Pertinence du concept d'addiction dans les troubles du comportement alimentaire

Le cadre nosographique des addictions rassemble diverses composantes cliniques parmi lesquelles les addictions aux produits et les addictions sans produits ou comportementales, dans lesquelles s intègrent les Troubles du Comportement Alimentaire (TCA). Ce travail cherche à établir et souligner les rapprochements entre TCA et addictions dans leurs perspectives étymologiques, historiques, épidémiologiques, cliniques, psychopathologiques et neurobiologiques. Interpellés par la fréquente comorbidité entre les addictions aux produits et les TCA, nous avons proposé des éléments de réflexion sur la nature, les déterminants et la prise en charge de cette vulnérabilité addictive partagée. Nous nous sommes intéressés au rôle que pouvait jouer cette composante addictive centrale des TCA dans le fonctionnement psychique des sujets. En particulier nous avons souligné les constructions de verrouillages comportementaux, biologiques, psychologiques et sociaux constituant et renforçant le fonctionnement des conduites addictives, que ce soit vis-à-vis des drogues ou de l alimentaire. La perspective d une vulnérabilité addictive partagée constitue un argument fort pour une meilleure prise en compte par le clinicien des formes de passage intriquées et à double sens entre une addiction et une autre, en particulier entre drogue et TCA. Ce concept des addictions reste donc encore ouvert à réflexion. Il mérite aussi d être mieux connu des acteurs de santé afin de favoriser les efforts de recherche, les actions de prévention, de dépistage et l optimisation des stratégies thérapeutiques.PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Prise en charge en hôpital de jour des troubles des conduites alimentaires

LE KREMLIN-B.- PARIS 11-BU Méd (940432101) / SudocSudocFranceF

Apport de la neuro-imagerie pour l'étude des anomalies cérébrales structurelles et métaboliques dans les dépressions pharmaco-résistantes

PARIS6-Bibl. St Antoine CHU (751122104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Underweight patients with anorexia nervosa: comparison of bioelectrical impedance analysis using five equations to dual X-ray absorptiometry

Body weight changes do not reflect the respective changes of body compartments, namely fat-free mass (FFM) and fat mass (FM). Both bioelectrical Impedance Analysis (BIA) and the Dual X-ray absorptiometry (DXA) measure FFM and FM. This study in underweight patients with anorexia nervosa (AN) aims to compare measurements of FM and FFM done by DXA and BIA using 5 different BIA equations already validated in healthy population and to identify the most suitable BIA equation for AN patients

Levels of autistic traits in anorexia nervosa: a comparative psychometric study.

International audienceBACKGROUND: A number of characteristics associated with Autism Spectrum Disorders (ASD) are over-represented among patients with Anorexia Nervosa (AN) as well as among relatives of these patients. Yet the co-occurrence of autistic traits in AN has not been fully explored and no previous study has directly compared self-reported evaluations of cognitive and socio-affective skills in AN and ASD. METHODS: We aimed to determine the degree of overlap between AN and ASD from scores on questionnaires classically used to measure ASD impairments. Fifteen AN participants, 15 ASD participants and two groups of matched controls completed a battery of self-reports measuring: autistic traits (Autism-Spectrum Quotient), empathy (Empathy Quotient-short and Interpersonal Reactivity Index), systemizing (Systemizing Quotient-short) and alexithymia (Bermond-Vorst Alexithymia Questionnaire-B). Univariate comparisons of mean totalled scores were performed on each measure (patients vs. controls, and AN vs. ASD), and a Principal Component Analysis was used to study subject proximities in a reduced-factor space constructed from AQ, BVAQ and IRI subscales. RESULTS: These analyses revealed similarities in a few cognitive domains (Attention Switching, Perspective Taking and Fantasy, lack of emotional introspection) and in some nonspecific affective dimensions (depression and feelings of distress), but also marked dissimilarities in social skills (the ability to communicate emotions to others, empathizing). CONCLUSION: The AN and ASD participants reported similar needs for sameness, and similar difficulties understanding their emotions and taking the perspective of another, but contrasting abilities to feel concerned in interpersonal situations. Our mixed findings encourage further exploration of transdiagnostic similarities and associations between these disorders

Cortical folding in patients with bipolar disorder or unipolar depression

International audienceBACKGROUND: Analysis of cortical folding may provide insight into neurodevelopment deviations, which, in turn, can predispose to depression that responds particularly poorly to medications. We hypothesized that patients with treatment-resistant depression would exhibit measurable alterations in cortical folding. METHODS: We computed hemispheric global sulcal indices (g-SIs) in T(1)-weighted magnetic resonance images obtained from 76 patients and 70 healthy controls. We separately searched for anatomic deviations in patients with bipolar disorder (16 patients with treatment-resistant depression, 25 with euthymia) and unipolar depression (35 patients with treatment-resistant depression). RESULTS: Compared with healthy controls, both groups of patients with treatment-resistant depression exhibited reduced g-SIs: in the right hemisphere among patients with bipolar disorder and in both hemispheres among those with unipolar depression. Patients with euthymic bipolar disorder did not differ significantly from depressed patients or healthy controls. Among patients with bipolar disorder who were taking lithium, we found positive correlations between current lithium dose and g-SIs in both hemispheres. LIMITATIONS: We cannot estimate the extent to which the observed g-SI reductions are linked to treatment resistance and to what extent they are state-dependent. Furthermore, we cannot disentangle the impact of medications from that of the affective disorder. Finally, there is interindividual variation and overlap of g-SIs among patients and healthy controls that need to be considered when interpreting our results. CONCLUSION: Reduced global cortical folding surface appears to be characteristic of patients with treatment-resistant depression, either unipolar or bipolar. In patients with bipolar disorder, treatment with lithium may modify cortical folding surface

Diversité des prises en charge hospitalières de l'anorexie mentale en psychiatrie en France

International audienceBackground: Hospitalization is rare in anorexia nervosa (AN) and local application of indications is heterogeneous. However, no study has evaluated the effect of these different treatment modalities on the mean length of stay. Our objective was to describe the context and modalities of a wide range of hospital care programs offered to patients with anorexia nervosa in eleven specialized French psychiatric centers for patients from childhood to adulthood. This work was carried out within the framework of the EVHAN (Evaluation of Hospitalization for AN, Eudract number: 2007-A01110-53, registered in Clinical trials) research program. The EVHAN program comprises five main lines: weight objectives at discharge, the practice or not of a separation period, the use of clear nutritional dietary objectives (cognitive/behavioral), the intensity of family involvement in treatment, and the existence or absence of a stabilization phase before ending inpatient treatment. These main lines will make it possible to study the impact of treatment modalities on the future of patients in the short and medium term (at discharge and at 1-year follow-up). Methods: The eleven centers are located in France (Bordeaux, Nantes, Paris and Ile-de-France, Rouen and Saint-Étienne). Various staff members (psychiatrists, somatic doctors, nurses, dieticians, psychologists) from each center were interviewed using a semi-structured questionnaire. Data on operating modalities and context of care were collected and analyzed. Results: Four of the eleven centers were exclusively child/adolescent centers, and seven of 11 were adolescent (from 11, 13 or 16 years) and young adult centers. All centers offered a graduated approach from outpatient to full hospitalization. The majority had a number of beds allocated for patients with eating disorders. The criteria for hospitalization were homogeneous with respect to somatic and/or psychic severity prefiguring the consensus criteria defined by the French Health Authority (HAS) in 2010. Child/adolescent units used the weight curve to set weight objectives at discharge (between the 10th and 50th percentiles). Most adult units used weight objectives at discharge corresponding to a body mass index between 17 and 20 kg/m2. Nine centers used a written or oral care contract. One unit did not separate the patient from her/his usual environment, the others had a practice gradient of partial separation and total separation times. These were either short, lasting a maximum of 3 weeks, or long, lasting more than 3 weeks. Conversely, patients were not isolated within the unit, and benefited from a rich social life, depending on her/his physical condition. The patient's family was in contact with the team and fully supported. The longest periods of separation involved adolescents and adults. Nutritional support varied from a group approach (meals in the dining room, standardized meals of the care center) to very individualized approaches within a specific framework. All the units reported meeting with families at least once during the hospitalization; with the patient's parents for child/adolescent patients and/or unmarried patients and with the husband/wife for married patients. The majority of the centers requested a phase of weight stabilization, whatever the age before hospital discharge. Conclusion: There is international and national consensus regarding the indications for hospitalization, and the main lines of multidisciplinary care to be developed within this framework. However, local application of these indications was heterogeneous resulting in diverse modalities of hospital care for anorexia nervosa in France. Specialized teams have developed management strategies arising from their “team culture”. The complexity of the anorexic pathology, due to the psyche-soma intrication and the diversity of age groups, highlights the complexity of care available. The impact of this diversity of hospital care on patient outcomes will be studied as a result of this work

Caregivers in anorexia nervosa: is grief underlying parental burden?

AUTEURS : The members of the EVHAN GroupInternational audiencePurpose: Anorexia Nervosa (AN) is a severe chronic disorder and parents’ experience of caregiving is usually marked by emotional distress and burden. Severe chronic psychiatric disorders are known to be linked with the concept of grief. Grief has not been investigated in AN. The aim of this study was to explore parents’ and adolescents’ characteristics that may be related to parental burden and grief in AN, and the link between these two dimensions. Methods: Eighty mothers, 55 fathers and their adolescents (N = 84) hospitalized for AN participated in this study. Evaluations of clinical characteristics of the adolescent’s illness were completed, as well as self-evaluations of adolescent and parental emotional distress (anxiety, depression, alexithymia). Levels of parental burden were evaluated with the Experience of Caregiving Inventory and levels of parental grief with the Mental Illness Version of the Texas Revised Inventory of Grief. Results: Main findings indicated that the burden was higher in parents of adolescents with a more severe AN; fathers’ burden was also significantly and positively related to their own level of anxiety. Parental grief was higher when adolescents’ clinical state was more severe. Paternal grief was related to higher anxiety and depression, while maternal grief was correlated to higher alexithymia and depression. Paternal burden was explained by the father’s anxiety and grief, maternal burden by the mother’s grief and her child’s clinical state. Conclusion: Parents of adolescents suffering from AN showed high levels of burden, emotional distress and grief. These inter-related experiences should be specific targets for intervention aimed at supporting parents. Our results support the extensive literature on the need to assist fathers and mothers in their caregiving role. This in turn may improve both their mental health and their abilities as caregivers of their suffering child. Level of evidence: Level III: Evidence obtained from cohort or case-control analytic studies