Encephale
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The aims of this paper is to study the relations between anxious, depressive and borderline symptomatology and cannabis use and dependence in adolescents and young adults. A convenient sample of 212 subjects composed of high-school and college students from Toulouse, France (85 boys, 127 girls; mean age=18.3 1.8 Years) completed questionnaires assessing the patterns of cannabis use, age of first use, the symptoms of dependence using a questionnaire derived from the Mini International Neuropsychiatric Interview, and the anxious, depressive and borderline symptomatology using the STAI-YA (State-Trait Anxiety Inventory; Spielberger et al., 1970), the CES-D (Center for Epidemiological Studies-Depression scale; Radloff, 1977) and the BPI (Borderline Personality Inventory; Leichsenring, 1999), respectively; 54% of subjects reported having used cannabis once during the last 6 Months (45.3% of girls and 66.6% of boys, p=0.002). Frequency of use was higher in boys: eg, 61% of boys used cannabis at least almost daily versus 31% of girls (p<0.00001). ⋯ Borderline symptomatology appeared to be highly linked to cannabis use and dependence in adolescents and young adults. Borderline personality disorder in adolescents is not the only risk factor for cannabis use and dependence in adolescents: borderline symptomatology even at a subclinical level seems to be a higher risk factor than anxious or depressive symptomatology. The frequency of daily or almost daily users may be a confounding variable for the study of relations between anxiety and depressive disorders in adolescents and young adults.
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Structured diagnostic interviews, which evolved along the development of classification's systems, are now widely used in adult psychiatry, in the fields of clinical trials, epidemiological studies, academic research as well as, more recently, clinical practice. These instruments improved the reliability of the data collection and interrater reliability allowing greater homogenisation of the subjects taking part in clinical research, essential factor to ensure the reproducibility of the results. The diagnostic instruments, conversely to the clinical traditional diagnostic processes allow a systematic and exhaustive exploration of disorders, diagnostic criteria but also severity levels, and duration. ⋯ In particular, the following points should be considered: drastic reduction of the length of the interviews; simplification in the use of these instruments, during the interviews, but also in the treatment of the data collected during the final phase of diagnosis generation, the clinician having to carry out ceaseless returns to check the presence or not of each diagnostic criterion; reduction of the duration of the highly necessary training, which can be easily solved by the global simplification of the instruments; quantitative and qualitative improvements of psychometric properties, in particular in terms of sensitivity, specificity and face-to-face validity. Finally, it is highly necessary to continue to develop structured diagnostic interviews adapted to the assessment of child and adolescent psychiatric diagnoses keeping in mind simplicity, feasibility and reliability. Developing this kind of instruments is hard, expensive, and sometimes tiresome but it remains the inescapable stage to produce high quality data in the future.
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An early recognition of bipolar disorders may have an important impact on the prognosis of this disorder according to different mechanisms. Bipolar disorder is nevertheless not easy to detect, the diagnosis being correctly proposed after, in average more than a couple of Years and three different doctors assessments. A short delay before introducing the relevant treatment should help avoiding inappropriate treatments (prescribing, for example, neuroleptics for long periods, antidepressive drugs each time depressive symptoms occurs, absence of treatment despite mood disorders), with their associated negative impact such as mood-switching, rapid cycling or presence of chronic side-effects stigmates. ⋯ Attention deficit-hyperactivity disorder also has unclear border with bipolar disorder, as a quarter of child hyperactivity may be latterly associated with bipolar disorder. The assessment of mood cycling and their follow-up in adulthood may thus be particularly important. Lastly, presence of some anxious disorders may delay the diagnosis of comorbid bipolar disorder.
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Clinical Trial
[Escitalopram is more effective than citalopram for the treatment of severe major depressive disorder].
Escitalopram is a highly selective serotonin reuptake inhibitor (SSRI). It is the therapeutically active S-enantiomer of citalopram. It has been shown, compared with placebo, to be an effective and well-tolerated treatment for major depressive disorders (MDD) in both primary and specialist care settings. A recent meta-analysis has found that escitalopram-treated patients showed significant higher response rates and increased mean change from baseline in the Montgomery-Asberg Depression Rating Scale (MADRS) total scores at weeks 1 and 8 compared with citalopram-treated patients. Each of these active drugs shares similar safety profiles. Although the efficacy of newer antidepressants has been well established for the treatment of mild-to-moderate depression, there are very few studies concerning severe depression. ⋯ This study shows that the new SSRI escitalopram has better efficacy in the treatment of severe depression than citalopram, its racemic parent. Mean differences between treatments groups were in favour of escitalopram for all scales. The benefits of escitalopram compared with citalopram, as demonstrated by both magnitude of effect and time of onset, are superior to the benefits of citalopram, an antidepressant drug with proven efficacy. This evidence clearly supports the use of escitalopram as a legitimate first-line treatment for MDD.
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The part played by psychosocial factors has frequently been studied in mental disorders whether as protective factors or as vulnerability factors, using variously adequate methods. A large body of research has shown that poor social support or poor self-esteem or presence of stressful life events could play a large part in triggering disorders. The importance of socioeconomic factors in mental illness is so great that such factors (unemployment, insecurity in employment, homelessness, lower social classes, low income) skew the studies in which they are not considered. In this study, in order to take into account these methodological problems, the study of psychosocial factors was undertaken in a standardized clinical manner and on a relatively socially privileged population. ⋯ Following this study, four psychosocial associated factors in depressive episodes can be considered as being risk factors for "neurotic depressive disorders". In the literature psychosocial factors are frequently considered to be factors that possess a certain independence. This idea is discussed in the full article.