Determinants of Gambling Disorders in Elderly People-A Systematic Review.

Background: Despite the growth in the number of studies on gambling disorders (GDs) and the potentially severe harm it may cause, problem gambling in older adults is rarely apparent in literature. Driven by the need to overcome this limitation, a broad systematic review is essential to cover the studies that have already assessed the determinants of GD in the elderly. Objectives: The aim of this systematic review is to understand the determinants related to GDs in elderly people. Methods: A total of 51 studies met the inclusion criteria, and data were synthesized. Results: Three major types of determinants were identified in this review: individual, socio-financial and environmental. Conclusions: This review explored the determinants influencing GDs in older people. The findings are relevant to academics, policymakers, patients, and practitioners interested in the identification and prevention of GD in older people.

Prevalence of Coaddictions and Rate of Successful Treatment Among a French Sample of Opioid-Dependent Patients With Long-Term Opioid Substitution Therapy: The OPAL Study.

Background: Opioid use disorder (OUD) is a worldwide major health concern due to increased early mortality and morbidity. Opioid substitution therapy (OST) is approved in the context of a global OUD treatment (OUDT), in conjunction with psychosocial interventions. Many factors can explain why unsuccessful treatment rates remain high. While the phenomenon of addiction switching is often proposed, it is not known whether this also includes gambling addiction. The primary objective of the OPAL study was to determine the prevalence of coaddictions, including problem gambling, among patients with OUDT. Secondary objectives were to assess the rate of unsuccessful OUDT and to characterize the associated factors. Methods: For this observational transversal multicenter study, patients with OUDT including OST for at least 6 months were recruited. Clinical assessment was based on a clinically structured interview and a set of self-reported questionnaires. Coaddictions were screened using the Fagerström, the CRAFFT, and the Lie/Bet questionnaires. Unsuccessful OUDT was defined as the persistence of opioid use and/or the worsening of another substance use or gambling practice. After a descriptive analysis, a multivariate analysis was performed to identify the factors associated with unsuccessful OUDT. Results: The sample consisted of 263 patients. Prevalence of coaddictions reached 97% of the sample. Problem gambling was associated with 10% of the patients. OUDT was considered as "unsuccessful" for 60% of the patients. Associated factors included having drug-using friends, psychiatric and professional negative consequences related to opioid use, more than one OST-prescribing physician, and impulsivity, especially high scores for lack of premeditation and sensation seeking. Conclusions: This study provides further evidence of the need to consider coaddictions and the usefulness of global addictive evaluations. Poor prognostic factors must alert the clinician to initiate more sustained care. Further implications are discussed.

Alcohol use by people in their seventies is not an exception: a preliminary prospective study.

The ageing population is rapidly increasing worldwide, and the alcohol-related disease burden in most Western countries is on the rise. However, very few studies assess alcohol use in older people. Here, a self-reported questionnaire was administered to all individuals aged 70 years or more who visited a social centre for older people in western France. The average age of the 98 subjects included in the survey was 79 years (range, 70-97 years; SD=6), and 57.1% (n=56) reported weekly alcohol consumption. An average consumption of over two standard units each day during weekends was reported by 53% subjects (n=52), and the same on each weekday was reported by 34% (n=33). Thus, a significant proportion of subjects aged 70 years or over consumed more alcohol than is recommended in current guidelines. The participants also reported that they rarely discussed alcohol consumption with their general practitioners. Alcohol use should be assessed regularly. District nurses and members of the primary care team should recommend strategies to help older people reduce their alcohol consumption.

Cannabinoid hyperemesis syndrome: Review of the literature and of cases reported to the French addictovigilance network.

BACKGROUND: Cannabinoid hyperemesis syndrome is a variant of cyclical vomiting syndrome in a context of chronic cannabis usage. Our aim was to compare French cases to those identified in the international literature in order to further our knowledge of the clinical criteria, pathophysiology and treatments for cannabinoid hyperemesis syndrome. METHODS: We analysed cases reported in the international literature up to 30 June 2017, obtained from the MEDLINE, PsycINFO and The Cochrane Library databases; we selected relevant articles based on title and abstract. We also analysed cases of cannabinoid hyperemesis syndrome reported to the French addictovigilance network. RESULTS: A systematic search through the three databases enabled us to identify 137 articles. Finally, 55 articles were selected as they involved reported cases. In total, 113 cases were reported in these 55 articles. We were thus able to analyse 29 reported French cases of cannabinoid hyperemesis syndrome. Cannabinoid hyperemesis syndrome mainly affects young male subjects who have been smoking cannabis daily for several years. Taking hot baths or showers is the most effective means of relieving the symptoms, while antiemetics and dopamine antagonists do not appear to effective for relieving nausea and vomiting. CONCLUSIONS: French cases display the same characteristics as the cases identified in the international literature. The pathophysiology of cannabinoid hyperemesis syndrome is unclear and several hypotheses have been put forward in the literature. We have only begun to characterise the syndrome, though there is an outbreak of cannabinoid hyperemesis syndrome in France.

[Gambling in elderly patients]. / Les jeux de hasard et d'argent chez les sujets âgés.

Behavioural addictions concern behaviour which generate pleasure (shopping, gambling, sex, etc.). Pathological gambling is the most common behavioural addiction in elderly people. It can be severely harmful causing psychological, financial and family problems and increasing the risk of suicide. Gambling addiction is underestimated in the elderly. Psychological, social and family support is important whatever the age, with treatment aiming to improve the person's quality of life, help them regain control of their gambling or stop altogether.

Inpatient Gamma-Hydroxybutyrate Detoxification: A Case Report Describing Day-to-day Therapeutic Management.

BACKGROUND: Gamma-hydroxybutyrate (GHB) is a synthetic drug increasingly used by consumers of psychoactive substances. The sought after psychoactive effects of GHB have resulted in an increase in recreational use in Europe. GHB is considered to have a high dependence potential, and abrupt discontinuation after long-term use can result in a severe withdrawal syndrome. Despite a large number of publications related to GHB withdrawal and detoxification, to date, no evidence-based protocol or consensual international therapeutic guidelines are available (over and above the administration of benzodiazepines). We hereby present a day-to-day description of inpatient GHB detoxification management, from admission to discharge. CASE SUMMARY: This case report pertains to a 47-year-old patient hospitalized for a severe GHB use disorder. The patient had independently made several unsuccessful attempts to stop GHB use. Following to these failures, the patient was oriented to our addiction department for inpatient detoxification. Withdrawal symptoms appeared 4 hours after the last dose of GHB, and consisted of diaphoresis, coenesthetic hallucinations, tremors, motor instability, tachycardia, and a hypertensive peak. Symptoms were successfully managed with diazepam titration and nonpharmacological treatment. The duration of hospitalization was 13 days. At discharge, detoxification was complete and the patient was engaged in relapse prevention therapy. Three months after discharge, the patient had maintained abstinence. CONCLUSIONS: GHB withdrawal, which can be severe, is better prevented or attenuated by daily medical monitoring and adjustment of treatment dosage. Failure of outpatient detoxification should be included in the indication criteria in the guidelines for inpatient detoxification.

[Concordance between hospital prescriptions and recommendations in the treatment of mania]. / Concordance entre prescriptions hospitalières et recommandations dans le traitement de la manie.

PURPOSE: There are differences between recommendations and practice in the pharmacological treatment of acute mania. OBJECTIVE: The objective was to assess conformity of the anti-manic prescription between national recommendations (Haute Autorité de santé [French health authority, HAS] and "résumé des caractéristiques du produit" [product characteristics, RCP]) and clinical practice. METHODS: We observed the drug prescriptions of in-patients for a manic episode. The main outcome measure was the concordance rate with the recommendations of the drugs prescriptions at the 48th hour. The secondary outcome repeated the same process with the hospital discharge statement of switches, associations, the presence of symptomatic and antidepressant treatments. RESULTS: Sixty-six episodes were included, 40 patients (60%) had a prescription complies with RCP recommendations H48 and 46 patients (70%) to HAS. These rates fall at hospital discharge. CONCLUSIONS: Off-label prescriptions, drug combinations and choices of not listed molecules are the most common reasons for non-conformity.

Using the Brief Assessment of Cognition in Schizophrenia (BACS) to assess cognitive impairment in older patients with schizophrenia and bipolar disorder.

OBJECTIVES: A growing body of evidence suggests that impairment in cognitive functioning is an important clinical feature of both schizophrenia and bipolar disorder, and that these cognitive alterations worsen with age. Although cognitive assessments are increasingly becoming a part of research and clinical practice in schizophrenia, a standardized and easily administered test battery for elderly patients with bipolar disorder is still lacking. The Brief Assessment of Cognition in Schizophrenia (BACS) captures those domains of cognition that are the most severely affected in patients with schizophrenia and the most strongly correlated with functional outcome. The primary aim of our study was to investigate the clinical usefulness of the BACS in assessing cognitive functioning in elderly euthymic patients with bipolar disorder, and to compare their cognitive profile to that of elderly patients with schizophrenia. METHODS: Elderly euthymic patients with bipolar disorder or schizophrenia were assessed using the BACS and a standard cognitive test battery. RESULTS: Fifty-seven elderly patients (aged 60 years and older) with bipolar disorder (n = 42) or schizophrenia (n = 15) were invited to participate. All of the patients were assessed by the BACS as being cognitively impaired. The patients with bipolar disorder scored significantly higher on the global scale and the verbal memory and attention sub-scores of the BACS than the patients with schizophrenia. DISCUSSION: The BACS appears to be a feasible and informative cognitive assessment tool for elderly patients with bipolar disorder. We believe that these preliminary results merit further investigation.

[Prevalence and issues of screening for alcohol consumption among elderly inpatients admitted to acute geriatric inpatient unit]. / Prévalence et enjeux du dépistage de la consommation d'alcool chez les personnes âgées hospitalisées en court séjour gériatrique.

BACKGROUND: alcohol use disorders in the elderly are often underdiagnosed in spite of their effects worsened by age-related physiological changes, comorbidities and frequent polymedication. OBJECTIVE: the aim of this study was to assess the prevalence of alcohol use in a geriatric acute care unit. SUBJECTS AND METHODS: a prospective and descriptive study was carried out in an acute care geriatric unit in France, from November 2011 to March 2012. It included inpatients aged 75 and older. We gathered medical data from medical records and conducted one-to-one interviews assessing the inpatients' weekly alcohol intake and personal history of alcohol use. We screened alcohol abuse and dependence by using parts of the MINI (Mini international neuropsychiatric interview). We also assessed benzodiazepine and tobacco consumption. Comprehensive geriatric assessment was conducted using the CIRS-G (cumulative illness scale in geriatrics), the MMSE (Mini mental state evaluation), the MNA (Mini nutritional assessment), the mini GDS (mini Geriatric depression scale) and the 4-IADL (4-Instrumental activities of daily living). Patients were dispatched in five groups according the DSM-IV-TR classification. RESULTS: the study included consicutively 100 inpatients (53 women and 47 men), with a mean age of 84.8±5.4 years. Forty-four percent had alcohol use disorders (29% at-risk users, 11% harmful users and 4% dependent). Very few inpatients with alcohol use disorders had been asked in the past about their alcohol consumption. They used benzodiazepine more often than the others. We did not find any differences in geriatric assessment when comparing the two sub-groups. CONCLUSION: alcohol use disorders are very common in elderly inpatients of acute geriatric care units, especially when considering the group of at-risk users. Alcohol use should thus be screened for every elderly inpatient.