The impact of discontinuing methylphenidate on weight and eating behavior

International audienceChronic administration of the amphetamine-derivative methylphenidate (MPH) may induce appetite reduction and weight loss. By contrast, the effects that stopping chronic MPH may exert on eating behavior and body weight are poorly known. We report the case of a male patient with childhood attention deficit/hyperactivity disorder (ADHD), who discontinued MPH treatment at the age of 11 years and was lost to follow-up until the age of 16. The patient's body mass index increased by five points within 1 year of MPH cessation while the symptoms of ADHD were re-emerging. The patient secondarily developed DSM-5 criteria for eating disorders. Discontinuing chronic MPH can significantly affect weight and eating behavior. Such risks should warrant further studies, as they could be particularly increased in patients with ADHD, who share common vulnerability factors with both obesity and eating disorders

Cannabis use: what to do in general practice?

Cannabis use is now more frequent than alcohol drinking or tobacco smoking among young people (15-34years), whereas it may induce numerous medical aftermaths. Identifying and assessing cannabis use in general practice have become a current public health issue. The two steps of screening consist in spotting risky use of cannabis, and then in checking criteria for cannabis use disorder (CUD). Risky use requires a "brief intervention" by the general practitioner (GP). In case of CUD, the new DSM-5 criteria allow measuring the severity of the subsequent disorder, and listing the medical and social consequences. Using these criteria can help the GP to decide when the patient should be referred to an addiction-specialized unit. The GP has also to spot the different physical and psychiatric complications of cannabis use, in order to coordinate care between the different specialists

Depression with and without a history of psychotic symptoms in the general population: sociodemographic and clinical characteristics

International audienceBackground: The aim of this study was to find the sociodemographic and clinical characteristics of major depressive episode (MDE) with (MDE-HPS+) and without a history of psychotic symptoms (MDE-HPS) in the general population.Methods: The Mental Health in the General Population survey interviewed 38,694 individuals in France by using the MINI. The prevalence and sociodemographic and clinical correlates of MDE-HPS+ were assessed.Results: Of the sample, 11.2% were diagnosed with current MDE and among them, 39.3% presented a history of at least one psychotic symptom (hallucination or delusion). Patients with MDE-HPS+ were younger with more severe social impairment than those with MDE-HPS-. We also found a higher proportion of three generations of migrants in the MDE-HPS+ group. Comorbid psychiatric disorders such as a history of a manic episode, alcohol use disorder, social anxiety, generalized anxiety disorder, and a personal history of a suicide attempt were more frequent in patients with MDE-HPS+ than in those with MDE-HPS-. Finally, we found a specific gradient of severity for psychiatric comorbid disorders depending on the number of psychotic symptoms lifetime in MDE.Limitations: The study also has an observational cross-sectional design that does not permit causal inferences, and it is difficult to eliminate recall bias and reporting errors.Conclusion: In the general population, patients with MDE-HPS+, when compared to MDE-HPS-, presented with a more severe clinical profile, with increased rates of psychiatric comorbidities, particularly a history of bipolar disorder and a history of a suicide attempt

Tranexamic Acid for the Prevention of Blood Loss after Cesarean Among Women With Twins. A Secondary Analysis of the TRAAP2 Randomized Clinical Trial

BACKGROUND: Although prophylactic tranexamic acid administration at cesarean delivery resulted in a lower incidence of calculated estimated blood loss > 1000 mL or red-cell transfusion by day 2, its failure to reduce the incidence of hemorrhage-related secondary clinical outcomes (TRAAP2 trial) makes its use questionable. The magnitude of its effect may differ in women at higher risk of blood loss, including those with multiple pregnancies. OBJECTIVE: To compare the effect of tranexamic acid vs placebo to prevent blood loss at cesarean delivery among women with multiple pregnancies. STUDY DESIGN: Secondary analysis of the TRAAP2 trial data including 319 women with multiple pregnancies in this double-blind, randomized controlled trial from March 2018 through January 2020 in 27 French maternity hospitals. Women with a cesarean before or during labor at 34 or more gestational weeks were randomized to receive intravenously 1 g of tranexamic acid (n=160) or placebo (n=159), both with prophylactic uterotonics. The primary outcome was a calculated estimated blood loss > 1000 mL or a red blood cell transfusion by 2 days after delivery. Secondary outcomes included clinical and laboratory blood loss measurements. RESULTS: Of the 4551 women randomized in this trial, 319 had a multiple pregnancy and cesarean delivery, 298 (93.4%) with primary outcome data available. This outcome occurred in 62 of 147 women (42.2%) in the tranexamic acid group and 67 of 152 (44.1%) receiving placebo (adjusted risk ratio, 0.97; 95% CI 0.68-1.38; P=.86). No significant between-group differences occurred for any hemorrhage-related clinical outcomes: gravimetrically estimated blood loss, provider-assessed clinically significant hemorrhage, additional uterotonics, postpartum blood transfusion, arterial embolization, and emergency surgery (P>.05 for all comparisons). CONCLUSION: Among women with a multiple pregnancy and cesarean delivery, prophylactic tranexamic acid did not reduce the incidence of any blood loss-related outcomes