Aymeric Petit

Sexual addiction or hypersexual disorder: different terms for the same problem? A review of the literature.

Sexual addiction, which is also known as hypersexual disorder, has largely been ignored by psychiatrists, even though the condition causes serious psychosocial problems for many people. A lack of empirical evidence on sexual addiction is the result of the diseases complete absence from versions of the Diagnostic and Statistical Manual of Mental Disorders. However, people who were categorized as having a compulsive, impulsive, addictive sexual disorder or a hypersexual disorder reported having obsessive thoughts and behaviors as well as sexual fantasies. Existing prevalence rates of sexual addiction-related disorders range from 3% to 6%. Sexual addiction/ hypersexual disorder is used as an umbrella construct to encompass various types of problematic behaviors, including excessive masturbation, cybersex, pornography use, sexual behavior with consenting adults, telephone sex, strip club visitation, and other behaviors. The adverse consequences of sexual addiction are similar to the consequences of other addictive disorders. Addictive, somatic and psychiatric disorders coexist with sexual addiction. In recent years, research on sexual addiction has proliferated, and screening instruments have increasingly been developed to diagnose or quantify sexual addiction disorders. In our systematic review of the existing measures, 22 questionnaires were identified. As with other behavioral addictions, the appropriate treatment of sexual addiction should combine pharmacological and psychological approaches. Psychiatric and somatic comorbidities that frequently occur with sexual addiction should be integrated into the therapeutic process. Group-based treatments should also be attempted.

Excessive Indoor Tanning as a Behavioral Addiction: A Literature Review

BACKGROUND Socially valorized, excessive indoor tanning can lead to dependence. This finding is based on the observations of many dermatologists, who report repeated failures in preventing their patients from visiting tanning cabins, despite the announcement of a diagnosis of malignant melanoma. OBJECTIVE The objective of this paper is to show that excessive indoor tanning can be included in the spectrum of addictive behavior. This review focuses on the clinical features, diagnosis, prevalence, etiology, treatment, prevention, and psychopathology of this disorder. METHODS A review of the medical literature was conducted using PubMed and Google Scholar and using the following key words alone or in combination: tanning, addiction, dependence, tanning bed, sun exposure, and solarium. We selected 41 English-language articles from 1974 to 2013. RESULTS Many excessive indoor tanners meet symptom criteria adapted from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) substance abuse and dependence criteria. Trial studies suggest that there may be a physiological basis, consisting of dependence on opioids, for excessive indoor tanning behaviors. CONCLUSION Excessive indoor tanning can be included in the spectrum of addictive behaviors, although other models may be proposed. Further controlled studies must be performed, especially in neurobiology and imaging, to improve our understanding of tanning dependence.

Exercise dependence among customers from a Parisian sport shop

AIM OF THE STUDY We assessed exercise dependence (ED), alcohol and nicotine use disorders, eating disorders, hypochondria and compulsive buying and in a population of customers of a Parisian sport shop. METHODS Five hundred consecutive customers of a sport shop were invited to participate. Diagnostic of exercise dependence was made with the Exercise Addiction Inventory and a specific questionnaire checking all diagnostic criteria. The DSM-IV-TR criteria for bulimia, alcohol and nicotine use disorders were checked and all subjects answered the CAGE and Fagerström questionnaires. Hypochondria was assessed with the DSM-IV-TR criteria and the Whiteley Index of Health Anxiety. For all parameters, customers with (ED+) and without (ED-) exercise dependence were compared. RESULTS The prevalence of exercise dependence was 29.6%. Subjects from the ED+ group were younger than in the ED-group (27.1 vs 29.8 years) and there were more women. They were more dependent on alcohol, had higher scores at the CAGE questionnaire. ED+ subjects more often presented hypochondria (23 vs 15%), bulimia and binge eating and they more often made gifts to themselves and to others. CONCLUSIONS Exercise dependence appears as a frequent and almost always unrecognized form of behavioral dependence in non clinical population frequenting sport shops. It is frequently associated to chemical dependence and eating disorders.

Methamphetamine Addiction: A Review of the Literature

Methamphetamine, a synthetically produced central nervous system stimulant, is the second most illicit drug world- wide after cannabis. This drug has an annual global prevalence estimated at 0.4%, and its use is important in North America, Asia, and Oceania. Literature review was conducted from 1989 to 2011, using PubMed, Google Scholar, EMBASE, and PsycInfo, using the following key words alone or in combination: methamphetamine, addiction, dependence, complications, and pharmacotherapy. Methamphetamine addiction is a serious public health problem with many consequences and complications. Significant morbidity, including cardiovascular, infectious, pulmonary, dental diseases and other systems complications are associated with methamphetamine acute or chronic use. Methamphetamine dependence also causes serious cognitive impairments that can persist during abstinence and negatively affect recovery outcomes. There are no approved medications for the treatment of methamphetamine dependence. Efficient treatments include behavioural and psychological approaches of contingency management, cognitive-behavioural therapy, and motivational enhancement strategies.

Addiction à la cocaïne : données actuelles pour le clinicien

Cocaine remains the second most commonly used illicit drug worldwide after cannabis. Observed levels of cocaine use among countries considerably vary. An increased cocaine use is recorded in the general European population. Cocaine addiction is a worldwide public health problem, which has somatic, psychiatric, socio-economic and judicial complications. It is a multifactorial disorder variable in its clinical manifestations and heritable. Compared to the general population, there is a high prevalence of somatic and psychiatric disorders among cocaine-dependent patients. There are predictable dose-related effects of pharmacological action of cocaine and effects which are uncommon, unrelated to dose and occur randomly in this population. The number of patients entering drug treatment for primary cocaine use has been increasing in Europe for several years. However, there is no specific pharmacotherapy with established efficacy for the treatment of cocaine addiction, nor is any medication approved by regulatory authorities for such treatment. Recent controlled clinical studies and laboratory studies have highlighted some very promising medications. The perfect therapeutic platform for abstinence initiation and relapse prevention of cocaine addiction is a combination of pharmacological treatments and behavioral treatments. Targeting somatic and psychiatric comorbidity is another way to use pharmacological treatments in addictions.

An Investigation of Factors Increasing the Risk of Aggressive Behavior among Schizophrenic Inpatients

Aim of the study: This study tried to identify risk factors of aggressive behavior in a population of schizophrenic inpatients. We tested the association between aggressive behavior and socio-demographic characteristics, addictive disorders, history of suicide attempt, and sexual violence, impulsivity, and sensation seeking. Methods: All consecutive schizophrenic inpatients (100) were assessed during 6 months. Aggressive behavior was quantified with a standardized scale, the Overt Aggression Scale (OAS). We studied socio-demographic characteristics and the history of suicide attempt and sexual violence with a specific standardized questionnaire. Addictive disorders were identified with the Fagerström and CAGE questionnaires and with the DSM-IV-R diagnostic criteria for nicotine, alcohol, cannabis opiates, and cocaine abuse and dependence disorders. Lastly, we studied sensation seeking with the Zuckerman scale and impulsivity with the Barratt scale. Results: Linear regression identified four factors associated with aggressive behavior: male gender (odd ratio = 12.8), history of sexual violence (odd ratio = 3.6), Fagerström score (odd ratio = 1.3), number of cigarettes smoked each day (odd ratio = 1.16). Patients with nicotine use or dependence had significantly higher levels of OAS scores. This difference was not observed between patients with or without alcohol dependence. OAS scores were correlated to the number of cigarettes smoked each day and to Fagerström scores. Patients with a higher level of sensation seeking and impulsivity also had higher OAS scores. Conclusion: A typical schizophrenic patient at risk of showing aggressive behavior is a man, who smokes and presents a history of sexual violence.

Phenomenology and psychopathology of excessive indoor tanning.

Excessive indoor tanning, defined by the presence of an impulse towards and repetition of tanning that leads to personal distress, has only recently been recognized as a psychiatric disorder. This finding is based on the observations of many dermatologists who report the presence of addictive relationships with tanning salons among their patients despite being given diagnoses of malignant melanoma. This article synthesizes the existing literature on excessive indoor tanning and addiction to investigate possible associations. This review focuses on the prevalence, clinical features, etiology, and treatment of this disorder. A literature review was conducted, using PubMed, Google Scholar, EMBASE and PsycINFO, to identify articles published in English from 1974 to 2013. Excessive indoor tanning may be related to addiction, obsessive‐compulsive disorder, impulse control disorder, seasonal affective disorder, anorexia, body dysmorphic disorder, or depression. Excessive indoor tanning can be included in the spectrum of addictive behavior because it has clinical characteristics in common with those of classic addictive disorders. It is frequently associated with anxiety, eating disorders, and tobacco dependence. Further controlled studies are required, especially in clinical psychopathology and neurobiology, to improve our understanding of excessive indoor tanning.

Consommation de tabac et trouble lié à l’usage de substances illicites : que devrions-nous faire ?

UNLABELLED Tobacco use is a commonplace phenomenon in our society. Its use is responsible for more death and disease than any other noninfectious cause. More deaths are caused each year by tobacco use than by all deaths from HIV, illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined. Tobacco remains responsible for greater morbidity than alcohol and all other drugs combined. Tobacco dependence is highly prevalent among drug-dependent patients. Substance abuse patients smoke more and are more vulnerable to the effects of smoking than general populations. Traditional substance abuse therapeutic programs too frequently focus only on treatment of alcohol or other drugs rather than including treatment for tobacco dependence. Currently, there are no official medical recommendations for the treatment of tobacco addiction in illicit polysubstance users. METHODS A comprehensive literature search from a range of electronic databases (PubMed, Embase, PsycInfo, Google Scholar) was conducted for the period from 1988 to September 2012, using the following keywords alone or in combination: tobacco, nicotine, cocaine, cannabis, amphetamines, opiates, substance abuse, substance dependence, addiction, treatment. There were no restrictions on the identification or inclusion of studies in terms of publication status, language and design type. RESULTS Our literature review will focus on epidemiological, neurobiological, clinical interactions between tobacco, alcohol and other illicit drugs. It will also focus on therapeutic programs in this dual addictive disorder. The aim of this literature review is to make proposals for the treatment of tobacco addiction in polysubstance users entering in specific therapeutic programs.

Mise au pointAddiction à la cocaïne : un facteur de risque de suicide ?Addiction to cocaine: A risk factor for suicide?

Cocaine is an illicit substance which is the greatest suicide-induced potential. Studies show a link between cocaine dependence and suicide. The prevalence of its use, in the days leading up to a suicide, may vary as between 9.4 and 20% according to the chosen method. The number of suicides is important. The acting out may be present at all stages of the addictive cycle associated with cocaine. On the 12th National Day on Suicide Prevention devoted to addictions and suicide, it was recommended that addictive phenomena should be taken more into account by experts in the subject, and that the risk of suicide should be evaluated by specialists in addiction in order that people presenting a risk be placed in appropriate preventative care in time.

Nicotine Dependence among Patients Examined in Emergency after a Suicide Attempt

Background: To assess the prevalence of nicotine dependence in a population of patients examined following a suicide attempt and to compare suicide attempts with and without nicotine dependence. Methods: 200 patients were examined in an emergency department after a suicide attempt. They answered the MAST and the Fagerstrom questionnaire, and the DSM-IV-TR criteria for alcohol and nicotine were checked. We also assessed socio-demographic characteristics, the mode of suicide attempt and level of sensation seeking. Results: The prevalence of nicotine dependence was 57% among suicide attempters. Suicide attempters with nicotine dependence were more often men (42 vs. 12%, p=0.001), single (67 vs. 32%, p=0.008) and had taken alcohol before suicide. They were often multi-attempters (2.7 vs. 1 suicide attempt in their history) and had been more often hospitalized in psychiatry (1.9 vs. 0.6 hospitalization, p<0.001) than others. They drank more alcohol (3.7 vs. 0.7 drinks/ day, p<0.001), presented more alcohol dependence and abuse (36 vs. 8%, p<0.00001) and had a higher level of sensation seeking. Factors associated to nicotine dependence were male gender, ingestion of alcohol before suicide attempt, number of previous suicide attempts and number of alcohol intoxication per week. Conclusion: 57% of the patients examined after a suicide attempt present nicotine dependence. Emergency units may provide an opportunity to systematically identify a dependence disorder and to offer appropriate information and treatment.