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To present the first real-world data of patients with treatment-resistant depression (TRD) treated with esketamine through a French cohort Temporary Authorisation for Use (ATUc) programme.In 2019, the French Health Authorities exceptionally granted the first ATUc in psychiatry for TRD patients. Clinical characteristics, safety and efficacy data were reported by physicians. The ATUc ended ∼6 months after initiation.The cohort (Patient characteristics of this cohort demonstrate high-level treatment resistance. The safety and efficacy of esketamine in patients with TRD in real-world clinical practice were consistent with Phase 3 trials.Key pointsPatients with treatment-resistant depression (TRD) exceptionally received esketamine nasal spray ahead of its launch through a French cohort Temporary Authorisation for Use (ATUc) programme.The clinical characteristics of 66 adult patients with TRD included in this cohort demonstrated a high-level of resistance to conventional treatments at the time of treatment request prior to esketamine initiation.No new safety signals were observed with esketamine initiation during the ATUc period compared with the Phase 3 clinical trials.The safety and efficacy of esketamine in the real world remain consistent with that established in Phase 3 clinical trials.The data collected during this ATUc also provide the first real-world data on the management and practical use of esketamine in a hospital setting in France.

Background: The COVID-19 pandemic has shaken the world by imposing unprecedented health measures, including in the postpartum period. Objectives: We aim to assess the impact of maternal isolation in the immediate postpartum period on the rate of postpartum depression (PPD) in a tertiary center. Study Design: We conducted a prospective cohort study, between 22 April and 29 October 2020, using anonymous questionnaires on 265 participants (129 during lockdown and 135 outside). The Edinburgh Postnatal Depression Scale (EPDS) was used as screening for PPD. We used a univariate logistic regression model to analyze the association between risk factors and PPD. Results: There was no difference between the two groups for PPD assessed by an EPDS score >10.5 on day 30 and/or day 60 (23.1% vs. 29.3%, p = 0.661) but on day 3 it was higher (31% vs. 17.8%, p = 0.015) during the lockdown period and partners were more impacted psychologically (48.3% vs. 10.5%, p < 0.001). Parity ≥1 was a protective factor for PPD (OR = 0.2, 95% CI [0.1–0.6], p = 0.003). Risk factors of PPD were: history of psychological abuses (OR = 6.4, CI 95% [1.1–37.6], p = 0.04), stressful life event (OR = 4.5, CI 95% [1.6–12.6], p = 0.004), and bad birth experience (OR = 5.1, CI 95% [1.4–17.8], p = 0.012). Conclusion: Maternal isolation in the immediate postpartum period is associated with an increased rate of moderate to severe symptoms of postpartum blues. The well-known long-term consequences of PPD must be balanced against the expected benefits of partner’s restrictive access to maternity ward.

Introduction: The perinatal period is an at-risk period for the emergence or decompensation of psychiatric disorders. Transcranial electrical stimulation (tES) is an effective and safe treatment for many psychiatric disorders. Given the reluctance to use pharmacological treatments during pregnancy or breastfeeding, tES may be an interesting treatment to consider. Our study aims to evaluate the efficacy and safety of tES in the perinatal period through a systematic literature review followed by three original case reports. Method: Following PRISMA guidelines, a systematic review of MEDLINE and ScienceDirect was undertaken to identify studies on tES on women during the perinatal period. The initial research was conducted until 31 December 2021 and search terms included: tDCS, transcranial direct current stimulation, tACS, transcranial alternating current stimulation, tRNS, transcranial random noise stimulation, pregnancy, perinatal, postnatal, and postpartum. Results: Seven studies reporting on 33 women during the perinatal period met the eligibility criteria. No serious adverse effects for the mother or child were reported. Data were limited to the use of tES during pregnancy in patients with schizophrenia or unipolar depression. In addition, we reported three original case reports illustrating the efficacy and safety of tDCS: in a pregnant woman with bipolar depression, in a pregnant woman with post-traumatic stress disorder (sham tDCS), and in a breastfeeding woman with postpartum depression. Conclusions: The results are encouraging, making tES a potentially safe and effective treatment in the perinatal period. Larger studies are needed to confirm these initial results, and any adverse effects on the mother or child should be reported. In addition, research perspectives on the medico-economic benefits of tES, and its realization at home, are to be investigated in the future.

International audience; Background: ECT is the most effective treatment of major depressive episode (MDE) but remains a neglected treatment. The French Society for Biological Psychiatry and Neuropsychopharmacology aimed to determine whether prescribing practice of ECT followed guidelines recommendations. Methods: This multicenter, retrospective study included adult patients with major depressive disorder (MDD) or bipolar disorder (BD), who have been treated with ECT for MDE. Duration of MDE and number of lines of treatment received before ECT were collected. The reasons for using ECT, specifically first-line indications (suicidality, urgency, presence of catatonic and psychotic features, previous ECT response, patient preference) were recorded. Statistical comparisons between groups used standard statistical tests. Results: Seven hundred and forty-five individuals were included. The mean duration of MDE before ECT was 10.1 months and the mean number of lines of treatment before ECT was 3.4. It was significantly longer for MDD single episode than recurrent MDD and BD. The presence of first-line indications for using ECT was significantly associated to shorter duration of MDE (9.1 vs 13.1 months, p

International audience; Background: Transcranial Direct Current Stimulation (tDCS) and Virtual Reality Exposure Therapy (VRET) are individually increasingly used in psychiatric research. Objective/Hypothesis: Our study aimed to investigate the feasibility of combining tDCS and wireless 360° full immersive active and embodied VRET to reduce height-induced anxiety. Methods: We carried out a pilot randomized, double-blind, controlled study associating VRET (two 20 min sessions with a 48 h interval, during which, participants had to cross a plank at rising heights in a building in construction) with online tDCS (targeting the ventromedial prefrontal cortex) in 28 participants. The primary outcomes were the sense of presence level and the tolerability. The secondary outcomes were the anxiety level (Subjective Unit of Discomfort) and the salivary cortisol concentration. Results: We confirmed the feasibility of the association between tDCS and fully embodied VRET associated with a good sense of presence without noticeable adverse effects. In both groups, a significant reduction in the fear of height was observed after two sessions, with only a small effect size of add-on tDCS (0.1) according to the SUD. The variations of cortisol concentration differed in the tDCS and sham groups. Conclusion: Our study confirmed the feasibility of the association between wireless online tDCS and active, fully embodied VRET. The optimal tDCS paradigm remains to be determined in this context to increase effect size and then adequately power future clinical studies assessing synergies between both techniques.

Patients with autism spectrum disorder (ASD) display distinctive neurophysiological characteristics associated with significant cognitive, emotional, and behavioral symptoms. Transcranial direct current stimulation (tDCS) applied to the frontal or temporoparietal lobes has demonstrated potential to reduce the severity of ASD-related symptoms. Recently, the cerebellum has been identified as a brain area involved in ASD pathophysiology. In this open-label pilot study, seven ASD patients aged between 9 and 13 years underwent 20 daily sessions of 20 min cathodal stimulation of the right cerebellar lobe. At the end of the treatment, the Aberrant Behavior Checklist (ABC) scores showed a 25% mean reduction in global severity of symptoms, with a more pronounced reduction in the “social withdrawal and lethargy” (−35%), “hyperactivity and noncompliance” (−26%), and “irritability, agitation, and crying” (−25%) subscales. Minor and no improvement were observed in the “stereotypic behavior” (−18%) and “inappropriate speech” (−0%) subscales, respectively. Improvements were not detected in the two patients who were taking psychotropic drugs during the study. Clinical response showed a symptom-specific time course. Quality of sleep and mood improved earlier than hyperactivity and social withdrawal. The treatment was generally accepted by patients and well tolerated. No serious adverse events were reported. Stimulation also appeared to markedly reduce the severity of tics in a patient with comorbid tic disorder and led to the disappearance of a frontal epileptogenic focus in another patient with a history of seizures. In conclusion, cerebellar tDCS is safe, feasible, and potentially effective in the treatment of ASD symptoms among children. Strategies to improve recruitment and retention are discussed.

International audience; Attention deficit with or without hyperactivity disorder (ADHD) is one of the most frequent neuropsychiatric disorders, and affects 2-4% of adults. In contrast with many European countries, the identification and management of adult ADHD remains underdeveloped in France, and a subject of controversy. This review provides a practical update on current knowledge about ADHD in adults for French-speaking professionals who have to detect or manage adult patients with ADHD. ADHD is classified as a neurodevelopmental disorder in the recent update of the international diagnostic classification. While symptoms and impairment due to ADHD are frequently severe during childhood, they often evolve as children grow older, with frequent persistent disabilities in adulthood. In adulthood, the clinical presentation, as in childhood, involves the symptom triad of inattention, hyperactivity and impulsivity. However, differences are noted: hyperactivity is more often internalized, symptoms of inattention may be masked by anxiety symptoms or obsessive-like compensation strategies. ADHD is often diagnosed during childhood, but it is not rare for the diagnosis to be made later. Failure to recognise symptoms resulting in misdiagnosis, or alternatively well-developed compensation factors could be two underlying reasons for the long delay until diagnosis. Other symptoms, such as emotional deregulation or executive function-related symptoms are also usually observed in adults. In addition, in adults, ADHD is often associated with other psychiatric disorders (in 80% of cases); this makes the diagnosis even more difficult. These disorders encompass a broad spectrum, from mood disorders (unipolar or bipolar), to anxiety disorders, and other neurodevelopmental disorders and personality disorders, especially borderline and antisocial personality disorder. Substance-use disorders are very common, either as a consequence of impulsivity and emotional dysregulation or as an attempt at self-treatment. Sleep disorders, especially restless leg syndrome and hypersomnolence, could share common pathophysiological mechanisms with ADHD. ADHD and comorbidity-related symptoms are responsible for serious functional impairment, in various domains, leading to academic, social, vocational, and familial consequences. The impact on other psychiatric disorders as an aggravating factor should also be considered. The considerable disability and the poorer quality of life among adults with ADHD warrant optimal evaluation and management. The diagnostic procedure for ADHD among adults should be systematic. Once the positive diagnosis is made, the evaluation enables characterisation of the levels of severity and impairment at individual level. A full examination should also assess medical conditions associated with ADHD, to provide personalized care. In recent years, a growing number of assessment tools have been translated and validated in French providing a wide range of structured interviews and standardized self-report questionnaires for the evaluation of core and associated ADHD symptoms, comorbidities and functional impairment. The treatment of ADHD in adults is multimodal, and aims to relieve the symptoms, limit the burden of the disease, and manage comorbidities. The most relevant and validated psychological approaches are psycho-education, cognitive-behavioural therapy and "third wave therapies" with a specific focus on emotional regulation. Cognitive remediation and neurofeedback are promising strategies still under evaluation. Medications, especially psychostimulants, are effective for alleviating ADHD symptoms with a large effect size. Their safety and tolerance are satisfactory, although their long-term clinical benefit is still under discussion. In France, methylphenidate is the only stimulant available for the treatment of ADHD. Unfortunately, there is no authorization for its use among adults except in continuation after adolescence. Hence the prescription, which is subject to the regulations on narcotics, is off-label in France. This article aims to provide practical considerations for the management of ADHD and associated disorders in adults, in this particular French context.

The safety and efficacy of neuronavigated intermittent theta burst stimulation (iTBS) in patients with bipolar depression has not yet been investigated. We hypothesized the superiority of active iTBS over sham. Twenty-six patients were randomly allocated to receive either active (n=12) or sham (n=14) iTBS. Response and remission rates according to changes in depression MADRS score were high following active iTBS (72% and 42% for response and remission rates, respectively), but no significant difference was found after sham stimulation (42%and 25%). No adverse events were observed. This study revealed the safety and tolerability of twice daily iTBS in patients with bipolar depression. Larger controlled studies are warranted to prove iTBS superiority in treatment-resistant bipolar depression.

Old age constitutes a vulnerable stage for developing gambling-related problems. The aims of the study were to identify patterns of gambling habits in elderly participants from the general population, and to assess socio-demographic and clinical variables related to the severity of the gambling behaviours. The sample included N = 361 participants aged in the 50-90 years range. A broad assessment included socio-demographic variables, gambling profile and psychopathological state. The percentage of participants who reported an absence of gambling activities was 35.5 per cent, while 46.0 per cent reported only non-strategic gambling, 2.2 per cent only strategic gambling and 16.3 per cent both non-strategic plus strategic gambling. Gambling form with highest prevalence was lotteries (60.4%), followed by pools (13.9%) and bingo (11.9%). The prevalence of gambling disorder was 1.4 per cent, and 8.0 per cent of participants were at a problematic gambling level. Onset of gambling activities was younger for men, and male participants also reached a higher mean for the bets per gambling-episode and the number of total gambling activities. Risk factors for gambling severity in the sample were not being born in Spain and a higher number of cumulative lifetime life events, and gambling severity was associated with a higher prevalence of tobacco and alcohol abuse and with worse psychopathological state. Results are particularly useful for the development of reliable screening tools and for the design of effective prevention programmes. Copyright © The Author(s), 2021. Published by Cambridge University Press.

International audience; Attention Deficit/Hyperactivity Disorder (ADHD) often persists into adulthood. However, few screening tools have been adaptedto assess adult ADHD using the DSM-5 criteria. This study assessed the diagnostic accuracy of a French version of the ADHDSelf-Report Screening for DSM-5 (ASRS-5). This multicentric cross-sectional study included 557 participants: 309 adult ADHDoutpatients without bipolar disorder (BD)/borderline personality disorder (BPD) (n = 236) or with BD/BPD (n = 36) and 285adults without ADHD who were either healthy volunteers (n = 248) or outpatients with BD or BPD (n = 37). Measures includedADHD diagnosis and the ASRS-5. The ASRS-5 was a good predictor of ADHD diagnosis (cut-off score ! 13/24: sensitivity =84.3%, specificity = 91.9%) in the sample of adult outpatients without comorbid disorders/healthy controls. Performances werelower with this cut-off score in some subgroups, notably low-severity ADHD symptomatology (sensitivity = 63.5%) and participantswith BD or BPD (sensitivity = 91.7%, specificity = 54.1%). The French ASRS-5 had acceptable screening properties,even if its performance varied according to clinical variables. Further evidence is needed for patients with comorbid disordershaving overlapping symptoms.

Resume La pandemie du COVID-19 a des consequences majeures sur l’organisation des soins. En France et dans le monde, les centres pratiquant l’electroconvulsivotherapie (ECT) ont vu leur activite diminuer, voire s’arreter, pour de diverses raisons. Dans ce contexte, le maintien ou la reprise de cette activite therapeutique essentielle pour de nombreux patients souffrant de troubles psychiatriques necessite des adaptations materielles, humaines et logistiques qu’il convient d’encadrer. L’objectif de ce travail collectif et national est de proposer des recommandations simples et applicables immediatement par tout etablissement de sante, public ou prive, pratiquant les ECT. Elles sont issues d’un retour d’experiences pluriprofessionnelles et interetablissements. Declinees en trois etapes, ces recommandations sont accompagnees d’une fiche pratique qui decrit, de facon precise, les conditions necessaires et prealables a toute reprise d’activite ECT.

Resume La pandemie recente de COVID-19 a entraine des changements organisationnels majeurs dans les lieux de soins et notamment en hospitalisation en psychiatrie. Pour evaluer l’evolution de l’activite des differents centres pratiquant l’ECT, une enquete nationale en ligne a ete realisee. 65 reponses de toute la France ont ete analysees. Plus de 90 % des centres pratiquant l’ECT ont connu une diminution de leur activite. Plus inquietant encore, la moitie des centres ont subi un arret total de leur activite et un quart des centres accusent une diminution de plus de la moitie de leur activite habituelle. Les soins psychiatriques post-pandemie COVID-19 s’annoncent difficiles. Il est essentiel de ne pas ajouter a cette difficulte les complications, souvent graves, qui seront liees au retard ou a l’arret de la pratique de l’ECT. Il conviendra aussi de rester vigilant quant aux consequences specifiques neuropsychiatriques qui feront suite a la pandemie.

International audience; Objectives: The coronavirus disease 2019 (COVID-19) pandemic has caused major sanitary crisis worldwide. Half of the world has been placed in quarantine. In France, this large-scale health crisis urgently triggered the restructuring and reorganization of health service delivery to support emergency services, medical intensive care units and continuing care units. Health professionals mobilized all their resources to provide emergency aid in a general climate of uncertainty. Concerns about the mental health, psychological adjustment, and recovery of health care workers treating and caring for patients with COVID-19 are now arising. The goal of the present article is to provide up-to-date information on potential mental health risks associated with exposure of health professionals to the COVID-19 pandemic.Methods: Authors performed a narrative review identifying relevant results in the scientific and medical literature considering previous epidemics of 2003 (SARS-CoV-1) and 2009 (H1N1) with the more recent data about the COVID-19 pandemic. We highlighted most relevant data concerning the disease characteristics, the organizational factors and personal factors that may contribute to developing psychological distress and other mental health symptoms.Results: The disease characteristics of the current COVID-19 pandemic provoked a generalized climate of wariness and uncertainty, particularly among health professionals, due to a range of causes such as the rapid spread of COVID-19, the severity of symptoms it can cause in a segment of infected individuals, the lack of knowledge of the disease, and deaths among health professionals. Stress may also be caused by organizational factors, such as depletion of personal protection equipment, concerns about not being able to provide competent care if deployed to new area, concerns about rapidly changing information, lack of access to up-to-date information and communication, lack of specific drugs, the shortage of ventilators and intensive care unit beds necessary to care for the surge of critically ill patients, and significant change in their daily social and family life. Further risk factors have been identified, including feelings of being inadequately supported, concerns about health of self, fear of taking home infection to family members or others, and not having rapid access to testing through occupational health if needed, being isolated, feelings of uncertainty and social stigmatization, overwhelming workload, or insecure attachment. Additionally, we discussed positive social and organizational factors that contribute to enhance resilience in the face of the pandemic. There is a consensus in all the relevant literature that health care professionals are at an increased risk of high levels of stress, anxiety, depression, burnout, addiction and post-traumatic stress disorder, which could have long-term psychological implications.Conclusions: In the long run, this tragic health crisis should significantly enhance our understanding of the mental health risk factors among the health care professionals facing the COVID-19 pandemic. Reporting information such as this is essential to plan future prevention strategies. Protecting health care professionals is indeed an important component of public health measures to address large-scale health crisis. Thus, interventions to promote mental well-being in health care professionals exposed to COVID-19 need to be immediately implemented, and to strengthen prevention and response strategies by training health care professionals on mental help and crisis management.

Samuel Bulteau,1,2 Marie Grall-Bronnec,1,2 Pierre-Yves Bars,3 Edouard-Jules Laforgue,1 François Etcheverrigaray,4 Jean-Christophe Loirat,3 Caroline Victorri-Vigneau,2,4 Jean-Marie Vanelle,1 Anne Sauvaget1 1CHU de Nantes, Addictology and Liaison Psychiatry Department, Nantes, France; 2University of Nantes-University of Tours, INSERM, SPHERE U1246 – “methodS for Patients-centered outcomes & HEalth REsearch”, l’Institut de recherche en Santé 2, Nantes, France; 3Clinique du Parc, Nantes, France; 4CHU de Nantes, Department of Clinical Pharmacology, Nantes, France Objective: Therapeutic observance is one of the cornerstones of bipolar disease prognosis. Nostalgia of previous manic phase has been described as a cause of treatment retrieval in bipolar disorder. But to date no systematic study has examined manic episode remembering stories. Our aim was to describe manic experience from the patient’s point of view and its consequences on subjective relation to care and treatment adherence. Patients and methods: Twelve euthymic patients with bipolar I disorder were interviewed about their former manic episodes and data was analyzed, thanks to a grounded theory method. Results: Nostalgia was an anecdotal reason for treatment retrieval in bipolar I disease. Although the manic experience was described as pleasant in a certain way, its consequences hugely tarnish the memory of it afterward. Treatment interruption appears to be mostly involuntary and state-dependent, when a euphoric subject loses insight and does not see any more benefit in having treatment. Conclusion: Consciousness destructuring associated with mood elation should explain treatment disruption in bipolar I patients more than nostalgia. Taking a manic episode story into account may help patients, family, and practitioners to achieve better compliance by improving their comprehension and integration of this unusual experience. Keywords: nostalgia, mania, compliance, insight, psychoeducation

International audience; Background Craving is a core symptom of addictive disorders, such as pathological gambling for example. Over the last decade, several studies have assessed the efficacy of repetitive transcranial magnetic stimulation (rTMS) in the addiction field, which triggers the dorsolateral prefrontal cortex (DLPFC) to decrease craving. The STIMJEU study investigated whether a single session of low-frequency (LF, i.e., 1 Hz) rTMS applied to the right DLPFC reduced cue-induced gambling craving in a sample of treatment-seeking pathological gamblers. Methods Thirty patients received both active and sham rTMS in random order and were blinded to the condition in a within-subject crossover design. Outcome measures included self-reported gambling craving (Visual Analog Scale and Gambling Craving Scale) and physiological measures (heart rate and blood pressure). Results The rTMS sessions were associated with a significant decrease in the gambling urge, regardless of whether the session was active or sham. When controlling cue-induced craving levels, no effects were observed on craving for active rTMS. Overall, rTMS was well-tolerated, and the credibility of the sham procedure was assessed and appeared to be appropriate. Conclusions We failed to demonstrate the specific efficacy of one session of LF rTMS to decrease cue-induced craving in pathological gamblers. A strong placebo-effect and rTMS parameters may partly explain these results. Yet, we are convinced that rTMS remains a promising therapeutic method. Further studies are required to examine its potential effect.

Aims In the literature, psychomotor retardation (PMR) is increasingly highlighted as a relevant marker for depression. Currently, we chose to focus on the fluency capacities as an evaluation of the frontal lobes functioning to reach a better understanding of cognitive and neurobiological mechanisms involved in PMR in depression. The aims of this study were 1) to explore the cognitive component of PMR through the analysis of Verbal Fluency (VF) performance in unipolar and bipolar depression; 2) to examine whether a repetitive transcranial magnetic stimulation (rTMS) treatment can improve concomitantly the RPM and VF capacities, as a relevant marker characteristic of the cognitive component of PMR. Methods 15 unipolar and 15 bipolar patients were compared to 15 healthy adults. Before treatment, the results showed VF deficits, particularly marked in the Bipolar Group. The investigation of the interplay between PMR, VF performance, MADRS and MoCA scores showed that the deficits in these various dimensions were not homogeneous. Results The absence of correlation between the psychomotor retardation scale (ERD) and VF, and the correlation with MoCA raise the hypothesis of a more global cognitive impairment associated with PMR in the BD group. The rTMS treatment had a positive impact on depression, PMR and fluency scores. Conclusion Correlations between ERD and VF performances appeared after treatment, evidencing the cognitive role of the psychomotor functioning in depression. Further analyses, including other cognitive measures in an objective evaluation of PMR, are required for a better understanding of these complex relationships.

International audience; Non-invasive brain stimulation (NIBS) might be a new approach to treat substance use disorders (SUD). A systematic review and critical analysis was performed to identify potential therapeutic effects of NIBS on addictions. A search of the Medline database was conducted for randomized sham-controlled trials using NIBS in the field of addiction and published until August 2016. Twenty-six studies in various SUD met the inclusion criteria. Converging evidence indicates that NIBS might be a promising mean to treat patients with alcohol and tobacco use disorders, by acting on craving reduction and other mechanisms such as improvement in cognitive dysfunctions.

International audience; The use of instruments originally developed for measuring gambling activity in younger populations may not be appropriate in older age individuals. The aim of this study was to examine the presence of problematic and disordered gambling in seniors aged 50 or over, and study the reliability and validity properties of the SOGS (a screening measure to identify gambling related problems). Two independent samples were recruited: a clinical group of n = 47 patients seeking treatment at a Pathological Gambling Outpatient Unit, and a population-based group of n = 361 participants recruited from the same geographical area. Confirmatory factor analysis verified the bifactor structure for the SOGS with two correlated underlying dimensions [measuring the impact of gambling on the self primarily (Cronbach's alpha α = 0.87) or on both the self and others also (α = 0.82)], and a global dimension of gambling severity (also with excellent internal consistency, α = 0.90). The SOG obtained excellent accuracy/validity for identifying gambling severity based on the DSM-5 criteria (area under the ROC curve AUC = 0.97 for discriminating disordered gambling and AUC = 0.91 for discriminating problem gambling), and good convergent validity with external measures of gambling (Pearson's correlation R = 0.91 with the total number of DSM-5 criteria for gambling disorder, and R = 0.55 with the debts accumulated due to gambling) and psychopathology (R = 0.50, 0.43 and 0.44 with the SCL-90R depression, anxiety and GSI scales). The optimal cutoff point for identifying gambling disorder was 4 (sensitivity Se = 92.3% and specificity Sp = 98.6%) and 2 for identifying problem gambling (Se = 78.8% and Sp = 96.7%). This study provides empirical support for the reliability and validity of the SOGS for assessing problem gambling in elders, and identifies two specific factors that could help both research and clinical decision-making, based on the severity and consequences of the gambling activity.

IntroductionDepression is among the most widespread psychiatric disorders in France. Psychiatric disorders are associated with considerable social costs, amounting to €22.6 billion for treatment and psychotropic medication in 2011. Treatment as usual (TAU), mainly consisting of pharmacotherapy and psychotherapy, is effective for only a third of patients and in most cases fails to prevent treatment resistance and chronicity. Transcranial direct current stimulation (tDCS) consists in a non-invasive and painless application of low-intensity electric current to the cerebral cortex through the scalp. Having proved effective in depressed patients, it could be used in combination with TAU to great advantage. The objective is to compare, for the first time ever, the cost-utility of tDCS-TAU and of TAU alone for the treatment of a depressive episode that has been refractory to one or two drug treatments.Methods and analysisThis paper, based on the DISCO study protocol, focuses on the design of a prospective, randomised, controlled, open-label multicentre economic study to be conducted in France. It will include 214 patients with unipolar or bipolar depression, assigning them to two parallel arms: group A (tDCS-TAU) and group B (TAU alone). The primary outcome is the incremental cost-effectiveness ratio, that is, the ratio of the difference in cost between each strategy to the difference in their effects. Their effects will be expressed as numbers of quality-adjusted life-years, determined through administration of the EuroQol Five-Dimension questionnaire over a 12-month period to patients (EQ-5D-5L). Expected benefits are the reduction of treatment resistance and suicidal ideation as well as social and professional costs of depression. Should depression-related costs fall significantly, tDCS might be considered an efficient treatment for depression.Ethics and disseminationThis protocol has been approved by a French ethics committee, the CPP-–Est IV (Comité de Protection des Personnes–Strasbourg). Data are to be published in peer-reviewed medical journals.Trial registration numberRCB 2018-A00474-51;NCT03758105

La stimulation magnétique transcrânienne répétée (rTMS) est un outil thérapeutique d’utilisation encore récente en psychiatrie. Cet article a pour objectif d’actualiser l’état des connaissances sur la rTMS dans le traitement des troubles de l’humeur. La rTMS possède une efficacité certaine (niveau de preuve de grade 1) dans le traitement initial curatif de la dépression unipolaire à condition d’utiliser des paramètres efficaces, c’est-à-dire, pour les schémas classiques à haute fréquence (5 à 20 Hz) : 20 à 30 séances, plus de 1200 pulses/séance, 5 Hz à 20 Hz, et au moins 110 % du seuil moteur. Les protocoles à 1 Hz sont également efficaces et bien tolérés. La durée de l’efficacité varie avec des taux de rechutes autour de 50 % à 1 an. Un traitement pharmacologique est, en règle, associé. La rTMS se positionne préférentiellement comme un traitement adjuvant aux psychotropes après échec ou efficacité partielle d’un ou deux antidépresseurs (niveau de résistance peu élévée) pour traiter des épisodes non chroniques (< 2 ans), sans critère de gravité (absence de symptômes psychotiques, risque suicidaire faible). En ce qui concerne les états maniaques et les états mixtes, les résultats ont encore un faible niveau de preuve se limitant à une possible réduction des symptômes. Dans le risque suicidaire associé aux troubles de l’humeur, l’intérêt de la rTMS est encore à démontrer, ainsi que dans la catatonie. Repeated transcranial magnetic stimulation (rTMS) is still a recent treatment in psychiatry. This article aims at updating the clinicians’knowledge about rTMS in the treatment of mood disorders (uni and bipolar depressive disorders, manic/mixed states, suicidal risk, catatonia). It is intended for clinicians who are required to indicate and/or use rTMS in their current practice. rTMShas the highest level of evidence for the treatment of unipolar depression, provided that effective parameters are used, that is to say, for classical high frequency protocols: 20 to 30 sessions, 1000 pulses/session, 5 to 20 Hz, and 110 % of the motor threshold. Low frequency protocol are also efficient and well tolerated. The duration of the efficacy varies with relapses rates around 50 % at one year. Pharmacological treatment generally remains associated. With regard to manic states, and mixed states the results are preliminary and limited to a possible reduction in symptoms. In the suicidal risk associated with mood disorders, the interest of rTMS is still to demonstrate, as well as in catatonia. The current place of the rTMS is no longer disputed in the curative treatment of major depressive disorder, preferentially used after one or two lines of antidepressants upstream. Further studies are needed to confirm preliminary positive findings in other aspects of mood disorders. 48;6

Introduction Le trouble depressif majeur est le plus prevalent de tous les troubles psychiatriques et peut affecter la reference a soi. La plupart des strategies therapeutiques de la depression visent a modifier le processus de reference a soi pour rectifier le biais cognitif negatif du patient. L’efficacite de ces traitements est souvent mesuree au moyen de questionnaires autorapportes evaluant des « Patient-Reported Outcomes » tels que la qualite de vie ou la depression. Ainsi, les traitements visant a induire un changement de perception de la maladie peuvent perturber la mesure de la depression via un auto-questionnaire. Dans une etude longitudinale, ce changement de perception, appele « response shift », peut se confondre avec l’evolution de la depression et aboutir a des conclusions erronees sur l’efficacite du traitement. Par ailleurs, la mesure du changement de perception induite par le traitement a egalement un interet en soi puisque c’est un objectif de la therapie. Dans l’evaluation de l’efficacite des traitements de la depression, il semble donc crucial de quantifier le « response shift » tout en mesurant correctement l’evolution des troubles depressifs autorapportes. Cette etude vise a analyser le « response shift » de patients souffrant d’une depression unipolaire resistante dans un essai clinique comparant les effets de trois strategies therapeutiques sur la depression. Methodes Les donnees d’un essai randomise multicentrique de 170 patients ayant recu un traitement antidepresseur ou une stimulation magnetique transcrânienne repetee ou la combinaison des deux ont ete reanalysees. Dans chaque groupe de traitement, la procedure de Oort basee sur des modeles a equations structurelles (SEM) a ete utilisee pour la detection du « response shift ». La depression a ete evaluee par l’inventaire de depression de Beck compose de trois dimensions : reference a soi negative, humeur triste, et alteration des performances. L’effet des strategies therapeutiques sur l’evolution de la depression a ensuite ete etudie dans un modele SEM longitudinal multigroupe prenant en compte le « response shift » detecte dans les differents groupes. Resultats Du « response shift » a ete detecte uniquement dans le groupe de patients traites par antidepresseur seul. Apres quatre semaines de traitement, ces patients avaient tendance a rapporter des scores moyens de reference a soi negative plus eleves qu’a baseline a niveau de depression inchange. Cette surdeclaration pourrait refleter une meilleure conscience du biais negatif de reference a soi induite par le traitement de la depression. De plus, le niveau moyen de depression a baisse significativement dans tous les groupes mais on peut noter que la diminution est significativement plus elevee dans le groupe traite par antidepresseur seul. A l’inverse, l’essai clinique, qui n’avait pas pris en compte le « response shift », avait initialement conclu a la meme diminution du trouble depressif pour toutes les strategies therapeutiques. Conclusion Si l’effet du « response shift » n’avait pas ete considere, l’amelioration de la depression aurait ete sous-estimee chez les patients ayant recu uniquement un antidepresseur biaisant ainsi la mesure de l’efficacite des strategies therapeutiques dans l’essai clinique. L’analyse du « response shift » a non seulement permis de corriger le biais de l’evolution de la depression mais aussi de deceler la potentielle meilleure conscience de la reference a soi negative pour cette strategie therapeutique.

International audience; INTRODUCTION: Trading and gambling appear to share some similarities. Indeed, traders can get professionally involved in high-risk types of trading as if it were gambling. This research explores whether excessive trading can be conceptualized as a subset of gambling disorders. OBJECTIVE: To better acknowledge the existence of an addictive-like trading behavior and to discuss its phenomenological similarities with gambling disorders. METHODS: The data of 8 excessive traders out of a cohort of 221 outpatients seeking treatment in our Problem Gambling unit were analyzed. RESULTS: Our case series revealed important similarities with gambling disorders in terms of diagnosis, trajectory and comorbidities. Like many disordered gamblers, excessive traders of this study experienced a number of small early wins, chased their losses, and ended up losing control over the money they invested. All of them invested in very risky stocks associated with short-term trading leading to potential large gains, but also with very significant losses. The structure itself of the two activities (gambling and trading) is very close. CONCLUSION: Our results tended to support the idea of an addictive-like trading behavior as a subset of gambling disorders. Investing is not a form of gambling, but some people gamble with investments. Several observations and recommendations can be made: (i) conduct researches; (ii) build and validate specific assessment tools; (iii) develop strategies for prevention and treatment; and (iv) conduct more rigorous studies to clarify what we named an addictive-like trading behavior.

Objectifs : Comparer la consommation de substances, les comportements de jeu et les traits de personnalité de deux groupes d’individus ayant un trouble de jeu pathologique (patients jeunes et adultes) ; explorer l’apport du sexe, de l’âge et des traits de personnalités sur la consommation de substances et évaluer la capacité de prédire la consommation de substances à partir de l’âge et des traits de personnalité.Méthodes : L’échantillon était formé de 428 patients ayant un trouble de jeu pathologique (TJP), divisés en deux groupes selon l’âge (55 jeunes patients [âge ≤ 25 ans] et 373 patients d’âge moyen à avancé [âge > 25 ans]). Tous les patients ont été admis dans un département de psychiatrie et diagnostiqués selon les critères du DSM-IV. En outre, d’autres évaluations cliniques, dont le Diagnostic Questionnaire for Pathological Gambling en vertu des critères du DSM-IV, le South Oaks Gambling Screen (SOGS) et le Temperament and Character Inventory-Revised (TCI-R), ont été utilisées pour examiner les comportements de jeu, la consommation de substances et la personnalité.Résultats : À la comparaison des deux groupes d’âge, nous avons observé des différences statistiquement significatives pour plusieurs variables sociodémographiques. En outre, les plus jeunes patients ayant un TJP présentaient un taux plus élevé de consommation de substances (p = 0,010). Pour ce qui est des traits de personnalité, des différences ont été remarquées seulement à l’échelle de recherche de nouveautés (RN) où les patients plus jeunes obtenaient des cotes élevées (p = 0,006). Des cotes plus élevées (p =0,022) à l’échelle de recherche de nouveautés (RN) et plus basses (p = 0,028) à l’échelle d’auto-transcendance représentaient des traits de personnalité ayant une interrelation significative avec la consommation de tabac (p = 0,003). Toutefois, seul l’âge était associé à la consommation d’autres substances (p =0,003).Conclusions : Les résultats confirment que le trouble de jeu pathologique (TJP) est souvent concomitant avec la consommation de substances. L’interrelation du TJP et de la consommation de tabac, d’alcool et d’autres substances entraîne une gamme d’implications cliniques et liées à la personnalité, particulièrement chez les populations jeunes. Puisque plusieurs études ont démontré que le taux de TJP est plus élevé chez les jeunes, le début précoce du trouble est souvent lié à une gravité accrue et à une persistance des problèmes de jeu. En outre, la présence d’un double diagnostic (consommation de substances) pourrait compliquer la réponse aux traitements. Pour cette raison, l’étude des populations jeunes est d’un intérêt particulier afin de concevoir et de mettre en oeuvre des programmes de traitement qui abordent tous les problèmes liés aux profils cliniques de ce groupe d’âge., Objectives: To compare substance use, gambling behaviors and personality traits between two different groups of individuals with a gambling disorder (young and adult patients); to explore the contribution of sex, age and personality traits on substance use; and to evaluate the capacity of age and personality traits to predict substance use.Methods: The participants were 428 gambling disorder (GD) patients, divided into two groups based on age [55 young participants (age≤25 years) and 373 middle- to old-aged participants (age>25 years)]. All were consecutively admitted to a Psychiatry Department and diagnosed according to the DSM-IV criteria. In addition, the Diagnostic Questionnaire for Pathological Gambling according to DSM-IV criteria, the South Oaks Gambling Screen (SOGS), the Temperament and Character Inventory-Revised (TCI-R), and other clinical measures were used to examine gambling behaviors, substance use and personality.Results: When the two age groups were compared, statistically significant differences were observed in several sociodemographic variables. Furthermore, the younger GD patients presented higher rates of drug use (p=.010). Regarding the personality traits, differences were found only in the Novelty Seeking (NS) scale, where the younger patients presented elevated scores (p=.006). Higher scores (p=.022) in NS and lower ones (p=.028) in Self-Transcendence (ST) were the personality traits significantly associated with tobacco consumption (p=.003). However, only age was associated with other substance use (p=.003).Conclusions: The results confirm that GD often co-occurs with substance use. The association between GD and the consumption of tobacco, alcohol and other drugs has a series of clinical and personality implications, particularly for young populations. Since several studies have demonstrated that GD rates are higher among younger individuals, early onset of the disorder is often associated with greater severity and persistence of the gambling problems. In addition, the presence of a dual diagnosis (drug consumption) could complicate the response to treatment. It is therefore of special interest to continue the study of young populations in order to design and implement treatment programs that address all the problems linked to the clinical profiles in this age range., Objetivos: comparar el consumo de sustancias, los comportamientos de juego y los rasgos de personalidad de dos grupos de personas que presentan un problema patológico de juego (pacientes jóvenes y adultos); explorar el aporte del sexo, de la edad y de los rasgos de la personalidad en el consumo de sustancias y evaluar la capacidad predictiva de la edad y de los rasgos de la personalidad sobre el consumo de sustancias.Métodos: la muestra estaba formada por 428 pacientes que presentaban un problema de juego patológico (PJP), divididos en dos grupos según la edad (55 pacientes jóvenes [edad ≤ 25 años] y 373 pacientes de edad promedio a avanzada [edad > 25 años]). Todos los pacientes fueron admitidos en un departamento de psiquiatría y diagnosticados según los criterios del DSM-IV. Se utilizaron además otras evaluaciones clínicas, como el Cuestionario de Diagnóstico del Juego Patológico [Diagnostic Questionnaire for Pathological Gambling] en virtud de los criterios del DSM-IV, el Despistaje del Juego de South Oakelle (SOGS) [South Oaks Gambling Screen] y el Inventario de Temperamento y Carácter Revisado (TCI-R) [Temperament and Character Inventory-Revised (TCI-R)] para examinar los comportamientos de juego, el consumo de sustancias y la personalidad.Resultados: en la comparación de los dos grupos de edad se observaron diferencias estadísticamente significativas en varias variables socio-demográficas. Además, los pacientes más jóvenes con PJP presentaban un porcentaje más elevado de consumo de drogas (p=0,010). Con respecto a los rasgos de la personalidad, se notaron diferencias solamente en la escala de búsqueda de novedades, en la que los pacientes más jóvenes obtenían cotas elevadas (p=0,006). Las cotas más elevadas (p=0,022) en la escala de búsqueda de novedades y las más bajas (p=0,028) en la escala de auto-trascendencia representaban los rasgos de la personalidad que tenían una interrelación significativa con el consumo de tabaco (p=0,003). Sin embargo, solamente la edad estaba relacionada con el consumo de otras sustancias (p=0,003).Conclusiones: los resultados confirman que el problema de juego patológico (PJP) es a menudo concomitante con el consumo de sustancias. La interrelación del PJP y del consumo de tabaco, de alcohol y de otras sustancias tiene como consecuencia una serie de implicaciones clínicas relacionadas con la personalidad, particularmente en los jóvenes. Puesto que numerosos estudios demostraron que el porcentaje de PJP es más elevado entre los jóvenes, el comienzo precoz del problema está ligado a menudo a un aumento de la gravedad y a una persistencia de los problemas de juego. Por otra parte, la presencia de un doble diagnóstico (consumo de sustancias) podría complicar la respuesta a los tratamientos. Por esta razón, el estudio de las poblaciones jóvenes es de particular interés para concebir y poner en práctica programas de tratamiento que aborden todos los problemas relacionados con los perfiles clínicos de este grupo de edad.

Background and Aims: gambling-related crimes are known to be associated with gambling disorder (GD). Due to a lack of consensus in the scientific community regarding the relevance of this diagnostic criterion, it was removed from the DSM-5. The primary aim of this study was to investigate through structural equation modeling (SEM) whether higher GD severity in treatment-seeking GD patients with a criminal record is mediated through the illegal acts criterion itself, or whether it can be better explained by other related clinical factors. Methods: an initial sample of 2,081 patients seeking treatment for gambling problems was included in the sample. SEM was used to evaluate the mediational role of the illegal acts criterion between the sex, age and personality traits, gambling severity, and comorbid depression levels. Comparisons between patients with coinciding and divergent DSM criterion for GD diagnosis were carried out. Results: illegal acts mediated the relationship between personality traits and GD severity: younger age, high levels of novelty seeking, and low levels of self-transcendence increased the risk of endorsing the illegal acts criterion. No differences between coincident-divergent groups in terms of DSM-IV and DSM-5 diagnosis were found with regards to sex (p = 0.878), education level (p = 0.387), or civil status (p = 0.792). Discussion and Conclusion: the results obtained in the present study offer new insights into the utility of using a history of illegal acts, their different personality characteristics, and psychopathology to categorize GD patients. Our findings suggest that patients who engage in criminal behavior may require a more comprehensive intervention.