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The EU-GEI Project was funded by grant agreement Health-F2-2010-241909 from the European Community’s Seventh Framework program. The Brazilian study was funded by grant 2012-0417-0 from the São Paulo Research Foundation, D'Andrea, Giuseppe; Lal, Jatin; Tosato, Sarah;Gayer-Anderson, Charlotte;Jongsma, Hannah E.;Stilo, Simona A.; van der Ven, Els;Quattrone, Diego;Velthorst, Eva;Berardi, Domenico;Rossi Menezes, Paulo; Arango, Celso; Parellada, Mara; Lasalvia, Antonio; La Cascia, Caterina; Ferraro, Laura; La Barbera, Daniele; Sideli, Lucia; Bobes, Julio; Bernardo, Miguel; Sanjuan, Julio; Santos, Jose Luis; Arrojo, Manuel; Marta Del-Ben, Cristina; Tripoli, Giada; Llorca, Pierre-Michel; de Haan, Lieuwe; Selten, Jean-Paul; Tortelli, Andrea; Szoke, Andrei; Muratori, Roberto; Rutten, Bart P.; van Os, Jim; Jones, Peter B.; Kirkbride, James B.; Murray, Robin M.; di Forti, Marta; Tarricone, Ilaria; Morgan, Craig

BackgroundIn Europe, the incidence of psychotic disorder is high in certain migrant and minority ethnic groups (hence: ‘minorities’). However, it is unknown how the incidence pattern for these groups varies within this continent. Our objective was to compare, across sites in France, Italy, Spain, the UK and the Netherlands, the incidence rates for minorities and the incidence rate ratios (IRRs, minorities v. the local reference population).MethodsThe European Network of National Schizophrenia Networks Studying Gene–Environment Interactions (EU-GEI) study was conducted between 2010 and 2015. We analyzed data on incident cases of non-organic psychosis (International Classification of Diseases, 10th edition, codes F20–F33) from 13 sites.ResultsThe standardized incidence rates for minorities, combined into one category, varied from 12.2 in Valencia to 82.5 per 100 000 in Paris. These rates were generally high at sites with high rates for the reference population, and low at sites with low rates for the reference population. IRRs for minorities (combined into one category) varied from 0.70 (95% CI 0.32–1.53) in Valencia to 2.47 (95% CI 1.66–3.69) in Paris (test for interaction: p = 0.031). At most sites, IRRs were higher for persons from non-Western countries than for those from Western countries, with the highest IRRs for individuals from sub-Saharan Africa (adjusted IRR = 3.23, 95% CI 2.66–3.93).ConclusionsIncidence rates vary by region of origin, region of destination and their combination. This suggests that they are strongly influenced by the social context.

ObjectiveThe CAGE questionnaire is considered a useful screening and case-finding tool for alcohol use disorders in clinical populations. Our objectives were to validate the French version of the CAGE against DSM-IV criteria and to assess performance of each item of the scale.MethodData were extracted from a hospital morbidity study conducted in central France. It concerned 5452 patients—48.5% men—in short and medium-stay units. Patients answered the CAGE questionnaire as a past-year assessment. The alcohol use disorders were diagnosed by the physicians using DSM-IV alcohol abuse or dependency criteria.ResultsThe CAGE questionnaire for a cut-off of 2 had a sensitivity of 77% and a specificity of 94%. The CAGE test was more sensitive for patients diagnosed as alcohol-dependent than for alcohol abusers (61% vs. 84%) with the same specificity (94%). These values are close to those for the English-language CAGE. The first three items (CAG) were very similar, with sensitivity 70% and specificity 94%. The eye-opening question (E) differentiated sharply between abuse and dependency, with sensitivities of 18% and 46%, respectively. A questionnaire comprising only the CAG questions of the CAGE had properties similar to the full questionnaire.ConclusionCAGE is a good screening tool for alcohol abuse or alcohol dependency. Given the frequent—and insufficiently diagnosed—alcohol problems among inpatients, CAGE is indicated as a first-line tool for screening for the most severe alcohol use disorders in hospital. It should ideally be used systematically. A positive reply to any of the first three items should alert the clinician and prompt further investigation.

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). 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. 331 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. 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. The results of the present study are in favor of a superior efficacy of second-generation antipsychotics in aggressiveness in patients with schizophrenia, 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.

SummaryCurrently, tardive dyskinesia (TD) remains an important clinical problem. The average prevalence is estimated at 30%. The appearance of antipsychotics has opened new paths. The extrapyramidal profile of these molecules is more favorable than that of conventional neuroleptics. In order to assess their prophylactic as well as curative potential, we reviewed the literature concerning four of these atypical antipsychotics: clozapine, risperidone olanzapine and amisulpride. Clozapine seems to induce fewer cases of TD than the conventional neuroleptics, and has a specific therapeutic effect. However, the risk of agranulocytosis reduces the possibility of utilisation. Risperidone appears to be an effective therapy, but several authors report cases of TD during treatment. Furthermore, larger studies and longer follow-ups are necessary to confirm the efficiency of olanzapine and amisulpride. Further studies and observations are still necessary before drawing any conclusion for these new atypical antipsychotic actions. They are doubtlessly promising, but we cannot ignore the notion of risk–benefit; regular monitoring and listening to the subjective experience of the patients must remain uppermost in the choice of therapy.

IntroductionIn a perspective of personalized care for smoking cessation, a better clinical characterization of smokers with schizophrenia (SZ) is needed. The objective of this study was to determine the clinical characteristics of SZ smokers with severe nicotine (NIC) dependence.MethodsTwo hundred and forty stabilized community-dwelling SZ smokers (mean age = 31.9 years, 80.4% male gender) were consecutively included in the network of the FondaMental Expert Centers for schizophrenia and assessed with validated scales. Severe NIC dependence was defined by a Fagerstrom questionnaire score ≥7. Major depression was defined by a Calgary score ≥6. Childhood trauma was self-reported by the Childhood Trauma Questionnaire score (CTQ). Ongoing psychotropic treatment was recorded.ResultsSevere NIC dependence was identified in 83 subjects (34.6%), major depression in 60 (26.3%). 44 (22.3%) subjects were treated by antidepressants. In a multivariate model, severe NIC dependence remained associated with major depression (OR = 3.155, P = 0.006), male gender (OR = 4.479, P = 0.009) and more slightly with childhood trauma (OR = 1.032, P = 0.044), independently of socio-demographic characteristics, psychotic symptoms severity, psychotropic treatments and alcohol disorder.ConclusionNIC dependence was independently and strongly associated with respectively major depression and male gender in schizophrenia, and only slightly with history of childhood trauma. Based on these results, the care of both nicotine dependence and depression should be evaluated for an effective smoking cessation intervention in schizophrenia. Bupropion, an antidepressant that has been found as the potential most effective strategy for tobacco cessation in schizophrenia to date, may be particularly relevant in male SZ smokers with comorbid major depression.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionLa prise en charge des épisodes dépressifs caractérisés, se heurte à un taux de réponse à un premier traitement antidépresseur ne dépassant pas 30 à 45 %, et un taux de rémission n’excédant pas 30 % [1]. Devant ce constat, des stratégies thérapeutiques non-pharmacologiques sont légitimement en cours d’étude. C’est le cas par exemple, des chronothérapies, applications d’un modèle chronobiologique de la dépression élaboré dès le début des années 1980 [2].ObjectifNous nous sommes intéressés à ce modèle et avons souhaité, à partir d’un exemple clinique, nous interroger sur la place des techniques thérapeutiques qui en découlent dans l’organisation hiérarchique des traitements de la dépression.MéthodeNous présentons le cas d’un patient souffrant de dépression unipolaire résistante de stade V [3], présentant à l’admission un score de sévérité côté à 35 sur l’échelle de Montgomery et Asberg. Devant certaines caractéristiques cliniques de l’état dépressif suggérant une « susceptibilité chronobiologique », d’une part, et à la vue de données d’efficacité émanant de la littérature, d’autre part, nous avons décidé d’associer au traitement antidépresseur médicamenteux, un traitement par privation partielle de sommeil et luminothérapie matinale.RésultatsAu terme de cette prise en charge, nous avons constaté une rémission des symptômes dépressifs, avec un score MADRS de 6 après 5 semaines de traitement, et un maintien de la rémission clinique à 6 mois.DiscussionL’application et l’efficacité de ces thérapies renvoient à l’hypothèse d’un fondement chronobiologique de la dépression. Leur place dans les recommandations pour la pratique clinique et dans les algorithmes de traitement de la dépression reste limitée. Il n’apparaît pas impossible que le paradigme pharmacologique dominant la psychiatrie puisse en être une des explications [4]. Il s’agit pourtant d’alternatives thérapeutiques simples, dont l’efficacité et la tolérance sont démontrées dans une littérature de plus en plus abondante.

Introduction To explore tolerability, safety and treatment response of flexibly dosed paliperidone palmitate (PP) in adult non-acute but symptomatic patients with schizophrenia previously unsuccessfully treated with risperidone long-acting injectable treatment (RLAT). Methods International, prospective 6-month open-label study. Major outcomes were clinical response (percentage of patients with ≥20% improvement in Positive and Negative Syndrome Scale (PANSS) total score at endpoint), functioning (Personal and Social Performance scale (PSP)), Extrapyramidal Symptom Rating Scale (ESRS), sleep quality, daytime drowsiness and treatment-emergent adverse events (TEAEs). Results The intent-to-treat population comprised 56 patients (64.3% male, mean age 39.9±11.0 years, 71.4% paranoid schizophrenia). 71.4% of patients completed the 6-month study. Withdrawal of consent (8.9%) and adverse events (10.7%) were the most frequent reasons for early discontinuation. Mean PANSS baseline total score was 67.5±20.7 and decreased by -9.2 points at endpoint (95% confidence interval -15.0;-3.5, p Conclusion These data suggest that paliperidone palmitate is associated with a meaningful clinical response and functional improvement and is well tolerated with less EPS in non-acute, symptomatic schizophrenia patients previously unsuccessfully treated with RLAT.

Introduction To explore tolerability, safety and treatment response of flexibly dosed paliperidone palmitate (PP) in adult non-acute patients with schizophrenia previously unsuccessfully treated with the decanoate of haloperidol (Hal), flupentixol (Fpt), fluphenazine (Flu) or zuclopenthixol (Zuc). Methods International, prospective 6-month open-label study. Outcomes were clinical response (≥20% improvement in Positive and Negative Syndrome Scale (PANSS) total score), Personal and Social Performance scale (PSP), Extrapyramidal Symptom Rating Scale (ESRS) and treatment-emergent adverse events (TEAEs). Results The intent-to-treat population comprised n=53 Hal, n=35 Fpt, n=44 Flu and n=42 Zuc patients. Mean age ranged from 42.1±10.7 [Zuc] to 44.4±9.4 years [Hal]), male gender from 57.1% [Zuc] to 69.8% [Hal]), and BMI from 27.3±5.9 [Hal] to 30.8±8.5 kg/m2 [Zuc]). Between 70.5% [Flu] and 85.7% [Fpt] of patients completed the study. Mean baseline PANSS total scores ranged from 73.7±14.1 [Fpt] to 75.7±13.2 [Hal]) and decreased significantly by -7.5±19.4 [Flu] to -10.6±21.5 points [Zuc] at endpoint (p Conclusion Paliperidone palmitate was associated with a clinically meaningful treatment response and well tolerated in non-acute schizophrenia patients previously unsuccessfully treated with conventional depot antipsychotics.

IntroductionLa psychoéducation du trouble bipolaire favorise l’adhésion thérapeutique et le maintien de l’euthymie à 2 ans [1]. Au terme d’un tel programme, les patients peuvent avoir besoin d’aide pour perpétuer la mise en place des apprentissages concernant l’observance thérapeutique, les routines de vie quotidienne, l’évitement des toxiques et le repérage des prodromes thymiques. Le Serious Game BIPOLIFE®, jeu centré sur un avatar souffrant de trouble bipolaire évoluant dans des situations de la vie courante, s’articule aussi autour de ces cibles. ObjectifsÉvaluer la qualité de l’observance thérapeutique par la Medication Adherence Rating Scale (MARS) [2], les indicateurs de routine de vie et de recours aux soins psychiatriques à 1 et 4 mois de la dernière séance de psychoéducation chez les patients utilisant BIPOLIFE® vs. suivi habituel.MéthodologieÉtude pilote multicentrique randomisée contrôlée à 2 bras (durée : 24 mois) incluant des sujets euthymiques (score de dépression MADRS ≤ 12 et de manie YMRS ≤ 8 depuis 3 mois), bénéficiant d’un programme de psychoéducation. Les patients du groupe « intervention » se connecteront au site BIPOLIFE®, de manière hebdomadaire, pendant un mois (durée de connexion libre). À l’inclusion (dernière séance de psychoéducation), 1 et 4 mois, seront évalués l’attitude vis-à-vis du traitement, la qualité du sommeil, l’indice de masse corporelle, le périmètre ombilical, la consommation de toxiques, le fonctionnement psychosocial et le recours aux soins psychiatriques.PerspectivesProposer BIPOLIFE® en add-on de la psychoéducation pour renforcer les compétences acquises lors du programme et le maintien de l’euthymie.

Schizophrenia is a severe and disabling disorder, which affects multiple functional domains adversely.Several factors like premorbid functioning and psychopathological symptoms can affect functional outcome. Residual psychopathology after an acute exacerbation has a variable influence, going from a weak correlation to positive symptoms to clear association of negative symptoms with reduced social functioning to widespread influence of cognitive symptoms.We performed a cross-sectional evaluation in a sample of 296 schizophrenic patients for demographic, functional characteristics (using different scales: Functional Recovery Scale in Schizophrenia (FRSS), Subjective Well-being Scale (SWN-K), Quality of Life Scale (QLS)) and symptomatic (using the Positive and Negative Syndrome Scale (PANSS)). Exploratory multivariate analyses were conducted and a model with “functioning” as a latent variable was proposed and tested. Results: Using the 5 clinical dimensions of the PANSS, negative, cognitive and excitation factors are significant predictors of functioning. The model was constructed with “functioning” defined as a latent variable; indicators are sub-scores on FRSS, SWN-K, QLS and exogenous variables included symptomatology, Duration of Untreated Psychosis and educational level. The negative and cognitive dimensions are highly correlated via the latent variable to the 3 dimensions of functioning evaluated by the FRSS: “daily life”, “social functioning” and “treatment” and the QLS sub-scores (“interpersonal”, “common object”, “instrumental role”). Educational level is significantly linked to functioning but not DUP. The model emphasizes the need for treatment strategies that have an effect on negative and cognitive factors, to improve functioning in schizophrenia.