Taste preference and psychopathology.

OBJECTIVE: Excessive food intake has been linked to many factors including taste preference and the presence of psychopathology. The purpose of this study was to investigate the association between sweet and salty taste preference and psychopathology in patients with severe obesity. METHODS: A consecutive series of patients applying for bariatric surgery was recruited for the study. Taste preference was self-reported. Psychopathology was assessed using the revised version of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). 190 patients were included in the study. RESULTS: In comparison with patients who had salty taste preference, patients with sweet taste preference had significantly higher elevations on the depression (OD: 4.090, p = 0.010) and the hysteria (OD: 2.951, p = 0.026) clinical scales of the MMPI-2. CONCLUSION: The results suggest the presence of an association between taste preference and psychopathology. The findings may be of interest for clinicians who are involved in the treatment of obesity. In particular, they may wish to pay increased attention to patients with sweet taste preference or who have a strong attraction for both sweet and salty foods, in order to detect psychopathology and to adapt the treatment.

Suicide methods in Europe: a gender-specific analysis of countries participating in the "European Alliance Against Depression".

OBJECTIVE: To identify the most frequent gender-specific suicide methods in Europe. DESIGN: Proportions of seven predominant suicide methods utilised in 16 countries participating in the European Alliance Against Depression (EAAD) were reported in total and cross-nationally. Relative risk (RR) relating to suicide methods and gender was calculated. To group countries by pattern of suicide methods, hierarchical clustering was applied. SETTING AND PARTICIPANTS: Data on suicide methods for 119,122 male and 41,338 female cases in 2000-4/5 from 16 EAAD countries, covering 52% of European population were obtained. RESULTS: Hanging was the most prevalent suicide method among both males (54.3%) and females (35.6%). For males, hanging was followed by firearms (9.7%) and poisoning by drugs (8.6%); for females, by poisoning by drugs (24.7%) and jumping from a high place (14.5%). Only in Switzerland did hanging rank as second for males after firearms. Hanging ranked first among females in eight countries, poisoning by drugs in five and jumping from a high place in three. In all countries, males had a higher risk than females of using firearms and hanging and a lower risk of poisoning by drugs, drowning and jumping. Grouping showed that countries might be divided into five main groups among males; for females, grouping did not yield clear results. CONCLUSIONS: Research on suicide methods could lead to the development of gender-specific intervention strategies. Nevertheless, other approaches, such as better identification and treatment of mental disorders and the improvement of toxicological aid should be put in place.

[Persistent psychotic disorder following bilateral mesencephalo-thalamic ischaemia: case report]. / Trouble psychotique persistant après ischémie mésencéphalo-thalamique bilatérale: à propos d'un cas clinique.

A 38-year old male patient with no history of psychiatric illness developed a progressive psychotic disorder after bilateral (predominantly left) mesencephalo-thalamic cerebral ischaemia. The reason of the emergency hospitalization was the sudden onset of a confusional state, culminating in a fluctuating comatose status. The neurological examination found mild right hemiparesia, praxic disorders and reactive left mydriasis with paresia of the downward vertical stare, leading to the hospitalisation in the neurology department for suspicion of a cerebral vascular ischaemic accident. The psychiatric symptoms started with acoustic-verbal hallucinations, poorly structured paranoid delusions, progressively developed over two weeks, followed by behavioural disorders with psychomotor agitation and heteroaggressivity. The patient was transferred to the psychiatric department, because of the heteroaggressive risk and lack of morbid consciousness, in spite of recovering from the confusional status. An intensive psychiatric management was proposed, combining a psychotherapeutic approach with 4 mg of risperidone and adjustable doses of benzodiazepine according to the psychomotor agitation. During the next days, there was a net recovery of the behavioural disorders, in spite of the persistence of the ideas of persecution. All the neurological symptoms also decreased. An anomaly of the polygon of Willis was found on a cerebral arteriography (the posterior cerebral arteries had a foetal origin, dependent on carotidal axes and not on the vertebro-basilar system). The main emboligen risk factor was the presence of a permeable foramen ovale, discovered during a transoesophageal echography. The patient underwent a surgical correction of the permeable foramen ovale. The psychiatric hospitalization for three months was continued by ambulatory follow-up. The initial positive symptoms (delusions, acoustic-verbal hallucinations) progressively diminished while negative symptoms became predominant after few months. One year after the first hospitalization the patient presented a second psychotic decompensation, with delusions of persecution, jealousy and behavioural disorders with heteroaggressivity, that required an emergency psychiatric hospitalization. The wife of the patient decided to divorce, because she was "frightened by the threats of death" from her husband. A neurological assessment during the second hospitalization in psychiatry did not find new ischaemic lesions after the cardiac surgery for the permeable foramen ovale, nor relevant changes in cerebral perfusion. The final diagnosis after the psychiatric follow-up of 14 months was: psychotic disorder with delusional ideas, due to cerebral ischaemia (DSM IV). There are relatively few data in the literature regarding persistent psychotic disorders in the context of ischaemic mesencephalo-thalamic lesions. However, several authors support the hypothesis of a possible disconnection of the thalamic nuclei, the frontal lobes and limbic system as a risk factor or a triggering factor for psychotic disorders in cerebral ischaemia. Observations concerning the occurrence of psychotic disorders following cerebral--especially localised--ischaemia may help to better understand the neuro-physiological mechanisms triggering or accompanying the psychiatric symptomatology. The role of functional cerebral imagery in the detection of possible structural lesions related to clinical observations must be emphasised. The slow progression (over a year) to psychotic disorder with predominantly negative symptoms emphasized the importance for long-term prospective studies. Isolated clinical observations arouse the interest for a specific scale for psychotic disorders occurring after cerebral ischaemia, similar to existing specific scale for post-ischaemic depressive disorders. The necessity of systematic psychiatric examination and re-evaluations in thalamic cerebral ischaemia is to be highlighted, both for the differential diagnosis and for the early psychiatric care.

[Tridimensional Personality Questionnaire (TPQ): validation in a French-speaking control population]. / Questionnaire de personnalité tridimensionnel (TPQ): validation chez une population contrôle francophone.

Among the dimensional scales that measure personality, Cloninger's TPQ (Tridimensional Personality Questionnaire) holds a place apart in the literature, because the hypotheses it relies on are partially biological. The questionnaire (100 forced binary items) includes three axes: "Novelty Seeking", "Harm Avoidance" and "Reward Dependence", each theoretically bound to a preferential neuromediator, respectively dopamine, serotonin and norepinephrine. Each axis includes four minor subscales. The study presented here is the analysis of 104 control volunteers from both genders (59 males). This database is the first to be published with a French-speaking population. The comparison with Cloninger's normative database shows many similarities: the mean values for the 3 axes are relatively close. The population studied here is younger and this factor could play a role in the somewhat higher mean novelty seeking scores found here. The three axes show a normal distribution. Skewness and kurtosis are between -1 and +1 for all the subscales, except here for NS2. Factorial structure is quite similar to Cloninger's results. The three first axes correspond to the variables isolated in the first studies and the fourth one includes the same subscales as in the large American database. Inverse correlation between age and novelty seeking, positive correlation between female gender and harm avoidance and reward dependence were also found. However, no correlation was found between novelty seeking and male gender. A correlation was found between level of instruction and NS1 only, not with the whole NS axis. Eighty-seven % of volunteers presented with at least one standard deviation on at least one axis and 68% on at least two. This does not seem to have been described previously. It can be a sign of the difficulty of human beings to show a balanced personality. In conclusion, the database presented here shows many similarities with Cloninger's normative database. This underscores its value for comparisons in clinical trials in the future.

WHO Study on the reliability and validity of the alcohol and drug use disorder instruments: overview of methods and results.

The WHO Study on the reliability and validity of the alcohol and drug use disorder instruments in an international study which has taken place in centres in ten countries, aiming to test the reliability and validity of three diagnostic instruments for alcohol and drug use disorders: the Composite International Diagnostic Interview (CIDI), the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and a special version of the Alcohol Use Disorder and Associated Disabilities Interview schedule-alcohol/drug-revised (AUDADIS-ADR). The purpose of the reliability and validity (R&V) study is to further develop the alcohol and drug sections of these instruments so that a range of substance-related diagnoses can be made in a systematic, consistent, and reliable way. The study focuses on new criteria proposed in the tenth revision of the International Classification of Diseases (ICD-10) and the fourth revision of the diagnostic and statistical manual of mental disorders (DSM-IV) for dependence, harmful use and abuse categories for alcohol and psychoactive substance use disorders. A systematic study including a scientifically rigorous measure of reliability (i.e. 1 week test-retest reliability) and validity (i.e. comparison between clinical and non-clinical measures) has been undertaken. Results have yielded useful information on reliability and validity of these instruments at diagnosis, criteria and question level. Overall the diagnostic concordance coefficients (kappa, kappa) were very good for dependence disorders (0.7-0.9), but were somewhat lower for the abuse and harmful use categories. The comparisons among instruments and independent clinical evaluations and debriefing interviews gave important information about possible sources of unreliability, and provided useful clues on the applicability and consistency of nosological concepts across cultures.

Concordance of DSM-IV alcohol and drug use disorder criteria and diagnoses as measured by AUDADIS-ADR, CIDI and SCAN.

This study was designed to examine the agreement of DSM-IV alcohol and drug use disorder diagnoses generated by three WHO/NIH diagnostic instruments, the AUDADIS-ADR, the CIDI, and the SCAN. This substudy, conducted in three countries, Greece, Luxembourg, and the United States, was part of the larger joint project on diagnosis and classification of mental disorders and alcohol and drug-related problems, which was initiated to evaluate the cross-cultural applicability of the instruments and the criteria. Overall, concordance among the three assessments was good for alcohol and opiate dependence, fair to good for cocaine and sedative dependence, and low for amphetamine dependence. Cannabis dependence concordance was significantly more discrepant than any other substance. Agreement on abuse was low for all substances examined. In addition, the concordance of DSM-IV criteria for each substance was examined. Finally, reasons for discrepancies in responses among assessments were examined, based on discrepancy interview protocol methodology. Further investigation will help to refine these instruments in order to provide a more thorough understanding of alcohol and drug abuse diagnoses.

Concordance between ICD-10 alcohol and drug use disorder criteria and diagnoses as measured by the AUDADIS-ADR, CIDI and SCAN: results of a cross-national study.

Agreement between the AUDADIS-ADR, CIDI and SCAN in case identification for ICD-10 alcohol and drug use disorders and diagnostic criteria was investigated in three countries, Luxembourg, Greece and the US. Overall, agreement for ICD-10 dependence diagnoses between the three instruments was fair to good for alcohol, opioids and cocaine, but generally lower for dependence diagnoses for other substance. In contrast, concordance between instruments for harmful use diagnoses was extremely poor for all substances. Implications of these major findings are discussed in terms of the relationship between prevalence, reliability and concordance and indications and cautions regarding cross-instrument comparisons.

Critical analysis of the theories advanced to explain short REM sleep latencies and other sleep anomalies in several psychiatric conditions.

One of the most consistent and most studied sleep modifications in several psychiatric conditions is the shortening of the rapid eye movement (REM) sleep latency. While its clinical usefulness is still to be proven and its meaning relatively obscure, the appearance of a short REM latency continues to be a daily fact in sleep laboratories. Many theories compete to explain what is observed, the most important being the circadian rhythm hypotheses, the homeostatic model and the reciprocal interaction model. These three are summarised and their pros and cons are exposed in a systematic manner. Points of conflict, possible convergences and limitations are discussed in the light of recent developments on the general theories of sleep regulation.

[DSM-IV]. / Le DSM-IV.

The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders has been published by the American Psychiatric Association in 1994. DSM-IV relies upon the same basic concepts as DSM-III and DSM-III-R: explicit diagnostic criteria, multiaxial system, and a descriptive approach that attempts to be neutral with respect to theories of etiology. The DSM-IV revision process has included comprehensive and systematic reviews of the published literature, reanalyses of already-collected data sets and extensive issue-focused field trials. Considerable efforts have been made to ensure that the codes and terms provided in DSM-IV are fully compatible with both ICD-9-CM and ICD-10. According to the authors of DSM-IV, the major innovation of DSM-IV lies not in any of its specific content changes but rather in the systematic and explicit process by which it was constructed and documented.

[Description of bulimic behaviors]. / Description des comportements boulimiques.

This report describes and comments the definitions which have been proposed for Bulimia nervosa in three recent classifications: DSM III, DSM III-R and ICD-10.

[The WP scale, an evaluation scale of anxious inhibition]. / La WP, une échelle d'évalutation de l'inhibition anxieuse.

The phenomenon of inhibition concerns a feeling of being blocked in usual functioning. It is frequently encountered, in many disorders. Using a general model of anxiety, the authors propose a taxonomy of the phenomenon into inhibition in anxiety states and inhibition associated with other disorders, a differentiation between generalized inhibition and specific inhibition, and between primary and secondary inhibition. Generalized inhibition due to anxiety can be assessed through use of the WP, which is a rating scale developed for this purpose by the authors.

The diagnosis of dementias of the Alzheimer type.

There are a large number of people with primary degenerative dementia of the Alzheimer type throughout the world. This number will continue to increase during the next century, and will represent a major health problem for future generations. The diagnosis of the dementia is based on the presence of disturbances in higher cortical functions, cognition, language or behaviour, and the presence of apraxia and agnosia. To determine the etiology of the dementia, a number of investigations are required; these include neurological examination, use of diagnostic criteria, assessment instruments and measurement of mental functions, electroencephalography, and imaging techniques. Diagnosis is generally obvious in the middle stages of the disorder, but may be difficult or even hazardous in the early stages. This is a major handicap for research investigations. At present, emission tomography is the only technique which identifies abnormalities in the early stages of the disorder and which differentiates primary degenerative dementia from multi-infarct dementia. For the time being, this technique is still too sophisticated and costly to be used on a regular basis, but it will prove indispensable in the identification, understanding and early treatment of dementia.

[Empirical French criteria for psychoses. II. Consensus of French psychiatrists and provisional definitions]. / Des critères empiriques français pour les psychoses. II. Consensus des psychiatres français et définitions provisoires.

The provisional definitions presented in this report are the first step of an empirical investigation initiated to establish operational definitions for schizophrenia and other non-affective psychoses of classical French nosology. They are the result of French clinicians' agreement on the identification of particular syndromes as distinct mental disorders.

[Empirical French criteria for psychoses. III. Algorithms and decision tree]. / Des critères empiriques français pour les psychoses. III. Algorithmes et arbre de décision.

The present report presents the final results of an empirical investigation initiated to establish operational definitions for schizophrenia and other non-affective psychoses of classical French nosology. For each category, the authors provide diagnostic criteria and algorithms. In addition, they propose a decision tree for the differential diagnosis of psychotic features included in the French classification of mental disorders.

Berner's axial syndromes and the polydiagnostic approach of the LICET system.

The LICET system is a polydiagnostic instrument permitting recording of diagnostic criteria and assignment by diagnostic algorithms as proposed in a number of different classification systems, including the Viennese Research Criteria. In the present report, French diagnostic practices are compared with the Viennese Research Criteria for endogenomorphic-schizophrenic and endogenomorphic-cyclothymic axial syndromes.

A computerized diagnostic system for comparing alternative classification schemes of depression.

The present report presents a computerized system, permitting recording of diagnostic criteria and assignment by diagnostic algorithms as proposed and intended in 7 different classification systems of depression. The potential of the procedure for comparing alternative classifications of depression is presented and discussed.

[Integrated lists of taxonomic evaluation criteria: LICET-S and LICET-D]. / Les listes intégrées de critères d'évaluation taxinomiques : LICET-S et LICET-D.

LICET-S and LICET-D are diagnostic instruments containing all diagnostic criteria for two major groups of disorders. LICET-S assembles the criteria proposed for non-affective psychoses in 9 different systems. LICET-D integrates the criteria defining the depressive categories listed in 7 different systems. Initially constructed to elaborate empirical criteria for specific categories pertaining to traditional French nosology, the two lists also permit to formulate diagnostic decisions according to 9 respectively 7 classification systems, on the basis of the algorithms defining each of the systems under discussion. The authors present the rationale that led to the construction of the LICET-system. They describe the composition of the two lists and the guidelines for use of the system. They finally illustrate the utility of the instruments on the basis of results obtained in recent investigations.