Work addiction test questionnaire to assess workaholism: Validation of French version

Background: Work addiction is a significant public health problem with a growing prevalence. The Work Addiction Risk Test (WART) is the gold standard questionnaire to detect workaholism. Objective: The main objective of this study was to validate the French version of the WART. Methods: Questionnaires were proposed to voluntary French workers using the WittyFit software. There were no exclusion criteria. The questionnaire was administered anonymously for initial validity testing and readministered one week later for test-retest reliability. We also assessed the workers’ sociodemographic characteristics, as well as other measurements for external validity, such as stress, well-being, and coaddictions to tobacco, alcohol, and cannabis. Several psychometric properties of the French-WART were explored: acceptability, reliability (internal consistency [Cronbach alpha coefficient] and reproducibility [Lin concordance coefficient]), construct validity (correlation coefficients and principal component analysis), and external validity (correlation coefficients). Results: Among the 1580 workers using WittyFit, 187 (11.83%) agreed to complete the WART questionnaire. Of those, 128 completed the test-retest survey (68.4%). Acceptability found that all respondents had fully completed the questionnaire, with few floor or ceiling effects. Reliability was very good with a Cronbach alpha coefficient at .90 (internal consistency) and Lin concordance coefficient at .90 (95% CI .87-.94] with a difference on the retest of .04 (SD 4.9) (95% CI −9.6 to 9.7) (reproducibility). We identified three main dimensions (construct validity). Relationships between WART and stress and well-being confirmed its external validity. Conclusions: The French version of the WART is a valid and reliable instrument to assess work addiction with satisfactory psychometric properties. Used in occupational medicine, this tool would allow the diagnosis of work addiction and can be easily implemented in current practice

Management of traumatic events: influence of emotion-centered coping strategies on the occurrence of dissociation and post-traumatic stress disorder

Our aim was to assess the influence of the coping strategies employed for the management of traumatic events on the occurrence of dissociation and traumatic disorders. We carried out a 1-year retrospective study of the cognitive management of a traumatic event in 18 subjects involved in the same road vehicle accident. The diagnosis of post-traumatic stress disorder (PTSD) was made for 33.3% of the participants. The participants with a PTSD diagnosis 1 year after the event used emotion-centered strategies during the event more often than did those with no PTSD, P < 0.02. In the year after the traumatic event, our results show a strong link between the intensity of PTSD and the severity of the post-traumatic symptoms like dissociation (P = 0.032) and the use of emotion-centered strategies (P = 0.004). Moreover, the participants who presented Peritraumatic Dissociative Experiences Questionnaire scores above 15 made greater use of emotion-centered coping strategies than did those who did not show dissociation, P < 0.04. Our results confirm that the cognitive management of traumatic events may play an essential role in the development of a state of post-traumatic stress in the aftermath of a violent event

Effect of the COVID-19 pandemic on the psychotropic drug consumption

International audienceImportance Although the COVID-19 pandemic has had a negative impact on mental health, there is no comprehensive longitudinal study of the entire population of a country without selection bias. Objective The objective of this study was to evaluate the prescription of psychotropic drugs during the COVID-19 pandemic, using data from the French national health data system (SNDS). Design, settings, and participants Prescriptions for psychotropic drugs (antidepressants, anxiolytics, hypnotics, and antipsychotics) from 1 January 2015 to 30 September 2021 were collected from administrative data provided by the SNDS. This database includes more than 99% of the French population, i.e., 67 million people. The data were analyzed using an interrupted time series analysis (ITSA) model. Main outcomes and measures Consumption of psychotropic drugs was aggregated in months and expressed in number of boxes per thousand inhabitants. Results During the study period, more than 1.3 billion boxes of psychotropic medications were dispensed. Comparison of psychotropic drug dispensing before and after the pandemic showed a relative increase of 0.76 (95 CI 0.57 to 0.95, p &lt;0.001) boxes per month per thousand inhabitants, all classes of psychotropic drugs combined. Three classes saw their consumption increase in an almost similar proportion, respectively, by 0.23 (0.15 to 0.32, p &lt;0.001) boxes for antidepressants, 0.27 (0.20 to 0.34, p &lt;0.001) boxes for anxiolytics and 0.23 (0.17 to 0.30, p &lt;0.001) boxes for hypnotics. The change in antipsychotic consumption was very small, with an increase of 0.04 boxes (0.02 to 0.06, p = 0.001) per month per thousand population. Conclusion and relevance The COVID-19 pandemic had led to an increase in the consumption of psychotropic drugs, confirming the significant impact of the pandemic on the mental health of the general population

COVID-19 pandemic lockdown and problematic eating behaviors in a student population

Background and aims: Since mid-March 2020, over 3 billion people have been confined as a result of the COVID-19 pandemic. Problematic eating behaviors are likely to be impacted by the pandemic through multiple pathways. This study examined the relationships between stress related to lockdown measures and binge eating and dietary restriction in a population of French students during the first week of confinement. Methods: A sample of undergraduate students (N = 5,738) completed an online questionnaire 7 days after lockdown measures were introduced. The survey comprised variables related to lockdown measures and the COVID-19-pandemic, mood, stress, body image, binge eating and dietary restriction during the past 7 days, as well as intent to binge eat and restrict in the following 15 days. Results: Stress related to the lockdown was associated with greater likelihood of binge eating and dietary restriction over the past week and intentions to binge eat and restrict over the next 15 days. Greater exposure to COVID-19-related media was associated with increased eating restriction over the past week. Binge eating and restriction (past and intentions) were associated with established risk factors, including female gender, low impulse regulation, high body dissatisfaction, and having a concurrent probable eating disorder. Discussion and conclusion: The higher the stress related to the first week of confinement, the higher the risk of problematic eating behaviors among students, particularly those characterized by eating-related concerns. Screening for risk factors and providing targeted interventions might help decrease problematic eating behaviors among those who are most vulnerable

Rationales, design and recruitment for the Elfe longitudinal study

Background Many factors act simultaneously in childhood to influence health status, life chances and well being, including pre-birth influences, the environmental pollutants of early life, health status but also the social influences of family and school. A cohort study is needed to disentangle these influences and explore attribution. Methods Elfe will be a nationally representative cohort of 20 000 children followed from birth to adulthood using a multidisciplinary approach. The cohort will be based on the INSEE Permanent Demographic Panel (EDP) established using census data and civil records. The sample size has been defined in order to match the representativeness criteria and to obtain some prevalence estimation, but also to address the research area of low exposure/rare effects. The cohort will be based on repeated surveys by face to face or phone interview (at birth and each year) as well as medical interview (at 2 years) and examination (at 6 years). Furthermore, biological samples will be taken at birth to evaluate the foetal exposition to toxic substances, environmental sensors will be placed in the child's homes. Pilot studies have been initiated in 2007 (500 children) with an overall acceptance rate of 55% and are currently under progress, the 2-year survey being carried out in October this year. Discussion The longitudinal study will provide a unique source of data to analyse the development of children in their environment, to study the various factors interacting throughout the life course up to adulthood and to determine the impact of childhood experience on the individual's physical, psychological, social and professional development

Alcoholism Risk Reduction in France: A Modernised Approach Related to Alcohol Misuse Disorders

During many years in France, risk reduction strategies for substance abuse concerned prevention strategies in the general population or interventions near users of illicit substances. In this spirit, the reduction of consumption only concerned opiate addicts. With regard to alcohol, the prevention messages relative to controlled consumption were difficult to transmit because of the importance of this product in the culture of the country. In addition, methods of treatment of alcoholism rested on the dogma of abstinence. Several factors have recently led to an evolution in the treatment of alcohol use disorders integrating the reduction of consumption in strategies. Strategies for reducing consumption should aim for consumption below recommended thresholds (two drinks per day for women, three for the men) or, at least, in that direction. It must also be supported by pharmacotherapy and psychotherapy, which offer possibilities. Failure to manage reduction will allow the goals to be revisited and to reconsider abstinence. Finally this evolution or revolution is a new paradigm carried in particular by a pragmatic approach of the disease and new treatments. The aims of this article are to give elements of comprehension relating to the evolution of the practices in France in prevention and treatment of alcohol use disorders and in particular with regard to the reduction of consumption

Etude des facteurs cliniques et pharmacogénétiques prédictifs de la réponse (efficacité) aux traitements neuroleptiques atypiques dans la schizophrénie

Schizophrenia is a frequent and serious disease occurring in approximately 1% of the population that usually begins between the ages of 15 and 25 years and constituting a major public health problem. Its evolution is marked by chronicity and high frequency of relapses. Since the early 1950s and the discovery of neuroleptics, and later the apparition of second generation of antipsychotic, the management of schizophrenia has been considerably modified. However, adverse side effects and non response or resistance constitute the main limits of these treatments. Percentage of non response during acute phases remains high, with no possible prediction of non response risk as a function of the selected treatment. Today, the prescription of these drugs follows a try/fail rule and there are no validated criteria to choose between the different treatments. A major progression in clinical research in schizophrenia, particularly for the apprehension of factors associated with prognosis, was obtained by using harmonized diagnosis criteria with good reliability (DSMIV) and by assessing response with dimensional tools (PANSS, BPRS, CGI). There have been descriptions of predictive factors of poor response to antipsychotic treatment mainly with first generation: age of onset of schizophrenia, duration of untreated psychosis and severity of symptomatology for clinical predictors. Pharmacogenetic study genetics mechanisms implicated in treatment response and allow underscoring predictive factors of treatment efficacy. By a literature review we aimed to summarize recent finding into pharmacodynamic approach of pharmacogenetics of antipsychotics and particularly second generation. Published studies in the field have mainly focused on pharmacodynamic hypotheses and genes implicated in monoamine's receptors synthesis. The methodological limits of the first published studies, in particular the lack of ethnic homogeneity of the studied populations and the weak definition of the phenotype, probably explain the lack of replication of such studies. In a prospective study of a sample of Caucasian schizophrenic patients treated with olanzapine or risperidone, clinical and socio-demographical criteria were assessed as factors that may predict drug response. Early onset and duration of the disease, individually predicted an unfavourable drug response. We also studied genetic variants of the norepinephrine transporter (which is inhibited by olanzapine and risperidone) to see how they may affect antipsychotic drug efficacy. Two polymorphisms were associated with a reduction in positive symptoms in treated schizophrenic patients. These results confirm the difficulty in predicting drug response in schizophrenia without developing strong biological markers. For the future the aim of pharmacogenetic research is to help practitioners to choose treatments in a more rational way.La schizophrénie est une pathologie fréquente et grave qui touche environ 1% de la population adulte jeune et constitue un problème majeur de santé public. Son mode évolutif reste marqué par la chronicité et la fréquence des rechutes. Depuis les années 1950 l'apport des neuroleptiques, puis celui des neuroleptiques atypiques présentant une meilleure tolérance neurologique, a considérablement modifié la prise en charge des patients souffrant de schizophrénie. Toutefois, les effets latéraux des neuroleptiques ont toujours constitués une des principales limites de cet apport thérapeutique la seconde étant l'importance des non réponses au traitement voire des résistances. Le pourcentage d'échec au traitement en phase aigue reste encore très élevé sans que l'on soit capable de prédire le risque de non réponse en fonction du traitement choisi. En pratique clinique, le choix thérapeutique se fait souvent de façon empirique. L'utilisation de critères diagnostics fiables et harmonisés (DSMIV) ainsi que l'approche de la réponse au traitement à l'aide d'outils de mesures dimensionnels (PANSS, BPRS, CGI) ont permis de réaliser une progression majeure dans l'abord de la recherche clinique dans la schizophrénie. En particulier les critères associés au pronostic évolutif ont pu être mieux appréhendés. Des facteurs prédictifs cliniques et précliniques d'une mauvaise réponse au traitement chez les patients principalement traités par des neuroleptiques conventionnels ont été décrits : l'âge de début de la maladie, la durée d'évolution sans traitement et la gravité de l'atteinte pour des critères cliniques. La pharmacogénétique étudie les mécanismes d'origine génétique impliqués dans la réponse aux médicaments et permet de mettre en évidence des critères prédictifs individuels en termes d'efficacité des traitements. Les données pharmacogénétiques concernant la réponse aux neuroleptiques sont présentées au cours de ce travail à travers une revue de la littérature. Les travaux effectués dans ce domaine concernent en particulier les hypothèses pharmacodynamiques et les gènes impliqués dans la synthèse des récepteurs aux monoamines. Les carences méthodologiques des 1ères études réalisées; en particulier en termes d'homogénéité ethnique des populations étudiées et d'évaluation du phénotype, expliquent que peu de résultat soient répliqués à ce jour. Dans une cohorte de patients schizophrènes caucasiens traités par olanzapine ou rispéridone et évaluée prospectivement pour l'efficacité et la tolérance du traitement, nous avons recherché des critères cliniques et socio-démographiques permettant de prédire la réponse au traitement. L'âge précoce de début des troubles et la durée de la maladie sont des prédicteurs individuels de la mauvaise réponse au traitement. Nous avons également étudié l'implication de variants génétiques du transporteur de la noradrénaline, inhibé par l'olanzapine et la rispéridone, dans l'efficacité des traitements antipsychotiques. Nous avons observé l'implication de 2 polymorphismes de ce transporteur dans la décroissance des symptômes positifs sous traitement. Ces travaux ont permis de confirmer la difficulté de prédire la réponse au traitement dans la schizophrénie sans développer des marqueurs biologiques fiables. L'apport de la pharmacogénétique semble une voie essentielle dans cette perspective

Intérêt d'un programme psychothérapique basé sur la pleine conscience dans la prévention de la rechute chez les patients alcoolodépendants

L'alcoolodépendance est une pathologie fréquente et aux complications multiples. Elle est décrite comme une maladie chronique à fort risque de rechute. Les thérapies cognitives et comportementales ont prouvé leur intérêt dans la prévention de la rechute. Mais malgré ces prises en charge, les taux de rechute restent élevés, soulignant le besoin de développer de nouvelles approches thérapeutiques. Dans ce travail, nous reprenons tout d'abord les données concernant l'alcoolodépendance, ses comorbidités,sa prise en charge générale et la problématique de la rechute. Nous abordons ensuite l'intérêt des thérapies cognitives et comportementales dans la prévention de la rechute alcoolique, tout d'abord avec la prévention de la rechute classique issue des travaux de Marlatt et Gordon, puis en abordant la troisième vague des thérapies cognitives et comportementales : les thérapies de pleine conscience. Ces dernières ont prouvé leur efficacité dans d'autres pathologies psychiatriques notamment la dépression et commencent à être utilisées en addictologie. Nous en exposons les concepts et les résultats prometteurs des premières études. Nous présentons ensuite un protocole d'étude qui va être mis en place au CHU de Clermont-Ferrand et va comparer l'efficacité en terme de prévention de la rechute alcoolique d'un programme de prévention de la rechute classique à un programme de thérapie de pleine conscience. Nous relatons l'expérience et les impressions de deux patients ayant suivi chacun un des programmes psychothérapiques. Les thérapies de pleine conscience ont un intérêt certain dans la prévention de la rechute alcoolique, notamment par le fait qu'elles permettent une prise en charge globale du patient, mais la recherche à ce sujet n'en est qu'à ses balbutiements.CLERMONT FD-BCIU-Santé (631132104) / SudocSudocFranceF

LA SALLE D'ATTENTE IDEALE DES MEDECINS GENERALISTES, D'APRES UNE ETUDE NATIONALE

CLERMONT FD-BCIU-Santé (631132104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Psychotraumatisme et consommation d'alcool (étude rétrospective d'une population exposée à des évènements traumatiques)

L'état de stress post-traumatique (PTSD) représente un enjeu majeur de santé publique avec une prévalence variant de 1 à 9% dans la population générale, et des chiffres supérieurs dans certaines populations à risque (combattants de guerre, réfugiés, professions exposées à des évènements traumatiques,...). Des relations importantes et complexes entre alcool et psychotraumatisme ont pu être mises en évidence par des études menées, pour la plupart, sur des victimes d'agression, ou d'exaction, de catastrophes collectives, ou chez des vétérans. Notre étude rétrospective a étudié une population de sapeur-pompiers volontaires et professionnels, sur les 12 mois précédant l'enquête. Celle-ci a mis en évidence une corrélation forte entre troubles addictifs liés à l'alcool et PTSD, ainsi qu'une prévalence importante de l'automédication par l'alcool dans la lutte contre les symptômes de stress aigu, dissociation et PTSD (stratégie de coping). Ces éléments, intéressants en pratique clinique, affichent la nécessité de renforcer la prise en charge des patients exposés à des évènements traumatisants, afin d'optimiser la prévention du PTSD et des troubles de la consommation d'alcool fréquemment associés.CLERMONT FD-BCIU-Santé (631132104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF