The opioid system modulator nalmefeneis the first pharmacological therapy approved in the European Union for reduction of alcohol consumption.

To evaluate the clinical relevance of the reduction of alcohol consumption in patients with at least high drinking risk level at screening and randomisation from the two, identically designed, randomised controlled 6-month studies ESENSE1 (NCT00811720) and ESENSE2 (NCT00812461) of nalmefene versus placebo.

Study medication was taken as-needed. All patients received a motivational and adherence-enhancing intervention (BRENDA). Response criteria were based on alcohol consumption at month 6 and Clinical Global Impression – Severity of Illness/Improvement (CGI-S/I), Short Form Health Survey version 2 (SF-36) mental component summary(MCS) scores at week 24. Clinical relevance was also studied using the Drinker Inventory of Consequences (DrInC), Alcohol Dependence Scale (ADS), and liver function variables.

Pooled study population: 667 patients (placebo N=332; nalmefene N=335). The proportion of responders was higher in the nalmefene group than in the placebo group with odds ratios for response consistently significantly (p<0.05) in favour of nalmefene. The difference in the proportions of responders translated to numbers-needed-to-treat ranging from 6 to 10. Significant differences to placebo (p<0.05) in the SF-36 MCS and physical component summary score, ADS, DrInC, CGI-I/S and liver enzymes further supported the clinical relevance of the treatment effect.

In view of the immense alcohol-related burden to society, the harm to the individual and the large treatment gap partly due to a reluctance to engage in abstinence, the effect of nalmefene is clearly clinically relevant.

The aim of our study was to investigate the effects of continuous action of ultrasonic waves of variable frequencies on behavior of rats in ’classical’ tests used to reveal depression-like behavior, to evaluate the influence of different antidepressants on rates and to analyze expression of several genes involved in pathogenesis of depression.

: Rats in individual cages were exposed to ultrasonic irradiation of variable frequencies (20–45 kHz) for 21 days.

48 male non-pedigree albino rats were divided into 5 groups: non-ultrasound-saline, ultrasound-saline, ultrasound-fluoxetine, ultrasound-bupropion and ultrasound-tianeptine. Administration of each drug was carried out daily from the first to the last day of the experiment. Behavioral tests were include: Social Interaction test, Porsolt and Anhedonia Test. Than rats were decapitated and expression genes coding serotonin receptors (5HT1, 5HT2 subtypes), SERT and BDNF were measured in prefrontal cortex, midbrain and hippocampus using Quantitative real-time PCR analysis.

Depression-like behavior manifests itself in reduced social activity in Social Interaction Test, increased immobility in Porsolt Test and lower sucrose consumption in Sucrose Preference Tests. The administrated antidepressants demonstrated their effectiveness. RT-qPCR gene expression analysis showed increased expression of SERT gene in all studied structures; decrease expression of 5-HT2A in prefrontal cortex and midbrain, increase 5HT1A in hippocampus. Expression of gene coding BDNF in hippocampus is significant decreased.

The obtained data allow to conclude that this model meets the main requirements set to animal models (face, predictive and construct validity) and can be used in pre-clinical studies of new antidepressants.

Psychological debriefing is a way for prevention and reducing post traumatic stress disorder (PTSD) symptoms. Many studies have shown the efficacy of cognitive behavioral therapy in treatment of PTSD. Few evidence is available for using of these techniques in large scale disasters.

This study was carried out to evaluate the efficacy of psychological debriefing and cognitive-behavioral group therapy combination on Bam earthquake-related PTSD symptoms in adolescents.

In a before-after trial, we evaluated the efficacy of one session psychological debriefing and three sessions of group cognitivebehavioral therapy in Bam earthquake adolescents survivors with PTSD symptoms. The mean age of participants was 16.4 years and no one had severe PTSD or other psychiatric disorder that needed pharmacological intervention. Before, immediately and 3 months after interventions we evaluated PTSD symptoms using Clinical Administrated PTSD Scale for DSM-IV and analyzed them.

30 persons were included in the study, 8 of whom were excluded during interventions because of migration. The mean frequency of PTSD symptoms reduced immediately after interventions which was statistically significant (P< 0.05). There was no efficacy for intensity and severity.

Psychological debriefing and group cognitive-behavioral therapy may be effective in reducing the frequency of avoidance symptoms.

Psychological debriefing has been widely advocated for routine use following major traumatic events. Cognitive Behavioral Interventions, art supportive therapies, and sport and recreational support activities are other interventions for reducing posttraumatic stress disorder.

We assessed the effects of theses methods individually and in combination on reduction posttraumatic stress disorder symptoms in adolescents who had experienced Bam earthquake.

In a field trial, we evaluated the efficacy of psychological debriefing, group cognitive-behavioral therapy, art and sport supportive interventions in 200 adolescents with PTSD symptoms who survived of Bam earthquake and compare it with a control group. Patients were randomly assigned to one of intervention programs including: group cognitive-behavioral therapy; group CBT plus art and sport interventions; art and sport interventions without group CBT; and control group.

Thirty one individuals were excluded because of migration. A statistically significant reduction in overall PTSD symptoms as well as in avoidance symptoms was observed after group cognitive-behavioral therapy. There was no significant difference in reduction of overall PTSD and avoidance symptoms between the other groups.

Psychological interventions in form of group cognitive behavioral therapy can reduce the symptoms of PTSD symptoms but we could not find the art and sport supportive therapy alone or in combination with group CBT to be useful in this regard.

Marchiafava-Bignami Disease is a rare complication in malnourished patients with chronic alcohol use. Due to its rarity, its pathogenesis is poorly understood. Patients suffering from Marchiafava-Bignami Disease can present with a plethora of symptoms including acute change in mental status, dementia, seizures and neurological dysfunction. This condition is characterised by corpus callosum demyelination with reported cases of white matter involvement.

To highlight the possibility that patients exhibiting predominant psychiatric symptoms with a history of chronic alcohol use might also be suffering from Marchiafava-Bignami Disease and that such a diagnosis should not be ruled out purely because of the psychiatric symptoms.

We report a 41-year-old man who presented with sub-acute cognitive decline, poorly defined psychotic symptoms and minimal neurological signs. MRI showed atrophy of the corpus callosum, consistent with Marchiafava-Bignami Disease. Despite timely diagnosis and adequate treatment, his psychotic symptoms have remained persistently debilitating.

During our review, the psychiatric symptoms proved to be a red-herring which masked the real diagnosis of this patient. However, based on the MRI findings, he was finally diagnosed with Marchiafava-Bignami Disease. Arrangements have been made to place him in a rehabilitation setting with regular neurological follow-ups to assess disease progression, which would facilitate further management.

This case highlights an atypical presentation of Marchiafava-Bignami Disease and raises the importance of thorough investigations in patients with a long history of alcohol consumption and the need to have a high index of suspicion. Concomitant conditions associated with chronic alcohol use should also be considered.

Bulimia is a psychopathological disorder characterized by the presence of episodes of binge eating, followed by compensatory mechanisms that aim to prevent weight gain. These episodes of uncontrolled ingestion of food are related with deficits in the inhibitory control of behavior (Fairburn & Harrison, 2003). The basal ganglia namely the Nucleus Accumbens (NA) and the Caudate nucleus (CN) are involved in the fronto-striatal circuits that allow the control of impulses.

The main goal of this study was to investigate the presence of structural alterations in the NAc and the CN in a sample of bulimic patients, when compared to normal controls.

Our sample was composed by 41 female participants, 21 diagnosed with bulimia and 20 healthy controls (CG) matched in socio-demographic features. The participants were submitted to the clinical assessment and to a structural magnetic resonance imaging (MRI) acquisition. The NA and the CN of the 41 MRIs were manually segmented using the software Slicer 3D.

No differences between patients with bulimia and healthy controls were found for the volume of the NA. However, the NC volume is significantly decreased in BN.

The reduction of volume in the CN of bulimic patients that was found in this study may be possibly associated with a lower functional activation of this brain structure, contributing to a lack of control of the excessive eating behavior of these patients.

Étudier la qualité de vie liée à la santé (QVS) et ses déterminants chez des adolescents consultant pour syndrome de Gilles de la Tourette (SGT).

Après hétéro-évaluation par la YGTSS et la CY-BOCS, la QVS des adolescents était mesurée à l’aide de 3 questionnaires d’autoévaluation (SF-36, VSP-A, CHAQ). Des contrôles appariés sur l’âge et le sexe ont rempli les mêmes questionnaires. Les parents des patients et des contrôles ont renseigné les questionnaires sociodémographique et médical, la CBCL et deux hétéroévaluations de la QVS des adolescents (VSP P et CHAQ parents). Tous les participants avaient donné leur consentement éclairé.

Pour les 75 adolescents (14,8 ans, DS = 1,8 ; 80 % de garçons) inclus, le score YGTSS moyen était de 33,9 (DS = 20). Pour la CBCL, le score total, les scores symptômes internalisés et symptômes externalisés étaient limites/pathologiques pour 39,4 %, 52,1 % et 33,3 % des adolescents respectivement. La QVS des adolescents SGT était significativement altérée comparée aux contrôles pour toutes les dimensions de la SF-36, pour les dimensions vitalité, relations avec les pairs et loisirs de la VSP A et pour le score total de la CHAQ. On retrouvait des corrélations négatives significatives entre les scores Tics moteurs et sévérité globale de la YGTSS et les dimensions psychologiques et sociales du SF-36, une corrélation positive entre le score Tics vocaux de la YGTSS et le score total à la CHAQ. Les adolescents avec des scores CBCL total et symptômes internalisés limites/pathologiques avaient des scores significativement plus bas sur plusieurs dimensions de QVS.

Les dimensions physiques, psychologiques et sociales de la QVS sont altérées chez les adolescents SGT. La sévérité des tics, les difficultés émotionnelles et comportementales ont un impact négatif sensible sur les dimensions physiques, psychologiques et sociales de la QVS chez les adolescents SGT.

The default mode network (DMN) is one of the best known resting state networks, which are active when the brain is “at rest” and the individual is not focused on any external demand. The DMN comprises areas of the posterior cingulate cortex (PCC) and adjacent precuneus; the medial prefrontal cortex (MPFC); medial, lateral and inferior parietal cortex and medial temporal cortex. DMN abnormalities have been found in several psychiatry disorders (Broyd et al., 2009) including depression and anxiety where increases in its connectivity namely on the MPFC have been reported (Greicius et al., 2007).

The goal of this study was to investigate the relationship between the DMN activation at rest and both anxiety and depressive symptoms.

Twenty-five participants completed the Hamilton Anxiety and Depression Rating Scales and were submitted to a functional magnetic resonance imaging task-free acquisition in which they were instructed to close their eyes and to think about nothing particular. Independent component analysis was used to extract the DMN maps of each subject and statistical analysis were performed in SPM.

Depression scores correlated positively with the activation of the orbitofrontal gyrus and middle frontal gyrus and negatively with the occipital gyrus, fusiform gyrus, PCC and precuneus. Anxiety scores correlated positively with the activation of the MFPC and ACC and negatively with parietal and temporal areas.

These results provide some support for the role of the DMN particularly its anterior nodes for the ruminative aspects that are common in depressive and anxious individuals.

Depression is a highly prevalent disease and its costs can be burdensome to both patients and payers.

To compare the short-term costs, outcomes, and cost-effectiveness associated with major depressive disorder (MDD) treatment with venlafaxine XR and major market comparators (duloxetine and two selective serotonin reuptake inhibitors [SSRIs], namely escitalopram and sertraline HCL) in Italy from the Italian National Health Service perspective.

To inform treatment decisions based on cost effectiveness of MDD treatments.

A decision tree structure was used to model MDD treatment over 1 year. Patients were treated with one of the model comparators and based on published clinical literature; either remained depressed, achieved response but no remission, or achieved remission. Drug costs were set to the reimbursed price for the recommended dose of each treatment. Costs of hospitalization and utility weights were based on depression status.

Venlafaxine XR was estimated to be the most effective treatment (0.736 quality-adjusted life years [QALYs]) followed by the SSRIs (0.731) and duloxetine (0.714). Total annual MDD-related costs for venlafaxine (€691) were estimated to be lower than all comparators (duloxetine=€1,308, escitalopram=€874) except sertraline HCL (€638), owing largely to drug cost differences and hospitalization savings associated with better projected depression status. Venlafaxine was cost-saving (more effective, less costly) compared with duloxetine and escitalopram. The incremental cost per QALY gained vs. sertraline HCL was €9,844.

Based on the model, venlafaxine XR represents a cost-effective treatment option for MDD in Italy and may result in costsavings depending on the comparison.

Comparer rétrospectivement la clinique de l’enfance et de l’adolescence d’une population d’adultes schizophrènes avec celle d’adultes bipolaires, afin de mettre en évidence des manifestations prémorbides et des prodromes plus spécifiques à l’une ou l’autre des pathologies.

Divers symptômes ont été recueillis dans les anciens dossiers pédopsychiatriques de 50 patients schizophrènes et de 50 patients bipolaires, grâce à une grille de recueil réalisée et évaluée par les auteurs. Ces symptômes ont ensuite été comparés entre les deux populations.

La clinique de l’enfance du groupe schizophrène est marquée par un plus grand nombre de symptômes cognitifs tels qu’un Quotient Intellectuel bas, des troubles logicomathématiques, un retard de langage et des troubles de la concentration. L’énurésie et l’encoprésie semblent également plus spécifiques d’une évolution vers une schizophrénie par rapport à un trouble du spectre bipolaire. La clinique de l’adolescence du groupe schizophrène est marquée par un plus grand repli social, un quotient intellectuel bas et des troubles logicomathématiques. Les symptômes négatifs et positifs (éléments évoquant une discordance, bizarreries du comportement et des propos) sont des prodromes assez spécifiques de la schizophrénie par rapport aux troubles bipolaires. Les fluctuations thymiques constitueraient le seul symptôme réellement spécifique d’une évolution vers un trouble du spectre bipolaire par rapport à une schizophrénie.

Les phases prémorbide et prodromique de la schizophrénie se caractérisent par des symptômes psychocomportementaux qualitativement et quantitativement plus sévères que celle des troubles du spectre bipolaire.

En outre, les troubles bipolaires et la schizophrénie semblent précédés, à l’adolescence, d’une phase prodromique constituée de symptômes déjà évocateurs de ceux caractérisant la pathologie à l’âge adulte mais dans une expression atténuée. Ceci marquant une continuité entre l’adolescence et l’âge adulte.