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Background. Current trends in population aging affect both recipients and providers of informal family caregiving, as the pool of family caregivers is shrinking while demand is increasing. Epidemiological research has not yet examined the implications of these trends for burdens experienced by aging family caregivers. Method. Cross-sectional community surveys in 20 countries asked 13 892 respondents aged 50+ years about the objective (time, financial) and subjective (distress, embarrassment) burdens they experience in providing care to first-degree relatives with 12 broadly defined serious physical and mental conditions. Differential burden was examined by country income category, kinship status and type of condition. Results. Among the 26.9-42.5% respondents in high-, upper-middle-, and low-/lower-middle-income countries reporting serious relative health conditions, 35.7-42.5% reported burden. Of those, 25.2-29.0% spent time and 13.5-19.4 % money, while 24.4-30.6 % felt distress and 6.4-21.7% embarrassment. Mean caregiving hours per week in those giving any time were 16.6-23.6 (169.9-205.8 h/week per 100 people aged 50+ years). Burden in low-/lower-middle- income countries was 2- to 3-fold higher than in higher-income countries, with any financial burden averaging 14.3% of median family income in high-, 17.7% in upper-middle-, and 39.8% in low-/lower-middle-income countries. Higher burden was reported by women than men and for conditions of spouses and children than parents or siblings. Conclusions. Uncompensated family caregiving is an important societal asset that offsets rising formal healthcare costs. However, the substantial burdens experienced by aging caregivers across multiple family health conditions and geographic regions threaten the continued integrity of their caregiving capacity. Initiatives supporting older family caregivers are consequently needed, especially in low-/lower-middle-income countries. [ABSTRACT FROM AUTHOR]

Background: Suicide is a major public health concern and suicide attempts (SA) are frequent and burdensome in people suffering from substance use disorders (SUDs). In particular, serious SAs are a preoccupying form of attempt, which remain largely overlooked in these populations, especially regarding basic risk factors such as gender, addictive comorbidity and substance use patterns. Thus, we undertook a gender-specific approach to identify the risk factors for serious SAs in outpatients with multiple SUDs.Material and Methods: 433 Treatment-seeking outpatients were consecutively recruited in specialized care centers and reliably classified as serious, non-serious and non-suicide attempters. We also characterized lifetime exposure to SUDs, including tobacco smoking, with standardized instruments. Current medication, including psychotropic treatments were collected, which informed psychiatric diagnoses. Multinomial regression identified independent factors specifically associated with serious SAs in each gender, separately.Results: 32% Participants (N=139, 47% Women and 27% Men) reported lifetime SA. There were 82 serious attempters (59% of attempters), without significant gender difference. Sedative dependence was an independent risk factor for serious SA compared to non-SA in Women and compared to non-serious SA in Men, respectively. Other risk factors included later onset of daily tobacco smoking in Men and history of psychiatric hospitalizations in Women, whose serious SA risk was conversely lower when reporting opiate use disorder or mood disorder, probably because of treatment issues.Conclusions: Despite several study limitations, we identified subgroups for a better-tailored prevention of serious SAs among individuals with SUDs, notably highlighting the need to better prevent and treat sedative dependence. [ABSTRACT FROM AUTHOR]

Abstract: Addiction to drugs is an important public health concern. Describing the frequency of dependence, abuse and use of substances in a country allows a monitoring and helps in the design of an appropriate healthcare system. We will present studies describing the prevalence of use of tobacco, alcohol, and illicit drugs in France, with a comparison to European or International studies. They show a decrease in the use of tobacco and cannabis, while there is an increase in alcohol use in young adults. We also observe that the difference in substances use between females and males is tightening, especially in young people. We have less studies of analytic epidemiology trying to describe risk or protective factors associated with substances’ use in France. Further studies on addicted people''s pathway (from use to abuse and to dependence, as well as from dependence to recovery, with or without medical support) are warranted. [Copyright &y& Elsevier]

Introduction: Impulsivity and decision making are impaired in cocaine addicts. However, most studies were performed in the USA. Objectives: To assess impulsivity and decision making in a sample of French cocaine addicts. Methods: Subjects: 40 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). Result: Compared 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. Discussion: The discrepancy between impulsivity and poor decision making in cocaine addicts is discussed. [ABSTRACT FROM AUTHOR]

Introduction: The burden of health problems, including mental disorders, can be assessed in several ways such as through healthcare costs or loss of productivity. Their impact on daily activities as a whole has received much less attention, especially in France. Therefore, we undertook the analysis of the French general population data from the World Mental Health (WMH) surveys promoted by the World Health Organization (WHO) assessing the number of days out of role due to common mental and physical disorders., Methods: Face-to-face interviews were carried out with 2894 respondents (45.9% pooled response rate). Presence of ten chronic physical disorders and nine mental disorders was assessed for each respondent along with information about the number of days in the past month each respondent reported being totally unable to work or carry out their other normal daily activities because of problems with either physical or mental health. Multiple regression analysis was used to estimate associations of specific conditions and comorbidities with days out of role, after controlling for basic socio-demographics., Results: One thousand four hundred and thirty-six subjects reporting at least one core-symptom of a mental disorder underwent the whole assessment. The mean annual number of days out of role was high among those with at least one mental disorder (24.2±8.3). The population attributable risk proportion (PARP), i.e. the proportion of days out of role that would have been avoided if the considered disorder had remitted, was also estimated. Mental disorders as a whole accounted for 49.5% of the PARP., Discussion: French data on days out of role from the WHO WMH surveys showed the high burden of mental illness in the general population. These results may have been underestimated, taking into account that subjects who were hospitalized at the time of recruitment, whose disorders might also account for a high proportion of days out of role, could not be assessed with our design., Conclusion: Common health conditions, especially mental disorders, make up a large proportion of the number of days out of role. Such data should be considered to design more efficient public health strategies., (Copyright © 2014 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Background and Objective: Suicide is a public health problem worldwide. The objective of this study is to analyse the prevalence and risk factors of suicide related outcomes (ideation, plan and attempt) using data from the ESEMeD-France project., Subjects and Method: This is a face-to-face household survey carried out in a probability representative sample of the adult general population of France. A total of 6796 subjects were interviewed using the Composite International Diagnostic Interview (CIDI) developed framework of the World Mental Health Survey Initiative. Based on evidence that reports of such potentially embarrassing behaviour are higher in self-administered than interviewer-administered surveys, these questions were printed in a self-administered booklet and referred to by letter., Results: Lifetime prevalence of suicide ideation, plan and attempts were 12.4, 4.4 and 3.4% respectively. Risk of suicide-related outcomes was significantly higher among women and younger cohorts. Having a mental disorder was associated with an increased risk, especially in the case of psychiatric comorbidity. Mental disorders that are associated with an increase in suicidal attempts are anxiety disorders (except social phobia), major depressive episodes, oppositional defiant disorders, and attention deficit hyperactivity disorders. The suicidal risk notably increases in conjunction with multiple mental disorders. In this study, employment and marital status do not appear to be a risk factor for suicidal behaviour., Conclusions: The prevalence of suicide-related outcomes is high when compared with other countries. Results identified groups with higher risk (women, young, subjects with a mental disorder and having a plan) in which suicide prevention could to be targeted. The results of this study suggest that to improve suicide prevention strategies it is necessary to perform an in-depth clinical evaluation of suicidal ideas and projects, and identify precisely psychiatric comorbidity to allow a more efficient treatment., (Copyright © 2011. Published by Elsevier Masson SAS.)

Background: Suicidality risk-factors between countries with similar economic and religious background have been rarely compared, especially within genders., Methods: Lifetime prevalence of suicide ideation, plans, and attempts in the ESEMeD surveys were stratified on four separate groups: French women, Spanish women, French men, and Spanish men. Outcome odds-ratios (OR) were modelled within each group using logistic regression including demographic characteristics, lifetime mood/anxiety disorders, parental bonding, marital status, and health service-use., Results: Lifetime prevalence of suicide attempts was 3.4% in France (1.1% men, 5.4% women) and 1.5% in Spain (1.2% men, 1.7% women), with a significantly greater gender difference in France (p=0.001). Regarding risk-factors, French women reported suicide attempt more commonly with authoritarian mothers (OR=1.51; 95%CI=1.04-2.18), unlike Spanish women (OR=0.77; 95%CI=0.51-1.15) (p<0.001). Spanish men showed more than eight-times higher odds of suicide attempt with overprotecting mothers than French men (p=0.03). General practitioner-(GP)-use was significantly protective of suicide attempt among Spanish women (OR=0.08; 95%CI=0.02-0.35) with no effect in French women (OR=1.03; 95%CI=0.54-2.00) (p=0.01). No significant differences in the effect of marital status, any lifetime antidepressant use, mental disorders, or religiosity on suicide attempt were observed between France and Spain within gender-stratum., Limitations: Parental bonding is retrospective and potentially influenced by mental state. Response rate was considerably lower in France than in Spain., Conclusions: Suicidality risk-factors play different roles across genders between France and Spain. Parental bonding dimensions may be interpreted differently according to country, underlining cultural importance. As recommended by WHO, mental health decisions must involve GPs in conjunction with psychiatrists or psychologists., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Context: In the 1990s, cannabis consumption in France increased considerably. So, in 10 years, the number of adolescents reporting regular cannabis use (10 or more times during the last 12 months) tripled. In 2004, an official program to address problems related to cannabis addiction was implemented. As part of this program, specific outpatient settings for cannabis use disorders were created., Objective: We present the sociodemographic characteristics, the prevalence of cannabis, alcohol and others psychoactive substances and the prevalence of mental disorders in 90 cannabis users seen at an outpatient specific setting for cannabis use disorders in the Lariboisière hospital (a university hospital in Paris)., Measures: Twelve months prevalence of substance abuse and dependence, psychiatric diagnoses based on the DSM-IV and the Mini-International Neuropsychiatric Interview (MINI) results are described., Results: The study population had the following characteristics: 67% male, mean age 27.5 (S.D.=8.4) years and 59% single or divorced. Approximately, two-thirds of the users (67%) were students or currently working and 32% were unemployed. Twenty-two percent of the cannabis users received unemployment, welfare or disability benefits and 11% declared no source of revenue. Most of the users (63%) decided on their own to seek care at the setting. Seventy-three percent of the subjects had seen a psychologist or a psychiatrist in the past, with or without relation to cannabis use. By far, most of the users were cannabis dependent (82%) and 9% cannabis abusers in the last 12 months according to DSM-IV criteria prior to their visit. Seven percent of the cannabis users had alcohol dependence and 7% were abusers. The 12 months prevalence of cocaine or ecstasy dependence was 2% and the prevalence of benzodiazepines, heroin or stimulants dependence 1%. The main substances used over lifetime were tobacco (99%); alcohol (96%); cocaine (41%); benzodiazepines and hypnotics (41%); ecstasy (40%) and heroin (23%). Four percent of cannabis users had a history of intravenous drug use. The main consumption mode of cannabis in France is the blunt. About three-quarters of the consumption is in the form of resin (hashish) and one-quarter as marijuana (grass). The average consumption of cannabis in the last six months was equivalent to 5.8 blunts per day (S.D.=4.4) and 12 g per week (S.D.=10.5), and the average monthly cost was 159 euro (S.D.=133) (234 USD, S.D.=196). The prevalence of psychiatric disorders according to DSM-IV criteria in the sample is high. A current mood disorder was present in 48% and an anxiety disorder in 55% of the cannabis users in the last 12 months. The prevalence of affective disorders in the last 12 months was major depressive disorder (38%), dysthymia (19%), hypomania (3%) and mania (1%). The prevalence of anxiety disorders in the last 12 months was social phobia (29%); generalised anxiety disorder (17%); panic disorder with or without agoraphobia (16%); obsessive compulsive disorder (12%); agoraphobia without panic disorder (9%) and post-traumatic stress disorder (5%). The prevalence of schizophrenia was 4%. The prevalence of bulimia was 4% and no anorexia. Women are more likely to report an affective disorder (64% versus 41%; p=0.04) or a post-traumatic stress disorder (17% versus 0%; p<0.001) in the last 12 months. The prevalence of family history for psychiatric disorders was 52% and for addiction, 59%., Conclusions: The cannabis users seen in our specific setting are a fairly homogeneous group and for the most part addicted to cannabis only, but with very high rates of dependence. Indeed, other than tobacco dependence, 80% of the users were only dependent on, or abused on cannabis in the last 12 months. In comparison with the cohort of French cannabis users (n=4202) seen at specific outpatient settings for marijuana users in 2005, cannabis users seen in Lariboisière Hospital are older, the percentage of females is greater, they are more dependent on marijuana and have a high prevalence of affective and anxiety disorders.

Background and Objective: In clinical settings with fixed resources allocated to predictive genetic testing for high-risk cancer predisposition genes, optimal strategies for mutation screening programmes are critically important. These depend on the mutation spectrum found in the population under consideration and the frequency of mutations detected as a function of the personal and family history of cancer, which are both affected by the presence of founder mutations and demographic characteristics of the underlying population. The results of multistep genetic testing for mutations in BRCA1 or BRCA2 in a large series of families with breast cancer in the French-Canadian population of Quebec, Canada are reported., Methods: A total of 256 high-risk families were ascertained from regional familial cancer clinics throughout the province of Quebec. Initially, families were tested for a panel of specific mutations known to occur in this population. Families in which no mutation was identified were then comprehensively tested. Three algorithms to predict the presence of mutations were evaluated, including the prevalence tables provided by Myriad Genetics Laboratories, the Manchester Scoring System and a logistic regression approach based on the data from this study., Results: 8 of the 15 distinct mutations found in 62 BRCA1/BRCA2-positive families had never been previously reported in this population, whereas 82% carried 1 of the 4 mutations currently observed in > or =2 families. In the subset of 191 families in which at least 1 affected individual was tested, 29% carried a mutation. Of these 27 BRCA1-positive and 29 BRCA2-positive families, 48 (86%) were found to harbour a mutation detected by the initial test. Among the remaining 143 inconclusive families, all 8 families found to have a mutation after complete sequencing had Manchester Scores > or =18. The logistic regression and Manchester Scores provided equal predictive power, and both were significantly better than the Myriad Genetics Laboratories prevalence tables (p<0.001). A threshold of Manchester Score > or =18 provided an overall sensitivity of 86% and a specificity of 82%, with a positive predictive value of 66% in this population., Conclusion: In this population, a testing strategy with an initial test using a panel of reported recurrent mutations, followed by full sequencing in families with Manchester Scores > or =18, represents an efficient test in terms of overall cost and sensitivity.

Cowden syndrome is a disease associated with an increase in breast cancer susceptibility. Alleles in PTEN and other breast cancer susceptibility genes would be responsible for approximately 25% of the familial component of breast cancer risk, BRCA1 and BRCA2 being the two major genes responsible for this inherited risk. In order to evaluate the proportion of high-risk French Canadian non-BRCA1/BRCA2 breast/ovarian cancer families potentially harboring a PTEN germline mutation, the whole coding and flanking intronic sequences were analyzed in a series of 98 breast cancer cases. Although no germline mutation has been identified in the coding region, our study led to the identification of four intronic variants. Further investigations were performed to analyze the effect of these variants, alone and/or in combination, on splicing and PTEN protein levels. Despite suggestive evidence emerging from in silico analyses, the presence of these intronic variants do not seem to alter RNA splicing or PTEN protein levels. In addition, as loss of PTEN or part of it has been reported, Western blot analysis has also been performed. No major deletion could be identified in our cohort. Therefore, assuming a Poisson distribution for the frequency of deleterious mutation in our cohort, if the frequency of such deleterious mutation was 2%, we would have had a 90% or greater chance of observing at least one such mutation. These results suggest that PTEN germline mutations are rare and are unlikely to account for a significant proportion of familial breast cancer cases in the French Canadian population.

Background: Ataxia telangiectasia-mutated and Rad3-related (ATR) is a member of the PIK-related family which plays, along with ATM, a central role in cell-cycle regulation. ATR has been shown to phosphorylate several tumor suppressors like BRCA1, CHEK1 and TP53. ATR appears as a good candidate breast cancer susceptibility gene and the current study was designed to screen for ATR germline mutations potentially involved in breast cancer predisposition., Methods: ATR direct sequencing was performed using a fluorescent method while widely available programs were used for linkage disequilibrium (LD), haplotype analyses, and tagging SNP (tSNP) identification. Expression analyses were carried out using real-time PCR., Results: The complete sequence of all exons and flanking intronic sequences were analyzed in DNA samples from 54 individuals affected with breast cancer from non-BRCA1/2 high-risk French Canadian breast/ovarian families. Although no germline mutation has been identified in the coding region, we identified 41 sequence variants, including 16 coding variants, 3 of which are not reported in public databases. SNP haplotypes were established and tSNPs were identified in 73 healthy unrelated French Canadians, providing a valuable tool for further association studies involving the ATR gene, using large cohorts. Our analyses led to the identification of two novel alternative splice transcripts. In contrast to the transcript generated by an alternative splicing site in the intron 41, the one resulting from a deletion of 121 nucleotides in exon 33 is widely expressed, at significant but relatively low levels, in both normal and tumoral cells including normal breast and ovarian tissue., Conclusion: Although no deleterious mutations were identified in the ATR gene, the current study provides an haplotype analysis of the ATR gene polymorphisms, which allowed the identification of a set of SNPs that could be used as tSNPs for large-scale association studies. In addition, our study led to the characterization of a novel Delta33 splice form, which could generate a putative truncated protein lacking several functional domains. Additional studies in large cohorts and other populations will be needed to further evaluate if common and/or rare ATR sequence variants can be associated with a modest or intermediate breast cancer risk.

Introduction: The use of psychotropic drugs is high in France and has increased over the last two decades. To date, no national study evaluating psychotropic drug use in the context of the diagnosis of psychiatric disorders has been performed. Such data has now been generated in the ESEMeD/MHEDEA 2000 study, which has allowed comparison of the situation in France with that in five other European countries (Germany, Belgium, Spain, the Netherlands and Italy)., Objectives: 1) To describe the declared use of psychotropic drugs (globally and by therapeutic class) in order to evaluate annual prevalence, treatment duration and demographic factors associated with use. 2) To estimate the proportion of subjects with an anxiety disorder, mood disorder or alcohol-related disorder (abuse or dependence) that have been appropriately treated with an antidepressant or anxiolytic drug. 3) to evaluate the proportion of psychotropic drug users who fulfil diagnostic criteria for these three classes of psychiatric disorder., Methods: This was a transversal survey carried out between 2001 and 2003 of non-institutionalised subjects aged 18 or over in the general population of Germany (n = 3,555), Belgium (n = 2,419), Spain (n = 5,473), France (n = 2,894), the Netherlands (n = 2,372) and Italy (n = 4,712). In France, the sampling source used was a randomly generated list of telephone numbers. Subjects were interviewed at home by professional interviewers. The WMH-CIDI questionnaire was used., Results: In France, 21% of subjects interviewed (n = 580) had taken at least one psychotropic drug during the year. For 19%, this was an anxiolytic or hypnotic (AX-HY), for 6.0% an antidepressant (AD), for 0.8% an antipsychotic (AP) and for 0.4% a mood regulating drug (TY). The distribution of users of AX-HY according to treatment duration was the following: 44% (1 to 15 days), 13% (16 to 30 days), 14% (1 to 3 months), 6.7% (3 to 6 months) and 23% (> 6 months). For users of ADs, the distribution was: 21% (1 to 15 days), 7.8% (16 to 30 days), 18% (1 to 3 months), 12% (3 to 6 months) and 42% (> 6 months). For subjects fulfilling diagnostic criteria for a mood disorder in the previous year or over their lifetime, 43% and 29% respectively had taken an AX-HY in the last twelve months and 29% and 16% an AD. For those who fulfilled diagnostic criteria for an anxiety disorder in the previous year or over their lifetime, the use of an AX-HY, in the last twelve months, concerned 43% and 30% of subjects respectively, whilst that of AD concerned 16% and 14%. For previous year or lifetime alcohol-related disorders, AX-HY use, in the last twelve months, concerned 63% and 22% of subjects respectively and use of ADs 9.3% and 7.2%. Amongst users of AX-HY in the last twelve months, a previous year or lifetime diagnosis of mood disorders was made for 16% and 39% of subjects respectively. Amongst users of ADs, the respective prevalence was 31% and 64%. A twelve-month and lifetime diagnosis of anxiety disorders was identified in 22% and 37% of users of AX-HY and among 27% and 50% of users of AD respectively. A twelve-month and lifetime diagnosis of alcohol-related disorders was found in 2.5% and 6.6% of users of AX-HY and among 1.1% and 7.8% of users of AD respectively. 68% of users of AX-HY had fulfilled none of these diagnostic criteria in the previous 12 months and 46% had never fulfilled them in their lifetime. With respect to AD users, the proportion who did not meet these diagnostic criteria in the previous 12 months was 56%, compared to 20% over their lifetime. Comparison of the French data from the study with those of the entire European sample showed that the annual prevalence of AX-HY and AD use was higher in France with mean treatment durations that were shorter. For antipsychotics and mood regulators, no clear differences were observed between France and the six countries of the study taken together., Discussion: Over the last two decades, use of AX-HY seems to have decreased in France, even though it remains higher than that observed in the other European countries participating in this study. This high use can be explained in part by the observation that, in around half the cases, it corresponds to occasional use. In contrast, the use of antidepressants has increased. In subjects with recent mood disorders or anxiety disorders, the use of AX-HY remains higher than that of antidepressants. Finally among users of AX-HY, only half of them had presented a mood disorder, anxiety disorder or alcohol use disorder during their lifetime, whereas this proportion rose to 80% for users of antidepressants.

Introduction: ESEMeD is the first international epidemiological study using a random sampling method that has allowed the prevalence of psychiatric disorders in France to be measured with precision and compared directly with that observed in other European countries., Objectives: 1) To determine the 12 month and lifetime prevalence of mood -disorders, anxiety disorders and alcohol-related disorders. 2) To estimate the comorbidity between these disorders. 3) To evaluate potential demographic risk factors for these disorders., Methods: This was a transversal survey carried out between 2001 and 2003 of non-institutionalised subjects aged 18 or over in the general population of Germany (n = 3,555), Belgium (n = 2,419), Spain (n = 5,473), France (n = 2,894), the Netherlands (n = 2,372) and Italy (n = 4,712). In France, the sampling source was a randomly generated list of telephone numbers. Subjects were interviewed at home by professional interviewers. The WMH-CIDI questionnaire was used., Results: The participation rate was 46% for France and 61% for all six countries combined. The 12 month and lifetime prevalence rates observed were respectively 6.0% and 21,4% for major depressive episodes, 1.6% and 7.9% for dysthymia, 2.1% and 6.0% for the generalised -anxiety disorders, 1.2% and 3.0% for panic disorders, 0.6% and 1.8% for agoraphobia, 2.2% and 3.9% for post-traumatic stress disorder, 1.7% and 4.7% for social phobia, 4.7% and 11,6% for specific phobia, 0.5% and 4.1% for alcohol abuse and 0.3% and 1.6% for alcohol dependence. Mood disorders and anxiety disorders were significantly more frequent in women, whilst alcohol-related disorders were more frequent in men. The prevalence of all three types of disorder was lower in elderly subjects and in those living in a rural environment. Mood disorders and alcohol-related disorders were more frequent in individuals living alone and mood disorders more frequent in those without paid employment. 38% of subjects with mood disorder also presented an anxiety disorder or an alcohol-related disorder. The comorbidity of mood and anxiety disorders was more frequent in women, younger subjects and those living alone. The comorbidity rate in subjects with anxiety disorders was 26% and did not differ between genders. For alcohol-related disorders, there was a striking difference in comorbidity rate between men and women: 26% in the former and 67% in the latter., Conclusion: This study underlines the high prevalence of mood disorders, anxiety disorders and alcohol-related disorders in France and demonstrates a high degree of comorbidity between them. For this reason, it is important to evaluate and take into account potential comorbidity in the management of individuals with psychiatric disorders.

The consumption of antidepressant seems to be in France higher than in comparable countries, as well as the overall consumption of healthcare and medications. In Western countries, in recent years, the use of antidepressants has regularly increased, mainly due to the use of serotoninergic antidepressants. In France, in a week, the prevalence of antidepressant use in the overall population increased from 1.7% in 1992 to 3% in 1995. This survey addressed the overall population in the form of a representative sample focusing on subjects who indicated, at the time they were consulted, that they were taking an antidepressant. The study aimed to determine the circumstances of prescription: prescriber file, reason for prescription, type of medication prescribed, match between the prescription and the product indications stated in the marketing authorization, prescription duration and reason for discontinuing treatment. Methodology - The first stage consisted in forwarding a letter to a panel of 44 000 subjects aged 15 years or more and representative of the French population. The aim was to achieve a cross-sectional description of the population taking antidepressants. The response rate was 82% (36 036 subjects). The subjects who stated that they were taking an antidepressant were re-contacted by telephone by an interviewer trained in the use of the Composite International Diagnostic Interview - lifetime (CIDI), exploring depression and anxiety diseases with a view to potential diagnosis as per DSM criteria. Longitudinal follow-up over 8 months from the initial screening was evaluated using a monthly questionnaire on the time course of antidepressant consumption. Results - Out of 20 000 households, comprising 44 000 people aged over 15 years, 1 333 people were taking an antidepressant or had taken one in the previous 4 weeks. The sex ratio of the antidepressant consumers was 3 women to 1 man, amplifying the known sex ratio with respect to depressive disorders. The mean age of the subjects taking an antidepressant at time t was 51 years. Lifestyle and socioprofessional category did not seem to influence antidepressant consumption. Somatic comorbidity was present in 60% of antidepressant consumers. Among the consumers of antidepressants at time t, 45% were taking a selective serotonin reuptake inhibitor (SSRI). The two products most widely prescribed in that class were fluoxetine (30% of the subjects taking an antidepressant at time t) and paroxetine (10% of the subjects taking an antidepressant at time t). The other SSRIs accounted for the remaining 5%. Thirty-nine percent of the consumers were taking a tricyclic antidepressant: clomipramine in 16% of cases, amitriptyline in 14%, and other tricyclic antidepressants in 9%. Lastly, 20% of the consumers were taking an antidepressant that was neither an SSRI nor a tricyclic antidepressant. Only 4% of the patients were concomitantly taking 2 antidepressants: single-agent therapy is in line with the recommendations of the various expert groups. In the survey, 9 antidepressant prescriptions out of 10 were written by an open-care practitioner, and 1 out of 10 by a hospital physician. For 60% of the subjects, the antidepressant treatment was prescribed by a general practitioner. General practitioners prescribe less tricyclic antidepressants and more SSRIs than specialists. The main reason for prescription reported by the patient was depression (57% of cases); followed by a state of anxiety or stress (15% of cases). In 10% of cases, the consumer stated that the reason for treatment was not psychological. Sixty-two percent of subjects presented with, or had presented with, a mood disorder as per M-CIDI (major depression, mood disorder, or a combination of the two) and 14% an isolated anxiety disorder. Twenty-five percent of the subjects on antidepressants did not fulfill all the M-CIDI criteria for any diagnosis. Among the people receiving antidepressants, 54% had a CIDI diagnosis in strict compliance with the marketing authorization indications for the product considered. One quarter (25%) presented with a diagnosis of a characterized psychiatric disease, outside of the marketing authorization indications for the product taken. This finding reflects misuse or use on the basis of published data not incorporated in the marketing authorization. The dosages were in line with those stated in the marketing authorization for the disease considered in almost 99% of cases for the subjects on paroxetine and fluoxetine, but for only 22% of cases for the subjects on tricyclic antidepressants. Tricyclic antidepressants would therefore appear to be frequently inappropriately in terms of proportions that would be ineffective: half of the subjects on clomipramine were taking a dose less than or equal to one third of the minimum recommended dose. Conclusion - This survey shows that the point-prevalence of antidepressants in the global population in France is about 3.5%. Women consume more antidepressants than men. SSRIs are the most widely prescribed antidepressants. The survey findings point out the discrepancies between official indications, such as the ones issued by the regulatory authorities, and the physicians' prescribing practices.

Objective: This study investigated the personality traits of social phobics using the Temperament and Character Inventory (TCI)., Method: A sample of 178 social phobics was assessed with the TCI, and compared with controls. The patients were classified into two groups, according to the absence (SP group) or to the presence (SP+D group) of depression., Results: We found significant elevated scores for harm avoidance (HA) in social phobics when compared with controls (16.2 +/- 2.7), in both the SP (26.2 +/- 3.5), and the SP+D (28.9 +/- 4.7), groups. Lower self-directedness scores were found in the SP and in the SP+D groups when compared with the controls. Patients with the generalized type of social phobia had higher HA scores as compared with other social phobics., Conclusion: The personality profile obtained in these social phobics, whatever their depressive symptomatology, reflects a dramatically anxious and avoidant temperament associated to an immature character.

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.

We explored the psychometric features of the French Temperament and Character Inventory (TCI) in a 602-subject community sample (263 men and 339 women), representative of the French population. The factor structures of the temperament and character dimensions, explored separately, were in agreement with the hypothesized constructs, except for the scales Novelty Seeking NS1 (exploratory excitability), Persistence, and Self-Directedness SD4 (self-acceptance). The internal consistency of the main dimensions was good (Cronbach alpha coefficients between 0.68 and 0.82), but weak for Persistence (0.49). The mean scores of the temperament dimensions were notably different from those published in other normative data - especially lower for Novelty Seeking (16.4+/-5.6) and higher for Harm Avoidance (16.1+/-7.2) when compared with US data - suggesting cross-cultural differences in personality assessment, and the necessity to use specific normative values with each translated instrument.

This 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.

Aims: To describe the psychiatric indications of neuroleptics (especially the relative share of schizophrenic and other psychotic disorders) and the usage patterns of these drugs (dose, duration, coprescriptions)., Methods: A one-day national cross-sectional survey in a random sample of 723 French psychiatrists was carried out in 1996. Each psychiatrist was asked to complete a standardized questionnaire for the first three patients seen the day of the survey to whom at least one neuroleptic was prescribed (initiated or renewed)., Results: One thousand seven hundred and fifty-four questionnaires were returned. Three quarters of the patients (74%) were psychotic (664 with schizophrenia, and 636 other psychosis), 19. 3% were depressive and 6.7% had other psychiatric disorders. Phenothiazines were the most often prescribed (40.8%), followed by butyrophenones (22.5%), benzamides (15.8%), other neuroleptics (14. 8%) and thioxanthenes (6.1%). Among schizophrenic subjects, an average number of 1.54 (95% CI: 1.50-1.60) neuroleptics were prescribed per patient, compared with 1.4 (95% CI: 1.32-1.41) and 1. 2 (95% CI: 1.14-1.23) in other psychotic and depressive subjects, respectively. Regardless of the indication, non-neuroleptic psychotropic drugs were coprescribed in 75.4%, mainly benzodiazepines (75.7%). Adjuvant drugs used in prevention or treatment of side-effects were coprescribed in 46.7%, mostly anticholinergic antiparkinsonians (86.1%)., Conclusions: Neuroleptics are mainly prescribed for psychotic disorders and especially schizophrenia. However, current recommendations are not always followed.

Clinicians are familiar with the life and psychological difficulties of incest victims, but their observations often are refuted as being retrospective and unsystematic. We aimed to ascertain similarities and differences between incestuous rape and nonincestuous rape. One hundred and two victims consulting a French forensic center were interviewed in a systematic follow-up study over 6 months using structured interview schedules. Stepwise logistic regression analysis adjusted for age, gender, and characteristics of the trauma showed that posttraumatic stress disorder, dissociative disorders, agoraphobia, and low self-esteem were overrepresented in the incest-rape group compared to the nonincest-rape group.

Objective: This study examined whether anxiety and depression were independently associated with elevated blood pressure in elderly persons., Method: The study group consisted of 1389 subjects aged 59 to 71 years recruited from the electoral rolls of the city of Nantes (France). Subjects completed the Center for Epidemiologic Studies-Depression scale (CES-D) and the Spielberger Inventory scales to assess depressive symptoms and anxiety symptoms, respectively. Data were collected on sociodemographic characteristics, smoking and drinking habits, medical history, and drug use. Two measures of systolic and diastolic blood pressure were taken after a 10-minute rest. Body mass index was computed from weight and height measurements. Subjects taking antihypertensive drugs (N = 281) were excluded from the present analysis., Results: Depression and anxiety scores were significantly correlated (r = .61 in men; r = .65 in women; p<.001). In univariate analyses, anxiety scores were correlated with systolic and diastolic blood pressure in men, but not in women; blood pressure was not associated with depressive symptoms in either sex. Multivariate logistic regressions, controlling for possible confounders, showed that in both men and women, the risk of high blood pressure increased with increasing anxiety scores; odds ratios for high blood pressure were less than 1 in subjects with depressive symptomatology., Conclusions: This study suggested that anxiety but not depression was independently associated with an increased risk for high blood pressure.

The relationship between social phobia and alcoholism is complex. Alcohol problems typically develop secondary to social phobia, with patients reporting that they find alcohol helpful in coping with the symptoms of anxiety. However, excessive alcohol consumption may actually precipitate anxiety symptoms, and thus a vicious circle of anxiety and alcoholism is established. The clinician must consider the possibility of comorbidity in patients presenting with either alcoholism or social phobia. Only when both components of the condition are adequately assessed and treated can the cycle of social phobia and alcohol abuse be broken.

Objective: To estimate the rates and patterns of major depression and bipolar disorder based on cross-national epidemiologic surveys., Design and Setting: Population-based epidemiologic studies using similar methods from 10 countries: the United States, Canada, Puerto Rico, France, West Germany, Italy, Lebanon, Taiwan, Korea, and New Zealand., Participants: Approximately 38000 community subjects., Outcome Measures: Rates, demographics, and age at onset of major depression and bipolar disorder. Symptom profiles, comorbidity, and marital status with major depression., Results: The lifetime rates for major depression vary widely across countries, ranging from 1.5 cases per 100 adults in the sample in Taiwan to 19.0 cases per 100 adults in Beirut. The annual rates ranged from 0.8 cases per 100 adults in Taiwan to 5.8 cases per 100 adults in New Zealand. The mean age at onset shows less variation (range, 24.8-34.8 years). In every country, the rates of major depression were higher for women than men. By contrast, the lifetime rates of bipolar disorder are more consistent across countries (0.3/100 in Taiwan to 1.5/100 in New Zealand); the sex ratios are nearly equal; and the age at first onset is earlier (average, 6 years) than the onset of major depression. Insomnia and loss of energy occurred in most persons with major depression at each site. Persons with major depression were also at increased risk for comorbidity with substance abuse and anxiety disorders at all sites. Persons who were separated or divorced had significantly higher rates of major depression than married persons in most of the countries, and the risk was somewhat greater for divorced or separated men than women in most countries., Conclusions: There are striking similarities across countries in patterns of major depression and of bipolar disorder. The differences in rates for major depression across countries suggest that cultural differences or different risk factors affect the expression of the disorder.

A study was conducted in Paris among primary care physicians as part of a World Health Organization study entitled Psychological Problems in General Health Care. Though social phobia is associated with significant impairment and drug use, the level of problem recognition by general practitioners was low. Social phobia (n = 38) was identified as a psychological case in 53% of the patients in whom social phobia was not comorbid with depression, and in 66% when comorbid with depression. This low level of recognition was comparable to that observed for depression where only 66% of the depressed patients (n = 121) were recognized as psychological cases. Psychotropic drug use was high: 61% of patients with social phobia had taken at least one psychotropic drug in the last month, compared to only 32% of those without social phobia. This difference was explained by a significant difference in the use of anxiolytics (45.4 versus 12.1%). The use of psychotropic drugs was twice as frequent in patients with social phobia who were depressed than in those not depressed. The results of this study emphasize the crucial need for primary care physician training in the recognition and treatment of mental disorders.

A higher anxiolytic and hypnotic consumption has been evidenced in France by recent international and national surveys. In an effort to counteract this pattern French Health authorities have enforced limitation to the prescription of these drugs. Understanding the causes of this overuse needs a careful analysis of the pattern of use of this medicine but also of the associated morbidity factors. In the last ten years several studies have attempted to address these issues. In the general population there were 25 to 30% of occasional or regular users with between 5 and 7% chronic users making french anxiolytic users two to three time superior to most industrialised countries. This high level of consumption is not the privilege of anxiolytic since the same pattern of use is observed for all medicine. Studies in primary care, in medical inpatients and psychiatric inpatients show as expected that anxiolytic use increase with the psychiatric morbidity and also with somatic disorder. The main risk factors for anxiolytic use are female sex, old age and psychic and somatic morbidity. Age seems to play a major role in subjects over 65: 17% are chronic users. Multiple factors might play a role in benzodiazepine use as medical care system, physician type of practice, cultural specific aspects but no proper simple explanation is available to explain the mechanism of the french high anxiolytic use. Given the poor global recognition of mental disorder observed in most countries it is suggested to privilege primary care physician training in psychiatry to optimize psychotropic drug use.

The individualization of social phobia among other phobic disorders is very recent, although previous clinical descriptions can be found in the literature. The new classifications (DSM-III, DSM-IV and ICD-10) have provided operationalized criteria for this disorder, which have allowed researchers to conduct epidemiological studies. However, some diagnostic issues are not completely solved, namely, those with other boundary disorders. Cross-cultural prevalence and risk factors of social phobia are reviewed. Results of a French community study have found a lifetime prevalence rate of 2.1% in males and 5.4% in females. Comorbidity of social phobia with other anxiety disorders and major depression was high. Suicidal tendencies, family history and health services utilization were analyzed according to the lifetime comorbidity pattern of social phobia and depression.

The validity of diagnosis in psychiatry remains controversial. The new international classifications of mental disorders and the use of diagnostic criteria have allowed a marked improvement in the diagnostic process but the validity of the clinical entities is far from being strongly established. Epidemiological approach is a way among others which can offer new insights to that problem. During the recent decade, several community surveys have been conducted using quite similar methods and designs, referring to the same classification systems and using structured diagnostic interviews. A systematic collection of clinical signs and symptoms has found that, in the community, as well as in clinical setting, anxiety and affective disorders are frequently comorbid in the same subject. The concept of comorbidity has different meanings in a clinical or epidemiological sense. Results from several community surveys underline the importance of this phenomenon in various countries whatever the specific prevalence of anxiety and affective disorders could be. The most recent large study, the National Comorbidity Survey, has been undergone partly to address many questions concerning the comorbidity patterns between affective, anxiety and substance use disorders, their risk factors and influence on morbidity and health seeking process. Comorbidity is high between major depression and all different anxiety disorders, and to a much larger extent with generalized anxiety disorder. The distinction between pur and comorbid disorders on one hand, primary and secondary disorders according to the sequence of age of onset in comorbid disorders on the other hand has been also underlined recently. Comorbidity between anxiety and affective disorders strongly argue for investigating the genetics as well as the psychosocial factors involved in this phenomenon. Within this methodological perspective, these studies may offer new answers to major problems encountered in clinical and psychopathological research and, by the way, improve current therapeutic strategies.

Both epidemiological and clinical studies have demonstrated a high prevalence of panic disorder among alcoholic patients. In contrast, little attention has been given to studying alcohol abuse and/or dependence in patients suffering from panic disorder. One hundred and fifty-five consecutive referrals for treatment for panic disorder were interviewed using a modified version of the Schedule for Affective Disorders and Schizophrenia--Lifetime Version, modified for the study of anxiety disorders. Thirty-two patients (20.7%) had a lifetime history of alcohol abuse and/or dependence. Although the lifetime comorbidity rate of either agoraphobia and/or social phobia seems without any influence on the risk of alcohol-related disorder, alcoholic patients suffering from panic disorder appear to be more likely to have a history of depression and other addictive disorders. The majority of patients with primary alcoholism were male, and those who became alcoholics after they developed panic disorder were more likely to be female. The comparison between patients with primary and secondary alcoholism did not indicate any difference in the comorbidity rate with other psychiatric disorders nor the severity of panic disorder.

The contrast between the great importance of psychiatric disorders and the fact that they are often not identified as thus in medical and surgical units has been emphasized during the last ten years. The prevalence of depression disorders in an hospitalised population of medical patients is generally estimated between 15% and 30%. It is admitted that one third to two third of theses cases are not diagnosed by non psychiatrist physicians. It is the reason why self questionnaires have been finalized in order to detect psychiatric troubles in medical populations. The General Health Questionnaire (GHQ), constructed by Goldberg, is surely the most internationality used, but no validation study has yet been undertaken in France. This study means the validation of a french version of GHQ-28 items, set on 46 diabetics (type 1 and type 2) selected in a week hospital. This validation is based on the comparison of the two principal scoring methods: "GHQ" (0,0,1,1); "CGHQ" (0,1,1,1 for negative items) and the determination of the best cut-off score in this specific population. The referring DSM III-R diagnoses were assessed by the Composite International Diagnostic Interview (CIDI; Robins et al., 1988), which is a highly structured psychiatric interview developed by the World Health Organisation. Sixteen patients out of the 46 diabetics showed criterions of depressive and/or anxious disorders, 6 of them presenting both. The analysis of the answers to the questionnaires was based upon the technic of the Relative Operating Characteristic (ROC) curves which takes all the sensitivity-specificity couples bound to each of the possible threshold-score into account.(ABSTRACT TRUNCATED AT 250 WORDS)

Drug use was examined in a French general population adult sample from a household survey conducted in 1987-8 in a newly built town near Paris. Psychotropic drug use was measured by the percentage of subjects reporting their use during the past week. It was prominently represented by benzodiazepines (90% of psychotropic users), differed strongly between genders (4.6% in men, 10.2% in women) and age groups (higher after 40 years). A lifetime history of major depressive episode (MDE) or of anxiety disorders was associated with a higher proportion of psychotropic drug use. Psychotropic drug use also went with a current well-being questionnaire score. Using a logistic analysis, the following set of variables held for women: well-being score, history of both MDE and anxiety disorder, age, and marital status. Making allowance for the cross-sectional nature of this retrospective survey, these finding confirmed the relatively high level of benzodiazepine drug use in an urban French community sample and emphasized its association with mental health status.