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Background and AimsFew studies have been conducted on the long-term evolution of gambling disorder (GD). The aim of this study was to identify factors that could predict GD relapse.MethodsData were part of a dataset from a large 5-year cohort of gamblers who were assessed at inclusion and each year thereafter. Participants were recruited from an outpatient addiction treatment center, from various gambling places and through the press. For this specific study, inclusion criteria included (i) transitioning from GD to recovery at a follow-up time and (ii) undergoing at least one follow-up visit afterwards. Participants were evaluated using a structured clinical interview and self-report questionnaires assessing sociodemographic, gambling and clinical characteristics. “Relapse” was defined as the presence of GD (according to the DSM-5) at the N+1th visit following the absence of GD at the Nth visit. A Markov model-based approach was employed to examine predictive factors associated with relapse at a subsequent follow-up visit.ResultsThe sample consisted of 87 participants, aged 47.6 years (sd = 12.6), who were predominantly male (65%). Among the participants, 49 remained in recovery, whereas 38 relapsed. Participants who reported not having experienced at least one month of abstinence and those with a low level of self-directedness at the previous follow-up visit were more likely to relapse.ConclusionsOur findings suggest the existence of factors that are predictive of relapse in individuals with GD who had previously achieved recovery. These results can inspire the development of measures to promote long-term recovery.

International audience; Background: Rubinstein-Taybi syndrome (RSTS) is a multiple congenital anomaly syndrome characterised by several typical somatic characteristics and by developmental disabilities with various degrees of severity. Focusing on children with RSTS, the aim of this study was to describe their psychomotor, cognitive, and socio-emotional developmental profiles.Method: Twenty-three children with RSTS (12 boys; 11 girls; mean chronological age: 4 years and 10 months) with severe intellectual disability (mean developmental quotient = 32.39) were recruited from an Expert Department of Medical Genetics. Developmental assessments were carried out with the Brunet-Lézine-Revised scale and the Social Cognitive Evaluation Battery.Results: The participants’ developmental profiles were characterised by heterogeneous psychomotor development, homogeneous cognitive and socio-emotional development, by more severe delays in expressive language, vocal imitation, and symbolic play skills, and by better developmental levels in socio-emotional abilities.Conclusions: Based on these atypical developmental profiles, early interventions should target the three most delayed abilities.

Background: The most common reasons why adults use e-cigarettes are to stop or reduce tobacco smoking. However, it is unclear if this reason is evenly distributed between young and older adults. Objectives: describe the motivations for e-cigarette use amongst young adults aged 18–25 and compare the reasons for using e-cigarettes of people who currently or formerly used tobacco products to those who had never smoked tobacco prior e-cigarette use. Methods: PubMed®, Scopus®, Cochrane Library®, SocINDEX®, PsycARTICLES®, Psychology and Behavioral Sciences Collection® and PsycINFO® databases were used. English written articles were screened up to March 2018. Depending on study design, quality was assessed using The STROBE or RATS checklists. Results: Six articles were included in the review, all with a moderate quality of evidence. Independently of smoking status, curiosity was the most frequently reported reason for initiating the use of e-cigarettes in young adults. Reasons for continuing to use e-cigarettes were various. The continued use of e-cigarettes could be either a means to replicate smoking habits, or a way for a different and personalized use of nicotine by inhalation. Conclusions: Reasons for using e-cigarettes in young adults are varied and are not limited to stopping smoking.

Introduction Craving has been proposed as a major contributor to addiction relapse and the influence of mood on craving and substance use has been extensively documented. However, information is lacking concerning the extent to which the magnitude of these effects may vary according to different types of substances. The aim of the present study was to compare the prospective links between emotions, craving and substance use in four groups of patients beginning treatment for alcohol, tobacco, cannabis, or opiate addiction. Methods Ecological Momentary Assessment (EMA) was used over a two-week period. Data were analyzed using hierarchical linear modeling (HLM). Results 159 participants were recruited (67.3% male; M = 36.7 years). The average response rate to the EMA assessments was 83.1%. The findings confirmed the strong predictive role of craving intensity on substance use reported at the next assessment of the day among the alcohol (γ = 0.224; p = .018), tobacco (γ = 0.133; p = .013) and cannabis groups (γ = 0.266; p = .019), but not for opiates (γ = 0.098; p = .142). Craving intensity was itself predicted by greater anxious mood (γ = 0.108; p = 0,029) and event negativity (γ = 0.107; p = .003) among tobacco patients, lower sad mood among cannabis patients (γ = −0.248; p = 0,002), and lower event negativity among opiate patients (γ = −0.201; p = .002). Conclusion While these results support the benefit of targeting craving in addiction treatment regardless of substance type, the substance-specific emotional risk factors for craving identified in this study may provide important insights for the development of personalized treatment strategies.

International audience

http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowAbstract&ArtikelNr=331007&Ausgabe=255655&ProduktNr=224233; International audience; Background: Therapeutic communities (TCs) are drug-free residential settings, focused on psychosocial rehabilitation. While TCs are considered an effective method, the bulk of the research evidence is from poorly controlled studies. The goal of this study was to evaluate TC effectiveness in terms of abstinence and to determine if there were predictive factors of abstinence. Methods: The search used Medline up to January 30, 2011 and was based on a systematic review method. Studies on retention in treatment and/or substance use were considered. Results: Of the 321 studies retrieved from Medline, 12 met selection criteria including overall 3,271 participants from 61 TCs. On average, subjects stayed in TC a third of the planned time. The completion rate ranged from 9 to 56%. All studies showed that substance use decreased during TC, but relapse was frequent after TC. Treatment completion was the most predictive factor of abstinence at follow-up. Surprisingly, psychiatric comorbidities did not appear associated with relapse or with dropout. Conclusions: There was a drop in consumption after TC, but long-lasting benefits were uncertain. Further studies are needed in order to compare the efficacy of TC programs and other types of treatment settings for substance-related disorders.

Summary Background The post-partum blues is a transient mood alteration affecting most women a few days after delivery. Its stereotypic pattern of symptoms and time course, peaking on post-partum day 3–5, is suggestive of biological determinants superimposed on psycho-social factors. This study was designed to evaluate the possible role of the serotonin system during this period through assessment of brain tryptophan availability. Methods Blood samples from 50 women were collected just before (D0) and 3 days after (D3) delivery. Based on plasma concentration of tryptophan, amino acids competing with tryptophan for transport across the blood–brain barrier and on their respective affinities for this transporter, a brain tryptophan availability index (BTAI) was calculated and its variation correlated with the intensity of post-partum blues evaluated through the Kennerley and Gath score at D3. Results The BTAI showed a −15% decrease between D0 and D3 ( p t -test). This decrease was not supported by a drop in plasma tryptophan since its level rather increased (+19%). There was no evidence for change in placental indoleamine-2,3-dioxygenase activity since the variation in plasma l -kynurenine (+12%) paralleled the change in tryptophan level. The decreased BTAI appeared the consequence of a dramatic increase in plasma levels of most amino acids, particularly the competitor aminoacids leucine, isoleucine, valine and tyrosine, during the early post-partum. This decrease in brain tryptophan availability was concomitant to the post-partum blues, whose intensity significantly correlated with the amplitude of BTAI variation (Pearson's coefficient −0.283, p Conclusion This study suggests that generalized, large amplitude metabolic and/or nutritional changes occurring in the early post-partum result in a transient decrease in brain tryptophan availability, partly accounting for the mood alteration referred to as the post-partum blues, a model for the triggering of puerperal mood disorder in vulnerable women.

Les psychothérapies sont des traitements d’utilisation largement répanduedans la pratique du soin pour les troubles mentaux chez l’adulte, l’adolescentet l’enfant. Elles accompagnent une médication pour certains troublessévères (schizophrénie, trouble bipolaire{). Elles sont pratiquées commealternative à un traitement pharmacologique pour d’autres troubles moinssévères ou qui ne relèvent pas de celui-ci (exemple, troubles de la personnalité).En France, les psychothérapies sont généralement conseillées aux patientspar des médecins psychiatres, des psychologues, des médecins généralistes oud’autres professionnels de santé, mais il existe aussi des demandes spontanées,en pourcentage non quantifiable car il n’y a pas de données disponibles dansce domaine. Les psychothérapies sont le plus souvent pratiquées en « ville »,dans le cadre du soin, par les psychiatres et les psychologues, et en institutionpar différents intervenants (infirmiers, psychologues{), souvent sous laresponsabilité d’un psychiatre. Dans la réglementation des soins en France,les psychothérapies ne sont pas inscrites à la nomenclature des actes techniques,à l’exception des thérapies de groupe ; il existe néanmoins une cotation« consultation psychiatrique » qui ne spécifie pas le type de soin pratiqué parle psychiatre dans cette consultation.Au plan international, d’après les travaux scientifiques publiés, les psychothérapiessont pratiquées par des psychiatres et des psychologues, et dans unemoindre mesure, au Royaume-Uni et aux États-Unis, par des infirmiersspécialisés (nurse therapist), des travailleurs sociaux, ou des conseillers spécialisés(counselors), ainsi que par des étudiants dans le cadre de projets derecherche en psychothérapie sous supervision étroite. Enfin, dans certainstravaux de recherche, il est fait mention de généralistes formés brièvement àappliquer des méthodes déjà testées et adaptées à la pratique médicale del’omnipraticien dans un but de soin ou de prévention.Comme d’autres traitements, les différentes méthodes de psychothérapie ontfait l’objet de nombreux travaux scientifiques. Certains de ces travaux se sontattachés à évaluer l’efficacité des pratiques dans différentes conditions.Dans le cadre du Plan santé mentale mis en place par le ministère de la Santéen 2001, la Direction générale de la santé (DGS) a sollicité l’Inserm pour établir un état des lieux de la littérature internationale sur les aspects évaluatifsde l’efficacité de différentes approches psychothérapiques. Deux associationsfrançaises, l’Unafam1 et la Fnap-psy2, se sont jointes à la DGS danscette démarche. En accord avec ces partenaires, le champ de l’expertise s’estappliqué à trois grandes approches psychothérapiques – l’approche psychodynamique(psychanalytique), l’approche cognitivo-comportementale, lathérapie familiale et de couple – fréquemment pratiquées pour le soin detroubles caractérisés de l’adulte, de l’adolescent ou de l’enfant.Pour répondre à la demande, l’Inserm a, dans le cadre de la procédured’expertise collective, réuni un groupe d’experts comprenant des psychiatres,psychologues, épidémiologistes et biostatisticiens. Le groupe d’experts astructuré l’analyse de la littérature internationale autour des questionssuivantes :• Comment envisager une évaluation des psychothérapies en termes d’efficacité?• Quels sont les différents types d’études permettant d’évaluer l’efficacité despsychothérapies ?• Quelles sont les difficultés méthodologiques rencontrées pour cette évaluation?• Quelles sont les étapes historiques de l’évaluation de l’efficacité despsychothérapies ?• Quelles sont les références théoriques des approches psychodynamiques(psychanalytiques), cognitivo-comportementales et familiales ?• Quelles sont les données de la littérature sur l’évaluation de l’efficacité desapproches psychodynamiques (psychanalytiques), cognitivo-comportementaleset familiales ?• Quelles sont les données de la littérature sur l’évaluation comparative del’efficacité de ces différentes approches psychothérapiques ?• Quelles sont les données de la littérature sur l’évaluation de l’efficacité deces trois approches psychothérapiques pour différentes pathologies ?• Quelles sont les données de la littérature sur l’évaluation de l’efficacité despsychothérapies chez l’enfant et l’adolescent ?Une interrogation indépendante des bases de données internationales,menée par le centre d’expertise collective, a conduit à rassembler plus de1 000 articles. Les experts ont été sollicités pour compléter cette bibliographiedans leur propre champ de compétence en relation avec les objectifs del’expertise. Au cours de onze séances de travail organisées entre les mois demai 2002 et décembre 2003, les experts ont présenté une analyse critique etune synthèse des travaux publiés aux plans international et national sur lesdifférents aspects du cahier des charges de l’expertise.