Les troubles anxiodépressifs dans la maladie de Parkinson : une revue de la littérature

For a long time, depression and anxiety have been neglected in Parkinson’s disease in favour of motor impairments. Since the 70’s and the beginning of the dopatherapy, the psychopathological perturbations are more and more considered, including by the neurologists. The aim of this study is to review the main studies related to depression and anxiety in Parkinson’s disease. Four main topics are tackled in this review: The prevalence, the etiology and the semiology of the depression as well as the anxiety disorders; the assessment tools and methodological problems for assessing these troubles. Beside these main subjects, we adress some interesting questions, which concern patients as well as clinicians, like the relationship between the depression and/or anxiety and the motor impairments, the disease duration and the type of the Parkinson’s disease. We tackle also the question of the relationship between the depression and/or anxiety and the cognitive troubles and we focus about the main types of cognitive impairment found in Parkinson’s disease with depression and anxiety. We review some studies, which found a link between psychic disorders and depression. It is now obvious that the deep brain stimulation has become an efficient treatment of motor symptoms. In this review, we focus on the effect of the deep brain stimulation on depression. We also discuss the different treatment available for depression and anxiety in Parkinson’s disease. Because of their frequency and their impact on the quality of life, it is particularly important to give a specific attention to these troubles in Parkinson’s disease.     

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.     

Prévalence de l’hypomanie dans les dépressions majeures récurrentes ou résistantes : enquêtes Bipolact

Bipolar II disorder is officially recognized as a mental disorder in DSM-IV-TR and defined by the presence of hypomanic episodes alternating with major depression. Despite data supporting clinical complexity and high morbidity and mortality rates, BP-II disorder is often overlooked or misdiagnosed as unipolar major depression or personality disorder. Moreover, many clinicians still regard it as a milder form of manic-depressive illness. These unsolved problems propose to investigate hypomania prevalence rates in resistant and recurrent depressions, at a large national scale, by means of three large surveys (Bipolact Surveys) carried out in both psychiatric and primary care settings. This research is a part of a national project for medical education on bipolar disorders established in September 2004. Screening of hypomania was done by self-assessment with the hypomania checklist HCL-20; hypomania cases were defined by a score greater or equal to 10 on the HCL-20. Inter-group comparisons (BP-II versus unipolar depression) and multiple logistic regression analyses were conducted on all demographic and clinical factors obtained. Data obtained in the “real world” medical practice (in total, 623 physicians and 2396 patients with major depression) revealed a high rate of hypomania around 62% in both recurrent depression samples (primary care and psychiatric settings) and 55% in resistant major depression. Additionally, the inter-group comparative data allowed drawing the BP-II disorder profile by selecting the most significant differences versus unipolars. “Ups and Downs” (cyclothymic traits) represented the most important and common (in all three different logistic models) risk factor of hypomania. In recurrent major depression, “ups and downs” seemed to act independently from another important risk factor, i.e. “family history of bipolarity”. “Mood switching” was the major risk factor for hypomania in patients with resistant depression; further risk factors were “substance abuse”, “young age of onset”, “agitated - mixed - atypical forms of depression”. These factors are meaningful at clinical and phenomenological levels, and can validate the dimensional approach of hypomania and the cut-off score on the HCL-20.     

Pactes suicidaires : une revue de la littérature

Suicide pacts are a mutual arrangement between more often two people who decide to kill themselves together, usually in the same place. After a presentation of some famous cases (Mayerling tragedy, double suicides of Heinrich Kleist, Stefan Zweig, Max Linder or Paul Lafargue), this article describe the epidemiology, circumstances and motivation, mental health, main differential diagnosis, psychopathology and legal issues in suicide pacts. These pacts are relatively rare, between 0.56 and 2.5% of all suicides in reference occidental studies. They are classically more frequent (4%) in Japan. The common romantic view of pacts between lovers unsuccessful in their marriage project, up to 58% of cases in a study in Japan, characterizes only a minority in Occident (6.4 to 20%). These pacts involve more often married couples (70 to 78%), average age being between 51 and 56 years. Couples of aged husbands, depressive, mutually devoted and socially isolated, suffering from physical debiliting or painful illness, are usually concerned. Parents and children, siblings or sometimes friends can also be implicated in suicide pacts. The threat of dissolution of a close, affectionate and exclusive relationship between both partners, one of them being dominant and becoming the instigator of a double suicide, is emphasized by some authors. Such suicide pacts may also occur between persons unknown to themselves before, sparing their difficulties in life on Internet and searching one or more partners to die together. Couples use preferentially the same non-violent method for death, above all intoxication by carbon monoxide from car exhausts or medicines in recent series in England and Wales (89 to 92%). Different means such as submersion, poisoning by other liquid or solid substances, jumping and suffocation can also be used. Firearms are more commonly in cause in homicide-suicide pacts. Considering psychopathology, major depressive disorder of one or both members of the couple seems the most frequent diagnosis, in a context of anxiety or pain related to illness or handicap, financial difficulties and a possible separation. Suicide pacts have also common characteristics with induced psychosis or “folie à deux”, with an exclusive bonding between these persons, social isolation and shared delusive thoughts of financial ruin or disease. In a forensic point of view, differential diagnoses are especially homicides-suicides without the consent of the victim, double or multiple homicides or accidental consequences of a suicide. Most legislations in many countries punish complicity or assistance to suicide and more over homicide. The fact that these suicide pacts are carefully premeditated and frequently lethal must arouse clinicians' attention to patients wishing or having already tried to die together.     

Dépistage des troubles bipolaires : une revue de la littérature

Objective

The aim of this article is to review the major instruments proposed for screening for bipolar disorder among clinical or general, adult or paediatric populations. They were developed in order to improve the detection of this illness which, far too often, remains unrecognized. Several of these screening instruments are already translated into several languages and validated.

Methodology

A systematic review of the literature published on this topic up to July 2007 was carried out, using the main electronic data base (Medline). The keywords employed included bipolar disorder, screening, questionnaire, diagnosis and early recognition.

Results

The studies reported here examine whether screening instruments perform similarly in various clinical and non-clinical samples. Different forms of the same questionnaire (like self-report or parent report used in paediatric samples) are sometimes compared, usually showing that parent reports supersede the adolescent self-report form. This is namely the case for the Mood Disorder Questionnaire (MDQ) which is a brief and widely tested tool, available both in adult and adolescent versions.The MDQ exhibits good psychometric properties in relation to sensitivity and specificity in adult psychiatric samples, but these are more limited in the general population. Moreover, it yields better sensitivity for BP type I than for other bipolar subtypes. This is also true for other screening instruments like the hypomania check list (HCL-32). In order to optimize the sensitivity for bipolar II disorders, proposals for changing the MDQ screening algorithm have been tested.

Discussion

Even though it does not replace a thorough clinical interview, the use of screening tools for bipolar disorder is widely advocated. We discuss the need for clinicians to rely upon instruments allowing for a rapid and economically feasible identification of this disorder. Involving family members in the evaluation process may also increase the rate of recognition. More studies are still required in order to improve diagnostic efficiency of the screening instruments.     

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.     

Transsexualisme et Rorschach : une revue de la littérature

The Rorschach test appears as the main projective method used to investigated the personality of sex reassignment candidates. We shall first look at studies testing, the hypothesis of troubled background. In a second time, we will analyze the hypothesis of independent issue. Finally, we will present the few follow up studies built up with the Rorschach test.     

L’enfance des schizophrènes : revue de la littérature

Introduction

Pre-morbid antecedents in schizophrenia have been studied for some time now more particularly as potential markers of vulnerability. What are the tell-tale signs in some of the patient's childhood? The authors suggest a non-exhaustive review of the literature on this subject.

Method

The authors reviewed the literature (English and French) of prospective and retrospective studies.

Results

Many fields appear to be impaired during the childhood of some schizophrenic patients, fields such as: developmental abnormalities, speech impairments, social interactions, behaviour, cognitive functioning. The authors also noticed the presence of neurological soft signs and para-clinical abnormalities.

Discussion

The authors suggest a critical and synthetic review of existing data: what can be retained of this data? The authors also discuss the evolution of these signs and their interaction with the evolution of the disease itself.

Conclusion

Many of these signs were noticed in several children who later developed schizophrenia. For many authors, the more important these signs are, the more severe the disease will be. These pre-morbid antecedents give rise to theoretical questions and open perspectives concerning an early diagnosis of schizophrenia.     

Psychose et migration, une revue de la littérature

In the last few years, different studies have found high rates of schizophrenia among migrants to some European countries. This work proposes a review of the literature of the last 10 years concerning the incidence, the prevalence and associated risk factors of schizophrenic syndromes among migrants through a research in the Medline database.     

Complications rénales chroniques induites par le lithium : revue de la littérature

Introduction

After 40 years of use of lithium in the treatment of mood disorders, the renal risks associated with the long-term exposure to lithium are better known.

Objectifve

This review is aimed at summarizing the information available in the literature regarding the impact of lithium on renal structure and function, the prevalence of renal abnormalities, the associated risk-factors and the strategy for their identification and management.

Method

Articles were selected using a Medline search. The keywords were lithium, renal function, kidney, nephrotoxicity, renal insufficiency, side-effects, polyuria, diabetes insipidus and drug monitoring.

Result

A well-recognized adverse effect of lithium exposure is the occurrence of nephrotic diabetes insipidus (NDI) resulting in polyuria and polydipsia, which occurs in 20% of the patients on long-term lithium treatment. This side-effect is linked to a deficit in urine concentrating ability. Its occurrence is associated with the duration of lithium therapy. Although this effect of lithium is initially functional and may disappear if the treatment is rapidly stopped, it may become structural and permanent over time. The decision to stop lithium or to treat the NDI with amiloride is mainly based upon its functional impact.

Discussion

A debate has been ongoing for decades regarding whether or not the long-term use of lithium may cause slowly progressive renal failure. According to the recent literature, progressive renal failure occurs in approximately 20% of the patients on long-term lithium treatment, among whom a few develop severe renal insufficiency due to lithium (possibly in conjunction with other somatic factors) in the form of interstitial nephritis. However, there is an increasing number of reports of patients requiring dialysis after long-term exposure to lithium.

Conclusion

Current recommended strategies for minimising the renal side effects of lithium include: avoiding acute episodes of renal toxicity; monitoring serum lithium concentrations in order to achieve optimal efficacy at the lowest possible concentrations; monitoring serum creatinine levels at least on a yearly basis, with discontinuation of lithium use, discussion with a nephrologist if creatinine clearance decreases below 60 ml/mn; and the possible application of lithium into single daily dose.     

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.     

Intérêt de la TMS au long cours au sein d’une population de patients âgés déprimés résistants

Repetitive transcranial magnetic stimulation treatment (rTMS) in elderly depressed subjects (>60 years) should be assessed in view of the absence of severe side effects. But most of the results in the literature were negative probably due to too short a duration of TMS treatment in this particular population. In this article, the authors report the results of an open study over a 6-month period: 1 month of curative treatment followed by an average of 5 months of maintenance sessions. Twelve refractory elderly depressed patients were included (five men and seven women, nine unipolar and three bipolar according to the DMS-IV criteria), aged between 60 and 78 years (70 ± 6.24) and no responders to at least two different antidepressants over 6 weeks. The average duration of depressive disease was 10.88 years (10.13) with an average of 3.82 (3.28) number of hospitalizations. All patients provided informed consent. During the first period, patients received a daily session of rTMS, 5 days a week for the first and second week then three sessions a week for the third and fourth week. The stimulation was performed on the left dorsolateral prefrontal cortex (10 Hz, 80 % of the motor threshold, 26 trains of 6 s with an interval of 30 s). In the second period, patients received one weekly session during the second month (M2), then one rTMS session each fortnight the following months. The Hamilton depression rating scale (17 items) was used to assess the intensity of depressive symptoms. Clinical ratings were assessed at baseline, each week during the first month and monthly for 5 months (M6). The authors used a 50 % reduction criteria in Hamilton Depression Rating Scale (HDRS) scores following treatment compared to baseline for responders, and HDRS <8 for patients in remission. The results show a significant drop in HDRS scores after 1 month of rTMS: at baseline 22.50 ± 2.84 versus at M1 10.25 ± 4.18, p < 0.001. Two no responders received only 1 month of rTMS treatment. The other responder patients (n = 10) had the possibility of receiving the treatment by rTMS maintenance for 5 months. The HDRS score showed no difference between the mean HDRS score at M1 and M6 (p > 0.05). We noted a high score in compliance to the TMS treatment in this sample: 75 % (n = 9) at M6 with only three drop-outs. No side effect was reported, except headache. The absence of cognitive effects is a strong argument in favor of TMS use in this population. Nevertheless, new double blind studies are needed to confirm this therapeutic tool and the benefits of rTMS in the treatment of elderly resistant depressed people.