Maladie d’Alzheimer et troubles psychiatriques

Psychiatric disorders in patients with Alzheimer’s disease occur very frequently, are heterogeneous and often associated. They are grouped under the heading “behavioural and psychological symptoms of dementia” (BPSD). They must be carefully assessed and treated because they make the prognosis worse (acceleration of cognitive decline), have a detrimental effect on quality of life (for both patient and relatives) and increase the cost of the disease. They must be distinguished from confusion and disorders related to another organic or iatrogenic condition. They can be explained by underlying psychological reactions or neurobiological disturbances. A multimode therapeutic approach is indicated accompanied by research into possible clinicoanatomic correlations. We can distinguish them arbitrarily according to the following headings: delusion and personality disorders, hallucinations, various kinds of agitation, aggressivity, anxiety, compulsions, disinhibition, apathy, hyperactivity, depression, elimination disorders, sexual disorders, eating disorders, circadian rate/rhythm disturbances and sleep disorders. If we are to recognise them we must be better informed about their specific attributes.     

Clarification of chromosomal abnormalities associated with sexual ambiguity by studies with Y-chromosomal DNA sequences

Cases of gonadal dysgenesis, both Turner syndrome and mixed, were studied with Y centromeric and short-arm probes. The Y-centromeric alphoid repeat clone, Y97, allowed sensitive detection of Y-chromosomal material in marker chromosomes or mosaics by in situ analysis or Southern hybridization with purified DNA. The Y short-arm probe, p75/79, allowed detection of sequences normally associated with proximal Yp by Southern analysis. The presence of DNA fragments characteristic of Yp correlates well with partial male sexual differentiation in the cases of mixed gonadal dysgenesis. Thus, the combined use of molecular and cytogenetic techniques has proven to be a powerful approach to the analysis of chromosomal sex disorders.     

Sex and the evolution of intrahost competition in RNA virus phi6.

Sex allows beneficial mutations that occur in separate lineages to be fixed in the same genome. For this reason, the Fisher-Muller model predicts that adaptation to the environment is more rapid in a large sexual population than in an equally large asexual population. Sexual reproduction occurs in populations of the RNA virus phi6 when multiple bacteriophages coinfect the same host cell. Here, we tested the model''s predictions by determining whether sex favors more rapid adaptation of phi6 to a bacterial host, Pseudomonas phaseolicola. Replicate populations of phi6 were allowed to evolve in either the presence or absence of sex for 250 generations. All experimental populations showed a significant increase in fitness relative to the ancestor, but sex did not increase the rate of adaptation. Rather, we found that the sexual and asexual treatments also differ because intense intrahost competition between viruses occurs during coinfection. Results showed that the derived sexual viruses were selectively favored only when coinfection is common, indicating that within-host competition detracts from the ability of viruses to exploit the host. Thus, sex was not advantageous because the cost created by intrahost competition was too strong. Our findings indicate that high levels of coinfection exceed an optimum where sex may be beneficial to populations of phi6, and suggest that genetic conflicts can evolve in RNA viruses.     

Techniques d’AMP et leurs indications dans l’hypofertilité masculine

In spite of several trials, medical treatment of male sterility is still deceiving. Only few indications are likely to gain from antibiotherapy, anti-inflammatory molecules or hormonotherapy. Most of the time, ART techniques remain the last issue in male sterility. In 1992, the WHO defined the threshold sperm criteria’s in order to obtain natural fertilization: sperm concentration ≥ 20 millions per ml., progressive motility ≥ 50% after liquefaction, and normal forms ≥ 30%. In vitro techniques used for sperm preparation before ART, are necessary for multiple reasons: selection of motile spermatozoa’s with normal morphology, suppression of dead spermatozoa’s and cellular fragments, elimination of seminal plasma, and induction of sperm capacitating process. Several ART techniques are now available and the result of in vitro sperm selection will help to choose the best technique in each indication.     

A Proposed Set of Ethical Practice Guidelines in the Assessment and Treatment of Pelvic Floor Disorders

The treatment of pelvic floor disorders using biofeedback, behavioral therapies, and other applied psychophysiological treatments has been well documented as effective. Practitioners must take due care to ensure that they practice within the boundaries of what is common practice for their discipline and within the scope of practice allowed by their professional license as outlined by the appropriate state licensing law(s), the ethical principles and practice guidelines and standards for their discipline, and those of the Association of Applied Psychophysiology and Biofeedback if using a biofeedback assessment or treatment. Being competent to provide a particular treatment does not necessarily make it legal and/or ethical. This paper provides a set of recommended practice guidelines for use in the assessment and treatment of pelvic floor disorders. Please note that they have not at this time been endorsed as an official position of the Association of Applied Psychophysiology and Biofeedback or any other professional organization.     

L’impuissant,les injections intracaverneuses,et le sexologue: pour une prise en charge globale

The current widespread use of intracavernosal injections (ICI) in the treatment of impotence has caused physicians confronted with this type of pathology, and sexologists in particular, to seek the best means of mastering the theoretical and practical aspects of such management. Since 1988, we have used ICI as a cognitive-behavioural tool. Our experience is based upon, on the one hand, an acquired practice, but also upon a conceptual model of sexuality which integrates various reflex, sensual and erotic components in a dynamic, interactive manner. In positioning ICI at the heart of an easily implemented cognitive-behavioural functional framework, we allow it to be not only symptomatic treatment (i.e. of erection failure, whatever the cause), but also to acquire a true therapeutic dimension. Such an integrated approach, which brings about a true healing process, is made possible by the renewal of the subject’s self-confidence, easing his anxiety, restoring his inadequate sexual performance, and by moving forwards in a spirit of success. In depending on the manifestly obvious results of the injection, the patient also rediscovers his sensual, erotic and fantasizing capacities, necessary for recovery of sexual satisfaction.     

Condition‐dependent mutation rates and sexual selection

‘Good genes’ models of sexual selection show that females can gain indirect benefits for their offspring if male ornaments are condition‐dependent signals of genetic quality. Recurrent deleterious mutation is viewed as a major contributor to variance in genetic quality, and previous theoretical treatments of ‘good genes’ processes have assumed that the influx of new mutations is constant. I propose that this assumption is too simplistic, and that mutation rates vary in ways that are important for sexual selection. Recent data have shown that individuals in poor condition can have higher mutation rates, and I argue that if both male sexual ornaments and mutation rates are condition‐dependent, then females can use male ornamentation to evaluate their mate’s mutation rate. As most mutations are deleterious, females benefit from choosing well‐ornamented mates, as they are less likely to contribute germline‐derived mutations to offspring. I discuss some of the evolutionary ramifications of condition‐dependent mutation rates and sexual selection.     

Dysfonctions sexuelles masculines et rapport à l’autre. Perspectives sexoanalytiques

According to sexoanalysis, sexual dysfunction has a specific significance in the individual’s mental and sexual functioning and can be managed based on an understanding of these processes. Psychogenic sexual dysfunctions are considered to be particular manifestations of the relationship with the Other, a relationship, involving sexuality and eroticism, in which the individual is faced with his or her own anxieties, defences or needs. Three clinical cases in men with erectile dysfunction are presented. They illustrate how the same diagnostic criterion can correspond to various sexual dynamics in terms of general functioning, fantasies and the relationship with the other. The authors conclude on the need to develop a holistic and dynamic view of sexual dysfunction. Therapeutic management must be based on sexual health and not only a standardized physiological functionality focussed on the symptom.     

Lamessende individualpsychologie: sur le rôle de l’expérimentation psychologique dans la psychiatrie d’Emil Kraepelin (seconde partie)

Contemporary historical investigations on Emil Kraepelin’s experimental work have argued variously that the psychological experiment had either no influence on his nosology, or that it was the very precondition of the nosology, or that it skewed the nosology in favor of organic disorders. The first part of this article considered Kraepelin’s experimental research in Wilhelm Wundt’s laboratory in Leipzig during the 1880s. This second part deals with Kraepelin’s work in Heidelberg in the 1890s. It emphasizes the role of the psychological experiment in stabilizing the professional and scientific legitimacy of psychiatry vis-à-vis general medicine and jurisprudence. Above all, it argues that Kraepelin’s experimental research agenda had not just nosological aims, but also clinico-diagnostic aims. Kraepelin believed that his research would help to develop a battery of diagnostic tools that could reveal prodromal symptoms, speed up diagnostic procedures, alleviate institutional overcrowding, and both generate and stabilize psychiatric norms.     

Female nursery web spiders (Pisaurina mira) benefit from consuming their mate

The often coincidental involvement of cooperation and conflict in animal reproduction is epitomized by sexual cannibalism, which can lead to obvious male costs while simultaneously providing direct benefits to developing offspring. Male nursery web spiders (Pisaurina mira) avoid postcopulatory sexual cannibalism by wrapping females with silk. Here, we test the hypothesis that this silk wrapping results in a loss of consumption cost for females. In specific, we hypothesize that females lose out on potential fitness benefits associated with cannibalizing their mating partners. To test this, we paired females with males that were experimentally manipulated to prevent the silk wrapping of females, thereby increasing the likelihood of sexual cannibalism. Females either did not kill their mate, and thus consumed nothing, or did kill their mate. If females killed their mating partner, we allowed them to consume the male, consume nothing, or consume a cricket. We found no effect of female or male body sizes on the likelihood of females killing their mate. While our treatments did not affect the number of offspring females produced, females that consumed either a male or a cricket produced egg sacs faster than females that consumed nothing, suggesting a benefit of increased postcopulatory food consumption. Further, only females that ate a male had heavier and longer lived offspring, suggesting a benefit of sexual cannibalism specifically. Our results support the hypothesis that females can receive fitness benefits associated with sexual cannibalism.     

Les troubles sexuels à l’origine d’une infertilité sont-ils une indication ou une contre-indication de l’A.M.P.?

The observation of 11 couples requesting MAP and presenting sexual disorders (male or mixed) responsible for infertility, led us to a number of conclusions: sexual disorders are a rare but not exceptional cause of infertility. Sexuality and the couple dynamics must be systematically assessed at an infertility visit. The absence of fertilizing sexual intercourse is not a disease, but a symptom, a body message, which always reflects psychological conflicts. Schematically, two groups can be distinguished: loving couples blocked by a repressed infantile drama or unresolved transgenerational conflicts; couples in which the desire for a child is designed to resolve serious marital dysfunction. These couples require preliminary psychotherapy and/or sex therapy to elucidate the meaning of the symptom with liberation of the couple’s sexuality, or, on the contrary, abandonment of the desire for a child until the marital conflict has been resolved. Medical management must not mask the couple’s absence of sexuality and must not promote dissociation between the sexual act and reproduction, which inevitably has certain symbolic psychological consequences. Management must be based on a multidisciplinary approach avoiding any position of omnipotence, and allowing evaluation of the indication for MAP.     

Agronomic approach: cropping systems and plant diseases

This paper deals with the effects of agronomic practices on parasite life cycles, and the design of integrated crop protection strategies. Cropping systems have a large effect on the size of the primary inoculum and its localisation, on the development and spread of epidemics, and on the coordination of the life cycle of cultivated plants and that of their parasites. They can disrupt ecological equilibria, either favouring or disfavouring the pathogens. By combining information concerning the effects of agricultural techniques on diseases and the physiological effects of diseases on growth and crop production, it is now possible to develop new crop management systems, in which the use of non-chemical methods for preventing diseases is a priority. However, the current knowledge need to be completed by studies on other scales, particularly of the effect of cropping systems on the genetics of disease populations integrating more completely the 'long-term' dimension of sustainable agriculture.     

Do Patients’ Symptoms and Interpersonal Problems Improve in Psychotherapeutic Hospital Treatment in Germany? - A Systematic Review and Meta-Analysis

Background

In Germany, inpatient psychotherapy plays a unique role in the treatment of patients with common mental disorders of higher severity. In addition to psychiatric inpatient services, psychotherapeutic hospital treatment and psychosomatic rehabilitation are offered as independent inpatient treatment options. This meta-analysis aims to provide systematic evidence for psychotherapeutic hospital treatment in Germany regarding its effects on symptomatic and interpersonal impairment.

Methodology

Relevant papers were identified by electronic database search and hand search. Randomized controlled trials as well as naturalistic prospective studies (including post-therapy and follow-up assessments) evaluating psychotherapeutic hospital treatment of mentally ill adults in Germany were included. Outcomes were required to be quantified by either the Symptom-Checklist (SCL-90-R or short versions) or the Inventory of Interpersonal Problems (IIP-64 or short versions). Effect sizes (Hedges’ g) were combined using random effect models.

Principal Findings

Sixty-seven papers representing 59 studies fulfilled inclusion criteria. Meta-analysis yielded a medium within-group effect size for symptom change at discharge (g = 0.72; 95% CI 0.68–0.76), with a small reduction to follow-up (g = 0.61; 95% CI 0.55–0.68). Regarding interpersonal problems, a small effect size was found at discharge (g = 0.35; 95% CI 0.29–0.41), which increased to follow-up (g = 0.48; 95% CI 0.36–0.60). While higher impairment at intake was associated with a larger effect size in both measures, longer treatment duration was related to lower effect sizes in SCL GSI and to larger effect sizes in IIP Total.

Conclusions

Psychotherapeutic hospital treatment may be considered an effective treatment. In accordance with Howard’s phase model of psychotherapy outcome, the present study demonstrated that symptom distress changes more quickly and strongly than interpersonal problems. Preliminary analyses show impairment at intake and treatment duration to be the strongest outcome predictors. Further analyses regarding this relationship are required.     

Psychopathologie et essence du langage: L’aphasie interprétée par Kurt Goldstein et Roman Jakobson

The article proposes a comparative analysis of the studies carried out on aphasia by the linguist Roman Jakobson and the neuro-psychiatrist Kurt Goldstein The linguistic theory of aphasia advocated by Jacobson in the 1950’s and 1960’s is based on clinical case studies reported by Goldstein at the beginning of 1930’s However, Jakobson used Goldstein’s clinical observations without taking into account his theoretical work on language pathology Thus, Jakobson included the symptoms described by Goldstein in a structuralist model which allowed him to predict deductively the different types of aphasia Goldstein, however, imagined the clinical manifestations of aphasia as a particular way of being in the world The study of the changes associated with the reaction of the patient to the disease should lead to an understanding of the functioning of language m the normal subject Goldstein distinguished between an instrumental use and a symbolic use of language, the latter being mainly characteristic of language used by the normal subject Only the symbolic use reveals the essence of language by showing its intimate nature, which is the psychic link tying the subject to the world.     

Cholinergic involvement in mental disorders.

A recent resurgence of interest in possible cholinergic mechanisms in schizophrenia, mania and depression represents a further extension of the attempt to explain these disorders on the basis of an abnormality in neurotransmission. New emphasis is less on individual neurotransmitters than it is upon their interdependent relationships. The latter is best exemplified by the treatment of Parkinson's disease, which has moved from a cholinergic approach to one that makes important use of dopaminergic mechanisms. Whether or not a reverse shift, from dopaminergic towards cholinergic approaches is justified for treating schizophrenia remains doubtful. Persuasive evidence can be adduced for new approachess to treatments of mania and depression through cholinergic mechanisms. The development of centrally active cholinemimetic agents will permit the clinical testing of some of the hypotheses engendered by this revival of inquiry into the role of acetylcholine in emotional disorders.     

The impact of severe mental disorders and psychotropic medications on sexual health and its implications for clinical management

Sexual dysfunction often accompanies severe psychiatric illness and can be due to both the mental disorder itself and the use of psychotropic treatments. Many sexual symptoms resolve as the mental state improves, but treatment‐related sexual adverse events tend to persist over time, and are unfortunately under‐recognized by clinicians and scarcely investigated in clinical trials. Treatment‐emergent sexual dysfunction adversely affects quality of life and may contribute to reduce treatment adherence. There are important differences between the various compounds in the incidence of adverse sexual effects, associated with differences in mechanisms of action. Antidepressants with a predominantly serotonergic activity, antipsychotics likely to induce hyperprolactinaemia, and mood stabilizers with hormonal effects are often linked to moderate or severe sexual dysfunction, including decreased libido, delayed orgasm, anorgasmia, and sexual arousal difficulties. Severe mental disorders can interfere with sexual function and satisfaction, while patients wish to preserve a previously satisfactory sexual activity. In many patients, a lack of intimate relationships and chronic deterioration in mental and physical health can be accompanied by either a poor sexual life or a more frequent risky sexual behaviour than in the general population. Here we describe the influence of psychosis and antipsychotic medications, of depression and antidepressant drugs, and of bipolar disorder and mood stabilizers on sexual health, and the optimal management of patients with severe psychiatric illness and sexual dysfunction.     

TMT‐Based Proteomics Profiling of Bovine Liver Underscores Protein Markers of Anabolic Treatments

Illegal use of growth promoter compounds in food production exposes consumers to health risk. Surveillance of such practices is based on direct detection of drugs or related metabolites by HPLC‐MS/MS. Screening strategies focusing on indirect biological responses are considered promising tools to improve surveillance. In this study, an untargeted shotgun proteomics approach based on tandem mass tags (TMTs) is carried out to identify proteins altered in bovine liver after different anabolic treatments. Three controlled pharmacological treatments with dexamethasone, a combination of dexamethasone and clenbuterol, or a combination of sexual steroids (trenbolone and estradiol) are analyzed. Untargeted TMT analysis of liver digests by high resolution MS allowed for the relative quantification of proteins. Thanks to partial least squarediscriminant analysis, a set of proteins capable to classify animals treated with dexamethasone alone (11 proteins), or in combination with clenbuterol (13 proteins) are identified. No significant difference is found upon administration of sexual steroids. After relative quantification of candidate markers by parallel reaction monitoring (PRM), two predictive models are trained to validate protein markers. Finally, an independent animal set of control bulls and bulls treated with dexamethasone is analyzed by PRM to further validate a predictive model giving an accuracy of 100%.