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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. [ABSTRACT FROM AUTHOR]

Even though obsessive-compulsive disorders (OCD) and anxiety disorders (AD) have been separated in the taxonomy adopted by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, many issues remain concerning the physiopathological similarities and differences between those categories. Our objective was therefore to explore and compare their personality and emotional features, with the assumption that the distinction of two independent spectrums should imply the existence of two partially distinct temperamental profiles. We used the Temperament and Character Inventory (TCI-R) and the Positive and Negative Emotionality (PNE) scale to compare two groups of patients with OCD ( n =227) or AD ( n =827). The latter group included patients with social anxiety disorder, panic disorder, agoraphobia, and generalized anxiety disorder. Most temperament, character and emotionality measures showed no significant differences between both groups. In the personality measures results, only the self-directedness score (TCI-R) was significantly lower in OCD patients but this difference was not significant when the comparison was adjusted for the depressive scale score and age. Only lower PNE positive affects scores were obtained in OCD patients in the adjusted comparisons. These findings suggest that OCD and AD are not really distinguishable from the point of view of associated personality traits. [ABSTRACT FROM AUTHOR]

Abstract: Social phobia (SP) is a prevalent and impairing condition, occurring especially in young subjects with deleterious consequences on their occupational and familial functioning. Cognitive behavioural therapy (CBT) has been shown to be effective for the treatment of SP in many studies for about 20 years. Validated components of this treatment can include psychoeducation, social skills training, in vivo exposure, video feedback, and cognitive restructuring. Other complementary methods, coming from the CBT, have been also integrated in therapeutic programs during last years. This is the case for example of specific techniques focused on fear of blushing (erythrophobia), based on the task concentration training. Eye movement desensitization and reprocessing therapy can be also interesting for the treatment of patients with past traumatic social experiences, as well as mindfulness meditation for the prevention of relapses after a CBT. Researches are conducted on the use of new technologies for web therapy or virtual reality exposure therapy. Lastly, drug facilitation of exposure therapy is a great challenge for the treatment of SP, and positive results have been recently obtained with agents like d-cycloserine or oxytocin. [Copyright &y& Elsevier]

Abstract: The Clinical Global Impression scale (CGI) is frequently used in clinical research because of its face validity and ease of use but data on its reliability are scarce. Our goal was to estimate the reliability of the scale and compare reliability between face-to-face and video scoring. We analyzed 50 different video interviews recorded during 5 visits of a crossover trial to study the effect of subthalamic nucleus stimulation. Six specialized clinicians rated the CGI using these videos, providing 300 different ratings. The intraclass correlation was lower at inclusion (0.30 [0.13–0.50]) than at later visits (0.68 [0.61–0.80]). Reliability was not influenced by the patients'' stimulation status. The mean of at least two independent evaluations of the video is needed to achieve an ICC greater than 0.8. The video CGI is a valid clinical outcome measure suitable for clinical trials (ClinicalTrials.gov number, NCT00169377). [Copyright &y& Elsevier]

Abstract: To date, few researches applied the emotional approach of the tripartite model of Watson and Clark, differentiating positive and negative affects, to the study of anxiety and depressive disorders. Nevertheless, the notion of emotional balance is interesting for the understanding of these pathologies and for the follow-up of treatments effects, both dimensions being independent and able to evolve differently according to the clinical syndromes. In our study, a large sample of outpatients with depressive and anxiety disorders was explored, with the Positive and Negative Emotionality (EPN-31) scale, and with other measures of anxiety and depressive symptoms. The results were in line with the tripartite model of emotions: high scores of negative affects in both categories of disorders, and low scores of positive affects especially in the depressive disorders. These results confirmed the relevance of an emotional approach of anxiety and depressive disorders, in particular for longitudinal studies and neuro-physiological correlations. [Copyright &y& Elsevier]

Abstract: In our experience a significant proportion of patients attending the emergency service of psychiatry in an general hospital in France, for a period of 3 to 10 days, can benefit from a couple of cognitive behavior therapy (CBT) sessions. An ambulatory follow-up will complete the therapy (with a total of 12 to 20 sessions). The CBT can be beneficial in different conditions: suicide attempts, addictions, pharmacopsychosis, thymic and anxious disorders, behavior disorders, etc. This specific approach is not indicated in chronic, severe disorders needing pluridisciplinary care and a rather long psychotherapy. The benefits of starting an in-patient CBT are: 1) the crisis experienced by the patient is a strong motivation to seek a psychological support. The rapid initiation of a brief therapy such as CBT will meet the patient’s request; 2) the therapist and the nurses can observe the hospitalized patient in a realistic situation; 3) various tasks of exposure can be accomplished in the presence of the therapist, outside the office; 4) rapid benefit with probable reduction of recurrence (especially for suicide attempts and depression); 5) to promote the psycho-educative approach and to assess the efficiency or lack of support of the relatives; 6) in chronic patient with a rupture of care, to restore a therapeutic project, by frequent and interactive exchanges; 7) last but not least, to informe about CBT, usually unkonwn or poorly known, while the patient evokes the failure of another type of therapy in the past. [Copyright &y& Elsevier]

Abstract: The therapeutic access of patients victims of sexual aggression is often through a double perspective: That of treating Post Traumatic Stress Disorder (PTSD) and of sexual avoidance. In light or moderate PTSD cases, there are complex forms in which co-morbidity is more evident and the rate of therapeutic failure is more important. At present active treatment methods based on exposure, more particularly EMDR (Eye Movement Desensitization and Reprocessing) considered as a brief and active therapy, give good results in the treatment of traumatic symptomatology. Few studies have been undertaken on the psychopathological evolution of patients having suffered from sexual attacks and who are being taken care of by EMDR. Within the framework of a case study, the authors discuss elements indicating a rapid evolution of traumatic symptomatology, of sexual avoidance and of regression of the expression of the co-morbidity signs. [Copyright &y& Elsevier]

Premenstrual dysphoric disorder is a form of mood disorder causing a significant reduction in the quality of life and in the daily function for about 3 % to 5 % of women of fertile age. Premenstrual dysphoric disorder (PMDD) includes various symptoms regularly present during the luteal phase of menstrual cycles, with principally depressive mood, anxiety, emotional lability and decrease of interest. The serotoninergic system is in close reciprocal relation with the gonadal hormones and has been identified as the most plausible target for interventions. The selective serotonin reuptake inhibitors are increasingly used as first-line therapy for severe PMDD. The response rate reported are better than responses to treatment of depression, obsessive-compulsive disorder or panic disorder. The doses used are variable, between 20 and 60 mg/day for fluoxe´tine, 50 and 150 mg/day for sertraline and 10–30 mg/day for paroxetine. The administration may be continuous every day in the menstrual cycle or intermittent (premenstrual only) or semi-intermittent (low doses during follicular phase and higher doses during luteal phase). Several studies indicate that intermittent treatment is more efficient in these women and thus, may offer an attractive treatment option because with reduced side-effects. [Copyright &y& Elsevier]

Abstract: Drug treatment of personality disorders is less developed than are psychological treatments in this area, but they are a logical prolongation of psychobiological models of personality and temperament, and respond to the need of many clinicians in front of difficult patients. The results obtained in the field of pharmacotherapy of personality disorders can be classified according to DSM-IV axis-II categorization. In anxious personalities (clusterC), some isolated studies suggest a favourable effect of antidepressants on obsessive-compulsive dimension, on avoidant personality disorder, and on inhibition and trait-anxiety, especially when serotoninergic agents are used. Few studies have been conducted in cluster A personality disorders, and some are in favour of the interest of low doses of antipsychotic drugs in this group. Most studies have been conducted in cluster B, and especially in antisocial and borderline personality disorders. Partial positive results have been obtained using various classes of drugs for dealing with aggression and impulsive behaviors, including lithium, beta-blockers, carbamazepine, valproate, antipsychotic drugs, and also SSRIs. Self-harm and suicidal behaviors seem to be partially but significantly improved by antidepressants and low doses of antipsychotics. Overall, the pharmacotherapy of personality disorder may lead in the future to the development of effective treatments, in complement to psychotherapy, for actually severe, chronic, and disabling disorder. [Copyright &y& Elsevier]

Expert consensus operationalized treatment response and remission in obsessive-compulsive disorder (OCD) as a Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) reduction ≥35% and score ≤12 with ≤2 on Clinical Global Impressions Improvement (CGI-I) and Severity (CGI-S) scales, respectively. However, there has been scant empirical evidence supporting these definitions. We conducted a systematic review and an individual participant data meta-analysis of randomized-controlled trials (RCTs) in adults with OCD to determine optimal Y-BOCS thresholds for response and remission. We estimated pooled sensitivity/specificity for each percent reduction threshold (response) or posttreatment score (remission) to determine response and remission defined by a CGI-I and CGI-S ≤ 2, respectively. Individual participant data from 25 of 94 eligible RCTs (1235 participants) were included. The optimal threshold for response was ≥30% Y-BOCS reduction and for remission was ≤15 posttreatment Y-BOCS. However, differences in sensitivity and specificity between the optimal and nearby thresholds for response and remission were small with some uncertainty demonstrated by the confidence ellipses. While the empirically derived Y-BOCS thresholds in our meta-analysis differ from expert consensus, given the predominance of data from more recent trials of OCD, which involved more refractory participants and novel treatment modalities as opposed to first-line therapies, we recommend the continued use of the consensus definitions. • Multiple thresholds model was used to evaluate consensus definitions in adult OCD. • A ≥ 30% Y-BOCS reduction was optimal for response in adult OCD based on CGI-I ≤ 2. • A ≤ 15 posttreatment Y-BOCS was optimal for adult OCD remission based on CGI-S ≤ 2. • These thresholds were in slight contrast to consensus definitions (≥35% and ≤12). • Differences in sensitivity and specificity across Y-BOCS thresholds were minimal. [ABSTRACT FROM AUTHOR]

Résumé L’anxiété peut varier d’un état émotionnel simple et physiologique à des pathologies structurées avec des syndromes bien établis comme le sont les troubles phobiques, le trouble panique ou encore le trouble anxiété généralisée. Dans cet article, nous présentons d’abord les composantes motrices de l’anxiété infraclinique (la gêne simple) et de la peur aiguë. On retrouve essentiellement : tension musculaire, tremblements, instabilité, modifications de la posture (repli, défense, autocontact), de la mimique ou du comportement (agitation ou inhibition). Nous montrons ensuite comment la sémiologie motrice s’intègre dans la description des principaux troubles anxieux et obsessionnels (classifications et échelles d’évaluation). Pour certains de ces troubles, la phobie sociale par exemple, des approches spécifiques comme l’étude de l’oculomotricité peuvent permettre d’objectiver des signes moteurs plus subtils. En ce qui concerne les troubles obsessionnels-compulsifs, ils peuvent s’avérer également marqués par une dimension motrice particulière, avec des gestes répétitifs, inopérants, et des modifications du comportement spatial. Enfin, nous discutons de l’intérêt de l’utilisation de la réalité virtuelle dans l’exploration de cette symptomatologie motrice identifiée dans les troubles anxieux et obsessionnels. Anxiety can vary from simple and physiological emotional states to structured pathologies with well-established syndromes such as phobia, panic disorder or generalized anxiety. In this article, we firstly present the motor components of subclinical anxiety (simple embarrassment) and acute fear. These components are represented by: muscular tension, tremor, instability, posture changes (withdrawal, defense, self-contact), facial expression or behaviour (agitation or inhibition). Then, we show how motor semiology fit in the description of the main anxiety and obsessive-compulsive disorders (classifications and rating scales). For some of these disorders, social anxiety for example, specific approaches as eye movement studies can highlight subtle motor signs. Regarding obsessive-compulsive disorders, they are characterized by a particular motor dimension, with repetitive, specific and non-operant gestures, and modifications of spatial behaviour. Finally, we discuss the interest of using virtual reality to explore the motor symptomatology in anxiety disorders. [ABSTRACT FROM AUTHOR]

Many studies have shown the state effect of depression on personality. However, the chronology of personality changes associated with depression recovery remains unstudied. The objective of this study is to assess early (first month) and delayed personality changes associated with depression recovery. Fifty-seven depressed inpatients were assessed with the Temperament and Character Inventory (TCI) at admission, 1 month, and 1 year post-treatment. Patients were divided into poor and favorable outcome. No significant personality change was observed in patients with poor depression outcome. Conversely, a favorable outcome of depression was associated with early and delayed personality changes. Early changes were: decrease in Harm avoidance (HA1:Worry and pessimism), increase in Cooperativeness and Self-directedness (SD1:Responsibility, SD4:Self-acceptance, SD2:Purposefulness and SD3:Resourcefulness). Delayed changes were changes in character: increase in Self-Directedness (SD1:Responsibility, SD4:Self-acceptance, SD5: Congruent second nature), decrease in Self-transcendence (ST2:Transpersonal identification). This study shows the different status of personality changes associated with depression recovery, and it contributes to a better knowledge of the state effect and of subtle clinical changes in patients who are recovering from depression. It may also have implications for the prediction of depression outcome. [Copyright &y& Elsevier]

Abstract: The severity of insomnia and the relationships between social fear, anxiety, depression and insomnia were examined in 179 patients with social phobia. Two-thirds of our sample had insomnia. Depression, anxiety, social anxiety, and insomnia were positively correlated. General and social anxiety contributed to insomnia when accounting for depression. [Copyright &y& Elsevier]

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. [ABSTRACT FROM AUTHOR]

Abstract: 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. [Copyright &y& Elsevier]

Background: High-frequency bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) is a promising treatment in refractory obsessive-compulsive disorder (OCD). Method: Using the crossover, randomized, and double-blind procedure adopted by the STOC study, 10 patients treated with high-frequency bilateral STN DBS underwent am 18-fluorodeoxyglucose positron emission tomography (PET) investigation to highlight the neural substratum of this therapeutic approach. Results: The median Yale–Brown Obsessive Compulsive Scale (Y-BOCS) scores for all 10 patients were 31 (minimum = 18, maximum = 36) with “Off-Stimulation” status and 19 (minimum = 0, maximum = 30) with “On-Stimulation” status (p = .05). The OCD patients in Off-Stimulation status showed a hypermetabolism in the right frontal middle and superior gyri, right parietal lobe, postcentral gyrus, and bilateral putamen compared with healthy control subjects. A significant decrease in cerebral metabolism was observed in the left cingulate gyrus and the left frontal medial gyrus in On-Stimulation conditions compared with Off-Stimulation conditions. In addition, the improvement assessed by Y-BOCS scores during the On-Stimulation conditions was positively correlated with PET signal changes at the boundary of the orbitofrontal cortex and the medial prefrontal cortex, between PET signal changes and the Y-BOCS scores modifications in On-Stimulation status. Conclusion: This study suggests that the therapeutic effect of STN DBS is related to a decrease in prefrontal cortex metabolism. [ABSTRACT FROM AUTHOR]

Abstract: Gaze aversion could be a central component of the physiopathology of social phobia. The emotions of the people interacting with a person with social phobia seem to model this gaze aversion. Our research consists of testing gaze aversion in subjects with social phobia compared to control subjects in different emotional faces of men and women using an eye tracker. Twenty-six subjects with DSM-IV social phobia were recruited. Twenty-four healthy subjects aged and sex-matched constituted the control group. We looked at the number of fixations and the dwell time in the eyes area on the pictures. The main findings of this research are: confirming a significantly lower amount of fixations and dwell time in patients with social phobia as a general mean and for the 6 basic emotions independently from gender; observing a significant correlation between the severity of the phobia and the degree of gaze avoidance. However, no difference in gaze avoidance according to subject/picture gender matching was observed. These findings confirm and extend some previous results, and suggest that eye avoidance is a robust marker of persons with social phobia, which could be used as a behavioral phenotype for brain imagery studies on this disorder. [Copyright &y& Elsevier]

Efavirenz has now become commonly used to treat HIV infection. Neuropsychiatric disorders have been reported in patients treated with efavirenz. Several factors often make it hard to determine the cause of these disorders: HIV infected patients take many different drugs, they may suffer from various organ diseases, and may also be heavily affected by problems in their everyday life. The French experts group working on neuropsychiatric side effects of efavirenz has undertaken a review of these disorders with the aim to identify: (1) semiology, (2) epidemiology in the global population, in HIV infected patients, and in patients treated with efavirenz. The expert group suggests recommendations to manage these disorders. [Copyright &y& Elsevier]