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Staff members of psychiatric facilities are at high risk of secondhand smoking. Smoking exposure was assessed in 41 nonsmoking employees of a psychiatry department before and after a ban. Subjective exposure measures decreased in 76% of the subjects. Salivary cotinine decreased in the subsample of seven subjects with high pre-ban levels (32 ±8 vs 40 ± 17 ng/ml, p = .045).

This naturalistic, prospective investigation examined the role of fear of negative evaluation and the personality trait of harm avoidance in the anxiety levels of treated social phobia patients. One hundred and fifty-seven patients with DSM-IV social phobia were assessed before starting treatment and were then followed for up to two years. As expected, greater fear of negative evaluation and higher scores of harm avoidance were associated with greater anxiety at the 6 month follow-up, and harm avoidance remained a significant predictor at 24 months. However, no evidence was found for an interaction between the personality and cognitive variables examined. The findings are discussed in terms of the relative independence of these factors, as well as their potential implications for the treatment of this disorder.

ObjectiveTo see if patient satisfaction with psychotropics (PSP) could be used as a patient-oriented outcome variable in the evaluation of PSP drugs in clinical epidemiological studies, relationships between PSP, clinical status, QoL, compliance and the type of antipsychotic were analyzed. Elements of validation of PSP were also assessed.MethodIn a 6-month prospective study, 933 schizophrenic outpatients with initiation or change to their antipsychotic treatment were enrolled. Psychiatrists completed five CGI-SCH scales (positive, negative, cognitive, depressive and global), hospitalization, compliance, and prescription variables. Patients completed PSP, EuroQoL scales, sexual function and compliance variables.ResultsA satisfactory structural equation model was obtained showing significant relationships PSP/compliance (coef. = 0.16), QoL/PSP (coef. = 0.37), clinical status/QoL (coef. = 0.61), clinical status/compliance (coef. = 0.09). Patients receiving olanzapine were more satisfied than patients receiving other atypicals (coef. =0 12) and had better clinical status than patients treated with typicals (coef. = 0.08). Evolution of PSP was related to clinical status, QoL, and continuation of treatment (all P < 001). Sensitivity to change of PSP was moderate (effect size = 0.2).ConclusionPSP produced consistent results in relation to validated outcome variables. However, a single-item measure was not sufficiently sensitive to change. Multi-item questionnaires evaluating different dimensions are needed.

Many hypotheses have been made to explain the high rate of benzodiazepine consumption in France, including a general cultural and/or familial tendency to use certain types of psychotropic drugs. This study explored the association between lifetime medication use by parents and their children. Two hundred and twenty-one young patients (158 boys and 63 girls) consulting at a child and adolescent psychiatry department, six to 16 years of age (mean = 9.7 years), were screened for lifetime use of psychotropic drugs using a structured interview. Parents were asked about their own consumption, as well as their children’s. Lifetime consumption rates (at least once) were 22.2% in boys and 20.6% in girls, and 19.6% in children less than 11 years old. Higher rates were found in patients with emotional disorders (anxiety disorders and depression). In parents, 45.1% of mothers and 24.1% of fathers reported using medications at least once. A significant association was found between child and parental medication use: 34.1% of children had positive lifetime consumption when their mothers also used medications at least once versus only 13.6% in other children (odds ratio = 3.31 [1.68–6.50]; P = 0.001). The most significant association was found between medication use by girls and their mothers (odds ratio = 12.1 [2.38–61.5];P = 0.003). These data point to the existence of a family pattern of psychotropic drug consumption, especially in females.

SummaryThis paper investigates the prevalence of symptoms and various diagnostic criteria of DSM-IV social phobia in a French national representative population of 12,873 subjects, aged 15 or more. Respondents filled out a mailed questionnaire based on the social phobia section of the Munich-Composite International Diagnostic Interview (M-CIDI) in the year 1996. Response rate was 80.5%.Sixty-seven point one percent of the sample acknowledge having at least once in their lifetime a strong fear of one or more of the six prototypical social fear situations that are used as the CIDI social phobia stem items. However, only a few fulfilled all DSM-IV diagnostic criteria for social phobia. Depending on the type of diagnostic algorithms used and the stringency in which these criteria are applied, the resulting prevalence varied between 1.9 and 7.3%. These findings provide some further evidence about the considerable effects of varying diagnostic criteria and thresholds on prevalence rates for social phobia, explaining why most recent surveys have reported considerably higher rates of social phobia than those in the early 1980s.

SummaryThis objectives of this study were three-fold: retrospectively evaluate anxiolytic/hypnotic consumption by psychiatric inpatients, identify the risk factors of prolonged intakes, and prospectively measure the impact of hospitalisation on the use of those drugs. Three hundred and seventy-six patients hospitalised in 11 psychiatric departments in the Paris region were studied using a structured interview for the anxiolytic/hypnotic treatments, DSM-III-R criteria, GHQ-12, HAD, Spiegel's questionnaire, COVI's anxiety scale and the CGI. Eighty-five per cent of the patients had taken one anxiolytic/hypnotic or more in the 3 months preceding hospitalisation. Hospitalisation induced little change in anxiolytic/hypnotic use: dosage frequency increased from 77% to 84% between the week preceding hospitalisation and that preceding discharge; 26% of consumers were taking at least two anxiolytics or two hypnotics in the first period vs. 23% in the second. The absence of withdrawal during hospitalisation was related to the high age and a diagnosis of depression rather than schizophrenia, to the existence of continuous intake over the 3 months preceding hospitalisation and to higher drug doses during the 7 days preceding hospitalisation. Prescription of treatment at the end of hospitalisation in previously non-user subjects was related to a higher HAD anxiety score at discharge.

ContexteDans une cohorte de patients traités par méthadone, nous avons retrouvé 35 % de tentatives de suicide (TS) sur la vie, 53 % un trouble anxieux et 61 % un trouble de l’humeur. Presque tous étaient fumeurs quotidiens de tabac, les trois quart avaient soit une dépendance au cannabis, à l’alcool ou à la cocaïne associée sur la vie. Dans ce contexte, l’identification de facteurs de variabilité interindividuelle de sévérité et de comorbidité pourrait prédire le risque d’évolution péjorative chez les sujets jeunes ou moins comorbides. Outre les traumas dans l’enfance [1], les styles parentaux [2] semblent avoir un rôle important dans ces trajectoires, tout comme un âge de début (ADD) plus précoce des consommations de substances [3].Objectif/méthodesNous avons ainsi recherché chez 85 patients stabilisés sous méthadone des associations entre les scores à la Measure of Parental Style (MOPS) [4] (séparés pour chaque parent) et l’ADD de tabac, alcool, cannabis, sédatifs et cocaïne ainsi que la présence de comorbidités addictives. Les caractéristiques sociodémographiques, les conduites suicidaires et les comorbidités addictives et psychiatriques (DSM IV) étaient évaluées par entretien semi-structuré.RésultatsNous avons retrouvé des associations significatives (p < 0,00625) après corrections de Bonferroni pour huit tests effectués) entre indifférence paternelle et ADD inférieur du tabac, et entre abus maternel et ADD inférieur des sédatifs, mais pas entre MOPS et présence d’un TA comorbide. Après ajustement sur âge, sexe, dépression majeure et troubles anxieux en régression linéaire, l’abus maternel restait prédictif d’un ADD plus précoce des sédatifs (bêta = –0,24, p = 0,039), tout comme la dépression (bêta = –0,24, p = 0,045).DiscussionMalgré des limites dues à notre évaluation rétrospective et à la faible taille de l’échantillon, ces résultats soulignent l’importance de l’environnement précoce dans la variabilité des trajectoires addictives. Cela suggère l’intérêt d’une prévention primaire chez des patients jeunes présentant ces dysfonctionnements parentaux.

Introduction Cocaine users often experience transient psychotic symptoms following cocaine use (Smith et al. 2009). The severity of such psychotic symptoms is influenced by cocaine dose (Vorspan et al. 2011). Several authors observed a higher prevalence of childhood trauma in cocaine addicts than control subjects (Enoch et al. 2010). Objective Describe cocaine induced psychosis and evaluate if it is associated with childhood trauma. Aim Define the population of cocaine users who experiment cocaine induced psychotic symptoms. Method We did a transversal retrospective study. 100 outpatient cocaine users were evaluated with Scale for the Assessment of Positive Symptoms of Crack Induced Psychosis (SAPS-CIP) and Childhood Trauma Questionnaire (CTQ). Informations were obtained about lifetime cocaine use (age of onset, DSM IV dependence criteria, route of administration, daily dose, days of use per month). Results We did not observe any link between SAPS-CIP and CTQ or CTQ and cocaine consumption. About cocaine consumption, more often patients took cocaine during the worst period, higher is the SAPS-CIP score. If patients are (or were) dependent to cocaine, they have higher scores on SAPS-CIP. Moreover, if patients took cocaine intravenously, they have higher scores on SAPS-CIP than if they took it by snorting, or smoking. Conclusion In the conditions of our study, childhood trauma isn’t a mediator for cocaine induced psychosis. About psychotic symptoms, they seem to be more severe among daily cocaine dependents who take it intravenously.

Introduction Methadone, a Mu-opioid receptor agonist, is currently used as a maintenance treatment in opioid dependant patients. However, its therapeutic index is narrow, and side effects are life threatening. Non-optimal dosing results in withdrawal symptoms and further heroin craving and use. The optimal dose is defined as the dose necessary to obtain a stable substitution. This optimal maximal dose can then be decreased, the final goal being to stop substitution. Objectives To identify factors to optimize the methadone optimal daily dose. Aims We aimed to identify genetic variants (SNP) associated with the methadone optimal dose. In a candidate gene approach, we focused on OPRM1 , which encodes the opioid receptor Mu, and on DRD2/ANKK1 SNP's, implied in the reward dopaminergic signalling. Methods Caucasians patients (n = 98) followed for methadone maintenance treatment were included in this prospective study. Candidate SNPs were genotyped ( ANKK1 : TaqI A; DRD2 : c.957C>T; OPRM1 : c.A118G). The plasmatic methadone level was determined using mass spectrometry in 59 patients. Results Two polymorphisms were significantly associated to the optimal methadone doses: OPRM1 c.A118G (p = 0.03) and DRD2 TaqI A (p = 0.035). The TaqIA polymorphism is located within ANKK1 , which encodes a serine threonine kinase which role remains elusive. Its molecular link to methadone pharmacodynamy remains to be established. None of these polymorphisms was associated neither to the current methadone doses, nor to the methadone plasmatic concentration. Conclusion This description is the first step to optimize the prescription of methadone in caucasian populations.

Introduction Withdrawal syndrome occurs in 50% of cannabis dependant patients. In our clinical practice, we observed that few patients recognize and attribute abstinence symptoms to cannabis cessation. Insight or awareness of cannabis dependence remains poorly studied. Objectives We propose to study the relationship between insight and cannabis withdrawal syndrome. Our hypothesis is that patients showing a higher score on a cannabis withdrawal scale would have a higher score on an insight scale. Methods We recruited 35 cannabis dependent outpatients between October 2008 and April 2009 in an addiction clinic. Insight of cannabis dependance was assessed with the insight Q8 scale ranging [0–8]. We designed a cannabis withdrawal scale by checking DSM V withdrawal symptoms, and each symptom was retrospectively scored by an analogue scale (from 0 to 5). Correlation between insight and withdrawal scores was calculated using Spearman's ρ. Results Sex ratio was 2.5. Mean age was 35.9 ± 1.4 years. Most patients (85.7%) reported at least one withdrawal symptom. Sleep disturbances (95.8%) and craving (75.8%) were the most frequent. Mean score of insight was of 4.2 ± 0.4 points. The intensity of withdrawal syndrome and insight score were positively correlated (ρ = 0.594, p Conclusion Our results show an association between experiencing more withdrawal symptoms and insight or awareness of cannabis dependence. These results could be used in the treatment of cannabis dependent patients.

IntroductionTreatment-resistant depression (TRD) has been a controversial issue for more than 35 years. Despite a large number of publications, clinicians and researchers still know few about the prevalence of TRD since no staging method has been validated.ObjectivesWe sought to assess similarities and differences between the 4 TRD-staging methods published to date and assess TRD prevalence in a clinical sample. We also wanted to look for clinical factors associated with TRD.MethodsWe conducted a clinical study in a psychiatric unit of a university hospital. We designed a hetero-questionnaire to stage TRD according to the 4 methods. Psychiatric diagnosis, depression severity and cognitive status were assessed using standardized tools. Patients were not included in the study if they suffer from schizophrenia, bipolar disorder, current substance dependence or major cognitive impairment.ResultsWe recruited 37 inpatients. Twenty-four had received an inadequate treatment, four had not responded after one adequate antidepressant trial and 9 after two trials. Only 7 were resistant according to the 4 staging methods, which showed several differences. The Massachussetts General Hospital (MGH) method appeared as the most specific and easy-to-use. Complete TRD seemed much less frequent than pseudo-resistance and relative resistance with untreated comorbidity. Chronic depression and comorbidity were frequent in the TRD subgroup.ConclusionThe concept of “difficult-to-treat” depression might be more appropriate for clinical practice than TRD. The MGH tool seems to fit best to clinical practice. Further research is needed to confirm these descriptive findings in a larger sample.

IntroductionImpulsivity and decision making are impaired in cocaine addicts. However, most studies were performed in the USA.ObjectivesTo assess impulsivity and decision making in a sample of French cocaine addicts.MethodsSubjects40 current cocaine addicts and 21 control subjects with no history of drug abuse were compared using the Barratt Impulsiveness Scale (BIS) and Iowa Gambling Task (IGT). Subjects from the cocaine addicted group were evaluated for cocaine craving with the Obessive Compulsive Cocaine Scale (OCCS), and for their pattern of use. Statistical analysis: The mean scores of impulsivity and decision making were compared in the two groups (Mann-Whitney U test). In the group of 40 cocaine addicts, clinical factors that could be associated with high impulsivity and poor decision making scores were tested (Spearman’ s rho, Chi-square and Mann-Whitney U tests).ResultCompared to controls, cocaine addicts had a higher impulsivity score (BIS: 72 ± 11 vs 57 ± 8, U = 138, p < .001) and had more disadvantageous choices on the decision making test (IGT) (advantageous minus disadvantageous choices -4 ± 19 vs 24 ± 35, U = 234, p = .005). There was a significant correlation between high impulsivity scores on the BIS and high cocaine craving as well as heavy cocaine use (more than 4 times a week). No correlation was found between poor decision making and high craving or frequent cocaine use.DiscussionThe discrepancy between impulsivity and poor decision making in cocaine addicts is discussed.

IntroductionMephenesin is a central muscle relaxant, acting through a depression of the activity of some neurones in the caudate nucleus. It was proposed as a potential treatment of alcohol withdrawal syndrome in the 50s. This over the counter medicine is now mainly prescribed to treat spasticity or as an adjunctive treatment of painful muscle spasm. We know little about this substance except that side effects are venous thrombosis, haemolysis or cutaneous intolerance. Yet, no case of abuse or dependence has been reported.AimsTo report a series of 5 clinical cases in patients who developed abuse or dependence to mephenesin.MethodsWe performed a systematic search in data bases of both Paris addictovigilance and poison centres from 1999 to 2010. Clinical details were obtained from clinicians when possible. A literature search was also performed to describe mephenesin mechanisms of actions that could be implied.ResultsThree (3) women et 2 men aged 35 to 52 years (m : 43.6) were identified as abusing mephenesin, among which 4 patients had a full DSM IV criteria of dependence. All had a previous history of abuse or substance dependence (alcohol, heroin, codeine, ketamine…).The average mephenesin daily intake was 13 g (9 to 24 g) when the maximum recommended dosage is 3 gr/d. In one case, a withdrawal syndrome was observed (tremor, aggressiveness).ConclusionMephenesin may be abused by patients with previous risk factors, especially a personal history of alcohol dependence.

Aims:The mean oral methadone dosage is reported to be 60-100 mg per day (Vazquez 2006).Methods:We measured methadone oral dosages in three methadone clinics in Paris (Espace Murger, Marmottan, Horizons). The number of patients evaluated was 197. They were all at the steady state of methadone treatment. The influence of sex, center, age and retention in the program on prescribed oral dosage was tested with khi2 and spearman tests.Results:The mean dosage was 52 mg/d (+/- 28). The mean retention in the methadone program was more than three years. The dose range was [5-130]. The dosage was not different according to sex (p= 0,388), retention (p = 0,744), and age (p = 0,144). But the dosages were statistically different according to the center: 60 mg/d in Horizons (N = 37), 54 mg/d in Murger (N = 104), and 44 mg/d in Marmottan (N = 56) (p = 0,022).Conclusion:This study confirms the great variability of methadone oral dosages in France, with a center-effect. Dosages that were found are still lower than what is found in other countries [5-350 mg/j] (Eap 2000). Other variability factors are to be considered: clinical, pharmacokinetic and pharmaco-dynamic factors.References[1]. Vazquez V, Gury C, Laqueille X. Methadone : de la pharmacocinetique a la pharmacologie clinique. L'Encephale 2006 ; 32 : 478-86[2]. Eap CP, Bourquin M, Martin JL, et al. Plasma concentrations of the enantiomers of methadone and therapeutic response in methadone maintenance treatment. Drug and Alcohol Dependence 2000 :61,47–54