[Victims of terrorist attacks: forensic issues]. / Victimes d'attentats : aspects médico-légaux.

Victims of terrorist attacks: forensic issues. France has recently suffered multiple terrorist attacks. A lot of physicians had to face massive incoming victims. The first priority was somatic and psychological care. However, lack of juridical counseling led to delay in victim status recognition. Legal procedures are essentials in patients' recovery. We propose guidelines for medical certificate writing and first response legal orientation of terrorism victims.

Victimes d'attentats : aspects médico-légaux. La France a récemment été le terrain de multiples attaques terroristes confrontant de nombreux médecins, parfois non spécialisés, à prendre en charge un afflux soudain et massif de personnes exposées. Dans ce cadre, l'urgence médicale initiale se complète d'un accompagnement dans les démarches médico-judiciaires. Celles-ci, souvent peu connues des non-spécialistes, sont nécessaires à la reconnaissance du statut de victime. Elles comportent plusieurs étapes bien définies. Nous proposons des recommandations afin de guider le praticien dans la rédaction du certificat médical initial, et dans l'accompagnement aux démarches de plainte pénale et d'indemnisation.

Do ADHD children with and without child behavior checklist-dysregulation profile have different clinical characteristics, cognitive features, and treatment outcomes?

OBJECTIVE: The Child Behavior Checklist-Dysregulation Profile (CBCL-DP), characterized by elevated scores on the "Attention Problems," "Aggressive Behavior," and "Anxious/Depressed" scales in the CBCL, has been associated with later severe psychopathology. In a sample of children with ADHD, this study sought to further explore the clinical characteristics, the response to methylphenidate medication, and the cognitive features of ADHD children with CBCL-DP. METHOD: The sample consisted of 173 ADHD outpatients (age = 10.9 ± 2.81) assessed using symptom severity scales, personality questionnaires (Emotionality Activity Sociability [EAS] and Junior Temperament and Character Inventory [JTCI]), and neuropsychological tests. A subsample of 136 participants was reassessed after optimal adjustment of methylphenidate dosage. RESULTS AND CONCLUSION: Variables that were independently associated with CBCL-DP were clinical severity (ADHD Rating Scale [ADHD-RS]), internalized disorders, high emotionality (EAS), and low self-directedness (JTCI). CBCL-DP was associated neither with poorer response to methylphenidate nor with more side effects. There were no differences in cognitive performances between participants with and without CBCL-DP.

Temperament and character dimensions associated with clinical characteristics and treatment outcome in attention-deficit/hyperactivity disorder boys.

BACKGROUND: Although differential patterns of temperament and character have been documented in subjects with attention-deficit/hyperactivity disorder (ADHD), few studies have investigated relations between these dimensions, clinical features of ADHD, and treatment outcome. METHODS: Ninety-five boys with ADHD and 87 controls participated in the study; 88.5% of the referred patients were reassessed after optimal titration of methylphendiate treatment. RESULTS: Compared with controls, boys with ADHD showed a temperament profile of high novelty seeking, low reward dependence, and persistence, as well as low scores on both self-determination and cooperativeness character dimensions. No significant differences were found between subjects with ADHD and controls in harm avoidance. Temperament and character traits were related to specific symptom domains and comorbidity but did not predict global severity of ADHD. Persistent and immature children with ADHD were more likely to experience short-term remission.

[Depression and addictions: links and therapeutic sequence]. / Dépression et addictions: quels liens et quelle séquence thérapeutique?

Substance use disorders and major depression are currently associated in clinical population where depression criteria have concerned twenty-five to fifty percent of addict people. The co-occurrence is also showed widespread among the general population for all kind of substance, alcohol and illicit drugs. This comorbidity has pejorative influence on prognosis for each disorder, with particular acuteness on suicide. Furthermore, presentation of major depression is often complicated by consumption or withdrawal. Clinical studies and general population surveys help to describe nature of the causal relationship with three main explanations: self-medication of mood disorders, independent co-occurrence, and substance-induced depressive disorders. Guidelines for treatment of depression on addict people are: no antidepressant medication before complete withdrawal, improvement of mood in the first two weeks of abstinence, indication to treat depression if no improvement after fifteen days. Dual diagnosis units offering psychiatric and addiction competencies could be relevant for this particular comorbidity.

Gene-environment interactions in addictive disorders: epidemiological and methodological aspects.

The gene-environment interactions' approach could explain some epidemiological and clinical factors associated with addictive behaviours. Twin studies first help to disentangle the respective roles of environment and genetic effects, finding convincing evidence for common genetic vulnerability in several addictive behaviours, and helping to delimit what syndrome could belong to the addictive disorder spectrum. Assessing gene x environment interaction (G x E) needs specifically designed studies, using multiplicative or additive approaches. Focusing on this G x E interaction already showed its relevancy in many recent studies, using both epidemiological and molecular approaches. For example, in a non-human primate model of alcohol dependence assessing the respective role of genetic vulnerability (having the short allele located in the promoter region of the gene coding for the serotonin transporter) and severe fostering conditions (as locked up in a cage with other inmates for the first six months of life), the only group of monkeys that has a significant risk of using spontaneously alcohol is the one that gathers both risk factors, i.e. being peer-raised and having the short allele. Such approach could help to more accurately select specific candidate genes, to identify more homogenous subgroups of patients (as sharing the same genetic vulnerability), to understand how genetic factors mediate the risk of associated psychiatric disorders, and ultimately, may lead to more focused, i.e. more efficient, prevention strategies.