传染病防控医生心理健康状况调查分析

目的调查分析疾病预防控制中心(疾控中心)传染病防控医生的心理健康状况。方法采用症状自评量表(SCL-90)和自编调查表,对昆明市12个县区疾病预防控制中心201名医生进行问卷调查,了解其心理健康情况及压力相关因素。结果疾控中心从事传染病防控医生SCL-90焦虑因子评分国内常模比较,差异有统计学意义[(1.99±0.49)分vs.(1.39±0.43)分,P0.01],抑郁因子评分与国内常模比较,差异有统计学意义[(1.59±0.26)分vs.(1.50±0.59分),P0.01];传染病防控医生与非传染病防控医生焦虑因评子分比较,差异有统计学意义[(1.99±0.49)分vs.(1.42±0.29分),P0.01],抑郁因子评分比较,差异有统计学意义[(1.59±0.26)分vs.(1.52±0.22分),P0.05]。传染病防控医生产生心理压力的主要相关因素排在前两位的是"怕被传染所接触的传染性疾病"(70.8%)和"将传染病传给家人"(54%)。结论传染病防控医生的心理健康状况较差,存在不同程度的焦虑和抑郁,心理压力可能与怕被传染所接触的传染性疾病和将传染病传给家人有关。     

头发、血浆皮质醇水平变化与抑郁症的相关性研究

目的探讨头发、血浆皮质醇水平在抑郁症发病过程中的特点及抗抑郁治疗前后的变化。方法纳入抑郁症患者47例和正常对照47名。抑郁症组给予选择性5-羟色胺再摄取抑制剂治疗4周,分别于治疗前、治疗4周后检测头发、血浆皮质醇水平,分别采用汉密尔顿抑郁量表17项(Hamilton Depression Rating Scale-17,HAMD-17)和汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)评估抑郁症状和焦虑症状的严重程度及疗效。对照组不予干预,于入组时检测头发、血浆皮质醇水平。结果抑郁症组治疗前头发皮质醇水平高于对照组[(17.42±12.40)nmol/L vs.(10.22±8.00)nmol/L,P0.01],血浆皮质醇水平两组间无统计学差异(P0.05)。抑郁症组治疗后HAMD-17总分[(10.60±4.57)vs.(24.00±4.86)]和HAMA总分[(6.30±4.86)vs.(15.78±5.45)]较治疗前均降低(P0.01),治疗后头发皮质醇水平较治疗前增高[(30.53±25.75)nmol/L vs.(16.02±11.77)nmol/L,P0.05],血浆皮质醇水平治疗前后差异无统计学意义(P0.05)。治疗后达到临床痊愈的患者治疗前血浆皮质醇水平高于非临床痊愈的患者[(27.47±14.48)nmol/L vs.(18.30±7.11)nmol/L,P0.05]。抑郁症组治疗前血浆皮质醇水平与HAMD-17中的胃肠道症状因子分呈正相关(r=0.335,P=0.023),与HAMD-17总分及其他因子的相关性均无统计学意义(P0.05)。结论抑郁症患者头发皮质醇水平高于正常对照,经抗抑郁药治疗后头发皮质醇水平较治疗前升高。治疗前血浆皮质醇水平高的患者可能对抗抑郁药治疗更敏感,可获得更好的临床疗效。     

广泛性焦虑障碍治疗前后血清脑源性神经营养因子水平的变化

目的研究广泛性焦虑障碍(generalized anxiety disorder,GAD)患者血清脑源性神经营养因子(brain derived neurotrophic factor,BDNF)水平的特点及其治疗变化。方法收集GAD患者及正常对照者各40名,采用帕罗西汀片有效治疗量治疗12周,治疗前后采用汉密尔顿焦虑量表(Hamilton Anxiety Scale,HAMA)进行疗效评估,采用ELISA法测定血清BDNF的浓度并与对照组比较。结果治疗前GAD患者的血清BDNF水平[(26.03±10.52)ng/mL]低于对照组[(43.27±10.28)ng/mL],治疗后GAD患者血清BDNF水平[(35.85±11.96)ng/mL]较治疗前升高,但仍低于正常对照组,其差异均有统计学意义(P均<0.05);治疗后GAD显效患者[(39.43±12.35)ng/mL]与对照组血清BDNF水平的差异无统计学意义(P>0.05);基线时,GAD患者血清BDNF水平与HAMA量表总分、精神性焦虑因子分呈负相关(P<0.05),与躯体性焦虑因子分的相关没有统计学意义(P>0.05);治疗后,GAD患者血清BDNF水平的变化与HAMA总分、躯体性焦虑因子分、精神性焦虑因子分变化均呈负相关(P均<0.05)。结论血清BDNF水平可能是GAD的状态性指标之一。     

不同性别首发精神分裂症患者前额叶和丘脑质子波谱的比较研究

目的探讨首发精神分裂症患者前额叶和丘脑神经生化代谢物质的特点及其性别差异。方法纳入首发精神分裂症患者男性33例、女性31例以及男性正常对照30名、女性正常对照22名,采用多体素磁共振质子波谱(proton magnetic resonance spectroscopy,1H-MRS)检测前额叶和丘脑N-乙酰基天门冬氨酸(NAA)、胆碱复合物(Cho)与肌酸复合物(Cr),完成NAA/Cr值、Cho/Cr值的计算。患者在抗精神病药物治疗8周末复查1H-MRS,治疗前后采用阳性与阴性症状量表(positive and negative syndrome scale,PANSS)评定临床症状和疗效。结果治疗前,男性患者组、女性患者组左侧前额叶NAA/Cr值[(1.38±0.33)、(1.37±0.35)]、左侧丘脑NAA/Cr值[(1.47±0.35)、(1.45±0.38)]均分别低于同性别正常对照组[(1.61±0.38)、(1.63±0.37)和(1.71±0.38)、(1.72±0.39)],差异均有统计学意义(P0.05)。治疗前与治疗后,男性与女性患者组之间1H-MRS各代谢指标的差异均无统计学意义(P0.05),两组中NAA/Cr值、Cho/Cr值的治疗前后自身比较均无明显差异(P0.05)。男性患者组治疗前后左侧前额叶NAA/Cr变化值分别与PANSS总分及阴性症状因子分的变化值呈负相关(r=-0.39,P0.05;r=-0.43,P0.05)。结论未发现首发精神分裂症患者前额叶和丘脑代谢物存在明显的性别差异,但男性左侧前额叶NAA浓度的变化与阴性症状的变化可能有关。     

双心诊疗模式对急性冠脉综合征患者血脂的影响研究

目的探讨双心诊疗模式对急性冠脉综合征(ACS)患者血脂控制的影响。方法选取100例ACS患者,随机分为双心诊疗模式组(双心组)和对照组各50例。两组患者均给予常规治疗。双心组同时接受心理干预。于入院前、1月、3月,采用汉密尔顿焦虑量表17项(HAMA-17)和汉密尔顿抑郁量表(HAMD)评定两组患者焦虑和抑郁状况,同时检测总胆固醇(CHOL)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)。结果①入院前,两组HAMD-17和HAMA评分比较差异无统计学意义(P0.05),3月后对照组评分[(22.56±4.99),(22.81±3.93)]较入院前、1月时高,双心组评分[(11.60±4.95),(12.44±4.13)]较入院前低,双心组评分下降更为明显(P0.05)。②入院1月、3月后,两组CHOL,LDL-C水平均较入院前降低(P0.05),且双心组低于对照组(P0.05)。结论双心诊疗模式可以改善ACS患者的心理状况,可能更有助于控制血脂。     

抑郁症患者血浆瘦素水平与童年受虐及下丘脑-垂体-肾上腺轴相关研究

目的:探讨儿童期受虐与抑郁症患者血浆瘦素水平及下丘脑-垂体-肾上腺轴功能之间的相关性。方法:选取首发抑郁症患者152例,使用儿童受虐问卷(CTQ)、汉密顿抑郁量表-24(HAMD-24)、汉密顿焦虑量表(HAMA)评定儿童期受虐状况及抑郁与焦虑严重程度;根据儿童受虐问卷评分将受试者分为受虐组(55例),无受虐组(97例)。采用酶联免疫吸附法测定血浆瘦素水平。各组行地塞米松抑制试验(DST),测量各组血浆皮质醇浓度,并计算各组脱抑制率。结果:152例入组患者中55例(36.18%)有儿童期受虐史。儿童期有无受虐组在首次发病年龄、性别比、HAMD-24总分、HAMA总分等方面差异均有统计学意义。儿童期受虐组的血浆瘦素水平[(5.164±2.754) ug/L]低于无受虐组[(7.234±4.892) ug/L;P0.05]和正常对照组[(9.791±7.433) ug/L;P0.000],无受虐组的血浆瘦素水平低于正常对照组(P0.01)。儿童期受虐组和无受虐组DST前后皮质醇水平[(578±126,374±139)ng/L和562±131,333±135)ng/L)]和脱抑制率(71%和68%)高于对照组[(416±104,225±86)ng/L;43%],差异均有统计学意义(均P0.05)。结论:抑郁症患者血浆瘦素及HPA轴均存在明显异常,有儿童期虐待者表现更严重,儿童期受虐导致血浆瘦素水平下降及HPA轴异常可能是成年后罹患抑郁症的可能机制。     

精神分裂症患者改良电休克治疗前后血清胶质源性神经营养因子水平的变化

目的:探讨改良电休克治疗(MECT)对精神分裂症(SZ)患者血清胶质源性神经营养因子(GDNF)水平的影响。方法:采用酶联免疫吸附法,对48名正常人(对照组)和70例SZ患者(患者组)在MECT前后进行血清GDNF水平检测。结果:MECT前,患者组血清GDNF水平[(34.98±20.36)ng/ml]显著低于对照组[(78.23±40.57)ng/ml](t=6.821,P0.001)。MECT后,患者组血清GDNF水平[(79.88±36.10)ng/ml]显著升高,与MECT前比较有显著差异(t=-10.64,P0.01),与对照组差异无统计学意义(t=-0.232,P0.05)。结论:SZ患者可能存在血清GDNF水平低下,MECT可能通过提高GDNF水平起作用。     

奎硫平对酒依赖患者稽延性戒断症状及睡眠的影响

目的:评估奎硫平对酒依赖患者稽延性戒断症状的治疗效果及睡眠质量和睡眠结构的影响。方法:选取80例酒依赖患者急性期戒酒治疗后随机分为奎硫平治疗组(研究组)和维生素治疗组(对照组),研究组给予200~400 mg/d奎硫平治疗,对照组给予维生素治疗。采用宾西法尼亚酒精渴求量表(PACS)、视觉模拟渴求量表(VAS)及汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)分别于入组时和治疗4周对两组患者进行评定,同时接受多导睡眠图(PSG)检测。结果:治疗前两组PACS、VAS和HAMD、HAMA评分差异无统计学意义(P0.05),治疗后研究组PACS、VAS和HAMD、HAMA总分较治疗前均显著降低,差异有统计学意义(P0.05)。治疗前两组PSG各指标差异无统计学意义(P0.05),治疗后研究组觉醒次数(AN)减少[(5.93±1.53)vs(6.91±1.60),t=2.559,P=0.000],睡眠效率(SE)升高[(68.3±4.17)vs(60.8±4.20),t=7.316,P=0.000],总睡眠时间(TST)增加[(292.5±25.9)vs(271.7±23.3),t=3.451,P=0.018],差异有统计学意义。睡眠潜伏期(SL)、快眼动睡眠(REM)百分比及REM睡眠潜伏期(RL)等指标两组间差异无统计学意义(P0.05)。对照组治疗前后各指标差异无统计学意义(P0.05)。结论:奎硫平可改善酒依赖患者急性戒断后的心理渴求、焦虑、抑郁等稽延性戒断症状,提高部分睡眠质量。     

习惯性流产夫妇的焦虑抑郁与婚姻质量的关系及性别差异

目的调查习惯性流产夫妇的焦虑/抑郁水平与婚姻质量,分析二者的关系及性别差异,为其心理健康教育指导提供依据。方法对2012年1月-2014年5月来自绵阳市第三人民医院妇产科门诊就医的57对习惯性流产夫妇,采用贝克抑郁量表(BDI)、状态-特质焦虑量表(STAI)和Olson婚姻质量问卷(OIMQ)进行调查。结果140.0%女性为轻度或以上抑郁,高于男性(15.3%);25.0%~27.0%女性为严重焦虑水平,高于男性(4.0%~5.7%),差异有统计学意义(P0.05);2女性焦虑抑郁评分高于男性(P0.05),夫妻交流评分低于男性(P0.05),婚姻满意度、性生活评分与男性差异无统计学意义(P0.05);3低婚姻满意度女性的焦虑抑郁水平高于高婚姻满意度(P0.05),女性焦虑抑郁水平与婚姻满意度呈负相关(r=-0.252~-0.041,P0.05),而男性无此关联(P0.05)。结论尽管习惯性流产夫妇的婚姻满意度无明显差异,但女性对夫妻交流的评价更低,其焦虑抑郁情绪更严重;婚姻满意度与焦虑抑郁之间的关联存在性别差异。     

吗啡戒断性焦虑大鼠海马突触界面结构及突触素表达变化

目的 探讨吗啡依赖戒断焦虑行为与海马CA1、CA3区突触界面结构和突触素表达变化之间的相关性.方法 剂量递增法建立大鼠吗啡依赖模型,高架十字迷宫检测焦虑行为,透射电镜技术结合图像分析系统、免疫组织化学比较对照组、模型组和治疗组(各6只)大鼠海马CA1、CA3区突触界面结构和突触素(P38)的表达.结果 (1)行为学:模型组开放臂的次数和时间均少于对照组和治疗组[最小有意义差异t检验(下同),P＜0.01或P＜0.05).(2)突触界面结构:模型组CA1区突触后致密物厚度[(10.7±0.9)nm]、突触活性区长度[(45±4)am]、突触间隙宽度[(3.80±0.30)nm]和突触界面曲率(1.37±0.12)均高于对照组和治疗组(P＜0.01或P＜0.05);模型组CA3区突触后致密物厚度[(12.7±1.1)nm]、突触活性区长度[(53±8)nm]、突触间隙宽度[(3.81 ±0.59)nm]、突触界面曲率(1.39±0.30)亦均高于对照组和治疗组(P＜0.01或P＜0.05).(3)突触素表达:模型组CA1、CA3区突触素吸光度(A)值分别为(0.42±0.06)和(0.43±0.05),显著高于对照组(0.2±0.02,0.25±0.03)和治疗组(0.27±0.04,0.26±0.03).结论吗啡戒断焦虑行为与海马CA1、CA3区突触形态结构可塑性及突触素表达水平有一定的相关性.     

Diagnostic Difficulties and Treatment Implications

Summary: Differentiation between types of epileptic seizures has been aided in recent years by the introduction of intensive neurodiagnostic techniques and the development of increasingly detailed classification systems. Paradoxically, these developments have not simplified the task of matching the appropriate antiepileptic drug to a particular seizure type. It is reasonable to assume that anticonvulsant drugs will have different effects on different types of seizures, but faulty, circular reasoning can enter the picture if one also assumes that responses of seizures to different drugs signify different seizure types. There are several examples of differential diagnoses that can fall prey to this problem, including the diagnosis between partial seizures with secondary generalization and generalized tonic-clonic seizures, and the diagnosis between complex partial seizures and absence seizures with automatisms, among others. Considerations of etiology in future classification systems can further complicate the problem: should one then choose an anticonvulsant drug on the basis of individual seizure type or on the basis of the type of epilepsy? Ramifications of this issue extend even to the drug approval process. Official sanction is not given for use of a drug for a seizure type not included in the original efficacy studies, even if later scientific evidence shows that seizure type to be related to a type that is included. New trials must be undertaken. These problems arise from how we choose to classify seizures.     

Cognitive Dysfunction Associated with Antiepileptic Drug Therapy

Summary: Epilepsy is frequently associated with cognitive dysfunction. However, the reasons for this correlation are unclear. Possible influential factors include patient age; duration, frequency, etiology, and type of seizures; hereditary factors; psychosocial issues; and antiepileptic drug (AED) therapy. Whereas many of these factors are beyond the physician's control, AED therapy is one element that can be addressed in treatment decisions by recognizing the potential cognitive effects of particular AEDs. For example, phenobarbital impairs memory and concentration; phenytoin affects attention, problem solving ability, and performance of visuomotor tasks. In contrast, carbamazepine may affect concentration, while valproate would appear to have minimal effects on cognition. Moreover, cognitive effects of AEDs are amplified with coadministration of multiple anticonvulsants (polytherapy). A review of studies on the cognitive effects of monotherapy with AEDs, as opposed to those of polytherapy, provides evidence that drug-related cognitive dysfunction can be reversed if patients are switched to a simpler therapeutic regimen. Future research should be directed toward developing reliable measures for assessing and monitoring cognition, and understanding the particular cognitive side effects of each AED. Physicians also need to revise their opinions about which side effects are "tolerable" for epileptic patients.     

Carbamazepine Efficacy in Adults With Partial and Generalized Tonic-Clonic Seizures

Summary: Carbamazepine and phenytoin are drugs of choice in initial monotherapy for adult partial and secondarily generalized tonic-clonic seizures. These designations reflect the results of the Veterans Administration Epilepsy Cooperative Study Group of 1985. An earlier comparative study of carbamazepine and phenytoin by Ramsay and associates found both drugs equally effective in controlling new-onset seizures. Among the advantages of carbamazepine is that it causes relatively few cognitive and dysmorphic side effects. Its disadvantages are its unavailability in parenteral formulation and its metabolic autoinduction. The latter must be compensated for by planned dosage increases to maintain therapeutic plasma steady-state levels during the first 2 or 3 months of treatment. Carbamazepine is judged a drug of choice in the treatment of these secondarily generalized tonic-clonic seizures, and the drug of choice in children, adolescents, and women susceptible to the dysmorphic side effects associated with other anticonvulsant agents.     

Etiologic and Preventive Aspects of Epilepsy in the Child–Bridging the Gap Between Laboratory and Clinic

Summary: Four broad categories of basic phenomena are pertinent to developing ways to prevent epilepsy. These include mechanisms of epileptogenesis, ictal initiation and temporary entrainment by the seizure discharge of normally functioning brain, seizure propagation, and control mechanisms that function both to restrain the cascade of epileptic events culminating in a seizure and to arrest the epileptic event and restore the interictal state. In newborns and children, hypoxia-ischemia is a major factor leading to epileptogenesis, and several schemes are proposed to classify, quantify, and prevent hypoxic-ischemic encephalopathy. Control mechanisms must be better understood in order to develop prophylactic recommendations for epilepsy, and an experimental model of "kindling antagonism" may increase our understanding of these. Programs of prevention of seizures in children will evolve only if basic researchers and clinicians work productively together to develop an adequate understanding of factors important in epileptogenesis and antiepileptogenic control mechanisms.     

Predisposing and Causative Factors in Childhood Epilepsy

Summary: We review information from large studies of defined populations, examining the role of known factors and especially of prenatal and perinatal factors in contributing to nonfebrile seizure disorders of early childhood. We depend especially, but not exclusively, on the recently completed analyses from the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke, the NCPP. About 4% of children in the NCPP who had at least one non-febrile nonsymptomatic seizure by the age of 7 years had a previous seizure during acute neurologic illness, such as meningitis or during the acute illness after trauma. Many such seizures should potentially be preventable. Of children with seizures, 10% had had a neonatal seizure and 13% had had a febrile seizure. Among the hundreds of prenatal and perinatal factors explored as predictors of childhood seizure disorders, the principal predictors identified were congenital malformations of the fetus, cerebral and noncerebral; family history of certain neurologic disorders; and neonatal seizures. In agreement with the British National Child Development Study, labor and delivery factors in the NCPP appeared to contribute very little to childhood seizure disorders. Maldevelopment, rather than damage at birth to an initially intact nervous system, appeared to be the more common mechanism. Most seizure disorders of early childhood remained unexplained by the large set of prenatal and perinatal characteristics examined.     

Anticonvulsant Drugs and Cognitive Function: A Review of the Literature

Summary: Alterations of cognitive function are separate from disturbances of behavior seen in association with epilepsy. The nature of the cognitive disability may to a certain extent depend on the seizure type. Partial seizures, mainly derived from a temporal lobe focus, impair memory tasks, while generalized seizures seem to have more effect on attentional abilities. A number of studies, reviewed in this paper, suggest that anticonvulsant drugs further impair cognitive function. Maximal impairments are seen in patients receiving polytherapy: rationalization of polytherapy improves cognitive abilities. Studies in children and adults have allowed differentiation of the effects of various commonly used antiepileptic agents. Maximal cognitive deficits are seen with. phenytoin, while phenobarbital and sodium valproate induce moderate disturbances, and carbamazepine seems relatively free from such toxicity. Further research is needed on the interrelationship between types of seizure disorders, types of anticonvulsant medications, and cognitive function.     

Effects of NMD A- and AMPA-Receptor Antagonists on Different Forms of Epileptiform Activity in Rat Temporal Cortex Slices

Summary: Lowering extracellular magnesium induces different patterns of epileptiform activity in rat hippocampus and entorhinal cortex. Short recurrent epileptiform discharges in the hippocampus are stable over time, whereas seizurelike events (SLEs) in the entorhinal cortex, the subiculum, and the neighboring neocortex develop into late recurrent discharges which are not blocked by clinically employed antiepileptic drugs. We tested the sensitivity of the different epileptiform discharge patterns to. /V-methyl-D-aspartate (NMDA)- and non-NMDA-receptor antagonists. As NMDA-receptor antagonist we used dextrorphan, ket-amine, and 2-aminophosphonovalerate (2APV); as α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA)-receptor antagonist we employed the quinoxaline derivative glutamate 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX). The findings show that the different patterns of epileptiform activity, including the late recurrent discharges, are sensitive to all NMDA-receptor antagonists. However, when dextrorphan was employed to suppress seizure-like events, later recurrent discharges did not develop during the remaining time course of the experiment. CNQX reversibly suppressed recurrent discharges in the hippocampus and SLEs in the entorhinal cortex. However, late recurrent discharges become insensitive to CNQX, even at a high concentration of 60 μM m. This finding suggests a prominent role for NMDA receptors in the generation of late recurrent discharges.     

The influence of comorbid depression on seizure severity

PURPOSE: To determine the relation between depressive symptoms and seizure severity among people with epilepsy. METHODS: A postal questionnaire was used to survey a nationwide community sample about seizures and depression. The Seizure Severity Questionnaire (SSQ) assessed the severity and bothersomeness of seizure components. The Centers for Epidemiological Studies-Depression scale categorized levels of depression. RESULTS: Respondents categorized as having current severe (SEV, n = 166), mild-moderate (MOD, n = 74), or no depression (NO, n = 443) differed significantly in SSQ scores (all p < 0.0001). People with SEV or MOD reported significantly worse problems than did those with NO depression for overall seizure recovery (mean, 5.3, 4.9, 4.5, respectively); overall severity (5.0, 4.5, 4.2); and overall seizure bother (5.3, 4.8, 4.4) (all p < 0.005). Cognitive, emotional, and physical aspects of seizure recovery also were rated worse among people with SEV than with NO depression (all p < 0.05). Symptoms of depression were significantly correlated with higher levels of all components of generalized tonic-clonic seizure severity (r = 0.33-0.48; all p < 0.0001), and partial seizures (r = 0.31-0.38; all p < 0.01). CONCLUSIONS: Clinically depressed people with epilepsy reported higher levels of perceived severity and bother from seizures, as well as greater problems with overall seizure recovery than did nondepressed people experiencing similar types of seizures. The pervasive influence of depressive symptoms on reports of seizure activity suggests that people with epilepsy should be screened for depression. These data highlight the importance of detecting and treating depression among people with epilepsy.     

Une phénoménologie de la dépendance à l'alcool. Une expérience primordiale de la « nostrité »

The phenomenological approach to alcoholism interestingly focuses on specific dynamics of interpersonal relationships displaying the founding of the Self from a primary “us” and its original basis in the human feast. Priorities for treatment intervention recommend to involve social setting and relationships of the patients, reaching their active participation to a motivational and long term group treatment, underlying the specific therapeutic effect of world exchanges. Biopsychosocial determination of alcoholism could be primarily based on components of interpersonal relationships. Regarding social background, drinking is one of the most famous supports for the achievement of the feast, a founding marker of present time. Taking an existential point of view, the feast appears as the heart of mankind because it presents a primary “us”, a plural state which indicates the beginning and founding of the Self from the others. During the feast, we regularly have to reach our Self from the “us” while avoiding two main dangers, drunkenness, an increase in the dizziness of upright verticality, and addiction, an opposite vertical surrender to alcohol and falling into in the alcoholic relapse, both situations imply a spatial domination and the disappearance of others. Treatment programs of alcohol addicts need to integrate the necessity of reaching the existential basic trust from the support of a group to the appropriation of the community which can be defined as an original “usness”.