L'impact des troubles de l'humeur sur le devenir à 12 mois de patients en demande de traitement pour un trouble lié au jeu d'argent / The effect of mood disorders on outcome at 12 months on patients seeking treatment for a gambling disorder

Les troubles addictifs et de l’humeur sont fréquemment cooccurrents. Le trouble lié au jeu d’argent est ainsi souvent accompagné de troubles de l’humeur, notamment d’épisode dépressif majeur, de trouble bipolaire ou de comportement suicidaire. De nombreuses études ont observé leur association, évalué leur prévalence et leur chronologie d’apparition, mais peu ont exploré l’impact d’un trouble de l’humeur, ou thymique, sur l’évolution du trouble lié au jeu d’argent. L’objectif de cette étude était d’évaluer le devenir à 1 an (rémission précoce) d’une cohorte de joueurs pathologiques traités, en fonction de la présence ou non d’antécédents de trouble de l’humeur à l’inclusion. Dans cette étude longitudinale monocentrique, le trouble lié au jeu d’argent et les troubles thymiques ont été évalués à l’inclusion et 12 mois après, au cours d’un entretien clinique standardisé. Près de 100 patients (N = 94, 45 sans trouble de l’humeur et 49 avec trouble de l’humeur) se sont présentés aux 2 visites. À 1 an, une rémission précoce du trouble lié au jeu d’argent a été observée chez 42 patients, avec un taux de rémission de 39 % en cas de présence et de 51 % en cas d’absence d’antécédent de trouble de l’humeur. Nous n’avons pas démontré qu’un antécédent de trouble de l’humeur à l’inclusion était un facteur prédictif de la rémission précoce du trouble lié au jeu d’argent. Le potentiel manque de puissance de notre étude peut expliquer ce résultat. Cependant, les prédicteurs de rémission précoce identifiés dans cette étude étaient la vie en couple, l’absence de trouble anxieux et l’absence de trouble lié à la consommation d’alcool

Parkinson's disease and iatrogenic impulsive-compulsive behaviors: A case/non-case study to build a complete model of individual vulnerability

Background and aims: Parkinson’s disease (PD) is one of the most prevalent neurodegenerative diseases. First-line medications consist of drugs that act by counteracting dopamine deficiency in the basal ganglia. Unfortunately, iatrogenic impulsive-compulsive behaviors (ICBs) can occur in up to 20% of PD patients over the course of their illness. ICBs must be considered multifactorial disorders that reflect the interactions of the medication with an individual’s vulnerability and the underlying neurobiology of PD. We aimed to explore the predictive genetic, psychopathological and neurological factors involved in the development of ICBs in PD patients by building a complete model of individual vulnerability. Methods: The PARKADD study was a case/non-case study. A total of 225 patients were enrolled (“ICB” group, N 5 75; “no ICB” group, N 5 150), and 163 agreed to provide saliva samples for genetic analysis. Sociodemographic, neurological and psychiatric characteristics were assessed, and genotyping for the characterization of polymorphisms related to dopaminergic and opioid systems was performed. Results: Factors associated with “ICBs” were younger age of PD onset, personal history of ICB prior to PD onset and higher scores on the urgency and sensation seeking facets of impulsivity. No gene variant was significantly associated, but the association with the opioid receptor mu 1 (OPRM1) rs1799971 polymorphism was close to significance. Discussion and conclusions: The influence of gene-environment interactions probably exists, and additional studies are needed to decipher the possible role of the opioid system in the development of ICBs in PD patients

Caractéristiques phénotypiques et génotypiques des mutations du gène HRPT 2 colligées dans l'inter-région Nord-Ouest

CAEN-BU Médecine pharmacie (141182102) / SudocSudocFranceF

Attention Deficit Hyperactivity Disorder and Gaming Disorder: Frequency and Associated Factors in a Clinical Sample of Patients with Gaming Disorder

International audienceBackground and aims: Since June 2018, gaming disorder (GD) has been recognized as a disease. It is frequently associated with attention deficit hyperactivity disorder (ADHD), as there are common vulnerability factors and bidirectional interactions between the two disorders. This study aims to evaluate the presence of ADHD symptoms and predictive factors of ADHD among patients with GD. Methods: Ninety-seven patients ≥16 years old referred to the University Hospital of Nantes between 2012 and 2020 for GD were included. The diagnosis of GD was given a posteriori in accordance with the new ICD-11 GD definition. ADHD was screened using the Adult-ADHD Self-Report Scale and the Wender-Utah Rating Scale. A multivariate logistic regression model was used to identify explanatory factors for ADHD-GD comorbidity. Results: The rate of GD patients who screened positive for ADHD was 39%. Predictive factors of ADHD-GD comorbidity were impulsivity (higher score on the negative urgency dimension) and low self-esteem. Discussion: The rate of ADHD found among patients with GD is consistent with that from the literature on internet GD but higher than that found for other behavioural addictions. The identification of a higher negative urgency score and low self-esteem as predictive factors of AHDH-GD comorbidity indicates that gaming could be considered a dysfunctional way to cope with emotional dysregulation in ADHD or to virtually escape. Conclusions: Comorbid ADHD must be taken into consideration to minimize its functional impact on GD patients and gamingrelated damage. In contrast, the evaluation of gaming habits in patients with ADHD could be useful for both prevention and care

L'impact des troubles de l'humeur sur le devenir à 12 mois de patients en demande de traitement pour un trouble lié au jeu d'argent

International audienceLes troubles addictifs et de l'humeur sont fréquemment cooccurrents. Le trouble lié au jeu d'argent est ainsi souvent accompagné de troubles de l'humeur, notamment d'épisode dépressif majeur, de trouble bipolaire ou de comportement suicidaire. De nombreuses études ont observé leur association, évalué leur prévalence et leur chronologie d'apparition, mais peu ont exploré l'impact d'un trouble de l'humeur, ou thymique, sur l'évolution du trouble lié au jeu d'argent. L'objectif de cette étude était d'évaluer le devenir à 1 an (rémission précoce) d'une cohorte de joueurs pathologiques traités, en fonction de la présence ou non d'antécédents de trouble de l'humeur à l'inclusion. Dans cette étude longitudinale monocentrique, le trouble lié au jeu d'argent et les troubles thymiques ont été évalués à l'inclusion et 12 mois après, au cours d'un entretien clinique standardisé. Près de 100 patients (N = 94, 45 sans trouble de l'humeur et 49 avec trouble de l'humeur) se sont présentés aux 2 visites. À 1 an, une rémission précoce du trouble lié au jeu d'argent a été observée chez 42 patients, avec un taux de rémission de 39 % en cas de présence et de 51 % en cas d'absence d'antécédent de trouble de l'humeur. Nous n'avons pas démontré qu'un antécédent de trouble de l'humeur à l'inclusion était un facteur prédictif de la rémission précoce du trouble lié au jeu d'argent. Le potentiel manque de puissance de notre étude peut expliquer ce résultat. Cependant, les prédicteurs de rémission précoce identifiés dans cette étude étaient la vie en couple, l'absence de trouble anxieux et l'absence de trouble lié à la consommation d'alcool

Stimulated thyroglobulin level at ablation in differentiated thyroid cancer: the impact of treatment preparation modalities and tumor burden

International audienc

Prevalence of Coaddictions and Rate of Successful Treatment Among a French Sample of Opioid-Dependent Patients With Long-Term Opioid Substitution Therapy: The OPAL Study

International audienceBackground: Opioid use disorder (OUD) is a worldwide major health concern due to increased early mortality and morbidity. Opioid substitution therapy (OST) is approved in the context of a global OUD treatment (OUDT), in conjunction with psychosocial interventions. Many factors can explain why unsuccessful treatment rates remain high. While the phenomenon of addiction switching is often proposed, it is not known whether this also includes gambling addiction. The primary objective of the OPAL study was to determine the prevalence of coaddictions, including problem gambling, among patients with OUDT. Secondary objectives were to assess the rate of unsuccessful OUDT and to characterize the associated factors. Methods: For this observational transversal multicenter study, patients with OUDT including OST for at least 6 months were recruited. Clinical assessment was based on a clinically structured interview and a set of self-reported questionnaires. Coaddictions were screened using the Fagerström, the CRAFFT, and the Lie/Bet questionnaires. Unsuccessful OUDT was defined as the persistence of opioid use and/or the worsening of another substance use or gambling practice. After a descriptive analysis, a multivariate analysis was performed to identify the factors associated with unsuccessful OUDT. Results: The sample consisted of 263 patients. Prevalence of coaddictions reached 97% of the sample. Problem gambling was associated with 10% of the patients. OUDT was considered as "unsuccessful" for 60% of the patients. Associated factors included having drug-using friends, psychiatric and professional negative consequences related to opioid use, more than one OST-prescribing physician, and impulsivity, especially high scores for lack of premeditation and sensation seeking. Conclusions: This study provides further evidence of the need to consider coaddictions and the usefulness of global addictive evaluations. Poor prognostic factors must alert the clinician to initiate more sustained care. Further implications are discussed

What Differs between Patients under Methadone and under Buprenorphine for Opioid Use Disorder (OUD) in Daily Clinical Practice in France? A Short Report

International audienceBackground: Opioid use disorder (OUD) is a complex condition that can require long-term treatment. Pharmacological therapy for OUD involves treatment with opioid agonists (OMT) tailored to individual profiles. The aim of our study in daily clinical practice was to compare the profiles of patients treated with methadone (MTD) and those using buprenorphine (BHD or BHD-naloxone-NX).Methods: A cross-sectional multicentre study explored the psychological, somatic and social profiles of patients with Opioid Use Disorder (OUD) following Opioid Maintenance Treatment (BHD, BHD/NX, or MTD). Descriptive and comparative analyses were performed Results: 257 patients were included, a majority were men using heroin. 68% (178) were on MTD, 32% (79) were on BHD. Patients with MTD were significantly more likely to report socio-affective damage, and more likely to be younger and not to report oral or sublingual use as the main route for heroin or non-medical opioidsConclusions: In daily clinical practice, regarding OUD damage, only socio-affective damage was significantly more prevalent among patients on MTD than among those on BHD in the multivariate model. Age and route of administration also differed, and our results could raise the issue of the type of OMT prescribed in case of non-medical use of prescribed opioids. These hypothesis should be confirmed in larger studie

Typology of Patients with Behavioral Addictions or Eating Disorders during a One-Year Period of Care: Exploring Similarities of Trajectory Using Growth Mixture Modeling Coupled with Latent Class Analysis

International audienceOBJECTIVES: Addictions are not restricted to substance-use disorders, and it is now widely recognized that they also include behavioral addictions. Certain individuals with eating disorders also experiment their disorder as an addiction. The objective was to identify typologies of patients presenting with various behavioral addictions or eating disorders according to their evolution within the framework of care, and to specify the factors associated with the differential clinical trajectories. METHODS: We included 302 patients presenting with problem gambling, sexual addiction, compulsive buying, excessive videogame use or eating disorders. The patients completed a multiaxial assessment through a face-to-face structured interview and self-administered questionnaires, including sociodemographic and addiction-related characteristics, psychiatric and addictive comorbidities and several psychological characteristics. The assessment was performed at inclusion and then repeated after 6 and 12 months. The statistical analysis included a combination of growth mixture models and latent class analysis. RESULTS: We identified five classes of patients with different profiles related to their trajectories during a one-year period of specialized care: "complex patients", "patients with impulsive psychological functioning", "patients with cooperative psychological functioning", "patients with immature psychological functioning," and "patients with resilient psychological functioning". CONCLUSIONS: The typology obtained brings interesting findings to propose patient-centered care strategies adapted to these disorders. Because the typology was independent from the type of disorder, it supports the general concept of behavioral addictions, and the similarities between eating disorders and behavioral addictions. The relevance of this model should be further examined in future studies