[The early maladaptive schemas: a study in adult patients with anxiety disorders]. / Les schémas précoces dysfonctionnels: étude chez des patients adultes souffrant d'un trouble anxieux.

The theory of early maladaptive schemas was initiated by Young, who postulated that each pathology is supported by one or several schemas. Adults with anxiety disorders more activate schemas that controls. This hyper activate schemas would go back the childhood. In this study, we measure some cognitive schema's activation, with the Schmidt and al. Questionnaire: this schema's questionnaire measures the dysfunctional schemas in actual way. Our purpose was to compare early maladaptive schema's activation of adults with anxiety disorders and adults healthy. The results indicate that each dysfunctional schema is more significatively activate by the adults with anxiety disorders that adults healthy. He doesn't exist schema typical of anxiety, but just a more important activation of all schemas of adults with -anxiety disorders. All subjects (with anxiety disorder and healthy) activate the schemas in the same order. It would appear that schema who imply an action of subject was more activate. So, in our study, we doesn't observe schema typical of anxiety, as opposed to postulate of Young and Klosko. In fact, in comparison with healthy subjects, all early maladaptive schemas of subjects with anxiety disorders were hypervalent. The order of schema's activation was the same in the two groups, but the activation in the anxious is always more important that in the healthy. All early maladaptive schemas would so hyperactivate in the anxious and a important activation of this schemas in the infancy would predispose to adult's anxious pathology. We consider this research as a preliminary work about early maladaptive schemas. In order to specify the research about schemas in the anxious, il will be interesting to observe this schemas according to different anxious disorders and to study prospectively the evolution of child's schemas.

Practice-based buprenorphine maintenance treatment (BMT): how do French healthcare providers manage the opiate-addicted patients?

UNLABELLED: France was the first country to promote the extensive use of buprenorphine for the treatment of drug-addicted subjects through the primary care system. To assess both professional commitment and patients' characteristics, all the physicians and pharmacists of a French area having prescribed/dispensed buprenorphine from 2/12/96 (the official release date) to 1/31/98 were identified from data files of the Health Insurance and then interviewed. During the first 61 weeks of buprenorphine maintenance treatment (BMT), 27.5% of physicians and 51.2% of pharmacists of that area were involved; 142 patient records were documented. Features of the clinical routines spontaneously implemented for practice-based BMT were: a high level of on-site supervised dispensation by the pharmacist (71% at treatment induction and 23% thereafter); the absence of objective measurement of illicit drug use; and a low buprenorphine dosage. These features are consistent with the lack of physicians' experience and training, and also the relatively good status of the population treated (no HIV-positives, heroin use duration averaging 4.2 +/- 3.1 years, and 81.7% with stable accommodations). Despite liberal regulations guiding BMT, a negligible proportion of cases had a "nomadic" attitude (multiple buprenorphine prescribers/deliverers). The treatment outcomes (no deaths, three drug overdoses, improvement in occupational status) are encouraging. CONCLUSION: Practice-based BMT appears to be a safe and acceptable response to moderate heroin addiction, but further training of the professionals involved and longitudinal investigations of individual outcomes are needed.

[Diagnosis and management of panic disorder in psychiatry (PANDA Study)]. / Etude sur le diagnostic et la prise en charge du trouble panique en psychiatrie (étude PANDA).

Panic disorder is a genuine public health problem given by their frequency and the various and repeated consultations that they involve. PD is underdiagnosed in primary care and in medical specialist. A public campaign might lead to improved diagnosis and better treatment of panic disorder, with a beneficial effect on medico-economic indicators. Intervention by the psychiatrist is of key importance, although it has not been evaluated to any great extend. The objective of the PANDA study was to look at the prevalence and diagnostic of panic disorder, the conditions of access to and use of care, as well as the method of treatment. Four hundred and twenty three psychiatrists participated in the study and 8,137 patients seen consecutively were included. The prevalence of actual panic disorder evaluated using the Mini International Neuropsychiatric Interview (MINI) systematic is 9%. In two third of cases coexisted agoraphobia and in one third a depression. Eighty six percent of patients with actual panic disorder were treated by the psychiatrists. The diagnosis and suitable treatment of panic disorder would appear to be a significant objective in term of public health, leading to a reduction in medical and social cost of this disorder.

[Predictive factors for patient maintenance on buprenorphine high dosage treatment: a naturalistic study in primary care]. / Facteurs prédictifs de réponse au traitement substitutif par buprénorphine haut dosage. Etude naturaliste en médecine générale.

High dosage buprenorphine is actually the principal treatment for substitution medication in France. Clinical trials have demonstrated the clinical efficacy of HD buprenorphine for narcotic addiction, but few data are published concerning the prognostic factors of treatment response in daily practice. A naturalistic study was performed in 1998. 200 generalist practitioners were recruited and 956 patients were included. Sociodemographic, medical and addiction history were collected. A quantitative socio-comportemental and medical indicator (SCMI) was performed. The psychometric properties of the SCMI were analyzed. Simple and multivariate analysis was performed. Patients with good social adjustment and past withdrawal are good responders to HD buprenorphine. Not treated psychiatric pathology was a prognostic factor associated with a relatively poor response to HD buprenorphine. A long duration of treatment (one year) and a clear therapeutic program were associated with good response.

[Treatment of adjustment disorder with anxiety: efficacy and tolerance of etifoxine in a double-blind controlled study]. / Traitement du trouble de l'adaptation avec anxiété: évaluation de l'efficacité et de la tolérance de l'étifoxine par un essai en double aveugle contre produit de référence.

Adjustment disorder with anxiety is defined as a clinically significant anxiety that occurs within 3 months after the onset of an identifiable psychological stressor. Recent studies indicate that this disorder is not uncommon and must be quickly identified and treated. However, few therapeutic trials have been done in relation with this disorder. According to the criteria set by DSM IV, 170 patients with a primary diagnosis of adjustment disorder with anxiety have been enrolled in a double blind multicenter controlled trial. Patients were treated for 4 weeks with etifoxine (150-200 mg/d), or buspirone (15-20 mg/d). Also both etifoxine and buspirone show clinical efficacy and safety, the two treatments are not equivalent. The global improvement score and the efficacy index are significantly improved in the etifoxine group. These results show the interest of using etifoxine in the treatment of adjustment disorder with anxiety and should be confirmed by further studies.

[Psychopathological disorders and coronary diseases]. / Troubles psychopathologiques et coronaropathies.

The role of psychological factors in the genesis of coronary diseases has been considered for a long time. Friedman took it upon himself to describe a personality profile (pattern A) constituting a risk factor for coronary heart disease of which, however, the practical interest seems limited. The association of psychopathological conditions and coronary heart disease has on the other hand not been extensively studied. Recent epidemiological data show that anxiety and depressive states represent a high comorbidity with coronary heart diseases. Panic attacks remain underestimated; they seem to participate in a complex physiopathological mechanism along with ischemic coronary heart diseases. Recent studies have shown that the existence of a depressive illness during coronary heart disease and particularly in the time period following a myocardial infarction, constitutes an independent risk factor, thus increasing the mortality rate. The evolution of coronary heart disease seems greatly influenced by the existence of anxious or depressive states, the diagnosis and the treatment of these states represent a major interest towards a better management of coronary patients.

[Eye disorders in children and adolescents]. / Le pithiatisme oculaire chez l'enfant et l'adolescent.

PURPOSE: We tried to better characterize non organic ocular disorders in children and adolescents: particularly clinical, perimetric and electrophysiological features. METHODS: We performed a prospective study in 25 cases during a period of 16 months. RESULTS: Non organic ocular disorders were seen among young girls between 9 and 11 years, mostly with bilateral, symmetrical and rapid visual loss. The symptoms were variable in time and responded favorably to suggestion. The ocular examination was normal. Visual field was abnormal in 52% of cases and very often showed a spiral (or snail) picture or a tubular constriction. 7' pattern visual evoked potentials were present in 88% of cases. The acuity was 20/20 in 92% of cases after the consultation and 100% later. CONCLUSION: The ophthalmic and electrophysiologic examination confirmed our diagnosis and eliminated more severe pathology.

[Cyclic oro-alimentary disorders]. / Troubles cycliques oro-alimentaires.

Eating behaviours have been changing in our society for at least twenty years. Thus, they represent a good indicator of the functioning of a society or a person. Beyond these recent sociocultural variations, recent clinical and research data, particularly in chronobiology, showed clearly the influence of hormonal or seasonal changes in our eating behaviours. Actually, we observed that an important proportion of these cyclic turmoils can fit into other phenomena and cyclic pathologies: premenstrual syndrome, seasonal affective disorders, bipolar disorders, binge eating.

[Is DSM IV of value in training of psychiatrists?]. / Le DSM IV est-il utile à la formation des psychiatres?

Acquiring the skill to be a psychiatrist requires learning in three fields: academic, clinical and research. Academic training includes various kinds of objectives which are analysed and to which the DSM IV provides only an imperfect response. Clinical training which shapes clinical practice, requires the organization of knowledge: the DSM IV, in so far as it analyses and classifies data is a useful tool, but the utility is limited since the DSM IV is inherently biased towards a psychiatric view of illness. The utility of the DSM IV is analysed for research training, particularly with the triple goal of preparing for the manipulation of knowledge, for practical care, and for the transmission of knowledge.

Bone marrow hypoplasia in anorexia nervosa: a case report.

If hematological abnormalities appear to be a common feature of severe anorexia nervosa, on the other hand bone marrow hypoplasia seems to be comparatively rare. We recently encountered a patient with anorexia nervosa who demonstrated a hypoplastic bone marrow associated with gelatinous transformation. These abnormalities were rapidly reversible with intensive nutritional rehabilitation. Bone marrow hypoplasia and gelatinous transformation are discussed in relation to current concepts of the role of nutrition in hematopoiesis in humans.

[Life events and anxiety]. / Evénements de vie et anxiété.

During the last few decades many studies have examined the role of life events in psychiatric disorders. Majority of investigators have mainly focused on depression. Recently the specific etiological role of life events in anxiety have been reexamined. Two possible causal relationships have been hypothesized: loss or separation during childhood can serve as a predisposing factor for adult psychologic conditions and life events occurring in the months before the onset of anxiety disorder, can serve as a precipitating factor. However the main methodologic issue in life events research involves the distorting effect of time recall when life events are elicited retrospectively. Epidemiological and clinical data are consistent with the view that panic disorder is significantly and strongly associated with both parental death and separation in childhood. The relationship between recent life events and anxiety disorders remain unclear. Studies that compare recent life events of anxiety disorder subjects and controls have equivocal results. Different variables (number of events, type, impact) may play a role in anxiety. Recent data have also suggested that early and recent life events specially loss and separation may be a risk factor for secondary depression in anxiety. However, life events do not operate independently of other predispositional variables such as genetic, neurologic and cognitive factors. Further studies using a prospective design may be useful to clarify the relation between life events and anxiety.

[Prevention and treatment of sleep disorders through regulation] of sleeping habits]. / Prévention et traitement des dyssomnies par une hygiène du sommeil.

Healthy sleeping habits is a complex balance between behaviour, environment and circadian rhythm. The quality of sleep can be improved by behaviour, e.g. eating tryptophan and carbohydrate rich foods, physical exercise in the afternoon or a cold shower just before going to bed. Total sleep time is maximal in thermoneutrality and decreases above and below the thermoneutrality zone. Thermoneutrality is reached for an environmental temperature of 30-32 degrees C without night clothing or of 16-19 degrees with a pyjama and at least one sheet. Noise also modifies sleep structure and above 50dB shortens total sleeping time. Although subjects do become subjectively accustomed to noise, vegetative cardiovascular reactivity to environmental noise remains unchanged. The spontaneous circadian awake/sleep cycle is 25 hours, slightly longer than the body temperature cycle, but when subjects are exposed to environmental synchronization, the two cycles coincide. In individuals undergoing temporal isolation, the two rhythms become independent often leading to subjective discomfort and fatigue. Certain factors including age can favour internal desynchronization. Other factors may include social contact, stress due to mental work load, and constant lighting which could lengthen the awake/sleep cycle. Caffeine blocks the receptors of adenosine, and thus its effects of inhibiting neurotransmission. Intake 30 to 60 minutes before sleeping shortens total sleep time and increases the duration of stage 2 and shortens stage 3 and 4. Alcohol may act as a relaxing, sedative agent when consumed just before sleeping but can also lead to night-time awakening due to sympathetic activation which does not return to baseline levels until the blood alcohol levels have returned to 0. Nicotine has a biphasic effect on sleep: at low concentrations, it leads to relaxation and sedation and at high concentrations inhibits sleep. A careful study of sleeping habits is the first step in evaluating complains of insomnia or hypersomnia. Before relying on drugs, treatment should start with attention to the sleep environment and personal habits.

[Clinical and epidemiologic study of "generalized anxiety" in general practice]. / Etude clinique et épidémiologique du trouble "anxiété généralisée" en médecine générale.

Recent studies have shown that 16 to 43% of general practice attenders express minor psychiatric disorders (Barrett et al. 1988). The present survey was carried out among a sample of 1,177 patients seen by 121 private general practitioners through out France. Its purpose was: to rate the point-prevalence of general anxiety disorders (GAD) according to DSM III criteria, to evaluate sociodemographic and clinical status of patients with a GAD, to identify the anxiety symptoms that were the most frequently exhibited in a primary-care practice. 181 patients (15.4%) were assessed a GAD diagnosis. 217 patients (18.4%) were assessed a "secondary anxiety" diagnosis ie anxiety associated with an affective disorder (14.8%), phobia (2.5%), panic disorder (1%). Patients with a GAD were predominantly female, between the age of 35-50 years. They tended to be widowed, separated or divorced and of an average socio-economic level. They also had more previous psychiatric disorders. The GAD appeared to start at the middle age of the life (36 years), to be chronic (lasting over one year) in half of the cases, and to be recurrent. The somatic expression of anxiety was frequent (21%) but 34% of the patients expressed directly their psychological distress. Psychotropic drugs were prescribed to 75% of the subjects. Benzodiazepines were prescribed in 34% of the cases. More surprisingly, antidepressive drugs were prescribed more often when a GAD was diagnosed. This results confirm the high point-prevalence rate of anxiety disorders in general practice.(ABSTRACT TRUNCATED AT 250 WORDS)

[Separation anxiety. Theoretical considerations]. / L'angoisse de séparation. Au fil des théories.

The interest in separation anxiety is nowadays increasing: this disorder appearing during childhood may predispose to the occurrence of anxiety disorders (such as panic disorder and agoraphobia) and major depression into adulthood. Psychoanalytic theories differ on the nature of separation anxiety and its place in child development. For some authors, separation anxiety must be understood as resulting from the unconscious internal conflicts inherent in the individuation process and gradual attainment of autonomy. From this point of view, the fear of loss of mother by separation is not regarded as resulting from a real danger. However, Freud considers the primary experience of separation from protecting mother as the prototype situation of anxiety and compares the situations generating fear to separation experiences. For him, anxiety originates from two factors: the physiological fact is initiated at the time of birth but the primary traumatic situation is the separation from mother. This point of view may be compared with behavioral theories. Behavioral theories suggest that separation anxiety may be conditioned or learned from innate fears. In Freud's theory, the primary situation of anxiety resulting from the separation from mother plays a role comparable to innate fears. Grappling with the problem of separation anxiety, Bowlby emphasizes then the importance of the child's attachment to one person (mother or primary caregiver) and the fact that this attachment is instinctive. This point of view, based on the watch of infants, is akin to ethological theories on behaviour of non human primates. Bowlby especially shows that the reactions of infant separated from mother evolve on three stages: the phase of protestation which may constitute the prototype of adulthood anxiety, the phase of desperation which may be the prototype of depression, and the phase of detachment. He emphasizes so the role of early separations in the development of vulnerability to depression. For Bowlby, these reactions are not acquired but genetically programmed and biologically determined.(ABSTRACT TRUNCATED AT 250 WORDS)

Early life events and panic disorder: course of illness and comorbidity.

1. Some reports have suggested that there may be a link between the experience of traumatic life events in childhood and adolescence and the development of panic disorder in adults. In addition early loss event also seems increase depressive risk by a factor about two to three. 2. The authors wondered whether panic patients who experienced a traumatic life event would have a higher prevalence of subsequent major depressive episode than panic patients without history of depression. 3. One hundred fifty seven patients with panic disorder according DSM III-R criteria are included in this study. Fifty three (33.7%) had experienced a major loss or separation before the age of 15 years. 4. The panic group with early life events showed a significantly higher life time prevalence of major depression than the panic group who did not experience early life events.

[Prevalence of hepatitis C, B and D markers and histopathological aspects in a group of intravenous drug addicts]. / Prévalence des marqueurs des hépatites C, B et D et aspects histopathologiques dans un groupe de toxicomanes intraveineux.

OBJECTIVES: The aim of this study was to assess the prevalence of infection by HCV, HBV, HDV and HIV and their biological and histopathological patterns in 104 intravenous drug users. METHODS AND RESULTS: Seventy-five patients (72%) had anti-HCV antibodies. Transmission was rapid because 33% of those who had been drug users for 6 months or less had anti-HCV antibodies. The contamination rate was very high because 90% of those who had been drug users for 2 years or less had anti-HCV antibodies. Thirty-four (33%) had an HBV marker, and 6 were HBs Ag carriers. None of the patients had anti-HDV antibodies. Only one patient had anti-HIV antibodies. Twenty-five anti-HCV antibody positive drug users underwent liver biopsy. Seven (28%) had normal ALAT levels and 18 (72%) had permanently or intermittently elevated ALAT levels. The mean histological activity on the Knodell index was 4.1 (range: 1-8). CONCLUSIONS: This study indicates that contamination by HCV is almost inevitable after 2 years of intravenous drug use. The low prevalence of HBV, HDV, and HIV infection might be explained by a low endemic state of these viruses in our area.

[Children and alcohol. A study in the school milieu]. / Les enfants et l'alcool. A propos d'une enquête en milieu scolaire.

Epidemiologic studies have consistently found that use of alcohol is increasing among teenagers and that children who have their first drink before the age of ten years are at increased risk for alcohol use during adolescence. In this study, a questionnaire was completed by 351 children (185 boys and 166 girls) aged 7 to 11 years in eight different schools in the Lille area (northern France). Most respondents (70.8%) reported previous experience with alcoholic beverages. Regular use of alcohol was reported by 8.7% of respondents and at least one episode of acute over-drinking by 23.6%. Attitudes towards alcohol and reasons for alcohol use varied across age groups. Use of alcohol produced guilt in the youngest children but was viewed as normal in the older age groups. Although some awareness of alcohol-related hazards was found, misconceptions were common. Use of alcohol was related to age and awareness: among the younger children, the level of awareness was significantly higher in regular users than in non-users, whereas the opposite was true in the older respondents. A positive correlation was found between current alcohol use and the children's predictions of future use. These data highlight the value of epidemiologic surveys for developing strategies aimed at preventing alcohol use in youngsters.

[Life events and military service]. / Evénements de vie et Service National.

OBJECTIVE: Life events preceding the year of enrollment in the military service were researched in 175 patients invalid out of army because of psychiatric disorders. METHOD: We assessed the diagnostic according to the DSM III-R criteria, using a semi-structured interview. We completed the evaluation with socio-demographic data. The scale for the assessment of life events was the Paykel's scale. RESULTS: 58% of patients fulfilled the diagnostic of adaptation disorders. The anxiety disorders (14.28%) and depressive disorders (9.71%) come after. Compared with an age and socio-demographic data matched conscript group without psychiatric disorders, it seems that the patients experienced twice as much events during the year preceding the enrollment than the control-group (respectively 6.92 and 3.65). In term of quality, the results show more events related to interpersonal conflict (inadaptation in family, affective relation or professional field). Whereas the events related to recent separation, the major events life; decrease, serious illness and the maternal loss were similar in both groups. CONCLUSION: Those data suggest that there is a relationship between excess of life events and personality disorders, which may explain the inadaptation in the military service. Some recent factors of stress could represent a risk of psychiatric disorders occurring during the military service.