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International audience; ObjectiveHypovitaminosis D has been associated with respectively major depressive disorder, schizophrenia (SZ) and cognitive disorders in the general population, and with positive and negative symptoms and metabolic syndrome in schizophrenia. The objectives were (i) to determine the prevalence of hypovitaminosis D and associated factors (with a focus on depression and cognition) in a national non-selected multicentric sample of community-dwelling SZ subjects (ii) to determine the rate of SZ patients being administered vitamin D supplementation and associated factors.MethodsA comprehensive 2 daylong clinical and neuropsychological battery was administered in 140 SZ subjects included between 2015 and 2017 in the national FondaMental Expert Center (FACE-SZ) Cohort. Hypovitaminosis D was defined by blood vitamin D level 0.05), however, a trend toward significance has been found for metabolic syndrome (p = 0.06). Vitamin D supplementation has been administered during the previous 12 months in only 8.5% of the subjects but was associated with lower depressive symptoms (aOR = 0.67 [0.46–0.98], p = 0.04) and lower rate of current anxiety disorder (aOR = 0.06 [0.01–0.66], p = 0.02) compared to patients with hypovitaminosis D.ConclusionHypovitaminosis D is frequent and associated with depressive symptoms and anxiety disorders in schizophrenia. Vitamin D supplementation is associated with lower depressive and anxiety symptoms, however patients with hypovitaminosis D remain insufficiently treated.

International audience; Non-selective and irreversible MAOI have become as third or fourth-line strategy for the management of treatment-resistant depression. Non-selective and irreversible MAOI requires careful monitoring of drug interactions and dietary restrictions. Nutritional supplements such as omega-3 have been found to produce beneficial effects in the management of treatment-resistant depression when administered in combination with the ongoing antidepressant treatment. The glutamate antagonist ketamine has been found to produce beneficial effects in the management of treatment-resistant depression while administered alone. Dopamine and/or norepinephrine agonists, such as methylphenidate, modafinil or pramipexole, have been found to produce beneficial effects in the management of treatment-resistant depression when administered in combination with the ongoing antidepressant treatment.

International audience; INTRODUCTION: Bipolar disorder (BD) is a life course illness; and there is increasing awareness of the many personal, social and economic consequences of the illness in older adults. However, it is important to emphasize that BD usually begins in late adolescence or early adulthood and 75 % cases have a first episode in this age period. This early onset and the associated level of disability mean that BD is the 4th leading cause of global disease burden in adolescents and young adults. Internationally, mental health services are increasingly striving to diagnose and treat BD as early as possible to try to prevent poor outcomes. In addition, researchers are using methods employed previously in psychosis studies as these may help us to recognise the earliest manifestations of BD. If it is possible to identify sub-threshold and 'ultra high risk' syndromes for BD, this might lead to new interventions that could target the prevention of first episodes of mania. One approach to understanding these risk syndromes is to examine prospective community cohort studies and BD offspring studies. METHODS: This paper reviews prospective cohort studies that identify robust risk factors in early illness onset, which was defined as age at onset of BD between 15-25 years. RESULTS: We found that although > 50 % of individuals who developed BD had developed a putative BD prodrome prior to 14 years of age, this usually began with non-specific symptoms that overlap with similar presentations for those who later develop psychosis or severe depression. However, there are some features that seem to better identify groups with a BD "at-risk" syndrome. This syndrome is frequently composed of several factors such as mood lability, depressive episodes, prior anxiety, sleep and/or conduct disorders, attention and concentration impairment, altered energy patterns, and a family history of mania and/or depression. The course of these early predictors suggests the precursor syndromes are composed of mini-clusters of symptoms many of which are episodic and change over time. During the early phases of BD, most of the affective disturbances reported were depressive in polarity and started during adolescence, there were few manic or mixed or psychotic episodes with an onset before puberty. The pathogenesis of BD demonstrates a gradual progression from non-specific to more specific symptoms and then to frank BD features. CONCLUSION: Prospective community and offspring BD cohort studies are approaches that together can help us understand the evolution of BD and allow us to define the developmental pathways. Further, identifying subjects with BD "at-risk" syndrome using a clinical staging model may allow benign interventions to be used as first-line treatment - such as neuroprotective agents like essential fatty acids; second line treatments, with a less benign risk to benefit ratio should be reserved for severe or resistant cases.

International audience; SOURCE MONITORING FRAMEWORK: Source monitoring refers to the ability to remember the origin of information. Three source monitoring processes can be distinguished: external source monitoring, internal or self-monitoring and reality monitoring (i.e. discrimination between internal and external sources of information). Source monitoring decisions are based on memory characteristics recorded such as perceptions, contextual information or emotional reactions and heuristic or more controlled judgement processes. BRAIN STRUCTURES: Several studies suggested that specific structures in the prefrontal and the mediotemporal lobes are the main areas implicated in source monitoring. ASSESSMENT: A typical source monitoring paradigm includes an items generation stage and a second stage of recognition of items (old versus new) and identification of their sources: external (usually the examiner) or internal (the subject). Several indices can be calculated based on the raw data such as the number of false alarms, attribution biases or discrimination indexes. To date, there is no standardized source monitoring task and differences in the type of items used (words, pictures), in the cognitive or emotional effort involved or in the delay between the two test stages, contribute to the heterogeneity of results. FACTORS INFLUENCING SOURCE MONITORING: Factors such as age (either very young or very old) and emotions influence source monitoring performances. Influence of gender was not properly explored, whereas the role of IQ and selective attention is still debated. SOURCE MONITORING DEFICITS IN NEUROLOGICAL DISORDERS: Source monitoring deficits are observed mainly in disorders affecting frontotemporal areas, such as frontal trauma, Alzheimer's disease or frontotemporal dementia. SOURCE MONITORING AND SCHIZOPHRENIA: Source monitoring errors (e.g. external misattribution of self-generated information) are observed in schizophrenia and seem to correlate with positive symptomatology, in particular auditory hallucinations, thought intrusion and alien control symptoms. These results are of particular interest in clinical research because source monitoring is one of the rare cognitive tests showing a correlation with the positive dimension. Source monitoring deficits have been proposed as a potential explanation for the positive symptoms and some, but not all studies lent support to this hypothesis. Heterogeneity of studied samples, in particular different criteria to define hallucinating subjects (e.g. currently versus anytime during their lives), could explain the discordant results. SOURCE MONITORING IN PSYCHIATRIC DISORDERS WITHIN THE SCHIZOPHRENIC SPECTRUM: Source monitoring impairments were observed in pharmacological models of psychosis, in first degree relatives of schizophrenic patients, and also in the general population associated with schizotypal dimensions. These results support a relationship between source monitoring deficits and some of the symptomatic dimensions of the schizophrenic spectrum but still await replication. SOURCE MONITORING AND OTHER PSYCHIATRIC DISORDERS: Some studies found source monitoring deficits in other psychiatric conditions such as mania or obsessive-compulsive disorder. Thus, those studies suggest that source monitoring deficits may be not specific to schizophrenia. CONCLUSION: Source monitoring competencies are critical for good (i.e. adapted) everyday functioning. Source monitoring deficits have been suggested as a potential explanation for some (or all) positive psychotic symptoms. However, to date, methodological inconsistencies (especially with regard to test design and choice of subjects' samples) have precluded firm, definite conclusions.

International audience; No abstract available

International audience; OBJECTIVE: This report describes the psychometric evaluation of the French translation of the Signs and Symptoms of Psychotic Illness (SSPI) scale. The SSPI scale was designed to assess the five main clusters of symptoms of people suffering from psychotic disorders (psychomotor poverty, reality distortion, disorganisation, depression, and psychomotor excitation) across diagnostic entities. This new tool has been built by Liddle because, in the existing scales assessing psychotic symptoms, individual items cover symptoms that belong to different pathophysiological processes. The SSPI scale comprises 20 items. Its interview is semi-standardised and typically lasts around 25 min. The English version of this scale has shown good psychometric properties (inter-rater reliability, factor structure). METHOD: We used the SSPI ratings of 81 patients with psychotic symptoms to assess its factor structure and concurrent validity with the Clinical Global Impressions (CGI) scale. Twenty-eight videotaped ratings were used to calculate the intra-class correlation coefficient (ICC) as a measure of inter-rater reliability. RESULTS AND DISCUSSION: The sample was composed of 46 schizophrenic subjects, 14 with schizoaffective disorder, three with major depressive episode with psychotic features, nine with manic episode with psychotic features and nine with other psychotic disorders. A principal component analysis was conducted to determine the factor structure. Using the Cattell test, we retained a five-factor solution. This solution explained 56.9% of the variance. After varimax rotation, 18 items were attributed to a unique factor. The five factors were: a psychomotor poverty factor, a reality distortion factor, a disorganised factor, an anxious/depressive factor and a psychomotor excitation factor. This structure is close to the original one. The inter-rater reliability of the French version of the SSPI was satisfactory for 18 items, with a mean ICC of 0.64 for the individual items, and an ICC of 0.76 for the global scale. Only two items had an unsatisfactory ICC. This scale showed a good correlation with the CGI scale, with a correlation coefficient between CGI score and SSPI global score of 0.64. Among the factor scores, reality distortion, disorganisation and depression factor scores exhibited a significant correlation with the CGI score. CONCLUSIONS: The French version of the SSPI scale has good psychometric properties, similar to the English version. Furthermore, its factor structure is similar to the English one. This scale is a robust instrument to rate psychotic symptoms and dimensions across diagnosis entities.

BACKGROUND: The schizotypal personality disorder is a recent psychiatric nosological concept developed by Spitzer at the end of the 1970s, based on the analysis of the characteristics of relatives of schizophrenic subjects included in the adoption studies carried out in the same decade by Kety, Wender and Rosenthal. HISTORICAL ASPECTS: However, this entity is based on older observations, at the beginning of the past century, showing common behavioural characteristics in relatives of schizophrenics. Its status within our current nosography remains dubious, sometimes classified among personality disorders, sometimes in the schizophrenia spectrum disorders. It is interesting to present the origins of this concept that stem from two complementary approaches: a family approach and a clinical approach of sporadic cases and then to redefine the framework within which the diagnostic approach was based and its continuity, up until our current classifications, the DSM and CIM. CURRENT STATUS: The historical origins cannot summarize the disorder and it appears important to redefine the multidimensional characteristics of the schizotypal personality disorder, generally a three-factor model. Indeed, dimensional models of psychosis are becoming established as conceptually and clinically useful. Recent studies on the dimensionality of psychosis show an evolution of the schizotypal concept, initially defined as being part of the schizophrenia spectrum and which now appears to be more broadly linked to a concept of unitary psychosis, including the bipolar disorder. CONCLUSION: Dimensions of psychosis seem to be associated with different familial aggregation and risk of psychosis, suggesting that they are underlined by different physiopathological processes. Hence, the dimensional approach can help to disentangle the genetic heterogeneity of the disease.

The autistic disorder was firstly described by Leo Kanner sixty years ago. This complex developmental disability is characterized by social and communicative impairments and repetitive and stereotyped behaviours and interests. The prevalence of autism in the general population is about 1 in 1,000, with four males affected for one female. In approximately 15% of the cases, autism is associated with known genetic disorders, such as fragile X syndrome, tuberous sclerosis or Rett syndrome. Nevertheless, a recognised medical etiology can only be identified in a minority of cases. A higher recurrence risk in families with autistic subjects (45 times greater than the prevalence in the general population) and higher concordance for autism among monozygotic (60-90%) than dizygotic (0-10%) twins argue for a genetic predisposition to idiopathic autism. The past decade has been marked by an increased interest in the genetic basis of autism, with a series of multiple independent whole genome scans and chromosomal abnormalities studies. These analyses have pointed out several candidate regions on chromosomes 2q, 7q, 6q, 15q and sex chromosomes. These regions possess candidate genes that have been screened for mutations or association with autism. However, a clear involvement of a major susceptibility gene (or genes) in autism remains far from clear. The results from linkage studies and the clear drop in the concordance rates between monozygotic and dizygotic twins suggests that the genetic aetiology of autism is certainly heterogeneous (different genes in different families) and polygenic (more than one affected gene per individual). The almost finished sequence of the human genome and the generation of haplotype maps will shed light on the inter-individual genetic variability and will certainly increase the power and reliability of association studies for complex traits, such as autism.; Soixante ans après sa caractérisation par Léo Kanner puis par Hans Asperger, les causes majeures du syndrome autistique restent toujours inconnues. Bien qu’un quart des cas d’autisme soit associé à des affections connues, les trois quarts restants demeurent idiopathiques.Cependant, les études sur les couples de jumeaux, réalisées durant les années 1970-1980, ont permis de déceler une forte influence géné-tique dans l’apparition de ce syndrome. En outre, le développement de nouvelles techniques d’analyse génétique, les nombreuses analyses de gènes candidats et l’amélioration de la définition du diagnostic ont permis au fil du temps de diri-ger les recherches sur plusieurs régions du génome comme les bras longs des chromosomes 2, 6, 7 et 15 ou les chromosomes sexuels. Cet article a donc pour but de retracer les dernières avancées dans la recherche de la prédisposition génétique au syndrome autistique.

International audience