S. Richa

Eating disorders and schizophrenia in male patients: A review

OBJECTIVE: To understand the comorbidity of schizophrenia and eating disorders (ED) in male patients. METHOD: A review of the published literature was made via Med-Line using the following terms: “schizophrenia” or “psychosis” in association with “eating disorders”, “anorexia nervosa”, “binge eating” or “bulimia nervosa”, in association with the terms “comorbidity” or “comorbidities” and finally in association with the term “male”, “man” or “men”. RESULTS: Groups of male patients known to suffer from schizophrenia and screened for ED suffer essentially from anorexia nervosa (0.81%). Groups of male patients screened for anorexia nervosa and then for schizophrenia demonstrate high comorbidity prevalence (36%). In general, ED symptoms diminish with psychotic episodes and recur when the psychotic episode remits. A man with an ED has a 3.6 times more risk than a woman with an ED to have comorbid schizophrenia. In men, ED present atypical features so that ED not otherwise specified (EDNOS) is relatively frequent. DISCUSSION AND CONCLUSION: Male patients described in the literature as suffering from schizophrenia and ED fall under one of four categories: a) acute psychotic episode related to organic causes due to malnutrition; b) male patients presenting with an ED who later develops schizophrenia; c) male patients known to suffer from schizophrenia and who develops distorted eating cognitions and disordered behaviors; d) male patients suffering from schizophrenia and developing a medication-induced ED.

Revue des cas d’allongements du QTC et de torsades de pointe chez des patients traités par méthadone

INTRODUCTION For the past 40 years, methadone has been known to be an efficient treatment of substitution. Its use allowed a significant reduction in the mortality related to opioid addiction. Since 2001, many articles have reported some cases of syncope, wave burst arrhythmia, ventricular tachycardia due to prolonged QT interval and sudden death secondary to cardiac arrest, with a risk of prolongation of the QT interval above 440 ms (men) and 460 ms (women). Many explorations have helped in understanding the physiopathology by showing that opioids, including methadone, cause a blockage of the potassium channels of the gene HERG K+P. This event could slow the repolarisation and the atrioventricular cardiac synchronization and could induce ventricular arrhythmia. LITERATURE FINDINGS Nearly 20 studies showed a prolonged QT interval secondary to methadone in patients exhibiting the following features: (1) patients with cardiac pathologies, notably bradycardia, congenital long QT interval, myocardial pathologies related to AIDS and electrolyte disturbances; (2) patients receiving concomitant treatment with substances known to prolong QT interval, such as psychoactive stimulants, narcoleptics, tricyclic antidepressants, antiarrhythmic agents, macrolids, quinolones, non diuretic hypokalemiants and certain corticoids; (3) patients receiving treatments that inhibit methadones metabolism, particularly those that act on the cytochrome P450 3A4 such as SSRI, antifungal agents, some macrolids and some retroviral agents. Many recent studies, while evaluating the dose-dependent effect of methadone on the QT prolongation, showed a tendency to a prolonged QT when using higher doses of methadone. CONCLUSION Screening for these risk factors should be carried out before prescribing methadone. EKG should not be systematically performed unless the conditions described above are present or if a higher dose of methadone is needed.

A 56-year-old female patient with facio-oculo-acoustico-renal syndrome (FOAR) syndrome. Report on the natural history and of a novel mutation

The facio-oculo-acoustico-renal syndrome (FOAR) is a rare autosomal recessive syndrome characterized by the presence of dysmorphic facial features, ocular anomalies, sensorineural hearing loss, and proteinuria. Diaphragmatic hernia, exomphalos, absent or abnormal corpus callosum, and myopia, can also be part of the syndrome. The disorder is caused by mutations of the LRP2 gene located on chromosome 2q23.3-q31.1. We hereby report the case of a 56-year-old female patient with typical FOAR features. Molecular study of the LRP2 gene revealed the presence of a novel splice-site mutation. In addition to what was reported in FOAR syndrome, this patient had a megadolichocolon complicated by a volvulus and a late-onset renal failure which necessitated hemodyalisis and renal transplantation. Reporting aging patients with genetic syndromes will provide information about their special needs and lead to improvements in their follow-up.

La formation en psychiatrie au Liban

Au Liban, il existe quelque 50 psychiatres essentiellement concentrés sur Beyrouth et le Mont-Liban inscrits à la Société libanaise de psychiatrie, soit pour une population de quatre millions d’habitants, 1,25 psychiatre pour 100 000 habitants. Par ailleurs, deux à trois nouveaux spécialistes s’inscrivent annuellement à l’Ordre libanais des médecins, complétant ainsi leur formation en psychiatrie. Pour cette dernière, il existe un programme de spécialité, le Comité d’enseignement post-doctoral de la faculté de médecine de l’université Saint-Joseph, qui admet un ou deux nouveaux internes par an suite à un concours d’admission. Par ailleurs, certains internes suivent le programme de l’Arab board de psychiatrie à l’Asile islamique des vieillards et d’autres sont formés à l’université de Balamand, université privée et à l’université libanaise, université de l’État libanais. Un maximum de deux spécialistes arrivent par an de l’étranger, essentiellement formés en France et aux États-Unis.

Clinical Predictors Relevant to Lithium Response

To adequately evaluate lithium response, one needs to consider the whole clinical profile of bipolar disorder; it is not sufficient just to consider symptoms. Clinical variables based on the anamnesis are still the best predictors of lithium response. A later age of disease onset, an episodic course characterized by a pattern of mania followed by depression, fewer hospitalizations preceding treatment and the absence of an episodic pattern of depression-mania interval and continuous cycling should give the physician some hope of making the right decisions. The possible future addition of biological or brain imaging signatures should provide valuable information that would help in several ways: by more powerfully predicting response in conjunction with genotypes, by serving as a biomarker of response in clinical trials and by revealing pathophysiological pathways from gene to clinical success. Because of their relative homogeneity, lithium responders represent an important population for psychiatric research. This group of bipolar patients can thus be regarded as a good candidate population to open new fields of biological investigation, especially in the research of biomarkers of lithium response.