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OBJECTIVE Several studies have shown that psychiatric disorders can be associated with venous thromboembolism (VTE) risk, that is, pulmonary embolism (PE) and/or deep vein thrombosis (DVT). In this study, we provide a systematic review and meta-analyses of the studies addressing this issue. METHODS All studies addressing the risk of VTE phenomena (whole VTE, PE, DVT, fatal VTE) in individuals with psychotic, mood, and anxiety disorders published between 1998 and 2019 were reviewed and included in the meta-analyses. Main characteristics of the studies and data concerning VTE risk were extracted. The methodological qualities of the studies were also analyzed. A random-effects meta-analysis model was used. A meta-analysis was conducted separately for each disorder, as well as separately for unadjusted and adjusted studies. Meta-analyses were repeated considering only good-quality studies. Heterogeneity was assessed. RESULTS Sixteen studies were reviewed and 15 included in the meta-analyses. Psychotic and bipolar disorders were significantly associated with VTE risk (VTE, DVT, PE, and fatal VTE for psychotic disorder: odds ratios [ORs] between 1.29 and 2.20; VTE, DVT, and PE for bipolar disorder: ORs between 1.22 and 2.14). Depression and anxiety disorders were associated with VTE risk only in adjusted analyses (DVT and PE for depression: ORs = 1.29; VTE and PE for anxiety disorders: ORs between 1.14 and 1.49). CONCLUSIONS The risk of VTE among individuals with psychiatric disorders may be explained by hypercoagulability and stasis, with both being related to, and independent of, treatment adverse effects. VTE risk should be taken into consideration in the treatment for people with psychiatric disorders.

International audience; Purpose of Review: This review provides an overview of current knowledge and understanding of EEG Neurofeedback for anxiety disorders and post-traumatic stress disorders. Recent Findings: The manifestations of anxiety disorders and post-traumatic stress disorders (PTSD) are associated with dysfunctions of neurophysiological stress axes and brain arousal circuits, which are important dimensions of the research domain criteria (RDoC). Even if the pathophysiology of these disorders is complex, one of its defining signatures is behavioral and physiological over-arousal. Interestingly, arousal-related brain activity can be modulated by electroencephalogram-based neurofeedback (EEG NF), a non-pharmacological and noninvasive method that involves neurocognitive training through a brain-computer interface (BCI). EEG NF is characterized by a simultaneous learning process where both patient and computer are involved in modifying neuronal activity or connectivity, thereby improving associated symptoms of anxiety and/or over-arousal. Summary: Positive effects of EEG NF have been described for both anxiety disorders and PTSD, yet due to a number of methodological issues, it remains unclear whether symptom improvement is the direct result of neurophysiological changes targeted by EEG NF. Thus, in this work we sought to bridge current knowledge on brain mechanisms of arousal with past and present EEG NF therapies for anxiety and PTSD. In a nutshell, we discuss the neurophysiological mechanisms underlying the effects of EEG NF in anxiety disorder and PTSD, the methodological strengths/weaknesses of existing EEG NF randomized-controlled trials (RCTs) for these disorders, and the neuropsychological factors that may impact NF training success.

This paper seeks to describe anxiety’s different symptomatologic presentations in Parkinson’s disease (PD), its longitudinal course and predictors, as well as its motor and non-motor correlates. It also reviews the available screening tools and different treatment modalities. In PD, longitudinal predictors of anxiety are mostly non-motor non-dopaminergic symptoms. The longitudinal course of anxiety is mainly a stable one. The Parkinson Anxiety Scale and the Geriatric Anxiety Scale are the 2 recommended screening tools. A third of PD patients suffer from an anxiety disorder at any time point. It can precede or follow PD motor symptoms. Anxiety is associated with demographic, disease-related motor and non-motor features. There is a lack of studies evaluating psychotropic treatment of anxiety in PD. Adjustment of dopaminergic treatment is indicated when anxiety is associated with motor fluctuations. DBS can be useful as well as CBT and body-mind interventions.

Obsessive-compulsive disorder (OCD) is a frequent and severe disease, potentially inducing a major impairment for the patient and burden for their family. Recent research in psychiatry and neuroscience have led to better comprehension of the disease's mechanisms and helped to improve its treatment. However, a large proportion of patients have refractory symptoms, including for traditional cognitive and behavioral therapy by exposure and response prevention (ERP), leading clinicians to look for new treatments. Mindfulness-based interventions (MBI) are a new type of approach, initially based on Buddhist meditation, which aims to provide better consciousness of the present moment. It has been successfully developed in some psychiatric diseases and other general medical conditions such as chronic pain. The two main programs using mindfulness meditation, Mindfulness-based stress reduction (MBSR) and Mindfulness-based cognitive therapy (MBCT), have shown effectiveness for the reduction of depressive and anxiety symptoms and relapses of depressive episodes in unipolar depression. It has no side effects and is well tolerated by patients. Its action relies on the specific correction of cognitive deficits in attention, emotion regulation and executive functions which are shared by OCD, GAD and depression. For OCD, we make the hypothesis that Mindfulness-Based Interventions could reduce the cognitive bias specifically existing in this pathology, such as dysfunctional beliefs, and therefore improve the symptoms. This article first reviews the existing literature on clinical trials involving Mindfulness-Based Interventions in OCD which comprises a small number of clinical studies based on very different types of protocols. At this time, and due to the lack of gold-standard studies with a large number of patients, no proof of the efficiency of mindfulness-based interventions in OCD has been shown. In a second section, following our hypothesis on the mechanisms of specific and non-specific action of this therapy in OCD, we propose a cognitive model of mindfulness-based therapy action in OCD involving the correction of OCD's cognitive bias. In this model, mindfulness-based therapy is supposed to treat specifically the cognitive aspects of the disease, while ERP is focused on its behavioral part. Then we present a clinical study aiming to prove the feasibility and the interest of the use of mindfulness in OCD, carried out in two different clinical centers. One of them used MBCT while the second used MBSR. Its results show the feasibility of mindfulness-based therapy in OCD patients and tend to prove that it could be more effective in young patients suffering from less severe forms of OCD. In parallel, attention tests and fMRI scans were done at the beginning and at the end of the therapy. Their results will be published separately. We also discuss the putative role of a specific form of MBCT adapted for OCD, specifically for its benefits in psychoeducation, which could reduce the dysfunctional beliefs present in OCD patients. Finally, we propose a therapeutic strategy in which the MBCT could complement the classical ERP therapy, as a "maintenance" treatment, aiming to extend the relapse of OCD symptoms. This article is a step further in the use of mindfulness-based therapy for OCD which could be added to the existing treatments reducing the patient's symptoms and improving their quality of life.

AimsThe COVID-19 pandemic and associated lockdown may have psychiatric consequences and increase the number of psychiatric emergency consultations. This study aimed to compare the number and characteristics of emergency psychiatric consultations during the four first weeks of the lockdown in three psychiatric emergency services from Paris and its suburbs, and to compare them to the same period in 2019.MethodsThree psychiatric centers in Paris and its suburbs took part in the study. We compared the number of total psychiatric emergency consultations during the 4 first weeks of the lockdown in France to the corresponding 4 weeks in 2019. We also compared the number of consultations during these 4-week time periods in 2020 and 2019 across different diagnostic categories.ResultsIn the 4 first weeks of the lockdown in France, 553 emergency psychiatry consultations were carried out, compared to 1224 consultations during the corresponding period of 2019, representing a 54.8 % decrease. This decrease was evident across all psychiatric disorders, including anxiety (number of consultations in 2020 representing 36.1 % of 2019), mood (41.1 %), and psychotic disorders (57.3 %). The number of suicide attempts also decreased (number of suicide attempts in 2020 representing 42.6 % of 2019). In comparison to 2019, the proportion of total consultations for anxiety disorders also decreased (16.6 % vs. 20.8 %), whilst the proportion of total consultations increased for psychotic disorders (31.1 % vs. 24.1 %).ConclusionsThe total number of psychiatric emergency consultations during lockdown dramatically decreased. The psychological consequences of lockdown may be delayed, indicating that psychiatric services should be prepared for a secondary increase in emergency presentations.

DRUG TREATMENT OF ANXIETY DISORDERS Three classes of drugs are available for the treatment of anxiety disorders: benzodiazepines, other anxiolytics, and serotonergic antidepressants. Except for acute anxiety and adjustment disorders, benzodiazepines are not recommended because of the risks associated with their chronic use (cognitive disorders, dependence, withdrawal syndromes). Other anxiolytics may be prescribed in generalized anxiety disorder but their effectiveness is generally poor. In contrast, several serotonergic antidepressants are indicated in generalized anxiety disorder, panic disorder and social phobia. These are long-term treatments, over at least 6 to 12 months, which can be very effective even in the absence of comorbid depression.BON USAGE DES TRAITEMENTS MÉDICAMENTEUX DANS LES TROUBLES ANXIEUX Trois catégories de médicaments sont disponibles pour le traitement des troubles anxieux : les benzodiazépines, d’autres anxiolytiques, et les antidépresseurs sérotoninergiques. En dehors de l’anxiété aiguë et des troubles de l’adaptation, les benzodiazépines sont peu recommandées du fait des risques associés à leur utilisation prolongée (troubles cognitifs, dépendance, syndrome de sevrage). Les autres anxiolytiques peuvent être prescrits dans l’anxiété généralisée, mais leur efficacité est limitée. En revanche, plusieurs antidépresseurs sérotoninergiques sont indiqués dans le trouble anxieux généralisé, le trouble panique et la phobie sociale. Il s’agit alors de traitements de fond, sur au moins 6 à 12 mois, qui peuvent être très efficaces même en l’absence de dépression associée.

International audience; Aims: To compare prevalence and risk factors for burnout, anxiety and depression among hospital psychiatrists and non-psychiatrists.Method: Regional online survey of psychiatric and non-psychiatric hospital physicians was performed including: a job-stress scale, the Hospital Anxiety and Depression Scale (HADS), the Copenhagen Burnout Inventory (CBI), a stressful work relationships list and a six items scale about work-related psychosocial risk factors (PRFs). The client-related burnout scale of the CBI has been changed to an interpersonal burnout scale. Cases were defined by a score of 8+ for the HADS-A/HADS-D and 50+ for the three CBI subscales.Results: 285 psychiatrists and 326 non-psychiatrists participated. The prevalence of depression, personal burnout and work-related burnout did not differ between physicians. Anxiety was lower in psychiatrists and interpersonal burnout was higher in senior psychiatrists. Multivariate analysis showed two main PRFs, common to both groups of physicians: "work intensity and time" was associated with four of the five syndromes and "emotional demands" with the three burnout syndromes. Interpersonal burnout was associated with stressful relationships with leaders, but not with patients.Conclusion: Reducing the workload, improving the management of emotions and increasing managerial skills are important approaches for prevention.

Anxiety disorders are widespread psychiatric conditions with significant social and professional disability, poor quality of life, an increased risk of suicide, and frequent attendance of medical services. Serotonin reuptake inhibitors (SRI) and serotonin and norepinephrine reuptake inhibitors (SNRI) have demonstrated a rather robust efficacy for the treatment of most of anxiety disorders. Nevertheless a substantial number of patients are resistant or still suffer from residual symptoms despite this first line treatment. The objective of our paper is to review relevant studies for the pharmacologic management of anxiety disorders resistant to the first line treatment. For this purpose, we conducted a pubmed/medline search for double-blind placebo-controlled trials of treatment-resistant anxiety disorders. An adequate trial for a SRI in the treatment of obsessive-compulsive disorder (OCD) should continue for at least 12 weeks. Special considerations of the comorbidities and symptom profile could help in the choice of an appropriate pharmacotherapy. Several trials have highlighted the efficacy of antipsychotics as an add-on to SRI in treatment-resistant OCD such as haloperidol more so when comorbid with a tic disorder, or risperidone that can reduce OCD as well as depressive symptoms. Aripiprazole has been shown efficacious in two placebo-controlled double-blind trials, while the efficacy of quetiapine and olanzapine remains controversial. Other trials showed some efficacy of anticonvulsants (lamotrigine, topiramate), pindolol, memantin and N-acetylcystein as an adjunctive treatment to SRI for resistant OCD. Few trials have investigated selective serotonin reuptake inhibitors (SSRI) or SNRI resistant generalized anxiety disorder showing a failure of adjunctive therapy with olanzapine, quetiapine, ziprasidone and risperidone. These studies were underpowered and very limited in number. Adjunctive risperidone for resistant post-traumatic stress disorder (PTSD) showed benefit in some but not all trials. Olanzapine was beneficial for the reduction of the CAPS score in addition to the improvement of sleep disturbances. Furthermore, prazosin was efficacious by reducing PTSD symptoms, sleep disturbances, nightmares, and psychological distress. One double-blind placebo-controlled study was conducted to investigate treatment-resistant social phobia showing no benefit of pindolol add-on paroxetine. Our results demonstrate that the pharmacological management of treatment-resistant anxiety disorders is not sufficiently investigated in double-blind placebo-controlled trials, despite a growing evidence in favor of antipsychotics and some other pharmacological agents in resistant OCD and, to a lesser extent, PTSD. Hence, there is a crucial need for larger double-blind placebo-controlled trials for resistant anxiety disorders. Finally, being out of the scope of our review, we omitted studies of non-pharmacologic therapies.

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.

The purpose of this review was to assess and present the findings up to this date on the efficacy of antipsychotics in the treatment of generalized anxiety disorders (GAD), social anxiety disorders (SAD), panic disorders (PD), and obsessive-compulsive disorders (OCD), mostly based on published randomized controlled trials (RCTs) or on open-label studies when RCT were lacking. Quetiapine could be recommended in patients with GAD. The efficacy of aripiprazole in two open-label studies on patients with antidepressant-refractory GAD should be assessed in RCTs. Despite preliminary positive results in open studies, there are currently no strong evidence for the effectiveness of antipsychotics in refractory SAD and in refractory PD. Conversely, risperidone and aripiprazole can be used for the treatment of refractory OCD as augmentation agents to antidepressants. Contrary to SAD and PD, this review found evidence for the use of second-generation antipsychotics in GAD and OCD. Otherwise, first-generation antipsychotics cannot be recommended in anxiety disorders and OCD.

BackgroundCognitive behavioural therapy (CBT) is a successful treatment of obsessive compulsive disorder (OCD). It is known to induce changes in cerebral metabolism; however, the dynamics of these changes and their relation to clinical change remain largely unknown, precluding the identification of individualized response biomarkers.MethodIn order to study the dynamics of treatment response, we performed systematic clinical and functional magnetic resonance imaging (fMRI) evaluation of 35 OCD patients immediately before a 3-month course of CBT, halfway through and at its end, as well as 6 months after. To sensitize fMRI probing, we used an original exposure task using neutral, generic and personalized obsession-inducing images.ResultsAs expected, CBT produced a significant improvement in OCD. This improvement was continuous over the course of the therapy; therefore, outcome could be predicted by response at mid-therapy (r2 = 0.67, p ConclusionsUsing an innovative and highly sensitive exposure paradigm in fMRI, we showed that clinical and haemodynamic phenotypes have similar time courses during CBT. Our results, which suggest that the initial CBT sessions are crucial, prompt us to investigate the anatomo-functional modifications underlying the very first weeks of the therapy.

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.

The neural bases of interactions between anxiety and cognitive control are not fully understood. We conducted an fMRI study in healthy participants and in patients with an anxiety disorder (social phobia) to determine the impact of stress on the brain network involved in cognitive control. Participants performed two working memory tasks that differed in their level of performance‐induced stress. In both groups, the cognitive tasks activated a frontoparietal network, involved in working memory tasks. A supplementary activation was observed in the right ventrolateral prefrontal cortex (VLPFC) in patients during the more stressful cognitive task. Region of interest analyses showed that activation in the right VLPFC decreased in the more stressful condition as compared to the less stressful one in healthy subjects and remain at a similar level in the two cognitive tasks in patients. This pattern was specific to the right when compared to the left VLPFC activation. Anxiety was positively correlated with right VLPFC activation across groups. Finally, left dorsolateral prefrontal cortex (DLPFC) activation was higher in healthy subjects than in patients in the more stressful task. These findings demonstrate that in healthy subjects, stress induces an increased activation in left DLPFC, a critical region for cognitive control, and a decreased activation in the right VLPFC, an area associated with anxiety. In patients, the differential modulation between these dorsal and ventral PFC regions disappears. This absence of modulation may limit anxious patients' ability to adapt to demanding cognitive control tasks. Hum Brain Mapp, 2012. © 2011 Wiley Periodicals, Inc

Background Fear of blushing (FB) in front of other people is a frequent and potentially incapacitating problem, but is not yet described as a specific diagnosis in psychiatric classifications. This can be explained by a lack of comparative studies with other forms of social anxiety disorder (SAD). Our aim was thus to explore the specificity of FB in patients with SAD. Methods SAD patients with FB but without other social threat (n = 142), the majority of whom were referred by a department of surgery after an initial request of sympathetic block for facial blushing, were compared to SAD patients with FB and other associated social fears (n = 97), and to SAD patients without FB (n = 190). They were assessed and compared with a structured diagnostic interview for DSM-IV and various scales measuring social anxiety, other anxiety and depressive symptoms, impairment and personality traits. Results The group with pure FB showed specific profiles when compared with the two other groups: later age of onset, less comorbidity, lower behavioral and temperamental inhibition, and higher self-esteem. However, their levels of social anxiety and impairment were high. No important differences appeared between the two other groups. Conclusion The specificity of FB should be considered in the social anxiety spectrum, and could be viewed either as a SAD subtype or as SAD form secondary to facial blushing. Further epidemiological and therapeutic studies on this disorder are necessary.

Only few clinical epidemiologic studies have been conducted on social phobia in France to date. It is however a frequent disorder, with often severe alteration of social adaptation and quality of life, and for which effective treatments exist. Thus, it seems really important to further explore how these patients are nowadays identified and treated in psychiatry. It was the objective of the Phoenix study. In this observational multi-center study, 952 psychiatric in- or out-patients, with a primary diagnosis of social phobia according to DSM IV criteria, were included. Numerous diagnostic and psychometric evaluations were carried out, in order to evaluate the comorbidity (Mini International Neuropsychiatric Interview, Hospital Anxiety and Depression Scale), the intensity of social anxiety (Liebowitz Social Anxiety Scale), and various aspects of the functional and emotional impact (Various Impact of Social Anxiety scale, Sheehan Disability Scale, SF-36, Positive and Negative Emotionality scale). The patients were in majority females (57.6%), with a mean age 37.5 years, and with a mean duration of social anxiety disorder 12.5 years. The mean scores of social anxiety on Liebowitz scale was 40.3 +/- 12.6 for the fear factor, and 38.3 +/- 13.6 for the avoidance factor. The generalized social anxiety subtype (anxiety in most social situations) was present in 67.8% of the patients. A major depressive disorder was found in 47.7% of the sample, and the prevalence of agoraphobia was even higher (49.2%). As known in clinical practice and in other studies, the prevalence rates of current alcohol dependence and substances abuse were also important in this population (respectively 10.6% and 12.7%). Mean scores of the Hospital Anxiety and Depression (HAD) sub-scales were 13.9 +/-3.8 for anxiety and 9.1 +/-4.5 for depression. About 15% of the patients had a history of suicide attempt, and a suicidal risk was present in nearly 40% of the sample. The psychosocial impact and the alteration of quality of life (with especially a poor physical health perception) were very significant, in the family, educational or occupational and social domains. Mean scores of the Sheehan Disability Scale were 6.1 +/- 2.6 for professional impairment, 5.0 +/- 2.7 for familial impairment, and 6.6 +/- 2.3 for social life impairment. In addition to the disability due to social phobia intensity, an important part of the burden was due to depressive symptoms. Approximately 60% of the patients had already a psychiatric treatment at the time of the survey (since 1,7 years in average), but only 17% had a cognitive behavioral therapy (CBT), and 48% had an antidepressant treatment. These proportions increased in a significant way after the consultation during which the investigation was carried out: an antidepressant was prescribed to 72% of the patients, and a CBT is proposed to 48%. On the whole, this study confirmed the severity and the morbidity of social phobia in a very large sample of French psychiatric patients. The depressive disorders, suicidal risk, and social impairment associated with this condition should incite to more detect and treat it. Seeing the long duration of the disease in our sample, and the lack of specific therapies in many cases, the identification and the treatment of social phobia must be improved, and the role of the psychiatrists in this process seems very important.

Objective : The etiology of depression and personality disorders in patients with sleep-disordered breathing (SDB) is not well defined and it is still unclear if they are directly related to the severity of the disease. In this study we test the hypothesis as to whether daytime sleepiness largely contributes to appearance of mood disorders. Methods : Sixty patients diagnosed as having snoring ( n =16) or OSA ( n =44) were examined. Daytime sleepiness was assessed by the administration of the Epworth Sleepiness Scale (ESS) and by the Maintenance Wakefulness Test (MWT). The Hospital Anxiety (HAD-A) and Depression (HAD-D) Scale and the Temperament and Character Inventory (TCI) questionnaires were used for psychopathological evaluation. Results : The mean HAD-A score was 6.9±0.45 and the average HAD-D score was 4.6±0.48, with no significant difference between snorers and OSA patients. Anxiety was present in 16% of cases and depression in 7%. The HAD-D score was related to the ESS score ( R =0.37, P =0.003), the mean sleep latency at the MWT ( R =−0.34, P =0.04), and the mean low SaO 2 , ESS score alone explaining the 17% of variance in the HAD-D score. Compared to controls, there were no differences in almost all TCI scores, with novelty-seeking temperament score higher in patients. No relationships were found between HAD or TCI scores and apnea density. Conclusions : We conclude that among patients evaluated for SDB, higher depression scores show an association with reduced daytime alertness, which therefore may have important effects on mood.

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.

Many hypotheses have been made to explain the high rate of benzodiazepine consumption in France, including a general cultural and/or familial tendency to use certain types of psychotropic drugs. This study explored the association between lifetime medication use by parents and their children. Two hundred and twenty-one young patients (158 boys and 63 girls) consulting at a child and adolescent psychiatry department, six to 16 years of age (mean = 9.7 years), were screened for lifetime use of psychotropic drugs using a structured interview. Parents were asked about their own consumption, as well as their children’s. Lifetime consumption rates (at least once) were 22.2% in boys and 20.6% in girls, and 19.6% in children less than 11 years old. Higher rates were found in patients with emotional disorders (anxiety disorders and depression). In parents, 45.1% of mothers and 24.1% of fathers reported using medications at least once. A significant association was found between child and parental medication use: 34.1% of children had positive lifetime consumption when their mothers also used medications at least once versus only 13.6% in other children (odds ratio = 3.31 [1.68–6.50]; P = 0.001). The most significant association was found between medication use by girls and their mothers (odds ratio = 12.1 [2.38–61.5];P = 0.003). These data point to the existence of a family pattern of psychotropic drug consumption, especially in females.

This study explored the relative impact of general medical conditions and psychopathology on the current and lifetime use of anxiolytic and/or hypnotic drugs by general hospital inpatients. One hundred and five consecutive patients, admitted to an internal medicine department, were assessed by a structured interview about current and lifetime use of anxiolytic and/or hypnotic drugs, and with somatic and psychopathology scales. Eighty percent of patients reported using anxiolytics and/or hypnotics at least once in a lifetime, 62.9% in the last year, 55.2% in the last 3 months, and 42.9% in the last week. Correlations were found between drug use and current levels of anxiety and depression, but not somatic pathology. Psychological suffering appeared to be a major determinant for anxiolytic and/or hypnotic use by patients with general medical conditions. Consumption rates were higher than in the general population, but there was no direct link between somatic morbidity and drug use.

Fear of blushing (FB) is a form of social anxiety disorder (SAD) characterized by an intense and obsessive threat of blushing in front of other people. No data are available on the specific efficacy of antidepressants on FB. This open-label pilot study investigated whether the selective serotonin reuptake inhibitor escitalopram specifically improves symptoms of FB in SAD patients. Thirty-nine patients meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for SAD and presenting a significant FB according to the Salpetriere Erythrophobia Questionnaire (SEQ) were administered open-label escitalopram (10-30 mg/d) for 12 weeks. A systematic assessment, at baseline and at week 12, included the SEQ, the Liebowitz Social Anxiety Scale, and the Hospital Anxiety and Depression scale. From the 39 patients included, 31 attended the week 4 visit, and 28 the week 12 visit. Significant reductions of FB were observed after 4 weeks of treatment and were more pronounced at the end of the 12-week treatment since patients experienced a 60% decrease in their FB symptoms (P < 0.001). Nineteen subjects (67.8%) reported a 50% decrease or more of their SEQ score, and 14 (50%) met criteria for remission of FB (SEQ score

BackgroundRepetitive checking in obsessive-compulsive disorder (OCD) would serve to relieve obsession-related anxiety and/or to compensate memory deficit, but experimental literature on this subject is inconsistent. The main objective is to test the influence of obsession-related anxiety and memory on repetitive checking in OCD.MethodsTwenty-three OCD checkers, 17 OCD non-checkers and 41 controls performed a delayed-matching-to-sample task with an unrestricted checking option. Some stimuli were obsession-related in order to measure the influence of anxiety on checking. A version of the task without checking possibility was used to assess memory abilities.ResultsOCD checkers had similar memory performances but checked more than the other groups when presented with non-anxiogenic stimuli. Level of anxiety associated to the stimulus did not influence the number of checks.ConclusionsIncreased checking in OCD checkers, being independent of memory abilities and primary obsession-related anxiety, would, therefore, be closer to an automated behaviour than a coping strategy.

International audience; Peu de travaux ont appliqué jusqu'à présent l'approche émotionnelle du modèle tripartite de Watson et Clark, différenciant affects positifs et négatifs, à l'étude des troubles anxieux et dépressifs. La notion de balance émotionnelle est pourtant intéressante pour la compréhension de ces pathologies, les deux dimensions pouvant évoluer différemment en fonction des syndromes cliniques. Notre étude porte sur un grand échantillon de patients souffrant de troubles dépressifs et anxieux, chez qui l'échelle EPN-31 (Émotionnalité Positive et Négative à 31 items) a été utilisée. Les résultats montrent essentiellement des profils émotionnels conformes au modèle tripartite: scores élevés d'affects négatifs dans les deux catégories de troubles, et scores faibles d'affects positifs surtout dans les troubles dépressifs. On trouve également des différences entre les troubles anxieux, avec en particulier des scores peu élevés d'affects négatifs dans le trouble panique et l'agoraphobie que dans les autres troubles anxieux. Ces résultats confirment la pertinence de cette approche émotionnelle, notamment pour des études longitudinales et des corrélations neurophysiologiques.

PurposeOnly a few European countries have carried out large, community-based, national surveys about psychiatric morbidity. Here is presented the first national French survey, aiming to estimate the prevalence of anxiety disorders and associated comorbidities according to sociodemographic characteristics.Materials and methodsThe Mental Health in General Population (MHGP) database is derived from a representative national survey of the French adult population (n = 36,105), conducted between 1999 and 2003. Data collection was done using an anonymous face-to-face interview. The presence of anxiety disorders (generalized anxiety disorder, panic disorder, agoraphobia, social phobia and post-traumatic stress disorder) was assessed using the Mini International Neuropsychiatric Interview.ResultsThe overall prevalence of anxiety disorders was estimated to be 21.6%, generalized anxiety disorder being the most prevalent one (12.8%). Women, young people, and people earning low income were identified as the more at risk. Major depressive episode, alcohol abuse and drug addiction frequently co-occur with anxiety disorders (28.3, 4.4 and 2.8% respectively).ConclusionsThe MHGP study showed that anxiety disorders are highly prevalent in France with a high frequency of comorbidities. Our results highlight the need for considering anxiety disorders as a public health priority in France as well as in other European countries.

BackgroundRepetitive behaviours (RB) in patients with Gilles de la Tourette syndrome (GTS) are frequent. However, a controversy persists whether they are manifestations of obsessive-compulsive disorder (OCD) or correspond to complex tics.Methods166 consecutive patients with GTS aged 15-68 years were recruited and submitted to extensive neurological, psychiatric and psychological evaluations. RB were evaluated by the YBOCS symptom checklist and Mini International Neuropsychiatric Interview (M.I.N.I), and classified on the basis of a semi-directive psychiatric interview as compulsions or tics.ResultsRB were present in 64.4% of patients with GTS (107/166) and categorised into 3 major groups: a 'tic-like' group (24.3%-40/166) characterised by RB such as touching, counting, 'just right' and symmetry searching; an 'OCD-like' group (20.5%-34/166) with washing and checking rituals; and a 'mixed' group (13.2%-22/166) with both 'tics-like' and 'OCD-like' types of RB present in the same patient. In 6.3% of patients, RB could not be classified into any of these groups and were thus considered 'undetermined'.ConclusionsThe results confirm the phenomenological heterogeneity of RB in GTS patients and allows to distinguish two types: tic-like behaviours which are very likely an integral part of GTS; and OCD-like behaviours, which can be considered as a comorbid condition of GTS and were correlated with higher score of complex tics, neuroleptic and SSRIs treatment frequency and less successful socio-professional adaptation. We suggest that a meticulous semiological analysis of RB in GTS patients will help to tailor treatment and allow to better classify patients for future pathophysiologic studies.Trial registrationClinicalTrials.gov NCT00169351.

Background Behavioral inhibition (BI), a heritable temperament, predisposes one to an increased risk of social phobia. Recent investigations have reported that BI may also be a precursor to anxiety as well as depressive and alcohol-related disorders, which are frequently comorbid with social phobia. In the present study, we explored the relationship between BI and psychiatric disorders in 256 adults with a primary diagnosis of social phobia. Methods BI severity was retrospectively assessed with the Retrospective Self-Report of Inhibition (RSRI). The severity of social phobia and the presence of comorbid diagnoses were evaluated with the Liebowitz Social Anxiety Scale (LSAS) and the Mini-International Neuropsychiatric Interview, respectively. Results The RSRI score was significantly and positively correlated with both the LSAS score and the occurrence of a major depressive disorder. No significant association was found with other anxiety and substance-related disorders. Limitation The assessment of BI was retrospective and self-reported. Conclusion A childhood history of BI was associated with an increased risk of depressive comorbidity in social phobia.

International audience; This study explores the environmental, clinical, and personality factors that are associated with increased chronic psychotropic drug consumption in elderly patients. We collected data from 88 elderly individuals living in nursing homes, home-dwellings, and residential homes between December 2003 and June 2004. We assessed each subject's (1) current (previous four weeks) and chronic (>90 days) psychotropic drug consumption, (2) mood and anxiety (GHQ), and (3) personality (Temperament and Character Inventory). We found that 63% of the elderly subjects studied had used psychotropic drugs at least once and that one out of three elderly chronically consumed psychotropic drugs. Personality factors like harm avoidance and low level of persistence seem to be associated with chronic consumption.; Cette étude a pour objectif d’explorer les facteurs environnementaux, cliniques et de personnalité pouvant être associés à l’accroissement de la consommation chronique de médicaments psychotropes chez les personnes âgées.Nous avons menée notre étude, de décembre 2003 et juin 2004, auprès de 88 personnes âgées résidant en maison de retraite, à leur domicile ou en résidence pour personne âgée (foyer logement). Pour chaque sujet nous avons évalué: 1) La consommation actuelle (au moins 4 semaines) et chronique (> à 90 jours) de médicaments psychotropes, 2) l’anxiété, la dépressivité, le dysfonctionnement social et les plaintes somatiques, 3) la personnalité (Temperament and Character Inventory, TCI, Cloninger).Nous avons mis en évidence que 63% des personnes âgées avaient déjà consommé au moins une fois dans leur vie un médicament psychotropes et qu’actuellement 1 personne sur 3 consomment ces médicaments de façon chronique.Des facteurs de personnalité tels que l’évitement de la douleur (Harm Avoidance) et un faible niveau de persistance, semblent être associés à une consommation chronique.

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.

International audience; 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.

International audience; BACKGROUND: Severe, refractory obsessive-compulsive disorder (OCD) is a disabling condition. Stimulation of the subthalamic nucleus, a procedure that is already validated for the treatment of movement disorders, has been proposed as a therapeutic option. METHODS: In this 10-month, crossover, double-blind, multicenter study assessing the efficacy and safety of stimulation of the subthalamic nucleus, we randomly assigned eight patients with highly refractory OCD to undergo active stimulation of the subthalamic nucleus followed by sham stimulation and eight to undergo sham stimulation followed by active stimulation. The primary outcome measure was the severity of OCD, as assessed by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), at the end of two 3-month periods. General psychopathologic findings, functioning, and tolerance were assessed with the use of standardized psychiatric scales, the Global Assessment of Functioning (GAF) scale, and neuropsychological tests. RESULTS: After active stimulation of the subthalamic nucleus, the Y-BOCS score (on a scale from 0 to 40, with lower scores indicating less severe symptoms) was significantly lower than the score after sham stimulation (mean [+/-SD], 19+/-8 vs. 28+/-7; P=0.01), and the GAF score (on a scale from 1 to 90, with higher scores indicating higher levels of functioning) was significantly higher (56+/-14 vs. 43+/-8, P=0.005). The ratings of neuropsychological measures, depression, and anxiety were not modified by stimulation. There were 15 serious adverse events overall, including 1 intracerebral hemorrhage and 2 infections; there were also 23 nonserious adverse events. CONCLUSIONS: These preliminary findings suggest that stimulation of the subthalamic nucleus may reduce the symptoms of severe forms of OCD but is associated with a substantial risk of serious adverse events. (ClinicalTrials.gov number, NCT00169377.)

It has been identified for a long time that obsessive-compulsive disorder (OCD) coexists with other psychiatric disorders: in over 50 percent of the OCD, patients meet the criteria for at least one axis I disorder (depression, anxiety disorders, eating disorders, impulse control disorders). Depressive disorders are the most commonly co-occurring difficulties and associated with significantly higher level of impairment and distress. Eating disorders and impulse control disorders are common comorbidity in OCD. These disorders as eating disorders, body dysmorphic disorder, trichotillomania, pathological gambling, share similarities in etiology, comorbidity, clinical features and treatment. Actually the notion of a spectrum of obsessive-compulsive related disorders is suggested by numerous studies.

The relationship between social phobia and alcoholism is complex. Alcohol problems typically develop secondary to social phobia, with patients reporting that they find alcohol helpful in coping with the symptoms of anxiety. However, excessive alcohol consumption may actually precipitate anxiety symptoms, and thus a vicious circle of anxiety and alcoholism is established. The clinician must consider the possibility of comorbidity in patients presenting with either alcoholism or social phobia. Only when both components of the condition are adequately assessed and treated can the cycle of social phobia and alcohol abuse be broken.

The nosology of anxiety disorders has been several times modified during the last years, but some important questions in this field still remain unresolved. The threshold between anxiety disorders and normal or physiological anxious states is often difficult to formally describe. Epidemiological studies do show that important variations of prevalence rates can be obtained by little modifications of diagnostic criteria. Generalized anxiety disorder and social phobia for example must be defined by severity and impairment criteria, adequately demanding to distinguish actual pathology from normal states or particular life styles. The other point is the distinction between anxiety disorders and personality traits or disorders. Only a few epidemiological studies have addressed this issue, but two models can be used: first categorical definitions of personality disorders (e.g. avoidant, dependent, or anankastic personality disorders), and second main personality traits such as neuroticism, behavioral inhibition, or trait-anxiety. Clinical epidemiological surveys and longitudinal studies may lead to significant progress in the comprehension of these problems.

Introduction Cognitive and Behavioral Therapy (CBT) is recognized as a valid tool to improve Obsessive Compulsive Disorder (OCD) symptoms. The orbitofrontal cortex (OFC)-striatal circuit appears to play an important role in the pathophysiology of OCD. Neuroimaging studies suggest that CBT might change its abnormal activity in OCD patients. Objectives The aim of this study is to use longitudinal functional Magnetic Resonance Imaging (fMRI) to assess the neural correlates of clinical improvement in OCD patients undergoing CBT. Methods Thirty-five OCD patients with checking compulsions undergoing 15 individual weekly CBT sessions were assessed on symptom severity with the Y-BOCS [1] at four stages of the therapies: before, during, at the end of therapy and six months later. On each assessment, patients also performed a symptom-provocation task in fMRI during which they reported their anxiety level upon watching neutral photographs, generic (validated in a population of OCD checkers) vs individualized (patient's photographs of personal objects) checking-provoking photographs. Results and conclusions Clinically, CBT resulted in a significant improvement (Y-BOCS scores: 24.8; 18,3; 13,7; 13.9). Behaviorally, the symptom-provocation task elicited anxiety that decreased through therapy (p

The Tridimensional Personality Questionnaire (TPQ) is a 100-item true-false self-questionnaire proposed by R. Cloninger and based on a three independent dimensions model of personality. These three dimensions, each with four sub-scales, are Novelty Seeking (NS), Harm Avoidance (HA) and Reward Dependence (RD). Recently, several groups have used the TPQ to study clinical samples, and other have reported normative data in the general population but, up to date, no result has been published on the French TPQ version. The aims of this study were therefore to assess the psychometric properties of this questionnaire and also to research an eventual relationship between dimensions of personality and anxiety and depression mood, measured by mood and anxiety scales in out-patients. A population of 165 subjects was included in this study and assessed with the TPQ. In this sample, 119 patients completed also the Hospital Anxiety and Depression (HAD) scale. The factor analysis with a Varimax rotation suggests three possible solutions with 3, 4 or 5 factors for the TPQ. These all three analysis indicate that the dimensions NS and HA load consistently unto the first two factors, and seem therefore two robust and independent dimensions. Contrastly, the RD dimension seems definitely heterogeneous, even if the RD2 sub-scale (persistence) is treated separately from the other as proposed by Cloninger. Analysis of correlations between TPQ dimensions and HAD sub-score show that only the HA dimension is related to anxiety sub-score (r = 0.34), depression subscore (r = 0.52) and total HAD score (r = 0.47).(ABSTRACT TRUNCATED AT 250 WORDS)

Personal space is the area individuals maintain around themselves into which others cannot intrude without arousing discomfort. This concept is potentially relevant in clinical psychiatry, especially in the context of disorders associated with social anxiety or social cognition disorders. Consistent with this idea, some rare studies have shown that personal space managing and interpersonal distance setting is disturbed in schizophrenic and bipolar patients. However, surprisingly, there is no data on personal space in social phobia. In this study, we aimed to investigate the characteristics of personal space in patients with social phobia using immersive and interactive virtual environments. Overall, the more the level of anxiety the more subjects leave space between themselves and others. The detailed results are discussed in the frame of cognitive models of social anxiety.

IntroductionMost of the literature examining sleep in anxiety disorders has focused on post-traumatic stress disorder and generalized anxiety disorder. Few studies have examined sleep disturbances in social phobia. Yet, social phobia has a lifetime prevalence of 12%. Previous studies assessed sleep disturbances in small samples of individuals with social phobia. Most studies reported bivariate analysis, the only multivariate analysis being in non treatment-seeking individuals.ObjectivesTo assess insomnia severity in a population of treatment-seeking patients with social phobia and investigate correlations between insomnia, depression, general anxiety, and social anxiety.AimsTo demonstrate that positive associations exist between anxiety, depression, and insomnia in patients with social phobia, depression contributing the most to insomnia severity.MethodsOne hundred and seventy-nine treatment-seeking individuals with a DSM-IV diagnosis of social phobia completed the Insomnia Severity Index (ISI), the Hospital Anxiety and Depression Scale (HAD-A and HAD-D) and the Liebowitz Social Anxiety Scale (LSAS).ResultsTwo-thirds of our sample had insomnia. Depression, anxiety, social anxiety, and insomnia were positively correlated. Sex, HAD-A and LSAS significantly contributed in explaining the ISI total score after accounting for age, medication use, and depression, whereas HAD-D was not a significant contributor. The model explained 33.5% of the overall variance.ConclusionAssessing sleep quality and quantity, and understanding the interactions between insomnia, anxiety and depression, is needed to improve treatment in patients with social phobia and could allow adapting cognitive and behavioral therapy for insomnia programs to social anxiety.

Background Bilateral subthalamic high-frequency stimulation significantly improves motor functions in patients with advanced forms of Parkinson disease (PD). This favorable effect contrasts with a growing number of reports that the treatment may result in psychiatric complications. Objective To analyze the presence of behavioral disorders and social maladjustment in PD patients successfully treated with continuous bilateral subthalamic stimulation. Design Prospective study. Setting University hospital. Methods Twenty PD patients underwent prospective evaluation for behavioral and personality changes, quality of life, and social functioning, 6 and 24 months after surgery to implant bilateral stimulating electrodes within the subthalamic nucleus. Results At 6 and 24 months after surgery, parkinsonian motor disability (on-stimulation/off-medication) was improved by 81% and 67%, respectively, and the severity of levodopa-related motor complications was improved by 84% and 70%, respectively. Levodopa-equivalent dosage was decreased by 79% and 66%, respectively; severity of depression was improved by 21% and 33%, respectively; and severity of anxiety was improved by 43% and 64%, respectively. The patients' personality traits were unmodified. Twenty-four months after surgery, the global score for quality of life was improved by 28%, whereas scores for social adjustment remained stable. Conclusions Provided that patients with PD are rigorously selected for neurosurgery, subthalamic stimulation (1) improves mood, anxiety, and quality of life; (2) does not result in severe permanent psychiatric disorders or modify patients' personality; and (3) does not ameliorate social adaptation.