Scielo RSS <![CDATA[The European Journal of Psychiatry]]> vol. 29 num. 1 lang. <![CDATA[SciELO Logo]]> <![CDATA[<b>Phobic anxiety and plasma levels of global oxidative stress in women</b>]]> Background and Objectives: Psychological distress has been hypothesized to be associated with adverse biologic states such as higher oxidative stress and inflammation. Yet, little is known about associations between a common form of distress -phobic anxiety- and global oxidative stress. Thus, we related phobic anxiety to plasma fluorescent oxidation products (FlOPs), a global oxidative stress marker. Methods: We conducted a cross-sectional analysis among 1,325 women (aged 43-70 years) from the Nurses' Health Study. Phobic anxiety was measured using the Crown-Crisp Index (CCI). Adjusted least-squares mean log-transformed FlOPs were calculated across phobic categories. Logistic regression models were used to calculate odds ratios (OR) comparing the highest CCI category (≥ 6 points) vs. lower scores, across FlOPs quartiles. Results: No association was found between phobic anxiety categories and mean FlOP levels in multivariable adjusted linear models. Similarly, in multivariable logistic regression models there were no associations between FlOPs quartiles and likelihood of being in the highest phobic category. Comparing women in the highest vs. lowest FlOPs quartiles: FlOP_360: OR = 0.68 (95% CI: 0.40 - 1.15); FlOP_320: OR = 0.99 (95% CI: 0.61 - 1.61); FlOP_400: OR = 0.92 (95% CI: 0.52, 1.63). Conclusions: No cross-sectional association was found between phobic anxiety and a plasma measure of global oxidative stress in this sample of middle-aged and older women. <![CDATA[<b>Drug-induced hallucination</b>: <b>a case/non case study in the French Pharmacovigilance Database</b>]]> Background and Objectives: Hallucinations are sensory perceptions which occur without external stimuli. There are associated with psychiatric disease but also can be related to organic disease and drug or toxic exposure. The purpose of our study was to investigate the association between exposure to medications and the reporting of hallucinations using data from the spontaneous-reporting French Pharmacovigilance Database (FPVD). Methods: We used the case/noncase method in the FPVD. Cases were all the observations of hallucination with the LLT term “perception disturbances”, registered into the FPVD from January 1985 to Jan 2013. Data were expressed as odds ratio (OR) with their 95% confidence intervals. Results: Among the 469,181 reports of adverse effects recorded between 1985 and 2013, 4,086 are hallucinations. For about 50% of these hallucinations were experimented by patient older than 65 years old. A statistically significant OR was found with several medications included rasagiline (OR 17.6 [95%CI 10.4-29.8]), zolpidem (OR 12.9 [95%CI 11.3-14.8]), methylphenidate (OR 9.3 [95%CI 5.9-14.6]) and baclofene (OR 5.4 [95%CI 3.7-7.8]). An increased risk of hallucinations was also observed with non central nervous system drugs, including ertapenem (OR 24.0 [95%CI 14.2-40.5]), voriconazole (OR 12.9[95%CI 10.2-16.5]) and valacyclovir (OR 9.1 [95%CI 6.9-11. 9]). Conclusions: This pharmacoepidemiological study describes an association between drugs and hallucinations. This relationship involves not only some already suspected drugs but also other drugs less known to induce such an adverse reaction. Despite the mandatory limits of this kind of study, these data should lead to special precautions in patient at risk. <![CDATA[<b>Risperidone regulates Dopamine D2-like receptors expression in rat brain in a time-dependent manner</b>]]> Background and Objectives: Antipsychotics can elicit dopamine super-sensitivity by up-regulation of D2-like receptors (DRD2, DRD3, and DRD4) expression. Nevertheless, the expression profile of dopamine D2-like receptors in different brain regions and peripheral blood mononuclear cells (PBMCs), and changes following risperidone administration were still unclear. In this study, we would investigate the expression of D2-like receptors mRNA in different brain regions and the peripheral blood mononuclear cells (PBMCs) in rats after 2, 6 weeks risperidone administration. Methods: The experimental rats were given risperidone (0.25mg/kg/day, i.p.), and the control rats were given 0.9% NaCl. The rats were sacrificed at 0 week, 2 weeks and 6 weeks after the drug administration. Expression of the dopamine D2-like receptors was quantified by Real-time PCR method. Results: Dopamine D2-like receptors expressed in all the examined regions of rat brain. Their expression significantly increased 2weeks after risperidone administration in different brain regions. However, the changed expression of DRD2 and DRD3 turned back to the basal level 6weeks later, while the increased DRD4 expression remained in left parietal cortex. Meanwhile, DRD2 and DRD3 but not DRD4 expressed in PBMCs, however, the risperidone could not affect their expression. Conclusions: The risperidone could change the dopamine D2-like receptors expression in a time-dependent manner in different brain regions, which might guide the clinical use in the near future. <![CDATA[<b>Dementia DSM-IV/ICD-10 or neurocognitive disorder DSM-5?</b>]]> Background and Objectives: According to existing data the term dementia was invented in the first century BC. It was introduced in the European literature in the 17th and 18th centuries AC. At the end of the 17th century, the French Encyclopedia points at ethiological implications which would later shape legal concepts. In the 19th century the Centroeuropean research develops specific nosologies until, in the 20th century, senile dementia is gradually discredited. Methods: Slightly over ten years ago, the Mild Cognitive Disorder (MCD) conceptualization was introduced as an early stage of Alzheimer's disease (AD), but the lack of coherence in relation to lesions sparked a still ongoing controversy, as the author of the MCD concept belongs to the Writing Board of DSM 5. Results: The DSM IV focuses on a categorical approach in spite of the difficulty in differentiating “normal” from “pathological” impairment at certain ages. On the other hand, the DSM 5 adopts the Dimensional System with a Mild or Severe Neurocognitive Disorder definition, which is necessarily arbitrary and imposes a statistical criterion. The widespread use of this classification would imply diagnosing a large proportion of the population with huge social and medical implications. This triggered a variety of reactions, such as the APA note which claims that DSM 5 and CIE-10 “virtually contain the same codes”. However a WHO study revealed that 70% of surveyed psychiatrists used CIE 10 criteria. Conclusions: The DSM 5 gives weight to cognitive aspects using as a severity criterion the number of standard deviations in relation to psychometric normality. It might be misleading if applied to some forms of dementia, for instance frontal dementias. The CIE-10 and DSM IV criteria are more operational. <![CDATA[<b>New perspectives in the search for reliable biomarkers in Alzheimer disease</b>]]> Background and Objectives: The search for accurate biomarkers in Alzheimer Disease (AD), on of the most devastating neurodegenerative diseases, remains essential to enable an early prognosis and diagnosis of the disease and to provide more efficient therapeutic strategies. A wide variety of potential biomarkers are has been identified by neuroimaging techniques and by the analysis of fluid samples, such as cerebrospinal fluid (CSF) or blood. Recently, a growing number of studies are focused on the discovery of reliable blood-based biomarkers in blood, especially in the prodromal stage of AD, which can predict the conversion of asymptomatic cases to AD demented cases. In this review, the latest challenges in the search for accurate biomarkers of AD is revised, in particular, an update in blood-based biomarkers is described in depth. Conclusions: Finally, the close link among AD and other neurodegenerative diseases is discussed, mainly based on the last discovered mutation, the chromosome 9 open reading frame 72, C9ORF72. <![CDATA[<b>Innovative methods in teaching psychiatry to medical students</b>]]> Background and Objectives: To test the conjecture that the innovative method to teach psychosomatic psychiatry previously reported will be confirmed as beneficial in the training of medical students in the field of general psychiatry. Methods: The emphasis in this course is placed on the discussion of clinical cases, bed-side clinical teaching, and a research-oriented part. The “Innovative Teaching Plan” (ITP) is intended to train student-leaders to guide small groups (SG) of students. The results of an intensive clerkship on bedside teaching are also studied. Trainee performance was assessed by the marks in the final examination, and a reliable and valid tool, the Medical Tea¬≠ching Quality Questionnaire (MTQQ) was used to document trainee satisfaction. The results of five academic courses are presented in this report. Results: External experts consulted assured that the content of the course was adequate. Eight hundred and thirty eight medical students have completed the learning course in the study period, and 418 (one of the two groups) completed the evaluation with the MTQQ. Most items related to the students' satisfaction were rated “high” or “very high”, including the items asking about the usefulness of the course for physicians, the quality of the teaching methods and the bedside teaching. In relation to innovation, the discussion of clinical cases in small groups was also very satisfactory and the “enhancement of a researcher's mind” was rated “high” or “very high” by 1/3rd of medical students. The utility of the yearly evaluation of the quality of teaching methods was supported by results showing that items scored not favourably in the initial evaluation were considerably improved in the follow-up evaluations, when modifications in the method were introduced. Conclusions: Good performance and high satisfaction of medical students was documented in a course on general psychiatry. Lessons may be drawn to inform about efficient and effective ways of teaching and learning this subject.