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Until the 90’s, the most commonly accepted hypothesis to understand how subjects become alcoholic was related to interactions of ethanol with various brain receptors of neurotransmitters at the level of the « brain reward circuit ». Recently, researchers have been trying to explain alcohol dependence by other mechanisms that do not involve this “brain reward circuit”.
Our working hypothesis is that the development of alcohol addiction would involve more peripheral mechanisms and especially gut-brain interactions. In the context of this final project, we tested the effect of ethanol on gut barrier in patients hospitalized for alcohol withdrawal. We tested the possibility that increased intestinal permeability would allow the translocation of LPS from the gut lumen to the systemic circulation. This endotoxemia would induce an inflammatory response that would contribute to mood changes like depression, anxiety and craving.
We observed that intestinal permeability and endotoxemia increased in alcoholic patients at the beginning of the withdrawal but restored completely after three weeks of abstinence. Additionally, inflammation and psychological disorders decreased during the alcohol withdrawal but were higher at the end of the withdrawal than in a control population. According to the “Sickness Behaviour Theory”, we think that pro-inflammatory cytokines would take part in the development of depressive symptoms and craving in alcoholic patients.
The pharmacological treatments of alcoholism that most often target neurotransmitters do not show to be very efficient. A reason might be that they do not act on inflammation. A very interesting perspective would be to test nutritional factors such as probiotics or prebiotics that are known to have a positive impact on gut barrier to reduce inflammation and improve mood and craving as a new treatment of alcohol dependence Jusqu’au bout des années 90, la recherche des mécanismes impliqués dans la dépendance alcoolique s’était essentiellement focalisée sur le cerveau. Les études neurobiologiques s’étaient surtout intéressées au rôle du « circuit de récompense cérébrale » et des variations de concentrations de neurotransmetteurs dans les terminaisons nerveuses pour expliquer l’alcool dépendance. Depuis peu, les chercheurs s’intéressent aux implications possibles de mécanismes plus périphériques dans le développement de la problématique alcoolique. Dans cette optique, nous avons mis à l’épreuve une hypothèse de régulation de l’appétence à l’alcool par des mécanismes impliquant une communication entre l’intestin et le cerveau (« gut-brain axis »). Plus précisément, nous avons testé chez les individus alcooliques au cours du sevrage en milieu hospitalier l’hypothèse d’un effet délétère de l’alcool sur la barrière intestinale qui, en la rendant plus perméable, entrainerait un passage de lipopolysaccharides intestinaux vers le sang. Cette translocation bactérienne induirait, chez ces patients, une réaction inflammatoire, laquelle participerait au développement des affects dépressifs et anxieux qui eux-mêmes stimuleraient l’envie de boire. Nos observations empiriques soutiennent en bonne partie cette hypothèse. La perméabilité intestinale et l’endotoxémie étaient nettement augmentées chez les alcooliques en début de sevrage. Par ailleurs, les facteurs inflammatoires et psychologiques également très augmentés en début de sevrage diminuaient de manière significative mais restaient, cependant en fin de sevrage, plus élevés que chez les sujets contrôles. Nos analyses corrélationnelles nous amènent à supposer, en accord avec la théorie du « Sickness Behaviour », que les cytokines pro-inflammatoires pourraient jouer un rôle dans la symptomatologie dépressive et le craving chez les sujets alcooliques

Alcoholism --- Permeability --- Intestinal Absorption --- Illness Behavior

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Health Behavior --- Patient Education as Topic --- Health behavior. --- Sick --- Patient education. --- Prediction (Psychology) --- Habitudes sanitaires --- Education des patients --- Prédiction (Psychologie) --- Behavior modification. --- Habits --- Illness Behavior

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What counts as health or ill health? How do we deal with the fallibility of our own bodies? Should illness and disease be considered simply in biological terms, or should considerations of its emotional impact dictate our treatment of it? Our understanding of health and illness had become increasingly more complex in the modern world, as we are able to use medicine not only to fight disease but to control other aspects of our bodies, whether mood, blood pressure, or cholesterol. This collection of essays foregrounds the concepts of health and illness and patient experience within the philosophy of medicine, reflecting on the relationship between the ill person and society. Mental illness is considered alongside physical disease, and the important ramifications of society's differentiation between the two are brought to light. Health, Illness and Disease is a significant contribution to shaping the parameters of the evolving field of philosophy of medicine and will be of interest to medical practitioners and policy-makers as well as philosophers of science and ethicists.--

Attitude to Health. --- Disease. --- Filosofie. --- Gesundheit. --- Gezondheid. --- Health. --- Illness Behavior. --- Krankheit. --- Medicine --- Medizin. --- Philosophie. --- Philosophy, Medical. --- Ziekte. --- Philosophy. --- Medical logic --- Philosophy --- Health Workforce

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Clinical health psychology --- Sick --- -Ill persons --- Persons --- Diseases --- Patients --- Health psychology --- Health psychology, Clinical --- Psychology, Clinical health --- Psychology, Health --- Salutogenesis --- Clinical psychology --- Medicine and psychology --- Psychology --- -Psychology --- Illness behavior --- Sick role --- Psychology, Applied --- Psychological aspects

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Neuroticism. --- Personality --- Sick --- Diseases --- Illness behavior --- Sick role --- Medicine and psychology --- Psychology, Applied --- Personal identity --- Personality psychology --- Personality theory --- Personality traits --- Personology --- Traits, Personality --- Psychology --- Individuality --- Persons --- Self --- Temperament --- Psychology, Pathological --- Neuroses --- Psychology. --- Psychological aspects