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Objectives: This study aims to identify the prevalence of Ultra High Risk (UHR) adults in a sample of patients in Lebanon and to compare screening and diagnostic tools., Methods: This is a cross-sectional pilot study which targeted patients aged 17-30 years willingly seeking psychiatric care in a university hospital in Beirut, Lebanon. Participants were invited to fill either the English or the French version of the Prodromal Questionnaire (respectively, PQ16 or fPQ16). The abbreviated version of the "Comprehensive Assessment of At-Risk Mental States" (CAARMS) was then administered to all participants. The latter were subsequently sorted into one of the three UHR groups - vulnerability group, attenuated psychosis (APS), intermittent psychosis (BLIPS) - or were diagnosed as suffering from a psychotic disorder., Results: Thirty-one patients participated in this study. The prevalence of positive screening on the PQ16/fPQ16 and positive diagnosis of UHR on the CAARMS were respectively of 61.29% and 45%. The APS group was the most prevalent (71.42%). A positive psychosis screening on PQ16/fPQ16 was statistically related to a UHR diagnosis on CAARMS (p-value: 0.011 on Chi 2 test), OR=8.5 (95% CI: 1.4-50.9; p-value: 0.018). No relation was found between PQ16/fPQ16 results and risk stratification or between the number of "True" responses on PQ16/fPQ16 and the intensity of symptoms on CAARMS. PQ16/fPQ16 statements 5, 9, 11 and 16 predicted a UHR diagnosis on CAARMS (p-value of 0.045, 0.006, 0.045 and 0.045, respectively)., Conclusion: This two-stage strategy for identifying UHR patients can be adopted in a tertiary health care center., (Copyright © 2022 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Objectives: We aimed to study the relationship between tobacco smoking and attenuated psychosis measures taking into account several aspects of tobacco consumption that to date have not been explored and that could help understand this association, such as age of onset, the influence of former consumption and the duration of abstinence., Methods: We investigated, in a sample of 580 students, the relationship between schizotypy (using the schizotypal personality questionnaire-brief in a Likert format) and smoking status, nicotine dependence (measured with the Fagerström test for nicotine dependence), age of onset of smoking and in former smokers, duration of smoking abstinence., Results: 35.2% of the students were current smokers and 13.4% were former smokers. We found that current but not former smokers had higher scores of schizotypy (total, positive and disorganized) than non-smokers. We found no association between schizotypy scores and nicotine dependence or earlier age of onset of smoking. The duration of smoking abstinence, in former smokers, was inversely correlated to the score of positive and total schizotypy., Conclusions: Our results suggest that tobacco has a reversible effect on schizotypy, but more studies with a different design (controlled, longitudinal) and a more thorough exploration of potential confounders (e.g. cannabis) are needed before a firm conclusion can be reached., (Copyright © 2022 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Objectives: Though relatively unexplored in clinical populations, aversive personality traits have been shown to impact the expression, the management, and the outcomes of psychotic disorders. This paper seeks to gather and organize existing evidence of the complex interplay linking social ethics, personality and experiences of psychosis through the lens of the so-called Dark Triad personality model, comprising the three multidimensional constructs Machiavellianism, narcissism and psychopathy., Methods: A semi-systematic review of major literature databases was conducted; search terms aimed at capturing each of the Dark Triad dimensions and their known relations with both clinical (with single-symptom approach) and non-clinical psychotic experiences., Results: Reviewed studies suggest that all the components of the Dark Triad model present significant clinical implications in the management of psychotic disorders., Conclusions: Aversive personality traits interact with and modulate the experiences of psychosis. They can be shown to influence the clinical and functional outcomes of psychotic patients. Therefore, further research on this theme seems justified in that it may inform rehabilitative efforts., (Copyright © 2022 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Background: If exposure to childhood trauma increases the risk to later develop a psychotic disorder, the impact of such events on clinical presentation and outcome after a first psychotic episode deserves attention both in order to identify specific patients' needs and to develop adapted therapeutic interventions., Methods: Three hundred and sixty-two patients treated at TIPP-Lausanne, a specialized program for the treatment of the early phase of psychotic disorders, were assessed prospectively, from baseline and every six months until the end of the 36 months of treatment. We compared characteristics of patients exposed to childhood sexual and/or physical abuse to those of non-exposed patients., Results: One hundred and eight patients (29.8 %) were exposed to at least one episode of physical and/or sexual abuse during childhood. Exposed patients displayed higher levels of positive and depressive symptoms and had lower levels of functioning throughout the entire three year follow-up period., Conclusions: The prevalence of exposure to major traumatic events during childhood in early psychosis patients is very high, and it has an important impact on symptomatic and functional outcome. However, when clinical care is adapted, such patients seem to have a great potential for recovery. This justifies the implementation of specialized early psychosis programs and additional research in order to develop specific and adapted therapeutic strategies for such patients., (Copyright © 2020 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Background: Prevalence of psychotic disorders in a prison population is higher than in the general population. Recent research has shown that early intervention is feasible in prison settings, and that approximately 5% of screened prisoners have met ultra-high-risk (UHR) for psychosis criteria. We aimed to identify the prevalence of the UHR states for developing psychosis in a group of newly incarcerated men in the Jendouba Civil Prison and to analyze the association between UHR states and socio-demographic data and substance use., Method: We carried-out a cross-sectional study among 120 prisoners. Every prisoner was interviewed using the Comprehensive Assessment of At-Risk Mental States (CAARMS). The Social and Occupational Functioning Assessment Scale (SOFAS) was used to assess the participant's level of functioning., Results: We found a prevalence of subjects meeting the UHR criteria of 21.3%. UHR subjects had significantly more psychiatric family history (P=0.035), personal history of suicide attempt(s) (0.035) and self-injury (P=0.013) compared to non-UHR subjects. Clinical self-evaluation found significantly more depression and anxiety in the UHR group (P=0.020 and P=0.035, respectively). In addition, social and occupational functioning was significantly more impaired in the UHR group (P=0.007). UHR subjects used significantly more cannabis in lifetime (P=0.015) as well as in the past year (P=0.022) and had a significantly higher frequency of cannabis use (P=0.01) compared to non-UHRs., Conclusion: Prison mental health teams face the challenge of identifying prisoners who need mental health services and providing early care to this vulnerable group; this challenge may offer a unique opportunity for intervention among a population that might not otherwise have had access to it., (Copyright © 2020 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Objective: This study aims to determine whether it is possible to identify clinical profiles at risk of violent behaviors (VB) in the early phase of psychotic disorders, on the basis of the main dynamic psychopathological risk factors and describe characteristics of the groups with highest levels of violent behaviors., Method: A total of 265 patients, aged 18 to 35, treated at the Treatment and early Intervention in Psychosis Program (TIPP-Lausanne), a specialized early psychosis program, were included in this study. We conducted a latent-class analysis and a discriminative analysis on the basis of the main dynamic VB risk factors: substance use disorder, impulsivity, positive symptoms, insight, aggression, hostility, anger, emotional instability and adherence to treatment. These factors were evaluated by specialized scales and on the basis of the Positive and Negative Syndrome Scale (PANSS). VB were restricted to physical aggression against people, defined as "serious violence". They were assessed on the basis of a questionnaire listing violent offenses (Swiss Criminal Code) and VB such as assault and battery, information through the forensic psychiatric services and on the basis of the Staff Observation Aggression Scale (SOAS-R scale) during inpatient treatment phase., Results: Four heterogeneous subgroups were identified with respect to the studied clinical characteristics, including two groups with high rates of VB. The first group, comprising 46% of patients with VB, is distinguished by the prevalence of a range of dimensions related to hostility, impulsivity and emotional instability, associated with high levels of substance abuse and positive symptoms. These clinical dimensions are very significant at the statistical level, since they explain 70% of the construction of subgroups (discriminant analysis). The second group with 37% of patients with VB, is characterized by a lack of insight, lack of adherence to treatment and substance use. These two clinical profiles could increase the impairment of cognitive, functional and relational abilities and contribute to the development of VB in this early phase of psychosis. The third subgroup, with a violent behaviors rate of 28.6%, is distinguished by its high proportion of diagnoses of substance abuse (100%) and women (54%). A last subgroup of patients, the largest quantitatively, has a low proportion of VB (15%) and the lowest levels on the studied factors, suggesting that the majority of patients with this profile commit few VB., Conclusion: Our results show that it is possible to identify groups at risk of violent behaviors during the early phase of psychosis on the basis of clinical characteristics that may evolve and therefore be the focus of preventive care. These results highlight the need to target substance use, impulsivity and lack of insight at follow-up in order to prevent VB., (Copyright © 2018 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Objective: Usually Schizophrenia starts in late adolescence or early adulthood. However in childhood it is associated with significant impairment. The aim of this study is to investigate behavior disorders of schizophrenic patients in this particular period of life, and whether the presence of these disorders leads to predict a subsequent development of schizophrenia., Methods: Our study is retrospective, about a group of patients with schizophrenia, conducted in the university department of psychiatry of Fez. The study of the behavior of our patients during their childhood and adolescence is based on interviews with the parents of the subjects. We also used the teen version of the Child Behavior Cheklist 4-18 (CBCL)., Results: The sample included a total of 100 patients with a schizophrenia disorder, of which 80 were male, the average age was 25.36±-3.54 years. According to parents, 60 % of our patients were shy and too wise; a third of them had a preference for solitary games, and they were disobedient at home and school, frequently fighting, breaking the laws, taking drugs. Finally 20 % were very aggressive, attacking and hitting others - they even destroyed their personal possessions - and had run away from home. The average CBCL score was 41.69±-26,397, with 47 % above the threshold. Several factors were significantly related to a high CBCL score: gender, early age of onset of schizophrenia, and a traumatic event in childhood., Conclusion: Childhood and adolescence are characterized by the presence of many symptoms and behavior disorders. Although they are not very specific, their presence should alert the clinician to the significant probability of developing schizophrenia, especially in a risky population., (Copyright © 2018 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Objectives: The duration of untreated psychosis is defined as the interval between the first psychotic symptoms and the first starting treatment. The duration of untreated psychosis is highly variable but often prolonged and may be influenced by several factors. Some studies suggested that duration of untreated psychosis is associated with poor outcome. The objectives of this study were to assess the duration of untreated psychosis in a Tunisian cohort and its impact on the quality of life and the cognitive functions of schizophrenic patients at 2 years., Methods: We conducted a cross sectional study at Razi Hospital between January 2014 and June 2014 that included patients with Schizophrenia diagnosis as defined in the DSMIV-TR with regular monitoring for at least 2 years. Eligible participants are those who had been hospitalized for the first time, between January 2011 and December 2012 for a first psychotic episode. Data were collected from medical records and by interviewing the patients and their family. Duration of untreated psychosis was determined using the Symptom Onset in Schizophrenia Inventory. The quality of life was assessed by the 'Short Form-36 Health Survey' scale in its Arabic version. All patients were evaluated with 'The Tunisian Cognitive Battery' composed of 7 tests. Patient scores are expressed as 'Z scores', which represents the position of the scores in a term of standard deviation from the mean of healthy subjects established by the authors of the battery. We divided the population into two groups based on the duration of untreated psychosis median. A short duration of untreated psychosis was lower than the median, and a long duration of untreated psychosis was equal to or greater than the median., Results: Our sample involved 42 patients with a mean age of 31.38 years. The average duration of untreated psychosis was 75.38 weeks with a range from 2 to 364 weeks and a median duration of 47.5 weeks. Patients with a short duration of untreated psychosis had a better quality of life with better scores for the majority of the dimensions and a significant difference in the limitations score due to the mental state (P=0.01). For cognitive function, the short duration of untreated psychosis was significantly correlated with a free recall of 'Hopkins Verbal Learning Test'., Conclusion: Our study suggest that the average duration of untreated psychosis in Tunisia is comparable to the one reported in the literature and that a short duration of untreated psychosis is correlated with better outcomes in terms of quality of life and verbal learning., (Copyright © 2018 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Migration can be considered as a major risk factor for the incidence of Psychotic disorders. It has observed in first and second-generation migrants. French studies provide concordant results. There is an increased risk in migrants from sub-saharian countries. Various hypotheses have been evoked as involvement of infectious agents, genetics and vitamin deficiency. Environmental factors seem to be of major important and more specifically discrimination. The role of protection factor as the social capital can be an interesting perspective to develop specific preventive strategies., (© 2018 L’Encéphale, Paris.)

The concept of staging is applied in medicine since many years, in order to better adapt treatment to patients' needs. Some authors have suggested one should also apply this concept to psychiatric disorders. If this approach seems to make sense, concrete progress in the domain are still limited. It is in the field of psychosis that most development have occurred, in the favorable context of early intervention programs. Some very detailed models have recently been proposed where successive stages of psychotic disorders are defined and corresponding treatment options are proposed. However, the limited reliability of clinical diagnoses systems and the absence of biomarkers allowing a more objective delineation of these various stages still hampers the concrete application of such strategies. Despite these limitations, the staging concept has already started to modify the mental health offer, especially for adolescents and young adults, for example through the development of the Headspace centers in Australia and other countries. These centers constitute accessible entry point for help seekers with mental health issues where treatment is defined according to the stage of illness. If such programs seem promising, a better understanding of the mechanisms underlying the development of psychiatric disorders seems important in order to facilitate the identification of stages and define the nature of the treatment needed for each of them, considering such knowledge has been the crucial for the development of the staging model in somatic disorders., (© 2018 L’Encéphale, Paris.)

Early detection and early intervention programs in early adolescent and young adult psychosis have developed in many countries and have shown their effectiveness. The main lesson of these programs is to have demonstrated that the progression of at-risk mental state into to a full-blown psychosis or of a psychotic episode to a chronic schizophrenic disorder is evitable. They have also shown that the earlier appropriate care is set up the better the functional remission and that the period of "early psychosis" encompassing the period preceding the emergence of psychosis and the first months after the first psychotic episode, is a period of opportunity for a preventive or curative intervention. Specialized therapeutic strategies shall include patient's centered integrative care. According to international recommendations, early intervention provides an extensive multidisciplinary assessment in search of possible organic etiologies and in instrumental to adapt care strategies to the person's need. It helps to identify levers for a psychosocial approach (psychoeducation, cognitive and behavioral therapies, cognitive remediation, case management) and for adressing aggravating factors (substance use, family interventions, educational support, etc.). A second-generation antipsychotic should be introduced, at lower doses than for a chronic disorder. The young patient must be accompanied until recovery by a specialized multidisciplinary team, usually for a period of 2 to 3 years. Deployment of such programs is a societal challenge and represents a paradigm shift: it questions the practices and organization of the healthcare system, but also the way healthcare professionals and the general public look at these diseases. In France, the Transition Network, a founding member of the French-speaking branch of IEPA, aims to facilitate the dissemination of these practices on a National scale, and to help to harmonize emerging initiatives., (© 2018 L’Encéphale, Paris.)

The exact modalities of switching between two antipsychotics are rarely studied despite the high frequency of this issue in clinical practice. In this context, description of clinical cases may be enlightening. We report on three new cases of agitation after replacing a dopaminergic antagonist with aripiprazole. A literature review indicated no other predictive clinical feature associated with a higher risk of agitation than therapeutic history. In fact, patients who previously received a greater dose of antipsychotic are more at risk to present paradoxical agitation when switching to aripiprazole. This has led to the hypothesis of dopaminergic hypersensitivity: dopaminergic antagonists could increase the number of receptors to be activated by a partial agonist-like aripiprazole. In one of the cases described here, the patient had received aripiprazole two years previously without any particular side effects. The reintroduction of aripiprazole after a treatment by risperidone was followed by agitation. Other pharmacological hypotheses to explain this agitation involve cholinergic and histaminergic rebounds as well. The frequency of these paradoxical reactions is probably underreported, and psychiatrists should be more attentive to them. During the replacement, aripiprazole should be prescribed at the maximal posology from the start, and the previous antipsychotic should be maintained and slowly decreased in no fewer than four weeks., (Copyright © 2017 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Frontotemporal degeneration (FTD) in its behavioral variant (bvFTD) is probably one of the conditions that best illustrates the links between psychiatry and neurology. It is indeed admitted that between a third and half of patients with this condition, especially in early-onset forms, receive an initial diagnosis of psychiatric disorder (depression, schizophrenia, bipolar disorder) and are then referred to a psychiatric ward. BvFTD can thus be considered a neurological disorder with a psychiatric presentation. Among psychiatric symptoms reported in this disease, psychotic symptoms (hallucinations, delusions, especially of persecution), which have long been underestimated in bvFTD and are not part of the current diagnostic criteria, are present in about 20% of cases and may be inaugural. They are particularly common in the genetic forms related to a mutation in the C9orf72 gene (up to 50%), and to a lesser extent in the GRN gene (up to 25%). C9orf72 gene mutation is often associated with a family history of dementia or motor neuron disease but also of psychiatric disorders. It has also been described in sporadic presentation forms. Sometimes, the moderate degree of brain atrophy on MRI described in patients carrying this mutation may complicate the differential diagnosis with late-onset psychiatric diseases. In the present article, we underline the importance of considering that psychiatric - especially psychotic - symptoms are not rare in bvFTD, which should lead to a revision of the diagnostic criteria of this disease by taking greater account of this fact. We also propose a diagnostic chart, based on concerted evaluation by neurologists and psychiatrists for cases of atypical psychiatric symptoms (late-onset or pharmacoresistant troubles) leading to consider the possibility of a neurological disorder, in order to shed a new light on these difficult clinical situations. In the field of research, bvFTD may constitute a model to explore the neural basis of certain psychiatric disorders, and a possible molecular link between bvFTD and psychoses, which could eventually lead to new therapeutic approaches, has been recently suggested. Thus, bvFTD illustrates how the links between neurology and psychiatry are close and tend to evolve with the progress of scientific knowledge. It is necessary to strengthen collaboration between the two disciplines both to improve the care - diagnosis and management of these patients - and to promote the emergence of innovative clinical research., (Copyright © 2016 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: The progressive shifts in the legal and social contexts, along with major changes in information seeking habits with the development of the Internet, have placed patients' information at the core of medical practice. This has to be applied to the psychiatric fields as well, and to questions about how schizophrenic patients are being told their diagnosis nowadays in France., Methods: This paper is a national and international literature review about schizophrenia diagnosis disclosure practices, from 1972 to 2014, using French and English languages and various psychology and medical databases. The used key words were "diagnosis", "disclosure", "communication", "breaking bad news", "information", "schizophrenia" and "psychosis"., Results: Proportions of diagnosis announcement: our results show that the proportion of psychiatrists delivering schizophrenia diagnosis to their patients varies between countries. Although we must acknowledge that the questionnaires and samples are diverse, we have found that psychiatrists are in general less prone to deliver diagnosis information in France (from 13,5% to 39% given the studies), Germany (28%), Italy (30%), and Japan (30%), than in Anglo-Saxon countries. Thus, 70% of the psychiatrists in North America and 56% in Australia claim that they disclose their diagnosis to schizophrenic patients. In the United-Kingdom, a study targeting psychotic patients themselves has shown that 47% of them had been told their diagnosis by their doctor. Even in the countries where the proportion of diagnosis disclosure is the highest, there remains a substantial difference with other mental illnesses such as affective or anxiety disorders, which are almost always labeled as such in the information communicated to the patient (90% in North America). Diagnostic information about schizophrenia continues therefore to appear problematic for health professionals, which can seem a paradox given the recent social and legal evolutions, the therapeutic progress, the proved benefits of disclosure on compliance and therapeutic alliance, and the fact that numerous studies have shown that a majority of patients already know their diagnosis having discovered it on the Internet or by reading their treatments' notice. Reasons alleged for not disclosing diagnosis: the reasons alleged by psychiatrists for not disclosing diagnosis are various, including fear of aggravating the stigma and the emotional state of the patient, fear of giving a wrong diagnosis, fear of suicidal behavior, risk of misunderstanding, low level of patient's insight, absence of therapeutic advantage, or absence of request from the patient. Evolution of the French position about diagnosis disclosure: The publication of the relatively large study of Baylé et al. in 1999, as well as the patients' rights evolutions, has led to a debate among psychiatrists about the reasons alleged in France for not disclosing diagnosis. Among other explanations, it appeared that the theoretical reference of the psychiatrist plays a role, a psychoanalytic practice leading to increased reluctance in breaking the bad news. Thus, the psychiatrist's view of the disease, in terms of etiology and prognosis, is important as the diagnosis could become accusing if the psychiatrist believes the family environment played a role, or harmful if he has a pessimistic conception of prognosis. The question of stigma: among other reasons alleged by psychiatrists for not announcing the diagnosis, the fear of causing an increased stigma is frequently reported by professionals. In France, stigma about schizophrenia is high, not only among the general population but also among health practitioners. Even if the context has evolved during the past 30 years and the therapeutic efficiency has improved, French representations of schizophrenia remain often tinted with catastrophism and should be modified. Benefits of diagnosis disclosure: however, the benefits of disclosing diagnosis have been constantly proved in France as in other environments. Several studies have shown that patients knowing their diagnosis were likely to develop a better compliance and a stronger therapeutic alliance with their doctor. No aggravation of symptoms, suicidal risk or anxiety has been linked to the diagnosis disclosure. On the contrary, the relief of being able to put some words on symptoms, better recognize them and anticipate them, and be part of a group of patients sharing the same symptomatology has been described by patients. Furthermore, disclosing a schizophrenia diagnosis can be essential to the psychotherapeutic project, in the sense that it places the patient into an active role towards the disease and the care plan. Last but not least, the relatives can benefit from the disclosure as well and build a partnership with health professionals about medical care. Existing recommendations: in the French context, apart from individual recommendations produced by a few authors in the literature, there are no official specific recommendations about how to disclose a difficult diagnosis in the psychiatric field; only recommendations concerning severe chronic somatic disease are available. The complexity of the schizophrenia diagnosis disclosure has led some researchers - especially in North America and Australia - to adapt and use in the context of schizophrenia protocols, recommendations and even communication skills training programs that have been developed in oncology or in the field of severe chronic somatic disease., Discussion: For the situation to evolve in France, tools able to measure patients' consent - including consent to hear the bad news - ability could be used. The question of how much information and what kind of information the patients really wish should therefore be explored in deep. Also, we have seen that schizophrenia representations should be modified in the general public understanding as well as in the professional environment. Families should be more included in the reflection about diagnosis announcement, as psycho-education programs have shown their efficiency and usefulness for both patients and relatives. Finally, in order to overcome some of the difficulties related to breaking the bad news about a schizophrenia diagnosis, developing the existing Anglo-Saxon models and recommendations in France, where only very few protocols exist, could allow a positive evolution in clinical practice and help to set a therapeutic and partnering approach of diagnosis disclosure. However, in order to better understand the situation in France regarding schizophrenia diagnosis disclosure, the present state of clinical practice still remains to be analyzed precisely, as the last study on a relatively large sample was made only in 1999. Thus, the obvious limits of our study lie in the fact that most available surveys in France are not recent enough to have taken into account legal and social evolutions. Also, the studies that we used for this paper use different methodologies, in the majority focus solely on health professionals, and they are not representative enough in terms of size or sample to inform about the present state of the practice., Conclusion: As a conclusion, having stressed the lack of recent data about schizophrenia diagnosis disclosure in France, we suggest a new study using validated tools on a representative sample and taking into account both perceptions of psychiatrist and patient. As has been the case for other severe pathologies, we also suggest that a consensus conference take place on the subject of schizophrenia diagnostic information in order to elaborate guidelines to support this difficult disclosure., (Copyright © 2016 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Psychosis in epilepsy can be categorized in relation to seizures in two main categories: interictal psychosis and postictal psychosis. Postictal psychosis (PIP) is a specific syndrome in relation to seizure activity: a clear temporal relation exists between the psychotic state of sudden onset and a precipitating bout of complex partial or generalized seizures. However, this very specific syndrome is not included as such within the DSM-5, and PIP belongs to the category "Psychotic disorder due to another medical condition". Diagnostic criteria are: (1) episode of psychosis within 1 week after a seizure(s); (2) psychosis lasts more than 15hours and less than 2 months; (3) delusions, hallucinations in clear consciousness, bizarre, or disorganized behavior, formal thought disorder, or affective changes; and (4) no evidence AED toxicity, non-convulsive status epilepticus, recent head trauma, alcohol, or drug intoxication or withdrawal, prior chronic psychotic disorder. The presence of a lucid interval between the last seizure and start of changes rules out a simple postictal delirium. The outcome is characterized by a remission of the psychotic symptoms over several days (mean: 1 week), with or without any treatment. Prepsychotic EEG abnormalities persist during the psychosis. Risk factors for PIP include: long standing localization-related epilepsy, extratemporal onset, bilateral epileptiform activity, secondary generalization, slowing of the EEG background activity and personal or family history of psychiatric disorders. Brain MRI frequently shows structural abnormalities. Several functional neuroimaging studies have shown hyperperfusion in various cerebral regions during PIP, suggesting an excessive activation of particular structures of the brain rather than a postictal depression of cerebral activity. Implanted electrode studies have shown that the EEG correlate of psychotic symptoms differs from the ictal EEG correlate of epileptic seizures. The value of antipsychotic treatment in PIP requires further studies. Despite their role in symptomatic relief, there is no clear effect of neuroleptics on duration or prognosis of PIP. Different combinations of pharmaceutical interventions can be tried on a case by case basis: (1) oral administration of benzodiazepine; (2) combined oral administration of benzodiazepine and atypical neuroleptics; (3) intramuscular administration of dopamine-blockers for rapid tranquilization of violent or agitated patients. The notion that neuroleptic drugs lower the seizure threshold has no clinical significance: there is no evidence that antipsychotic drugs increase seizure frequency in epileptic patients treated with antiepileptic drugs., (Copyright © 2016 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Objectives: There is evidence that psychiatrists are rarely aware of how religion may intervene in their patient's life. That is particularly obvious concerning patients with psychosis. Yet, even for patients featuring delusions with religious content, religious activities and spiritual coping may have a favourable influence. Indeed, patients with psychosis can use religion to cope with life difficulties related to their psychotic condition, in a social perspective but also in order to gain meaning in their lives. Also, religion may be part of explanatory models about their disorder with, in some cases, a significant influence on treatment adhesion., Patients and Methods: This paper describes a prospective randomized study about a spiritual assessment performed by the psychiatrists of patients with schizophrenia. The outpatient clinics in which the sample was collected are affiliated with the department of psychiatry at the university hospitals of Geneva. Eighty-four outpatients with psychosis were randomized into two groups: an experimental group receiving both traditional treatment and spiritual assessment with their psychiatrist and a control group of patients receiving only their usual treatment. Psychiatrists were supervised by a clinician (PH) and a psychologist of religions (PYB) for each patient in the spiritual assessment group. Data were collected from both groups before and after 3 months of clinical follow-up., Results: Spiritual assessment was well-tolerated by all patients. Moreover, their wish to discuss religious matters with their psychiatrist persisted following the spiritual assessment. Even though clinicians acknowledged the usefulness of the supervision for some patients, especially when religion was of importance for clinical care, they reported being moderately interested in applying spiritual assessments in clinical settings. Compared to the control group, there were no differences observed in the 3 months' outcome in terms of primary outcome measures for satisfaction with care, yet the attendance at the appointments was significantly increased in the group with spiritual assessment. The same result was found when restricting analyses to patients for whom an intervention was suggested or patients who invested more in religion. Areas of potential intervention were frequent both in a psychiatric and psychotherapeutical perspective., Conclusions: Spiritual assessment appears to be useful for patients with psychosis. This is in accordance with the recommendations of the World Psychiatric Association which promotes considering the whole person in clinical care. Spiritual assessment is quite simple to perform, providing that clinicians do not prescribe or promote religion, and that no critical comments are made concerning religious issues. Clinicians do not need to know in depth the religious domains of each of their patients, as it appears that each patient accommodates his/her religious background his/her own way., (Copyright © 2015 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: The 22q11.2 deletion syndrome (22q11.2DS) is caused by hemizygous microdeletions on chromosome 22. 22q11.2DS has several presentations including Di George's syndrome, velo-cardio-facial syndrome or Shprintzen's syndrome and it is the most frequent microdeletion syndrome in the general population (prevalence estimated at 1/4000 births, de novo: 90%). The inheritance of the syndrome (10%) is autosomal dominant. Most people with 22q11.2DS are missing a sequence of about 3 million DNA building blocks (base pairs) on one copy of chromosome 22 in each cell. A small percentage of affected individuals have shorter deletions in the same region (contiguous gene deletion syndrome). The general features of 22q11.2DS vary widely (more than 180 phenotypic presentations) and the syndrome is under diagnosed. Characteristic symptoms may include congenital heart disease, defects in the palate, neuromuscular problems, velo-pharyngeal insufficiency, hypoparathyroidism, craniofacial features and problems with the immune system T-cell mediated response (caused by hypoplasia of the thymus)., Cognitive Phenotype: The neurocognitive phenotype of the 22q11.2DS is complex. Cognitive deficits are seen in the majority (80-100%) of individuals with 22q11DS with impairments in sustained attention, executive function, memory and visual-spatial perception. Borderline intellectual function (IQ: 70-75) is most common, mild intellectual disability (IQ: 55-75) is slightly less frequent and a small percentage of children fall into the low average intelligence range. Most children with 22q11.2DS achieve higher scores in verbal tasks than in non-verbal tasks, although this pattern of dysfunction being not universal. Brain MRI studies have shown volumetric changes in multiple cortical and subcortical regions in individuals with 22q11DS that could be related to both cognition and psychoses., Psychiatric Phenotype: General psychiatric features included anxiety disorders, attention deficit disorder and poor social skills (40-50%). An elevated risk of bipolar disorder and major depression occurs in adolescence and young adulthood. A strong and specific relationship exists between the presence of the 22q11.2 microdeletion and schizophrenia (30-40%). This risk is not associated with any other neurogenetic syndrome. Social cognition is impaired in 22q11.2 DS and this observation is correlated with psychotic features. So, long-term medical care is increasingly being directed towards the treatment and recognition of these symptoms., Treatment: Required pharmacological treatment strategies have to be adapted to the syndrome. Moreover, cognitive remediation is a promising tool for treating neuro- and social cognitive deficits in 22q11.2DS. However, these new therapeutic strategies have to be developed to improve quality of life., (Copyright © 2014 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

This article aims to present the validation study of the French version of the Comprehensive Assessment of at risk mental states (CAARMS), an interview that seeks to determine whether young adults criteria for at-risk (AR) mental states, or psychosis. We assessed 40 young subjects, 15 were considered as "prodromal" (Prd) and 10 as experiencing a first episode of psychosis (PEP) by our expert clinician at the center - centre d'évaluation des jeunes adultes et adolescents, University Hospital Centre, Paris - and 15 were healthy controls matched for age and sex. When assessed with the CAARMS, 73 % (n=11) of the prodromal subjects reached the criteria for AR mental state, four subjects did not reach the criteria for AR, nor psychosis (P) and 100 % of the PEP reached the criteria for P. The three groups were significantly different on CAARMS total score (P<0.001) and subscores ; Prd subjects had intermediate scores between PEP (P<0.001) and controls (P<0.001) scores, PEP showing the highest scores. Post-hoc analysis showed that Prd significantly differed from Controls on each subscale (P<0.001) and that Prd differed from PEP on the "positive symptoms" subscale (P<0.001), as well as on "behavioural change" (P=0.021), owing to difference on the item "impaired role function". We used the brief psychiatric rating scale 24 items with anchor (BPRS24-EA) in addition to with the CAARMS, the AR group showed intermediate scores between controls and P subjects. Total scores of both scales were correlated (r=0.408 ; P=0.043) and the BPRS24-EA "positive symptoms" score was correlated with CAARMS' scores on the "Positive symptoms" subscale (r=0.456, P=0.022), "emotional disturbance" (r=0.506, P=0.01), and "behavioural change" (r=0.666 P=0.001). We found no correlation between BPRS negative and depression subscales and any of the CAARMS' subscales. When looking at its reliability, reliability coefficients (Cronbach's alpha) showed excellent reliability for "positive symptoms", "emotional disturbance", "behavioural change" and "general psychopathology" (respectively r=0.82, 0.75, 0.78, 0.84, 0.83) and moderate reliability for "cognitive change", "negative symptoms" and "motor/physical change" (respectively r=0.39, 0.59, 0.43). Overall, analysis of the results of construct validity, concurrent validity and reliability of the CAARMS indicates that the French version is valid and reliable. It is now available to develop and implement early detection programs in French speaking countries., (Copyright © 2014. Published by Elsevier Masson SAS.)

In the last decades, schizophrenia has intensively been studied using various brain imaging techniques. However, several potential confounding factors limited their interpretation power (e.g. chronicity, the impact of antipsychotic medication). By considering psychosis as a continuum of changes starting from mild cognitive impairments to serious psychotic symptoms, it became possible to provide deeper insight in the neurobiological mechanisms underlying the onset of psychosis by focusing on at-risk individuals and first-episodes. Recent brain imaging meta-analyses of the first episode psychosis (FEP), noteworthy reported conjoint bilateral structural and functional differences at the level of the insula, the superior temporal gyrus and the medial frontal gyrus, encompassing the anterior cingulate cortex. In the present review, we thus provide an update of brain imaging studies of FEP with a particular emphasis on more recent anatomical, functional and molecular explorations. Specifically, we provide 1) a review of the common features observed in individuals with high risk for psychosis and changes characterizing the transition to psychosis, 2) a description of the environmental and drug factors influencing these abnormalities, 3) how these findings in FEP may differ from those observed in chronic individuals with schizophrenia, and 4) a short overview of new classification algorithms able to use MRI findings as valuable biomarkers to guide early detection in the prodromal phase of psychosis., (Copyright © 2013 L’Encéphale. Published by Elsevier Masson SAS.. All rights reserved.)

Cognitive difficulties are a core feature of schizophrenia. They are frequent, severe, and clearly associated with functional disabilities. They have been explored during different phases of the disease, but what we know essentially concerns the chronic period in middle-age patients. In this article we will specifically focus on cognition at the time of first episode. First episode is a key life period, occurring while social demands are increasing and more complex on the one hand, and while there are important changes in structural and functional cerebral anatomy on the other hand. Exploring cognitive difficulties at the time of first episode offers the opportunity to better know their time course, to avoid interpretative difficulties due to the chronicity of the disease and its treatments, and to develop early therapeutics in order to improve outcome. Cognitive difficulties are clearly present at the time of first episode; their nature and severity appear similar to those observed in more chronic patients. Therefore, they cannot be entirely explained by treatments, hospitalizations or chronicity, and appear more as an intrinsic feature of the disease. The course of their trajectory through the progression of the disease remains uncertain; while they are already present during childhood or adolescence in some subjects who will later declare schizophrenia, they seem to worsen during the period of early prodroms, that is years before psychotic symptoms emerge. Whether they aggravate again during the first episode process is still a matter of debate. While longer DUP is associated with a poor outcome, this does not seem to hold true for cognitive impairments. Cannabis or tobacco use are neither associated with worse cognitive abilities in first-episode patients; a reverse relationship even sometimes exists. Cognitive impairment appears as largely independent from other clinical dimensions, acknowledging its own physiopathology and requiring specific evaluation and treatment. Several cognitive batteries can be used in clinical practice to explore cognitive abilities in first-episode patients; this is a necessary step before treating. While current pharmacological treatments display little or no efficacy for treating cognitive impairments, new medications offer some hope for the future. Still, efforts especially concern cognitive remediation for the moment. Several programs can be used in patients following their first episode, and some studies suggest that deficits in cognition are more amenable to remediation during earlier phases of the illness especially when cognitive remediation is associated with psychosocial rehabilitation, including school or work support. In the future, exploring and treating cognitive difficulties in first episode patients appear as a matter of collaborative work between psychiatrists and cognitive psychologists and between health and social services., (Copyright © 2013 L’Encéphale. Published by Elsevier Masson SAS.. All rights reserved.)