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Resume L’echangisme est une sexualite de groupe, pratiquee par une minorite de personnes et de maniere occasionnelle. Notre enquete porte sur 95 echangistes (62 hommes et 33 femmes, âge moyen 38 ± 9,6 ans) recrutes sur des sites Internet francais, principalement le site « http://www.netechangisme.com ». Environ un echangiste sur deux est celibataire (42 %). La plupart sont cadres moyens ou artisans (45 %) et cadres superieurs ou exercant une profession liberale (42 %). Au total, 67 % des echangistes declarent etre heterosexuels (81 % hommes, 42 % femmes), 31 % etre bisexuels (19 % hommes, 52 % femmes) et 2 % etre homosexuelles (0 % hommes, 6 % femmes) ( p −3 ). Un echangiste sur deux (48 %) declare frequenter les lieux echangistes toujours avec son partenaire habituel, 13 % la plupart du temps, 24 % parfois, et 15 % jamais. Les types de sexualite pratiques sont : triolisme (86 %) ; melangisme (72 %) ; echangisme (60 %) ; voyeurisme (56 %) ; candaulisme (42 %) ; exhibitionnisme (39 %) ; gang-bang (33 %) ; cote-a-cotisme (31 %) ; et sadomasochisme (19 %). Il n’y pas de difference significative selon le sexe, ni selon l’orientation sexuelle, dans les types de sexualite pratiques. La principale caracteristique des libertins actuels, par rapport aux libertins passes, est la frequentation des lieux echangistes toujours ou la plupart du temps avec leur partenaire habituel. L’echangisme et le triolisme sont associes a la poursuite actuelle de cette sexualite de groupe chez les hommes, et le gang-bang et le voyeurisme sont associes a son arret chez les femmes. La dimension de personnalite recherche de sensations, la frequence de consommation d’alcool, de cannabis, et la prevalence d’usage sur la vie de cocaine, et d’ecstasy sont plus elevees chez les echangistes que chez les temoins.

Summary Swinging is a group sexual practice engaged in by a minority of people infrequently. Our study includes 95 swingers (62 men and 33 women, average age 38 ± 9.6 years) recruited via Internet French websites, mainly “ http://www.netechangisme.com ”. Approximately half of all swingers included declare to be single (42%). Most are middle managers or skilled workers (45%) and higher level managers or other professionals (42%). As to sexual orientation, 67% of the swingers describe themselves as heterosexual (81% men, 42% women), 31% as bisexual (19% men, 52% women) and 2% as homosexual (0% men, 6% women) ( P −3 ). Half of all the swingers (48%) state they go to swinging locations with their usual partner, 13% most of the time, 24% sometimes, and 15% never. The types of sexual activities engaged in are: threesomes (86%); soft-swinging (72%); swinging (60%); voyeurism (56%); candaulism (42%); exhibitionism (39%); gangbang (33%); same room sex (31%); and sadomasochism (19%). There is no significant difference of swinging practices based on sex or sexual orientation. The main characteristic of current swingers, as opposed to people who were swingers in the past (past swingers), is that they frequent swinging locations all or most of the time with their usual partner. Among the men, sexual practices which differentiate current swingers from past swingers include swinging and threesomes. Among the women, sexual practices which differentiate past swingers from current swingers include gangbang and voyeurism. The personality dimension sensation seeking, the frequency of alcohol and cannabis consumption and the lifetime prevalence of cocaine and ecstasy use are higher in the swingers than controls.

In this paper, an agent-based model of heterogeneous farmer decision-making was coupled with an individual-based model of skylark breeding populations, and applied to a small intensive arable catchment in Scotland. The impacts of farmer decisions on a tradeoff between food and bioenergy production, and skylark numbers, were simulated under the assumptions of three socio-economic scenarios until the year 2050. Bioenergy and food production had a significant negative effect on adult and fledgling skylarks. In a business-as-usual context, the production of food and bioenergy increases smoothly, and the number of skylarks is more stable over time than in other scenarios. Food production was higher in an economic liberalisation scenario, due to intensive management and higher yield performance. This explained the low average number of skylarks found at the landscape level in this scenario. The number of skylarks was highest in a sustainability-oriented scenario, but a sharp decrease was observed from 2035 onwards due to the large area planted with bioenergy crops. The different values for economic, environmental and social attributes of farmer decisions played an important role in the land use mosaic, the implementation of ecologically-related actions and on the provision of ecosystem services and biodiversity. Overall, results suggest that a re-assessment of policy targets and design is necessary to maximise environmental management efficiency at the catchment level by taking into account the heterogeneity in farmer objectives and the tradeoffs in ecosystem services provision. The novel approach of coupling an ABM with an IBM is encouraged in further land use related studies.

BACKGROUND Health care seeking for a problematic use of cannabis is in progress in France. OBJECTIVES The aim is to assess the addictive and psychiatric comorbidity in cannabis users seen in the specific setting at the Lariboisiere hospital. METHOD Two hundred and seven cannabis users were included from January 2004 to December 2009. Twelve-month and lifetime diagnosis of abuse and dependence (cannabis, alcohol, cocaine/crack) (DSM-IV), current and lifetime mood disorders, anxiety disorders, eating disorders and psychotic disorders were assessed (Mini-International Neuropsychiatric Interview). Logistic regression analyses identified adjusted odds ratios associated with the gender and the health care seeking (P=0.01). RESULTS One hundred and forty-seven men (71%) and 60 women (29%), 29.3±8.6 years (15.2-51.6 years). Most of the outpatients ask for health care themselves (59.7%), whereas 19.4% are asked to seek health care by relatives (19.4%) or because of an academic, health or justice injunction (20.4%). In total, 49.3% of the outpatients are single, 35.7% are cohabitating, 9.3% are married and 6.3% are separated/divorced. About 20.4% of the outpatients are students, 35.7% have a professional activity, 19% are jobless, 2.4% are impaired, 0.5% are retired, at home and 12.1% do not have an official income. Twelve-month and lifetime prevalence of abuse/dependence are: cannabis (10.1/82.1% and 8.7/88.4%), alcohol (9.7/8.7% and 19.3/18.8%), cocaine/crack (2.4/3.4% and 4.8/11.6%). The mean duration of cannabis dependence for the current dependent users is 8.4±5.8 years. The mean number of "joints" during the last 6 months is 6±4.3, the mean amount of cannabis per week is 12.5±11.3g. About 51.3% of the dependent users report externalized and/or internalized disorders at school during childhood and adolescence. In total, 19.4% of the dependent users have a suicide attempt history and 18.9% have a psychiatric hospitalisation history, more frequently women (P

There is growing interest in creating empirically grounded agent based models (ABMs) to simulate land use change at a variety of spatio-temporal scales. The development of land use change models is challenging, as there is a need to connect representations of human behavioural processes to simulations of the biophysical environment. This paper presents a new agent-based modelling framework (Aporia) that has the goal of reducing the complexity and difficulty of constructing high-fidelity land use models. Building on earlier conceptual developments for modelling land use change and the provision of ecosystem services, Aporia was designed to be modular, flexible and open, using a declarative, compositional approach to create complex models from subcomponents. The framework can be tightly or loosely coupled with multiple vegetation models, it can be set up to evaluate a range of ecosystem service indicators, and it can be calibrated for a range of different landscape-scale case studies and modelling styles. The framework is released under an Open Source licence, and can be freely re-used and modified to form the basis of new models. We illustrate this with two case studies implemented using Aporia, exploring different socio-economic scenarios and behavioural characteristics on the land use decisions of Swiss and Scottish farmers. We also discuss the benefits of frameworks in terms of their flexibility, expandability, verification and transparency. Open-source framework simulating land use decisions and their impacts on ecosystem services.Declarative approach to configuration provides flexibility in model creation.Multilevel handling of temporality, and distinctions between land cover and land management.Rich socio-economic context for multi-criteria decision-making with multiple behavioural models.Multiple techniques for coupling with vegetation models.

The future of the Common Agricultural Policy (CAP) in Europe suggests support for a “greening” of production related payments, however, the loss of set-aside and the increasing freedom to respond to market prices raises doubts on the actual consequences for farm-related ecology. Voluntary Agri-Environmental Schemes (AES) are believed to play a key role in the conservation of ecological attributes of farming landscapes. Nevertheless, the options proposed within these schemes are directed beyond a single objective and the level of participation remains low. This paper presents a fine-grained approach for examining the behavioural intentions of farmers within a catchment with regards to the moral consideration of specific ecological aspects of farming, such as the preservation of birdlife. The findings indicate that most farmers hold strong values towards birds living on their land and have incorporated this within their decision-making. Nevertheless, very few respondents intend to participate in these schemes in the future and this is due to some misinterpretations of the underlying ecological requirements for providing suitable habitats and bird population trends. In addition, the stated need by farmers for more measures focused on bird conservation implies a requirement for increasingly directed financial rewards and for proposing guidance that fits within current farm management.

Perception-based typologies have been used to explore the decision making process of farmers and to inform policy design. These typologies have been criticised, however, for not fully capturing true farmer behaviour, and are consequently limited for supporting policy formulation. We present a method that develops a typology, using a social survey approach based on how farmers perceive their environment (e.g. birds and agri-environmental schemes). We then apply time-series census data on past farm strategies (i.e. land use allocation, management style and participation into agri-environmental schemes) to refine these typologies. Consequently, this offers an approach to improving the profiling of farmer types, and strengthens the validity of input into future agricultural policies. While the social survey highlights a certain degree of awareness towards birds with respect to farmer types, the analysis of past farm strategies indicated that farmers did not entirely follow their stated objectives. External factors such as input and output price signals and subsidy levels had a stronger influence on their strategies rather than stated environmental and social issues. Consequently, the refining of farmer types using this approach would aid the design of policy instruments, which integrate ecological issues within planning.

This study evaluates the French version of the Cannabis Use Disorders Identification Test (CUDIT) in a clinical sample with a high rate of cannabis misuse. A group of 194 cannabis users, including 134 outpatients (Group 1) seen at a specific cannabis clinic and 60 drug/alcohol addicts hospitalized for withdrawal (Group 2), filled out the CUDIT. The majority (82% of the sample) were cannabis dependent or abusers (DSM-IV). Internal reliability was assessed by Cronbach's alpha, item-total correlation by Spearman's rho and temporal reliability by the test-retest method. Construct validity was evaluated by factor analysis. Convergent validity was evaluated by measuring the correlation with the quantity of cannabis consumed. The cut-off score used to distinguish cannabis users from misusers was set using a Receiver Operating Characteristic curve analysis. Cronbach's alpha was high (0.83). There was no significant difference between the total test and retest scores (p = 0.1) indicating good temporal reliability....

The aim of this study was to evaluate the psychometric properties of the French version of the Marijuana Effect Expectancy Questionnaire (48 items) and study the cannabis expectancies according to the patterns of substance use and psychiatric disorders (DSM-IV). A sample of 263 subjects (average age 33.1 years [SD = 8.7], 56% men) consisting of cannabis users (n = 64), psychiatric inpatients (n = 175, most of whom were hospitalized for withdrawal), and a control group (n = 24) completed the questionnaire. Internal reliability was good (α= .87) and temporal reliability was satisfactory, with 24 of 48 items having a significant κ ≥ .41. Factor analysis showed four main factors that explained 42.1% of the total variance. The women feared Cognitive Impairment and Negative Effects, and Negative Behavioral Effects more than the men. The onset age of cannabis use, onset age of abuse, abuse and dependence were associated with fewer negative expectancies. Cannabis dependents differed from abusers by more Relaxation and Social Facilitation expectancies. Patients with major depressive episodes, panic disorder, social anxiety disorder, or posttraumatic stress disorder feared negative effects the most. Schizophrenic patients expected more Perceptual Enhancement and Craving. The French version of the Marijuana Effect Expectancy Questionnaire has good psychometric properties and is valid to assess cannabis expectancies in adolescents and adults with substance use disorders.

Resume L’existence d’un syndrome de sevrage a l’arret du cannabis survient chez plus de la moitie des sujets dependants. Or, bien que l’usage et la dependance au cannabis soient plus frequents chez les sujets dependants des opiaces qu’en population generale, la frequence et la semiologie des symptomes d’arret du cannabis sont inconnus dans cette population. C’est pourquoi nous avons compare par des entretiens retrospectifs la frequence du syndrome de sevrage au cannabis lors d’un arret volontaire dans deux groupes : 56 patients dependants du cannabis ne presentant aucune dependance actuelle a une autre drogue illicite et 43 patients dependants du cannabis et actuellement dependants des opiaces. Les diagnostics de dependance etaient portes selon les criteres du DSM IV a l’aide de l’entretien structure MINI. La proportion de sujets ayant presente un syndrome de sevrage (defini comme la presence d’au moins deux symptomes) etait la meme dans les deux groupes (65 %). Les deux groupes ne presentaient pas de difference pour ce qui est de la frequence des symptomes suivants : perte d’appetit ou de poids (30,8 %), irritabilite (45,1 %), anxiete (56 %), agressivite (36,3 %), impatience, incapacite a rester en place (45,1 %). En revanche, les sujets dependants des opiaces etaient plus nombreux a signaler des troubles du sommeil (79,1 vs 53,6 %, chi 2 = 6,91, p = 0,007). La mediane de duree de ces symptomes est de 20 jours apres l’arret.

The aim of this article was to report on the attitudes, opinions and confidences of final year dental students in three European schools towards the restoration of posterior teeth and in particular towards the use of amalgam and resin composite. One hundred and twenty-eight pre-piloted questionnaires were distributed to final year dental students in Cardiff, Dublin and Malmo. The questionnaire sought information relating to various opinions and attitudes towards the use of amalgam and resin composite in posterior teeth. Information was returned anonymously. Ninety-one completed questionnaires were returned (response rate=71%; Cardiff: n =40, Dublin: n=24, Malmo: n=27). Ninety-three per cent of Malmo students (n=24), 67% of Dublin students (n=16) and 60% of Cardiff students (n=24) reported that they feel confident when placing posterior resin composites. One hundred per cent of Malmo students (n=27), 75% of Cardiff students (n=30) and 33% of Dublin students (n=8) would prefer to have a resin composite rather than amalgam, placed in one of their own posterior teeth. Eighty-five per cent of Malmo students (n=23), 30% of Cardiff students (n=12) and 25% of Dublin students (n=6) perceive amalgam as being harmful to the environment. For the restoration of a posterior tooth in a pregnant female, 44% of students (n=40) would place a resin composite restoration, and 7% (n=6) would place an amalgam restoration, while 32% (n=29) would place a temporary restoration. Students at Malmo report that they place more posterior resin composites and have greater confidence at placing posterior resin composites than students at Cardiff or Dublin. There was confusion relating to the choice of restorative materials for pregnant females. Large variations in restorative strategies among graduates must be considered as dental professionals can practice in all countries within the European Union. @ 2010 Blackwell Publishing Ltd.

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).

Resume Objectif et mesures Nous presentons les caracteristiques sociodemographiques, la prevalence de l’abus et de la dependance au cannabis et aux autres substances psychoactives (criteres DSM-IV) ainsi que la comorbidite des troubles mentaux dans les 12 derniers mois (diagnostics evalues par le Mini-International Neuropsychiatric Interview [MINI] et les criteres DSM-IV) chez 90 usagers de cannabis vus en consultation specialisee cannabis a l’hopital Lariboisiere. Resultats Les caracteristiques sociodemographiques des usagers associent : une predominance d’hommes (67 %), un âge moyen de 27,5 ans (±8,4), une majorite de celibataires ou divorces (59 %). Deux tiers des usagers (67 %) sont actifs ou etudiants et 32 % sont inactifs. D’un point de vue des ressources, 22 % des usagers percoivent l’allocation chomage, le RMI ou une AAH et 11 % sont sans aucune ressource. La majorite des usagers sont venus d’eux-memes (63 %) et la plupart ont deja consulte un psychologue ou un psychiatre par le passe (73 %). Les usagers sont pour la grande majorite dependants (82 %) et abuseurs (9 %) du cannabis dans les 12 derniers mois. En dehors du tabac, on retrouve une dependance a l’alcool chez seulement 7 % des usagers, une dependance a la cocaine ou a l’ecstasy chez 2 %. Les principales substances consommees sur la vie sont le tabac (99 %), l’alcool (96 %) et la cocaine (41 %). La consommation cannabique dans les six derniers mois est de 5,8 (±4,4) joints quotidiens, 12 (±10,5) g hebdomadaires et le cout mensuel de 159 € (±133). Le cannabis est consomme dans plus des trois quarts des cas sous forme de haschisch. Environ un usager sur deux (48 %) presente au moins un trouble de l’humeur et plus de la moitie (55 %) au moins un trouble anxieux dans les 12 derniers mois. Les troubles de l’humeur sont l’episode depressif majeur (38 %), la dysthymie (19 %), l’hypomanie (3 %) et la manie (1 %). Les troubles anxieux sont la phobie sociale (29 %), l’anxiete generalisee (17 %), le trouble panique avec et sans agoraphobie (16 %), le trouble obsessionnel compulsif (12 %), l’agoraphobie sans trouble panique (9 %) et le syndrome de stress post-traumatique (5 %). Le pourcentage de schizophrenes est de 4 %. Les femmes souffrent plus frequemment que les hommes d’au moins un trouble de l’humeur (64 % versus 41 % ; p = 0,04) ou d’un syndrome de stress post-traumatique (17 % versus 0 % ; p Conclusion En dehors du tabac, 80 % des usagers vus a notre consultation sont uniquement dependants ou abuseurs du cannabis. Les taux de dependance au cannabis sont tres eleves. En comparaison avec les etudes publiees sur les autres consultations specialisees cannabis en France, les usagers vus a l’hopital Lariboisiere sont plus âges, plus frequemment des femmes, plus dependants du cannabis et ont une comorbidite elevee de troubles de l’humeur et anxieux. Certains resultats de notre etude ont ete presentes lors de la reunion de l’Association francaise de psychiatrie biologique du 14 novembre 2006 [L’Encephale 33 (2007) 101].

This study sought to compare the serum cholesterol levels of psychiatric in-patients, with and without recent suicidal behavior. The hypothesis was that the temperament dimension novelty seeking (NS) would be an intermediary variable, correlated with both serum cholesterol level and suicidal behavior. The study included 155 psychiatric in-patients, 21.9% (n=34) of whom had recently attempted suicide. Their cholesterol level was compared to that of patients with no suicide attempt. The NS dimension was explored with the aid of Cloninger's Temperament and Character Inventory. Significantly lower average cholesterol levels were found in women who had attempted suicide before hospitalization than for the others (4.71 mmol/l+/-0.83 vs. 5.52 mmol/l+/-1.36). Similar results were not found for men. However, the average NS scores did not differ according to suicide attempts in women or in men, and the scores of NS were not correlated with cholesterol level. This study confirms an association between low cholesterol and suicidal behavior in women only, but this association seems independent from the NS personality dimension. The absence of a correlation between serum cholesterol levels and suicidal behavior in men could be linked to the small number of men included in the study.

Health care seeking for a problematic use of cannabis is in progress in France.The aim is to assess the addictive and psychiatric comorbidity in cannabis users seen in the specific setting at the Lariboisière hospital.Two hundred and seven cannabis users were included from January 2004 to December 2009. Twelve-month and lifetime diagnosis of abuse and dependence (cannabis, alcohol, cocaine/crack) (DSM-IV), current and lifetime mood disorders, anxiety disorders, eating disorders and psychotic disorders were assessed (Mini-International Neuropsychiatric Interview). Logistic regression analyses identified adjusted odds ratios associated with the gender and the health care seeking (P=0.01).One hundred and forty-seven men (71%) and 60 women (29%), 29.3±8.6 years (15.2-51.6 years). Most of the outpatients ask for health care themselves (59.7%), whereas 19.4% are asked to seek health care by relatives (19.4%) or because of an academic, health or justice injunction (20.4%). In total, 49.3% of the outpatients are single, 35.7% are cohabitating, 9.3% are married and 6.3% are separated/divorced. About 20.4% of the outpatients are students, 35.7% have a professional activity, 19% are jobless, 2.4% are impaired, 0.5% are retired, at home and 12.1% do not have an official income. Twelve-month and lifetime prevalence of abuse/dependence are: cannabis (10.1/82.1% and 8.7/88.4%), alcohol (9.7/8.7% and 19.3/18.8%), cocaine/crack (2.4/3.4% and 4.8/11.6%). The mean duration of cannabis dependence for the current dependent users is 8.4±5.8 years. The mean number of "joints" during the last 6 months is 6±4.3, the mean amount of cannabis per week is 12.5±11.3g. About 51.3% of the dependent users report externalized and/or internalized disorders at school during childhood and adolescence. In total, 19.4% of the dependent users have a suicide attempt history and 18.9% have a psychiatric hospitalisation history, more frequently women (P0.01 and P=0.02). About 73.8% have a psychologist or psychiatrist care history. In total, 38.1% of users have at least one current mood disorder, females more frequently than males (P0.001). Current and lifetime prevalence of mood disorders are: major depressive disorder (MDD) (29.1% and 57.1%); current dysthymia (20.3%); hypomania (1.9 and 6.7%); mania (2.9 and 12.8%). Females have more frequently than males current and lifetime MDD (P0.001). About 53.2% of users have at least one current anxiety disorder, females more frequently than males (P0.001). Current and lifetime prevalence of anxiety disorders are: panic disorder (10 and 16.4%); agoraphobia (13.9 and 17.4%); social phobia (26.9 and 32.8%); obsessive-compulsive disorder (9.5 and 12.9%); post-traumatic stress disorder (PTSD) (6.5 and 16.4%); current generalized anxiety disorder (26.8%). Females have more frequently current and lifetime: agoraphobia (P=0.01 and P0.001); PTSD (P0.001); current social phobia (P=0.049). Current and lifetime eating disorders prevalence are: anorexia (0 and 1.5%); bulimia (4 and 8%); females more frequently have bulimia (P=0.02 and P0.001). In total, 4.8% have a psychotic disorder. Adjusted odds ratios of associated variables to gender (women/men) are lifetime MDD OR=4.71 [2.1-10.61] (P0.001) and later age of onset of cannabis abuse OR=1.1 [1.04-1.17] (P=0.002). Adjusted odds ratios associated with personal health care seeking compared to a non personal motivated health care seeking are the numbers of criteria of 12-month cannabis dependence OR=1.26 [1.06-1.51] (P=0.009) and age OR=1.07 [1.03-1.12] (P=0.002).Our survey confirms the high mood and anxiety disorders comorbidity in cannabis dependent users seen in a specific setting and underlines the need to evaluate those disorders.

The aim of this article was to report on the attitudes, opinions and confidences of final year dental students in three European schools towards the restoration of posterior teeth and in particular towards the use of amalgam and resin composite. One hundred and twenty-eight pre-piloted questionnaires were distributed to final year dental students in Cardiff, Dublin and Malmö. The questionnaire sought information relating to various opinions and attitudes towards the use of amalgam and resin composite in posterior teeth. Information was returned anonymously. Ninety-one completed questionnaires were returned (response rate=71%; Cardiff: n =40, Dublin: n=24, Malmö: n=27). Ninety-three per cent of Malmö students (n=24), 67% of Dublin students (n=16) and 60% of Cardiff students (n=24) reported that they feel confident when placing posterior resin composites. One hundred per cent of Malmö students (n=27), 75% of Cardiff students (n=30) and 33% of Dublin students (n=8) would prefer to have a resin composite rather than amalgam, placed in one of their own posterior teeth. Eighty-five per cent of Malmö students (n=23), 30% of Cardiff students (n=12) and 25% of Dublin students (n=6) perceive amalgam as being harmful to the environment. For the restoration of a posterior tooth in a pregnant female, 44% of students (n=40) would place a resin composite restoration, and 7% (n=6) would place an amalgam restoration, while 32% (n=29) would place a temporary restoration. Students at Malmö report that they place more posterior resin composites and have greater confidence at placing posterior resin composites than students at Cardiff or Dublin. There was confusion relating to the choice of restorative materials for pregnant females. Large variations in restorative strategies among graduates must be considered as dental professionals can practice in all countries within the European Union.

A cannabis withdrawal syndrome (at least two symptoms) occurs in more than 50% of dependent smokers after cessation (1). The typical withdrawal pattern is composed of 6 symptoms: anger or aggression, decreased appetite or weight loss, irritability, nervousness/ anxiety, restlessness, and sleep difficulties (1). The rate of sleep disturbances during cannabis cessation was found to be 32% in non-treatment seeking dependent smokers (2). The two most frequent sleep symptoms are reduced sleep duration and strange or vivid dreams. These have been related to longer sleep onset latency, reduced slow wave sleep, and REM rebound (3).

The cannabis withdrawal syndrome occurs after cannabis cessation in more than 50% of dependent smokers. But although opioid-dependent patients are more frequently cannabis users and cannabis-dependent than the general population, the frequency and phenomenology of cannabis withdrawal symptoms in this specific population is unknown. Our hypothesis was that cannabis-dependent patients with current opioid dependence would experience the same withdrawal syndrome after cannabis cessation.To describe cannabis withdrawal symptoms in cannabis-only dependent patients and in cannabis-dependent patients with current opioid dependence.Using retrospective interviews, we evaluated the number and duration of six cannabis withdrawal symptoms in two groups: 56 cannabis-dependent patients without and 43 cannabis dependent patients with current opioid dependence. Cannabis and opioid dependence diagnoses were defined with DSM IV criteria using the MINI structured interview.The two groups were not different in terms of age of onset of cannabis use, and number of cannabis joints smoked at the time of the cannabis cessation attempt. The frequency of a cannabis withdrawal syndrome (defined as at least two different symptoms) did not differ in the two groups (65%). Neither was the proportion of subjects with the following symptoms: appetite or weight loss (30.8%), irritability (45.1%), anxiety (56%), aggression (36.3%) and restlessness (45.1%). Patients with cannabis dependence and current opioid dependence were more likely to report sleep disturbances (79.1 vs. 53.6%, chi(2)=6.91, P=0.007). The median duration of this cannabis withdrawal syndrome was 20 days post-cessation.This is, to our knowledge, the first study describing cannabis withdrawal syndrome in cannabis-dependent patients with current opioid dependence. These patients experience a cannabis withdrawal syndrome as often as cannabis-only dependent subjects, but describe more frequently sleep disturbances. This high rate of sleep disturbances may cause relapse to cannabis use.

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.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).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.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%; p0.001) in the last 12 months. The prevalence of family history for psychiatric disorders was 52% and for addiction, 59%.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.

We report on a tianeptine dependence lasting for eighteen months in a 42 year old patient. The patient had a previous history of addiction to opiates, amineptine, cocaïne and alcohol. He also had a family history of addiction to alcohol and opiates. Tianeptine was prescribed for a major depressive disorder. The patient alleged a "flash sensation" like with heroin since the very first doses with a physical and psychological well-being sensation, better psychomotor performances and transient mood elation. His addiction to tianeptine was immediate and heavy. The positive reinforcement faded away after one month and a total dependance took over, with physical and psychological withdrawal symptoms when doses were not renewed. After two months of treatment, the daily consumption of tianeptine was of 90 tablets. The patient was hospitalised to treat both the addiction to tianeptine and the ongoing major depressive disorder. He was taking 240 tablets daily. In the literature, reports of addictions to antidepressants are scarce and most of them involve agents with amphetamine-like properties, including amineptine and tranylcypromine. Other reports involving other antidepressant agents, including amitriptyline, fluoxetine and tianeptine remain exceptional. Addictions to antidepressants almost exclusively concern patients with a diagnosis of personality disorder and a previous history of drug or alcohol abuse and who are treated for a depressive disorder. Tianeptine, which is devoid of any psychostimulating effect in human, does not seem to have addictive properties apart from the reports of scarce cases.

We report on the case of a 20 year old woman with no previous psychiatric history, who displayed a first episode of catatonia with acute onset. Symptoms started plainly with sudden general impairment, intense asthenia, headache, abdominal pain and confusion. After 48 hours, the patient was first admitted to an emergency unit and transferred to an internal medicine ward afterwards. She kept confused. Her behaviour was bizarre with permanent swinging of pelvis, mannerism, answers off the point and increasingly poor. The general clinical examination was normal, except for the presence of a regular tachycardia (120 bpm). The paraclinical investigations also showed normal: biology, EEG, CT Scan, lumbar puncture. Confusion persisted. The patient remained stuporous, with fixed gazing and listening-like attitudes. She managed to eat and move with the help of nurses but remained bedridden. The neurological examination showed hypokinaesia, extended hypotonia, sweating, urinary incontinence, bilateral sharp reflexes with no Babinski's sign and an inexhaustible nasoorbicular reflex. The patient was mute and contrary, actively closed her eyes, but responded occasionally to simple instructions. For short moments, she suddenly engaged in inappropriate behaviors (wandering around) while connecting back to her environment answering the telephone and talking to her parents. The patient's temperature rose twice in the first days but with no specific etiology found. During the first 8 days of hospitalization, an antipsychotic treatment was administered: haloperidol 10 mg per os daily and cyamemazine 37.5 mg i.m. daily. Despite these medications, the patient worsened and was transferred to our psychiatric unit in order to manage this catatonic picture with rapid onset for which no organic etiology was found. On admission, the patient was stuporous, immobile, unresponsive to any instruction, with catalepsy, maintenance of postures, severe negativism and refusal to eat. A first treatment by benzodiazepine (clorazepate 20 mg i.v.) did not lead to any improvement. The organic investigations were completed with cerebral MRI and the ruling out of a Wilson's disease. Convulsive therapy was then decided. It proved dramatically effective from the first attempt; 4 shocks were carried out before the patient's relatives ask for her discharge from hospital. The patient revealed she had experienced low delirium during her catatonic state. The clinical picture that followed showed retardation with anxiety. She was scared with fear both for the other patients and the nursing team. She kept distant and expressed few affects. The treatment at the time of discharge was olanzapine 10 mg per os. She was discharged with a diagnosis of catatonia but with no specific psychiatric etiological diagnosis associated. She discontinued her follow-up a few weeks later. After one year, we had no information about her. Catatonia has now become rare but remains a problem for clinicians. We reviewed data concerning short term vital prognosis and psychiatric long term prognosis in catatonia. Lethal catatonia is associated with acute onset, both marked psychomotor and neurovegetative symptoms. In the light of literature, there is no proband clinical criterion during the episode that is of relevant diagnostic value to ascertain the psychiatric etiology.

Epidemiologic studies in the general population, taking into account certain bias inherent to the clinical observation have confirmed the clinical impression reporting a higher psychiatric comorbidity with persons suffering from migraine than in persons without migraine. Persons with migraine are at increased risk for affective and anxiety disorders, personality traits disorders (neuroticism), suicide attempts, but not for alcohol or illicit drug abuse. The comorbidity is more important in migraine with aura than in migraine without aura. Concerning affective disorders, the lifetime prevalence of major depression is 34.4% in persons with migraine and 10.4% in persons without migraine. For bipolar I disorder, prevalence is 6.8% in migraine with aura versus 0.9% when no migraine. Compared to no migraine, the lifetime prevalence of anxiety disorders in migraine is significantly increased in: panic disorder (10.9% vs 1.8%); generalized anxiety disorder (10.2% vs 1.9%); obsessive-compulsive disorder (8.6% vs 1.8%); phobic disorder (39.8% vs 20.6%). In addition, no psychopathological, biological or genetic explanation seems to be meaningful for the comprehension of this comorbidity pattern. These results remain primarily descriptive but they justify a clinical investigation of affective and anxiety disorders, and suicide attempts, in all person with migraine, and it also justifies the treatment of pain associated with the treatment of eventual affective or anxiety disorders.

Metabolic alkalosis usually complicates the evolution of patients with hypercapnia under diuretic or steroid therapy. The objective of this study was to analyze the efficiency of therapy with acetazolamide, a reversible carbonic anhydrase inhibitor, in this condition.Prospective study conducted at our hospital from June 1994 to March 1996, with 45 patients who had chronic respiratory acidosis and metabolic alkalosis. After a previous stabilization of the patient and eventually the discontinuation of diuretic or corticosteroid drugs fro 24-48 hours, 500 or 750 mg of acetazolamide were administered daily for 48 hours. Later, variations both in arterial gasometry and venous electrolytes were analyzed by comparing two means of paired data.After therapy with acetazolamide a clinical improvement was observed in patients, a decrease in PaCO2, pH and CO3H (p0.001) and an increase in PaO2 (p0.001). Hypochloremia (82.2%) and hypopotassemia (33.3%) were the most common electrolytic abnormalities before therapy. Both abnormalities improved significantly after the administration of acetazolamide. In five patients (11.1%) acetazolamide was discontinued when metabolic acidosis appeared, which only in three cases was associated with acidemia. No secondary effects were observed.Acetazolamide is an efficient alternative for treatment of patients with respiratory acidosis and metabolic alkalosis, particularly when other more common measures in this condition (discontinuation of diuretics and/or volemic replacement) have failed or are contraindicated. On the other hand, the emergence of relevant secondary effects is unlikely.

Our aim was to evaluate the utility of thrombolytic therapy administered outside tertiary hospital.We analyzed 80 consecutive patients with acute myocardial infarction admitted to the emergency area of primary hospital within 24 hours after the onset of symptoms and lastly transported to a coronary care unit (CCU) of a reference hospital. The thrombolytic protocol was performed by medicine department of primary hospital and the CCU of reference hospital.23 patients without (group A) and 57 with (group B) fibrinolytic therapy (APSAC 50 patients and streptokinase 7 patients) were analyzed. Group A patient were older (mean: 67 +/- 11 vs mean: 62 +/- 10 years; p = 0.01), and arrived later to emergency area (mean 254 +/- 284 vs mean 163 SD 161 min; p = 0.04) and to the coronary care unit (mean 561 +/- 371 vs mean 334 +/- 177 min; p = 0.0002). The guard physician decision to start or not the fibrinolytic therapy, was adequate in 86% of the patients (sensitivity 87%, predictive positive value 95%, specificity 83%). Complications on emergency area or during transport in group B were ventricular fibrillation in 9%, AV block (2-3 degree) in 9%, severe nonsustained ventricular arrhythmia in 11% and transitory hypotension in 23%. No death occurred before CCU admission. In group B, 35% patients was treated within the first 2 hours. The average time gain was 124 min (thrombolysis administration--CCU admission).On emergency area of primary hospital, thrombolytic therapy is feasible and safe when administered by well-equipped and well-trained medical emergence area and ambulance staff.