[The early maladaptive schemas: a study in adult patients with anxiety disorders]. / Les schémas précoces dysfonctionnels: étude chez des patients adultes souffrant d'un trouble anxieux.

The theory of early maladaptive schemas was initiated by Young, who postulated that each pathology is supported by one or several schemas. Adults with anxiety disorders more activate schemas that controls. This hyper activate schemas would go back the childhood. In this study, we measure some cognitive schema's activation, with the Schmidt and al. Questionnaire: this schema's questionnaire measures the dysfunctional schemas in actual way. Our purpose was to compare early maladaptive schema's activation of adults with anxiety disorders and adults healthy. The results indicate that each dysfunctional schema is more significatively activate by the adults with anxiety disorders that adults healthy. He doesn't exist schema typical of anxiety, but just a more important activation of all schemas of adults with -anxiety disorders. All subjects (with anxiety disorder and healthy) activate the schemas in the same order. It would appear that schema who imply an action of subject was more activate. So, in our study, we doesn't observe schema typical of anxiety, as opposed to postulate of Young and Klosko. In fact, in comparison with healthy subjects, all early maladaptive schemas of subjects with anxiety disorders were hypervalent. The order of schema's activation was the same in the two groups, but the activation in the anxious is always more important that in the healthy. All early maladaptive schemas would so hyperactivate in the anxious and a important activation of this schemas in the infancy would predispose to adult's anxious pathology. We consider this research as a preliminary work about early maladaptive schemas. In order to specify the research about schemas in the anxious, il will be interesting to observe this schemas according to different anxious disorders and to study prospectively the evolution of child's schemas.

Practice-based buprenorphine maintenance treatment (BMT): how do French healthcare providers manage the opiate-addicted patients?

UNLABELLED: France was the first country to promote the extensive use of buprenorphine for the treatment of drug-addicted subjects through the primary care system. To assess both professional commitment and patients' characteristics, all the physicians and pharmacists of a French area having prescribed/dispensed buprenorphine from 2/12/96 (the official release date) to 1/31/98 were identified from data files of the Health Insurance and then interviewed. During the first 61 weeks of buprenorphine maintenance treatment (BMT), 27.5% of physicians and 51.2% of pharmacists of that area were involved; 142 patient records were documented. Features of the clinical routines spontaneously implemented for practice-based BMT were: a high level of on-site supervised dispensation by the pharmacist (71% at treatment induction and 23% thereafter); the absence of objective measurement of illicit drug use; and a low buprenorphine dosage. These features are consistent with the lack of physicians' experience and training, and also the relatively good status of the population treated (no HIV-positives, heroin use duration averaging 4.2 +/- 3.1 years, and 81.7% with stable accommodations). Despite liberal regulations guiding BMT, a negligible proportion of cases had a "nomadic" attitude (multiple buprenorphine prescribers/deliverers). The treatment outcomes (no deaths, three drug overdoses, improvement in occupational status) are encouraging. CONCLUSION: Practice-based BMT appears to be a safe and acceptable response to moderate heroin addiction, but further training of the professionals involved and longitudinal investigations of individual outcomes are needed.

[Diagnosis and management of panic disorder in psychiatry (PANDA Study)]. / Etude sur le diagnostic et la prise en charge du trouble panique en psychiatrie (étude PANDA).

Panic disorder is a genuine public health problem given by their frequency and the various and repeated consultations that they involve. PD is underdiagnosed in primary care and in medical specialist. A public campaign might lead to improved diagnosis and better treatment of panic disorder, with a beneficial effect on medico-economic indicators. Intervention by the psychiatrist is of key importance, although it has not been evaluated to any great extend. The objective of the PANDA study was to look at the prevalence and diagnostic of panic disorder, the conditions of access to and use of care, as well as the method of treatment. Four hundred and twenty three psychiatrists participated in the study and 8,137 patients seen consecutively were included. The prevalence of actual panic disorder evaluated using the Mini International Neuropsychiatric Interview (MINI) systematic is 9%. In two third of cases coexisted agoraphobia and in one third a depression. Eighty six percent of patients with actual panic disorder were treated by the psychiatrists. The diagnosis and suitable treatment of panic disorder would appear to be a significant objective in term of public health, leading to a reduction in medical and social cost of this disorder.

[Treatment of adjustment disorder with anxiety: efficacy and tolerance of etifoxine in a double-blind controlled study]. / Traitement du trouble de l'adaptation avec anxiété: évaluation de l'efficacité et de la tolérance de l'étifoxine par un essai en double aveugle contre produit de référence.

Adjustment disorder with anxiety is defined as a clinically significant anxiety that occurs within 3 months after the onset of an identifiable psychological stressor. Recent studies indicate that this disorder is not uncommon and must be quickly identified and treated. However, few therapeutic trials have been done in relation with this disorder. According to the criteria set by DSM IV, 170 patients with a primary diagnosis of adjustment disorder with anxiety have been enrolled in a double blind multicenter controlled trial. Patients were treated for 4 weeks with etifoxine (150-200 mg/d), or buspirone (15-20 mg/d). Also both etifoxine and buspirone show clinical efficacy and safety, the two treatments are not equivalent. The global improvement score and the efficacy index are significantly improved in the etifoxine group. These results show the interest of using etifoxine in the treatment of adjustment disorder with anxiety and should be confirmed by further studies.

[Psychopathological disorders and coronary diseases]. / Troubles psychopathologiques et coronaropathies.

The role of psychological factors in the genesis of coronary diseases has been considered for a long time. Friedman took it upon himself to describe a personality profile (pattern A) constituting a risk factor for coronary heart disease of which, however, the practical interest seems limited. The association of psychopathological conditions and coronary heart disease has on the other hand not been extensively studied. Recent epidemiological data show that anxiety and depressive states represent a high comorbidity with coronary heart diseases. Panic attacks remain underestimated; they seem to participate in a complex physiopathological mechanism along with ischemic coronary heart diseases. Recent studies have shown that the existence of a depressive illness during coronary heart disease and particularly in the time period following a myocardial infarction, constitutes an independent risk factor, thus increasing the mortality rate. The evolution of coronary heart disease seems greatly influenced by the existence of anxious or depressive states, the diagnosis and the treatment of these states represent a major interest towards a better management of coronary patients.

[Eye disorders in children and adolescents]. / Le pithiatisme oculaire chez l'enfant et l'adolescent.

PURPOSE: We tried to better characterize non organic ocular disorders in children and adolescents: particularly clinical, perimetric and electrophysiological features. METHODS: We performed a prospective study in 25 cases during a period of 16 months. RESULTS: Non organic ocular disorders were seen among young girls between 9 and 11 years, mostly with bilateral, symmetrical and rapid visual loss. The symptoms were variable in time and responded favorably to suggestion. The ocular examination was normal. Visual field was abnormal in 52% of cases and very often showed a spiral (or snail) picture or a tubular constriction. 7' pattern visual evoked potentials were present in 88% of cases. The acuity was 20/20 in 92% of cases after the consultation and 100% later. CONCLUSION: The ophthalmic and electrophysiologic examination confirmed our diagnosis and eliminated more severe pathology.

[Cyclic oro-alimentary disorders]. / Troubles cycliques oro-alimentaires.

Eating behaviours have been changing in our society for at least twenty years. Thus, they represent a good indicator of the functioning of a society or a person. Beyond these recent sociocultural variations, recent clinical and research data, particularly in chronobiology, showed clearly the influence of hormonal or seasonal changes in our eating behaviours. Actually, we observed that an important proportion of these cyclic turmoils can fit into other phenomena and cyclic pathologies: premenstrual syndrome, seasonal affective disorders, bipolar disorders, binge eating.

[Is DSM IV of value in training of psychiatrists?]. / Le DSM IV est-il utile à la formation des psychiatres?

Acquiring the skill to be a psychiatrist requires learning in three fields: academic, clinical and research. Academic training includes various kinds of objectives which are analysed and to which the DSM IV provides only an imperfect response. Clinical training which shapes clinical practice, requires the organization of knowledge: the DSM IV, in so far as it analyses and classifies data is a useful tool, but the utility is limited since the DSM IV is inherently biased towards a psychiatric view of illness. The utility of the DSM IV is analysed for research training, particularly with the triple goal of preparing for the manipulation of knowledge, for practical care, and for the transmission of knowledge.

Bone marrow hypoplasia in anorexia nervosa: a case report.

If hematological abnormalities appear to be a common feature of severe anorexia nervosa, on the other hand bone marrow hypoplasia seems to be comparatively rare. We recently encountered a patient with anorexia nervosa who demonstrated a hypoplastic bone marrow associated with gelatinous transformation. These abnormalities were rapidly reversible with intensive nutritional rehabilitation. Bone marrow hypoplasia and gelatinous transformation are discussed in relation to current concepts of the role of nutrition in hematopoiesis in humans.

[Life events and anxiety]. / Evénements de vie et anxiété.

During the last few decades many studies have examined the role of life events in psychiatric disorders. Majority of investigators have mainly focused on depression. Recently the specific etiological role of life events in anxiety have been reexamined. Two possible causal relationships have been hypothesized: loss or separation during childhood can serve as a predisposing factor for adult psychologic conditions and life events occurring in the months before the onset of anxiety disorder, can serve as a precipitating factor. However the main methodologic issue in life events research involves the distorting effect of time recall when life events are elicited retrospectively. Epidemiological and clinical data are consistent with the view that panic disorder is significantly and strongly associated with both parental death and separation in childhood. The relationship between recent life events and anxiety disorders remain unclear. Studies that compare recent life events of anxiety disorder subjects and controls have equivocal results. Different variables (number of events, type, impact) may play a role in anxiety. Recent data have also suggested that early and recent life events specially loss and separation may be a risk factor for secondary depression in anxiety. However, life events do not operate independently of other predispositional variables such as genetic, neurologic and cognitive factors. Further studies using a prospective design may be useful to clarify the relation between life events and anxiety.

Early life events and panic disorder: course of illness and comorbidity.

1. Some reports have suggested that there may be a link between the experience of traumatic life events in childhood and adolescence and the development of panic disorder in adults. In addition early loss event also seems increase depressive risk by a factor about two to three. 2. The authors wondered whether panic patients who experienced a traumatic life event would have a higher prevalence of subsequent major depressive episode than panic patients without history of depression. 3. One hundred fifty seven patients with panic disorder according DSM III-R criteria are included in this study. Fifty three (33.7%) had experienced a major loss or separation before the age of 15 years. 4. The panic group with early life events showed a significantly higher life time prevalence of major depression than the panic group who did not experience early life events.

[Separation anxiety. Theoretical considerations]. / L'angoisse de séparation. Au fil des théories.

The interest in separation anxiety is nowadays increasing: this disorder appearing during childhood may predispose to the occurrence of anxiety disorders (such as panic disorder and agoraphobia) and major depression into adulthood. Psychoanalytic theories differ on the nature of separation anxiety and its place in child development. For some authors, separation anxiety must be understood as resulting from the unconscious internal conflicts inherent in the individuation process and gradual attainment of autonomy. From this point of view, the fear of loss of mother by separation is not regarded as resulting from a real danger. However, Freud considers the primary experience of separation from protecting mother as the prototype situation of anxiety and compares the situations generating fear to separation experiences. For him, anxiety originates from two factors: the physiological fact is initiated at the time of birth but the primary traumatic situation is the separation from mother. This point of view may be compared with behavioral theories. Behavioral theories suggest that separation anxiety may be conditioned or learned from innate fears. In Freud's theory, the primary situation of anxiety resulting from the separation from mother plays a role comparable to innate fears. Grappling with the problem of separation anxiety, Bowlby emphasizes then the importance of the child's attachment to one person (mother or primary caregiver) and the fact that this attachment is instinctive. This point of view, based on the watch of infants, is akin to ethological theories on behaviour of non human primates. Bowlby especially shows that the reactions of infant separated from mother evolve on three stages: the phase of protestation which may constitute the prototype of adulthood anxiety, the phase of desperation which may be the prototype of depression, and the phase of detachment. He emphasizes so the role of early separations in the development of vulnerability to depression. For Bowlby, these reactions are not acquired but genetically programmed and biologically determined.(ABSTRACT TRUNCATED AT 250 WORDS)

[Prevalence of hepatitis C, B and D markers and histopathological aspects in a group of intravenous drug addicts]. / Prévalence des marqueurs des hépatites C, B et D et aspects histopathologiques dans un groupe de toxicomanes intraveineux.

OBJECTIVES: The aim of this study was to assess the prevalence of infection by HCV, HBV, HDV and HIV and their biological and histopathological patterns in 104 intravenous drug users. METHODS AND RESULTS: Seventy-five patients (72%) had anti-HCV antibodies. Transmission was rapid because 33% of those who had been drug users for 6 months or less had anti-HCV antibodies. The contamination rate was very high because 90% of those who had been drug users for 2 years or less had anti-HCV antibodies. Thirty-four (33%) had an HBV marker, and 6 were HBs Ag carriers. None of the patients had anti-HDV antibodies. Only one patient had anti-HIV antibodies. Twenty-five anti-HCV antibody positive drug users underwent liver biopsy. Seven (28%) had normal ALAT levels and 18 (72%) had permanently or intermittently elevated ALAT levels. The mean histological activity on the Knodell index was 4.1 (range: 1-8). CONCLUSIONS: This study indicates that contamination by HCV is almost inevitable after 2 years of intravenous drug use. The low prevalence of HBV, HDV, and HIV infection might be explained by a low endemic state of these viruses in our area.

[Children and alcohol. A study in the school milieu]. / Les enfants et l'alcool. A propos d'une enquête en milieu scolaire.

Epidemiologic studies have consistently found that use of alcohol is increasing among teenagers and that children who have their first drink before the age of ten years are at increased risk for alcohol use during adolescence. In this study, a questionnaire was completed by 351 children (185 boys and 166 girls) aged 7 to 11 years in eight different schools in the Lille area (northern France). Most respondents (70.8%) reported previous experience with alcoholic beverages. Regular use of alcohol was reported by 8.7% of respondents and at least one episode of acute over-drinking by 23.6%. Attitudes towards alcohol and reasons for alcohol use varied across age groups. Use of alcohol produced guilt in the youngest children but was viewed as normal in the older age groups. Although some awareness of alcohol-related hazards was found, misconceptions were common. Use of alcohol was related to age and awareness: among the younger children, the level of awareness was significantly higher in regular users than in non-users, whereas the opposite was true in the older respondents. A positive correlation was found between current alcohol use and the children's predictions of future use. These data highlight the value of epidemiologic surveys for developing strategies aimed at preventing alcohol use in youngsters.

[Life events and military service]. / Evénements de vie et Service National.

OBJECTIVE: Life events preceding the year of enrollment in the military service were researched in 175 patients invalid out of army because of psychiatric disorders. METHOD: We assessed the diagnostic according to the DSM III-R criteria, using a semi-structured interview. We completed the evaluation with socio-demographic data. The scale for the assessment of life events was the Paykel's scale. RESULTS: 58% of patients fulfilled the diagnostic of adaptation disorders. The anxiety disorders (14.28%) and depressive disorders (9.71%) come after. Compared with an age and socio-demographic data matched conscript group without psychiatric disorders, it seems that the patients experienced twice as much events during the year preceding the enrollment than the control-group (respectively 6.92 and 3.65). In term of quality, the results show more events related to interpersonal conflict (inadaptation in family, affective relation or professional field). Whereas the events related to recent separation, the major events life; decrease, serious illness and the maternal loss were similar in both groups. CONCLUSION: Those data suggest that there is a relationship between excess of life events and personality disorders, which may explain the inadaptation in the military service. Some recent factors of stress could represent a risk of psychiatric disorders occurring during the military service.

Platelet serotonin levels in alcoholic patients: changes related to physiological and pathological factors.

This study investigated platelet serotonin (5-hydroxytryptamine; 5-HT) levels and the effects of different physiological and pathological factors in 108 alcoholic patients (alcohol abuse, n = 49; alcohol dependence, n = 59) and 32 healthy control subjects. Platelet 5-HT levels were determined by a fluorescent-ortho-phthalaldehyde assay. In patients, platelet 5-HT levels during withdrawal from alcohol and after 2 weeks of abstinence were significantly lower than in control subjects. Among patients, this decrease was enhanced both in alcohol-dependent patients and in patients who were depressed during the withdrawal phase, whereas lifetime impulse control disorders (mostly found in alcohol abusers) were associated with comparatively high platelet 5-HT levels (i.e., close to control subjects' values). These results, which reflect the likely biphasic effect of alcohol ingestion upon 5-HT functioning, are consistent with the dimensional 5-HT hypothesis in psychiatric disorders.

[Correlations between delayed auditory evoked potentials and clinical evaluation of schizophrenic symptoms]. / Corrélations entre les potentiels évoqués auditifs tardifs et l'évaluation clinique des symptômes de schizophrénie.

Late auditory evoked potentials (AEPs) were recorded by the "odd-ball" method in 20 schizophrenic patients according to DSM III R diagnosis criteria compared with 30 control subjects matched for sex and age. Patients were on antipsychotic medications; mean duration of illness was 3, 55 years. We have also proceeded to a clinical quantitative assessment of negative and positive symptoms of schizophrenia with Andreasen's rating scales. In the group of patients, we have observed a significant lengthening of the latency of N 1, N 2, P 3, N 3 and a decreased amplitude of N 1 and P 3. These results are in favour of an impairment of cerebral information processing probably localized in the subcortical level. Statistically significant correlations have been noticed between the anomalies of the last stages of information processing (P 3, N 3) and negative symptoms, more particularly affective flattening and attentional impairment. The disturbances of the first stages of information processing (P 2) and of automatic information processing (N 2) were related to positive symptoms, hallucinations and delusions especially. The anomalies of N 2 were also related to the sum of the global scores: an attentional impairment could be a main factor in the determinism of schizophrenia.

[A case of delusional melancholia: "a variant of loss of psychological self-activation"?]. / Un cas de mélancolie délirante: "variante de perte de l'autoactivation psychique"?

A 62 year-old man presented with melancholia with delusions, possibly resulting from lenticular lesion in the left and frontal damages in the right. Atypical signs of our observation led us to consider our patient not as suffering of affective disorder. We suggest that melancholia could be a consequence of a certain type of stereotyped mental activity, and we would compare this stereotyped mental activity to mental compulsive activity described in "loss of psychic self activation" of D. Laplane. In this perspective our observation would be a variant of "Loss of psychic self-activation". Heuristic value of this concept is discussed.