Background. - Hospitalization is rare in anorexia nervosa (AN) and local application of indications is heterogeneous. However, no study has evaluated the effect of these different treatment modalities on the mean length of stay. Our objective was to describe the context and modalities of a wide range of hospital care programs offered to patients with anorexia nervosa in eleven specialized French psychiatric centers for patients from childhood to adulthood. This work was carried out within the framework of the EVHAN (Evaluation of Hospitalization for AN, Eudract number: 2007-A01110-53, registered in Clinical trials) research program. The EVHAN program comprises five main lines: weight objectives at discharge, the practice or not of a separation period, the use of clear nutritional dietary objectives (cognitive/behavioral), the intensity of family involvement in treatment, and the existence or absence of a stabilization phase before ending inpatient treatment. These main lines will make it possible to study the impact of treatment modalities on the future of patients in the short and medium term (at discharge and at 1-year follow-up).Methods. - The eleven centers are located in France (Bordeaux, Nantes, Paris and Ile-de-France, Rouen and Saint-Etienne). Various staff members (psychiatrists, somatic doctors, nurses, dieticians, psychologists) from each center were interviewed using a semi-structured questionnaire. Data on operating modalities and context of care were collected and analyzed.Results. - Four of the eleven centers were exclusively child/adolescent centers, and seven of 11 were adolescent (from 11, 13 or 16 years) and young adult centers. All centers offered a graduated approach from outpatient to full hospitalization. The majority had a number of beds allocated for patients with eating disorders. The criteria for hospitalization were homogeneous with respect to somatic and/or psy-chic severity prefiguring the consensus criteria defined by the French Health Authority (HAS) in 2010. Child/adolescent units used the weight curve to set weight objectives at discharge (between the 10th and 50th percentiles). Most adult units used weight objectives at discharge corresponding to a body mass index between 17 and 20 kg/m2. Nine centers used a written or oral care contract. One unit did not separate the patient from her/his usual environment, the others had a practice gradient of partial separation and total separation times. These were either short, lasting a maximum of 3 weeks, or long, lasting more than 3 weeks. Conversely, patients were not isolated within the unit, and benefited from a rich social life, depending on her/his physical condition. The patient's family was in contact with the team and fully supported. The longest periods of separation involved adolescents and adults. Nutritional support varied from a group approach (meals in the dining room, standardized meals of the care cen-ter) to very individualized approaches within a specific framework. All the units reported meeting with families at least once during the hospitalization; with the patient's parents for child/adolescent patients and/or unmarried patients and with the husband/wife for married patients. The majority of the centers requested a phase of weight stabilization, whatever the age before hospital discharge.Conclusion. - There is international and national consensus regarding the indications for hospitalization, and the main lines of multidisciplinary care to be developed within this framework. However, local application of these indications was heterogeneous resulting in diverse modalities of hospital care for anorexia nervosa in France. Specialized teams have developed management strategies arising from their "team culture". The complexity of the anorexic pathology, due to the psyche-soma intrication and the diversity of age groups, highlights the complexity of care available. The impact of this diversity of hospital care on patient outcomes will be studied as a result of this work.(c) 2021 L'Encephale, Paris.

Objectives: In a clinical population, we estimated the frequency of mood disorders among 271 patients suffering from Anorexia Nervosa (AN) and Bulimia Nervosa (RN) in comparison to a control group matched for age and gender.Method: The frequency of mood disorders was measured using the Mini International Neuropsychiatric Interview (MINI), DSM-IV version.Results: Mood disorders were more frequent among eating disorder (ED) patients than among controls, with a global prevalence of the order of 80% for each ED group. The majority of the mood disorders comorbid with ED were depressive disorders (MDD and clysthymia). The relative chronology of onset of these disorders was equivocal, because mood disorders in some cases preceded and in others followed the onset of the eating disorders.Limitations: Our sample was characterized by patients with severe ED and high comorbidities, and thus do not represent the entire population of AN or BN. This also may have resulted in an overestimation of prevalenceConclusion: Mood disorders appear significantly more frequently in patients seeking care for ED than in controls.These results have implications for the assessment and treatment of ED patients, and for the aetiopathogenesis of these disorders. (C) 2015 Elsevier B.V. All rights reserved.

Évaluer de façon systématique l’état de santé psychique d’un échantillon de sapeurs-pompiers de la Loire. Dans les 11 plus grandes casernes de la Loire, nous avons interrogé les pompiers professionnels et volontaires par le biais d’un livret comprenant un questionnaire de données sociodémographiques et professionnelles, d’antécédents psychiatriques et d’habitudes toxiques, une échelle visuelle analogique et quatre auto-questionnaires : la Post-Traumatic Stress Disorder Checklist Scale (PCLS), l’échelle d’évaluation de la dépression de Beck, l’échelle d’anxiété trait-état de Spielberger et le Burn Out Inventory de Maslach. Deux cent vingt-sept personnes ont répondu au questionnaire. La moyenne d’âge était de 34,17 ans (écart-type = 8,55). On comptait 211 hommes pour 16 femmes soit 7,4 %. Les pompiers professionnels occupaient 65,90 % de l’échantillon. L’abus d’alcool et les troubles du sommeil étaient comparables à la population générale avec respectivement 0,8 % et 31,4 % de l’échantillon ; 2,7 % étaient sous traitement psychotrope. On retrouvait 21,8 % de personnes déprimées sans aucune dépression sévère. La population qui était plus anxieuse que la population de référence représentait 2,2 %. La prévalence de l’état de stress post-traumatique était de 4 %. Enfin, 39,5 % des pompiers étudiés présentaient un burn out bas, 8,3 % un burn out modéré et une seule personne souffrait de burn out élevé. Pour la plupart des variables, les données psychopathologiques étaient comparables à la population générale excepté la prévalence de l’état de stress post-traumatique qui était plus élevée que dans la population française mais inférieure aux données des autres études portant sur cette maladie chez les pompiers. De plus, nous avons pu mettre en évidence des scores d’épuisement émotionnel particulièrement bas. Des études longitudinales et de plus grande envergure seraient nécessaires pour obtenir des résultats plus représentatifs de la population étudiée. To systematically assess mental health in a sample of firefighters from the Loire department. In the 11 largest fire stations of the department, we interviewed the professional and volunteer firefighters through a booklet including a questionnaire on sociodemographic and professional data, psychiatric history and toxic habits, a stress Visual Analogue Scale and four self-administered questionnaires: the Post-Traumatic Stress Disorder Checklist Scale (PCLS), the Beck Depression Inventory, Spielberger's State Anxiety Inventory, and the Maslach Burn out Inventory. Two hundred and twenty-seven people responded to the questionnaire. The average age was 34.17 years (SD = 8.55). There were 211 men to 16 women i.e., 7.4%. Professional firefighters accounted for 65.90% of the sample. Alcohol abuse and sleep disorders were comparable to the general population: respectively 0.8% and 31.4% of the sample; 2.7% were on psychotropic treatment. We found 21.8% of depressed patients, without severe depression. Two point two percent of the population were more anxious than the reference population. The prevalence of post-traumatic stress disorder was 4%. Finally, 39.5% of the firefighters had a mild burn out, 8.3% had a moderate one and only one person suffered from severe burn out. For most variables, psychopathological data were comparable to the general population except for the prevalence of post-traumatic stress disorder, which was higher than in the French population. But it was lower than in other studies which assessed the prevalence of this disease in firemen. In addition, we were able to show scores of emotional exhaustion particularly low. Longitudinal and larger studies would be needed to obtain more representative results of the studied population.

Purpose of the study. To systematically assess mental health in a sample of firefighters from the Loire department.Method. In the 11 largest fire stations of the department, we interviewed the professional and volunteer firefighters through a booklet including a questionnaire on sociodemographic and professional data, psychiatric history and toxic habits, a stress Visual Analogue Scale and four sell-administered questionnaires: the Post-Traumatic Stress Disorder Checklist Scale (PCLS), the Beck Depression Inventory, Spielberger's State Anxiety Inventory, and the Maslach Burn out Inventory.Results. Two hundred and twenty-seven people responded to the questionnaire. The average age was 34.17 years (SD = 8.55). There were 211 men to 16 women i.e., 7.4%. Professional firefighters accounted for 65.90% of the sample. Alcohol abuse and sleep disorders were comparable to the general population: respectively 0.8% and 31.4% of the sample; 2.7% were on psychotropic treatment. We found 21.8% of depressed patients, without severe depression. Two point two percent of the population were more anxious than the reference population. The prevalence of post-traumatic stress disorder was 4%. Finally, 39.5% of the firefighters had a mild burn out, 8.3% had a moderate one and only one person suffered from severe burn out.Conclusion. For most variables, psychopathological data were comparable to the general population except for the prevalence of post-traumatic stress disorder, which was higher than in the French population. But it was lower than in other studies which assessed the prevalence of this disease in firemen. In addition, we were able to show scores of emotional exhaustion particularly low. Longitudinal and larger studies would be needed to obtain more representative results of the studied population. (C) 2013 Elsevier Masson SAS. All rights reserved.

Introduction After 50 years of international experience and 15 years of use in France, the positive impact of drug replacement treatments on the care of patients with opiates dependence is now well established. Even though there is a vast literature on the two existing treatments (methadone and high-dosage buprenorphine), few works have focused on patients who have changed replacement therapy during follow-up. Objectives and aims The aim of our study was to analyze the follow-up of substituted patients throughout an 11-year period. Patients were characterized by the type of treatment: methadone only, high-dosage buprenorphine only, or both treatments. Methods These groups of patients were studied depending on their characteristics at the beginning of the treatment (sociodemographic data, addictive behaviours, psychiatric assessment) and in terms of healthcare and follow-up regularity. We also tried to bring to light predictive factors of unstable follow-ups at the point of entry in healthcare. Results 891 patients were included in our results. Patients having had two substitution treatments initially present with higher severity in terms of socio-professional integration, addictive behaviours and psychiatric comorbidity. Their treatment is more discontinued and they have longer healthcare. Conclusions Psychiatric comorbidities and poly-drug use seem to characterize unstable patients who jeopardize our treatments. They have to be identified very early in order to better adjust healthcare. This preliminary work underlines the necessity of carrying out a prospective study integrating better adapted assessment tools.

Objectives. - In schizophrenia, alteration in the prefrontal cortex can induce some deficiencies of the executive functions, and among them errors in inhibition of prepotent responses. This type of inhibitory processes was called "restraint function" by Hasher et al. It implies a conscious and voluntary inhibition which demands attentional resources. Among the tasks exploring this function, the Hay ling completion sentence task (Burgess and Shallice) appears to be the most specific. Moreover, healthy subjects performing this task in functional magnetic resonance imaging (fMRI) show activation of the prefrontal cortex. In this study, we investigated inhibitory processes in schizophrenic patients using two versions of the Hay ling completion sentence task, a behavioural version and an fMRI version in order to assess both performance levels and brain correlates of inhibitory processes.Methods. - Forty-eight schizophrenic participants according to DSM-IV, (mean age: 32.8, S.D. 7.7), stabilized for at least one month, receiving antipsychotic medication and with IQ higher than 70 (mean: 96.86, S.D. 20.67) and education level (mean: 11.15, S.D. 3.26) participated in the behavioural study. They were matched on age (mean: 33.8, S.D. 7.6) and education level (mean: 12.28, S.D. 2.87) with thirty-two healthy controls. Nineteen of schizophrenic participants (mean age: 33, S.D. 6.9 and IQ: 99, S.D. 10.74) were assessed by an fMRI adaptation of the Hayling task, matched with 12 controls (mean: 33.9, S.D. 7.3). All the participants had to perform the Hayling task and a speed accuracy task. The Hayling task consists in sentences for which the last word is missing. In the initiation condition, the participants had to complete the sentence with the appropriate word, whereas in inhibition condition the participants had to complete the sentence with inappropriate and unrelated words.Results. - Compared to controls, schizophrenics showed an increased number of errors in the inhibition of prepotent responses associated with increased reaction times, even when considering information processing speed. fMRI results showed fairly similar frontal activations in both groups. Nevertheless, schizophrenic patients presented principally large activations in dorsolateral and ventrolateral frontal cortex, the superior frontal sulcus, the frontal pole and the premotor cortex, and stronger activations (bilateral) in the posterior parietal cortex. Control subjects demonstrated a network of deactivated brain regions whereas the schizophrenics did not.Discussion. - Our results are in favour of poorer efficacy of restraint function, sometimes comprising impairment of inhibitory processes inducing errors in schizophrenics. This deficiency might be considered as insufficiency in attentional resources and/or in working memory. Hence patients cannot simultaneously restrain prepotent response and find appropriate controlled strategy for correct completion of the task. Moreover, bilateral patterns of parietal hyperactivation and absence of patterns of deactivation seem also in favour of an attentional hypothesis. The Hayling task might be interesting for assessment of inhibitory processes in schizophrenia. (C) L'Encephale, Paris, 2010.

Introduction.-This work deals with the comparative study of two standardised instruments, which can be used to diagnose personality disorders (PD): the SCID-II and the DIP. Each instrument used as a self -questionnaire followed by a semi-structured interview by the same clinician was applied to 21 patients suffering from PD. The DIP (DSM-IV and ICD-10 Personality), which is a recent instrument, consists of a self-questionnaire (DIP-Q) and a semi-structured interview (DIP-I), created by Bodlund and Ottosson. It makes it possible to evaluate PD from criteria based on the DSM-IV as well as the ICD-10. We translated it into French then evaluated it in comparison with another instrument, the Structured Clinical Interview for DSM-IV Axis II PD (SCID-II) whose validity was demonstrated by Bouvard.Method.-For the self-questionnaire (SCID-auto), we used CUNGI'S computerised version. The present version of the semi-structured interview SCID-E (French translation by Bouvard et at.) evaluates the 10PD of the DSM-IV, the depressive personality and the passive-aggressive personality, included in the DSM-IV appendix B. The DIP-Q questionnaire is made up of 140 right/wrong items referring to the 10PD of the DSM-IV and the eight disorders of the ICD-10. The DIP-I is the self-structured interview created by Ottosson et at. and it is built on the same pattern as the SCID-II. It provides diagnoses for all DSM-IV and/or ICD-10 PD as well as the schizotypic disorder. The DIP-I is usually preceded by a general "scan" interview in order to assess an existing personality disorder corresponding to Axis I of the DSM-IV or the ICD-10. In our study, we substituted a Mini International Neuropsychiatric Interview (MINI) questionnaire for this interview. Twenty-four patients suffering from one or several PD were chosen among ambulatory or out-patients by clinicians from the Saint-Etienne Psychiatric University Hospital Center. The diagnosis was not revealed to the examiner during the study. The subjects fitted in the DIP-I and the SCID-II self-questionnaires. The answers to each test were first processed through a computer, then the patients were seen over the following weeks for the DIP-I and SCID-II semi-structured interviews. For both questionnaires, we only explored the diagnostic categories reaching pathological level (as was recommended by the authors). Considering the small number of patients involved, we used nonparametric tests: Witcoxon test, Mac Nemar test and the Kappa.Results.-As far as the self-questionnaire results are concerned, we noticed important differences for the schizoid and the schizotypic PD between the DIP-Q (ICD) and the DIP-Q (DSM). The most represented PDs are the paranoiac, borderline, avoiding and obsessional personalities. After the semi-structured interviews, it appears that only 30 to 50% of the diagnoses obtained through self-evaluation were confirmed (with the exception of the schizotypic personality and the antisocial personality for the SCID with perfect agreement between self and clinical evaluation). Globally, the agreement between diagnosis by self-evaluation and diagnosis by semi-structured interview is not very satisfactory. Finally, a cluster analysis of the results of the three semi-structured interviews put together reveals that five patients show at least one PD diagnosed in the three clusters, two have no diagnosis, six patients have one or several PDs in clusters B and C, three patients have some in clusters A and C, and five patients only have some in clusterC. Our results lead to several remarks: the size of our group is small, but it must be pointed out that the investigations for each patient took about three hours which made it difficult for the patients to agree when the clinicians proposed the study; three patients originally included could not be evaluated because of suicidal behaviour. In their self-administered form, the SCID and the DSM version of the DIP-Q broadly diagnose a little more than three PDs per patient, whereas the ICD version of the DIP-Q diagnoses more than five. The administration of semi-structured interviews leads to an average of 1.3 diagnosis for the DIP-Q DSM-IV and 1.6 for the ICD against 1.9 PD for the SCID interview. These results correspond to the literature data. There are differences between the SCID and the DIP-I, as regards to the way they were used: the SCID-II makes it necessary to repeat the questions positively answered in the self-questionnaire, whereas the DIP-I explores all the criteria of the whole diagnosed PD, which may favour the inclusions. Concerning other instruments compared to the SCID-II in the international literature, our results with the DIP are globally satisfactory.Conclusion.-The results must be interpreted with some care, considering the small number of patients. Important discrepancies were noticed between the diagnoses obtained through self-evaluation and the semi-structured interview, mainly for the A and C personality clusters of the DSM-IV, showing the tests to be extremely sensitive, but not specific enough for detection. However, the agreement between both instruments referring to the DSM-IV is satisfactory. The main interest of our work was to make the first French translation of the DIP known and to compare it to another instrument, which has often been evaluated previously. (C) Encephale, Paris, 2009.

INTRODUCTION:This work deals with the comparative study of two standardised instruments, which can be used to diagnose personality disorders (PD): the SCID-II and the DIP. Each instrument used as a self-questionnaire followed by a semi-structured interview by the same clinician was applied to 21 patients suffering from PD. The DIP (DSM-IV and ICD-10 Personality), which is a recent instrument, consists of a self-questionnaire (DIP-Q) and a semi-structured interview (DIP-I), created by Bodlund and Ottosson. It makes it possible to evaluate PD from criteria based on the DSM-IV as well as the ICD-10. We translated it into French then evaluated it in comparison with another instrument, the Structured Clinical Interview for DSM-IV Axis II PD (SCID-II) whose validity was demonstrated by Bouvard.METHOD:For the self-questionnaire (SCID-auto), we used CUNGI'S computerised version. The present version of the semi-structured interview SCID-E (French translation by Bouvard et al.) evaluates the 10 PD of the DSM-IV, the depressive personality and the passive-aggressive personality, included in the DSM-IV appendix B. The DIP-Q questionnaire is made up of 140 right/wrong items referring to the 10 PD of the DSM-IV and the eight disorders of the ICD-10. The DIP-I is the self-structured interview created by Ottosson et al. and it is built on the same pattern as the SCID-II. It provides diagnoses for all DSM-IV and/or ICD-10 PD as well as the schizotypic disorder. The DIP-I is usually preceded by a general "scan" interview in order to assess an existing personality disorder corresponding to Axis I of the DSM-IV or the ICD-10. In our study, we substituted a Mini International Neuropsychiatric Interview (MINI) questionnaire for this interview. Twenty-four patients suffering from one or several PD were chosen among ambulatory or out-patients by clinicians from the Saint-Etienne Psychiatric University Hospital Center. The diagnosis was not revealed to the examiner during the study. The subjects filled in the DIP-I and the SCID-II self-questionnaires. The answers to each test were first processed through a computer, then the patients were seen over the following weeks for the DIP-I and SCID-II semi-structured interviews. For both questionnaires, we only explored the diagnostic categories reaching pathological level (as was recommended by the authors). Considering the small number of patients involved, we used nonparametric tests: Wilcoxon test, Mac Nemar test and the Kappa.RESULTS:As far as the self-questionnaire results are concerned, we noticed important differences for the schizoid and the schizotypic PD between the DIP-Q (ICD) and the DIP-Q (DSM). The most represented PDs are the paranoiac, borderline, avoiding and obsessional personalities. After the semi-structured interviews, it appears that only 30 to 50% of the diagnoses obtained through self-evaluation were confirmed (with the exception of the schizotypic personality and the antisocial personality for the SCID with perfect agreement between self and clinical evaluation). Globally, the agreement between diagnosis by self-evaluation and diagnosis by semi-structured interview is not very satisfactory. Finally, a cluster analysis of the results of the three semi-structured interviews put together reveals that five patients show at least one PD diagnosed in the three clusters, two have no diagnosis, six patients have one or several PDs in clusters B and C, three patients have some in clusters A and C, and five patients only have some in cluster C. Our results lead to several remarks: the size of our group is small, but it must be pointed out that the investigations for each patient took about three hours, which made it difficult for the patients to agree when the clinicians proposed the study; three patients originally included could not be evaluated because of suicidal behaviour. In their self-administered form, the SCID and the DSM version of the DIP-Q broadly diagnose a little more than three PDs per patient, whereas the ICD version of the DIP-Q diagnoses more than five. The administration of semi-structured interviews leads to an average of 1.3 diagnosis for the DIP-Q DSM-IV and 1.6 for the ICD against 1.9 PD for the SCID interview. These results correspond to the literature data. There are differences between the SCID and the DIP-I, as regards to the way they were used: the SCID-II makes it necessary to repeat the questions positively answered in the self-questionnaire, whereas the DIP-I explores all the criteria of the whole diagnosed PD, which may favour the inclusions. Concerning other instruments compared to the SCID-II in the international literature, our results with the DIP are globally satisfactory.CONCLUSION:The results must be interpreted with some care, considering the small number of patients. Important discrepancies were noticed between the diagnoses obtained through self-evaluation and the semi-structured interview, mainly for the A and C personality clusters of the DSM-IV, showing the tests to be extremely sensitive, but not specific enough for detection. However, the agreement between both instruments referring to the DSM-IV is satisfactory. The main interest of our work was to make the first French translation of the DIP known and to compare it to another instrument, which has often been evaluated previously.

Before 2001, psychiatric care on the island of Mayotte was ensured by missionaries from the Reunion Island. A mental health system has since been gradually installed, although the culture in Mayotte, mixing practicing Muslim women and traditional animists, still leaves a broad place for traditional heaters. This paper presents a retrospective study of 1212 psychiatric case reports, aimed at indexing the various psychopathologies according to the CIM 10, on the island of Mayotte between 1998 and 2004. The files, before and after the opening of the mental health centre, were compared with those of the psychiatric diagnoses of the Comorians.The results show an evolution in the chronic pathologies treated in the Comorians: delirious disorders, and the organic, major, mental disorders in the first psychiatric files have given way to depressive episodes and somatoform disorders. Nevertheless, an underlying prevalence of depression and addiction persist. It is interesting to note the reduced number of suicide attempts, far lower than in western countries: one suicide attempt per annum for 375 inhabitants in metropolitan France, whereas, in this study, one suicide attempt in Mayotte was reported for 2504 inhabitants.The cultural characteristics are also taken into account in the discussion of these results. Thus, if there are more demonstrations with somatic expression in the Comorians, related to a stronger implication of the body in situations of psychological faintness: 1.75% of hysterical conversion in the Comorians versus 0.99% in Mayotte, this does not mean a more histrionic personality in this population: 1.8% of Comorians, against 1.98% in Mayotte.The results of this study consolidate the impressions felt by the experts and show the effects of the mental health policy on the island. Thus, the assumption of responsibility of chronic psychotics made it possible to improve their quality of life, and to decrease the number of medical evacuations that decreased from 17 to three, between 2001 and 2004. However, this study also underlined the possible axes of development in this field, namely the assumption of responsibility of psychiatric emergencies with a crisis centre, and the development of a specialized pedopsychiatric assumption of responsibility. Indeed, in the first six months of 2004, 35% of the patients were 0-20year-old. (C) L'Encephale, Paris, 2008.

Objective: To determine whether the presence of anxiety disorders is related to depressive comorbidity in subjects with eating disorders (ED), while taking into account certain variables that may be related to depression (subjects' age, ED duration, prior incidents of anorexia nervosa in bulimic subjects, inpatient or outpatient status, nutritional state [as measured by body mass index]).Method: We evaluated the frequency of depressive disorders in 271 subjects presenting with a diagnosis of either anorexia nervosa or bulimia, using the Mini International Neuropsychiatric Interview, DSM-IV version.Results: A multivariate analysis reveals that anxiety disorders do not all have the same influence in terms of risk of onset of major depressive episode in anorexics and bulimics when adjusted on variables related to depression.Conclusion: Depression in subjects with ED can be explained in part by comorbidity with obsessive-compulsive disorder, generalized anxiety, social phobia, and panic disorder. (c) 2006 Published by Elsevier Inc.

Excessive interpersonal dependency has been described in depression and addictive disorders. Moreover, excessive dependency and suicidality are linked in psychiatric subjects, but their relationships have not been studied in specific addictions. Separate samples of female anorectic patients (n = 150), female bulimic patients (n = 95), male (n = 150) or female (n = 68) alcoholics, male (n = 94) or female (n = 54) drug abusers and non-psychiatric control subjects (n = 683) were included in the study. On the basis of a structured interview, suicidal ideations, number of previous suicide attempts and diagnoses of dependent personality disorder (DSM-IV) were collected, and the subjects completed the Interpersonal Dependency Inventory and the Beck Depression Inventory. Logistic regression analysis revealed that excessive dependency and notably dependent personality disorder increased the likelihood of suicidal ideation or suicide attempts with a range of 2.65 to 9.42 in bulimic patients, female alcoholics and male drug abusers. Excessive dependency in specific addictive disorders as well as in male non-psychiatric subjects could constitute a risk factor for suicide. This hypothesis must be confirmed using prospective studies.

UNLABELLED:The primaty objective is to determine whether the presence anxiety disorders is related to depressive comorbidity in subjects suffering from ED, while taking into account certain variables which may be related to depression [subjects' age, ED duration, prior incidents of anorexia nervosa in BN subjects, inpatient or outpatient status, nutritional state (as measured by Body Mass Index or BMI)]. Our secondary objective is to evaluate the relative chronology of the onset of anxiety disorders and depressive disorders in anorexic and bulimic subjects.METHOD:We evaluated the frequency of depressive disorders in 271 subjects presenting with a diagnosis of either anorexia nervosa or bulimia, using the Mini International Neuropsychiatric Interview (MINI), DSM IV version.RESULTS:While univariate analyses show that nearly all anxiety disorders are related to major depressive episode (MDE), a separate analysis of each anxiety disorder reveals that they do not all have the same influence in terms of risk of onset of MDE in anorexics and bulimics, when adjusted for univariate variables related to MDE (subjects' age, ED duration, prior incidents of anorexia nervosa in BN subjects, inpatient or outpatient status, nutritional state). Current generalized anxiety is significantly related to lifetime presence of MDE in AN subjects, and to current MDE in AN and BN subjects. Generalized anxiety is the most frequent disorder in AN and BN subjects to according our study; it also appears to be one of the principal predictive factors for MDE, which is 2.4 to 4.2 times more frequent when GAD is present. Diagnosis of OCD has its own particular effect on lifetime risk for MDE in AN subjects, regardless of GAD: it increases the risk of depression by 3.5. It is one of the most frequent anxiety disorders among AN subjects, present in nearly a quarter of them. In bulimics, when GAD is excluded, two factors are related to current diagnosis of MDE: panic disorder and subjects' inpatient or outpatient status. Hospitalized bulimics are diagnosed with current MDE 4.4 times more often than those seen as.

L’objectif principal est de déterminer si la présence de certains troubles anxieux est liée à la comorbidité dépressive chez les sujets souffrant de TCA, en tenant compte des variables qui peuvent, elles-mêmes, être liées à la dépression (âge des sujets, durée d’évolution du TCA, antécédents d’anorexie mentale chez les BN, statut hospitalier ou ambulatoire, état nutritionnel). Nous avons évalué la fréquence des troubles anxieux et dépressifs dans un échantillon de 271 sujets présentant un diagnostic actuel d’AN ou de BN, et 271 sujets témoins, en utilisant le Mini International Neuropsychiatric Interview (MINI), version DSM IV. Les anorexiques ont 4,7 fois plus de risque de développer un EDM en cas de comorbidité avec un trouble anxieux, et les boulimiques environ 3 fois plus. L’anxiété généralisée est le trouble anxieux le plus fréquent chez les AN et les BN de notre étude, il apparaît aussi comme l’un des principaux facteurs prédictifs de l’EDM (AN 2.4 et BN 4.2). Le diagnostic de TOC chez les AN augmente par 3,5 le risque de dépression indépendamment de l’anxiété généralisée. La dépression chez les sujets atteints de TCA est plus fréquente en cas de comorbidité avec le TOC, l’anxiété généralisée et le trouble panique.

L’objectif était de répondre à la question suivante : existe-il des différences entre les groupes diagnostiques de troubles du comportement alimentaire (TCA) pour la prévalence des troubles dépressifs et des troubles anxieux, en tenant compte des différences cliniques observées entre les groupes (âge actuel des sujets, durée d’évolution du TCA, patient hospitalier ou ambulatoire, Body Mass Index) ? Nous avons évalué la fréquence des troubles anxieux et des troubles dépressifs chez 271 sujets présentant un diagnostic actuel d’anorexie mentale ou de boulimie, en utilisant le Mini International Neuropsychiatric Interview (MINI), version DSM IV. Nous avons comparé les prévalences entre les sous-types d’anorexiques (AN-R et AN-BN) et entre les sous-types de boulimiques (BN-P et BN-NP), et enfin entre les anorexiques mentales et les boulimiques en ajustant sur les variables définies ci-dessus. La comorbidité actuelle ou vie entière des troubles anxieux et dépressifs ne diffère ni entre les AN-R et les AN-BN, ni entre les BN-P et les BN-NP. Seuls les diagnostics actuels d’agoraphobie et de trouble obsessionnel compulsif sont significativement plus fréquents chez les AN que chez les BN. La plus grande fréquence de la comorbidité entre trouble obsessionnel compulsif et AN en comparaison avec la BN, connue de longue date, n’est pas remise en question ; la plupart des autres troubles anxieux et des troubles dépressifs sont aussi fréquents dans tous les types diagnostiques de TCA.

Our objective was to answer the following question : are there differences between diagnostic groups of eating disorders (ED) for the prevalence of depressive and anxiety disorders, when clinical differences between the groups are taken into account (ie age of subjects, ED duration, inpatient or outpatient status, and Body Mass Index) ? Method We evaluated the frequency of anxiety disorders and depressive disorders in 271 subjects presenting with a diagnosis of either anorexia nervosa or bulimia, using the Mini International Neuropsychiatric Interview (MINI), DSM IV version. We compared the prevalences between sub-groups of anorexics (AN-R and AN-BN), between sub-groups of bulimics (BN-P and BN-NP) and between anorexics and bulimics while adjusting for the variables defined below. Results - Current or lifetime comorbidity of anxiety and depressive disorders did not differ between AN-Rs and AN-BNs, nor between BN-Ps and BN-NPs. Only current diagnoses of agoraphobia and obsessive-compulsive disorder were significantly more frequent in anorexics than in bulimics. Conclusion - The greater frequency of comorbidity between obsessive-compulsive disorder and AN compared to BN, already well documented, is not questioned The remaining anxiety disorders are equally frequent among all the diagnostic types of ED.

Alexithymia, depressive feelings, and dependency are interrelated dimensions that are considered potential “risk factors” for addictive disorders. The aim of this study was to investigate the relationships between these dimensions and to define a comprehensive model of addiction in a large sample of addicted subjects, whether affected by an eating disorder or presenting an alcohol- or a drug use-related disorder. The participants in this study were gathered from a multicenter collaborative study on addictive behaviors conducted in several psychiatric departments in France, Switzerland, and Belgium between January 1995 and March 1999. The clinical sample was composed of 564 patients (149 anorexics, 84 bulimics, 208 alcoholics, 123 drug addicts) of both genders with a mean age of 27.3 ± 8 years. A path analysis was conducted on the 564 dependent patients and 518 matched controls using the scores of the Toronto Alexithymia Scale, the Depressive Experiences Questionnaire, and the Interpersonal Dependency Inventory. Statistical analyses showed good adjustment (Goodness of Fit Index = 0.977) between the observable data and the assumed model, thus supporting the hypothesis that a depressive dimension, whether anaclitic or self-critical, can facilitate the development of dependency in vulnerable alexithymic subjects. This result has interesting clinical implications because identifying specific patterns of relationships leading from alexithymia to dependency can provide clues to the development of targeted strategies for at-risk subjects.

Objectives: The purpose of this study was to determine whether subjects suffering from anorexia nervosa (AN) or bulimia nervosa (BN) would demonstrate more severe social disability than a control group; and whether social disability could be best explained as a function of the eating disorder itself or as a function of comorbid anxiety or depressive disorders. Method: Subjects were166 AN subjects, 105 BN subjects and 271 control subjects matched for age, sex and socio-economic status. Prevalence of anxiety or depressive disorders was assessed (through the Mini International Neuropsychiatric Interview), and social functioning was measured (through the Groningen scale). Results: The majority of AN and BN subjects demonstrated social disability in the “social role” (leisure time, time spent with friends) and the “occupational role” (work or educational activities). A regression analysis was employed to uncover predictive factors of social disability. Eating disorders (AN and BN), anxiety disorders and depression accounted for a large portion of social disability. Discussion: Anxiety and depressive disorders appear to play an important role in the type of social disability demonstrated in eating disorder patients. Therapeutic implications are discussed.

L’hypothèse principale de cette étude est de confirmer la prévalence élevée de l’alexithymie chez les toxicomanes en vérifiant son indépendance par rapport aux variables sociodémographiques (sexe, âge, catégorie socioprofessionnelle). Dans un deuxième temps, le lien entre alexithymie et état dépressif chez les toxicomanes est étudié. Pour ce faire, un échantillon de 128 toxicomanes répondant aux critères DSM IV de dépendance aux substances psychoactives (alcool exclu) a été apparié selon les variables sociodémographiques à un échantillon témoin de 128 sujets. Différents instruments d’hétéro et d’auto-évaluation ont été utilisés : TAS-20 pour l’alexithymie, BDI à 13 items pour l’évaluation de la symptomatologie dépressive, et MINI. Les résultats, aussi bien en analyse dimensionnelle que catégorielle, confirment la prévalence élevée de l’alexithymie chez les toxicomanes (43,5 %) par rapport à celle des témoins (24,6 %). Cette différence est obtenue grâce à la composante émotionnelle, la composante cognitive ne différenciant pas les deux échantillons. L’alexithymie, dans la population des toxicomanes, est indépendante des variables sociodémographiques. Au BDI, 66,4 % des toxicomanes présentent une symptomatologie dépressive (significativement plus fréquente pour le sexe féminin), contre seulement 26 % des témoins. La complexité des rapports entre alexithymie et dépression est discutée, la TAS et le BDI corrélant significativement, surtout pour le facteur « difficulté à identifier ses émotions ». Dans notre étude, l’alexithymie apparaît comme thymo-dépendante.

Alexithymia is a multidimensional concept associating an emotional component focused on the difficulty in identifying and describing feelings and a cognitive one centred on the use of a concrete and poorly introspective way of thinking. Alexithymia can be assessed by self-assessment instruments and in particular by the 20 items version of the Toronto Alexithymia Scale (TAS-20). Depressive disorders have complex relationships with the construct of alexithymia and there exist few experimental works on the subject. Epidemiological studies frequently raise an overlap between alexithymia and depression, in particular in the context of addiction. The main aim of this study was to confirm the high prevalence of alexithymia among drug addicted patients taking into account socio-demographic variables (sex, age, social and economic categories). The second aim of the study was to investigate the relationships between alexithymia and depression among drug addicted patients. A sample of 128 drug addicted patients answering DSM IV criteria of dependence to a psycho-active substance (alcohol excluded) was paired according to socio-demographic variables to a control sample of 128 normal subjects. Diagnostic assessment was made using the Mini International Neuropsychiatric Interview (MINI). Alexithymia and depression were assessed with the TAS-20 and with the short version of the Beck Depression Inventory (BDI-13). The results confirm the high prevalence of alexithymia among drug addicted patients (43.5 %) compared to controls (24.6 %). This difference is based namely on the emotional component of alexithymia, the cognitive component failing to show any difference between the two samples. Moreover, alexithymia appears to be independent from socio-demographic variables in our sample of drug addicted patients; 66.4 % of drug addicted patients presents a depressive symptomatology (which is significantly more important in female patients), compared to 26 % of the controls. Studies using the TAS and the BDI with 21 items have shown that from 10 to 20 % of the variance of alexithymia is explained by depression. Our own results show a shared variance of 20 % between the TAS-20 and the BDI, going in the direction of a moderated correlation between alexithymia and depressive symptomatology. Moreover, when we retain only subjects without depressive symptomatology at BDI, drug addicted (n = 42) are not any more alexithymic than controls (n = 114). Our results plead fora positive association between depression and alexithymia in drug addicted, depressed or healthy subjects. Alexithymia and depression would be two associated dimensions, the emotional component explaining alone this association. The emotional component of the alexithymia would be thymo-dependent, whereas the cognitive component (externally oriented thought) would be independent and constitute a stable clinical feature. These results are concordant with other studies in the literature suggesting that alexithymia in its emotional component is supported by depression. Alexithymia thus did not appear as an autonomous dimension which would discriminate between drug addicted and controls, independently of the absence of a depressive state. The authors discuss the complexity of the relationships between alexithymia and depression and the correlations between TAS and BDI scales especially for the factor Difficulty Identifying Feelings. These results deserve further studies. The cross-sectional nature of this stud V do not allow to establish if alexithymia is a subjacent and preexistent in the form of a psychopathological dimension in addictive behaviours, so supporting its emergence, and/or if it develops once the dependence is installed and chronicized. Longitudinal studies remain to be realised.

: Sidney Blatt, considering as being insufficient the categorical-symptomatic approach of depression, has worked out a theory of depression and psychopathology that integrates the contributions of psychoanalysis as well as cognitive and developmental psychology. Within a broad psychoanalytic framework, Blatt's formulation focus on the quality of interpersonal relationship, the nature of object representation and early life experiences. Personality development is viewed as the consequence of the interaction of 2 basic developmental tasks: the establishment of the capacity to form stable, enduring, mutually satisfying interpersonal relationships and the achievement of a differentiated, realistic, essentially positive identity. The relationship between these 2 developmental lines involves a complex dialectical process during which progress in each line is essential for progress in the other and which contributes to the development of both a sense of identity and the capacity for interpersonal relatedness. These developmental lines permit not only to define an during individual's primary personality configuration but also enable to identify cognitive structures that are inherent in various forms of psychopathology, including depression. Disruptions at different developmental stages create vulnerability to different subsequent psychological disturbances. Blatt characterised as anaclitic or dependent the axis concerned with interpersonal relationship and as introjective or self-critical the axis concerned with development of the sense of self and identity. Depressive Experience Questionnaire was developed by Blatt et al. to determine the validity of this model of psychopathology which emphazises continuities between normal and pathological forms of depression. The instrument was developed by Blatt et al. by assembling a pool of items describing experiences frequently reported by depressed individual. Sixty-six items were selected and administered to a large nonclinical sample (500 female and 160 male undergraduates). Principal component analysis within sex performed on the answers to DEQ confirmed his assumption in identifying two principal depressive dimensions. The first factor involved items that are primarily externally directed and refer to a disturbance of interpersonal relationships (anaclitism); the second factor consists of items that are more internally directed and reflect concerns about self-identity (self-criticism). A third factor emerged, assessing the good functioning of subject and confidence in his resources and capacities (efficacy). Scales derived from these factors have high internal consistency and substantial test-retest reliability. The solutions for men and women were highly congruent. Factor structure has been replicated in several nonclinical and clinical samples, supporting considerable evidence to the construct validity of the DEQ Dependency and Self-criticism scales. An adolescent form of DEQ (DEQ-A) has successively been developed. Factor analysis revealed three factors that were highly congruent in female and male students and with the three factors of the original DEQ. The reliability, internal consistency and validity of DEQ-A indicate that the DEQ-A closely parallels the DEQ, especially in the articulation of Dependency and Self-criticism as two factors in depression. These formulations and clinical observations about the importance of differentiating a depression focused on issues of self-criticism from issues of dependency are consistent with the formulations of others theorists which, from very different theoretical perspectives, posit 2 types of depression, one in which either perceived loss or rejection in social relationships is central and the other in which perceived failure in achievement, guilt or lack of control serves as the precipitant of depression. These 2 types of experiences have been characterized as dominant other and dominant goal , as anxiously attached and compulsively self-reliant and as sociotropic and autonomous . Our work presents the results of a validation study of both forms of Blatt's questionnaire (for adults--DEQ--and for adolescents--DEQA) translated in French in a large population of normal subjects, aged 15 to 45 years. DEQ and DEQ-A were compared by inspection of items loading strongly on each factor and by correlation of the three factors of adults and adolescents. The exploratory factor analysis of DEQ and DEQA revealed three orthogonal factors, corresponding with Blatt's original dimensions. Consistency and external validity were adequate for all 3 factors of DEQ and DEQ-A. Anaclitism and self-criticism dimensions of DEQ and DEQ-A correlate positively with measures of depression (DSM-IV, Beck Depression Inventory), consistently with the results obtained by Blatt. Differently from this author, anaclitism appears to be less differentiated in males than in females, suggesting that the concept of dependence could assume different relevance for men and women.