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Treatment-resistant schizophrenia (TRS) affects around 30% of patients with schizophrenia (SZ) resulting in poor functioning, relapses, and reduced quality of life. Convergent findings show that inflammation could contribute to resistance. We thus search for immune signatures of patients with TRS/ultra TRS (UTRS) in a sample of community-dwelling outpatients with SZ. In total, 195 stabilized SZ patients (mean age = 31.2 years, 73% male gender) were consecutively included in the network of the FondaMental Expert Centers for Schizophrenia in France and received a thorough clinical assessment. At inclusion, psychotic symptomatology was evaluated by the Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Circulating serum/plasma levels of a large panel of markers reflecting the main inflammatory pathways were evaluated. TRS was defined by current treatment by clozapine (CLZ) and UTRS by current CLZ treatment + PANSS total score ≥ 70. The frequency of TRS and UTRS patients was, respectively, 20% and 7.7% and was defined using multivariable analysis elevated by high levels of interleukin (IL)-12/IL-23p40, IL-17A, IL-10, and beta 2 microglobulin (B2M) and IL-12/IL-23p40, IL-17A, IL-6, IL-10, IFNγ, and B2M, respectively. These observations suggest that resistance and ultra resistance to CLZ treatment are underpinned by pro-inflammatory molecules mainly belonging to the T helper 17 pathway, a finding making sense given the interplay between inflammation and antipsychotic treatment responses. If confirmed, our findings may allow us to consider IL-23/IL-17 pathway as a therapeutic target for patients with resistance to antipsychotics.

Resume Les patients atteints du trouble de la personnalite borderline sont souvent diagnostiques a tort comme ayant un trouble bipolaire et inversement. En effet, un certain nombre de caracteristiques communes aux deux troubles pourraient expliquer ce probleme : l’instabilite affective ainsi que l’impulsivite representent des facteurs de confusion et contribuent au risque de mauvais diagnostic. Cependant, ces caracteristiques se manifestent de manieres differentes selon la pathologie. Les dimensions emotionnelles et impulsives de 40 patients (21 patients presentant un trouble bipolaire et 19 patients presentant un trouble de la personnalite borderline) ont ete comparees a l’aide des echelles ALS, AIM et UPPS. Les patients borderline obtiennent des scores significativement plus eleves que les patients bipolaires aux echelles ALS et AIM. En ce qui concerne l’UPPS, les patients borderline presentent des scores significativement plus eleves que les patients bipolaires aux dimensions « manque de premeditation » et « manque de perseverance » ; en revanche, les patients bipolaires ont obtenu des scores significativement plus eleves que les patients borderline a la dimension « urgence negative ». Cette etude montre que l’on peut differencier le trouble bipolaire du trouble de la personnalite borderline grâce aux dimensions affectives ainsi qu’aux differentes dimensions de l’impulsivite.

Resume Le trouble bipolaire et le trouble de la personnalite borderline presentent une incidence sur la vie des patients tant sur la symptomatologie que sur la qualite de vie. Ces deux troubles semblent avoir des similitudes cliniques ne facilitant pas le diagnostic. En effet, les dimensions affectives, tant d’un point de vue de la labilite que de l’intensite ainsi qu’au niveau de l’impulsivite, rendent difficile la distinction clinique entre ces deux pathologies. Au travers de cette revue de la litterature, nous tenterons de mettre en avant les differences, au niveau de l’affectivite et de l’impulsivite, entre le trouble bipolaire et le trouble de la personnalite borderline afin de tenter d’apporter une finesse clinique entre ces deux pathologies dans le but, a plus long terme, d’affiner la prise en charge therapeutique.

Early onset of heroin use is a severity marker of heroin use disorder. We studied the interaction between early onset and rapid transition to heroin dependence recorded with retrospective interviews in 213 patients with severe heroin dependence and history of methadone maintenance treatment. General linear models were used to identify independent factors associated with early onset, factors associated with rapid transition to dependence, and a multivariate model was used to study the interaction of those two dimensions. Lifetime history of anxiety disorders and age at onset of cannabis use are shared common risk factors and are associated with the interaction.

Introduction Cocaine users often experience transient psychotic symptoms following cocaine use (Smith et al. 2009). The severity of such psychotic symptoms is influenced by cocaine dose (Vorspan et al. 2011). Several authors observed a higher prevalence of childhood trauma in cocaine addicts than control subjects (Enoch et al. 2010). Objective Describe cocaine induced psychosis and evaluate if it is associated with childhood trauma. Aim Define the population of cocaine users who experiment cocaine induced psychotic symptoms. Method We did a transversal retrospective study. 100 outpatient cocaine users were evaluated with Scale for the Assessment of Positive Symptoms of Crack Induced Psychosis (SAPS-CIP) and Childhood Trauma Questionnaire (CTQ). Informations were obtained about lifetime cocaine use (age of onset, DSM IV dependence criteria, route of administration, daily dose, days of use per month). Results We did not observe any link between SAPS-CIP and CTQ or CTQ and cocaine consumption. About cocaine consumption, more often patients took cocaine during the worst period, higher is the SAPS-CIP score. If patients are (or were) dependent to cocaine, they have higher scores on SAPS-CIP. Moreover, if patients took cocaine intravenously, they have higher scores on SAPS-CIP than if they took it by snorting, or smoking. Conclusion In the conditions of our study, childhood trauma isn’t a mediator for cocaine induced psychosis. About psychotic symptoms, they seem to be more severe among daily cocaine dependents who take it intravenously.