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

Aim: Sudden cardiac death occurs mainly outside of the hospital, placing witnesses in a pivotal role to intervene and enhance the survival. We aim to investigate its potential psychological repercussions on both the patient and the witness.

Outcomes: Incidence of acute stress disorder and/or post-traumatic stress disorder among patients and their relatives at 3 and 6 months following sudden cardiac death.

Methods: All patients admitted for resuscitated sudden cardiac death at our institution between 2019 to 2021 were screened. Within 15 days following resuscitated sudden cardiac death, both the patients and one of their relatives underwent face-to-face interviews with dedicated questionnaires. At 3-6 months post-event, participants were contacted by phone to complete the questionnaires.

Results: Twenty-two patients (6 females, 51±11yo) and 23 relatives (13 females, 49±15yo) were included. The reason for sudden cardiac death was ischemic (n=9/22) or dilated cardiomyopathies (n=5/22), idiopathic ventricular fibrillation (n=4/22) or others (4/22). Relatives exhibited a higher magnitude of acute stress compared to patients (26±25 vs 48±20, P<0.001). Five persons were lost to follow-up (2 patients and 3 relatives). Nevertheless, 4/20 (20%) patients and 3/20 (15%) relatives were diagnosed with post-traumatic stress disorder.

Conclusions: Post-traumatic stress disorder in patients/relatives is frequent after resuscitated sudden cardiac death (20 to 15%). It is crucial to maintain close vigilance since patients remain susceptible to the future onset of post-traumatic stress disorder, even when they manifest milder symptoms of acute stress. Offering early interventions for relatives may serve as a preventive measure.

Introduction: Borderline Personality Disorder (BPD) affects 1 to 3% of the general population and up to 20% of psychiatric inpatients. It is characterized by emotional dysregulation, impaired interpersonal relationships, and impulsive behaviors. This systematic review aims to identify psychopathological mechanisms, comorbidities, and gender differences associated with violence in BPD.

Methods: This review followed PRISMA guidelines and included studies published in English or French with no time restriction. Literature searches were conducted in PubMed and Ovid using the search equation: ((violence [MeSH Terms]) or (aggression [MeSH Terms])) and (borderline personality disorder [MeSH Terms]) and (psychiatry). Of 502 initial publications, 28 were included in the final analysis.

Results: Aggressiveness in BPD was found to be associated with emotional dysregulation and impulsivity, influencing violent behaviors (β=0.25 to 0.52). Comorbidities such as bipolar disorder, substance use, or co-occurring personality disorders exacerbated aggression (OR=2.1 to 3.2). Suicidal and self-harming behaviors affected 78% of adolescents and 73% of adults with BPD. Women accounted for 75% of BPD diagnoses and presented more self-directed aggression (suicide, self-harm), whereas men more frequently exhibited outwardly directed aggression. Finally, childhood trauma and dysfunctional family environments were seen as major predictors of aggressive and suicidal behaviors in adulthood (OR=3.9 to 5.8).

Conclusion: Findings highlighted the central role of emotional dysregulation, impulsivity, and early trauma in BPD-related aggression. Clinical implications include the need for targeted therapies (e.g., DBT, MBT), early screening for trauma, and gender-sensitive approaches. This review underscores the interaction between biological, psychological, and social factors in BPD-associated violence and calls for personalized interventions and the integration of longitudinal research designs.

Objectives: The aim of this study was to examine the relationship between psychoeducation for relatives (PER) following a first-episode psychosis (FEP), as well as the impact of this PER on the mental health of these relatives.

Methods: We conducted an observational study of patients who experienced a FEP and underwent psychoeducation (PE) about it (FEP - PE). We divided the sample into two groups according to the achievement of PER. The assessment of post-FEP outcome was based on subsequent diagnosis of schizophrenia, bipolar disorder, schizoaffective disorder, or major depressive episode, as well as subsequent hospitalization in a mental health unit. Mental health of relatives was assessed using the Center for Epidemiological Studies Depression Scale (CES-D), the State-Trait Anxiety Inventory Form Y (STAI-Y1 and 2), and the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS).

Results: We enrolled 51 patients, 28 of whom had at least one relative who had benefited from PER. We found no significant association between PER and outcome after FEP. We found a positive and significant effect of PER on relatives' anxiety. The effect on depressive symptoms and well-being was positive but not significant.

Conclusions: This study found promising results regarding the psychological impact of PE for relatives of patients with an FEP but no significant impact on the evolution of the FEP. This work suggests the extension of PE to improve the mental health of relatives and further studies regarding the effect on the evolution of FEP.

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.