Baptiste Pignon

Baclofen for alcohol dependence: Relationships between baclofen and alcohol dosing and the occurrence of major sedation

High-dose baclofen, i.e., 300 mg/d or more, has recently emerged as a strategy for treating alcohol dependence. The impact that the co-exposure of large amounts of alcohol and baclofen has on sedation is unclear. In a prospective cohort of 253 subjects with alcohol dependence, we collected daily alcohol and baclofen doses across the first year of baclofen treatment and the monthly maximum subjective sedation experienced by each patient (0-10 visual analog scale). For each patient-month, we determined the average weekly alcohol consumption (AWAC; standard-drinks/week) and the maximum daily dose of baclofen (DDB; mg/d). The occurrence of an episode of major sedation (EMS) during a patient-month was defined as a sedation score ≥7. The relationship between the EMS occurrence and the concurrent AWAC and DDB was investigated using a generalized estimating equation model. In total, 1528 patient-months were compiled (70 with an EMS). Univariate analyses demonstrated that the rate of patient-month to EMS increased gradually with AWAC (p<0.001), from 0.9% for AWAC=0 to 9.4% for AWAC >35. There was also a significant gradual risk for EMS associated with DDB (<0.001). Multivariate analysis demonstrated a significant interaction between DDB and AWAC on EMS risk (p=0.047). Each 20mg/d increase in DDB was associated with an OR of EMS in AWAC >35 of 1.22 (95%CI, 1.08-1.38) versus 1.11 (95%CI, 0.96-1.29) in AWAC=1-35, and 0.95 (95%CI, 0.76-1.19) in AWAC=0. The level of sedation observed in patients using baclofen for alcohol dependence appears to directly depend on the immediate doses of both the baclofen and the alcohol.

Prevalence and clinical severity of mood disorders among first-, second- and third-generation migrants

BACKGROUND The role of migration as a risk factor remains unknown for mood disorders because of poor data. We sought to examine the prevalence and severity of mood disorders (bipolar disorder (BD), unipolar depressive disorder (UDD) and dysthymia) in first, second, and third generation migrants in France. METHODS The Mental Health in the General Population survey interviewed 38,694 individuals. The prevalence of lifetime mood disorders, comorbidities, and clinical features was compared between migrants and non-migrants and by generation. All analyses were adjusted for age, sex and level of education. RESULTS The prevalence of any lifetime mood disorder was higher in migrants compared with non-migrants (OR = 1.36, 95% CI [1.27 - 1.45]). This increased prevalence was significant for UDD (OR = 1.44, 95% CI [1.34 - 1.54]), but not for BD (OR = 1.15, 95% CI [0.96 - 1.36]) or dysthymia (OR = 1.09, 95% CI [0.94 - 1.27]), although the prevalence of BD was increased in the third generation (OR = 1.27, 95% CI [1.01 - 1.60]). Migrants with BD or UDD were more likely to display a comorbid psychotic disorder compared to non-migrants with BD or UDD. Cannabis-use disorders were more common in migrant groups for the 3 mood disorders, whereas alcohol-use disorders were higher in migrants with UDD. Posttraumatic stress disorder was more frequent among migrants with UDD. LIMITATIONS The study used cross-sectional prevalence data and could be biased by differences in the course of disease according to migrant status. Moreover, this design does not allow causality conclusion or generalization of the main findings. CONCLUSION Mood disorders are more common among migrants, especially UDD. Moreover, migrants with mood disorders presented with a more severe profile, with increased rates of psychotic and substance-use disorders.

The dose–effect relationship of baclofen in alcohol dependence: A 1-year cohort study

Our aim is to study the relationship between dose of baclofen and effectiveness in alcohol dependence.

Dependence on Internet-Purchased Ethylphenidate.

downregulates AQP-2 expression through prostaglandin E2 activation. Thus, 1 cellular mechanism, GSK-3 inhibition through its serine phosphorylation, which attributed a central role in lithium therapeutic response, seems to be also responsible for one of its major adverse effects. In treatment-resistant depression, the rate of response to lithium adjunctive strategy is estimated around 40% to 50%with a mean response rate of 41%, which roughly corresponds to the frequency of polyuria polydipsia adverse effect. Integration of this knowledge suggests that polyuria may be an early predictive sign of the response to lithium in mood disorder.

A latent class analysis of psychotic symptoms in the general population

Objective: Individuals with psychotic symptoms may actually correspond to various subgroups, characterized by different patterns of psychotic symptoms as well as specific sociodemographic and clinical correlates. We aimed to identify groups of individuals from the general population with specific patterns of psychotic symptoms. Methods: In a 38,694-subject survey, a latent class analysis was performed to identify subgroups based on the distribution of seven psychotic symptoms taken from the Mini International Neuropsychiatric Interview. The different classes were subsequently compared according to sociodemographic and clinical correlates. Results: The best fit was obtained with a four-class solution, including the following: (1) a class with a low prevalence of all psychotic symptoms (‘LOW’, 85.9%); (2) a class with a high prevalence of all psychotic symptoms (‘HAL + DEL’, 1.7%); and classes with a high prevalence of (3) hallucinations (‘HAL’, 4.5%) or (4) delusions (‘DEL’, 7.9%). The HAL + DEL class displayed higher rates of history of trauma, social deprivation and migrant status, while the HAL and DEL classes displayed intermediate rates between HAL + DEL and LOW. HAL + DEL displayed the highest rates of psychotic and non-psychotic disorders and the use of mental health treatment, while HAL and DEL displayed intermediate rates of these disorders between HAL + DEL and LOW. In comparison to the HAL class, psychotic and substance use disorders were more frequent in the DEL class, while anxiety and mood disorders were less frequent. Conclusion: These findings support the hypothesis of a continuum model relating the level of psychotic symptoms to the level of global psychopathology.

Spatial distribution of psychotic disorders in an urban area of France: an ecological study

Previous analyses of neighbourhood variations of non-affective psychotic disorders (NAPD) have focused mainly on incidence. However, prevalence studies provide important insights on factors associated with disease evolution as well as for healthcare resource allocation. This study aimed to investigate the distribution of prevalent NAPD cases in an urban area in France. The number of cases in each neighbourhood was modelled as a function of potential confounders and ecological variables, namely: migrant density, economic deprivation and social fragmentation. This was modelled using statistical models of increasing complexity: frequentist models (using Poisson and negative binomial regressions), and several Bayesian models. For each model, assumptions validity were checked and compared as to how this fitted to the data, in order to test for possible spatial variation in prevalence. Data showed significant overdispersion (invalidating the Poisson regression model) and residual autocorrelation (suggesting the need to use Bayesian models). The best Bayesian model was Leroux’s model (i.e. a model with both strong correlation between neighbouring areas and weaker correlation between areas further apart), with economic deprivation as an explanatory variable (OR = 1.13, 95% CI [1.02–1.25]). In comparison with frequentist methods, the Bayesian model showed a better fit. The number of cases showed non-random spatial distribution and was linked to economic deprivation.

Prevalence and predictors of no lifetime utilization of mental health treatment among people with mental disorders in France: findings from the ‘Mental Health in General Population’ (MHGP) survey

PurposeNo lifetime utilization of mental health treatment (NUMT) is an indicator of the treatment gap among people in need of treatment. Until now, the overall prevalence and predictors of NUMT have never been explored in France.MethodsIn a 39,617-respondent survey, participants were assessed for NUMT, i.e., no lifetime psychotherapy, psychopharmacotherapy, or psychiatric hospitalization. Mental disorders were investigated using the Mini International Neuropsychiatric Interview (MINI 5.0.0). MINI diagnoses were grouped into five categories: mood disorders (MDs); anxiety disorders (ADs); alcohol use disorders (AUDs); substance use disorders (SUDs); and psychotic disorders (PDs). Using multivariable logistic regression models, we explored the factors associated with NUMT among the MINI-positive respondents. The odds ratio and 95% confidence interval were calculated for each factor.ResultsIn total, 12,818 (32.4%) respondents were MINI-positive, 46.5% of them reported NUMT (35.6% for MDs, 39.7% for PDs, 42.8% for ADs, 56.0% for AUDs, and 56.7% for SUDs). NUMT was positively associated with being male [OR 1.75 (1.59–1.91)] and practising religion [OR 1.13 (1.02–1.25)] and negatively associated with ageing [per 10-year increase: OR 0.88 (0.85–0.91)], being single [OR 0.74 (0.66–0.84)], being a French native [OR 0.67 (0.60–0.75)], and experiencing MDs [OR 0.39 (0.36–0.43)], ADs [OR 0.47 (0.43–0.52)], AUDs [OR 0.83 (0.73–0.96)], SUDs [OR 0.77 (0.65–0.91)], or PDs [OR 0.50 (0.43–0.59)].ConclusionsIn France, NUMT rates were the highest for AUDs and SUDs. Additionally, suffering from MDs or ADs increased the lifetime treatment utilization for people having any other mental disorder. This finding emphasizes the need to better screen AUDs and SUDs among people treated for MDs or ADs.

T132. ASSESSMENT OF CROSS-NATIONAL EQUIVALENCE OF THE COMMUNITY ASSESSMENT OF PSYCHIC EXPERIENCES (CAPE)

Abstract Background The Community Assessment of Psychic Experiences (CAPE) is a self-report questionnaire that has been developed to measure the dimensions of psychosis in the general population. The cross-national equivalence of a questionnaire allows the comparability of a scale across different populations in different countries, i.e., using different versions of the scale according to the considered language. In this study, our aim was to investigate the equivalence of the CAPE across different countries. Methods Data were drawn from the European Union Gene-Environment Interaction (EU-GEI) study. Participants (incident case of psychotic disorder, controls and siblings of cases) were recruited across in six countries: United Kingdom, the Netherlands, Italy, Spain, Brazil and France. To analyse the cross-national equivalence of the dichotomised version of the CAPE, we used the multigroup categorical confirmatory factory analysis (MCCFA). The cross-national equivalence can be stated after the establishment of three invariances characterised by increased constraints: the configural invariance, the metric invariance and the scalar invariance across the multiples groups. Results The configural invariance model fits well, providing evidence for identical factor structure across countries. The assumption that factor loadings are identical across countries is granted based on the negligible change in the fit indices in the metric invariance model. Moreover, the fit indices suggest that the CAPE shows scalar invariance across countries. Discussion These findings suggest that comparisons across countries of factor and observed means of the CAPE are possible. Thus, differences observed in scores between samples from different countries can be considered as different levels of psychosis.

T103. ODIP (OUTIL DE DIAGNOSTIC INFORMATISé DES PSYCHOSES / PSYCHOSIS COMPUTERIZED DIAGNOSTIC TOOL): A NEW, SIMPLE METHOD FOR GENERATING DSM DIAGNOSES FOR PSYCHOTIC DISORDERS

Abstract Background OPCRIT was designed as a powerful tool to diagnose psychotic and affective psychoses. It has been frequently used in international psychiatric research. However, with 90 items it is time-consuming to complete and the diagnoses provided include many which are no longer used. Furthermore, this application is no updated for certain operating systems or psychiatric classifications. For these reasons, we have developed, a similar but much simpler tool focused on DSM classification of affective and non-affective psychoses. Methods ODIP is based on the DSM-IV psychotic disorders classification, focusing on psychotic disorders (affective and non-affective). We identified 13 criteria that allow for the distinction between affective disorders with psychotic features (Bipolar or Depressive episode), schizophrenia, schizophreniform, schizoaffective, delusional, brief or non-specified psychotic disorders. We also designed a form to collect data on these 13 items. To assess how ODIP performs we tested it against the more complete OPCRIT and discordances in diagnosis were compared with the clinical diagnosis or, in a subsample of patients, with a research diagnosis. This was done in a total sample of 464 patients with a first episode of psychosis. First, we observed that only 34 out of 90 OPCRIT items are required to obtain a coherent DSM-IV diagnosis and that we could complete the items automatically using an algorithm based on the ODIP form. All the process was first tested with 212 patients to avoid any computer generated errors. Then we compared results for all patients together and discordance between ODIP and OPCRIT diagnosis was then analysed to determine which corresponded better to the Clinician’s diagnosis when available (unavailable for 17 patients with discordant diagnoses). Results 88.2% of diagnoses for the 364 patients were equivalent when comparing ODIP and OPCRIT results. For the discordant diagnoses most of them (7.2%) were so mainly because of lack of needed information and when one of the systems provided a wrong diagnosis it was more often the OPCRIT (4.1%) than ODIP (0.5%). Discussion We demonstrated the ability of our 13 item ODIP tool to provide more reliable diagnosis than OPCRIT in the context of first episode psychosis with no organic or toxic origin. Limitations This tool was not intended to assess affective disorder diagnosis but only specify the diagnosis for the episode. As yet it was tested only on first psychotic episodes. The primary interest of this new tool is the speed of administration and the relatively simple algorithm implemented in an excel file and available from the authors on request.

Increased prevalence of anxiety disorders in third-generation migrants in comparison to natives and to first-generation migrants

INTRODUCTION We sought to examine the prevalence of anxiety disorders associated with migration in the first-, second- and third-generation. METHODS The French Mental Health in the General Population cross-sectional survey interviewed 38,694 individuals using the MINI. The prevalence of lifetime anxiety disorders, and comorbidities was compared between migrants and non-migrants and by generation. All analyses were adjusted for age, sex, and income and education levels. RESULTS In comparison to natives, pooled anxiety disorders were more common among migrants (25.3% vs. 20.7%, OR = 1.24) and among the three studied generations of migrants. Moreover, the prevalence rate of the pooled anxiety disorders was significantly higher in third-generation migrants, in comparison to first-generation (26.7% vs. 22.6%, OR = 1.14). Prevalence rates were higher in migrants for panic disorder (6.6% vs. 5.3%, OR = 1.20), general anxiety disorder (15.0% vs. 12.0%, OR = 1.24), posttraumatic stress disorder (1.0% vs. 0.6%, OR = 1.51), but not for social anxiety disorder. In comparison to natives, migrants with anxiety disorders had higher prevalence rates of suicide attempts (14.0% vs. 12.8% for natives), psychotic disorders (8.3% vs. 5.7%), unipolar depressive disorder (29.5% vs. 25.4%), bipolar disorder (5.0% vs. 4.0%), and addictive disorders (9.6% vs. 6.2% for alcohol use disorder, 8.2% vs. 4.1% for substance use disorders). CONCLUSION Migration was associated with a higher prevalence of all anxiety disorders, in the first, second and third generation, and associated with more psychiatric comorbidities. Moreover, the prevalence increased across generations, and was significantly higher among third-generation migrants, in comparison to first-generation.