[ADH/D and impulsiveness: Prevalence of impulse control disorders and other comorbidities, in 81 adults with attention deficit/hyperactivity disorder (ADH/D)]. / L'impulsivité dans le TDAH: prévalence des troubles du contrôle des impulsions et autres comorbidités, chez 81 adultes présentant un trouble déficit de l'attention/hyperactivité (TDA/H).

UNLABELLED: Attention deficit hyperactivity disorder (ADH/D) is a neuropsychological developmental disorder characterized by pervasive and impairing symptoms of inattention, hyperactivity, and impulsivity. Whereas it is well known in children, there is still little information about ADH/D in adults, including prevalence. Indeed, there are actually no epidemiological studies in France, despite the considerable impact of this disorder in a patient's professional and affective life. Moreover, ADH/D rarely stays isolated, and many comorbidities often complicate the diagnostic investigation. It is well known that the so-called ADH/D is composed of two main categories of symptoms (Attentional Disorder/Hyperactiviy Disorder), but Impulsiveness also remains a major symptom. OBJECTIVE: The aim of this study was to evaluate not only the prevalence of Impulse Control Disorders (ICD) but also psychological and addictive comorbidities among adult patients with ADH/D. A total of 100 patients from specialized consultations of adult ADH/D were evaluated in this study, but only 81 were included after presenting all the clinical criteria of ADH/D. METHOD: We used the DSM IV-T-R for ADH/D, the Minnesota Impulsive Disorders Interview a semi-structured clinical interview assessing impulse control disorders (ICD) (compulsive buying, trichotillomania, compulsive sexual behaviour, kleptomania, pyromania and intermittent explosive disorder), and the Mini International Neuropsychiatric Interview in order to evaluate psychiatric and addictive comorbidities. RESULTS: More than 90 % of the patients met the early apparition criteria of ADH/D (before 7years). More than half of the patients presented a mixed type of ADH/D (both inattentive and hyperactive-impulsive forms): 55.6 % vs 44.4 % for the inattentive type. The vast majority of patients showed a complete form (with a total of 6 or more symptoms out of 9, of inattentive and/or impulsive-hyperactivity category): 93.8 % and only 6.2 % presented a sub-syndromic form of ADH/D (with 3 symptoms at least of one and/or the other category). Regarding the ICDs, we found a proportion of 66 % of patients manifesting at least one, the most frequent ICD being the Intermittent Explosive Disorder (IED): 29.6 %, followed by Compulsive Buying (CB): 23.4 %, Pathological Gambling (PG): 7.4 %, Kleptomania and Compulsive Sexual Behaviour: 2.4 %, and Trichotillomania: 1.2 %. Among the psychiatric comorbidities evaluated, generalized anxiety disorder: 61.7 %, followed by dysthymia: 44.4 %, major depressive episode: 28.3 %, Agoraphobia: 22.2 %, panic disorder: 17.2 %, hypomanic episode: 16 %, social phobia: 11.1 %, bulimia nervosa: 8.6 %, and antisocial personality disorder and obsessive-compulsive disorder: 3.7 %. Regarding the addictive comorbidities, we found a prevalence of 14.8 % of substance abuse (non-alcohol), followed by 7.4 % of alcohol abuse, 6.1 % of substance dependence (non-alcohol), and 3.7 % of alcohol dependence. CONCLUSION: ADH/D in adults continues to be unrecognized in France. The aim of this study was to evaluate the prevalence of impulse control disorders, psychiatric and addictive comorbidities in adults with ADH/D. The results enable us to appreciate quantitative and qualitative data for 81 French adults with ADH/D. This disorder rarely remains isolated and is often associated with many others, especially anxiety and mood disorders. We also observed that impulsivity stays at the heart of the ADH/D, either through impulsive behaviours or addictive disorders. Considering the lack of studies with ADH/D adults, it is difficult to compare our data. The diagnosis of ADH/D is complex and stays controversial, moreover the strong prevalence of comorbidities points out the importance of differential diagnosis.

[Cannabis cessation interventions offered to young French users: predictors of follow-up]. / Facteurs prédictifs de suivi des jeunes fumeurs de cannabis consultant pour sevrage.

INTRODUCTION: Cannabis use is very problematic among young French people, because of the young age of first consumption and its health consequences. Indeed, the average age of cannabis experimentation is about 15 in France and 49.5% of 17 year-olds report having used cannabis in their lives. To prevent this problem, tobacco and cannabis cessation services are dedicated to handle patients who want to stop tobacco and/or cannabis. Moreover, in 2004, specific medical outpatient services have been implemented to address the problem of young cannabis users. Since their establishment, some studies have reported demographic and clinical characteristics of the patients attending these services, but we still lack data on their follow-up and their medical and psychological care. OBJECTIVE: The aim of this study is to describe the clinical and psychiatric characteristics of young patients referred to tobacco/cannabis cessation consultations or specific young cannabis users' consultations and to evaluate their medical care and monitoring. PATIENTS AND METHODS: We designed a retrospective study in seven cessation clinics in the Paris area between 2005 and 2007. Eligible patients were regular cannabis users aged under 40. An electronic medical database was completed using patients' medical records. Medical files reported demographic and clinical data. Psychiatric disorders were assessed using the HAD and the Beck scores. Nicotine dependence was evaluated by Fagerström's score. The history of addictions, and data about consumption of cannabis, tobacco, alcohol and other drugs were recorded in the medical file. The follow-up of patients was defined by having at least two visits at the medical outpatient services. Tobacco and cannabis cessations were assessed at one-month follow-up. Univariate and multivariate logistic models were used to assess factors associated with patients' follow up and monitoring. RESULTS: Four cessation clinics accepted to participate in our study. One hundred and eight eligible patients were listed during the study period. One hundred and eleven patients (75%) were males and seventy-nine (53%) were employed. The average age of patients was 26 years old (±6.8). Fifty patients (34%) came to the clinic on their own decision, thirty-three (22%) were referred by a hospital and twenty-eight (19%) came because of their family's advice. The mean age of first cannabis consumption was 16 years old (±7.3) and cannabis consumption was most often associated with tobacco use. Fifty-nine percent of patients had anxiety disorders and 28% had depression according to D-HAD score. The dropout rate after first visit was about 40%. The most frequent therapy proposed to young cannabis users was nicotine replacement therapy. Follow-up data were collected for 135 patients and only 85 (37%) patients made at least two visits at the outpatient services. The average number of consultations was five (±3.8). Multivariate analysis found an association between follow-up and previous cannabis cessation (P=0.04), pharmacological treatment of tobacco withdrawal (P=0.04), and antidepressant treatment (P=0.04). Only one quarter of patients had quit cannabis and/or tobacco at one-month follow-up. DISCUSSION: This study describes clinical characteristics of patients attending cannabis consultations in France. As reported in other studies, anxiety disorders and depression are important problems in this population and should be considered during their medical care. The efficacy of specific French medical outpatient services is difficult to evaluate because of the high rate of dropout. Some patients' characteristics seem linked to their monitoring but other studies should be assessed to confirm these results. As pharmacological treatments seem associated with patients' follow-up, new research should be implemented to develop therapeutic solutions for cannabis addiction.

Indication of electron neutrino appearance from an accelerator-produced off-axis muon neutrino beam.

The T2K experiment observes indications of ν(µ) → ν(e) appearance in data accumulated with 1.43×10(20) protons on target. Six events pass all selection criteria at the far detector. In a three-flavor neutrino oscillation scenario with |Δm(23)(2)| = 2.4×10(-3) eV(2), sin(2)2θ(23) = 1 and sin(2)2θ(13) = 0, the expected number of such events is 1.5±0.3(syst). Under this hypothesis, the probability to observe six or more candidate events is 7×10(-3), equivalent to 2.5σ significance. At 90% C.L., the data are consistent with 0.03(0.04) < sin(2)2θ(13) < 0.28(0.34) for δ(CP) = 0 and a normal (inverted) hierarchy.

Improved search for nu(mu) --> nu(e) oscillation in a long-baseline accelerator experiment.

We performed an improved search for nu(mu) --> nu(e) oscillation with the KEK to Kamioka (K2K) long-baseline neutrino oscillation experiment, using the full data sample of 9.2 x 10(19) protons on target. No evidence for a nu(e) appearance signal was found, and we set bounds on the nu(mu) --> nu(e) oscillation parameters. At Deltam(2)=2.8 x 10(-3) eV(2), the best-fit value of the K2Knu(mu) disappearance analysis, we set an upper limit of sin(2)2theta(mue) < 0.13 at a 90% confidence level.

Search for coherent charged pion production in neutrino-carbon interactions.

We report the result from a search for charged-current coherent pion production induced by muon neutrinos with a mean energy of 1.3 GeV. The data are collected with a fully active scintillator detector in the K2K long-baseline neutrino oscillation experiment. No evidence for coherent pion production is observed, and an upper limit of is set on the cross section ratio of coherent pion production to the total charged-current interaction at 90% confidence level. This is the first experimental limit for coherent charged pion production in the energy region of a few GeV.

Evidence for muon neutrino oscillation in an accelerator-based experiment.

We present results for nu(mu) oscillation in the KEK to Kamioka (K2K) long-baseline neutrino oscillation experiment. K2K uses an accelerator-produced nu(mu) beam with a mean energy of 1.3 GeV directed at the Super-Kamiokande detector. We observed the energy-dependent disappearance of nu(mu), which we presume have oscillated to nu(tau). The probability that we would observe these results if there is no neutrino oscillation is 0.0050% (4.0 sigma).

Physiological significance of the cytometric distribution of fluorescent yeasts after viability staining.

This article describes a new method for the early detection of alcoholic fermentation arrest. This methodology is based on the flow cytometric assessment of Saccharomyces cerevisiae yeasts stained with a carboxyfluorescein diacetate fluorescent viability probe. Multicomponent analysis of viable cell distribution constitutes a promising new tool to describe physiological and dynamic changes to heterogeneous viable populations during alcoholic fermentation, through its ability to discriminate between successful processes and those ending prematurely. This framework, which is based on the comparison of cytometric histogram descriptors' combinations that can be related to simple physiological significance comparison, quickly and simply, allows testing yeasts for their fermentation ability and can be used to detect any kind of viability loss so that fermentation arrest can be avoided.

Substitution with buprenorphine in methadone- and morphine sulfate-dependent patients. Preliminary results.

In France, during the 1990s, there have been some rapid developments in the treatment of opioid addiction with the introduction of legal substitution agents. Originally, some patients were treated with morphine sulfate, but this was superseded by high dose buprenorphine (Subutex(R)) and methadone. This resulted in those patients originally treated with morphine being transferred to either of these two licensed products. A study investigating the effects of the transition from morphine to either buprenorphine or methadone was undertaken. Supplementary to this, a trial investigating transition between these new compounds was also conducted. The primary outcome measures for these trials were retention rate, which was assessed at 5, 9 and 12 months, and the precipitation of withdrawal symptoms. The studies showed that transferring patients between substitution agents can be accomplished without severe withdrawal symptoms, although specific management may be required for transfer from high doses of methadone to buprenorphine. High long-term retention rates were observed in the studies, with most drop-outs occurring directly after transfer. Results suggest that patients on long-term buprenorphine maintenance therapy may have good compliance in comparison with other agents.

The French experience--the pharmacist, general practitioner and patient perspective.

High-dose buprenorphine (Subutex(R)) has been available in France as a maintenance treatment since February 1996. Results from a twice yearly survey of pharmacists, general practitioners (GPs) and patients themselves in the use of Subutex(R) appeared to be representative of the general substitution therapy situation in France. Results from May 1997 were encouraging, with improved relationships between pharmacists and patients, and GPs and patients being reported in all three surveys. The most commonly prescribed dosage of buprenorphine (6-8 mg) was within the recommended range, although there was evidence that this was usually taken as several daily intakes by the majority of addicts. Although intravenous injection may occur in some cases, illicit resale was suspected only in a few cases. Treatment efficacy was high and retention at six months was good since patients had a positive opinion of their treatment and reported few adverse effects. Further improvement in the relationships between GPs and pharmacists is desirable to increase the success of the treatment programme.

Genotypes of cytochrome P450 and clinical response to clomipramine in patients with major depression.

The genetic cytochrome P450 polymorphism is reported in factors affecting the individual response to drugs. The interindividual variation at steady-state levels or also in elimination of drugs, finds an explanation in genetic differences in the metabolism. In particular, activities of the P450-IID6 isoenzyme are related to the sparteine/debrisoquine oxidation polymorphism. Phenotyping such a system has been proposed to analyse variability in the tricyclic antidepressant level. To analyse clinical relevance of a pharmacogenetic approach, we studied the cytochrome P450 CYP2D6 genotypes and the clinical responses to clomipramine in 21 hospitalised patients who met DSM-III-R criteria for major depression. Three patients were predicted as poor metabolizers. We suggested a limitation of clomipramine (CMI) hydroxylation in poor metaboliser (PM) patients which is balanced by a desmethylation. The clinical efficacy pattern does not differ in poor metaboliser and early metaboliser patients. Firstly, there is no significant differences in the evolution of scores on MADRS and specific retardation scale into the two groups. Secondly, outcome of side effects does not occur more frequently in PM patients. Clinical relevance of such an approach needs further study.