Le tabagisme (étude en psychiatrie, épidémiologie et programme de soins)

LIMOGES-BU Médecine pharmacie (870852108) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Chronobiologie et troubles affectifs (dépression saisonnière et photothérapie)

LIMOGES-BU Médecine pharmacie (870852108) / SudocLYON1-BU Santé (693882101) / SudocSudocFranceF

Sevrage alcoolique en psychiatrie (participation à l'étude prospective du centre hospitalier Esquirol de Limoges)

Malgré la diminution de sa consommation en France, l'alcool avec 45000 décés annuels reste la deuxième cause de mortalité évitable. Conduites alcooliques (abus et dépendance) et pathologies mentales sont fréquemment associées, conduisant à de nombreuses hospitalisations en services de psychiatrie. Afin de mieux connaître la population demandeuse de servage alcoolique, le Département de recherche et développement du Centre Hospitalier Esquirol de Limoges a mis en place dans le cadre d'un Programme Hospitalier de Recherche Clinique une étude intitulée "statut alcoolique 24 mois après une demande de sevrage en psychiatrie : évaluation du devenir et des parcours thérapeutiques avec constitution d'une sérogénothèque spécifique". Ce travail de thèse expose les résultats intermédiaires de cette étude prospective longitudinale non interventionnelle. Il décrit la population incluse dans cette cohorte du 1er mars 2006 au 30 juin 2007 (250 participants hospitalisés) et celle dont le suivi à six mois a pu être réalisé (70 participants). Au terme de cette analyse, le profil qui se dégage est celui majoritairement de patients alcoolodépendants, de sexe masculin, âgés de 45 ans, plutôt bien insérés sur le plan socioprofessionnel, célibataires ou divorcés, présentant souvent une comobidité psychiatrique associée, en particulier un épisode dépressif et peu de complications somatiques de leur alcoolisation. Cette description semble nous éloigner des représentations sociales habituelles de "l'alcoolique".LIMOGES-BU Médecine pharmacie (870852108) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Serum inflammatory molecules and markers of neuronal damage in alcohol-dependent subjects after withdrawal.

International audienceOur aim is to describe changes in serum concentration for the pro-inflammatory factors TNF-α, IFN-γ, IL-1β, IL-8, IL-6, IL-10, IL-12 and MCP-1, for the satiety factor leptin and for factors associated with neuronal changes, neuron-specific enolase (NSE) and glial activation S100-beta protein (S100-β), and explore their association with abstinence in alcohol-dependent subjects after withdrawal.Serum sampling and clinical assessments from 115 alcohol-dependent subjects admitted to a psychiatric hospital for alcohol were repeated during the first 48 h of withdrawal (M0) and 1, 2, 4 and 6 months (M1, M2, M4 and M6) thereafter. Serum factors were determined with Luminex technology or by ELISA.The levels of TNF-α, IL-1β, IL-8, IL-6, IL-12, MCP-1, and leptin decreased after withdrawal and remained low until M6, regardless of alcohol consumption. IFN-γ levels remained constant and IL-10 levels changed only slightly. NSE levels were not modified, whereas serum S100-β concentration increased significantly on M1 and then plateaued, regardless of abstinence status at 6 months.Alcohol-dependent subjects present an inflammatory condition that is not dependent on alcohol consumption. An understanding of the changes in concentration of the various proteins considered here would provide insight into the physiology of withdrawal or dependence

Evolution of BDNF serum levels during the first six months after alcohol withdrawal

International audienceObjectives: Brain-Derived Neurotrophic Factor (BDNF) has been associated with alcohol dependence and appear to vary after withdrawal, although the link with the withdrawal outcome on the long term is unknown. We aimed to assess the evolution of BDNF levels during the six months following withdrawal and determine the association with the status of alcohol consumption. Methods: Serum BDNF levels of alcohol-dependent patients (n = 248) and biological and clinical parameters were determined at the time of alcohol cessation (D0), 14 days (D14), 28 days (D28), and 2, 4, and 6 months after (M2, M4, M6). Results: Abstinence decreased during follow-up and was 31.9% after six months. BDNF levels increased by 14 days after withdrawal and remained elevated throughout the six-month period, independently of alcohol consumption. Serum BDNF levels evolved over time (p < 0.0001), with a correlation between BDNF and GGT levels. The prescription of baclofen at the time of withdrawal was associated with higher serum BDNF levels throughout the follow-up and that of anti-inflammatory drugs with lower BDNF levels. Conclusions: A link between BDNF levels, liver function, and the inflammatory state in the context of alcohol abuse and not only with alcohol dependence itself is proposed

Serum inflammatory molecules and markers of neuronal damage in alcohol-dependent subjects after withdrawal.

International audienceOur aim is to describe changes in serum concentration for the pro-inflammatory factors TNF-α, IFN-γ, IL-1β, IL-8, IL-6, IL-10, IL-12 and MCP-1, for the satiety factor leptin and for factors associated with neuronal changes, neuron-specific enolase (NSE) and glial activation S100-beta protein (S100-β), and explore their association with abstinence in alcohol-dependent subjects after withdrawal.Serum sampling and clinical assessments from 115 alcohol-dependent subjects admitted to a psychiatric hospital for alcohol were repeated during the first 48 h of withdrawal (M0) and 1, 2, 4 and 6 months (M1, M2, M4 and M6) thereafter. Serum factors were determined with Luminex technology or by ELISA.The levels of TNF-α, IL-1β, IL-8, IL-6, IL-12, MCP-1, and leptin decreased after withdrawal and remained low until M6, regardless of alcohol consumption. IFN-γ levels remained constant and IL-10 levels changed only slightly. NSE levels were not modified, whereas serum S100-β concentration increased significantly on M1 and then plateaued, regardless of abstinence status at 6 months.Alcohol-dependent subjects present an inflammatory condition that is not dependent on alcohol consumption. An understanding of the changes in concentration of the various proteins considered here would provide insight into the physiology of withdrawal or dependence

Serum inflammatory molecules and markers of neuronal damage in alcohol-dependent subjects after withdrawal

<p><b>Objectives:</b> Our aim is to describe changes in serum concentration for the pro-inflammatory factors TNF-α, IFN-γ, IL-1β, IL-8, IL-6, IL-10, IL-12 and MCP-1, for the satiety factor leptin and for factors associated with neuronal changes, neuron-specific enolase (NSE) and glial activation S100-beta protein (S100-β), and explore their association with abstinence in alcohol-dependent subjects after withdrawal.</p> <p><b>Methods:</b> Serum sampling and clinical assessments from 115 alcohol-dependent subjects admitted to a psychiatric hospital for alcohol were repeated during the first 48 h of withdrawal (M0) and 1, 2, 4 and 6 months (M1, M2, M4 and M6) thereafter. Serum factors were determined with Luminex technology or by ELISA.</p> <p><b>Results:</b> The levels of TNF-α, IL-1β, IL-8, IL-6, IL-12, MCP-1, and leptin decreased after withdrawal and remained low until M6, regardless of alcohol consumption. IFN-γ levels remained constant and IL-10 levels changed only slightly. NSE levels were not modified, whereas serum S100-β concentration increased significantly on M1 and then plateaued, regardless of abstinence status at 6 months.</p> <p><b>Conclusions:</b> Alcohol-dependent subjects present an inflammatory condition that is not dependent on alcohol consumption. An understanding of the changes in concentration of the various proteins considered here would provide insight into the physiology of withdrawal or dependence.</p

Determinants of Blood Brain-Derived Neurotrophic Factor Blood Levels in Patients with Alcohol Use Disorder.

International audienceBlood brain-derived neurotrophic factor (BDNF) levels are influenced by both addiction and mood disorders, as well as somatic conditions, gender, and genetic polymorphisms, leading to widely varying results. Depressive symptoms and episodes are frequently observed in patients with alcohol use disorder, and vary widely over time, making it a challenge to determine which aspects are specifically involved in variations of serum BDNF levels in this population.We assessed 227 patients with alcohol dependence involved in a detoxification program, at baseline and after a follow-up of 6 months, for the Alcohol Use Disorders Identification Test score, the length of alcohol dependence, and the number of past detoxification programs. The Beck Depression Inventory and information on current tobacco and alcohol use, suicidal ideation, body mass index, age, gender, and psychotropic treatments were also collected. Serum BDNF (ELISA) and 2 genetic polymorphisms of the BDNF gene (Val33Met and rs962369) were analyzed.The presence of the Met allele, 2 markers of the history of alcohol dependence (gamma glutamyl transferase and the number of past treatments in detoxification programs), and the presence of a depressive episode (but not depressive score) were significantly associated with the 2 blood levels of BDNF at baseline and after 6 months. After controlling for baseline BDNF levels, the presence of the Met allele and an ongoing depressive episode were the only variables associated with changes in BNDF levels after 6 months.Low serum BDNF levels are associated with characteristics related to alcohol consumption and mood disorders, and variants of the BDNF gene in alcohol use disorder patients. The factors that most strongly influenced changes in serum BDNF levels following treatment in an alcohol detoxification program were variants of the BDNF gene and ongoing depression

rTMS for pharmacoresistant major depression in the clinical setting of a psychiatric hospital: effectiveness and effects of age.

International audienceBACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive method of brain stimulation used in the treatment of drug-resistant major depressive disorder (MDD). It has been suggested that the efficacy of rTMS decreases with the age of the patient, but the data are contradictory. Here, we analyze in our clinical setting the efficacy of a 3-week rTMS treatment in drug-resistant MDD during a 3 month period and the potential influence of age on this efficacy. METHODS: Stimulation consisted of 15 sessions of rTMS over the dorsolateral prefrontal cortex. Clinical evaluations included the Hamilton Depression Rating Scale (HDRS), and the Beck Depression Inventory (BDI) at baseline, after 3 weeks of treatment, and 1 month and 3 months after the last session. RESULTS: Data from 93 patients issued from the 178 patients active file were analyzed. The antidepressant effect observed in the two age groups (<65 and ≥65) did not differ at the end of the treatment and 3 months later, with a comparable number of responders (50% decrease in HDRS score from baseline) (53.3% for age <65 versus 46.7% for age ≥65, p=0.51). The treatment had a significant effect over time. We found no evidence of the age affecting outcome at 3 months after the last session. LIMITATIONS: Previous antidepressant treatments, and therapeutic drug use modifications after rTMS treatment, degree of pharmaco-resistance or duration of current episode are not reported. CONCLUSION: RTMS of the DFPLC is effective as an add-on treatment for cases of pharmacologically refractory major depression, independent of the patient age

Past Pain Experience and Experimentally induced Pain Perception

International audienceMany intercurrent factors may be involved in the modulation of the pain message and its expression, such as the previous experience of pain built along the life. In this study, we aimed to determine whether susceptibility to experimentally induced pain is differentially influenced by the individual previous painful experience in subjects with schizophrenia (SC) major depression (MD), and controls (C).Methods: The SC (30), MD (32) and C (30) groups participated in experimental pain tests (application of pressure and induction of ischemia) after a semi-structured interview to make an inventory of the previous painful experiences, and the evaluation of anxiety either with autonomic (heart rate, blood pressure) or psychological (Hospital Anxiety Depression scale HAD) measures, and catastrophism.Results: The reported pain intensities, severities, duration, of the previous pain events, and the number of previous painful events were equivalent in the three groups, except for the number of painful events experimented before the last six months which was lower in the MD group. Experimental pain sensitivity was influenced by the diagnosis, the HAD scores or the number and intensities of previous lived painful events.Conclusion: The lack of a past experience of pain was comparable for the different groups, suggesting that psychiatric disorders do not affect the experience of pain associated with daily life or past events. For each subject, the reported previous experience of pain influences the present feeling of pain