Homicide and Associated Steroid Acute Psychosis: A Case Report

We report the case of an old man treated with methylprednisolone for chronic lymphoid leukemia. After two months of treatment, he declared an acute steroid psychosis and beat his wife to death. Steroids were stopped and the psychotic symptoms subsided, but his condition declined very quickly. The clinical course was complicated by a major depressive disorder with suicidal ideas, due to the steroid stoppage, the leukemia progressed, and by a sudden onset of a fatal pulmonary embolism. This clinical case highlights the importance of early detection of steroid psychosis and proposes, should treatment not be stopped, a strategy of dose reduction combined with a mood stabilizer or antipsychotic treatment. In addition have been revised the risks of the adverse psychiatric effects of steroids

How Much Do Benzodiazepines Matter for Electroconvulsive Therapy in Patients With Major Depression?

BACKGROUND: Electroconvulsive therapy (ECT) is one of the most effective treatments for major depressive disorder (MDD), especially in cases of treatment-resistant MDD. Because of their pharmacological profiles, benzodiazepines (BZDs) are suspected to decrease the efficacy of ECT. This study investigated the effect of BZDs on ECT-induced clinical outcomes and ECT course parameters in patients with MDD. METHOD: The impact of BZDs on severity of depression (Montgomery-Asberg Depression Rating Scale scores) and on ECT course parameters (seizure threshold, clinical and electroencephalographic seizure duration) was investigated in 70 patients with MDD who received an ECT course using dose-titration method (22 received concomitant BZDs). RESULTS: Lower remission rates (52.0%) and smaller decreases in Montgomery-Asberg Depression Rating Scale scores were observed in the non-BZD group than in the BZD group (81.2%, P = 0.02). There were no significant differences between the 2 groups regarding seizure duration and seizure threshold. LIMITATIONS: This was a retrospective study. Impact of BZDs on anxiety and cognition was not assessed. CONCLUSIONS: Benzodiazepines increased the clinical efficacy of ECT when delivered using dose-titration method and bitemporal stimulation. Further studied are needed to understand the interaction between BZDs and ECT on clinical outcomes

Quetiapine Poisoning and Factors Influencing Severity

PURPOSE/BACKGROUND: Quetiapine is a relatively new atypical antipsychotic with fewer adverse effects. It is increasingly prescribed to patients. The purpose of this study was to describe the cases of poisoning observed at the western France Poison Control Centre and identify potential risk factors that increase the severity of the cases. METHODS: This was a retrospective study of self-poisoning with quetiapine as reported by the western France Poison Control Centre between 2007 and 2017. RESULTS: There were 372 cases of quetiapine poisoning. Circumstances are known in 367 of 372 cases. There were 75 cases of null severity (grade 0), 133 cases of mild severity (grade 1), 85 cases of moderate severity (grade 2), and 79 cases of high severity (grade 3). Five deaths were listed in this series. The most commonly observed symptoms were neurological and cardiovascular in nature (drowsiness, coma, tachycardia, hypotension). Of these cases, 79.8% included voluntary ingestions. Among 302 cases with coagents, the most common coagents were benzodiazepines (56%), other psychotropic drugs (41%), and antidepressants (37%). An evaluated ingested dose 1500 mg or greater and 2 or more coagents increase the risk of severe poisoning. In particular, concomitant ingestion of benzodiazepines and antidepressants with quetiapine was associated with high severity (odds ratio, 2.478 [confidence interval, 1.3-4.723]; odds ratio, 1.820 [confidence interval, 1.010-3.316]). CONCLUSIONS: Quetiapine may lead to severe poisoning for which there is currently no specific treatment. Patients and practitioners should be aware of this when quetiapine is prescribed, particularly when used in combination with other medications, and in order to deal with cases of poisoning

Blue light-filtering intraocular lenses and post-operative mood: a pilot clinical study

The purpose of the study was to determine if implantation of blue-filtering intraocular lenses (IOLs) affects post-operative mood, inducing more depression, compared to patients undergoing implantation with conventional IOLs. The study was conducted at the Angers University Hospital, France. This was a prospective with a lowercase pilot study, including consecutive patients planned to undergo cataract surgery in both eyes within 1 week. The same type of IOL was used in both eyes of each patient. The choice of IOL was not randomized but driven by the habits and experience of each participating surgeon. Cognitively healthy patients (an MMSE score higher than 25) were assessed before and after surgery, using the 30-item geriatric depression scale (GDS) to seek symptoms of depression. Univariate and multiple logistic regressions were used to examine the association between the type of IOL and the 30-item GDS score improvement during the 3 months after lens implantation, while adjusting for participants\u27 characteristics (age, visual acuity). Blue-filtering IOLs were used in 16 patients (mean +/- standard deviation, 75.6 +/- 7.5 years; 75 % female), and untinted IOLs in 18 patients (77.3 +/- 6.9 years; 77.8 %female). Pre-operatively visual acuity and GDS scores were comparable in the two groups. The post-operative GDS score was improved by 1.91 +/- 3.10 points in the whole sample (P = 0.002), as well as in each subgroup of patients. Three months after surgery, the mean change in GDS score did not differ between groups (P = 0.365), nor did the mean visual acuity (P = 0.198)

Syntheses and NMR and XRD studies ofcarbohydrate–ferrocene conjugates

Carbohydrate–ferrocene conjugates were synthesized and showed that the ferrocene entity appeared to be confined to a low volume so that proton NMR spectroscopy revealed 3 to 4 signals for substituted cyclopentadienyl instead of two usually

Les unités médico-psychiatriques : les soins partagés en santé mentale

Cet article décrit le fonctionnement d’une unité hospitalière originale, couplant approche somatique et psychiatrique sous rubrique générique d’une Unité Médico-Psycho-Sociale (UMPS) implantée au sein du CHU d’Angers depuis 1996. Nous proposons d’examiner l’intérêt de cette mixité, tout en interrogeant ses limites et ses difficultés de fonctionnement. L’intérêt de la structure est de proposer une approche pluridisciplinaire, somatique et psychiatrique dans un même lieu de soins. Cette double compétence de la part des personnels médicaux et paramédicaux est nécessaire lorsque les avis ponctuels de la consultation-liaison ne suffisent plus et lors de situations complexes, dans lesquelles le double savoir-faire est sollicité, en lien avec les ressources d’une réanimation et des services de spécialités médicales et chirurgicales. Ce type d’unité, fondée sur un fonctionnement mixte et à binôme confirmé est peu représenté, tant en France qu’à l’étranger. La fréquence de la co-morbidité somatique et organique conduit pourtant à les considérer comme une réponse innovante aux difficultés rencontrées dans ces prises en charge. Nous décrivons deux cas cliniques afin d’argumenter notre propos

Decision-Making Measured by the Iowa Gambling Task in Patients with Alcohol Use Disorders Choosing Harm Reduction versus Relapse Prevention Program

AIMS: Two main therapeutic programs were offered to patients suffering from alcohol use disorders (AUDs): avoid the alcohol by abstinence or controlling their consumption. After information and motivational sessions, the patient chooses his own therapeutic plan. However, patients with AUD exhibit poor decision-making. The purpose of this study was to investigate the decision-making in AUD by comparing patients who chose to reduce and control their consumption to those who chose abstinence program. METHODS: Sixty-seven subjects with alcohol use disorder were included (AUD group) for treatment, choosing either a relapse prevention program (RPP) or a harm reduction program (HRP). Patients were compared to a healthy control group (n = 31). Cognitive skills were assessed through the Montreal Cognitive Assessment test, the National Adult Reading Test, the Trail Making Test and the Iowa Gambling Task (IGT). RESULTS: Thirty-seven patients with AUD chose the RPP while 30 followed a HRP. The AUD group performed worse than controls on the IGT. The RPP group had significantly lower performance than both HRP and control groups (these later groups being not statistically different). No correlation was observed between the available clinical, cognitive and intellectual measures. CONCLUSION: This study confirms that the decision-making process of patients with an alcohol use disorder is impaired. However, the 2 groups differ on the IGT scores, despite comparable clinical and cognitive profiles. The patients\u27 decision-making abilities could be a useful guide when developing therapeutic programs

Étude exploratoire des caractéristiques professionnelles d'un échantillon de suicidants hospitalisés

Cette étude a pour objectif de décrire les caractéristiques professionnelles d’un échantillon de suicidants. Un enquêteur a interrogé les suicidants âgés de 18 à 65 ans, hospitalisés consécutivement dans une unité spécialisée du CHU d’Angers sur une durée de 6 mois et demi. Au total, 87 suicidants actifs avec un emploi ont été interrogés. Ils ont souvent été confrontés à des contraintes organisationnelles décrites dans la littérature comme responsables de souffrance mentale liée au travail. Cela concerne globalement autant les hommes que les femmes. En comparaison aux enquêtes de santé au travail (Sumer, Samotrace…), les suicidants sont plus nombreux à ressentir entre autres un stress intense au travail, une conscience professionnelle heurtée et à être en situation tendue selon le modèle de Karasek. Cela pourrait être en faveur d’un lien entre les tentatives de suicide et certains facteurs de pénibilité mentale au travail. Les résultats de cette étude sont à interpréter avec prudence du fait des phénomènes de circularité des données et de la faiblesse de l’échantillon

Etchant-induced shaping of nanoparticle catalysts during chemical vapour growth of carbon nanofibres

10 pagesInternational audienceCarbon nanofibres (CNFs) obtained by plasma enhanced chemical vapour deposition are made of cone-shaped graphene layers, the opening angle of which has a significant influence on their properties: the smaller the angle, the closer the properties to those of carbon nanotubes. That angle is determined by the shape of the metal nanoparticle used to catalyse the growth. We show in this paper that the shape of Ni nanoparticle catalysts, and in turn the CNF properties, can be tuned during plasma-enhanced chemical vapour deposition, by the choice of the etchant gas. We show in particular that a water-containing etchant (H2O or H2O+H2) increases the growth rate by an order of magnitude at 600°C compared to an ammonia-containing etchant (NH3 or NH3+H2), and leaves more elongated Ni particles with a cone angle three times smaller. We conclude that the cone angle and the growth rate are directly related, and propose a mechanism to explain that large difference between the two etchants