Laurent Karila

Career choices of medical students: a national survey of 1780 students.

Medical Education 2010: 44: 603–612

Is love passion an addictive disorder

Aims: Inquiry regarding the relationship between passionate love and addiction has long been a topic of intense debate. Recent advances in neurobiology now allow for an examination between these two states. Methods: After describing the clinical distinctions between “love passion,” “love addiction,” and “sex addiction,” we compare clinical, neuropsychological, neurobiological, and neuroimaging data on love, passion, pathological gambling (PG) and substance dependence. Results: There are no recognized definitions or diagnostic criteria for “love addiction,” but its phenomenology has some similarities to substance dependence: euphoria and unrestrained desire in the presence of the love object or associated stimuli (drug intoxication); negative mood, anhedonia, and sleep disturbance when separated from the love object (drug withdrawal); focussed attention on and intrusive thoughts about the love object; and maladaptive or problematic patterns of behavior (love relation) leading to clinically significant impairment or distress, with pursuit despite knowledge of adverse consequences. Limited animal and human studies suggest that brain regions (e.g., insula, anterior cingulated [ACC], orbitofrontal [OFC]) and neurotransmitters (dopamine) that mediate substance dependence may also be involved with love addiction (as for PG). Ocytocin (OT), which is implicated in social attachment and mating behavior, may also be involved in substance dependence. There are no data on the epidemiology, genetics, co-morbidity, or treatment of love addiction. Conclusion: There are currently insufficient data to place some cases of “love passion” within a clinical disorder, such as “love addiction,” in an official diagnostic nomenclature or to firmly classify it as a behavioral addiction or disorder of impulse control. Further clinical and scientific studies are needed to improve our understanding and treatment of this condition. For these studies, we propose new criteria for evaluating addiction to love.

Association between ABCB1 C3435T polymorphism and increased risk of cannabis dependence.

Prolonged cannabis use has a significant impact on health and well-being. Genetic factors are known to influence cannabis dependence, but few specific genetic markers have been identified. ABCB1 polymorphisms are known to modify drug pharmacokinetics but have yet to be studied for their role in generating and maintaining cannabis dependence. The objective of this study is to determine if ABCB1 C3435T polymorphism may represent an independent genetic marker for cannabis dependence risk. An open bi-centric association study was conducted in two French Addiction Centres. Caucasian patients diagnosed with isolated cannabis dependence were compared with healthy age-matched controls for socio-demographic, clinical and genetic data using chi-square test, Fishers exact test, or Mann-Whitney U test. Independent association between ABCB1 C3435T SNP marker and cannabis dependence was evaluated using multiple logistic regression analysis. Versus controls (n=40), patients with cannabis dependence (n=40) had a significantly higher 3435C allele frequency (62.5% versus 43.8% respectively, P=0.017) and CC genotype (50% versus 20%, P=0.005, OR=4.00 [1.50-10.60]). Multiple logistic regression analysis of the C3435T SNP and variables identified in univariate analyses indicated that the CC genotype was independently associated with cannabis dependence (P=0.045, OR=6.61 [1.05-46.58]). This is the first time a significant specific genetic marker has been shown in cannabis dependence. ABCB1 polymorphisms may alter Delta9THC distribution, its psychoactive effects and individual vulnerability to dependence. These results pave the way to a new pharmacogenetic hypothesis in cannabis dependence.

Motivation of French medical students to pursue surgical careers: Results of national survey of 1742 students

OBJECTIVESnAnalyze the aspirations and personal motivations behind the choice of surgical specialties in a large sample of students in their 6th year of medical school.nnnMATERIAL AND METHODSnIn December 2008, 2588 students participated in a nation-wide mock exam, before taking the National Ranking Exam. When they looked for their grades on the web, the students were prompted to answer a questionnaire containing socio-demographic questions concerning their choice and motivation to pursue a career in a surgical specialty. The survey called also for listing the three main factors (out of a list of 11) motivating their choice.nnnRESULTSnStudents originated from 39 medical schools. Of the 2588 students, 1427 (55%) were women. The response rate to the questionnaire was 1742/2588=67%. Two hundred and twenty students (13%) did not express any specific professional orientation. Of the 1522 responses obtained, 522 students wanted to become surgeons. Gender was a determining factor as 44% of male students (n=252) versus 29% of female students wanted to become a surgeon; P<0.0001. The three most selected surgical subspecialties were gynecology (n=137), orthopedics (n=91) and ophthalmology (n=57). Once again gender played a role in the choice: 82% who chose gynecology were women while 73% of future urologists were men (P<0.0001). Special interest in specific diseases (n=356, 23%), the possibility of private practice (n=280, 18%) and life style (n=175, 11%) were the motivations most often cited to back their choice.nnnCONCLUSIONnOne third of medical students want to become surgeons. Feminization, life style and income are the principal factors influencing the choice of the type of surgical subspecialization.

L’artérite progressive cannabique, un sous-type clinique de la thromboangéite oblitérante ?

Resume Introduction Depuis la fin des annees 1990, le cannabis est non seulement incrimine dans la thromboangeite obliterante, mais aussi comme element inducteur de lesion atheromateuse chez le sujet jeune. Observation Un patient âge de 18 ans, d’origine caucasienne, a ete adresse pour sevrage therapeutique en cannabis a l’occasion d’une prise en charge d’une arterite du membre inferieur gauche. Commentaires Le cannabis est de loin la substance psychoactive illicite la plus consommee chez les 15-25 ans. Les donnees de la litterature, notamment depuis la fin des annees 1990, montrent que le cannabis semble etre mis en cause dans un type d’arteriopathie proche de ce qui est retrouve dans la maladie de Buerger (ou thromboangeite obliterante) chez le sujet jeune, quel que soit son sexe.INTRODUCTIONnSince the end of the nineteen-nineties, cannabis is not only incriminated in the onset of thromboangiitis obliterans but also in inducing artheromatous lesions in young subjects.nnnOBSERVATIONnA young, Caucasian, 18 year-old man was referred for cannabis withdrawal in the treatment of arteritis of the left leg.nnnDISCUSSIONnCannabis is by far the illicite psychoactive substance most consumed by the 15-25 year-olds. Data in the literature, notably since the end of the nineteen-nineties, show that cannabis is accused of provoking arterial disease similar to that which is found in Buergers disease (or thromboangiitis obliterans) in young subjects of whichever sex.

L’apprentissage de la « médecine fondée sur les preuves » est-il influencé par des facteurs déterminés ? Résultats d’une enquête nationale auprès de 1870 étudiants français en sixième année de médecine

OBJECTIVESnTo investigate the baseline level of knowledge of evidence based medicine (EBM) concepts in a sample of French medical students in their sixth year of training.nnnMETHODSnAn electronic-questionnaire was proposed to 3125 sixth-year students from all 39 French medical schools in 2009.nnnRESULTSnOverall, 1870 students (58.2% response rate) completed the questionnaire (women=1168; 63%). The concept of EBM was known by 1716 students (92%). Most students (n=1382; 74%) read at least one French medical article per year, but 1051 students (56%) never read international articles. Just over half of students (1030; 55%) knew of web-based medical information databases. Treatment guidelines were considered to be important by most students (97%). Only 24.3% and 29% of students said that they write or speak English. In multivariate analysis, studying in a Parisian University and/or knowledge of what a journals impact factor is were both associated with a ranking in the top 20% of the National Ranking Exam practice session.nnnCONCLUSIONSnOnly the most successful students showed interest in obtaining more knowledge of EBM. The lack of education about EBM in this sample suggests a lack of efficacy in the current heterogeneous EBM teaching programs.

Protective effect against alcohol dependence of the thermolabile variant of MTHFR

BACKGROUNDnHyperhomocysteinemia is frequently observed in alcohol-dependent subjects, in particularly in those with marked withdrawal symptoms. The common C677T transition on the methylenetetrahydrofolate reductase (MTHFR) gene influences homocysteinemia. Our objective was to study the prevalence of the MTHFR C677T polymorphism in alcohol-dependent subjects and the influence of this polymorphism on symptoms associated with alcoholism.nnnMETHODSnMTHFR C677T polymorphism was determined in 93 control subjects and 242 alcohol-dependent subjects. Serum homocysteine, folate and vitamin B12 levels together with hepatic biological parameters were determined in the control and alcohol-dependent subjects.nnnRESULTSnHyperhomocysteinemia is frequently observed in alcohol-dependent subjects, particularly in those with marked withdrawal symptoms. Alcohol-dependent subjects showed a significant decrease in MTHFR 677TT prevalence (9%, 21/242) compared to controls (18%, 17/93) (p<0.02). The relative risk estimated as an odds ratio for alcoholism in subjects with the TT genotype is 0.42 (odd ratio 95% confidence interval, 0.21-0.83). Moreover, drinkers with TT genotype presented lower values for markers of alcohol misuse (p<0.05), better liver function tests, a lower frequency of relapses and no marked withdrawal symptoms as assessed by the Lesch typology.nnnCONCLUSIONnMTHFR 677TT genotype could play a protective role against alcohol dependence. Moreover, when subjects with MTHFR 677TT genotype become dependent to alcohol, they seem to constitute a subgroup of alcoholic patients with a decreased risk for developing neurotoxic withdrawal symptoms and hepatic toxicity.

[Synthetic cannabinoids: A new addiction matrix].

Synthetic cannabinoids (SC) belong to the emergent market of new psychoactive substances, sold on the Internet or specialized shops. Since the 1970s, more than 160xa0new SC have invaded the drug market. These substances imitate the psychoactive effects of cannabis. Underestimated for too long, SCs market growth and consequences are no longer to be ignored, first of all in terms of public health. SC were first synthesized during researches on the endocannabinoid system. Though they are agonists of the cannabinoid receptorsxa01xa0andxa02, as Δ9-tetrahydrocannabinol in cannabis, they can also have a really high affinity with these receptors, rising up their potency. Each country in the world has chosen various ways how to deal with SC: scheduling, blanket ban, regulation… In order to contour the legal system, producers regularly modify the chemical formulas of those substances and hand out an attracting packaging looking harmless. However, the content of those small packets is extremely unstable and unreliable, including harmful compounds to health. Reports show an increasing number of non-fatal intoxications but also fatalities. Consequences on the body are numerous but there have been also reports of mental health imbalance and appearances of addiction-linked clinical signs. This review of literature aims at establishing a picture on SC in order to raise awareness among professionals in the health field on this new addiction matrix.