The 20-item Toronto Alexithymia Scale (TAS-20) is the most widely used measure of alexithymia in non-clinical or clinical populations. The TAS-20 evaluates three dimensions of the alexithymia construct: the difficulty identifying feelings (DIF), the difficulty describing feelings (DDF) and externally oriented thinking (EOT). The TAS-20 is also used in adolescents or children, and the psychometric properties of the scale have not been systematically evaluated in these populations. Recently several studies have shown systematic age differences in the factor structure and a decrease of the quality of the measurement with age. Notably, low reliability measured by the Cronbach α coefficient has been found for the EOT factor. Taking into account the limitations of the TAS-20 in pre-adult populations the Alexithymia Questionnaire for Children (AQC), an adaptation of the TAS-20, has been proposed by a reformulation of the TAS-20 items (Rieffe et al., 2006). Two studies in healthy children found satisfactory psychometric properties with the three-factor structure demonstrating adequate parameters in the confirmatory factorial analyses (CFA). In the two studies low reliabilities of the EOT factor were reported, and recent studies in adolescents using the TAS-20 found that a two-factor model (DDF, DIF) had a better fit than the original three-factor model. Thus, the aim of the present study was firstly to verify the psychometric properties of the AQC in a sample of adolescents presenting various psychiatric disorders and secondly to test the adequacy of the bi- or tridimensional model of the scale. METHOD: One hundred and five adolescents (27 males, 78 females) with a mean age of 15.06 years (sd=1.55, range: 12-18 years) were hospitalized in the adolescent psychiatric department of the Erasme Hospital (Bruxelles, Belgium) for various psychiatric disorders. The main diagnoses were: adjustment disorder (n=56, 53.5%), mood or anxiety disorders (n=17, 16.2%), impulse control disorder (n=11, 10.5%). The subjects completed the French version of the AQC. CFA were done testing the adequacy of the three or two-factor structure of the scale. Two indices were considered: the normed χ2 (ratio of χ2 and degrees of freedom) and the root mean square error of approximation (RMSEA). The values for acceptable fit were normed χ2<3 and RMSEA<0.05. Cronbach α were also calculated. RESULTS: Fit indices for the three-factor model were respectively 1.165 and 0.0303 for the normed χ2 and RMSEA. For the two-factor model, the values were respectively 0.819 and 0. Thus, these two well-fitting models were compared using the χ2-difference test, which indicated a significantly better fit for the two-factor model over the three-factor model (χ2-difference=151.447, delta df=114, P<0.05). The values of the Cronbach α coefficients were respectively 0.72, 0.75, 0.18 for DIF, DDF and EOT subscales. Moreover, the values of the Cronbach α coefficients were respectively 0.71 and 0.83 for the full scale and the scale without the EOT items. CONCLUSION: The Alexithymia Questionnaire for Children had satisfactory psychometric properties found in a sample of adolescent psychiatric inpatients. Taking into account firstly the superiority of the two-factor model over the classical three-factor model and secondly the low value of the Cronbach α for the EOT factor, it is proposed to use only the twelve-item scale by excluding the EOT items.

[Treatment resistant depression: actuality and perspectives in 2017]. / Dépression résistante au traitement : actualité et perspective en 2017.

Major depressive disorder (MDD) affects 3 to 17 % of adults. 15 to 30 % of patients with MDD suffer from treatment resistant depression (TRD). No international consensus defines TRD. The most common definition is " MDD that is not enough improved after two successive and different classes of antidepressant treatments in appropriate dose and duration ". The appropriate dose corresponds to maximal dose accepted by scientific reports and clinical recommendations, while the appropriate duration is around 6 weeks. TRD is diagnosed after excluding a pseudoresistant depression, that is related to weak compliance or to somatic and psychiatric differential diagnosis. As well as in MDD, molecular, neuro-anatomical and metabolic disturbances are involved in TRD. A decreased cerebral plasticity induced by low level of Brain-Derived Neurotrophic Factor (BDNF) is also reported. Several authors describe that the cerebral atrophy and the dopaminoglutaminergic system disturbances are more severe in TRD than in MDD. In contrast to MDD treatment, TRD treatment is most often physical treatment. Electroconvulsive therapy (ECT) followed by a tricyclic antidepressant and/or lithium is the most effective treatment. Deep brain stimulation and vagal nerve stimulation reach also a high rate of remission but they are both very invasive technique. Repetitive transcranial magnetic stimulation in TRD seems to be effective in TRD but lower than ECT. There are two majors purposes for this review. First it may help the clinician to understand the TRD's complexity and also it details the kind of treatment useful to care it.

3 à 17 % de la population adulte souffre d'un épisode dépressif majeur (EDM). Parmi ceux-ci, 15 à 30 % présenteront une dépression résistante au traitement (DRT). Malgré l'absence de consensus international sur une définition de la DRT, la définition la plus fréquemment utilisée est " l'EDM est caractérisé par l'absence d'effet acceptable après deux traitements médicamenteux antidépresseurs de classes différentes prescrits à dose et durée adéquates ". La dose adéquate est reconnue comme la dose maximale autorisée par les recommandations officielles ; tandis que la durée adéquate, basée sur un ensemble d'études pharmacologiques contrôlées et randomisées, varie souvent autour de 6 semaines. Le diagnostic de DRT peut être posé après avoir exclu toutes causes de pseudorésistance : soit une mauvaise compliance au traitement, soit la présence d'un autre diagnostic différentiel psychiatrique ou somatique. Tout comme dans l'EDM, des perturbations moléculaires, neuro-anatomiques et métaboliques sont également en cause dans la DRT. Une diminution de la plasticité cérébrale provoquée par une diminution du facteur de croissance Brain-Derived Neurotrophic Factor (BDNF) est également rapportée. Plusieurs auteurs décrivent une atrophie cérébrale plus importante et un plus grand dysfonctionnement des systèmes dopamino-glutaminergiques chez les patients souffrant de DRT. Le traitement des DRT est essentiellement basé sur les techniques de neurostimulation. L'électroconvulsivothérapie (ECT) avec relais vers un antidépresseur tricyclique et/ou le lithium reste le plus efficace. La stimulation cérébrale profonde et la stimulation du nerf vague présentent également des taux de rémission élevés mais restent des techniques invasives. La stimulation magnétique trans-crânienne répétitive apporte également de bons résultats en cas de DRT. Toutefois son efficacité reste inférieure à celle de ECT. Le but de cet article est double : aider le clinicien à comprendre la complexité de la DRT, et offrir une revue détaillée des différents traitements, pharmacologiques ou non, pouvant y faire face.

[The DSM-V : An overview]. / Les particularités du DSM-V.

The aim of the present article is to present an overview of the recently published 5th version of the DSM. After a brief historic of the different versions of the DSM since the third edition, the main features of the classification were presented followed by the particularities of the fifth version.

La classification américaine des troubles mentaux depuis sa troisième version (DSM-III)* connaît un retentissement important sur le plan mondial avec son adoption dans de nombreux pays au détriment de la classification mondiale élaborée par l'Organisation Mondiale de la Santé. L'historique du DSM est abordé suivi par les particularités de la 5ème version sortie en 2013 et publiée en français en 2015.

[Support for insomnia : Recommendations for practice in general medicine]. / Prise en charge de l'insomnie : Recommandations pour la pratique en médecine générale.

In Belgium, poor sleep complaints are numerous and frequent in the general population. Of these complaints, one of the most important is insomnia. Acute onset and chronicity of insomnia can be explained by different models based on genetic criteria, neurophysiological, neuroendocrine, neuroimmunological and neuroimaging. Insomnia can be associated with a lot of somatic and psychiatric comorbidities. The diagnosis of insomnia is primarily a clinical diagnosis based on medical history and physical examination. Different tools can help us in our approach, such as self-questionnaires and sleep diaries while additional tests (polysomnography and actigraphy) should be reserved for research of associated sleep disorders and for unclear situations. The management of insomnia can be non-drug treatment (exercise, light therapy, acupuncture and self-treatment cognitive behavioral therapy) but also drug treatment (benzodiazepine, Z-DRUGS, melatonin, antidepressants, herbal medicines, neuroleptics and antihistaminics). Each of these approaches has advantages and disadvantages that must be considered when choosing treatment. The aim of this review is to allow general practitioners to better understand the mechanisms of insomnia and to have recommendations for the diagnosis and treatment of insomnia.

En Belgique, les plaintes de mauvais sommeil sont multiples et fréquentes dans la population générale. Parmi ces plaintes, l'une des plus importantes est l'insomnie. La survenue aiguë et le passage à la chronicité de l'insomnie peuvent être expliqués par différents modèles reposant sur des critères génétiques, neurophysiologiques, neuroendocriniens, neuroimmunologiques et de neuroimageries. L'insomnie peut être associée à de nombreuses comorbidités somatiques et psychiatriques. Le diagnostic de l'insomnie est avant tout un diagnostic clinique reposant sur l'anamnèse médicale et l 'examen physique. Différents outils peuvent nous aider dans notre démarche, tels que les auto-questionnaires et les agendas de sommeil tandis que les examens complémentaires (polysomnographie et actimétrie) sont à réserver à la recherche de pathologies du sommeil associées et pour les situations peu claires. La prise en charge de l'insomnie peut être non médicamenteuse (exercice physique, luminothérapie, acupuncture, auto-traitement et thérapie cognitivocomportementale), mais aussi médicamenteuse (benzodiazépines, Z-DRUGS, mélatonine, antidépresseurs, médicaments à base de plantes, neuroleptiques et antihistaminiques). Chacune de ses approches présente des avantages et des inconvénients dont il faudra tenir compte lors du choix du traitement. Le but de cette revue est de permettre aux médecins généralistes de mieux comprendre les mécanismes de l'insomnie et de disposer de recommandations pour le diagnostic et le traitement de l'insomnie.

[Munchausen by proxy syndrome]. / Le syndrome de Munchausen par procuration.

The Munchausen syndrome by proxy (MSBP) was first described in 1977 by the English paediatrician Roy Meadow. The MSBP is an extremely complicated diagnosis because of the difficulty in finding the incriminating evidence of its existence and because of the ethical issue it raises for caregivers. Its implications from a medical, psychological and legal point of view raise difficult questions for any professional confronted to it. In this article we will first present the case of a 16-year-old teenager who had been bedridden in hospital for a year, before an atypical form of MSBP was finally diagnosed, after a stay in a child and adolescent psychiatry unit. We will then discuss this case in light of a literature review on the MSBP.

Mood disorders in eating disorder patients: Prevalence and chronology of ONSET.

OBJECTIVES: In a clinical population, we estimated the frequency of mood disorders among 271 patients suffering from Anorexia Nervosa (AN) and Bulimia Nervosa (BN) in comparison to a control group matched for age and gender. METHOD: The frequency of mood disorders was measured using the Mini International Neuropsychiatric Interview (MINI), DSM-IV version. RESULTS: Mood disorders were more frequent among eating disorder (ED) patients than among controls, with a global prevalence of the order of 80% for each ED group. The majority of the mood disorders comorbid with ED were depressive disorders (MDD and dysthymia). The relative chronology of onset of these disorders was equivocal, because mood disorders in some cases preceded and in others followed the onset of the eating disorders. LIMITATIONS: Our sample was characterized by patients with severe ED and high comorbidities, and thus do not represent the entire population of AN or BN. This also may have resulted in an overestimation of prevalence. CONCLUSION: Mood disorders appear significantly more frequently in patients seeking care for ED than in controls. These results have implications for the assessment and treatment of ED patients, and for the aetio-pathogenesis of these disorders.

Alcohol, cigarette, and illegal substance consumption among medical students: a cross-sectional survey.

This study investigated addictive substance use by French medical students. A cross-sectional survey was distributed to 255 participants randomly selected from 1,021 second- to sixth-year medical students. Questionnaires were self-administered and included questions on sociodemographic characteristics, mental health, and alcohol (The Alcohol Use Disorders Identification Test [AUDIT test]), tobacco (Fagerstrom test), and illegal substance consumption (Cannabis Abuse Screening Test [CAST test]). The AUDIT scores indicated that 11% of the study participants were at risk for addiction and 21% were high-risk users. Tobacco dependence was strong or very strong for 12% of the participants. The CAST score showed that 5% of cannabis users needed health care services. Cannabis users were also more likely than non-users to fail their medical school examinations (89% vs. 39%, p<.01). One quarter of medical student participants (n=41) had used other illegal drugs, and 10% of study participants had considered committing suicide during the previous 12 months. Psychoactive substance consumption by French medical students requires preventive measures, screening, and health care services.

[Influence of resistance to voices on depression]. / Influence de la résistance aux hallucinations auditives sur la dépression : étude au moyen du questionnaire révisé des croyances à propos des voix.

OBJECTIVE: Beliefs about voices and reactions to voices have been proposed as important variables influencing the course of depression in schizophrenia. Consequences of auditory hallucinations are different according to identity, goals, omnipotence, omniscience, and meanings attributed to voices by the client. Ten to 15 % of the general population experience auditory hallucinations during lifetime without any distress or need for medical care. In addition, neither frequency of voices, nor their topography, influence the emotional consequences of auditory hallucinations experiences, but the relationships to voices. The Revised Belief about Voices Questionnaire analyzes voices along 5 dimensions: malevolence, benevolence, omnipotence, resistance, and engagement. Malevolent voices are related to depression, whereas benevolent voices engender more positive emotions. Subjects usually engage with benevolent voices, and resist to malevolent voices. But resistance strategies are barely efficient and often backfire. Patients resisting to their voices consider them more malevolent and present with more depressive symptoms. This research aims at studying the influence of resistance to auditory hallucinations on depression in a group of patients suffering from schizophrenia and experiencing auditory hallucinations, using the Revised Beliefs About Voices Questionnaire (BAVQ-R). It also provides a study of the psychometrics properties of the French language version of the BAVQ-R. METHOD: Thirty-eight patients suffering from paranoid schizophrenia, undifferentiated schizophrenia or schizoaffective disorder, have been tested with the French versions of the Revised Beliefs About Voices Questionnaire (BAVQ-R), the Positive and Negative Syndrome Scale (PANSS), and the Calgary Depression Scale for Schizophrenia (CDSS). Each patient presented with auditory hallucinations during the week before evaluation, with a minimum score of 3 on P3 item of PANSS. Mean age was 39.39 years (SD 11.33); mean duration of symptoms was 13.92 years (SD 10.81), and patients' mean history of hospitalizations was 7.66 (SD 9.24). Each patient was receiving an antipsychotic medication at the time of evaluation, with a mean chlorpromazine equivalent dose of 806.69 mg/d (ET 539.51); 18.5 % of patients were receiving serotonin reuptake inhibitor, and 31.57 % once committed a suicide attempt. RESULTS: The French version of the BAVQ-R presents with a satisfying internal consistency (Cronbach's alpha=0.74). Similar to the original version, Malevolence and Resistance, and Benevolence and Engagement dimensions are strongly correlated (r=0.73, and r=0.90, P<0.05, respectively). The BAVQ-R scores correlate with the CDSS (r=0.40, P<0.05) and the PANSS General Psychopathology subscale scores (r=0.44, P<0.05), but not with the Positive and Negative subscales. (r=0.17, and r=0.13, P>0.05, respectively). Correlations and forced entry multiple regressions analyses show that Resistance and Malevolence are both strongly correlated to depression, but Resistance is the only dimension that influences depression. Moreover, clients presenting with depressive symptoms resist more to their auditory hallucinations. Finally, emotional resistance, in comparison to behavioral resistance, is responsible for depression in people suffering from auditory hallucinations. CONCLUSION: Emotional resistance to auditory hallucinations constitutes the most important variable influencing depression in schizophrenia comparing to what the voices say or are supposed to know, their malevolence or benevolence. Demonstration of the influence of resistance to voices on depression would help the development of new therapeutic practices.

Optical fiber Sagnac interferometer for sensing scalar directional refraction: application to magnetochiral birefringence.

We present a setup dedicated to the measurement of the small scalar directional anisotropies associated to the magnetochiral interaction. The apparatus, based on a polarization-independent fiber Sagnac interferometer, is optimized to be insensitive to circular anisotropies and to residual absorption. It can thus characterize samples of biological interests, for which the two enantiomers are not available and/or which present poor transmission. The signal-to-noise ratio is shown to be limited only by the source intensity noise, leading to a detection limit of Δϕ = 500 nrad Hz(-1/2). It yields a limit on the magnetochiral index nMC < 4 × 10(-13) T(-1) at 1.55 µm for the organic molecules tested.

[The psychiatrist and the Tako Tsubo]. / Le psychiatre de liaison et le Tako Tsubo

INTRODUCTION: Stress cardiopathy, also called "Tako Tsubo" is a cardiac pathology linked to an acute coronary syndrome with electrocardiographic signs and an increase in the level of cardiac enzymes, without any abnormality on coronarography. This syndrome is secondary to great physical or mental stress. Mortality and the risk of recurrence are low. However, there is no consensus for treatment or prevention. CASE REPORT: We report the case of 75-year-old woman presenting recurrent cardiogenic shocks. A symptomatic sinusal dysfunction motivated the introduction of a pacemaker in March 2008. One month later, she was hospitalized for a new cardiogenic shock with left ventricular dysfunction, a 40% ejection fraction, and a third degree mitral insufficiency. Cardiac enzymes were initially elevated. Electrocardiogram showed an ST elevation. The transthoracic echocardiogram revealed a left anterolateral ventriculogram dysfunction, and cardiac catheterization showed healthy coronary arteries. The cardiologist wondered about the existence of an anxiodepressive syndrome. No personal psychiatric background was known. The patient was widowed 3 years earlier. She described herself as a naturally anxious person. She hadn't experienced any recent stressing event. She was not depressed and wasn't taking any psychotropic drug. Her family was caring for her. The next day, the patient had another cardiogenic shock and died a few hours later. Maybe the introduction of the pacemaker occasioned one more stress for this patient… DISCUSSION: We know that people with a stressing job have probably more chance to suffer a myocardial infarction (the risks are 1.5 or two times greater for them). The prevalence of cardiomyopathy syndrome is 4.9% for women. These women have gone through the menopause, with a history of hypertension and anxiodepressive symptoms. However, we do not find any similar description (behavioural scheme type A) as is shown by the psychosomatic school in cases of patients who have gone through myocardial infarction. We also can question ourselves about the fact that some people can be predisposed to suffer from "Tako Tsubo" cardiomyopathy and about the existence of personality disorders. What then is the role of the psychiatrist with these patients?

Non-linear optoelectronic phase-locked loop for stabilization of opto-millimeter waves: towards a narrow linewidth tunable THz source.

We propose an optoelectronic phase-locked loop concept which enables to stabilize optical beat notes at high frequencies in the mm-wave domain. It relies on the use of a nonlinear-response Mach-Zehnder modulator. This concept is demonstrated at 100 GHz using a two-axis dual-frequency laser turned into a voltage controlled oscillator by means of an intracavity electrooptic crystal. A relative frequency stability better than 10⁻¹¹ is reported. This approach of optoelectronic down conversion opens the way to the realization of continuously tunable ultra-narrow linewidth THz radiation.

[Assessment of targeted clinical audit in suicide attempt]. / Prise en charge des suicidants. Quel apport d'une démarche d'audit clinique ciblé?

BACKGROUND: Suicide attempt is a serious condition that is frequent in France. Picardie ranks fifth in France for suicide (418 deaths in 2005 for 1,890,000 inhabitants). Suicide attempt is one of the priorities of the regional public health program. The National Agency for Accreditation and Evaluation in Health (Anaes) has designed targeted clinical audits (TCA) on various conditions to promote this method as the basic tool for quality improvement. AIM: We investigated the contribution of TCA for improving the quality of care of suicide attempt within a regional framework in Picardie. METHODS: TCA were conducted in 12 state hospitals (eight Surgical Medicine and Obstetrics, three specialized in psychiatry, one local) between 2004 and 2006. The standards from the Anaes had 16 criteria in three fields: care on admission (n=10); assessment of family and social environment (n=2); management for after hospital care (n=4). A project manager and a MD certified in health care quality supported the medical (MD certified in acute care and in psychiatry) and nursing staff of the emergency wards. All the wards analyzed 30 patients' files for the first cycle, set up and implemented improvement actions and then performed the second cycle of data collection. RESULTS: All wards fully satisfied the protocol with 30 patients' files per cycle and two cycles. In all wards the teams consisted of physicians (both certified for emergency or psychiatry) and others care providers (nurses, psychologists, social workers, secretary). For the first cycle, three criteria (patient assessment, somatic examination and coordination) met the 100% target for more than half of the wards while three criteria (sociofamily and environmental evaluation, management for after hospital care, monitoring of follow-up) did not conform by more than 50% in more than half of the wards. All wards implemented changes after the first cycle with a total of 29 interventions, each one specifically devoted to improving a particular criterion. Intervention included better coordination and communication, protocol design and reminders, and information tools. The second cycle showed modest and mixed changes. After the interventions only one criteria reached the 100% target in one ward; the degree of conformity decreased in nine cases (with a mean of -23%) and increased in 16 cases (+19%). Globally, three criteria improved by less than 10% while three slightly decreased. DISCUSSION: G. Shaw introduced clinical audits in 1989 to boost a poorly performing system within the "clinical governance" framework, a condition quite different from the French healthcare system in 2005. Therefore, the validation of clinical audit in a different context appeared necessary. Anaes has not yet published the evaluation of this method in a peer reviewed journal. Observed changes are modest and mixed. Moreover, the true impact on care delivery appears limited and one cannot rule out that the observed improvements are in fact related to an improvement in traceability or due to Hawthorne's effect. Quality improvement methods must be evaluated and validated by scientific methods such as for new treatments with clinical research. CONCLUSION: The feasibility of the method was excellent, due to the methodological and technical support, however the method did not significantly improve the quality of care.

Beat note stabilization of a 10-60 GHz dual-polarization microlaser through optical down conversion.

Down-conversion of a high-frequency beat note to an intermediate frequency is realized by a Mach-Zehnder intensity modulator. Optically-carried microwave signals in the 10-60 GHz range are synthesized by using a two-frequency solid-state microchip laser as a voltage-controlled oscillator inside a digital phase-locked loop. We report an in-loop relative frequency stability better than 2.5×10⁻¹¹. The principle is applicable to beat notes in the millimeter-wave range.

[The Alexithymia Questionnaire for Children (AQC): French translation and validation study in a convenience sample of 80 children]. / Le questionnaire d'alexithymie pour enfants (QAE): traduction française et étude de validation dans une population de 80 enfants « tout venant ¼.

INTRODUCTION: Alexithymia refers to a specific disturbance in psychic functioning characterized by a limited ability to identify and communicate one's feelings. Development of specific rating scales and notably the well-validated 20-item Toronto alexithymia Scale (TAS-20) have allowed the study of alexithymia in numerous samples of clinical or non-clinical subjects. Recently, Rieffe et al. [Pers and Individ Differ 40 (2006) 123-133] have developed an alexithymia questionnaire for children (AQC) basing on the TAS-20. The AQC comprised 20 items divided into three subscales: difficulty-identifying feelings (DIF), difficulty describing feelings (DDF) and externally-oriented thinking (EOT). Using a sample of 740 children and the Dutch version of the AQC the three-factor structure of alexithymia was found, using confirmatory factorial analysis, but the EOT factor showed low factor loadings and reliability. OBJECTIVE: The aim of the study was to present the French version of the AQC and to assess the psychometric properties of this version. METHODS: Eighty children recruited from a convenience sample were included in the study. There were 43 boys and 37 girls with a mean age of 11.81 (SD = 1.99, range: 9-16). The validity and the reliability of the AQC were studied using a confirmatory factorial analysis (CFA), the determination of the Cronbach alpha coefficient, and the calculation of the correlations between each item and the total score. RESULTS: Adequation parameters of the CFA showed that the 3-factor solution of the AQC was adequate (χ 2/df = 1.27, RMSEA = .039) although the EOT factor had low factor loadings. The Cronbach alpha coefficient was 0.64 and 15 items had significant correlations with the total score. CONCLUSION: The three-factor model of the AQC was reported for the French version of scale but the EOT factor had low validity. This result confirms the recent study using the Dutch version of the AQC. Moreover, several studies using foreign versions of the TAS-20 reported low reliability of the EOT factor. Thus, other studies are necessary to explore the reliability of the EOT factor of the French version of the AQC, and it's recommended to use only the total score of the AQC instead of the sub-scores.

[The Dependent Personality Questionnaire (DPQ): French translation and validation study in a population of 138 hospitalized psychiatric patients]. / Le questionnaire de personnalité dépendante (QPD) : traduction française et étude de validation dans une population de 138 patients psychiatriques hospitalisés.

INTRODUCTION: Dependent personality disorder is a new diagnosis introduced in the third version of the DSM (DSM-III). Contrary to other disorders of personality, as the borderline or the schizotypal personalities, there are no specific interviews or questionnaires focusing on dependent personality. Thus the study of dependent personality disorder requires the use of global interviews or questionnaire as the SCID -II or SIDP-IV. Recently, Tyrer and colleagues (2004) have proposed an 8-item questionnaire, the DPQ (Dependent Personality Questionnaire). Each item of the DPQ is rated from 0 to 3 with a total score ranging from 0 to 24. Using a sample of 30 psychiatric patients presenting various diagnoses and a dependent personality disorder for the half of the sample, the authors have determined the cutoff score allowing the diagnosis of DSM-IV Dependent Personality Disorder. A cutoff of 10 was associated with the best sensitivity (87.5%), specificity (87.5%) and positive predictive value (87.5%). Moreover, the value of the Youden coefficient (Sensitivity+Specificity - 100) was 75. OBJECTIVE: The aim of the study was to present the French version of the DPQ and to determine its psychometric properties as well as the cutoff score. METHODS: One hundred and thirty-eight psychiatric inpatients (97 females, 41 males) with a mean age of 42.26 years were included in the study. The patients were hospitalized in an inpatients unit receiving mood disorders, neurotic disorders or suicide attempters. The subjects filled out the French versions of the DPQ and the Personality Disorders Questionnaire of Hyler, PDQ-4+. Using the PDQ-4+ two groups were built: 25 subjects filled out the diagnoses of dependent personality disorder and 20 subjects did not meet any criteria of dependent personality disorder. Then, for different values of the DPQ, sensitivity, specificity and positive predictive value and Youden indicia (Sensitivity+Specificity - 100) were calculated. RESULTS: The best values of Youden indicia (74) were obtained for the cutoff of 13 on the DPQ. The corresponding sensitivity, specificity and positive predictive value were respectively 84, 90 and 91.3%. CONCLUSION: The French version of the DPQ is now available and permits detection of dependent personality in French populations. LIMITATIONS: Our results must be replicated using structured interviews of personality disorder instead of questionnaires (PDQ-4+) and other samples with different prevalence of dependent personality disorders must be used to test the potential cutoff scores of the DPQ.