Xavier Laqueille

Validity of the CAGE questionnaire in schizophrenic patients with alcohol abuse and dependence

The objective of the study was to assess the sensitivity and the specificity of the CAGE questionnaire in 114 schizophrenic patients. The Composite International Diagnostic Interview was used to assess the DSM-III-R diagnosis of abuse of or dependence on alcohol. The CAGE questionnaire can be reliably used to assess alcohol use disorders in schizophrenic patients: with a cutoff score of 1 or more, the sensitivity of the CAGE questionnaire was 0.91 and the specificity was 0.83. With a cutoff score of 2 or more, the sensitivity of the CAGE questionnaire was 0.82 and the specificity was 0.94. The post test probabilities (PPV) were high (PPV1=0.74; PPV2=0.85) compared to the primary probability of alcoholism (29.8%).

Méthadone : de la pharmacocinétique à la pharmacologie clinique

Resume La methadone est un opiace de synthese aux proprietes pharmacocinetiques specifiques qui permettent un traitement de la substitution des pharmacodependances opiacees. Apres une prise orale, la methadone est absorbee a 75 % en moyenne et subit un metabolisme hepatique. La methadone a un volume de distribution de 4 L/kg environ. Sa demi-vie est de 22 heures en moyenne. Ces proprietes pharmacocinetiques permettent une prise quotidienne unique. Le faible pic plasmatique et l’effet plateau des concentrations sanguines n’induisent pas les effets habituellement engendres par l’heroine ou les medicaments opiaces detournes de leur usage. La variabilite interindividuelle du metabolisme de la methadone entraine de grandes variations des parametres pharmacocinetiques et peut etre a l’origine d’un syndrome de sevrage ou d’un surdosage. Par ailleurs, les voies metaboliques sont communes a de nombreux medicaments. Les in-teractions medicamenteuses qui en resultent peuvent etre responsables d’un echec therapeutique en raison d’un sous- ou d’un surdosage. Le clinicien doit connaitre ces differentes proprietes, les interactions medicamenteuses et utiliser des outils comme le suivi pharmaco-therapeutique des concentrations residuelles plasmatiques afin de reussir son approche therapeutique substitutive.

Clinical profile of responders to buprenorphine as a substitution treatment in heroin addicts: results of a multicenter study of 73 patients.

In France, high-dosage buprenorphine (HDB) is the main substitution treatment for narcotic addiction. Few data have been published concerning clinical factors predicting a good response to this treatment in a daily practice. A hospital-based multicenter clinical research program (PHRC) was undertaken in heroin-addicted patients, diagnosed according to DSM-III-R, to detect clinical criteria susceptible of predicting a good response to HDB administered during a 3-month treatment period. At the inclusion time in the study, a diagnostic structured interview (DIGS) was performed, and the Addiction Severity Index (ASI), Zuckerman scale, depression scale from Jouvent, and CGI were scored. MMPI was also administered. Good response was defined as an ongoing participation in the study, with absence of opiate detected in 75% of urine collected during the last month of treatment. Only subjects treated for at least 1 month were eligible for analyses. One hundred fifteen patients were recruited and 73 were analyzed. Patients received 8.5+/-2.6 mg (m+/-S.D.) of buprenorphine for 1 to 3 months. A forward stepwise logistic regression showed that six clinical parameters may predict a good response to treatment: probability to respond to buprenorphine was higher in subjects having a high psychopathology (ASI) subscore, low disinhibition and boredom susceptibility factor scores (Zuckerman scale), no alcohol dependence, no family history of addiction or mood disorder, and duration of opiate dependence less than 10 years. Only the MMPI D subscale was a psychological pattern correlated to a good response to substitution treatment. These findings are important to consider when making the decision to prescribe HDB substitution treatment in opiate addiction.

Neurological soft signs in non-psychotic patients with cannabis dependence.

Psychomotor performance has consistently been found to be altered in chronic cannabis users. Neurological soft signs (NSS) reflect neurological dysfunction involving integrative networks, especially those involving the cerebellum, where cannabinoid receptors are particularly concentrated. Our objective was to study, for the first time, NSS in a group of patients with cannabis dependence compared with a of healthy control subjects, matched for age, gender and level of education. All outpatients seeking treatment for chronic cannabis use in the substance abuse department of Sainte‐Anne Hospital in Paris between June 2007 and May 2009 and meeting the cannabis dependence DSM‐IV criteria were included in the study (n = 45). Patients with psychotic disorders, bipolar 1 disorder and current alcohol, opioid or cocaine dependence were excluded. All patients and controls were assessed using the Diagnostic Interview for Genetic Studies, which screens for lifetime DSM‐IV diagnoses, and the Standardized Neurological Examination of Neurological Soft Signs. NSS scores were significantly higher in patients with cannabis dependence compared with healthy subjects (8.90 ± 4.85 versus 6.71 ± 2.73, respectively, Mann–Whitney: U = 775.0, P = 0.05). Patients had particularly high scores on motor coordination and sensory integration NSS factors. Cannabis dependence is associated with more NSS and especially motor coordination and sensory integration signs. These results suggest that cannabinoids interact with the brain networks underlying NSS, known to be altered in schizophrenia.

Impulsivity and sensation seeking in alcohol abusing patients with schizophrenia.

Objective: Some studies have found that high levels of impulsivity and sensation seeking, particularly disinhibition are associated with substance abuse in patients with schizophrenia, as in the general population. However, no study has assessed impulsivity and sensation seeking specifically in schizophrenia patients with alcohol abuse or dependence. Materials and methods: We compared impulsivity and sensation seeking in a group of schizophrenia patients (DSM-III-R criteria) with lifetime alcohol abuse or dependence (n = 34) and in a group without lifetime substance abuse or dependence (n = 66). The patients were assessed using the composite international diagnostic interview (CIDI) for DSM-III-R disorders, the positive and negative syndrome scale (PANSS), the Barratt impulsivity scale (BIS), the Zuckerman seeking sensation scale (SSS), and the physical anhedonia scale (PAS). Results: The mean scores for impulsivity and sensation seeking were higher in the group with lifetime alcohol abuse or dependence than in the group without substance abuse or dependence (BIS: 63.4 ± 18.7 vs 51.3 ± 14.2 respectively, ANOVA: F = 11.12, p = 0.001; SSS: 17.6 ± 5.9 vs 13.5 ± 6.7 respectively, ANOVA: F = 7.45, p = 0.008). There was no significant difference between the two groups on PAS score. Conclusion: Increased impulsivity or sensation seeking may be a link between schizophrenia and alcohol abuse or dependence.

Cannabis : usage et dépendance

The main characteristics of cannabis dependence are craving, persistent desire or unsuccessful efforts to cut down or control cannabis use and important social, occupational, or recreational activities given up or reduced because of cannabis use. Withdrawal symptoms include insomnia, irritability, anger, restlessness, depression, mood swings and cravings. Regular cannabis use induces cognitive impairment, especially of attention, episodic memory and working memory. Alcohol and other substances abuse or dependence are frequently found in patients with cannabis dependence. Psychiatric comorbidities are frequent in patients with cannabis dependence, in particular anxiety disorders, mood disorders, and personality disorders. The treatment of cannabis dependence includes behavioral psychotherapy, especially motivational interviewing and cognitive-behavioral therapy, alongside treatment of co-occurring mental health and substance use conditions. There are currently no available pharmacological treatment interventions for cannabis dependence. The treatment of cannabis dependence and withdrawal remains nonspecific.

Schizophrénie et dépendance aux amphétamines

Resume Nous rapportons le cas d’un patient souffrant de schizophrenie, qui a presente une dependance aux amphetamines durant 7 ans. La consommation a ete suivie d’une aggravation de l’activite delirante interpretative et hallucinatoire. De telles observations sont rares, la plupart des observations de troubles psychotiques associes a une dependance aux amphetamines etant generalement des troubles psychotiques induits par ces substances. Des etudes en dose unique ont montre que les amphetamines accentuaient les signes positifs de schizophrenie, en particulier les hallucinations, et tendent a reduire la symptomatologie negative. Il n’y a pas d’etudes evaluant les effets au long cours des amphetamines dans cette population. Les amphetamines pourraient avoir des effets cliniques et neurobiologiques prolonges.

Antidepressant Treatment and Smoking Cessation in Bipolar Disorder

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Military combat deployment and alcohol use.

coated tube (P=.06). We and others have demonstrated that the silver-coated endotracheal tube consistently influences outcomes in addition to colonization in preclinical and clinical studies. A study by Olson et al reported that the silver-coated endotracheal tube reduced colonization severity and histologic evidence of inflammation in the lungs of mechanically ventilated dogs challenged with Pseudomonas aeruginosa. Studies by Berra et al reported that another silver-coated tube reduced bacterial biofilm formation in vitro and prevented bacterial colonization and was associated with a thinner mucus layer in sheep and humans. In the NASCENT study, the silver-coated tube reduced not only the overall incidence of microbiologically confirmed VAP but also the incidence within 10 days of intubation and delayed VAP onset; the association between treatment group and each of these outcomes was significant in multivariate analyses (P .01). The lack of between-group differences in mortality and durations of mechanical ventilation, ICU stay, and hospital stay is probably attributable to the low VAP rate in the NASCENT study. The observed incidence of 7.5% in the control group was only half the expected rate of 15% that was used to estimate the target sample size for detecting betweengroup differences in the primary end point. Our study was clearly underpowered for analysis of secondary end points. Collectively, the findings from the NASCENT study and previous studies provide robust evidence that the silvercoated endotracheal tube is likely to benefit patients requiring at least 24 hours of intubation in institutions where VAP continues to occur despite other preventive measures. Moreover, the silver-coated tube is expected to be cost-effective based on the number needed to treat reported in NASCENT and high attributable cost of VAP. The break-even cost to avoid 1 case of VAP, calculated as VAP cost of

Naltrexone in the Treatment of Broadly Defined Behavioral Addictions: A Review and Meta-Analysis of Randomized Controlled Trials

25 072 divided by a number needed to treat of 37, would be