Mechanical ventilation as an indicator of somatic severity of self-poisoning: implications for psychiatric care and long-term outcomes.

BACKGROUND: Somatic severity of a self-poisoning episode varies widely between patients. AIMS: To determine the correlates (psychiatric profiles, long-term outcome) of mechanical ventilation used as a proxy to define somatic severity during a self-poisoning. METHOD: All patients who required mechanical ventilation were pair-matched with ones who did not for age, gender and presence of psychiatric history. One year after the self-poisoning episode, patients were interviewed using the Hospital Anxiety and Depression Scale (HADS) and a quality-of-life assessment questionnaire (Short-Form 12 Health Survey). RESULTS: The ventilation group (n = 99) more frequently had mood disorders and less frequently had adjustment disorders (P = 0.007), with a higher depression score on the HADS (P = 0.01) than those in the non-ventilation group (n = 97). Survival curves showed lower survival in the ventilation group (P = 0.03). CONCLUSIONS: Requirement for mechanical ventilation following self-poisoning is associated with a high prevalence of mood disorders and poor long-term outcome.

[Psychiatric disorders observed in the Angers university hospital occupational psychopathology department]. / Troubles psychiatriques rencontrés en consultation de psychopathologie du travail au Centre hospitalier universitaire d'Angers.

INTRODUCTION: This epidemiological study was conducted on the medical records of 168 employees consecutively evaluated by the occupational health psychiatrist between 2007 and 2009. METHODS: Psychiatric disorders were listed according to the WHO International Classification of Diseases. RESULTS: The diagnoses observed were anxiety disorder including post-traumatic stress disorder, major depressive episode, burn-out and work-related stress. Suicidal thoughts were systematically investigated and more often affected men and were associated with major depressive episodes, burn-out and post-traumatic stress disorder. DISCUSSION: This study opens several fields of reflection. The delayed management of suffering employees could be improved by better awareness and training of healthcare professionals in work-related mental health problems. Employees should be encouraged to more readily consult occupational health services. The creation of specific healthcare networks would avoid inappropriate treatment and delayed management that predispose to chronic disorders. A detailed analysis by policy-makers on working conditions in post-modern societies is essential to prevent progression of mental suffering in the workplace.

[A same deficit of cognitive inhibition in early and late-onset depression in elderly women: a pilot study]. / Déficit de l'inhibition cognitive identique dans la dépression précoce et tardive chez la femme âgée.

OBJECTIVE: Late-life depression has been associated with frontostriatal abnormalities that are thought to lead to deficits of cognitive inhibition. However, it remains unclear, whether age-of-onset identifies subgroups of depression. The objective of this study was to compare cognitive inhibition in depressed women aged 60 and older, according to age of the first onset depression (before or after 60 years old). METHODS: We compared 10 currently depressed women (HDRS-17≥18) with a late-onset depression to 10 depressed women with an early-onset depression, and to 10 healthy controls. We examined cognitive inhibition (Stroop, Hayling, Go/No-Go), shifting (TMT), updating in working memory (WAIS) and executive functions (BREF). All groups were matched for age, education level, and MMSE score (MMSE≥24). RESULTS: Depressed elderly women with a late and an early-onset depression had a greater impairment in executive functions and cognitive inhibition compared with healthy controls (p<0,001), but without significant differences according to the age of the first onset depression. Futhermore, late-onset depression in women was significantly correlated with a deficit of cognitive inhibition (rs=0.55; p=0.012). CONCLUSION: Cognitive inhibition should be assessed in late-life depression. Interventions may be developed to specifically target cognitive impairment in the prevention of late-life depression, to identify those who are the most vulnerable to relapse.

[Explarotory study about professional characteristics of suicide attempters]. / Étude exploratoire des caractéristiques professionnelles d'un échantillon de suicidants hospitalisés.

We aimed to describe the professional characteristics of suicide attempters. One investigator asked 87 consecutive patients, aged 18 to 25 years, who had been hospitalized in a university hospital in Angers after having attempted suicide anytime during a 6.5-month period (November 2008-April 2009) to complete a questionnaire about their working conditions. The working conditions of both sexes were approximatively the same. Many patients described situations where work organization was known to produce given mental disorders. Patients hospitalized for suicide attempts are in professions that leaves them more stressed than the general population of workers (Sumer, Samotrace etc.). This evidence could favour a link between attempted suicide and mental factors of strain at work. The results of this study should be interpreted with caution because of the phenomena of circuitous data and small sample size.

[Medical-psychiatric units: shared care in mental health]. / Les unités médico-psychiatriques : les soins partagés en santé mentale.

This paper describes a highly unusual hospital unit that combines somatic and psychiatric approaches under the generic heading of a Medico-Psycho-Social Unit (MPSU) established at Angers University Hospital since 1996. The paper examines the value of a mixed approach while highlighting its limitations. The interest of the MPSU is that it provides a multidisciplinary, somatic and psychiatric approach on the same site. The joint expertise of medical and paramedical staff is required in cases where the assessment of the consultation-liaison services is not sufficient and in complex situations requiring the resources of an intensive care unit and specific medical and surgical specialties. Based on an established partnership and joint service provision, this type of unit is relatively uncommon both in France and abroad. However, the prevalence of somatic and organic comorbidity suggests that MPSUs are an innovative solution for the challenges of this type of care. Two clinical cases will be used as examples.

Cognitive inhibition and working memory in unipolar depression.

BACKGROUND: Over the past decade, evidence has accumulated to suggest that people suffering from Major Depressive Disorder (MDD) present impairment in attention, working memory, executive function, including cognitive inhibition, problem- and task-planning. The aim of the current study was to assess inhibitory mechanisms within working memory with emotionally neutral material in a group of patients suffering from MDD. We hypothesized that impairment in cognitive inhibition is global and not only due to the emotional valence of the stimuli employed for the tasks. METHODS: Twenty patients with MDD (DSM-IV) and 20 healthy controls were recruited. To assess cognitive inhibition, we used neutral material, in the form of the Prose Distraction Task (PDT) (Connelly SL, 1991), Trail Making Test (TMT), Modified Card Sorting Test (MCST), Rule Shift Cards (RSC), Stroop test and Hayling Sentence Completion test (HSC). The Modified 6 elements test, the Brixton Spatial Anticipation test, the dual task performance and the verbal fluencies test were also used to assess other executive function such as flexibility, planning tasks and memory. RESULTS: Individuals with depression showed impairment in cognitive inhibition. They made more errors on the PDT, alongside slower response times. Slower response times were also observed on the Stroop, TMT and RSC. The MDD group made more errors in HSC and performed worse than controls in the semantic part of verbal fluency and Modified 6 elements tasks. The impairment of access function was significantly associated with the level of depression. CONCLUSION: Depressed patients showed inability to inhibit neutral information access to working memory, restrain and delete irrelevant information. This impairment in cognitive inhibition could underlie cognitive slowness and attentional deficits in depression.

Hepatitis C, alpha interferon, anxiety and depression disorders: a prospective study of 71 patients.

This article presents a prospective study of 71 patients infected with chronic viral hepatitis C and treated with interferon alpha during one year. The objective was to assess the incidence and predictive factors of anxiety and depression symptoms during and after the therapy. Each patient received psychiatric assessment before, during and after treatment, with evaluations using Hamilton-anxiety and MADRS scales. Results confirm the great incidence of depression and anxiety not only during interferon alpha therapy but also after treatment is discontinued. Sleep disorders and MADRS ratings of M4 seem to be predictive of the therapy's side effects. Thus, there seem to be easily discernable parameters allowing depression and suicidal behaviour to be anticipated. This paper emphasises their possible occurrence after the treatment and, therefore, the need for routine assessments after treatment is discontinued. Teams comprising both hepatologists and psychiatrists should complete these assessments. This shows the necessity of interdisciplinary collaboration treatment of this kind.