Troubles de la marche et hydrocéphalie à pression normale

Normal pressure hydrocephalus must be considered when gait disturbance, cognitive impairment and sphincter disorders are associated. Symptoms of normal pressure hydrocephalus, especially gait disturbance, are potentially curable by surgery. Our paper provides a summary review of gait disorders associated with normal pressure hydrocephalus detailing their characteristics and the best assessment methods. Although the pathogenic mechanisms underlying normal pressure hydrocephalus remain poorly understood, advances in imaging have enabled considerable progress in our fundamental knowledge of the condition. Tapping the cerebrospinal fluid by lumbar puncture or external lumbar drainage remains the diagnostic test and is predictive of a favorable response to surgical treatment. Clinical severity scores validated for walking and for sphincter dysfunction and cognitive disorders provide the best means of assessing each patient's response to treatment.     

Le réentraînement à l’effort chez l’enfant atteint de paralysie cérébrale (PC). Revue de littérature

The exercise training now appears to be an effective way to combat and reduce the chronic deficiencies in adults with chronic pathology and more recently in the adolescent (or child) suffering from neurological disorders, including cerebral palsy. Numerous studies to date have produced encouraging results in improving some quality of life factors in young patients with cerebral palsy. Firstly, a rehabilitation training based on exercises carried out in endurance improves aerobic capacity and the distance and speed of walking and the GMFCS. A strength training will help improve muscle mass and GMFCS as well. Finally, the type of exercise training to focus now is a “mixed” training, i.e. based on exercises involving the two training protocol before. But to clarify the procedures for carrying out such training, it will take into account various parameters such as muscle fatigue.     

Actualités et perspectives dans la prise en charge de l’hémiplégie cérébrale infantile en médecine physique et de réadaptation

Hemiplegic (or spastic unilateral) cerebral palsy accounts for about 30% of all cases of cerebral palsy. With a population prevalence of 0.6 per 1000 living births, it is the most common form of cerebral palsy among children born at term and the second most common type among preterm infants. Precocity of care at observation of the first symptoms allows preventing orthopaedic disorders and furthermore the installation of pathological patterns. Before any therapeutic intervention, it is necessary to evaluate the lower and upper limb function by means of reliable, valid and reproducible tools. This helps define precise and mutual objectives for child and family as well as therapists, therefore allowing an objective evaluation of the results. This principle applies as much in fundamental techniques (physiotherapy, occupational therapy, psychomotricity, orthesis…) as in more recent developments such as botulinum toxin, exercise programs, constraint-induced therapy, motor mental imagery or virtual reality. These recent therapies present, at various degrees, scientific evidence of their efficiency in the improvement of limb function and are now an integral part of the usual care of children with hemiplegic cerebral palsy.     

Joueurs de machines à sous dans une population française : étude de la dépression, de l’alexithymie et de la recherche de sensations

There are a multitude of factors implied in the acquisition, the development and the maintenance of gambling behavior. Among them, sensation seeking occupies an important place. Zuckerman originally suggested a relationship between sensation seeking and gambling. However, studies in this area have provided heterogeneous results. To explain these discrepancies, Zuckerman emphasized the fact that the type of gambling may be a crucial factor in the relationship with sensation seeking. Nevertheless, few studies have evaluated the link between the different types of gambling and problem behaviors. Furthermore, few studies were interested specifically on slot machines. While recent research has found high-levels of alexithymia in individuals with substance use and eating disorders only two studies have investigated the relationship between alexithymia and pathological gambling. Thus, these studies were focused on students. It is therefore important to study alexithymia in adult gamblers. Empirical data has shown that alexithymia levels may be influenced by negative mood states, especially depression. Some studies have found a positive correlation between alexithymia and depression scores, particularly in people with addictive behaviours. Nevertheless, studies found heterogeneous results. The main objective of this research was to evaluate scores on sensation seeking, alexithymia and depression (and the link between those variables) in gamblers of slot machines. Thus, slot machines gamblers were selected in the casino of Enghien-les-Bains, which is Paris nearest casino. Among them one distinguishes: regular gamblers (n = 45) from which were extracted pathological gamblers (n = 27), and occasional gamblers (n = 19). The South Oaks Gambling Screen and the criteria of the DSM-IV were used to measure the intensity of gambling behavior; sensation seeking was evaluated by the Sensation Seeking Scale form V; alexithymia by the Toronto Alexithymia Scale (TAS-20) and the depression by the Beck Depression Inventory. No differences appeared significant between the three groups of gamblers for the sensation seeking scores. Pathological gamblers obtained higher alexithymia scores than occasional gamblers. Nevertheless, these findings didn’t remain stable when controlling for the effect of depression. Among pathological gamblers, the BDI score is positively correlated to the ‘difficulty identifying feelings’ factor. This result is consistent with the literature, which shows that alexithymia is closely related to depression in addictive behaviors. Indeed, the ‘difficulty identifying feelings’ factor seems to be explained by depression severity. These results suggest that the emotional component of alexithymia would be thymo-dependent, whereas the cognitive component would be independent and constitute a stable clinical feature. Pathological gamblers who play slot machine are low sensation seekers who shun the more dramatic and extraverted form of sensation seeking. They play to reduce or avoid unpleasant emotional states like depression. Pathological gambling could therefore be in part a maladaptive coping strategy to deal with affective disturbances; the game may function as a self-medication to treat emotional states, which the gambler finds no other way of treating. According to previous studies, slot machine gambling is referred to as ‘escape’ gambling, where gamblers may dissociate.     

Profil toxique du lithium : revue exhaustive de la littérature avec méta-analyse des résultats

Objectives

Lithium is a widely used and effective treatment for mood disorders. There has been concern about the safety of lithium but no adequate recent synthesis of the evidence on adverse effects was published in French language. The objective of this study was to produce a clinically informative, systematic toxicity profile of lithium.

Materials and methods

We up-to-dated the systematic review and meta-analysis of randomized controlled trials and observational studies investigating the association between lithium and all reported major adverse effects that we previously published. We searched electronic databases specialist journals, reference lists, textbooks and conference abstracts. We used a hierarchy of evidence which considered RCTs, cohorts, case-control studies and case reports including patients with mood disorders treated with lithium. Outcome measures were renal, thyroid and parathyroid function; weight change, skin disorders, hair disorders and teratogenicity.

Results

Five thousand nine hundred and eighty-eight abstracts were screened for eligibility and 390 studies included in the analysis. On average, glomerular filtration rate was reduced by –9.30 mls/min [95 % CI –12.15 to –6.44, P < 0.001] and urinary concentrating ability was reduced by 15 % of normal maximum. Lithium use may increase rates of renal failure but absolute risk appears to be of the order of 0.3 %. The prevalence of clinical hypothyroidism was increased in patients taking lithium [OR 5.78, 95 % CI 2.00 to 16.67, P = 0.001], whilst thyroid stimulating hormone was increased on average by 4.00 iU/mL [95 % CI 3.90 to 4.10, P =  < 0.001]. Lithium treatment was associated with increased blood calcium [+0.09 mmol/L, 95 % CI 0.02 to 0.09; P = 0.009], and parathyroid hormone [+7.32 pg/mL, 95 % CI 3.42 to 11.23; P < 0.001]. Lithium was associated with more weight gain than placebo [OR 1.89 (1.27 to 2.82) P = 0.002], but not olanzapine [OR 0.32 (0.21 to 0.49) P ≤ 0.001]. There was no statistically significant increased risk of congenital malformations, alopecia, or skin disorders despite many suggesting such associations.

Conclusions

Lithium is associated with increased risk of reduced urinary concentrating ability, hypothyroidism, hyperparathyroidism and weight gain. There is little evidence for a clinically significant reduction in renal function in the majority of patients and the risk of end-stage renal failure is low. The risk of congenital malformations is uncertain; the balance of risks should be considered before lithium is withdrawn during pregnancy. The consistent finding of a high prevalence of hyperparathyroidism means calcium levels should be checked before and during treatment.     

Traduction et validation française du questionnaire de répression de Weinberger

In a cognitive perspective, repression is defined as a coping strategy whose objective is to extinguish awareness of subjective emotional experience, leading to restriction of subjective experience. It is characterized by avoidance of threatening and distressing information, minimization of negative affects and low tendency to anxiety. Several measures of repressive coping style have been developed and the Weinberger Adjustment Inventory (WAI) appears to be the most psychometrically sound measure of repression.

Objectives

The main aim of this study was to translate and validate a French version of the WAI in non-clinical individuals on general population. The secondary objectives were to investigate its relationship to independent measures of anxiety, depression and alexithymia.

Materials and methods

Subjects (n = 159) were asked to complete the WAI questionnaire. A principal component analysis was carried out. The internal consistency was measured by the Cronbach alpha coefficients, and discriminant validity was assessed by examining correlations between the scales of the WAI. Because there is no other French validated instrument assessing repression, convergent validity was studied with alexithymia (Bermond-Vorst Alexithymia Questionnaire), anxiety and depression (Hospital Anxiety Depression Scale).

Results

Our factorial structure of the French WAI resembles the Weinberger's one. The “Consideration for Others” subscale does not belong to the Self-Restraint dimension: this is consistent with literature findings. The others results show solid metrological properties. Cronbach alpha reliabilities for principal and secondary factors were ranged from 0.80 to 0.93 (from 0.65 to 0.85 for the subscales) and the intercorrelations were low. Correlations were found between the WAI, the HAD and the Bvaq-b. Anxiety and Depression (HAD) are positively correlated to Distress and negatively correlated to Restraint, Defensiveness and Composite score. The repressive style, characterized by high scores on Defensiveness and Composite score, is positively correlated to affective component of alexithymia and negatively correlated to the cognitive score of alexithymia.

Conclusion

Globally, findings replicate earlier findings obtained in the Anglo-American context. The French version of the WAI thus appears to be valid and will help studying repression in France, especially in its complex relationships to alexithymia.     

Risque d’homicide et troubles mentaux graves : revue critique de la littérature

Introduction

Tragic and high profile killings by people with mental illness have been used to suggest that the community care model for mental health services has failed. It is also generally thought that schizophrenia predisposes subjects to homicidal behaviour.

Objective

The aim of the present paper was to estimate the rate of mental disorder in people convicted of homicide and to examine the relationship between definitions. We investigated the links between homicide and major mental disorders.

Methods

This paper reviews studies on the epidemiology of homicide committed by mentally disordered people, taken from recent international academic literature. The studies included were identified as part of a wider systematic review of the epidemiology of offending combined with mental disorder. The main databases searched were Medline. A comprehensive search was made for studies published since 1990.

Results

There is an association of homicide with mental disorder, most particularly with certain manifestations of schizophrenia, antisocial personality disorder and drug or alcohol abuse. However, it is not clear why some patients behave violently and others do not. Studies of people convicted of homicide have used different definitions of mental disorder. According to the definition of Hodgins, only 15% of murderers have a major mental disorder (schizophrenia, paranoia, melancholia). Mental disorder increases the risk of homicidal violence by two-fold in men and six-fold in women. Schizophrenia increases the risk of violence by six to 10-fold in men and eight to 10-fold in women. Schizophrenia without alcoholism increased the odds ratio more than seven-fold; schizophrenia with coexisting alcoholism more than 17-fold in men. We wish to emphasize that all patients with schizophrenia should not be considered to be violent, although there are minor subgroups of schizophrenic patients in whom the risk of violence may be remarkably high. According to studies, we estimated that this increase in risk could be associated with a paranoid form of schizophrenia and coexisting substance abuse. The prevalence of schizophrenia in the homicide offenders is around 6%. Despite this, the prevalence of personality disorder or of alcohol abuse/dependence is higher: 10% to 38% respectively. The disorders with the most substantially higher odds ratios were alcohol abuse/dependence and antisocial personality disorder. Antisocial personality disorder increases the risk over 10-fold in men and over 50-fold in women. Affective disorders, anxiety disorders, dysthymia and mental retardation do not elevate the risk. Hence, according to the DMS-IV, 30 to 70% of murderers have a mental disorder of grade I or a personality disorder of grade II. However, many studies have suffered from methodological weaknesses notably since obtaining comprehensive study groups of homicide offenders has been difficult.

Conclusions

There is an association of homicide with mental disorder, particularly with certain manifestations of schizophrenia, antisocial personality disorder and drug or alcohol abuse. Most perpetrators with a history of mental disorder were not acutely ill or under mental healthcare at the time of the offence. Homicidal behaviour in a country with a relatively low crime rate appears to be statistically associated with some specific mental disorders, classified according to the DSM-IV-TR classifications.     

De la non-expression à la surexpression des émotions ou comment l’expérience émotionnelle repose la question des liens entre sexe, alexithymie et répression

Objectives

Alexithymia, considered as a disorder of affect regulation, is well known for its consequences on the vulnerability to negative emotions, but nevertheless it raises the question of the repressive dimension according to Myers’ (1995) and Newton and Contrada’s (1994) researches. If, under certain conditions, alexithymia refers to this dimension we should observed traces of this repressive behaviour on emotional distress. We thus studied the influence of alexithymia scores on trait anxiety, state anxiety and depression, and this relatively to the gender of the participants.

Methodology

We first compared the mean scores of distress of our three groups of subjects (low alexithymia, N = 32; moderate alexithymia, N = 62, high alexithymia, N = 33) with the norms of the general population. Secondly, we studied the consequences of alexithymia intensity on depressive symptoms, trait and state anxiety, with regard to the gender differences. We used 1) the State-Trait Anxiety Inventory (Spielberger) to assess dispositional and acute anxiety, 2) the Center for Epidemiological Scale for Depression (Radloff) to evaluate depressive symptomatology and 3) the Toronto Alexithymia Scale (Bagby) for the alexithymia construct.

Results

In the lower alexithymia group, the total mean scores of depression for men or women (men: 8.06 ± 7.06; women: 8.88 ± 6.84) were significantly lower than those in the general population (men: 12.73 ± 3.02; women: 13.97 ± 3.62). We obtained the same pattern of consequences of a low alexithymia with regard to trait anxiety (men: 32.73 ± 10.20 versus 41.86 ± 9.48; women: 37.17 ± 8.48 versus 45.09 ± 11.11). Finally, there was no difference between the lower alexithymia group mean scores and the general population references, regardless of gender. In addition, in our group of women, the higher the alexithymia mean scores, the more important were the depression (F(2,68) = 21.13, P ≤ 0.000), trait anxiety (F(2,68) = 12.51, P ≤ 0.000) and state anxiety (F(2,68) = 6.72, P ≤ 0.002) mean scores. The male participants did not show a particular vulnerability to the alexithymia intensity, except for trait anxiety in the moderate condition (t(43) = -2.30, P ≤ 0.026).

Conclusion

Our results support the reality of the emotional repression in the condition of lower alexithymia and raise the question of the links between alexithymia and gender. Indeed, emotional experience follows different and surprising ways, inviting us to think about the relevance of a differentiation of the type of alexithymia according to whether one is a man or a woman.     

Conscience de soi et conscience de la maladie dans la schizophrénie : relations avec l’anxiété et la dépression

Elevated rates of suicide in schizophrenia lead us to think that a lot of patients can’t cope with such a frightening, disorganizing or apragmatic experience. In contrast, we insist about the frequency of unawareness of illness as a characteristic of the schizophrenic patient, with paradoxically litlle or no effect on suicidal behaviour. Our study tended to precise the links between awareness of illness, anxiety and depression. We also rated self-consciousness, to see if this tendency could be correlated with other variables, and confirm if possible the hypothesis that awareness of illness relies on a broader tendency for self consciousness.In our population of 46 schizophrenic or schizoaffective inpatients, we failed to show any correlation between awareness of illness, anxiety or depression. Moreover, awareness of illness is not correlated with self-consciousness. On the other hand, anxiety and depression are correlated with self-consciousness. A tendency for high self reflection is frequently observed in autistic attitudes but also when the patient is in relation with others. Some patients sometimes feels like if a an “active” and a “reflexive” self were simultaneously present when they speak to others or even when they are doing daily life activities. The consequences are a loss of spontaneity, apragmatism, anxiety and depression. Those data are discussed in regard to phenomenological studies of Bin Kimura and to mescaline experiences described by the writer H. Michaux.     

Les instruments de mesure de la résilience chez les adolescents ayant été confrontés à un traumatisme : une revue de la littérature

The review of international literature presented here aims at determining the presently available instruments, which measure resilience in adolescents who have been confronted with a traumatism. This research task, focusing on 30 years (1980–2010), was carried out starting from the numerical databases Psyinfo, Psyarticles, Pubmed and Medline, with various key words such as resilience, scale, measure, assessment, protective factors, teenager and adolescent. More than 250 articles have been selected. Among these articles, only five instruments have been identified as enabling to evaluate the characteristics of resilience in teenagers who have been confronted with a traumatism. For all of them, we reported the psychometric development as well as their limitations. This discussion analyses the relevance and the impact of these measuring instruments.     

Cannabis et trouble bipolaire : recherche d’une association à partir d’une revue de la littérature

Introduction

It has been established that cannabis use is involved in the emergence and evolution of psychotic disorders. Although cannabis use is very frequent in mood disorders, there has been a considerable debate about the association observed between these two disorders. This review aims to clarify the relation between cannabis use and bipolar disorder, in order to unveil a possible causality and find the effect of cannabis on the prognosis and expression of bipolarity.

Methods

The review used MedLine database using the keywords “cannabis” or “marijuana” and “bipolar” or “mania” or “depression”. This search found 36 articles who were clinically relevant to the subject and were included and discussed in this review.

Results

The first studies discussing the link between cannabis use and psychotic disorders reveal manic features in the substance abuse group, hence suggesting a possible association between cannabis use and bipolar disorder, in favor of triggering a manic episode. According to the studies, between 25 and 64% of bipolar patients are cannabis users, and the prevalence is higher in younger and male patients. The risk of developing a mood disorder is higher among cannabis users compared to the general population. This substance abuse in bipolar disorders would increase the frequency and duration of manic episodes without changing the total duration of mood episodes. In a first episode of bipolar disorder, the use of cannabis would increase the rate of relapses of manic episodes and worsen the prognosis of the disorder.

Discussion

The frequency of substance abuse in bipolar disorders is higher than the prevalence in the general population, and cannabis is one of the most used illegal substances in the worldwide. Hence, the association between cannabis use and bipolar disorders is frequent. Cannabis users may experience euphoria, relaxation and subjective feelings of well-being; this substance may also have antiepileptic effect, which may explain some of the effects of cannabis on bipolar disorders. In fact, the use of cannabis would increase the frequency and duration of manic episodes in bipolar patients without increasing the total duration of mood episodes, suggesting a possible antidepressing and mood stabilizing effects. This impact of cannabis on mood disorders and its possible pharmacological effect is still controversial and needs further experiencing to be proved.     

Suppression de la dépendance à l’alcool et de la consommation d’alcool par le baclofène à haute dose : un essai en ouvert

The present paper reports the results of an open 3-month trial of baclofen for the treatment of alcohol dependence. Baclofen was prescribed at escalating dose, with 300 mg/day as set upper limit, up to the point at which patients experienced a decrease or a suppression of their motivation to drink. The results show that, at 3 months, 88% of the patients had either totally stopped drinking, or had significantly decreased their alcohol intake and that many of them had become indifferent to alcohol, effortlessly. Efficacious doses were highly variable from patient to patient, ranging from 15 mg/day to 300 mg/day (average 145 mg/day). Approximatelaly 2/3 of the patients needed a dose higher than the approved 80 mg/day dose.