Cannabis use is being increasingly liberalized worldwide, and an increasing prevalence of cannabis-use disorder (CUD) is observed. The few current therapeutic options for CUD are only modestly effective. Mindfulness-based interventions offer promising prospects for the management of substance-use disorders. However, despite proliferating literature on mindfulness and substance use, few studies have explored mindfulness in terms of cannabis use and CUD. There are many possibilities for the implementation of mindfulness-based interventions for cannabis use reduction, especially for younger users, who are more vulnerable to cannabis-related harms. Accordingly, large controlled trials are needed to reliably assess the potential of such interventions.

COVID-19-related national lockdowns worldwide have had repercussions on people’s well-being and have led to increased substance use. Mindfulness has previously been associated with reduced psychological distress and benefits in terms of addictive behaviors. We aimed to assess whether dispositional mindfulness protected against increased tobacco and alcohol use in hospital workers after France’s first lockdown started. All workers in two French hospitals were contacted by email to participate in an online survey. Three hundred eighty-five workers answered. We ran two separate logistic regression models to test for associations between the level of dispositional mindfulness and both increased tobacco and alcohol use, after adjusting for affect deterioration. Dispositional mindfulness was associated with a lower likelihood of increased tobacco (adjusted odds ratio (AOR) [95% CI] 0.71 [0.51; 0.99], p = 0.046) and alcohol (0.66 [0.50; 0.87], p = 0.004) use. The effect of mindfulness on tobacco use was partially mediated by affect deterioration. Dispositional mindfulness appeared to be a protective factor against lockdown-related tobacco and alcohol use increases in French hospital workers.

Eating disorders, characterized by abnormal eating, weight control behaviors or both include anorexia nervosa (AN) and bulimia nervosa (BN). We investigated their potential iatrogenic triggers, using real-world data from the WHO safety database (VigiBase®). VigiBase® was queried for all AN and BN reports. The reports were classified as `pediatric' or `adult' according to age. Disproportionality analyses relied on the Information Component (IC), in which a 95% confidence interval lower-end positivity was required to suspect a signal. Our queries yielded 309 AN and 499 BN reports. Isotretinoin was disproportionately reported in pediatric AN (IC 3.6; [2.6-4.3]), adult AN (IC 3.1; [1.7-4.0]), and pediatric BN (IC 3.9; [3.0-4.7]). Lamivudine (IC 4.2; [3.2-4.9]), nevirapine (IC 3.7; [2.6-4.6]), and zidovudine (IC 3.4; [2.0-4.3]) had the highest ICs in adult AN. AN was associated with isotretinoin, anticonvulsants in minors, and antiretroviral drugs in adults. In adults, BN was related to psychotropic and hormonally active drugs. Before treatment initiation, an anamnesis should seek out mental health conditions, allowing the identification of patients at risk of developing or relapsing into AN or BN. In addition to misuse, the hypothesis of iatrogenic triggers for AN and BN should also be considered.

Background and Aims: This work aims to assess the impact of the COVID-19 pandemic on hospital workers' psychological parameters and attitudes toward substance use, before and during the French COVID-19 lockdown. Methods: An online survey was proposed to the staff of the University Hospital of Nice and Sainte-Marie psychiatric hospital in France from May 18 to June 6, 2020 assessing changes in daily habits, psychological distress and changes in substance use, including smoking. Results: A total of 702 respondents (80.3% female) filled out the survey. Overall, most of the workers reported increased stress, irritability, sadness, decreased motivation, and a worse quality of sleep after the beginning of the COVID-19 lockdown. Additionally, hospital workers who were more likely to use tobacco during the COVID-19 lockdown reported increased sadness (OR = 1.23, p < 0.001), loss of motivation (OR = 0.86, p < 0.05), alcohol consumption (OR = 3.12, p < 0.001), lower incomes (OR = 1.69, p < 0.05), living alone (OR = 1.77, p < 0.001) and doing less physical activity (OR = 0.36, p < 0.001). Conclusion: During the first lockdown, significant psychological changes (sadness, distress, irritability) associated with changes in tobacco use and physical activity were reported. Such results should encourage hospital leaders to implement dedicated policies to better accompany hospital workers' psychological distress.

We study the impact of the spring 2020 lockdown in France on gender-related potentially addictive behaviors and associated negative emotions. We rely on an online survey we administered 1 week after the beginning of the lockdown, with responses collected within 2 weeks after the beginning of the lockdown (N = 1,087). We focus on potential addictions to non-creative activities as food consumption and smartphone usage (female-related), and videogame play (male-related). We find that women were about 1.6 times more likely than men to losing control of their usual diet and about 2.3 times more likely than men to increase smartphone usage, while no significant gender effect is detected as for increased videogame play. This is since the negative emotions driving the increase of female-related non-creative activities (sadness, discouragement, and nervousness) were themselves female-related, while the negative emotions driving the increase of male-related non-creative activities (boredom, emptiness, and stress) were shared by women too. Our study supports the intuition that the same negative emotion induced by COVID-19 side-effects could lead to different potentially addictive behaviors; this difference is explained by the interplay between different gender's sensitivities to such emotion and different gender's preferences for specific non-creative activities.

Background Relationships between mindfulness and general craving have been documented. However, there is still no data regarding relationships between mindfulness and the different craving factors. Methods Using data from an online survey among hospital workers smoking tobacco in France (n = 127), we performed linear regression models with the four craving factors as outcomes, and dispositional mindfulness as explanatory variable. Results After adjusting for nicotine dependence, mindfulness was negatively associated with general craving and three out of four craving factors (emotionality, compulsivity and purposefulness, but not expectancy). Conclusions These results support the implementation of mindfulness-based interventions in the context of tobacco cessation attempt.

The status of mental health of physicians practicing in cancer research centers is evaluated. To date little information is given in research to date concerning the burnout syndrome. Recommendations are made for a better psychological development of caregivers.

Introduction : Cette étude a pour objectif de décrire la fréquence et le codage des prises en charge psychiques des patients hospitalisés en court séjour au Centre hospitalier universitaire de Nice en 2013. Méthodes : Différentes informations ont été mesurées : le pourcentage d’actes ambulatoires de psychiatrie ou de codes de diagnostics psychiques ; les variabilités des pratiques de codage entre le Programme de médicalisation des systèmes d’information pour les activités de médecine-chirurgie-obstétrique et le recueil d’information médicale en psychiatrie ; l’impact du codage sur le groupage des séjours. Résultats : Vingt-quatre pour cent des patients hospitalisés ont bénéficié d’une prise en charge psychique (soit un acte ambulatoire, soit un diagnostic psychique) et 3,9 % ont à la fois un acte et un diagnostic repéré. Les psychiatres de liaison utilisent davantage les codes des troubles névrotiques liés à des facteurs de stress et somatoformes (28 % vs 16 %). Les médecins des services somatiques codent davantage les troubles liés à l’utilisation de substances psychoactives (26 % vs 16 %). La présence d’une comorbidité de psychiatrie a un impact sur le classement en GHM ou niveau de sévérité pour 0,5 % des résumés standardisés de séjours. Conclusion : Cette étude montre l’importance de l’implication des acteurs de la psychiatrie dans les prises en charge de court séjour. Pour améliorer la valorisation de l’activité psychosomatique au sein d’un établissement de santé de court séjour, il serait nécessaire de travailler à une meilleure définition des règles de codage de ces pathologies, d’actualiser, et de repérer des unités fonctionnelles ou des lits dédiés aux troubles psychosomatiques.

Background > Depression is a sustainable state of deep sadness and abatement. It is frequently identified in patients with cancer and often undervalued by oncologists. The reduced PRIME-MD questionnaire is a questionnaire of 2 items validated in French. However, it has been neither translated nor validated in French. The objective of our study is to translate the PRIME-MD and validate it into French.Method > The PRIME-MD questionnaire was translated into French by using the recommendations of the EORTC and compared to the French gold standard questionnaire Mini-International Neuropsychiatric Interview (MINI).Results > Two hundred and ninety-nine patients were included in our study. With a 98% filling rate, the Q2i questionnaire has been well accepted. The prevalence of depression in our population was measured at 7.4%. With a sensitivity of 89.47%, a specificity of 58.85%, found percentages are equal to those of the questionnaire in English. The negative predictive value was measured at 98.52%.Conclusion > This study demonstrates that the Q2i questionnaire is a quick and easy screening tool, requiring less than 2 minutes to target patients likely to benefit from psychological support.

Announcement of diagnosis is a critical step in establishing a trust-based relationship of quality between patient and physician. Disclosing "bad news" is a difficult and sensitive task which has direct consequences on psychological, emotional and relational levels, as well as on therapeutic management. This is a potentially traumatic experience which requires a long process of integration and psychological adaptation. The hematologist-oncologist occupies a central position: He introduces the framework for a multidisciplinary care, while taking into account the personality and behavior of the teenager or young adult. We propose an analysis of doctor-patient interaction; an overview of psychological issues associate with diagnosis disclosure; suggestions to build and manage communication with patients; and a clarification of the role of the psychologist and of the psychological adjustment at the time of disclosure.

Innes et al.1 must be congratulated for providing important data on liver-related morbidity and mortality in patients treated for hepatitis C virus (HCV) infection. The authors underlined the importance of comorbidity, particularly in alcohol consumption. Recently, Backus et al.2 showed a strong decrease in hepatic mortality and, more surprisingly, in nonhepatic and global mortality in cases of sustained virological response (SVR). We hypothesized that patient empowerment prompted by an SVR could lead these patients to consider comorbidities such as alcohol intake, and in this way could decrease hepatic and/or global morbidity or mortality.3 We conducted a pilot study aimed at evaluating the impact of SVR on detoxification in 40 alcoholic heavy drinkers (26 men, 14 women; mean age, 46 years; mean daily quantity, 87 g alcohol) infected with HCV. All patients presented an abuse or dependence according to DSM-IV classification and a CAGE questionnaire score ≥2 at baseline. Thirty-three patients (20 genotypes 1/4, 13 genotypes 2/3) were treatment-naïve. Pegylated interferon-α and ribavirin were initiated simultaneously with a treatment course for alcohol detoxification according to the recommendations (48 weeks for genotypes 1/4, 24 weeks for genotypes 2/3, 72 weeks for nonresponders). The patients were regularly followed up by a team composed of a nurse, a psychiatrist, a psychologist, and a hepatologist. Six patients discontinued treatment (two for severe anemia, one for hepatocarcinoma, and three for psychiatric side effects [depression, massive alcohol consumption]). For treatment-naïve patients, the SVR observed on intention-to-treat and per-protocol analysis was 40% and 50%, respectively, for genotypes 1/4 and 69% and 82%, respectively, for genotypes 2/3. At the end of the study, 55% of the 40 patients were weaned off alcohol; among these, 71% of the treatment-naïve patients with SVR were also weaned off alcohol, whereas only 37% of nonresponders were weaned off alcohol (P = 0.056). At the end of the study, the Hamilton's score significantly improved in patients with an SVR (P = 0.07). Treatment of HCV concomitant with a program of alcohol weaning was possible in heavy drinkers when subjected to effective psychiatric evaluation. Therefore, our results and the Innes et al. data fit well with the proposed hypothesis3: that patients achieving an SVR are more prone to change their way of life and to control some pathological factors, such as excessive alcohol consumption. Régine Truchi*, Eve Gelsi*, Faredj Cherikh*, Albert Tran*, Patrice Couzigou*, * Service Hépato-Gastroenterology, Hôpital du Haut Leveque, Pessac, France.

Le psychiatre a pour mission de lutter contre le trouble mental avec pour préoccupation de réduire le « handicap psychique », où il voit une séquelle de l’état psychiatrique avant de le considérer comme « état antérieur », également indépendants des troubles. Clinique et thérapeutique convergent vers l’évaluation individualisée des composants de la vulnérabilité qui, dans les modèles pathogéniques les plus élaborés et concernant les pathologies les plus graves – les schizophrénies – gardent une valeur de prototype. Les modèles de vulnérabilité structurent la réponse au stress selon divers processus qui dictent les principes essentiels des interventions thérapeutiques et motivent l’approche conjointe des facteurs défensifs et stratégiques de la personnalité et le domaine des compétences de la personne, comportant notamment l’expérience acquise et le « support social » comme tissu relationnel étayant le champ de la socialité. Une perspective « salutogène » appelle le « sens de la cohérence », une préoccupation relative à la « qualité de vie » et le dépassement d’une logique de compensation technique pour la mise en œuvre, sous l’action de la « permissivité thérapeutique », d’un travail de la créativité humaine.

The purpose of this study was to conduct a descriptive and comparative analysis of the tools used by healthcare professionals specializing in addictive disorders to promote a rapprochement of information systems. The evaluation guide used to assess the compensation needs of disabled persons treated in "Maisons Départementales des Personnes Handicapées" (centres for disabled people) organizes information in different areas, including a psychological component. The guide includes social and environmental information in the "Recueil Commun sur les Addictions et les Prises en charges" (Joint Report on Drug Addiction and Drug Treatment). While the program for the medicalization of information systems includes care data, the current information about social situations remains inadequate. The international classification of diseases provides synthetic diagnostic codes to describe substance use, etiologic factors and the somatic and psychological complications inherent to addictive disorders. The current system could be radically simplified and harmonized and would benefit from adopting a more individualized approach to non-substance behavioral addictions. The international classification of disabilities provides tools for evaluating the psychological component included in the recent definition of addictive disorders. Legal information should play an integral role in the structure of the information system and in international classifications. The prevalence of episodes of care and treatment of addictive and psychological disorders was assessed at Nice University Hospital in all disciplines. Except in addiction treatment units, very few patients were found to have a RECAP file.

Résumé Dans l’objectif de proposer des pistes de réflexion vers un rapprochement des systèmes d’information, une analyse descriptive et comparative des outils utilisés par les professionnels de santé spécialisés dans les troubles addictifs, a été réalisée. Le guide d’évaluation des besoins de compensation des personnes handicapées (GEVA) des Maisons Départementales des Personnes Handicapées structure les informations en volets, dont un psychologique. Il rassemble l’ensemble des informations sociales et environnementales du Recueil Commun sur les Addictions et les Prises en charge (RECAP). Le programme de médicalisation des systèmes d’information structure les informations relatives aux prises en charge. Il ne repère cependant pas suffisamment les situations sociales. La classification internationale des maladies propose des codes diagnostiques complexes et synthétiques, utilisés pour décrire modalités de consommation de produits, facteurs étiologiques et complications psychiques et somatiques inhérentes aux troubles addictifs. Elle pourrait être simplifiée et harmonisée d’un chapitre à l’autre de la classification et individualiser davantage les addictions comportementales sans produit. La classification du handicap propose des éléments d’évaluation de la dimension psychologique repris dans la définition récente des troubles addictifs. Les informations légales mériteraient une place à part entière dans la structuration du dossier et dans les classifications internationales. La prévalence des épisodes de prise en charge sanitaire des troubles addictifs et psychiques a été estimée au CHU pour toute discipline. En dehors des structures de soins dédiés à l’addictologie, très peu de patients font l’objet d’une fiche RECAP.

AIMS:The aims of this study were to determine whether alcohol consumption or cessation influences transient elastography (TE) measurements and whether TE is a useful tool to monitor alcoholic patients.PATIENTS:Twenty-three consecutive heavy drinkers (20 men and 3 women; mean age 47.2 years) admitted for a 7-day hospitalization for alcohol detoxification were included. On admission (D0), a detailed medical history was taken and the following laboratory tests were performed [aspartate aminotransferase (ASAT), gamma glutamyltransferase (γGT), and carbohydrate-deficient transferrin (CDT) levels, and Fibroscan(®)]. All examinations were repeated on D8, D30, and D60. Variation in the median Fibroscan value of >20% was considered significant.RESULTS:After 1 week of detoxification, the % variation in TE was -21.67 ± -27.6%. The median variation in TE between D8 and D60 was -20% in the abstinent group and 32% in the relapse group (p = 0.007). An increase in proportion of patients with a significant decrease in TE was observed with an increased duration of abstinence: 41.7% at D8 and 66.7% at D60. TE values were significantly correlated with ASAT, γGT, and CDT at D0 and D8, and with ASAT and γGT at D60.CONCLUSIONS:TE in alcoholics is influenced by major variations in the biochemical activity of the disease. The kinetics of variation of TE suggest that this method may be useful to assess alcohol abuse and control.