Encephale-Revue De Psychiatrie Clinique Biologique et Therapeutique最新文献

Objectives: The COVID-19 pandemic had a huge impact on global mental health. Health care students, both as young people and regarding their student condition, were a more at-risk population. During the first and the third waves, two national surveys already found high levels of psychological distress (21 to 83% of severe psychological distress). This nationwide study focused on health care student changes in substance or treatment use during the pandemic.

Methods: We did an online national cross-sectional study addressing all health care students in France from April 4 to May 11, 2021. The questionnaire included sociodemographic and work conditions questions, Kessler 6 scale, and simple questions about psychotropic treatments or substance use.

Results: We obtained 16,937 answers, including 54% nurses and 16% medical students. Increased psychoactive substance use (alcohol, tobacco and cannabis) was associated with males, older students, those having financial difficulties and using more psychotropic treatments. Nursing students were more at risk than others. Increased psychotropic treatment use (anxiolytics, hypnotics) was associated with being a woman, older, having financial difficulties, having high psychological distress, and using more psychoactive substances. Medical, pharmacy, dental and midwife students were more at risk than others. The response rate was low (5,6%), and nursing students represented more than half of the respondents.

Conclusions: Compared to our first national survey, substance use (21% versus 13%) and psychotropic treatment use (18% versus 7.3%) increased hugely. These results highlight the need to identify the specific causes of substance use by health care students to better support them. As future health professionals, this is a major public health issue.

Introduction: Tardive seizure refers to a spontaneous seizure, which occurs after electroconvulsive therapy (ECT). It is a rare and poorly understood phenomenon that can lead to other serious consequences such as status epilepticus. Risk factors may be associated, and its management is by no means consensual. However, tardive seizure remains little explored in the absence of feedback and data sharing. The purpose of this study was to report the prevalence of late-onset seizures following ECT during the acute phase of treatment at the stimulation unit of Razi Hospital during its seven years of activity and to identify variables associated with this adverse event.

Methods: This is a descriptive and retrospective study that was carried out at the ECT unit of Razi Hospital, Tunisia, based on the medical records of patients treated with ECT between December 2015 and September 2023. Every recorded ECT session during the initial course of treatment with available EEG tracings was included in the study. Maintenance ECT sessions, undocumented sessions, those without clinical observations, and/or those without EEG tracings were all excluded. A tardive seizure was retained according to criteria that included both recorded motor manifestations such as "motor jerks" or "generalized tonic-clonic seizures" which began spontaneously after ECT and the resumption of a state of consciousness concurrent with an equivocal EEG tracing.

Results: A total of 162 patients received at least one course of ECT during the research period. Ultimately, we included 1931 well documented sessions that were completed for 157 patients in all. Of the 157 patients, seven had experienced at least one late seizure after receiving ECT, accounting for 4.45% of patients. Among the 1931 sessions, 11 late seizures were noted. The prevalence of tardive seizures in our series was 0.57%. Several factors have been associated to the onset of a tardive seizure, including being a male, the presence of a neurological lesion, treatment that lowers the epileptogenic threshold, anesthesia with etomidate, stimulation charge near seizure threshold or maximum electrical load, prolonged induced seizure, and poor post-ictal suppression on the induced seizure tracing.

Conclusion: Despite the dearth of information, tardive seizure following ECT is considered to be a rare event. Risk factor management would be the first action to be taken to prevent such an event.

Introduction: Avoidant Restrictive Food Intake Disorder (ARFID) is a recently described disorder. Data on inpatient treatment is still scarce, ARFID mainly being an outpatient condition. The purpose of this study is to describe a rare population of adolescents with severe ARFID receiving full-time multimodal inpatient care by examining their clinical characteristics, management, and evolution.

Methods: We conducted a retrospective study on a series of patients diagnosed with ARFID who were hospitalised from 2005 to 2022. This study was carried out at the Adolescent Medicine department of a University Hospital in Paris, France, specialising in the treatment of eating disorders.

Results: Sixteen adolescents aged 12 to 17 were hospitalised for severe ARFID associated with malnutrition, growth retardation, pubertal delay, and/or psychiatric comorbidities. All but one had body mass indexes less than -2 standard deviations. Mean BMI upon admission was 14,1 [standard deviation=1,8]. They benefited from multimodal treatment plans supported by a multidisciplinary team, including nutritional, somatic and psychiatric transdisciplinary assessment and care, residential care, and family involvement. Length of stay was five months on average, and 50% had achieved normal body mass index at discharge.

Conclusions: Full-time inpatient care with multimodal and multidisciplinary interventions and tailored management can help restore normal weight for some adolescents. These interventions are aimed at patients with severe ARFID with major complications such as stunted growth and delayed puberty, and/or comorbidities such as depression. Specific subtypes of patients with severe ARFID need to be identified to delineate their characteristics, prognosis, and treatments effective for this group.

Introduction: Excessive use of social media can lead to addiction with adverse consequences for health. Through this work, we evaluated the prevalence of addiction to social media of college students from different fields and the associated factors.

Methods: We conducted a survey of 115 students by means of a questionnaire posted online during two weeks in groups of students aged between 19 and 30years from different fields in Tunisia. The questionnaire consisted of an information sheet and three self-administered questionnaires: Bergen social media addiction scale, Hospital Anxiety and Depression scale, and UCLA 3-item loneliness scale.

Results: Our population was 70% female. The average age was 25.1±3.5years. Regarding lifestyle habits, twenty-nine students (25.2%) were smokers, thirty-three students (28.7%) consumed alcohol, and nine students (7.8%) used cannabis. The average number of years of social media use was 11.77±3.28years. The average time on line per day was 3.8±1.81hours. The main social networks were Facebook (98.3%), Instagram (93%), Whatsapp (80.9%), Tiktok (28.7%), Snapchat (20%), and Twitter (19.1%). The use of social networks was the first action in the morning when waking up in 71.3% of the students and before sleeping in almost all students (94%). According to the results of the Bergen Social Media Addiction Scale, 31.3% of students had problematic social media use, defined by a score≥19/30. Thirty-three students (28.7%) had moderate to severe anxiety symptomatology and 41 students (35.7%) had moderate to severe depressive symptomatology. Sixty-two students (53.9%) were considered lonely according to the UCLA loneliness scale. Marital status was significantly associated with social media addiction score, with higher rates among single students. Smoking was also associated with higher social media addiction scores. Social media addiction scores were positively and significantly correlated with anxiety, depression, and loneliness scores. Frequency of going out with friends was negatively and significantly associated with social media addiction score, as well as depression and loneliness scores.

Conclusions: This study shows that social media addiction is a major health problem. Therefore, it is important for college students to recognize a problematic social media use and take steps to use it in a healthy way.

Elderly suicide is a public health problem, especially in the presence of unipolar depression. Very few tools have been developed to assess suicide risk in the elderly. Suicidal behaviors (SB) are often associated with perturbations of emotional information processing. Recent eye-tracking evidence has indicated specific visual exploration of emotional facial expressions based on age, pathological status, or type of facial emotion expression, which encourage the development of more specific and reliable tools to help in the detection of SB in depressed elderly patients. The aim of this study was to characterize emotional facial information processing in elderly depressed patients with SB vs. patients without SB. We assessed fixation time on their facial expressions (SB n=10 and with noSB n=11). Results showed that depressed SB patients spent more time on emotional regions (i.e. eyes and mouth) of disgust, fear and neutral emotions than did depressed noSB patients. Conversely, fixation time did not differ between the groups for angry, sad and happy emotions. We discuss the difficulties in disengaging attention from emotional information congruent with the patient's emotional state. Specific visual exploration observed in suicidal depressed patients could be used as novel risk factors to more accurately assess and predict suicide risk.

Objectives: The aim of this study was to translate the Stigma Resistance Scale into French and to examine its psychometric qualities to measure stigma resistance in people with psychotic disorders.

Methods: The Stigma Resistance Scale was rigorously translated into French, involving translation, back-translation, and adjustments based on focus groups. The French version of the Stigma Resistance Scale comprises 20 items divided into five subscales measuring resistance to stigma at different levels. The psychometric qualities of the French version were assessed in comparison with other scales such as the Internalized Stigma of Mental Illness, the Beck Depression Inventory, the Self-Evaluation of Negative Symptoms, and the Schizophrenia Quality of Life Questionnaire Short Form. The study involved 59 patients with psychotic disorders and was approved by a committee for the protection of individuals. Participants were recruited from seven investigating centers, and data were collected via semi-structured interviews and self-questionnaires.

Results: The five-factor structure developed by the original scale for a multi-diagnostic population was not found by confirmatory factor analysis on our sample. An exploratory factor analysis revealed a two-factor structure. Internal consistency, measured by Cronbach's alpha coefficient, was greater than 0.7 in favor of a strong internal consistency of the psychometric instrument. The correlation result obtained with the only instrument measuring stigma resistance (Internalized Stigma of Mental Illness subscale) demonstrated good convergent validity (r=-0.37). Similarly, scores on the Stigma Resistance Scale were strongly correlated with scores on other scales measuring negative symptomatology, depression, quality of life and insight. This demonstrates the satisfactory divergent validity of the instrument.

Conclusion: The study aimed to validate the Stigma Resistance Scale in French, revealing a two-factor structure in patients with psychotic disorders. The two dimensions identified reflect a proactive attitude to stigma (egocentrism) and a willingness to defend the rights of people with mental disorders (allocentrism). Cultural factors may explain the differences in the factorial models between the original and French versions. The Stigma Resistance Scale is the first tool validated in the French language to provide a specific self-assessment of stigma resistance with good psychometric properties for patients suffering from psychotic disorders.

Introduction: Genetic polymorphisms in genes encoding enzymes metabolizing psychotropics drugs result in various isoenzymes with different catalytic efficacies. Of particular interest, some of these isoenzymes are highly catalytic leading to an ultrarapid metabolism (UM) of their substrate medication, which in turn results in lower medication concentrations and possibly poor clinical outcomes, including a higher risk for suicidal behavior. In this study, we investigate the role of CYP2D6 (metabolizing most antidepressant medications) and CYP2C19 (important in metabolizing antipsychotics) UM isoenzymes on suicidal behavior among a cohort of patients with schizophrenia.

Methods: One hundred and seventy-eight patients diagnosed with schizophrenia were recruited from the day hospital of a regional psychiatric academic hospital. Lifetime suicide attempts were compared between groups of patients stratified according to their enzymatic profile. Several socio-demographics and clinical covariates were controlled for.

Results: Among the 178 patients, 16 and 44 were UM as determined by their CYP2D6 and CYP2C19 genotype respectively. Univariate analysis showed a significant association between suicidal attempts and CYP2D6 and CYP2C19 UM status (P=0.041 and P=0.029 respectively). These associations remained significant in multivariate analyses (adjusted for age, sex, dose exposure and antidepressant use…) for both CYP2D6 (P=0.020, OR=4.096, 95% CI [1.25-13.48]) and CYP2C19 (P=0.016, OR=2.680, 95% CI [1.21-5.95]).

Conclusion: This study suggests that the UM phenotypes for both CYP2D6 and CYP2C19 are associated with an increased risk for suicide attempts in patients with schizophrenia.

Objectives: Substance use disorders are of worldwide public health interest. Local estimates of problematic drug use provide useful indicators to regional public health agencies in developing prevention and treatment programs. The purpose of the current study was to estimate the prevalence of problematic drug use in Martinique.

Methods: The capture-recapture method was applied to a multisource data collection (eight specialized drug and two law enforcement sources) to provide an estimate of drug use (opiates, cocaine hydrochloride, crack (cocaine base), stimulants and/or hallucinogens). Data collection was organized over a period of six consecutive months (September 2005 to March 2006) and concerned all persons residing in Martinique longer than three months and who had consumed at least one of the studied drugs in the month prior to the study.

Results: We identified 287 cases (86% male; mean age 36.1±9.6 years), 98% of whom had used crack. Comorbid use of illicit drugs other than alcohol and cannabis was 4%. Our study showed that patients with problematic drug use in Martinique is estimated to be 1.936 [95% CI: 964,2907] in a total population of 380.863 (INSEE, 1999). Prevalence rates were 5.0 per thousand among the global population and 7.7 per thousand in the adult population aged 15-64 years.

Conclusions: Our study is the first to provide relevant data on the extent of problematic drug use in Martinique for health policies and decision-makers.

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. ADHD is commonly treated with medication, such as methylphenidate, but some families and practitioners prefer psychosocial interventions as first line treatments. Many studies have investigated neurofeedback as a potential non-pharmacological treatment for ADHD yielding contradictory findings regarding its efficiency. Qualitative research on neurofeedback in ADHD is limited and can add valuable information on the acceptability and perceived efficacy among service users. This study aimed to explore the perceptions and experiences of children and adolescents with ADHD regarding the use of neurofeedback and methylphenidate. Eleven interviews with children and their parents explored their subjective experiences and perceived changes. Overall, neurofeedback was negatively experienced by those families: the intervention did not meet their expectations, and they reported minimal observed changes. The treatment with methylphenidate, however, was more manageable for families and was perceived to be more efficient despite its side effects.

The author shares her experience as patient and epidemiologist with bipolar disorder and cancer. She explains why stigma was more challenging to bear with bipolar disorder than with cancer. This account also includes the perspective of two psychiatrists who provided her medical care. This paper aims to share a message of hope with patients with psychiatric diseases and offer some thoughts to help to reduce a patient's stigma.