Démences : où sont les corps de Lewy ?

Dementia with Lewy bodies (DLB) is the second cause of degenerative dementia in autopsy studies. In clinical pratice however, the prevalence of DLB is much lower with important intercenter variations. Among the reasons for this low sensitivity of DLB diagnosis are (1) the imprecision and subjectivity of the diagnostic criteria; (2) the underestimation of non-motor symptoms (REM-sleep behavior disorder, dysautonomia, anosmia); mostly (3) the nearly constant association of Lewy bodies with Alzheimer's disease pathology, which dominates the clinical phenotype. With the avenue of targeted therapies against the protein agregates, new clinical scales able to apprehend the coexistence of Lewy pathology in Alzheimer's disease are expected.     

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.     

Les troubles de la marche et de l’équilibre dans les syndromes parkinsoniens « plus »

The degenerative Parkinsonian “Plus” syndromes form a heterogeneous spectrum of pathologies comprising multiple system atrophy, progressive supranuclear palsy, Lewy body disease and cortico-basal degeneration. Their developmental profile is distinguished from that of Parkinson's disease by the early appearance of gait and balance disorders, isolated freezing of gait, primary progressive freezing of gait or an isolated or “pure” akinesia. The origin of these symptoms however remains poorly understood. The association of nigrostriatal dopamine neuron loss with either cortical lesions, in the case of cortico-basal degeneration and Lewy body disease, and/or of the brainstem, in the case of progressive supranuclear palsy, explains both the severity of the motor symptoms and the lack of, or minimal, improvement following levodopa therapy. Other symptomatic drug and surgical treatments have been proposed, but with generally disappointing results. Physiotherapeutic techniques targeting balance control can bring some temporary improvements.     

Une méningovascularite infectieuse de Lyme révélée par des accidents ischémiques cérébraux successifs

Introduction

Infectious vascularitis is an unusual cause of ischemic stroke (IS). We report a case of Lyme meningovascularitis complicated with multiple IS.

Case report

A 64-year-old man, without any cardiovascular risk factor, was admitted for a right hemiparesia with a left thalamic hypodensity on the initial cerebral CT scan. No cause for this presumed IS could be identified. Later, the patient developed cognitive impairment and a bilateral cerebellar syndrome. Multiple infarcts and multiple intracranial stenosis were seen on cerebral MRI with magnetic resonance angiography (MRA). Cerebrospinal fluid tests showed meningitis and positive Lyme serology with an intrathecal specific anti-Borrelia antibody index. Antibiotic treatment was followed by good biological and partial clinicoradiological outcome.

Conclusion

The diagnosis of Lyme neuroborreliosis should be entertained as a possible cause of IS in highly endemic zones.     

Étude de la dépression,des événements de vie,de l’impulsivité et du lieu de contrôle au sein d’une population nouvellement incarcérée

Introduction

During the first days of incarceration, the “shock prison” may encourage the appearance of symptomatology reaction with the presence of depressive disorders. Several studies in prisons showed the presence of certain socio-demographic characteristics, psychological and legal in this population life course singular susceptible to weaken against the event that represents an incarceration.

Objective

The present study is twofold. This is firstly to assess depression, life events, impulsivity and locus of control in a newly incarcerated population and secondly to compare the results with depressed people those do not show depression.

Method

Maintenance of semi-structured research was proposed to 46 inmates in the unit of outpatient consultations in a prison in 2010. This interview was completed by placing two questionnaires (Beck Depression Questionnaire, Eysenck Impulsivity Questionnaire) and scale (Multidimensional locus of control scale of Levenson).

Results

Of the forty four inmates incarcerated for less than 10 days, who participated in the study twenty-six had a depression, a significant number of incarceration, psychiatric history, certain life events (personal and maternal abuse, parental alcoholism), as well as significantly higher scores with regard to empathy and external locus of control type “powerful character”.

Conclusion

Home maintenance is a systematic critical time. Newly incarcerated population, with a depression score above the standard psychological characteristics show support from the idea of a unique formation of the personality associated with the presence of life events and highlights particularly difficult childhood susceptible to weaken, especially to cope with the event that is incarceration.     

Critères diagnostiques des troubles cognitifs légers dans une cohorte de 100 patients

Introduction

Tracking can be proposed for subjects with prodromal sates of Alzheimer disease (AD) or people with mild cognitive impairment (MCI) at risk to develop dementia who present a memory complaint.

Patients and methods

We present a cohort of 100 subjects who attended a French memory unit with a diagnostic of MCI. We applied the different definitions used in daily practice. We used the following diagnostic criteria: amnestic MCI (MCIa), multiple domain impairment (MDI), single non-memory dysfunction impairment (SDI), and prodromal Alzheimer's disease (Prod-AD), using only the neuropsychological episodic memory criteria. We also analyzed the population of subjects presenting MCI and vascular risk factors.

Results

Ninety-nine subjects met the criteria of MCIa, 43 met the criteria of isolated MCIa; 56 met the criteria of MDI; one met the criteria of SDI; 40 met the criteria of MAPD; 58 met the criteria of MCI with vascular risk factors.

Discussion

Using the diagnostic criteria of MCI can lead to clinical ambiguity because the population recruited on the bases of memory complaint is highly variable. Moreover, many subjects meet many definitions. This overlap of the classifications further complicates the decision to favor one criterion over another. In clinical practice, a classification system using the concepts of MCI, MDI and SDI seems to be quite operational but cut-offs are necessary for the tests applied, in addition to a clarified choice of which tests to use.     

Caractérisation clinique et criminologique des meurtriers âgés présentant une démence

Homicide is an extreme outcome of violence which is infrequent in older adults, with a prevalence ranging from 1% to 4%. In those cases, homicide is usually followed by suicide. Homicide appears in different psychopathology contexts: Mood disorder, alcohol disorder and psychosis disorder. An association of mild to moderate dementia with homicide has been reported. The risk factors of homicide in demented patients remain unknown. Dysexecutive syndrome could be a cause of homicide in demented patients. The reported case highlights this issue and shows that neuropsychiatric evaluation of older murderers could be useful in understanding the murder. Clinical and criminological characteristics of elderly murderers with a dementia will also be discussed.     

Recherche de sensations, désinhibition et pratique de sports à risque : quelques pistes de réflexion

Sensation seeking is at the root of different behaviours. Skydivers, artists, drug addicts and criminals somehow share the same need for stimulation. But are there drug-addicted skydivers? Are there different ways to seek sensations? Studies on risky sport practices and disinhibition are contradictory. While some find risk-taking athletes do not consume substances, others maintain these athletes are indeed the most uninhibited of all. Diversity and the type of activities supposedly depend on what exactly an athlete seeks from a psychological point of view. The analysis of different sensation seekers’ personality traits helps to better understand the choice and role of one or several sources of activation. Based on a review of studies, we will discuss three sensation seeker profiles. Depressed “escapists” primarily seek sensations through substance use in order to regulate their negative affects. This “passive” stimulation mode seems better suited than practising risky sports for these individuals lacking in energy. Conversely, extraverted “hedonists” comfort their positive affectivity by seeking multi-faceted pleasure in risky sports or the “social” use of substances. They are not characterized by negative affects but by alexithymia. Some probably bypass their difficulty to understand their feelings by seeking various readily available sensations that need not be mentally interiorised (purportedly found in disinhibition or risky sports). Finally, “compensatory” types are adventurers who seek sensations in high-risk sports only. They are not characterized by depression, anxiety, disinhibition, extraversion or alexithymia. They seek to enhance and build up their personality by confronting the natural environment and danger. While all athletes seek sensations, these might not be essential to escapist and compensatory types who use them only as a mere means to escape and compensate. Extraverted hedonists seem to be the “true” sensation seekers inasmuch as stimulations are worthwhile in themselves. This strong need for hedonistic sensations might lead to an addictive process, a common answer to psychic sufferings that may also derive from boredom or a need for sensations and pleasure.     

Stimulation cérébrale profonde et troubles de la marche dans la maladie de Parkinson

Introduction

Gait disorders and freezing of gait (FOG) are seen in most patients with advanced Parkinson disease. Response to levodopa and deep brain stimulation is variable across patients.

State of art

Thalamic stimulation is ineffective on gait and can even worsen balance when bilaterally applied. Pallidal stimulation moderately improves gait disorders and FOG although this effect tends to wane after three to five years. Stimulation of the subthalamic nucleus (STN) improves levodopa-responsive gait disorders and FOG. However, some patients worsen after STN stimulation and others are better improved under levodopa than under STN stimulation. Synergistic effects of the two treatments have been reported. As for pallidal stimulation, there is a failure of long-term STN stimulation to improve gait, probably due to the involvement of non-dopaminergic pathways as the disease progresses. Levodopa-resistant gait disorders and FOG do not usually benefit from STN stimulation. In the rare cases of levodopa-induced FOG, STN stimulation may be indirectly effective, as it enables reduction or arrest of the levodopa treatment.

Perspectives

Pedunculopontine nucleus stimulation has recently been performed in small groups of patients with disabling gait disorders and FOG. Although encouraging, the first results need to be confirmed by controlled studies involving larger series of patients.

Conclusions

Overall, gait disorders remain a motor PD symptom that is little improved, or only temporarily, by current pharmacological and surgical treatments. Patient management is complex.     

Infarctus cérébral récidivant révélant une maladie de Biermer

Introduction

Biermer's disease is an autoimmune disorder characterized by vitamin B12 deficiency. Ischemic stroke is an uncommon complication of Biermer's disease, possibly though hyperhomocysteinemia.

Case report

A 58-year-old male presented with recurrent ischemic stroke. Extensive investigations were normal, except for a high plasma level of homocysteine in the context of pernicious anemia which was otherwise asymptomatic.

Discussion

Hyperhomocysteinemia is a known marker, and probably a risk factor, for stroke, fostering atherosclerosis and thrombosis. It can be found among individuals suffering from homocysteinuria, but also when there is deficiency of vitamin B12 or folic acid. Vitamin B12 supplementation would reduce homocysteine concentration which in turn would reduce the risk of ischemic stroke.     

Étude de l’influence des troubles mentaux sur les difficultés de réinsertion sociale

The psychiatric problems of the “homeless” population are now recognized. The aim of this article is to focus the study on a sample of this population (n = 999) asking for help in their social insertion. The results on clinical disorders (Axis I of the DSM-IV) and personality disorders (Axis II of the DSM-IV) are compared to estimations on general population and to other studies on “homeless” in France. These comparisons show the prevalences of some disorders whose symptoms involve problems in social rehabilitation. At last, measures of interaction and impact (multiplicative interactions, odd ratio, etiologic fractions) shows that these morbid associations increase the problems in the attempts to social rehabilitation.     

Entre événements de vie et croyances culturelles : un délire à la croisée des chemins

We present the story of a woman who lost in a shipwreck her last 19-years-old son. Mariama T. is a widow, her husband died eight years ago, after a mysterious illness according to her. The couple had got four children before the birth of Landing, dying successively in their early weeks or months of life. A curse of the ancestors was suspected, the kañaalen's ritual was performed to restore relation with the ghost of ancestors to guarantee the survival of her child. Landing effectively survived until the fateful date of the drama: the shipwreck of the boat, Le Joola that happened on September 26th 2002. After his sudden death, Mariama developed progressively a paranoiac delusion centred on women who practised the kañaalen whom she accused of treason. She is persuaded that they had killed her son by digging up the fetish that was protecting him. Since then, she talked only about means she may use to avenge on them. This observation is the occasion of a critical reflection on a missed therapeutic relation.     

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.     

Obésité, régulation émotionnelle,estime de soi. Étude comparative et structurale à méthodologie quantitative et qualitative intégrée

The authors present the results of a comparative and structural study aiming at exploring the differences between obesity linked to binge eating and classical eating disorders. The responses to the questionnaire SVF-120 and to Rotter's semi-projective test were analyzed for women belonging to three clinical sub-groups: Obesity (n = 13), Anorexia (n = 12), Bulimia (n = 21), and a paired Control group (n = 31). The comparative study shows that the emotional difficulties of patients suffering from obesity are less heavy than those of the sub-groups suffering from eating disorders and that they are related mainly to difficulties in expressing and elaborating negative feelings. The results of the structural analysis suggest that the feelings that have to be accounted for within a multidisciplinary therapeutic approach are the need to be accepted by others and a deep rooted feeling of shame, hence the proposal of an adapted eclectic kind of psychotherapy.     

Coping et qualité de vie dans la sclérose en plaques et la maladie de Parkinson : une réflexion clinique

Objective

In neurological disorders, such as multiple sclerosis (MS) and Parkinson’ s disease (PD), psychological and adaptive processes have not been extensively investigated, it has, however, been demonstrated that they have a great impact on “quality of life” (QoL). Interestingly, even though these two diseases affect people of different ages, both of them have a substantial impact on mood and QoL. In these two diseases, the authors objective was to analyse the style of coping in relation with the QoL taking depression and anxiety into account.

Methods

Two hundred and seventy MS and PD subjects were seen for a semistructured interview in order to collect sociodemographic and clinical information, after which there was an assessment of their mental and cognitive states using: the Mini International Neuropsychiatric Interview (MINI), the Montgomery and Asberg Depression Rating Scale (MADRS), the Depressive Mood Scale (EHD), the Hamilton Anxiety scale (HAMA) and the Frontal Assessment Battery (FAB). Then, all subjects completed three self-report questionnaires; two about coping strategies: the Ways of Coping Checklist (WCC), the Coping with Health, Injuries and Problems scale (CHIP), and one about QoL: the SEP 59 for MS and the French version of PDQ-39 for PD.

Results

The studies show that the psychosocial dimension of QoL is preserved in the two diseases studied. They also demonstrated that in MS and PD the two factors associated with a poor QoL are depression and emotion-focused coping strategies. Furthermore, these variables are highly dependent on the clinical courses in MS and motor signs in PD. However, the MS patients tended to be more irritable and to lose the control of their emotions more easily than PD patients.

Discussion

The report discusses the importance, first, of identifying these manifestations in patients with MS or PD and, second, of offering patients interventions tailored to the characteristics of each disorder. The authors propose some examples of psychotherapy, which could be used with neurological patients. The studies show that it is also important to work with MS and PD patients on both the expression and the management of their emotions in connection with their diseases.