Social phobia, fear of negative evaluation and harm avoidance.

This naturalistic, prospective investigation examined the role of fear of negative evaluation and the personality trait of harm avoidance in the anxiety levels of treated social phobia patients. One hundred and fifty-seven patients with DSM-IV social phobia were assessed before starting treatment and were then followed for up to two years. As expected, greater fear of negative evaluation and higher scores of harm avoidance were associated with greater anxiety at the 6 month follow-up, and harm avoidance remained a significant predictor at 24 months. However, no evidence was found for an interaction between the personality and cognitive variables examined. The findings are discussed in terms of the relative independence of these factors, as well as their potential implications for the treatment of this disorder.

Side-effects of subthalamic stimulation in Parkinson's disease: clinical evolution and predictive factors.

Chronic bilateral high-frequency stimulation of the subthalamic nucleus (STN) is an alternative treatment for disabling forms of Parkinson's disease when on-off fluctuations and levodopa-induced dyskinesias compromise patients' quality of life. The aim of this study was to assess the evolution of side-effects during the first year of follow-up and search for clinical predictive factors accounting for their occurrence. We compared the frequency of side-effects at 3 and 12 months after surgery in a cohort of 44 patients. The off-medication scores of Unified Parkinson's Disease Rating Scale (UPDRS) II, III, axial symptoms, disease duration and age at surgery were retained for correlation analysis. Dysarthria/hypophonia, weight gain and postural instability were the most frequent chronic side-effects. Whereas dysarthria/hypophonia remained stable over time, weight gain and postural instability increased during the first year post-op. High axial and UPDRS II scores at surgery were predictive of dysarthria/hypophonia. Age and axial score at surgery were positively correlated with postural instability. Despite the occurrence of side-effects, the benefit/side-effects ratio of STN stimulation was largely positive during the first year of follow-up. Age, intensity of axial symptoms and UDPRS II off-medication score before surgery are predictive factors of dysarthria/hypophonia and postural instability after surgery.

Body dysmorphic disorder in a sample of cosmetic surgery applicants.

Body dysmorphic disorder (B.D.D.) consists of a preoccupation with an imagined or slight physical defect. This study is the first European report on prevalence and several clinical and functional characteristics of patients with B.D.D. in a cosmetic surgery setting. Comparisons with defect- and severity-matched subjects without B.D.D. were also performed.

Sensation seeking as a common factor in opioid dependent subjects and high risk sport practicing subjects. A cross sectional study.

OBJECTIVE: Animal research has outlined a vulnerability trait to drug dependence like behavior. The behavioral characteristic of this vulnerability is hyperactivity in response to a novel environment of which sensation seeking (SS) has been suggested as a possible equivalent in humans. If this is the case, SS should be more frequent in drug dependent and risky sports practicing subjects then controls. The objective of this study was to determine if opioid dependent subjects (ODS) and regular paragliders (RP) would be more SS then normal controls. DESIGN: Cross sectional study. PARTICIPANTS: Three groups of 34 individuals (total 102) matched for age and sex were selected from ODS seeking treatment, a paragliding club, and a college staff. MAIN OUTCOME MEASURES: Global and sub-scores of the Zuckerman sensation seeking scale (SSS). RESULTS: Non parametric statistics (Kruskal Wallis and Wilcoxon 2-Sample Tests) were used given the non-normal distribution of SSS scores in the ODS and RP groups. Significant differences were found across the three groups for the Thrill and Adventure Seeking (TAS) (P = 0.001), dishinibition (Dis) (P = 0.0003) and total score (P = 0.001). ODS and RP scored significantly higher than controls on two (Dis and the TAS scales). RP also scored significantly higher on the Boredom Susceptibility (BS) scale (P = 0.04). CONCLUSION: Our results show that RP and ODS differ from controls and have some similarities based on the SSS. In this study, the ODS and the RP could express different forms of a general tendency to seek intense and abrupt sensations through various behaviors. Our results in humans are in favor of the hypothesis that the behavioral trait of vulnerability to drug dependence behavior is expressed through SS.

[Case study--relationship between prevalence of shyness, social phobia and avoidant personality in male sexual disorders]. / Etude cas--témoins de la prévalence de la timidité, de la phobie sociale et de la personnalité évitante dans les troubles sexuels masculins.

UNLABELLED: Social phobia, avoidant personality disorder and shyness are very akin disorders, despite the fact that the first two are mental disorders, whereas the third is found mainly in lay or psychological literature. The relationship between these disorders and male sexual disorders can only be hypothesized from clinical studies and psychopathological theories. Social phobia, avoidant personality disorder, and shyness, share a probable indirect responsibility in sexual disorders because they impair the ability of subjects to meet partners. There are only a few direct studies of the negative impact of shyness on sexual behavior. OBJECTIVE: The objective of this study was to compare males with sexual disorders to non-sexual disorder males on diagnosis of social phobia, avoidant personality disorder and shyness. METHODS: We conducted a case-control study comparing a group of male patients seeking care for sexual disorders (n = 87) and a control group of male subjects without sexual disorder (n = 87), regarding the diagnosis of social phobia, avoidant personality disorder and shyness. Diagnoses were appreciated with a structured diagnostic interview (CIDI for the diagnosis of social phobia) or a list of criteria (DSM IV criteria for avoidant personality disorder) and through standardized scales (Fear Questionnaire, CBSHY, Cottraux male sexual problems questionnaire). Severity of shyness was evaluated through visual analog scales. RESULTS: We found strong significant statistical differences between cases and controls regarding the percentage in each group of social phobia, avoidant personality disorder and shyness. For shyness, the mean score at CBSHY was 16.2 (+/- 12.63) for the cases and 6.07 (+/- 6.67) for the controls (p < 0.0001), whereas the percentage of cases with a score of > 19.5 was 41.4% vs 6.9% for the controls (p < 0.001); 27.6% of the cases had a CIDI diagnosis of social phobia vs 8% of the controls (p < 0.001); 31% of the cases implemented DSM IV criteria for the diagnosis of avoidant personality disorder vs 6.9% of the cases (p < 0.001). CONCLUSION: Our results are in favor of one or several factors in common between social phobia, avoidant personality disorder and shyness, which would be strongly related to male sexual disorders.

[Quantitative evaluation of sharing practices of materials at risk for infectious virus contamination by intravenous opiate users seeking treatment--application of the RAB(Risk for AIDS Behavior) self-administered questionnaire]. / Evaluation quantitative des pratiques de partage de matériel à risque de contamination infectieuse virale chez les usagers d'opiacés par voie intraveineuse faisant une demande de soins--utilisation de l'auto-questionnaire RAB.

The objective of this study was to quantify the occurrence of AIDS risk related sharing activities in i.v. opiate users seeking treatment using a self administered questionnaire. Subjects were recruited among first time consultants of an outpatient clinic and assessed using the Risk for AIDS Behavior questionnaire (RAB), a self administered questionnaire that assesses both needle-sharing and unprotected sexual activity; the Beck Depression Inventory (BDI) a self administered questionnaire that assesses depressive symptoms; and the Addiction Severity Index (ASI), a 45-min, structured interview that provides assessments of problem severity in seven functional areas commonly impaired among drug abusers. Among the 102 patients who came in for treatment, all 66 subjects reporting i.v. drug abuse agreed to participate. The study was based on the data collected from these 66 subjects of whom 49 were males (74%) and mean age +/- SD was 31 +/- 5. Fifty-eight-percent of theses subjects reported having shared needles or related paraphernalia over the past 6 months. Despite informational campaigns on the risks of sharing and despite the well spread knowledge of such a risk, most i.v. opiate users seeking treatment report having shared at least once over the previous 6 months.

[Evaluating the quality of life of 42 heart transplant patients and candidates: a cross-sectional study]. / Evaluation de la qualité de la vie de 42 greffés et candidats à la greffe cardiaque: une étude transversale.

OBJECTIVE: Although evaluation of heart transplant candidates and recipients is usually based on objective clinical variables, self-assessment has been proved to be an important component of treatment evaluation. Quality of life is a multidimensional concept, a mix of objective and subjective measures, that could reflect the adjustment to the illness and its treatment. Few studies have reported on quality of life in heart transplantation candidates. This exploratory study, conducted in Bordeaux (France), was designed to assess both objectively and subjectively the quality of life in heart transplant candidates and recipients and to determine the relationships between subjective and objective variables. METHOD: The assessment was cross-sectional; 21 candidates evaluated at an average of 10 (Sd 21.4) months into the waiting period, were matched with 21 recipients at 29.5 months post operative. Subjective evaluation of the quality of life was self-assessed by the Tableau d'évaluation assistée de la qualité de la vie (TEAQV) and the Nottingham Health Profile (NHP). A semi structured psychiatric interview, and the NYHA (New York Heart Association) cardiac insufficiency score provided objective measurements. RESULTS: The NHP and TEAQV mean scores were not not significantly different between the two groups: candidates (C) and recipients (R) reported similar subjective data regarding positive quality of life experience. The objective data indicated significant disadvantages for the candidate group: the cardiac insufficiency score was worse in the candidates [(NYHA mean score: (C) = 2.7 Sd 0.56 vs (R) = 0.7 Sd 0.8, t de Student p < 0.01)] and the DSM III-R axis 1 diagnoses were more frequent in the candidates [(C) = 16/21 vs (R) = 9/21 Chi2 p < 0.05)]. There was a prevalence of adjustment disorders in the candidates. Significant correlations were found between NYHA and NHP mean scores (r = 0.6, p < 0.01) and NYHA and physical and psychological dimensions of the TEAQV (r = -0.65 and r = -0.55, p < 0.01) in the recipient group. In the candidate group, no correlation was found between these scores. CONCLUSION: In the recipient group, objective and subjective assessment showed greater concordance than in the candidate group. Despite more objective physical and moderate yet frequent psychiatric complications, the candidate group reported as positively as did the recipients upon the quality of their life experience. This could be the result of psychological adaptation to the stressful situation. These data were in accordance to several earlier reports. However, the literature has remained controversial upon the evaluation of the quality of life of the candidates. The results of this study, limited by some methodological bias (the small number of patients assessed), need to be confirmed in a prospective study.

Prevalence and occupational covariates of mood, anxiety disorders, and alcohol dependence in a French ancillary staff population.

The aim of this study was to confirm the high prevalence of three frequent psychiatric disorders : anxiety, depressive illnesses, and alcohol dependence among ancillary staff, and to examine for occupational risk factors. Two hundred and forty-six women were randomly selected from the ancillary staff of the regional hospital centre of Bordeaux, and 186 subjects were interviewed between June 1996 and October 1997. First, a self-administrated questionnaire was completed concerning socio-economic status, lifestyle, health, and working conditions. Second, the two sections of the composite international diagnosis interview (CIDI), devoted to explore anxiety and depression, and the short Michigan alcoholism screening test (S-MAST) were used. Mean age of the subjects was 40.8 years (SD = 8.3 years). During the year preceding the interview, 77 (42.5%) subjects had stopped their job because of illness. Prevalence of the psychiatric disorders studied was 33.9% (95% confidence interval, 27.1-40.7%). These disorders were related to sickness absence. This is why the use of drugs raises questions for work physicians. Two protective factors associated against depression in logistic regression analysis were found : training at the time of employment, and the task 'cleaning sickroom'. A high prevalence of psychiatric disorders was confirmed and occupational risk factors for the prevalence of increased psychiatric disorders were isolated that could have practical consequences, such as for the training at time of employment.

[A survey of private practice psychiatrist's training and activity in activity in Aquitaine, France, in 1993]. / Enquête sur la formation et la pratique des psychiatres libéraux de la région Aquitaine.

UNLABELLED: This study was conducted to gather information regarding the current professional activities of French private practice psychiatrists. METHOD: A mail survey was carried out in an attempt to find more about the characteristics of the 380 private practice psychiatrists in Aquitaine (south west France) in 1993. Data are reported in terms of psychiatrist's characteristics (demographics, training and practice activities), patient characteristics and trends in treatment modalities. RESULTS: There was a good response rate (55%), and this enabled us to statistically analyze the data to determine profiles of activities. For the respondents in this survey, the median age is 45 years and 30.7% of respondents are women. The portion of responders reporting a qualification in Neuropsychiatry versus Psychiatry, is low (1/7). The patients seen in private practice are generally young females with anxiety and affective disorders. An important feature was the trend for psychotherapy training and practice. Psychoanalytically oriented and individual psychotherapy were predominant over other forms of psychotherapy. Half of the psychiatrists reported using pharmacotherapy in combination with psychotherapy. There are only little differences in the practice of young and female psychiatrists. CONCLUSION: The impact of psychodynamic theories on the training of French private practice psychiatrists is still very important. Interestingly, these same psychiatrists seem to use an eclectic approach to their practice of psychiatry; about half of the respondents report using pharmacological treatments in combination with psychoanalytically oriented psychotherapy.

[Descriptive studies of the use of the Addiction Severity Index in France]. / Données descriptives issues de l'utilisation de l'Addiction Severity Index en France.

The Addiction Severity Index (ASI) is an instrument that provides, in a 45-minutes semi-structured interview, a multidimensional assessment of substance abuse patients. It was designed in 1980 by A.T. McLellan et al., from Philadelphia PA, in North-America and introduced in France by our group in 1990. Over the past five years we have used it in different substance abuse populations including alcohol users. The goal of this paper is to review the adaptation procedure into French context and to present ASI data from different substance abuse sub-groups: opioïd dependent subjects seeking treatment and former heroïn addicted patients in maintenance treatment. After description of the ASI, presentation of the training procedure for its optimized use and methodological issues, we present for each opiate dependent group acceptability data, results of some of the ASI's 240 items and the severity scores. The Addiction Severity Index provides assessment of problem severity in seven functional areas in which substance abusers are commonly impaired and unable assessment of need for treatment. Objective and subjective patient data are collected in the following seven areas: medical, employment/ support, alcohol, drug use, legal, family/social relationship, and psychiatric. The ASI is both broad in the extent of its evaluation and yet easy to use for appropriately trained interviewers. Use of the ASI over the past five years allows us to underline the following characteristics: in the clinical setting the ASI unable a common descriptive analysis for need and adaptation for treatment of different patients populations; in the research setting the ASI is particularly suited for epidemiological studies of addiction and description, analysis or evaluation research.

[Assisted evaluation scale of quality of life]. / Tableau d'évaluation assistée de la qualité de vie (TEAQV).

The TEAQV (Tableau d'évaluation assistée de qualité de vie) is an instrument designed to standardize the collection of quality of life data among patients with chronic psychiatric or somatic diseases. This instrument is a two-part. 7 point-scale (0 = extremely bad; 6 = excellent), self-rated quantitative evaluation of quality of life at different time points in 4 areas (physical and psychological well-being, family relationships, professional activity). The first part is a one time retrospective lifetime evaluation whereas the second part is a current state evaluation that can be prospectively repeated. Time points are determined by important periods during the illness or treatment course. This instrument is administered by a trained interviewer in 5 to 10 minutes. The TEAQV has been used in different populations. Correlation coefficients between TEAQV current state and conventional scales were studies. Among 26 lung and heart-lung transplant patients, the correlation coefficients between TEAQV and the Sickness Impact Profile are: physical: -.622; psychological: -.406. Among 18, treated, opioid dependent patients, the correlation coefficients between TEAQV and the Addiction Severity Index are: physical: -.548; psychological: -.763; social professional: -.747; family: -.341. Our early results with the TEAQV suggest that it is an easy to use and beneficial instrument to assess quality of life.

Use of midazolam for ECT anesthesia: effects on antidepressive efficacy and seizure duration. Preliminary findings.

Midazolam is a short acting benzodiazepine that has been used for electroconvulsive therapy (ECT) anesthesia. The purpose of this study was to determine whether midazolam used for this purpose would impair the antidepressive efficacy of ECT. In a double-blind random-assignment study midazolam was compared to methohexital on the antidepressive efficacy of bilateral ECT as measured by the reduction in the Montgomery Asberg Depression Rating Scale (MADRS) scores and seizure duration. Sixteen DSM-III-R major depressive disorder patients with melancholia were included. Midazolam and methohexital did not differ in their effects on the MADRS score or seizure duration; no correlation was found between seizure duration and outcome of depression for either group. Our preliminary findings do not support the claim that benzodiazepines should not be used during bilateral ECT.

A naturalistic follow-up study of French-speaking opiate-maintained heroin-addicted patients: effect on biopsychosocial status.

The purpose of this study was to evaluate the impact of opiate maintenance pharmacotherapy (OMP) on the biopsychosocial status of opiate-addicted patients in a cultural environment (France) that is not favorable to OMP and where methadone is not available. Buprenorphine and laudanum (opium tincture), which, to our knowledge, has not been reported previously in the scientific literature for OMP, were used in this study of a group of 18 opioid-dependent subjects. At time of initiation of OMP, mean age was 33 years, sex ratio male: female was 14:4, average duration of drug use was 11.2 years. Six patients received laudanum p.o., 15 g daily; 12 patients received buprenorphine sublingual 2 to 4 mg daily. This group of patients was selected because of persistent relapse and impairment after an average of 5.7 drug-free-oriented treatments over a period of 6.8 years. Initial evaluation and follow-up were made by way of a 150-min semi-structured interview using the Lifetime Retrospective Evaluation Score Table (LREST) and the Addiction Severity Index (ASI). Results showed that body weight and scores for physical and psychological health, socioprofessional status, and family relationships improved significantly after 14 months of OMP. These results show that highly impaired opiate-addicted patients doing poorly in drug-free treatment can respond to OMP even though methadone is not available and the idea of OMP is not favored.