[The motivational week: A new approach in smoking cessation]. / La semaine motivationnelle : une nouvelle approche dans le sevrage tabagique.

INTRODUCTION: Smoking cessation is complex and challenging. The motivational week is a multidisciplinary approach that has been established in order to increase the chances of quitting smoking. The purpose of this study was to determine the rates of abstinence achieved and the predictive factors for quitting. METHODS: Clinical data, smoking status, levels of dependence and motivation as well as rates of continuous abstinence in the short and long-term of all patients who participated in the motivational week were analysed. RESULTS: Two hundred and thirteen patients were included. The mean age was 49.8 years (10.6). The rates of continuous abstinence were 40.4% at 6 months, 29.1% at 12 months and 21.6% at 2 years. Using logistic regression, having depression or a history of depression was associated with reduced likelihood of smoking cessation: OR: 0.32 [95%CI: 0.16-0.76; P=0.003] at 6 months, OR: 0.35 [95%CI: 0.16-0.77; P=0.009] at 12 months and OR: 0.27 [95%CI: 0.11-0.65; P=0.004] at 2 years. CONCLUSIONS: The motivational week seems to be an approach which is effective long-term and could be used in smoking cessation. This study confirms that depression is an unfavourable factor for quitting.

[ELECTRONIC LOGBOOK: LEARNING TOOL AND TEACHING AID FOR THE EVALUATION OF LEARNING ACTIVITIES]. / LogBook numérique: un carnet de bord réflexif comme outil d'apprentissage en contexte de stage.

A LogBook is a learning tool and teaching aid I where clinical settings lived during training courses are provided. A LogBook is basically a journal which evidences learning and skills. LogBook provides a means for monitoring student learning, both for the student and for the instructor. It provides a feedback loop for the evaluation of learning activities. This LogBook has been developed for the student's training in psychiatry but it may be extended to all medical disciplines. The authors have developed an electronic logbook to support learning and assessment. In the context of Europe, it has become necessary to set up a LogBook of uniform learning outcomes to assist medical students.

[50 Hz electric and magnetic fields and health: which message to the public?]. / Champs électriques et magnétiques 50 Hz et santé: quel message au grand public?

Scientific data of effects of 50 Hz electric and magnetic fields on health are inconclusive. This uncertainty raises numerous questions. In this paper, significant key concepts are described to better understand the potential effects of electric and magnetic fields on health. Everyday life exposure values are included, as well as courses of action to be taken in front of a patient asking questions on health effects of 50 Hz electric and magnetic fields.

[Depression as a common complication of systemic lupus erythematosus]. / La vignette diagnostique de l'etudiant. La dépression est une complication fréquente du lupus érythémateux disséminé: considérations épidémiologiques, pathogéniques et thérapeutiques.

Systemic lupus erythematosus (SLE) is an inflammatory disease with multiple and disabling consequences, including the psychological status. The prevalence of major depressive episodes among patients suffering from SLE is significantly higher than in healthy people, or people suffering from other inflammatory diseases. While it is obvious that its chronic disease status with a frequently pejorative ending, as well as the number of treatments it requires, are contributing factors, it is likely that due to its pathogenic mechanisms, SLE causes direct injury to the brain, leading to a depressive symptomatology. Numerous hypotheses are under consideration. We shall review them all, recall a few epidemiologic features, add histology and medical imaging contributions and discuss the importance of setting up a fitting therapy for such patients.

Additional intranasal oxytocin to escitalopram improves depressive symptoms in resistant depression: an open trial.

The aim of this open trial was to assess the antidepressant/anxiolytic effects of oxytocin used as an adjunct to antidepressant in treatment-resistant depression. Fourteen patients, who have not responded to 40mg of escitalopram, received intranasal synthetic oxytocin during 4 weeks, in association with antidepressant. This is the first open trial study suggesting OT in association with escitalopram significantly reduced scores on Hamilton Depression Rating Scale.

Folinic acid treatment for schizophrenia associated with folate receptor autoantibodies.

BACKGROUND: Auto-antibodies against folate receptor alpha (FRα) at the choroid plexus that block N(5)-methyltetrahydrofolate (MTHF) transfer to the brain were identified in catatonic schizophrenia. Acoustic hallucinations disappeared following folinic acid treatment. Folate transport to the CNS prevents homocysteine accumulation and delivers one-carbon units for methyl-transfer reactions and synthesis of purines. The guanosine derivative tetrahydrobiopterin acts as common co-factor for the enzymes producing dopamine, serotonin and nitric oxide. METHODS: Our study selected patients with schizophrenia unresponsive to conventional treatment. Serum from these patients with normal plasma homocysteine, folate and vitamin B12 was tested for FR autoantibodies of the blocking type on serial samples each week. Spinal fluid was analyzed for MTHF and the metabolites of pterins, dopamine and serotonin. The clinical response to folinic acid treatment was evaluated. RESULTS: Fifteen of 18 patients (83.3%) had positive serum FR auto-antibodies compared to only 1 in 30 controls (3.3%) (χ(2)=21.6; p<0.0001). FRα antibody titers in patients fluctuated over time varying between negative and high titers, modulating folate flux to the CNS, which explained low CSF folate values in 6 and normal values in 7 patients. The mean±SD for CSF MTHF was diminished compared to previously established controls (t-test: 3.90; p=0.0002). A positive linear correlation existed between CSF MTHF and biopterin levels. CSF dopamine and serotonin metabolites were low or in the lower normal range. Administration of folinic acid (0.3-1mg/kg/day) to 7 participating patients during at least six months resulted in clinical improvement. CONCLUSION: Assessment of FR auto-antibodies in serum is recommended for schizophrenic patients. Clinical negative or positive symptoms are speculated to be influenced by the level and evolution of FRα antibody titers which determine folate flux to the brain with up- or down-regulation of brain folate intermediates linked to metabolic processes affecting homocysteine levels, synthesis of tetrahydrobiopterin and neurotransmitters. Folinic acid intervention appears to stabilize the disease process.

[Clinical study of the month: depressive pseudo-dementia]. / Le cas clinique du mois. Pseudo-démence dépressive.

We report the case of a man aged 62 suffering from a known type I bipolar disorder and referred by his attending psychiatrist because of a state of spatiotemporal disorientation, confusion and prostration evoking significant neurologic impairment. The interest of this case report is in the use of the 18-FDG PET-Scanner, which is increasingly widespread in clinical psychiatry, to support the differential diagnosis between a psycho-organic pathology like dementia or a functional psychiatric pathology like depressive pseudo-dementia (also named melancholic dementia), in which some patterns of dysfunction can now be identified by functional imaging.

[Depression and type 2 diabetes: etiopathogenic analysis of a frequent comorbidity]. / Dépression et diabète de type 2. Analyse étiopathogénique d'une comorbidité fréquente.

Recent advances in the neurobiology of depression have underlined the importance of markers of inflammation, neurotrophins, and hypothalamo-pituitary adrenal (HPA) axis dysfunction in the development of this pathology. These disorders could have some impact on other systems such as the glucose metabolism regulation with an increased risk of insulin resistance and type 2 diabetes. Type 2 diabetes is also frequently associated with a pro-inflammatory state that could favour the development of a depressive episode. Inflammatory phenomena and HPA axis dysfunction could be biological links between depression and type 2 diabetes and account not only for the frequent association between those two disorders, but also for the treatment-resistance to classical antidepressants.

[Psychiatric complications and addictions]. / Complications psychiatriques et addictions.

Psychiatric complications are clearly associated with substance abuse. Psychopathological symptoms appear during intoxication or in patients suffering from substance-induced psychiatric disorders. However, the assessment of the psychiatric symptomatology is particularly challenging in patients who express clear difficulties to accept that the disorder is favoured by substance abuse. Psychotic reactions, major depression and anxiety disorders are the main psychiatric issues observed in addict patients.

[Rapid opiate detoxification under anesthesia (RODA)]. / Sevrage rapide aux opiacés sous anesthésie (RODA).

Rapid Opiate Detoxification under Anesthesia (RODA) involves the use of opiate antagonists combined with anesthesia and pharmacotherapy to reduce withdrawal symptoms. The aim of our study was to measure the plasma concentrations of heroin metabolites and methadone during anesthesia and patient stay at the hospital in order to assess the amount of active substances at each protocol step. Plasma concentrations of antagonists were also quantified and compared to the recommended target values. Blood samples were drawn in 10 patients undergoing RODA at different times of the procedure (during anesthesia, in post-anesthesia care unit and in psychiatry unit). The plasma concentrations of heroin metabolites, methadone and antagonists were measured using a previously described method. Heroin active metabolites were no longer detected in the patient blood when helshe left the hospital; by contrast, methadone was still present at significant concentrations 3 days after the beginning of the detoxification procedure. Naltrexone analysis allowed us to adjust doses to insure opiate receptor blockade during acute withdrawal, which is a critical period.

[Heroin]. / L'héroïne.

Heroin (or diacetylmorphine), a depressant nervous central system, is a semi-synthetic opiate. Its main adverse effect, respiratory depression, can lead to death, especially after an intravenous injection. By loss of tolerance, an overdose can be lethal following heroin use after a period of abstinence (voluntary or not). Mortality rate among heroin users is between 1 and 3%. Addiction, following a regular and continuous use, occurs in less than a quarter of persons who ever tried heroine. Heroin addicts often present with different problems (for instance, a criminal behaviour), without any obvious link with addiction. For a fraction of the addicts, addiction becomes a chronic relapsing disease, requiring a long term maintenance substitution therapy. However, relapses and sometimes continuous heroin use are frequent, For treatment resistant and severe heroin addicts, heroin-assisted treatment can be a solution. Despite the numerous available therapies, heroin is considered to be the drug with the most negative effects on the user.

[Affective dependency]. / La dépendance affective.

Affective dependency is characterized by emotional distress (insecure attachment) and dependency to another person with a low self-esteem and reassurance need. The paper proposes a reflection on the definition of emotional dependency and the confusion caused by various denominations. Overprotective and authoritarian parenting, cultural and socio-environmental factors may contribute to the development of dependent personality. Psychological epigenetic factors, such as early socio-emotional trauma could > on neuronal circuits in prefronto-limbic regions that are essential for emotional behaviour.We also focus on the interrelations between dependent personality, domestic violence and addictions. The objective for the clinician is to propose a restoration of self-esteem and therapeutic strategies focused on autonomy.

[The acute management of agitation]. / Comment je traite ...la prise en charge de l'agitation en urgence.

Agitation in psychiatry is defined as "a request to which an answer cannot be deferred". If some types of controllable agitation can be solved by human means or psychotropic drugs, others may require the intervention of intensivists who will contribute to the onset of crisis resolution. In addition, an organic aetiology must be carefully excluded a before considering a psychiatric origin of agitation, especially in patients with no psychiatric history and in the elderly. Indeed, acute agitation can hide serious somatic traps and be life threatening.

Plasma level monitoring of the major metabolites of diacetylmorphine (heroin) by the "chasing the dragon" route in severe heroin addicts.

The objective of the present study was to verify if severe physical health problems frequently encountered in heroin addicts and the concomitant use of alcohol and legal or illegal drugs other than heroin influenced the pharmacokinetics of the major metabolites of heroin. We conducted a 90 minutes follow-up of the plasma concentrations of the pharmaceutical heroin, named diacetylmorphine (DAM), in patients recruited in a DAM assisted treatment centre. TADAM (Traitement Assisté par DiAcétylMorphine) aimed to compare the efficacy of heroin-assisted treatment (HAT) compared with methadone maintenance treatment (MMT) for heroin users considered as treatment resistant patients and who have severe physical and mental health problems. Eleven patients were recruited. Blood samples were collected at baseline and 15, 45 and 90 minutes after DAM administration. All patients received DAM by the "chasing the dragon" route. Plasma samples were analyzed by a previously described ultra-high pressure liquid chromatography coupled to tandem mass spectrometry (UHPLC/MS-MS) method. A principal component analysis (PCA) was performed and 8 metabolite concentrations ratios were calculated to evaluate the influence of various factors (DAM dose, patient pathologies, concomitant use of medications, methadone, street heroin, alcohol and cocaine) on heroin metabolite pharmacokinetics. It seemed to be not affected by the DAM dose, patient pathologies and the concomitant use of medications, methadone, street heroin and alcohol. Cocaine use was the only parameter which showed differences in heroin pharmacokinetics.

[Sexual dysfunction induced by antidepressants and antipsychotics].

The interest in sexual dysfunction induced by psychotropic drugs has increased considerably in recent years because of the new-generation antidepressants (AD) and antipsychotics (AP) being put into medical practice. These drugs are widely used to treat not only depression and schizophrenia, but also anxiety and affective disorders. Other, additional indications for the use of antidepressants are appetite disorders, premenstrual syndrome, chronic pain, etc. Neuroleptics are administered to treat resistant depressions, aggressiveness, impulsivity, and alcoholism. Impaired sexual functioning due to AD and AP lowers quality of life in patients and increases the risk of their refusing treatment, the result of which is a phenomenon associated with the occurrence of recurrent mental illnesses. There are few scientific data on the nature and prevalence of sexual dysfunctions induced by these medications. This topic is universally underestimated as it is rarely touched upon by specialists during their consultations. The aim of the review is to show the side effects of AP and AD on the sexual sphere, to compare different classes of the drugs, and to propose possible management strategies to correct these undesirable effects.

[Bipolar disorder: a multifactorial disease]. / Le trouble bipolaire: une affection bien complexe.

Bipolar disorder is a multifactorial disease with a strong genetic component. However, environmental factors also play a role in the onset of the disease and in manic and depressive recurrence. The onset of the disorder is the consequence of a complex interaction between genetic and environmental factors. This gene-environment interaction is well illustrated by the influence of childhood trauma on the clinical expression of the disease in terms of age of onset, comorbidity and suicide. The complexity and heterogeneity of bipolar disorder require the identification of homogenous sub-groups with the use of biomarkers that could help reduce the etiological heterogeneity and better target the therapeutical options.

[Post-traumatic stress disorder and psychological debriefing: a controversial topic]. / Etat de stress post-traumatique et débriefing psychologique: un sujet controversé.

The last decades have demonstrated the value of early interventions after a traumatic event. The purpose of these interventions is to prevent the development of psychological consequences such as post-traumatic stress disorder. Psychological debriefing is clearly the most popular intervention. However, in the literature, it is subject to a real controversy. The objective of the present paper is to define the interest of psychological debriefing, but also alternative therapeutical strategies for people exposed to traumatic events.

Staff concerns in heroin-assisted treatment centres.

Heroin-assisted treatment (HAT) is a solution for improving the condition of treatment-resistant heroin addicts. Since 1994, six randomized controlled trials have concluded that HAT is more efficacious than oral methadone for severe heroin addicts. We visited seven HAT treatment centres in four countries in order to observe diacetylmorphine (DAM) administration and to study the main concerns of the staff. Nurses were concerned by the risk taken if a previously intoxicated patient received his dose of DAM. Another concern was the smuggling of DAM doses. The HAT centres face a dilemma: treating patients while at the same time allowing their risky street habits in the centre.

[Clinical and therapeutical approach of depression in old age]. / Approche clinique et thérapeutique de la dépression chez la personne agée.

Despite recent clinical and scientific developments in the psychogeriatric field, depression in old age remains an underdiagnosed and undertreated disorder. However, depressive symptoms are frequent in older people and the impact on patients, their family and the society is very important. Depression is also frequently associated with somatic illnesses, with alcoholism, anxiety and a significant risk of suicide. In this context, a systematic screening of depression and an adequate treatment are a priority.