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

Objectives: This survey explores the experience of French patients suffering from insomnia disorder, focusing on their perception of the disorder and their therapeutic journey to identify gaps in their care pathway. The main objectives included assessing the impact of insomnia disorder on daily life, well-being, and awareness of treatment options.

Methods: The survey was performed at the end of 2022 and included 150 French patients aged 35 to 65years suffering from chronic insomnia disorder according to the DSM-5 criteria. Participants were recruited from a national online panel managed by IPSOS via an electronic pre-screening questionnaire (community/non-hospital setting). A 20-item questionnaire was used to assess perception of sleep, the impact of insomnia symptoms, and views on the therapeutic options proposed to them.

Results: Seventy-one percent of respondents with clinical insomnia associated "good quality sleep" with uninterrupted sleep and feeling refreshed in the morning. Mental stress and having an overactive brain were perceived as the main factors contributing to insomnia for 73% and 38% of clinical insomnia patients, respectively. Insomnia disorder significantly impacted patients' daily functioning, with many reporting difficulties in work performance (61%), poor concentration (73%), and anxiety (39%). A large portion of respondents also expressed concerns over forgetfulness (53%) and diminished social and emotional well-being (up to 67%). Although multiple diagnostic and therapeutic guidelines exist for insomnia treatment, only 19% of participants received educational support, and 79% had never been referred for cognitive behavioral therapy for insomnia (CBT-I), considered to be the first-line treatment. Most patients (79%) would like to have access to more educational content about insomnia.

Conclusion: This survey highlights the substantial impact of insomnia disorder on patients' lives, extending beyond sleep quality to affect overall well-being and work performance. It points toward important gaps in current treatment practices, especially non-pharmacological approaches. Improving clinicians' awareness of evidence-based approaches and resources is key to improved insomnia disorder care and patient outcomes.

Introduction and objectives: A 2011 study on general practitioners' (GP) management of major depressive disorders (MDD) revealed limited treatment options, predominantly pharmacotherapy. Since then, France has implemented mental health initiatives, including "Mon Soutien Psy", covering up to 12 psychologist sessions by health insurance (8 during our study). The program "Dispositif de Soins Partagés en Psychiatrie" (DSPP) is a specific scheme implemented in the Occitanie region (South of France) with the aim of improving collaboration between psychiatrists and GPs at a local level. The aim of this study was to investigate MDD care management in primary care according to the implementation of these new schemes.

Methods: We reused the 2011 case vignette survey, adding items related to new schemes. The survey was done by means of electronic-questionnaires sent to GPs by the regional Union of Health professionals in three different French administrative areas (Bouches-du-Rhône and Ille-et-Vilaine, with "Mon Soutien Psy", and Haute-Garonne for the DSPP).

Results: In total, 158 GPs completed the survey - 69.0% from Haute-Garonne - for a total response rate of 3.4%. Compared with the 2011 survey, there was a significant increase in the number of GPs managing patients in collaboration with a specialist (6.3 versus 3.3%; P<0.05) and assessing the situation before prescribing an antidepressant (44.2 versus 10.7%; P<0.00001). GPs were mostly from Haute-Garonne (DSPP area). Attitudes towards psychotherapies had improved since 2011, though some misconceptions persisted. Barriers were no longer the reimbursement or the patient's reluctance to undergo psychotherapy but rather the overly long wait to get an appointment. Overall, MDD management in primary care aligned more closely with the guidelines.

Conclusion: Results indicate positive trends: GPs show greater adherence to MDD management guidelines and a willingness to consult specialists while handling cases independently. Nonetheless, further improvements are necessary with larger studies needed for validation. Recent mental health programs likely contributed to these advancements.

Introduction: France is poised to legalize Medical Aid in Dying (MAiD). Such a law may have potential implications for mental healthcare.

Methods: We conducted an anonymous survey of 168 French psychiatrists between June and July 2024 to assess familiarity with the proposed law, willingness to participate in MAiD, and perceived ethical implications.

Results: Eighteen percent of psychiatrists were unaware of the draft law, while only 9% had precise knowledge. Thirty-seven percent expressed a willingness to participate in MAiD for their patients. Concerns emerged around differentiating rational end-of-life requests from suicidal ideation driven by potentially treatable mental disorders such as depression.

Discussion: The absence of psychiatric assessment in the proposed legislation raises ethical and clinical dilemmas, particularly given the high prevalence of underdiagnosed depression in severe medical conditions. Psychiatrists find themselves balancing suicide-prevention mandates with respect for patient autonomy.

Objectives: To assess the clinical and socio-demographic characteristics of patients hospitalized for heart failure (HF) with schizophrenia or psychotic disorder comorbidity.

Method: We conducted an observational study from the national French PMSI database. We included patients hospitalized with a principal diagnosis of HF between 2019 and 2023, with and without a secondary diagnosis of schizophrenia or psychotic disorder. In total, we included 693,398 HF patients, 7368 with and 686,030 without schizophrenia or psychotic disorder.

Results: Men with HF and schizophrenia or psychotic disorder were on average eight years younger (69.9 vs. 77.8 years), and women were four years younger (79.4 vs. 83.6 years) than men and women without this comorbidity. Overall, HF patients with schizophrenia or psychotic disorder were more often women (57.9 vs. 49.9%) and had a higher prevalence of obesity (29.9 vs. 22.6%), chronic obstructive pulmonary disease (19.6 vs. 14.2%), and stroke (12.6 vs. 10%). The length of stay was longer in patients with schizophrenia (11.7 vs. 10.2 days). Men with HF and schizophrenia or psychotic disorder were on average ten years younger than women with this pathology (69.9 vs. 79.4 years) and had a higher prevalence of myocardial infarction (13.7 vs. 8.3%).

Conclusion: Patients with HF and schizophrenia or psychotic disorder are younger than HF patients without this comorbidity. Despite the younger age, patients with schizophrenia or psychotic disorder have a higher burden of comorbidities and a longer length of stay. Patients with schizophrenia or psychotic disorder, especially men, need close follow-up to prevent the early occurrence of HF.

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.