Occurrence and severity of cocaine-induced hallucinations: Two distinct phenotypes with shared clinical factors but specific genetic risk factors.

Cocaine-induced transient hallucinations (CIH) are a frequent complication following cocaine intake that is associated with addiction severity. METHODS: Two hundred and forty-two non-psychotic and Caucasian lifetime cocaine users were included in a French multicentric study. Clinical variables and dopamine pathway genotype data were extracted and tested with CIH scores using a zero-inflated binomial model, which allows for the exploration of factors associated with occurrence and severity separately. RESULTS: Cocaine dependence (poccurrence= 6.18 × 10-5, pseverity= 9.25 × 10-8), number of cocaine dependence DSM IV-Tr criteria (poccurrence= 1.22 × 10-7, pseverity= 5.09 × 10-6), and frequency of intake during the worst period of misuse (poccurrence= 8.51 × 10-04, pseverity= 0.04) were associated with greater occurrence and higher severity of CIH. The genetic associations did not yield significant results after correction for multiple tests. However, some nominal associations of SNPs mapped to the VMAT2, DBH, DRD1, and DRD2 genes were significant. In the multivariate model, the significant variables were the number of cocaine dependence criteria, lifetime alcohol dependence, and the nominally associated SNPs. CONCLUSION: Our study shows that CIH occurrence and severity are two distinct phenotypes, with shared clinical risk factors; however, they likely do not share the same genetic background.

Childhood trauma and the severity of past suicide attempts in outpatients with cocaine use disorders.

Introduction: Suicide attempts have been associated with both cocaine use disorder (CocUD) and childhood trauma. We investigated how childhood trauma is an independent risk factor for serious and recurrent suicide attempts in CocUD. Method: 298 outpatients (23% women) with CocUD underwent standardized assessments of substance dependence (Diagnostic and Statistical Manual-mental disorders, fourth edition, text revised), impulsiveness, resilience, and childhood trauma, using validated tools. Suicide attempts history was categorized as single vs. recurrent or non-serious vs. serious depending on the lifetime number of suicide attempts and the potential or actual lethality of the worst attempt reported, respectively. Bivariate and multinomial regression analyses were used to characterize which childhood trauma patterns were associated with the suicide attempts groups. Results: 58% of CocUD patients reported childhood trauma. Recurrent and serious suicide attempts clustered together and were thus combined into "severe SA." Severe suicide attempt risk increased proportionally to the number of childhood traumas (test for trend, p = 9 × 10-7). Non-severe suicide attempt risk increased with impulsiveness and decreased with resilience. In multinomial regression models, a higher number of traumas and emotional abuse were independently and only associated with severe vs. non-severe suicide attempts (effect size = 0.82, AUC = 0.7). The study was limited by its cross-sectional design. Conclusion: These preferential associations between childhood trauma and severe suicide attempts warrant specific monitoring of suicide attempts risk in CocUD, regardless of the severity of addiction profiles.

Gambling and money games disorder / Addiction aux jeux de hasard et d'argent

Gambling and money games disorder. Pathological gambling was recently re-categorized, in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), into the group of substance-related and addictive disorders and renamed « gambling disorder ¼. This change confirms the conceptualization of gambling disorder as an addiction. The prevalence of this trouble has been shown to be 1.2-7.1% in the general population. The gambling disorder presents many psychiatric comorbidities and substance-related disorders. After a win phase, severe damages can occur, on the financial and psychiatric levels. Treatment is essentially based on psychotherapy and social support. There are no approved treatments for gambling disorder; pharmacotherapy may be used in combination with other therapies.

Addiction aux jeux de hasard et d'argent. L'addiction au jeu a récemment été reconnue par la cinquième édition de la classification américaine du Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Initialement considéré comme un trouble du contrôle des impulsions, le jeu pathologique a progressivement été inclus dans le groupe des addictions comportementales. La prévalence du trouble est estimée entre 1,2 et 7,1 % dans la population générale. Des comorbidités psychiatriques et addictologiques sont très fréquemment associées au trouble. Après une phase de gain, l'addiction au jeu s'installe et des dommages sévères peuvent apparaître, notamment sur les plans financier et psychiatrique. La prise en charge repose essentiellement sur la psychothérapie et l'accompagnement social. Aucun traitement médicamenteux n'a encore reçu l'autorisation de mise sur le marché dans cette indication mais il peut constituer un traitement d'appoint.

[Sleep disorders in Internet addiction]. / Les troubles du sommeil dans l'addiction à Internet.

BACKGROUND: The relationship between sleep disorders and Internet addiction has been little work. Given the importance of these disorders, we felt it appropriate to make a synthesis of available data and to establish causality or accountability between Internet addiction and the onset of sleep disorders. METHODS: A literature review was then performed. We selected scientific articles in English and French, published between 1987 and 2016 by consulting the databases Medline, Embase, PsycINFO and Google Scholar. The words used alone or in combination are as follows: addiction, dependence, Internet, behavioral addiction, sleep. RESULTS: A computer screen light inhibits melatonin secretion and acts as a real external desynchronizer circadian rhythm resulting in a withdrawal syndrome or syndrome sleep phase delay when the stress of social awakening is suppressed. CONCLUSION: We assume here that the specific treatment of addictive disorders have an influence on sleep disorders.