Alain Dervaux

Substance abuse and suicidality in schizophrenia: a common risk factor linked to impulsivity.

Lifetime substance abuse comorbidity is frequent in schizophrenic patients, but the clinical correlates remain unclear. We have explored the chronological relations between substance abuse and course of schizophrenia, and compared several clinical characteristics and personality dimensions in 50 schizophrenic patients with or without lifetime substance abuse or dependence. Abuse occurred mainly after the first prodromal symptoms and just before the first psychotic episode. Substance-abusing patients were not different from non-substance-abusing patients on the Chapman Physical Anhedonia Scale, PANSS total score, negative subscore or depression item, CGI, treatment response and demographic variables. In contrast, substance-abusing patients had higher scores on the Barratt Impulsivity Scale (total, cognitive and non-planning scores) and had attempted suicide more often. In patients with schizophrenia, as in the general population, substance abuse or dependence appears associated with higher impulsivity and suicidality. High impulsivity could facilitate substance abuse as a maladaptive behavior in response to prodromal symptoms, precipitating the onset of a characterized psychosis.

Cannabis : usage et dépendance

The main characteristics of cannabis dependence are craving, persistent desire or unsuccessful efforts to cut down or control cannabis use and important social, occupational, or recreational activities given up or reduced because of cannabis use. Withdrawal symptoms include insomnia, irritability, anger, restlessness, depression, mood swings and cravings. Regular cannabis use induces cognitive impairment, especially of attention, episodic memory and working memory. Alcohol and other substances abuse or dependence are frequently found in patients with cannabis dependence. Psychiatric comorbidities are frequent in patients with cannabis dependence, in particular anxiety disorders, mood disorders, and personality disorders. The treatment of cannabis dependence includes behavioral psychotherapy, especially motivational interviewing and cognitive-behavioral therapy, alongside treatment of co-occurring mental health and substance use conditions. There are currently no available pharmacological treatment interventions for cannabis dependence. The treatment of cannabis dependence and withdrawal remains nonspecific.

Schizophrénie et dépendance aux amphétamines

Resume Nous rapportons le cas d’un patient souffrant de schizophrenie, qui a presente une dependance aux amphetamines durant 7 ans. La consommation a ete suivie d’une aggravation de l’activite delirante interpretative et hallucinatoire. De telles observations sont rares, la plupart des observations de troubles psychotiques associes a une dependance aux amphetamines etant generalement des troubles psychotiques induits par ces substances. Des etudes en dose unique ont montre que les amphetamines accentuaient les signes positifs de schizophrenie, en particulier les hallucinations, et tendent a reduire la symptomatologie negative. Il n’y a pas d’etudes evaluant les effets au long cours des amphetamines dans cette population. Les amphetamines pourraient avoir des effets cliniques et neurobiologiques prolonges.

Antidepressant Treatment and Smoking Cessation in Bipolar Disorder

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Military combat deployment and alcohol use.

coated tube (P=.06). We and others have demonstrated that the silver-coated endotracheal tube consistently influences outcomes in addition to colonization in preclinical and clinical studies. A study by Olson et al reported that the silver-coated endotracheal tube reduced colonization severity and histologic evidence of inflammation in the lungs of mechanically ventilated dogs challenged with Pseudomonas aeruginosa. Studies by Berra et al reported that another silver-coated tube reduced bacterial biofilm formation in vitro and prevented bacterial colonization and was associated with a thinner mucus layer in sheep and humans. In the NASCENT study, the silver-coated tube reduced not only the overall incidence of microbiologically confirmed VAP but also the incidence within 10 days of intubation and delayed VAP onset; the association between treatment group and each of these outcomes was significant in multivariate analyses (P .01). The lack of between-group differences in mortality and durations of mechanical ventilation, ICU stay, and hospital stay is probably attributable to the low VAP rate in the NASCENT study. The observed incidence of 7.5% in the control group was only half the expected rate of 15% that was used to estimate the target sample size for detecting betweengroup differences in the primary end point. Our study was clearly underpowered for analysis of secondary end points. Collectively, the findings from the NASCENT study and previous studies provide robust evidence that the silvercoated endotracheal tube is likely to benefit patients requiring at least 24 hours of intubation in institutions where VAP continues to occur despite other preventive measures. Moreover, the silver-coated tube is expected to be cost-effective based on the number needed to treat reported in NASCENT and high attributable cost of VAP. The break-even cost to avoid 1 case of VAP, calculated as VAP cost of

Troubles sexuels chez les patients schizophrènes, rôle des antipsychotiques

25 072 divided by a number needed to treat of 37, would be

La psychiatrie en 2030

678. Lastly, the silver-coated endotracheal tube may be more attractive than some other preventive measures because it does not require any special daily care by clinicians.

Mise au pointLe traitement par thiamine (vitamine B1) dans l’alcoolodépendanceThiamine (vitamin B1) treatment in patients with alcohol dependence

Points essentiels ● Bien que rarement signales spontanement, les troubles sexuels sont frequents chez les patients schizophrenes. ● Les troubles sexuels peuvent etre lies a la schizophrenie, aux traitements neuroleptiques et aux comorbidites psychiatriques, en particulier les troubles depressifs et les addictions. ● Les troubles sexuels induits par les antipsychotiques sont lies a leur action sur les recepteurs histaminiques, adrenergiques et dopaminergiques, en particulier les recepteurs dopaminergiques des voies tubero-infundibulaires a l’origine d’une augmentation de la secretion de prolactine.

Le traitement par thiamine (vitamine B1) dans l’alcoolodépendance

La Presse Medicale - In Press.Proof corrected by the author Available online since jeudi 16 janvier 2014

Torsade de Pointes Associated With Laxative Abuse in a Patient Receiving Methadone

Thiamine deficiency (vitamin B1) is common in patients with alcohol dependence. Cognitive impairments may be an early consequence of thiamine deficiency. Wernickes encephalopathy is underdiagnosed and undertreated. In patients with established Wernickes encephalopathy, parenteral thiamine 200-500mg three times a day should be given for 3-5 days, followed by oral thiamine 250-1000mg/day. In patients with suspected Wernickes encephalopathy, parenteral thiamine 250-300mg should be given two times a day for 3-5 days, followed by oral thiamine 250-300mg/day. In patients at high risk of thiamine deficiency, parenteral thiamine 250-500mg/day should be given for 3-5 days, followed by oral thiamine 250-300mg/day. In patients at low risk (with uncomplicated alcohol dependence), oral thiamine 250-500mg/day should be given for 3-5 days, followed by oral thiamine 100-250mg/day.