Venue: Centre Broca
Defense in french
Impact of the addictive profile on post-stroke emotional status.
Every year in France 140000 patients had a stroke. Amongst them, a third develop emotional impairments such as post-stroke depression or anxiety (respectively PSD and PSA). These complications contribute to an alteration in the functional prognostic and quality of life of these patients. The early identification and management of these emotional impairments is therefore a major clinical issue. Outside of non-modifiable risk factors such as a history of psychiatric disorders or the clinical stroke severity, the influence of the changes in health lifestyle that are recommended post-stroke is not known. In this context, the impact of problematic substance use, as conceptualized in addictology, of usual substances, such as tobacco and alcohol, or of the new and emerging hyper-palatable and highly processed (HP) foods, has yet not been explored.
The objectives of this present work were to determine amongst the stroke population the characteristics of such problematic substance use in terms of prevalence and impact on post-stroke emotional impairments, on the one hand, and to explore the pathophysiological mechanisms supporting the response to substance use cessation treatment strategies.
In order to answer the first objective, three prospective cohorts comprising of patients admitted to the Neuro-vascular Unit at the University Hospital of Bordeaux and who benefited from clinical and neuropsychiatric evaluations were analyzed (1: N=2300, 66.8±15.1 years old, 63% males, NIHSS at 3 months=1.26±2.60; 2) N=74, 60.3±12 years old, 68.9% males, NIHSS at admission= 2.73±3.13; 3) N=101, 62.8±13.7 years old, 60.4% males, NIHSS at admission= 2.31±3.13). In the context of our second objective, we conducted a systematic review of the current literature on the cerebral biomarkers identified by Magnetic Resonance Imaging as predictors of smoking cessation treatment outcome (N=24 studies: N=7 anatomical, N=9 resting state, N=14 activation).
The results of our work suggest that 1) there is an important proportion (30,3%) of stroke victims presenting a problematic substance use; 2) a link exists between the addiction profile severity to tobacco and HP foods and the anxious and/or depressive symptomatology at 3 months post-stroke; and 3) highlight the key role of the insula in the neuronal anatomical-functional circuits implicated in smoking cessation treatment outcome.
These different studies offer a new insight into the importance of the screening and management of addictive behaviours in the secondary prevention of stroke. The early identification of disorders linked to substance abuse, as defined in the classification of mental illnesses but also to food addiction, could help to enhance the patients’ emotional well-being and therefore reduce the socio-economical burden of post-stroke complications. Moreover, characterizing specific imaging biomarkers of the response to cessation treatment could constitute the first step towards precision medicine by prescribing specific therapeutic strategies tailored at an individual scale.
Key words: stroke, emotional impairments, depression, anxiety, addictive disorders, problematic substance use, tobacco, alcohol, food addiction
Rabat Y, Chanraud S, Abdallah M, Sibon I, Berthoz S. Precision Preventive Medicine of Relapse in Smoking Cessation: Can MRI Inform the Search of Intermediate Phenotypes? Biology (Basel). 2021 Dec 27;11(1):35. doi: 10.3390/biology11010035. PMID: 35053034; PMCID: PMC8773102.
Rabat Y, Sibon I, Berthoz S. Implication of problematic substance use in poststroke depression: an hospital-based study. Sci Rep. 2021 Jun 25;11(1):13324. doi: 10.1038/s41598-021-92639-5. PMID: 34172774; PMCID: PMC8233374.
Rabat Y, Houeze R, Sagnier S, Olindo S, Poli M, Debruxelles S, Renou P, Rouanet F, Berthoz S, Sibon I. Association between neurological outcome and poststroke comorbid mood and anxiety disorders: A real-life experience. Brain Behav. 2021 Jun;11(6):e02158. doi: 10.1002/brb3.2158. Epub 2021 May 5. PMID: 33951353; PMCID: PMC8213928.
Rabat Y, Berthoz S, Sibon I. Is addictive-like eating an overlooked stroke risk factor? A study case. Eat Weight Disord. 2021 Dec;26(8):2801-2806. doi: 10.1007/s40519-021-01115-6. Epub 2021 Feb 9. PMID: 33559834.
Rabat Y, Henkous N, Corio M, Nogues X, Beracochea D. Baclofen but Not Diazepam Alleviates Alcohol-Seeking Behavior and Hypothalamic-Pituitary-Adrenal Axis Dysfunction in Stressed Withdrawn Mice. Front Psychiatry. 2019 Apr 16;10:238. doi: 10.3389/fpsyt.2019.00238. PMID: 31105600; PMCID: PMC6492502.
- Arnaud CARRE (Rapporteur) – Maître de conférences des Universités, Savoie
- Mathieu ZUBER (Rapporteur) – Professeur des Université et Praticien hospitalier – Université Paris Descartes, Paris
- Sonia ALAMOWITCH (Examinatrice) – Professeure des Université et Praticienne hospitalier – Université de la Sorbonne, Paris
- Cécile DANTZER (Examinatrice) – Maître de conférences des Universités, Bordeaux
- Sonia REYES-OLIVIERO (Examinatrice) – Psychologue clinicienne, Paris
- Sylvie BERTHOZ (Invitée) – Dr en Neurosciences et Psychologue, Bordeaux
- Igor SIBON (Directeur de thèse) – Professeur des Université et Praticien hospitalier – Université de Bordeaux, Bordeaux