Vanessa Milhiet

Bio: Vanessa Milhiet is an academic researcher from Pierre-and-Marie-Curie University. The author has contributed to research in topics: Mental health & Psychological intervention. The author has an hindex of 5, co-authored 7 publications receiving 87 citations.

Treatment use in a prospective naturalistic cohort of children and adolescents with catatonia.

Abstract: We aimed to (1) describe the treatment used in a large sample of young inpatients with catatonia, (2) deter- mine which factors were associated with improvement and (3) benzodiazepine (BZD) efficacy. From 1993 to 2011, 66 patients between the ages of 9 and 19 years were consecu- tively hospitalized for a catatonic syndrome. We prospec- tively collected sociodemographic, clinical and treatment data. In total, 51 (77 %) patients underwent a BZD trial. BZDs were effective in 33 (65 %) patients, who were asso- ciated with significantly fewer severe adverse events (p = 0.013) and resulted in fewer referrals for electrocon- vulsive therapy (ECT) (p = 0.037). Other treatments included ECT (N = 12, 18 %); antipsychotic medications, mostly in combination; and treatment of an underlying medical condition, when possible. For 10 patients, four different trials were needed to achieve clinical improvement. When all treatments were combined, there was a better clinical response in acute-onset catatonia (p = 0.032). In contrast, the response was lower in boys (p = 0.044) and when posturing (p = 0.04) and mannerisms (p = 0.008) were present as catatonic symptoms. The treatment response was independent of the underlying psychiatric or systemic medical condition. As in adults, BZDs should be the first-line symptomatic treatment for catatonia in young patients, and ECT should be a second option. Additionally, the absence of an association between the response to treatment and the underlying psychiatric condition suggests that catatonia should be considered as a syndrome.

Early interventions for youths at high risk for bipolar disorder: a developmental approach.

Abstract: In recent decades, ongoing research programmes on primary prevention and early identification of bipolar disorder (BD) have been developed. The aim of this article is to review the principal forms of evidence that support preventive interventions for BD in children and adolescents and the main challenges associated with these programmes. We performed a literature review of the main computerised databases (MEDLINE, PUBMED) and a manual search of the literature relevant to prospective and retrospective studies of prodromal symptoms, premorbid stages, risk factors, and early intervention programmes for BD. Genetic and environmental risk factors of BD were identified. Most of the algorithms used to measure the risk of developing BD and the early interventions programmes focused on the familial risk. The prodromal signs varied greatly and were age dependent. During adolescence, depressive episodes associated with genetic or environmental risk factors predicted the onset of hypomanic/manic episodes over subsequent years. In prepubertal children, the lack of specificity of clinical markers and difficulties in mood assessment were seen as impeding preventive interventions at these ages. Despite encouraging results, biomarkers have not thus far been sufficiently validated in youth samples to serve as screening tools for prevention. Additional longitudinal studies in youths at high risk of developing BD should include repeated measures of putative biomarkers. Staging models have been developed as an integrative approach to specify the individual level of risk based on clinical (e.g. prodromal symptoms and familial history of BD) and non-clinical (e.g. biomarkers and neuroimaging) data. However, there is still a lack of empirically validated studies that measure the benefits of using these models to design preventive intervention programmes.

Changes in the Use of Emergency Care for the Youth With Mental Health Problems Over Decades: A Repeated Cross Sectional Study.

Abstract: To understand whether changes exist in the types of youths mental health problems addressed in emergency in a context of increasing demand, we conducted a retrospective chart review in an emergency care outpatient unit. Data from children and adolescents admitted at four different time periods (years 1981, 1992, 2002, and 2017) were compared to determine trends in terms of patients' characteristics, nature of the mental health problems and final care decisions. Between 1981 and 2017 there was a 3.85 times increase in the annual number of patients presenting to the emergency consultations. The proportion of youths being referred for anxiety or depressive symptoms sharply increased over time, while no differences were found for the proportion of aggressive behaviors and suicidal attempts. Anxiety disorders became the most frequent discharge psychiatric disorder in youths admitted in the emergency unit, rising from 5% in 1981 to 34% in 2017. Significant changes were also observed in the source of referral to the emergency unit; in particular emergency consultations in 2017 were about twice as likely as in 1981 to be requested directly by the family. This data suggested that the increased use of emergency services observed over the last decades is associated with significant changes in the patient and his/her family's demands about mental health difficulties. Such findings are worth considering for mental health interventions that aim to address the emergency overcrowding issue.

Prise en charge du trouble bipolaire de type 1 chez l’enfant et l’adolescent

Abstract: Resume La prevalence du trouble bipolaire (TB) type I est estimee a 0,1 % chez l’enfant et l’adolescent. Bien qu’il soit rare, un interet grandissant est porte a ce trouble compte tenu du pronostic severe de la maladie, du retentissement fonctionnel et du risque suicidaire eleve. Ce diagnostic est complexe, en partie a cause des comorbidites plus frequentes a cet âge, des specificites developpementales de l’expression clinique et du recoupement symptomatique avec d’autres troubles (comme le trouble deficitaire attention-hyperactivite, TDAH). Alors que chez les adolescents, la presentation est proche de celle de l’adulte, chez les enfants prepuberes, les symptomes sont plus souvent chroniques sans retour clair a une phase d’euthymie ; l’irritabilite et la labilite emotionnelle sont souvent au premier plan. Cette presentation ne repond que rarement aux criteres de trouble bipolaire type I (TB-1) ; le diagnostic de trouble bipolaire non specifie (TB-NOS) est alors souvent pose chez ces enfants aux Etats-Unis, ce qui a contribue a une inflation du diagnostic ces dernieres annees. Les etudes sur de telles dysregulations emotionnelles de l’enfant ne retrouvent pas de continuite avec le TB a l’âge adulte, mais une evolution plus frequente vers un trouble depressif. Pour mieux identifier ces patients et eviter l’amalgame avec le TB, le diagnostic de Disruptive Mood Dysregulation Disorder (DMDD) a ete propose dans le DSM-5. Au plan de la prise en charge, l’objectif des traitements pharmacologique et psychosocial est de traiter l’episode aigu, de prevenir la rechute, d’ameliorer le fonctionnement global intercritique et de prevenir le risque suicidaire. Plusieurs traitements medicamenteux ont ete evalues dans le TB-1 de l’adolescent dans des essais randomises en double insu. Aux Etat-Unis, outre les sels de lithium, quatre antipsychotiques ont l’AMM pour l’episode maniaque aigu de l’adolescent a partir de 10 a 13 ans (risperidone, olanzapine, aripiprazole et quetiapine). En France, les sels de lithium ont l’AMM a partir de 16 ans ; l’aripiprazole a partir de 13 ans. Les essais therapeutiques sur les autres formes de TB sont peu concluants. Plusieurs strategies psychotherapeutiques individuelles et familiales ont aussi ete proposees.

Dysrégulation émotionnelle et comportementale sévère : une nouvelle entité pour des enfants irritables ?

Abstract: Resume Le trouble de dysregulation emotionnelle et comportementale severe est un nouveau diagnostic relativement peu connu. Il est integre dans la classification du DSM 5 sous le terme de disruptive mood dysregulation disorder pour DMDD. Cette entite a ete isolee a partir des travaux anglo-saxons sur les troubles bipolaires de l’enfant pre-pubere. Ces enfants souffrent de symptomes thymiques d’allure hypomaniaque ou dysphorique accompagnes de reactions de coleres explosives ayant un retentissement important sur leur environnement familial et scolaire. Ce trouble apparait precocement et evolue de facon chronique et non episodique. On retrouve un mauvais controle emotionnel, ainsi qu’une incapacite a acceder a l’euthymie et a un attachement secure chez ces enfants. L’objet de cet article est de rappeler les controverses qui ont conduit a l’elaboration de cette entite en particulier les travaux sur les troubles bipolaires pediatriques. Nous avons examine les arguments scientifiques qui plaident en faveur de son individualisation. Nous avons aussi etudie les liens avec d’autres troubles psychiatriques comorbides, dont le trouble deficitaire de l’attention avec hyperactivite. Notre discussion est illustree par deux vignettes cliniques.

Cognitive-Behavioural Therapy for Severe and Recurrent Bipolar Disorders: Randomised Controlled Trial

Abstract: Background: Efficacy trials suggest that structured psychological therapies may significantly reduce recurrence rates of major mood episodes in individuals with bipolar disorders. Aims: To compare the effectiveness of treatment as usual with an additional 22 sessions of cognitive-behavioural therapy (CBT). Method: We undertook a multicentre, pragmatic, randomised controlled treatment trial (n = 253). Patients were assessed every 8 weeks for 18 months. Results: More than half of the patients had a recurrence by 18 months, with no significant differences between groups (hazard ratio = 1.05; 95% CI 0.74–1.50). Post hoc analysis demonstrated a significant interaction (P = 0.04) such that adjunctive CBT was significantly more effective than treatment as usual in those with fewer than 12 previous episodes, but less effective in those with more episodes. Conclusions: People with bipolar disorder and comparatively fewer previous mood episodes may benefit from CBT. However, such cases form the minority of those re...

A Clinical Review of the Treatment of Catatonia

Abstract: Catatonia is a severe motor syndrome with an estimated prevalence among psychiatric inpatients of about 10%. At times, it is life-threatening especially in its malignant form when complicated by fever and autonomic disturbances. Catatonia can accompany many different psychiatric illnesses and somatic diseases. In order to recognize the catatonic syndrome, apart from thorough and repeated observation, a clinical examination is needed. A screening instrument, such as the Bush-Francis Catatonia Rating Scale, can guide the clinician through the neuropsychiatric examination. Although severe and life-threatening, catatonia has a good prognosis. Research on the treatment of catatonia is scarce, but there is overwhelming clinical evidence of the efficacy of benzodiazepines, such as lorazepam, and electroconvulsive therapy.

The Course of Subthreshold Bipolar Disorder in Youth: Diagnostic Progression From Bipolar Disorder Not Otherwise Specified

Abstract: OBJECTIVE To determine the rate of diagnostic conversion from an operationalized diagnosis of bipolar disorder not otherwise specified (BP-NOS) to bipolar I disorder (BP-I) or bipolar II disorder (BP-II) in youth over prospective follow-up and to identify factors associated with conversion. METHOD Subjects were 140 children and adolescents recruited from clinical referrals or advertisement who met operationalized criteria for BP-NOS at intake and participated in at least one follow-up evaluation (91% of initial cohort). Diagnoses were assessed at follow-up interviews using the Longitudinal Interval Follow-Up Evaluation. The mean duration of follow-up was 5 years and the mean interval between assessments was 8.2 months. RESULTS Diagnostic conversion to BP-I or BP-II occurred in 63 subjects (45%): 32 (23%) to BP-I (nine of whom had initially converted to BP-II) and 31 to only BP-II (22%). Median time from intake to conversion was 58 weeks. First- or second-degree family history of mania or hypomania was the strongest baseline predictor of diagnostic conversion (p = .006). Over follow-up, conversion was associated with greater intensity of hypomanic symptoms and with greater exposure to specialized, intensive outpatient psychosocial treatments. There was no association between conversion and exposure to treatment with particular medication classes. CONCLUSIONS Children and adolescents referred with mood symptoms that meet operationalized criteria for BP-NOS, particularly those with a family history of BP, frequently progress to BP-I or BP-II. Efforts to identify these youth and effectively intervene may have the potential to curtail the progression of mood disorders in this high-risk population.

Prevalence of Catatonia and Its Moderators in Clinical Samples: Results from a Meta-analysis and Meta-regression Analysis

Abstract: Catatonia is an independent syndrome that co-occurs with several mental and medical conditions. We performed a systematic literature review in PubMed/Scopus until February 2017 and meta-analyzed studies reporting catatonia prevalence. Across 74 studies (cross-sectional = 32, longitudinal = 26, retrospective = 16) providing data collected from 1935 to 2017 across all continents, mean catatonia prevalence was 9.0% (k = 80, n = 110764; 95% CI = 6.9-11.7, I2 = 98%, publication bias P 1000 (2.3%, 95% CI = 1.3-3.9, I2 = 99%, k = 16). Meta-regression showed that smaller sample size (P < .01) and less major depressive disorder (P = .02) moderated higher catatonia prevalence. Year of data collection did not significantly moderate the results. Results from this first meta-analysis of catatonia frequencies across time and disorders suggest that catatonia is an epidemiologically and clinically relevant condition that occurs throughout several mental and medical conditions, whose prevalence has not decreased over time and does not seem to depend on different rating scales/criteria. However, results were highly heterogeneous, calling for a cautious interpretation.