[Psychoactive drug use in a declared non-addicted control sample and comorbidity. Results of a study in 860 French-speaking subjects]. / Consommation de substances psycho-actives dans une population témoin déclarée non addictive et co-morbidité. Résultats d'une étude chez 860 sujets francophones.

AIMS: This study, conducted within the framework of a broader research program of the INSERM 494013 Dependence Network, was designed to estimate illicit drug use and tobacco smoking in a declared non-addicted sample and to determine whether illicit drug users differ from non-users in terms of comorbidity. METHODS: The study was conducted in an "all and sundry" sample of subjects. Patterns of drug use and comorbid factors (psychiatric disorders, suicide attempts, repeated accidents, social inadaptation) were assessed using a semi-structured interview (heteroevaluation, MINI DSM IV interview, Gröningen). RESULTS: Among 860 subjects, 107 (12.4%) used illicit drugs and 26 of these 107 (24.3%) were dependent users or abusers. Specific analysis of non-dependent non-abuser subjects who had used illicit drugs (70 occasional and 11 regular users) showed a higher rate of use in younger subjects (12.7% in the 15-24 year group, 5.7% in the 24-49 year group) and men. Except for repeated accidents (OR=5.5 [1.6-18.5]), comorbid disorders were not more frequent in non-users than in users. CONCLUSION: Besides use for recreational purposes, the rate of use of illicit drugs with abuse or dependence was high in our non-clinical sample. Although no specific comorbid psychiatric disorders were identified among non-dependent non-abuser subjects who had used illicit drugs, the frequency of repeated accidents evidenced the ill-fated side effects of illicit drugs and/or the specific biopsychological vulnerability of these subjects. This highlights the importance of not neglecting drug abuse.

Psychoactive substance consumption in eating disorders.

Research investigating the comorbidity between eating disorders and substance-use disorders have reported positive but contrasting results. The aim of this study was to further explore this association by studying patterns of consumption of the entire range of psychoactive substances (alcohol, specific drugs, prescribed psychotropics) in a large sample (N=271) of eating-disorder DSM-IV subtypes. Results show that subjects suffering from anorexia of the restrictive type show significantly less drug-consumption behaviors and alcohol abuse and/or dependence disorders than purging anorexic and bulimic subjects. No difference was found in the total consumption of psychotropics among the four groups of eating disorders. However, more than half of eating-disorder subjects are regular consumers of psychotropics. Among these regular consumers, bulimics self-prescribe and increase their doses of psychotropics significantly more than anorexics. Features of impulsivity that are associated with purging and bulimic behaviors could play a specific role in these patterns of comorbidity and account for such differences.

[Pertinence of the addiction concept in eating behavior disorders]. / Pertinence du concept d'addiction dans les troubles des conduites alimentaires.

From a psychodynamic perspective, dependence disorders, irrespective of the object of addiction, can be seen as the expression of the subject's neurobiological, psychopathological, cultural and social vulnerability. Since vulnerability strengthens and reorganizes the personality, it can drive these subjects to perpetuate pathological behaviors. In this light, behavior disorders belong to the field of addiction diseases, especially considering that the underlying psychopathological structures are close to those observed in addiction, that depression plays a central role, and that their development into toxic addictive behavior (drugs, alcohol, psychotrope) is frequent.

[Eating disorders. Anorexia nervosa in adolescents]. / Troubles des conduites alimentaires. L'anorexie mentale de l'adolescence.

EPIDEMIOLOGICAL DATA: Anorexia nevrosa is mainly observed in young women in the 15-24 year age range. The incidence is 1 to 2% in the general population of female adolescents. The sex ratio is 9 girls for 1 boy. SYMPTOM TRIAD: Three symptoms predominate in anorexia nevrosa: weight loss, anorexia, amenorrhea. Weight loss results from restrictive eating behavior and not from a loss of appetite. CLINICAL DIAGNOSIS: Diagnosis is clinical and confirmed by an analysis of the underlying psychological conflicts which involve difficulty in accepting the female identity and in assuming self-sufficiency outside the family. The clinician should evaluate the quality of the familial environment, particularly the mother-daughter and father-daughter relationship as well as the social environment (school, friends) which is also needed to apprehend the global situation. Physical examination and laboratory tests are aimed at rapidly eliminating any differential diagnosis and to quantify the weight loss and its rate, and identify any nutritional disorders. ETIOLOGY: Anorexia nevrosa is not a truly structured psychopathological disorder but rather a loss of a stable organization of Self, with a highly vulnerable narcissistic element and precarious neurotic defences. CLINICAL COURSE: The risk of poor outcome is very real, sometimes life threatening. The treatment of choice is to implement analytical management as soon as possible, but outside acute episodes.

[Eating disorders. Osteoporosis and infertility after anorexia nervosa]. / Troules des conduites alimentaires. Ostéoporose et infertilité aprés anorexie mentale.

EATING DISORDERS: The development of somatic complications observed in patients with eating disorders depends both on the duration of the clinical course and on the gravity of the symptoms and psychological factors. It would thus appear advisable to obtain a complete endocrine (gonadotropic, thyroid, hypothalamo-hypophyseal-adrenal) work-up which could be repeated every year after the patient has controlled the behavior disorder. Two aspects of these complications predominate: osteoporosis and infertility. OSTEOPOROSIS: A common finding after anorexia nevrosa, osteoporosis can lead to multiple, sometimes spontaneous, fractures. Bone mass can be assessed with biphotonic absorptiometry. The indication for estroprogestogen prophylaxis is debatable, depending on the patient's psychological profile, but also because efficacy has not always been demonstrated. Third-generation biphosphonates appear to offer promising results. INFERTILITY: Among a population of women consulting for infertility, a non-negligible percentage have infraclinical manifestations of anorexia nevrosa. The question of prescribing estroprogestogens, which would allow normal cycles and a certain vaginal trophicity, is often raised. We advocate a dose coordination between endocrinologists, infertility specialists and psychiatrists in order to better define the precise modalities of a given treatment aimed at regulating hypothalamo-pituitary function or favoring procreation.