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Background Although there is an increasing number of adults older than 60 years old (>60) suffering from psychiatric disorders, there are only few studies about elderly patients in psychiatric emergencies, and no European data. The goal of our study is to describe the population of patients > 60 consulting in the most important French emergency psychiatric centre, and to identify predictive factors of psychiatric hospitalisation. Methods Our study was monocentric and prospective, including 300 consecutive patients > 60. Results Patients > 60 consulting in psychiatric emergencies were more often females and autonomous. More than 40% had a history of at least one psychiatric hospitalisation, and 44% had consulted a psychiatrist in the 6 preceding months. 75% were taking at least 1 psychotropic drug, and 50% at least 2. The most frequent reasons for consultation were depression, anxiety, sleep disorders and suicidal thoughts. Psychiatric disorders were mainly mood disorders, neurotic, stress-related and somatoform disorders, and schizophrenia, schizotypal and delusional disorders. Organic, including symptomatic, mental disorders were diagnosed in only 10% of the total sample. 39% of elderly patients were hospitalised in psychiatry. Factors predicting hospitalisation were a history of psychiatric hospitalisation, suicidal thoughts, and a diagnosis of mood disorder or schizophrenia / schizotypal / delusional disorder. Conclusion Only psychiatric factors intervene in the decision of psychiatric hospitalisation for elderly people consulting in psychiatric emergencies. Socio-demographic characteristics, level of autonomy at home and MMSE score have no influence on the hospitalisation decision. We need more data to better understand the current and future needs of this population.

The population of older adults is growing fast, especially in Europe and Northern America. Old age is often associated with mental health comorbidities. Moreover, life expectancy of people suffering from psychiatric disorders has increased, but with age-related difficulties, such as loss of independence. This represents a challenge for public health policies, as this population requires specific care and living conditions. As a response, a convention was signed between living facilities for dependent elderly (EHPAD) and the GHU Paris Psychiatry and Neurosciences. The agreement included dedicated places in EHPAD for older patients with psychiatric disorders. The aim of the study was to describe the sociodemographic and clinical characteristics of those patients.We conducted a cross-sectional study among patients who applied for an EHPAD admission.Between 2016 and 2019, 163 patients applied for placement in an EHPAD, and 117 were admitted (72%). Applicants were 71 years old on average. Admitted patients were older than non-admitted and lived in different Parisian sectors. Among admitted patients, nine in 10 were single, divorced or widowed, and 64.3% were childless. Almost half of them were schizophrenic or had delusional disorders (46.9%), and 65.3% were considered as moderately dependent. At the time of the study, 89 patients still lived in EHPAD. Almost half of them had anxiety and depressive disorders (48.3%), 19.1% had cognitive disorders, and 42.7% manifested agitation.Our study highlighted older psychiatric patients' specificities regarding their admission status into long-term living facilities.

Resume Cet entretien est la suite et le complement de l’article « Transidentites et changement de sexe : le point de vue du sociologue, le role du psychiatre ». Les psychologues Sandrine Coussinoux, Eirini Rari et le psychiatre Thierry Gallarda y evoquent la problematique de la reassignation de sexe pour des personnes transidentitaires ainsi que le role des psychologues qui travaillent sur ce sujet au sein de l’equipe parisienne pluridisciplinaire specialisee « Dysphorie de genre et sante mentale ».

Very-late-onset psychotic symptoms (PS) are a common gateway to both neurodegenerative dementias and primary psychiatric disorders. Despite similarities in clinical expression, no consensual guidelines or a specific nosographic framework exist. The purpose of this systematic review is to establish a phenomenological classification of PS among the main neurodegenerative dementias and late psychosis. More specifically, to: 1) allow psychotic phenotypes to be considered according to aetiology; 2) help clinicians screen for psychiatric-type dementia, when appropriate; and 3) justify research into very-late-onset PS in patients with dementias at a pre-clinical cognitive stage in order to establish a nosographic framework for these PS based on the prognosis of dementia. Methods A literature review was conducted to search for very-late-onset PS (>60 years old) in reports of late-onset (known as primary) psychoses, Alzheimer-type dementia and Lewy body dementia, focusing on the phenomenological data. Results Very-late-onset schizophrenia-like psychosis appears to be a primary psychiatric diagnosis that is clinically distinct from PS, which emerges among established dementias, but remains a heterogeneous entity due to its age-based syndromic aspect. It is possible to differentiate between the more common phenotypes based on the aetiology of the dementia. Conclusion The results confirm the value of the phenomenological approach in terms of distinguishing between different aetiologies of PS among confirmed cases of dementias. Prospective longitudinal studies are required to examine the early discriminatory characteristics of PS in order to improve prognosis based on the nosographic framework thus established.

Background Although treatment-resistant and nontreatment-resistant depressed patients show structural brain anomalies relative to healthy controls, the difference in regional volumetry between these two groups remains undocumented. Methods A whole-brain voxel-based morphometry (VBM) analysis of regional volumes was performed in 125 participants’ magnetic resonance images obtained on a 1.5 Tesla scanner; 41 had treatment-resistant depression (TRD), 40 nontreatment-resistant depression (non-TRD), and 44 were healthy controls. The groups were comparable for age and gender. Bipolar/unipolar features as well as pharmacological treatment classes were taken into account as covariates. Results TRD patients had higher gray matter (GM) volume in the left and right amygdala than non-TRD patients. No difference was found between the TRD bipolar and the TRD unipolar patients, or between the non-TRD bipolar and non-TRD unipolar patients. An exploratory analysis showed that lithium-treated patients in both groups had higher GM volume in the superior and middle frontal gyri in both hemispheres. Conclusions Higher GM volume in amygdala detected in TRD patients might be seen in perspective with vulnerability to chronicity, revealed by medication resistance.

International audience; Qu’entend-on par transidentités ? Pourquoi des personnes transidentitaires veulent ou ne veulent pas changer de sexe ? Quel est le rôle du psychiatre dans le changement de sexe de personnes transidentitaires ? C’est à ces questions, aux enjeux souvent complexes, qu’Arnaud Alessandrin, sociologue, et Thierry Gallarda, psychiatre, répondent dans cet entretien.

Objective Repetitive transcranial magnetic stimulation (rTMS) over the left temporo-parietal region has been proposed as a treatment for resistant auditory verbal hallucinations (AVH), but which patients are more likely to benefit from rTMS is still unclear. This study sought to assess the effects of rTMS on AVH, with a focus on hallucination phenomenology. Method Twenty-seven patients with schizophrenia and medication-resistant AVH participated to a randomized, double-blind, placebo-controlled, add-on rTMS study. The stimulation targeted a language-perception area individually determined using functional magnetic resonance imaging and a language recognition task. AVH were assessed using the hallucination subscale of the Scale for the Assessment of Positive Symptoms (SAPS). The spatial location of AVH was assessed using the Psychotic Symptom Rating Scales. Results A significant improvement in SAPS hallucination subscale score was observed in both actively treated and placebo-treated groups with no difference between both modalities. Patients with external AVH were significantly more improved than patients with internal AVH, with both modalities. Conclusions A marked placebo effect of rTMS was observed in patients with resistant AVH. Patients with prominent external AVH may be more likely to benefit from both active and placebo interventions. Cortical effects related to non-magnetic stimulation of the auditory cortex are suggested.

A recently tested hypothesis suggests that inter-individual differences in episodic autobiographical memory (EAM) are better explained by individual identification of typical features of a gender identity than by sex. This study aimed to test this hypothesis by investigating sex and gender related differences not only in EAM but also during retrieval of more abstract self-knowledge (i.e., semantic autobiographical memory, SAM, and conceptual self, CS), and considering past and future perspectives. No sex-related differences were identified, but regardless of the sex, feminine gender identity was associated with clear differences in emotional aspects that were expressed in both episodic and more abstract forms of AM, and in the past and future perspectives, while masculine gender identity was associated with limited effects. In conclusion, our results support the hypothesis that inter-individual differences in AM are better explained by gender identity than by sex, extending this assumption to both episodic and semantic forms of AM and future thinking.

Autobiographical memory (AM) underlies the formation and temporal continuity over time of personal identity. The few studies on sex-related differences in AM suggest that men and women adopt different cognitive or emotional strategies when retrieving AMs. However, none of the previous works has taken into account the distinction between episodic autobiographical memory (EAM), consisting in the retrieval of specific events by means of mental time travel, and semantic autobiographical memory (SAM), which stores general personal events. Thus, it remains unclear whether differences in these strategies depend on the nature of the memory content to be retrieved. In the present study we employed functional MRI to examine brain activity underlying potential sex differences in EAM and SAM retrieval focusing on the differences in strategies related to the emotional aspects of memories while controlling for basic cognitive strategies. On the behavioral level, there was no significant sex difference in memory performances or subjective feature ratings of either type of AM. Activations common to men and women during AM retrieval were observed in a typical bilateral network comprising medial and lateral temporal regions, precuneus, occipital cortex as well as prefrontal cortex. Contrast analyses revealed that there was no difference between men and women in the EAM condition. In the SAM condition, women showed an increased activity, compared to men, in the dorsal anterior cingulate cortex, inferior parietal and precentral gyrus. Overall, these findings suggest that differential neural activations reflect sex-specific strategies related to emotional aspects of AMs, particularly regarding SAM. We propose that this pattern of activation during SAM retrieval reflects the cognitive cost linked to emotion regulation strategies recruited by women compared to men. These sex-related differences have interesting implications for understanding psychiatric disorders with differential sex prevalence and in which one of key features is overgenerality in AM.

Background Depression negatively affects rehabilitation and quality of life after stroke. Identifying in the acute phase patients at high risk for post-stroke depression would facilitate early detection of depressive symptoms. Methods The DEPRESS (Depression Predictors after Ischemic Stroke) study was a prospective cohort study designed to identify baseline predictors of depression occurring within six months after ischemic stroke and high-risk patients for post-stroke depression. All patients without aphasia were screened for depression by a neurologist using the Patient Health Questionnaire, and the diagnosis was confirmed by a psychiatrist with the Mini International Neuropsychiatric Interview. In severely aphasic patients, depression was diagnosed using the Aphasic Depression Rating Scale and the Visual Analog Mood Scale. Results Depression was present in 61 of 251 (24%) patients enrolled in the DEPRESS study. Female gender, prior history of depression, major physical disability, prior history of stroke, stressful life event exposure in the month preceding stroke onset, and pathologic crying were significant predictors of depression within six months after ischemic stroke. Depression was more frequent in patients with left caudate and/or lenticular nucleus lesion (OR = 2.4, 95% confidence interval, 0.97–5.91), but the difference was not significant. The presence of ≥2 predictors identified the largest proportion of depressed patients (62%) in the smallest proportion of the cohort (36%). Conclusion Female gender, prior history of depression, major physical disability, prior history of stroke, recent stressful life event exposure before stroke, and pathologic crying were significant predictors of post-stroke depression occurring within six months after stroke onset.

International audience; Self-referential processing relies mainly on the medial prefrontal cortex (MPFC) and enhances memory encoding (i.e., Self-Reference Effect, SRE) as it improves the accuracy and richness of remembering in both young and older adults. However, studies on age-related changes in the neural correlates of the SRE on the subjective (i.e., autonoetic consciousness) and the objective (i.e., source memory) qualitative features of episodic memory are lacking. In the present fMRI study, we compared the effects of a self-related (semantic autobiographical memory task) and a non self-related (general semantic memory task) encoding condition on subsequent episodic memory retrieval. We investigated encoding-related activity during each condition in two groups of 19 younger and 16 older adults. Behaviorally, the SRE improved subjective memory performance in both groups but objective memory only in young adults. At the neural level, a direct comparison between self-related and non self-related conditions revealed that SRE mainly activated the cortical midline system, especially the MPFC, in both groups. Additionally, in older adults and regardless of the condition, greater activity was found in a fronto-parietal network. Overall, correlations were noted between source memory performance and activity in the MPFC (irrespective of age) and visual areas (mediated by age). Thus, the present findings expand evidence of the role of the MPFC in self-referential processing in the context of source memory benefit in both young and older adults using incidental encoding via semantic autobiographical memory. However, our finding suggests that its role is less effective in aging.