Greater vulnerability to cannabis dependence among heavy cannabis user French women.

BACKGROUND AND OBJECTIVES: Between 1990 and the mid-2010s, France registered a sharp rise in the spread and consumption of cannabis. At the same time, there has been an increase in the concentration of Δ9-tetrahydrocannabinol contained in cannabis. The aims of our study are to measure addictive and psychiatric comorbidities in cannabis users in France, and to compare characteristics between women and men. METHODS: Three hundred and forty-two heavy cannabis users seen in a cannabis clinic between 2004 and 2014 were assessed during a 2-h clinical interview (DSM-IV, MINI). RESULTS: 83.2% of users are currently cannabis dependent, 10.6% alcohol dependent, and 2.1% cocaine/crack dependent. 37.8% have a current mood disorder, 47.6% have a current anxiety disorder, and 8.8% are psychotic. Women suffer significantly more often than men from major depressive episodes, dysthymia, agoraphobia, social phobia, generalized anxiety disorder and posttraumatic stress disorder (PTSD), both current and lifetime. Logistic regression shows that women have a significantly higher risk than men of suffering from PTSD over their lifetime (odds ratio [OR] = 5.48; p < 10-3). The vast majority of women suffering from PTSD report having been sexually assaulted in the course of their lives. In addition, women are at greater risk of cannabis dependence (OR = 3.87; p < .05) for lower cannabis consumption (grams smoked per week) (OR = 0.96; p < .05). DISCUSSION AND CONCLUSIONS: French women heavy cannabis users are particularly at risk of PTSD and are more likely than men to be dependent despite consuming fewer. SCIENTIFIC SIGNIFICANCE: Further studies are needed to clinically quantify cannabis consumption and distinguish its impact on women and men.

Bibliometric analysis of publications on attention deficit hyperactivity disorder (ADHD) in France since 1974.

BACKGROUND: The predominance of the psychodynamic approach is often put forward to explain the delay in diagnosis and treatment of attention-deficit disorder with hyperactivity (ADHD) reported in France. OBJECTIVE: A bibliometric study of abstracts, articles, or letters authored by French researchers may provide objective insight into this issue. METHODS: Online electronic databases were searched without any date limits for documents related to ADHD, and allocated to the AllFR group when all authors had an affiliation in France or to the notAllFR group when at least one author had an affiliation in France. Publications expressing any psychodynamic point of view on the causes and/or treatment of ADHD were identified. RESULTS: A total of 747 documents were analyzed: 417 were exclusively indexed in SCOPUS, and 418 were allocated to the AllFR group. Compared with documents in the notAllFR group, documents in the AllFR group were written by a smaller number of authors (median 3 vs. 6, p<0.002), more frequently evoked psychodynamic concepts (10.45% vs. 1.67%, p<0.001), and less frequently acknowledged the persistence of ADHD in adulthood (29.10% vs. 42.14%). The psychodynamic approach was likely to rely on case reports of fewer than three children. CONCLUSIONS: Any serious review of the literature should pool documents from several online databases, especially SCOPUS. In publications by only French authors, the psychodynamic approach seems predominant and the persistence of ADHD in adulthood is overlooked. This may concur with the excessive delay observed in the diagnosis and treatment of children and adults in France compared to other European countries.

The ability of early changes in motivation to predict later antidepressant treatment response.

INTRODUCTION: Baseline values and early changes of emotional reactivity, cognitive speed, psychomotor function, motivation, and sensory perception have not been studied to any extent in unipolar depression, although they could help to characterize different dimensions of illness that are harder to capture by clinicians, give new insights on how patients improve, and offer new early clinical markers for later treatment response. METHODS: About 1,565 adult outpatients with major depressive disorder receiving agomelatine completed the clinician-rated 16-item quick inventory of depressive symptoms, Clinical Global Impression, and Multidimensional Assessment of Thymic States (MAThyS) rating scales at inclusion, Week 2 and Week 6. The MAThyS includes a 20-item self-rated visual analog scale (from inhibition [0] to activation [10], with [5] representing the usual state) leading to five a priori dimensions (emotional reactivity, cognitive speed, psychomotor function, motivation, and sensory perception). RESULTS: All MAThyS dimension scores increased from inclusion to Week 2 and from inclusion to Week 6 (P<0.001). Improvement was around 2 points (out of 10) for motivation, 1.5 points for psychomotor function, and 0.5 points for other dimensions. Motivation showed a trend to being more severely impaired at inclusion in future nonresponders (t=1.25, df=1,563, P=0.10). Its improvement at Week 2 was the most discriminating MAThyS dimension between future responders and nonresponders, and represents the best predictor of future response, with the highest area under the receptor operating characteristic curve (area under curve =0.616, 95% confidence interval [0.588-0.643], P<0.001). Finally, improvements in motivation correlated the most strongly with clinician-rated 16-item quick inventory of depressive symptoms improvement (r=-0.491, df=1,563, P<0.001). CONCLUSION: Motivation had the most capacity for early improvement, the best predictive value for response, and the largest global margin of progress in depressed outpatients. Assessing the evolution of self-reported motivation over time in major depressive disorder could offer an interesting complementary approach to predict response.

A composite scale applied to evaluate anxiety in schizophrenic patients (SAES).

Anxiety in schizophrenia possesses specific features and is difficult to assess because no specific evaluating tool is currently available. The aim of this study was to develop and validate a hetero-assessment-based scale to specifically measure anxiety in schizophrenia. A literature review and a survey among psychiatrists allowed the selection of 29 items from 4 previous scales evaluating anxiety. Factor analysis allowed building up a final 22-item composite scale of anxiety evaluation in schizophrenia (SAES), which was then validated in 147 schizophrenic patients. One hundred and forty-seven (147) schizophrenic patients (70.8 % male, mean age = 36.9 years) were included in the study. Principal component analysis of the SAES revealed three factors, namely "expressed and perceived anxiety," "somatic anxiety," and "anxiety and environment". All total and factor scores of the SAES were significantly correlated (p < .001) with total and factor scores of the original scales. Finally, the SAES showed good inter-rater reliability [intra-class correlation coefficient (ICC) = .82]. In conclusion, a specific tool for evaluating anxiety in schizophrenia (SAES) was developed and validated in a sample of schizophrenic patients. The SAES can be useful to investigate clinical, psychopathological, and therapeutic aspects of anxiety in schizophrenia.

Premorbid functioning and treatment response in recent-onset schizophrenia: prospective study with risperidone long-acting injectable.

Premorbid functioning may be associated with treatment response, but this is confounded by a lack of prospective longitudinal data and controls for medication compliance. This study tested the hypothesis that good premorbid functioning will be associated with better antipsychotic treatment response after controlling for drug adherence by using a long-acting injectable antipsychotic. This was a 6-month, open label, multicenter, phase IV trial in recent-onset schizophrenia treated with flexible doses of risperidone long-acting injectable (25-50 mg every 14 days). Premorbid functioning was assessed with the Premorbid Adjustment Scale (PAS)-Structured Interview; efficacy was evaluated with clinician-rated Positive and Negative Syndrome Scale, Clinical Global Impression scale of Severity of Illness, Clinical Global Impression scale of Change, Global Assessment of Functioning Scale, and trial participant completed SF-36. Analyses controlled for baseline scores and demographics. With the use of a priori PAS scoring criteria, the participants' premorbid functioning was categorized as stable-good (n = 142), stable-poor (n = 116), and deteriorating (n = 36). At baseline, the stable-good group had the best functioning on most efficacy measures. All groups showed significant improvement on efficacy measures with treatment. Improvement was significantly higher for the stable-good group. The PAS global assessment of highest level of functioning scale (excellent, n = 75; good, n = 117; fair, n = 78; and poor, n = 31) showed a strong association with baseline functioning and improvement and had a significant linear association with meeting Remission in Schizophrenia Working Group symptom criteria at baseline (P = 0.003) and attained and sustained remission for 3 months during study (47.7%, 49.3%, 29.6%, and 22.2%; P = 0.006). Good premorbid functioning corresponds with better treatment response in recent-onset psychosis as captured on both clinician and patient-reported measures.

An aid for diagnosing attention-deficit/hyperactivity disorder at adulthood: psychometric properties of the French versions of two Wender Utah Rating Scales (WURS-25 and WURS-K).

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects up to 4% of the adults in the general population. The Utah criteria were devised in the 1970s to help a retrospective diagnosis of ADHD during childhood, a necessary but not sufficient condition for diagnosing ADHD at adulthood. A sample of 466 adults was collected from a referral center and a large university. We investigated the psychometric properties (reliability and factor structure) of the original WURS-25 and the WURS-K, two shortened versions of the Wender Utah Rating Scale. These scales have similar psychometric properties; both have a 3-factor structure with only the first two factors highly and positively correlated. The third factor in the WURS-K, antisocial behavior, is less specific to the construct of ADHD than the third factor in the WURS-25, mood/self-esteem. The 18-item Adult ADHD Self-Rating Scale (ASRS) was used as a screening tool for actual ADHD. The composite total scores and the factorial scores correlated moderately with ASRS total and subscores. Research is warranted to assess the cutoff scores against a diagnosis of ADHD using a structured interview.

Efficacy of the novel antidepressant agomelatine on the circadian rest-activity cycle and depressive and anxiety symptoms in patients with major depressive disorder: a randomized, double-blind comparison with sertraline.

OBJECTIVE: This study evaluates the efficacy of agomelatine, the first antidepressant to be an agonist at MT(1)/MT(2) receptors and an antagonist at 5-HT(2C) receptors, versus sertraline with regard to the amplitude of the circadian rest-activity cycle and depressive and anxiety symptoms in patients with major depressive disorder (MDD). METHOD: Outpatients with DSM-IV-TR-defined MDD received either agomelatine 25 to 50 mg (n = 154) or sertraline 50 to 100 mg (n = 159) during a 6-week, randomized, double-blind treatment period. The study was conducted from 2005 to 2006. The main outcome measure was the relative amplitude of the individual rest-activity cycles, expressed as change from baseline to week 6 and collected from continuous records using wrist actigraphy and sleep logs. Secondary outcome measures were sleep efficiency and sleep latency, both derived from actigraphy, and efficacy on depression symptoms (17-Item Hamilton Depression Rating Scale total score and Clinical Global Impressions scale scores) and anxiety symptoms (Hamilton Anxiety Rating Scale total score and subscores). RESULTS: A significant difference in favor of agomelatine compared to sertraline on the relative amplitude of the circadian rest-activity cycle was observed at the end of the first week (P = .01). In parallel, a significant improvement of sleep latency (P <.001) and sleep efficiency (P <.001) from week 1 to week 6 was observed with agomelatine as compared to sertraline. Over the 6-week treatment period, depressive symptoms improved significantly more with agomelatine than with sertraline (P <.05), as did anxiety symptoms (P <.05). CONCLUSIONS: The favorable effect of agomelatine on the relative amplitude of the circadian rest-activity/sleep-wake cycle in depressed patients at week 1 reflects early improvement in sleep and daytime functioning. Higher efficacy results were observed with agomelatine as compared to sertraline on both depressive and anxiety symptoms over the 6-week treatment period, together with a good tolerability profile. These findings indicate that agomelatine offers promising benefits for MDD patients. TRIAL REGISTRATION: www.isrctn.org: ISRCTN49376288.

Inattentive symptoms of ADHD are related to evening orientation.

OBJECTIVE: Morningness is a stable characteristic of individuals, related to impulsivity and novelty seeking. The evening orientation is a risk factor for psychiatric conditions such as depression and personality disorders. The authors hypothesized that adults suspected of having ADHD are more evening oriented than adults without ADHD. METHOD: Exploratory factor analyses were performed on the polychoric correlation matrices of the full Adult Self-Report Scale for ADHD (ASRS) and the Composite Scale of Morningness (CSM). RESULTS: As expected, two factors for the ASRS--Inattention and Impulsivity- Hyperactivity--and three factors for the CSM were retrieved. All three CSM factors correlated negatively with ASRS Inattention, none with ASRS Impulsivity-Hyperactivity. CONCLUSION: Inattention is more strongly related to eveningness than is Impulsivity-Hyperactivity, and therefore eveningness may constitute an endophenotype of the predominantly inattentive subtype of ADHD. These findings need to be replicated in a patient population with a standardized assessment of sleep quality.

Sadness as an integral part of depression.

Sadness is considered by numerous authors to be a core symptom of depression. Currently, many arguments exist for its particular importance in depressed patients. Sadness makes up part of the various definitions of the depressive syndrome, even if its presence is not required for diagnosis. Furthermore, it is closely linked to the other depressive symptoms, and has prognostic value, in particular for remission. The recognition and measurement of sadness seem important for therapeutic evaluation, in clinical studies, and in depressed patients at an individual level. This paper presents a selective review of some of the various aspects of sadness as an integral part of depression, and an examination of its links with a disease which is a major health concern.

Validity of the CAGE questionnaire in schizophrenic patients with alcohol abuse and dependence.

The objective of the study was to assess the sensitivity and the specificity of the CAGE questionnaire in 114 schizophrenic patients. The Composite International Diagnostic Interview was used to assess the DSM-III-R diagnosis of abuse of or dependence on alcohol. The CAGE questionnaire can be reliably used to assess alcohol use disorders in schizophrenic patients: with a cutoff score of 1 or more, the sensitivity of the CAGE questionnaire was 0.91 and the specificity was 0.83. With a cutoff score of 2 or more, the sensitivity of the CAGE questionnaire was 0.82 and the specificity was 0.94. The post test probabilities (PPV) were high (PPV1=0.74; PPV2=0.85) compared to the primary probability of alcoholism (29.8%).

Specific pattern of attentional changes in impulsive individuals.

INTRODUCTION: Although impulsivity is recognised as a major psychopathological feature, its cognitive correlates remain controversial. We evaluated readiness to act induced by a warning signal and attentional engagement in healthy impulsive participants. METHODS: People with high impulsivity scores (HI) and low impulsivity (LI) scores on Barratt's Impulsivity Scale (BIS) were selected among 1250 students from top and bottom deciles. Subjects with personal or family of lifetime Axis I disorders were excluded. Motor preparation was evaluated by a Choice Reaction Time task (CRT) with a randomly presented warning signal with a delay before target of 500 ms or 2000 ms depending on the trial block. Attentional engagement and maintenance of fixation was evaluated by a Cued Target Detection task (CTD) comparing cued (valid, invalid, or double cue) and uncued trials and contrasting fixation offset (gap) or maintenance (overlap) conditions. RESULTS: HI, but not LI participants had a shortened reaction time in the 2000 ms condition of CRT with warning signal, indicating a persistent readiness to act. In contrast to LI, HI showed a decreased reinforcement of attention in the overlap condition of CTD with a hyperreactivity to all types of visual stimuli. CONCLUSIONS: Impulsivity per se appears to be associated with hyperreactivity to warning or cue signals and on inability to maintain attentional fixity.

Impulsivity but not venturesomeness is related to morningness.

The Composite Scale of Morningness (CSM) is a psychometrically sound instrument available in several languages, including French, aimed at arranging individuals along a continuum from high "eveningness" to high "morningness." On the other hand, impulsivity is involved in many personality disorders and is thought to be orthogonal to venturesomeness, which can be seen as a component of the broader construct of sensation seeking. We hypothesized that evening-type subjects would be more impulsive than morning-types. Self-administered questionnaires were distributed to students, and only complete forms were analyzed (194 males and 358 females). A four-way analysis of covariance showed significant effects of age, gender and impulsivity, but not venturesomeness, on morningness in the sense of a higher degree of eveningness in more impulsive subjects. In addition, the correlation coefficients in both genders were similar to those reported in smaller samples. Our findings deserve further interest because, regardless of gender, they suggest a possible physiopathological approach to impulsivity that may be accessible by circadian interventions such as midday bright light exposure or pharmacological treatments.

Nicotine use in schizophrenia and disinhibition.

The role of personality in nicotine use has been little studied in patients with schizophrenia. The objectives of the present study were to compare impulsivity, sensation seeking and anhedonia in a group of schizophrenic patients with and without current cigarette smoking. One hundred patients with schizophrenia or schizoaffective disorder (DSM-III-R criteria) were assessed with the Positive and Negative Syndrome Scale, the Fagerström Scale, the Barratt Impulsivity Scale, the Zuckerman Seeking Sensation Scale, and the Chapman Physical Anhedonia Scale. Among these patients, 67% were current smokers. The mean scores for sensation seeking were higher in the group of smokers than in the group of nonsmokers. The differences were found exclusively with the "disinhibition" subscale. No significant difference was found for impulsivity and physical anhedonia mean scores. The scores on the Sensation Seeking Scale were especially low in nonsmokers. Cigarette smoking could influence disinhibition and possibly help to normalize inhibition in schizophrenic patients.

The Spielberger Trait Anxiety Inventory measures more than anxiety.

OBJECTIVE: Researchers tried to explain the overlap between anxiety and depression by suggesting that some items of self-administered questionnaires were badly selected and that both constructs should rather be considered as multidimensional. Thus, we hypothesise that the Spielberger trait anxiety inventory (TAI) includes items related to depression. METHOD: A non-clinical sample of 193 subjects filled out the TAI and the Hospitalised Anxiety-Depression Scale. Factors were postulated on the basis of item content and submitted to confirmatory factor analysis (CFA). RESULTS: We found five factors: a 10-item anxiety factor containing three factors, a four-item unsuccessfulness factor correlated with the HADS anhedonia factor, and a six-item happiness factor. CONCLUSION: The TAI scale encompasses measures of anxiety, depression and well-being. Consequently, the overlap with other measures of depression may result from item selection. This work awaits replication in independent normal and pathological samples.

Cross-cultural study of the Impulsiveness-Venturesomeness-Empathy Questionnaire (IVE-7).

The construct of impulsivity has gained interest in the last decades, and has been developed from different theoretical positions. Among these, the Eysencks proposed a specific self-administered questionnaire (IVE-7) for measuring two components, Impulsiveness (IMP) and Venturesomeness (VENT), which are included within their psychoticism-extraversion-neuroticism (P-E-N) system of personality. In the current study, the IVE-7 was translated into French and back-translated into English. Students filled out the French version, and data were analyzed for males and females separately. The scales reliabilities are similar between languages for IMP and VENT. The exploratory factor analyses revealed two acceptable three-factor solutions, although they failed to clearly identify the third factor. The factor similarity between genders was found very satisfactory using three different methods. The French and English factorial solutions also showed a very good level of similarity in each gender. Finally, the IMP was positively correlated with the Motor Impulsivity subscale of the Barratt Impulsivity Scale-10 (BIS-10) and with Dickman's Dysfunctional Impulsivity scale, and independent of the Spielberger Trait-Anxiety Inventory (TAI). We conclude that IMP and VENT are relatively stable between cultures and can be used reliably in French-speaking samples.

Psychopathology and comorbidity of psychiatric disorders in patients with kleptomania.

OBJECTIVE: This study compared patients with kleptomania, patients with alcohol abuse or dependence, and psychiatric patients without impulse-control disorders or substance-related disorders on several key psychopathological dimensions. In addition, the comorbidity of kleptomania with other psychiatric disorders was examined. METHOD: Eleven patients with kleptomania recruited over a cumulative 2-year period and 60 patients with alcohol abuse or dependence and 29 psychiatric comparison patients recruited over a consecutive 6-month period participated in structured clinical interviews to determine the presence of impulse-control and substance-related disorders and of other psychiatric disorders that were comorbid with kleptomania. Psychopathological dimensions were measured with the Barratt Impulsiveness Scale, the Sensation Seeking Scale, the Montgomery-Asberg Depression Rating Scale, and the anxiety and depression subscales of the Hospital Anxiety and Depression Scale. RESULTS: Significant group effects were found for the Barratt Impulsiveness Scale total and cognitive impulsivity scores, with the patients with kleptomania having higher impulsivity scores than the other groups. Significant group differences were found on the Sensation Seeking Scale total and disinhibition scores. No significant group effects were found for the mood and anxiety measures. Patients with kleptomania had high rates of comorbid psychiatric disorders, particularly mood disorders, other impulse-control disorders, and substance abuse or dependence (mainly nicotine dependence). CONCLUSIONS: Kleptomania presented a specific psychopathological profile that distinguished patients with this disorder from patients with alcohol abuse or dependence and other psychiatric comparison patients. Impulsivity was the major psychopathological feature of kleptomania. A link between kleptomania and affective disorder was supported by the high rate of comorbid affective disorders in patients with kleptomania and a specific pattern of variation in the two conditions over time. Further prospective studies are needed to confirm this pattern. Because kleptomania is characterized by a low rate of comorbid substance-related disorders other than nicotine dependence and by severe psychopathology, it could be an appropriate disorder in which to study the information processes and psychobiology underlying impulsivity.

How does the Hospital and Anxiety and Depression Scale measure anxiety and depression in healthy subjects?

Many anxiety and depression scales are commonly used, although the assumption that they all measure the same construct may be questioned. Thus, researchers have to pay attention to the nature of the scales they use. The Hospital Anxiety and Depression Scale (HADS) was constructed in 1983 to allow a rapid and separate measure of depression and generalised anxiety. Surprisingly, since its introduction, there has been no comprehensive documentation of its psychometric properties. Therefore, as a contribution to assessing the construct validity of the HADS, we conducted a set of confirmatory factor analyses in a sample of 195 healthy students. None of the formerly proposed models fit our data. We were able to split the original Anxiety subscale into two components that we have labelled 'Anxiety' and 'Restlessness', while the original Depression subscale is slightly modified. The results are discussed from both clinical and theoretical points of view.