Les premières années d’AMADES

Jean Benoist a eu, dans le précédent bulletin, la générosité d’évoquer le colloque stéphanois du 11 mars 1989 comme une sorte d’événement fondateur d’AMADES. Par chance, j’ai depuis retrouvé un dossier concernant cette journée, que j’avais organisée, alors jeune chef de clinique, à la faculté de médecine de Saint-Etienne, et j’ai pu me pencher à nouveau sur cette petite aventure avec une vague nostalgie. Le dossier jauni contient beaucoup de choses « écrites à la main » (comme les longues let..

Culture, Medicine & Psychiatry

Les éditeurs de ce numéro (Joseph Dumit et Nathan Greenslit) spécifique dévolu à l’anthropologie du médicament constatent ce qu'ils appellent "a pervasive pharmaceuticalization of culture" et dressent quelques pistes possibles d'une anthropologie du médicament, à travers les articles de ce numéro. Dans un article intitulé "Manufacturing consensus", David Healy s'intéresse à la « fabrication d'un apparent consensus académique » à partir des essais contrôlés de médicaments (il s'agit essentiel..

An unusual cause of spontaneous bleeding in the intensive care unit – mastocytosis: a case report

We report the case of a 39-year old male patient who presented with anaphylactoid shock and diffuse bleeding with prolonged activated partial thromboplastin time at the emergency room. The diagnosis of aggressive mastocytosis was suspected and then confirmed by raised tryptase level and mastocytic infiltration of the bone marrow. The outcome was favorable with supportive measures, antihistamine drugs, and imatinib mesylate

Pulmonary Involvement Responsive to Enzyme Replacement Therapy in an Elderly Patient with Gaucher Disease

Type 1 Gaucher disease (GD) is a rare autosomal recessive lysosomal storage disorder caused by deficient activity of beta-glucocerebrosidase, leading to accumulation of its substrate (glucosylceramide) in macrophages of the reticuloendothelial system, which are then referred to as Gaucher cells. The most frequent symptoms are asthenia, spleen and liver enlargement, bone abnormalities and cytopenia due to bone marrow infiltration. Lung involvement in GD is a rare finding, and it is unclear whether it may regress under enzyme replacement therapy (ERT) or substrate reduction therapy (SRT). Here we report a case of type 1 GD recently diagnosed in an elderly patient complicated by infiltrative lung disease, which responded to ERT

Acute camptocormia induced by olanzapine: a case report

<p>Abstract</p> <p>Introduction</p> <p>Camptocormia refers to an abnormal posture with flexion of the thoraco-lumbar spine which increases during walking and resolves in supine position. This symptom is an increasingly recognized feature of parkinsonian and dystonic disorders, but may also be caused by neuromuscular diseases. There is recent evidence that both central and peripheral mechanisms may be involved in the pathogenesis of camptocormia. We report a case of acute onset of camptocormia, a rare side effect induced by olanzapine, a second-generation atypical anti-psychotic drug with fewer extra-pyramidal side-effects, increasingly used as first line therapy for schizophrenia, delusional disorders and bipolar disorder.</p> <p>Case presentation</p> <p>A 73-year-old Caucasian woman with no history of neuromuscular disorder, treated for chronic delusional disorder for the last ten years, received two injections of long-acting haloperidol. She was then referred for fatigue. Physical examination showed a frank parkinsonism without other abnormalities. Routine laboratory tests showed normal results, notably concerning creatine kinase level. Fatigue was attributed to haloperidol which was substituted for olanzapine. Our patient left the hospital after five days without complaint. She was admitted again three days later with acute back pain. Examination showed camptocormia and tenderness in paraspinal muscles. Creatine kinase level was elevated (2986 UI/L). Magnetic resonance imaging showed necrosis and edema in paraspinal muscles. Olanzapine was discontinued. Pain resolved quickly and muscle enzymes were normalized within ten days. Risperidone was later introduced without significant side-effect. The camptocormic posture had disappeared when the patient was seen as an out-patient one year later.</p> <p>Conclusions</p> <p>Camptocormia is a heterogeneous syndrome of various causes. We believe that our case illustrates the need to search for paraspinal muscle damage, including drug-induced rhabdomyolysis, in patients presenting with acute-onset bent spine syndrome. Although rare, the occurrence of camptocormia induced by olanzapine must be considered.</p

A European research agenda for somatic symptom disorders, bodily distress disorders, and functional disorders: Results of an estimate-talk-estimate delphi expert study

Background: Somatic Symptom Disorders (SSD), Bodily Distress Disorders (BDD) and functional disorders (FD) are associated with high medical and societal costs and pose a substantial challenge to the population and health policy of Europe. To meet this challenge, a specific research agenda is needed as one of the cornerstones of sustainable mental health research and health policy for SSD, BDD, and FD in Europe. Aim: To identify the main challenges and research priorities concerning SSD, BDD, and FD from a European perspective. Methods: Delphi study conducted from July 2016 until October 2017 in 3 rounds with 3 workshop meetings and 3 online surveys, involving 75 experts and 21 European countries. EURONET-SOMA and the European Association of Psychosomatic Medicine (EAPM) hosted the meetings. Results: Eight research priorities were identified: (1) Assessment of diagnostic profiles relevant to course and treatment outcome. (2) Development and evaluation of new, effective interventions. (3) Validation studies on questionnaires or semi-structured interviews that assess chronic medical conditions in this context. (4) Research into patients preferences for diagnosis and treatment. (5) Development of new methodologic designs to identify and explore mediators and moderators of clinical course and treatment outcomes (6). Translational research exploring how psychological and somatic symptoms develop from somatic conditions and biological and behavioral pathogenic factors. (7) Development of new, effective interventions to personalize treatment. (8) Implementation studies of treatment interventions in different settings, such as primary care, occupational care, general hospital and specialty mental health settings. The general public and policymakers will benefit from the development of new, effective, personalized interventions for SSD, BDD, and FD, that will be enhanced by translational research, as well as from the outcomes of research into patient involvement, GP-patient communication, consultation-liaison models and implementation. Conclusion: Funding for this research agenda, targeting these challenges in coordinated research networks such as EURONET-SOMA and EAPM, and systematically allocating resources by policymakers to this critical area in mental and physical well-being is urgently needed to improve efficacy and impact for diagnosis and treatment of SSD, BDD, and FD across Europe

Disease Evolution and Response to Rapamycin in Activated Phosphoinositide 3-Kinase δ Syndrome: The European Society for Immunodeficiencies-Activated Phosphoinositide 3-Kinase δ Syndrome Registry

Activated phosphoinositide 3-kinase (PI3K) δ Syndrome (APDS), caused by autosomal dominant mutations in PIK3CD (APDS1) or PIK3R1 (APDS2), is a heterogeneous primary immunodeficiency. While initial cohort-descriptions summarized the spectrum of clinical and immunological manifestations, questions about long-term disease evolution and response to therapy remain. The prospective European Society for Immunodeficiencies (ESID)-APDS registry aims to characterize the disease course, identify outcome predictors, and evaluate treatment responses. So far, 77 patients have been recruited (51 APDS1, 26 APDS2). Analysis of disease evolution in the first 68 patients pinpoints the early occurrence of recurrent respiratory infections followed by chronic lymphoproliferation, gastrointestinal manifestations, and cytopenias. Although most manifestations occur by age 15, adult-onset and asymptomatic courses were documented. Bronchiectasis was observed in 24/40 APDS1 patients who received a CT-scan compared with 4/15 APDS2 patients. By age 20, half of the patients had received at least one immunosuppressant, but 2–3 lines of immunosuppressive therapy were not unusual before age 10. Response to rapamycin was rated by physician visual analog scale as good in 10, moderate in 9, and poor in 7. Lymphoproliferation showed the best response (8 complete, 11 partial, 6 no remission), while bowel inflammation (3 complete, 3 partial, 9 no remission) and cytopenia (3 complete, 2 partial, 9 no remission) responded less well. Hence, non-lymphoproliferative manifestations should be a key target for novel therapies. This report from the ESID-APDS registry provides comprehensive baseline documentation for a growing cohort that will be followed prospectively to establish prognostic factors and identify patients for treatment studies

Du « burn out » au « syndrome des yuppies » : deux avatars modernes de la fatigue

Pascal Cathébras : From "Burn out" to "Yuppies' Syndrome": Two Modem Avatars of Fatigue. Originating in North America, like neurasthenia one century ago, "burn out" (or professional exhaustion) and "yuppies' syndrome" (or "post-viral chronic fatigue syndrome") are described as "new" diagnostic entities, and then analysed as attribution phenomena that give shape and meaning to undifferentiated states of fatigue. Both diagnoses imply a process in which the individual is exonerated from any personal responsibility in the disease and an external cause is pointed out: modem life for neurasthenia, viruses for "chronic fatigue syndrome", and work conditions for "burn out". A diagnosis of "burn out" or "chronic fatigue syndrome" gives the individual the opportunity to deny any psychological dimensions of his fatigue as well as the implicit charge of imaginary illness frequently attached to them. The medical institution plays an ambiguous role, alternatively legitimizing and disqualifying the causal attributions it had brought on.Résumé. Nés en Amérique du Nord comme cent ans plus tôt la neurasthénie, le « burn out » (ou syndrome d'épuisement professionnel) et le « syndrome des yuppies » (ou syndrome de fatigue chronique post-viral) sont décrits comme deux « nouvelles » entités diagnostiques, puis envisagés comme des phénomènes d'attribution permettant de donner forme et sens à des états de fatigue indifférenciés. Dans tous les cas se met à l'œuvre un processus de « disculpation » et d'extériorisation de la cause : la vie moderne pour la neurasthénie, les virus pour le syndrome de fatigue chronique et le milieu de travail pour le burn out. Endosser un diagnostic de burn out ou de syndrome de fatigue chronique permet ainsi d'éviter la psychologisation de la fatigue et l'accusation implicite de maladie imaginaire qui y reste communément attachée. L'institution médicale s'avère jouer un rôle ambigu, légitimant et disqualifiant alternativement les attributions qu'elle a elle-même suscitées.Pascal Cathébras : Del « burn out » al « sindrome de los yuppies » : dos avatares modernos de la fatiga. Originados en América del Norte al igual que la neurastenia cien años atrás, el « burn out » (o síndrome de agotamiento profesional) y el « síndrome de los yuppies » (o síndrome de fatiga crónica post-viral) son descritos como dos « nuevas » entidades diagnósticas y analyzados posteriormente como fenómenos de atribución que dan forma y sentido a estados indiferenciados de fatiga. En esto casos se pone en funcionamiento un proceso de « descarga de culpa », al mismo tiempo que se exterioriza la causa : la vida moderna para la neurastenia, los virus para el síndrome de fatiga crónica y las condiciones laborales para el « burn out ». Un diagnóstico de « burn out » o de fatiga crónica évade la interpretación sicológica de la fatiga y su carácter implicito de enfermedad imaginaria. La institución médica juega en estos casos un papel ambiguo al legitimar y descalificar altemativamente las atribuciones creadas por ella.Cathébras Pascal. Du « burn out » au « syndrome des yuppies » : deux avatars modernes de la fatigue. In: Sciences sociales et santé. Volume 9, n°3, 1991. pp. 65-94

Lithium-induced downbeat nystagmus

We report the case of a 76-year old lady under lithium carbonate for a bipolar disorder who presented with a suspected optic neuritis. A typical lithium-induced downbeat nystagmus was observed. Discontinuation of lithium therapy resulted in frank improvement in visual acuity and disappearance of the nystagmus