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Romeo B, Kervadec E, Fauvel B, Strika-Bruneau L, Amirouche A, Verroust V, Piolino P, Benyamina A. Safety and risk assessment of psychedelic psychotherapy: A meta-analysis and systematic review. Psychiatry Res 2024; 335:115880. [PMID: 38579460 DOI: 10.1016/j.psychres.2024.115880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/07/2024]
Abstract
Psychotherapies assisted by psychedelic substances have shown promising results in the treatment of psychiatric disorders. The aim of this systematic review and meta-analysis was to evaluate safety data in human subjects. We carried out a search on MEDLINE, Embase and PsycINFO databases between 2000 and 2022. Standardized mean differences between different dose ranges and between acute and subacute phases were calculated for cardiovascular data after psychedelic administration. Risk differences were calculated for serious adverse events and common side effects. Thirty studies were included in this meta-analysis. There were only nine serious adverse events for over 1000 administrations of psychedelic substances (one during the acute phase and 8 during the post-acute phase). There were no suicide attempts during the acute phase and 3 participants engaged in self-harm during the post-acute phase. There was an increased risk for elevated heart rate, systolic and diastolic blood pressure for all dose range categories, as well as an increased risk of nausea during the acute phase. Other common side effects included headaches, anxiety, and decreased concentration or appetite. This meta-analysis demonstrates that psychedelics are well-tolerated, with a low risk of emerging serious adverse events in a controlled setting with appropriate inclusion criteria.
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Affiliation(s)
- B Romeo
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800, Villejuif, France; Unité de Recherche Psychiatrie-Comorbidités-Addictions - Psycomadd - Paris Saclay University Île-de-France, France.
| | - E Kervadec
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800, Villejuif, France; Unité de Recherche Psychiatrie-Comorbidités-Addictions - Psycomadd - Paris Saclay University Île-de-France, France
| | - B Fauvel
- Laboratoire Mémoire, Cerveau et Cognition (UR 7536), Institut de Psychologie, Université de Paris Cité, Paris, France
| | - L Strika-Bruneau
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800, Villejuif, France; Unité de Recherche Psychiatrie-Comorbidités-Addictions - Psycomadd - Paris Saclay University Île-de-France, France
| | - A Amirouche
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800, Villejuif, France; Unité de Recherche Psychiatrie-Comorbidités-Addictions - Psycomadd - Paris Saclay University Île-de-France, France
| | - V Verroust
- Unité de Recherche Psychiatrie-Comorbidités-Addictions - Psycomadd - Paris Saclay University Île-de-France, France; Université Picardie-Jules Verne, France
| | - P Piolino
- Laboratoire Mémoire, Cerveau et Cognition (UR 7536), Institut de Psychologie, Université de Paris Cité, Paris, France
| | - A Benyamina
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800, Villejuif, France; Unité de Recherche Psychiatrie-Comorbidités-Addictions - Psycomadd - Paris Saclay University Île-de-France, France
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Romeo B, Fauvel B, Dejean S, Strika L, Amirouche A, Verroust V, Piolino P, Benyamina A. Impact of a Naturalistic Psychedelic Experience on Smoking: A Retrospective Survey. J Psychoactive Drugs 2023; 55:640-649. [PMID: 37341764 DOI: 10.1080/02791072.2023.2227171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 04/17/2023] [Accepted: 05/01/2023] [Indexed: 06/22/2023]
Abstract
Tobacco use disorder is a major public health concern. The aim of this study was to investigate the impact of a psychedelic experience in a natural context on tobacco use. A retrospective online survey was conducted on 173 individuals who reported having had a psychedelic experience while being smokers. Demographic information was collected, and characteristics of the psychedelic experience, tobacco addiction and psychological flexibility were assessed. Mean number of cigarettes smoked per day, and proportion of individuals with high tobacco dependency significantly decreased between the three time points (p < .001). Participants who reduced or quit smoking had more intense mystical experiences during the psychedelic session (p = .01) and lower psychological flexibility before the psychedelic experience (p = .018). The increase in psychological flexibility post psychedelic session, and the personal motives for the psychedelic experience were significant positive predictors of smoking reduction or cessation (p < .001). Our results confirmed that a psychedelic experience in smoker individuals can be associated with smoking and tobacco dependency reduction and that the personal motives for the psychedelic session, the intensity of the mystical experience, and the increase of psychological flexibility following the psychedelic experience, are associated with smoking cessation or reduction.
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Affiliation(s)
- B Romeo
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, Villejuif, France
- Unité de Recherche Psychiatrie-Comorbidités-Addictions - PSYCOMADD -Paris Saclay University Île-de-France, Villejuif, France
| | - B Fauvel
- Laboratoire Mémoire, Cerveau Et Cognition (UR 7536), Institut de Psychologie, Université de Paris Cité, Paris, France
| | - S Dejean
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, Villejuif, France
| | - L Strika
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, Villejuif, France
- Unité de Recherche Psychiatrie-Comorbidités-Addictions - PSYCOMADD -Paris Saclay University Île-de-France, Villejuif, France
| | - A Amirouche
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, Villejuif, France
- Unité de Recherche Psychiatrie-Comorbidités-Addictions - PSYCOMADD -Paris Saclay University Île-de-France, Villejuif, France
| | - V Verroust
- Unité de Recherche Psychiatrie-Comorbidités-Addictions - PSYCOMADD -Paris Saclay University Île-de-France, Villejuif, France
- Centre d'histoire des sciences, des sociétés et des conflits, Université Picardie-Jules Vernes, Amiens, France
| | - P Piolino
- Laboratoire Mémoire, Cerveau Et Cognition (UR 7536), Institut de Psychologie, Université de Paris Cité, Paris, France
| | - A Benyamina
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, Villejuif, France
- Unité de Recherche Psychiatrie-Comorbidités-Addictions - PSYCOMADD -Paris Saclay University Île-de-France, Villejuif, France
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Lestra V, Romeo B, Martelli C, Benyamina A, Hamdani N. Could CRP be a differential biomarker of illness stages in schizophrenia? A systematic review and meta-analysis. Schizophr Res 2022; 246:175-186. [PMID: 35785580 DOI: 10.1016/j.schres.2022.06.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 05/13/2022] [Accepted: 06/22/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with schizophrenia display peripheral inflammation but the impact of illness phase is not clear. Our meta-analysis investigated the difference in CRP levels between patients with schizophrenia and controls according to their illness phase. METHODS After a systematic search, all studies measuring CRP in patients with schizophrenia and controls were included. Standardized mean differences were calculated between patients and controls according to illness phase. The influence of sociodemographic and clinical variables on our results was investigated using a meta-regression analysis. RESULTS Fifty studies were included in this meta-analysis. Patients with schizophrenia had higher CRP levels than controls in the acute (p < 0.00001) and stable (p < 0.00001) stage of their disease. Patients with acute exacerbation of schizophrenia had higher CRP levels than stable patients (p = 0.02) but this difference did not persist when considering antipsychotic-medicated patients in both phases. Meta-regressions found that the increase of CRP in acutely ill patients as compared to controls was influenced by age (p < 0.01), BMI (p = 0.01) and first episode (p = 0.02), whereas the increase in CRP levels of stable patients as compared to controls was moderated by BMI (p = 0.004). CONCLUSIONS In conclusion, this meta-analysis provides strong evidence that patients with schizophrenia have higher CRP levels than controls, but also show an increase in inflammatory response in the acute stage of the disease as compared to the stable stage. CRP could thus be considered as a state marker and a trait marker of the disease.
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Affiliation(s)
- V Lestra
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800 Villejuif, France; Unité Psychiatrie-Comorbidités-Addictions, PSYCOMADD 4872, Université Paris-Sud - AP-HP, Université Paris Saclay, France
| | - B Romeo
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800 Villejuif, France; Unité Psychiatrie-Comorbidités-Addictions, PSYCOMADD 4872, Université Paris-Sud - AP-HP, Université Paris Saclay, France.
| | - C Martelli
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800 Villejuif, France; Unité Psychiatrie-Comorbidités-Addictions, PSYCOMADD 4872, Université Paris-Sud - AP-HP, Université Paris Saclay, France; Institut National de la Santé et de la Recherche Médicale U1299, Research unit, NeuroImaging and Psychiatry, Paris Sud University, Paris Saclay University, Paris Descartes University, Digiteo Labs, Bâtiment 660, Gif-sur-Yvette, France
| | - A Benyamina
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800 Villejuif, France; Unité Psychiatrie-Comorbidités-Addictions, PSYCOMADD 4872, Université Paris-Sud - AP-HP, Université Paris Saclay, France
| | - N Hamdani
- Unité Psychiatrie-Comorbidités-Addictions, PSYCOMADD 4872, Université Paris-Sud - AP-HP, Université Paris Saclay, France; Cédiapsy, 87 rue d'Assas, 75006 Paris, France
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Maatoug R, Bihan K, Duriez P, Podevin P, Silveira-Reis-Brito L, Benyamina A, Valero-Cabré A, Millet B. Non-invasive and invasive brain stimulation in alcohol use disorders: A critical review of selected human evidence and methodological considerations to guide future research. Compr Psychiatry 2021; 109:152257. [PMID: 34246194 DOI: 10.1016/j.comppsych.2021.152257] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Alcohol use disorder (AUD) ranks among the leading causes of decrements in disability-adjusted life-years. Long-term exposure to alcohol leads to an imbalance of activity between frontal cortical systems and the striatum, thereby enhancing impulsive behaviours and weakening inhibitory control. Alternative therapeutic approaches such as non-invasive and invasive brain stimulation have gained some momentum in the field of addictology by capitalizing on their ability to target specific anatomical structures and correct abnormalities in dysfunctional brain circuits. MATERIALS AND METHODS The current review, covers original peer-reviewed published research on the use of brain stimulation methods for the rehabilitation of AUD. A broad and systematic search was carried out on four electronic databases: NCBI PubMed, Web of Science, Handbooks and the Cochrane Library. Any original article in English or French language, without restrictions of patient age or gender, article type and publication outlet, were included in the final pool of selected studies. RESULTS The outcomes of this systematic review suggest that the dorsolateral prefrontral cortex (DLPFC) is a promising target for treating AUD with high frequency repetitive transcranial magnetic stimulation. Such effect would reduce feelings of craving by enhancing cognitive control and modulating striatal function. Existing literature also supports the notion that changes of DLPFC activity driven by transcranial direct current stimulation, could decrease alcohol craving and consumption. However, to date, no major differences have been found between the efficacy of these two non-invasive brain-stimulation approaches, which require further confirmation. In contrast, beneficial stronger evidence supports an impact of deep brain stimulation reducing craving and improving quality of life in AUD, effects that would be mediated by an impact on the nucleus accumbens, a central structure of the brain's reward circuitry. Overall, neurostimulation shows promise contributing to the treatment of AUD. Nonetheless, progress has been limited by a number of factors such as the low number of controlled randomized trials, small sample sizes, variety of stimulation parameters precluding comparability and incomplete or questionable sham-conditions. Additionally, a lack of data concerning clinical impact on the severity of AUD or craving and the short follow up periods precluding and accurate estimation of effect duration after discontinuing the treatment, has also limited the clinical relevance of final outcomes. CONCLUSION Brain stimulation remains a promising approach to contribute to AUD therapy, co-adjuvant of more conventional procedures. However, a stronger therapeutic rational based on solid physio-pathological evidence and accurate estimates of efficacy, are still required to achieve further therapeutic success and expand clinical use.
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Affiliation(s)
- R Maatoug
- Sorbonne Université, AP-HP, Service de psychiatrie adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, F-75013 Paris, France.
| | - K Bihan
- Regional pharmacovigilance center, department of pharmacology, Pitié-Salpêtrière hospital, 47/83, boulevard de l'Hôpital, 75013 Paris, France
| | - P Duriez
- Institute of Psychiatry and Neurosciences of Paris, Unité Mixte de Recherche en Santé (UMRS) 1266 Institut National de la Santé et de la Recherche Médicale (INSERM), University Paris Descartes, Paris, France; Clinique des Maladies Mentales et de l'Encéphale, Groupement Hospitalier Universitaire (GHU) Paris Psychiatry and Neuroscience, Sainte-Anne Hospital, Paris, France
| | - P Podevin
- Sorbonne Université, AP-HP, Service de psychiatrie adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, F-75013 Paris, France
| | - L Silveira-Reis-Brito
- Sorbonne Université, AP-HP, Service de psychiatrie adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, F-75013 Paris, France; Rede mater dei de saúde, Brazil
| | - A Benyamina
- Dispositif Territorial de Recherche et de Formation (DTRF) Paris Sud, 94275 Le Kremlin-Bicêtre, France; Département de psychiatrie et d'addictologie, Hôpital Paul Brousse, Hôpitaux Universitaires Paris Sud, Assistance Publique-Hôpitaux de Paris, 94800 Villejuif, France
| | - A Valero-Cabré
- Institut du Cerveau et de la Moelle Epinière (ICM), CNRS UMR 7225, INSERM U 1127 and Sorbonne Université, Paris, France; Laboratory for Cerebral Dynamics Plasticity and Rehabilitation, Boston University, School of Medicine, Boston, MA, USA; Cognitive Neuroscience and Information Technology Research Program, Open University of Catalonia (UOC), Barcelona, Spain
| | - B Millet
- Sorbonne Université, AP-HP, Service de psychiatrie adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, F-75013 Paris, France
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Berkovitch L, Roméo B, Karila L, Gaillard R, Benyamina A. [Efficacy of psychedelics in psychiatry, a systematic review of the literature]. Encephale 2021; 47:376-387. [PMID: 33888297 DOI: 10.1016/j.encep.2020.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Psychedelics are powerful psychoactive substances. Natural psychedelics have been used for millennia by human civilizations, in particular in Latin America, while synthetic psychedelics were discovered in the 50s, giving rise to a lot of research before they were prohibited. More recently, their therapeutic properties have been studied especially to help patients with psychiatric conditions, psychological distress or substance use disorders. This article is a systematic review of the literature which aims to provide an overview of all studies that assessed the efficacy of psychedelics, i.e. psilocybin, ayahuasca and lysergic acid diethylamide (LSD), on psychiatric diseases and addictions. METHODS We conducted this literature review following the PRISMA recommendations. MEDLINE, PsycInfo, Web of Science and Scopus were searched from January 1990 to May 2020 with the following keywords "(ayahuasca OR psilocybin OR lysergic acid diethylamide) AND (depression OR anxiety OR major depressive disorder OR bipolar disorder OR anxiety disorder OR substance use disorder OR dependence)". RESULTS Twenty-five articles met the inclusion criteria. Five articles studied psychedelic efficacy in the treatment of life-threatening diseases related to anxiety and depression: four were randomized controlled crossover trials (three with psilocybin for a total of 92 patients, and one with LSD, n=12), and one was a long-term follow-up study. Eleven articles explored the efficacy of psychedelics in the treatment of major depressive episodes: two were open-labeled trials (one with ayahuasca, n=17, one with psilocybin, n=20), one was a randomized controlled trial using ayahuasca against placebo (n=29), and the others were long-term follow-up studies or assessed more precise dimensions of the depressive disorder, such as suicidality, emotion processing or personality traits. Eight articles studied the efficacy of psychedelics in the treatment of addictions: two were open-labeled studies using psilocybin (one in alcohol use disorder, n=10, and one in tobacco use disorder, n=15), and the others were long-term follow-up studies or retrospective observational descriptive studies on alcohol, tobacco, opioids, cannabis, and psychostimulants. One study explored the efficacy of psilocybin in obsessional-compulsive disorder (n=9). Overall, these studies found a quick and important response after psychedelic administration that lasted for several months, even after a single dose. However most of these studies were descriptive or open-label studies conducted on small size samples. No severe adverse events occurred. CONCLUSIONS Psychedelics are promising treatments for anxiety, depression and addiction, their efficacy is quick and sustainable, and they are well tolerated. These effects need to be confirmed in larger studies and compared to standard care.
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Affiliation(s)
- L Berkovitch
- Université de Paris, 75006 Paris, France; Département de psychiatrie, service Hospitalo-Universitaire, GHU Paris psychiatrie & neurosciences, 75014 Paris, France.
| | - B Roméo
- Département de psychiatrie et d'addictologie AP-HP, hôpital Paul Brousse, Villejuif, France; Unité psychiatrie-comorbidités-addictions-unité de recherche PSYCOMADD 4872, Université Paris Saclay, France
| | - L Karila
- Département de psychiatrie et d'addictologie AP-HP, hôpital Paul Brousse, Villejuif, France; Unité psychiatrie-comorbidités-addictions-unité de recherche PSYCOMADD 4872, Université Paris Saclay, France
| | - R Gaillard
- Université de Paris, 75006 Paris, France; Département de psychiatrie, service Hospitalo-Universitaire, GHU Paris psychiatrie & neurosciences, 75014 Paris, France; Unité de neuropathologie expérimentale, département santé globale, institut Pasteur, 75015 Paris, France
| | - A Benyamina
- Département de psychiatrie et d'addictologie AP-HP, hôpital Paul Brousse, Villejuif, France; Unité psychiatrie-comorbidités-addictions-unité de recherche PSYCOMADD 4872, Université Paris Saclay, France
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Gay F, Romeo B, Martelli C, Benyamina A, Hamdani N. Cytokines changes associated with electroconvulsive therapy in patients with treatment-resistant depression: a Meta-analysis. Psychiatry Res 2021; 297:113735. [PMID: 33497973 DOI: 10.1016/j.psychres.2021.113735] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 01/14/2021] [Indexed: 12/11/2022]
Abstract
One third of depressive patients do not achieve remission after several steps of treatment and are considered as treatment resistant. Electroconvulsive therapy (ECT) improves symptoms in 70 to 90% of such cases. Resistant depression is associated with a dysregulation of the immune system with a dysbalance between the pro- and the anti-inflammatory cytokines. Therefore, we aimed to measure the kinetic of cytokines levels before, during and at the end of ECT. To test this hypothesis, we performed a meta-analysis assessing cytokines plasma levels before, during and after ECT in patients with major depressive disorders. After a systematic database search, means and standard deviations were extracted to calculate standardized mean differences. We found that IL-6 levels increased after 1 or 2 ECT session (p = 0.01) then decrease after 4 ECT sessions (p < 0.01) with no difference at the end of ECT (p = 0.94). A small number of studies were included and there was heterogeneity across them. The present meta-analysis reveals that ECT induces an initial increase of IL-6 levels and a potential decrease of TNF-α levels. No changes on IL-4 and IL-10 levels were found. Further work is necessary to clarify the impact of ECT on peripheral cytokines.
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Affiliation(s)
- F Gay
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800 Villejuif, France
| | - B Romeo
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800 Villejuif, France; Unité de recherche Psychiatrie-Comorbidités-Addictions - PSYCOMADD 4872 - Université Paris-Sud - AP-HP - Université Paris Saclay.
| | - C Martelli
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800 Villejuif, France; Unité de recherche Psychiatrie-Comorbidités-Addictions - PSYCOMADD 4872 - Université Paris-Sud - AP-HP - Université Paris Saclay; Institut National de la Santé et de la Recherche Médicale U1000, Research unit, NeuroImaging and Psychiatry, Paris Sud University, Paris Saclay University, Paris Descartes University, Digiteo Labs, Bâtiment 660, Gif-sur-Yvette, France
| | - A Benyamina
- APHP, Paul Brousse Hospital, Department of Psychiatry and Addictology, F-94800 Villejuif, France; Unité de recherche Psychiatrie-Comorbidités-Addictions - PSYCOMADD 4872 - Université Paris-Sud - AP-HP - Université Paris Saclay
| | - N Hamdani
- Unité de recherche Psychiatrie-Comorbidités-Addictions - PSYCOMADD 4872 - Université Paris-Sud - AP-HP - Université Paris Saclay; Cédiapsy, 1 avenue Jean Moulin 75014 Paris
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Romeo B, Rari E, Mazari A, Toullec A, Martelli C, Benyamina A. First-episode psychosis following vaccination against yellow fever: A case report. Encephale 2021; 47:630-631. [PMID: 33541715 DOI: 10.1016/j.encep.2020.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 09/14/2020] [Indexed: 10/22/2022]
Affiliation(s)
- B Romeo
- Department of psychiatry and addictology, Paul Brousse hospital, AP-HP, 12, avenue Paul Vaillant-Couturier, 94800 Villejuif, France; Unité de recherche 4872 psychiatrie-comorbidités-addictions - PSYCOMADD, Paris Saclay university, Le Kremlin Bicêtre;, France.
| | - E Rari
- Department of psychiatry and addictology, Paul Brousse hospital, AP-HP, 12, avenue Paul Vaillant-Couturier, 94800 Villejuif, France; Unité de recherche 4872 psychiatrie-comorbidités-addictions - PSYCOMADD, Paris Saclay university, Le Kremlin Bicêtre;, France
| | - A Mazari
- Department of psychiatry and addictology, Paul Brousse hospital, AP-HP, 12, avenue Paul Vaillant-Couturier, 94800 Villejuif, France; Unité de recherche 4872 psychiatrie-comorbidités-addictions - PSYCOMADD, Paris Saclay university, Le Kremlin Bicêtre;, France
| | - A Toullec
- Department of psychiatry and addictology, Paul Brousse hospital, AP-HP, 12, avenue Paul Vaillant-Couturier, 94800 Villejuif, France; Unité de recherche 4872 psychiatrie-comorbidités-addictions - PSYCOMADD, Paris Saclay university, Le Kremlin Bicêtre;, France
| | - C Martelli
- Department of psychiatry and addictology, Paul Brousse hospital, AP-HP, 12, avenue Paul Vaillant-Couturier, 94800 Villejuif, France; Unité de recherche 4872 psychiatrie-comorbidités-addictions - PSYCOMADD, Paris Saclay university, Le Kremlin Bicêtre;, France; Digiteo Labs, research unit, neuroImaging and psychiatry, Paris Sud university - Paris Saclay university, Paris Descartes university, Institut national de la santé et de la recherche médicale U1000, bâtiment 660, Gif-sur-Yvette, France
| | - A Benyamina
- Department of psychiatry and addictology, Paul Brousse hospital, AP-HP, 12, avenue Paul Vaillant-Couturier, 94800 Villejuif, France; Unité de recherche 4872 psychiatrie-comorbidités-addictions - PSYCOMADD, Paris Saclay university, Le Kremlin Bicêtre;, France
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Chevance A, Gourion D, Hoertel N, Llorca PM, Thomas P, Bocher R, Moro MR, Laprévote V, Benyamina A, Fossati P, Masson M, Leaune E, Leboyer M, Gaillard R. [Ensuring mental health care during the SARS-CoV-2 epidemic in France: A narrative review]. Encephale 2020; 46:S3-S13. [PMID: 32312567 PMCID: PMC7130411 DOI: 10.1016/j.encep.2020.03.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 03/29/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The lack of ressources and coordination to face the epidemic of coronavirus raises concerns for the health of patients with mental disorders in a country where we keep in memory the dramatic experience of famine in psychiatric hospitals during the Second World War. This article aims at proposing guidance to ensure mental health care during the SARS-CoV epidemy in France. METHODS Authors performed a narrative review identifying relevant results in the scientific and medical literature and local initiatives in France. RESULTS We identified four types of major vulnerabilities in patients suffering from mental disorders during this pandemic: (1) medical comorbidities that are more frequently found in patients suffering from mental disorders (cardiovascular and pulmonary pathologies, diabetes, obesity, etc.) which represent risk factors for severe infections with Covid-19; (2) age (the elderly constituting the population most vulnerable to coronavirus); (3) cognitive and behavioral troubles which can hamper compliance with confinement and hygiene measures and finally and (4) psychosocial vulnerability due to stigmatization and/or socio-economic difficulties. Furthermore, the mental health healthcare system is more vulnerable than other healthcare systems. Current government plans are poorly adapted to psychiatric establishments in a context of major shortage of organizational, material and human resources. In addition, a certain number of structural aspects make the psychiatric institution particularly vulnerable: many beds are closed, wards have a high density of patients, mental health community facilities are closed, medical teams are understaffed and poorly trained to face infectious diseases. We could also face major issues in referring patients with acute mental disorders to intensive care units. To maintain continuity of psychiatric care in this pandemic situation, several directions can be considered, in particular with the creation of Covid+ units. These units are under the dual supervision of a psychiatrist and of an internist/infectious disease specialist; all new entrants should be placed in quarantine for 14 days; the nurse staff should benefit from specific training, from daily medical check-ups and from close psychological support. Family visits would be prohibited and replaced by videoconference. At the end of hospitalization, in particular for the population of patients in compulsory ambulatory care situations, specific case-management should be organized with the possibility of home visits, in order to support them when they get back home and to help them to cope with the experience of confinement, which is at risk to induce recurrences of mental disorders. The total or partial closure of mental health community facilities is particularly disturbing for patients but a regular follow-up is possible with telemedicine and should include the monitoring of the suicide risk and psychoeducation strategies; developing support platforms could also be very helpful in this context. Private psychiatrists have also a crucial role of information with their patients on confinement and barrier measures, but also on measures to prevent the psychological risks inherent to confinement: maintenance of sleep regularity, physical exercise, social interactions, stress management and coping strategies, prevention of addictions, etc. They should also be trained to prevent, detect and treat early warning symptoms of post-traumatic stress disorder, because their prevalence was high in the regions of China most affected by the pandemic. DISCUSSION French mental healthcare is now in a great and urgent need for reorganization and must also prepare in the coming days and weeks to face an epidemic of emotional disorders due to the containment of the general population.
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Affiliation(s)
- A Chevance
- Université de Paris, CRESS, Inserm, INRA, 75004 Paris, France.
| | - D Gourion
- HEC Paris (Jouy-en-Josas), Paris, France
| | - N Hoertel
- Centre ressource régional de psychiatrie du sujet âgé (CRRPSA), service de psychiatrie et d'addictologie de l'adulte et du sujet âgé, DMU psychiatrie et addictologie, Inserm U1266, institut de psychiatrie et neurosciences de Paris, centre université de Paris, AP-HP, Paris, France
| | - P-M Llorca
- Université Clermont-Auvergne, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - P Thomas
- Laboratoire de sciences cognitives et sciences affectives (SCALab-PsyCHIC), université de Lille, CNRS UMR 9193, CHU de Lille, Lille, France
| | | | - M-R Moro
- Université de Paris, collège national des universitaires de psychiatrie (CNUP), Inserm, CESP, Paris, France
| | - V Laprévote
- Pôle hospitalo-universitaire de psychiatrie d'adultes et d'addictologie du Grand-Nancy, centre psychothérapique de Nancy, Laxou, France; Faculté de médecine, université de Lorraine, Nancy, France
| | - A Benyamina
- Département de psychiatrie et d'addictologie, hôpital Paul-Brousse, AP-HP, 94800 Villejuif, France; Unité psychiatrie-comorbidités-addictions-unité de recherche, PSYCOMADD université Paris Sud, université Paris Saclay, AP-HP, Paris, France
| | - P Fossati
- Service de psychiatrie adultes, Sorbonne université, groupe hospitalier Pitié-Salpêtrière, ICM, Inserm U1127, AP-HP, Paris, France
| | - M Masson
- SHU, GHU psychiatrie et neurosciences, Nightingale Hospitals-Paris, clinique du Château-de-Garches, Paris, France
| | - E Leaune
- Centre hospitalier Le Vinatier, Bron, France; Université Lyon, Lyon, France
| | - M Leboyer
- Université Paris Est Créteil, Inserm, Fondation FondaMental, AP-HP, Paris, France
| | - R Gaillard
- Université de Paris, GHU psychiatrie et neurosciences, Paris, France
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9
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Chevance A, Gourion D, Hoertel N, Llorca PM, Thomas P, Bocher R, Moro MR, Laprévote V, Benyamina A, Fossati P, Masson M, Leaune E, Leboyer M, Gaillard R. Ensuring mental health care during the SARS-CoV-2 epidemic in France: A narrative review. Encephale 2020; 46:193-201. [PMID: 32370982 PMCID: PMC7174154 DOI: 10.1016/j.encep.2020.04.005] [Citation(s) in RCA: 141] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The lack of resources and coordination to face the coronavirus epidemic raises concerns for the health of patients with mental disorders in a country where we still have memories of the dramatic experience of famine in psychiatric hospitals during the Second World War. This article aims to propose guidance to ensure mental health care during the SARS-CoV epidemic in France. METHODS The authors performed a narrative review identifying relevant results in the scientific and medical literature and in local initiatives in France. RESULTS We identified four types of major vulnerabilities among patients with mental disorders during this pandemic: (1) medical comorbidities that are more frequently found among patients with mental disorders (cardiovascular and pulmonary pathologies, diabetes, obesity, etc.) which are risk factors for severe covid-19 infection; (2) age (the elderly form the population most vulnerable to the coronavirus); (3) cognitive and behavioural disorders, which can hamper compliance with confinement and hygiene measures and finally and (4) psychosocial vulnerability as a result of stigmatization and/or socio-economic difficulties. Furthermore, the mental health healthcare system is more vulnerable than other healthcare systems. Current government plans are poorly suited to psychiatric establishments in a context of major shortages of organizational, material and human resources. In addition, a certain number of structural aspects make the psychiatric institution particularly vulnerable: many beds have been closed, wards have high densities of patients, mental health community facilities are closed, and medical teams are understaffed and poorly trained to face infectious diseases. There are also major issues when referring patients with acute mental disorders to intensive care units. To maintain the continuity of psychiatric care in this pandemic situation, several directions can be considered, in particular with the creation of "COVID+ units". These units are under the dual supervision of a psychiatrist and an internist/infectious disease specialist; all new entrants are placed in quarantine for 14 days; the nursing staff receives specific training, daily medical check-ups and close psychological support. Family visits are prohibited and replaced by videoconference. At the end of hospitalization, in particular for the population of patients in compulsory ambulatory care situations, specific case-management are organized with the possibility of home visits, in order to support patients when they get back home and to help them cope with the experience of confinement, which is liable to induce recurrences of mental disorders. The total or partial closure of community mental health facilities is particularly disturbing for patients, but a regular follow-up is possible with telemedicine and should include the monitoring of suicide risk and psycho-education strategies; developing support platforms could also be very helpful in this context. Private practice psychiatrists also have a crucial role of information towards their patients on confinement and barrier measures, and also on measures to prevent the psychological risks inherent in confinement: maintenance of regular sleep r, physical exercise, social interactions, stress management and coping strategies, prevention of addictions, etc. They should also be trained to prevent, detect and treat early warning symptoms of post-traumatic stress disorder, because their prevalence was high in the regions of China most affected by the pandemic. DISCUSSION French mental healthcare is now facing a great and urgent need for reorganization and must also prepare in the coming days and weeks to face an epidemic of emotional disorders due to the confinement of the general population.
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Affiliation(s)
- A Chevance
- Université de Paris, CRESS, Inserm, INRA, 75004 Paris, France.
| | - D Gourion
- Psychiatre libéral, HEC, Paris (Jouy-en-Josas), France
| | - N Hoertel
- Centre ressource régional de psychiatrie du sujet âgé (CRRPSA), Service de psychiatrie et d'addictologie de l'adulte et du sujet âgé, DMU psychiatrie et addictologie, AP-HP, Centre-Université de Paris, Inserm U1266, Institut de psychiatrie et neurosciences de Paris, France
| | - P-M Llorca
- CHU Clermont-Ferrand, Clermont-Ferrand, France; Université Clermont Auvergne, Clermont-Ferrand, France
| | - P Thomas
- CHU Lille, Université de Lille, CNRS UMR 9193, laboratoire de sciences cognitives et sciences affectives (SCALab-PsyCHIC), Lille, France
| | | | - M-R Moro
- Université de Paris, Présidente du Collège National des Universitaires de Psychiatrie (CNUP), Inserm, CESP, Paris, France
| | - V Laprévote
- Pôle hospitalo-universitaire de psychiatrie d'adultes et d'addictologie du Grand-Nancy, Centre Psychothérapique de Nancy, Faculté de Médecine, Université de Lorraine, Nancy, France
| | - A Benyamina
- AP-HP, Hôpital Paul Brousse, Département de Psychiatrie et d'Addictologie, Unité Psychiatrie-Comorbidités-Addictions-Unité de Recherche, PSYCOMADD Université Paris Sud - AP-HP, Université Paris Saclay, 94800 Villejuif, France
| | - P Fossati
- Service de psychiatrie adultes, APHP, Sorbonne université, Groupe Hospitalier pitié Salpêtrière, ICM, Inserm U1127, Paris, France
| | - M Masson
- Nightingale Hospitals-Paris, Clinique du Château de Garches, SHU, GHU Psychiatrie et neurosciences, Paris, France
| | - E Leaune
- Centre Hospitalier Le Vinatier, Université Lyon, Bron, Lyon, France
| | - M Leboyer
- AP-HP, Université Paris Est Créteil, Inserm, Fondation FondaMental, Paris, France
| | - R Gaillard
- Université de Paris, GHU Psychiatrie et neurosciences, Président de la sous-section 49-03 du Conseil National des Universités (CNU), Paris, France
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Charre M, Herrero H, Martelli C, Benyamina A. [Hallucinogen perception persisting disorder: Discussion about a clinic situation]. Encephale 2020; 46:408-409. [PMID: 32151453 DOI: 10.1016/j.encep.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/10/2020] [Accepted: 01/16/2020] [Indexed: 10/24/2022]
Affiliation(s)
- M Charre
- Département de psychiatrie et d'addictologie, hôpital Paul-Brousse, AP-HP, 12, avenue P. V. Couturier, 94800 Villejuif, France
| | - H Herrero
- Département de psychiatrie et d'addictologie, hôpital Paul-Brousse, AP-HP, 12, avenue P. V. Couturier, 94800 Villejuif, France; Groupe hospitalier Paul-Guiraud, 94800 Villejuif, France
| | - C Martelli
- Département de psychiatrie et d'addictologie, hôpital Paul-Brousse, AP-HP, 12, avenue P. V. Couturier, 94800 Villejuif, France; Université Paris-Saclay École Normale Supérieure Paris-Saclay, CNRS 9010, Centre Borelli, Cachan, Institute for Health and Medical Research INSERM ERL « Trajectoires développementales en psychiatrie » , Digiteo - Labs, bâtiment 660, Claude-Shannon, avenue des Sciences, 91190 Gif-sur-Yvette, France.
| | - A Benyamina
- Département de psychiatrie et d'addictologie, hôpital Paul-Brousse, AP-HP, 12, avenue P. V. Couturier, 94800 Villejuif, France; Faculté de médecine, université Paris Saclay, Le Kremlin-Bicêtre, France
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11
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Roméo B, Petillion A, Martelli C, Benyamina A. Failure of rechallenge clozapine after agranulocytosis: A case report. Encephale 2019; 45:449-450. [PMID: 30878138 DOI: 10.1016/j.encep.2019.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/19/2019] [Accepted: 02/11/2019] [Indexed: 10/27/2022]
Affiliation(s)
- B Roméo
- Department of psychiatry and addictology, Paul Brousse hospital, AP-HP, 12, avenue Paul Vaillant Couturier, 94800 Villejuif, France; Faculté de médecine, Paris Sud university, Le Kremlin-Bicetre, 94270 Île-de-France, France; Institut national de la santé et de la recherche médicale U 1178, 91190 Paris, France.
| | - A Petillion
- Department of psychiatry and addictology, Paul Brousse hospital, AP-HP, 12, avenue Paul Vaillant Couturier, 94800 Villejuif, France
| | - C Martelli
- Department of psychiatry and addictology, Paul Brousse hospital, AP-HP, 12, avenue Paul Vaillant Couturier, 94800 Villejuif, France; Institut national de la santé et de la recherche médicale U1000, Research unit, NeuroImaging and Psychiatry, Paris Sud university-Paris Saclay University, Paris Descartes University, Digiteo Labs, Bâtiment 660, Gif-sur-Yvette, France
| | - A Benyamina
- Department of psychiatry and addictology, Paul Brousse hospital, AP-HP, 12, avenue Paul Vaillant Couturier, 94800 Villejuif, France; Faculté de médecine, Paris Sud university, Le Kremlin-Bicetre, 94270 Île-de-France, France; Institut national de la santé et de la recherche médicale U 1178, 91190 Paris, France
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12
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Lafaye G, Benyamina A. Clock genes SNP array identifies a key role of the PER1/HES7 gene in the risk of cannabis addiction and psychiatric comorbidities. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.1739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The existence of biological rhythms disruption in addicted subjects has been described including disturbances in their sleep-wake pattern, rest-activity rhythms, and feeding schedules. Circadian rhythms have also been related to psychiatric diseases, including mood and anxiety disorders and the regulation of dopaminergic transmission, especially in reward circuitry in substance abusers. The relationship between them remained enigmatic and no data on the role of clock genes variants on cannabis dependence have been documented. We aimed at exploring the role of clock gene genotypes as potential predisposing factor to cannabis addiction, using a high throughput mass spectrometry methodology that enables the large-scale analysis of all the known clinically-relevant polymorphisms of the core human clock genes. We have conducted a case-control study on 177 Caucasians categorizing between cannabis-addicted subjects (n = 83) and casual cannabis consumers (n = 94). We report here a strong association between the TT* genotype RS1442849 in PER1/HES7 gene and a significantly higher risk of vulnerability to be dependent to cannabis. Moreover, this SNP was overrepresented in the subsets of cannabis users with more severe characteristics like personal psychiatric history, unemployed status, and beginning of cannabis use early in lifetime as well as large weekly consumption. HES7 gene is a newly described gene with a circadian expression regulated by reactive oxygen species in many cell types including neural stem cells. The HES7 TT* genotype RS1442849 gene could intervene on the dopamine reward systems. This genotype thus represents the first potential biomarker for stratification of cannabis consumers for the risk to develop a true dependence.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Dupont P, Benyamina A, Aubin HJ. Sécurité d’emploi de la nicotine au long cours : le débat n’est pas clos. Rev Mal Respir 2016; 33:892-898. [DOI: 10.1016/j.rmr.2016.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 11/07/2015] [Indexed: 02/02/2023]
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14
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Omarkharoubi P, Benyamina A. Aluminum and brain transaminase activity. Toxicol Lett 2015. [DOI: 10.1016/j.toxlet.2015.08.797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Chiali A, Khelil A, Mahmoudi N, Moulay I, Hamlaoui M, Kettaf N, Belatrous I, Hakim Mohammed G, Boumehdi A, Benyamina A, Kadri A, Hacène F. Rosacée oculaire : à propos d’un cas. Ann Dermatol Venereol 2013. [DOI: 10.1016/j.annder.2013.01.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Karila L, Seringe E, Benyamina A, Reynaud M. The reliability and validity of the French version of the Cocaine Craving Questionnaire-Brief. Curr Pharm Des 2011; 17:1369-75. [PMID: 21534927 DOI: 10.2174/138161211796150819] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 05/03/2011] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Cocaine has become a noticeable part of the European drug scene and is the second most commonly used illicit drug among the general population. Craving is a core issue in cocaine dependence and is strongly associated with lapse and/or relapse. However, no craving scale exists in French. The objective of our study was to assess the reliability and validity of a French language version of the 10-item Cocaine Craving Questionnaire-Brief (CCQ-Brief). METHODS A total of 131 individuals ranging in age from 18 to 65 years were enrolled in a 12-month outpatient treatment program in 2009. The participants were seeking treatment for cocaine dependence. They completed the Mini-International Neuropsychiatric Interview (MINI) and the French version of the CCQ-Brief. At the end of the interview, a Clinical Global Impression Scale (CGIS) was completed by a clinician blind to the subject's treatment group. We evaluated the internal consistency of the French CCQ-Brief using Cronbach's α coefficient and the correlation of each item with the total scale using the Pearson's coefficient. We conducted an exploratory factorial analysis followed by a scree test. Only items with factor loading >0.3 were retained. The convergent validity of the French CCQ-Brief was assessed using Pearson's correlation between the CCQ-Brief and the CGIS. RESULTS The mean (SD) score of the 10-item CCQ-Brief was 3.4 (1.5). Cronbach's α coefficient 0.88 and remained high even when an item was deleted (ranging from 0.86 to 0.88), indicating that this tool possesses a high internal consistency. Each item exhibited a strong correlation with the total score ranging from 0.62 to 0.83. All items presented factor loadings ranged from 0.47 to 0.83. The correlation between the CCQ-Brief and the CGIS was high (r=0.49, p<0.0001), indicating a sufficient convergent validity. DISCUSSION The French version of the CCQ-Brief is a reliable and valid instrument that can provide a comprehensive assessment of cocaine craving in treatment-seeking cocaine-dependent patients.
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Affiliation(s)
- L Karila
- Addiction Research and Treatment Center, Paul-Brousse Hospital (Assistance Publique-Hôpitaux de Paris [AP-HP]), Villejuif, France.
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Ganzleben I, Seitz H, Mueller S, Millonig G, Helminen A, Salaspuro M, Vakevainen S, Breitkopf-Heinlein K, Gaitantzi H, Meyer C, Li Q, Dzieran J, Millonig G, Mueller S, Bantel H, Bergheim I, Dooley S, Helminen A, Salaspuro M, Vakevainen S, Blecha L, Benyamina A, Domart M, Lemoine A, Debuire B, Saffroy R, Reynaud M. S22 * YOUNG RESEARCHER SYMPOSIUM II: PATHOGENETIC MECHANISMS OF ALCOHOLIC ASSOCIATED ORGAN INJURY * S22.1 * IRON METABOLISM IN PATIENTS WITH ALD. Alcohol Alcohol 2011. [DOI: 10.1093/alcalc/agr112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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Blecha L, Benyamina A, Reynaud M. [Family management of cannabis in adolescent]. Arch Pediatr 2009; 17:191-4. [PMID: 19892535 DOI: 10.1016/j.arcped.2009.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Revised: 09/07/2009] [Accepted: 09/21/2009] [Indexed: 11/26/2022]
Abstract
Cannabis is the most frequently used illegal drug in France. In 2007, the average age for a first use was 15.1 years. Most teenagers will limit their use to a few experiences or controlled use. However, for those who do become dependent, the lapse between the first use and dependence is brief (approximately 18 months) with an average of 28 months compared to tobacco (3-5 years) and alcohol (5-9 years). In light of this brief delay, it is crucial to quickly recognize adolescents who have problem cannabis use and to educate parents to warning signs and to teach them how to efficiently discuss the subject with their teenager. Multidimensional Family Therapy, Cognitive and Behavioral Family Therapy and Brief Strategic Family Therapy have shown their efficacy in clinical trials. Improving family dynamics represents not only a motivational opportunity to help the adolescent to adhere to drug dependence treatment, but may also facilitate reintegration into a drug-free social environment and maintenance in a drug-free existence. Family interventions have been shown to be even more effective when community family assistance relations (social workers, educational counselors) are optimized. Family therapy should also be combined with personal empowerment and life planning interventions which enable the adolescent to increase his self-esteem through scholastic and professional achievement.
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Affiliation(s)
- L Blecha
- Inserm U669, 75014 Paris, France
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19
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Abstract
Numerous symptoms in psychiatry are subjective (e.g., sadness, anxiety, craving or fatigue), fluctuate and are environment dependent. Accurate measurement of these phenomena requires repeated measures, and ideally needs to be performed in the patient's natural environment rather than in an artificial laboratory environment or a protected hospital environment. The usual paper and pencil questionnaires do not meet these two conditions for reasons of logistics. A recently developed method, ecological momentary assessment (EMA), made it possible to implement these field assessments via ingenious use of various devices (most frequently an electronic diary) coupling an auditory signal with computerized data capture. The subject carries the device with him/her at all times, and data is recorded in vivo in real time. The programming of repeated measures in the form of a Likert scale or pull-down menu is easily achieved. A recall alarm system can help increase compliance. Compared with classical self-report, EMA improves the validity of the assessment of certain symptoms, which are the main evaluation criteria in clinical trials concerning certain pathologies (e.g., craving and treatment of addiction), where measurement was previously liable to bias. This article sets out to present this method, its advantages and disadvantages, and the interest it presents in psychiatry, in particular via three original applications developed by the authors including: measurement of reaction time without the knowledge of the subject in order to test certain cognitive models; use of a graphic solution for the data recorded for functional analysis of disorders; and the use of data collection via mobile phone and text messages, which also enables therapeutic interventions in real time by text messages, personalized on the basis of the situational data collected (e.g., in the case of craving, the associated mood, solitary or group consumption or concomitant occupations).
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20
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Lukasiewicz M, Benyamina A, Reynaud M, Falissard B. An in vivo study of the relationship between craving and reaction time during alcohol detoxification using the ecological momentary assessment. Alcohol Clin Exp Res 2006; 29:2135-43. [PMID: 16385183 DOI: 10.1097/01.alc.0000191760.42980.50] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To study cognitive interference associated with craving for alcohol, the Ecological Momentary Assessment (EMA) method was used to measure the relationship between craving and reaction time. A secondary aim was the study of the predictive factors for craving during alcohol detoxification. The EMA enables both repeated measures of craving in a natural setting and the recording of reaction time without the patient being aware of this. METHODS Craving for alcohol, reaction time, sadness and anxiety were recorded 8 to 12 times a day, over three weeks of detoxification in 14 alcoholics (n=1767 measures), on an electronic diary issuing random prompts. Mixed models were used for statistical analysis (alpha=5%, 1-beta=88%). RESULTS Reaction time was significantly increased in univariate analysis when a craving episode occurred but this difference did not persist after multivariate analysis. Craving episodes were more frequent and intense than previously reported. Predictive factors of craving during detoxification were: age, gender, sadness, anxiety and the number of previous detoxifications. Antidepressants, anti-craving medications but not benzodiazepines were negatively associated to craving.
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Affiliation(s)
- M Lukasiewicz
- INSERM (Institut National pour la Santé et la Recherche Medicale), Paris, France.
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