Comorbid Addiction Research Articles

Addiction vulnerability and binge eating in women: Exploring reward sensitivity, affect regulation, impulsivity & weight/shape concerns

Almost 40% of individuals with eating disorders have a comorbid addiction. The current study examined weight/shape concerns as a potential moderator of the relation between the hypothesized latent factor “addiction vulnerability” (i.e., impairments in reward sensitivity, affect regulation and impulsivity) and binge eating. Undergraduate women (n=272) with either high or low weight/shape concerns completed self-report measures examining reward sensitivity, emotion regulation, impulsivity and disordered (binge) eating. Results showed that (1) reward sensitivity, affect regulation and impulsivity all loaded onto a latent “addiction vulnerability” factor for both women with high and with low weight/shape concerns, (2) women with higher weight/shape concerns reported more impairment in these areas, and (3) weight/shape concerns moderated the relation between addiction vulnerability and binge eating. These findings suggest that underlying processes identified in addiction are present in individuals who binge eat, though weight/shape concerns may be a unique characteristic of disordered eating.

Assessment of suicide risk in schizophrenia with addictive comorbidity

Introduction Comorbid drug use disorders are associated with greater risk for relapse in schizophrenia and lower adherence to treatment. A comprehensive evaluation of patients with dual diagnosis should address the problem of suicide risk, which is a reputated complication of both psychotic disorders and drug use disorders. Objectives Depression and suicide risk assessment in subjects diagnosed with schizophrenia and drug related disorders. Aims To establish a protocol for early intervention in cases with depressive features that associate suicide risk. Methods All the patients ( n =37, female n =15, male n =12) with both schizophrenia and a drug related disorder, consecutively admitted in our department during a 6-month period, were evaluated using Calgary Depression Scale for Schizophrenia (CDSS), Positive and Negative Syndrome Scale (PANSS), Inventory of Drug Taking Situations (IDTS), Clinical Global Impression- Severity (CGI-S). Subjects were evaluated at admission, discharge and after 3 months. Results A percentage of 21.6 of all patients registered CDSS score at baseline above the cutt-off score for a major depressive episode of 6, while 10.8% had CDSS score of 6 and 8.1% had a CDSS score of 5. IDTS had greater scores in all these 15 patients with high CDSS values, comparative to the other, P Conclusions Using a specific method for depression and suicide risk in patients with schizophrenia and drug related disorder is very useful for establishing a specific treatment approach and monitoring plan.

Peculiarities of comorbid addictions in neurotic disorders

IntroductionUnder contemporary social circumstances, there is a tendency to increasing of amount of persons disposed to addictive behavior (AB) as a mean to remove psychoemotional tension and to solve their significant problems. This tendency raises in patients with neurotic disorders (ND) that influences on clinical manifestations of the pathology and impedes diagnosis and timely care for this category of patients.AimTo investigate AB in the structure of neurotic disorders (F44.7, F40.8, F48.0).MethodsAssessment of personal addictive status with AUDIT-like tests to detect disorders related to substance and non-substance abuse; 109 patients with ND (main group) and 52 persons without ND (control group) were examined.ResultsIt was revealed that patients with ND had significantly higher risk of AB formation (59.73% compared with 21.15% in healthy persons; P < 0.0001). According to the group comparison, in patients with ND levels of AB expression on parameters of “Job” (12.06 points), “Food” (11.98 points), “Internet” (11.10 points), “TV” (8.82 points), “Shopping” (6.59 points) were significantly higher than in healthy persons (9.73; 9.23; 9.00; 7.38; 4.25 points, respectively; P < 0.05). However, levels of keenness on computer were significantly higher in healthy persons (3.48 points) than in patients with ND (2.34 points; P < 0.05). AB connected with substance abuse was not registered in the groups.ConclusionsThe results suggest that the patients use AB in forms of food, Internet, job, TV, shopping dependencies as a subconscious mechanism substituting unsatisfied needs and decreasing motivation-emotional tension under conditions of a frustration conflict.Disclosure of interestThe authors have not supplied their declaration of competing interest.

L’impulsivité dans le TDAH : prévalence des troubles du contrôle des impulsions et autres comorbidités, chez 81 adultes présentant un trouble déficit de l’attention/hyperactivité (TDA/H)

Attention deficit hyperactivity disorder (ADH/D) is a neuropsychological developmental disorder characterized by pervasive and impairing symptoms of inattention, hyperactivity, and impulsivity. Whereas it is well known in children, there is still little information about ADH/D in adults, including prevalence. Indeed, there are actually no epidemiological studies in France, despite the considerable impact of this disorder in a patient's professional and affective life. Moreover, ADH/D rarely stays isolated, and many comorbidities often complicate the diagnostic investigation. It is well known that the so-called ADH/D is composed of two main categories of symptoms (Attentional Disorder/Hyperactiviy Disorder), but Impulsiveness also remains a major symptom. ObjectiveThe aim of this study was to evaluate not only the prevalence of Impulse Control Disorders (ICD) but also psychological and addictive comorbidities among adult patients with ADH/D. A total of 100 patients from specialized consultations of adult ADH/D were evaluated in this study, but only 81 were included after presenting all the clinical criteria of ADH/D. MethodWe used the DSM IV-T-R for ADH/D, the Minnesota Impulsive Disorders Interview a semi-structured clinical interview assessing impulse control disorders (ICD) (compulsive buying, trichotillomania, compulsive sexual behaviour, kleptomania, pyromania and intermittent explosive disorder), and the Mini International Neuropsychiatric Interview in order to evaluate psychiatric and addictive comorbidities. ResultsMore than 90 % of the patients met the early apparition criteria of ADH/D (before 7years). More than half of the patients presented a mixed type of ADH/D (both inattentive and hyperactive-impulsive forms): 55.6 % vs 44.4 % for the inattentive type. The vast majority of patients showed a complete form (with a total of 6 or more symptoms out of 9, of inattentive and/or impulsive-hyperactivity category): 93.8 % and only 6.2 % presented a sub-syndromic form of ADH/D (with 3 symptoms at least of one and/or the other category). Regarding the ICDs, we found a proportion of 66 % of patients manifesting at least one, the most frequent ICD being the Intermittent Explosive Disorder (IED): 29.6 %, followed by Compulsive Buying (CB): 23.4 %, Pathological Gambling (PG): 7.4 %, Kleptomania and Compulsive Sexual Behaviour: 2.4 %, and Trichotillomania: 1.2 %. Among the psychiatric comorbidities evaluated, generalized anxiety disorder: 61.7 %, followed by dysthymia: 44.4 %, major depressive episode: 28.3 %, Agoraphobia: 22.2 %, panic disorder: 17.2 %, hypomanic episode: 16 %, social phobia: 11.1 %, bulimia nervosa: 8.6 %, and antisocial personality disorder and obsessive-compulsive disorder: 3.7 %. Regarding the addictive comorbidities, we found a prevalence of 14.8 % of substance abuse (non-alcohol), followed by 7.4 % of alcohol abuse, 6.1 % of substance dependence (non-alcohol), and 3.7 % of alcohol dependence. ConclusionADH/D in adults continues to be unrecognized in France. The aim of this study was to evaluate the prevalence of impulse control disorders, psychiatric and addictive comorbidities in adults with ADH/D. The results enable us to appreciate quantitative and qualitative data for 81 French adults with ADH/D. This disorder rarely remains isolated and is often associated with many others, especially anxiety and mood disorders. We also observed that impulsivity stays at the heart of the ADH/D, either through impulsive behaviours or addictive disorders. Considering the lack of studies with ADH/D adults, it is difficult to compare our data. The diagnosis of ADH/D is complex and stays controversial, moreover the strong prevalence of comorbidities points out the importance of differential diagnosis.

Editorial: Exploring Gender and Sex Differences in Behavioral Dyscontrol: From Drug Addiction to Impulse Control Disorders.

Editorial: Exploring Gender and Sex Differences in Behavioral Dyscontrol: From Drug Addiction to Impulse Control Disorders.

Trans-Sector Integrated Treatment in Psychosis and Addiction.

Patients with psychosis often develop comorbid addiction, with a lifetime prevalence of ca. 50%. Dual diagnoses are considered hard to treat. Long-term integrated treatment programs might improve such patients' outcomes, at least to a moderate extent, but they have not yet been adequately studied or implemented in Germany to date. 100 dual diagnosis patients participated in a single-center, randomized, controlled trial under standard hospital treatment conditions. They were randomly allotted to two groups. Patients in the intervention group were admitted to a specialized open hospital ward, where they were given integrated treatment, including disorder-specific group therapy. Their treatment was continued with further disorder-specific group therapy in the outpatient setting. Patients in the control group were admitted to an open general psychiatric ward and received treatment as usual, but no disorder-specific treatment either during their hospitalization or in the subsequent outpatient phase. Follow-up examinations were performed three, six, and twelve months after inclusion. The primary outcome was defined as the changes in substance use and abstinence motivation. The secondary outcome consisted of the patients' satisfaction with treatment and with life in general, retention rate, psychopathology, rehospitalizations, and global level of functioning. The patients in the intervention group developed higher abstinence motivation than those in the control group (p = 0.009) and transiently reduced their substance use to a greater extent (p = 0.039 at three months). They were also more satisfied with their treatment (group effect: p = 0.011). Their global level of functioning and their retention rate were also higher, but these differences did not reach statistical significance. Low-threshold, motivational, integrated treatment programs with psycho-educative and behavioral therapeutic elements may be helpful in the treatment of dual diagnosis patients and should be more extensively implemented as part of standard hospital treatment. Larger-scale, methodologically more complex studies will be needed to identify subgroups of patients that respond to such treatments in different ways.

Addressing Risk Factors Associated With Women's Sexually Compulsive Behaviors Through Psycho-Education and Self-leadership Development

The author believes that one can teach women self-leadership strategies to successfully deal with risk factors that—if left unattended—increase women's likelihood of engaging in sexually compulsive behaviors. A literature review included studies published in Medline and PsychInfo databases with articles, textbooks, and textbook chapters. Experimental and correlational studies were included if sample size was greater than 20 per group and if samples were separated by gender. Case studies were included if they pertained to the treatment of sexually addicted women. The literature review yielded several risk factors: (1) Exposure to developmental stressors; (2) Unregulated negative affect; (3) Comorbid addictions; (4) Lack of relationship skills; and (5) Sex work. The author derived treatment strategies for at-risk women (i.e., psycho-education and the teaching of self-regulatory or so called self-leadership strategies) from current treatment practices of sexually compulsive women. Implications for treatment providers of at-risk women are discussed.Psycho-education on risk factors associated with sexual compulsivity in women and self-leadership trainings to deal with such risk factors seem a promising tool to decrease at-risk women's likelihood of engaging in sexual compulsive behaviors.

Prevention and interventions for suicidal youth considerations for health professionionals in Switzerland

Adolescence is associated with a dramatic surge in suicide rate. While worldwide age-adjusted suicides rate per 100’000 in under 14-year olds are relatively low around 0.6, a dramatic increase to 7.4 can be observed in 15 – 19 year olds with suicide being one of the three leading causes of mortality in most countries in this age group. From 2000 to 2013 the Swiss annual average of completed suicides in 15 – 19 year olds was 33.1 (minimum 24; maximum 47). This corresponds to an average age-specific death rate of 7.6, which is slightly above the global mean. Suicide prevention and treatment of suicidality in adolescents is a complex underpinning. Subjectively experienced feelings of insufficiency, hopelessness and the feeling of worthlessness combined with concrete suicidal ideations and the capacity to act out are important indicators for assessing suicidal risk. Suicide attempts as the strongest risk factor for suicide should always be taken seriously, even if they occur in the context of situational crisis. Narcissistic personality traits or increased impulsivity are further indicators of risk. The early detection and effective treatment of mental disorders such as depression, anxiety disorders, bipolar-affective disorders or psychotic disorders provide a great opportunity to reduce the frequency of suicide attempts and suicide. Particular caution is required when co-morbid addictions are present. The maintenance or establishment of sustainable relationships with significant others is considered a key protecting factor. Increasing withdrawal from significant others is an important warning sign and needs urgent involvement of experts. In acute suicidality, the admission to a psychiatric hospital must be considered, if necessary against the will of affected adolescent and their relatives. Personality-related recurrent suicidal behavior requires specific treatment approaches taking into account the prevention of iatrogenic worsening of suicidal patterns.

SY20ALCOHOLISM IN SPAIN: CURRENT STATE AND TREATMENTSSY20-1IN-PATIENT ALCOHOLISM TREATMENT IN SPAIN

Severe alcohol-dependent patients, that suffer an alcohol withdrawal syndrome, and frequently medical, psychiatric or addictive comorbidities, show a better response to in-patient treatment than to out-patient treatment, in their first stage of recovery. Ten to fourteen days of complete hospitalization allows an easy and effective treatment of alcohol withdrawal, …

Depression and addiction comorbidity: towards a common molecular target?

The comorbidity of depression and cocaine addiction suggests shared mechanisms and anatomical pathways. Specifically, the limbic structures, such as the nucleus accumbens (NAc), play a crucial role in both disorders. P11 (S100A10) is a promising target for manipulating depression and addiction in mice. We summarized the recent genetic and viral strategies used to determine how the titration of p11 levels within the NAc affects hedonic behavior and cocaine reward learning in mice. In particular, p11 in the ChAT+ cells or DRD1+ MSN of the NAc, controls depressive-like behavior or cocaine reward, respectively. Treatments to counter maladaptation of p11 levels in the NAc could provide novel therapeutic opportunities for depression and cocaine addiction in humans.

Dysfunctional Beliefs Related to Alcohol Craving as a Prognostic Factor of Six-months Relapse After Inpatient Alcohol Withdrawal

According to the cognitive model of addiction by Beck taking substance represents the final common voice of the activation of beliefs through the involvement of craving. To assess whether beliefs related to craving is a prognostic factor for relapse 6 months after a residential alcohol withdrawal and analyze the evolution of these beliefs. 107 participants were solicited for this non-interventional prospective study in a department of Psychiatry and Addictive Medicine. All patients showed a dependence on alcohol, and were hospitalized for alcohol withdrawal and had to master the French language and be reachable by telephone to help ensure follow-up. The presence of severe cognitive disorders or schizophrenia constitute a basis for non-inclusion. In the end, 68 patients were included. Beliefs related to craving on alcohol were assessed by Craving Beliefs Questionnaire (CBQ), psychiatric and addictive comorbidities by the MINI and consumption of alcohol by the AUDIT. Among the 68 patients, 27 were abstinent and 25 had relapsed at 6 months. The CBQ score at baseline was positively correlated with relapse at 6 months (p <.05). Relapsers were characterized by more frequent presence of major depressive disorder, suicidal risk, antisocial personality and an AUDIT and alcohol dependence largest scores. Three months after hospitalization CBQ score drops significantly among non-relapsers (p <.001) but not among relapsers. This study supports the role of beliefs related to alcohol craving in the relapse after residential withdrawal. These beliefs could be assessed in routine practice and treated with cognitive therapies.

Comorbidity of Addiction of Opoids and Bipolar Disorder: Justification of Substitution

Many people with opioid addiction (OA) have co-occuring mental disorders. Even though some authors thing that co-occured disorders in OA are overdiagnosed, according to representative studies, patients in medication assisted treatment for opioid addiction (MAT) show higher rates of co-occuring disorders comparing with general population. Mood disorders, including bipolar disorder (BD) are the most common co-occuring disorders among patients in MAT. OA and BD are very complex psychiatric disorders and major psychiatric public health problems today. Both are also in very close relationship with suicidality. There are some findings that patients in MAT and co-existing mental illness benefit of substitution. We are going to present very complex case of 42 years of age male patient abused different psychoactive substances, dominantly heroin, with diagnosed BD, HIV+, treated several times in different programes in Switzerland and Croatia (Zagreb and Rab). Patient was overdosed 2 months after starting of drug-free programe in first week dismissed from the psychiatric hospital. There are many questions to be discussed such as: * adequate psychopharmacological treatment of OA/BD comorbidity and justification of long term use of substitution; * ethical issues of HIV+ patient in psychiatric hospital; * motivation for drug-free programe; * overdose or suicidal act?; * family, social and migration factors included in etiology of illness etc. In treatment of OA/BD comorbidity, we could take in consideration long term use of substitution as a protective factor to prevent overdosing. We speak in favour of individual, personalized, integrative approach to the patients taking in consideration primary diagnosis.

Role of Cognitive Rehabilitation in Patients Suffering From Schizophrenia with a Comorbid Addiction to Amphetamine and Cannabis

Introduction An important element of the rehabilitation in schizophrenia is cognitive rehabilitation, aimed at the greatest possible reduction in deficits. Objective The aim of this study was to examine cognitive functioning in schizophrenic patients with a comorbid addiction to psychoactive substances participating in a cognitive rehabilitation program. Methods All recruited patients were men, aged between 20 and 45 years. They were examined in the initial period of the stay at the treatment center and after 4-7 weeks of hospitalization, after the stabilization of acute psychotic symptoms. During this time patients participated in the cognitive rehabilitation program. Cognitive function were assessed: Trail Making Test (TMT A & B), Stroop Test, and Verbal Fluency Test. Patients were divided into two groups according to abused substances: a) amphetamine users (n = 15), b) cannabis users (n = 11). As for the medication – 25 of 26 patients were treated with second generation antipsychotics. Results After the process of rehabilitation of cognitive functions of all gained patients gained a significant improvement. The type of abused psychoactive substance did not significantly affect cognitive functioning. However, amphetamine-dependent patients achieved better results in some of the cognitive tests. Cognitive rehabilitation does not affect the reduction of psychopathological symptoms. However, in patients addicted to amphetamines a decrease in the severity of these symptoms was found. Conclusions Cognitive rehabilitation exerts a positive effect on cognitive functioning of schizophrenic patients with concomitant dependence on psychoactive substances.

Additional Diagnostic Markers of Alcohol Addiction Based On Complex Estimation of Addictive Status.

The prevalence of alcohol addiction (AA) – one of the most pressing problems among addictive pathology. The massive spread of diverse subjects of abuse and dependence, both chemical and non-chemical, leads to intense interaction between them, as at the population level and at the individual level, to form complex combinations of comorbidities. That why aims of study were a complex assessment of addictive status of individuals with AA and selection of associated non-alcoholic addictive phenomena as additional diagnostic markers of primary substance abuse disorder. Objects 142 people were examined, including 71 patients with AA and 71 virtually healthy people. System of AUDIT-like tests (including the actual test AUDIT) was used for complex assessment of addictive status. The data were processed by methods of mathematical statistics (analysis of variance, and the calculation of the coefficients and diagnostic measures informativeness of Kulback). Download : Download full-size image Figure 1 . Informativeness of different addictions as markers of presence-absence of alcohol addiction. As results was found that addictive status of people, who are alcohol addictive, is characterized by stable combination of'titular' AA with a range of non-alcoholic addictive phenomena of varying severity. It was shown that among all non-alcoholic addictive phenomena most informative as markers of the presence of alcohol addiction are: tobacco smoking, on the level of addiction and computer games as risky 'consumption'. Markers of absence of alcohol addiction were found keenness of reading and shopping in any grade, but weak informative. Conclusion selected comorbid addictions can be used as additional diagnostic markers of alcohol addictions.

Allostasis as a conceptual framework linking bipolar disorder and addiction.

Bipolar disorders (BDs) and addictions constitute reciprocal risk factors and are best considered under a unitary perspective. The concepts of allostasis and allostatic load (AL) may contribute to the understanding of the complex relationships between BD and addictive behaviors. Allostasis entails the safeguarding of reward function stability by recruitment of changes in the reward and stress system neurocircuitry and it may help to elucidate neurobiological underpinnings of vulnerability to addiction in BD patients. Conceptualizing BD as an illness involving the cumulative build-up of allostatic states, we hypothesize a progressive dysregulation of reward circuits clinically expressed as negative affective states (i.e., anhedonia). Such negative affective states may render BD patients more vulnerable to drug addiction, fostering a very rapid transition from occasional drug use to addiction, through mechanisms of negative reinforcement. The resulting addictive behavior-related ALs, in turn, may contribute to illness progression. This framework could have a heuristic value to enhance research on pathophysiology and treatment of BD and addiction comorbidity.

Supporting veterans with post-traumatic stress disorder

The very nature of working in conflict zones makes former soldiers vulnerable to symptoms of post-traumatic stress disorder (PTSD). The culture of the military can also mean that personnel do not seek help and can endure symptoms for years. The two main treatments recommended for veterans diagnosed with PTSD – group therapy and exposure to trauma – have been shown to reduce PTSD symptoms. Even though these are recommended, veterans are not receiving evidence-based treatments due to the lack of training and reduced numbers of healthcare staff. There are high dropout rates from treatment because of the stigma of mental illness and because veterans feel that healthcare professionals do not understand them. Also, in some cases, veterans cannot be treated if they are experiencing a comorbid mental health problem or addiction. It is recommended that more research is carried out with veterans who are diagnosed with PTSD. The combination of treatments and treatment specific to the era in which the veteran served might further improve recovery from symptoms. It may also be beneficial to develop an intense educational programme for health professionals about the military and their needs.

A study investigating the association between compulsive buying with measures of anxiety and obsessive–compulsive behavior among internet shoppers

BackgroundCompulsive buying is a chronic, repetitive behavior that becomes a primary response to negative events and feelings. Compulsive buyers are obsessed by buying and their behavior occurs in response to negative emotions and results in a decrease in the intensity of negative emotions. Euphoria or relief from negative emotions is the most common consequence of compulsive buying. A large number of studies have investigated the association between compulsive buying and anxiety, and some studies have used the Spielberger trait–state anxiety inventory. ProcedureCompulsive buying, state and trait anxiety and general obsessive–compulsive measures were assessed among 120 habitual internet shoppers (2+ times a week, 70 men and 50 women). ResultsResults showed that Edwards Compulsive Buying scale measures were associated with Spielberger trait and not state anxiety measures. Spielberger Trait anxiety measures were also correlated with measures of Yale–Brown Obsessive–Compulsive scale (Y-Bocs). Finally, there were no sex differences in this sample. ConclusionsThe results of this study support existing evidence for an association between compulsive buying and anxiety and they will be discussed in view of current research on comorbidity of behavioural addiction.

L’utilisation addictive des jeux vidéo est-elle une solution adaptative à la perception de soi et à la symptomatologie dépressive des jeunes adolescents (11–14 ans) ?

ObjectivesThe video game is part to social and economic current events. It's also one of preferential activities of adolescents. However, video gaming is associated to negative image and is sometimes considered as a problematic behavior. Thus, video games addiction becomes an object of the clinic. The avatar –character from the video game embodied, directed and played by the player –and the virtual world –namely the environment of the avatar– are the two essential components of any video game. The avatar would be a possibility to change different parts of self. In addition, depression is a comorbidity of addiction and cyberaddiction. Moreover, in reference of the self-discrepancy theory, depressive symptomatology should correspond to a significant gap between the actual self and the ideal self. The aim of this study is to provide an understanding of the addictive videogame behavior, in the light of the “real” and “virtual” self-perception and of the depressive symptomatology. MethodsThis work was conducted with 74 adolescents aged from 11 to 14 years (Mage=12.78 and SD=0.921). The instruments used were the Game Addiction Scale, the Profile of self-perception - used with two different instructions in order to measure the perception about real and virtual self - and the Child Depression Inventory. ResultsRegarding GAS scores from the 74 adolescents, 14 adolescents were considered as addicted to video games, and 15 adolescents presented a depressive symptomatology. The results showed that this “depressive” adolescents had a perception of real and virtual self less than others adolescents, their virtual self-perception tended to be greater than real self-perception. In addition, adolescents considered as addicted to video games presented a depressive symptomatology higher than other adolescents. Furthermore, virtual self-perception, self-perception and depressive symptomatology were explicative from videogame addictive process. ConclusionsThese results lead us to question the video games addictive process as a functional restoration of identity, in order to reduce a major source of distress in adolescent. We consider it as the object of a “re-construction of self” in order to raise its self-perception and to reduce its suffering. In against part, a gap is created with the everyday environment, thus reinforcing the depressive symptomatology and addictive behavior. This addictive behavior would be a double process, both cause and consequence of the suffering of the subject, and wherein the failure of the self-image is a central axis. Nonetheless, questions arise concerning the relationship between the player and his avatar, but also on the impact of different formats of video games on this process.

P.3.d.055 Cognitive rehabilitation in schizophrenic patients with a comorbid addiction to amphetamine and cannabis

L’éthylisme chronique entraîne des problèmes psychocomportementaux et des déficits cognitifs qu’il est nécessaire de traiter conjointement. Les troubles intellectuels des personnes alcoolo-dépendantes vont compliquer et ralentir le travail thérapeutique. Une prise en charge intégrant un programme de réhabilitation cognitive n’est pas toujours facile à mettre en place et à suivre chez ce type de patient. Les résultats fonctionnels directs sont souvent difficiles à anticiper. En revanche, les conséquences d’une telle approche sont multiples et les interactions entre les composantes psychoaffectives, comportementales et cognitives nombreuses. Le cas clinique décrit permet d’illustrer l’influence d’un travail neuropsychologique sur la prise en charge globale. Les outils utilisés pour les évaluations ainsi que pour la rééducation peuvent secondairement permettre un travail sur la métacognition. Ainsi, les performances obtenues aux tests effectués, le temps nécessaire à la réduction des pertes intellectuelles et les restaurations fonctionnelles réalisées facilitent la prise de conscience des troubles et donc des conséquences neurobiologiques sur le cerveau d’une prise excessive d’alcool. Cette influence indirecte des interventions sur les déficits cognitifs peut réduire les fluctuations motivationnelles de ces patients et constituer une aide à l’abstinence. Il est important de considérer l’ensemble de ces effets dans les propositions thérapeutiques afin d’optimiser les chances de résultats.Alcoholism causes psychological, behavioral and cognitive symptoms that need to be addressed together. The neuropsychological alterations among alcohol-dependent people are considered to make the therapeutic work complex and longer. A cognitive rehabilitation program is sometimes difficult to achieve with these patients. Functional results are often difficult to anticipate. However, the consequences of this therapeutic approach are multiple and there are many interactions between psycho-affective, behavioral and cognitive components. A neuropsychological approach can be used like a tool to improve metacognition. A bad contribution to treatment programs is often secondary to the illusion of a satisfying intellectual functioning. Patients’ motivation for the therapeutic work is very changeable. A complete consciousness of impairments can help them to stay involved.The following case shows the cognitive effects and secondary benefits associated with a neuropsychological work, which was carried out by a chronic ethylic patient with severe physical and cognitive symptoms. The patient aged 50, with a good qualification level (scientific section in the final year of secondary school, with no diploma, then attended a training program to become a croupier) was suffering from chronic alcoholism since his adolescence. He arrived in the closed unit after many hospitalizations in psychiatric and hepato-gastroenterology units. He had been showing mental confusion. He presented a frontal and subcortical profile of alcohol-related dementia according to Oslin's criteria. MRI revealed global cerebral atrophy, more pronounced on the fronto-parietal cortex with cerebellar leukoencephalopathy, but no pontine central myelinolysis. The neurocognitive program had two main lines: reducing attentional, executive and graphical deficits with training exercises (individual and group sessions) and compensating memory, and executive disorders with an external aid. The cognitive program had been assessed by means of repeated psychometric measures, behavior and metacognition estimated by direct clinical observations. The cognitive remediation was carried out during a 10-month hospitalization, and then in an outpatient rehabilitation setting over a 12-month period. The external individual sessions were associated with medical consultations and support for reintegration at home provided by the mobile psychiatric team.The test results showed a significant improvement in attentional processes and executive functions. On graphic level, his writing was recovered after 10 months. Impairment within episodic memory processes-encoding was observed, and prospective memory was reinforced by external aids. At the end of the program, the use of an agenda proved to be effective even if updating was difficult once back home. Although a part of these effects could be expected, their psychological influence on the patient must be underlined: his perception of the alcohol related problem had been modified with more consciousness of the neurobiological consequences and a strong desire of personal implication. He worked a lot on his own (always under supervision) on cognitive exercises and succeeded in remaining abstinent for nearly 2 years. He died of complications of acute hepatitis.All the cognitive assessments and rehabilitation results seem to have increased his participation in the global therapeutic care. Therapeutic tools used for cognitive work give a concrete picture of the consequences of alcohol consumption and the necessary time to retrieve brain capacities. Visible improvements in terms of reduction in disability-handicaps encouraged the patient, valued his efforts, and increased his determination to solve his alcohol related problem. Thus, cognitive programs can help to reduce passiveness and develop activeness. This patient regarded therapeutic difficulties as a challenge, not as an obstacle. We can reasonably assume the effect of the cognitive rehabilitation on the Persistence of the Cloninger's biosocial model. This increase in temperament corresponds to a certain form of tenacity, which would facilitate abstinence.

Stabilisation des patients schizophrènes en post-aigu : de l’hôpital à la cité

Schizophrenia is a debilitating disease that usually begins in young adulthood, at a time when a person would usually make the transition to independent living, but it can occur at any age. The symptoms and behaviour associated with psychosis and schizophrenia have a distressing impact on the individual, and the family. The course of schizophrenia varies considerably. Although most patients will recover, some will have persisting difficulties or remain vulnerable to future episodes. Therefore, stabilisation of patients in acute phases and avoidance of relapse are major objectives of management throughout the course of this disease. The purpose of this article is to clarify the stabilisation, to study the contributing factors and strategies to implement to achieve stability, through a literature review and key guidelines. Thus, the patient is stabilised when productive symptoms and behavioural problems have decreased. So, the stable phase represents a prolonged period of treatment and rehabilitation during which symptoms are under adequate control and the focus is on improving functioning and recovery. Important predictive criteria of stabilisation include: positive symptoms, the number of previous relapses, cooperation with the patient and family, good adherence to treatment and the use of long acting injectable second-generation antipsychotics. After an acute relapse, the careful organization of the discharge and the development of a proposed ambulatory care in tailored care structures will help consolidate stabilisation and obtain remission. Accepting the idea of continuing treatment is a complex decision in which the psychiatrist plays a central role beside patients and their families. The course of integrated actions on modifiable risk factors such as psychosocial support, addictive comorbidities, identification of prodromes, active information for the therapeutic education of patients and families and access to care will also be supported. This would improve the functional abilities of patients, their social adaptation and particularly their quality of life.