[From preconceived ideas on hysteria to functional neurological disorder]. / Des idées reçues sur l'hystérie au trouble neurologique fonctionnel.

Functional neurological disorders (FND), formerly called «conversion hysteria¼, are still poorly understood diseases that suffer from an outdated, sometimes erroneous and stigmatizing conception on the part of health care teams. Enlightened by historical concepts, we propose a modern reading of FND with the aim of deconstructing preconceived ideas and proposing a global, benevolent and individualized approach.

Les troubles neurologiques fonctionnels (TNF), appelés autrefois «hystéries de conversion¼, sont des maladies encore mal connues qui souffrent à l'heure actuelle d'une conception désuète, parfois erronée et stigmatisante de la part des équipes soignantes. Éclairés par les concepts historiques, nous proposons une lecture moderne des TNF dans l'optique de déconstruire les idées reçues et proposer une approche globale, bienveillante et individualisée.

[How I explore affective instability]. / Comment j'explore l'instabilité affective.

Affective instability is a common phenomenon in adults. It may be the expression of underlying organic or psychiatric conditions. This is a potentially disabling symptom for the individual, which can cause psychological distress and even consequences in daily life functioning. This article is intended for any healthcare professional and aims to clarify the assessment and diagnostic approach to a patient with mood swings.

L'instabilité affective est un phénomène fréquent chez l'adulte. Elle peut être l'expression d'affections psychiatriques ou non psychiatriques sous-jacentes. Il s'agit d'un symptôme potentiellement invalidant pour l'individu, pouvant entraîner une détresse psychologique, voire des conséquences dans le fonctionnement au quotidien. Cet article est destiné à tout professionnel de la santé et vise à éclaircir l'évaluation et la démarche diagnostique face à un patient avec des sautes d'humeur.

Neurologists, neurosurgeons, and psychiatrists' personality traits: a comparison.

BACKGROUND: Clinicians in neuroscientific disciplines may present distinct personality profiles. Despite of potential relevance to clinical practice, this has not yet been studied. We therefore aimed to compare personality profiles of physicians working in the three main disciplines of clinical neuroscience, i.e., neurologists, neurosurgeons, and psychiatrists, between each other, across levels of training and to other specialties. METHODS: An online survey using the Ten-Item Personality Inventory (TIPI), an internationally validated measure of the five-factor model of personality dimensions, was distributed to board-certified physicians, residents, and medical students in several European countries and Canada. Differences in personality profiles were analyzed using multivariate analysis of variance and canonical linear discriminant analysis on age- and sex-standardized z-scores of personality traits. Single personality traits were analyzed using robust t tests. RESULTS: Of the 5148 respondents who completed the survey, 723 indicated the specialties neurology, neurosurgery, or psychiatry. Compared to all other specialties, personality profiles of training and trained physicians in these three main clinical neuroscience disciplines ("NN&P") significantly differed, with significantly higher scores in openness to experience. Within NN&P, there were significant differences in personality profiles, driven by lower neuroticism in neurosurgeons, higher conscientiousness in neurosurgeons and neurologists, and higher agreeableness in psychiatrists. Across levels of training, NN&P personality profiles did not differ significantly. CONCLUSION: The distinct clinical neuroscience personality profile is characterized by higher levels of openness to experience compared to non-neuroscience specialties. Despite high variability within each discipline, moderate, but solid differences in the personality profiles of neurologists, neurosurgeons and psychiatrists exist.

Influence of COX-2 and OXTR polymorphisms on treatment outcome in treatment resistant depression.

Inflammatory pathways play a crucial role in the pathomechanisms of antidepressant efficacy. The aim of this study was to investigate whether a set of single nucleotide polymorphisms (SNPs) within cyclooxygenase-2 (COX-2, rs5275 and rs20417) and oxytocin receptor (OXTR, rs53576 and rs2254298) genes was associated with antidepressant treatment resistance, response or remission. Three hundred seventy-two patients were recruited in the context of a multicenter resistant depression study. They were genotyped for COX-2 and OXTR SNPs. Treatment resistance (according to two different definitions), response and remission were recorded. We did not observe any association between the genotypes or alleles of the selected SNPs within COX-2 and OXTR genes and treatment resistance, response and remission in the whole sample. Our results are consistent with those of some studies but not with those of other ones. Indeed, several factors could be involved in the discrepancy observed across studies. They include sample size, environmental factors, differences in ethnicity, different study designs, and different definitions of treatment resistance.

The TaqI A DRD2 polymorphism in type II alcohol dependence: a marker of age at onset or of a familial disease?

Cloninger's type II is a severe, early-onset, male-limited, and genetically influenced, impulsive form of alcoholism. Significant association has been reported between the A1 allele of the D2 dopamine receptor (DRD2) gene, substance misuse and personality traits of impulsivity and novelty seeking. We assessed the association between the TaqI A DRD2 gene polymorphism with Cloninger's typology and family history of alcohol abuse, which is thought to be more frequent in type II alcoholics. Fifty-one male alcohol-dependent patients were discriminated between type I and type II according to age at onset of alcohol-related problems and interviewed about family history of alcoholism. The associations between DRD2 (A1 or A2 alleles), family history, and typology were assessed by Pearson's chi-square test. Although typology was not associated with the studied polymorphism, a higher rate of general family history of alcohol abuse was still observed in type II patients (chi(2)(1)=4.53; P=.033). Furthermore, the A1 allele of the DRD2 was significantly associated with paternal history of alcoholism (chi(2)(1)=4.66; P=.031) and male, first-degree, collateral history of alcoholism (chi(2)(1)=4.40; P=.036). Age at onset of alcohol-related problems as main discriminator between type I and type II alcohol dependence does not seem to be associated by the TaqI A DRD2 polymorphism. However, the A1 allele of the DRD2 may be a marker of male familial alcoholism, which has been associated with type II alcohol dependence.

The short allele of the serotonin transporter promoter polymorphism influences relapse in alcohol dependence.

AIMS: The short (S) allele of the serotonin transporter gene promoter polymorphism (5-HTTLPR) contributes to the risk of alcohol dependence and co-occurring clinical features. We studied the putative link between this allele and relapse. METHODS: 48 alcohol-dependent male patients were recruited and genotyped for the 5-HTTLPR. Relapse to alcohol drinking was monitored during 3 months after standardized withdrawal. RESULTS: The S allele was significantly associated with relapse (p = 0.008) while no other factor that was measured played a significant role. CONCLUSIONS: The S allele of the 5-HTTLPR polymorphism may influence the risk of relapse in abstinent alcohol-dependent patients, possibly through intermediate phenotypes.

Vasopressin-neurophysin and DST in major depression: relationship with suicidal behavior.

The purpose of the present study was to assess if AVP-neurophysin is associated with hypercortisolemia and suicidal behaviour in depressed patients. The study included 28 patients subgrouped into suicide attempters (n=13) and nonattempters (n=15). We assessed basal AVP-neurophysins concentrations and post-dexamethasone (DST) cortisol levels. Concentrations of AVP-neurophysins did not differ between DST suppressors and nonsuppressors: 0.29+/-0.13 ng/ml vs 0.36+/-0.21 ng/ml, (F=1.1, df=1, 27, p=0.30). Suicide attempters did not differ from nonattempters for AVP-neurophysins levels. Our results fail to support a role of AVP in the early cortisol escape.