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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.

International audience; RésuméIntroduction Le risque de développer une maladie d’Alzheimer augmente avec l’âge. Le rôle de celle-ci comme un facteur de risque indépendant de suicide n’est pas bien compris et demeure complexe et mal élucidé. L’objectif de cet article est d’envisager une compréhension neuropsychologique de la crise suicidaire dans le cas d’une maladie d’Alzheimer débutante. Méthode Une évaluation cognitive globale (Mini-Mental State Examination, Batterie Rapide d’Évaluation Frontale) complétée de l’exploration de l’inhibition cognitive selon ses fonctions d’accès (tâche de lecture en présence de distracteurs), de suppression (Trail Making Test), et de freinage (Stroop, Hayling, Go/No-Go) a été réalisée chez une femme souffrant d’une maladie d’Alzheimer (MMSE à 21/30) avant et après réalisation d’une tentative de suicide dans un contexte de dépression. Résultats L’échelle d’Hamilton était cotée à 24/52, l’échelle de dépression de Cornell à 21/38. L’intentionnalité suicidaire était modérée avec un score à 15/25à l’échelle d’intentionnalité suicidaire de Beck. Initialement préservées, le déclin des fonctions exécutives a coïncidé avec l’émergence d’une crise suicidaire dans un contexte de dépression chez une patiente souffrant de maladie d’Alzheimer. Les fonctions de l’inhibition cognitive étaient altérées dans ses trois composantes, après ajustement des facteurs de confusion. Conclusion Une évaluation détaillée des fonctions exécutives et singulièrement de l’inhibition cognitive dans la population des patients atteints d’une maladie d’Alzheimer permettrait de détecter les personnes les plus à risque de passage à l’acte et de proposer une surveillance plus étroite dans le cadre des soins généraux de leur maladie. AbstractIntroduction The role of Alzheimer's disease as a risk factor for suicide is unclear. The aim of this study was to understand neuropsychological component of the suicidal crisis in Alzheimer's disease. Method Using an extensive neuropsychological battery, different aspects of cognitive inhibition were particularly examined: Access to relevant information (using the Reading with distraction task), suppression of no longer relevant information (Trail Making Test, Rule Shift Cards), and restraint of cognitive resources to relevant information (Stroop test, Hayling Sentence Completion test, Go/No-Go). One female Alzheimer depressed case was assessed before and after a suicide attempt. Results Ten days after the patient's suicide attempt, dementia was still moderate with a MMSE score at 21/30 but with a worsening of executive functions (FAB at 8/18) in the context of depression and suicide. The Hamilton-Depression Rating Scale was at 24 (maximal score at 52), and the Cornell Scale for Depression was at 21 (maximal score at 38). Suicidal intent was moderate with a score of 9 on the Beck Suicide Intent Scale (maximal score at 25). The patient did not present a delirium, psychotic symptoms, or anosognosia. Her episodic memory was altered as shown by her semantic performance on verbal fluency (naming 12animals in 120 seconds) and on lexical fluency (naming 8 words beginning with the letterP). Initially preserved, executive function declined during a suicidal crisis in a context of depression in Alzheimer's disease case. Neuropsychological testing confirmed a dysexecutive syndrome (FAS at 8/18), with an impairment in her conceptualization capacity (MCST) and a deficit in cognitive inhibition and its access (reading task in the presence of distractors), deletion (TMT) and restraint (Stroop, Go/No-Go, Hayling) functions. Computed tomography has shown no signs of intracranial expansive process. Conclusion Assessing predictors of suicide and means of completion in patients with dementia may help the development of interventions to reduce risk of suicide among the growing population of individuals with dementia. Because of Alzheimer's-related cognitive inhibition impairment, identification and intervention addressing the complex issues of depression, executive dysfunction and dementia may help clinicians to mitigate the risk of suicide in patients with Alzheimer's disease.

International audience; Neuroimaging studies of patients with treatment-resistant depression (TRD) have reported abnormalities in frontal and temporal regions. We sought to determine whether metabolism in those regions might be related to response to repetitive transcranial magnetic stimulation (TMS) in patients with TRD. Magnetic resonance images and baseline resting-state cerebral glucose uptake index (gluMI) obtained using 18F-fluorodeoxyglucose positron emission tomography were analyzed in TRD patients who had participated in a double-blind, randomized, sham-controlled trial of prefrontal 10Hz-TMS. Among the patients randomized to active TMS, 17 responders, defined as having 50% depression score decrease, and 14 nonresponders were investigated for pre-stimulation glucose metabolism and compared with 39 healthy subjects using a voxel-based analysis. In nonresponders relative to responders, gluMI was lower in left lateral orbitofrontal cortex (OFC), and higher in left amygdala and uncinate fasciculus. OFC and amygdala gluMI negatively correlated in nonresponders, positively correlated in responders, and did not correlate in healthy subjects. Relative to healthy subjects, both responders and nonresponders displayed lower gluMI in right dorsolateral prefrontal (DLPFC), right anterior cingulate (ACC), and left ventrolateral prefrontal, cortices. Additionally, nonresponders had lower gluMI in left DLPFC, ACC, left and right insula, and higher gluMI in left amygdala and uncus. Hypometabolisms were partly explained by gray matter reductions, while hypermetabolisms were unrelated to structural changes. The findings suggest that different patterns of frontal-temporal limbic abnormalities may distinguish responders and nonresponders to prefrontal magnetic stimulation. Both preserved OFC volume and amygdala metabolism might precondition response to TMS.