Yolaine Rabat

Chaque année en France plus de 140000 patients sont victimes d’un accident vasculaire cérébral(AVC). Parmi eux plus d’un tiers développent des troubles émotionnels de type dépression ou anxiété post-AVC (respectivement D-PAVC et A-PAVC). Ces complications contribuent à une altération du pronostic fonctionnel et de la qualité de vie. L’identification et la prise en charge précoce des déterminants des troubles émotionnels est donc un enjeu clinique majeur. En dehors de facteurs non modifiables, tels que les antécédents psychiatriques ou la sévérité de l’AVC,l’influence des modifications d’hygiène de vie recommandées en post-AVC est indéterminée.Dans ce contexte l’influence de la dépendance, telle que conceptualisée en addictologie, à des substances usuelles - dont le tabac et l’alcool - ou émergentes comme l’alimentation hyperpalatable et ultra-transformée n’a pas été explorée.Les objectifs de ce travail étaient d’une part de déterminer les caractéristiques de l’usage problématique de substances dans la population victime d’AVC en termes de prévalence et d’impact sur le statut émotionnel post AVC, et d’autre part d’explorer les mécanismes physiopathologiques sous-tendant l’efficacité des stratégies d’interruption de ces comportements addictifs.Pour répondre au premier objectif, trois cohortes prospectives (respectivement N=2300,66,8±15,1ans, 63% d’hommes, NIHSS à 3mois=1,26±2,60 ; N=74, 60,3±12 ans, 68,9%d’hommes, NIHSS à l’admission= 2,73±3,13 et N=101, 62,8±13,7 ans, 60,4% d’hommes,NIHSS à l’admission= 2,31±3,13) de patients pris en charge dans l’Unité Neuro-Vasculaire du CHU de Bordeaux et ayant bénéficié d’évaluation cliniques et neuropsychologiques ont été analysées. Dans le cadre du second objectif, nous avons mené une analyse systématique de la littérature sur les biomarqueurs anatomo-fonctionnels cérébraux identifiés par Imagerie par Résonance Magnétique comme prédicteurs de la réponse à un traitement d’arrêt du tabac(N=24 études ; Anatomie N=7, Activité cérébrale de repos N=9, Activité cérébrale post-tâche d’activation N= 14). Les résultats de nos travaux suggèrent qu’il y a 1) une proportion importante (30,3%) de patients victimes d’AVC présentant une consommation problématique de substances ; 2) un lien entre la sévérité du profil addictif au tabac et à l’alimentation et la symptomatologie anxieuse et/ou dépressive 3 mois après l’AVC et 3) le rôle clé de l’insula dans les réseaux neuronaux anatomofonctionnels impliqués dans la réponse à un traitement de sevrage au tabac.Ces différents travaux apportent un éclairage nouveau sur l’importance du dépistage et la prise en charge des comportements addictifs dans la prévention secondaire des AVC. L’identificationRésumé6précoce de troubles liés aux consommations de substances tels que définis dans les classifications des maladies mentales, mais aussi de l’addiction à l’alimentation, pourrait permettre d’améliorer le devenir émotionnel des patients et réduire le fardeau humain et sociétal des complications post-AVC. Par ailleurs l’identification de biomarqueurs d’imagerie pourrait constituer la première étape vers une médecine de précision permettant d’adapter les stratégies thérapeutiques à l’échelle individuelle.

Introduction Diabetes represents an increasing public health challenge in France, yet national data distinguishing type 1 from type 2 diabetes and insulin use remain limited. This study aimed to describe trends in the epidemiology, care pathways and health outcomes of adult individuals living with type 1 or type 2 diabetes in France from 2010 to 2019. It focused on individuals treated or not with insulin and applied a predictive classification algorithm to accurately distinguish between diabetes types using real-world data. Methods A 10-year retrospective population-based cohort study was conducted from a representative one-tenth sample of the French national healthcare database (i.e. SNDS, Système National des données de Santé), covering nearly the entire French population. Adults (≥ 18 years) affiliated with the general insurance scheme were included. A machine learning algorithm, trained on clinical data from general practitioners, was applied to classify diabetes type. Annual trends in prevalence, incidence, comorbidities, treatments, outpatient care, complications and mortality were assessed. Results Among an extrapolated 5.5 million individuals with diabetes in 2019, 3.5% had type 1 diabetes and 96.5% had type 2 diabetes. The prevalence of type 2 diabetes increased from 6.2% in 2010 to 8.0% in 2019, while type 1 diabetes remained stable. Comorbidity rates were high and increasing in insulin-treated individuals with type 2 diabetes. In 2019, 15.3% of insulin-treated individuals with type 2 diabetes had at least one complication-related hospitalisation. Specialist consultations were underused, especially in type 2 diabetes. The mortality rate in individuals with type 1 diabetes declined from 2.6% to 1.5%, with an increase in mean age at death. Conclusion This national study provides updated insights into diabetes in France and highlights the need to improve access to specialised care and reinforce long-term surveillance strategies.

Chronic tobacco smoking remains a major health problem worldwide. Numerous smokers wish to quit but most fail, even if they are helped. The possibility of identifying neuro-biomarkers in smokers at high risk of relapse could be of incredible progress toward personalized prevention therapy. Our aim is to provide a scoping review of this research topic in the field of Magnetic Resonance Imaging (MRI) and to review the studies that investigated if MRI defined markers predicted smoking cessation treatment outcome (abstainers versus relapsers). Based on the available literature, a meta-analysis could not be conducted. We thus provide an overview of the results obtained and take stock of methodological issues that will need to be addressed to pave the way toward precision medicine. Based on the most consistent findings, we discuss the pivotal role of the insula in light of the most recent neurocognitive models of addiction.

The prevalence of clinically defined problematic substance use among stroke patients is overlooked and its association with post-stroke depression (PSD) is unknown. Our aims were to: (1) estimate the proportion of stroke patients with a problematic substance use as defined by clinical screening scales; (2) determine the proportion of PSD at three months of follow-up; (3) explore if the baseline severity in substance use and its evolution are independent predictors of PSD. A cohort of first-ever non-severe stroke adult patients was screened at baseline and three months post-stroke using recommended cut-off scores of standardized scales for tobacco, alcohol and cannabis abuse. PSD was defined using the Center of Epidemiological Studies Depression scale score. Out of the 244 eligible patients, 74 (30.3%) presented a problematic substance use, including 21 (8.6%) polydrug abusers. Among these patients, the prevalence of PSD was 50.8%, including 29.5% of severe depression. The severity of tobacco dependence at baseline was found to double the risk (OR 1.59, 95% CI 1.05–2.43) of presenting a PSD, independently of previously reported risk factors. We found no significant evidence for an effect of the evolution in substance use at follow-up. Addictive disorders are part of the critical unmet needs that should be addressed in the management of PSD.

Introduction: Poststroke depression (PSD) and anxiety (PSA) are prevalent and have a strong impact on functional outcome. Beside stroke severity, little is known on their clinical determinants. This study investigated the association between stroke mechanism, neurological poststroke complications and remaining vascular risk factors and the presence of comorbid PSD and PSA, termed poststroke emotional distress (PSED).Methods: This was a retrospective analysis of a prospectively compiled medical records database of consecutive patients evaluated during a follow‐up visit 3‐ to 4‐month poststroke. HAD scale was used to define PSED category (PSD+PSA vs. NoPSD+NoPSA). Stroke mechanism and poststroke complications were identified clinically or using appropriate scales. Their association with PSED was tested using a multivariate logistic regression model.Results: The sample included 2,300 patients (male: 64.8%); 19% had a PSED and 56.39% were free of any depression or anxiety. The most frequent poststroke complications were fatigue/fatigability (58.4%), sleep problems (26.7%), and pain (20.4%). While no association was observed between PSED and stroke mechanism, higher functional disability (OR:1.572), lower cognitive abilities (OR:0.953), sleep problems (OR:2.334), pain (OR:1.478), fatigue/fatigability (OR:2.331), and abnormal movements (OR:2.380) were all independent risk factors. Persisting tobacco consumption (OR:1.360) was the only vascular significant risk factor.Conclusions: The frequency of comorbid PSED remains high (1/5 patient) despite improved awareness of these conditions. The association between poststroke complications and the presence of PSED emphasizes the need for standardized neurological and psychological evaluations at follow‐up. These results foster the need to improve the management of addictive behaviors to reduce the burden of PSED.

Purpose While stroke is already considered a nutrition-related disease, the prevalence of the broad array of disordered eating behaviors is under-reported in this disease. We describe the case of a stroke in a young woman following a recent food addiction to fatty-sweet food. Methods She was diagnosed with a Night-Eating-Syndrome, with a loss-of-control exclusively towards sugary carbohydrates used to manage her insomnia and distress, and her consummatory behaviors were investigated. Results This case report illustrates a self-medication of a significant psychological distress by shifting from a healthy diet to an overconsumption of hyper-palatable foods, triggering an addiction disorder. The related hypertriglyceridemia, on top of chronic smoking, contributed to the development of an atherosclerotic plaque and thrombus formation. Conclusion Food addiction might be considered as an emerging stroke risk factor. We suggest it fosters the need to take into consideration addictive-like eating behaviors and associated mental disorders in the primary and secondary prevention of stroke. This may be particularly relevant for the prevention of stroke in women as they are more prone to comfort their emotions with food. Level of evidence V, descriptive study.

This study compares the impact of repeated injections of baclofen (an agonist of GABA_B receptors) or diazepam (a benzodiazepine having an agonist action on GABA_A receptors) given during the alcohol-withdrawal period on the stress-induced restoration of alcohol-seeking behavior and hypothalamic–pituitary–adrenal (HPA) axis dysfunction after a long (4 weeks) abstinence. Thus, C57BL/6 mice were submitted to a 6-month alcohol consumption [12% volume/volume (v/v)] and were progressively withdrawn to water before testing. Diazepam (Valium^®, Roche) and baclofen (Baclofen^®, Mylan) were administered intraperitoneally for 15 consecutive days (1 injection/day) during the withdrawal period at decreasing doses ranging from 1.0 mg/kg (Day 15) to 0.25 mg/kg (Day 1) for diazepam and from 1.5 mg/kg (Day 15) to 0.37 mg/kg (Day 1) for baclofen. Alcohol-seeking behavior was evaluated by alcohol-place preference in an odor recognition task. In the stress condition, mice received three electric footshocks 45 min before behavioral testing. Blood was sampled immediately after behavioral testing, and plasma corticosterone concentrations were measured by commercial enzyme immunoassay kits. Results showed that non-stressed withdrawn mice did not exhibit alcohol-place preference or alteration of plasma corticosterone concentrations relative to water controls. After stress, however, withdrawn mice exhibited a significant alcohol-place preference and higher circulating corticosterone concentrations as compared to stressed water controls. Interestingly, repeated administration during the withdrawal phase of baclofen but not diazepam suppressed both the alcohol-place preference and normalized corticosterone levels in stressed withdrawn animals. In conclusion, this study evidences that a pre-treatment with baclofen but not with diazepam during the withdrawal phase normalized, even after a long period of abstinence, the HPA axis response to stress, which contributes to the long-term preventing effects of this compound on alcohol-seeking behavior.