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

Introduction: Electroconvulsive therapy (ECT) is an effective and widely used treatment for managing severe and/or resistant psychiatric disorders. Historically, the bitemporal setup (BT) and the age-based dosing method (ABM) have been the most common approaches. However, more recent practices, including the titration method (TM), right unilateral (RUL) electrode placement, and pulse width reduction, appear to have comparable efficacy and better tolerability. The primary objective of this study was to evaluate clinical outcomes before and after the implementation of these new practices at Sainte-Anne Hospital (GHU psychiatrie & neurosciences), the largest psychiatric hospital in Paris, France.

Method: This retrospective study included adult patients who underwent an acute course of ECT between December 2022 and May 2024. Clinical and sociodemographic data, stimulation parameters (electrodes placement, ABM vs. TM, charge difference between first and last session), and seizure characteristics (seizure duration and postictal suppression during first and last session) were collected from medical records. Data were compared and analyzed before and after the implementation of the new practices and according to the dosing method (ABM vs. TM). For treatments with TM the administered charge determined by the TM was also compared with the theoretical charge determined by ABM. As not all data followed a normal distribution, comparisons of quantitative data were made using the Mann-Whitney or Kruskal-Wallis test. Categorical data were compared using Chi² test.

Results: Data from 75 patients were included, of whom 72 completed the course of ECT and were included in the analysis of efficacy and tolerability. Compared with the previous practices, the new practices resulted in a significant reduction in charge increase between the first and the last session (P<0.01) and a trend toward less frequently perceived memory disturbances (-21%, P<0.10), with no significant differences in sociodemographic data or seizure characteristics (P>0.05). There was a trend towards more full responders with the new practices (+15%), albeit the difference was statistically non-significant. Compared with ABM, TM resulted in a significant reduction in charge difference (P<0.001) and a trend toward less perceived memory disturbances (-23%, P<0.10) with no significant differences in other variables (P>0.05). In patients who received ECT with the TM, the administered charge was significantly lower than the theoretical charge (P<0.01).

Conclusion: The new ECT practices improve tolerability, especially regarding memory, while maintaining clinical efficacy by using reduced electrical charges. These findings highlight the importance of personalizing ECT protocols to optimize tolerability without compromising efficacy.

Objective: Exercise offers trans-diagnostically numerous mental health benefits. Mental health professionals play a crucial role in prescribing exercise to their patients. However, there is limited research on exercise prescription behavior among French-speaking mental health professionals. This study aimed to translate the Exercise in Mental Illness Questionnaire (EMIQ-HP) into French, validate it cross-culturally and evaluate the psychometric properties of the translated version.

Methods: We followed guidelines for the cross-cultural adaptation of self-rating questionnaires to translate the EMIQ-HP and tested its 7-day test-retest reliability in a sample of 46 French-speaking Belgian mental health professionals. Reliability was assessed using intra-class correlations (ICC) and Cohen's kappa (κ).

Results: The items and scales of the French version of the questionnaire (EMIQ-Fr) demonstrated ICCs ranging from 0.41 to 0.77 and κ values from 0.42 to 0.71, with all items exhibiting either moderate (≥0.41) to substantial (≥0.61) 7-day test-retest reliability. ICCs for subscales ranged from 0.44 to 0.84 with scales exhibiting either moderate (≥0.41) to almost perfect (≥0.81) 7-day test-retest reliability.

Conclusions: The EMIQ-Fr is the first standardized French language questionnaire designed to assess mental health professionals' views on exercise in mental disorders. Its application in future research could enhance our understanding and support of patients with mental disorders in achieving or maintaining health-beneficial levels of exercise.

The Conners Teacher Rating Scale revised: short (CTRS-R: S) is a widely used psychometric instrument to screen for Attention Deficit and Hyperactivity Disorder (ADHD) as well as a broader construct of abnormal child behavior. In this study, we aimed to examine the network structure of abnormal child behavior using the CTRS-R: S in a sample of 525 French-speaking primary school students from Belgium. We employed Bayesian network analysis to estimate both the 28-item network and the network with the 8 items with the highest strength centrality, using the PC algorithm and bootstrapping to estimate the figures. Our study uncovered associations between inattention symptoms and learning disorders, shedding new light on the complexity of abnormal child behavior. We also identified different network structures, revealing a fresh perspective on the underlying mechanisms of these conditions. Our findings, though preliminary, are consistent with previous research and add to the burgeoning literature on Bayesian network analysis in abnormal child behavior research. Overall, our study underscores the complexity of the construct of abnormal child behavior and the importance of considering multiple factors in screening and diagnosis, emphasizing the need for a comprehensive approach to understanding and treating these disorders.

In March 2025 the French Minister of Justice announced that, beginning at the end of July 2025, the prisons of Vendin-le-Vieil and Condé-sur-Sarthe would host approximately 200 individuals convicted of drug trafficking within newly established units specifically designed to address organized crime. Incarceration conditions in these high-security facilities will be extremely strict, with the explicit goal of severing incarcerated people's contact with the outside world. The detrimental effects of solitary confinement on incarcerated people's health are well-documented, and numerous international conventions and treaties stipulate that such measures should be used only in exceptional circumstances, as a last resort, and for the shortest time possible. This article examines the role of healthcare professionals within these high-security units. To what extent can the principle of equivalence of care - according to which incarcerated individuals must receive healthcare equivalent to that provided to the general population - be upheld in this context? We address the issue of the ethical responsibility of healthcare professionals working in facilities where conditions of incarceration are known to have deleterious effects on the health of incarcerated individuals.

Objective: To explore the limitations of psychiatric dangerousness assessments in Belgium, France, the UK, and the Netherlands, and to assess whether systematic and structured risk assessment, supported by enhanced forensic psychiatry skills and interdisciplinarity, could improve involuntary care decisions.

Methods: Comparative analysis of legislative frameworks (Belgian law of 26 June 1990, amended in 2024; French Public Health Code; Mental Health Act 1983; Compulsory Mental Health Care Act 2020; Wet verplichte geestelijke gezondheidszorg 2020) and assessment practices based on literature and statistical data.

Results: Compulsory measures have been strongly increasing in Belgium, France, the UK, and the Netherlands for over a decade. Subjective dangerousness assessments, based on vague legal criteria not recently revised, show significant variability in Belgium and France where structured tools are absent, unlike the UK and the Netherlands which are developing initiatives around risk assessment, notably with the HCR-20 V3 to structure decisions. These tools demonstrate validated predictive accuracy but would require essential training for implementation.

Conclusions: Implementing structured tools, combined with interdisciplinary and forensic psychiatry training inspired by the Nixon line, could reduce subjective biases, stigma, and trauma pending studies confirming their effectiveness.

Introduction: Alexithymia is a central concept in understanding the psychological vulnerability to eating disorders. Associations between alexithymia and distinct components of interoception have previously been reported in healthy individuals and those with mental health problems. From a therapeutic perspective, it is important to determine whether such associations exist for adolescents with anorexia nervosa and which domains of interoception (i.e., accuracy [IAc], awareness [IAw], and sensibility [ISe]) are concerned.

Method: A cross-sectional study was conducted on twenty 12-17-year-old hospitalized adolescent girls with restrictive anorexia nervosa (M=14years±1.59, mean BMI of 15.59). The heartbeat detection task (HBDT) assessed IAc and IAw. The Porges Body Perception Questionnaire (PBPQ) was used for ISe, the Children-Toronto Alexithymia Scale (CTAS) for alexithymia, alongside the Child Depressive Inventory (CDI) for depression, the ECAP for anxiety, and the Difficulties in Emotion Regulation Scale-Youth scale (DERS-Y) for emotional dysregulation.

Results: The error rate at the HBDT was negatively correlated with the CTAS sub score "Externally-oriented thinking" but no other CTAS sub scores or other clinical dimensions. The association between IAw and the CTAS sub-score "Externally-oriented thinking" failed to remain significant after Bonferroni correction. The PBPQ total score was positively correlated with the CDI total score and the ECAP fear sub score.

Conclusion: Among adolescents hospitalized for anorexia nervosa, the more accurate the detection of heart rate, the more frequently operative thinking was reported, while a high level of ISe was associated with anxiety and depression-related symptoms. The mechanisms underlying the relation between the discrimination of body perception and emotional processing may vary across psychiatric disorders.