Attachment and Mental Health of Men Having Sex with Men Engaging in Chemsex: Is Substance Abuse Only the Tip of the Iceberg?

Gay and bisexual men and other men who have sex with men (GBMSM) with problematic chemsex (a specific sexualized drug use pattern) face several health issues. The aim of this monocentric observational study was to assess the mental health history and attachment style (AS) within 71 GBMSM seeking care for problematic chemsex. Attachment style (AS) was evaluated using the Relationship Scales Questionnaire. 82% of the cohort (58) had at least one mental health disorder (among depression, anxiety, alcohol use disorder or hypersexuality). 9.9% were admitted to intensive care due to chemsex use. Traumas were frequent, with 31% reporting childhood sex abuse and 24% declaring having attempted suicide. 62 (87%) had insecure AS: 38% preoccupied, 23% fearful and 24% dismissing. Users with a positive self model (N = 24) had fewer comorbidities (63% vs 92%, p = .003) and practiced more chemsex alone (75% vs 33%, p < .001) than users with negative self model (N = 47). Users with a positive other model (N = 35) practiced more slamsex (injections of substance in a sexual context) (80% vs 50%, p = .008) and had fewer comorbidities (71% vs 92%, p = .027) than users with a negative other model (N = 36). Attachment theory is a way to provide holistic and tailored and harm reduction.

EYERUBBICS: The Eye Rubbing Cycle Study.

Purpose: Describe the cognitive and behavioral symptomatology of patients with chronic ocular rubbing in keratoconus (KC) and Ocular Surface Disease (OSD) using a self-questionnaire. Methods: A prospective study was conducted in a tertiary ophthalmology center between May and July 2021. We consecutively included all patients presenting with one of the following conditions: KC and OSD. A questionnaire including the evaluation of Goodman and CAGE-modified criteria for eye rubbing was given to patients in consultation to evaluate their ocular symptoms and medical background. Results: We included 153 patients in the study. Of these, 125 (81.7%) patients reported eye rubbing. The average Goodman score was 5.8 ± 3.1 and was ≥ 5 in 63.2% of cases. The CAGE score was ≥ 2 in 74.4% of patients. Addiction (p = 0.045) and psychiatric family history (p = 0.03) were more frequent in patients with higher scores. Ocular symptoms and eye rubbing were significantly more frequent and intense in patients with higher scores; Conclusion: Eye rubbing presents addictive-like cognitive and behavioral characteristics in patients with KC or OSD. The eye rubbing cycle could play an essential role in the onset and progression of keratoconus and could be a factor in the maintenance of dry eye.

Position statement on the diagnosis and management of premature/primary ovarian insufficiency (except Turner Syndrome).

Premature ovarian insufficiency (POI) is a rare pathology affecting 1-2% of under-40 year-old women, 1 in 1000 under-30 year-olds and 1 in 10,000 under-20 year-olds. There are multiple etiologies, which can be classified as primary (chromosomal, genetic, auto-immune) and secondary or iatrogenic (surgical, or secondary to chemotherapy and/or radiotherapy). Despite important progress in genetics, more than 60% of cases of primary POI still have no identifiable etiology; these cases are known as idiopathic POI. POI is defined by the association of 1 clinical and 1 biological criterion: primary or secondary amenorrhea or spaniomenorrhea of>4 months with onset before 40 year of age, and elevated follicle-stimulating hormone (FSH)>25IU/L on 2 assays at>4 weeks' interval. Estradiol level is low, and anti-Müllerian hormone (AMH) levels have usually collapsed. Initial etiological work-up comprises auto-immune assessment, karyotype, FMR1 premutation screening and gene-panel study. If all of these are normal, the patient and parents may be offered genome-wide analysis under the "France Génomique" project. The term ovarian insufficiency suggests that the dysfunction is not necessarily definitive. In some cases, ovarian function may fluctuate, and spontaneous pregnancy is possible in around 6% of cases. In confirmed POI, hormone replacement therapy is to be recommended at least up to the physiological menopause age of 51 years. Management in a rare diseases center may be proposed.

First case report of tDCS efficacy in severe chemsex addiction
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Chemsex is an escalating public health issue among men who have sex with men, with potentially severe somatic and psychiatric consequences. Given the limited knowledge and lack of treatment recommendations available in this area, we proposed the use of noninvasive brain stimulation in order to reduce problematic chemsex behavior. This is the first open-label case report of a positive effect of transcranial direct current stimulation (tDCS) in a patient who was complaining of severe chemsex addiction. Total disappearance of chemsex behavior occurred after 5 days of daily sessions of right prefrontal cortex stimulation and did not return after 8 months of follow-up. The strengthening of dorsolateral prefrontal cortex activity may have modulated limbic pathways and reduced incentive salience and craving of both sexual addiction and concomitant illicit drug use.
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El Chemsex es un problema de salud pública creciente entre los hombres homosexuales, con consecuencias somáticas y psiquiátricas potencialmente graves. Dados el conocimiento limitado y la falta de recomendaciones de tratamiento disponibles en esta área, propusimos el uso de estimulación cerebral no invasiva para reducir los comportamientos problemáticos relacionados con el chemsex. Este es el primer informe de caso clínico abierto que muestra un efecto positivo de la estimulación transcraneal de corriente directa (tDCS) en un paciente que se quejaba de una adicción grave al chemsex. La desaparición total de los comportamientos relacionados con el chemsex se produjo después de 5 días de sesiones diarias de estimulación de la corteza prefrontal derecha y no regresó después de 8 meses de seguimiento. El aumento de la actividad de la corteza prefrontal dorsolateral puede haber modulado las vías límbicas y reducido la prominencia del incentivo y los antojos asociados tanto con la adicción sexual como con el uso concurrente de drogas ilícitas.

Le chemsex est un problème de santé publique croissant chez les hommes ayant des relations homosexuelles, aux conséquences somatiques et psychiatriques potentiellement graves. Compte tenu des connaissances limitées et du manque de recommandations de traitement disponibles dans ce domaine, nous avons proposé l'utilisation de stimulation cérébrale non invasive afin de réduire les comportements problématiques liés au chemsex. C'est le premier rapport de cas clinique ouvert montrant un effet positif du courant continu transcrânien stimulation (tDCS) chez un patient qui se plaignait d'une grave dépendance au chemsex. La disparition totale des comportements liés au chemsex est survenue après 5 jours de séances quotidiennes de stimulation du cortex préfrontal droit et n'est pas revenue après 8 mois de suivi. Le renforcement de l'activité du cortex préfrontal dorsolatéral peut avoir modulé les voies limbiques et réduit la saillance incitative et les état de manque liés tant à la dépendance sexuelle qu'à l'usage concomitant de drogues illicites.

Pharmacotherapy of Sexual Addiction.

PURPOSE OF REVIEW: We reviewed recent data on sexual addiction and its treatment. We examined the different definitions of this disorder, related to the pathophysiological mechanisms. We addressed the pharmacological treatment of sexual addiction. RECENT FINDINGS: Hypersexual behavior can be considered an addictive disorder. Sexual addiction is accompanied by significant psychiatric and addictive comorbidities and is responsible for life impairment. A comprehensive and efficient treatment must be proposed. Selective serotonin reuptake inhibitors seem the first-line pharmacological treatment for sexual addiction. Naltrexone could be another therapeutic option. Psychotherapy and preferentially cognitive-behavioral therapy should be used in association with pharmacotherapy and treatments of comorbidities.

Virtual Reality (VR) in Assessment and Treatment of Addictive Disorders: A Systematic Review.

Background: Substance Use Disorder (SUD) and behavioral addictions are common and require a multidisciplinary approach. New technologies like Virtual Reality could have the potential to improve assessment and treatment of these disorders. Objective: In the present paper, we therefore present an overview of Virtual Reality (Head Mounted Devices) in the field of addiction medicine for craving assessment and treatment. Method: We conducted a systematic review by querying PubMed database for the titles of articles published up to March 2019 with the terms [virtual] AND [addictive] OR [addiction] OR [substance] OR [alcohol] OR [cocaine] OR [cannabis] OR [opioid] OR [tobacco] OR [nicotine] OR [methamphetamine] OR [gaming] OR [gambling]. Results: We screened 319 abstracts and analyzed 37 articles, dividing them into two categories, the first for assessment of cue reactivity (craving, psychophysiological response and attention to cue) and the second for intervention, each drug (nicotine, cocaine, alcohol, cannabis, gambling) being detailed within each category. Conclusions: This overview suggest that VR provide benefits in the assessment and treatment of substance use disorders and behavior addictions and achieve high levels of ecological validity. While, craving provocation in VR is effective across addiction disorders, treatments based exclusively on virtual exposure to drug related cues as shown heterogenous results.