Impulsivity and decision making are impaired in cocaine addicts. However, most studies were performed in the USA.

To assess impulsivity and decision making in a sample of French cocaine addicts.

Compared to controls, cocaine addicts had a higher impulsivity score (BIS: 72 ± 11 vs 57 ± 8, U = 138, p < .001) and had more disadvantageous choices on the decision making test (IGT) (advantageous minus disadvantageous choices -4 ± 19 vs 24 ± 35, U = 234, p = .005). There was a significant correlation between high impulsivity scores on the BIS and high cocaine craving as well as heavy cocaine use (more than 4 times a week). No correlation was found between poor decision making and high craving or frequent cocaine use.

The discrepancy between impulsivity and poor decision making in cocaine addicts is discussed.

Mephenesin is a central muscle relaxant, acting through a depression of the activity of some neurones in the caudate nucleus. It was proposed as a potential treatment of alcohol withdrawal syndrome in the 50s. This over the counter medicine is now mainly prescribed to treat spasticity or as an adjunctive treatment of painful muscle spasm. We know little about this substance except that side effects are venous thrombosis, haemolysis or cutaneous intolerance. Yet, no case of abuse or dependence has been reported.

To report a series of 5 clinical cases in patients who developed abuse or dependence to mephenesin.

We performed a systematic search in data bases of both Paris addictovigilance and poison centres from 1999 to 2010. Clinical details were obtained from clinicians when possible. A literature search was also performed to describe mephenesin mechanisms of actions that could be implied.

Three (3) women et 2 men aged 35 to 52 years (m : 43.6) were identified as abusing mephenesin, among which 4 patients had a full DSM IV criteria of dependence. All had a previous history of abuse or substance dependence (alcohol, heroin, codeine, ketamine…).The average mephenesin daily intake was 13 g (9 to 24 g) when the maximum recommended dosage is 3 gr/d. In one case, a withdrawal syndrome was observed (tremor, aggressiveness).

Mephenesin may be abused by patients with previous risk factors, especially a personal history of alcohol dependence.

Cocaine users often experience transient psychotic symptoms following cocaine use (Smith et al. 2009). The severity of such psychotic symptoms is influenced by cocaine dose (Vorspan et al. 2011). Several authors observed a higher prevalence of childhood trauma in cocaine addicts than control subjects (Enoch et al. 2010).

Describe cocaine induced psychosis and evaluate if it is associated with childhood trauma.

Define the population of cocaine users who experiment cocaine induced psychotic symptoms.

We did a transversal retrospective study. 100 outpatient cocaine users were evaluated with Scale for the Assessment of Positive Symptoms of Crack Induced Psychosis (SAPS-CIP) and Childhood Trauma Questionnaire (CTQ). Informations were obtained about lifetime cocaine use (age of onset, DSM IV dependence criteria, route of administration, daily dose, days of use per month).

We did not observe any link between SAPS-CIP and CTQ or CTQ and cocaine consumption. About cocaine consumption, more often patients took cocaine during the worst period, higher is the SAPS-CIP score. If patients are (or were) dependent to cocaine, they have higher scores on SAPS-CIP. Moreover, if patients took cocaine intravenously, they have higher scores on SAPS-CIP than if they took it by snorting, or smoking.

In the conditions of our study, childhood trauma isn’t a mediator for cocaine induced psychosis. About psychotic symptoms, they seem to be more severe among daily cocaine dependents who take it intravenously.

Withdrawal syndrome occurs in 50% of cannabis dependant patients. In our clinical practice, we observed that few patients recognize and attribute abstinence symptoms to cannabis cessation. Insight or awareness of cannabis dependence remains poorly studied.

We propose to study the relationship between insight and cannabis withdrawal syndrome. Our hypothesis is that patients showing a higher score on a cannabis withdrawal scale would have a higher score on an insight scale.

We recruited 35 cannabis dependent outpatients between October 2008 and April 2009 in an addiction clinic. Insight of cannabis dependance was assessed with the insight Q8 scale ranging [0–8]. We designed a cannabis withdrawal scale by checking DSM V withdrawal symptoms, and each symptom was retrospectively scored by an analogue scale (from 0 to 5). Correlation between insight and withdrawal scores was calculated using Spearman's ρ.

Sex ratio was 2.5. Mean age was 35.9 ± 1.4 years. Most patients (85.7%) reported at least one withdrawal symptom. Sleep disturbances (95.8%) and craving (75.8%) were the most frequent. Mean score of insight was of 4.2 ± 0.4 points.

The intensity of withdrawal syndrome and insight score were positively correlated (ρ = 0.594, p < 0.001).

Our results show an association between experiencing more withdrawal symptoms and insight or awareness of cannabis dependence. These results could be used in the treatment of cannabis dependent patients.

A substantial proportion of persons with mental disorders seek treatment from complementary and alternative medicine (CAM) professionals. However, data on how CAM contacts vary across countries, mental disorders and their severity, and health care settings is largely lacking. The aim was therefore to investigate the prevalence of contacts with CAM providers in a large cross-national sample of persons with 12-month mental disorders.

In the World Mental Health Surveys, the Composite International Diagnostic Interview was administered to determine the presence of past 12 month mental disorders in 138 801 participants aged 18–100 derived from representative general population samples. Participants were recruited between 2001 and 2012. Rates of self-reported CAM contacts for each of the 28 surveys across 25 countries and 12 mental disorder groups were calculated for all persons with past 12-month mental disorders. Mental disorders were grouped into mood disorders, anxiety disorders or behavioural disorders, and further divided by severity levels. Satisfaction with conventional care was also compared with CAM contact satisfaction.

An estimated 3.6% (standard error 0.2%) of persons with a past 12-month mental disorder reported a CAM contact, which was two times higher in high-income countries (4.6%; standard error 0.3%) than in low- and middle-income countries (2.3%; standard error 0.2%). CAM contacts were largely comparable for different disorder types, but particularly high in persons receiving conventional care (8.6–17.8%). CAM contacts increased with increasing mental disorder severity. Among persons receiving specialist mental health care, CAM contacts were reported by 14.0% for severe mood disorders, 16.2% for severe anxiety disorders and 22.5% for severe behavioural disorders. Satisfaction with care was comparable with respect to CAM contacts (78.3%) and conventional care (75.6%) in persons that received both.

CAM contacts are common in persons with severe mental disorders, in high-income countries, and in persons receiving conventional care. Our findings support the notion of CAM as largely complementary but are in contrast to suggestions that this concerns person with only mild, transient complaints. There was no indication that persons were less satisfied by CAM visits than by receiving conventional care. We encourage health care professionals in conventional settings to openly discuss the care patients are receiving, whether conventional or not, and their reasons for doing so.

Research on post-traumatic stress disorder (PTSD) course finds a substantial proportion of cases remit within 6 months, a majority within 2 years, and a substantial minority persists for many years. Results are inconsistent about pre-trauma predictors.

The WHO World Mental Health surveys assessed lifetime DSM-IV PTSD presence-course after one randomly-selected trauma, allowing retrospective estimates of PTSD duration. Prior traumas, childhood adversities (CAs), and other lifetime DSM-IV mental disorders were examined as predictors using discrete-time person-month survival analysis among the 1575 respondents with lifetime PTSD.

20%, 27%, and 50% of cases recovered within 3, 6, and 24 months and 77% within 10 years (the longest duration allowing stable estimates). Time-related recall bias was found largely for recoveries after 24 months. Recovery was weakly related to most trauma types other than very low [odds-ratio (OR) 0.2–0.3] early-recovery (within 24 months) associated with purposefully injuring/torturing/killing and witnessing atrocities and very low later-recovery (25+ months) associated with being kidnapped. The significant ORs for prior traumas, CAs, and mental disorders were generally inconsistent between early- and later-recovery models. Cross-validated versions of final models nonetheless discriminated significantly between the 50% of respondents with highest and lowest predicted probabilities of both early-recovery (66–55% v. 43%) and later-recovery (75–68% v. 39%).

We found PTSD recovery trajectories similar to those in previous studies. The weak associations of pre-trauma factors with recovery, also consistent with previous studies, presumably are due to stronger influences of post-trauma factors.

Although specific phobia is highly prevalent, associated with impairment, and an important risk factor for the development of other mental disorders, cross-national epidemiological data are scarce, especially from low- and middle-income countries. This paper presents epidemiological data from 22 low-, lower-middle-, upper-middle- and high-income countries.

Data came from 25 representative population-based surveys conducted in 22 countries (2001–2011) as part of the World Health Organization World Mental Health Surveys initiative (n = 124 902). The presence of specific phobia as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition was evaluated using the World Health Organization Composite International Diagnostic Interview.

The cross-national lifetime and 12-month prevalence rates of specific phobia were, respectively, 7.4% and 5.5%, being higher in females (9.8 and 7.7%) than in males (4.9% and 3.3%) and higher in high- and higher-middle-income countries than in low-/lower-middle-income countries. The median age of onset was young (8 years). Of the 12-month patients, 18.7% reported severe role impairment (13.3–21.9% across income groups) and 23.1% reported any treatment (9.6–30.1% across income groups). Lifetime co-morbidity was observed in 60.5% of those with lifetime specific phobia, with the onset of specific phobia preceding the other disorder in most cases (72.6%). Interestingly, rates of impairment, treatment use and co-morbidity increased with the number of fear subtypes.

Specific phobia is common and associated with impairment in a considerable percentage of cases. Importantly, specific phobia often precedes the onset of other mental disorders, making it a possible early-life indicator of psychopathology vulnerability.

Although there is robust evidence linking childhood adversities (CAs) and an increased risk for psychotic experiences (PEs), little is known about whether these associations vary across the life-course and whether mental disorders that emerge prior to PEs explain these associations.

We assessed CAs, PEs and DSM-IV mental disorders in 23 998 adults in the WHO World Mental Health Surveys. Discrete-time survival analysis was used to investigate the associations between CAs and PEs, and the influence of mental disorders on these associations using multivariate logistic models.

Exposure to CAs was common, and those who experienced any CAs had increased odds of later PEs [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.9–2.6]. CAs reflecting maladaptive family functioning (MFF), including abuse, neglect, and parent maladjustment, exhibited the strongest associations with PE onset in all life-course stages. Sexual abuse exhibited a strong association with PE onset during childhood (OR 8.5, 95% CI 3.6–20.2), whereas Other CA types were associated with PE onset in adolescence. Associations of other CAs with PEs disappeared in adolescence after adjustment for prior-onset mental disorders. The population attributable risk proportion (PARP) for PEs associated with all CAs was 31% (24% for MFF).

Exposure to CAs is associated with PE onset throughout the life-course, although sexual abuse is most strongly associated with childhood-onset PEs. The presence of mental disorders prior to the onset of PEs does not fully explain these associations. The large PARPs suggest that preventing CAs could lead to a meaningful reduction in PEs in the population.

Considerable research has documented that exposure to traumatic events has negative effects on physical and mental health. Much less research has examined the predictors of traumatic event exposure. Increased understanding of risk factors for exposure to traumatic events could be of considerable value in targeting preventive interventions and anticipating service needs.

General population surveys in 24 countries with a combined sample of 68 894 adult respondents across six continents assessed exposure to 29 traumatic event types. Differences in prevalence were examined with cross-tabulations. Exploratory factor analysis was conducted to determine whether traumatic event types clustered into interpretable factors. Survival analysis was carried out to examine associations of sociodemographic characteristics and prior traumatic events with subsequent exposure.

Over 70% of respondents reported a traumatic event; 30.5% were exposed to four or more. Five types – witnessing death or serious injury, the unexpected death of a loved one, being mugged, being in a life-threatening automobile accident, and experiencing a life-threatening illness or injury – accounted for over half of all exposures. Exposure varied by country, sociodemographics and history of prior traumatic events. Being married was the most consistent protective factor. Exposure to interpersonal violence had the strongest associations with subsequent traumatic events.

Given the near ubiquity of exposure, limited resources may best be dedicated to those that are more likely to be further exposed such as victims of interpersonal violence. Identifying mechanisms that account for the associations of prior interpersonal violence with subsequent trauma is critical to develop interventions to prevent revictimization.

In this global study we sought to estimate the degree to which a family member might feel embarrassed when a close relative is suffering from an alcohol, drug, or mental health condition (ADMC) versus a general medical condition (GMC). To date, most studies have considered embarrassment and stigma in society and internalized by the afflicted individual but have not assessed family embarrassment in a large-scale study.

In 16 sites of the World Mental Health Surveys (WMHS), standardized assessments were completed including items on family embarrassment. Site matching was used to constrain local socially shared determinants of stigma-related feelings, enabling a conditional logistic regression model that estimates the embarrassment close relatives may hold in relation to family members affected by an ADMC, a GMC, or both conditions.

There was a statistically robust association such that subgroups with an ADMC-affected relative were more likely to feel embarrassed compared to subgroups with a relative affected by a GMC (p < 0.001), even with covariate adjustments for age and sex.

The pattern of evidence from this research is consistent with conceptual models for interventions that target individual- and family-level stigma-related feelings of embarrassment as possible obstacles to effective early intervention and treatment for an ADMC. Macro-level interventions are under way but micro-level interventions may also be required among family members, along with care for each person with an ADMC.

Current trends in population aging affect both recipients and providers of informal family caregiving, as the pool of family caregivers is shrinking while demand is increasing. Epidemiological research has not yet examined the implications of these trends for burdens experienced by aging family caregivers.

Cross-sectional community surveys in 20 countries asked 13 892 respondents aged 50+ years about the objective (time, financial) and subjective (distress, embarrassment) burdens they experience in providing care to first-degree relatives with 12 broadly defined serious physical and mental conditions. Differential burden was examined by country income category, kinship status and type of condition.

Among the 26.9–42.5% respondents in high-, upper-middle-, and low-/lower-middle-income countries reporting serious relative health conditions, 35.7–42.5% reported burden. Of those, 25.2–29.0% spent time and 13.5–19.4% money, while 24.4–30.6% felt distress and 6.4–21.7% embarrassment. Mean caregiving hours per week in those giving any time were 16.6–23.6 (169.9–205.8 h/week per 100 people aged 50+ years). Burden in low-/lower-middle-income countries was 2- to 3-fold higher than in higher-income countries, with any financial burden averaging 14.3% of median family income in high-, 17.7% in upper-middle-, and 39.8% in low-/lower-middle-income countries. Higher burden was reported by women than men and for conditions of spouses and children than parents or siblings.

Uncompensated family caregiving is an important societal asset that offsets rising formal healthcare costs. However, the substantial burdens experienced by aging caregivers across multiple family health conditions and geographic regions threaten the continued integrity of their caregiving capacity. Initiatives supporting older family caregivers are consequently needed, especially in low-/lower-middle-income countries.

A number of western studies have suggested that the 6-month duration requirement of generalized anxiety disorder (GAD) does not represent a critical threshold in terms of onset, course, or risk factors of the disorder. No study has examined the consequences of modifying the duration requirement across a wide range of correlates in both developed and developing countries.

Population surveys were carried out in seven developing and 10 developed countries using the WHO Composite International Diagnostic Interview (total sample=85 052). Prevalence and correlates of GAD were compared across mutually exclusive GAD subgroups defined by different minimum duration criteria.

Lifetime prevalence estimates for GAD lasting 1 month, 3 months, 6 months and 12 months were 7.5%, 5.2%, 4.1% and 3.0% for developed countries and 2.7%, 1.8%, 1.5% and 1.2% for developing countries, respectively. There was little difference between GAD of 6 months' duration and GAD of shorter durations (1–2 months, 3–5 months) in age of onset, symptom severity or persistence, co-morbidity or impairment. GAD lasting ⩾12 months was the most severe, persistently symptomatic and impaired subgroup.

In both developed and developing countries, the clinical profile of GAD is similar regardless of duration. The DSM-IV 6-month duration criterion excludes a large number of individuals who present with shorter generalized anxiety episodes which may be recurrent, impairing and contributory to treatment-seeking. Future iterations of the DSM and ICD should consider modifying the 6-month duration criterion so as to better capture the diversity of clinically salient anxiety presentations.