Psychiatric comorbidities associated with a positive screening using the Montreal Cognitive Assessment (MoCA) test in subjects with severe alcohol use disorder.

BACKGROUND: Patients with severe alcohol use disorder (SAUD) frequently show cognitive deficits that can be efficiently identified using screening tools such as the Montreal Cognitive Assessment (MoCA) test. These cognitive deficits, which reduce the efficacy of therapeutic interventions and may contribute to dropout and relapse, could be, however, partly due to a treatable other cause. Accordingly, this exploratory study examined whether psychiatric comorbid disorders can induce a positive MoCA screening among recently detoxified SAUD subjects. METHODS: One hundred recently detoxified patients with SAUD were divided into two groups according to whether they presented cognitive deficits using the MoCA. Groups were compared for demographic data, SAUD severity, impulsivity, and psychiatric comorbidities. The significant parameters were then introduced in a logistic regression model to establish their relative contributions in a positive MoCA status in SAUD subjects. RESULTS: Among the significant parameters revealed by the bivariable analyses, agoraphobia and current depressive episode were found to be significant predictors of the MoCA status in the multivariable comparisons. CONCLUSIONS: A positive MoCA screening for cognitive impairments among post-detoxification SAUD patients could also be related to comorbid agoraphobia and depressive episode rather than to SAUD itself. A comprehensive psychiatric assessment must be performed in SAUD patients so that other potential causes of cognitive deficits, in particular with regard to mood and anxiety disorders, can be identified and treated.

[Temporary recommendation for use on off-label baclofen: viewpoint of Prescribers of the CAMTEA system]. / La « recommandation temporaire d'utilisation ¼ sur le baclofène : point de vue des prescripteurs du dispositif CAMTEA.

The use of high dose baclofen for alcohol-dependence emerged in France from 2008 based on empirical findings, and is still off-label. However, due to the rapid increase in this prescribing practice, the French health authorities have decided to frame it using an extraordinary regulatory measure named "temporary recommendation for use" (TRU). Baclofen prescribers from CAMTEA, a regional team-based off-label system for supervising baclofen prescribing, which was developed much prior to the TRU, discuss herein the pros and cons of this measure and the applicability of its different aspects in the daily clinical practice.