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Crack-cocaine dependence is a severe condition with a high mortality rate. This single case study report details the first deep brain stimulation (DBS) trial targeting the sub-thalamic nucleus (STN) for crack-cocaine dependence. The investigation aimed to assess the effects of STN-DBS on cocaine craving and cocaine use, as well as STN-DBS safety and tolerance in this indication. In this pilot study, we performed double blind cross-over trials, with “ON-DBS” vs. “SHAM-DBS” for 1-month periods. STN-DBS failed to reduce cocaine craving and use. An episode of DBS-induced hypomania occurred after several weeks of cocaine intake at stimulation parameters previously well tolerated. Future research on cocaine dependence should be conducted after a prolonged abstinence period and/or explore novel types of stimulation patterns.

Background Parental alienation is a relatively newly described disorder, with a growing prevalence, as divorce and custody battles are becoming more and more complex with increased difficulty of joint custody. In parental alienation, one parent, the alienating parent, forms an alliance with the child involved in the custody dispute and manages to effectively alienate the targeted parent completely. The child and the alienating parent manifest a form of folie à deux and, hence, are in complete synchrony in the hatred and denigration of the targeted parent. Issues, such as potentially false allegations of sexual, physical, and emotional abuse of the child by the targeted parent, arise. The child and the alienating parent become mutually convinced of the targeted parent’s transgressions. Consequently, it becomes difficult for the courts and psychiatric professionals to differentiate true abuse from parental alienation. Case presentation In this case study, we aimed to conduct an in-depth psychological and psychiatric evaluation of a Lebanese family (white race) where a father was wrongly accused by the mother and his 11-year-old white boy of both physical and sexual abuse. The data for this study were collected through unstructured and semi-structured interviews, observations, and psychological tests (Rorschach test for the parents and Blacky test for the child), and through the analysis of documented evidence presented in the trial. Conclusion This case manifested most criteria set forth for the diagnosis of parental alienation and created serious doubt regarding the validity of the allegations set forth by the mother and the child. Uncovered parental alienation often misleads mental health professionals at the expense of the child’s mental health .

OBJECTIVE Several studies have shown that psychiatric disorders can be associated with venous thromboembolism (VTE) risk, that is, pulmonary embolism (PE) and/or deep vein thrombosis (DVT). In this study, we provide a systematic review and meta-analyses of the studies addressing this issue. METHODS All studies addressing the risk of VTE phenomena (whole VTE, PE, DVT, fatal VTE) in individuals with psychotic, mood, and anxiety disorders published between 1998 and 2019 were reviewed and included in the meta-analyses. Main characteristics of the studies and data concerning VTE risk were extracted. The methodological qualities of the studies were also analyzed. A random-effects meta-analysis model was used. A meta-analysis was conducted separately for each disorder, as well as separately for unadjusted and adjusted studies. Meta-analyses were repeated considering only good-quality studies. Heterogeneity was assessed. RESULTS Sixteen studies were reviewed and 15 included in the meta-analyses. Psychotic and bipolar disorders were significantly associated with VTE risk (VTE, DVT, PE, and fatal VTE for psychotic disorder: odds ratios [ORs] between 1.29 and 2.20; VTE, DVT, and PE for bipolar disorder: ORs between 1.22 and 2.14). Depression and anxiety disorders were associated with VTE risk only in adjusted analyses (DVT and PE for depression: ORs = 1.29; VTE and PE for anxiety disorders: ORs between 1.14 and 1.49). CONCLUSIONS The risk of VTE among individuals with psychiatric disorders may be explained by hypercoagulability and stasis, with both being related to, and independent of, treatment adverse effects. VTE risk should be taken into consideration in the treatment for people with psychiatric disorders.

Resume Objectif Le parcours de soins du patient souffrant de troubles psychiques etant un parcours complexe et a risque d’interruption de traitement, nous avons mis en place la conciliation medicamenteuse a l’admission en psychiatrie en fevrier 2017. L’objectif de ce travail a ete de realiser un retour d’experience repondant a nos questionnements sur la faisabilite et la pertinence de cette demarche. Methode Une analyse prospective des conciliations sur les 7 premiers mois de mise en place a ete realisee selon 3 indicateurs d’activite et 6 indicateurs de performance. Resultats Au total, 39 patients ont ete concilies dont 56,4 % en secteur ferme. La totalite des patients ont ete rencontres lors d’un entretien pharmaceutique. Les informations issues de cet entretien etaient concordantes avec au moins l’une des autres sources dans 70,4 % des cas. 13 patients n’ont pu etre concilies dans les 72 h en raison de leur pathologie psychiatrique. Le nombre moyen de divergences non intentionnelles (DNI) par conciliation etait de 0,97. Le taux de DNI de gravite majeure etait de 23,7 %. Le nombre de DNI par patient etait significativement superieur en secteur ferme (p Conclusion Ces resultats montrent que la conciliation d’entree est realisable et pertinente en psychiatrie. Pour limiter les contraintes liees a la pathologie psychiatrique, nous proposons de concilier les patients au-dela de 72h apres leur admission, des que leur etat clinique le permet.

International audience; Purpose of Review: This review provides an overview of current knowledge and understanding of EEG Neurofeedback for anxiety disorders and post-traumatic stress disorders. Recent Findings: The manifestations of anxiety disorders and post-traumatic stress disorders (PTSD) are associated with dysfunctions of neurophysiological stress axes and brain arousal circuits, which are important dimensions of the research domain criteria (RDoC). Even if the pathophysiology of these disorders is complex, one of its defining signatures is behavioral and physiological over-arousal. Interestingly, arousal-related brain activity can be modulated by electroencephalogram-based neurofeedback (EEG NF), a non-pharmacological and noninvasive method that involves neurocognitive training through a brain-computer interface (BCI). EEG NF is characterized by a simultaneous learning process where both patient and computer are involved in modifying neuronal activity or connectivity, thereby improving associated symptoms of anxiety and/or over-arousal. Summary: Positive effects of EEG NF have been described for both anxiety disorders and PTSD, yet due to a number of methodological issues, it remains unclear whether symptom improvement is the direct result of neurophysiological changes targeted by EEG NF. Thus, in this work we sought to bridge current knowledge on brain mechanisms of arousal with past and present EEG NF therapies for anxiety and PTSD. In a nutshell, we discuss the neurophysiological mechanisms underlying the effects of EEG NF in anxiety disorder and PTSD, the methodological strengths/weaknesses of existing EEG NF randomized-controlled trials (RCTs) for these disorders, and the neuropsychological factors that may impact NF training success.

Los trastornos de ansiedad forman parte de las enfermedades mas frecuentes en la poblacion general, con una prevalencia total de alrededor del 10%. Ademas de los estados de ansiedad agudos, existen cinco diagnosticos principales de trastornos de ansiedad cronicos: las fobias (especificas, sociales y agorafobia), el trastorno de panico y el trastorno de ansiedad generalizada. Cada uno de estos sindromes presenta una ansiedad excesiva, pero el diagnostico especifico esta basado en las caracteristicas semiologicas, como el objeto del miedo, sus mecanismos y las estrategias que se ponen en marcha para controlarlo. La intensidad de los sintomas es variable de una categoria a otra y de un individuo a otro, pero algunas formas de trastornos de ansiedad pueden ser extremadamente graves e invalidantes, en particular ciertas fobias. Las complicaciones y las comorbilidades, depresivas y adictivas, tambien aportan gravedad a estas enfermedades, que deben detectarse especialmente en los individuos jovenes para poder tratarlas eficazmente. Las estrategias terapeuticas que se han mostrado eficaces en los trastornos de ansiedad son, sobre todo, las terapias conductuales y cognitivas, y algunos antidepresivos serotoninergicos.

This paper seeks to describe anxiety’s different symptomatologic presentations in Parkinson’s disease (PD), its longitudinal course and predictors, as well as its motor and non-motor correlates. It also reviews the available screening tools and different treatment modalities. In PD, longitudinal predictors of anxiety are mostly non-motor non-dopaminergic symptoms. The longitudinal course of anxiety is mainly a stable one. The Parkinson Anxiety Scale and the Geriatric Anxiety Scale are the 2 recommended screening tools. A third of PD patients suffer from an anxiety disorder at any time point. It can precede or follow PD motor symptoms. Anxiety is associated with demographic, disease-related motor and non-motor features. There is a lack of studies evaluating psychotropic treatment of anxiety in PD. Adjustment of dopaminergic treatment is indicated when anxiety is associated with motor fluctuations. DBS can be useful as well as CBT and body-mind interventions.

Obsessive-compulsive disorder (OCD) is a frequent and severe disease, potentially inducing a major impairment for the patient and burden for their family. Recent research in psychiatry and neuroscience have led to better comprehension of the disease's mechanisms and helped to improve its treatment. However, a large proportion of patients have refractory symptoms, including for traditional cognitive and behavioral therapy by exposure and response prevention (ERP), leading clinicians to look for new treatments. Mindfulness-based interventions (MBI) are a new type of approach, initially based on Buddhist meditation, which aims to provide better consciousness of the present moment. It has been successfully developed in some psychiatric diseases and other general medical conditions such as chronic pain. The two main programs using mindfulness meditation, Mindfulness-based stress reduction (MBSR) and Mindfulness-based cognitive therapy (MBCT), have shown effectiveness for the reduction of depressive and anxiety symptoms and relapses of depressive episodes in unipolar depression. It has no side effects and is well tolerated by patients. Its action relies on the specific correction of cognitive deficits in attention, emotion regulation and executive functions which are shared by OCD, GAD and depression. For OCD, we make the hypothesis that Mindfulness-Based Interventions could reduce the cognitive bias specifically existing in this pathology, such as dysfunctional beliefs, and therefore improve the symptoms. This article first reviews the existing literature on clinical trials involving Mindfulness-Based Interventions in OCD which comprises a small number of clinical studies based on very different types of protocols. At this time, and due to the lack of gold-standard studies with a large number of patients, no proof of the efficiency of mindfulness-based interventions in OCD has been shown. In a second section, following our hypothesis on the mechanisms of specific and non-specific action of this therapy in OCD, we propose a cognitive model of mindfulness-based therapy action in OCD involving the correction of OCD's cognitive bias. In this model, mindfulness-based therapy is supposed to treat specifically the cognitive aspects of the disease, while ERP is focused on its behavioral part. Then we present a clinical study aiming to prove the feasibility and the interest of the use of mindfulness in OCD, carried out in two different clinical centers. One of them used MBCT while the second used MBSR. Its results show the feasibility of mindfulness-based therapy in OCD patients and tend to prove that it could be more effective in young patients suffering from less severe forms of OCD. In parallel, attention tests and fMRI scans were done at the beginning and at the end of the therapy. Their results will be published separately. We also discuss the putative role of a specific form of MBCT adapted for OCD, specifically for its benefits in psychoeducation, which could reduce the dysfunctional beliefs present in OCD patients. Finally, we propose a therapeutic strategy in which the MBCT could complement the classical ERP therapy, as a "maintenance" treatment, aiming to extend the relapse of OCD symptoms. This article is a step further in the use of mindfulness-based therapy for OCD which could be added to the existing treatments reducing the patient's symptoms and improving their quality of life.

Virtual reality can be used for psychotherapeutic purposes. Our main objective is to assess the feasibility and the tolerance of a relaxation therapy in virtual reality from patients suffering from schizophrenia, by studying the risks of symptoms of depersonalization or cybersickness. It is a prospective, open, five-week clinical study. Evaluations were carried out before and after each session. They were 13 patients aged 18 to 65. Analyzes showed a good tolerance and acceptance regarding virtual reality and anxiolytic effects have been observed between baseline values and those obtained after the first session and after the fifth session (p 0.05).

BACKGROUND Impulse control disorders are frequently associated with dopaminergic therapy in Parkinson's disease. Genetic studies have suggested a high heritability of impulse control disorders in the general population and in PD. The aim of this study was to identify candidate gene variants associated with impulse control disorders and related behaviors in PD. METHODS We performed a multicenter case-control study in PD patients with (cases) or without impulse control disorders and related behaviors despite significant dopamine agonist exposure of >300 mg levodopa-equivalent daily dose during 12 months (controls). Behavioral disorders were assessed using the Ardouin scale. We investigated 50 variants in 24 candidate genes by a multivariate logistic regression analysis adjusted for sex and age at PD onset. RESULTS The analysis was performed on 172 cases and 132 controls. Cases were younger (60 ± 8 vs 63 ± 8 years; P

Points essentiels Les mesures d’isolement et de contention mecanique font desormais l’objet d’une loi, ainsi que de recentes publications d’autorites administratives, tels qu’un rapport du Controleur General des Lieux de Privation de Liberte ou des recommandations de l’HAS. Les episodes d’agitation psychomotrice et l’auto- ou l’hetero-agressivite des episodes maniaques ou psychotiques constituent les indications les plus frequentes de leur prescription. La prescription de ces mesures obeit a des modalites de prescription particulieres qui sont detaillees dans ce travail. Les mesures d’isolement et de contention mecanique, bien qu’ayant montre leur efficacite, representent un dernier recours therapeutique, compte tenu notamment des complications physiques et du retentissement psychique. Dans les episodes d’agitation psychomotrice justifiant ces prescriptions, une prise en charge medicamenteuse specifique sera associee a visee anxiolytique, dont nous rappellerons les principales recommandations de bonnes pratiques. Enfin, la prevention et la prise en charge des complications physiques liees aux mesures d’isolement et de contention mecanique doivent faire l’objet d’une surveillance attentive. Nous presentons ici des protocoles de prevention des complications liees a la constipation et a la maladie thromboemboliques veineuse.

Resume Objectifs Les interventions basees sur la pleine conscience (MBI: Mindfulness Based Interventions) ont recemment fait leur apparition en medecine occidentale. L’efficacite de ces programmes a ete demontree en ce qui concerne la regulation emotionnelle et le deploiement des ressources cognitives, notamment de l’attention. Malgre l’interet potentiel des MBI sur la stabilisation attentionnelle, le recours a ces therapeutiques est encore rare dans la rehabilitation neuropsychologique. Nous avons realise une revue de la litterature dont l’objectif est de discuter les possibles articulations entre les MBI et la prise en charge neuropsychologique. Resultats Dans la premiere partie, nous rappelons les concepts cles de la neuropsychologie de l’attention. Ensuite, nous examinons l’efficacite des approches MBI sur les processus cognitifs, affectifs et somatiques. La complexite des manifestations psychiatriques provient entre autres des liens etroits entre ces trois types des processus. Les MBI, qui tiennent compte de ces interdependances peuvent ainsi avoir une pertinence clinique dans la prevention et la prise en charge des alterations cognitives. Dans la derniere partie, nous suggerons d’integrer les principes des MBI dans les programmes de remediation cognitive et d’education therapeutique. Dans cette perspective nous proposons plusieurs recommandations pour la mise en place des outils de rehabilitation inspires de la pleine conscience. Conclusions L’approche integrative preconisee ici s’inspirerait ainsi d’une part de la neuropsychologie actuelle et des MBI qui restructurent le rapport a soi, a ses affects, a ses cognitions et a son environnement via un travail metacognitif.

Resume L’anxiete peut varier d’un etat emotionnel simple et physiologique a des pathologies structurees avec des syndromes bien etablis comme le sont les troubles phobiques, le trouble panique ou encore le trouble anxiete generalisee. Dans cet article, nous presentons d’abord les composantes motrices de l’anxiete infraclinique (la gene simple) et de la peur aigue. On retrouve essentiellement : tension musculaire, tremblements, instabilite, modifications de la posture (repli, defense, autocontact), de la mimique ou du comportement (agitation ou inhibition). Nous montrons ensuite comment la semiologie motrice s’integre dans la description des principaux troubles anxieux et obsessionnels (classifications et echelles d’evaluation). Pour certains de ces troubles, la phobie sociale par exemple, des approches specifiques comme l’etude de l’oculomotricite peuvent permettre d’objectiver des signes moteurs plus subtils. En ce qui concerne les troubles obsessionnels-compulsifs, ils peuvent s’averer egalement marques par une dimension motrice particuliere, avec des gestes repetitifs, inoperants, et des modifications du comportement spatial. Enfin, nous discutons de l’interet de l’utilisation de la realite virtuelle dans l’exploration de cette symptomatologie motrice identifiee dans les troubles anxieux et obsessionnels.

Introduction: Classical well-established treatments of social anxiety disorder (SAD) are now complemented by more recent therapeutic strategies. This review aims to summarize available therapies for SAD and discuss recent evidence-based findings on the management of this disorder.Areas covered: Recent guidelines recommend psychotherapy, particularly cognitive-behavioral therapy (CBT), and pharmacotherapy, as first-line treatments of patients with SAD, without a clear superiority of one option over the other. CBT includes classical approaches such as in vivo exposure to social situations and cognitive therapy, but new modalities and techniques have been recently developed: third-wave approaches, internet-delivered therapy, virtual reality exposure, and cognitive bias modification. Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors have been also extensively studied and shown to be effective in SAD. Two alternative strategies have been developed to treat SAD with disappointing results: cognitive bias modification, and pharmacological augmentation of psychotherapy using D-cycloserine during exposure sessions.Expert opinion: Personalized treatments for SAD patients are now available. Innovative strategies such as online psychotherapy and virtual reality exposure are useful alternatives to CBT and SSRIs. Future developments and optimization of attention bias modification and of pharmacological augmentation of psychotherapy can be promising.

Here, we propose to review the immuno-inflammatory hypothesis in OCD given the concurrent incidence of autoimmune comorbidities, infectious stigma, and raised levels of inflammatory markers in a significant subset of patients. A better understanding of the immune dysfunction in OCD may allow stratifying the patients in order to design personalized pharmaco/psychotherapeutic strategies. A persistent low-grade inflammation involving both innate and adaptive immune system with coexisting autoimmune morbidities and stigma of infectious events has been prominently observed in OCD. Hence, specific treatments targeting inflammation/infection are a feasible alternative in OCD. This review highlights that OCD is associated with low-grade inflammation, neural antibodies, and neuro-inflammatory and auto-immune disorders. In some subset of OCD patients, autoimmunity is likely triggered by specific bacterial, viral, or parasitic agents with overlapping surface epitopes in CNS. Hence, subset-profiling in OCD is warranted to benefit from distinct immune-targeted treatment modalities.

International audience; Aims: To compare prevalence and risk factors for burnout, anxiety and depression among hospital psychiatrists and non-psychiatrists.Method: Regional online survey of psychiatric and non-psychiatric hospital physicians was performed including: a job-stress scale, the Hospital Anxiety and Depression Scale (HADS), the Copenhagen Burnout Inventory (CBI), a stressful work relationships list and a six items scale about work-related psychosocial risk factors (PRFs). The client-related burnout scale of the CBI has been changed to an interpersonal burnout scale. Cases were defined by a score of 8+ for the HADS-A/HADS-D and 50+ for the three CBI subscales.Results: 285 psychiatrists and 326 non-psychiatrists participated. The prevalence of depression, personal burnout and work-related burnout did not differ between physicians. Anxiety was lower in psychiatrists and interpersonal burnout was higher in senior psychiatrists. Multivariate analysis showed two main PRFs, common to both groups of physicians: "work intensity and time" was associated with four of the five syndromes and "emotional demands" with the three burnout syndromes. Interpersonal burnout was associated with stressful relationships with leaders, but not with patients.Conclusion: Reducing the workload, improving the management of emotions and increasing managerial skills are important approaches for prevention.

Background In 2017 a patient’s death occurred in the psychiatry department of our establishment. After a morbidity-mortality review, the hypothesis of a cardiac arrest after intake of torsadogenic drugs has been suggested. Purpose The state of cardiac patient care in our psychiatry units was one of the strategic axes retained to define priority actions for improvement. Material and methods Records of the hospitalised psychiatry patients were analysed on a given day in April 2018. A literature review allowed selection of the factors to analyse: ionogram dates and results, thyroid function, arterial tension (AT), heart rhythm (HR), electrocardiogram realisation, corrected QT interval (QTc), torsadogenic risk factors (female ≥65 years, ischaemic heart disease, torsadogenic drug) and co-prescriptions of psychotropic drugs inducing QT prolongation (PDIQTP). Only the factors traced in the patients’ records during the first 30 days of hospitalisation were analysed. Results Ninety-six records were analysed (100% of inpatients). Found at admission were ionograms, thyroid function, AT, HR and electrocardiogram realisation, respectively for 94%, 70%, 95%, 96% and 90% of patients. Seven hypokalaemias were found and were all adjusted during the first month. No hypocalcaemia or hypothyroidism were found but one hyperthyroidism was revealed and explored. Seven hypertensions were explored. No bradycardia was recorded. Four patients had QTc prolongation (≥450 ms). Among them, two profited from an additional electrocardiogram. The percentage of patients with one risk factor was 19% and 2% of patients had more than one risk factor. Half of these patients underwent an additional electrocardiogram. During hospitalisation, 44 PDIQTP, 17 initiations and 12 raises of torsadogenic drug dosage were carried out. These modifications were monitored by an extra electrocardiogram in 13% of cases. Conclusion Admission cardiac check-up was mainly realised and its disturbances corrected or explored. However, the thyroid function was underestimated whereas its disturbance can cause not only cardiac disorders but also psychiatric disorders. Furthermore, in risk situations that need an extra electrocardiogram during hospitalisation (QTc prolongation for example), cardiac monitoring was insufficient. These two points will be spotlighted in a cardiac monitoring protocol for psychiatry inpatients, in order to prevent iatrogenic cardiac arrests throughout the hospitalisation. References and/or acknowledgements No conflict of interest.

Resume Objectif L’hypnose est souvent proposee comme une methode de psychotherapie dans diverses pathologies psychiatriques, notamment en rapport avec le stress et l’anxiete. Sa place au sein des strategies therapeutiques des troubles anxieux chroniques reste cependant incertaine. L’objectif de cette revue est donc d’analyser la litterature medicale portant sur l’efficacite therapeutique de l’hypnose dans les troubles anxieux. Methodes Une recherche bibliographique exhaustive a ete realisee via Pubmed pour identifier les publications originales, entre 1980 et 2015, rapportant des donnees cliniques sur l’efficacite de l’hypnose dans six categories de troubles anxieux. Chaque publication a ensuite ete analysee au plan methodologique et des resultats therapeutiques. Resultats Seulement trois essais controles ont ete identifies au total, un dans le trouble panique et deux dans l’etat de stress post-traumatique (ESPT). Les autres articles portent sur des etudes ouvertes (4 articles), ou sur des cas uniques (20 articles). L’etude realisee dans le trouble panique conclut a l’absence d’efficacite de l’hypnose associee a la therapie comportementale et cognitive, de meme qu’un des essais realises dans l’ESPT. Seule une etude effectuee chez 48 enfants indonesiens souffrant d’ESPT suggere l’efficacite d’une technique particuliere d’hypnose adaptee a la culture locale. Les autres articles signalent des resultats positifs dans des etudes en ouvert ou dans des rapports de cas, mais leurs conclusions peuvent difficilement etre generalisees. Conclusion Les donnees de la litterature sont actuellement negatives ou insuffisantes pour attester de l’efficacite therapeutique de l’hypnose dans les troubles anxieux chroniques, et cela quelle que soit la categorie consideree (phobies, ESPT, etc.). Des etudes specifiques seraient necessaires pour determiner d’eventuels profils de patients repondeurs aux methodes d’hypnose dans ces pathologies.

Objectives Incidence-prevalence-mortality (IPM) models have been developped to estimate incidence or prevalence when one of these two measures is unavailable. We aimed to test the consistency of an IPM model of psychotic disorders on a recent incidence-prevalence couple dataset and to identify potential causes of inconsistency by applying the model to (a) the whole population, (b) female and male subgroups, (c) migrant subgroups, and (d) psychotic disorders with age at onset (AAO) between 18 and 24 (18-24 AAO). Methods We modelled prevalence (MP) using incidence data and the expected mortality and remission values. We then compared the MP to the observed prevalence (OP). Results In the whole population, the model significantly underestimated the prevalence (MP = 3.30, 95% CI [2.97, 3.66]; OP = 4.98, 95% CI [4.58, 5.41]). The results were similar for the two genders. In the migrants group, results were in the opposite direction, the model significantly overestimating the prevalence. Finally, in the 18-24 AAO subgroup, the model performed well, with OP and MP not significantly different. Conclusion These results suggest that standard IPM models do not perform well for psychotic disorders and more complex models taking into account the heterogeneity of the sample (in terms of remission, mortality, population movements, etc.) need to be developed.

International audience; INTRODUCTION:The primary objective of this study was to determine if second-generation antipsychotic (SGA) administration was associated with lower aggressiveness scores compared to first-generation (FGA) in schizophrenia (SZ). The secondary objective was to determine if antidepressants, mood stabilizers, and benzodiazepines administration were respectively associated with lower aggressiveness scores compared to patients who were not administered these medications.METHODS:Three hundred thirty-one patients with schizophrenia (N = 255) or schizoaffective disorder (N = 76) (mean age = 32.5 years, 75.5 % male gender) were systematically included in the network of FondaMental Expert Center for Schizophrenia and assessed with the structured clinical interview for DSM-IV Axis I disorders and validated scales for psychotic symptomatology, insight, and compliance. Aggressiveness was measured by the Buss-Perry Aggression Questionnaire (BPAQ) score. Ongoing psychotropic treatment was recorded.RESULTS:Patients who received SGA had lower BPAQ scores than patients who did not (p = 0.01). More specifically, these patients had lower physical and verbal aggression scores. On the contrary, patients who received benzodiazepines had higher BPAQ scores than patients who did not (p = 0.04). No significant difference was found between BPAQ scores of patients respectively being administered mood stabilizers (including valproate), antidepressant, and the patients who were not. These results were found independently of socio-demographical variables, psychotic symptomatology, insight, compliance into treatment, daily-administered antipsychotic dose, the way of antipsychotic administration (oral vs long acting), current alcohol disorder, and daily cannabis consumption.CONCLUSION:The results of the present study are in favor of the choice of SGA in SZ patients with aggressiveness, but these results need further investigation in longitudinal studies. Given the potent side effects of benzodiazepines (especially dependency and cognitive impairment) and the results of the present study, their long-term prescription is not recommended in patients with schizophrenia and aggressive behavior.

Anxiety disorders are widespread psychiatric conditions with significant social and professional disability, poor quality of life, an increased risk of suicide, and frequent attendance of medical services. Serotonin reuptake inhibitors (SRI) and serotonin and norepinephrine reuptake inhibitors (SNRI) have demonstrated a rather robust efficacy for the treatment of most of anxiety disorders. Nevertheless a substantial number of patients are resistant or still suffer from residual symptoms despite this first line treatment. The objective of our paper is to review relevant studies for the pharmacologic management of anxiety disorders resistant to the first line treatment. For this purpose, we conducted a pubmed/medline search for double-blind placebo-controlled trials of treatment-resistant anxiety disorders. An adequate trial for a SRI in the treatment of obsessive-compulsive disorder (OCD) should continue for at least 12 weeks. Special considerations of the comorbidities and symptom profile could help in the choice of an appropriate pharmacotherapy. Several trials have highlighted the efficacy of antipsychotics as an add-on to SRI in treatment-resistant OCD such as haloperidol more so when comorbid with a tic disorder, or risperidone that can reduce OCD as well as depressive symptoms. Aripiprazole has been shown efficacious in two placebo-controlled double-blind trials, while the efficacy of quetiapine and olanzapine remains controversial. Other trials showed some efficacy of anticonvulsants (lamotrigine, topiramate), pindolol, memantin and N-acetylcystein as an adjunctive treatment to SRI for resistant OCD. Few trials have investigated selective serotonin reuptake inhibitors (SSRI) or SNRI resistant generalized anxiety disorder showing a failure of adjunctive therapy with olanzapine, quetiapine, ziprasidone and risperidone. These studies were underpowered and very limited in number. Adjunctive risperidone for resistant post-traumatic stress disorder (PTSD) showed benefit in some but not all trials. Olanzapine was beneficial for the reduction of the CAPS score in addition to the improvement of sleep disturbances. Furthermore, prazosin was efficacious by reducing PTSD symptoms, sleep disturbances, nightmares, and psychological distress. One double-blind placebo-controlled study was conducted to investigate treatment-resistant social phobia showing no benefit of pindolol add-on paroxetine. Our results demonstrate that the pharmacological management of treatment-resistant anxiety disorders is not sufficiently investigated in double-blind placebo-controlled trials, despite a growing evidence in favor of antipsychotics and some other pharmacological agents in resistant OCD and, to a lesser extent, PTSD. Hence, there is a crucial need for larger double-blind placebo-controlled trials for resistant anxiety disorders. Finally, being out of the scope of our review, we omitted studies of non-pharmacologic therapies.

Introduction We sought to examine the prevalence of anxiety disorders associated with migration in the first-, second- and third-generation. Methods The French Mental Health in the General Population cross-sectional survey interviewed 38,694 individuals using the MINI. The prevalence of lifetime anxiety disorders, and comorbidities was compared between migrants and non-migrants and by generation. All analyses were adjusted for age, sex, and income and education levels. Results In comparison to natives, pooled anxiety disorders were more common among migrants (25.3% vs. 20.7%, OR = 1.24) and among the three studied generations of migrants. Moreover, the prevalence rate of the pooled anxiety disorders was significantly higher in third-generation migrants, in comparison to first-generation (26.7% vs. 22.6%, OR = 1.14). Prevalence rates were higher in migrants for panic disorder (6.6% vs. 5.3%, OR = 1.20), general anxiety disorder (15.0% vs. 12.0%, OR = 1.24), posttraumatic stress disorder (1.0% vs. 0.6%, OR = 1.51), but not for social anxiety disorder. In comparison to natives, migrants with anxiety disorders had higher prevalence rates of suicide attempts (14.0% vs. 12.8% for natives), psychotic disorders (8.3% vs. 5.7%), unipolar depressive disorder (29.5% vs. 25.4%), bipolar disorder (5.0% vs. 4.0%), and addictive disorders (9.6% vs. 6.2% for alcohol use disorder, 8.2% vs. 4.1% for substance use disorders). Conclusion Migration was associated with a higher prevalence of all anxiety disorders, in the first, second and third generation, and associated with more psychiatric comorbidities. Moreover, the prevalence increased across generations, and was significantly higher among third-generation migrants, in comparison to first-generation.

The purpose of this review was to assess and present the findings up to this date on the efficacy of antipsychotics in the treatment of generalized anxiety disorders (GAD), social anxiety disorders (SAD), panic disorders (PD), and obsessive-compulsive disorders (OCD), mostly based on published randomized controlled trials (RCTs) or on open-label studies when RCT were lacking. Quetiapine could be recommended in patients with GAD. The efficacy of aripiprazole in two open-label studies on patients with antidepressant-refractory GAD should be assessed in RCTs. Despite preliminary positive results in open studies, there are currently no strong evidence for the effectiveness of antipsychotics in refractory SAD and in refractory PD. Conversely, risperidone and aripiprazole can be used for the treatment of refractory OCD as augmentation agents to antidepressants. Contrary to SAD and PD, this review found evidence for the use of second-generation antipsychotics in GAD and OCD. Otherwise, first-generation antipsychotics cannot be recommended in anxiety disorders and OCD.

IntroductionReligion was and still is considered to be a major aspect of life, affecting mental health outcome worldwide and more particularly in the Middle Eastern Arab patients. The aim of this study was to develop an original Arabic religiosity scale and to test its psychometric properties to be

Resume Quatre-vingt-dix-sept patients repondant au diagnostic de trouble de l’adaptation avec anxiete (TAA) ont ete recrutes dans cette etude multicentrique realisee en medecine generale et compares a 30 sujets temoins apparies pour l’âge et le sexe. Le diagnostic etait pose a partir de la passation du Mini-International Neuropsychiatrie Interview (MINI) completee d’une recherche standardisee des evenements stressants et d’une evaluation de la symptomatologie anxieuse au moyen de differents instruments d’evaluation : echelle de la symptomatologie anxieuse et depressive (HAD), echelle d’evaluation de l’anxiete de Hamilton (HAM-A), questionnaire sur les inquietudes du Penn-State (QIPS), inventaire d’anxiete etat de Spielberger (STAI-S), echelle d’emotionnalite positive et negative a 31 items (EPN-31). Les resultats montrent que les evenements concernant le domaine de la vie professionnelle sont les plus frequemment en cause (43 %). Sur le plan de la symptomatologie, les resultats montrent que le TAA presente un niveau d’anxiete — tant sur le plan general (physique et somatique) que des ruminations et des emotions negatives — proche des resultats obtenus avec les autres troubles anxieux, particulierement le trouble anxieux generalise. Des recherches futures permettront d’apporter les elements necessaires pour mieux connaitre le trouble et en preciser les limites diagnostiques qui restent encore un sujet a controverse, particulierement vis-a-vis de la reponse homeostatique au stress et les autres categories de troubles anxieux. Les resultats de notre etude plaident pour que cette entite sub-syndromique soit reconnue et prise en charge, particulierement en medecine generale ou elle est tres frequente.

BackgroundCognitive behavioural therapy (CBT) is a successful treatment of obsessive compulsive disorder (OCD). It is known to induce changes in cerebral metabolism; however, the dynamics of these changes and their relation to clinical change remain largely unknown, precluding the identification of individualized response biomarkers.MethodIn order to study the dynamics of treatment response, we performed systematic clinical and functional magnetic resonance imaging (fMRI) evaluation of 35 OCD patients immediately before a 3-month course of CBT, halfway through and at its end, as well as 6 months after. To sensitize fMRI probing, we used an original exposure task using neutral, generic and personalized obsession-inducing images.ResultsAs expected, CBT produced a significant improvement in OCD. This improvement was continuous over the course of the therapy; therefore, outcome could be predicted by response at mid-therapy (r2 = 0.67, p ConclusionsUsing an innovative and highly sensitive exposure paradigm in fMRI, we showed that clinical and haemodynamic phenotypes have similar time courses during CBT. Our results, which suggest that the initial CBT sessions are crucial, prompt us to investigate the anatomo-functional modifications underlying the very first weeks of the therapy.

International audience; Doubt, and its behavioural correlate, checking, is a normal phenomenon of human cognition that is dramatically exacerbated in obsessive-compulsive disorder. We recently showed that deep brain stimulation in the associative-limbic area of the subthalamic nucleus, a central core of the basal ganglia, improved obsessive-compulsive disorder. To understand the physiological bases of symptoms in such patients, we recorded the activity of individual neurons in the therapeutic target during surgery while subjects performed a cognitive task that gave them the possibility of unrestricted repetitive checking after they had made a choice. We postulated that the activity of neurons in this region could be influenced by doubt and checking behaviour. Among the 63/87 task-related neurons recorded in 10 patients, 60% responded to various combinations of instructions, delay, movement or feedback, thus highlighting their role in the integration of different types of information. In addition, task-related activity directed towards decision-making increased during trials with checking in comparison with those without checking. These results suggest that the associative-limbic subthalamic nucleus plays a role in doubt-related repetitive thoughts. Overall, our results not only provide new insight into the role of the subthalamic nucleus in human cognition but also support the fact that subthalamic nucleus modulation by deep brain stimulation reduced compulsive behaviour in patients with obsessive-compulsive disorder.

Childhood traumas have been extensively associated with the development of psychotic disorders. However, our understanding of processes underlying this relationship remains poor. In order to address this issue, we examined which specific aspects of childhood trauma are significantly associated with a first episode of psychosis. 109 patients with first episode of psychosis and 145 controls representative from general population were recruited in three centers in France. Child experiences of care and abuses allowed obtaining information about types of childhood trauma, age at first exposure, identity of perpetrator, and social support. Odds ratio were calculated for each of these aspects, adjusted for age, sex, and education. Sexual and physical abuses (OR=2.26 (1.19-4.32)), and separation from one or both parents (OR ranging from 1.94 to 3.17; all significant) are significantly associated with an increased risk to present a first episode of psychosis. Furthermore, separation from mother occurring before age of 4 (OR=5.96 (1.24-28.77)), and sexual and physical abuses perpetrated by someone other than parents (OR=4.61 (1.66-12.80)) were also associated with an increased risk of first episode of psychosis. Finally, social support was significantly associated with a decreased risk to develop psychotic disorders (OR ranging from 0.33 to 0.42; all significant). Together, these findings suggest that some but not all aspects of childhood trauma are related to a significant risk to develop a first episode of psychosis.

Benzodiazepine (BZD) inappropriate use (i.e., misuse and overuse) is a worldwide public health problem. Despite current knowledge about increased sensitivity to side effects in the elderly, that should lead to more caution, only a third of BZD prescriptions in this age group are considered appropriate. The most frequent inadequate situations are excessive duration and/or dosage of a medical prescription or self-medication, especially in a context where it would be contraindicated, e.g., long-acting BZD in the elderly. Polypharmacy and comorbidities are major risk factors. Consequences of BZD inappropriate use are falls, delirium and other cognitive dysfunction, acute respiratory failure, car accidents, dependence, and withdrawal symptoms. An emerging concern is a potentially increased risk of dementia. Contrary to most clinicians' belief, discontinuation of chronic BZD use in elderly patients is feasible, with adequate psychotherapeutic or pharmacological strategies, and can lead to long-term abstinence. Brief cognitive therapy mostly relies on psychoeducation and motivational enhancement and is particularly useful in this context. Further research is needed, notably in three areas: (1) assessing the impact of public health programs to prevent BZD inappropriate use in the elderly, (2) developing alternative strategies to treat anxiety and insomnia in elderly patients, and (3) exploring the association between chronic BZD use and dementia.

International audience; Obsessive-compulsive disorder (OCD) is a mental disorder featuring obsessions (intrusive thoughts) and compulsions (repetitive behaviors performed in the context of rigid rituals). There is strong evidence for a neurobiological basis of this disorder, involving limbic cortical regions and related basal ganglion areas. However, more research is needed to lift the veil on the precise nature of that involvement and the way it drives the clinical expression of OCD. Altered cognitive functions may underlie the symptoms and thus draw a link between the clinical expression of the disorder and its neurobiological etiology. Our extensive review demonstrates that OCD patients do present a broad range of neuropsychological dysfunctions across all cognitive domains (memory, attention, flexibility, inhibition, verbal fluency, planning, decision-making), but some methodological issues temper this observation. Thus, future research should have a more integrative approach to cognitive functioning, gathering contributions of both experimental psychology and more fundamental neurosciences.

Los trastornos de ansiedad se encuentran entre las alteraciones psiquiatricas mas frecuentes en la poblacion general, con una prevalencia total del 12-15%. Existen siete diagnosticos principales de los trastornos de ansiedad cronicos: las fobias (especificas, sociales y la agorafobia), el trastorno de panico, el trastorno de ansiedad generalizada, los trastornos obsesivo-compulsivos (TOC) y los estados de estres postraumatico. Ademas de la ansiedad, presente en cada uno de dichos sindromes, hay caracteristicas semiologicas que permiten plantear un diagnostico especifico; por ejemplo, el objeto del miedo, sus mecanismos, las estrategias empleadas para controlarlo, etc. En cuanto a los tratamientos de los trastornos de ansiedad, los mas eficaces parecen ser las terapias cognitivo-conductuales y algunos antidepresivos serotoninergicos. Los trastornos neuroticos dependen de modos de funcionamiento particulares de la personalidad y pueden o no asociarse a los trastornos de ansiedad. La neurosis histerica ocupa un lugar particular, con cuadros a menudo complejos y mecanismos aun poco elucidados.

Gaze aversion could be a central component of social phobia. Fear of blushing is a symptom of social anxiety disorder (SAD) but is not yet described as a specific diagnosis in psychiatric classifications. Our research consists of comparing gaze aversion in SAD participants with or without fear of blushing in front of pictures of different emotional faces using an eye tracker. Twenty-six participants with DSM-IV SAD and expressed fear of blushing (SAD+FB) were recruited in addition to twenty-five participants with social phobia and no fear of blushing (SAD-FB). Twenty-four healthy participants aged and sex matched constituted the control group. We studied the number of fixations and the dwell time in the eyes area on the pictures. The results showed gaze avoidance in the SAD-FB group when compared to controls and when compared to the SAD+FB group. However we found no significant difference between SAD+FB and controls. We also observed a correlation between the severity of the phobia and the degree of gaze avoidance across groups. These findings seem to support the claim that social phobia is a heterogeneous disorder. Further research is advised to decide whether fear of blushing can constitute a subtype with specific behavioral characteristics.

Les notions de severite ou de gravite de la depression peuvent se poser a un niveau « macroscopique », c’est-a-dire societal, de sante publique, avec les aspects epidemiologiques de prevalence, d’impact socio-economique, de prise en charge et d’acces aux soins. Nous nous limiterons ici aux aspects cliniques individuels de la severite ou de la gravite de la depression, et a leurs consequences en termes de choix de therapeutique antidepressive et de prise en charge, en particulier psychotherapique. Malgre la diversite des outils therapeutiques disponibles – nombre de molecules antidepressives et de techniques psychotherapiques – il persiste, en France, des diffi cultes averees d’acces aux soins, un certain nombre de patient ne consultant pas, d’autres eprouvant des diffi cultes a accepter la necessite d’un traitement specifi que adapte. L’un des enjeux majeurs pour la psychiatrie, dans le domaine de la depression, est donc le reperage des patients necessitant des soins, vis-a-vis desquels un accompagnement et une pedagogie particulierement attentifs devront etre mis en œuvre. La severite de la symptomatologie est l’un des criteres principaux qui doivent conduire a la mise en place des soins, un consensus general existant quant a l’interet des antidepresseurs dans les depressions severes. Si le depistage est aise pour les depressions tres severes (depressions melancoliques, depressions avec caracteristiques psychotiques), il est en revanche souvent diffi cile pour des tableaux de severite intermediaire, avec une decision therapeutique moins univoque.