COMPARISON OF HOSPITALIZED DEPRESSED PATIENTS RELATIVES ADMITTED THROUGH THE EMERGENCY DEPARTMENT OR CONSULTATIONS

Background: A previous study showed an overuse of psychiatric emergencies by physicians. Now we study whether patients hospitalized through emergencies have more pejorative specifications than patients admitted through consultations. Method: All patients with Major depressive disorder admitted in our department through emergencies (N=146) or consultations (N=2172) between January 1, 2010 and December 31, 2012 were included in an open study. They completed the Beck Depression Inventory (BDI), analogical visual scales about stress levels (in professional, social, family, married life), life events scale over the past year and the past month and the Olson Family Adaptation and Cohesion Scale. Results: The depression (t=1.438; p=0.90) and stress level in the previous month (t=1.704; p=0.90) was similar in both samples. Patients admitted through emergencies are characterized by lower levels of marital stress (t=2.590; p=0.01), higher levels of cohesion (t=-2.988, p=0.003), higher adaptability of the current couple (t=-2.975, p=0.003) as well as the adaptability of the family of the origin (t=-2.504, p=0.012). Conclusions: If both samples are comparable in terms of stress or severity of depression, patients admitted through emergencies have relatives who are more supportive and more adaptable! How can we explain why they did not consult before? We propose the hypothesis that physicians and families would be exceeded or overloaded with symptoms they thought they could contain, forcing them at this point to request an urgent care of the pathology. On the contrary patients with environments which are less cohesive and adaptable would be redirected earlier to specialised consultation

Nitrogen Budgets and Soil Nitrogen Stocks of Organic and Conventional Cropping Systems: Trade-Off between Efficiency and Sustainability of Nitrogen Use

Organic and conventional cropping systems differ in the nature and amounts of nitrogen (N) inputs, which may affect efficiency and sustainability of N use. In the DOK (bio-Dynamic, bio-Organic, Konventionell) field experiment, organic and conventional cropping systems have been compared since 1978 at two fertilization levels. Nitrogen inputs via manure and/or mineral fertilizers, and N exports from plots with harvested products have throughout been recorded. For all treatments, N outputs with harvests have exceeded the inputs with fertilizers. Over the past years, symbiotic N2 fixation by soybean and clover grown in the trial has additionally been assessed, indicating average annual inputs of about 100 kg ha-1 yr-1 of N fixed from the atmosphere. Soil surface budgets opposing N inputs via fertilization, symbiotic fixation, seeds and deposition to N outputs via harvested products have been computed at the plot level for the duration from 1985 to 2012. The resulting balances range from negative values of about -20 kg N ha-1 yr-1 (where outputs exceed the sum of said N inputs) to surpluses of about +50 kg N ha-1 yr-1. The budget based N use efficiency (NUE; N output via harvested products divided by sum of N inputs) in the case of negative balances suggests irrationally high NUE (>100%), while positive balances are related to lower NUE for treatments with inputs exceeding outputs. Negative balances, however, indicate soil N mining, while surpluses point to a risk of N losses, and/or N accumulation in the soil. Estimation of soil N stock changes based on yearly total N concentration measurements in the topsoil layer is currently ongoing. Preliminary results suggest that soil N stocks in the topsoil decreased under all treatments more than expected from the N balance, and that positive N balances are needed to maintain topsoil N stocks. An increase in soil N concentration was observed in none of the treatments. In conclusion, the results indicate an efficiency-sustainability trade-off. Treatments with a higher NUE lose more soil stock N than those with a lower NUE. Treatments with lower NUE indicate higher N losses from the studied crop-topsoil system. Sustainable soil N management in addition to organic fertilizer inputs might at this site require reduced soil tillage. The significance of N contained in deeper soil layers, and deep rooting crops in recovering leached N should as well be investigated

L’image « abymée »

Cet article propose d'aborder le thème de " l'image abîmée " par le biais d'un néologisme homonyme - l' image abymée -, et voudra montrer comment le procédé structurel très singulier qu'est la mise en abyme a offert, en peinture, l'opportunité d'un repli sur la matérialité de l'oeuvre et son processus de genèse. Ce sur quoi je vais m'attarder a trait plus exactement à la possibilité qu'offre la mise en abyme, pour la peinture figurative, d'énoncer son " faire " sans contrecarrer le dispositif..

DEPRESSION, FAMILY AND IMMUNITY: INFLUENCE OF HUMORAL IMMUNITY ON FAMILY RELATIONSHIPS AND ON THE SEVERITY OF DEPRESSION

Background: Previous study shows that cellular immunity and family relationships are each correlated with the severity of depression and suggests that the psycho-immunological theory should look at the relation between immunity and family life. The aim of the present study based on the same sample is to investigate if similar correlations exist with humoral immunity. Subjects and method: 498 inpatients with major depressive disorder were enrolled in an open-label trial. In addition to a sociodemographic questionnaire, they completed Olsen’s FACES III and the Beck Depression Inventory (BDI). We performed a classic blood test, a plasma cortisol assay at 8 a.m., 4 p.m. and 8 p.m. and a dexamethasone suppression test (Carroll test). Electrophoresis is used for separation and quantification of serum proteins. Results: There is no correlation between humoral immunity and the severity of depression. We found a correlation between cohesion of the family of the origin and beta-globulins (r=-0.147; p=0.016), and C4 (r=0.124; p=0.039). Between adaptability of the family of the origin and cortisol levels at 8 a.m. (r=0.122; p=0.008). We showed a correlation between both C4 (r=-0.263; p=0.000) and beta-globulins (r=-0.148; p=0.013) with CD8. There is a correlation between cortisol at 8 a.m. and CD4 (r=-0.095; p=0.033). Conclusions: Humoral immunity has no correlation with depression but has multiple interactions with cellular immunity which is correlate with the severity of the depression. The psycho-immunological theory is reinforced. It is quite original to find correlation between the family functioning and C4 or beta-globulins while the link with cortisol strengthens some studies about psychological stress, cortisol and immunity. Future studies should examine which kind of family or relation are implicated and how the family functioning and immunity could be connected

THE PSYCHO-IMMUNOLOGICAL MODEL AS A PSYCHOSOMATIC ENTITY: A LITERATURE REVIEW OF INTERACTIONS BETWEEN DEPRESSION AND IMMUNITY

Background: A large amount of evidence has already shown associations between depression and immunity, a bi-directional relationship seems to be increasingly evident. We showed in several precedent studies that family dynamics (Dubois et al. 2016, Zdanowicz et al. 2015), some coping skills (Manceaux et al. 2016) or gender (Fagniart et al. 2016) are correlated with depression and/or immunity and change the way depression and immunity interact together. Method: The objective of this review is to study the literature in search of older and recent evidence about how immunity and depression interact and which determinants influence this relationship. We searched on PubMed, PsycINFO, PsycARTICLES and Sciencedirect articles with the keywords immunity and depression and with coping, gender and family. Results and discussions: Surprisingly we observed in the literature that depression is mostly correlated with both inflammatory and impaired immunity mainly for cell-mediated immunity. Recent studies showed that gender differences in immunity seems to explain in part some variabilities concerning depression and acute/chronic stress among men and women. There is evidence for a sexual dimorphism of the immune system. Coping style, perceived control or personality impact the immune system. There is evidence that childhood maltreatment or stress occurring early in life can exert persistent effects over a long period of time like a «biological scar». Conclusions: There seems to be an individual and biological heterogeneity behind the label of major depressive disorder. We demonstrated the role of several modulators on immunity and depression such as gender, coping, personality, early-life stress or relationships. Many other modulators could exist and should be considered for further investigations

DEPRESSION AND IMMUNITY: A PSYCHOSOMATIC UNIT

Background: The effects of depression on the immune system are well known. Recently, depression as a consequence of an immune disorder has received increased research attention. Here, we test the hypothesis that the depression–immunity association is a buffer zone between external stimuli, defence mechanisms, and intrinsic determinants. Subjects and methods: Five hundred and forty-nine patients presenting with a major depressive episode completed the Beck Depression Inventory (BDI), Lazarus and Folkman’s coping inventory, and the Family Adaptability and Cohesion Scale (FACES III). Lymphocyte subtypes were quantified using flow cytometry. Results: Links between immunity and depression were confirmed: levels of CD3, CD4 and CD8 cells accounted for 12.7% of the variance in the BDI (p<0.001, linear regression; LR). The depression–immunity pairing interacted with family dynamics, coping mechanisms, and gender. Dynamics in the family of origin explained 11.4%of the BDI score (LR) and 1% of CD3 and CD4 levels (p<0.001, Pearson’s r). Coping mechanisms were associated with 12% of the BDI score (p<0.001, LR), and the capacity of distancing oneself from one’s problems was associated with 10.3% of CD3, CD8, and CD16/56 levels (p<0.01, LR). BDI scores in women were 2.9 points higher than in men (p<0.01, t=2.379) and associated with a greater risk of immune depression (p<0.001, odds ratio=0.5). Conclusions: External determinants (family), coping mechanisms, and internal determinants (such as gender) simultaneously influence a depression–immunity pairing. Sometimes these factors act more on the mood component, sometimes more on the immune component. The two components also interact closely with each other

FROM FAMILY SURROUNDINGS TO INTESTINAL FLORA, A LITERATURE REVIEW CONCERNING EPIGENETIC PROCESSES IN PSYCHIATRIC DISORDERS

Background: Some behaviors or psychiatric conditions seem to be inherited from parents or explain by family environment. We hypothesized interactions between epigenetic processes, inflammatory response and gut microbiota with family surroundings or environmental characteristics. Subjects and methods: We searched in literature interactions between epigenetic processes and psychiatric disorders with a special interest for environmental factors such as traumatic or stress events, family relationships and also gut microbiota. We searched on Pubmed, PsycINFO, PsycARTICLES and Sciencedirect articles with the keywords psychiatric disorders, epigenome, microbiome and family relationships. Results: Some gene polymorphisms interact with negative environment and lead to psychiatric disorders. Negative environment is correlated with different epigenetic modifications in genes implicated in mental health. Gut microbiota diversity affect host epigenetic. Animal studies showed evidences for a transgenerational transmission of epigenetic characteristics. Conclusions: Our findings support the hypothesis that epigenetic mediate gene-environment interactions and psychiatric disorders. Several environmental characteristics such as traumatic life events, family adversity, psychological stress or internal environment such as gut microbiota diversity and diet showed an impact on epigenetic. These epigenetic modifications are also correlated with neurophysiological, inflammatory or hypothalamic-pituitary-adrenal axis dysregulations

TOWARDS A VULNERABILITY MODEL FOR MAJOR DEPRESSIVE EPISODES

Background: While many studies have investigated depression risk factors, few attempts have been made to weight, and compare them. Therefore, we conducted a prospective comparison of a sample of subjects suffering from major depressive disorder and a group of healthy subjects. We compared classic risk factors with internal elements such as personality, family dynamics and hea lth locus of control. We also looked for prognostic factors. Methods: Forty people with major depressive disorder (the MDD group) were randomly assigned to different treatment groups and followed for two years. In parallel, we followed a group of 21 healthy subjects (healthy group). At the beginning of the st udy, sociodemographic data were recorded and all subjects were asked to complete the Multidimensional Health Locus of Control (MHLC) scale, the NEO Five-Factor Inventory (NEO-FFI), and the Family Adaptation and Cohesion Scale (FACES III). During the study, subjects were regularly assessed using the Hamilton Depression Scale (HDS) and the Short Form Health Survey (SF-12). Results: Of the 23 explanatory variables, 13 were statistically different (p .05): age, gender, number of people living together, income, extravert personality and neuroticism, Internal HLC, Powerful others HLC, Adaptability of the current couple and the family of origin, and Cohesion of the ideal and nuclear family and family of origin. The accumulation of risk factors doubles the chan ces of suffering from MDD (odds ratio 1.905**). Independent of treatment, among the 13 variables, the first nine explain 34.1% of chan ge in depression measured on the HDS scale (p<0.001). Conclusion: While the size of our sample limits the robustness of our results, our study suggests that some risk factors are also prognostic. The respective weights of these factors vary as a function of age group. Finally, some, such as health locus of control, family dynamics or extraversion, can be modified as an adjunct to pharmacological treatmen