Fortune telling addiction: Unfortunately a serious topic about a case report

Background: Constant social change brings about new forms of behavior, such as smartphone use, social network-ing, indoor tanning, cosmetic surgery, etc., that could become excessive or even lead to new forms of addictive disor-ders. Methods: We report the case of a woman who starts consulting for “clairvoyance addiction”. We then discuss the addictive nature of her disorder, based on several classifications of addiction. Results: The patient fulfilled the criteria for addiction and her clinical features were typical of that of addicted people. Other differential diagnoses were discussed. Conclusion: As for any addictive behavior, the interaction of several risk factors should be consid-ered. They are related to the individual himself, but also to the object of addiction and to the socio-environmental context. In this case, all the conditions were met for fortune telling use to become addictive

Pretransplant renal function according to CKD-EPI cystatin C equation is a prognostic factor of death after liver transplantation

International audienceBackground & aims - In patients with cirrhosis, cystatin C (CystC) based equations may be more accurate indicators of glomerular filtration rate (GFR) than creatinine (Pcr) based equations. Renal function before liver transplantation (LT) is thought to impact survival after LT. We aimed at assessing pretransplant creatinine and CystC based equations with respect to their predictive value on long-term survival after LT. Methods - From 2001 to 2011, CystC was determined at pre-LT evaluation in 682 patients together with GFR assessed using MDRD-4, MDRD-6, CKD-EPI-cystatin C, CKD-EPI-creatinine and CKD-EPI-creatinine-cystatin C equations. Patients were classified according to the Kidney Disease Outcomes Quality Initiative classification (KDOQI). Results - Median age at LT was 55 [49-60] years with a median MELD score of 13.5 [8.3-19.2] and a median post-transplant follow-up of 60 [26-89] months. Using CKD-EPI Cystatin C and the KDOQI classification, 21.1% of patients were stage 1, 43.1% stage 2, 29.1% stage 3 and 6.5% stage 4. Kaplan-Meier survival estimates were significantly different between KDOQI stages when determined using the CKD-EPI-CystatinC equation. This was not the case when using the other equations. At multivariate analysis, GFR and KDOQI estimated using the CKD-EPI-CystatinC equation were significantly associated with death (HR: 0.992; CI95%: 0.986-0.999 and 1.24; CI95%: 1.02-1.50 respectively). When assessed using the MDRD-4, MDRD-6, CKD-EPI-Creatinine-CystatinC and CKD-EPI-Creatinine equations GFR was not significantly associated with death. Conclusions - Estimated pre-LT renal function is predictive of post-LT survival only when assessed using the CKD-EPI cystatin C equation. This supports the use of Cystatine C and of its related equation for the assessment of renal function before liver transplantation

Nitrous oxide: a unique official French addictovigilance national survey

IntroductionNitrous oxide has become over the last few years a public health problem in many countries. France has a dedicated health monitoring system dedicated to the surveillance of the abuse, dependence and consequences associated with the use of psychoactive substances coordinated by the French National Agency for the Safety of Medicines and Health Products.We present the French national survey of nitrous oxide.Materials and methodsWe analyzed all the cases with nitrous oxide from 2012 to 2021: number of notifications, characteristics of the subjects and consumption, consequences reported and their evolutions over time. In addition, we have made a special focus on the four main complications reported.ResultsA total of 525 cases were received with an exponential increase since 2019. We observed changes in the characteristics of the notifications with an increase in the proportion of women [42.7% in 2021 vs. 30.8% in 2020 (p = 0.02)]; an increase in the quantities consumed (use of cylinders); a negative evolution of the contexts of use with a search for self-therapeutic effects and use in violent contexts; an increasing trend of the severity of cases [78.1% in 2021 vs. 70.0% in 2020 (p = 0.07)].The main effects were substance use disorders and/or associated criteria (82.5%), neurological disorders (75.4%), psychiatric symptoms (15.4%) and cardiovascular events (8.6%). In terms of evolution, we observed a significant increase in cases with a use disorder and an increase in neurological complications. Moreover, new serious effects, notably cardiovascular events were reported.DiscussionThe combination of high availability, varied effects from euphoria to relief of discomfort in a stressful global pandemic context and the development of dependence could explain the rapid growth of consumption and the seriousness of the cases.It must now be taken into account that (i) Substance use disorders are associated with nitrous oxide consumption; (ii) clinicians must consider “nitrous oxide” in young subjects presenting different types of manifestations; and (iii) stopping consumption is imperative and is the first treatment. In this context, an addictological assessment must also be carried out

A Comparison of Treatment-Seeking Behavioral Addiction Patients with and without Parkinson's Disease

The administration of dopaminergic medication to treat the symptoms of Parkinson's disease (PD) is associated with addictive behaviors and impulse control disorders. Little is known, however, on how PD patients differ from other patients seeking treatments for behavioral addictions. The aim of this study was to compare the characteristics of behavioral addiction patients with and without PD. N = 2,460 treatment-seeking men diagnosed with a behavioral addiction were recruited from a university hospital. Sociodemographic, impulsivity [Barratt Impulsiveness Scale (BIS-11)], and personality [Temperament and Character Inventory-Revised (TCI-R)] measures were taken upon admission to outpatient treatment. Patients in the PD group were older and had a higher prevalence of mood disorders than patients without PD. In terms of personality characteristics and impulsivity traits, PD patients appeared to present a more functional profile than PD-free patients with a behavioral addiction. Our results suggest that PD patients with a behavioral addiction could be more difficult to detect than their PD-free counterparts in behavioral addiction clinical setting due to their reduced levels of impulsivity and more standard personality traits. As a whole, this suggests that PD patients with a behavioral addiction may have different needs from PD-free behavioral addiction patients and that they could potentially benefit from targeted interventions

A comparison of treatment-seeking behavioral addiction patients with and without parkinson's disease

The administration of dopaminergic medication to treat the symptoms of Parkinson's disease (PD) is associated with addictive behaviors and impulse control disorders. Little is known, however, on how PD patients differ from other patients seeking treatments for behavioral addictions. The aim of this study was to compare the characteristics of behavioral addiction patients with and without PD. N = 2,460 treatment-seeking men diagnosed with a behavioral addiction were recruited from a university hospital. Sociodemographic, impulsivity [Barratt Impulsiveness Scale (BIS-11)], and personality [Temperament and Character Inventory-Revised (TCI-R)] measures were taken upon admission to outpatient treatment. Patients in the PD group were older and had a higher prevalence of mood disorders than patients without PD. In terms of personality characteristics and impulsivity traits, PD patients appeared to present a more functional profile than PD-free patients with a behavioral addiction. Our results suggest that PD patients with a behavioral addiction could be more difficult to detect than their PD-free counterparts in behavioral addiction clinical setting due to their reduced levels of impulsivity and more standard personality traits. As a whole, this suggests that PD patients with a behavioral addiction may have different needs from PD-free behavioral addiction patients and that they could potentially benefit from targeted interventions

Characterization of antipsychotic utilization before clozapine initiation for individuals with schizophrenia: an innovative visualization of trajectories using French National Health Insurance data

Abstract Aims Despite recommendations to initiate clozapine after two unsuccessful trials of antipsychotics, clozapine is underprescribed and initiated too late. The aim of this study was to describe different antipsychotic treatment sequences in the 36 months before the initiation of clozapine and to characterize clusters of treatment trajectories. Methods Using the French National Health Insurance database, a historical cohort study of the population in an area in western France was performed. The data from all new users of clozapine with a diagnosis of schizophrenia or schizoaffective disorder in the period of 2017–2018 were evaluated. All outpatient reimbursements for antipsychotics during the 36 months before clozapine initiation were analysed. Successive reimbursements for identical treatments were grouped into treatment trials (TTs), and different trajectories were clustered using a state sequence analysis. Results The results showed 1191 TTs for 287 individuals. The mean number of TTs per individual was 3.2. Risperidone, aripiprazole and haloperidol were the main treatments delivered. The frequencies of antipsychotics used differed between monotherapies and combination therapies. A three-cluster typology was identified: one cluster (n = 133) of ‘less treated’ younger individuals with fewer TTs and shorter TT durations; a second cluster (n = 53) of ‘more treated’ individuals with higher numbers of TTs and combinations of antipsychotics; and a third cluster (n = 103) of ‘treatment-stable’ older individuals with longer TT durations. Conclusions The results indicate that the median number of TTs during the 36 months before clozapine prescription was higher than the two recommended. The different trajectories were associated with individual characteristics and treatment differences, suggesting that additional studies of clinical parameters are needed to understand barriers to clozapine prescription

Front Public Health

INTRODUCTION: Nitrous oxide has become over the last few years a public health problem in many countries. France has a dedicated health monitoring system dedicated to the surveillance of the abuse, dependence and consequences associated with the use of psychoactive substances coordinated by the French National Agency for the Safety of Medicines and Health Products.We present the French national survey of nitrous oxide. MATERIALS AND METHODS: We analyzed all the cases with nitrous oxide from 2012 to 2021: number of notifications, characteristics of the subjects and consumption, consequences reported and their evolutions over time. In addition, we have made a special focus on the four main complications reported. RESULTS: A total of 525 cases were received with an exponential increase since 2019. We observed changes in the characteristics of the notifications with an increase in the proportion of women [42.7% in 2021 vs. 30.8% in 2020 (p = 0.02)]; an increase in the quantities consumed (use of cylinders); a negative evolution of the contexts of use with a search for self-therapeutic effects and use in violent contexts; an increasing trend of the severity of cases [78.1% in 2021 vs. 70.0% in 2020 (p = 0.07)].The main effects were substance use disorders and/or associated criteria (82.5%), neurological disorders (75.4%), psychiatric symptoms (15.4%) and cardiovascular events (8.6%). In terms of evolution, we observed a significant increase in cases with a use disorder and an increase in neurological complications. Moreover, new serious effects, notably cardiovascular events were reported. DISCUSSION: The combination of high availability, varied effects from euphoria to relief of discomfort in a stressful global pandemic context and the development of dependence could explain the rapid growth of consumption and the seriousness of the cases.It must now be taken into account that (i) Substance use disorders are associated with nitrous oxide consumption; (ii) clinicians must consider "nitrous oxide" in young subjects presenting different types of manifestations; and (iii) stopping consumption is imperative and is the first treatment. In this context, an addictological assessment must also be carried out

La bandelette urinaire (quel apport dans le suivi des patients recevant un traitement de substitution aux opiacés)

En France, depuis les années 1980, s'est développée une politique de prise en charge des toxicomanes. Le traitement, visant à réduire les risques infectieux liés à l'utilisation des substances psychoactives, et à favoriser l'insertion sociale des usagers, intègre la prescription d'un médicament de substitution aux opiacés (MSO) : la buprénorphine haut dosage ou la méthadone. Si les indications des deux médicaments sont identiques, leurs propriétés pharmacologiques et pharmacocinétiques diffèrent, ce qui a conduit le législateur à mettre en place un cadre réglementaire distinct pour les deux molécules. La réglementation en vigueur impose donc une analyse d'urines avant le début du traitement par méthadone, afin de poser le diagnostic de dépendance aux opiacés. Pour la buprénorphine, la réglementation est plus ouverte et donne davantage de latitude au prescripteur. Il en résulte une grande diversité de pratiques. On retrouve également ces disparités dans le suivi des traitements, certains médecins estimant indispensable le monitoring des consommations pour détecter précocement une éventuelle rechute et adapter la posologie du MSO, d'autres n'y trouvant aucun intérêt. Le dosage des toxiques urinaires en laboratoire présente comme principal inconvénient pour le prescripteur, le délai plus ou moins long avant la réception des résultats. C'est pourquoi il existe des bandelettes urinaires, permettant la prise de connaissance immédiate des substances consommées par le patient. Néanmoins, l'apport de leur utilisation dans la prise en charge des patients sous MSO demeurait jusqu'à maintenant inexploré. Cette étude montre que l'utilisation de la bandelette urinaire a un apport sur la pratique médicale dans la majorité des situations, notamment en confortant les décisions médicales et en enrichissant le dialogue médecin/patient. Son utilisation permet aussi dans certains cas l'ajustement et la personnalisation des modalités de prescription et de délivrance du MSO.NANTES-BU Médecine pharmacie (441092101) / SudocSudocFranceF

Consommation de substances psychoactives et grossesse (suivi de femmes enceintes prises en charge en consultation d'addictologie au CHU de Nantes de 2008 à 2012)

En France métropolitaine, on estime à 790 290 le nombre de naissances en 2012. La grossesse est un moment privilégié où les premiers liens se créent entre une mère et son bébé. C'est également une période à risque puisque les consommations de la mère, qu'elles soient licites ou illicites, vont possiblement imprégner le fœtus. C'est le cas des médicaments de substitution aux opiacés (MSO) et des benzodiazépines. Au travers d'une étude réalisée au sein du Centre d'Evaluation et d'Information sur la Pharmacodépendance Addictovigilance, en collaboration avec le service d'addictologie du CHU de Nantes, nous avons suivi des femmes enceintes, consommatrices de MSO et/ou de benzodiazépines. Ces femmes enceintes ont été prises en charge en consultation d'addictologie au CHU de Nantes de 2008 à 2012. Cette étude souligne l'importance de la prise en charge des femmes enceintes présentant une problématique addictive. En effet, la substitution chez les femmes pharmacodépendantes aux opiacés permet de réduire les risques de complication de la grossesse, notamment ceux associés aux conditions de vie, à l'environnement, à la malnutrition, au suivi médical aléatoire ou encore à la consommation d'autres substances à risque. Elle vise également à réduire les périodes de manque, néfastes pour le fœtus. Pour les femmes pharmacodépendantes aux benzodiazépines, nous décrivons les bénéfices de la prise en charge et présentons les recommandations actuelles sur la consommation des benzodiazépines chez les femmes enceintes.NANTES-BU Médecine pharmacie (441092101) / SudocSudocFranceF