[Affective mentalizing in Addictive Borderline Personality: A literature review]. / La mentalisation affective de la personnalité limite addictive : une revue de la littérature.

This literature review concerns affective mentalizing in borderline addictive personality. This concept postulates the group between addictions and borderline personalities may correspond to Personality Disorders (PDs). First, we will present conceptualizations and evaluations of affective mentalizing. The latter refers to one dimension of mentalization, a process by which an individual interprets his/her mental states and those of others. Lecours and Bouchard proposed a hierarchic model: the Élaboration verbale de l'affect (EVA). They also developed an empiric methodology: the Grille de l'élaboration verbale de l'affect (GEVA). The methodological approach of Lecours fulfils the requirements made by Cho-Kain, Gunderson and Luyten, involving a narrower operationalization of the mentalization concept through the evaluation of its dimensions. Conceptualizations and evaluations enabled focus on mentalization psychopathology. Fonagy and Bateman studied this latter in the subjects with PDs, particularly in Borderline Personality Disorders (BPD). We describe mentalization failure, its etiology and consequences in the BPD. Several forms of mentalization psychopathology are identified. Its etiology is largely environmental. Fonagy and Bateman developed the optimum developmental model of mentalization and referred to it to explain etiology of mentalization failure in BPD. Consequences of mentalization failure explicate its functioning. Mentalization may be considered as essential in their comprehension and their care. Research about mentalization of PDs does not integrate addiction as one comorbidity factor. However, Allen, Fonagy and Bateman describe a bidirectional interaction between mentalization failure and addiction. We propose to examine the mentalization of Borderline Addictive Personality. This concept groups addictions and borderline personalities in just one clinical entity other than their links of co-morbidities.

[Addictive behavior of street children: interculturation and resilience]. / Conduites addictives des enfants en situation de rue : interculturation et résilience.

UNLABELLED: This research belongs to a more comprehensive study on the care of street children in Cameroon. The idea is to develop an analysis of the street pathology where symptoms such as addictive behavior and drug addiction can be found. Beside HIV AIDS, addictive behaviors are the main risk factors that many professionals have to face with while dealing with the street problems today. AIM: Through an intercultural approach, we examined the practices of addictive typology, their initiatory role and their function in the integration of the street system. We also analysed their importance in the survival strategies. After an overview of theoretical controversies that feed the debate on addictions, we questioned the impact of these practices on the street career through the prism of general theory of addictions, particularly the hedonic management model. Addiction helps to resist adversity, it helps to desist and then to begin a harmonious neo development despite the horrors of the street experience. METHODOLOGY: We undertook a quantitative and qualitative study on a sample of 148 street children. We proposed to 128 of them a questionnaire focused on addictive behaviors and survival strategies in the street context. We notably evaluated the street career of 24 of them, using interviews and standardized tests to assess self-esteem (Coopersmith's SEI) frustration tolerance (Rosenweig's P-F) and self-efficacy (Sherer's SE Scale) in order to measure the impact of addictive behaviors on the resilience process. RESULTS: We found that the street career is essentially traumatic, and that addictive behaviors involving various integration strategies are strongly linked to the interculturation process through the identity strategies and the intercultural competences. Addiction itself is not significantly related to self-esteem issues but strongly impacts on self-efficacy and the ability to tolerate frustration. They allow the street children to withstand the street adversity but are a real obstacle to their resilience process.

[Marcus Gunn Syndrome. Study of 3 rare cases]. / Syndrome de Marcus Gunn. Etude de 3 cas rares.

PURPOSE: reporting three rare cases of Marcus Gunn Syndrome and analyzing the clinical features of this entity. METHODS: Case reports of three patients with a Marcus Gunn Syndrome, treated at the Ophthalmology B CHU service Rabat - Morocco. RESULTS: Our patients are two boys aged 1 and 2 years old, and a 31 year old woman with a Marcus Gunn Syndrome. As special features, in the boys' cases this syndrome is bilateral, as for the other case it is associated with congenital fibrosis clinically predominant of the Ipsilateral inferior rectus muscle in an adult. Surgical treatment was not offered for children because of their young age. The adult patient has benefited from a recession of the inferior rectus muscle and a pleating in the superior rectus muscle. The forced duction test objectified a fibrosis of the inferior rectus muscle. Surgical correction of Ptosis and Synkinesis has not been indicated in this patient, given the residual oculomotor disorder and the risk of exposure keratitis. CONCLUSION: Marcus Gunn Syndrome is exceptional in adults. This can be explained by the tendency of the lid retraction to fade with age. Bilateral involvement in Marcus Gunn Syndrome is rare. Its association with congenital fibrosis of extraocular muscles has allowed a better etiopathogenic approach highlighting a supra nuclear origin of this Syndrome.

[Impact of personality disorders in a sample of 212 homeless drug users]. / Impact des troubles de la personnalité dans un échantillon de 212 toxicomanes sans domicile fixe.

INTRODUCTION: The impact of the mental disorders (axis I and II, according to DSM IV) on psychosocial problems (axis IV) is now a well-known fact, notably when substance abuse disorders are encountered on axis I. This leads to the conclusion that personality disorders increase the risk of substance abuse, that substance abuse increases the risk of homelessness, that dual diagnosis has a high impact on homelessness and underlines interactions between personality disorders (PD), drug abuse (DA) and homelessness. The aim of this paper is also to study these interactions. METHOD: We will process the classical epidemiological measures, which have already produced interesting findings on other substance-linked disorders. We will study the multiplicative interaction (I(AB)) and the etiological fraction (EFi) linked to interaction, which evaluate the effects of two factors on another. According to the authors, the I(AB) determines whether the co-occurrence of two risk factors in a group induces more cases than each factor acting together; also if the I(AB) is greater than 1 it is possible to estimate the EFi, that proportionally measures the number of cases of the third factor that can be attributed to the co-occurrence. We will also study the interactions of homelessness and PD on DA, of the PD and DA on homelessness, and of this association DA and homelessness on PD. The data we will use in the paper deal with the prevalence of PD in general, drug users (n=226), homeless (n=999) and homeless drug abusers (n=212). The two last data are extracted from the same population and have been collected through clinical interviews, and the diagnosis follows the DSM criteria. They are comparable to Kokkevi et al.'s sample regarding the drug (heroin), the mean age (28 years for Kokkevi et al., 27 years in our sample), and the geographic origin of the populations (Mediterranean basin). RESULTS: The repartition of PD differs significantly (0.001) in the homeless population and the homeless drug abusers (chi(2)=70.5, df=20). Therefore, the intensity of this link is low (rphi=0.30), which is a consequence of the high prevalence of PD in the homeless population (80% versus 10% in general population). On the other hand, the reparation of PD in the homeless drug abusers sample and Kokkevi et al.'s drug abusers is different at 0.001 (chi(2)=92.64, df=20). The link is high (rphi=0.45) and could be interpreted as a supplementary effect of PD's linked to homelessness and in the PD linked to DA, thus motivating further exploration of the interactions. The comorbidity DA/PD multiplies by 7 the risk of homelessness and explains 46% of the cases of homelessness of our sample (n=212). According to table 4, the association PD/homelessness multiplies by 13 the risk of DA and explains three-quarter of the cases of DA in the personality-disordered homeless people. Moreover, PD appear as basic in the etiopathology of such a morbid constellation since the frequency of their observation is independent of the association homelessness/DA. These findings rejoin the outcomes of similar studies on other addictions. DISCUSSION: It could be objected that our sample of homeless men presents a high prevalence (20%) of DA; therefore agreeing with epidemiological works on the homeless population. The results could be discussed regarding other outcomes in drug abuser populations, in which a higher prevalence of PD has been found. Hence, the main results concerning interactions would not change and would have still led to the conclusion that PD are not influenced by the association homelessness/DA. This does not mean that neither homelessness nor DA have an impact on PD. Indeed, some authors have shown that there are variations in drug users' PD or in the neuropsychological effects of drugs. According to this and to the theory of a central role of PD in substance abuse, PD could influence drug use and be increased by the abuse. This hypothesis should be tested in another study. CONCLUSION: Clinically, the association between DA and PD in homeless populations is a major concern regarding the future of these persons. This paper leads to the conclusion that the association PD/homelessness is a risk factor for DA, as is the dual diagnosis PD/DA for homelessness. In other words, in the case of PD, the DA increases the risk of homelessness, which is a risk factor for DA. Lastly, these findings confirm the interest of therapeutic approaches focused on PD.

[Uveitis and chronic intestinal inflammatory diseases: three case studies]. / Uvéites et maladies inflammatoires chroniques de l'intestin: à propos de 3 cas.

INTRODUCTION: The most frequent inflammatory chronic bowel diseases are Crohn disease and ulcerative colitis, which present extra intestinal manifestations, particularly, arthritis and ocular inflammation. Anterior uveitis is the main ocular manifestation and remains exclusively an inflammatory process. MATERIAL AND METHODS: [corrected] We report three cases of bilateral uveitis, with ulcerative colitis in two cases and Crohn disease in the last case. In the two first cases, uveitis occurred after 8 years of bowel disease which was stabilized by sulfasalazopyridine and 6 months after bowel surgery. In the third case, the patient was followed for Crohn disease for 3 years with anterior uveitis relapse concomitant to bowel relapse. RESULTS: In the two first cases, there was no recurrence after corticosteroids topical therapy. In the third case, topical and systemic corticosteroids provided adequate control of ocular inflammation, but the follow-up was marked by pupillary and inflammatory glaucoma, which required gonio-surgery. DISCUSSION: Anterior uveitis is the most frequent ocular manifestation in chronic inflammatory bowel disease: approximately 1.9-4.9% in Crohn disease and 1.6% in ulcerative colitis. The uveitis course is synchronous with bowel relapse and its treatment requires anti-inflammatory agents. Nevertheless, in severe relapse, recovery is obtained after the resection of the entire involved bowel segment.

[Isolated hypertrophy of the superior oblique muscle in Basedow disease]. / Hypertrophie isoleé du muscle oblique supérieur d'origine basedowienne.

INTRODUCTION: Proptosis is the most common feature of Graves' ophthalmopathy. We report an exceptional case of proptosis in relation with an isolated enlargement of the superior oblique muscle in Graves' ophthalmopathy. OBSERVATION: After ocular contusion a 37 years old man presented a progressive right exophthalmos. On examination there was an unilateral proptosis with dilated conjunctival vessels, without any clinical signs of inflammation and no decreased vision. Ocular movements were full. On general examination signs of hyperthyroidism were present. CT-scan showed a superior oblique muscle enlargement with enlarged superior ophthalmic vein. Cerebral angiography excluded the diagnosis of a carotid-cavernous fistula. Dosage of thyroid hormone revealed hyperthyroidism. DISCUSSION: This case has a double interest: --Diagnostic: a CT-scan picture mimicking a carotido-cavernous fistula in this particular clinical context (history of ocular trauma, enlarged conjunctival vessels). --Isolated enlargement of superior oblique muscle in Graves' disease, which is exceptional in the literature.

[Melanoma of the iris and pregnancy]. / Mélanome de l'iris et grossesse.

Iris melanoma is a malignant melanocytic tumor, making up 1.2%-6.6% of uveal malignant melanomas. The growth of choroidal melanoma during pregnancy is described and a hormonal influence is suggested. We present a case of iris melanoma occurring during pregnancy. A 32-year-old woman, in the 28(th) week of her fifth pregnancy, was referred to the ophthalmologist with a 2-month history of blurred vision and pain in her left eye. The visual symptoms became progressively worse with decreasing vision. Her visual acuity was 20/70 in her left eye, with a temporal, pigmented, prominent iris mass extending into the trabecular meshwork and the corneal endothelium. Elsewhere other pigmented localizations were found in the iris and in the trabecular meshwork. There was secondary glaucoma with intraocular pressure of 36mmHg and C/D=0.9. The right eye was normal. A general physical examination found no pigmented lesions. Chest radiography and hepatic ultrasonography revealed no metastasis. The diagnosis of iris malignant melanoma was made from the diffuse involvement extending into the trabecular meshwork and the advanced secondary glaucoma; an enucleation was performed and histopathological examination confirmed the diagnosis of iris melanoma with involvement of the trabecular meshwork. The patient had no further problems (follow-up of 11 months). From this case report, we discuss the differential diagnosis of iris melanoma and the hormonal influence on its growth.

[Cannabis addiction and Telic Dominance Scale]. / L'addiction au cannabis à l'épreuve de la Telic Dominance Scale (TDS).

The research presented originates in a double set of problems: on the one hand the revelation of cannabis addiction and the borderline personality, and the other hand the link between cannabis addiction/borderline personality and the activity system (Telic; Paratelic). Examination of the relationship between these two notions makes it possible to differentiate cannabis addicts according to adjustments of border line personality. With this aim in mind, we hypothesized that "Activity System" is the type of personality adjustment of cannabis addict, "Character Neurosis" and "Character Psychosis". The first phase of our research consisted of characterization of the sample. Our population consisted of 70 cannabis addicts selected according to precise inclusion criteria (score below 7 on the Cannabis Dependency Questionnaire, score below 4 on the Addiction Severity Index and at least five criteria of borderline personality according to the DSM IV). The second phase investigated our hypothesis based on "Activity system". We expected that the cannabis addicts who had adjusted on the "Character Neurosis" mode would have a telic activity system unlike the cannabis addicts who had adjusted on the "Character Psychosis" mode. In conclusion, we can consider that there is a retroactive effect between cannabis addiction and borderline personality. The personality adjustment of cannabis addict through the intermediary of activity system has an influence on cannabis consumption.

[Validation of the French version of of the Telic Dominance Scale (TDS)]. / Validation française de la Telic Dominance Scale (TDS)--echelle de dominance télique.

There are connections between sensation seeking, difficulties to plan the future and to work towards aims, in relation with fails of mentalisation and addictions. Those characteristics have been described by M.J. Apter as a paratelic dominance of the person, in opposition with the telic dominance. That dimension of the personality has been formalizing as a part of the Reversal Theory. After a presentation of the foundations of this theory, and the validity's studies of the English version of the Telic Dominance Scale, the article explains the proceedings of validation of the TDS French version (Echelle de dominance télique). The population is 72 subjects: 38 addicts--ASI criteria--and 34 control. The component analysis with varimax rotation doesn't allow to find the three factors of construction, but there is a good inter-correlation between the factors. Alpha's Cronbach coefficient is correct, underlining the intern consistency of the scale. At the comparison between groups, the scale has a good sensitivity. There is no correlation between the variables of population (age, sex, employment) and TDS. Lastly, there is a correct correlation between self esteem, anxiety, depression and TDS. The results make TDS a scale with an imperfect validity in its French version, but this scale has sufficient qualities to be used in the case of short studies about addicted population. In association with others instruments, this scale can assess a stable component of the personality giving a measure of the addictive risk.

Local application of neurotensin to abdominal organs triggers cardiovascular reflexes in guinea pigs: possible mechanisms.

Intraabdominal (IAB) injections or topical application of neurotensin (NT) to the serosal surface of the ileum or stomach evoked dose-dependent increases of blood pressure and of heart rate in anesthetized guinea pigs. These effects were markedly reduced by prior animal treatment with a ganglion blocker, alpha and beta adrenoceptor blockers, as well as by exposure of the abdominal organs to lidocaine, a local anesthetic. The blood pressure and heart rate responses to IAB injections or topical application of NT to the ileum or stomach were both inhibited by animal pretreatment with capsaicin. Cervical vagotomy or atropine pretreatment did not prevent or alter the cardiovascular responses to IAB injections of NT. These results suggest the presence in some organs and/or tissues of the abdominal cavity of sympathetic, capsaicin-sensitive sensory nerve fibers which, upon stimulation by NT, produce reflex increases of blood pressure and of heart rate.

Effects of capsaicin desensitization on the stimulatory effect of kinins, prostaglandins, biogenic amines and various drugs in guinea-pig isolated atria.

1. A simple desensitization protocol was set up using capsaicin and isolated, spontaneously beating atria of guinea-pigs to assess the possible participation of cardiac, capsaicin-sensitive, substance P (SP)- and calcitonin gene-related peptide (CGRP)-containing sensory nerve fibres, in the cardiac stimulatory effects of bradykinin (Bk), kallidin (Kd), 5-hydroxytryptamine (5-HT), histamine, prostaglandin E2 (PGE2), prostaglandin E1 (PGE1), prostaglandin F2 alpha, (PGF2 alpha), adrenaline (Ad), glucagon, nicotine and angiotensin II (AII). 2. The positive chronotropic and inotropic effects of Bk, Kd and 5-HT were markedly reduced in capsaicin-desensitized atria compared to control. The percentage inhibition of the chronotropic and inotropic responses to the three agonists seemed to be inversely related to the concentration of agonist used and to vary also with the type of cardiac effect produced by the drug (for Bk the percentage inhibition was: 36-81% (chronotropic effect) and 62-86% (inotropic effect); for Kd: 61-78% (chronotropic effect) and 53-77% (inotropic effect); for 5-HT: 25-66% (chronotropic effect) and 40-64% (inotropic effect]. 3. The positive chronotropic and inotropic effects of histamine, PGE1, PGE2, PGF2 alpha, glucagon and AII had similar amplitudes in capsaicin-desensitized and control atria. 4. The positive chronotropic and inotropic effects of Ad and nicotine were differentially affected by capsaicin desensitization. The inotropic effects of 7.5 x 10(-7) and 7.5 x 10(-6) M Ad were reduced by 41 and 27% respectively, in capsaicin-desensitized atria compared to control. The chronotropic effects of 1.54 x 10(-5) and 6.17 x 10(-5) M nicotine were inhibited by 57 and 26% respectively, by capsaicin desensitization. On the other hand, the chronotropic effect of Ad and the inotropic action of nicotine were of similar amplitude in capsaicin-desensitized and control atria. 5. These results were taken as an indication that a substantial part of the chronotropic and inotropic effects of Bk, Kd or 5-HT in guinea-pig atria, unlike those of histamine, PGE1, PGE2 PGF2 alpha, glucagon and AII, might be the result of stimulation of capsaicin-sensitive, SP- and CGRP- containing sensory nerve fibres. The slight, differential inhibition of the chronotropic and inotropic effects of Ad and nicotine by capsaicin desensitization suggests a minor contribution by cardiac, capsaicin-sensitive sensory nerve fibres to the effects of nicotine and Ad in guinea-pig atria.

Capsaicin-sensitive structures as potential target sites for neurotensin and bradykinin in guinea pig atria.

We tested the influence of capsaicin (CAP) desensitization on the positive chronotropic and inotropic effects of neurotensin (NT), bradykinin (BK), calcitonin gene-related peptide (CGRP) and noradrenaline (NA) in guinea pig isolated atria. The positive chronotropic and inotropic effects of NT and BK were completely inhibited, whereas those elicited by CGRP and NA were either slightly reduced (CGRP) or unaffected (NA), in CAP-desensitized compared to control atria. Cross-desensitization studies using CAP, NT and BK showed that the positive chronotropic and inotropic effects of CAP are slightly affected, whereas those evoked by BK are markedly reduced in NT-desensitized atria. On the other hand, the positive chronotropic and inotropic effects of CAP and NT were similar in BK-desensitized and control atria. The results were interpreted as an indication that NT, BK and CAP produce their excitatory effects in guinea pig atria by interacting with a common population of CAP-sensitive sensory nerve fibers (presumably substance P (SP)- and CGRP-containing nerve fibers). The absence of cross-desensitization between NT or BK and CAP, or between NT and BK, suggests that the activation and desensitization of atrial, CAP-sensitive sensory nerve fibers by the latter agents involve different receptors and/or mechanisms.

Influence of sodium balance on urinary excretion of immunoreactive kinins in rats.

Antibodies against bradykinin (BK) and its metabolites, namely des-Arg9-BK and des-Phe8,Arg9-BK were raised in rabbits, and specific radioimmunoassays (RIA) for these peptides were developed. Specificity studies showed that each RIA was specific for its antigen, since the cross-reactivities of various kinin-related peptides were less than 1.5%. The lowest concentration of peptide that could be measured in these assays was approximately 60 pg/ml. The antibodies were used to measure concentrations of BK and its metabolites in urine and kidneys of rats maintained on different sodium balance for 5 wk. The results showed that normal rats excrete low quantities of BK (63.78 +/- 2.98 ng/day, 88 determinations). The urinary excretion of des-Arg9-BK averaged 77.69 +/- 5.53 ng/day, whereas the amount of des-Phe8,Arg9-BK is equal to 7.13 +/- 0.42 ng/day. Sodium loading brings about a small decrease in the concentration of BK (45.57 +/- 2.36 ng/day, 76 determinations), whereas sodium depletion significantly increased the excretion of BK (94.23 +/- 5.50, 102 determinations, P less than 0.01) accompanied by no modification of the excretion of metabolites. Regression analysis of the results showed a positive correlation between urinary volume and BK in control and sodium-loaded animals and urinary BK and sodium in the sodium-loaded group. In kidney homogenates, sodium depletion increased not only the concentration of BK (10-fold) but also that of des-Arg9-BK and des-Phe8,Arg9-BK by a factor of four and two, respectively, when compared with normal and sodium-loaded animals. These results support the hypothesis that the renal kallikrein-kinin system may be regulated by corticosteroids.