Cédric Lemogne

ABSTRACT En dépit de son utilisation fréquente en milieu médical, la contention mécanique fait l’objet de controverses aussi bien auprès du grand public, des patients ou de leurs proches que des soignants et de la communauté médicale. Bien que considérée comme une mesure thérapeutique urgente, son rapport bénéfice / risque est souvent équivoque et elle ne dispose pas d’un cadre juridique précis. Avant toute mise en contention, la prise en charge relationnelle est une obligation médicale. Ce n’est qu’en cas d’échec de celle-ci que la contention mécanique sera retenue. Ses modalités doivent s’approcher autant que faire se peut des protocoles utilisés en psychiatrie. Elle repose sur une prescription médicale initiale, l’utilisation d’un matériel homologué et une mise en place par un effectif soignant de cinq personnes dont un coordinateur qui informe le patient des buts et des modalités de la procédure. Elle est encadrée par une surveillance médicale stricte des constantes vitales, des points de contention, de la survenue d’éventuelles complications et une remise en question régulière de son indication par un médecin. Elle est toujours accompagnée d’une sédation médicamenteuse choisie en fonction du contexte de l’agitation: delirium d’origine organique ou toxique, agitation caractérielle, psychiatrique ou mixte. Contention mécanique et sédation sont à considérer comme des mesures avant tout symptomatiques et ne doivent pas faire omettre le traitement étiologique de l’agitation. L’hétérogénéité des pratiques, secondaire au faible niveau de preuve du bénéfice de la contention mécanique en milieu médical, confirme la nécessité de réalisation d’études de meilleure qualité et impose une réflexion éthique spécifique.

To examine the predictive value of social support in postoperative delirium. Prospective observational study. Postoperative recovery room and orthopedic surgery department. 106 consecutive patients undergoing a planned orthopedic surgery with general anesthesia. All patients completed questionnaires to assess depressive mood (the Beck Depression Inventory) and social support (Sarason's Social Support Questionnaire) during the preanesthesia visit. Postoperative delirium symptoms were assessed daily using the Memorial Delirium Assessment Scale. Demographic, clinical, and biological data, including anesthesia procedure, were recorded. Controlling for various potential confounders through multivariate binary logistic regression, postoperative delirium was independently predicted by satisfaction with social support, but neither by depressive mood nor the number of supportive persons. Other significant predictors were the preoperative use of benzodiazepines, age, and type of surgery. Patients who report low satisfaction with social support may present with a particular vulnerability to postoperative delirium, even after controlling for physical confounding variables and depressive mood.

Introduction Autobiographical memory and personal identity (self) are linked by a reciprocal relationship. Autobiographical memory is critical for both grounding and changing the self. Individuals’ current self-views, beliefs, and goals influence their recollections of the past. According to Tulving, episodic memory is characterized by autonoetic consciousness, which is associated with a sense of the self in the past (emotions and goals) and mental reliving of an experience. Its close relationship with self and emotion strongly involves episodic autobiographical memory in the psychopathology of depression. However, due to methodological and conceptual issues, little attention has been paid to episodic autobiographical memory in depression. Since the seminal work of Williams et al. 15 years ago, there is now growing interest around this issue. Literature findings We reviewed the evidence for three major features of autobiographical memory functioning in depression : an increase in ge...

Impact of blood pressure (BP) visit-to-visit variability remains controversial for untreated hypertensives and for normotensive subjects. Association between 6-year systolic BP change and all-cause and cardiovascular (CVD) mortality was studied in general primary care population including untreated hypertensive and normotensive subjects. Normotensive individuals and untreated high BP patients (40 926 and 14 283, respectively) had two check-ups (interval: 5.8±2.2 years) at the IPC center (Paris). Follow-up was 6.1±3.2 years: 1131 people died, 114 from CVD causes. Systolic BP (SBP) change was assessed by tertiles of absolute differences between V1 and V2, and the relationship with mortality was analysed with multivariate Cox models (hazard ratio (HR), 95% confidence interval (CI)) including V1 or V2 parameters notably SBP. Adjusting for V1 variables, mortality was associated with SBP change, for the entire population (all-cause: HR=1.15 (95%: 1.01-1.30) and CVD: HR=1.95 (95%: 1.25-3.0...

Patients with anosmia are not able to detect volatile chemicals signaling the presence of infectious and non-infectious environmental hazards, which typically elicit disgust and fear, respectively. Social animals may compensate a loss of olfaction by taking advantage of signals of threat that are produced by their conspecifics. Among humans and other primates, body postures and facial expressions are powerful cues conveying emotional information, including fear and disgust. The aim of the present study was to examine whether humans with agenesis of the olfactory bulb, a rare disorder characterized by congenital anosmia, would be more accurate in recognizing facial expressions of fear and disgust. A total of 90 participants with no history of mental disorder or traumatic brain injury were recruited, including 17 patients with congenital anosmia (10 men, mean age±standard deviation: 36.5±14.8 years), 34 patients with acquired anosmia (18 men, mean age±standard deviation: 57.2±11.8 years) and 39 healthy subjects (22 men, mean age±standard deviation: 36.7±13.2 years). For each patient with congenital anosmia, the agenesis of the olfactory bulb was ascertained through magnetic resonance imaging. Emotion recognition abilities were examined with a dynamic paradigm in which a morphing technique allowed displaying emotional facial expressions increasing in intensity over time. Adjusting for age, education, depression and anxiety, patients with congenital anosmia required similar levels of intensity to correctly recognize fear and disgust than healthy subjects while they displayed decreased error rates for both fear (mean difference [95% confidence interval]=-28.3% [-46.3%, -10.2%], P=0.003) and disgust (mean difference [95% confidence interval]=-15.8% [-31.5%, -0.2%], P=0.048). Furthermore, among patients with acquired anosmia, there was a negative correlation between duration of anosmia and the rate of errors for fearful (Spearman's ρ=-0.531, P=0.001) or disgust (Spearman's ρ=-0.719, P<0.001) faces recognition. No significant difference was observed for the other primary emotions. Overall, these results suggest that patients with congenital anosmia and long-lasting acquired anosmia may compensate their inability to detect environmental hazards through olfaction by an increased ability to detect fear or disgust as facially expressed by others.

ABSTRACT Psychopathology is worthy of consideration to inform the application of functional neuroimaging to the study of mental disorders. By promoting an approach based on mental processes underlying disorders rather than an approached based on diagnostic categories, it offers the opportunity to identify biomarkers that could be used as nosological tools. Such biomarkers may eventually inform treatment strategies. However, the question of whether functional brain imaging can be used to learn something about psychopathology, that is understanding the nature and the relationships of mental processes that underlie psychiatric disorders, remains controversial. A potential advantage of functional brain imaging could be the examination of non-conscious mental processes that could be both non reportable by the subject and difficult to capture with behavioral measures. As an example, several studies found depression and anxiety to be associated with amygdala aberrant reactivity to masked emotional stimuli. This might be interpreted as signaling automatic cognitive biases such as those proposed by cognitive theory. But when trying to deduce the presence of a mental process M from a specific pattern of brain activity A, frequently referred to as reverse inference, one has to consider several issues, regardless of the nature of the mental process. These issues can be best formalized with a Bayesian approach where the probability of the presence of M according to A, P(M|A) depends on the a priori probability of M to be present, P(M), as well as on conditional probabilities P(R|M) and . Obviously, P(M) depends on the specificity of the experimental paradigm used. However, reverse inference usually takes place when A was unexpected (i.e. not supposed to be engaged by the experimental task). Conditional probabilities regarding the probability of A according to the presence or the absence of M, P(A|M) and can be estimated using methods of data mining based on growing databases. The less A is specific to M, that is to say the higher is, the less valid the reverse inference will be. This is even worse when the definition of R is loose. Despite these limitations, reverse inference is nevertheless a powerful heuristic tool when it comes to generate testable hypotheses about the nature of mental processes and their relationships. Combined with carefully designed experimental paradigms, functional brain imaging is thus likely to bring new knowledge to psychopathology.

We aim to assess the prevalence and associated factors of clinical depression in older patients with cancer. We studied a prospective cohort of cancer patients aged ≥70 years and referred to geriatric oncology clinics between 2007 and 2012. A multidimensional geriatric assessment was performed before choosing the cancer-treatment strategy. Clinical depression was diagnosed by senior geriatricians by a semi-structured interview. It encompassed criteria of the Diagnostic and Statistical Manual of Mental Disorders (fourth edition) and of the International Classification of Diseases (10th edition). Multivariate logistic regression was performed. Of 1121 consecutive patients, 1092 had available data (mean age, 80.4 years; women, 48.8%; metastases, 51.3%; cancer location: colorectal 21.1%, breast 16.8%, kidney, bladder or urinary tract 14.0%, and prostate 11.4%). The overall prevalence of clinical depression was 28.4% (95% confidence interval, 25.7-31.2). Factors independently associated ...

To investigate the association between alcohol consumption and different causes of work cessation and estimate the loss of occupational activity among high consumers compared with low consumers. From the prospective study of men employed in the French gas and electric company, 8442 men during a median follow-up of 8.4 years reported on their alcohol consumption. Information on work cessation was collected from the company administrative records. Hazard Ratios (HRs) by cause of work cessation (death, disability, retirement before or after age 55) were estimated using a competing risk method. An increasing quantity of daily alcohol consumption was associated with an increased risk of death, disability and retirement before age 55 (P trend ≤ 0.01, = 0.03 and ≤ 0.01, respectively), but not of retirement after age 55 (P trend = 0.56). Moreover, compared with low consumption, moderate, high or very high daily intakes were associated with an increased risk of early work cessation (combination of the three causes: death, disability and retirement before age 55) (HR = 1.14, 95% confidence interval (CI) = 1.05-1.25; HR = 1.23, 95% CI = 1.12-1.35 and HR = 1.49, 95% CI = 1.15-1.92 respectively). Between ages 50 and 60, we estimated that high or very high consumers could gain 6.04 months of occupational activity if they drank like low consumers. Our results provide evidence of a dose-effect relationship between alcohol consumption and early work cessation.

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