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While the impact of the gut microbiota on brain and behavior is increasingly recognized, human studies examining this question are still scarce. The primary objective of the current study was to explore the potential relationships between the gut microbiota composition, motor cortical excitability at rest and during inhibitory control, as well as behavioral inhibition, in healthy volunteers and in patients suffering from alcohol use disorder. Motor cortical excitability was examined using a range of transcranial magnetic stimulation (TMS) measures probed at rest, including the recruitment curve, short and long intracortical inhibition, and intracortical facilitation within the primary motor cortex. Moreover, TMS was applied during a choice reaction time task to assess changes in motor excitability associated with inhibitory control. Finally, behavioral inhibition was investigated using a neuropsychological task (anti-saccade). Overall, our results highlight several interesting correlations between microbial composition and brain measures. Hence, higher bacterial diversity, as well as higher relative abundances of UGC-002 and Christensenellaceae R-7 group were correlated with stronger changes in motor excitability associated with inhibitory control. Also, higher abundance of Anaerostipes was associated with higher level of corticospinal excitability. Finally, relative abundances of Bifidobacterium and Faecalibacterium were positively related to performance in the neuropsychological task, suggesting that they might have a positive impact on behavioral inhibition. Although correlation is not causation, the present study suggests that excitatory and inhibitory brain processes might be related to gut microbiota composition.

info:eu-repo/semantics/nonPublished

Alcohol use disorder (AUD) is a chronic relapsing disease associated with malnutrition, metabolic disturbances, and gut microbiota alterations that are correlated with the severity of psychological symptoms. This study aims at supplementing AUD patients with prebiotic fiber during alcohol withdrawal, in order to modulate the gut microbiota composition and to evaluate its effect on gastrointestinal tolerance, metabolism, and patient’s behavior. A randomized, double-blind, placebo-controlled study included 50 AUD patients assigned to inulin versus maltodextrin daily supplementation for 17 days. Biological measurements (fecal microbial 16S rDNA sequencing, serum biology), dietary intake, validated psychological questionnaires, and gastrointestinal tolerance assessment were performed before and after the intervention. Inulin significantly decreased the richness and evenness and induced changes of 8 genera (q < 0.1) including Bifidobacterium and Bacteroides. Prebiotic had minor effects on gastrointestinal symptoms and nutritional intakes compared to placebo. All patients showed an improvement in depression, anxiety, and craving scores during alcohol withdrawal regardless of the intervention group. Interestingly, only patients treated with inulin significantly improved the sociability score and had an increased serum level of brain-derived neurotrophic factor. This pilot study shows that inulin is well tolerated and modulates the gut microbiota and the social behavior in AUD patients, without further improving other psychological and biological parameters as compared to placebo. Gut2Brain study, clinicaltrial.gov: NCT03803709, https://clinicaltrials.gov/ct2/show/NCT03803709

Numerous risk factors have been involved in the pathogenesis of hypertension. The contribution of psychological factors, including post-traumatic stress disorder, remains largely underexplored, despite their potential role in hypertension. We compared the prevalence of trauma, post-traumatic stress and other psychological disorders between hypertensive and normotensive patients from Bukavu (Democratic Republic of Congo), a 25-year war-exposed city. In this case-control study, we assessed past traumatic events with the Stressful-Events-Scale, post-traumatic stress disorder through the post-traumatic diagnostic scale, depression and alcohol use disorder through the MINI-International-Neuropsychiatric-Interview, and emotion regulation through the Emotion-Regulation-Questionnaire in 106 hypertensive and 106 normotensive patients, enrolled at the Bukavu General Hospital. Compared with normotensive controls (73% women, age: 43 ± 14 years, BP: 121 ± 10/75 ± 8 mmHg), hypertensive patients (57% women, age: 42 ± 13 years, BP: 141 ± 12/82 ± 7 mmHg, on a median of two antihypertensive drugs) were exposed to more man-made traumas (61 vs. 13%, P < 0.001), used more expressive suppression (P = 0.05) and less cognitive reappraisal (P = 0.02) as emotional regulation strategies. They developed more frequent post-traumatic stress disorder (36 vs. 7%, P < 0.001) and major depressive disorder (37 vs. 13%, P = 0.001), often in association with alcohol use disorder (23 vs. 4%, P < 0.001). In multivariate logistic regression, post-traumatic stress disorder [OR = 3.52 (1.23-6.54)], man-made trauma [OR = 2.24 (1.15-4.12)], family history of hypertension [OR = 2.24 (1.06-4.44)], fasting blood glucose [OR = 1.85 (1.07-3.08)], BMI [OR = 1.28 (1.12-2.92)], expressive suppression [OR = 1.23 (1.11-2.23)] and cognitive reappraisal [OR = 0.76 (0.63-0.98)] were independent predictors of hypertension. In Congolese populations exposed to war, man-made trauma exposure and post-traumatic stress disorder

La question de la mesure du risque de passage à l’acte est un vaste débat dont la réponse n’est jamais binaire. La réflexion menée autour de cette question a pour visée d’approcher comment l’ancrage par le soin psychique amènerait à une évolution autre que meurtrière pour le sujet. Partir d’une situation clinique permet d’articuler les différents aspects d’une rencontre avec le soin. Nous aborderons ici quelles sont les possibilités de déplacements de la violence par le soin, c’est-à-dire par la « fonction de contention du cadre coercitif » et la « fonction de contenance du cadre soignant » (Morhain, 2012)3 . Nous développerons également l’aspect de la crise homicidaire comme le pendant de la crise suicidaire, ce qui permettra de venir questionner ce que le sujet cherche à atteindre dans l’autre.

Visuospatial impairments have long been reported in Severe Alcohol Use Disorder but remain poorly understood, notably regarding the involvement of magnocellular (MC) and parvocellular (PC) pathways. This empirical gap hampers the understanding of the implications of these visual changes, especially since the MC and PC pathways are thought to sustain central bottom-up and top-down processes during cognitive processing. They thus influ- ence our ability to efficiently monitor our environment and make the most effective decisions. To overcome this limitation, we measured PC-inferred spatial and MC-inferred temporal resolution in 35 individuals with SAUD and 30 healthy controls. We used Landolt circles displaying small apertures outside the sensitivity range of MC cells or flickering at a temporal frequency exceeding PC sensitivity. We found evidence of preserved PC spatial resolution combined with impaired MC temporal resolution in SAUD. We also measured how spatial and tem- poral sensitivity is influenced by the prior presentation of fearful faces – as emotional content could favor MC processing over PC one – but found no evidence of emotional modulation in either group. This spatio-temporal dissociation implies that individuals with SAUD may process visual details efficiently but perceive rapidly updating visual information at a slower pace. This deficit has implications for the tracking of rapidly changing stimuli in experimental tasks, but also for the decoding of crucial everyday visual incentives such as faces, whose micro-expressions vary continuously. Future studies should further specify the visual profile of individuals with SAUD to incorporate disparate findings within a theoretically grounded model of vision.

Visuo-perceptive deficits in severe alcohol use disorder (SAUD) remain little understood, notably regarding the respective involvement of the two main human visual streams, i.e., magnocellular (MC) and parvocellular (PC) pathways, in these deficits. Besides, in healthy populations, low-level visual perception can adapt depending on the nature of visual cues, among which emotional features, but this MC and PC pathway adaptation to emotional content is unexplored in SAUD. To assess MC and PC functioning as well as their emotional modulations in SAUD. We used sensitivity indices (d') and repeated-measures analyses of variance to compare orientation judgments of Gabor patches sampled at various MC- and PC-related spatial frequencies in 35 individuals with SAUD and 38 matched healthy controls. We then explored how emotional content modulated performances by introducing neutral or fearful face cues immediately before the Gabor patches and added the type of cue in the analyses. SAUD patients showed a general reduction in sensitivity across all spatial frequencies, indicating impoverished processing of both coarse and fine-scale visual content. However, we observed selective impairments depending on facial cues: individuals with SAUD processed intermediate spatial frequencies less efficiently than healthy controls following neutral faces, whereas group differences emerged for the highest spatial frequencies following fearful faces. Altogether, SAUD was associated with mixed MC and PC deficits that may vary according to emotional content, in line with a flexible but suboptimal use of low-level visual content. Such subtle alterations could have implications for everyday life's complex visual judgments.

Een recent rapport van het National Institute for Health and Care Excellence vernoemt oefentherapie in groep als eerstelijnsbehandeling voor volwassen patiënten met een depressie, ook voor ernstige gevallen. Het gaat erom tegelijk de symptomen van de depressie terug te dringen, maar ook de slechtere fysieke toestand van de patiënten te verbeteren. Bij adolescenten met een depressie wordt lichaamsbeweging voorgesteld maar niet erkend als aanvullende eerstelijnsbehandeling. Bemoedigende nieuwe studies toonden nochtans een duidelijk effect tegen depressie aan bij jongeren, vooral in psychiatrische ziekenhuizen. De antidepressieve effecten van oefening in groep zouden het gevolg kunnen zijn van neurobiologische (neuroplasticiteit, ontsteking, endocriene respons…) en psychosociale (lichaamsbeeld, gevoel van eigenwaarde, gevoel van zelfredzaamheid, sociale steun…) mechanismen. Een dergelijk oefenprogramma omvat begeleiding door opgeleid personeel en zorgt voor een kader en structuur met sessies die specifiek zijn afgestemd op mensen met een depressie. De lichaamsbeweging moet aeroob zijn, van matige intensiteit met ten minste twee sessies per week bij volwassenen en drie bij adolescenten gedurende ten minste tien weken. Er moet voor worden gezorgd dat het programma aantrekkelijk is en aangepast aan de fysieke en mentale moeilijkheden van elk individu om actieve deelname aan te moedigen.

Un rapport récent du National Institute for Health and Care Excellence inclut la thérapie par l’exercice en groupe parmi les traitements de première ligne auprès des patients adultes souffrant de dépression, y compris dans les cas graves. L’intérêt est à la fois de réduire les symptômes dépressifs mais aussi d’améliorer leur santé physique plus faible. Chez l’adolescent souffrant de dépression, la pratique de l’exercice physique est suggérée mais n’est pas reconnue comme faisant partie des traitements complémentaires de première ligne. Cependant, de nouvelles études encourageantes ont montré un effet antidépresseur notable chez les jeunes, notamment en milieu hospitalier psychiatrique. Les effets antidépresseurs de l’exercice en groupe pourraient être dus à des mécanismes neurobiologiques (neuroplasticité, inflammation, réponse endocrine…) et psycho-sociaux (image de son corps, estime de soi, sentiment d’auto-efficacité, support social…). Un tel programme d’exercices physiques implique une supervision par un personnel qualifié, assurant un cadre et une structure de séances spécialement conçus pour les personnes souffrant de dépression. L’exercice doit être aérobie, d’intensité modérée avec au moins 2 séances par semaine chez l’adulte et 3 chez l’adolescent pendant au moins 10 semaines. Il faudra veiller à ce que le programme soit attrayant et adapté aux difficultés physiques et psychiques de chaque individu pour favoriser sa participation active.

Coronavirus disease 2019 has spread rapidly over the globe and has put an unprecedent psychological pressure on health care workers (HCWs). The present study aimed at quantifying the psychological consequences of the COVID-19 pandemic on HCWs during and after the first wave and identify sociodemographic, situational, and psychological risk/protective factors for symptoms severity. An online survey was sent by e-mail to all nurses and physicians employed by a teaching hospital in Brussels, Belgium. 542 (20,62%) completed the survey. 47%, 55%, 32% and 52% of participants reported posttraumatic stress, anxiety, depression and insomnia symptoms, respectively, during the peak. Two to three months later, posttraumatic symptoms emerged in 54% of HCWs. It persisted in 89% of those presenting severe symptoms initially. Neuroticism was the strongest predictor of posttraumatic stress, anxiety, and insomnia. Work overload was the strongest predictor of depression and second predictor of posttraumatic stress, anxiety, and insomnia. Other significant predictors included being a nurse, the number of past traumatic experiences, avoidant coping style, and expressive suppression of emotions.

Non-alcoholic fatty liver disease (NAFLD) is a quickly expanding welfare disease. It has been associated with unhealthy high-sugar beverages containing fructose. Here we describe the case of a 64-year-old woman who has been followed at the endocrinology consultation for about 20 years, for a metabolic syndrome associating type 2 diabetes. Due to the development of liver test disturbances, the patient was referred to hepatology and the diagnosis of metabolic dysfunction-associated fatty liver disease (MAFLD) was made. Interestingly, the patient denied any major consumption of sweetened beverages or other processed food, but on thorough history mentioned an excessive and uncontrollable consumption of fruits. Psychiatric follow-up was then initiated. After a period of six months, the body weight remained stable, but we found a reduction of fruit consumption, a reduction of insulin resistance and a normalisation of liver blood tests and elasticity. We further describe how fructose has specific metabolic pathways that cause liver damage and similarities with alcohol in terms of addictive potential. In conclusion, this case shows the importance of a detailed and personalised care in NAFLD-MAFLD and considering food addiction (also for foods that are considered “healthy”) as a real substance-use disorder and a potential cause of liver disease.

Consistent data highlight the presence and clinical significance of social cognition impairments in severe alcohol use disorder (SAUD). However, social perception and knowledge (i.e., the ability to interpret social situations and to identify latent social rules), an important social cognition component, has not yet been explored in this disorder. 35 patients with SAUD and 35 healthy controls (HC) completed the Social Perception and Knowledge test (PerSo), an experimental task requiring participants to comprehensively describe social situations and to identify the social rules illustrated in 8 pictures. We performed group and single-case analyses. Patients with SAUD, as a group, spontaneously identified less relevant "where"/"who"/"what" aspects of the social situations (social perception) than HC. They were however able to provide these elements when explicitly asked to. They were also less able to identify the social rules that subtended the situations (social knowledge). Single-case analyses revealed that 23 % of patients were significantly impaired for social perception, and 34 % for social knowledge. We provide novel evidence that SAUD is associated with social perception and knowledge impairments at the group level, and that these impairments strongly vary across patients. Such results should lead to the integration of social perception and knowledge impairments in the conceptualization and treatment of socio-affective difficulties in SAUD.

Electroconvulsive therapy (ECT) is a highly effective treatment for depression but how it achieves its clinical effects remains unclear. We set out to study the brain's response to ECT from a large-scale brain-network perspective. Using a voxelwise analysis, we looked at resting-state functional connectivity before and after a course of ECT at the whole-brain and the between- and within-network levels in 17 patients with a depressive episode. Using a group-independent component analysis approach, we focused on four networks known to be affected in depression: the salience network (SN), the default mode network (DMN), the cognitive executive network (CEN), and a subcortical network (SCN). Our clinical measures included mood, cognition, and psychomotor symptoms. We found ECT to have increased the connectivity of the left CEN with the left angular gyrus and left middle frontal gyrus as well as its within-network connectivity. Both the right CEN and the SCN showed increased connectivity with the precuneus and the anterior DMN with the left amygdala. Finally, improvement of psychomotor retardation was positively correlated with an increase of within-posterior DMN connectivity. The limitations of our study include its small sample size and the lack of a control dataset to confirm our findings. Our voxelwise data demonstrate that ECT induces a significant increase of connectivity across the whole brain and at the within-network level. Furthermore, we provide the first evidence on the association between an increase of within-posterior DMN connectivity and an improvement of psychomotor retardation, a core symptom of depression.

Metadehumanisation (i.e., the perception of being considered as less than human by others) is proposed to be widespread in stigmatised populations, such as people with severe alcohol use disorder (SAUD). However, the relations between metadehumanisation, self-dehumanisation (i.e., the self-perception of being less than human), and stigmatisation (i.e., the negative taint applied to some groups) remain unexplored. The aim of this research is thus to investigate the relations between these processes. Metadehumanisation, self-dehumanisation, self-stigma (and its subdimensions) and environmental satisfaction were assessed in 120 inpatients with SAUD and analysed in a mediational model. Stigma awareness was positively associated with metadehumanisation, whereas environmental satisfaction was negatively associated with metadehumanisation. Stigma's application to the self was associated with increased self-dehumanisation. Self-stigma and self-dehumanisation are closely intertwined phenomena. Self-dehumanisation seems to follow a multi-step process suggesting that some steps, such as dehumanisation awareness, are missing from current models of dehumanisation.

Prior studies suggest that IL-6 may be involved in the pathophysiology of psychomotor symptoms in depression. Electroconvulsive therapy (ECT), as yet the most effective biological treatment of severe depression, is known to improve psychomotor functioning, while recent studies have shown a decrease in the elevated IL-6 levels of depressed patients following ECT. This study investigates whether the improvement in psychomotor functions in patients with depression after ECT is related to changes in IL-6 levels. Peripheral IL-6 was quantified and the severity of psychomotor agitation and retardation determined using the CORE assessment of psychomotor symptoms in 62 patients with a (unipolar or bipolar) depressive episode within one week before and within one week after their course of ECT. IL-6 levels had decreased significantly following ECT and both psychomotor retardation and agitation had improved. The decrease in IL-6 levels was related to the improvement of psychomotor retardation, with post-hoc analysis revealing that higher baseline IL-6 levels positively correlated with higher psychomotor retardation scores. With this study, we provide the first evidence that the improvement of psychomotor retardation after ECT for depression is related to the immunomodulatory properties of the treatment, most specifically the decrease in IL-6 levels.

The coronavirus disease 2019 (COVID-19) pandemic considerably affects health, wellbeing, social, economic and other aspects of daily life. The impact of COVID-19 on blood pressure (BP) control and hypertension remains insufficiently explored. We therefore provide a comprehensive review of the potential changes in lifestyle factors and behaviours as well as environmental changes likely to influence BP control and cardiovascular risk during the pandemic. This includes the impact on physical activity, dietary patterns, alcohol consumption and the resulting consequences, for example increases in body weight. Other risk factors for increases in BP and cardiovascular risk such as smoking, emotional/psychologic stress, changes in sleep patterns and diurnal rhythms may also exhibit significant changes in addition to novel factors such as air pollution and environmental noise. We also highlight potential preventive measures to improve BP control because hypertension is the leading preventable risk factor for worldwide health during and beyond the COVID-19 pandemic.

Following the recognition of 'internet gaming disorder' (IGD) as a condition requiring further study by the DSM-5, 'gaming disorder' (GD) was officially included as a diagnostic entity by the World Health Organization (WHO) in the 11th revision of the International Classification of Diseases (ICD-11). However, the proposed diagnostic criteria for gaming disorder remain the subject of debate, and there has been no systematic attempt to integrate the views of different groups of experts. To achieve a more systematic agreement on this new disorder, this study employed the Delphi expert consensus method to obtain expert agreement on the diagnostic validity, clinical utility and prognostic value of the DSM-5 criteria and ICD-11 clinical guidelines for GD. A total of 29 international experts with clinical and/or research experience in GD completed three iterative rounds of a Delphi survey. Experts rated proposed criteria in progressive rounds until a pre-determined level of agreement was achieved. For DSM-5 IGD criteria, there was an agreement both that a subset had high diagnostic validity, clinical utility and prognostic value and that some (e.g. tolerance, deception) had low diagnostic validity, clinical utility and prognostic value. Crucially, some DSM-5 criteria (e.g. escapism/mood regulation, tolerance) were regarded as incapable of distinguishing between problematic and non-problematic gaming. In contrast, ICD-11 diagnostic guidelines for GD (except for the criterion relating to diminished non-gaming interests) were judged as presenting high diagnostic validity, clinical utility and prognostic value. This Delphi survey provides a foundation for identifying the most diagnostically valid and clinically useful criteria for GD. There was expert agreement that some DSM-5 criteria were not clinically relevant and may pathologize non-problematic patterns of gaming, whereas ICD-11 diagnostic guidelines are likely to diagnose GD adequately and avoid pathologizing.

BACKGROUND & AIMS: Chronic alcohol consumption can cause malnutrition that may contribute to alcohol-induced organ injury and psychological disorders. We evaluated the link between nutrient intake, especially dietary fibers (DF) and different parameters reflecting mental health and well being, namely anxiety, depression, alcohol craving, sociability, fatigue and intestinal comfort in alcohol use disorder (AUD) patients. METHODS: Cross-sectional data from 50 AUD patients, hospitalized for a 3-week detoxification program were used. Three 24-h recalls allowed to calculate dietary habits and nutrient intakes, that was also assessed in healthy subjects (HS). Diet quality was measured using the NOVA score. Psychological factors and intestinal discomfort were evaluated using validated self-administered questionnaires. RESULTS: Energy intake (excluding alcoholic beverage), total fat, monounsaturated and polyunsaturated fatty acids, protein and DF intakes were lower in AUD subjects compared to HS. Ninety percent of patients had a DF intake below the recommendation. AUD patients consumed more than twice as much ultra-processed food than HS. Fructan intake was negatively associated with anxiety (p = 0.04) adjusted for main confounders. Total DF, insoluble, soluble DF and galacto-oligosaccharide intakes were associated with higher sociability score. Soluble DF intake was associated with better satisfaction of bowel function (p = 0.02) and a lower intestinal discomfort (p = 0.04). CONCLUSIONS: This study reveals that insufficient DF intake is part of AUD-related malnutrition syndrome, and is associated with higher anxiety, lower sociability score and intestinal discomfort. Our results suggest that an adequate intake of DF might be beneficial for recovery from AUD. TRIAL REGISTRATION: NCT03803709, https://clinicaltrials.gov/ct2/show/NCT03803709.

Metadehumanization, the perception of being treated as less than a human by others, is a pervasive phenomenon in intergroup relations. It is dissociated from stigmatization or stereotypes, and it has been recently identified as a critical process in severe alcohol use disorders (SAUD). Metadehumanization is associated with a wide array of negative consequences for the victim, including negative emotions, aversive self-awareness, cognitive deconstruction, and psychosomatic strains, which are related to anxiety and depression. This study aims to investigate if metadehumanization occurring among patients with SAUD is associated with clinical factors involved in the maintenance of the disease, namely symptoms of depression or anxiety and drinking refusal self-efficacy. A cross-sectional study was conducted among 120 patients with SAUD. Self-reported questionnaires measured metadehumanization, self-dehumanization (i.e., the feeling of being less than a human), anxiety, depression, drinking refusal self-efficacy, and demographics. Metadehumanization was significantly associated with self-dehumanization, anxiety, depression, and drinking refusal self-efficacy. Additionally, path analyses showed that self-dehumanization mediated the links between metadehumanization and clinical variables. These results indicate that metadehumanization and self-dehumanization could be essential factors to consider during SAUD treatment, as they are associated with increased psychiatric symptoms and reduced drinking refusal self-efficacy.

The gut-brain communication is mostly driven by the immune, metabolic and neural pathways which remained poorly explored in patients with alcohol use disorder (AUD). The metabolites arising from the tryptophan-kynurenine pathway have gained considerable attention since they are at the interface between intestinal bacteria, host immune response and brain functions. This study described the circulating levels of kynurenine metabolites in AUD patients, at the onset (T1) and end (T2) of a 3-week detoxification program, and tested correlations between those metabolites and inflammatory markers, the gut microbiota and the psychological symptoms. Increased concentration of the neurotoxic metabolite quinolinic acid (QUIN) and decreased levels of the neuroprotector metabolite kynurenic acid (KYNA) which both modulate glutamatergic neurotransmission were observed in AUD patients, particularly at T2. The inflammatory marker hsCRP was associated with several metabolic ratios of the kynurenine pathway. Tryptophan, KYNA and QUIN were correlated with depression, alcohol craving and reaction time, respectively. Analysis of gut microbiota revealed that bacteria known as short-chain fatty acid producers, as well as bacterial metabolites including butyrate and medium-chain fatty acids were associated with some metabolites of the tryptophan-kynurenine pathway. Targeting the glutamatergic neurotransmission through the modulation of the kynurenine pathway, by manipulating the gut microbiota, might represent an interesting alternative for modulating alcohol-related behavior.

Partant des nombreux ponts possibles entre une clinique de la transition adolescentaire et les impasses des personnes dépendantes à l’alcool, nous avons mis en avant la difficulté pour ces personnes de vivre les divers moments de transition en dehors d’un vécu de rupture et de fragilisation identitaire. Toute séparation ramène à une perte réelle de l’autre et, en miroir, de soi. Comment un cadre thérapeutique peut tenter de soutenir un certain travail autour de ces « passages » ? Pour ce faire, nous avons exploré le concept de transitionnalité, de préoccupation maternelle primaire, d’accrochage à un objet réel de dépendance afin d’aboutir sur les processus de séparation et d’individuation. Nous évoquons comment les différentes étapes et approches spécifiques d’un dispositif peuvent être autant d’occasions d’éprouver ces enjeux. La reprise dans les espaces de soin, de parole et de lien à l’autre réhumanisant (soignants et non-soignants) devrait rendre possible une transformation du patient lui permettant de renouer avec ses parts « capables », ouvrant la porte à d’autres investissements du côté d’une liberté nouvelle., [What would a successful hospital alcohol dependency program for patients in transition look like ?] Taking as a starting point the many possible connections between a teenage transition clinic and the roadblocks encountered in alcohol dependency, we stress the difficulty for anyone going through multiple moments of transition outside of the experience of fragile identity and breakdown. Each separation is a real loss of the other, and a part of oneself. How does a therapeutic framework attempt to work around these episodes? In an attempt to answer this question, we have explored the concepts of transitionality and primary maternal preoccupation, of transitional attachment, in order to get to grips with the processes of separation and individuation. We discuss how the different stages and specific approaches of a program can provide an opportunity to appreciate these challenges. Reestablishing speech and connecting to the other in caring spaces rehumanizes health professionals and nonhealth professionals alike, and should encourage patients to make changes enabling them to rediscover their inner strengths, also paving the way for them to reclaim their freedom. © 2021 Boeck Universite. All rights reserved.

Les problèmes de santé mentale représentent un enjeu majeur de notre époque. Il est démontré que les enfants ayant un parent souffrant d'une maladie mentale encourent un risque accru de développer un trouble psychique. Il en ressort la nécessité de mettre davantage en place de programmes de prévention à l'intention première de ces enfants. Il s'agit d'abord de repérer ces enfants, par exemple via les services de psychiatrie adulte, pour ensuite proposer des programmes adaptés sans stigmatiser les familles concernées. Dans cette perspective, une collaboration plus étroite entre psychiatrie adulte et psychiatrie infanto-juvénile est certainement à développer. Il est évident que la prévention peut aussi se réaliser à partir d'autres instances comme les institutions scolaires. Notre contribution propose un rapide tour d'horizon de différents programmes de prévention indiquant le développement d'initiatives intéressantes. Il reste cependant nécessaire de continuer à les implémenter et à les évaluer afin d'améliorer la vie et le devenir de ces enfants et de leurs parents., [What about prevention programs for children of mentally ill parents?$ Mental health problems are a major issue in today's world. It is proven that children of parents with mental illness are at higher risk of developing a mental disorder. We should therefore implement more prevention programs for such children. The first step is to identify them, for instance through the adult psychiatric units. Then, a specific program should be put forward without stigmatizing the families concerned. In the interest of those families, it is clear that a closer collaboration between adult psychiatry and child psychiatry should be developed. Prevention can obviously also be fomented in other areas, such as schools. Our contribution offers a quick overview of various prevention programs, highlighting the development of interesting initiatives. However, it is important to continue implementing and evaluating these programs in order to improve the life and future of these children and parents.

BACKGROUND: Electroconvulsive therapy (ECT) is the most effective biological treatment for depression. Aside the well-known therapeutic effect on mood symptoms, it has also a unique positive impact on psychomotor agitation and retardation, which are core symptoms of depression. The neurobiology behind these effects, however, remains unclear. The basal ganglia are proposed to be important regions in the pathogenesis of psychomotor symptoms in depression. Since ECT can trigger neuroplasticity in these subcortical nuclei, we speculate that ECT-induced volumetric changes of the basal ganglia will positively influence psychomotor symptoms. METHODS: Psychomotor symptoms were analyzed in 17 patients with severe depression before and after an acute ECT course using a CORE assessment of the retardation, agitation, and non-interaction domains. The volumes of the caudate, putamen, pallidum, and accumbens regions were determined using magnetic resonance imaging one week before and after ECT. RESULTS: Psychomotor functions had improved significantly after ECT and significant volume increases were found for the accumbens region, the putamen, and pallidum. The volume increase of the nucleus accumbens correlated with an improvement of psychomotor retardation, while the volume increase of the pallidum correlated negatively with an improvement of the agitation subscore. CONCLUSION: Our findings support the notion of an association between the impact of ECT on depression-related psychomotor symptoms and volume increases of the accumbens region and pallidum, pointing to the importance of the basal ganglia in the therapeutic effect of ECT on psychomotor functioning. TRIAL REGISTRATION: ClinicalTrials.gov NCT02562846.

BACKGROUND: The BODY-Q is a new patient-reported outcome (PRO) instrument designed to measure patient perceptions of weight loss and/or body contouring procedure. A report regarding the translation procedure into French and its preliminary results has been previously published. We here describe the finalization of the translation process and cultural validation. MATERIALS AND METHODS: The translation process followed guidelines established by the International Society for Pharmacoeconomics and Outcome Research (ISPOR) and the World Health Organisation (WHO). The process included two forward translations, one backward translation, a review by a panel of expert and cognitive debriefing interviews with patients. RESULTS: The 26 scales of the BODY-Q were translated and adapted into French. Each step of the process allowed to make changes leading to a conceptually and culturally equivalent French version. Backward translation comparison to the English version led to the identification of 16 differences necessitating re-translation. Overall feedback from patients over the final version was excellent. CONCLUSIONS: The BODY-Q proved to be a reliable and suited PRO for bariatric and body contouring patients. The thorough method of translation and cultural adaptation allowed us to achieve a conceptually and culturally valid French translation of the BODY-Q.

INTRODUCTION : The aim of this systematic review was to summarize the effects of yoga, qi gong or tai chi in COPD patients. METHODS : Studies evaluating effects of the selected complementary therapies on lung function, dyspnea, quality of life or functional exercise capacity in COPD patients were identified and reviewed from three databases. RESULTS : Eighteen studies were included. Six studies evaluated the effects of yoga and the others focused on tai chi or qi gong separately or combined. The duration of the programs ranged from 6 weeks to 6 months and the frequency from 2 to 7 times a week. Each session reached 30 to 90 minutes. Benefits were observed on lung function and functional exercise capacity but benefit was clearly stated neither on quality of life nor on dyspnea. CONCLUSION : This systematic review highlights the potential of these therapies as complementary therapeutic approach in COPD patients..

According to the Cognitive-Interpersonal Maintenance Model of anorexia nervosa, social factors are involved in the maintenance and development of this disorder. Therefore, this study aimed to test whether patients with restrictive-type anorexia nervosa (AN-R) experience malicious envy (negative emotions associated with the wish that others lack their superior quality), benign envy (negative emotions associated with the desire to reach and obtain the others' superior quality) and Schadenfreude (pleasure at the misfortunes of others) with a higher intensity than healthy controls (HC). METHODS: 26 AN-R patients and 32 HC completed scenarios that aimed to induce envy and Schadenfreude and completed questionnaires measuring envy, self-esteem and social comparison. RESULTS: AN-R patients reported more benign envy than HC. Interestingly, higher body mass index (BMI) was associated with less Schadenfreude, malicious and benign envy in AN-R only. CONCLUSIONS: This study shows that AN-R patients present higher motivation to evolve when facing others' superior quality (i.e., benign envy). It also underlines the importance of considering social factors in the maintenance of AN-R and the role of BMI when examining emotions related to others' fortune. LEVEL OF EVIDENCE: Level III, case-control analytic study.

In this paper we focus on adolescents in transition towards young adulthood (ATYA). We know from international studies that the transition process makes adolescents vulnerable to mental illness. However, little is known about Belgian ATYA mental-health status. Nor are risk factors associated with their mental illness understood, in particular with regard to depressive and anxiety disorder. The aim of this study is (1) to discuss evolution in time of prevalence of depressive disorder (DD) and anxiety disorder (AD) among Belgian ATYA and (2), to identify risk factors associated with these disorders among ATYA. Data was extracted from the Belgian Health Interview Survey (BHIS), which is a cross-sectional population survey, carried out in 2001, 2004, 2008, and 2013. Information about the population's background characteristics, health services utilization, health behaviours and mental health status were extracted and statistically analyzed. ATYA prevalence of DD and AD was higher in 2013 in comparison with previous years. These changes were significant only for DD (F=4.466, p=0.004). In contrast with younger adolescents, among ATYA odds of DD were 28.2% higher (OR 1.282, 95% CI 0.967-1.698, p=0.084) and, odds of AD were 55.2% higher (OR 1.552, 95% CI 1.137-2.119, p=0.006). For ATYA, a poor quality of social support was the most predictive factor of DD (OR 11.187, 95% CI 5.530-22.629, p<0.0001) and AD (OR 6.238, 95% CI 2.845-13.676, p<0.0001); whereas, having a paid job was the most protective factor with regard to DD (OR 0.282, 95% CI 0.169-0.470, p<0.0001) and AD (OR 0.552, 95% CI 0.330-0.924, p<0.024). Prevalence of mental illness among Belgian ATYA appears to worsen in time. In comparison with younger adolescents, ATYA are more vulnerable to anxiety disorders. Adverse and protective risk factors were identified and discussed in a way to improve access, continuity and mental healthcare pathways for Belgian ATYA.

Substance use disorders (SUDs) are associated with impairments of cognitive functions, and cognitive training programs are thus rapidly developing in SUD treatment. However, neuropsychological impairments observed early after withdrawal (i.e., early impairments), that is, approximately in the first six months, may be widespread. Consequently, it might not be possible to train all the identified early impairments. In these situations, we propose that the priority of cognitive training should be given to the early impairments found to be associated with early dropout or relapse (i.e., relapse-related impairments). However, substance-specific relapse-related impairments have not been singled out among all early impairments so far. Using a systematic literature search, we identified the types of established early impairments for all SUDs, and we assessed the extent to which these early impairments were found to be associated with relapse-related impairments. All cognitive functions were investigated according to a classification based on current neuropsychological models, distinguishing classical cognitive, substance-bias, and social cognition systems. According to the current evidence, demonstrated relapse-related impairments in alcohol use disorder comprised impulsivity, long-term memory, and higher-order executive functions. For cannabis use disorder, the identified relapse-related impairments were impulsivity and working memory. For stimulant use disorder, the identified relapse-related impairments were attentional abilities and higher-order executive functions. For opioid use disorder, the only identified relapse-related impairments were higher executive functions. However, many early impairments were not explored with respect to dropout/relapse, particularly for stimulant and opioid use disorders. The current literature reveals substance-specific relapse-related impairments, which supports a pragmatic patient-tailored approach for defining which early impairments

Alcohol addiction is a complex and multifactorial disease influenced by social, psychological and biological aspects. The current pharmacological drugs used in the management of alcohol dependence have shown only a modest efficacy and the relapse rate remains high in this disease. Recently, the gut microbiota, a huge and dynamic ecosystem made up of billions of microorganisms living in our intestine, has been shown to regulate many important functions for human health. Indeed, the gut microbiota is known to influence our metabolism, our immune system as well as our nervous system with consequences for brain functions, mood and behaviour. We have shown that heavy and chronic alcohol consumption induced important changes in the composition of the gut microbiota. Furthermore, the microbial changes are associated with the severity of depression, anxiety and alcohol craving that are important factors predicting the risk of relapse. This suggests the existence of a gut-brain axis in alcohol dependence and supports the development of new therapeutic alternatives, targeting the gut microbiota, in the management of alcohol dependence.

Aims: The aim of the present study was to evaluate the relation between anhedonia and depression in alcohol use disorders (AUD) during detoxification: Is trait anhedonia measured at the beginning of detoxification predictive of depressive symptoms observed at the end? Does state anhedonia recover during detoxification as depression does? Gender differences that have been previously observed for depression in AUD were also explored. Methods: 81 AUD inpatients were tested at T1 (day 1) and T2 (day 14-18) of withdrawal with the trait physical anhedonia scale (PAS), the state anhedonia Snaith–Hamilton Pleasure Scale (SHAPS), the Beck depression inventory (BDI) and the Spielberger state anxiety inventory (STAI) and compared to 34 control participants, matched for age and gender. Results: AUD patients scored significantly higher than controls on depression, anxiety and state and trait anhedonia when they just entered the detoxification unit. Depression, anxiety and state anhedonia decreased between T1 and T2 in AUD patients. In women, state anhedonia at T1 was predictive of depressive symptoms at T2 over and above anxiety and depression at T1. Conclusion: In AUD, state anhedonia recovers during detoxification, concurrently to other affective-related symptoms. However, in women, trait anhedonia predicts the level of depression at the end of detoxification, above and beyond anxiety. This finding stresses the importance of addressing anhedonia in the treatment of AUD and emphasizes the need for targeted interventions within clinical settings in this gender. Clinical consequences are discussed.

Dysfunctional use of cybersex has often been conceptualized as a "behavioral addiction" sharing common traits with substance addiction. We describe the case of a treatment-seeking man, who displayed addictive use of pornography. The case is presented from two perspectives: (1) a symptom-based approach inspired by the addiction model of excessive sexual behaviors and (2) a process-based approach aimed to identify the psychological processes and risk factors that may foster the development of addiction-like symptoms. This article shows how case conceptualization according to a process-based approach is likely to result in psychological intervention that targets the specific processes and risk factors involved in addictive cybersex use.

Both research and clinical practice acknowledge the importance of craving as a maintenance and relapse factor in gambling disorder. The elaborated intrusion theory (EIT; Kavanagh et al., 2005) of desire has been extensively investigated in relation to psychoactive substance or food cravings but, to date, has scarcely been studied in relation to gambling. In such a context, developing an assessment tool of gambling craving based on the EIT is warranted. To fill this gap in the literature, we aimed to develop and test the psychometric properties of a gambling-adapted version of the Craving Experience Questionnaire (CEQ; May et al., 2014), which is the best established measure of craving theoretically anchored in the EIT. An online survey that included the gambling CEQ (g-CEQ) and a craving induction procedure was administered to 274 community participants involved in gambling at least a few times a year. Concurrent and convergent validity were explored through correlations with a scale that measured gambling urge and with a series of questionnaires that measured disordered gambling symptoms, gambling cognitions, and gambling motives. The confirmatory factor analyses supported the validity of the expected three-factor model of the “strength” and “frequency” forms of the g-CEQ and showed better model fit than a one-factor solution, corroborating the initial structure of the CEQ. Furthermore, the scale has good internal consistency and its validity is supported by correlations with gambling-related constructs. The g-CEQ is thus a theoretically and psychometrically sound instrument to measure gambling craving based on the EIT.

Patients with schizophrenia can have difficulty recognizing emotion, and the impact of this difficulty on social functioning has been widely reported. However, earlier studies did not thoroughly explore how this deficit may vary according to emotion intensity, or how it may differ among individuals and across cultures. In the present study, our aim was to identify possible deficits in facial emotion recognition across a wide range of emotions of different intensities among patients with schizophrenia from the Democratic Republic of Congo (DRC). Thirty stable patients with schizophrenia and 30 healthy controls matched for age and level of education were evaluated using a validated and integrative facial emotion recognition test (TREF). A total recognition score and an intensity threshold were obtained for each emotion. Patients with schizophrenia had emotion recognition deficits, particularly for negative emotions. These deficits were correlated to the severity of negative symptoms. Patients showed no threshold deficit at the group level, but analysis of individual profiles showed marked heterogeneity across patients for the intensity of the emotion decoding deficit. Our study confirms the existence of deficits in emotion recognition for negative emotions in patients with schizophrenia, generalizes it to DRC patients, and underlines considerable heterogeneity among patients.

Bariatric surgery or reconstructive body contouring surgery performed after weight loss, has the potential to have a major impact one's body image, health-related quality of life (HRQOL) and mental wellbeing. Many researches show interest in measuring this impact using generic instruments that unfortunately are not specifically oriented toward bariatric or surgery patients. The BODY-Q is a new patient-reported outcome (PRO) instrument designed to measure patient perceptions of weight loss and/or body contouring. In this article, we describe the methods used to translate and culturally adapt the French version of the BODY-Q. We followed the recommendation for translation process established by the International Society for Pharmacoeconomics and Outcome Research (ISPOR) and the World Health Organisation (WHO). This process included two forward translations, one backward translation, a review by a panel of expert and cognitive debriefing interviews with patient. Our aim was to ensure a conceptual and culturally valid translation. This translation process led to a conceptually and culturally equivalent French version of the Body-Q. Backward translation comparison to the English original version led to the identification of 16 differences necessitating re-translation. The expert panel offered support to identify inadequate expressions and proposed changes to the translations. The cognitive debriefing interviews with 15 patients contributed to minor changes in the translation. This thorough method of translation and cultural adaptation allowed us to develop a conceptually and culturally valid French translation of the BODY-Q.

Alcohol dependence and alcoholic liver disease represent a major public health problem with substantial morbidity and mortality. By yet incompletely understood mechanisms, chronic alcohol abuse is associated with increased intestinal permeability and alterations of the gut microbiota composition, allowing bacterial components, bacteria, and metabolites to reach the portal and the systemic circulation. These gut-derived bacterial products are recognized by immune cells circulating in the blood or residing in remote organs such as the liver leading to the release of pro-inflammatory cytokines which are considered important mediators of the liver-gut-brain communication. Although circulating cytokines are likely not the sole factors involved, they can induce liver inflammation/damage and reach the central nervous system where they favor neuroinflammation which is associated with change in mood, cognition, and drinking behavior. In this review, the authors focus on the current evidence describing the changes that occur in the intestinal microbiota with chronic alcohol consumption in conjunction with intestinal barrier breakdown and inflammatory changes sustaining the concept of a gut-liver-brain axis in the pathophysiology of alcohol dependence and alcoholic liver disease.

Gambling disorder is a well-established behavioural addiction, which was classified with substance-related disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. Although craving was introduced as a new diagnostic criterion for substance-related disorders, it was not included for gambling disorder. This study aimed to explore the experience of gambling craving and to evaluate whether the elaborated intrusion theory of desire (EIT), a cognitive model of craving, fits gambling craving. A mixed methods study was conducted among 31 non-clinical gamblers. The qualitative part consisted of open-ended questions targeting the components of the EIT. The quantitative part consisted of a questionnaire designed to assess triggers and descriptions of gambling craving. Qualitative analysis revealed six distinct conceptual categories related to gambling craving: positive and negative affect, external cues, mental imageries, thoughts and physiological sensations. The quantitative analysis highlighted the most relevant triggers (e.g. spontaneous thoughts) and experiential characteristics (e.g. visual imagery) of gambling craving. The present study allowed the authors to support the relevance of the EIT as it applies to gambling craving by disentangling its core features. Findings from this study suggest that the use of interventions derived from the EIT may be relevant for problem gambling treatment.

Recognizing others' emotions is a fundamental social skill, widely impaired in psychiatric populations. These emotional dysfunctions are involved in the development and maintenance of alcohol-related disorders, but their differential intensity across emotions and their modifications during disease evolution remain underexplored. Affective prosody decoding was assessed through a vocalization task using six emotions, among 17 patients with severe alcohol use disorder, 16 Korsakoff syndrome patients (diagnosed following DSM-V criteria) and 19 controls. Significant disturbances in emotional decoding, particularly for negative emotions, were found in alcohol-related disorders. These impairments, identical for both experimental groups, constitute a core deficit in excessive alcohol use.

Alcohol-dependent individuals (ALC) simultaneously present decreased inhibitory control and increased attention towards alcohol-related cues. The dual-process models have proposed that these symptoms reflect an imbalance between prefrontal/reflective and limbic/automatic systems, respectively leading to cognitive dysfunctions in executive processes and to alcohol-related bias. However, most previous research has focused on a separate exploration of these systems among ALC, and the direct measure of their interactions remains to be conducted. Moreover, no study has explored the evolution of this imbalance across the successive stages of alcohol-related disorders, and particularly in Korsakoff syndrome (KS), the most frequent neurological complication of alcohol-dependence. Ten KS, 14 ALC, and 14 matched control participants performed a modified Flanker task, the "Alcohol Flanker Task," based on congruent, incongruent, and neutral conditions with alcohol-related stimuli. This task required inhibitory processing on alcohol-related stimuli and evaluated, through a behavioral approach, the interaction between reflective and automatic systems, as well as its evolution between ALC and KS. ALC and KS both presented high reactivity towards alcohol-related stimuli, confirming the presence of alcohol-related bias. KS showed increased omission rates (related to distractor interference) while ALC showed higher false-alarm rates (related to prepotent response inhibition). These results suggest that different inhibitory subcomponents might be altered at the successive stages of the pathology, and experimentally confirms the crucial role of the interaction between reflective and automatic processes in alcohol-use disorders. The present results reinforce the proposal that alcohol-related cues significantly impact inhibitory control in alcohol-related disorders. However, ALC and KS present different patterns of deficits depending on task complexity (i.e., executive load), thus sugges

Background: Psychiatric side effects of mefloquine, an antimalarial drug, are well known (agitation, depression and suicidal ideation, psychosis with paranoia and hallucinations). Case Presentation: We report the case of a 30-year-old man without psychiatric antecedents, who developed acute psychosis and depression with suicidal ideation after five weeks of treatment with mefloquine. The symptomatology decreased rapidly a few days later, under antipsychotic drug (olanzapine) and benzodiazepines (lorazepam) and the treatment doses were diminished after one week. However, three weeks later, the same symptomatology reappeared and the treatment doses of both psychotropic drugs had to be increased once again. The antidepressant escitalopram was also introduced. Three months were necessary to definitively suppress the psychotropic drugs. Plasma mefloquine clearance was monitored by a validated liquid-chromatography massspectrometric method and confirmed the very long halflife of the drug, which is estimated at 14.5 days. Conclusions: The pathophysiological mechanisms of these psychiatric side effects probably involve a toxic limbic encephalopathy. Mefloquine is highly lipophilic and may accumulate in the limbic system. In conclusion, due to the very long half-life of mefloquine, psychiatric symptoms can persist for weeks, necessitating an appropriate psychotropic treatment. Chronic symptoms resulting from permanent neurotoxicity may also occur.

Impaired inhibitory control contributes to the development, maintenance, and relapse of alcohol-dependence, but the neural correlates of this deficit are still unclear. Because inhibitory control has been labeled as an executive function, most studies have focused on prefrontal areas, overlooking the contribution of more "primary" structures, such as the motor system. Yet, appropriate neural inhibition of the motor output pathway has emerged as a central aspect of healthy behavior. Here, we tested the hypothesis that this motor inhibition is altered in alcohol-dependence. Neural inhibitory measures of motor activity were obtained in 20 detoxified alcohol-dependent (AD) patients and 20 matched healthy subjects, using a standard transcranial magnetic stimulation procedure whereby motor-evoked potentials (MEPs) are elicited in a choice reaction time task. Moreover, behavioral inhibition and trait impulsivity were evaluated in all participants. Finally, the relapse status of patients was assessed 1 year after the experiment. As expected, AD patients displayed poorer behavioral inhibition and higher trait impulsivity than controls. More importantly, the MEP data revealed a considerable shortage of neural motor inhibition in AD patients. Interestingly, this neural defect was strongest in the patients who ended up relapsing during the year following the experiment. Our data suggest a strong motor component in the neural correlates of altered inhibitory control in AD patients. They also highlight an intriguing relationship with relapse and the perspective of a new biomarker to follow strategies aiming at reducing relapse in AD patients.

Hypertension has long been suspected of being, in some patients, a psychosomatic disorder. The impact of daily exposure to life stresses, to anger, or to anxiety on high blood pressure has been studied for decades, but these works showed inconsistent results and, as such, mostly failed to confirm the underlying hypotheses.1 Nevertheless, the role of 2 specific psychological impairments in the development of hypertension is supported by stronger evidence and, as such, deserves further investigation: the repression of the expression of affects2 and the exposure to intensely traumatic life events [...]

BACKGROUND: Alcohol-dependent individuals (ALC) simultaneously present decreased inhibitory control and increased attention towards alcohol-related cues. The dual-process models have proposed that these symptoms reflect an imbalance between prefrontal/reflective and limbic/automatic systems, respectively leading to cognitive dysfunctions in executive processes and to alcohol-related bias. However, most previous research has focused on a separate exploration of these systems among ALC, and the direct measure of their interactions remains to be conducted. Moreover, no study has explored the evolution of this imbalance across the successive stages of alcohol-related disorders, and particularly in Korsakoff syndrome (KS), the most frequent neurological complication of alcohol-dependence. METHOD: Ten KS, 14 ALC, and 14 matched control participants performed a modified Flanker task, the "Alcohol Flanker Task," based on congruent, incongruent, and neutral conditions with alcohol-related stimuli. This task required inhibitory processing on alcohol-related stimuli and evaluated, through a behavioral approach, the interaction between reflective and automatic systems, as well as its evolution between ALC and KS. RESULTS: ALC and KS both presented high reactivity towards alcohol-related stimuli, confirming the presence of alcohol-related bias. KS showed increased omission rates (related to distractor interference) while ALC showed higher false-alarm rates (related to prepotent response inhibition). These results suggest that different inhibitory subcomponents might be altered at the successive stages of the pathology, and experimentally confirms the crucial role of the interaction between reflective and automatic processes in alcohol-use disorders. CONCLUSION: The present results reinforce the proposal that alcohol-related cues significantly impact inhibitory control in alcohol-related disorders. However, ALC and KS present different patterns of deficits depending on task compl

The gastrointestinal tract is the natural habitat for a huge community of microorganisms, comprising bacteria, viruses, fungi and yeast. This microbial ecosystem codevelops with the host throughout life and is subject to a complex interplay that depends on multiple factors including host genetics, nutrition, life-style, stress, diseases and antibiotics use. The gut microbiota, that refers to intestinal bacteria, has profound influence on the host immune system, metabolism and nervous system. Indeed, intestinal bacteria supply the host with essential nutrients such as vitamins, metabolize bile acids and undigested compounds, defend against pathogen invasion, participate to the development of the intestinal architecture and the intestinal immune system and play an important role in the maintenance of the gut barrier function. More recently, the gut microbiota has been shown to influence brain functions, such as myelin synthesis, the blood-brain barrier permeability and neuroinflammatory responses but also mood and behavior. The cross-talk between microbes and the host implicates a vast array of signaling pathways that involve many different classes of molecules like metabolites produced by the bacteria from dietary or endogenous sources of carbohydrates and proteins (i.e. short-chain fatty acids (SCFAs), indole), neurotransmitters and inflammatory cytokines. This review will focus on the involvement of the gut microbiota in the pathophysiological aspects of alcohol dependence related to the gut barrier function, liver damage and psychological disturbances. We will also discuss the possibility to create new and realistic humanized animal models of alcohol dependence by the use of fecal transplantation.

To compare the symptom patterns of major depressive disorder (MDD) among subjects with MDD and 1) no alcohol use disorder (AUD), 2) alcohol abuse and 3) alcohol dependence, respectively. In a general population survey of 38,694 French individuals, MDD and AUDs were assessed using the Mini International Neuropsychiatric Interview 5.0.0 (MINI). A total of 4339 subjects (11.2%) in the sample met the criteria for MDD. Among them, 413 (9.5%) AUD subjects were identified: 138 (3.2%) for alcohol abuse and 275 (6.3%) for alcohol dependence. The associations of each of the ten MDD criteria of the MINI and psychiatric clinical features were compared among the three groups. The relative profiles of 'MDD + AUD' vs. 'MDD alone' were determined using a multivariable stepwise regression model. With the noAUD group as the reference, sadness (OR = 0.46; 95%CI, 0.29-0.74) and anhedonia (OR = 1.66; 95%CI, 1.06-2.73) were only associated with alcohol abuse. Sleep disorders (OR = 2.07; 95%CI, 1.51-2.88), feelings of guilt (OR = 1.41; 95%CI, 1.05-1.90), diminished concentration/indecisiveness (OR = 1.52; 95%CI, 1.12-2.07) and thoughts of death (OR = 1.95; 95%CI 1.49-2.55) were only associated with alcohol dependence. Weight or appetite variations were both associated with alcohol abuse (OR = 1.7; 95%CI, 1.15-2.53) and dependence (OR = 1.41; 95%CI, 1.06-1.88). Bipolar disorder and PTSD were only associated with alcohol dependence. Psychotic features, previous suicide attempts, and panic disorder were more frequent in the MDD-AUD group. MDD-AUD subjects displayed a more severe profile with specific symptomatology and comorbidity profiles compared to MDD-only subjects.

Adolescents with chronic conditions are highly likely to encounter physical, social and psychological difficulties that can threaten their overall wellbeing and health. As any other adolescent, they need to be helped to tackle the non-medical determinants of their health. This is the aim of primary prevention and general health promotion interventions. The present paper aims to review any hospital-based intervention that strives to promote general health in chronically ill teenagers. A systematic process of search and screening revealed four articles that presented and evaluated non-disease specific interventions that explicitly aimed to promote the overall health of chronically ill teenagers in clinical settings. Congruently with health promotion principles and values, the interventions described in our selection of articles targeted positive health determinants, in terms of personal skills and attitudes that contribute to psychosocial resiliency. The clinical relevance and feasibility of developing non-disease specific health promotion interventions in clinical settings was confirmed. However, the lack of relevant reported details did not allow us to highlight the key factors and mechanisms associated with successful interventions for health promotion targeted at chronically ill adolescents attending health care settings. Moreover, the design of the included studies varied in quality: number of participants, presence of a post-test and a follow-up, use of validated questionnaires, etc. Well-conducted non-disease specific clinical health promotion interventions still remain an under-investigated area of research, and maybe even of practice.

The dual-process model, describing addictive disorders as resulting from an imbalance between increased automatic approach behaviors towards the substance and reduced abilities to control these behaviors, constitutes a sound theoretical framework to understand alcohol-use disorders. The present study aimed at exploring this imbalance at behavioral and cerebral levels in binge drinking, a pattern of excessive alcohol consumption frequently observed in youth, by assessing both reflective control abilities and automatic processing of alcohol-related stimuli. For this purpose, 25 binge drinkers and 25 comparison participants performed a Go/No-Go task during electrophysiological recording. Inhibition abilities were investigated during explicit (ie, distinguishing alcoholic versus nonalcoholic drinks) and implicit (ie, distinguishing sparkling versus nonsparkling drinks, independently of their alcohol content) processing of beverage cues. Binge drinkers presented poorer inhibition for the explicit processing of beverage cues, as well as reduced N200 amplitude for the specific processing of alcohol-related stimuli. As a whole, these findings indicated inhibition impairments in binge drinkers, particularly for alcohol cues processing and at the attentional stage of the cognitive stream. In line with the dual-process model, these results support that binge drinking is already characterized by an underactivation of the reflective system combined with an overactivation of the automatic system. Results also underlined the influence of explicit processing compared with implicit ones. At the clinical level, our findings reinforce the need to develop intervention methods focusing on the inhibition of approach behaviors towards alcohol-related stimuli.