Cannabis arteritis: review of the literature.

Consumption of cannabis in young adults has continued to increase in recent years. Cannabis arteritis was first described in the 1960s, but the number of cases has continued to increase. We reviewed current knowledge of the different types of cannabis arteritis in young adults and found 70 cases of cannabis arteritis in the literature. We discuss physiopathological arguments in favor of cannabis vascular toxicity per se, although we did not find sufficient evidence to identify cannabis arteritis as a specific diagnostic entity. Many factors suggest a link between cannabis consumption and arteritis in young adults, but it is difficult to say whether this type of arteritis is similar to thromboangiitis obliterans. We were unable to demonstrate a formal association between cannabis smoking and the development of thromboangiitis obliterans, because most case reports showed associated tobacco smoking (97%) and the number of years cannabis had been smoked by the participants was mostly unknown. Cannabis consumption would however seems to be an aggravating factor, together with tobacco, in arteritis, which occurs in young adults.

Impact of midwives' training on postnatal depression screening in the first week post delivery: a quality improvement report.

BACKGROUND: postnatal depression (PND) is a major public health problem. The objective of this study was to improve early PND screening by midwives in a maternity unit. Professional screening techniques were evaluated and compared with reference screening techniques [Edinburgh Postnatal Depression Scale (EPDS), Mini International Neuropsychiatric Interview (MINI-DSM-IV)]. METHODS: the evaluation took place before and after the midwife training in order to determine the effectiveness of specific clinical recommendations for two successive 10-week inclusion periods (from November 2004 to September 2005). A short training course and posters were used to convey the recommendations, agreed by obstetricians, paediatricians and psychiatrists. RESULTS: a total of 463 postpartum women were included in the two phases of the study. Quantitative and qualitative PND screening by midwives improved significantly following training (Z=2.07, p=0.04; Z=2.62, p=0.008, respectively). Early detection of major depressive episodes increased by 37.7% (95% confidence interval 25.7-49.7) following training. A combination of midwives' perception of poor emotional well-being and the EPDS led to a significant improvement in early detection of PND (Q=8.00, p=0.04). DISCUSSION: targeted recommendations given to the midwives led to an improvement in the early detection of PND. Suitable programmes need to be offered to reduce the number of cases of PND. Perinatal psychiatrists should be seen to be meticulous and available for such prevention action.

Catatonia recognition and treatment.

BACKGROUND: Catatonic syndrome is no longer considered a subtype of schizophrenia but is more frequently associated with mood disorders (mania, melancholia, and psychotic depression) as well as general medical conditions (neurological disorders, drug-induced and toxic-induced conditions, metabolic conditions). A case of catatonia is reported which occurred after alcohol withdrawal. CASE REPORT: Catatonia occurred 48 hours after alcohol withdrawal in a 54-year-old woman who had stopped all her treatment (in the context of a type II bipolar disorder). A dramatic improvement of symptoms was observed after oral administration of zolpidem. CONCLUSIONS: This case seems to confirm that catatonia can represents a nonspecific response to stress factors. The withdrawal of multiple medications was already described as a basis for catatonia. Alcohol withdrawal could constitute an additional risk factor for catatonia. The zolpidem test is a useful diagnostic and therapeutic test.

Catatonia and systemic lupus erythematosus: a clinical study of three cases.

Catatonia may be encountered in psychiatric disorders, but also in general medical conditions. Cases of catatonia associated with systemic lupus erythematosus (SLE) are rare. Several articles have described this symptomatic association, as well as its management, using electroconvulsive therapy, plasma exchange or benzodiazepines. We report three cases here of patients who presented with catatonia during a lupus relapse, in whom treatment with lorazepam improved the catatonic symptomatology, thus allowing the associated condition to be treated. We touch on several points about the diagnosis, etiology and treatment of catatonia, when it is associated with SLE.

[Study on personality and psychiatric disorder in fibromyalgia]. / Importance des troubles de la personnalité et des comorbidités psychiatriques chez 30 patients atteints de fibromyalgie.

UNLABELLED: WORK INTEREST: To assess vulnerability factors of outpatients with fibromyalgia, by the evaluating prevalence of DSM-IV axis I disorders (mental disorders) and axis II disorders (personality disorders). METHODS: 30 outpatients with fibromyalgia were examined consecutively, and were administered the Mini International Neuropsychiatric Interview and the Structured Clinical Interview for DSM-IV. RESULTS: The patients were found to have a high prevalence of DSM-IV axis I disorders (63,3% received a diagnosis of depressive and/or anxious disorder), and axis II disorders (46,7% received at least one diagnosis of personality disorder, including obsessive-compulsive personality disorder: 30%, borderline personality disorder: 16,7%, and depressive personality disorder: 16,7%). PERSPECTIVES: Our results show the importance of psychiatric comorbidities, including personality disorders from outpatients with fibromyalgia. Personality disorders have to be taken into account in the treatment by their impact on doctor-patient relation. Our results suggest the importance of liaison psychiatry in the treatment of those patients.

Catatonia and consultation-liaison psychiatry study of 12 cases.

Nowadays, catatonia is no more considered as a subtype of schizophrenia. Catatonia seems more frequently associated to mood disorders as well as general medical conditions. It is sometimes difficult to associate formally a medical etiology to this syndrome. But we found, in the literature, three groups of associated general medical conditions: neurological disorders, drug induced and toxic induced conditions, metabolic conditions. We present a prospective study of 12 clinical cases of catatonia due to general medical conditions we realized in the Consultation-Liaison Psychiatry Department of the University Hospital of LILLE (France) during a period of 5 months. We find coherent data with the literature. However, our results suggest that if medical conditions precipitate the catatonia syndrome, they are rarely its only etiology. We think that if somatic factors are co-morbid with psychiatric conditions they do not necessarily predominate as the target of treatment. The treatment of the catatonia must be a priority and remain symptomatic, to allow in parallel the specific treatment for the somatic disorder or the psychiatric disorder.

Relationship between posttrauma GABA plasma levels and PTSD at 1-year follow-up.

OBJECTIVE: Gamma-aminobutyric acid (GABA) exerts a prominent effect on central adrenergic stress responses in times of high stress and has been associated with acute posttraumatic stress disorder (PTSD). The authors examined the association between low posttrauma plasma GABA levels and long-term PTSD. METHOD: Plasma GABA levels were measured in 78 victims of road traffic accidents who met criteria for trauma exposure on arrival at a trauma department and were admitted for at least 3 days. Patients were assessed for PTSD and major depressive disorder at 6-week and 1-year follow-ups. RESULTS: At 6 weeks and at 1 year, mean posttrauma GABA levels were significantly lower among subjects who met all or nearly all criteria for PTSD than among those who did not. Among patients who met all or nearly all criteria for PTSD at 6 weeks, 75% of those with posttrauma GABA levels above 0.20 mmol/ml no longer met criteria at 1 year. By contrast, among patients whose GABA levels were below 0.20 mmol/ml, 80% met all or nearly all criteria for PTSD at 1 year. Two-thirds of patients who met all or nearly all criteria for PTSD at 1 year also met criteria for major depressive disorder. CONCLUSIONS: A plasma GABA level above 0.20 mmol/ml may protect against chronic PTSD and may represent a marker of recovery from trauma.

Effect of telephone contact on further suicide attempts in patients discharged from an emergency department: randomised controlled study.

OBJECTIVE: To determine the effects over one year of contacting patients by telephone one month or three months after being discharged from an emergency department for deliberate self poisoning compared with usual treatment. DESIGN: Multicentre, randomised controlled trial. SETTING: 13 emergency departments in the north of France. PARTICIPANTS: 605 people discharged from an emergency department after attempted suicide by deliberate self poisoning. INTERVENTION: The intervention consisted of contacting patients by telephone at one month or three months after discharge from an emergency department for attempted suicide to evaluate the success of recommended treatment or to adjust treatment. Control patients received treatment as usual, in most cases referral back to their general practitioner. MAIN OUTCOME MEASURES: The primary outcome measures were proportion of participants who reattempted suicide, number of deaths by suicide, and losses to follow-up at 13 months' follow-up. Secondary outcome measures were types and number of contacts with health care. RESULTS: On an intention to treat basis, the three groups did not differ significantly for further suicide attempts, deaths by suicide, or losses to follow-up: contact at one month (intervention 23% (34/147) v controls 30% (93/312), difference 7%, 95% confidence interval - 2% to 15%), three months (25% (36/146) v 30%, difference 5%, - 4% to 14%). Participants contacted at one month were less likely at follow-up to report having reattempted suicide (12% v 22% in control group, difference 10%, 2% to 18%). CONCLUSION: Contacting people by telephone one month after being discharged from an emergency department for deliberate self poisoning may help reduce the number of reattempted suicides over one year.

Predictive validation study of the Edinburgh Postnatal Depression Scale in the first week after delivery and risk analysis for postnatal depression.

BACKGROUND: Postnatal depression is a major public health problem. The aim of this study is to validate the use of the Edinburgh Postnatal Depression Scale (EPDS) in the early postpartum, and to identify the markers for risk of postnatal depression. METHODS: 815 women filled out an EPDS and general information questionnaire between the third and the fifth day postpartum. The women with an EPDS score of >8 and a randomized control group from those with scores of <8 were contacted 8 weeks postpartum. 363 women therefore had a structured diagnostic interview by telephone at 8 weeks postpartum (MINI-DSM-IV), without knowledge of their EPDS scores, to screen for a major or minor depressive episode. RESULTS: The sensitivity of EPDS was measured as 0.82 [0.78-0.86], with a positivity threshold of 9.5/30. For an estimated prevalence for all depressive episodes of 16.1%, the positive predictive value of EPDS was measured as 42.8% [39.1-46.5%]. Multivariate risk analysis using logistical regression identified the following as risk markers for postnatal depression: previous history of depression (postnatal or other), unemployment, premature delivery or stopping breast-feeding in the first month for non-medical reasons. CONCLUSION: The use of EPDS between the third and fifth day postpartum is valid. An EPDS score of >10 should be completed by a clinical assessment and suitable management. The risk markers identified here are clinical indices that can be used for first-line early screening by non-psychiatric health workers.

Low posttrauma GABA plasma levels as a predictive factor in the development of acute posttraumatic stress disorder.

BACKGROUND: Gamma amino-butyric acid (GABA) regulates the intensity and the duration of the central hyperadrenergic response in times of high stress and has been negatively associated with anxiety, depression, and sleep problems. We hypothesized that individuals with low plasma GABA levels may be more prone to develop posttraumatic stress disorder (PTSD) in the aftermath of trauma exposure. METHODS: To test this hypothesis, we measured plasma GABA levels in a population of 108 road traffic accident victims on arrival at a traumatology department and assessed them for PTSD 6 weeks later. RESULTS: The mean GABA level (nmol/mL) in the PTSD group (n = 55; M =.20; SD =.08) was significantly lower compared with members of the trauma-exposed group who did not develop PTSD [n = 17; M =.30; SD =.09), t(70) = 3.94, p =.0002]. CONCLUSIONS: Provided that GABA levels in the brain are genetically predetermined, our results would suggest that individuals with low plasma GABA levels are premorbidly more vulnerable to stress-related disorders such as acute PTSD. If replicated, plasma GABA levels measured in the aftermath of trauma exposure might help to identify individuals at high risk for developing PTSD.

Fright (effroi) and other peritraumatic responses after a serious motor vehicle accident: prospective influence on acute PTSD development.

OBJECTIVE: We prospectively examined the relation between various peritraumatic responses (that is, fear, helplessness, horror, amnesia, and fright) and the development of posttraumatic stress disorder (PTSD) 2 months after a trauma. METHOD: Participants included 123 motor vehicle accident (MVA) victims consecutively hospitalized in a traumatology department for over 72 hours during a 16-month period. Between day 2 and day 5 of their hospitalization, a psychiatrist assessed the patients' peritraumatic responses and acute stress disorder (ASD). Two months after the accident, an experienced psychiatrist contacted the patients by telephone, and the PTSD symptoms and the diagnosis were assessed with a modified version of the Clinician-Administered PTSD Scale (CAPS). RESULTS: Of the participants, 48 reported an immediate fright reaction when faced with the prospect of their own death. Participants who reported a fright experience had a 17 times greater risk of subsequently meeting the diagnostic criteria for PTSD (odds ratio 16.75). A fright reaction predicted PTSD development with a specificity of 0.93 and a sensitivity of 0.60 CONCLUSION: The immediate reactions described in criterion A2 of the DSM-IV (that is, fear, helplessness, and horror) did not seem to be equally relevant. An initial feeling of fright seems to be an essential qualitative factor in the clinical description of psychological trauma.

SPECT imaging, clinical features, and cognition before and after low doses of amisulpride in schizophrenic patients with the deficit syndrome.

The aim of the study was to examine the action of low-dose amisulpride (100 mg/d), an atypical antipsychotic from the benzamide class with a high affinity for the D2 and D3 dopamine receptors, given for 4 weeks in 19 schizophrenic patients with the deficit syndrome, in terms of clinical response, modifications in their cognitive performance and changes in brain perfusion values. A secondary objective was to distinguish between primary and secondary deficit, according to Carpenter's definition. Both efficacy and a relatively low rate of side effects of low-dose amisulpride in the deficit forms of schizophrenia were found as expected from earlier placebo-controlled studies. Our study found significant changes in the cerebral blood flow, before and after treatment, more marked in the frontal area and particularly in the dorso-lateral frontal area. A significant improvement of cognitive function was found after treatment, without a link to any particular changes in a loco-regional perfusion value. Finally, a distinction between primary and secondary deficit showed a higher percentage of clinical improvement in the patients with a secondary deficit. The psychometric and cerebral perfusion changes were no different in the two groups.

Regional cerebral blood flow in deficit/nondeficit types of schizophrenia according to SDS criteria.

A relationship between "hypofrontality" and a negative form of schizophrenia is commonly found. The Schedule for the Deficit Syndrome (SDS) provides specific criteria for assessing the presence of negative symptoms, their duration and whether the symptoms are primary or secondary. The purpose of our study was to compare the regional cerebral blood flow (rCBF) at rest, in 62 deficit and nondeficit schizophrenic patients, according to the SDS criteria (French version). The deficit patients in our population were comparable to those described in the literature (stability of their negative symptoms with time, poor premorbid adjustment, duration of the illness, age at the first episode, etc.). No difference was found in the locoregional perfusion with respect to the DSM-III-R type of schizophrenia, the sex or the type of treatment received. The patients with a deficit form of schizophrenia showed a significant bilateral reduction in single photon emission computed tomography (SPECT) perfusion in the right frontodorsolateral cortex (P=.0105) and the left frontodorsolateral cortex (P=.0004) compared with the nondeficit schizophrenic patients. The contribution of SDS seems to be helpful in distinguishing between significant cerebral characteristics in deficit schizophrenics, as defined by Carpenter. These results suggest a decrease in prefrontal perfusion at rest, which corresponds with neuropsychological data.