Prescription fractionnée de psychotropes (évaluation de l impact préventif sur la répétition d intoxications médicamenteuses volontaires)

Introduction : La prévention des intoxications médicamenteuses volontaires est peu étudiée chez les patients récidivants, dont les critères psychopathologiques sont mal connus. Objectifs : Comparer l impact d une délivrance médicamenteuse hebdomadaire versus mensuelle, et mettre en évidence un phénotype psychopathologique particulier chez des patients répétant les intoxications médicamenteuses volontaires. Méthode : 9 patients ayant au moins deux antécédents d IMV ont été répartis de manière randomisée en deux groupes, l un bénéficiant d une délivrance fractionnée hebdomadaire de son traitement, l autre d une délivrance mensuelle habituelle. Nous avons recueilli les caractéristiques psychopathologiques grâce aux échelles psychométriques suivantes : MINI, TCI-R, les critères d addiction de Goodman, TAS 20, BIS-11, Echelle H, SIS, RRRS, le questionnaire anamnestique et le statut clinique. Résultats : Les patients en délivrance fractionnée hebdomadaire ont effectué leur première IMV plus tardivement, et les répétitions ont été moins fréquentes que les patients en délivrance mensuelle. Certaines caractéristiques psychopathologiques de la population d étude ont pu être mises en avant. Conclusion : La délivrance fractionnée hebdomadaire semble avoir des conséquences bénéfiques sur la prévention de la répétition des IMV à court terme. Une étude avec un effectif plus important devra confirmer ces résultats préliminaires.Introduction : A few studies have investigated deliberate self poisoning prevention, especially among repeaters, whose psychopathological caracteristics are not well known. Aim : To compare the impact of weekly versus monthly dispensing among repeated attempters at risk of recurrence of deliberate self poisoning, and to highlight a psychopathological phenotype among these particular patients. Méthod : Nine patients with at least two previous attempts of deliberate self poisoning were randomly dispatched in two groups, the first with a weekly dispensing of the patients treatment, the second with a monthly dispensing. At the time of the inclusion, we collected their pharmacological path, as well as their psychopathological and sociodemographic data thanks to the following evaluations : MINI, TCI-R, Goodman s Addiction Criteria, TAS 20, BIS-11, Hopelessness scale, RRRS, the anamnestic questionnaire and the clinical status. Results : After inclusion, patients with weekly dispensing had their first deliberate self poisoning episode later, and the recurrences were less frequent than patients with monthly dispensing. . Some psychopathological caracteristics were highligted in this population. Conclusion : Weekly dispensing may have beneficial consequences in short term prevention of repeated deliberate self poisoning. A study with a larger headcount will be needed to confirm these preliminary results.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

Les benzodiazépines au long cours (un facteur de risque de répétition d intoxications médicamenteuses volontaires ?)

Introduction : la prescription de benzodiazépines au long cours semble présenter des risques chez certains patients. Les benzodiazépines les plus prescrites sont aussi les plus retrouvées dans les intoxications médicamenteuses volontaires. Objectifs: étudier le lien entre consommation de benzodiazépines au long cours et intoxications médicamenteuses volontaires répétées et comparer le profil psychopathologique de sujets consommateurs chroniques de benzodiazépines sans antécédent d intoxication médicamenteuse volontaire et de patients faisant des intoxications médicamenteuses volontaires à répétition. Méthode : caractériser les sujets consommateurs de benzodiazépines au long cours et les sujets faisant des intoxications médicamenteuses répétées à l aide de l historique de leurs traitements, leurs antécédents suicidaires et addictologiques. Leur profil psychopathologique sera caractérisé grâce à des échelles d évaluation clinique. L intoxication médicamenteuse volontaire index sera caractérisée à l aide de questionnaires de létalité et d intentionnalité. Résultats : le lien entre consommation chronique de benzodiazépines et intoxications médicamenteuses volontaires répétées ne semble pas être systématique. Une prise de benzodiazépines au long cours pourrait favoriser la récidive de ces épisodes chez des patients présentant certains antécédents psychiatriques, certains troubles de la personnalité, ainsi que des dimensions de tempérament et de caractère plus marquées. Conclusion : nécessité d un accompagnement des patients répétant les intoxications médicamenteuses volontaires au sein d un réseau de professionnels de santé délivrant des messages d informations et de prévention.Introduction : long term benzodiazepine prescription seems to be at risk in some patients. The most frequently prescribed benzodiazepines are also the most often identified in deliberate self-poisoning. Objectives : to study the relationship between long term benzodiazepine use and repeated deliberate self-poisoning and to compare the psychopathological profile of chronic benzodiazepine users with no history of deliberate self-poisoning and patients repeating deliberate self-poisoning. Method : to assess long term benzodiazepine users and subjects repeating deliberate self-poisoning thanks to their treatments history, their suicidal and addictological history. Their psychopathological profile will be assessed thanks to clinical evaluation scales. Index deliberate self-poisoning will be assessed thanks to lethality and intentionality questionnaires. Results : the relationship between chronic benzodiazepine use and repeated deliberate self-poisoning doesn t seem to be systematic. Long term benzodiazepine use could favor the recurrence of these episodes in patients with a psychiatric history, some personality disorders, as well as more pronounced temperament and character dimensions. Conclusion : necessity to accompany patients repeating deliberate self-poisoning within an actual network of healthcare professionals delivering information and prevention messages.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

Repeated self-poisoning : an addictive rather than a suicidal behavior. Clinical phenotyping and behavioral modeling using a dimensional approach

Les intoxications médicamenteuses volontaires répétées (IMVr) constituent un problème de santé publique croissant, mais sous-évalué et traité comme une conduite suicidaire, alors qu’elles appartiendraient au registre des addictions. Notre travail abonde dans ce sens en montrant que les suicides alcoolisés se font principalement par IMV et correspondent au deliberate self-harm syndrom ; les suicidants récidivants se distinguent par un névrosisme et un attachement anxieux typiques des addictions ; les IMVr même suicidaires témoignent d’une relation addictive aux médicaments ; le facteur le plus prédictif d’IMV serait de l’avoir envisagée. Conceptualisé de façon translationnelle et argumenté par une approche pharmacologique, nous proposons un modèle dimensionnel des conduites suicidaires, intégré au continuum des addictions, confirmant l’hypothèse initiale et l’intérêt d’un raisonnement transnosographique diagnostique et thérapeutique dans le champ des pathologies mentales.Repeated Self-poisoning (RSP) constitute an under evaluated but growing public health problem, treated as a suicidal rather than an addictive behavior. Our work brings arguments by showing that suicides involving alcohol are mainly by self-poisoning and correspond to deliberate self-harm syndrome; repeat suicide attempters are identified by a neuroticism and anxious attachment typically found in addicts; even suicidal RSP shows addictive behavior involving medicines; the best predictor of self-poisoning is having thought about it. Conceptualized through a translational approach and supported by pharmacological arguments, we propose a multidimensional model of suicidal behaviors, that could integrate the continuum of addictive behaviors. This confirms the initial hypothesis and the viability of a transnosographic concept for diagnosis and treatment of mental illnesses

Étude de la personnalité et des styles d attachement en fonction de l intentionnalité et de la létalité suicidaires

Introduction : L hétérogénéité des conduites suicidaires constitue un obstacle à l identification de facteurs de risque spécifiques à la tentative de suicide, et à leur prise en charge. Objectif : Etudier les dimensions de la personnalité et les styles d attachement dans un sous-groupe homogène de sujets dont le passage à l acte était de faible intentionnalité et de faible létalité suicidaires. Méthode : Dans une population de 60 suicidants, caractériser la tentative de suicide en termes d intentionnalité (Suicidal Intent Scale, SIS) et de létalité (Risk-Rescue Rating Scale, RRRS), et les spécificités psychopathologiques des suicidants sur le plan de la personnalité (Eysenck Personality Questionnaire-Revised, abrégé, EPQR-A), et des styles d attachement (Relationship Scales Questionnaire de Bartholomew, RSQ), à l'aide d une analyse statistique uni et multivariée. Résultats : Seule la fréquence des actes suicidaires a permis de distinguer deux profils psychopathologiques différents. Lors d un geste inaugural ou isolé, le névrosisme était d autant plus élevé que l intentionnalité et la létalité étaient faibles, tandis que l attachement évitant augmentait avec l intentionnalité et la létalité. Lors d un geste récidivant, névrosisme et attachement anxieux avaient tendance à être corrélés positivement à l intentionnalité suicidaire. Conclusion : Notre étude a confirmé l intérêt diagnostique d un phénotypage des conduites suicidaires, avec potentiellement une utilité pronostique et thérapeutique.Introduction: Heterogeneity of suicidal behavior is a major obstacle for identifying specific risk factors of suicide attempts and their management. Objective: To study personality dimensions and attachment styles in a homogeneous subgroup of patients with low suicidal intent and lethality. Method: Using an uni- and multivariate analysis, we characterized in 60 suicide attempters both suicidal intent and lethality with the Suicidal Intent (SIS) and Risk-Rescue Rating (RRRS) scales respectively, and we studied their psychopathology and attachment patterns with the Eysenck Personality Questionnaire-Revised abbreviated (EPQR-A) and the Relationship Scales Questionnaire of Bartholomew (RSQ), respectively. Results: Only the rate of suicide attempts allowed the identification of two distinct psychopathology profiles. For first or isolated suicide event, high neuroticism dimension was associated with low suicidal intent and lethality, whereas avoidant attachment style increased with levels of lethality and suicidal intent. For repeated suicide attempts, high neuroticism and ambivalent attachment style tended to positively correlate with high suicidal intent. Conclusion: Our study has highlighted the diagnostic relevance of phenotyping suicidal behaviors, with potential prognostic and therapeutic usefulness.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

Is suicide under the influence of alcohol a deliberate self-harm syndrome? An autopsy study of lethality

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Analgesic opioid use disorders in patients with chronic non-cancer pain: A holistic approach for tailored management

International audienceChronic pain is a major public health issue that frequently leads to analgesic opioid prescriptions. These prescriptions could cause addiction issues in high-risk patients with associated comorbidities, especially those of a psychiatric, addictive, and social nature. Pain management in dependent patients is complex and is yet to be established. By combining the views of professionals from various specialties, we conducted an integrative review on this scope. This methodology synthesizes knowledge and results of significant practical studies to provide a narrative overview of the literature. The main results consisted in first proposing definitions that could allow shared vocabulary among health professionals regardless of their specialties. Next, a discussion was conducted around the main strategies for managing prescription opioid dependence, as well as pain in the context of opioid dependence and associated comorbidities. As a conclusion, we proposed to define the contours of holistic management by outlining the main guidelines for creating a multidisciplinary care framework for multi-comorbid patients with chronic pathologies

Omega-3 supplements reduce self-reported physical aggression in healthy adults

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Prevalence and Characteristics of Chronic Pain in Buprenorphine and Methadone-Maintained Patients

International audienceChronic pain and substance use disorders frequently co-occur. Indeed, chronic pain is highly prevalent, affecting 23–68% of patients receiving opioid agonist treatments (OAT) worldwide. The majority of available estimates come from American studies, but data are still lacking in Europe. We aim to provide European estimates of the prevalence of chronic pain in patients receiving OAT using French data, since France is the first European country in terms of number of patients with OAT. The secondary objectives were to characterize the features and management of chronic pain, as well identify associated risk factors. We conducted a multicenter, cross-sectional study, recruiting patients treated either with buprenorphine or methadone in 19 French addiction centers, from May to July 2016. All participants had to complete a semi-directed questionnaire that collected sociodemographic and medical data, pain characteristics, and licit or illicit drug consumption. In total, 509 patients were included. The prevalence of chronic pain was estimated at 33.2% (95% CI: 29.1–37.3). Compared to non-chronic pain patients, chronic pain patients were older (38.4 vs. 36.1 years, p = 0.006), were more unemployed (66 vs. 52%, p = 0.003), had more psychiatric comorbidities (50 vs. 39%, p = 0.02), and split their OAT for pain management more frequently (24 vs. 7%, p = 0.009). Pain intensity was moderate or severe in 75% of chronic pain patients. Among patients with chronic pain, 15.4% were not prescribed, and did not self-medicate with, any analgesic drugs, 52.1% were prescribed analgesics (non-opioid analgesics, 76.3%; codeine, tramadol, opium, 27.2%; and morphine, fentanyl, oxycodone, 11.8%), and 32.5% exclusively self-medicated with analgesics. Moreover, 20.1% of patients with chronic pain also used illicit drugs for pain relief. On multivariate analysis, variables that remained significantly associated with chronic pain were age [OR = 1.03 (95% CI: 1.00–1.05], p = 0.02], anxiety [OR = 1.52 (1.15–2.02), p = 0.003], and depression [OR = 1.25 (1.00–1.55), p = 0.05]. Chronic pain is a highly prevalent condition in patients receiving OAT, and its appropriate management remains uncertain, since insufficient relief and frequent additional self-medications with analgesics or illicit drugs were reported by these patients. Increased awareness among caregivers is urgently needed regarding a systematic and careful assessment, along with an adequate management of chronic pain in patients receiving OAT

Alcohol and Violence in the Emergency Room: A Review and Perspectives from Psychological and Social Sciences

Our objective is to present a focused review of the scientific literature on the effect of alcohol consumption on violence related-injuries assessed in the emergency room (ER) and to show how psychological and behavioral sciences could lead to a better understanding of the factors contributing to alcohol-related injuries in the ER. We retrieved published literature through a detailed search in Academic Search Premier, MEDLINE with Full Text PsycARTICLES, Psychology and Behavioral Sciences Collection, PsycINFO, PUBMed and SocINDEX with Full Text for articles related to emergency rooms, medical problems and sociocognitive models addressing alcohol intoxication articles. The first search was conducted in June 2011 and updated until August 2013. Literature shows that compared to uninjured patients; injured ones have a higher probability of: (i) having an elevated blood-alcohol concentration upon arrival at the ER; (ii) reporting having drunk alcohol during the six hours preceding the event; and (iii) suffering from drinking-related consequences that adversely affect their social life. The main neurocognitive and sociocognitive models on alcohol and aggression are also discussed in order to understand the aetiology of violence-related injuries in emergency rooms. Suggestions are made for future research and prevention