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Background: Slamming has been developing since 2011 as a new international phenomenon, mostly among men who have sex with men (MSM). It consists of intravenous drug injection before or during planned sexual activity to sustain, enhance, disinhibit, or facilitate the experience. We aimed to synthesize the available published evidence through a systematic literature review in order to precisely describe this phenomenon and to better characterize the population engaging in this practice and its specific motives. Methods: A systematic review of the available literature was conducted to identify all relevant publications using PubMed, Psyc­INFO, the Cochrane Library, and ScienceDirect. To complete the review, we followed the recommendations of the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” method. We limited the search to studies published between January 2008 and May 2020. Results: Our search identified 530 publications, of which 27 were included in the final data synthesis. One study focused on heterosexual and homosexual subpopulations, and all other studies focused on MSM-specific samples. Among MSM, slam prevalence was extremely variable, ranging from 2 to 91%; regarding other sexually active subjects, prevalence ranged from 7 to 14%. The prevalence of HIV-positive subjects varied widely across studies, ranging from 0.6 to 100%. We found less data about hepatitis C virus serostatus, ranging from 3 to 100%. Methamphetamine and mephedrone were the 2 most used drugs. Discussion/Conclusion: The data we found in international literature were very heterogeneous and from poorly reproducible studies. The definition of slamming in the international literature is not always clear, which limits the completeness of the collected data. This topic has been open to studies only recently; however, health professionals must be trained in the management of this practice, considering its risks in the short and medium terms and its addictive potential. We provided and discussed recommendations and potential future directions.

(1) Background: Opioid use disorder (OUD) is a complex condition that can require long-term treatment. Pharmacological therapy for OUD involves treatment with opioid agonists (OMT) tailored to individual profiles. The aim of our study in daily clinical practice was to compare the profiles of patients treated with methadone (MTD) and those using buprenorphine (BHD or BHD-naloxone-NX). (2) Methods: A cross-sectional multicentre study explored the psychological, somatic and social profiles of patients with Opioid Use Disorder (OUD) following Opioid Maintenance Treatment (BHD, BHD/NX, or MTD). Descriptive and comparative analyses were performed (3) Results: 257 patients were included, a majority were men using heroin. 68% (178) were on MTD, 32% (79) were on BHD. Patients with MTD were significantly more likely to report socio-affective damage, and more likely to be younger and not to report oral or sublingual use as the main route for heroin or non-medical opioids (4) Conclusions: In daily clinical practice, regarding OUD damage, only socio-affective damage was significantly more prevalent among patients on MTD than among those on BHD in the multivariate model. Age and route of administration also differed, and our results could raise the issue of the type of OMT prescribed in case of non-medical use of prescribed opioids. These hypothesis should be confirmed in larger studies.

Hypersexuality is a well-known adverse side effect of dopamine replacement therapy (DRT), and anti-craving drugs could be an effective therapeutic option. Our aim was to update the knowledge on this issue, particularly on the influence of an Opioid Receptor Mu 1 (OPRM1) genetic polymorphism. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We also analyzed a case of iatrogenic hypersexuality that occurred in a patient treated with DRT. An analysis of the OPRM1 gene was performed on said patient. Our search identified 597 publications, of which only 7 were included in the final data synthesis. All seven publications involved naltrexone use. Five of them were case reports. None of the publications mentioned DRT side effects, nor did they report genetic data. Regarding our case report, the introduction of naltrexone corresponded with the resolution of the patient’s hypersexuality. Moreover, the patient carried the A/G genotype, which has been reported to be associated with a stronger response to naltrexone for patients with an alcohol use disorder. Although studies are inconclusive so far, naltrexone could be an interesting therapeutic option for resistant hypersexuality due to DRT. Carrying the A/G genotype could help explain a good response to treatment.

Resume L’interet des antidepresseurs dans le traitement curatif de la depression bipolaire est tres controverse. Cependant ils representent la premiere classe medicamenteuse prescrite dans cette indication. La persistance de cet usage important peut etre expliquee par leur relative bonne place dans les guidelines . Cependant, il existe un manque d’etudes approfondies evaluant formellement les risques et l’efficacite des antidepresseurs les plus prescrits. Les limites des prescriptions refletent les limites floues du diagnostic du trouble bipolaire. L’objectif de cet article est de faire un etat des lieux de cette question a partir de la litterature afin d’aider le clinicien a la reflexion therapeutique, en prenant en compte le reperage de la depression bipolaire, les modalites d’utilisation des antidepresseurs dans ce cadre, et les risques a surveiller. Cette prescription releve de l’expertise du psychiatre, compte tenu de la complexite du traitement de la depression bipolaire.

Resume L’episode depressif majeur est une pathologie dont la frequence et la gravite ont un impact socioeconomique important. Les antidepresseurs valides dans cette indication, bases sur l’hypothese tri-mono-aminergique, ont une efficience globale limitee par leur latence d’action et le taux de patients repondeurs ou en remission. Les donnees scientifiques sur l’implication du systeme glutamatergique et la decouverte de l’effet antidepresseur rapide et robuste de la ketamine, antagoniste des recepteurs NMDA du glutamate, amenent de nouvelles perspectives dans la prise en charge medicamenteuse des depressions. Cet article passe en revue les differentes modalites d’utilisation de la ketamine dans les etats depressifs. Les essais cliniques sont en faveur d’un effet antidepresseur rapide sur la majorite des symptomes depressifs, dont les idees suicidaires, suite a une perfusion de 0,5 mg/kg de ketamine. Cet effet est transitoire, se limitant a quelques jours. Les effets indesirables, essentiellement psychomimetiques, sont reversibles en quelques heures. L’absence d’etudes de grande envergure, la modalite d’administration intraveineuse et le risque de mesusage sont les principales limites a la generalisation de l’usage de la ketamine. Neanmoins, son utilisation en tant que « starter » d’un traitement conventionnel, comme traitement de la depression resistante ou encore comme traitement de l’urgence suicidaire sont autant de potentielles innovations therapeutiques.

Background The treatment of depression remains a challenge since at least 40% of patients do not respond to initial antidepressant therapy and 20% present chronic symptoms (more than 2 years despite standard treatment administered correctly). Repetitive transcranial magnetic stimulation (rTMS) is an effective adjuvant therapy but still not ideal. Intermittent Theta Burst Stimulation (iTBS), which has only been used recently in clinical practice, could have a faster and more intense effect compared to conventional protocols, including 10-Hz high-frequency rTMS (HF-rTMS). However, no controlled study has so far highlighted the superiority of iTBS in resistant unipolar depression. Methods/design This paper focuses on the design of a randomised, controlled, double-blind, single-centre study with two parallel arms, carried out in France, in an attempt to assess the efficacy of an iTBS protocol versus a standard HF- rTMS protocol. Sixty patients aged between 18 and 75 years of age will be enrolled. They must be diagnosed with major depressive disorder persisting despite treatment with two antidepressants at an effective dose over a period of 6 weeks during the current episode. The study will consist of two phases: a treatment phase comprising 20 sessions of rTMS to the left dorsolateral prefrontal cortex, localised via a neuronavigation system and a 6-month longitudinal follow-up. The primary endpoint will be the number of responders per group, defined by a decrease of at least 50% in the initial score on the Montgomery and Asberg Rating Scale (MADRS) at the end of rTMS sessions. The secondary endpoints will be: response rate 1 month after rTMS sessions; number of remissions defined by a MADRS score of

Introduction La grande variabilite interindividuelle de la pharmacocinetique et des concentrations plasmatiques de methadone est fortement liee a une variabilite de l’activite des cytochromes P450 (CYP). Des etudes recentes ont souligne l’importance du polymorphisme genetique CYP2B6 G516 T sur la pharmacocinetique de la methadone. A notre connaissance, aucune etude n’a explore l’impact de la variabilite genetique sur la reponse clinique de la methadone de maniere integrative, en etudiant un ensemble de donnees cliniques, d’histoire de la maladie, en incluant les aspects biopsychosociaux. Notre etude a pour objectif d’evaluer l’impact clinique du polymorphisme genetique du CYP2B6 G516 T chez des patient recevant de la methadone comme traitement de substitution aux opiaces. Materiel et methode OPAL est une etude multicentrique observationnelle dans laquelle 263 patients âges de plus de 18 ans et recevant un traitement de substitution aux opiaces ont ete inclus dans 10 centres. Un sous-groupe de 72 patients recevant de la methadone a ete inclus dans une etude ancillaire de pharmacogenetique evaluant des polymorphismes du CYP2B6 et CYP2D6. Les patients porteurs de variants du CYP2B6 G516 T ont ete compares aux patients non porteurs. Resultats Nous montrons un impact du genotype sur (i) la pharmacocinetique de la methadone : les patients porteurs d’au moins un allele T ont des concentrations plasmatiques de methadone significativement plus elevees que les non porteurs p = 0,0029 (ii) l’arret des autres opiaces (superieur dans le groupe porteur d’au moins un allele T p = 0,045) et la frequence de consommation si non-arret (inferieur dans le groupe porteur d’au moins un allele T). Aucune difference entre les deux groupes n’est retrouvee en ce qui concerne les variables sociodemographiques, l’histoire et les consequences de la pathologie addictive, les consommations au moment de l’evaluation (incluant les consommations a risque), les pratiques de jeux (incluant le jeu pathologique) et les traitements psychotropes associes. Conclusion L’augmentation de la concentration plasmatique de methadone (cas des porteurs d’au moins un allele T) a un impact sur l’arret des opiaces et non l’utilisation d’autres substances. Il est fondamental d’identifier des biomarqueurs d’efficacite de la methadone. Les analyses genetiques pourraient etre tres contributives.