Benoit Schreck

Dès le tournant des années 2000, l'apparition des cathinones de synthèse, nouvelles substances psychostimulantes, a été associée à l'apparition de nouveaux comportements de consommation. L'un d'entre eux, le slam, se caractérise par l'injection de psychostimulants par voie intraveineuse dans le cadre de relations sexuelles. Dès 2007, on a observé un net développement de l'usage des cathinones en contexte sexuel parmi les hommes ayant des rapports sexuels avec des hommes (HS). Le slam se distinguerait des formes antérieures d'usages de substances en contexte sexuel chez les HSH par l'utilisation privilégiée de plateformes numériques de rencontre, par la consommation de cathinones se faisant strictement au service des activités sexuelles et par la très fréquente association à des pratiques sexuelles extrêmes. Ainsi, en 2017, ce nouveau phénomène en plein essor suscitait de nombreuses interrogations. Cependant, très peu de données scientifiques étaient disponibles pour y répondre. Cette thèse de doctorat visait donc à faire progresser la compréhension de comportements qualifiés d'addictifs, en clarifiant les données pharmacologiques et les processus psychologiques impliqués dans cette pratique singulière. Les travaux de recherche présentés ont démontré la nature hautement addictive des cathinones de synthèse lorsqu'elles sont utilisées dans ce contexte et la fréquente perte de contrôle vis-à-vis de la sexualité. Nos résultats ont mis également en évidence le rôle facilitateur et valorisant des drogues dans le sexe. li est indispensable que l'ensemble des acteurs de santé développent des dispositifs de soins adaptés à cette pratique afin de favoriser une prise en charge efficace des slameurs.

Sex addiction is characterized by a persistent pattern of failure to control intense and repetitive sexual urges, thus causing marked distress or impairment in important areas of functioning. Sex addiction may co-occur with other psychiatric conditions, including suicide risk, but few studies have explored such co-occurrences in depth, and these studies were based on small samples. A total of 136 patients referred to the Nantes University Hospital for sex addiction between 2013 and 2022 were included. Sex addiction was diagnosed using Goodman’s scale for the diagnosis of behavioral addictions. Suicide risk was assessed using the suicidality module of the MINI 5.0. A multivariate logistic regression model was used to identify factors associated with the presence of suicide risk. Suicide risk was detected among 46% of patients. Four variables were found to be associated with suicide risk: a higher proportion of relatives aware of the sex addiction, a higher frequency of anxiety disorders, a higher frequency of mood disorders and a lower level of self-directedness. The frequency of suicide risk in patients with behavioral addictions is greater than that reported in previous studies. Mood and anxiety disorders are two factors that are often found to be associated with suicide risk among individuals with sex addiction, while awareness of sex addiction by relatives and a low level of self-directedness are two factors that have not been previously identified. In fact, it may be relevant to improve the self-directedness dimension through psychotherapies and to consider the inclusion of the patient’s partner in the treatment.

Objective A large body of literature has examined the links between the use of dopamine replacement therapy (DRT) in Parkinson’s disease (PD) and the development of “impulsive-compulsive behaviors (ICBs).” Little is known regarding the link between the development of ICBs and health-related quality of life (HRQOL). We aimed to explore the factors that are associated with poorer HRQOL, especially in relation to DRT-induced ICBs, in a sample of PD patients.Methods This PARKADD (PARK: PARKinson’s disease; ADD: behavioral ADDictions) study was a prospective case‒control study initially designed to assess the factors associated with ICBs in PD patients. A prospective clinical follow-up was added, aiming to capture the long-term evolution of HRQOL in relation to ICBs occurring or worsening after the beginning of PD. We focused on sociodemographic and PD characteristics and the history or presence of ICBs. HRQOL was measured using the Parkinson’s Disease Questionnaire-8. A multivariate linear regression was performed to identify factors related to poorer HRQOL.Results A total of 169 patients were eligible for the follow-up study. The presence of an ICB, a higher levodopa equivalent daily dose (LEDD) and a longer PD duration were significantly associated with poorer HRQOL, with an interaction between LEDD and PD duration.Conclusion The presence of an ICB was related to poorer HRQOL and should be considered a crucial factor for the management of PD patients. Several studies were recently published that provide guidelines for the management of these patients, with recommendations based on two key principles: prevention and specific treatment.

Introduction: Since the first description of sex addiction (SA) by Carnes, research on this problematic behaviour has continued to grow, and the association with attention-deficit hyperactivity disorder (ADHD) appears to be frequent. This study aimed to estimate the frequency of a history of probable ADHD in a population of patients with SA and to explore the factors associated with it. Methods: One hundred 85 patients referred to the Nantes University Hospital for SA between 2011 and 2020 were included. Patients completed the Sexual Addiction Screening Test (SAST) or its revised version (SAST-R) to establish the presence of SA. As the SAST-R was not validated in French, we conducted a validation study for the French version. ADHD was screened using the Wender-Utah Rating Scale in childhood and the Adult ADHD Self-Report Scale in adulthood. A multivariate logistic regression model was used to identify factors associated with the presence of a history of probable ADHD. Results: Childhood ADHD was identified in 36% of patients with SA. Factors associated with the presence of a history of probable ADHD were a low education level, an earlier age of onset of problematic sexual behaviour, another addictive disorder, an anxiety disorder, impulsivity (high negative urgency score), and high scores on harm avoidance and novelty-seeking temperament scales. Furthermore, the French version of the SAST-R displayed good psychometric properties, especially excellent sensitivity. Conclusion: The frequency of a history of probable ADHD among patients with SA is consistent with the literature and close to the highest range. Specific personality traits in patients with both SA and a history of probable ADHD could induce lasting problems of adaptation, which may precipitate the development of SA or maintain it.

Background and aims: Parkinson's disease (PD) is one of the most prevalent neurodegenerative diseases. First-line medications consist of drugs that act by counteracting dopamine deficiency in the basal ganglia. Unfortunately, iatrogenic impulsive-compulsive behaviors (ICBs) can occur in up to 20% of PD patients over the course of their illness. ICBs must be considered multifactorial disorders that reflect the interactions of the medication with an individual's vulnerability and the underlying neurobiology of PD. We aimed to explore the predictive genetic, psychopathological and neurological factors involved in the development of ICBs in PD patients by building a complete model of individual vulnerability. Methods: The PARKADD study was a case/non-case study. A total of 225 patients were enrolled (“ICB” group, N = 75; “no ICB” group, N = 150), and 163 agreed to provide saliva samples for genetic analysis. Sociodemographic, neurological and psychiatric characteristics were assessed, and genotyping for the characterization of polymorphisms related to dopaminergic and opioid systems was performed. Results: Factors associated with “ICBs” were younger age of PD onset, personal history of ICB prior to PD onset and higher scores on the urgency and sensation seeking facets of impulsivity. No gene variant was significantly associated, but the association with the opioid receptor mu 1 (OPRM1) rs1799971 polymorphism was close to significance. Discussion and conclusions: The influence of gene-environment interactions probably exists, and additional studies are needed to decipher the possible role of the opioid system in the development of ICBs in PD patients.

Background: To “limit the risk of abuse and misuse” and “encourage correct usage”, the French drug regulatory authority stated that—from April 2017—zolpidem prescription must be performed on a secured prescription pad. This national study aims to evaluate the perception of general practitioners (GPs) towards this new regulation and its link with prescription strategies. Methods: We conducted structured interviews of GPs. Data were collected about GPs’ perception of the measure and therapeutic strategies towards zolpidem. The primary outcome was the description of the GPs’ strategy of prescription, based on the perception towards the new regulation for zolpidem. Results: For 206 GPs, the new regulation was mainly perceived as helpful (61%) and as a difficulty (55%). Other perceptions were the awareness of the risks of zolpidem (18%), awareness of the risks of hypnotics (13%), and nothing changed (5%). Four clusters of GPs were identified. In the clusters with the perception as a difficulty (only or associated with helpful), the GPs who applied the strategy “no modification” for >50% of their patients were more frequently compared to awareness and helpful only clusters (60.8%; 42.9%; 20.4%; 26.7%) (p < 0.001). Conclusions: We highlighted an association between the perception of the new regulation of zolpidem prescription by GPs and a strategy of prescription.