The impulsivity rating scale (IRS): preliminary results

Until now, the instruments for the clinical evaluation of impulsivity have relied essentially on either personality inventories or to a lesser extent on specific questionnaires. Therefore this paper presents the preliminary results of a new rating scale: the Impulsivity Rating Scale (IRS). This is a 7-item hetero-evaluation of impulsivity based on the behaviour of the patient in usual life situations. The administration of the scale is easy and short: 15 minutes. The IRS was tested in five different population samples: 31 impulsive inpatients, 36 adults with major depressive episode, 15 healthy control subjects, 56 smokers before and after one week of tobacco withdrawal, and 47 adolescent depressed inpatients before and four weeks after antidepressant treatment. The results show good construct validity, good concurrent validity, good inter-rater reliability and sensitivity to change. A threshold of 8 for the total score (range 0 to 21) gives good specificity and sensitivity. The principal component analysis shows the existence of a main factor composed of all items, with lower correlation for two items which may belong to a second factor needing further investigations.

[Obstetrical follow-up and perinatal prognosis in drug addict pregnant women]

OBJECTIVE

To identify the factors associated with a good obstetric follow-up and a good perinatal prognosis, in order to adapt the management of pregnant women with addiction to opiates.

METHODS

A retrospective study was carried out in our maternity between January 2012 and December 2014, including 104 women who were addicted to opiates, whether or not they were substituted, with or without associated consumptions, regardless of the term of delivery beyond 22 weeks of amenorrhea.

RESULTS

A good obstetrical follow-up was observed by 32.7% of women. The father's presence (OR=3.9; P=0.0113) and investment in pregnancy (OR=4.4; P=0.0029), as well as the desired character of the pregnancy (OR=4.5; P=0.0008) appeared to be associated with the quality of the observed follow-up. Preterm deliveries (11.8 versus 35.8%; P=0.0103), and social measures taken at the discharge of the newborn from the maternity (2.9 versus 24.3%, P=0.0057) were less frequent. A good perinatal prognosis was found for 29.8% of the cases. Associated consumptions <3 (OR=2.6 [1.1-6.2]; P=0.0281) confirmed by negative urine drug screening (OR=2.9 [1.1-7.8]; P=0.0307) were more numerous.

CONCLUSION

Although the follow-up and the perinatal prognosis of these pregnancies have improved considerably in recent years, it seems necessary to further optimize their management.

Prevalence of Clostridium species and behaviour of Clostridium botulinum in gnocchi, a REPFED of italian origin

Sales and consumption of refrigerated processed foods of extended durability (REPFEDs) have increased many-fold in Europe over the last 10 years. The safety and quality of these convenient ready-to-eat foods relies on a combination of mild heat treatment and refrigerated storage, sometimes in combination with other hurdles such as mild preservative factors. The major hazard to the microbiological safety of these foods is Clostridium botulinum. This paper reports on the prevalence and behaviour of proteolytic C. botulinum and non-proteolytic C. botulinum in gnocchi, a potato-based REPFED of Italian origin. Attempts to isolate proteolytic C. botulinum and non-proteolytic C. botulinum from gnocchi and its ingredients were unsuccessful. Based on assessment of the adequacy of the methods used, it was estimated that for proteolytic C. botulinum there was < 25 spores/kg of gnocchi and < 70 spores/kg of ingredients. The total anaerobic microbial load of gnocchi and its ingredients was low, with an estimated 1 MPN/g in processed gnocchi. Most of the anaerobic flora was facultatively anaerobic. A few obligately anaerobic bacteria were isolated from gnocchi and its ingredients and belonged to different Clostridium species. The protection factor, number of decimal reductions in the probability of toxigenesis from a single spore, was determined for eight different gnocchi formulations by challenge test studies. For all gnocchi stored at 8 degrees C (as recommended by the manufacturer) or 12 degrees C (mild temperature abuse), growth and toxin production were not detected in 75 days. The protection factor was >4.2 for proteolytic C. botulinum, and >6.2 for non-proteolytic C. botulinum. When inoculated packs were stored at 20 degrees C (severe temperature abuse), toxin production in 75 days was prevented by the inclusion of 0.09% (w/w) sorbic acid (protection factors as above), however in the absence of sorbic acid the packs became toxic before the end of the intended shelf-life and the protection factors were lower. Providing sorbic acid (0.09% w/w) is included in the gnocchi, the safety margin would seem to be very large with respect to the foodborne botulism hazard.

[Risk-taking. Adolescent girls versus adolescent boys]

Epidemiologists as well as professionals working in the area of adolescent health generally agree that adolescence is a period characterized by a difference in frequency of risk-taking behaviour between girls and boys. An explanation of these data through ethno-psychological and psychodynamical approaches is hereby presented. Such approaches should be taken into account for general preventive strategies to take effect.

Personality dimensions in social phobics with or without depression

OBJECTIVE

This study investigated the personality traits of social phobics using the Temperament and Character Inventory (TCI).

METHOD

A sample of 178 social phobics was assessed with the TCI, and compared with controls. The patients were classified into two groups, according to the absence (SP group) or to the presence (SP+D group) of depression.

RESULTS

We found significant elevated scores for harm avoidance (HA) in social phobics when compared with controls (16.2 +/- 2.7), in both the SP (26.2 +/- 3.5), and the SP+D (28.9 +/- 4.7), groups. Lower self-directedness scores were found in the SP and in the SP+D groups when compared with the controls. Patients with the generalized type of social phobia had higher HA scores as compared with other social phobics.

CONCLUSION

The personality profile obtained in these social phobics, whatever their depressive symptomatology, reflects a dramatically anxious and avoidant temperament associated to an immature character.

Screening for clostridium botulinum type A, B, and E in cooked chilled foods containing vegetables and raw material using polymerase chain reaction and molecular probes

A molecular method was used for the detection of Clostridium botulinum spores of type A, B, and E in commercial cooked and pasteurized vegetable purées and in the raw materials (vegetables and other ingredients). The method allowed the detection of less than 8 spores/g of product for C. botulinum type A, less than 1 spore/g for proteolytic type B, less than 21 spores/g for nonproteolytic type B, and less than 0.1 spore/g for type E. Thirty-seven samples of raw vegetables and ingredients were tested for the presence of C. botulinum type A, B, and E; 88 and 90 samples of vegetable purées were tested, respectively, for the presence of C. botulinum type A and B and for the presence of C. botulinum type E. All samples were negative, suggesting that the prevalence of C. botulinum in these vegetable purées and the raw ingredients is probably low.

[Anxiety, aggression, agitation and depression: psychopathologic aspects]

While clinical experience has long since shown that there are different types of depression, in particular anxious and hostile depressions, the psychopathological analysis of the various forms remains of current interest. At least four psychopathological models are currently available. The first raises the question of the continuity between reactions to separation, particularly studied in children, and the clinical expression of certain forms of depression in adults. In many aspects, the latter suggest the sequence: protest-despair-detachment. The second model raises the question of the relationship between the depressive disorder and the organization of certain personalities. The considerable comorbidity between the borderline personality and affective disorders suggest that these two different disorders share a common dimension. The third-cultural-model hypothesizes a relationship between the sociocultural prohibition of aggressive responses and the incidence of depression. The fourth model is based on the existence of a specific biological constraint related to abnormalities of serotonin metabolism, to which dysregulation of anxious and aggressive-impulsive behavior patterns during depression are considered related. In conclusion, it may be considered that several models, in particular that of reaction to separation, may, at least in part, account for "positive-expression" depression, but that at least two questions have still to be answered: that regarding the relationships between depression and personality, and that concerning the relationships between the psychopathological constraints related to serotonin metabolism dysfunction and the "positive" expressions.

[Panic attack and panic disorder in the child and adolescent]

In the light of the current interest in the development of this disorder in adults, a number of recent studies have been devoted to the condition in children and adolescents. These papers include retrospective studies of adults suffering from the disorder, clinical reports on children or adolescents with the same problems, epidemiological studies of children and adolescents consulting psychiatrists, epidemiological studies of the general population, family studies, and studies of chemotherapeutic treatments. The conclusion from these papers is that many children and adolescents who present with physical symptoms are suffering from a panic disorder which has not been identified as such at the time. Other studies have analysed the age of onset of the first attack. All these studies are now in agreement in confirming that adolescence is the preferential age of onset of panic disorder. There even appears to be a correlation between the stages of puberty (Tanner) and the onset of panic attacks in young adolescents. At each successive stage of puberty, C. Hayward et al. (1992) found a progressively higher rate of panic attacks. "Panic disorder" thus preferentially develops in adolescence, more commonly in girls than boys, particularly in subjects who are prone to anxiety or show traits of the "avoiding personality", but who also have a depressive tendency. A number of studies also suggest that pathological separation anxiety developing in childhood represents a risk factor for the development of "panic disorder" and/or agoraphobia during adolescence or adult life. The natural history of Panic Disorder in adolescence is still little known. The greatest risk appears to be chronic anxiety, but the progressive establishment of panic disorder, its development in the direction of depressive disorder, and self-medication and/or abuse of psychotropic drugs, also give cause for concern. Finally, a number of psychopathological considerations have raised the possibility that the onset of a panic disorder may be a danger signal of an underlying depressive personality.

[Disorders of catecholamine metabolism in infantile autism. Comparative study of 22 autistic children]

In a group of 22 autistic children aged 5 to 16 y., and a group of normal controls matched for age and sex, catecholamines metabolism has been investigated in plasma, platelets and urine. This investigation was part of a research project in which several biological parameters (including serotonin) were simultaneously explored in the same children. In the autistic group, epinephrine and norepinephrine and dopamine were significantly lower in isolated platelets, and no significant difference was found between the two groups for the urinary excretion of epinephrine, norepinephrine, dopamine, DOPAC and MHPG. Other differences between the two groups in the statistical correlations of several biochemical parameters (plasma norepinephrine and dopamine with platelet MAO activity, platelet norepinephrine with platelet dopamine, platelet dopamine, platelet dopamine with platelet serotonin) also suggest abnormalities of bioamine metabolism in the platelets of autistic children.

[Metabolism of serotonin in autism in children]

In this controlled study of 22 autistic children and 22 normal controls matched for age and sex, the frequency of hyperserotonemia in infantile autism was confirmed. Platelet serotonin was elevated in patients. Comparative to controls, serotonin was also high in urine of autistic patients, while, on the contrary there was no difference for the urinary excretion of 5-HIAA. No difference was observed either for serotonin uptake and efflux or for MAO activity, in isolated platelets. The elevation of plasma free tryptophan - significant only with the Kolmogorov Smirnov test - suggests that 5-HT biosynthesis might be enhanced. In the group of patient reported in this study, disorders of serotonin metabolism are associated with disturbances of platelet catecholamines, and also with elevated immunoglobulins and enhanced cellular immunity reactions.

[Immune status in infantile autism. Correlation between the immune status, autistic symptoms and levels of serotonin]

In sixteen autistic children high values of IgG and a high level of lymphocyte stimulation with PHA were observed. Principal component analysis showed: 1) a significant correlation between basic lymphocyte mitogenic activity and the clinical symptoms opposition and hyperactivity, 2) a significant correlation between high Ig levels, high PHA stimulation responses and the main autistic symptoms (withdrawal, inaffectivity, hypoactivity, mannerism, stereotypy and negatively echolalia), 3) a significant correlation with serotonin uptake by platelets and high immunological responses. Such correlations are strongly in favor of an immunologic component in autistic disease.

Serotonin metabolism and other biochemical parameters in infantile autism. A controlled study of 22 autistic children

The serotonin metabolism was extensively studied in 22 couples of autistic children and age- and sex-matched controls. Histamine, calcium, and uric acid were also measured in urine and whole blood or plasma. Autistics and controls did not differ in histamine, and only minor changes were noticed in calcium content. According to previous reports, serotonin levels were often, but not always, elevated in the blood of autistic children. Based on data including urinary serotonin and 5-hydroxyindoleacetic acid, platelet serotonin uptake and efflux, platelet monoamine oxidase and glutathione peroxidase activities, and uric acid and plasma tryptophan, the origin(s) of such hyperserotonemia in autism appear(s) to be of metabolic origin, i.e., a decreased catabolism and/or an increased biosynthesis of serotonin.

Catecholamines metabolism in infantile autism: a controlled study of 22 autistic children

In a group of 22 autistic children aged 5 to 16 years and a group of normal controls matched for age and sex, catecholamines metabolism was investigated in plasma, platelets, and urine. This investigation was part of a research project in which several biological parameters (including serotonin) were explored simultaneously in the same children. In the autistic group, epinephrine and norepinephrine were significantly elevated in plasma, while epinephrin, norepinephrine, and dopamine were significantly lower in isolated platelets. No significant difference was found between the two groups for the urinary excretion of epinephrine, norepinephrine, dopamine, DOPAC, and MHPG. Other differences between the two groups in the statistical correlations of several biochemical parameters also suggest abnormalities of bioamine metabolism in the platelets of autistic children.

[Heterogeneity of the depressive mood. Construction of a polydimensional scale]

The evaluation of depressive mood implies several levels of the clinician's inferences: behaviour observation, subjective experience report, affective communication... The authors report the first stages in the construction of a specific depressive mood scale administered to a major depressive disorder population of 52 patients meeting DSM III criteria. The principal component analysis splits mood into three main factors: dysphoria, expressed sadness, emotional blunting. These various emotional dimensions should be taken into account for the analysis of drugs effects.

[A "condemned" child. Case of borderline personality disorder]

The import of this observation resides in the significance of the patient's destiny and in the poor organization of his personality, indicating that defense mechanisms may have been prevented from building up as a result of the bearing of real and phantasmic events on his mental working. We speculate that a mechanism as essential as interiorization could not develop, as a direct result of the continuous confrontation of conflicts with a disrupted reality and the recollection of this last. The limits constituted by death and incest could not be normally interiorized and integrated within the psychic organization of this young boy, "doomed" at the age of four, and perhaps even earlier.

[Psychoanalytic therapy in adolescence]

Psychoanalytic therapies in adolescence can be classified into four groups: the analytic cure or "standard cure", psychoanalytic psychotherapy (PP), psychoanalytic psychodrama and psychoanalytic relaxation psychotherapy. In other instances, the psychoanalyst works with the adolescent's family or with the staff working in an institution for adolescents, but this does not involve a direct relationship between the psychoanalyst and the adolescent. In adolescence, PP and psychodrama seem to be the most readily used psychoanalytical methods.

[Depression in adolescents]

After having believed that depression is a normal feature of adolescence, most practitioners discriminate between the moderate, transient, depressive feelings, which are indeed part of the normal process of adolescence, and the various forms of true depression that may occur at this age. The problem of "depressive equivalents" is probably the most studied. Our opinion, based on a clinical and psychodynamic viewpoint, is that four types of depression can be distinguished in adolescence: anxious-depressive reactions, inferiority depression, abandonment depression and melancholic depression. These four conditions share a basic depressive reaction typified by a psychomotor slowness and "freezing" of feelings, ideas and motions.

[Psychiatry of adolescence. Prevention of mental diseases in adults]

Several impediments to the recognition of psychological disorders in adolescents are analyzed. In spite of the difficulties, it is worthwhile to overcome these obstacles. Indeed, it must be pointed out that the therapy of psychological disturbances during adolescence has a preventive effect upon longstanding psychiatric disorders in adulthood. Psychological manifestations in adolescence can be classed into four groups: the normal process of transformation, transient psychopathological reactions to transformation, conflictual organizations and severe impediments to the process of transformation. To these four clinical groups answer different consultation settings.