French Journal of Psychiatry最新文献

Objectives

Patients who survive a suicide attempt present an increased risk of relapse during the three months after discharge from a hospital, referred to herein as the post-discharge period. Developing and assessing the efficacy and safety of methods that reduce the risk of relapse in the post-discharge period is critical for professionals in the field of suicide prevention. This study aimed to compare the efficacy of a new Intensive Psychosocial Care (IPC) program after discharge for a suicide attempt with a Standard Care Program (SCP) in non-hospitalized patients.

Methods

We conducted a open-label prospective trial to compare the outcome of patients who have attempted suicide for a duration of 6 months according to whether they were included in care program group IPC or SCP after discharge from the emergency department.

Results

Using the Beck Depression Inventory short-form (BDI-SF), the IPC program was significantly associated with both a decrease of the total score of the scale at 6th month, and a trend towards a decline in the time lag between discharge and the improvement of depressive symptoms. When compared to SPC, patients receiving the IPC had also a lower drop-out rate (31% versus 43% in the 6th month) and a higher adherence to treatment until the 3rd month (56% versus 41.7%). Median time to reattempt was 83.7 [95%CI: 45.8–121.7] days for IPC as compared to 75.6 [95%CI: 38.8–112.4] days for SCP, respectively.

Conclusions

Personalized follow-up with close contacts by the same caregivers as those who initially assessed the patient in the emergency room improved adherence to care and reduced depressive symptoms more intensely and faster after a suicide attempt.

An increase of the number of psychiatric patients requesting euthanasia or assisted suicide (EAS) has been reported in countries practicing EAS. The debate raised by EAS invites psychiatrists to think about their role in this societal issue. If euthanasia for patients with unbearable somatic suffering is the subject of fierce ethical debate, the debate is even fiercer in cases of unbearable psychiatric suffering. In this manuscript, we discuss 3 main points concerning EAS for psychiatric patients. First, we question the notion of irreversibility of the condition and the related medical futility. Second, we focus on the capacity to make informed decisions in such situations. Third, we ask whether psychiatric EAS should be considered as a copycat of traditional suicide or an additional therapeutic alternative. Psychiatrists should produce practice guidelines to be involved in the EAS debate and develop research programs.

Background

The CHRNA5/A3/B4 acetylcholine receptor gene cluster has been strongly and repeatedly associated with tobacco dependence, but the studied populations were usually made of adults, with frequently associated somatic comorbidities (such as lung cancer).

Methods

Four SNPs within this gene, previously associated with tobacco dependence, were tested in a large population of untreated, young French students (average age, 20 years old).

Results

We found strong evidence (surviving corrections for multiple comparisons) that different genetic variants within the studied cluster of genes (rs637137, rs3813567, and an ‘AGG’ haplotype based on rs637137, rs3813567 and rs16969968) are able to distinguish the presence of tobacco dependence in adolescents.

Conclusions

The present results argue in favor of the possibility to use different genetic markers of the CHRNA5/A3/B4 acetylcholine receptor gene cluster in adolescents, to potentially help more specifically those that need it most (as carrying risk alleles), interventions leading to more benefits when performed in young subjects, or proposed early in the process of tobacco use disorder.

Introduction

Suicide prevention is a critical issue, and is related to the care and follow-up provided after a suicide attempt. This treatment is, however, linked to a patient's ability to memorize the information given to them in the emergency department, even though their memory may be impaired due to the drugs ingested after a self-poisoning suicide attempt. There is therefore a recommendation that a patient's cognitive-function should be evaluated in these circumstances. The aim of this study was to examine how this advice is applied in practice.

Methods

We performed a telephone survey of the 30 teaching hospitals in France. The psychiatric team at each center was asked about the cognitive tests or other methods they employed to evaluate a patient's cognitive-function. We also examined the other markers used.

Results

Only one of the hospitals contacted used a cognitive test. The others determined cognitive recuperation based on factors such as clinical opinion, vigilance or the plasma half-life of the drugs ingested.

Conclusion

There was no consensus on whether and which cognitive tests should be used following a self-poisoning suicide attempt. Indeed, these tests were very rarely employed. Most of the hospitals contacted used clinical markers, even though these have major limitations. The issue of conducting cognitive evaluations after deliberate self-poisoning must therefore be addressed in order to harmonize clinical practice throughout the country.

The French Brain Council, which has a balanced representation of Neurology, Psychiatry and Neurosciences, participated in the launch of a survey on the current status of care for patients suffering from brain diseases with the aim to identify 10 consensual priorities to be emphasized in the building the National Brain Plan in all European member states. This National Brain and Mental Health plan was approved by the National Brain Councils of 17 European member states. The present report details the 11 responses that obtained a consensus, the top five (over 90% of agreement) being the needs to: (1) improve multidisciplinary integrated home care and structures of coordinated health care, (2) increase homogeneity within regions for current state of prevention, (3) develop evidence based and socially responsible policy by collecting data from ongoing clinical trials and basic research to optimally address unmet needs, (4) promote education on innovative technologies, and (5) facilitate translational research.

Objective

Between 40 and 60% of patients with obsessive-compulsive disorder (OCD) are resistant to first-line treatments, including exposure and response prevention techniques. Those are likely to benefit from the rise of virtual reality (VR). However, very few studies have been conducted on the use of VR in OCD with several limitations including a lack of ecological validity. This proof of concept study aims to assess the feasibility and therapeutic potential of a personalised exposure protocol using immersive video.

Methods

This protocol was applied to a patient suffering from severe and resistant OCD and consisted of 15 weekly sessions of exposure via a VR headset to 360° immersive videos filmed from the subject's viewpoint in their own environment.

Results

Besides the high acceptability of the immersive device, our patient exhibited a therapeutic response with a reduction in emotional responses measured by skin conductance recording, a reduction in obsessive-compulsive symptoms and an improvement in quality of life.

Conclusions

This study provided promising results in a patient initially refractory to conventional treatments. Replication of these results would place personalised immersive 360^o video exposure as a technique of choice in the therapeutic arsenal for OCD due to its cost-effectiveness and high acceptability.

Introduction

Crack cocaine use disorder (CCUD) is a major public health with a strong heritability component.

Objectives

This study was aimed to investigate the putative association between the dopamine transporter gene (DAT1/SLC6A3) and crack-cocaine use disorders (CCUD) as well as the possible involvement of attention-deficit hyperactivity disorder (ADHD), impulsivity and sensation-seeking.

Methods

Seventy-seven male subjects with CCUD were compared with 60 male control subjects of Afro-Caribbean origin. The Barratt Impulsivity Scale, the Wender Utah scale Scale-25 item and the Zuckerman Sensation-Seeking Scale were used. The subjects’ DNAs were genotyped by quantitative PCR (TaqMan method).

Results

We found an association with two SNPs (rs6347 and rs27048) of the DAT gene in crack-cocaine use disorder, and a significantly lower frequency of one of the three haplotype blocks of the DAT gene (AT haplotype, defined by the two previous SNPs) and CCUD.

Conclusion

DAT1 rs6347 and rs27048 polymorphisms seem to be associated with CCUD. The risk-effect of these polymorphisms appeared to be specific to individuals who are crack users rather than being driven by impulsivity or ADHD.

Background

Case reports and clinical studies suggest that dissociative symptoms (DS) and dissociative disorders (DD) are prevalent in bipolar disorders (BD).

Methods

We conducted a systematic qualitative review on this association. MEDLINE and PsycINFO studies published up to November 15th, 2018 were searched, with an additional search through bibliographical references. English or French articles published in peer-reviewed journals, reporting quantitative measures of DS and/or frequency of DD, and at least one group or measure of BD were included. Six hundred and seven articles were reviewed on abstracts, 22 full-text articles screened, and 15 finally included.

Results

Four studies showed that BD patients had more DS than healthy controls. DS were more frequent in BD than in unipolar depression in four studies, but less than in borderline personality disorder. DS were associated with an earlier age at onset of BD in two studies and possibly more comorbidity, while the associations with type of BD, suicidal behavior or childhood trauma need confirmation.

Conclusions

While not specific among mental disorders, our review suggests an association between DS/DD and BD. Results should incite clinicians not to exclude too early an unrecognized BD in depressed patients with DS/DD, and consider DS/DD as markers of severity in BD.