Bowlby (1984) regarded attachment as a model of psychological vulnerability to depression. Since then, a large number of studies have considered vulnerability to depression in light of the idea of attachment style. Attachment styles correspond to two dimensions observed in relationships (anxiety and avoidance) evoking ideally the internal operating models of self and other respectively, as first described by Bowlby (1984). Two types of adult attachment styles are evaluated in our study: romantic attachment (Hazan and Shaver, 1987) and interpersonal attachment (Bartholomew and Horowitz, 1991). The existing literature indicates that depression is associated with the insecure attachment styles, in both romantic an interpersonal relationships. Nevertheless, a question remains concerning the nature of the link between attachment style and depression: are attachment styles stable and independent of the depression or are they modified as the depression evolves? The aim of the present study was to investigate the relationships between attachment and depression in adult women hospitalized for depression; following up the evolution in their romantic and interpersonal attachment styles from the beginning to the end of their hospitalization.The study population consisted of 50 women hospitalized for an episode of major depression (Axis I, DSM IV). Individuals exhibiting bipolar disorders and other pathologies linked to depression were not included in the population. Sixty-eight percent of the depressed women in our population had previously experienced depressive episodes and 42% of them also exhibited a personality disorder (Axis II, DSM IV). The clinical group participated in two psychological investigations, one at the beginning (T1) and one at the end of the hospitalization (T2), including each time a clinical interview during which the depression as well as the romantic (ECR, 1998) and interpersonal (RQ, 1991) attachment styles were evaluated.Our findings showed that depression is positively correlated with the "avoidant" dimension of the romantic attachment style and negatively with the "secure" dimension of the interpersonal attachment style. Between the beginning and the end of hospitalization, only the "secure" and "fearful" dimensions of the interpersonal attachment styles were modified, whereas the styles of romantic attachment remained stable. In terms of the links between attachment styles and the evolution of depression during hospitalization (between T1 and T2), we noted that an increase in security of attachment was correlated with a decrease in the depressive symptomatology. Conversely, the other romantic and interpersonal attachment styles were not linked with the evolution of the depressive symptomatology.Our results confirm that romantic and interpersonal styles of attachment constitute factors of vulnerability to depression. But more importantly, these findings open up new perspectives in terms of the nature of the relationships between attachment styles and depression. They provide matter for discussion concerning the stability or the change in romantic and interpersonal attachment styles. Indeed, we have revealed the stable and independent nature of romantic attachment styles in relation to depressive symptomatology. On the contrary, security in the interpersonal attachment style was shown to be a factor of change, associated with the evolution of the depressive symptomatology in progress. In the quest to take combined account of romantic and interpersonal attachment styles and their links with the evolution of depression, the present study results in a new understanding of depression, viewed from the perspective of the model of attachment in adults.

Introduction/Objective. - Bowlby (1984) [3] regarded attachment as a model of psychological vulnerability to depression. Since then, a large number of studies have considered vulnerability to depression in light of. the idea of attachment style. Attachment styles correspond to two dimensions observed in relationships (anxiety and avoidance) evoking ideally the internal operating models of self and other respectively, as first described by Bowlby (1984) [3]. Two types of adult attachment styles are evaluated in our study: romantic attachment (Hazan and Shaver, 1987) [18] and interpersonal attachment (Bartholomew and Horowitz, 1991) [2]. The existing literature indicates that depression is associated with the insecure attachment styles, in both romantic an interpersonal relationships. Nevertheless, a question remains concerning the nature of the link between attachment style and depression: are attachment styles stable and independent of the depression or are they modified as the depression evolves? The aim of the present study was to investigate the relationships between attachment and depression in adult women hospitalized for depression; following up the evolution in their romantic and interpersonal attachment styles from the beginning to the end of their hospitalization.Methodology. - The study population consisted of 50 women hospitalized for an episode of major depression (Axis I, DSM IV). Individuals exhibiting bipolar disorders and other pathologies linked to depression were not included in the population. Sixty-eight percent of the depressed women in our population had previously experienced depressive episodes and 42% of them also exhibited a personality disorder (Axis II, DSM IV). The clinical group participated in two psychological investigations, one at the beginning (T1) and one at the end of the hospitalization (T2), including each time a clinical interview during which the depression as well as the romantic (ECR, 1998) and interpersonal (RQ, 1991) attachment styles were evaluated.Study results. - Our findings showed that depression is positively correlated with the "avoidant" dimension of the romantic attachment style and negatively with the "secure" dimension of the interpersonal attachment style. Between the beginning and the end of hospitalization, only the "secure" and "fearful" dimensions of the interpersonal attachment styles were modified, whereas the styles of romantic attachment remained stable. In terms of the links between attachment styles and the evolution of depression during hospitalization (between T1 and T2), we noted that an increase in security of attachment was correlated with a decrease in the depressive symptomatology. Conversely, the other romantic and interpersonal attachment styles were not linked with the evolution of the depressive symptomatology.Discussion/conclusion. - Our results confirm that romantic and interpersonal styles of attachment constitute factors of vulnerability to depression. But more importantly, these findings open up new perspectives in terms of the nature of the relationships between attachment styles and depression. They provide matter for discussion concerning the stability or the change in romantic and interpersonal attachment styles. Indeed, we have revealed the stable and independent nature of romantic attachment styles in relation to depressive symptomatology. On the contrary, security in the interpersonal attachment style was shown to be a factor of change, associated with the evolution of the depressive symptomatology in progress. In the quest to take combined account of romantic and interpersonal attachment styles and their links with the evolution of depression, the present study results in a new understanding of depression, viewed from the perspective of the model of attachment in adults. (C) L'Encephale, Paris, 2011.

INTRODUCTION:The outcome of cerebral ischemic stroke associated with cannabis use is usually favorable. Here we report the first case of cannabis-related stroke followed by neuropsychiatric sequelae.CASE PRESENTATION:A 24-year-old Caucasian man was discovered in a deeply comatose non-reactive state after cannabis use. A magnetic resonance imaging scan of his brain showed bilateral multiple ischemic infarcts. The patient remained deeply comatose for four days, after which time he developed other behavioral impairments and recurrent seizures.CONCLUSION:Stroke related to cannabis use can be followed by severe neuropsychiatric sequelae. Concomitant alcohol intoxication is essential neither to the occurrence of this neurologic event nor to its severity.

Several studies have revealed a relatively high frequency of hypokalemia in the general psychiatric population. This may be explained by adrenergic stimulation observed in the acute phase of psychiatric disorders. Little is known about the effects of hypokalemia on cardiac repolarisation in these circumstances. The current study was designed to determine if the hypokalemia observed among patients with acute psychiatric disorders can cause significant QT interval prolongation, and thus increase the risk of ventricular arrhythmia. Electrocardiograms were obtained in 282 non-selected patients admitted to a psychiatric unit. Heart-rate adjusted QT intervals (QTc) were compared to serum potassium levels and to other risk factors for QT prolongation (bradycardia, age, gender, and administration of antipsychotics). Hypokalemia, diagnosed in more than 11% of the patients, was associated with a significantly longer QTc interval (means 423.5 +/- 40 ms vs 408.5 +/- 31 ms), as was female sex. Multiple linear regression analysis on the studied risk factors revealed that only hypokalemia and female sex were independently associated with lengthening of the QT interval. According to our results, hypokalemia seems to be one of the most important risk factors for QT prolongation. We therefore strongly recommend that psychiatric patients should be screened for hypokalemia on admission. (C) 2008 Elsevier Ireland Ltd. All rights reserved.

Evidence is presented which challenges the widely held view that urinary tract infection (UTI) in adult men under 50 years of age is rare, and usually associated with structural or functional abnormalities. During a 14 month period, 999 men in the age group presented to their general practitioners with symptoms suggesting UTI; 223 had bacteriuria and 63 had ‘sterile pyuria’. Details are given of their symptoms, their response to antibacterial treatment, and the radiological findings in those referred for hospital investigation. We suggest that infection probably originates in the prostate in many of these patients, that antibacterial agents which penetrate prostatic tissue should be used for treatment, and that a wider search for pathogenic organisms in those with ‘sterile pyuria’ is indicated.

RESULTS:This study, inspired by the attachment model and research in the field of social support, attempts to reveal the link between styles of attachment, social support and depressive vulnerability.AIM OF THE STUDY:It investigates current styles of attach-ment and the quality of social support perceived by 35 hospitalized, depressed subjects compared to 35 control subjects who exhibited no pathology. After giving their consent, each subject took part in an in-depth psychological investigation consisting of a recorded clinical interview and various clinical scales.METHOD:The study presents only the responses to the Perception of Relations questionnaire which distinguishes between four styles of attachment (secure, detached, preoccupied and disorganized) and the Social Support Questionnaire (SSQ6) which contains two dimensions: social availability and social satisfaction. The results were subjected to statistical analyses: a comparative analysis between the two groups and a correlational analysis between the dimensions of social support and the dimensions of style of attachment. On the one hand, the study reveals that the social network is perceived to be less available by depressed subjects, together with the absence of a current intimate relationship with other people, the absence of people to confide in, and a relationship between this absence and the large number of losses experienced by depressed subjects, in particular the loss of figures of attachment (father and mother). On the other hand, depressed subjects tend to exhibit a preoccupied, disorganized style of attachment which is characterized by negative models of the self.DISCUSSION:The discussion addresses the way these styles of attachment should be understood: do they represent the consequence of the depressive pathology or an older relational style?

La dépression après un accident vasculaire cérébral (AVC) est une complication grave affectant 30 à 50% des patients au cours de la 1re année mais dont les premiers symptômes sont décelables dès les premiers jours en unité neurovasculaire grâce à des échelles validées, et grâce à une nécessaire expertise des personnels médicaux et paramédicaux. Nous avons interrogé Medline jusqu’en décembre 2005, en utilisant les mots clés “Accident Vasculaire Cérébral“–“dépression“–“epidémiologie“issus d’articles en anglais et en français. Nous avons inclus les études prospectives bien définies en termes de populations et en termes de critères diagnostiques recommandés par le DSM-IV. Il s’agit d’une urgence médicale car la dépression non soignée entrave la rééducation et la réinsertion sociale et familiale. Le diagnostic précoce reste difficile dans le contexte de lésion cérébrale aiguë. La prédominance de la séméiologie somatique et cognitive de la dépression en est un signe évocateur. La survenue d’une dépression post-AVC est un événement inquiétant dans le devenir du patient car elle peut annoncer un déclin cognitif à venir. La prise en charge repose sur l’association antidépresseurs sérotoninergiques et psychothérapie. La poursuite de recherches cliniques est nécessaire pour améliorer les connaissances sur le dépistage et la prise en charge précoce de la dépression post-AVC. Post-stroke depression is a severe complication affecting 30–50% of patients during the first year. Experienced medical and paramedical staff in stroke units, using validated scales, can now identify initial signs of depression in the first days after stroke onset. This review of the literature is based on a Medline search for the terms stroke, depression, and epidemiology. It discusses problems of pathophysiology, diagnosis, prognosis, and therapeutics. Depression is an emergency in stroke patients because it impedes rehabilitation and family and social insertion. Early diagnosis is difficult, but possible with clinical somatic and cognitive symptoms. Post-stroke depression may also be a marker of pending cognitive decline. Management requires both antidepressants and psychotherapy. There is a pressing need for further research to improve clinical practice in this area of stroke care.

INTRODUCTION:Post-stroke depression is a severe complication affecting 30-50% of patients during the first year. Experienced medical and paramedical staff in stroke units, using validated scales, can now identify initial signs of depression in the first days after stroke onset.METHODS:This review of the literature is based on a Medline search for the terms stroke, depression, and epidemiology. It discusses problems of pathophysiology, diagnosis, prognosis, and therapeutics.RESULTS:Depression is an emergency in stroke patients because it impedes rehabilitation and family and social insertion. Early diagnosis is difficult, but possible with clinical somatic and cognitive symptoms. Post-stroke depression may also be a marker of pending cognitive decline. Management requires both antidepressants and psychotherapy.CONCLUSION:There is a pressing need for further research to improve clinical practice in this area of stroke care.

Cette étude s’inspire du modèle de l’attachement et des travaux sur le support social pour mettre en évidence une relation entre vulnérabilité dépressive, styles d’attachement et support social. Elle porte sur l’investigation des styles d’attachement actuels et de la qualité du soutien social perçu chez 35 sujets déprimés hospitalisés comparés à 35 témoins ne présentant aucune pathologie. Chaque sujet participe, après avoir donné son consentement, à une investigation psychologique approfondie comportant un entretien clinique enregistré et plusieurs échelles cliniques. L’étude ne présente ici que les réponses au questionnaire de Perception des relations (4) qui distingue quatre styles d’attachement (sécure, détaché, préoccupé et désorganisé) et au questionnaire de Soutien social (SSQ6) (46) qui comprend deux dimensions : la disponibilité et la satisfaction sociales. Les résultats ont fait l’objet d’une analyse statistique comparative entre les deux groupes et corrélationnelle entre les dimensions du soutien social et celles du style d’attachement. L’étude met en évidence une plus faible disponibilité perçue du réseau social chez les déprimés, l’absence de relation intime actuelle avec autrui et l’absence de confidents, ce qui est à relier à un plus grand nombre de pertes vécues par le sujet déprimé, en particulier des figures d’attachement (père et mère). Par ailleurs, les sujets déprimés présentent davantage des styles d’attachement préoccupé et désorganisé qui se caractérisent comme des modèles de soi négatif. La discussion porte sur la manière de comprendre ces styles d’attachement : représentent-ils la conséquence de la pathologie dépressive ou bien sont-ils le reflet d’un style relationnel plus ancien ?

Torsades de pointes (TdP), a form of ventricular arrhythmia that con cause ventricular fibrillation and sudden death, may occur during prolongation of the QT interval.QT prolongation has recently been reported with antipsychotic drugs. Physicians should be able to obtain a corrected measurement of the QT interval.QT is measured from the beginning of the QRS complex to the end of the T wave (Qtm). This value must then be corrected to take heartbeat into account. The most common formula in current use is Bazett's.In practice, a QTc interval value greater than 500 ms indicates on increased risk of TdP.Safe combinations of antipsychotic drugs have been recommended by the French drug agency (Agence francaise de securite sanitaire des produits de sante).Many other drugs, including psychotropic drugs such as tricyclic antidepressants, con prolong the QT interval. Combinations of these medications with one another with antipsychotic medications, or with other concomitant factors, such as hypokalemia, also increase the risk.