Emotional Memory in Post-traumatic Stress Disorder: A Systematic PRISMA Review of Controlled Studies

Background: Emotional memory is an adaptive process that improves the memorization of emotional events or stimuli. In Post-Traumatic Stress Disorder (PTSD), emotional memory may be altered, which in turn may affect symptoms. Having a clearer view of the processes of interaction between memory and emotional stimuli in PTSD may improve our knowledge of this disorder, and could create new therapeutic management tools. Thus, we performed a systematic review of the evidence of specific emotional memory in PTSD patients.Method: Following PRISMA guidelines, a systematic review of MEDLINE, PsycInfo, and ScienceDirect was undertaken to identify controlled studies on emotional memory that used cognitive tasks on PTSD patients. The initial research was conducted from June 2017 to July 2017, and search terms included: Post-Traumatic Stress Disorder; PTSD; emotional memory; emotion; emotional; memory; and episodic memory.Results: Eighteen studies reporting on 387 PTSD patients met the eligibility criteria. Among the studies selected, 11 observed specific memory processing in PTSD patients, such as a greater memorization of negative information, or a trend to false recognition of negative information. In addition, attentional and inhibition processing seem to play an important role in emotional memory in PTSD sufferers. Furthermore, other studies that did not find behavioral differences between PTSD and control groups nevertheless showed differences in both specific cerebral activities and neurohormone levels during emotional memory tasks.Conclusion: This review has several limitations, including a limited number of controlled studies, small sample sizes, different tasks and methods. Nevertheless, the results of this systematic review provide interesting information on emotional memory for clinicians and researchers, as they seem to highlight facilitated memory processing for negative information in PTSD patients. This topic needs further controlled studies with sensitive behavioral tasks. Also, future studies may evaluate emotional memory after symptom amelioration

Estimating Attributable Mortality Due to Nosocomial Infections Acquired in Intensive Care Units

Background. The strength of the association between intensive care unit (ICU)-acquired nosocomial infections (NIs) and mortality might differ according to the methodological approach taken. Objective. TO assess the association between ICU-acquired NIs and mortality using the concept of population-attributable fraction (PAF) for patient deaths caused by ICU-acquired NIs in a large cohort of critically ill patients. Setting. Eleven ICUs of a French university hospital. Design. We analyzed surveillance data on ICU-acquired NIs collected prospectively during the period from 1995 through 2003. The primary outcome was mortality from ICU-acquired NI stratified by site of infection. A matched-pair, case-control study was performed. Each patient who died before ICU discharge was defined as a case patient, and each patient who survived to ICU discharge was denned as a control patient. The PAF was calculated after adjustment for confounders by use of conditional logistic regression analysis. Results. Among 8,068 ICU patients, a total of 1,725 deceased patients were successfully matched with 1,725 control Patients. The adjusted PAF due to ICU-acquired NI for patients who died before ICU discharge was 14.6% (95% confidence interval [CI], 14.4%—14.8%). Stratified by the type of infection, the PAF was 6.1% (95% CI, 5.7%-6.5%) for pulmonary infection, 3.2% (95% CI, 2.8%-3.5%) for central venous catheter infection, 1.7% (95% CI, 0.9%-2.5%) for bloodstream infection, and 0.0% (95% CI, -0.4% to 0.4%) for urinary tract infection. Conclusions. ICU-acquired NI had an important effect on mortality. However, the statistical association between ICU-acquired NI and mortality tended to be less pronounced in findings based on the PAF than in study findings based on estimates of relative risk. Therefore, the choice of methods does matter when the burden of NI needs to be assesse

Early-onset ventilator-associated pneumonia incidence in intensive care units: a surveillance-based study

ABSTRACT: BACKGROUND: The incidence of ventilator-associated pneumonia (VAP) within the first 48 hours of intensive care unit (ICU) stay has been poorly investigated. The objective was to estimate early-onset VAP occurrence in ICUs within 48 hours after admission. METHODS: We analyzed data from prospective surveillance between 01/01/2001 and 31/12/2009 in 11 ICUs of Lyon hospitals (France). The inclusion criteria were: first ICU admission, not hospitalized before admission, invasive mechanical ventilation during first ICU day, free of antibiotics at admission, and ICU stay >=48 hours. VAP was defined according to a national protocol. Its incidence was the number of events per 1,000 invasive mechanical ventilation-days. The Poisson regression model was fitted from day 2 (D2) to D8 to incident VAP to estimate the expected VAP incidence from D0 to D1 of ICU stay. RESULTS: Totally, 367 (10.8%) of 3,387 patients in 45,760 patient-days developed VAP within the first 9 days. The predicted cumulative VAP incidence at D0 and D1 was 5.3 (2.6-9.8) and 8.3 (6.1-11.1), respectively. The predicted cumulative VAP incidence was 23.0 (20.8-25.3) at D8. The proportion of missed VAP within 48 hours from admission was 11% (9%-17%). CONCLUSIONS: Our study indicates underestimation of early-onset VAP incidence in ICUs, if only VAP occurring [greater than or equal to]48 hours is considered to be hospital-acquired. Clinicians should be encouraged to develop a strategy for early detection after ICU admission

DMTs and Covid-19 severity in MS: a pooled analysis from Italy and France

We evaluated the effect of DMTs on Covid-19 severity in patients with MS, with a pooled-analysis of two large cohorts from Italy and France. The association of baseline characteristics and DMTs with Covid-19 severity was assessed by multivariate ordinal-logistic models and pooled by a fixed-effect meta-analysis. 1066 patients with MS from Italy and 721 from France were included. In the multivariate model, anti-CD20 therapies were significantly associated (OR = 2.05, 95%CI = 1.39–3.02, p < 0.001) with Covid-19 severity, whereas interferon indicated a decreased risk (OR = 0.42, 95%CI = 0.18–0.99, p = 0.047). This pooled-analysis confirms an increased risk of severe Covid-19 in patients on anti-CD20 therapies and supports the protective role of interferon

Impact de l'annonce diagnostique sur le développement de l'insight chez les patients schizophrènes stabilisés

Le rôle pronostique de l'insight chez les patients schizophrènes est un thème actuel au centre de nombreuses études. Il permettrait l'amélioration de la qualité de vie des patients et une meilleure adhésion aux soins. Ce travail porte sur l'étude de l'insight chez des patients schizophrènes stabilisés. Tout d'abord nous avons fait un rappel théorique du concept d'insight dans cette pathologie afin d'introduire le sujet de notre étude. Trente et un patients schizophrènes stabilisés ont été inclus. L'objectif était l'évaluation du degré d'insight chez des patients sensibilisés à leur maladie par un protocole psycho-éducatif et la comparaison de ces résultats à ceux obtenus chez une population témoin. Des analyses statistiques de comparaison et de corrélation ont été réalisées. L'intérêt de ce travail était de démontrer l'effet bénéfique apporté par ces nouvelles thérapeutiques psycho-éducatives sur l'amélioration de l'insight chez les patients schizophrènes. Nous avons pu mettre en évidence que les deux populations étaient significativement différentes : la population ayant reçu l'annonce diagnostiques est plus jeune, moins malade et a développé un meilleur degré d'insight. Nous avons mis en évidence la difficulté des patients à s'auto évaluer. Nous avons trouvé retrouvé des associations modérées de l'insight avec la symptomatologie clinique d'une part et avec le quotient intellectuel d'autre part (résultats conformes aux données de la littérature). L'analyse de ces résultats confirme notre hypothèse de départ qu'un abord psycho-éducatif sur la maladie aide les patients schizophrènes à prendre conscience de leurs troubles. Ce travail ouvre des réflexions sur les modalités à mettre en œuvre pour évaluer le plus fidèlement possible ce phénomène et sur la nécessité, dans son évaluation, de prendre en compte certains items reflétant l'adaptation sociale que le patient aura pu développer.PARIS7-Xavier Bichat (751182101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Étude du mécanisme d'action du lithium sur le récepteur 5-HT1B (implication clinique de l'association lithium-clomipramine dans la dépression unipolaire)

PARIS-BIUSJ-Thèses (751052125) / SudocPARIS-BIUP (751062107) / SudocPARIS-BIUSJ-Physique recherche (751052113) / SudocSudocFranceF

Ideal Parent Figure method in the treatment of complex posttraumatic stress disorder related to childhood trauma: a pilot study

Background: There is a consensus within the trauma field for the necessity of a three-phase treatment programme for complex posttraumatic stress disorder (CPTSD). This pilot study focuses on the stabilisation phase, the goal of which is the development of psychological resources and the reduction of disabling symptoms. Objective: To test the efficacy of the Ideal Parent Figure (IPF) method as a stabilization treatment for CPTSD patients with a history of childhood trauma. Method: The sample was comprised of 17 adults with a history of childhood trauma concomitant with CPTSD symptoms consulting at a clinic in France. Participants enrolled in a 5-week psychotherapy programme based on the IPF method, a semi-structured visualization programme designed to treat attachment disturbances. Measures of DESNOS symptoms, psychological symptoms, quality of life, and adult attachment were administered pre- and posttreatment as well as at 8-month follow-up. Results: A significant decrease in symptom severity and attachment traumatization and a significant increase in quality of life were found, both with medium-to-large effect sizes. The 8-month follow-up assessment showed outcome stability. Conclusions: These results suggest that treating attachment disturbances directly with an approach akin to the Ideal Parent Figure method may lead to fast and stable improvement for individuals with CPTSD