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

Introduction: Despite the evidence and expert opinion that many adults with autism spectrum disorder (ASD) face barriers to formal diagnosis, qualitative studies examining adult patients' experience and requirements for better access to the diagnosis are still lacking.

Aims: To qualitatively explore the pre-diagnosis experiences of adults with ASD, the impact of receiving a diagnosis, and the need for improved access to diagnosis both for adults with ASD and for adult psychiatrists.

Methods: Sixteen semi-structured interviews were conducted (11 adults diagnosed with ASD and 5 psychiatrists). A mixed deductive-inductive thematic analysis was employed.

Results: Several factors contributing to delayed diagnosis were identified including difficulties accessing healthcare, limited awareness of ASD among some clinicians, the use of camouflaging behaviors by participants, and family adaptation to their symptoms. Receiving a diagnosis was often described as a relief, allowing participants to understand past social difficulties and seek better acknowledgment and accommodation from their environment. The analysis highlighted the need to reduce wait times and service costs, as well as to enhance clinicians' knowledge of ASD to improve accessibility and satisfaction with diagnosis. Participants also noted the complex interplay between media portrayals of ASD and public understanding of the disorder.

Conclusions: Increased education for mental health professionals and broader public awareness campaigns are necessary to facilitate timely access to appropriate diagnosis and support services.

Objectives: Trauma-related nightmares (TRNs), core features of post-traumatic stress disorder (PTSD), partially or fully replicate the traumatic event and are often associated with nocturnal awakenings and significant emotional distress. In light of the imminent withdrawal of prazosin in France, this review explores the potential of doxazosin as a pharmacological alternative while emphasizing the central role of psychotherapeutic interventions in TRNs management.

Methods: Following a brief overview of TRNs and existing therapeutic strategies, both pharmacological and non-pharmacological, this review examines the available evidence on doxazosin, a selective α₁-adrenergic receptor antagonist, and proposes a practical initiation protocol for clinicians.

Results: Although limited and heterogeneous, the literature suggests that doxazosin may reduce the frequency and intensity of TRNs and improve sleep continuity, particularly in patients with marked adrenergic hyperactivation or those who previously responded to prazosin. Tolerance is generally good and extended-release formulations enable convenient nocturnal dosing. However, randomized controlled trials have produced mixed results due to small sample sizes, population heterogeneity, and comorbidities such as alcohol-related disorders. Across studies, psychotherapeutic interventions remain the most evidence-based and durable treatment for TRNs, and pharmacological options are best considered as adjuncts within an integrated care pathway.

Conclusions: Doxazosin may represent a pragmatic pharmacological option for managing TRNs in PTSD, especially in the context of prazosin withdrawal. Its use should complement, rather than replace, first-line psychotherapeutic approaches and be integrated into a comprehensive, coordinated, and individualized treatment plan with careful monitoring of adverse effects. Larger, well-designed randomized controlled trials are needed to determine optimal dosing, treatment duration, and predictors of response.

Background: In France, the judicial control of involuntary hospitalization by the "custody and liberty judge" (Juge des libertés et de la detention, JLD) is systematic. However, the way it is perceived by incarcerated individuals' involuntary hospitalization in specially adapted hospital units (Unités hospitalières spécialement aménagées, UHSA) remains unknown. This study aimed to: (i) explore how incarcerated patients hospitalized in UHSA under involuntary psychiatric care experience and understand the JLD hearing; and (ii) compare these aspects based on the hearing format (videoconference vs. in-person).

Methods: We conducted a questionnaire-based survey at the Lille-Seclin UHSA during two periods: from January 14th, 2021 to May 2nd, 2021 (videoconference hearings) and from October 7th, 2021 to March 31st, 2022 (in-person hearings) among involuntarily hospitalized adult male patients.

Results: A total of 56 out of 68 eligible patients agreed to complete the questionnaire (response rate: 82%). Our results showed that people imprisoned and involuntary hospitalised were fairly satisfied with their hearing before the JLD and that they felt they understood the issues involved. Around 60% of respondents felt that they had been listened to by the JLD and that their rights had been respected during the hearing. However, 40% perceived that the hearing concerned their criminal status (whereas both systems are independent). No statistically significant differences were found between the "Videoconference" and "In-person" groups.

Conclusion: Our findings suggest that incarcerated patients hospitalized under involuntary psychiatric care in UHSA are generally satisfied with the JLD hearing, regardless of whether it takes place via videoconference or in person. However, the hearing appears to blur the distinction between psychiatric care and the judicial process, an issue that healthcare professionals should address with particular attention.

Objectives: Between 2004 and 2014 the cannabis clinic at Lariboisière Hospital in Paris received cannabis users seeking treatment. The objective was to identify what distinguishes (1) cannabis users with lifetime anxiety and/or mood disorders from users without such disorders, and (2) users according to the age of onset of cannabis use, the first anxiety disorder, and the first mood disorder.

Methods: Three hundred and forty-two heavy cannabis users were assessed for sociodemographic characteristics and addictive and psychiatric comorbidity (DSM-IV).

Results: Logistic regression analysis was carried out to distinguish cannabis users with comorbidity (n=234) from users without (n=71): women were more numerous (aOR=7.02; P<10^-3), the number of criteria for past cannabis dependence was higher (aOR=1.43; P<10^-3), and the users were older (OR=1.06; P=2×10^-3). Latent class analysis identified three classes: C1 (50%) (age of onset of cannabis use preceded age of onset of anxiety and mood disorders); C2 (27.3%) (age of onset of mood and anxiety disorders preceded age of onset of cannabis use); C3 (22.7%) (age of onset of anxiety disorders preceded age of onset of cannabis use and onset of mood disorders).

Conclusions: These three classes differ significantly in terms of lifetime anxiety disorder, lifetime social anxiety disorder, and parental separation/divorce rates: C1 (63.3%, 27.4%, 34.2%), C2 (82.8%, 50%, 41.7%), C3 (100%, 69.8%, 54.9%). Taking into account parental separation/divorce, and by extension adverse childhood experiences, is essential when studying the impact of the age of onset of cannabis use on the occurrence of anxiety and mood disorders.

Introduction: Attention deficit disorder with or without hyperactivity (ADHD) affects between 2% and 3% of the world's adult population. In France, there is a noticeable lack of understanding of adult ADHD, which is still too often considered a childhood disorder and is sometimes the cause of a delayed diagnosis for these patients.

Method: To assess the diagnostic experience of people diagnosed with ADHD during adulthood, we carried out a quantitative study with a self-questionnaire proposed to 201 patients aged 17 or over, as well as a qualitative study with 8 patient interviews.

Results: In our sample of respondents, 47% felt that they had had a difficult to very difficult diagnostic journey. Throughout the diagnostic process, patients diagnosed with ADHD in adulthood were confronted with various factors influencing their experience, some of which cannot be modified (age, gender, personal experiences, characteristics of the disorder, etc.), and some of which may have had an impact on the direction this process took. For the rest, the patient's surroundings and the encountered care providers played a major role in the patient's experience of the people around him/her and their beliefs, the patient him/herself, or the physicians met, and their responses and attitudes towards the patient. These factors were all evaluated in this study. Interview analysis of these patients' experiences reflected the serious consequences of misdiagnosis. Even though ADHD has been recognized and defined for many years, the persistence of controversy, beliefs and even misinformation, with disagreements sometimes even within the medical profession, have impacted the patient's journey. However, the diagnosis of ADHD, albeit later in life, is generally well accepted by patients who express relief from the guilt associated with their past experiences. This diagnosis also helps reduce the consumption of medical treatments, because of an adapted care, and represents a key for these patients to understand their own identity.

Conclusion: The diagnostic journey for adult ADHD sufferers is long and difficult. Efforts to raise awareness of adult ADHD, both among medical staff and the general public, as well as the introduction of tools to help facilitate this diagnostic journey still need to be developed.

Introduction and objectives: Posttraumatic stress disorder is a common diagnosis in the French population. Current treatments are based on first-line trauma psychotherapies (CBT, exposure therapy, EMDR, and narrative therapy), accompanied by medication, particularly antidepressants. The role of hypnosis in the treatment of posttraumatic stress has been little studied and not yet defined in the literature, despite partially common dissociative processes between hypnosis and posttraumatic stress symptoms.

Method: In our PRISMA systematic review, randomized or uncontrolled clinical trials were included from five databases (PubMed, Web of Science, Google Scholar, PsycInfo, PubPsy).

Results: The 12 articles selected are heterogeneous in terms of population characteristics and study design. The excessive heterogeneity of the studies required the following individual description of the results and hypnosis protocols for each study.

Discussion: A majority of the articles reported complete or partial effectiveness of hypnosis on posttraumatic symptoms and their progression, as well as an improvement in associated depressive and anxiety symptoms. The heterogeneity of methods raised questions about the criteria for assessing psychological trauma and its impact, hypnosis protocols, and the place of hypnosis among internationally recognized trauma therapies.

Introduction: Our study aimed to measure the prevalence of service use and adequate treatment in health students and to compare medical, dental and pharmacy specialties.

Methods: In 2021, we conducted a survey at Université Paris Cité for dental and pharmacy students. Data for medical students came from a national study conducted during the same period, using the same procedure. We used the Composite International Diagnostic Interview Short-Form (CIDI-SF) questionnaire to evaluate the presence of Major Depressive Disorder (MDD) in the last year. We asked the subjects if they had consulted health professionals or used pharmacotherapy for psychological problems in the previous year.

Results: Our sample comprised 1595 students, with very few dental students (N=76), few pharmacy students (N=187) and a vast majority of medical students. Among all students, 30% suffered from MDD, 31% used any pharmacological treatment, 16% anxiolytics, 9.5% hypnotics and 9% antidepressants. Among students with MDD, 33% received adequate treatment, including 30% recommended psychotherapy and 20% recommended pharmacological treatments. Pharmacy and preclinical students (medical students in year 2 or 3) consulted less often a psychiatrist and received less adequate treatment, recommended psychotherapy and recommended pharmacological treatments than the other students.

Discussion: In our study, we found a high prevalence of psychotropic use among health students but only 33% of students with MDD received adequate treatment.

Conclusion: This underlines the need for better detection of psychiatric disorders in health students and improved treatment for them. Specific attention is needed for pharmacy students.

Introduction: The prevalence of psychiatric disorders in young adults increased with the COVID-19 pandemic. The prevalence of mental disorders among physiotherapy students increased. Our study aimed to present the results on the mental health status of physiotherapy students in France since the COVID-19 pandemic.

Methods: An online cross-sectional survey was performed between October 1st 2023 and November 5th 2023. Anonymous questionnaires were sent to physiotherapy students via academic emails by all physiotherapy schools in France. We assessed the prevalence of depressive symptoms, generalised anxiety symptoms, burnout, eating disorder symptoms, 12-month major depressive disorder and 12-month suicidal ideation, humiliation, sexual harassment, and sexual assaults. Multivariate logistic regression was performed to identify factors associated with major depressive disorder and suicidal ideation.

Results: Among the 12,568 physiotherapy students, 1280 responded (response rate: 10.2%) and were included. The prevalences of depressive symptoms, anxiety symptoms, eating disorder symptoms, 12-month major depressive disorder, and 12-month suicidal ideation were 25%, 23%, 21%, 11% and 11%, respectively. Humiliation, sexual harassment and sexual aggression were reported by 19%, 1.8% and 0.7%, respectively. In multivariable analyses, curriculum year and sexual violence were associated with higher rates of major depressive episodes and suicidal ideation.

Conclusion: This survey is the first to be carried out on French physiotherapy students at a distance from the peak of the COVID-19 pandemic. It revealed a high prevalence of various mental issues. The results of this survey highlighted the urgent need for action to improve the mental health of physiotherapy students in France.

Objectives: A growing body of research has recently highlighted that informant-report is a unique and too often neglected source of personality information. Several personality questionnaires have a form that can be filled out by informants, including the second version of the Big Five inventory (BFI-2), which uses 60 items to assess five major personality dimensions or domains and 15 facets. However, researchers sometimes need shorter questionnaires. The objective of this study was to verify the psychometric properties of the two short forms of the BFI-2 informant-report.

Methods: We asked 1445 students of psychology and sports science and technology to describe a person they know well, and we obtained the complete description of 1380 people. We used exploratory structural equation models to analyze the factor structure of the two sets of items making up the 30-item BFI-2-S, which provides the assessment of the "Big Five" domains and 15 facets (6 items per domain, 2 items per facet), and the 15-item BFI-2-XS which only provides the assessment of the Big Five. We assessed the psychometric properties of the scales measuring the big five domains using conventional indices, and the psychometric properties of the BFI-2-S facets based on the significance and magnitude of the observed and residual correlations between the two items of which they are composed.

Results: The analyses showed excellent fits to the data of the five-factor models. For both questionnaires, almost all items had a high loading on the expected factor, and the cross-loadings overall were small. The correlations between the factors were also small, which indicated discriminant validity. The correlations of the short form scales with the full BFI-2 scales were very large, including the facet scales of the BFI-2-S, indicating excellent concurrent validity. Multigroup analyses suggested differential functioning of certain items, but the magnitude of this bias was small to negligible and insufficient to explain differences according to the gender and age of the people described.

Discussion: The two short forms of the informant-report BFI-2 presented the expected factorial structure and had satisfactory psychometric properties. When the informants were students, they provided reliable and valid descriptions of older people, engaged in family, professional and social life and who often were not available to participate in personality studies. However, it is unknown whether this conclusion can generalize to less educated informants.

Conclusion: The 30-item BFI-2-S and the 15-item BFI-2-XS informant-report forms provide a valid substitute for the full BFI-2 when external circumstances limit the time available for data collection, provided that it is possible to call on reliable informants.