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

Introduction: Genetic polymorphisms in genes encoding enzymes metabolizing psychotropics drugs result in various isoenzymes with different catalytic efficacies. Of particular interest, some of these isoenzymes are highly catalytic leading to an ultrarapid metabolism (UM) of their substrate medication, which in turn results in lower medication concentrations and possibly poor clinical outcomes, including a higher risk for suicidal behavior. In this study, we investigate the role of CYP2D6 (metabolizing most antidepressant medications) and CYP2C19 (important in metabolizing antipsychotics) UM isoenzymes on suicidal behavior among a cohort of patients with schizophrenia.

Methods: One hundred and seventy-eight patients diagnosed with schizophrenia were recruited from the day hospital of a regional psychiatric academic hospital. Lifetime suicide attempts were compared between groups of patients stratified according to their enzymatic profile. Several socio-demographics and clinical covariates were controlled for.

Results: Among the 178 patients, 16 and 44 were UM as determined by their CYP2D6 and CYP2C19 genotype respectively. Univariate analysis showed a significant association between suicidal attempts and CYP2D6 and CYP2C19 UM status (P=0.041 and P=0.029 respectively). These associations remained significant in multivariate analyses (adjusted for age, sex, dose exposure and antidepressant use…) for both CYP2D6 (P=0.020, OR=4.096, 95% CI [1.25-13.48]) and CYP2C19 (P=0.016, OR=2.680, 95% CI [1.21-5.95]).

Conclusion: This study suggests that the UM phenotypes for both CYP2D6 and CYP2C19 are associated with an increased risk for suicide attempts in patients with schizophrenia.

Objectives: Substance use disorders are of worldwide public health interest. Local estimates of problematic drug use provide useful indicators to regional public health agencies in developing prevention and treatment programs. The purpose of the current study was to estimate the prevalence of problematic drug use in Martinique.

Methods: The capture-recapture method was applied to a multisource data collection (eight specialized drug and two law enforcement sources) to provide an estimate of drug use (opiates, cocaine hydrochloride, crack (cocaine base), stimulants and/or hallucinogens). Data collection was organized over a period of six consecutive months (September 2005 to March 2006) and concerned all persons residing in Martinique longer than three months and who had consumed at least one of the studied drugs in the month prior to the study.

Results: We identified 287 cases (86% male; mean age 36.1±9.6 years), 98% of whom had used crack. Comorbid use of illicit drugs other than alcohol and cannabis was 4%. Our study showed that patients with problematic drug use in Martinique is estimated to be 1.936 [95% CI: 964,2907] in a total population of 380.863 (INSEE, 1999). Prevalence rates were 5.0 per thousand among the global population and 7.7 per thousand in the adult population aged 15-64 years.

Conclusions: Our study is the first to provide relevant data on the extent of problematic drug use in Martinique for health policies and decision-makers.

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. ADHD is commonly treated with medication, such as methylphenidate, but some families and practitioners prefer psychosocial interventions as first line treatments. Many studies have investigated neurofeedback as a potential non-pharmacological treatment for ADHD yielding contradictory findings regarding its efficiency. Qualitative research on neurofeedback in ADHD is limited and can add valuable information on the acceptability and perceived efficacy among service users. This study aimed to explore the perceptions and experiences of children and adolescents with ADHD regarding the use of neurofeedback and methylphenidate. Eleven interviews with children and their parents explored their subjective experiences and perceived changes. Overall, neurofeedback was negatively experienced by those families: the intervention did not meet their expectations, and they reported minimal observed changes. The treatment with methylphenidate, however, was more manageable for families and was perceived to be more efficient despite its side effects.

The author shares her experience as patient and epidemiologist with bipolar disorder and cancer. She explains why stigma was more challenging to bear with bipolar disorder than with cancer. This account also includes the perspective of two psychiatrists who provided her medical care. This paper aims to share a message of hope with patients with psychiatric diseases and offer some thoughts to help to reduce a patient's stigma.

Objectives: Studies on suicidal behaviors in the French overseas territories remain rare. Although mental health resources are limited, some patients identified as being at risk of suicide do not attend the specialist consultations scheduled after identification or screening. Thus, the objective of our study was, firstly to provide a descriptive profile of patients followed up for a suicide attempt in Martinique and Reunion Island, and secondly to explore the risk factors associated with appointments no-show during follow-up.

Methods: We conducted an ancillary retrospective cross-sectional study using data from the APSOM study. Data were collected on 255 patients aged at least 16, admitted to hospital emergency departments after a suicide attempt and followed up in ambulatory care, including 137 in Martinique and 118 in Reunion Island. The characteristics of the sample were described by means [min, max] and proportions [95% confidence intervals]. Differences according to the presence of appointments no-show or not were analyzed using comparison tests of means and percentages (Chi², Fisher and Wilcoxon). Factors associated with appointments no-show were analyzed using a bootstrapped multivariate logistic regression model.

Results: The mean age of patients was 35 years [16-84 years]. Women were predominant with a sex ratio of 2.4:1 (71% women). Unemployment affected 37% [28%, 46%] of patients in Martinique and 49% [40%, 59%] in Reunion Island. Psychoactive substances consumption at the time of the suicidal act was observed in 36% [27%, 45%] of patients in Martinique and 34% [26%, 44%] in Reunion Island. The average number of suicide attempts was two per patient [1-20]. Finally, we found no significant association with appointments no-show except for center. Patients from Reunion Island were associated with better compliance than patients from Martinique (OR: 0.20 [0.05-0.65], P<0.012).

Conclusion: Our study provides a description of suicide attempts admitted to hospital and followed up in ambulatory care in two French overseas territories and suggests interesting approaches for adapting prevention strategies to the socioeconomic context and cultural realities of these territories, particularly outreach interventions for the most vulnerable patients.

Objectives: Electroconvulsive therapy is known as an efficient therapy, which is sometimes recommended for the management of severe and resistant depression. However, ECT is associated with cognitive adverse effects. The study of the neurobiological correlates of the cognitive adverse effects of ECT has been covered in few published reviews. However, these mechanisms have been investigated in an increasing number of studies in recent years, particularly in neuroimaging. This systematic review of the literature focuses on correlates between changes in structural or functional neuroimaging and impairment of cognitive functions during the ECT treatment.

Methods: We conducted a systematic review of the literature using PRISMA methodology. Searches were performed on the Medline and Web of Science databases using the following equation: "electroconvulsive therapy AND (MRI OR fMRI OR DTI OR neuroimaging) AND depression AND cogniti*".

Results: This article highlights the significant heterogeneity of the results. In structural imaging, approximately 50% of the studies did not report any correlation between volumetric changes and neuropsychological changes. In studies that did highlight a correlation, the latter was mainly reported with changes in the hippocampus. From a functional perspective, we highlighted a correlation between changes in the connectivity of the hippocampal region and cognition.

Conclusion: These results demonstrate a growing interest in understanding the neurobiological mechanisms underlying cognitive disorders secondary to ECT treatment. The ultimate aim behind this understanding is to adopt a more effective prevention strategy vis-à-vis these adverse effects.

Objectives: This work aimed to assess the association between sleep apnea syndrome (SAS) and opioid substitution treatments (OST) dose/timing of administration in patients receiving methadone or buprenorphine for an opioid use disorder (OUD).

Methods: We conducted a retrospective cross-sectional study by including files of adult patients treated between November 2015 and January 2023 with methadone or buprenorphine and who had a nocturnal respiratory polygraphy. We collected information on treatments and polygraphical recording data such as the apnea-hypopnea index (AHI).

Results: We enrolled 60 patients on methadone and 15 on buprenorphine. The sample encompassed 72% of males, and the mean age was 36±7.49years. Moderate to severe and severe SAS were significantly associated with the daily dose and the evening administration but was not predicted by the type of OST. However, the mean and median values of AIH were significantly greater with methadone. Contrary to methadone, there was no significant correlation between the buprenorphine daily dose and the AHI. The best sensitivities and specificities for the prediction of an AHI≥15 events/h and an AHI≥30 events/h were respectively obtained with methadone dose thresholds of 77.5mg/day.

Conclusions: In this sample, the methadone daily dose of 77.5mg was the best cut-point to predict moderate to severe SAS, especially while taken in the evening, and we found no correlation between buprenorphine and the AHI. These results draw clinicians' attention to buprenorphine use as an alternative for patients treated with methadone and having SAS.

Introduction: Psychiatry is an area of medicine that is particularly exposed to the risks of cognitive bias, notably because diagnosis is subjective. However, psychiatrists may develop psycho-cognitive skills that protect against bias, as the reflective approach to their patients favors the activation of system 2 (logical) as opposed to system 1 (intuitive) processes. Furthermore, the collegial practices found in psychiatry, a consequence of the ethical questions psychiatrists must address, can also mitigate the impact of bias. On the other hand, clinical ethics committees have adopted structured deliberation practices that aim to improve collective decision-making and limit the cognitive biases associated with groupthink.

Objective: The primary aim was to compare blind spot bias in a group of psychiatrists and a group of 'ethicists', experts in group deliberation. The secondary objective was to study the distribution of skills influencing the balance between systems 1 and 2 (notably, ethical deliberation, feeling of efficacy, mindfulness, and values) in both groups. The general hypothesis is that psychiatrists are less prone to blind spot bias and are more competent in the skills studied.

Methods: This descriptive, cross-sectional study was conducted from April 2022 to May 2023. Thirty-two psychiatrists were recruited from several French hospitals, along with 20 'ethicists'. All participants completed the following self-administered questionnaires: the Bias Blind Spot Scale (French version), the Euro Moral Case Deliberation (Euro-MCD, ethical skills), Bandura's self-efficacy scale (self and collective efficacy), the Freiburg Mindfulness Inventory (mindfulness), and the Schwartz Value Survey (values).

Results: The ratio of self/other blind spot bias was lower in the 'ethicists' group than the psychiatrists' group (P<0.001). Euro-MCD scores were higher (P<0.001) and psychiatrists tended to have a better sense of collective efficacy (P=0.08). No significant difference was found between the two groups for total mindfulness or presence and acceptance sub-scores. Scores for hedonic value were higher among psychiatrists (P<0.02).

Conclusion: The results do not confirm our hypotheses. There is less evidence of blind spot bias among our sample of 'ethicists', who are experts in group deliberation, than psychiatrists, who have experience of the patient/physician dyad. The ethical skills that are developed within the formal deliberation process seem particularly interesting in terms of reducing cognitive bias.