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Objective: The potential metabolic adverse effects of second-generation antipsychotics (SGA) need to be monitored. The Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics (CAMESA) offers guidelines for this purpose. We aimed to evaluate the long-term rates of youths receiving monitoring in mental health clinics and document the factors that may influence them. Method: The charts of 180 patients (13.3 ± 3.1 years, 54.4% males) receiving SGA treatment for the first time between January 2016 and June 2018 were reviewed. Monitoring was divided into baseline and 1- to 6-month and 9- to 24-month periods. Population under study was stratified into children (4 to 12 years) and adolescents (13 to 18 years). Sociodemographic characteristics, psychiatric diagnosis and comorbidities, prescribed SGAs and comedications, anthropometric measures (AM), blood pressure (BP), blood tests (BT), electrocardiogram, and the psychiatrist’s years of practice were collected. Cross tables were used to present the monitoring rates. Categories were compared by covariate analysis. Rates of patients monitored across categories were compared using Fisher exact test. Results: Monitoring rates for AM, BT, and BP were 55%, 47.8%, and 46.7% at baseline; 50%, 41.7%, and 45.2% at 1 to 6 months; and 47.2%, 41.5%, and 40.6% at 9 to 24 months, respectively. Higher monitoring rates were significantly associated with adolescent status (baseline, 1 to 6 months), a diagnosis of psychotic and/or affective disorder (baseline, 1 to 6 months, 9 to 24 months), having ≤1 psychiatric comorbidities (1 to 6 months), high SGA dose (baseline, 1 to 6 months), and clinician’s experience (baseline, 9 to 24 months). Significantly lower monitoring rates were associated with the psychostimulant/atomoxetine comedication (baseline, 1 to 6 months, 9 to 24 months). Conclusion: Five years after publication of the CAMESA guidelines, metabolic monitoring is conducted for less than half of patients. In our sample, age, diagnostic category, psychiatric comorbidities, SGA dose, clinician’s experience, and comedications influenced the monitoring rates. Major progress still needs to be made before reaching a satisfactory level of monitoring.

Video game addiction in young children is relevant, but it is especially important for children with ADHD. In order to obtain more data about the use of video games by Canadian children, and in particular by ADHD children, we explored the modalities of use (playtime, addiction score and usage by age) and compared them between ADHD and non-ADHD children. We then examined associations between addiction and ADHD symptoms and explored innovative results about the gender impact. Our study was cross-sectional, multicenter in child psychiatrist departments, exploratory and descriptive. We recruited three groups of children aged 4–12 years: the ADHD Group, the Clinical-Control Group and the Community-Control Group. For each group, the material used consisted of questionnaires completed by one of the parents. Data collection took place from December 2016 to August 2018 in Montreal (n = 280). Our study highlighted a vulnerability in ADHD children: they would exhibit more addictive behaviors with respect to video games (Addiction score: 1.1025 in ADHD Group vs. 0.6802 in Community-Control Group) and prolonged periods of use. We also observed a correlation between the severity of ADHD symptoms and excessive use of video games (p = 0.000). Children with severe ADHD showed significantly higher addiction scores and, in a multiple regression analysis a combination of gender and ADHD explained the excessive use of video games.

Aim The COVID-19 pandemic has introduced many mental health professionals to therapy via videoconferencing. Mostly individual teletherapy has been offered and studied, although group therapy is often offered in clinics. In fact, little is known regarding group therapy's acceptability, feasibility, and potential impact when offered via videoconferencing. Methods This pilot study offered group cognitive-behavioural therapy for psychosis via videoconferencing to 14 individuals with early psychosis either living in remote areas or confined during the pandemic. Results The rate of consenting to the study (79%) and actual participation rates were acceptable (18.5 sessions out of 24). Although some technological obstacles were encountered, solutions offered allowed the videoconferencing group to be considered feasible for most participants and therapists. Prepost results on symptoms and self-esteem were comparable to those of other studies using the same group treatment but in-person. Alliance scores seemed similar as well. Conclusions More studies are warranted on the efficacy of group therapy via videoconferencing. This pilot study does offer promising results, suggesting that a wider range of people with early psychosis can be reached and benefit from the advantages of receiving an evidence-based group intervention.

IntroductionSecond-generation antipsychotics (SGAs) are widely used in the paediatric population. It is currently established that SGAs may induce metabolic adverse events (AEs) such as weight gain, perturbation of blood lipids or glucose with risk of potential cardiovascular morbidity and mortality. The Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics in children (CAMESA) has published recommendations for monitoring the metabolic AEs of SGAs. Factors that may be associated with the onset of SGA’s metabolic AEs and long-term consequences are less studied in the literature. The objectives of our research are to evaluate some factors that can influence the development of the SGA’s metabolic AEs and to study clinical adherence to CAMESA guidelines.Methods and analysisThe Monitoring des Effets Métaboliques des Antipsychotiques de Seconde Génération study is a multicenter, prospective, longitudinal observational study with repeated measures of metabolic monitoring over 24 months. Two recruiting centres have been selected for patients under 18 years of age, previously naive of antipsychotics, starting an SGA or who have started an SGA for less than 4 weeks regardless of the diagnosis that motivated the prescription. Assessments are performed for anthropometric measures, blood pressure, blood tests at baseline and 1, 2, 3, 6, 9, 12 and 24 months of follow-up.Ethics and disseminationThe study protocol was approved by the CHU Sainte-Justine’s Research Ethics Board (MP-21-2016-1201) in 2016 and obtained institutional suitability for the ‘Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’Île-de-Montréal’ Research Center in May 2018. For all participants, written consent will be obtained from parents/caregivers as well as the participant’s assent in order to enable their participation in this research project. The results of this research will be published.Trial registration numberClinicalTrials.gov (numberNCT04395326).

Cette etude evalue les benefices d’un groupe d’entrainement aux habiletes sociales, sur les relations sociales et la comprehension de situations sociales, chez des adolescents presentant un trouble du spectre de l’autisme sans deficience intellectuelle (TSA). Seize adolescents avec TSA, âges de 10 a 15 ans, ont participe a ce programme et ont beneficie d’un protocole d’evaluation de la cognition sociale avant et apres l’intervention. Leurs parents ont, par ailleurs, repondu a differents questionnaires concernant la reciprocite sociale, la communication pragmatique et le fonctionnement executif afin de determiner l’impact de l’intervention en situation ecologique. Les resultats montrent une amelioration des capacites de reconnaissance des emotions, de theorie de l’esprit et de pragmatique du langage. Les progres dans la vie quotidienne des adolescents concernent principalement la sphere executive, plus particulierement la regulation comportementale et la metacognition. Les resultats de cette etude suggerent que les groupes d’entrainement aux habiletes sociales sont des dispositifs pertinents pour ameliorer la cognition sociale chez les personnes avec TSA. Demeure toutefois la question du transfert des competences en vie quotidienne qui doit etre encore approfondie.

Dry storage cask materials must withstand severe temperature conditions coming from conservative ambient assumptions and from envelope values of residual heat from spent fuels. TN International (TN...

L'abord du phenomene religieux dans la pathologie mentale est peu etudie dans la litterature et reste d'un abord difficile en pratique. La dimension religieuse est pourtant d'un interet majeur sur le plan diagnostique, therapeutique ou pour la recherche. Il s'agira de circonscrire ce phenomene et de soulever ses differents points d'intrication avec la pathologie et la sante mentale, dans la recherche neuroscientifique ou dans les differentes approches therapeutiques. Il s'agira donc de definir des points de repere mais aussi de comprendre quelle peut etre notre resistance a l'abord de ce theme, cela afin de faciliter l'echange avec le patient, de favoriser son ecoute et sa comprehension.

The purpose of this study was to investigate the neurofunctional substrate of verbal learning and memory impairments in schizophrenic patients. In this pilot study, our aim was to compare the memory disturbance of schizophrenic patients to the subcortico-frontal memory profile of Parkinson's disease (PD) patients. The California Verbal Learning Test, a verbal episodic memory test, was administered to 60 subjects, 20 patients with schizophrenia, 20 patients with PD and 20 healthy control subjects. All subjects were aged between 50 and 70 years and all patients were in a stable phase. Like the Parkinson patients, the schizophrenic patients showed a major deficit of retrieval characterized by deficit of recalls but contrarily to PD patients, schizophrenic patients' encoding scores were altered. These impairments in episodic memory could suggest a dysfunction of the subcortico-frontal circuits in schizophrenic patients. However, they demonstrated an additional encoding deficit associated with probable frontal in situ alteration.

The aim of this study was to determine whether executive/attentional cognitive performances could be considered as markers of vulnerability to schizophrenia. The Stroop Color Word and fluency tests were significantly impaired in schizophrenic patients and their parents compared to controls matched on age and sex while performances on Nelson's Modified Card Sorting Test and the Trail Making Test did not differ. The impairments on the Stroop and fluency could be considered as endophenotypic markers of schizophrenia.

ResumenLa recurrencia de flashbacks sin consumo de alucinógenos agudo o crónico se ha reconocido en los criterios del DSM-IV como trastorno perceptivo persistente por alucinógenos (TPPA). Las perturbaciones perceptivas pueden durar 5 años o más y representan un sufrimiento psicosocial real. Comunicamos aquí un caso de un joven varón de 18 años que presentaba TPPA después de una intoxicación mixta con psilocibina y cannabis. Este informe muestra recurrencias sintomáticas que persistieron más de 8 meses. Se evocan diagnósticos diferenciales diferentes y se describen nuestras estrategias terapéuticas.

The recurrence of flashbacks without acute or chronic hallucinogen consumption has been recognized in the DSM IV criteria as the hallucinogen persisting perception disorder (HPPD). Perceptual disturbances may last for 5 years or more and represent a real psychosocial distress. We reported here a case of a 18-year-old young man presenting HPPD after a mixed intoxication with psylocibin and cannabis. This report shows symptomatic recurrences persisting more than 8 months. Various differential diagnoses were evoked and our therapeutic strategies were described.

The central benzodiazepine receptor occupancy by zolpidem in man is unknown. The present study used positron emission tomography (PET) and [11C]flumazenil to assess in five healthy volunteers, central benzodiazepine receptor occupancy in brain regions with high receptor densities 1 h following an acute oral administration of twice the usual hypnotic dose of zolpidem (20 mg). Receptor occupancy was measured in five discrete structures (middle frontal gyrus, middle temporal gyrus, posterior occipital cortex, lateral parietal cortex, and cerebellar cortex) and in a large neocortical area as the fractional change in the [11C]flumazenil bound/free ratio for the interval 15-40 min post-administration of the radiotracer. The free-radioligand concentration was estimated from the pons, a reference structure virtually devoid of central benzodiazepine receptor. With individual pons values, mean occupancy was about 21% but with spurious inter-subject variability. With pons values averaged across the five subjects and separately for control and treated condition, the occupancy was (mean +/- S.D.) 27 +/- 11% for the whole neocortex, and ranged from 26 to 29% in the five discrete structures (P < 0.01). By showing hypnotic effect at moderate occupancies, this study directly provides evidence for the full-agonist properties of zolpidem in human.

Studies of central benzodiazepine receptors in the human brain in vivo are now possible using positron emission tomography (PET) and [11C]flumazenil. With the aim of measuring Bmax and Kd in brain regions, we used a two-injection [11C]flumazenil (at high and low specific radioactivity, respectively) pseudo-equilibrium paradigm to evaluate, in seven unmedicated healthy volunteers, the relative merits of three 'reference' structures (pons, hemispheric white matter and corpus callosum) in which the free radioligand concentration in brain tissue was estimated 15-40 min after i.v. injection of the radioligand. By means of high-resolution PET, the Bmax and Kd were calculated for each subject in 18 gray matter structures, based on a two-point Scatchard plot. We found that the use of the corpus callosum as reference often resulted in spurious Bmax and Kd values. The pons was the best reference structure because it provided satisfactory Bmax values (closest to in vitro data) and most consistent Kd values, and was the region easiest to sample on PET images. The pattern of regional Bmax was consistent with that expected from in vitro studies, with values highest in the cerebral cortex, intermediate in the cerebellum, and lowest in the striatum and the thalamus. The Kd values were uniform among regions and were consistent with earlier in vitro and in vivo data. This work documents the feasibility of estimating Bmax and Kd of central benzodiazepine receptors in multiple brain regions for clinical research.

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OBJECTIVE: Proton magnetic resonance spectroscopy (1H-MRS) was used to study medial prefrontal metabolic impairments in schizophrenic patients with the deficit syndrome. METHOD: The subjects were 22 schizophrenic patients categorized as deficit (N=5) or nondeficit (N=17) and 21 healthy subjects. 1H-MRS was performed for the right and the left medial prefrontal cortex. RESULTS: The patients with the deficit syndrome had significantly lower ratios of N-acetylaspartate to creatine plus phosphocreatine than did the healthy subjects or nondeficit patients. CONCLUSIONS: As N-acetylaspartate levels could reflect neuronal density and/or viability, this finding suggests a neuronal loss in the medial prefrontal cortex of deficit patients.

Drugs acting upon the benzodiazepine binding sites of the GABAA receptor complex constitute one of the most widely used class of psychotropic agents. These drugs increase the sensitivity of the GABAA receptor to its natural agonist, γ-aminobutyric acid (GABA). This allosteric facilitation of GABAergic neurotransmission has found clinical application in the treatment of a large number of disorders [1–3]. These applications are based on the sedative, anxiolytic, anticonvulsant and myorelaxant activities of benzodiazepine receptor agonists. Moreover, these drugs also display untoward effects such as memory disruption, and after chronic treatment, induction of tolerance and dependence. These pleitropic actions constitute one of the most important drawback of benzodiazepines. For this reason, much research has tried to dissociate the effects responsible for the therapeutic activity from those considered as secondary. For example, to dissociate anxiolytic from sedative effects, or hypnotic effects from memory impairment or myorelaxant activities, and also to avoid the induction of tolerance or dependence.

Les troubles du spectre de l’autisme (TSA) sont caractérisés par des manifestations atypiques dans la socialisation et la communication, par des intérêts restreints et des stéréotypies, et par des difficultés affectives et adaptatives. Les conduites suicidaires sont fréquemment évoquées chez les adolescents et adultes avec un TSA, sans déficience intellectuelle (SDI). Mais la recherche clinique dans ce domaine est très limitée et le diagnostic n’est pas envisagé dans les services d’urgence. Parmi les facteurs de risque individuels de suicide chez les patients TSA, on retrouve la dépression, les troubles anxieux et les antécédents familiaux de troubles affectifs. L’intimidation et les difficultés d’intégration socio-professionnelle sont également des facteurs environnementaux rapportés. Des études en lien avec les caractéristiques cognitives permettraient d’explorer plus rigoureusement la phénoménologie du suicide chez les patients TSA., The Autistic Spectrum Disorders (ASD) are characterized by an atypical sociability, alterations in communication, restricted interests and stereotypies, with adding affective and adaptative disabilities. The suicidal behaviors are frequently observed in the adolescents and adults with an ASD without intellectual deficience. However, the clinical research on the topic is limited and the diagnosis not assessed in the emergency units. Among the individual risk factors of the suicidal behavior in ASD patients, mood and anxiety disorders are found as well as a familial affective disorder history. The intimidation and the lack of socio-professional integration were also reported as environnemental risk factors. Laters tudies taking into account the cognitive characteristics would permit to investigate the suicidal phenomenology in ASD patients.