Self-referral to group cognitive behavioural therapy: Is it effective for treating chronic insomnia?

ObjectivesTo evaluate the effectiveness of a short (3 session) programme of group cognitive behavioural therapy (CBT) on insomnia, sleepiness and symptoms of anxiety and depression.MethodsProspective observational study of group CBT with follow-up at 3 months. Participants were self-referred patients with chronic insomnia. Outcome measures were the insomnia severity scale (ISI), the Epworth sleepiness scale (ESS), depression (Pichot scale), and the number of anxiety symptoms.ResultsParticipation in CBT was offered to 489 patients of whom 474 completed the programme and 154 were followed up at 3 months. Significant improvements in insomnia were seen: ISI score (17.74–14.27, P < 0.0001) after CBT and at follow-up (13.78, P < 0.0001). At the end of CBT, 76% (59/78) with initial severe insomnia and 52% (132/255) with moderate insomnia were improved, maintained at 3 months in 71% (15/21) with severe insomnia and 56% (50/90) with moderate insomnia. Depression and anxiety symptoms were significantly improved: mean depression symptoms (4.15–3.35, P < 0.0001) and anxiety symptoms (4.52–3.95, P < 0.0001), maintained at 3 months with mean depression symptoms (3.17, P < 0.0001) and mean anxiety symptoms (3.62, P < 0.0001). Sleepiness increased between baseline and the end of the group (6.67–7.24, P = 0.015) followed by a reduction at 3 months (7.19–6.34 at 3 months, P = 0.001). Initial ISI score but neither sex nor age were predictive of outcome.ConclusionsA short programme of CBT can improve sleep, depression and anxiety symptoms in self-referred patients suffering from chronic insomnia with good adherence and maximum benefit in patients with severe insomnia.     

Distinct domains of impulsivity are impaired in juvenile myoclonic epilepsy but not in temporal lobe epilepsy

ObjectiveThe Barratt Impulsiveness Scale (BIS-11) is the most widely used questionnaire to study impulsivity in persons with psychiatric disorders, but it has rarely been applied to persons with epilepsy. The present study aimed to evaluate the usefulness of BIS-11 as a tool to explore impulsivity in two distinct epilepsy syndromes.MethodThe BIS-11 was applied to 20 patients with juvenile myoclonic epilepsy (JME) (32.5 ± 8.95 years old), 20 patients with temporal lobe epilepsy (TLE) (37.7 ± 13.25 years old), and 26 healthy controls (31.86 ± 11.25 years old). The scores in motor, attentional, and lack of planning impulsivity were compared between groups.ResultsPatients with JME showed higher scores than patients with TLE and controls in all domains: motor (JME vs TLE: 28.60 vs 13.25 (mean score), p < 0.001 and JME vs controls: 28.60 vs 14.12, p < 0.001), attentional (JME vs TLE: 21.55 vs 13.45, p < 0.001 and JME vs controls: 21.55 vs 14.88, p < 0.001) and nonplanning (JME vs TLE: 28.05 vs 13.10, p < 0.001 and JME vs controls: 28.05 vs 16.15, p < 0.001).ConclusionHigher BIS-11 scores in all domains of impulsivity [i.e., motor, attentional, and lack of planning] corroborated previous findings described in patients with JME. On the other hand, BIS-11 could not demonstrate problem solving and inhibitory control deficits related to impulsive behavior, which were described in patients with TLE. Other behavioral measures may be more sensitive to some aspects of impulsivity in TLE. Our results reinforce the concept that distinct epileptic syndromes require different neuropsychological approaches, especially considering a complex construct such as impulsivity.     

Orthorexia Nervosa in Turkish dietitians and dietetic students

ObjectivesOrthorexia Nervosa (ON) is characterized by a pathological obsession with healthy eating, and dietetic majors may have a potential risk of developing ON due to their occupation that necessitates consideration of optimal food choices. This study aimed to determine the prevalence of ON among a large sample of dietitians and dietetic students in Turkey and to investigate the association of ON with socio-demographic features and eating attitudes within the whole sample.MethodsParticipants (n = 1429) completed a self-administered online survey that featured socio-demographic characteristics, the Orthorexia Nervosa Questionnaire (ORTO-11), and the Eating Attitudes Test-26 (EAT-26). Scores on the ORTO-11 and EAT-26 determined the prevalence of ON and disordered eating behaviors, respectively.ResultsThe prevalence of ON among Turkish dietetic majors was 59.8% with a higher ratio in dietetic students (63.8%) than dietitians (52.9%) (P < 0.001). While graduation was associated with 33.1% lower odds of ON (P = 0.006), eating disorders could increase the ON risk approximately five times (P < 0.001). Furthermore, the greater total and subscale (dieting, bulimia, and oral control) scores of EAT-26 were associated with higher ON tendency (P < 0.001), even after adjustment for potential confounders.ConclusionsOur findings may shed light on the relevance of developing strategies to reduce the prevalence of ON in the dietetic population but need to be supported by further longitudinal and prospective studies.     

The validity of self-rated psychotic symptoms in depressed inpatients

BackgroundSelf-ratings of psychotic experiences might be biased by depressive symptoms.MethodData from a large naturalistic multicentre trial on depressed inpatients (n = 488) who were assessed on a biweekly basis until discharge were analyzed. Self-rated psychotic symptoms as assessed with the 90-Item Symptom Checklist (SCL-90) were correlated with the SCL-90 total score, the SCL-90 depression score, the Beck Depression Inventory (BDI), the Hamilton Depression Rating Scale 21 item (HAMD-21) total score, the Montgomery Åsberg Depression Rating Scale (MADRS) total score and the clinician-rated paranoid-hallucinatory score of the Association for Methodology and Documentation in Psychiatry (AMDP) scale.ResultsAt discharge the SCL-90 psychosis score correlated highest with the SCL-90 depression score (0.78, P < 0.001) and with the BDI total score (0.64, P < 0.001). Moderate correlations were found for the MADRS (0.34, P < 0.001), HAMD (0.37, P < 0.001) and AMDP depression score (0.33, P < 0.001). Only a weak correlation was found between the SCL-90 psychosis score and the AMDP paranoid-hallucinatory syndrome score (0.15, P < 0.001). Linear regression showed that change in self-rated psychotic symptoms over the treatment course was best explained by a change in the SCL-90 depression score (P < 0.001). The change in clinician-rated AMDP paranoid-hallucinatory score had lesser influence (P = 0.02).ConclusionsIn depressed patients self-rated psychotic symptoms correlate poorly with clinician-rated psychotic symptoms. Caution is warranted when interpreting results from epidemiological surveys using self-rated psychotic symptom questionnaires as indicators of psychotic symptoms. Depressive symptoms which are highly prevalent in the general population might influence such self-ratings.     

L’addiction aux smartphones : validation française de l’échelle Internet Addiction Test-version smartphone (IAT-smartphone) et caractéristiques psychopathologiques associées

IntroductionSince their first appearance in 1992 smartphones have improved constantly, and their use, combined with the rapid spread of the Internet, has increased dramatically. The recent emergence of this technology raises new issues, at both individual and societal levels. Several studies have investigated the physical and psychological harm that may be caused by smartphones. The issue of excessive smartphone use as an addictive disorder is frequently raised and debated, although it is not acknowledged in international classifications. In France, there is no validated assessment tool for smartphone addiction. Therefore, the aims of this research were: to validate a French translation of the Internet Addiction Test-smartphone version (IAT-smartphone); to study the links between smartphone addiction, Internet addiction, depression, anxiety and impulsivity.MethodTwo hundred and sixteen participants from the general population were included in the study (January to February 2016), which was available online using Sphinx software. We assessed smartphone addiction (French version of the Internet Addiction Scale – smartphone version, IAT-smartphone), specificity of smartphone use (time spent, types of activity), Internet addiction (Internet Addiction Test, IAT), impulsivity (UPPS Impulsiveness Behavior Scale), and anxiety and depression (Hospital Anxiety and Depression scale, HAD). We tested the construct validity of the IAT-smartphone (exploratory factor analysis, internal consistency, non-parametric correlation tests for convergent validity). We also carried out multiple linear regressions to determine the factors associated with IAT-smartphone.ResultsMean age was 32.4 ± 12.2 years; 75.5% of the participants were women. The IAT-smartphone had a one-factor structure (explaining 42 % of the variance), excellent internal consistency (α = 0.93) and satisfactory convergent validity. Smartphone addiction was associated with Internet addiction (ρ = 0.85), depression (ρ = 0.31), anxiety (ρ = 0.14), and some impulsivity subscales, including “negative urgency” (ρ = 0.20; P < 0.01), “positive urgency” (ρ = 0.20; P < 0.01), and “lack of perseverance” (ρ = 0.16; P < 0.05). Age was negatively associated with the IAT-S total score (ρ = −0.25; P < 0.001), and there was a non-significant difference between the IAT-S total scores of men and women (29.3 ± 10.2 vs. 32.7 ± 12.4; P = 0.06). Multiple linear regression showed that age, anxiety, depression, average time spent on the smartphone, impulsivity and Internet addiction explained 71.4 % of the variance of IAT-smartphone scores. However, this score dropped to 13.2 % when Internet addiction was removed from the model. This variable alone explained 70.8 % of the IAT-smartphone scores.ConclusionThe French version of the IAT-smartphone is a reliable and valid questionnaire to assess smartphone addiction. This addiction appears to be strongly linked to anxiety, depression and impulsivity. The strong association between smartphone addiction and Internet addiction suggests that smartphone addiction is one of the many forms of Internet addiction. In fact, smartphones may not be the object of the addiction but rather a medium facilitating Internet access as it makes it possible to connect anywhere anytime. This raises the issue of the potential role of smartphones in speeding up and facilitating the development of Internet addiction.     

Relation entre alexithymie et impulsivité dans un échantillon d’adolescents scolarisés de la région de Sfax,Tunisie

ObjectivesThe study of alexithymia in adolescence seems particularly interesting for various reasons. First, physical, psychological and social changes create new experiences of emotional reactivation. Second, the adolescent period coincides with the maturation of the hormonal, neuronal, and cognitive systems that underlie the development of emotional regulation. Finally, evidence suggests that alexithymia may have detrimental consequences in adolescents, including substance use disorders, depression, anxiety, behavioral disorders and self-injury. Also, alexithymia is associated with impulsivity because of a deficit in the cognitive processing of emotions with tendencies to act rather than talking about feelings. The purpose of the current study is to estimate the prevalence of alexithymia in a sample of school-aged adolescents in the Sfax region (Tunisia) and to evaluate its links with impulsivity.Materials and methodsCross-sectional study involving 474 students from public institutions in the Sfax region. Participants completed, after consent, an epidemiological fact sheet, the Toronto Alexithymia Scale (TAS-20) and the Barratt Impulsiveness Scale (BIS-11).ResultsThe average age of the students was 14.77 ± 1.75 years with extremes ranging from 13 to 18 years old. The sex ratio was 0.96. The prevalence of alexithymia was 35.86% and that of impulsivity 39%. The analytical study showed that alexithymic adolescents had a higher degree of impulsivity (27.4% vs 11.8%, p = 0.001) with a positive correlation between TAS20 and Barratt scores (p < 10⁻³ ; r = 0,33).ConclusionOur study shows that alexithymia is common in our adolescents and is associated with impulsivity. The prevention of alexithymia seems essential to reduce the frequency of impulsive behavior.     

An epidemological study of obsessive compulsive disorder in adolescents from India

ObjectivesThere is scarce data on the prevalence of OCD among adolescents in India. This study reports point prevalence of OCD among school students (age 12–18 years) in the Kerala state of India and examines its association with ADHD, psychological distress, tobacco/alcohol abuse, suicide risk and history of sexual abuse.Method7560 students of 73 schools were self-administered the OCD subsection of Clinical Interview Schedule–Revised, the Composite International Diagnostic Interview (CIDI) for obsessive compulsive symptoms and other relevant instruments to identify OCD and related clinical measures. A diagnosis of ICD-10 OCD was derived through the CIS-R algorithm which required duration of at least 2 weeks and at least a thought/behavior to be resisted along with a cut-off score for severity and impairment.ResultsIn the sample, 50.3% were males with a mean age of 15.2 years (range of 12–18 years). The response rate was 97.3% (7380 valid responses). 0.8% (n = 61) fulfilled criteria for OCD with a male predominance (1.1 vs. 0.5%, p = 0.005). Prevalence was higher among Muslims and increased with age. Taboo thoughts (62.3%) and mental rituals (45.9%) were the commonest symptoms. Those with OCD had significantly higher suicidal thoughts (59 vs. 16.3%, p < 0.01) suicide attempts (24.6 vs. 3.8%, p < 0.01), ADHD (28 vs. 4%, p < 0.001), sexual abuse (24.6 vs. 4.2%, p < 0.01), and tobacco use (23 vs. 6.8%, p = 0.01). They also reported greater psychological distress and poorer academic performance.ConclusionsOCD is common among adolescents in India. Its associations with ADHD, sexual abuse, psychological distress, poorer academic performance and suicidal behavior are additional reasons for it to be recognized and treated early.     

Insomnia symptoms,objectively measured sleep,and disease severity in chronic obstructive pulmonary disease outpatients

BackgroundSleep disturbances are known to have a negative impact on a range of clinical outcomes in chronic obstructive pulmonary disease (COPD). We examined the associations of insomnia symptoms and objectively measured sleep parameters to a composite score for body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index (a multidimensional index of COPD severity), arterial blood gases, nocturnal respiratory disturbances, periodic limb movements (PLM), psychologic distress, pain, age, and sex.MethodsThe sample comprised 73 COPD outpatients (mean age, 63.6 years; standard deviation {SD}, 7.5; range 47–85 years; 41.1% women). Insomnia symptoms were measured with the Bergen Insomnia Scale (BIS) and sleep efficiency (SE), slow-wave sleep (SWS), and total sleep time (TST) were assessed with clinical polysomnography (PSG).ResultsBODE index was positively associated with composite BIS score (P = .040). Patients with more severe COPD presented more complaints of nonrestorative sleep compared to patients with less severe COPD (P = .010). In multivariate analysis, the composite BIS score was independently associated with PLM (P < .001), nocturnal respiratory disturbances (P = .001), pain (P = .031), and psychologic distress (P = .044) but not with the BODE index. Objectively measured sleep variables were not associated with any of the health-related variables.ConclusionInsomnia symptoms in COPD patients result from a wide range of health-related factors. More severe COPD may be associated with a subjective experience of nonrestorative sleep but not with objectively measured sleep variables.     

Les conduites suicidaires dans le trouble bipolaire de type 1

ObjectivesBipolar disorder is one of the most common and severe psychiatric conditions. It is frequently complicated by suicidal behaviors, and patients with BD are among those at higher risk of suicide. The aims of our study were to evaluate the predictive factors of suicidal behaviors in patients with BD type 1, through the assessment of their socio-demographic, clinical and evolutionary characteristics as well as to study the implications of the childhood traumas and impulsivity as predictive factors for suicidal behaviors in these patients with bipolar disorder.MethodsOne hundred patients with bipolar disorder type 1were recruited in order to conduct a cross-sectional, analytical and comparative study. The recruitment involved a first group made up of 40 patients suffering from type 1 bipolar disorder with a history of suicidal acts. This group was compared with a second group made up of 60 patients with no history of attempted suicide. We used a pre-established collection sheet for collecting socio-demographic, clinical and therapeutic data. We also used the Childhood Trauma Questionnaire for the assessment of childhood adversities, the Barratt Impulsivity Scale in its eleventh version for the assessment of impulsivity levels and the Global Assessment of Functioning Scale for the evaluation of overall functioning.ResultsThe suicidal behaviors in patients with bipolar disorder were significantly associated with: female gender (P < 0.001), professional instability (P = 0.002), family history of BD (P = 0.02), family history of other psychiatric disorders (P = 0.003), frequency of depressive episodes (P = 0.002), shorter remission (P = 0.025), more subsyndromal symptoms (P = 0.029), sexual abuse dimension (P = 0.009), and a high level of impulsivity (P < 0.001). The predictive factors for suicidal behaviors in multivariate analysis, after adjusting for the confounding variables were: childhood sexual abuse (P = 0.01; adjusted OR 4.5; 95% CI 1.44–14.2), a high level of impulsivity (P = 0.002; adjusted OR 6.6; 95% CI 2–20), a higher rate of depressive episodes (P = 0.003; adjusted OR 5; 95% CI 1.69–14.2) and more subyndromal symptoms (P = 0.007; adjusted OR 5.8; 95% CI 1.63–20).ConclusionsSuicide prevention is an important mental health subject. It would be imperative to include systematic screening for childhood adversities and adequate management of bipolar disorder and impulsivity.     

Attached to the web — harmful use of the Internet and its correlates

Background and aimsThe aim of this study was to test the validity of the Finnish version of the Internet Addiction Test and the correlates of harmful use of the Internet.MethodsOne thousand eight hundred and twenty-five students (45.5% men and 54.5% women, mean age 24.7 years, S.D. = 5.7) filled in a web-based questionnaire including IAT, reasons for use of the Internet, distress, social support, and substance use.ResultsMen had a statistically significantly higher mean score on the IAT than women. Subjects with self-reported use of cannabis had higher mean score on the IAT compared to non-users (39.5 [11.3] vs 35.8 [10.8]). The total IAT score was associated with “adult entertainment” (OR = 1.07, 95%CI: 1.06–1.08, P < 0.001), “playing games” (OR = 1.05, 95%CI: 1.04–1.06, P < 0.001), “chatting” (OR = 1.07, 95%CI: 1.06–1.08, P < 0.001) and “discussion” (OR = 1.08, 95%CI: 1.07–1.09, P < 0.001) as reasons for Internet use. The IAT score had a significant negative correlation with social support (r = ?0.24, P < 0.001) and a significant positive correlation with the CAGE score (r = 0.18, P < 0.001). Using factor analysis, we found a single factor solution with a Cronbach's α of 0.92.ConclusionsThe IAT seems to provide a valid measurement of harmful use of the Internet, as the score was significantly associated with variables tapping psychopathology.     

L’impulsivité : quelles conséquences sur l’adhésion aux soins ? Présentation d’une étude réalisée en addictologie

IntroductionImpulsivity is a transnosographical dimension with major consequences on medical care with which psychiatrists are frequently confronted. Furthermore, compliance is a major variable that can affect the efficiency of therapeutics and hospitalizations in psychiatry. A study was carried out in three drug and alcohol rehabilitation hospitalization units to find out if impulsivity can have consequences on compliance.MethodThe studied population was composed of 85 patients aged from 18 to 70, hospitalized for one or more addiction disorders in a psychometric hospital in Vannes (France). Impulsivity was measured for all patients with the BIS-11 at the beginning of the rehabilitation program. Because no tool to evaluate a total rehab program compliance existed, a scale, used at the end of the hospitalization, was created to measure patient compliance. This score was composed of two simple numeric scales (one used by the nurses and one used by the patient's psychiatrist) and a coefficient of hospitalization duration that was the ratio of completed to planned days of hospitalization. Correlations were made between the different dimensions: impulsivity and compliance, impulsivity and hospitalization conditions, compliance and hospitalization conditions (voluntary or involuntary, planned by a psychiatrist or not, etc.).ResultsThe main statistically significant result of the study was a negative correlation existing between the motor dimension of impulsivity and compliance (r = −0.37 and P = 0.001). The other dimensions of impulsivity showed no significant correlation with compliance score. The study revealed that the different hospitalization conditions showed no link with compliance or impulsivity.ConclusionThese original results show that motor impulsive patients need an adaptation of the rehabilitation programs. Shorter programs might be more efficient.     

Suggestibility,Facebook use and relationship with substance addictive behaviors

ObjectiveSeveral health issues related to the us of social networking sites (SNS) are documented. One concept that is not clearly studied is suggestibility as the tendency of a person to accept and internalize communication. The aim of the study is to test a model in which suggestibility of people can predict SNS use, which in turn can predict substance use.MethodsParticipants answered a questionnaire measuring suggestibility, alcohol consumption, dependence to nicotine and Facebook use. Linear regression and a structural equation model (SEM) were carried out to assess which utilization of Facebook variables explained best the level of alcohol consumption or nicotine dependence and to assess how suggestibility predicted Facebook use.ResultsLinear regression analyses indicate that only the number of friends on Facebook is a predictor of the level of alcohol consumption (P < 0.001). Suggestibility predict the frequency of Facebook use (P < 0.001) and of the number of friends on Facebook (P = 0.022). The SEM demonstrates that participants with a higher level of suggestibility have more friends on the SNS, which can influence substance consumption.ConclusionIndividuals’ level of suggestibility affects Facebook use. People with a higher level of suggestibility are more likely to have many friends on the SNS resulting in a possible environmental influence on substance use.     

Daily life impairments associated with self-reported childhood/adolescent attention-deficit/hyperactivity disorder and experiences of diagnosis and treatment: Results from the European Lifetime Impairment Survey

The Lifetime Impairment Survey assessed impairment and symptoms of attention-deficit/hyperactivity disorder (ADHD) in children/adolescents from six European countries. Parents/caregivers of children/adolescents aged < 20 years with ADHD (ADHD group; n = 535) and without ADHD (control group; n = 424) participated in an online survey. History of ADHD diagnosis was self-reported. ADHD and control groups were compared using impairment and symptom scales; higher scores indicate greater impairment. Mean (SD) age at ADHD diagnosis was 7.0 (2.8) years, following consultation of 2.7 (2.6) doctors over 20.4 (23.9) months. Parents/caregivers (64%; 344/535) reported frustration with some aspect of the diagnostic procedure; 74% (222/298) were satisfied with their child's current medication. ADHD had a negative impact on children/adolescents in all aspects of life investigated. The ADHD group had a higher mean (SD) school impairment score (2.7 [0.7]) compared with the control group (2.1 [0.7]; P < 0.001) and were more likely to be in the bottom of their class (P < 0.001). These data provide insights into impairments associated with ADHD in childhood/adolescence, and identify areas for improvement in its management and treatment.     

Driving performance in adults with ADHD: Results from a randomized,waiting list controlled trial with atomoxetine

PurposeTo investigate effects of a 12-week treatment with atomoxetine (ATX) on driving performance in real traffic, driving-related neuropsychological performance tests and self-evaluation of driving in adult patients with ADHD compared to an untreated control group with ADHD.MethodsParallel group design with an ATX and a waiting list group. At baseline and endpoint patients were evaluated with a standardized on-road driving test (SDBO), a driving-related neuropsychological test battery (Act and React Test System [ART2020]), and subjective measures of driving performance (one-week driving diary, Driver Coping Questionnaire).ResultsForty-three of the 64 included patients completed the study (n = 22 ATX, n = 21 controls). Mean intervention period was 11.9 ± 3.0 weeks, mean daily ATX dosage was 71.6 ± 14.9 mg. At endpoint, 60.1% of patients treated with ATX and 0% of waiting list group had reduced ADHD symptoms by greater or equal to 30%. In SDBO, ATX group reduced driving errors in three of four driving performance categories (attention, P < 0.05; risk-related self-control, P < 0.005; driver skills, P < 0.001), number of driving errors remained stable in control group. At endpoint, 47.6% of control group and 18.2% of ATX group (P < 0.05) did not fulfil the driving fitness criteria according to German Guidelines (percentile rank less or equal to 16 in one or more subtests in ART2020). Total number of self-reported critical traffic situations decreased from 12.0 to 6.8 per week in ATX group (P < 0.05) and remained stable in controls by 9.3 and 9.9 at baseline and endpoint (ns). Coping strategies with stressful traffic situations did not change within both groups.ConclusionOur study provides first evidence that treatment with ATX improves driving performance in real traffic in adults with ADHD.     

Tempéraments affectifs des toxicomanes : étude cas-témoins

IntroductionThe study of affective temperaments is a dimensional approach to personality that would provide a better understanding of the emergence of psychopathological disorders including addictive behaviors. However, in the literature, there is a lack of studies focusing on the links between this type of disorder and affective temperaments. Our objectives were to study the distribution of the five known affective temperaments in a group of drug addicts compared to a control group, and to identify sociodemographic and clinical factors associated with emotional traits.MethodsThis was a case-control study carried out in the drug abuse prevention center “ATUPRET” of Sfax in Tunisia. It included 50 drug addicts, all male, and 50 healthy control subjects matched for age (P = 0.22), marital status (P = 0.28), socioeconomic level (P = 0.36) and educational level (P = 0.95). Sociodemographic data were collected through an interview for drug addicts hospitalized in this center while clinical data were collected from medical records. The TEMPS-A questionnaire, 110 questions validated Tunisian version, has been used to evaluate five affective temperaments.ResultsThe average age of drug addicts was 32.98 years (19–59 years) and the average age at onset of drug use was 20.36 years (12–52 years). Among drug users, the highest mean scores were observed for hyperthymic temperament (13.68 ± 4.20), followed by cyclothymic (13.14 ± 4.89), anxious (11.32 ± 6.00) and depressive (11.02 ± 3.65) ones. The lowest mean score was for irritable temperament (10.14 ± 3.95). All of these scores, except that of cyclothymic temperament, were significantly higher than in the control group (P < 0.01). The age of drug addicts was negatively correlated with cyclothymic (P = 0.023) and irritable (P = 0.035) temperament scores. These two temperaments were more dominant in the group of drug addicts with post-secondary education (P respectively 0.035 and 0.002). The age of onset of psychoactive substance use was negatively correlated with irritable temperament (r = −0.355, P = 0.012). Cyclothymic temperament was correlated with alcohol dependence (P = 0.03) and psychiatric comorbidity (P = 0.01) among drug addicts.ConclusionThe present study provides support for the existence of temperamental dysregulation in drug-addicted patients. This result leads us to suggest that affective temperaments are implicated as a potential endophenotype and may represent a marker for the identification of persons vulnerable to drug use. These affective temperaments also appear to influence clinical features of drug addiction.     

Impulsividad en el trastorno por déficit de atención e hiperactividad en niños después de una intervención de 8 semanas con dieta mediterránea y/o ácidos grasos omega-3: ensayo clínico aleatorizado

IntroductionThe Barratt Impulsiveness Scale (BIS) is a self-administered instrument designed to assess the personality/behavioural construct of impulsiveness. Impulsiveness has been associated with several psychiatric disorders, including attention-deficit/hyperactivity disorder (ADHD). This study assesses the progression of impulsive behaviour in children with ADHD after an 8-week dietary intervention with the Mediterranean diet and/or omega-3 fatty acid supplementation, by using a version of the 11-item BIS adapted for children (BIS-11c).MethodsThis cross-sectional study includes 60 children with ADHD from the region of Madrid, Spain. Participants were divided into 4 groups, with one control group (G1) and 3 intervention groups (Mediterranean diet [G2]; omega-3 supplementation [G3]; and Mediterranean diet plus omega-3 supplementation [G4]). A personalised Mediterranean diet was designed for members of groups 2 and 4. The BIS-11c was administered to determine the level of impulsiveness, and the KIDMED test was used to assess adherence to the Mediterranean diet.ResultsThe supplementation group showed a fairly significant decrease in the total BIS-11c (P = .049). Total cognitive score slightly decreased in the diet and supplementation groups. Only the control group showed a considerable decrease in the total motor score. Total nonplanning scores were lower in all groups after the intervention. Baseline and final BIS-11c scores were positively correlated with treatments (r > 0.9).ConclusionAn intake of 550 mg EPA fatty acid and 225 mg DHA fatty acid per day for 8 weeks is associated with less marked impulsive behaviour in children with ADHD. A Mediterranean diet may improve BIS scores, although our results are not conclusive in this population.     

Validation de la version française du Sexual Addiction Screening Test (SAST-Fr)

IntroductionThe Sexual Addiction Screening Test (SAST) is one of the most frequently used tools on the international level for assessing sexual addiction. This study aimed to translate the English version of the SAST, and adapt and test the psychometric properties of its French version (the SAST-Fr) by establishing its factor structure, internal consistency and convergent validity.MethodsThree hundred ninety eight voluntary participants were recruited online through specialized forums. Participants completed a sociodemographic questionnaire, the SAST-Fr and the diagnostic criteria of sexual addiction proposed by Goodman. We tested the psychometric properties of SAST-Fr through an exploratory factorial analysis, especially its internal consistency, using the Kuder-Richardson alpha (KR-20) given that the items were dichotomous. We also performed correlation analyses of Bravais-Pearson on numerical variables. Finally, we studied the predictive validity of Goodman's score in predicting SAST-Fr criteria using a ROC (Receiver Operating Characteristics) analysis.ResultsMean age of participants was 29.08 years (± 11.30) and included 54% of women (n = 215). Statistical analysis had shown that SAST-Fr had a one-factor structure explaining 31% of the variance, an excellent internal consistency (KR-20 = 0.90). We found significant correlation between SAST-Fr item scores and PEACCE scores (r = 0.87; P < 0.001) and Goodman's criteria (r = 0.79; P < 0.001).ConclusionOur results indicate that the psychometric properties of the French version of the SAST are comparable to its original English version with a one-factor structure. The SAST-Fr is a reliable and valid questionnaire to assess symptoms of sexual addiction.     

Trends in the presentation,surgical treatment,and outcomes of tethered cord syndrome: A nationwide study from 2001 to 2010

ObjectiveThis is a nationwide query into surgical management techniques for tethered cord syndrome, focusing on patient demographic, hospital characteristics, and treatment outcomes. Our hypothesis is that detethering vs. fusion for TCS results in different in-hospital complications.Materials and methodsRetrospective review of the Nationwide Inpatient Sample 2001–2010. Inclusion: TCS discharges undergoing detethering or fusion. Sub-analysis compared TCS cases by age (pediatric [≤9 years] vs. adolescent [10–18 year]). Independent t-tests identified differences between fusion and detethering for hospital-related and surgical factors; multivariate analysis investigated procedure as a risk factor for complications/mortality.Results6457 TCS discharges: 5844 detetherings, 613 fusions. Fusion TCS had higher baseline Deyo Index (0.16 vs. 0.06), procedure-related complications (21.3% vs. 7.63%), and mortality (0.33% vs. 0.09%) than detethering, all p < 0.001. Detethering for TCS was a significant factor for reducing mortality (OR 0.195, p < 0.001), cardiac (OR 0.27, p < 0.001), respiratory (OR 0.26, p < 0.001), digestive system (OR 0.32, p < 0.001), puncture nerve/vessel (OR 0.56, p = 0.009), wound (OR 0.25, p < 0.001), infection (OR 0.29, p < 0.001), posthemorrhagic anemia (OR 0.04, p = 0.002), ARDS (OR 0.13, p < 0.001), and venous thrombotic (OR 0.53, p = 0.043) complications. Detethering increased nervous system (OR 1.34, p = 0.049) and urinary (OR 2.60, p < 0.001) complications. Adolescent TCS had higher Deyo score (0.08 vs. 0.03, p < 0.001), LOS (5.77 vs. 4.13 days, p < 0.001), and charges ($54,592.28 vs. $33,043.83, p < 0.001), but similar mortality. Adolescent TCS discharges had increased prevalence of all procedure-related complications, and higher overall complication rate (11.10% vs. 5.08%, p < 0.001) than pediatric.ConclusionsWith fusion identified as a significant risk factor for mortality and multiple procedure-related complications in TCS surgical patients, this study could aid surgeons in counseling TCS patients to optimize outcomes.     

Anticyclic modulated ventilation versus continuous positive airway pressure in patients with coexisting obstructive sleep apnea and Cheyne–Stokes respiration: a randomized crossover trial

BackgroundAlthough coexisting obstructive sleep apnea (OSA) and Cheyne–Stokes respiration (CSR) occur frequently in patients with heart diseases, optimal treatment remains unclear. Positive airway pressure (PAP) effectively treats OSA and adaptive servo-ventilation (ASV) has been shown to improve CSR. We compared a new treatment algorithm combining automatic continuous positive airway pressure (APAP) and ASV (anticyclic modulated ventilation, ACMV) versus continuous positive airway pressure (CPAP).MethodsThirty-nine patients (35 male, four female; aged 65.5 ± 9.7 years; body mass index, 31.0 ± 5.9 kg/m²) with underlying heart disease and coexisting OSA and CSR were enrolled. After diagnostic polysomnography (PSG) and CPAP titration, patients were randomized either to CPAP or to ACMV for four weeks of treatment in a crossover design.ResultsTotal apnea–hypopnea index (AHI) was 49.0 ± 18.8/h at baseline, 12.3 ± 14.6/h with CPAP (P < 0.001 vs baseline), and 3.7 ± 5.6/h with ACMV (P < 0.001 vs baseline and vs CPAP). Obstructive AHI was 20.7 ± 14.4/h at baseline, 5.1 ± 9.3/h with CPAP (P < 0.001 vs baseline), and 0.4 ± 0.4/h with ACMV (P < 0.001 vs baseline and vs CPAP). Central AHI was 28.3 ± 13.4/h at baseline, 7.2 ± 9.7/h with CPAP (P < 0.001 vs baseline) and 3.3 ± 5.4/h with ACMV (P < 0.001 vs baseline and vs CPAP). Ejection fraction was increased significantly (from 38.6 ± 15.6 to 44.4 ± 12.2%) only with ACMV. Subjective sleepiness significantly improved only with CPAP whereas objective sleep quality and treatment adherence were not different between both treatment modalities.ConclusionACMV is an effective treatment option in patients with coexisting OSA and CSR. It is superior to CPAP in reducing total AHI as well as obstructive and central AHI.     

Assessment of COVID-19 trauma responses. Who has been more traumatized during the pandemic?

Background and ObjectiveTo evaluate the effect of cognitive and sociodemographic characteristics of healthcare and non-healthcare workers on their traumatic responses to the COVID-19 pandemic.MethodsData were collected using an online survey between August-September 2020. The survey included the following scales: Beck Anxiety Inventory (BAI), Anxiety Sensitivity Index (ASI), and Impact of Event Scale-Revised (IES-R). Traumatic responses were categorized into three types: avoidance (IES-R_A), intrusion (IES-R_I), and hyperarousal (IES-R_H).ResultsThe study included a total of 672 participants, comprised of 399 (59.4%) men, and 273 (40.6%) women with a mean age of 39.25 ± 933 years. The results indicated that women had higher IES-R_I (r = .5.78, p < 0.001), IES-R_A (r = 4.47, p < 0.001), and IES-R_H (r = .5.20, p < 0.001) scores compared to men. Patients with a history of psychiatric diseases had significantly higher IES-R_I (r = ?3.82, p < 0.001), IES-R_A (r = ?2.00, p < 0.05), and IES-R_H (r = ?4.06, p < 0.001) scores compared to patients with no history of psychiatric diseases. Non-healthcare workers had significantly higher IES-R_A (r = ?2.69, p < 0.01) scores compared to healthcare workers.ConclusionFemale gender and a positive history of psychiatric diseases were found to lead to an increase in the frequency of all three traumatic responses to COVID-19. Contrary to expectation, being a healthcare worker was not found as a factor facilitating trauma response formation in our study.