Spatiotemporal brain signal associated with high and low levels of proactive motor response inhibition

Proactive motor response inhibition is used to strategically restrain actions in preparation for stopping. In this study, we first examined the event related potential (ERP) elicited by low and high level of proactive response inhibition, as assessed by the stop-signal task. Corroborating previous studies, we found an increased amplitude of the contingent negative variation (CNV) in the high level of proactive inhibition. As the main goal of the present study, swLORETA was used to determine the neural generators characterising CNV differences between low and high levels of proactive inhibition. Results showed that the higher level of proactive inhibition involved numerous generators, including within the middle and medial frontal gyrus. Importantly, we observed that the lower level of proactive inhibition also involved a specific neural generator, within the frontopolar cortex. Altogether, present findings identified the specific brain sources of ERP signals involved in the later phase of motor preparation under low or high levels of proactive motor response inhibition.

[Short-term and long-term effects of cannabis use]

Cannabis is used worldwide. So, it is necessary to stay especially concerned by the medical and social consequences of its use. For a long time, it was seen as a " soft drug ", in reference to the apparent low medical risk related to its use. However, the psycho-social consequences of cannabis use albeit of major importance are commonly neglected. Furthermore, danger for the health does exist, both from psychiatry and somatic medicine points of view. The danger is growing especially due to the apparition on the market of more potent presentations of cannabinoids.

Reasons for Attempted Suicide in Europe: Prevalence, Associated Factors, and Risk of Repetition

To examine the prevalence of specific reasons for attempted suicide, factors associated with them, and whether reasons for attempted suicide influence risk of repetition. As part of the Monitoring Suicide in Europe (MONSUE) project, data on 4,683 suicide attempters from nine European countries were collected. Independence tests were used to study the influence of age, gender, and other factors on reported reasons. We examined risk of repetition using logistic regression analysis. Interpersonal conflict was common for all patients except those widowed, living alone, or retired. Mental health problems were prevalent among over 45 year-olds, patients unable to work, and patients with a history of at least three suicide attempts. Financial difficulties were cited more often by patients who were 45-64 years old, divorced or separated, living with children only, and unemployed. Close bereavement/serious illness and own physical illness were associated with those over 65 years of age. Two reasons for suicide attempt, interpersonal conflict and mental health problems, were associated with increased risk of repetition independent of other factors. Suicide attempters have a multitude of problems of varying prevalence depending on age, gender, and other factors. They present a range of clinical profiles that require a multidisciplinary response.

[Doping, sport and addiction--any links?]

Sport is widely encouraged as it is beneficial for health. However, high-performance sport is more and more associated to rather suspicious practices; doping is one of the best example. From a physician point of view, the use of doping agents is obviously a major concern because taking such products often induce serious adverse effects on health. The present manuscript aims to inform physicians about the most frequent doping practices. It also points out that intensive sport can generate an "addictive" behavior sharing with "common"addictions a loss of practice control, a lack of interest in other activities and even a sport's practice detrimental to athlete's health. Analysis of the doping issue needs to take this reality into account as some doping products display an established " addictive" effect.

[Self-help program: a new tool to facilitate the access to treatment for problem gamblers]

Shame, fear of stigmatization, denial, accessibility to and the cost of treatment program may explain why only a small proportion of problem gamblers sought clinical treatment. In the hope to overcome these barriers, the Gambling Clinic and Other Behavioral Addictions of C.H.U. Brugmann (Brussels) has developed its own self-help program for excessive gamblers. Our goals were to foster readiness to change gambling behaviors and when appropriate to facilitate the transition from self-help program to classical face-to-face clinical intervention. In a sample of 172 problem gamblers who participated, 40% had never sought help (e.g., clinical treatment) and/or never attempted quit gambling. Interestingly, for some, internet-based self-help treatment preceded their determination for seeking a traditional face-to-face therapeutic setting. Those results led us to discuss this program as a valid clinical tool within a broader health care setting in excessive gamblers.

[A case of central pontine and extrapontine myelinolysis, without hyponatremia, during alcohol withdrawal with favorable outcome]

Central pontine and extra-pontine myelinolysis (CPM/EPM) is a rare neurological disorder, well documented for more than 50 years but whose pathogenesis remains obscure. The existence of predisposing factors occurs in the most cases; chronic alcohol abuse is one of the most commonly encountered, among many others. Alcohol withdrawal represents an additional vulnerability factor, being responsible for electrolyte imbalances which are not always demonstrable but are certainly involved in the development of CPM and/or EPM. CPM/EPM may be responsible for severe morbidity and is potentially life-threatening. The diagnosis of CPM/ EPM remains mostly clinical and is confirmed by magnetic resonance imaging of the brain. It should be considered in the setting of any unexplained neurological symptoms during the course of alcohol withdrawal or for any patient with chronic alcohol abuse, as promptly as possible, given the potentially fatal outcome.

[Munchausen's syndrome: a factitious disorder? A case report]

Munchausen's syndrome is classified as a chronic factitious disorder with predominant physical signs and symptoms. Several symptoms are specific to this disorder, such as travelling and pseudologia fantastica. Others symptoms, such as multiple physical complaints with no organic substrate, are shared with somatoform disorders. We report a case showing how difficult it is to diagnose a Munchausen syndrome. We discuss also the opportunity to classify such a syndrome as a factitious disorder. Indeed, several authors suggest classifying Munchausen syndrome as a subtype of somatoform disorders, as those two disorders share a lot of characteristics.

[Treatment of depression with transcranial magnetic stimulation]

Major depression disorder is a frequent psychiatric condition with serious consequences. Many patients don't respond to usual psychopharmacological and/or psychotherapeutic treatments. This observation has stimulated the research of alternative treatment options. Repeated transcranial magnetic stimulation (rTMS) is a recent therapeutic tool with few side effects. Its efficacy relies on stimulation of cortical networks through the application of a magnetic field on the skull. rTMS has been approved as a full therapeutic option for major depressive disorder by the FDA in 2008. It could therefore be routinely used in the future and complete the usual treatments in this condition. Our paper reviews what is currently known about the clinical use of rTMS in major depressive disorder.

[Perception of training in doctor-patient communication for students at faculty of medicine]

Doctor-patient communication is the heart of any medical practice. The technology of medicine today is focused on knowledge, its application and know-how, rather than skills of being, of knowing and of knowing when to do nothing. In 2005, Belgian High Council of Health emphasizes a quantitative and qualitative reduction of communication aspects within the initial medical training. The aim of our study is to investigate Belgian and foreign students perception of how the doctor-patient communication was taught during their studies. A questionnaire was sent by email to 300 Belgian and foreign Universities. We obtained 13.6% of answers of 99 students belonging to 41 Faculties from 22 countries. 55.6% of respondents thought to be well trained in the doctor-patient communication. 85.9% of students received theoretical courses out of which only 64.6% have the opportunity to enhance their apprenticeship by practical work. Majority of respondents required more practical work in learning to communicate. All of them agree on that they would like more applied practical communication incorporated into their curriculum. Like wise the society that calls for doctors with increased communication skills and communication researchers who emphasize the central role of the doctor-patient communication in the clinical and therapeutic approach, students are also seeking longitudinal transdisciplinary learning, including more practical practices.

[Factorial study of the psychopathological factors of morbid obesity in the adolescent]

BACKGROUND

The prevalence of paediatric obesity is high in most countries. Added to this, the degree of paediatric obesity is also on the rise. It is however to be noted that although the psychological causes of the problem are well known, they remain difficult to assess. Facing the great number of adolescents suffering from severe obesity, who are looking for treatment and failing to find one, this survey aims at facts-finding and analyses of the psychological and psychopathological origin and associated severity of obesity, and of the parameters that can lead to a successful treatment.

METHODS

This survey has been carried out among 125 adolescents suffering from grade 2 obesity. To lose weight, the adolescents were treated during 1 year at the boarding dietary department of the "Institut Médical Pédiatrique Clairs-Vallons" in Belgium. The evaluation consists in a type CFTMEA-R-2000 psychopathological diagnosis including previous traumatic factors, taking into consideration the information regarding weight, weight evolution over one year and a quality assessment of the compliance of the patient with the treatment. These data have been submitted to the SPADN statistical program in order to carry out an analysis taking into account the various connections.

RESULTS

Our results have underlined that the severity of the obesity in our population can be coupled with pathological family environment factors such as mental illness, care deficiencies, child abuse and, as a result, the presence of a psychopathological diagnosis. The same can be said in cases of lesser compliance with the treatment by the patient and his family, although in the short term the weight loss is greater. Likewise, a less severe obesity and a better compliance with the treatment can be coupled with the absence of both psychopathological diagnosis and pathological family environment.

CONCLUSION

In our sample population, the psychological and psychopathological factors tend to be linked with a more severe obesity, and less good compliance with the treatment on both individual and family accounts. As a result, obesity could be considered as a way for the patient to adapt him/herself or compensate in front of traumatic family experiences. The isolation from the family seems therefore indispensable for any change in the adolescent, but then raises the problem of long term care after hospitalisation. If obesity is an adaptation process, the loss of weight could then have deeper psychological implications, implying a more complex follow-up of the patient.

[General practitioner burnout: risk factors]

This paper aims to review current knowledge on risk factors leading to burn-out of general practitioners, who are particularly concerned by burn-out, as 50% of them are being more or less affected. This article is based on bibliographic research covering literature between 1975 and 2010, using PUB MED software, medical books and articles. 44 articles were selected as dealing well with the aspects of the burn-out reviewed here. It seems established that stress precedes burnout symptoms. Theories investigating relationships between stress and work are presented. Exogenic stress (load and organization of work, emotional interaction with the patient, constraints, lack of recognition, conflicts between private and professional life) interacts with endogenous stress (idealism, (too much) acute feeling of responsibility, mood disorder, difficulty in collaborating, character, personality). Burn-out symptoms would appear preferentially when these two stresses coexist. Despite the wealth of publications, there is still a lack of knowledge of the causes of burn-out, requiring therefore increased research efforts, in order to improve the implementation of preventive measures, beneficial to the doctors as well as to their patients.

Impaired conditional reasoning in alcoholics: a negative impact on social interactions and risky behaviors?

AIMS

To study the 'social brain' in alcoholics by investigating social contract reasoning, theory of mind and emotional intelligence.

DESIGN

A behavioral study comparing recently detoxified alcoholics with normal, healthy controls.

SETTING

Emotional intelligence and decoding of emotional non-verbal cues have been shown to be impaired in alcoholics. This study explores whether these deficits extend to conditional reasoning about social contracts.

PARTICIPANTS

Twenty-five recently detoxified alcoholics (17 men and eight women) were compared with 25 normal controls (17 men and eight women) matched for sex, age and education level.

MEASUREMENTS

Wason selection task investigating conditional reasoning on three different rule types (social contract, precautionary and descriptive), revised Reading the Mind in the Eyes Test, Trait Emotional Intelligence Questionnaire (modified version) and additional control measures.

FINDINGS

Conditional reasoning was impaired in alcoholics. Performance on descriptive rules was not above chance. Reasoning performance was markedly better on social contract and precautionary rules, but this performance was still significantly lower than in controls. Several emotional intelligence measures were lower in alcoholics compared to controls, but these were not correlated with reasoning performance.

CONCLUSIONS

Conditional reasoning, including reasoning about social contracts and emotional intelligence appear to be impaired in alcoholics. Impairment seems to be particularly severe on descriptive rules. Impairment in social contract reasoning might lead to misunderstandings and frustration in social interactions, and reasoning difficulties about precautionary rules might contribute to risky behaviors in this population.

Major depression is associated with impaired processing of emotion in music as well as in facial and vocal stimuli

BACKGROUND

The processing of emotional stimuli is thought to be negatively biased in major depression. This study investigates this issue using musical, vocal and facial affective stimuli.

METHODS

23 depressed in-patients and 23 matched healthy controls were recruited. Affective information processing was assessed through musical, vocal and facial emotion recognition tasks. Depression, anxiety level and attention capacity were controlled.

RESULTS

The depressed participants demonstrated less accurate identification of emotions than the control group in all three sorts of emotion-recognition tasks. The depressed group also gave higher intensity ratings than the controls when scoring negative emotions, and they were more likely to attribute negative emotions to neutral voices and faces.

LIMITATIONS

Our in-patient group might differ from the more general population of depressed adults. They were all taking anti-depressant medication, which may have had an influence on their emotional information processing.

CONCLUSIONS

Major depression is associated with a general negative bias in the processing of emotional stimuli. Emotional processing impairment in depression is not confined to interpersonal stimuli (faces and voices), being also present in the ability to feel music accurately.

[Drug dependence on benzodiazepines and antidepressants]

Since years, the concepts of drug abuse and drug dependence changed, due to new knowledge coming from the neurosciences. Specifically, the role of a brain structure called "reward circuit" was emphasized. Therefore, the diagnosis criteria for abuse and dependence on drugs are presently defined mostly from a behavioral point of view: both in animal models and in clinical situations, it was stressed the importance of drug-seeking behavior and of the loss of control of the consumption. The occurrence of a pharmacological dependence is in fact of concern for only some of addictive drugs. According to these new criteria, dependence on benzodiazepines or antidepressants is certainly not frequent, even if withdrawal manifestations can occur after a long-term exposition. Furthermore, it is important to keep in mind the risk for non-medical use of benzodiazepines in persons with illicit drug use.

Chronic alcoholism: insights from neurophysiology

INTRODUCTION

Increasing knowledge of the anatomical structures and cellular processes underlying psychiatric disorders may help bridge the gap between clinical signs and basic physiological processes. Accordingly, considerable insight has been gained in recent years into a common psychiatric condition, i.e., chronic alcoholism.

MATERIAL AND METHODS

We reviewed various physiological parameters that are altered in chronic alcoholic patients compared to healthy individuals--continuous electroencephalogram, oculomotor measures, cognitive event-related potentials and event-related oscillations--to identify links between these physiological parameters, altered cognitive processes and specific clinical symptoms.

RESULTS

Alcoholic patients display: (1) high beta and theta power in the resting electroencephalogram, suggesting hyperarousal of their central nervous system; (2) abnormalities in smooth pursuit eye movements, in saccadic inhibition during antisaccade tasks, and in prepulse inhibition, suggesting disturbed attention modulation and abnormal patterns of prefrontal activation that may stem from the same prefrontal "inhibitory" cortical dysfunction; (3) decreased amplitude for cognitive event-related potentials situated along the continuum of information-processing, suggesting that alcoholism is associated with neurophysiological deficits at the level of the sensory cortex and not only disturbances involving associative cortices and limbic structures; and (4) decreased theta, gamma and delta oscillations, suggesting cognitive disinhibition at a functional level.

DISCUSSION

The heterogeneity of alcoholic disorders in terms of symptomatology, course and outcome is the result of various pathophysiological processes that physiological parameters may help to define. These alterations may be related to precise cognitive processes that could be easily monitored neurophysiologically in order to create more homogeneous subgroups of alcoholic individuals.

Alcoholism leads to early perceptive alterations, independently of comorbid depressed state: an ERP study

INTRODUCTION

Alcoholism is associated with a deficit in the processing of emotional facial expressions (EFE) and with a delayed P3b component, partially mediated by earlier perceptive deficits (P100, N170). Since alcohol dependence often occurs with depression, we aim at investigating whether classical event-related potentials (ERP) alterations observed in alcoholism are modulated or not by depression.

METHODS

Four groups (controls; alcoholics; depressed; alcoholics-depressed) of 12 participants performed two different discrimination tasks, a gender and an emotional one. They had to decide as quickly as possible about the gender or the emotion displayed by facial stimuli during an ERP recording session (32 channels). Reaction times (RTs), P100, N100, N170 and P3b were recorded.

RESULTS

At the behavioural level, control participants discriminated EFE (but not gender) more rapidly than the three other groups. At the ERP level, the differences observed on RTs for emotional task were neurophysiologically indexed by a delayed P3b component. This delay was associated with earlier ERP alterations (P100, N100, N170), but only in participants suffering from alcohol dependence, in association or not with depression.

DISCUSSION

On the one hand, individuals with alcoholism, associated or not with a comorbid depression, were impaired in the processing of EFE. This deficit was neurophysiologically indexed by early perceptive (P100, N100, N170) and decisional (P3b) alterations. On the other hand, non-alcoholic patients with depression only exhibited P3b impairment. These results lead to potential implications concerning the usefulness of the ERP for the differential diagnosis in psychiatry, notably concerning the comorbidities in alcoholism.

Is the P300 deficit in alcoholism associated with early visual impairments (P100, N170)? An oddball paradigm

OBJECTIVE

Studies exploring chronic alcoholism with event-related potentials (ERPs) have shown delayed latency and reduced amplitude of the P300, a long-lasting positive potential reflecting decisional processing. This P300 deficit in alcoholism is generally interpreted as a disturbance in central nervous system inhibition or in memory/attention. The present study aimed at identifying if this electrophysiological deficit is already present on earlier components, and advances a new hypothesis concerning the interpretation of the P300 alteration.

METHODS

Patients suffering from alcoholism and matched healthy controls had to detect, in an oddball paradigm, emotional faces among a succession of neutral faces. Behavioral performance and ERP data (recorded from 32 electrodes) were analyzed.

RESULTS

In line with previous studies, data showed that alcoholism led to a P300 deficit. Moreover, we observed for the first time that this deficit begins at earlier visual (P100) and face-processing (N170) stages, and we found high positive correlations between P100, N170 and P300 for amplitude and latency values, suggesting cumulative deficits on the cognitive continuum.

CONCLUSIONS

We suggest that the P300 deficit observed in chronic alcoholism could be linked to earlier visuo-spatial deficits rather than being an impairment of the specific processes linked to the P300.

SIGNIFICANCE

These results call for reconsidering the interpretation of P300 impairments at a fundamental and clinical level, and shows that earlier ERP components must be taken into account in future studies.

[Evidence of a modification of the profile of addictive drugs consumption through the study of patients consulting a psychiatric emergency room]

The consumption of psychoactive drugs is frequently the reason of consultation in a psychiatric emergency unit. We present here the evolution over time of the consumption pattern of patients consulting the psychiatric emergency unit of the Brugmann University Hospital. Major modifications were observed during this period. Mainly, problematic consumption of opiates was progressively overwhelmed by this of cannabis, psychostimulants and recently synthesis drugs. We suggest that this reflects the situation of psychoactive drugs consumption in the general population. This implicates a modification of prevention and treatment attitudes in drug consuming persons.

[Experience of obesity's treatment by an interdisciplinary team]

Owing to the multifactorial origin of obesity, we have created an interdisciplinary team devoted to a limited-in-time treatment, following three axles : nutritional education, body self-perception and emotions expression. The philosophy of this approach and some results are presented.

Early visual components (P100, N170) are disrupted in chronic schizophrenic patients: an event-related potentials study

INTRODUCTION

On the basis of the Positive and Negative Syndrome Scale (PANSS), fourteen schizophrenic patients and 7 normal controls were confronted with pictures from the Ekman & Friesen series in an event-related potentials study.

PROCEDURE

Participants were confronted with a visual face-detection task, in which they had to detect, as quickly as possible, deviant faces amongst a train of standard stimuli (neutral faces). Deviant faces changed either on identity (different identity, neutral expression), or on emotion (same identity, happy, fearful or sad expression).

RESULTS

Schizophrenics exhibited a decrease in amplitude of the face N170, recorded around 170 ms at occipito-temporal sites; this was observed as well for emotional as for identity faces, which suggests a global involvement of face processing. Moreover, this decrease of the face-N170 was positively correlated to positive, but not negative, symptoms of schizophrenia. Finally, the amplitude of P100 was also decreased, which suggests that the N170 decrement would result from a more global deficit in visual processing deficit.

DISCUSSION

It is suggested that, in schizophrenics, an involvement of early visual processing might underlie the decreased amplitudes and the higher onset latencies of later P300 and N400 components.

[Hard use of soft drugs]

The concept of "soft drugs" is unclear and refers more to the behaviour of consumers than to the specific pharmacological properties of substances. However, "soft drugs" is often understood as "safe drugs." However, it is of major importance to underline that all drugs can induce major loss of the control of consumption, what is the crucial point of addictive behaviour. This is due to a sensitization of the so-called" brain reward system"; moreover, there is cross-sensitization between drugs. Only cannabis and alcohol are frequently thought to be associated to a long-term safe consumption. In our experience, this reputation is broadly usurped. Indeed, we observed that even when they do not have major health problems, cannabis consumers present major alterations of social functioning. In another way, we have shown that heavy alcohol consumers without neurological complications have frequently frontal dysfunction, clinically correlated to major alterations of executive functions.

EFFECT OF COMMUNITY NURSE FOLLOW-UP WHEN TREATING ALCOHOL DEPENDENCE WITH ACAMPROSATE

AIMS

To measure the effect of community nurse follow-up on abstinence and retention rates in the outpatient treatment of alcohol-dependent patients treated with acamprosate.

METHODS

Recently detoxified alcohol-dependent patients were prescribed acamprosate for 26 weeks and randomized to either physician-only follow-up, or physician plus regular visits from a community nurse. Drinking behaviour in the next 26 weeks was assessed at monthly visits to non-blind clinicians.

RESULTS

The cumulative abstinence duration proportion (CADP) was significantly longer in (P=0.03) the subjects who had received community nurse support (0.57) than in those who had not (0.39). This might, in part, be an artefact of the higher retention rate among those followed up by the nurse, in that, the method of calculating CADP allocates 100% days of drinking for the month before a failed attendance. Differences favouring nurse in the follow-up were seen for time to first drink, and clinical global impression.

CONCLUSIONS

For recently detoxified alcohol-dependent patients treated with acamprosate, follow-up by a community nurse improves patient retention and probably also improves the 6-month drinking outcome.

Personality profile and drug of choice; a multivariate analysis using Cloninger's TCI on heroin addicts, alcoholics, and a random population group

As personality may predispose, precipitate or perpetuate substance abuse and/or dependence, and as it is considered to remain stable across the years in a given subject, potential links with the drug of choice may help screen future patients before drug consumption. The present study compared three groups: 42 patients with heroin dependence (mean age: 31.2; standard deviation (SD): 5.5; 10 females), 37 patients with alcohol dependence (mean age 44.2; SD: 9.1; 9 females) and 83 subjects from a random population sample (mean age: 38.8; SD: 6.9; 20 females). Personality was measured by Cloninger's Temperament and Character Inventory (TCI). Pillai's MANCOVA with age as a covariate and gender as a cofactor was highly significant. Univariate ANOVA analyses using TCI dimensions as dependent variable showed most variables to vary in parallel for the two patient groups in comparison with controls. Post-hoc tests showed heroin patients to score higher in Novelty-Seeking and Self-Directedness than alcohol patients. Sub-dimensions Exploratory Excitability, Fear of the Uncertain, Responsibility, Congruent Second Nature and Transpersonal Identification were also significantly different in the two patient samples. Logistic regression showed Exploratory Excitability to segregate up to 76% of heroin patients from alcohol patients. In conclusion, personality profiles were linked to some preferential choice of drug and personality screening might be tested in preventive strategies.

[Appraisal of treatment of the trigger points associated with relaxation to treat chronic headache in the adult. Relationship with anxiety and stress adaptation strategies]

Since the 1950's and even still today, the concomitance between headaches and psychological symptoms (anxiety and depression) is the subject of considerable research. Even so, headaches still pose a problem of difficult diagnosis related to their multiform aspect. Their understanding may be regarded as neurological, psychological or musculo-articular. This complexity explains the lack of effectiveness of anti-migraine treatments in certain cases. This situation encourages recourse to complementary procedures such as those used in physiotherapy. The questions that could be posed regarding physiotherapeutic treatment are: Is the treatment effective? How does it act on the level of pain? and How does it act at the psychological level? It is to answer these questions that the work, which is the basis of this article, has been carried out.

METHODOLOGY

Two groups were studied during this research: a group of 25 patients and a reference group of 100 people. The headache patients were sent for physiotherapy by a GP or consultant neurologist. The pathologies retained for experimentation were: migraines without aura; Arnold's neuralgia; headaches of spinal origin; tension headaches and associated migraines. These pathologies are covered in International Headache Society Classification: Essential headache and in Section 45.4 of DSM IV: Painful problems . The physiotherapeutic treatments applied to the patients were: muscular massage and friction plus ultra-sound vibration of the trigger-points in the spinal, scapular, dorsal and facial regions; articular reharmonisation work on the spinal column; thermotherapy and relaxation as a technique allowing control of physical (muscular) and psychological (anxiety, fear of pain) tension to be regained. The treatment is evaluated by comparison of the periodicity and intensity of the headaches before and after treatment; comparison of anxiety (state and trait) before and after treatment and comparison of coping strategies before and after treatment.

RESULTS

As far as the description of the headaches of the patient group is concerned, the periodicity/intensity evaluated each day of the week before the treatment and presented in graphical form, showed a heterogeneous distribution and did not exhibit any particular characteristics. In addition, the fact of having studied this periodicity/intensity during a period of one week reinforces the reliability of the values found and reinforces the impact, showing clearly that it is not just incidental. The headaches were hereditary in 32-64% of cases; the trigger factors related to stress were the large majority. As far as the treatment used in the population studied is concerned, medication was used punctually, as prescribed. This was in the form of analgesics/antipyretics (68%) or anxiolytics (20%). In 85% of the cases, at the end of the physiotherapy treatment, the person no longer used any medication. The effectiveness of the treatment is clearly illustrated by the fact that the periodicity/intensity of the headaches had diminished significantly after treatment. The physiotherapy treatment lasted for 10 to 20 sessions with an average duration of 14 sessions. The treatment results in a significant reduction in the anxiety trait and the anxiety state as well as a readjustment of the coping strategies. During periods of headache crisis, anxiety and coping strategies are modified significantly. The modifications to these coping strategies during crises are: an increase in auto-accusation, the search for social support, avoidance and strategies for the resolution of emotion prior to treatment; an increase in strategies for the resolution of the problem after treatment; co-ping self-control is diminished if the anxiety state increases and it increases if the anxiety trait increases. Apart from the headache crises, there are no differences in anxiety characteristics or coping strategies between headache sufferers and others except for a greater use of coping avoidance by the headache sufferer.

CONCLUSION

Treatment by relaxation allows for a perceived increase in control of symptoms by the sufferer. Consequently, it reduces anxiety, improves the quality of life and the behavioural responses to stress. In turn, the treatment improves the long-term prognosis for the headaches as well as the health of the sufferer in general. The treatment described here addresses 3 types of people: 1. Sufferers with difficult headaches which do not respond well to medical treatment. 2. People for whom anxiety and coping strategies are very much modified by the headaches. 3. People who abuse medication for the treatment of their headaches.

Alcohol and withdrawal: from animal research to clinical issues

The withdrawal syndrome in alcohol-dependent patients appears to be a major stressful event whose intensity increases with repetition of detoxifications according to a kindling process. Disturbances in the balance between excitatory and inhibitory neural processes are reflected in a perturbed physical state while disturbances in the balance between positive and negative reinforcements are reflected in a perturbed mood state. Our purpose is to link the different behavioral outcomes occurring during withdrawal with specific biological brain mechanisms from the animal to the human being. Better understanding of the various biological mechanisms underlying withdrawal from alcohol will be the key to design and to apply appropriate pharmaceutical management, together with appropriate therapy aimed at inducing protracted abstinence.

[Clinical and therapeutic aspects in the treatment of alcohol addiction]

The alcohol-withdrawal syndrome is a well-known clinical situation, so does its treatment. However, new researches have shown that the risk of severe withdrawal manifestations increases proportionally with the number of previous detoxifications, according to a sensitisation stress model. As a consequence, special attention should be paid to patients with a clinical history of multiple alcohol detoxifications, even if they never previously had delirium tremens and/or comitiality. Even in the absence of characteristic neurologic lesions, long-lasting heavy drinking is associated with brain dysfunction, concerning mostly the frontal cortex. This is clinically associated to neuropsychological deficits, specifically disorders of working memory and the so-called "executive functions". These deficits have a dramatic importance, because they impair drastically the outcome of alcoholic patients after detoxification. In Belgium like in other countries, an increasing prevalence of hepatitis C is present in alcoholic patients. This is due probably to the increase of a former illegal drugs consumption in those patients. This association between alcoholism and hepatitis C is of major importance, because alcohol consumption increases the viral load and the risk of cirrhosis and hepatocarcinoma. Furthermore, alcohol reduces the response to interferon therapy.

An atypical neuropsychological profile of a Korsakoff syndrome patient throughout the follow-up

The basis of amnesia in alcoholic Wernicke-Korsakoff syndrome (WKS) has been generally associated with diencephalic lesions and more specifically with lesions of the anterior thalamic nuclei. These brain structures are considered to be involved in encoding/consolidation processes of episodic memory. However, frontal lobe damage responsible for executive function deficits has also been documented. The present report details the nature and extent of amnesia in an alcoholic patients with WKS and which appears to be mainly due to frontal lobe (executive) deficits.

Interference with withdrawal signs of naloxone-induced opiate withdrawal under anesthesia is anesthetic-specific in opiate-dependent rats

We hypothesized that interference of opiate antagonist-precipitated withdrawal signs under anesthesia is anesthetic-specific. Three groups of morphine-dependent rats were compared in different experimental conditions using a protocol of rapid withdrawal induction by an antagonist under anesthesia. We observed that ketamine and midazolam have different effects on the expression of withdrawal. This brings specific insights into the pharmacological basis of therapy with induction of opiate antagonist.

Supervisory attentional system in nonamnesic alcoholic men

BACKGROUND

Many studies have shown that recently detoxified alcoholic persons perform poorly on tasks thought to be sensitive to frontal lobe damage, supporting the hypothesis that the frontal lobes are highly vulnerable to chronic alcohol consumption. However, it appeared that most of the executive tasks used in these studies also involved nonexecutive components, and these tasks had been shown to be impaired as a result of nonfrontal lobe lesions. In this study, we examined further the "frontal lobe vulnerability" hypothesis using executive tasks, proved to be associated with frontal lobe functioning, that allowed us to distinguish the relative importance of executive and nonexecutive processes.

METHOD

Thirty recently detoxified asymptomatic male alcoholic inpatients and 30 control subjects were tested for planning, inhibition, rule detection, and coordination of dual task, as well as the speed of processing and nonexecutive functions (such as short-term memory storage).

RESULTS

Alcoholics performed worse than controls in almost all tasks assessing executive functions. However, they were not slower than the controls and showed normal results for nonexecutive functions.

CONCLUSIONS

Chronic alcohol consumption seems to be associated with severe executive function deficits, which are still present after a protracted period of alcohol abstinence. These data support the idea that the cognitive deficits in recently detoxified sober alcoholic subjects are due, at least partly, to frontal lobe dysfunctioning.

Correlation between inhibition, working memory and delimited frontal area blood flow measure by 99mTc-Bicisate SPECT in alcohol-dependent patients

Recently detoxified non-neurological alcoholic patients appear to be impaired in cognitive tasks measuring inhibitory processes as well as working memory (involving storage and manipulation of information). The aim of this study was to investigate in alcoholic participants the relationship between these two cognitive functions and regional cerebral blood flow (rCBF) studied at rest in regions of interest selected on the basis of recent PET studies which explored inhibitory and working memory in normal subjects. Twenty non-neurological alcoholic patients and 20 normal volunteers were selected for a neuropsychological exploration, including assessment of inhibition processes (by means of the Hayling test) and working memory (by means of the Alpha-span task). rCBF of alcoholics was also evaluated with a semi-quantitative method using a 99mTc-Bicisate single photon emission computed tomography (SPECT) procedure. Alcoholic patients performed worse than controls in the alphabetical condition of the Alpha-span task (involving manipulation and storage of information), and on the Hayling test. Significant correlation emerged between inhibition performance and both the bilateral inferior (left BA 47, r = -0.40; right BA 47, r = -0.599) and median frontal gyrus (left BA 10, r = -0.55; right BA 10, r = -0.59), but not with the region of reference (occipital/cerebellum, r = -0.13). Coordination of storage and manipulation was correlated with bilateral median frontal (left BA 10/46, r = -0.50; right BA 10/46, r = -0.45), but not with bilateral parietal area (left BA 7, r = -0.12, right BA 7, r = -0.18). These results suggest a relationship between inhibition and working memory deficits in alcoholic patients, and regional rCBF measured in frontal areas. Clinical implications of these data related to alcohol relapse are discussed.

Temperament and Character Inventory (TCI) personality profile and sub-typing in alcoholic patients: a controlled study

Cloninger's Temperament and Character Inventory (TCI) personality profile was used to compare alcohol-dependent patients with non-psychiatric control subjects, and a search made for sub-types of alcoholics with different TCI profiles, using the criteria age of onset of alcohol-related problems, paternal dependence on alcohol and familial antecedents of alcohol dependence. Alcohol-dependent patients (n = 38) were characterized by higher Novelty-Seeking [corresponding to Diagnostic and Statistical Manual of Mental Disorders (4th edition) group B personality type] and lower Self-Directedness than non-psychiatric control subjects (n = 47). Lower Self-Directedness indicates a higher probability of personality disorder in the alcohol-dependent population. Only age of onset of alcohol-related problems delineated the two sub-populations with different TCI profiles: early-onset alcoholics (< or =25 years of age, n = 19), but not late-onset ones (n = 16), in comparison with control subjects, were associated with higher Novelty-Seeking. Both early and late-onset patients scored lower on Self-Directedness than control subjects. Self-Directedness and Cooperation scores were lower in early-onset than in late-onset patients. These results in part support Cloninger's typology, and the TCI data add to evidence concerning a higher probability of personality disorder in alcohol-dependent patients, particularly those with early-onset.

Impaired emotional facial expression recognition in alcoholism compared with obsessive-compulsive disorder and normal controls

Emotional facial expression (EFE) decoding skills have been shown to be impaired in recovering alcoholics (RA). The aim of the present study is to replicate these results and to explore whether these abnormalities are specific to alcoholism using two control groups: non-patient controls (NC) and patients with obsessive-compulsive disorder (OC). Twenty-two alcoholic patients at the end of their detoxification process (RA) were compared to 22 OC and 22 NC matched for age, sex and education level. They were presented with 12 photographs of facial expressions portraying different emotions: happiness; anger; and fear. Each emotion was displayed with mild (30%) and moderate (70%) intensity levels. Each EFE was judged on 8 scales labeled happiness, sadness, fear, anger, disgust, surprise, shame and contempt. For each scale, subjects rated the estimated intensity level. RA were less accurate in EFE decoding than OC and NC, particularly for anger and happiness expressions. RA overestimated the emotional intensity for mild intensity level expressions compared with both OC and NC while no significant differences emerged for moderate intensity level expressions. Deficits in EFE decoding skills seem to be specific to RA when compared with OC. Comparison with other psychopathological groups is still needed. Possible consequences of EFE decoding deficits in RA include distorted interpersonal relationships.

Deficits in recognition of emotional facial expression are still present in alcoholics after mid- to long-term abstinence

OBJECTIVE

Emotional facial expression (EFE) decoding skills play a key role in interpersonal relationships. Decoding errors have been described in several pathological conditions, including alcoholism. The aim of this study was to investigate whether EFE decoding skill deficits persist after abstention from alcohol of at least 2 months.

METHOD

Alcoholic patients abstinent for at least 2 months (n = 25) were compared with 25 recently detoxified patients and with 25 normal controls matched for age, gender and educational level. Subjects were presented with 40 photographs of facial expressions portraying happiness, anger, sadness, disgust and fear. Each emotion was displayed with neutral, mild, moderate and strong emotional intensity. Each facial expression was judged successively on eight scales labeled happiness, sadness, fear, anger, disgust, surprise, shame and contempt. For each scale, subjects rated the estimated intensity level. A complementary scale assessed the self-estimated difficulty in performing the task.

RESULTS

Recently detoxified alcoholics were significantly less accurate than controls, making more EFE labeling errors and overestimating the intensity of the portrayed emotions. Deficits in decoding accuracy for anger and disgust were present in mid- to long-term abstinent patients; intensity overestimation was present in the former and absent in the latter.

CONCLUSIONS

Deficits in decoding accuracy for anger and disgust, and to a lesser degree sadness, persist with an abstinence of 2 months and beyond. Right frontotemporal regions and cingulate could be implicated. These deficits may contribute to the social skills deficits frequently encountered in alcoholic patients.

Previous anesthesia can temporarily overshadow the expression of a withdrawal syndrome in opiate dependent rats

We hypothesized that induction of opiate antagonist-precipitated withdrawal under anesthesia can decrease the expression of later withdrawal signs. Three groups of morphine-dependent rats were compared in different experimental conditions of withdrawal precipitation using naloxone. We showed that anesthesia can temporarily overshadow the expression of withdrawal signs, but that some signs can be delayed and increased in intensity. This can be explained by a parallel and temporary effect of anesthesia on arousal and pain threshold. This carries important implications on the use of anesthesia in detoxification procedures.