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Background: At the beginning of COVID-19 pandemic, specific COVID/PSY wards were created in France to provide care for inpatients with COVID-19 and psychiatric disorders. In this multi-center prospective study, we set out to assess the clinical features and risk factors of somatic aggravation in patients hospitalized in COVID/PSY wards. Methods: Data were collected between 28 February and 30 May, 2020. We collected demographic data, psychiatric diagnoses, medical data and COVID-19-related clinical data. Somatic aggravation was estimated by the number of patients transferred to intensive care or medicine units, the number of deaths and the number of patients presenting a confusional state. A multivariate logistic model was used to assess the risk factors of confusional state and transfer to intensive care or medicine units. The risk of death was analysed by the univariate predictors of this outcome. Outcomes: 350 patients were included in the study. The number of inclusions peaked one week after that of the general population and declined more slowly. Overall, 24 (7%) were transferred to medicine units, 7 (2%) died and 51 (15%) patients presented a confusional state. Severe respiratory symptoms predicted the transfer to a medicine unit (OR 17.1; CI 4.9-59.3). Older age, an organic mental disorder, a confusional state, and severe respiratory symptoms predicted mortality in univariate analysis. Age > 55 (OR 4.9; CI 2.1-11.4), an affective disorder (OR 4.1; CI 1.6-10.9), and severe respiratory symptoms (OR 4.6; CI 2.2-9.7) predicted a higher risk, while smoking (OR 0.3; CI 0.1-0.9) predicted a lower risk of a confusional state. Interpretation: COVID-19 patients with severe psychiatric disorders have multiple somatic comorbidities and a high risk of confusion. COVID/PSY wards may play a role in reducing the mortality of COVID-19 in patients with psychiatric disorders. Funding Statement: There was no funding source for this study. Declaration of Interests: There are no conflicts of interest to be declared. Ethics Approval Statement: This observational study was conducted according to the principles of the Declaration of Helsinki. In accordance with French bioethics laws, it was classified as a non- interventional study, since it concerned anonymized clinical data that are routinely compiled in medical records. Compliance with French regulations on personal data collection was supervised by the personal data referent of the Centre Psychotherapique de Nancy. Patients, and their legal guardian when appropriate, were informed in writing, in agreement with national regulations for observational studies.

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; Both shorter telomeres and schizophrenia have been associated with a decrease in life expectancy. Furthermore, several studies found a shorter telomere length (TL) in schizophrenia. Understanding whether or not telomere shortening is directly related to pathophysiology of schizophrenia or is a consequence of a cumulative exposure to chronic stress is of major importance. Comparing the TL of subjects at the very beginning of the disease (FEP) and control subjects could help to decide between these two hypotheses. The aim of the present study was to compare TL between FEP subjects (N=91) and controls (N=137). After accounting for multiple potential confounders, no significant association was observed between FEP and TL. Our result is consistent with the hypothesis that psycho-social stress / adversities and stressful situations in people with schizophrenia affect TL rather than that telomere erosion contributes to the development of this disorder.

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.

The search for the genetic factors underlying complex neuropsychiatric disorders has proceeded apace in the past decade. Despite some advances in identifying genetic variants associated with psychiatric disorders, most variants have small individual contributions to risk. By contrast, disease risk increase appears to be less subtle for disease-predisposing environmental insults. In this study, we sought to identify associations between environmental pollution and risk of neuropsychiatric disorders. We present exploratory analyses of 2 independent, very large datasets: 151 million unique individuals, represented in a United States insurance claims dataset, and 1.4 million unique individuals documented in Danish national treatment registers. Environmental Protection Agency (EPA) county-level environmental quality indices (EQIs) in the US and individual-level exposure to air pollution in Denmark were used to assess the association between pollution exposure and the risk of neuropsychiatric disorders. These results show that air pollution is significantly associated with increased risk of psychiatric disorders. We hypothesize that pollutants affect the human brain via neuroinflammatory pathways that have also been shown to cause depression-like phenotypes in animal studies., Exploratory analyses of two independent datasets comprising 151 million Americans and 1.4 million Danes revealed that polluted air was associated with a significantly increased risk of psychiatric disorders, including bipolar disorder and schizophrenia.

BACKGROUND Impulse control disorders are frequently associated with dopaminergic therapy in Parkinson's disease. Genetic studies have suggested a high heritability of impulse control disorders in the general population and in PD. The aim of this study was to identify candidate gene variants associated with impulse control disorders and related behaviors in PD. METHODS We performed a multicenter case-control study in PD patients with (cases) or without impulse control disorders and related behaviors despite significant dopamine agonist exposure of >300 mg levodopa-equivalent daily dose during 12 months (controls). Behavioral disorders were assessed using the Ardouin scale. We investigated 50 variants in 24 candidate genes by a multivariate logistic regression analysis adjusted for sex and age at PD onset. RESULTS The analysis was performed on 172 cases and 132 controls. Cases were younger (60 ± 8 vs 63 ± 8 years; P

Background In 2017 a patient’s death occurred in the psychiatry department of our establishment. After a morbidity-mortality review, the hypothesis of a cardiac arrest after intake of torsadogenic drugs has been suggested. Purpose The state of cardiac patient care in our psychiatry units was one of the strategic axes retained to define priority actions for improvement. Material and methods Records of the hospitalised psychiatry patients were analysed on a given day in April 2018. A literature review allowed selection of the factors to analyse: ionogram dates and results, thyroid function, arterial tension (AT), heart rhythm (HR), electrocardiogram realisation, corrected QT interval (QTc), torsadogenic risk factors (female ≥65 years, ischaemic heart disease, torsadogenic drug) and co-prescriptions of psychotropic drugs inducing QT prolongation (PDIQTP). Only the factors traced in the patients’ records during the first 30 days of hospitalisation were analysed. Results Ninety-six records were analysed (100% of inpatients). Found at admission were ionograms, thyroid function, AT, HR and electrocardiogram realisation, respectively for 94%, 70%, 95%, 96% and 90% of patients. Seven hypokalaemias were found and were all adjusted during the first month. No hypocalcaemia or hypothyroidism were found but one hyperthyroidism was revealed and explored. Seven hypertensions were explored. No bradycardia was recorded. Four patients had QTc prolongation (≥450 ms). Among them, two profited from an additional electrocardiogram. The percentage of patients with one risk factor was 19% and 2% of patients had more than one risk factor. Half of these patients underwent an additional electrocardiogram. During hospitalisation, 44 PDIQTP, 17 initiations and 12 raises of torsadogenic drug dosage were carried out. These modifications were monitored by an extra electrocardiogram in 13% of cases. Conclusion Admission cardiac check-up was mainly realised and its disturbances corrected or explored. However, the thyroid function was underestimated whereas its disturbance can cause not only cardiac disorders but also psychiatric disorders. Furthermore, in risk situations that need an extra electrocardiogram during hospitalisation (QTc prolongation for example), cardiac monitoring was insufficient. These two points will be spotlighted in a cardiac monitoring protocol for psychiatry inpatients, in order to prevent iatrogenic cardiac arrests throughout the hospitalisation. References and/or acknowledgements No conflict of interest.

International audience

International audience; Purpose of Review This review will aim to summarize the current body of epidemiological, clinical and therapeutic knowledge concerning specific co-occurrence of obsessive-compulsive symptoms (OCS) and schizophrenia spectrum disorder.Recent Findings Almost 30 % of the patients with schizophrenia display OCS, and three main contexts of emergence are identified: prodromal symptoms of schizophrenia, co-occurrence of OCS and schizophrenia, and antipsychotics-induced OCS. Recent clinical studies show that patients with SZ and OCS has more severe psychotic and depressive symptoms, higher suicidality and lower social functioning. A recent cognitive investigation found that OCS and delusions share specific metacognitive profiles, particularly through a heightened need to control thoughts. Finally, a recent cross-sectional study of clozapine-induced OCS found a dose-response relationship between clozapine and OCS.Summary: OCS appeared reliably as linked to poorer outcomes among patients with schizophrenia. However, the specific clinical value of OCS among other prodromal symptoms of schizophrenia remains unknown.

Objectives Incidence-prevalence-mortality (IPM) models have been developped to estimate incidence or prevalence when one of these two measures is unavailable. We aimed to test the consistency of an IPM model of psychotic disorders on a recent incidence-prevalence couple dataset and to identify potential causes of inconsistency by applying the model to (a) the whole population, (b) female and male subgroups, (c) migrant subgroups, and (d) psychotic disorders with age at onset (AAO) between 18 and 24 (18-24 AAO). Methods We modelled prevalence (MP) using incidence data and the expected mortality and remission values. We then compared the MP to the observed prevalence (OP). Results In the whole population, the model significantly underestimated the prevalence (MP = 3.30, 95% CI [2.97, 3.66]; OP = 4.98, 95% CI [4.58, 5.41]). The results were similar for the two genders. In the migrants group, results were in the opposite direction, the model significantly overestimating the prevalence. Finally, in the 18-24 AAO subgroup, the model performed well, with OP and MP not significantly different. Conclusion These results suggest that standard IPM models do not perform well for psychotic disorders and more complex models taking into account the heterogeneity of the sample (in terms of remission, mortality, population movements, etc.) need to be developed.

Resume Objectif L’hypnose est souvent proposee comme une methode de psychotherapie dans diverses pathologies psychiatriques, notamment en rapport avec le stress et l’anxiete. Sa place au sein des strategies therapeutiques des troubles anxieux chroniques reste cependant incertaine. L’objectif de cette revue est donc d’analyser la litterature medicale portant sur l’efficacite therapeutique de l’hypnose dans les troubles anxieux. Methodes Une recherche bibliographique exhaustive a ete realisee via Pubmed pour identifier les publications originales, entre 1980 et 2015, rapportant des donnees cliniques sur l’efficacite de l’hypnose dans six categories de troubles anxieux. Chaque publication a ensuite ete analysee au plan methodologique et des resultats therapeutiques. Resultats Seulement trois essais controles ont ete identifies au total, un dans le trouble panique et deux dans l’etat de stress post-traumatique (ESPT). Les autres articles portent sur des etudes ouvertes (4 articles), ou sur des cas uniques (20 articles). L’etude realisee dans le trouble panique conclut a l’absence d’efficacite de l’hypnose associee a la therapie comportementale et cognitive, de meme qu’un des essais realises dans l’ESPT. Seule une etude effectuee chez 48 enfants indonesiens souffrant d’ESPT suggere l’efficacite d’une technique particuliere d’hypnose adaptee a la culture locale. Les autres articles signalent des resultats positifs dans des etudes en ouvert ou dans des rapports de cas, mais leurs conclusions peuvent difficilement etre generalisees. Conclusion Les donnees de la litterature sont actuellement negatives ou insuffisantes pour attester de l’efficacite therapeutique de l’hypnose dans les troubles anxieux chroniques, et cela quelle que soit la categorie consideree (phobies, ESPT, etc.). Des etudes specifiques seraient necessaires pour determiner d’eventuels profils de patients repondeurs aux methodes d’hypnose dans ces pathologies.

International audience; INTRODUCTION:The primary objective of this study was to determine if second-generation antipsychotic (SGA) administration was associated with lower aggressiveness scores compared to first-generation (FGA) in schizophrenia (SZ). The secondary objective was to determine if antidepressants, mood stabilizers, and benzodiazepines administration were respectively associated with lower aggressiveness scores compared to patients who were not administered these medications.METHODS:Three hundred thirty-one patients with schizophrenia (N = 255) or schizoaffective disorder (N = 76) (mean age = 32.5 years, 75.5 % male gender) were systematically included in the network of FondaMental Expert Center for Schizophrenia and assessed with the structured clinical interview for DSM-IV Axis I disorders and validated scales for psychotic symptomatology, insight, and compliance. Aggressiveness was measured by the Buss-Perry Aggression Questionnaire (BPAQ) score. Ongoing psychotropic treatment was recorded.RESULTS:Patients who received SGA had lower BPAQ scores than patients who did not (p = 0.01). More specifically, these patients had lower physical and verbal aggression scores. On the contrary, patients who received benzodiazepines had higher BPAQ scores than patients who did not (p = 0.04). No significant difference was found between BPAQ scores of patients respectively being administered mood stabilizers (including valproate), antidepressant, and the patients who were not. These results were found independently of socio-demographical variables, psychotic symptomatology, insight, compliance into treatment, daily-administered antipsychotic dose, the way of antipsychotic administration (oral vs long acting), current alcohol disorder, and daily cannabis consumption.CONCLUSION:The results of the present study are in favor of the choice of SGA in SZ patients with aggressiveness, but these results need further investigation in longitudinal studies. Given the potent side effects of benzodiazepines (especially dependency and cognitive impairment) and the results of the present study, their long-term prescription is not recommended in patients with schizophrenia and aggressive behavior.

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.

International audience; BACKGROUND:Repetitive transcranial magnetic stimulation has been explored in patients with obsessive-compulsive disorder, but with negative or conflicting results. This randomized double-blind study was designed to assess the efficacy of 1-Hz repetitive transcranial magnetic stimulation over the presupplementary area.METHODS:Forty medication-resistant patients were assigned to 4 weeks of either active or sham repetitive transcranial magnetic stimulation targeting the presupplementary area with the help of a neuronavigation system.RESULTS:According to the Yale-Brown obsessive-compulsive scale, the baseline-week 4 evolution showed no significant differences between groups. Responder rates at week 4 were not different between groups (repetitive transcranial magnetic stimulation 10.5% vs sham 20%; P=.63).CONCLUSION:Low-frequency repetitive transcranial magnetic stimulation applied to the presupplementary area seems ineffective for the treatment of obsessive-compulsive disorder patients, at least in severe and drug-refractory cases such as those included in this study. Further research is required to determine profiles of responder patients and appropriate repetitive transcranial magnetic stimulation parameters for obsessive-compulsive disorder.

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.

Childhood traumas have been extensively associated with the development of psychotic disorders. However, our understanding of processes underlying this relationship remains poor. In order to address this issue, we examined which specific aspects of childhood trauma are significantly associated with a first episode of psychosis. 109 patients with first episode of psychosis and 145 controls representative from general population were recruited in three centers in France. Child experiences of care and abuses allowed obtaining information about types of childhood trauma, age at first exposure, identity of perpetrator, and social support. Odds ratio were calculated for each of these aspects, adjusted for age, sex, and education. Sexual and physical abuses (OR=2.26 (1.19-4.32)), and separation from one or both parents (OR ranging from 1.94 to 3.17; all significant) are significantly associated with an increased risk to present a first episode of psychosis. Furthermore, separation from mother occurring before age of 4 (OR=5.96 (1.24-28.77)), and sexual and physical abuses perpetrated by someone other than parents (OR=4.61 (1.66-12.80)) were also associated with an increased risk of first episode of psychosis. Finally, social support was significantly associated with a decreased risk to develop psychotic disorders (OR ranging from 0.33 to 0.42; all significant). Together, these findings suggest that some but not all aspects of childhood trauma are related to a significant risk to develop a first episode of psychosis.

Benzodiazepine (BZD) inappropriate use (i.e., misuse and overuse) is a worldwide public health problem. Despite current knowledge about increased sensitivity to side effects in the elderly, that should lead to more caution, only a third of BZD prescriptions in this age group are considered appropriate. The most frequent inadequate situations are excessive duration and/or dosage of a medical prescription or self-medication, especially in a context where it would be contraindicated, e.g., long-acting BZD in the elderly. Polypharmacy and comorbidities are major risk factors. Consequences of BZD inappropriate use are falls, delirium and other cognitive dysfunction, acute respiratory failure, car accidents, dependence, and withdrawal symptoms. An emerging concern is a potentially increased risk of dementia. Contrary to most clinicians' belief, discontinuation of chronic BZD use in elderly patients is feasible, with adequate psychotherapeutic or pharmacological strategies, and can lead to long-term abstinence. Brief cognitive therapy mostly relies on psychoeducation and motivational enhancement and is particularly useful in this context. Further research is needed, notably in three areas: (1) assessing the impact of public health programs to prevent BZD inappropriate use in the elderly, (2) developing alternative strategies to treat anxiety and insomnia in elderly patients, and (3) exploring the association between chronic BZD use and dementia.

International audience; AimCognitive behavioral therapy (CBT) is recognized as an effective treatment for obsessive-compulsive disorder (OCD). To maximize its effectiveness, we designed an “experimental” CBT defined by the addition of a computerized psychoeducative tool.MethodIn a participative process involving patients through meetings of the French OCD association (AFTOC) and therapists through methodological workshops, we built a therapeutic tool from an experimental checking task. This task, which had been published in an earlier work, was adapted for its psychoeducative dimension. We here report on a randomized double-blind trial which included 35 patients with a moderate to severe OCD (Yale-Brown obsessive-compulsive scale, YBOCS between 16 and 25) predominant checking symptoms, no comorbidities, and 2-month stabilized or no treatment. Patients were randomly assigned to either “standard” versus “experimental” CBT. Both therapies were conducted by four CBT-experienced therapists specialized in OCD through weekly individualized sessions over 3 months. Therapy sessions of the experimental CBT were conducted as the standard CBT except for a short exercise with the computerized psychoeducative tool performed by the patient and debriefed with the therapist at the end of the sessions. Patients were assessed before, during, after therapy and again 6 months later using standard clinical tools and a neurobehavioral assessment based on an original symptom-provocation task with anxiety ratings including three types of photographs: neutral, generic inducing obsessions (e.g., doorknobs, electric wires…) and personalized (taken by the patients in their own environment).ResultsClinically, “standard” and “experimental” CBT resulted in a significant but equivalent improvement (48% vs 45% reduction of the Y-BOCS score; P = 0.36; d = 0.12). Therapists were satisfied with the psychoeducative dimension of the computerized psychoeducative tool but reported variable acceptance across patients. Patients appreciated its usability. The clinical improvement was associated with a reduction of the task-induced anxiety (r = 0.42, P < 0.05), especially towards personalized items (−28,2% vs −20.41% for generic and −6.24% for neutral photographs, P < 0.001). Mid-therapy response level was predictive of the final improvement (r = 0.82, P < 0.001).ConclusionThe computerized tool may provide a well-accepted therapeutic adjuvant even though it doesn’t improve the therapeutic effect. Using a personalized symptom-provocation task reveals the parallel evolution of symptoms and neurobehavioral markers through CBT. Despite the difficulty of improving an evidence-based therapy, mid-therapy results call for investigating the possible adjustments of treatment strategies at an early stage.; La thérapie cognitive et comportementale (TCC) est reconnue comme efficace pour soigner le trouble obsessionnel compulsif (TOC). Pour maximiser son efficacité, nous avons conçu, dans une démarche participative associant patients et thérapeutes, une TCC « expérimentale » définie par l’adjonction d’un outil psychopédagogique informatisé basé sur une tâche de vérification. Cette étude randomisée en double insu inclut 35 patients atteints de TOC de vérification suivis en TCC « standard » ou « expérimentale » sur le plan clinique et neurocomportemental grâce à une tâche originale de provocation de symptômes avec des photographies neutres, anxiogènes génériques et anxiogènes personnalisées. Les thérapeutes ont apprécié la dimension psychopédagogique de l’outil informatisé. Les deux TCC ont entraîné une amélioration des symptômes équivalente et significative et une diminution de l’anxiété induite par les photographies anxiogènes personnalisées. La réponse à mi-thérapie était prédictive de l’amélioration finale. L’outil informatisé peut fournir un adjuvant thérapeutique bien accepté même s’il n’augmente pas le gain thérapeutique. La tâche de provocation de symptômes utilisant des images personnalisées permit de mettre en évidence l’évolution parallèle des symptômes et des marqueurs neurocomportementaux au cours des TCC. Malgré la difficulté d’augmenter l’efficacité d’une thérapie fondée sur les preuves, les résultats observés à mi-thérapie suggèrent d’explorer précocement les ajustements possibles des stratégies thérapeutiques.

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.

Objectif: Étudier les principales caractéristiques psychométriques du questionnaire d'éreutophobie de la Salpětrière (QES) auprès d'un échantillon clinique et non clinique. Méthode: Trois groupes, constitués de patients souffrant de phobie sociale (PS) ( n = 212), de patients souffrant d'autres troubles anxieux ( n = 146), et de participants de la population générale ( n = 171), ont été étudiés. Ils ont rempli le QES ainsi que plusieurs échelles de symptomatologie anxieuse et dépressive. Le diagnostic d'éreutophobie était posé selon des critères standardisés et évalué sur une échelle d'impression clinique globale. Résultats: La structure factorielle de l'échelle QES est claire, un seul facteur expliquant 83,9 % du score total, et son coefficient de cohérence interne alpha s'élève à 0,96. Le score du QES est corrélé significativement à une hétéro-évaluation dimensionnelle de la peur de rougir (rho = 0,91) et à des mesures de PS (rho = 0,23 à 0,55). La moyenne des scores au QES est plus élevée dans le groupe des patients avec PS, et encore supérieure dans celui des patients avec éreutophobie. Un score de 7 sur 24 permet de dépister l'éreutophobie avec une sensibilité de 92,1 % et une spécificité de 87,7 %. La stabilité test-retest du QES à 15 jours d'intervalle est satisfaisante (CCI = 0,83). Conclusion: Le QES est un outil valide et sensible pour dépister et mesurer l'intensité de l'éreutophobie, qui peut ětre utilisé dans des études psychopathologiques et thérapeutiques sur cette pathologie.

Depression is a common disorder considered to be a serious public health problem although clinicians encounter very different levels of severity and the treatment strategies are tailored according to this variability. There are however no consensus criteria to define severe depression. This review presents and discusses the different possible qualitative and quantitative options. In the international classifications there are three levels of severity of episodes of major depression (mild, moderate, severe), which are defined above all on the number of diagnostic criteria found. There are other more qualitative severity factors : the presence of psychotic symptoms, melancholia and the presence of endogenous signs. Pronounced psychomotor retardation and risk of suicide are amongst the main clinical severity markers. Quantitative assessment scales for the severity of depression can also define severity thresholds for use for example in clinical studies. These thresholds are still poorly defined and vary between studies. Specific severity scales for melancholic depression or depression with psychomotor retardation can also be used in clinical studies for these factors, which are central to the concept of severe depression. Overall, the inclusion criteria for most studies combine severe depression with qualitative (clinicians' judgement) and quantitative (minimum score on a scale) aspects.

Resume Objectif et mesures Nous presentons les caracteristiques sociodemographiques, la prevalence de l’abus et de la dependance au cannabis et aux autres substances psychoactives (criteres DSM-IV) ainsi que la comorbidite des troubles mentaux dans les 12 derniers mois (diagnostics evalues par le Mini-International Neuropsychiatric Interview [MINI] et les criteres DSM-IV) chez 90 usagers de cannabis vus en consultation specialisee cannabis a l’hopital Lariboisiere. Resultats Les caracteristiques sociodemographiques des usagers associent : une predominance d’hommes (67 %), un âge moyen de 27,5 ans (±8,4), une majorite de celibataires ou divorces (59 %). Deux tiers des usagers (67 %) sont actifs ou etudiants et 32 % sont inactifs. D’un point de vue des ressources, 22 % des usagers percoivent l’allocation chomage, le RMI ou une AAH et 11 % sont sans aucune ressource. La majorite des usagers sont venus d’eux-memes (63 %) et la plupart ont deja consulte un psychologue ou un psychiatre par le passe (73 %). Les usagers sont pour la grande majorite dependants (82 %) et abuseurs (9 %) du cannabis dans les 12 derniers mois. En dehors du tabac, on retrouve une dependance a l’alcool chez seulement 7 % des usagers, une dependance a la cocaine ou a l’ecstasy chez 2 %. Les principales substances consommees sur la vie sont le tabac (99 %), l’alcool (96 %) et la cocaine (41 %). La consommation cannabique dans les six derniers mois est de 5,8 (±4,4) joints quotidiens, 12 (±10,5) g hebdomadaires et le cout mensuel de 159 € (±133). Le cannabis est consomme dans plus des trois quarts des cas sous forme de haschisch. Environ un usager sur deux (48 %) presente au moins un trouble de l’humeur et plus de la moitie (55 %) au moins un trouble anxieux dans les 12 derniers mois. Les troubles de l’humeur sont l’episode depressif majeur (38 %), la dysthymie (19 %), l’hypomanie (3 %) et la manie (1 %). Les troubles anxieux sont la phobie sociale (29 %), l’anxiete generalisee (17 %), le trouble panique avec et sans agoraphobie (16 %), le trouble obsessionnel compulsif (12 %), l’agoraphobie sans trouble panique (9 %) et le syndrome de stress post-traumatique (5 %). Le pourcentage de schizophrenes est de 4 %. Les femmes souffrent plus frequemment que les hommes d’au moins un trouble de l’humeur (64 % versus 41 % ; p = 0,04) ou d’un syndrome de stress post-traumatique (17 % versus 0 % ; p Conclusion En dehors du tabac, 80 % des usagers vus a notre consultation sont uniquement dependants ou abuseurs du cannabis. Les taux de dependance au cannabis sont tres eleves. En comparaison avec les etudes publiees sur les autres consultations specialisees cannabis en France, les usagers vus a l’hopital Lariboisiere sont plus âges, plus frequemment des femmes, plus dependants du cannabis et ont une comorbidite elevee de troubles de l’humeur et anxieux. Certains resultats de notre etude ont ete presentes lors de la reunion de l’Association francaise de psychiatrie biologique du 14 novembre 2006 [L’Encephale 33 (2007) 101].

Somatic pains are frequent in patients with major depression. Although they are not included in classical symptoms of depression, physical pains are found in 50-90% of depressed patient. They are more frequent in severe depressions, and especially in psychiatric inpatients with depression. Physical painful symptoms are good indices of depression severity and namely are predictive of poorer responses to treatments, and then of elevated rates of relapse when pains are persistent as residual symptoms after remission of the episode. More frequent pains in depressive patients are headaches, limb, back and joint pains. Aetiological hypothesis to explain the coexistence of physical pains and depression are based on the well-known dysfunction of the serotonergic and noradrenergic pathways in depression, which explains mood symptoms but also a lack of inhibitory control of ascending pain messages, normally controlled in spinal cord by descending serotonergic and noradrenergic projections. This phenomenon could explain the development of an interoceptive painful hypersensitivity, without external sensitivity. Antidepressants with dual serotonergic and noradrenergic actions are efficacious to treat chronic pains, for example in diabetic neuropathy. In line with monoaminergic hypotheses shown above, this is in favour of the use of these serotonin and norepinephrine reuptake inhibitors in depression with important physical pains, but this issue needs further confirmation studies.

Resume Les antidepresseurs inhibiteurs specifiques de recapture de la serotonine (ISRS) font partie des medicaments de reference des troubles anxieux. L’escitalopram a la specificite et la puissance d’effet ISRS des plus elevees, permettant d’envisager une action particulierement interessante dans ces pathologies. Des resultats d’essais cliniques sont disponibles depuis peu dans quatre indications de troubles anxieux chroniques. Dans le traitement du trouble panique, une etude controlee comparant les effets de l’escitalopram, du citalopram et du placebo sur dix semaines a conclu a l’efficacite de l’escitalopram (10 mg/j) dans cette indication. Dans le trouble anxieux generalise (TAG), plusieurs essais ont montre l’efficacite de l’escitalopram pour des traitements d’attaque sur huit semaines mais aussi a 24 semaines. Une etude de prevention des rechutes sur une periode allant jusqu’a 76 semaines avec une taille d’effet importante permet d’obtenir plus de 80 % de maintien de la reponse a 24 semaines. L’escitalopram (10–20 mg/j) est egalement indique dans les phobies sociales generalisees, trois essais controles ayant montre sa superiorite face au placebo, avec notamment une etude de prevention des rechutes a 24 semaines et des resultats comparables au TAG. L’efficacite clinique de l’escitalopram dans les troubles obsessionnels-compulsifs (TOC) a ete etudiee recemment dans une etude realisee sur 466 patients comparant trois groupes pendant 24 semaines : l’escitalopram 10–20 mg/j, la paroxetine 40 mg/j, le placebo. Les resultats montrent que l’escitalopram, notamment a la dose de 20 mg/j, est significativement plus efficace que le placebo et presente des avantages par rapport a la paroxetine : efficacite plus rapide (des 6 semaines), pourcentage de patients repondeurs et en remission plus eleve, meilleure tolerance, en particulier sexuelle. Une etude controlee a montre l’efficacite de l’escitalopram pour la prevention des rechutes de TOC a 24 semaines, avec un taux de rechute de 52 % lors du passage sous placebo contre seulement 23 % en cas de maintien de l’escitalopram. Ces resultats confirment l’interet de l’escitalopram dans le traitement des quatre troubles anxieux principaux, en termes d’efficacite, de tolerance a court et long terme et de prevention des rechutes pour les patients repondeurs a 12 semaines pour le TAG, les phobies sociales ou les TOC. L’efficacite pour la prevention des rechutes sur 24 a 76 semaines est particulierement bien documentee avec une taille d’effet importante.

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.

We report the case of a young woman who deve-loped catatonic syndrome a few days after neuroleptic mali-gnant syndrome (NMS), arising the problem of the chronology of both affections. A 20-year old woman with an history of bipolar disorder, experienced an acute manic syndrome that made hospitalization necessary. Fourteen days after loxa-pine prescription, the patient developed a NMS (DSM IV criteria) dyskinesia, dysphagia, fever and alteration of cons-ciousness. Hepatic transaminases and muscular enzymes increased. Neuroleptic was immediately interrupted and benzodiazepines (Lorazepam) was started. Biological parameters were normalized after 7 days, hyperpyrexia decreased and extrapyramidal symptoms disappeared but manic symptoms persisted. Two weeks later, the patient presented nega-tivism, rigidity of the four limb, catalepsia and hyperpyrexia. She also had been anxious for death and presented auditory hallucinations. Bacteriological samples and computed tomography were normal. This catatonic symptoms did not decreased and electroconvulsive therapy (ECT) was necessary. After six ECT, she started standing up, walking, taking food and speaking. After 12 ECT, the clinical state was the same as it was before the acute episod. The patient was then treated with valproate and lorazepam for anxiety symptoms. Acute catatonie, a rare and life-threatening acute syndrome was described in psychosis before the advent of neuroleptic drugs. It's characterized by hyperexia, stupor alternated with exctement, rigidity. Many etiolologic factors have been reported for this affection: psychogenic, organic or toxic. Neuroletic malignant syndrome is a potentially fatal complication of neuroleptic treatment occuring in about 1% of patients treated with neuroleptic. This syndrome is characterised by consciousness alteration, extrapyramidal symptoms, autonomic and thermic disorders. Similar clinical and biological features in catatonia and neuroleptic malignant syndrome (NMS) suggest a relationship between both affections and common physiopathological mechanisms and neurochemical basis: a central dopamine deficiency. We believe like many authors that catatonia and NMS are two aspects of a same disease, arising the question of chronology of both affections: NMS precipitates catatonia evolution. In the same way, Revuelta reported a case of patient who presented a lethal catatonia worsened by neuroleptic malignant syndrome. Neuroleptic malignant syndrome may be related to a dopamine deficiency, predominantly in the basal ganglia and anterior hypothalamus. Dopaminergic impairment has also been postulated to explain hyperthermia and catatonic signs in acute catatonie. ECT increases cerebral concentrations of dopamine, GABA and noradrelanine. The efficacy of ECT also argues for the dopaminergic hypothesis. A relation between those syndromes are complexes. A catatonic syndrome is regard as an acute form of malignant syndrome. In the other way, a severity scores of malignant syndrome are correlated among catatonic signs. In this case report, we suggest that the neuroleptic malignant syndrome accelerate the evolution to catatonic syndrome.

Resume Divers recommandations et consensus d’expert envisagent les modalites de prise en charge des troubles depressifs recurrents, en particulier en fonction des differents facteurs de risques identifies de recidive. Mais peu de donnees sont disponibles sur la facon dont ces facteurs de risques influent sur les modalites de prise en charge des patients souffrant de depression recurrente et en phase de remission partielle ou totale. L’etude ECLAIR est une etude observationnelle longitudinale multicentrique nationale descriptive des differents facteurs participant aux prises de decisions des medecins dans le suivi des patients atteints de trouble depressif unipolaire recurrent (au moins 3 episodes depressifs majeurs anterieurs, au sens du DSM IV). Le present article concerne les donnees de cette etude recueillies a l’inclusion (V0), portant sur les caracteristiques demographiques et l’histoire de la maladie, le diagnostic, l’evaluation de la symptomatologie (CGI-S, HAM-D, echelle de Carroll, echelle de Sheehan) et l’evaluation de la personnalite (TCI). Un total de 596 patients presentant une depression recurrente, et etant en remission partielle (RPa) ou totale (RTo) au moment de l’inclusion ont ete inclus. Le score moyen de l’HAM-D a V0 etait de 10,3 ± 1,6 pour le groupe RPa, et de 4,0 ± 1,9 pour le groupe RTo. Le temps moyen ecoule depuis le dernier episode etait de 6,5 ± 10,5 mois dans le groupe RPa et de 11,2 ± 16,9 mois dans le groupe RTo (n = 385). Une symptomatologie residuelle entre les intervalles precedents avait ete systematiquement presente pour 47,6 % des patients du groupe RPa, et pour 26,7 % des patients du groupe RTo. Le sentiment d’avoir une vie quotidienne stressante restait present chez 62,5 % des patients du groupe RPa et 34,3 % du groupe RTo ; la persistance du facteur causal etait rapporte par 70,3 % des patients du groupe RPa et 57,9 % du groupe RTo. Les principaux facteurs de risque de recidive decrits par les patients etaient le nombre d’episodes anterieurs (64,9 %), l’existence de conflits familiaux (52,9 %), et d’evenements de vie recents (45,1 %). Au TCI, une difference significative a ete retrouvee par rapport aux donnees normalisees de la population francaise pour trois dimensions : l’Evitement du danger, la Cooperation, la Determination. Cette etude confirme diverses caracteristiques des troubles depressifs unipolaires, en particulier le risque eleve de recidive ulterieure chez des patients ayant deja presente plusieurs episodes depressifs. Dans la recherche d’indices predictifs de recidives, ceux distinguant les patients susceptibles d’une remission partielle et ceux qui presenteront une remission totale seraient particulierement interessants.

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

Resume Le trouble dysphorique premenstruel est une forme de trouble de l'humeur qui touche environ 3 a 5 % des femmes. Il se manifeste durant la phase luteale du cycle menstruel par une humeur depressive, une anxiete, une labilite emotionnelle et une diminution d'interet pour les activites, l'ensemble de ces signes alterant notablement la qualite de vie et le fonctionnement personnel. Les hormones steroidiennes et la serotonine jouent probablement un role determinant dans l'etiopathogenie de ce trouble. Les antidepresseurs serotoninergiques sont les medicaments les plus etudies et qui semblent les plus efficaces pour le traitement des troubles dysphoriques premenstruels. Les taux de reponse rapportes sont superieurs a ceux obtenus generalement dans le traitement des depressions ou des troubles obsessionnels-compulsifs. L'administration peut etre continue tous les jours du cycle, intermittente (uniquement pendant les phases luteales) ou semi-intermittente (doses basses pendant la phase folliculaire et haute durant la phase luteale). Ces particularites psychobiologiques et les possibilites therapeutiques existantes doivent encourager les psychiatres (de meme que les medecins generalistes, endocrinologues ou gynecologues) a prendre en charge plus souvent et a poursuivre des etudes sur ce trouble de l'humeur particulier.

We examined the test-retest reliability of the Temperament and Character Inventory (TCI) in a clinical sample of 29 inpatients with opiate dependence disorder (DSM-IV). The previously validated French translation of the TCI was administered at baseline and again four weeks later. Intraclass correlation coefficients (ICCs) were used to estimate stability of the TCI over time for the 15 patients who completed the study. For all ICCs, the TCI showed satisfactory to excellent stability across all factors (ICC= 0.66-0.82). Stability was lower for the two temperamental traits of 'persistence' (ICC=0.51) and 'reward dependence' (ICC=0.63), possibly reflecting both clinical instability and measurement errors. These results highlighted the overall stability of the TCI in patients with opiate dependence and provided evidence for the usefulness of this questionnaire, which was originally designed to explore genetic and environmental factors underlying normal and abnormal personality dimensions. Further studies are required to confirm these results on larger clinical samples.

This study sought to compare the serum cholesterol levels of psychiatric in-patients, with and without recent suicidal behavior. The hypothesis was that the temperament dimension novelty seeking (NS) would be an intermediary variable, correlated with both serum cholesterol level and suicidal behavior. The study included 155 psychiatric in-patients, 21.9% (n=34) of whom had recently attempted suicide. Their cholesterol level was compared to that of patients with no suicide attempt. The NS dimension was explored with the aid of Cloninger's Temperament and Character Inventory. Significantly lower average cholesterol levels were found in women who had attempted suicide before hospitalization than for the others (4.71 mmol/l+/-0.83 vs. 5.52 mmol/l+/-1.36). Similar results were not found for men. However, the average NS scores did not differ according to suicide attempts in women or in men, and the scores of NS were not correlated with cholesterol level. This study confirms an association between low cholesterol and suicidal behavior in women only, but this association seems independent from the NS personality dimension. The absence of a correlation between serum cholesterol levels and suicidal behavior in men could be linked to the small number of men included in the study.

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.

SummaryThis paper investigates the prevalence of symptoms and various diagnostic criteria of DSM-IV social phobia in a French national representative population of 12,873 subjects, aged 15 or more. Respondents filled out a mailed questionnaire based on the social phobia section of the Munich-Composite International Diagnostic Interview (M-CIDI) in the year 1996. Response rate was 80.5%.Sixty-seven point one percent of the sample acknowledge having at least once in their lifetime a strong fear of one or more of the six prototypical social fear situations that are used as the CIDI social phobia stem items. However, only a few fulfilled all DSM-IV diagnostic criteria for social phobia. Depending on the type of diagnostic algorithms used and the stringency in which these criteria are applied, the resulting prevalence varied between 1.9 and 7.3%. These findings provide some further evidence about the considerable effects of varying diagnostic criteria and thresholds on prevalence rates for social phobia, explaining why most recent surveys have reported considerably higher rates of social phobia than those in the early 1980s.

Resume Les troubles du sommeil sont une cause frequente de consultation chez l'enfant d'âge prescolaire et conduisent souvent, dans la population francaise, a la prescription de sedatifs et d'hypnotiques, faisant de cette pathologie un veritable probleme de sante publique pour cette tranche d'âge. Patients et methodes Nous avons etudie la prise de medicaments hypnotiques chez des enfants consultant en milieu hospitalier pour ≪ troubles du sommeil ≫ et âges de 1 mois a 4 ans (23 ± 11,3 mois). Deux cent trois questionnaires portant sur les troubles du sommeil et les prises d'hypnotiques des enfants (112 garcons et 91 filles) ont ete remplis par les parents. L'investigation portait egalement sur le sommeil des parents et sur leur eventuelle prise d'hypnotiques. Resultats Les resultats montrent que 70 % des enfants ont recu au moins une fois un medicament hypnotique pour leur trouble, et ce, quel que soit leur âge. Cette exposition est correlee avec l'existence d'une consommation d'hypnotiques par les meres, notamment chez les garcons (odds-ratio = 4,8; 1,1–8,7). Ces resultats confirment l'exposition precoce de jeunes enfants a des prises de medicaments hypnotiques, avec des schemas familiaux de consommation influences surtout par l'attitude maternelle. Conclusion Ces donnees devraient permettre d'identifier des sous-populations a risque d'exposition precoce aux traitements psychotropes. Elles devraient egalement inciter a developper des strategies therapeutiques non medicamenteuses.

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.

The primary objective of this study was to determine if second generation antipsychotic (SGA) administration was associated with lower aggressiveness scores compared to first generation (FGA). The secondary objective was to determine if antidepressants, mood stabilizers and benzodiazepines administration were respectively associated with lower aggressiveness scores compared to patients who were not administered these medications. 331 patients with schizophrenia (n = 255) or schizoaffective disorder (n = 76) (mean age = 32.5 years, 75.5 % male gender) were systematically included in the network of FondaMental Expert Center for Schizophrenia and assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders and validated scales for psychotic symptomatology, insight and compliance. Aggressiveness was measured by the Buss-Perry Aggression Questionnaire (BPAQ) score. Ongoing psychotropic treatment was recorded. Patients who received SGA had lower BPAQ scores than patients who did not (p = 0.01). More specifically, these patients had lower physical and verbal aggression scores. On the contrary, patients who received benzodiazepines had higher BPAQ scores than patients who did not (p = 0.04). No significant difference was found between BPAQ scores of patients respectively being administered mood stabilizers (including valproate), antidepressant, and the patients who were not. These results were found independently of socio-demographical variables, psychotic symptomatology, insight, compliance into treatment, daily-administered antipsychotic dose, the way of antipsychotic administration (oral vs long acting), current alcohol disorder and daily cannabis consumption. The results of the present study are in favor of a superior efficacy of second-generation antipsychotics in aggressiveness in patients with schizophrenia, but these results need further investigation in longitudinal studies. Given the potent side effects of benzodiazepines (especially dependency and cognitive impairment) and the results of the present study, their long-term prescription is not recommended in patients with schizophrenia and aggressive behavior.

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

Initially based on empirical observations, the concept of RBD has led to operational diagnostic criteria allowing further studies in various and large populations. In line with the hypothesis of a continuum from normal sad mood to major depression, the spectrum of affective disorders is thus probably more in agreement with everyday clinical practice. Moreover, recurrent and so-called subthreshold conditions have been concurrently investigated in other fields of psychopathology. Nevertheless, many methodological problems and clinical implications of RBD still require further research. The question of a precise definition of the disorder, even if a consensus seems to be obtained about some key points, remains partially to be addressed, for example, concerning the problem of the reliability of assessment. The possibility of a seasonality of the episodes needs further investigations, as do the relationships between RBD and personality disorders such as borderline personality disorder. Finally, the important question of prophylactic treatment of RBD remains unsolved, as antidepressants have failed to demonstrate any efficacy and some neuroleptics have been proposed in particular conditions. Angst's prediction that clinical relevance, impairment, distress and public health impact of affective disorders could be related not only to the duration of an episode but also to the recurrence of episodes, possibly referring to a kindling model, has therefore been confirmed. His major contribution has been to underline, in various forms of affective disorders, the importance of conducting longitudinal clinical as well as epidemiologic studies to refine our psychopathological knowledge.

International audience; Abstract Objectives. Obsessive-compulsive disorder (OCD) is a chronic, often severe, neuropsychiatric disorder leading to a dramatic impairment in interpersonal and occupational functions. rTMS has been tried out in several studies in patients with OCD with different characteristics. In this paper, we review the safety and efficacy of rTMS in the treatment of mostly severe resistant OCD. Methods. A review of the English literature from 1966 to 2010 pertaining to rTMS in the treatment of OCD was conducted using MEDLINE by selectively entering the search terms "transcranial magnetic stimulation", "repetitive transcranial magnetic stimulation", "obsessive-compulsive disorder" and "OCD". Twelve studies including open and randomized, sham-controlled trials were included in this review. Results. Although available data about the use of rTMS in OCD treatment are quite heterogeneous in terms of sample size, study design, stimulus parameters used and stimulation areas targeted, promising findings regarding rTMS efficacy appeared for two structures based on recent controlled studies: the supplementary motor area and the orbitofrontal cortex. On the other hand, rTMS of the dorsolateral prefrontal cortex is not significantly effective when compared to sham rTMS. Conclusions. Three target areas have already been selected of which the supplementary motor area in particular and the orbitofrontal cortex seem to be the most promising in terms of potential efficacy and could more accurately be targeted with the help of neuronavigational techniques. Larger randomized controlled trials should be conducted in order to better clarify the therapeutic role of rTMS in OCD.

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.

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

International audience; Background:High-frequency bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) is a promising treatment in refractory obsessive-compulsive disorder (OCD). Method Using the crossover, randomized, and double-blind procedure adopted by the STOC study, 10 patients treated with high-frequency bilateral STN DBS underwent am 18-fluorodeoxyglucose positron emission tomography (PET) investigation to highlight the neural substratum of this therapeutic approach. Results The median YaleBrown Obsessive Compulsive Scale (Y-BOCS) scores for all 10 patients were 31 (minimum = 18, maximum = 36) with "Off-Stimulation" status and 19 (minimum = 0, maximum = 30) with "On-Stimulation" status (p = .05). The OCD patients in Off-Stimulation status showed a hypermetabolism in the right frontal middle and superior gyri, right parietal lobe, postcentral gyrus, and bilateral putamen compared with healthy control subjects. A significant decrease in cerebral metabolism was observed in the left cingulate gyrus and the left frontal medial gyrus in On-Stimulation conditions compared with Off-Stimulation conditions. In addition, the improvement assessed by Y-BOCS scores during the On-Stimulation conditions was positively correlated with PET signal changes at the boundary of the orbitofrontal cortex and the medial prefrontal cortex, between PET signal changes and the Y-BOCS scores modifications in On-Stimulation status. Conclusion This study suggests that the therapeutic effect of STN DBS is related to a decrease in prefrontal cortex metabolism. © 2010 Society of Biological Psychiatry.

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.