Annales de medecine interne最新文献

Natural hallucinogenic substances have been used in numerous cultures throughout the world for millenniums, providing a sacred intermediary between men and gods. They were used during initiatory, divinatory rites and played an essential role in the myths of exorcism and charm where the initiated enters a sort of trance which separates the soul from the body before "revival". It resulted that a number of plants were given names reflecting their relationship with the divinities, bestowing upon them an aura of mystery and sacredness. With the development of free information superhighways via the net, recipes using these hallucinogenic substances can now travel anywhere on the planet, offering the non-initiated a means of experimenting their search for strong sensations. At the same time, the science of botany has undergone a major revolution. Patient observation of nature is no longer necessary since a well-conducted computer search can easily yield a large supply of plants offered for on-line purchase. Children and adolescents in primary and secondary schools are becoming a new target for the botanical market: young people exchange the latest recipes and Internet addresses, or more simply the objects of their new on-line purchase. This has led to an outbreak in the use of mushrooms and hallucinogenic plants where the cultural notion of initiation or sacred rites has metamorphosed into a phenomenon of communication between young people, notably during festive parties. Datura stramonium has become quite popular and the number of hospitalizations for acute datura poisoning has increased rapidly, as indicated by the statistics of the Bordeaux Poison Center (14 hospitalizations for voluntary poisonings with datura in 2002, compared with 5 in 2001). Besides the self-inflicted risk, one of the most important problems is the delay to diagnosis, simply because the primary care physician did not think of such an "exotic" cause. We report here the case of a 22-year-old young man hospitalized following ingestion Datura stramonium seeds. He presented confusions and dreamlike frenzy. The clinical course was favorable in 72 hours with symptomatic treatment, marked by amnesia of the episode.

In France, by the end of 1999, a study of a naturalistic-type was led by the Louis-Harris Institute on 303 persons taking high dosage (HD) buprenorphine. This study aimed to identify factors likely to be correlated with stopping or continuing HD buprenorphine injections. We carried out a comparative study of four groups of HD buprenorphine users: "non-injectors" (n=90), "ex-injectors" (n=71), "monitored injectors" (n=69) and "un-monitored injectors" (n=72), with intra-group representativeness. The data was gathered in the context of anonymous interviews, by objective interviewers, in 20 regions. Most of the interviewees were also users or ex-users of more than one psychoactive substance. The "un-monitored injector" group was younger than the "non-injector" group and not as well integrated into society. The injection frequency was lower in patients receiving medical care. Research into the reasons for stopping and cutting down on HD buprenorphine injections revealed indicators such as the impossibility of breaking the injection habit, the fact that users seek the immediate sedation effect, and associating with friends who also inject. These factors seem to be greatest during critical periods, such as depression or the absence of well being. We showed that the factors involved in cutting down included: revaluation of the way in which the medicine was taken with the doctor, and becoming aware of the problems resulting from injection through information received from the doctor and/or by experiencing problems firsthand. In all the groups, the benefits associated with taking HD buprenorphine were observed and evaluated, starting with a list of 14 items. Five main benefits were found: cutting down on or stopping heroine, taking better care of oneself, making new plans, being in better physical shape, and finally, sleeping better. The improvement was greatest in the "non-injector" and "ex-injector" groups. The work that would be necessary to establish effective medical support involves a global approach including an appropriate initial prescription, paying special attention during critical periods, and verification of the mode of use so as to avoid under-dosing, and constant evaluation of the risk of resorting to injections. The fact that there are ex-injectors and that some regular injectors have not resorted to injecting during the last month shows the benefits of medical support.

Dr Olivier Jacquiez has practised in the Specialised Care Centre of Dunkerque for 3 years. From his own clinical experience related to the use of methadone and the medical literature, he gives his points of view concerning maintenance treatment delivery, and the eventual influence of the regulations promulgated on January 30th, 2002 by the French Health Authorities (DGS/DHOS 2002/57) allowing each hospital practitioner to initiate a drug maintenance treatment with methadone.

Few studies have analyzed in the general population psychoactive substance use among athletes, especially among females. In fact, sporting activity is often promoted in prevention actions, as an alternative to addiction or alcohol, tobacco or other substance misuse. So, we propose an analysis of the ESPAD 1999 sample among students (16-18 years old), focused on the relationship between sporting activities and substance use. Boys play sport more frequently than girls (71.5% versus 49.5%) and report 8 hours and more a week 4 more times than girls (14% versus 3.5%). Sixty-eight percent of boys and 36% of girls have already participated in sport competitions, more often at a local, departmental or regional level; a minority of them (26% of boys and 20% of girls) have already participated in sport competitions at a national or international level. Sporting activity is decreasing with age among girls, students from general lycée play sport more frequently than others do (vocational lycée); the higher the father's education level, the more frequently the students play sport. Moderate sporting activity (1-8 hours a week) is a protective factor against regular smoking (OR=0.54 in boys and OR=0.60 in girls) and against regular cannabis use among boys (OR=0.64). Intensive sporting activity (>8 hours a week) is a risk factor for illicit drugs (except cannabis) use (OR=2.74) and sleeping drugs/tranquillizers (OR=1.82) only among girls. Competition level is the most important risk factor for substance misuse as well in boys (except sleeping drugs/tranquillizers) as in girls. Practical implications are: adjusting health policy concerning the beneficial effects of sporting activity, raising sports associations abilities and avoiding doping and addiction in high-level sporting activities.

The aim of this study was to describe and analyze the patterns of illicit psychoactive drug consumption, and the utilization of buprenorphine (BHD) in opiate-dependent patients interviewed in the drug agency of Lens. In our sample, multiple drug use was a massive phenomenon. Misuse of BHD was related to young age, multiple drug injection, gender (male) and risky injecting behavior. Multiple drug use was less frequent among patients with a BHD prescription. It is urgent that health professionals and decision-makers be aware of the heterogeneity of drug consumption habits and their impact on the utilization of drug maintenance treatment. Research is needed to understand the history and motivations for misuse and persistent injecting among some drug users. A national conference of consensus on how to implement and maintain treatments is a necessary step forward in caring for opiate drug addicts.

Several reports have focused on prescription of high-dose buprenorphine using data electronically transmitted to the French health reimbursement system. This study deals with high-dose buprenorphine prescriptions in the Bouches-du-Rhone region between 1999 and 2001. We determined the number of maintained patients followed by practitioners (either short- or long-term care), the doses administered, and the associated prescription of psychotropic treatments. The number of general practitioners involved in 84% of the prescriptions of high-dose buprenorphine grew with a high turnover (20%). More than 25% of the general practitioners in the region prescribed this drug, but only 38% of them were involved in long-term follow-up of more than one maintained patient. The number of maintained patients and the mean daily treatment dose delivered (13.4 mg/d during 2001) increased. The associated prescriptions of benzodiazepines concerned 47% of the patients during 2001 (on the rise), but the associated prescription of flunitrazepam tended to decrease (29% of the subjects during 2001 versus 32% during 2000). This study shows a tendency for deviant behaviors to increase, constituting a public health concern.

In the scientific literature, the term of addiction is currently used to describe a whole range of phenomena characterized by an irresistible urge to engage in a series of behaviors carried out in a repetitive and persistent manner despite accruing adverse somatic, psychological and social consequences for the individual. It has been suggested that subjects presenting such behaviors would share specific features of personality which support the appearance or are associated with these addictive behaviors. Dimensions such as alexithymia and depression have been particularly well investigated. The aim of this study was to explore the hypothesis of a specific psychopathological model relating alexithymia and depression in different addictive disorders such as alcoholism, drug addiction or eating disorders. Alexithymic and depressive dimensions were explored and analyzed through the statistical tool of path analysis in a large clinical sample of addicted patients and controls. The results of this statistical method, which tests unidirectional causal relationships between a certain number of observed variables, showed a good adjustment between the observed data and the ideal model, and support the hypothesis that a depressive dimension can facilitate the development of dependence in vulnerable alexithymic subjects. These results can have clinical implications in the treatment of addictive disorders.