Cécile Dantzer

Anxiety and depression in juvenile diabetes: a critical review.

A critical examination of the recent literature on anxiety and depression in juvenile diabetes is presented. The objectives of this review are: (1) to determine the general association of psychological factors, especially anxiety and depression, with diabetes, (2) to examine the specific association of anxiety and depression with metabolic control, and (3) to propose methodological changes that are needed to advance future research in this field. The major conclusions of this review support the notion of a general association of psychological disorders with juvenile diabetes. However, while anxiety and depression appear to play an important and complex role in determining adaptation to the disease, their relationship to metabolic control does not yet appear clear. Additional prospective and controlled studies as well as multivariate models of chronic disease are now necessary to more fully understand the etiology and impact of these disorders in the adolescent population.

International study of heavy drinking: attitudes and sociodemographic factors in university students.

Abstract. The authors studied the prevalence of heavy drinking among students in 21 developed and developing countries using an anonymous survey of 7,846 male and 9,892 female students aged 17 to 30 years. There were wide variations in the prevalence of drinking among countries, and the highest rates of heavy drinking (defined as 5 or more drinks for men and 4 or more drinks for women on at least 1 occasion over the past 2 weeks) were reported in Belgium, Colombia, Ireland, and Poland (men), and Ireland and England (women). Heavy drinking was associated with living away from home, having a wealthier family background, and having well-educated parents. Beliefs about the dangers to health of excessive consumption were negatively related to heavy drinking. Heavy drinking is a concern among students in several countries and is associated with greater affluence. Challenging beliefs concerning health risks is a crucial aspect of prevention in this population.

Chronic vagus nerve stimulation in Crohn's disease: a 6-month follow-up pilot study

The vagus nerve (VN) is a link between the brain and the gut. The VN is a mixed nerve with anti‐inflammatory properties through the activation of the hypothalamic–pituitary–adrenal axis by its afferents and by activating the cholinergic anti‐inflammatory pathway through its efferents. We have previously shown that VN stimulation (VNS) improves colitis in rats and that the vagal tone is blunted in Crohns disease (CD) patients. We thus performed a pilot study of chronic VNS in patients with active CD. Seven patients under VNS were followed up for 6 months with a primary endpoint to induce clinical remission and a secondary endpoint to induce biological (CRP and/or fecal calprotectin) and endoscopic remission and to restore vagal tone (heart rate variability). Vagus nerve stimulation was feasible and well‐tolerated in all patients. Among the seven patients, two were removed from the study at 3 months for clinical worsening and five evolved toward clinical, biological, and endoscopic remission with a restored vagal tone. These results provide the first evidence that VNS is feasible and appears as an effective tool in the treatment of active CD.

Relationship between vagal tone, cortisol, TNF-alpha, epinephrine and negative affects in Crohn's disease and irritable bowel syndrome.

Crohn’s disease (CD) and irritable bowel syndrome (IBS) involve brain-gut dysfunctions where vagus nerve is an important component. The aim of this work was to study the association between vagal tone and markers of stress and inflammation in patients with CD or IBS compared to healthy subjects (controls). The study was performed in 73 subjects (26 controls, 21 CD in remission and 26 IBS patients). The day prior to the experiment, salivary cortisol was measured at 8∶00 AM and 10∶00 PM. The day of the experiment, subjects completed questionnaires for anxiety (STAI) and depressive symptoms (CES-D). After 30 min of rest, ECG was recorded for heart rate variability (HRV) analysis. Plasma cortisol, epinephrine, norepinephrine, TNF-alpha and IL-6 were measured in blood samples taken at the end of ECG recording. Compared with controls, CD and IBS patients had higher scores of state-anxiety and depressive symptomatology. A subgroup classification based on HRV-normalized high frequency band (HFnu) as a marker of vagal tone, showed that control subjects with high vagal tone had significantly lower evening salivary cortisol levels than subjects with low vagal tone. Such an effect was not observed in CD and IBS patients. Moreover, an inverse association (r = −0.48; p<0.05) was observed between the vagal tone and TNF-alpha level in CD patients exclusively. In contrast, in IBS patients, vagal tone was inversely correlated with plasma epinephrine (r = −0.39; p<0.05). No relationship was observed between vagal tone and IL-6, norepinephrine or negative affects (anxiety and depressive symptomatology) in any group. In conclusion, these data argue for an imbalance between the hypothalamus-pituitary-adrenal axis and the vagal tone in CD and IBS patients. Furthermore, they highlight the specific homeostatic link between vagal tone and TNF-alpha in CD and epinephrine in IBS and argue for the relevance of vagus nerve reinforcement interventions in those diseases.

The link between negative affect, vagal tone, and visceral sensitivity in quiescent Crohn's disease.

Autonomic dysfunction and mood disorders are frequently described in Crohns disease (CD) and are known to influence visceral sensitivity. We addressed the link between vagal tone, negative affect, and visceral sensitivity in CD patients without concomitant features of irritable bowel syndrome (IBS). Rectal distensions to a discomfort threshold of 70% and onset of pain were performed in nine CD patients in remission and eight healthy controls. Autonomic parameters were evaluated with heart rate variability and electrodermal reactivity. We showed that CD patients had (i) higher scores of depressive symptomatology (12 ± 3 in patients vs 4 ± 1 in controls on the Center for Epidemiologic Studies‐Depression Scale; p = 0.038), (ii) reduced vagal tone (HF 257 ± 84 ms2 vs 1607 ± 1032 ms2, p = 0.043; LF 455 ± 153 ms2 vs 1629 ± 585 ms2, p = 0.047), (iii) decreased sympathetic reactivity during an aversive stimulus, and (iv) higher tolerance to rectal distension pressures (43 ± 3 mmHg vs 30 ± 2 mmHg, p = 0.002) and low sensitivity index scores. In conclusion, our results provide preliminary evidence that patients with quiescent CD, in the absence of IBS, are hyposensate to experimental rectal distension. These data provide further evidence that anxiety and depressive symptomatology in addition to autonomic dysfunction modulate visceral pain perception in quiescent CD patients in the absence of IBS.

Do (un)certainty appraisal tendencies reverse the influence of emotions on risk taking in sequential tasks

According to the Appraisal-Tendency Framework (Han, Lerner, & Keltner, 2007), certainty-associated emotions increase risk taking compared with uncertainty-associated emotions. To date, this general effect has only been shown in static judgement and decision-making paradigms; therefore, the present study tested the effect of certainty on risk taking in a sequential decision-making task. We hypothesised that the effect would be reversed due to the kind of processing involved, as certainty is considered to encourage heuristic processing that takes into account the emotional cues arising from previous decisions, whereas uncertainty leads to more systematic processing. One hundred and one female participants were induced to feel one of three emotions (film clips) before performing a decision-making task involving risk (Game of Dice Task; Brand et al., 2005). As expected, the angry and happy participants (certainty-associated emotions) were more likely than the fearful participants (uncertainty-associated emotion) to make safe decisions (vs. risky decisions).

Evaluating short-term and working memory in older adults: French normative data

Short-term and working memory (WM) capacities are subject to change with ageing, both in normal older adults and in patients with degenerative or non-degenerative neurological disease. Few normative data are available for comparisons of short-term and WM capacities in the verbal, spatial and visual domains. To provide researchers and clinicians with a set of standardised tasks that assess short-term and WM using verbal and visuospatial materials, and to present normative data for that set of tasks. The present study compiled normative French data for three short-term memory tasks (verbal, visual and spatial simple span tasks) and two WM tasks (verbal and spatial complex span tasks) obtained from 445 healthy older adults aged between 55 and 85 years. Our data reveal main effects of age, education level and gender on older adults’ short-term and WM performances. Equation-based normalisation can therefore be used to take these factors into account. The results provide a set of cut-off scores for five standardised tasks that can be used to determine the presence of short-term or WM impairment in older adults.

Brain responses to uncertainty about upcoming rectal discomfort in quiescent Crohn's disease – a fMRI study

Patients with Crohns disease (CD) in remission are exposed to chronic psychological distress, due to the constant risk of relapse. This permanent situation of anticipation and uncertainty can lead to anxiety, which may, in turn, trigger relapse. We aimed to investigate the effects of uncertainty on behavioral and brain responses to anticipation of visceral discomfort in quiescent CD patients.

Toward a Definition of a Global Psycho-Physiological Criterion of Vulnerability to Relapse in Inflammatory Bowel Diseases

Toward a Definition of a Global Psycho-Physiological Criterion of Vulnerability to Relapse in Inflammatory Bowel Diseases

Emotional overactivity in patients with irritable bowel syndrome

Negativity is often observed in patients with irritable bowel syndrome (IBS). No study has examined their emotional expressiveness as a marker of emotional reactivity. We investigated IBS patients’ vulnerability to an emotional load by associating their expressiveness with psychological and neurophysiological assessments. We hypothesized that IBS would be characterized by a lack of expressiveness coupled with high scores in psychological and neurophysiological parameters.