Epidemiologic survey of psychiatric disorders in specialized consultation]

This epidemiological survey was performed with 317 clinicians of each structure of care (hospital, private practice...), randomly selected among french psychiatrists. During one day of a week, in January or June, all outpatients completed a self-questionnaire regarding sociodemographic data, previous and actual symptoms and for some of them randomly selected, the clinicians filled in a semi-standardized evaluation form and had to give the complete diagnosis according to the DSM III-R criteria. 2686 outpatients have completed the self-questionnaire and for 1568 (51%), the diagnosis DSM III-R was given. The mean age was 41.3; most of patients were females (59.2%), married (50.5%), urban (77.2%), employees (25.2%). The most frequent main diagnoses were: mood disorders (26%), schizophrenia (19.5%) and generalized anxiety (15%); in 47% of the cases, a second diagnosis was given. There was no significant difference between the 2 periods of evaluation. In conclusion: among psychiatric outpatients, the proportion of depression and anxiety disorders is nearly the same as in the total psychiatric population; in contrast, schizophrenia is more frequent, and alcohol or drug abuse less frequent.     

Switching to the bingeing/purging subtype of anorexia nervosa is frequently associated with suicidal attempts

OBJECTIVE: Anorexia nervosa has the highest suicide mortality ratio of psychiatric disorders, suicide being associated with many factors. We assessed the first lifetime occurrence of these factors taking into account their possible overlap. METHOD: Three hundred and four in- and out-patients with anorexia nervosa (DSM-IV) were systematically recruited in three hospitals of Paris suburbs, between December 1999 and January 2003. Patients were assessed by a face-to-face interview (DIGS). Current eating disorder dimensions were measured, and patients interviewed by a trained clinician to assess minimal BMI and, retrospectively, the age at which anorexia nervosa, major depressive disorder, anxiety disorders and switch to bingeing/purging type occurred for the first time, if applicable. RESULTS: Major depressive disorder (p<0.001) and subtype switch from the restrictive to the bingeing/purging type (p<0.001) were the two factors significantly more frequently occurring before suicidal attempts, and remained involved when a multivariate analysis is performed, whether syndromic or dimensional measures are being used. Taking into account lifetime occurrence with a survival analysis, the switch to bingeing/purging type of anorexia appears as a major predictive factor, with a large increase of the frequency of suicidal attempts (OR=15) when compared to patients with neither major depressive disorder nor bingeing/purging type. CONCLUSIONS: Bingeing/purging type of anorexia nervosa is largely associated with suicidal attempts, and may deserve specific attention. If confirmed on a prospectively designed study, these results would argue for early detection and/or more intensive and specific therapeutic intervention on this aspect of bingeing and purging behaviors.     

Energy cost and running mechanics during a treadmill run to voluntary exhaustion in humans

The aim of the present study was to examine the physiological and mechanical factors which may be concerned in the increase in energy cost during running in a fatigued state. A group of 15 trained triathletes ran on a treadmill at velocities corresponding to their personal records over 3000m?[mean 4.53 (SD 0.28) m?·?s^?1] until they felt exhausted. The energy cost of running (C _R) was quantified from the net O₂ uptake and the elevation of blood lactate concentration. Gas exchange was measured over 1?min firstly during the 3rd–4th?min and secondly during the last minute of the run. Blood samples were collected before and after the completion of the run. Mechanical changes of the centre of mass were quantified using a kinematic arm. A significant mean increase [6.9 (SD 3.5)%, P?C _R from a mean of 4.4 (SD 0.4) J?·?kg^?1?·?m^?1 to a mean of 4.7 (SD 0.4) J?·?kg^?1?·?m^?1 was observed. The increase in the O₂ demand of the respiratory muscles estimated from the increase in ventilation accounted for a considerable proportion [mean 25.2 (SD 10.4)%] of the increase in C_R. A mean increase [17.0 (SD 26.0)%, P?C _M) from a mean of 2.36 (SD 0.23) J?·?kg^?1?·?m^?1 to a mean of 2.74 (SD 0.55) J?·?kg^?1?·?m^?1 was also noted. A significant correlation was found between C _R and C _M in the non-fatigued state (r?=?0.68, P?r?=?0.25, NS). Furthermore, no correlations were found between the changes (from non-fatigued to fatigued state) in C _R and the changes in C _M suggesting that the increase in C _R is not solely dependent on the external work done per unit of distance. Since step frequency decreased slightly in the fatigued state, the internal work would have tended to decrease slightly which would not be compatible with an increase in C _R. A stepwise regressions showed that the changes in C _R were linked (r?=?0.77, P?C _R was due to an increase in the step variability. The underlying mechanisms of the relationship between C _R and step variability remains unclear.     

Perceptions,professional responsibility and management experiences of patients with alcohol,tobacco and opioid use disorder by residents in general practice and teaching general practitioners

BackgroundSubstance use disorders (SUDs) are based on pathophysiological mechanisms common to all psychoactive substances. However, general practitioners (GPs) hold different views depending on the substance in question.ObjectivesTo determine whether the perceptions that teaching GPs and final-year residents in general practice have of patients with a SUD vary according to the substance involved and explore their professional responsibility and management experiences.MethodsA cross-sectional observational study was carried out by asking residents and teaching GPs from eight faculties of medicine about their perceptions, professional responsibility and management experience of patients with tobacco, alcohol and opioid use disorders, using an online questionnaire between June and September 2017.ResultsThe responses of 238 teaching GPs (mean age 50 years SD 3.5; 58% men) and 327 residents (mean age 28 years SD 9.9; 67% women) were analysed (response rates: 9 and 15% respectively). Tobacco smokers were considered to be more responsible for their acts than the other users. Teaching GPs and residents considered that it was their responsibility to discuss substance use. They did not feel able to manage alcohol and opioid use disorders. Tobacco cessation was mainly managed alone (78%). The results were quite similar among teaching GPs and residents.ConclusionThe majority of practitioners had no difficulty managing smoking cessation. During the management of alcohol and particularly opioid use disorders, practitioners did not feel competent. The gap between their perceived responsibility and competencies should be addressed by training and promoting collaborative care.     

Plantar fibromatosis may adopt the brain gyriform pattern of a low-grade fibromyxoid sarcoma

We report the case of a 42-year-old man with histologically proven plantar fibromatosis (Ledderhose disease) demonstrating an uncommon brain gyriform pattern at MRI, so far exclusively described in the low-grade fibromyxoid sarcoma (LGFMS). An acoustic posterior enhancement at ultrasound, a high intensity on T2w and post-contrast T1wMR images were unusual and related to a high tumor cellularity at histology with no myxoid tissue. The juxtaposition of areas of high and low cellularity (with more fibrous material) in a multilobulated mass built a brain gyriform pattern at MR, similar to what was so far described exclusively in LGFMS. This case demonstrates that the brain gyriform pattern may also be observed in other soft tissue fibrous tumors with no myxoid material but with high cellularity areas alternating with fibrous zones of low cellularity.     

An alarmingly high prevalence of diabetic nephropathy in Asian type 2 diabetic patients: the MicroAlbuminuria Prevalence (MAP) Study

Aim/hypothesis Microalbuminuria represents the earliest clinical evidence of diabetic nephropathy and is a marker of increased cardiovascular morbidity and mortality. Its early detection allows the implementation of individualised and aggressive intervention programmes to reduce cardiovascular risk factors. There is limited information on the prevalence of microalbuminuria among hypertensive type 2 diabetic patients in Asia.Methods This cross-sectional epidemiological study aimed to assess the prevalence of microalbuminuria and macroalbuminuria among consecutively screened hypertensive type 2 diabetic adult patients in 103 centres in 10 Asian countries or regions. Predictive factors for microalbuminuria and macroalbuminuria were characterised using a stepwise logistic regression model.Results A total of 6,801 patients were enrolled and 5,549 patients constituted the per-protocol population (patients with bacteriuria and haematuria were excluded). The prevalence of microalbuminuria was 39.8% (39.2–40.5; 95% CI) and the prevalence of macroalbuminuria was 18.8% (18.2–19.3; 95% CI). Only 11.6% of the patients had systolic and diastolic blood pressure below the 130/80 mm Hg target. In the multivariate analyses, the predictive factors for the presence of microalbuminuria were age, BMI, systolic blood pressure and ethnic origin. The highlighted predictive factors for the presence of macroalbuminuria were age, sex, ethnic origin, BMI, duration of diabetes, presence of diabetic complications, intake of diuretics, intake of calcium channel blockers, diastolic and systolic blood pressure.Conclusions/interpretation The high prevalence (58.6%) of micro or macroalbuminuria observed in these patients is alarming and indicates an impending pandemic of diabetic cardiovascular and renal diseases in Asia with its potential economic consequences.A.Y.T. Wu, F.A. de Leon and M.R. Weir received honoraria for speaking engagements and A. Rouillon is employed by Sanofi-Synthelabo Groupe.