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

Objective: In 2019, a regional survey of potentially inappropriate prescriptions (PIP) of psychotropic drugs in elderly psychiatric inpatients was carried out highlighting their inappropriate use in this population. The aim of this study was to assess the clinical relevance - defined as the provision of an appropriate and necessary treatment, chosen from other alternatives as being the most likely to produce the expected results for a given patient - of these prescriptions considered inappropriate according to current established criteria.

Material and method: Patients aged over 75, or 64 to 75 and polypathological with at least one PIP of psychotropic drugs or drugs with a high anticholinergic burden, identified by an audit grid established on the basis of STOPP/STARTv2 criteria and the Laroche list on the prescription at 48h of hospitalization, were included. The weighing of the inappropriateness nature of the prescription (resistance to treatment, period of crisis, comorbidities…) was established by a pharmacist-psychiatrist pair on the entire computerized record of the current episode. The clinical relevance of the PIP and the overall prescription was rated as 0 (irrelevant), 1 (partially relevant) or 2 (relevant).

Results: Thirty-four patients were included. One hundred and twenty-five PIP of psychotropic drugs were noted: 50.4% concerned benzodiazepines and non-benzodiazepines anxiolytics (BZD/Z), 25.6% neuroleptics (NL), 12% antidepressants (ATD) and 12% drugs with a high anticholinergic burden. On one hand, 49.2% of PIP of BZD/Z, 50% of PIP of NL and 20% of PIP of ATD were considered irrelevant. On the other hand, 49.2% of PIP of BZD/Z, 31.3% of PIP of NL and 13.3% of PIP of ATD were considered partially relevant. Furthermore, 1.6% of PIP of BZD/Z, 18.8% of PIP of NL and 66.7% of PIP of ATD were considered relevant. For PIPs of drugs with a high anticholinergic burden, 80% were deemed irrelevant, 13.3% partially relevant and 6.7% relevant. In all, of the 34 drug prescriptions studied, three (8.8%) were considered irrelevant, 11 (32.4%) partially relevant and 20 (58.8%) clinically relevant.

Conclusion: This study highlighted the clinical relevance of more than half the prescriptions considered inappropriate according to current PPI criteria in the elderly. It underlines the interest of a new PPI detection tool for elderly patients with psychiatric disorders.

Objective: Pain in children and adolescents with autism spectrum disorders remains underdiagnosed due to their inherent communication difficulties. The goal of this review is to identify the most suitable methods for assessing pain in this population and for evaluating the specific perceptions of, or behavioural reactions to, pain whilst considering disorder severity and specifiers (with or without accompanying intellectual impairment, with or without accompanying language impairment).

Method: A systematic review and analysis of the international literature was conducted.

Results: Fourteen studies were selected. No difference was found in pain-related behaviours based on the age or gender of children or adolescents with autism. Three studies showed pain-related behaviours in autism spectrum disorders to be similar to control groups. Other studies showed specific behavioural responses in autism spectrum disorders with a longer physiological and behavioural recovery time associated with an episode of acute pain in this population. Similarly, the three studies that focused on sensory perceptions of pain all showed differences in the autism spectrum disorders population compared to control groups. In hospital or daily life contexts, studies essentially showed idiosyncratic expressions, hypervigilance, motor agitation, negative emotional reactions, or vocalizations. Regarding the association of autism severity with hyposensitivity to pain, the results remain unclear even when language disorders or intellectual disabilities are also present (in conjunction with autism). The Non-Communicative Children Pain Checklist and its translation into French and Italian showed good internal validity and was used by almost half of the studies in hetero-assessment, mostly by parents. Studies recommend the inclusion of parents in the assessment in order to optimise the evaluation process. Similarly, analysis of parent/child/caregiver interviews from the studies highlights the importance of personalizing pain assessment of children and adolescents, taking into account subject-specific characteristics, pathology, and context.

Conclusion: An integrative and personalized approach to pain assessment appears to be the most appropriate for enhancing the understanding and detection of pain in individuals with autism spectrum disorders. This approach aligns well with a care setting where a nominated professional with a good expertise in autism is responsible for pain assessment. Given the complexity of identifying pain in individuals with autism, further qualitative studies, in conjunction with new pain exploration technologies, are considered necessary as well as a more extensive categorization of the population studies.

Autism spectrum disorders (ASD) are neurodevelopmental disorders of varying intensity and disability. The reference health strategy in France for the care of young children with autism is day care hospital (DCH). As the number of places in DCH is insufficient, medically coordinated care programs by the mental health consultation centers (MHCC) are being developed in response.

Objectives: Our objective is to evaluate the effectiveness of a medically coordinated care program in a MHCC versus the care in DCH of child psychiatry.

Methods: Non-inferiority retrospective study comparing the evolution after one year of care of 20 ASD children divided into two groups DCH and MHCC. In the DCH ASD group, the child is taken care of two half-days a week in a day hospital with individual educational care. In the MHCC ASD group, the child benefits from a medically coordinated care program. The medical care is reinforced by more frequent and longer consultations with guidance offered to parents. In both groups, the child receives speech therapy and psychomotor therapy in private practice at the same rate. Comparison is made using a composite criterion associating CARS-2 and VABS-II. Non-inferiority of the medically coordinated care program in autism in reference to DCH was tested on the difference between the changes (DCH group variation - MHCC group variation) with a non-inferiority threshold of 10% of the initial value of each score.

Results: We observed a reduction in autism severity at the CARS-2 and a moderate improvement in socio-adaptive behavior at the VABS-II in both groups. This trend was even more pronounced in the MHCC group than in the DCH group, but only the greater reduction in CARS-2 severity in the MHCC was statistically significant.

Conclusions: As it is necessary to integrate the two scales into the composite criterion, it is not possible to retain the non-inferiority of the MHCC with care program. However, both those children followed in DCH and those in the MHCC care program progress. This shows the relevance of the care offered at the MHCC for children suffering from ASD, in the context of a growing lack of space in DCH. The continuation of this research work through multicenter studies with larger numbers could demonstrate the non-inferiority of coordinated care programs in the MHCC versus DCH. It would also allow subgroups to be set up, taking into account the initial characteristics of the children in order to have more precise indications concerning the relevance of each treatment.

This work is a descriptive cross-sectional study that aimed to assess by means of an online survey the well-being and psychological impact, mainly depression, anxiety, stress and post-traumatic stress disorder (PTSD), experienced by the general population after the end of lockdown following the COVID-19 pandemic. In this study, we used the PCL-S scales to assess PTSD and the DASS scale to assess depression, anxiety, and stress related to end of quarantine. Our study found that following the decontamination related to COVID-19, the psychological impact was not negligible with a significant prevalence of occurrence for several psychological disorders. We found depression (68.8%), anxiety (57.47%), stress (45.50%) and post-traumatic stress disorder (31.5%) in the subjects of our study. Following the decontamination related to COVID-19, the psychological impact was found to be as important or even more serious than the other situations that preceded it. The development of a database allowing us to understand the effect of the decontamination on the mental health of Moroccans could be useful in order to watch and prevent the occurrence of complications for psychological disorders such as depression, anxiety, stress or even a state of post-traumatic stress.

Objective: The aim of this study was to determine French psychiatrists' level of general knowledge about dissociative identity disorder and to evaluate their perceptions of this condition.

Methods: In this study, French psychiatrists were invited by e-mail to answer an online survey. The questionnaire asked about their general knowledge and perceptions of dissociative identity disorder.

Results: We received 924 answers including 582 complete questionnaires. The survey revealed that almost two-thirds (60.8%) of psychiatrists working in France had never received any training on dissociative disorders and 62% had never managed patients suffering from dissociative identity disorder. Only 19.5% of them claimed to believe unreservedly in the existence of the diagnosis of dissociative identity disorder. The psychiatrists' confidence in diagnosing or treating dissociative identity disorder was low (mean confidence in diagnosis: 3.32 out of 10 (SD 1.89), mean confidence in treatment: 3.1 out of 10 (SD 1.68)). Fifty percent believed that dissociative identity disorder is an entity created by cinema, medias or social networks. Seventy-seven point seven percent thought that confusion with borderline personality disorder is possible, and 41.3% with schizophrenia.

Conclusion: In France, there is a lack of training and knowledge about dissociative identity disorder, as well as persistent skepticism about the validity of the diagnosis. Specific training seems essential for a better understanding of dissociative identity disorder.

Objectives: Schizophrenia (SZ) and bipolar disorders (BP) are chronic and severe neuropsychiatric diseases. These disorders are tightly related to immune deregulations. In the current study, we intended to replicate the previously reported involvement of the soluble HLA-E isoforms (sHLA-E) in the risk of developing the two conditions along with disease severity in a Tunisian population group.

Patients and methods: One hundred and twenty-four patients with schizophrenia and 121 with bipolar disorder meeting the DSM-IV criteria along 111 healthy controls were included in this present case-control study. The soluble HLA-E isoforms circulating levels were measured using the ELISA method. The statistical analyses were performed using Kruskal-Wallis and Wilcoxon rank sum tests by R software and GraphPad prism 9.

Results: We found that the sHLA-E circulating levels were significantly higher in BP patients as compared to healthy controls (P<0.0001) and that such increases were mainly observed in patients during an acute phase of their disease (P<0.0001). In SZ patients, while we failed to observe an association with the levels of sHLA-E in the entire SZ sample, we found that high sHLA-E levels characterized stabilized patients in comparison with those during an acute episode (P=0.022). Finally, we did not observe any association between sHLA-E circulating levels and symptoms assessed by the classical clinical scales either in BP or SZ patients.

Conclusion: Overall, the present findings replicate in a Tunisian population group the previously demonstrated implication of sHLA-E circulating levels in the risk of developing BP or SZ in a French patient cohort. Such replication allows to consider HLA-E as a potent and true inflammatory marker in the context of the two disorders.

Background: The number of patients consulting with suicidal thoughts and behavior in the health care centers have increased since the Covid-19 pandemic. This increase has been particularly important among adolescents. Most often these patients are diagnosed with anxiety or depressive symptoms. We only have a limited amount of information on depression and STB in adolescents since epidemiological monitoring in health care institutions is based on computerized coding derived from ICD-10. This coding system is very specific for the different forms of depression yet fails to provide accurate coding for suicidal thoughts and behavior. The objectives of this study were to compare the numbers of adolescents with depression who were admitted with suicidal thoughts and behavior before and after the initial Covid-19 lockdown and to highlight possible gender disparities.

Methods: Patients' medical charts for this retrospective research were obtained from the Department of Adolescent Psychiatry at the University Hospital Centre of Reunion Island, manually screened, and then analyzed. We included all adolescents diagnosed with depression who had had their first consultation between January 1, 2019 and July 31, 2021. The number of patients presenting suicidal thoughts, self-harm and suicide attempts were compared before and after the initial Covid-19 lockdown.

Results: Three hundred and sixty-one adolescents diagnosed with depression participated in the study (33.5% males, 66.5% females). Their average age was 16 (SD=1.7). The number of admitted patients increased from 9 to 16 new adolescents with depression and STB each month between the period before and after the first lockdown, with a large proportion of female patients (increase of 74.1%).

Conclusion: This study showed an increase in the number of adolescents consulting for suicidal thoughts or behavior in an adolescent psychiatry department in Reunion Island after the initial Covid-19 lockdown. They were mainly female. This increase has strained an already overburdened mental health system by doubling the number of adolescents that each health care provider has had to help which increases the risk of inadequate care by rapidly increasing the workload but with constant resources.

Pregnancy is a period of heightened risk period for many psychiatric disorders, particularly anxiety disorders. However, there is limited knowledge regarding the usage of psychotropic medications during pregnancy. Over the past decade there has been a notable increase in the use of medications during pregnancy, with benzodiazepines being the primary choice for alleviating anxiety. It is important to note, though, that benzodiazepines have been associated with various risks for both pregnancy and newborns. In Lebanon, to date, there has been no study estimating the prevalence of the use of benzodiazepines during pregnancy. Our study aims to find the prevalence of benzodiazepines use in a population of pregnant women in Hôtel-Dieu Hospital, a tertiary care center in Beirut, and the medical center of Saint-Joseph University and to compare our results to international literature. To accomplish our objectives we administered questionnaires to over two hundred women who had recently given birth in the gynecology department. These forms encompassed inquiries about benzodiazepine consumption, as well as various medical and socio demographic details. In total, we interviewed 225 women who gave birth at the Hôtel-Dieu de France between the months of December 2019 and February 2020 and between the months of February 2021 and October 2021 in the gynecology department. The questionnaires included socio demographic, medical, and psychiatric information as well as questions about the use of benzodiazepines. We found a significantly lower prevalence of benzodiazepine use among these women compared to the figures reported in international literature. The approval of the ethics committee was obtained on December 19, 2019 after making sure that this study raised no ethical objections. (File number: CEHDF 1533).