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Resume Objectifs Nous avons realise une etude pilote afin de deceler et de caracteriser la croissance post-traumatique chez des victimes de violences conjugales comparativement a d’autres types de violences. L’etude visait egalement a rechercher l’existence d’un trouble de stress post-traumatique dans notre population clinique et de preciser son impact sur la croissance post-traumatique. Methode L’etude a inclus 17 victimes de violences conjugales et 42 victimes d’autres types de violences, via l’Unite Medico-Judiciaire de Poitiers et le Centre Regional de Psychotraumatologie Nord Nouvelle Aquitaine. Les participants ont beneficie d’une consultation au cours de laquelle les donnees socio-demographiques d’interet etaient recueillies et les echelles PTGI et PCL-5 administrees. Resultats La prevalence de la croissance post-traumatique etait plus importante chez les victimes de violences conjugales (82 %). Cette croissance post-traumatique etait d’intensite faible a moderee, et presente precocement chez les victimes recrutees via l’Unite Medico-Judiciaire. Toutes les dimensions de la croissance post-traumatique pouvaient etre affectees precocement. Il existait un trouble de stress post-traumatique dont la presence etait correlee negativement a l’apparition de la croissance post-traumatique. Discussion Nous montrons l’emergence d’une croissance post-traumatique plus precoce chez les victimes de violences conjugales, et mesurable dans toutes les dimensions de la croissance post-traumatique. Nous ne mettons pas en evidence de facteurs favorisant l’emergence de la croissance post-traumatique. L’existence d’un trouble de stress post-traumatique semble freiner l’apparition de la croissance post-traumatique. L’ensemble de nos resultats est en faveur d’interventions pluridisciplinaires precoces chez les victimes de violences conjugales afin de favoriser l’apparition de la croissance post-traumatique et ainsi la reinsertion des victimes.

International audience; AIM: The placebo effect and the specific effect are often thought to add up (additive model). Whether additivity holds can dramatically influence the external validity of a trial. This assumption of additivity was tested by Kleijnen et al. in 1994 but the data produced since then has not been synthetized. In this review, we aimed to systematically review the literature to determine whether additivity held. METHODS: We searched Medline and PsychInfo up to 10/01/2019. Studies using the balanced placebo design (BPD), testing two different strengths of placebos, were included. The presence of interaction was evaluated by comparing each group in BPD with analysis of variance or covariance. RESULTS: 30 studies were included and the overall risk of bias was high: four found evidence of additivity and 16 studies found evidence of interaction (seven had evidence of positive additivity). CONCLUSION: Evidence of additivity between placebo and specific features of treatments was rare in included studies. We suggest interventions for placebo-sensitive ailments should be tested in trials designed to take interactions seriously once an exploratory RCTs has proven their efficacy with sufficient internal validity.

International audience; OBJECTIVE: The objective of this study was to evaluate the proportion of therapeutics that have proven their efficacy on patient-important outcomes with a high quality of evidence among Cochrane systematic reviews (SRs). METHODS: We surveyed a random sample of 400 SRs’ abstracts published between September 2012 and December 2015, which compared therapeutic interventions with at least a placebo or no intervention control. The primary endpoint was the proportion of SRs with a statistically significant efficacy on a patient-important outcome and with a high quality of evidence. RESULTS: Among the 400 abstracts surveyed, 32 (8%) found efficacy on a patient-important outcome with a high quality of evidence. Half of the 400 SRs (50.2%) evaluated a pharmacological intervention and 12% of these found efficacy of the intervention on a patient-important outcome with a reported high quality of evidence. CONCLUSION: Based on an analysis of 400 abstracts of SRs from the Cochrane Collaboration, we found that there is a low number of therapeutic interventions which have proven their efficacy on patient-important outcomes with a high quality of evidence.

Resume Introduction L’efficacite des trois medicaments valides du sevrage tabagique (ST) : substituts nicotiniques, varenicline et bupropion, en monotherapie, peut etre insuffisante chez les fumeurs en echecs repetes dans l’arret du tabac. Objectifs Cette revue systematique a etudie l’efficacite de la combinaison de medicaments du ST sur l’abstinence tabagique et sa tolerance. Resultats . Trois etudes controlees randomisees (ECR) comparaient le traitement combine par varenicline et patchs de nicotine vs. Varenicline ; deux retrouvaient une augmentation des taux d’abstinence avec le traitement combine. Dans une etude, l’effet benefique n’etait constate que chez les gros fumeurs. Les quatre ECR comparant le traitement combine par varenicline et bupropion vs. Varenicline, montraient une augmentation des taux d’abstinence avec le traitement combine, le plus souvent chez des gros fumeurs tres dependants au tabac. Les resultats des trois ECR comparant le traitement combine par bupropion et substituts nicotiniques vs. varenicline etaient discordants. Trois etudes incluaient d’autres molecules (mecamylamine, selegiline, sertraline, buspirone). La tolerance des traitements combines etait satisfaisante. Conclusion Les traitements combines permettent d’obtenir des taux d’abstinence tabagique superieurs aux monotherapies, notamment chez les fumeurs en echec dans le sevrage (Hard-core smokers). Le traitement combinant varenicline et substituts nicotiniques est une option therapeutique du sevrage tabagique.

En psychiatrie clinique, le concept d’insight designe la perception et la conscience qu’a un patient de son trouble. Son deficit dans le contexte de l’addiction a l’alcool se traduit par une incapacite a reconnaitre l’addiction, le deni de cet etat et une incapacite a considerer le besoin de se soigner. Une meilleure prise de conscience de la gravite de sa consommation d’alcool est un bon facteur pronostique de maintien de l’abstinence apres le traitement ; en revanche, un deficit d’insight serait un facteur de risque de rechute. L’unique outil d’evaluation de l’insight dans les troubles d’usage d’alcool – l’Hanil Alcohol Insight Scale (HAIS) – a ete developpe en coreen et publie en anglais il y a plus d’une vingtaine d’annees. L’objectif de la presente etude etait de valider sa version francaise. Elle a concerne 65 patients francophones suivis pour des troubles d’usage d’alcool dans un centre hospitalier universitaire francais. Le questionnaire traduit presentait une coherence interne satisfaisante (coefficient α de Cronbach = 0,74 et ω de McDonald = 0,78) ainsi qu’une bonne validite convergente. Les analyses factorielles ont permis de regrouper les items en trois sous-dimensions : (1) la minimisation des problemes d’alcool, (2) la reconnaissance d’une perte de controle et (3) la conscience d’un probleme avec l’alcool et de la necessite de traitement. La presente traduction francaise de l’HAIS possede les proprietes psychometriques adequates pour aider a ameliorer l’identification des patients a risque et leur prise en charge.

Resume Introduction La prevalence du tabagisme chez les patients asthmatiques est identique ou plus elevee qu’en population generale. Objectifs Cette revue systematique etudie les consequences du tabagisme sur l’asthme, les strategies de sevrage tabagique (ST) chez l’asthmatique et les consequences du ST sur l’asthme. Resultats Le tabagisme actif ou passif peut favoriser le developpement de l’asthme et a des nombreux effets deleteres sur l’asthme. Les rares etudes sur le ST chez les fumeurs asthmatiques montrent l’efficacite des strategies classiques du ST chez ces patients (substituts nicotiniques, varenicline, bupropion, therapies cognitives et comportementales). L’arret du tabagisme des parents ayant des enfants asthmatiques est essentiel et repose sur les memes strategies. La cigarette electronique peut etre une aide utile a l’arret du tabac chez certains patients. L’arret du tabagisme est benefique chez les fumeurs asthmatiques : reduction des symptomes, des exacerbations aigues, de l’hyperreactivite bronchique et de l’inflammation bronchique ; diminution du recours aux medicaments d’urgence et des doses de corticosteroides inhales ; amelioration du controle de l’asthme, de la qualite de vie et de la fonction respiratoire. Conclusion Chez les patients asthmatiques, il est essentiel d’evaluer le statut tabagique et les professionnels de sante doivent les aider a arreter de fumer.

Resume Objectifs Cette revue systematique de la litterature a porte sur des patients souffrant de schizophrenie, de troubles psychotiques ou de pathologies mentales incluant la schizophrenie. Elle s’est interessee aux donnees concernant la prevalence de l’usage de la cigarette electronique, a la perception et aux attentes des patients, ainsi qu’a l’attitude des soignants vis-a-vis de la cigarette electronique, a son benefice dans l’aide a l’arret ou la reduction de la consommation de tabac. Methode Les recherches ont ete effectuees sur Medline pour la periode 2000–2020. Les etudes transversales, cas-temoins, prospectives, controlees randomisees et les etudes preliminaires ont ete integrees dans cette revue. Resultats La cigarette electronique est tres utilisee par les patients souffrant de pathologies mentales avec un usage vie entiere de 28,6 %. Plus specifiquement, les patients souffrant de schizophrenie et de troubles schizo-affectifs observent un usage vie entiere de 36 %. De multiples raisons sont evoquees par les patients pour son usage dont la possibilite d’en user dans les endroits ou il est interdit de fumer, sa moindre toxicite pour soi et l’entourage par rapport a la cigarette, son moindre cout, l’aide apportee pour reduire la consommation. Conclusion La cigarette electronique est utilisee par les fumeurs atteints de pathologies mentales ; plusieurs etudes confirment la possibilite pour ces fumeurs de reduire leur consommation de tabac au moyen de la cigarette electronique sans perturber leur etat mental. En revanche, son interet pour aider l’arret du tabac demeure incertain.

BackgroundThe severity of symptoms represents an important source of distress in patients with a psychiatric disease. However, the extent to which this endogenous stress factor interacts with genetic vulnerability factors for predicting suicide risks remains unclear.MethodsWe evaluated whether the severity of symptoms interacts with a genetic vulnerability factor (the serotonin transporter gene-linked promoter region variation) in predicting the frequency of lifetime suicide attempts in patients with a psychiatric disease. Symptom severity and 5-HTTLPR polymorphism were collected from a sample of 95 patients with obsessive-compulsive disorder (OCD). Lifetime suicide attempt was the primary outcome, and antecedent of multiple suicide attempts was the secondary outcome.ResultsThe gene-by-symptoms interaction was associated with an excess risk of suicide attempts (OR = 4.39, 95CI[1.44, 13.38], p < 0.009) and of multiple suicide attempts (OR = 4.18, 95CI[1.04, 16.77], p = 0.043). Symptom severity (moderate, severe, or extreme) was associated with an approximately five-fold increase in the odds of a lifetime suicide attempt in patients carrying one or two copies of the short allele of 5-HTTLPR. No such relationship was found for patients carrying the long allele.ConclusionThis study provides preliminary evidence for the gene-by-stress interaction on suicide attempt when stress is operationalized as symptom severity. Progress in suicide research may come from efforts to investigate the gene-by-symptoms interaction hypothesis in a variety of diseases.

Background: There is a lack of knowledge regarding the actionable key predictive factors of homelessness in psychiatric populations. Therefore, we used a machine learning model to explore the REHABase database (for rehabilitation database—n = 3416), which is a cohort of users referred to French psychosocial rehabilitation centers in France. Methods: First, we analyzed whether the different risk factors previously associated with homelessness in mental health were also significant risk factors in the REHABase. In the second step, we used unbiased classification and regression trees to determine the key predictors of homelessness. Post hoc analyses were performed to examine the importance of the predictors and to explore the impact of cognitive factors among the participants. Results:First, risk factors that were previously found to be associated with homelessness were also significant risk factors in the REHABase. Among all the variables studied with a machine learning approach, the most robust variable in terms of predictive value was the nature of the psychotropic medication (sex/sex relative mean predictor importance: 22.8, σ = 3.4). Post hoc analyses revealed that first-generation antipsychotics (15.61%; p < 0.05 FDR corrected), loxapine (16.57%; p < 0.05 FWER corrected) and hypnotics (17.56%; p < 0.05 FWER corrected) were significantly associated with homelessness. Antidepressant medication was associated with a protective effect against housing deprivation (9.21%; p < 0.05 FWER corrected). Conclusions: Psychotropic medication was found to be an important predictor of homelessness in our REHABase cohort, particularly loxapine and hypnotics. On the other hand, the putative protective effect of antidepressants confirms the need for systematic screening of depression and anxiety in the homeless population.

Intrusive traumatic recollections suggest an inability in Posttraumatic Stress Disorder (PTSD) to control and notably to inhibit memories for trauma-related information. Supported by inhibitory deficits found on experimental settings in PTSD, memory functioning and memory biases in the disorder were usually explained through inhibitory and control deficits in the processing of trauma-related information. The present study aimed to directly assess this hypothesis by investigating memory control abilities for emotional information in PTSD. For this purpose, 34 patients diagnosed with PTSD were compared to 37 non-PTSD controls on an item-cued directed forgetting paradigm for emotional words combined with a Remember/Know recognition procedure. Results revealed enhanced amounts of Remember recognitions for trauma-related words in PTSD. Moreover, we replicated findings of memory control impairments in the disorder. However, such impairments only occurred for non-trauma-related words. Accordingly, it appeared that PTSD patients presented preserved memory control abilities for trauma-related words, at the expenses of other emotional valences. Surprisingly, PTSD patients presented a preserved ability to control and notably to inhibit their memory functioning for trauma-related material. In addition to potential theoretical and clinical relevance, these results are discussed in the light of resource reallocation hypotheses and vigilant-avoidant theories of information processing in PTSD.

The time spent in front of various technology screens during adolescence could be linked to risk behaviours. Our study, carried out in June 2012, was designed to show that this correlation differs not only depending on sex but also according to the type of screen being used. Method: A cross-sectional survey was conducted on 1235 schoolchildren, aged 15, from 90 different schools in the Poitou-Charentes region. The questions asked were based on the Health Behaviour in School-aged Children Survey. Questions on the amount of time spent daily either in front of a television, a computer, on video games and mobile phones were added on. Three sample subgroups were defined according to the frequency of six risk behaviours (smoking, drunkenness, cannabis consumption, early sexual intercourse, fights and suicide attempts). Results: Our total sample comprised 923 15-year-olds: 468 girls and 455 boys: 74.7% of the pupils were registered in the schools selected. The correlation between time spent in front of various technology screens and frequency of risk behaviours varied according to type of screen but not according to sex. Cellphone use resulted in the highest correlation amongst all teenagers: OR = 9.40 [6.1 - 14.4]. Amongst boys, no excess risk was found whilst watching the television, and there is only moderate risk when playing video games (OR = 2.11 [1.14 - 3.91]) or whilst using the computer to surf the internet (OR = 2.21 [1.13 - 4.34]). Amongst girls, risk grew when using the computer to surf the internet (OR = 3.31 [1.61 - 6.78]) and playing video games (OR = 5.84 [1.65 - 20.6]). Conclusion: These results suggest that questioning teenagers on screen use could represent an approach to risk behavior that would complement other screening tests.

International audience; BACKGROUND: Female sex/gender has been associated with better longitudinal outcomes in schizophrenia spectrum disorders (SSDs). Few studies have investigated the relationships between female gender and recovery-related outcomes. Women's specific psychiatric rehabilitation needs remain largely unknown. OBJECTIVE: The objectives of the present study are to investigate sex differences in (1) objective and subjective aspects of recovery and (2) psychiatric rehabilitation needs in a multicenter non-selected psychiatric rehabilitation SSD sample. METHODS: 1,055 outpatients with SSD (DSM-5) were recruited from the French National Centers of Reference for Psychiatric Rehabilitation (REHABase) cohort between January 2016 and November 2019. Evaluation included standardized scales for quality of life, satisfaction with life, and well-being and a broad cognitive battery. Socially valued roles at enrollment were recorded. Functional recovery was measured using the Global Assessment of Functioning scale (GAF) and personal recovery with the Stages of Recovery Instrument (STORI). RESULTS: Female sex was the best predictor of having more than 2 socially valued roles in the multivariate analysis (P

Resume Objectif Le modele de croissance post-traumatique (CPT) est un concept de psychologie positive relativement peu etudie en France, bien qu’il ait ete propose et etudie depuis les annees 1990 dans les pays anglo-saxons. L’objectif de cet article est de decrire ce modele de CPT sous tous ses aspects : definition et historique du concept, evaluation, mecanismes sous-jacents et epidemiologie. Methode Les auteurs ont realise une synthese de la litterature internationale via la base de donnees Pubmed. Resultats La CPT designe tous les changements psychologiques positifs qui apparaissent a la suite d’une exposition a un traumatisme majeur. Ce modele postule qu’il est possible de ressortir grandi, et donc plus fort, a la suite d’un evenement de vie particulierement negatif. La CPT se manifeste dans cinq domaines : l’appreciation de la vie, les relations aux autres, le developpement d’une force personnelle, les nouvelles possibilites et le developpement d’une certaine spiritualite. Une echelle d’autoevaluation de la CPT a ete developpee, la PTGI (Post-Traumatic Growth Inventory). L’existence de la CPT a ete demontree apres la survenue d’evenements traumatiques tels qu’un accident, des catastrophes naturelles, les violences interpersonnelles ou la maladie. Sa prevalence a ete estimee entre 3 et 98 %, selon l’evenement traumatique considere. Discussion L’omnipresence du concept de resilience ou des biais d’evaluation ont pu freiner l’emergence du concept de CPT. La recherche francaise autour de la CPT doit etre developpee. Il est necessaire d’en identifier les determinants precis dans le but de favoriser l’emergence de la croissance. Ainsi, une nouvelle forme de therapie centree sur la facilitation de la CPT pourrait etre proposee dans le cadre de la prise en charge d’un psychotraumatisme.

BackgroundElectroconvulsive therapy (ECT) is one of the most effective treatments for treatment-resistant depression (TRD). However, due to response delay and cognitive impairment, ECT remains an imperfect treatment. Compared to ECT, repetitive transcranial magnetic stimulation (rTMS) is less effective at treating severe depression, but has the advantage of being quick, easy to use, and producing almost no side effects. In this study, our objective was to assess the priming effect of rTMS sessions before ECT on clinical response in patients with TRD.MethodsIn this multicenter, randomized, double-blind, sham-controlled trial, 56 patients with TRD were assigned to active or sham rTMS before ECT treatment. Five sessions of active/sham neuronavigated rTMS were administered over the left dorsolateral prefrontal cortex (20 Hz, 90% resting motor threshold, 20 2 s trains with 60-s intervals, 800 pulses/session) before ECT (which was active for all patients) started. Any relative improvements were then compared between both groups after five ECT sessions, in order to assess the early response to treatment.ResultsAfter ECT, the active rTMS group exhibited a significantly greater relative improvement than the sham group [43.4% (28.6%) v. 25.4% (17.2%)]. The responder rate in the active group was at least three times higher. Cognitive complaints, which were assessed using the Cognitive Failures Questionnaire, were higher in the sham rTMS group compared to the active rTMS group, but this difference was not corroborated by cognitive tests.ConclusionsrTMS could be used to enhance the efficacy of ECT in patients with TRD. ClinicalTrials.gov: NCT02830399.

Summary Objective.- To re-assess the effect of tight glycaemic control on diabetic microvascular complications. Method.- Meta-analysis and trial sequential analyses of randomised trials included in Hemmingsen et al that specifically assessed glycaemic control with a specific HbA1c level targeted in the intervention group, and compared intensive glycaemic control versus standard glycaemic control. Results.- Seven clinical trials that randomised 28 614 participants with type 2 diabetes (15 269 to intensive control and 13 345 to conventional control), including 3 sub-studies, were included. Strict control of blood glucose levels is associated with a reduction of retinopathy progression (RR = 0.77, 95% CI 0.66–0.89, I 2 = 33%), incidence or progression of macular oedema (RR = 0.66, 95% CI 0.40–0.99, I 2 = 0%), number of photocoagulations (RR = 0.84, 95% CI 0.73–0.97, I 2 = 0%), risk of microalbuminuria (RR = 0.76, 95% CI 0.64–0.9, I 2 = 76%) and risk of “macroalbuminuria or proteinuria” (RR = 0.68, 95% CI 0.55–0.85, I 2 = 36%). Conclusion.- This meta-analysis has shown that a tight control of blood glucose levels is associated with a decrease of specific microvascular complication of diabetes: photocoagulation, progression of diabetic retinopathy, incidence or progression of macular oedema, risk of microalbuminuria and risk of macroalbuminuria or proteinuria. Regarding all the other outcomes (vision loss, surgery of cataract, proliferative or non-proliferative retinopathy, death related to kidney disease, development of kidney disease, doubling of serum creatinine, neuropathy), no significant result was found.

BackgroundStigma resistance (SR) is defined as one's ability to deflect or challenge stigmatizing beliefs. SR is positively associated with patient's outcomes in serious mental illness (SMI). SR appears as a promising target for psychiatric rehabilitation as it might facilitate personal recovery.ObjectivesThe objectives of the present study are: (i) to assess the frequency of SR in a multicentric non-selected psychiatric rehabilitation SMI sample; (ii) to investigate the correlates of high SRMethodsA total of 693 outpatients with SMI were recruited from the French National Centers of Reference for Psychiatric Rehabilitation cohort (REHABase). Evaluation included standardized scales for clinical severity, quality of life, satisfaction with life, wellbeing, and personal recovery and a large cognitive battery. SR was measured using internalized stigma of mental illness – SR subscale.ResultsElevated SR was associated with a preserved executive functioning, a lower insight into illness and all recovery-related outcomes in the univariate analyses. In the multivariate analysis adjusted by age, gender and self-stigma, elevated SR was best predicted by the later stages of personal recovery [rebuilding; p = 0.004, OR = 2.89 (1.36–4.88); growth; p = 0.005, OR = 2.79 (1.30–4.43)). No moderating effects of age and education were found.ConclusionThe present study has indicated the importance of addressing SR in patients enrolled in psychiatric rehabilitation. Recovery-oriented psychoeducation, metacognitive therapies and family interventions might improve SR and protect against insight-related depression. The effectiveness of psychiatric rehabilitation on SR and the potential mediating effects of changes in SR on treatment outcomes should be further investigated in longitudinal studies.

Aims To assess the methodological quality of the systematic reviews of the literature for Good Practice Guidelines (GPGs) for treatment of type 2 diabetes (T2D). Methods The GPGs on treatment of T2D from May 2012 onwards were searched on PubMed, the Guidelines International Network, the National Guidelines Clearing House and the Infobanque des guides de pratique clinique. Quality of the GPGs was assessed by means of grading of levels of evidence, strength of recommendations, statements pertaining to systematic reviews, description of their methods, search for Randomized Controlled Trials meta-analyses, and citations from three meta-analyses which contested the strategy of intensive glycemic control and metformin as first-line treatment. Results Fiflty-two GPGs were included; half of them had and applied a system of grading and strength of recommendation and 58% stated they had carried out a systematic review. Only one GPG cited the three meta-analyses. Three quarters of the GPGs failed to detail their bibliographic research methods. Conclusion The GPGs for treatment of T2D were of poor quality and their methodological rigor was insufficient. Even though the meta-analyses had a higher level of evidence, they were seldom cited.

Background Obsessive–compulsive disorder (OCD) is a complex disorder with 40%–60% of patients' refractory to treatment. Transcranial direct current stimulation (tDCS) has been shown to induce potent and long‐lasting effects on cortical excitability. The aim of the present clinical trial was to evaluate the therapeutic efficacy and tolerability of cathodal tDCS over the supplementary motor area (SMA) in treatment‐resistant OCD patients. Methods Twenty‐one treatment‐resistant OCD outpatients received 10 sessions of tDCS. Each treatment session consisted of 2 mA stimuli for 30 min. The cathode was positioned over the bilateral SMA and the anode over the right supraorbital area. Patients were evaluated at baseline, end of treatment, one‐month follow‐up, and three‐month follow‐up. Response to treatment was defined as at least a decrease of 35% on the Yale–Brown Obsessive–Compulsive Scale (YBOCS) and a score of 2 or less on the Clinical Global Impressions‐Improvement (CGI‐I) between baseline and 1‐month follow‐up. Results There was a significant decrease of YBOCS scores between baseline and one‐month assessment. At one month, five patients (24%) were considered as responders and 3 (15%) at 3 months. We also observed concomitant changes in depressive symptoms, and insight. The treatment was well tolerated. Short‐lasting side effects were reported as localized tingling sensation and skin redness. Conclusion Our results suggest that the use of cathodal tDCS over the SMA and anodal tDCS over the right supraorbital area in OCD treatment‐refractory patients is safe and promising to improve obsessive and compulsive symptoms. Large randomized controlled trials are needed to confirm this positive result., Obsessive–compulsive disorder (OCD) is a complex disorder with 40%–60% of patients refractory to treatment. Transcranial direct current stimulation (tDCS) will offer a new insight in OCD treatment. The aim of the present open clinical trial was to evaluate the therapeutic efficacy and tolerability of cathodal tDCS over the supplementary motor area in treatment‐resistant OCD patients.

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

International audience

Background. Self-stigma is a major issue in serious mental illness (SMI) and is negatively associated with patient outcomes. Most studies have been conducted in schizophrenia (SZ). Less is known about self-stigma in other SMI and autism spectrum disorder (ASD). The objectives of this study are: (i) to assess the frequency of self-stigma in a multicentric nonselected psychiatric rehabilitation SMI and ASD sample; and (ii) to investigate the correlates of elevated self-stigma in different SMI conditions and in ASD. Methods. A total of 738 SMI or ASD outpatients were recruited from the French National Centers of Reference for Psychiatric Rehabilitation cohort (REHABase). Evaluations included sociodemographic data, illness characteristics, and standardized scales for clinical severity, quality of life, satisfaction with life, wellbeing, personal recovery, a large cognitive battery, and daily functioning assessment. Results. 31.2% of the total sample had elevated self-stigma. The highest prevalence (43.8%) was found in borderline personality disorder and the lowest (22.2%) in ASD. In the multivariate analysis, elevated self-stigma was best predicted by early stages of personal recovery (moratorium, p = 0.001, OR = 4.0 [1.78–8.98]; awareness, p = 0.011, OR = 2.87 [1.28–6.44]), history of suicide attempt (p = 0.001, OR = 2.27 [1.37–3.76]), insight (p = 0.002, OR = 1.22 [1.08–1.38]), wellbeing (p = 0.037, OR = 0.77 [0.60–0.98]), and satisfaction with interpersonal relationships (p Conclusions. The present study has confirmed the importance of addressing self-stigma in SMI and ASD patients enrolled in psychiatric rehabilitation. The effectiveness of psychiatric rehabilitation on self-stigma and the potential mediating effects of changes in self-stigma on treatment outcomes should be further investigated.

Resume Relativement peu connue en psychiatrie, la medecine thermale psychiatrique est une approche originale qui commence a faire l’objet d’evaluations rigoureuses. Depuis les annees 2000, elle a fait l’objet d’etudes qui en ont mieux montre les contours et les potentiels domaines d’application. Situee a l’interface de la medecine generale et de la psychiatrie, entre la medecine ambulatoire et la medecine hospitaliere, la medecine thermale s’adresse essentiellement aux troubles anxieux, aux troubles reactionnels, adaptatifs, et a des situations cliniques telles que le sevrage de benzodiazepines ou la psychoeducation. A base de balneotherapie, celle-ci est basee sur la qualite de la relation entre le medecin et le patient, sur la mise en place d’un environnement medicalise, structurant, anxiolytique et a developpe des modeles de prise en charge psychoeducatifs inspires des therapies cognitives et comportementales. En 2010, la preuve de l’efficacite de la crenotherapie a ete apportee dans la prise en charge des troubles anxieux generalises sur une duree de deux mois. En 2016, une autre etude a permis de demontrer l’interet de la balneotherapie en cure thermale pour realiser le sevrage de benzodiazepines chez les patients anxieux, consommateurs chroniques et motives pour l’arret. Parallelement, la balneotherapie a ete evaluee dans les troubles affectifs de pathologies douloureuses chroniques, en particulier de la fibromyalgie. Une autre etude a demontre son interet dans la prise en charge du burn-out. Nous resumons ici les resultats de ces principaux travaux.

Electrical stimulation studies have recently evidenced the involvement of orbitofrontal cortex (OFC) in obsessive–compulsive disorder (OCD). In addition, lateral OFC is activated in healthy subjects during delayed non-matching-to-sample task (DNMS). In the present study, we hypothesized that OCD results from a specific defect of lateral OFC processing that can be evidenced via a DNMS task. To this end, we compared the DNMS performances of 20 OCD patients vs 20 demographically matched healthy controls. As predicted, our results showed that OCD patients performed worse than healthy controls at DNMS task. To test for the specificity of this behavioral impairment, we furthermore compared OCD patients and healthy subjects on a different task not involving directly the lateral OFC: the delayed match-to-sample task (DMS). As expected, OCD patients are more impaired for both the DNMS and the DMS task, compared with healthy subjects. Moreover, OCD patients tend statistically to perform worse for the DNMS task than for DMS task. Our results suggest the DNMS task specifically target the malfunctioning areas in OCD, such as the lateral OFC. In light of these results, lateral OFC should therefore be the focus of future therapeutic interventions.

Background The Paris and Nice terrorist attacks affected a thousand of trauma victims and first-line responders. Because there were concerns that this might represent the first of several attacks, there was a need to quickly enhance the local capacities to treat a large number of individuals suffering from trauma-related disorders. Since Reconsolidation Therapy (RT) is brief, relatively easy to learn, well tolerated and effective, it appeared as the ideal first-line treatment to teach to clinicians in this context. Methods This study protocol is a two-arm non-randomized, multicenter controlled trial, comparing RT to treatment as usual for the treatment of trauma-related disorders. RT consists of actively recalling one’s traumatic event under the influence of the ß-blocker propranolol, once a week, for 10–25 min with a therapist, over 6 consecutive weeks. This protocol evaluates the feasibility, effectiveness, and cost-utility of implementing RT as part of a large multi-center (N = 400) pragmatic trial with a one-year follow-up. Discussion Paris MEM is the largest trial to date assessing the efficiency of RT in the aftermath of a large-scale man-made disaster. RT could possibly reinforce the therapeutic arsenal for the treatment of patients suffering from trauma-related disorders, not only for communities in western countries but also worldwide for terror- or disaster-stricken communities. Trial registration Clinical Trials (ClinicalTrials.gov). June 3, 2016. NCT02789982.

Low insight is reported as a risk factor for relapse among patients treated for alcohol use disorders. However, to date, little is known on why patients with low insight are at higher risk for relapse. In this study, we tested the hypothesis that an implicit preference for alcohol over abstinence predicts relapse in patients with low, but not high, alcohol insight. Participants consisted of 77 patients who had received treatment for severe alcohol use disorder in a hospital in France. During hospitalization, they completed a self-report measure of insight and an implicit association test to assess implicit preference for alcohol over abstinence. The primary outcome was relapse assessed one month after discharge. Control variables were gender, age, cognitive deficit, anxiety, depression, craving, and impulsivity. Data were analysed using logistic regression analysis. After adjusting for demographic and clinical variables, relapse was predicted by the interaction between insight and implicit preference for alcohol but not by their main effects alone. Implicit preference for alcohol predicted relapse among patients with relatively low insight, but not among those with relatively high insight. These findings suggest that patients with low insight and strong implicit preference for alcohol are at a higher risk of relapse. Clinicians may therefore focus on and tailor specific interventions to prevent relapse in this vulnerable and at-risk population., SCOPUS: ar.j, info:eu-repo/semantics/published

Objectives To explore whether clozapine users have specific rehabilitation needs compared to users of other antipsychotics. Methods The study was performed using the REHABase collecting data on persons referred to a French network of psychosocial rehabilitation centers. It was restricted to persons with schizophrenia spectrum disorder using antipsychotics. Multivariate analyses were used to compare baseline functioning and cognitive characteristics in clozapine users vs. users of other antipsychotics. Results Of the 675 patients identified in the REHABase, one out of ten (n = 70) used clozapine. Compared to users of other antipsychotics, clozapine users had been more frequently hospitalized in psychiatry and presented less frequently with psychoactive substance use. Functional measures did not significantly differ between the two groups. Clozapine users had poorer short-term verbal memory performance than users of other antipsychotics and did not differ on executive performance. Conclusion Clozapine users may reach a recovery level comparable to that obtained in persons without treatment-resistant schizophrenia. In order to reduce the negative impact of memory deficits on the recovery process of clozapine users, it is necessary to optimize their psychotropic treatment and to promote their access to cognitive remediation programs addressing their specific needs.

The REHABase project is a French observational, prospective, and multicenter cohort study of serious mental illness and autism spectrum disorder (ASD), launched in 2016 for a planned minimum duration of 15 years. The aim is to characterize the care and quality-of-life needs of participants. This article presents initial results from data collection.Psychosocial, cognitive, and functional data were collected at baseline, annually, and after rehabilitation care. Data from the baseline evaluation on diagnoses, medications, well-being, insight, life satisfaction, and care needs are presented. The clinical profiles of REHABase participants with serious mental illness or ASD were assessed in relation to their level of satisfaction with life and well-being in nine life dimensions and their needs, according to their stage of recovery in a five-stage model.Baseline data were collected for 1,397 participants between January 2016 and August 2018. Main diagnoses were schizophrenia spectrum disorder (49%); ASD (13%); and personality (12%), bipolar (9%), and major depressive (6%) disorders. More than 50% of participants reported needs for care or interventions in four of nine dimensions: employment, cognitive functioning, symptom management, and interpersonal relationships. Nearly half of participants were not in the active stages of recovery (stages 4 and 5), and even those considered to have reached the final stage continued to require help in several areas.Most participants had already received psychiatric care for several years, and most remained dissatisfied with their social and emotional life and their psychological well-being.

International audience; BACKGROUND:Obsessive-compulsive disorder (OCD) is a complex disorder with 40 to 60 % of patients resistant to treatment. Theta burst transcranial magnetic stimulation (TBS) is a promising new technique that has been shown to induce potent and long lasting effects on cortical excitability. The present study evaluated for the first time therapeutic efficacy and tolerability of continuous TBS (cTBS) over the supplementary motor area (SMA) in treatment resistant OCD patients using a double blind, sham-controlled design.METHODS:Thirty treatment resistant OCD outpatients were randomized to receive either active cTBS or sham cTBS for 6 weeks (5 sessions per week). Each treatment session consisted of 600 stimuli at an intensity of 70% of resting motor threshold. Patients were evaluated at baseline, at the end of treatment (week 6), and follow-up (week 12). Response to treatment was defined as at least 25% decrease on the Yale-Brown Obsessive Compulsive Scale.RESULTS:There was no significant difference between active and sham cTBS groups in treatment efficacy. Responder rates were not different between the two groups at week 6 (cTBS 28% versus sham 36%; p = 0.686) and week 12 (cTBS 28% versus sham 36%; p = 0.686). Depressive and anxious symptoms improvements were similar in the two groups.CONCLUSION:This study is the first controlled trial using cTBS in treatment resistant OCD patients. The use of cTBS over the SMA is safe but not sufficient to improve OCD symptoms. Further studies are needed to identify the optimal parameters to be used in OCD patients.