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A superheterodyne transmission scheme is adopted and analyzed in a 300 GHz wireless point-to-point link. This was realized using two different intermediate frequency (IF) systems. The first uses fast digital synthesis which provides an IF signal centered around a carrier frequency of 10 GHz. The second involves the usage of commercially available mixers, which work as direct up- and down-converters, to generate the IF input and output. The radio frequency components are based on millimeterwave monolithic integrated circuits at a center frequency of 300 GHz. Transmission experiments over distances up to 10 m are carried out. Data rates of up to 60 Gbps using the first IF option and up to 24 Gbps using the second IF option are achieved. Modulation formats up to 32QAM are successfully transmitted. The linearity of this link and of its components is analyzed in detail. Two local oscillators (LOs), a photonics-based source and a commercially available electronic source are employed and compared. This work validates the concept of superheterodyne architecture for integration in a beyond-5G network, supplying important guidelines that have to be taken into account in the design steps of a future wireless system.
Les troubles addictifs sont des troubles complexes où les traitements actuellement efficaces restent peu nombreux. Dans ce contexte, la tDCS de part son action neuromodulatrice, sa simplicité d’utilisation et sa faible innocuité pourrait être une option valable à la fois pour mieux comprendre la physiopathologie de ces troubles que comme traitement potentiel. Les comportements addictifs sont marqués par un ensemble de symptômes cognitifs, comportementaux et physiologiques faisant qu’un individu continue à consommer en dépit des conséquences négatives auquel il s’expose. Parmi ces caractéristiques, le craving est particulièrement impliqué dans le maintien des consommations. La neurobiologie du craving implique les régions préfrontales. Cela en fait une cible de choix pour la tDCS. Des études tDCS versus une stimulation placEbo ciblant le cortex préfrontal ont montré une diminution du craving. Ces résultats ont été retrouvé dans une série d’addiction allant du tabac à la methamphetamine en passant par l’alcool et la nourriture. Dans certaines études, cette diminution du craving était associée cliniquement à une diminution des consommations de nourriture ou de cigarettes.
Une autre cible d’action potentielle pourrait être neurocognitive. Les addictions sont marquées par des altérations de la prise de décision, une hypersensibilité à la récompense et une impulsivité importante. Des études très préliminaires chez des sujet dépendants au tabac et au cannabis suggèrent qu’un programme de tDCS ciblant le cortex préfrontal dorsolatéral améliore ces fonctions neuropsychologiques et ainsi indirectement le pronostic de l’addiction. Les données actuelles ne permettent cependant pas de préciser si il existe un maintien à long terme des effets observés. L’intérêt clinique et les paramètres optimaux d’utilisation doivent également être mieux définis. Néanmoins ces premières données suggèrent que la tDCS pourrait permettre le développement de nouvelles approches thérapeutiques dans des troubles où les prises en charge actuelles sont perfectibles.
As part of a process to improve bipolar disorders (BPD) treatment and outcome in France, AFBP developed recommendations in the management of patients with bipolar disorders for French practitioners. The recommendations aim to reflect both evidence-based practice and real-world experience. Here, we will focus on the management of BPD with comorbid addictive disorders.
A formalized method by expert consensus panel was used. 239 questions were developed and sent to a panel of 40 French experts in order to assess six domains:
1) screening and diagnosis,
2) acute phase treatment,
3) maintenance and non pharmacological treatment,
4) somatic comorbidities,
5) psychiatric comorbidities and suicide risk management and
6) special populations.
Special attention was made to situations where evidence based treatment are lacking.
The treatment of BPD and comorbid addictive disorders should be concurrent. The only exception is during an alcohol withdrawal where mood state may be reassessed for a second time. Experts recommend the use of atypical antipsychotics or anticonvulsants during a manic, mixed or depressive episode as well as in prophylaxia. During a depressive episode, the adjunction of an antidepressant may be considered. If adjunctive sedative treatment is necessary, a sedative classical antipsychotic seems to be a better choice that benzodiazepine. Substitution treatment for opioid must not be stopped. A psychotherapy focused on the addiction should be systematic in susbtance dependence and proposed in substance abuse.
The French expert panel recommends different therapeutic options for patients with dual diagnosis compared to usual BPD patients.
As part of a process to improve the quality of care, the French Society of Biological Psychiatry developed recommendations for clinical practice in bipolar disorder.
The method chosen for these guidelines is a formalized consensus of experts. It enables, through a series of specific clinical situations proposed to the experts, to provide recommendations for the management of bipolar disorder. The situations where defined because they are not associated to evidence-based recommendations according to the lack of controlled studies.
40 experts participate to this consensus. As in most of the guidelines for the treatment of bipolar disorder, more than 50 % of experts (51,3 to 72,9%) recommend the same therapeutic strategies to treat major depressive episode whichever the type (bipolar I or II).
Unlike to other guidelines, French experts propose different therapeutic according to the presence or absence of rapid cycling. For major depressive episode without rapid cycling, 63% experts recommend a combination of an antidepressant with a mood stabilizer. In rapid cyclers, 51% experts recommend the use of a mood stabilizer in monotherapy or in combinaison, but never associated with antidepressant.
This methodological approach enables to get closer to everyday clinical practice and integrate specificities of prescription through a national panel of experts. On the other hand, this type of methodology highlights the research perspectives: i.e. management of acute depression with rapid cycle in bipolar disorder.
Childhood trauma and aggressive traits are considered risk factors for suicidal behavior. The hypothesis we aimed to test in this study was the existence of an association between childhood trauma and aggression in two distinct samples of Italian and French suicide attempters.
Study participants comprise 587 subjects with different psychiatric diagnoses according to DSM-IV-TR criteria. Three different samples were analyzed and compared: a group of French suicide attempters (N = 396; mean age 40.47 SD = 13.52; M/F: 110/286); a group of Italian suicide attempters (N = 103; mean age 38.60 SD = 12.04; M/F 27/76) and an Italian psychiatric comparison group (N = 88; mean age: 41.49 SD = 12.05; M/F; 37/51). Patients were interviewed with the Brown–Goodwin Assessment for Lifetime History of Aggression (BGLHA) and the Childhood Trauma Questionnaire (CTQ) 34-items for Italian data and 28-items for French data.
When compared with the comparison group, Italian suicide attempters had significantly higher scores on the BGLHA scale and reported higher scores on the CTQ scores for physical abuse, sexual abuse and emotional abuse. Significant correlations between childhood trauma and aggression were found in both groups, Italian and French, of suicide attempters.
The hypothesis tested was supported as psychiatric patients who had attempted suicide reported significantly more childhood trauma and aggression. Significant correlations were found between aggressive behavior, and childhood trauma in suicidal patients. This finding was replicated in two independently recruited samples in two countries with different prevalence of suicidal behavior.
A better understanding of the pathophysiology of suicidal behaviour (SB) may enable the discovery of more specific treatments and a better identification of vulnerable patients. The vulnerability to SB appears to be underlied by genetic factors coding for traits rendering the individual less able to cope with stressing situations, and more likely to be engaged in a suicidal process.
During the recent years, neuroscientific studies begun to identify potential endophenotypes.
We have shown that disadvantageous decision making (DM) was involved in the vulnerability to SB. DM impairment appears to be independent of comorbid psychiatric disorders, associated with emotional dysregulation (i.e. affective lability trait and skin conductance responses), and modulated by serotonergic genotypes associated with SB. In recent fMRI studies, the region that is likely involved in DM, is overactivited in response to angry faces, suggesting a higher sensitivity to specific negative social stimuli. Deficit in risk evaluation and excessive response to specific emotional stimuli may represent key processes in the vulnerability to SB.
These potential endophenotypes may represent future relevant markers of vulnerability for the identification of vulnerable patients, and relevant targets for the development of new treatments.
People with eating disorders (ED) are at high risk for suicidal behavior. Among different ED, anorexia nervosa (AN) has the highest rates of completed suicide whereas suicide attempt rates are similar or lower than in bulimia nervosa (BN). Attempted suicide is a key predictor of completed suicide, thus this mismatch is intriguing. We sought to explore whether the clinical characteristics of suicidal acts differ between suicide attempters with AN, BN or without an ED.
Case-control study in cohort of suicide attempters (n = 1563). Forty-four patients with AN and 71 with BN were compared with 235 non-ED attempters matched for sex, age and education, using interview measures of suicidal intent and severity.
AN patients were more likely to have made a serious attempt (OR = 3.4, 95% CI 1.4–7.9), with a higher expectation of dying (OR = 3.7, 95% CI 1.1–13.5), and an increased risk of lethality (OR = 3.4, 95% CI 1.2–9.6). BN patients did not differ from the control group.
There are distinct features of suicide attempts in AN. This may explain the higher suicide rates in AN. Deaths from suicide in AN may not be the result simply of their greater physical frailty.
Les techniques de neuromodulation sont de plus en plus utilisées en psychiatrie. Dans le contexte des troubles des conduites alimentaires (TCA) où peu de prises en charge efficaces sont disponibles, plusieurs de ces techniques pourraient avoir un intérêt pour mieux appréhender la physiopathologie et/ou comme thérapie innovante. Trois techniques émergent. Deux sont des techniques de neuromodulation non invasives : la repetitive Transcranial Magnetic Stimulation (rTMS) et la transcranial Direct-Current Stimulation (tDCS) et une nécessite une intervention chirurgicale : la stimulation cérébrale profonde. Dans la boulimie, plusieurs études versus placebo utilisant la rTMS ont montré une diminution des pulsions alimentaires sur du court terme. Nos résultats préliminaires dans une étude multicentrique suggèrent une diminution du nombre de crises dans les 15 jours post-rTMS. La rTMS dans cette population est bien tolérée. Une série d’études pilote suggère également que la tDCS diminue les pulsions et les prises alimentaires et améliore des fonctions cognitives perturbées dans les TCA. Dans l’anorexie, la tolérance de la rTMS a été montrée comme bonne, même chez des patientes à poids très bas. Plusieurs études sont actuellement en cours pour évaluer l’effet sur des fonctions-clés de l’anorexie comme la perception corporelle ou la conscience intéroceptive avec pour objectif essentiel de mieux cerner la physiopathologie. Mais la technique de neuromodulation qui offre le plus d’espoir est la stimulation cérébrale profonde. Deux études pilotes récentes chez des patientes anorexiques très sévères suggèrent non seulement une bonne tolérance mais aussi une amélioration très nette de la symptomatologie alimentaire dans les mois ayant suivi l’intervention. Néanmoins, ces études restent à répliquer et les meilleurs sites et protocoles de stimulation restent à définir. Ainsi, ces techniques suscitent beaucoup d’espoir dans des pathologies résistantes mais leurs efficacités potentielles et utilisation clinique restent encore à définir.
Repetitive Transcranial Magnetic Stimulation (rTMS) research in psychiatry mostly excludes left-handed participants. We recruited left-handed people with a bulimic disorder and found that stimulation of the left prefrontal cortex may result in different effects in left- and right-handed people. This highlights the importance of handedness and cortex lateralisation for rTMS.
Anorexia nervosa (AN) may be associated with impaired decision-making. Cognitive processes underlying this impairment remain unclear, mainly because previous assessments of this complex cognitive function were completed with a single test. Furthermore, clinical features such as mood status may impact this association. We aim to further explore the hypothesis of altered decision-making in AN.
Sixty-three adult women with AN and 49 female controls completed a clinical assessment and were assessed by three tasks related to decision-making [Iowa Gambling Task (IGT), Balloon Analogue Risk Task (BART), Probabilistic Reversal Learning Task (PRLT)].
People with AN had poorer performance on the IGT and made less risky choices on the BART, whereas performances were not different on PRLT. Notably, AN patients with a current major depressive disorder showed similar performance to those with no current major depressive disorder.
These results tend to confirm an impaired decision making-process in people with AN and suggest that various cognitive processes such as inhibition to risk-taking or intolerance of uncertainty may underlie this condition Furthermore, these impairments seem unrelated to the potential co-occurent major depressive disorders.
Les conduites suicidaires (CS) constituent un problème de santé publique majeur à travers le monde. Elles présentent une vulnérabilité propre, et sont maintenant considérées comme une entité diagnostique indépendante dans le DSM5. La thérapie d’acceptation et d’engagement (ACT) est une thérapie intégrative ayant démontré son utilité dans une grande variété de troubles psychiatriques, à travers une diminution de l’évitement expérientiel et une amélioration de la flexibilité psychologique (socles communs à l’ensemble des troubles psychiatriques) .
Nous avons conduit une étude pilote suggérant la faisabilité de la thérapie ACT, sous forme de groupes, chez les patients suicidants (CHRU de Montpellier, Pr Courtet) . À travers la présentation des processus thérapeutiques utilisés dans la thérapie ACT, nous aborderons les hypothèses d’action de la thérapie ACT dans les conduites suicidaires. Puis nous présenterons l’étude IMPACT, en cours de réalisation dans le service urgences et post-urgences psychiatriques (CHRU de Montpellier, Pr Courtet). Il s’agit de la première étude contrôlée randomisée recherchant des biomarqueurs neuroanatomiques et fonctionnels de réponse à la thérapie ACT chez des patients ayant un trouble des conduites suicidaires. Nous aborderons enfin, de façon pratique, comment présenter la thérapie ACT à un patient, à travers une matrice . Il s’agit d’une analyse fonctionnelle permettant de faire percevoir au patient le fonctionnement actuel dans lequel il se sent enlisé, de mettre en lumière ce qui est important dans sa vie, et donc d’avoir un outil motivationnel simple et efficace pour l’accompagner vers le changement.
La thérapie ACT semble être une thérapie prometteuse dans la prise en charge des conduites suicidaires. L’étude IMPACT servira à accroître les connaissances sur les conduites suicidaires par l’identification de biomarqueurs de réponse thérapeutique et la mise en évidence des régions cérébrales associées aux processus thérapeutiques.
Smoking and suicidal behavior are two major public health problems associated in epidemiological and clinical studies. Smoking has been associated with suicidal ideation, suicide attempts, and suicide, independently of mental disorders. Yet, the mechanism that links smoking and suicidal behavior is unknown. We investigated the relationship between the level of tobacco dependence and the severity of suicidal outcomes among suicide attempters.
We examined a sample of 542 adult suicide attempters to compare the characteristics of the attempts depending on the level of tobacco dependence. All participants had made a suicide attempt in the previous two years (criterion for suicidal behavior disorder). Level of tobacco dependence was assessed with the Fagerstrom test. Diagnoses were ascertained with the Mini International Neuropsychiatric Interview and suicidal behaviors were assessed, among others, with the Risk Rescue Rating Scale and the Suicidal Intent Scale. Impulsivity was measured with the Barratt Impulsiveness Scale.
Independently of potential confounders, heavy smokers (Fagerstrom≥7) made more attempts and reached higher medical lethality than non-smokers (OR=2.42; 95%CI= 1.43-4.11, p=0.001, and OR=1.88; 95%CI=1.09-3.24; p=0.03, respectively). Light smokers (Fagerstrom<7) were not associated with features of severity in their suicide attempts. The combination of high impulsiveness and severe tobacco dependence showed an additive effect on the number of suicide attempts (OR=3.55; 95%CI= 1.75-7.21).
A high level of tobacco dependence could indicate a specific vulnerability leading to more severe suicide attempts, which was only partially explained by impulsivity traits.
Selon les recommandations actuelles, les traitements de choix des troubles alimentaires compulsifs type boulimie et hyperphagie boulimique reposent sur plusieurs aspects. Tout d’abord, une prise en charge hygiéno-diététique ayant pour objectif de restructurer les prises alimentaires, modifier les comportements alimentaires en dehors des crises, tester les croyances erronées vis-à-vis des aliments, aider à la gestion des vomissements… Elles sont le plus souvent associées à une prise en charge psychothérapique et/ou médicamenteuse. La psychothérapie de choix est la thérapie cognitivo-comportementale (TCC). Compte tenu de leurs cibles thérapeutiques les TCC sont plutôt à réserver à des patientes euthymiques, ayant de fortes préoccupations pour la minceur. L’alternative psychothérapique peuvent être les thérapies interpersonnelles et éventuellement les thérapies psychanalytiques dans certaines situations. Le traitement médicamenteux de première ligne est la fluoxetine à dose anti-compulsive (60 mg/j). D’autres prises en charge médicamenteuses sont proposées (epitomax, naltrexone…) mais doivent être réservées à des deuxièmes lignes après avis spécialisé. Quelle que soit la prise en charge retenue, il est fondamental dans le cadre de l’hyperphagie boulimique d’expliquer aux patients que ces prises en charge n’auront pas d’effets amaigrissants En complément de ces prises en charge, des techniques de self-help devraient être systématiquement associées. Ces techniques consistent en l’utilisation de différents outils (livres, des sites Internet, CD…) qui seront utilisé par le patient seul ou accompagné par le thérapeute dans le but d’augmenter ses connaissances par rapport sa problématique et lui apporter des compétences et des outils pour diminuer les symptômes voir les faire disparaître. Ces techniques simples et pouvant être facilement utilisées par tous ont été validées scientifiquement dans plus d’une trentaine d’études y compris en population française. Certains de ces supports de self-help, actuellement disponibles en France, seront présentés.
Pre- and perinatal insults, childhood maltreatment, and personality traits have been separately related to suicidal behavior.
To explore if all these factors act in an additive fashion.
To examine characteristics of suicide attempts in a life course perspective.
Sample and procedure: Cross-sectional study of 1042 suicide attempters. Indexes of pre- and perinatal adversity were hospitalization in neonatology, very premature birth (< 31 weeks of pregnancy), tobacco during mother's pregnancy, and mother's and father's age at patient's birth. All suicide attempters were evaluated using the French version of the Childhood Trauma Questionnaire, and the Tridimensional Personality Questionnaire. Characteristics studied in suicide attempters included violence of suicide attempt, age at first suicide attempt, and number of suicide attempts. Statistical Analyses: Comparisons between groups was made using c2 with crude and adjusted odds ratios, and 95% confidence intervals. All analyses were adjusted for gender, age, study level, Alcohol dependence or abuse, Substance dependence or abuse, Tobacco, Episode of major depression, Bipolar, Anxiety, Eating disorders, and Schizophrenia.
We found an additive effect between prematurity and sexual abuse (OR[95%] = 3.57[1.03–12.50];p < 0.001), emotional abuse (OR[95%] = 4.54[1.76–12.50];p < 0.05), novelty seeking (OR[95%] = 9.09[1.76-12.50];p < 0.001), and harm avoidance (OR[95%] = 5.88[2.38-14.28];p < 0.001) for a younger age at first suicide attempt. Tobacco during mother's pregnancy, and harm avoidance also had an additive effect on the age at first suicide attempt (OR[95%] = 4.76[1.96–11.11];p < 0.05) and number of suicide attempts (OR[95%] = 3.31[1.37–7.99];p < 0.05).
Pre- and perinatal insults, childhood maltreatment, and personality traits influence in an additive fashion characteristics of suicide attempts.
Several studies have demonstrated various neuropsychological dysfunctions in patients with EDs . Among them, cognitive inhibition deficits has been studied. While Eating Disorders (ED) are characterized by difficulties to inhibit feeding behavior, there is no consensus regarding neuropsychological studies about cognitive inhibition deficits [2, 3]. The goal of this study is to examine the contribution of the type of measurement used (self-report questionnaires versus neuropsychological tests) to explain these differences between studies.
Patients (ED) suffering from anorexia nervosa (AN; n=33), bulimia nervosa (BN; n=27) with no psychiatric comorbidity and free of psychotropic medication, and healthy controls (HC; n=xx) with no psychiatric history were assessed using the Hayling Test (neuropsychological test) and BIS-10 (self-report questionnaires).
 Significant differences in self-report questionnaires (BIS-10) were observed between ED and HC. BN showed more pronounced cognitive inhibition deficits then AN.
 No significant differences in neuropsychological tests (Hayling Test) were observed between ED and HC.
This study confirms dissociation between measures of self-report questionnaires and neuropsychological tests of cognitive inhibition and impulsivity in people with ED.
Despite the multidimensionality of suicidal behavior, to date there is no precise depiction of suicide attempters according to their features. In this study we investigate if a sample of suicide attempters can be clustered in homogeneous subgroups according to the characteristics of their suicidal behavior. Once the main clusters were identified, we have compared the main risk factors between the groups to establish clinical profiles.
Patients between 18 and 84 years old were recruited as part of a suicide attempters study (n=1009). They were consecutively hospitalized and survivors of a current suicide attempt in a specialized unit of the Montpellier University Hospital. We used an Ascending Hierarchical Classification following Ward's method to identify clusters among suicide attempters. Clusters were then compared with regards to phenotypic and genetic variables.
Three clusters were identified. Attempt planning, substance use, and few possibilities of rescue characterized the first cluster (‘reflexive’, n=40). The second cluster (‘moderate’, n=604) did not plan the attempts but used non-severe non-violent means. Finally, the third cluster (‘impulsive’, n=365) made the first attempt at an earlier age, made more attempts, and more violent attempts. Significant differences between clusters were also found regarding gender, tobacco smoking, childhood abuse, family history of suicide and several genetic polymorphisms.
Three clearly differentiated clusters of suicide attempters were identified. Phenotypic and genetic differences allow the identification of these clusters in clinical settings. Prevention programs might be improved by targeting specific subgroups of attempters.
CYP2D6 and CYP2C19 are involved in the metabolism of widely used antidepressants and other drugs with psychotropic activity. They also participate in the metabolism of endogenous substrates, and are expressed in the brain.
Objectives and Aims
This study examined, for the first time, whether a high CYP2D6-CYP2C19 metabolic capacity combination increases the likelihood of suicidal intent severity in a large study cohort.
Survivors of a suicide attempt (n=587; 86.8% women) were genotyped for CYP2C19 (*2, *17) and CYP2D6 (*3, *4, *4xN, *5, *6, *10, wtxN) genetic variation and evaluated with the Beck Suicide Intent Scale (SIS).
Patients with a high CYP2D6-CYP2C19 metabolic capacity showed an increased risk for a severe suicide attempt (P<0.01) as measured by the SIS-objective circumstance subscale (odds ratio (OR)=1.37; 95% confidence interval (CI)=1.05-1.78; P=0.02). Importantly, the risk was greater in those without a family history of suicide (OR=1.82; CI=1.19-2.77; P=0.002).
Further research is warranted to evaluate whether the observed relationship is mediated by the role of CYP2D6 and CYP2C19 involvement in the endogenous physiology or drug metabolism or both.
This work was supported in part by Union Europea Fondo Social Europea (FEDER/FSE), Instituto de Salud Carlos III-FIS (PI10/02758) and Gobierno de Extremadura Consejería de Economía, Competitividad e Innovación (IB13186 and PD10199). CHU Montpellier (PHRC UF 7653), Agence Nationale de la Recherche (ANR NEURO 2007 'GENESIS').
Most patients (70%) discontinuing tobacco smoking will relapse within 6 months. A major challenge is the understanding of the processes involved in relapse. High cigarette craving has been proposed as a predictor of relapse. A recent study suggests that low inhibitory control capacities (low ability to inhibit prepotent responses) were correlated with high nicotine dependence. In this study, we focused on the link between inhibition capacity, craving, tobacco dependence and relapse.
134 smokers willing to quit smoking were consecutively included and followed prospectively. Tobacco dependence was assessed with the Fagerstorm test. We used the Hayling task to measure their inhibitory capacity and a specific questionnaire to measure tobacco craving (TCQ 12). Assessments were performed at baseline, 1, 3 and 6 months after smoking cessation. Any relapse in smoking during the follow-up was evaluated.
There was an association between lower inhibition capacities and higher dependance level at baseline. Low inhibition capacities were an independent predictor of relapse at 6 months (logit R 2 = .08, F (2,134) = 10.851, p <. 004). In contrast, although level of tobacco dependence and craving predicted relapse in the short term (first month), they did not predict relapse at 6 months.
These results suggest that inhibition capacities may predict smoking relapse in the long term (6 months) better than usual measures of craving. In clinical practice, an inhibition test, which is short and feasible, could be of interest to identify smokers at higher risk of relapse.
Decision-making impairment has been found associated with several neuropsychiatric disorders. This cognitive function has been found under influence of genetics factors, but very few are known on how development of decision-making process may be modulated by early environmental factors.
Childhood sexual abuse has also been linked with numerous psychiatric disorders mainly through persistent changes in corticotrophin-releasing factor neurotransmission and sustains alteration of the HPA axis.
We explored the link between decision-making abilities in adulthood and sexual childhood abuse. We hypotheses than childhood sexual abuse may be associated with a lower decision making abilities. We have also hypotheses than this association may be modulated by some genotype critical in modulation of stress response.
The Iowa Gambling Task was used to assess decision-making in 217 patients with a personal history of attempted suicide. The Childhood Trauma Questionnaire was used to examine traumatic childhood experiences. Patients were genotyped for 8 single-nucleotide polymorphisms on four genes related to stress: CRHR1, CRHR2, FKPB5 and AVP.
There was a trend of association between IGT total score and sexual abuse showing that sexually abused subjects had lower scores than non-sexually abused one. This association became significant in the last part of the game (61–80). There was a significant interaction between rs1396862, rs878886 and rs242948 within CRHR1 and childhood sexual abuse in IGT total scores.
Decision making abilities in adulthood may be influenced by the interaction between childhood sexual abuse and functional polymorphism in the CRHR1 gene.
Bipolar disorder (BIPD) is a chronic and disabling illness with frequent comorbid addictive disorders (ADD). Little is known about the prevalence and correlates of cannabis use disorders (CUD) in that population.
We sought to characterize clinical, sociodemographic, childhood trauma and psychological correlates associated with CUD in bipolar patients.
Our main hypothesis was that BIPD + CUD patients would be more impulsive and affectively unstable than those without.
Patients enrolled in a French national network underwent a thorough assessment including lifetime diagnoses using the SCID-IV questionnaire and measures of current symptomatology (Altman and MADRS), impulsivity (BIS-10), emotional instability (AIM and ALS), hostility (BDHI) and history of childhood trauma (CTQ). Univariate and multivariate analyses were used to identify specific associations between several correlates and CUD status.
Among the 718 patients included, 414 (57.7%) were women, with a mean age of 43 years, and 546 (76.4%) were diagnosed with type I bipolar disorder and 190 (26.9%) had at least one lifetime substance use disorder. CUD were associated with lifetime history of suicidal behavior, psychotic symptoms during an affective episode, rapid cycling and CTQ sub-scores, clinical and psychological dimensions. Parts of these associations remained after controlling for comorbid alcohol use disorders.
These results suggest a high prevalence of CUD in BIPD, which was associated with a higher severity and worse outcomes of illness. Although the retrospective nature of this study prevents causal interpretations, our results suggest that at-risk traits among CUD+BIPD patients may induce these clinical features.