Exploring sexualized substance use, sexual behaviors and HIV-screening practices in people attending erotic industry shows.

Previous studies showed that Erotic industry sShows (ES) were appropriate events for sexual health promotion and testing interventions. A cross-sectional survey exploring screening practices, sexual behaviors, substance use, and sexual motives for substance use was conducted in ES in December 2017 and completed by 781 respondents. Overall, . Eighteen18% percent reported substance use in the last 3 months (51% alcohol), 26%. Twenty-six percent reported a sexual purpose for substance use. Main sexual partners were spouse (68%), regular (21%), unknown (18%) and several (17%) partners. Main sexual practices were libertinism (22%), partner swapping (15%) and threesome (15%). Twenty-seven percent of respondents reported cContactless sex was reported by 27% of the respondents. 18% reported no previous HIV test. Univariate analysis showed that having or not previous HIV test was linked to male sex (76.8% vs. 54.5%, p < 10-3), alcohol consumption in the last three months (58.7% vs. 49.4%, p = .043), number of drugs in a lifetime (1.3% vs. 1.6%, p = .022), sexual partnership with spouse/long-term partner (57.3% vs. 70.5%; p = .002), at least one multiple-partner sexual practice (23.1% vs. 31.8%, p = .040) and type of sexual attraction (p = <10-3). Results contribute to establishing the usefulness of HIV-testing and awareness campaigns in ES eventsand informing potential combined risk behaviors and related interventions.

ADHD and addictive behavior in crack-cocaine users.

BACKGROUND: Crack consumption is a major public health issue in Martinique with a poor prognosis. A preliminary study has found a high prevalence of history of childhood ADHD (C-ADHD) in crack users. OBJECTIVE: To determine the prevalence of C-ADHD and adult ADHD (A-ADHD) in crack users and their potential associations with substance use behavior. METHODS: All consecutive patients consulting in the public academic hospital covering 376,000 inhabitants were included in the present study and received a comprehensive battery measuring addictive behavior, psychiatric and somatic comorbidities. C-ADHD groups and A-ADHD groups were defined with the Wender-Utah Rating Scale-25 and the Brown ADD Rating Scale, respectively. Impulsivity was evaluated with the Barratt Impulsiveness Scale (BIS-11). FINDINGS: In total, 111 participants were evaluated. Among them, 50 (45%) were classified in the C-ADHD group and 20 (18%) in the A-ADHD group. Compared to the patients without ADHD, those with ADHD were found to have higher impulsivity (C-ADHD: BIS total score 67.90 (10.1) vs. 63.28 (10.5), P=0.021, BIS attentional score 17.5 (3.6) vs. 15.3 (3.4), P=0.002, A-ADHD: BIS total score 75.1 (11.3) vs. 63.4 (9.2), P<0.001, BIS motor impulsivity 26.9 (5.3) vs. 22.6 (4.3), P<0.001, BIS attentional score 19.3 (3.3) vs. 15.6 (3.5), P<0.001, BIS planification 28.9 (5.7) vs. 25.10 (4.7), P=0.003). Fifty percent of A-ADHD patients were found with high impulsivity vs. 15% of patients without A-ADHD (P<0.001). However, ADHD was not associated with more severe addictive behavior or history of legal consequences. INTERPRETATION: ADHD prevalence is high in cocaine-crack users and associated with increased impulsivity. However, neither ADHD nor impulsivity explains addictive behaviors or legal consequences.

The Covid-19 infection: An opportunity to develop systematic vitamin D supplementation in psychiatry.

Psychiatric patients are at risk of hypovitaminosis D and Covid-19-related mortality. In addition to the mental health benefits, vitamin D supplementation may be potentially effective in preventing severe forms of Covid-19 infections. Vitamin D supplementation is not necessary and is not reimbursed in France for this indication. A monthly supplementation of 50,000 IU may be sufficient in most cases. Double the dose is recommended for obese patients. The risk of renal lithiasis is not increased at these doses, even when supplemented in a patient without vitamin D deficiency. The Covid-19 crisis is an opportunity to disseminate vitamin D supplementation in psychiatric patients, as it has been shown to be effective in other respiratory diseases such as mild upper respiratory tract infections and influenza.

Redefining peripheral inflammation signature in schizophrenia based on the real-world FACE-SZ cohort.

BACKGROUND: Peripheral inflammation is associated with impaired prognosis in schizophrenia (SZ). Highly sensitive C-reactive protein (hs-CRP) is the most used inflammatory biomarker in daily practice. However, no consensual cut-off has been determined to date to discriminate patients with peripheral inflammation from those without. AIMS: To determine if patients with peripheral inflammation between 1 and 3 mg/L had poorer outcomes compared to those with undetectable CRP (<1 mg/L). METHOD: Consecutive participants of the FACE-SZ cohort with a hs-CRP < 3 mg/L were included in 10 expert academic centers with a national geographical distribution between 2010 and 2018. Potential sources of inflammation, socio-demographics, illness characteristics, current illness severity, functioning and quality of life and were reported following the FACE-SZ standardized protocol. RESULTS: 580 patients were included, of whom 226 (39%) were identified with low-grade inflammation defined by a hs-CRP between 1 and 3 mg/L. Overweight and lack of dental care were identified as potential sources of inflammation. After adjustment for these factors, patients with inflammation had more severe psychotic, depressive and aggressive symptomatology and impaired functioning compared to the patients with undetectable hs-CRP. No association with tobacco smoking or physical activity level has been found. CONCLUSIONS: Patients with schizophrenia with hs-CRP level between 1 and 3 mg/L should be considered at risk for inflammation-associated disorders. Lowering weight and increasing dental care may be useful strategies to limit the sources of peripheral inflammation. Hs-CRP > 1 mg/L is a reliable marker to detect peripheral inflammation in patients with schizophrenia.

Depressive symptoms and chronic peripheral inflammation are associated with impaired functional remission in schizophrenia independently of psychotic remission.

BACKGROUND: While psychotic remission in schizophrenia (SZ) has been defined by consensus and associated with a rank of clinical predictive factors, there is a lack of data of factors associated with functional remission. OBJECTIVES: To identify clinical and biological factors associated with impaired functional remission in a non-selected chronic stabilized SZ outpatients. METHODS: This study was a cross-sectional study carried out on all admitted SZ stabilized outpatients in an academic daily care psychiatric hospital. Functional remission was defined by a global assessment of functioning score ≥61. Psychotic remission was defined according to international criteria. Depression was assessed with the Calgary Depression Rating scale for Schizophrenia. Sociodemographic variables, tobacco status, clozapine treatment and obesity were reported. Chronic peripheral inflammation was defined by a highly sensitive C-reactive protein serum level ≥3 mg/L and metabolic syndrome according to international recommendations. RESULTS: 273 patients were included, among them 51 (18.7%) were classified in the functional remission group. In the multivariate analysis, higher rate of functional remission was associated with psychotic remission (adjusted Odd ratio = 18.2, p <0.001), lower depressive symptoms (aOR=0.8, p = 0.018) and lower peripheral inflammation (aOR=0.4, p = 0.046). No association of functional remission with age, gender, illness duration, second-generation antipsychotics, clozapine treatment, tobacco smoking, obesity or metabolic syndrome has been found. CONCLUSION: Depressive symptoms and chronic peripheral inflammation are associated with impaired functional remission in SZ independently of psychotic remission. Future intervention studies should determine if improving depressive symptoms and chronic peripheral inflammation may improve SZ patients reaching functional remission.

Major depression, sleep, hostility and body mass index are associated with impaired quality of life in schizophrenia. Results from the FACE-SZ cohort.

BACKGROUND: Impaired Quality of life (QoL) in schizophrenia has been mostly associated with psychotic and mood symptomatology, insight and functioning so far. AIMS: QoL levels remain unsatisfactory due to other factors we aim to explore. METHOD: We have explored sleep quality with the Pittsburgh Sleep Quality Index, hostility with the Buss&Perry questionnaire, major depression with the Positive and Negative Syndrome Scale depressive factor, functioning with the Global Assessment of Functioning scale and weight gain with body mass index in addition to other classical QoL-associated factors. RESULTS: 559 patients (mean age=31 (SD 9) years, 74% male sex) were included in the national FACE-SZ cohort. Impaired QoL has been significantly associated with respectively major depression, impaired sleep quality, increased hostility, impaired functioning and impaired insight independently of age, sex, treatments, tobacco smoking and body mass index. Major depression was associated with impaired psychological and physical well-being, and impaired self-esteem. Impaired sleep quality has been associated with impaired psychological and physical well-being and sentimental life. Hostility has been associated with impaired psychological well-being and self-esteem, impaired friends' relationships and impaired autonomy. Weight was associated with impaired physical well-being. Tobacco smoking was associated with higher level of friends' relationships. CONCLUSIONS: Major depression, sleep, hostility, and weight gain have been identified as potential targets to improve QoL in schizophrenia and should be implemented in the recommendations for good practice to optimize schizophrenia care.

Sexual-orientation based discrimination is associated with anxiety and depression in young physicians. A national study.

INTRODUCTION: The professional risk factors for depression and anxiety are underexplored in young physicians. While there has been increasing research on the mental health and well-being of lesbian, gay and bisexual patients, few studies have examined the mental health and well-being of lesbian, gay and bisexual young physicians. OBJECTIVE: The objective of the present study was to determine the prevalence of Sexual Orientation-Based Discrimination (SOBD) in French young physicians and if SOBD was associated with increased anxiety and depression in this population. METHOD: This national study is a cross-sectional observational epidemiological national study. The participants were recruited between April 1st 2019 and June 31st 2019. One question with binary answer was asked on SOBD. Mental health was assessed by Hamilton Anxiety & Depression scales. RESULTS: On the 2003 participants, 148 (7%) reported SOBD exposure, 647 (32%) current anxiety disorders and 174 (9%) a current major depressive disorder according to their HAD score. SOBD was almost twice more frequently reported in participants with anxiety disorder and major depression (respectively 10%,vs 6% and 12% vs. 7%, p<0.05). In the first model of multivariate analyses, current anxiety disorder was significantly associated with being woman (adjusted odds ratio aOR=1.688, 95%CI 1.350-2.110, p<0.001) and SOBD (aOR=1.729, 95%CI 1.226-2.440, p=0.002). In the second model of multivariate analyses, current major depression was significantly associated with only SOBD (aOR=1.748, 95%CI 1.057-2.888, p=0.029). CONCLUSION: SOBD has been associated with increased rates of anxiety disorder and major depression in young physicians and should be targeted in mental health prevention programs.