Samuel Bulteau

Transcranial direct current stimulation (tDCS) in behavioral and food addiction: a systematic review of efficacy, technical, and methodological issues.

Objectives: Behavioral addictions (BA) are complex disorders for which pharmacological and psychotherapeutic treatments have shown their limits. Non-invasive brain stimulation, among which transcranial direct current stimulation (tDCS), has opened up new perspectives in addiction treatment. The purpose of this work is to conduct a critical and systematic review of tDCS efficacy, and of technical and methodological considerations in the field of BA. Methods: A bibliographic search has been conducted on the Medline and ScienceDirect databases until December 2014, based on the following selection criteria: clinical studies on tDCS and BA (namely eating disorders, compulsive buying, Internet addiction, pathological gambling, sexual addiction, sports addiction, video games addiction). Study selection, data analysis, and reporting were conducted according to the PRISMA guidelines. Results: Out of 402 potential articles, seven studies were selected. So far focusing essentially on abnormal eating, these studies suggest that tDCS (right prefrontal anode/left prefrontal cathode) reduces food craving induced by visual stimuli. Conclusions: Despite methodological and technical differences between studies, the results are promising. So far, only few studies of tDCS in BA have been conducted. New research is recommended on the use of tDCS in BA, other than eating disorders.

Fortune telling addiction: Unfortunately a serious topic About a case report

Background Constant social change brings about new forms of behavior, such as smartphone use, social networking, indoor tanning, cosmetic surgery, etc., that could become excessive or even lead to new forms of addictive disorders. Methods We report the case of a woman who starts consulting for “clairvoyance addiction”. We then discuss the addictive nature of her disorder, based on several classifications of addiction. Results The patient fulfilled the criteria for addiction and her clinical features were typical of that of addicted people. Other differential diagnoses were discussed. Conclusion As for any addictive behavior, the interaction of several risk factors should be considered. They are related to the individual himself, but also to the object of addiction and to the socio-environmental context. In this case, all the conditions were met for fortune telling use to become addictive.

Excessive trading, a gambling disorder in its own right? A case study on a French disordered gamblers cohort.

INTRODUCTION Trading and gambling appear to share some similarities. Indeed, traders can get professionally involved in high-risk types of trading as if it were gambling. This research explores whether excessive trading can be conceptualized as a subset of gambling disorders. OBJECTIVE To better acknowledge the existence of an addictive-like trading behavior and to discuss its phenomenological similarities with gambling disorders. METHODS The data of 8 excessive traders out of a cohort of 221 outpatients seeking treatment in our Problem Gambling unit were analyzed. RESULTS Our case series revealed important similarities with gambling disorders in terms of diagnosis, trajectory and comorbidities. Like many disordered gamblers, excessive traders of this study experienced a number of small early wins, chased their losses, and ended up losing control over the money they invested. All of them invested in very risky stocks associated with short-term trading leading to potential large gains, but also with very significant losses. The structure itself of the two activities (gambling and trading) is very close. CONCLUSION Our results tended to support the idea of an addictive-like trading behavior as a subset of gambling disorders. Investing is not a form of gambling, but some people gamble with investments. Several observations and recommendations can be made: (i) conduct researches; (ii) build and validate specific assessment tools; (iii) develop strategies for prevention and treatment; and (iv) conduct more rigorous studies to clarify what we named an addictive-like trading behavior.

Outcome of Non-Invasive Brain Stimulation in Substance Use Disorders: A Review of Randomized Sham-Controlled Clinical Trials

Non-invasive brain stimulation (NIBS) might be a new approach to treat substance use disorders (SUD). A systematic review and critical analysis was performed to identify potential therapeutic effects of NIBS on addictions. A search of the Medline database was conducted for randomized sham-controlled trials using NIBS in the field of addiction and published until August 2016. Twenty-six studies in various SUD met the inclusion criteria. Converging evidence indicates that NIBS might be a promising mean to treat patients with alcohol and tobacco use disorders, by acting on craving reduction and other mechanisms such as improvement in cognitive dysfunctions.

Effect of Repetitive Transcranial Magnetic Stimulation on Psychomotor Retardation in Major Depression: A Pilot Feasibility Study

This pilot study investigated the feasibility of a comprehensive battery of tests assessing psychomotor retardation after a 3-week protocol of repetitive transcranial magnetic stimulation for depression. In addition to the beneficial effect of this treatment on depression, the results showed positive changes in psychomotor retardation.

DAPHNE: A New Tool for the Assessment of the Behavioral Variant of Frontotemporal Dementia

Background: The diagnosis of behavioral variant of frontotemporal dementia (bvFTD) relies primarily on clinical features and remains challenging. The specificity of the recently revised criteria can be disappointing, justifying development of new clinical tools. Objective: We produced a behavioral inventory named DAPHNE. This scale (adapted from Rascovskys criteria) explores six domains: disinhibition, apathy, perseverations, hyperorality, personal neglect and loss of empathy. It is composed of ten items (five answer categories). The aim was (1) to assess the validity and reliability of DAPHNE and (2) to evaluate its contribution in differentiating patients. Methods: Two scores were computed: DAPHNE-6 (screening) from the six domains and DAPHNE-40 (diagnosis) from the ten items. Reliability and reproducibility were assessed. External validity was studied with the Frontal Behavioral Inventory (FBI) and the Frontotemporal Behavioral Scale (FBS). Finally, the diagnostic performance of DAPHNE was compared to revised criteria, FBI and FBS. Results: DAPHNE was administered to the caregivers of 89 patients, 36 with bvFTD, 22 with Alzheimers disease, 15 with progressive supranuclear palsy and 16 with bipolar disorder. Reliability and reproducibility were excellent, as was external validity. DAPHNE-6 allowed bvFTD diagnosis (score ≥4) with a sensitivity of 92%, while DAPHNE-40 (score ≥15) had a specificity of 92%. Conclusion: We demonstrate excellent psychometric features for DAPHNE. This quick tool could help for both diagnosing and screening bvFTD.

Balance characteristics in patients with major depression after a two-month walking exercise program: a pilot study

UNLABELLED Recent studies have demonstrated impaired balance performance in patients with major depressive disorder (MDD) in comparison to healthy controls (HC), which is likely to be related to deficits in integration of visual and proprioceptive inputs necessary for efficient postural control. In parallel, considerable literature supports the positive effects of a walking program on depressive symptoms. Thus this study aimed to determine the effects of a two-month walking program on implicit postural control strategies in MDD. Compared with twelve age- and body mass index-matched non-psychiatric HC (mean age 50.41 ± 6.93 years; five women), nine MDD (mean age 51.88 ± 10.01 years; five women) performed two sessions of standing postural control assessment, separated by eight weeks of the walking program, while the HC were only assessed at t0. The walking program included one-hour supervised walking sessions, three times a week over a two-month period. Postural performance was assessed by various center of pressure (COP) parameters, in particular those that bound the COP velocity of postural sway. The primary findings were that MDD patients exhibited positive physical activity-related changes in postural performance, with a decrease in body sway in the most difficult condition (with a foam surface). The real impact of the walking program on COP velocity-based variables suggests that MDD patients improved their ability to make more efficient postural corrections, which is useful for daily activities and autonomy. A balance assessment in the clinical screening routine might be used as a new index of the effectiveness of walking programs recommended for people with depression. TRIAL REGISTRATION This study is registered at http://clinicaltrials.gov/: NCT01995422.

Poppers regulation for public sale: No measure in France yet

AIM Poppers have become legal in France since June 2013. Is their liberalisation associated with an increase of severe side effects observed? METHODS To identify elevated methaemoglobinaemia related to poppers abuse, we reviewed all methaemoglobin concentrations measured in Nantes university hospital, during 12 months. RESULTS Methaemoglobin concentrations were superior to 25% in three cases of poppers consumption that occurred after the legalisation. CONCLUSION Evaluating the prevalence of elevated methaemoglobinaemia could help to monitor severe complications of poppers use in France.

A comparison of treatment-seeking behavioral addiction patients with and without Parkinson's disease

The administration of dopaminergic medication to treat the symptoms of Parkinson’s disease (PD) is associated with addictive behaviors and impulse control disorders. Little is known, however, on how PD patients differ from other patients seeking treatments for behavioral addictions. The aim of this study was to compare the characteristics of behavioral addiction patients with and without PD. N = 2,460 treatment-seeking men diagnosed with a behavioral addiction were recruited from a university hospital. Sociodemographic, impulsivity [Barratt Impulsiveness Scale (BIS-11)], and personality [Temperament and Character Inventory-Revised (TCI-R)] measures were taken upon admission to outpatient treatment. Patients in the PD group were older and had a higher prevalence of mood disorders than patients without PD. In terms of personality characteristics and impulsivity traits, PD patients appeared to present a more functional profile than PD-free patients with a behavioral addiction. Our results suggest that PD patients with a behavioral addiction could be more difficult to detect than their PD-free counterparts in behavioral addiction clinical setting due to their reduced levels of impulsivity and more standard personality traits. As a whole, this suggests that PD patients with a behavioral addiction may have different needs from PD-free behavioral addiction patients and that they could potentially benefit from targeted interventions.

Psychiatric disorders, acne and systemic retinoids: comparison of risks

ABSTRACT Background: The link between isotretinoin, treatment of a severe form of acne, and psychiatric disorders remains controversial, as acne itself could explain the occurrence of psychiatric disorders. This study aims at assessing the disproportionality of psychiatric adverse events reported with isotretinoin in the French National PharmacoVigilance Database, compared with other systemic acne treatments and systemic retinoids. Materials and methods: Data were extracted from the French National PharmacoVigilance Database for systemic acne treatments, systemic retinoids and drugs used as comparators. Each report was subjected to double-blind analysis by two psychiatric experts. A disproportionality analysis was performed, calculating the number of psychiatric ADRs divided by the total number of notifications for each drug of interest. Results: Concerning acne systemic treatments: all 71 reports of severe psychiatric disorders involved isotretinoin, the highest proportion of mild/moderate psychiatric adverse events was reported with isotretinoin (14.1%). Among systemic retinoids, the highest proportion of severe and mild/moderate psychiatric events occurred with isotretinoin and alitretinoin. Conclusion: Our study raises the hypothesis that psychiatric disorders associated with isotretinoin are related to a class effect of retinoids, as a signal emerges for alitretinoin. Complementary studies are necessary to estimate the risk and further determine at-risk populations.