Showing papers in "Encephale-revue De Psychiatrie Clinique Biologique Et Therapeutique in 2019"
TL;DR: A multiplicity of sham stimulation protocols, used in the tDCS research field, might have different biological effects beyond the intended transient sensations, and it is sought to enlighten the scientific community to this possible confounding factor in order to increase reproducibility of neurophysiological, cognitive and clinical tDCS studies.
Abstract: Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique increasingly used to modulate neural activity in the living brain. In order to establish the neurophysiological, cognitive or clinical effect of tDCS, most studies compare the effects of active tDCS to those observed with a sham tDCS intervention. In most cases, sham tDCS consists in delivering an active stimulation for a few seconds to mimic the sensations observed with active tDCS and keep participants blind to the intervention. However, to date, sham-controlled tDCS studies yield inconsistent results, which might arise in part from sham inconsistencies. Indeed, even if most studies report using similar approaches as described in an early study by Gandiga et al. (2006,) [1] , the original protocol (i.e., 10 s ramp-up followed by 30 s of active stimulation at 1 mA before manually turning off the stimulator) has been largely modified, adjusting (a) the intensity and duration of active current being delivered (from “no current” to 2 minutes at 1 mA), (b) the duration of ramp-in and ramp-out phases (e.g. 5–30 s), and (c) the number of ramps done throughout the stimulation. Therefore, this multiplicity of sham stimulation protocols, used in the tDCS research field, might have different biological effects beyond the intended transient sensations. Here, we seek to enlighten the scientific community to this possible confounding factor in order to increase reproducibility of neurophysiological, cognitive and clinical tDCS studies.
45 citations
TL;DR: Exogenous melatonin proves to be useful among patients with a stabilized psychiatric disorder or in remission, to prevent relapse in case of associated complaints of insomnia, poor quality sleep or delayed sleep phase syndrome.
Abstract: Melatonin is a hormone secreted by the pineal gland at night. This hormone has many physiological functions, the main one being to synchronise individuals' biological rhythms. Exogenous melatonin has the same chronobiotic action, even at small doses (0.125mg). In addition, a sleep-inducing (soporific) action appears to occur in a dose-effect relationship, i.e. as the dose increases. In psychiatric disorders, these two effects could have interesting applications in clinical practice. The French institute of medical research on sleep (SFRMS) appointed a group of experts to conduct a consensus conference to study the indications of melatonin and the conditions of its prescription. An account of the conclusions on adult psychiatric disorders (presented orally at the Congress on Sleep in Marseille, 23 November 2017) is given here. Exogenous melatonin proves to be useful among patients with a stabilized psychiatric disorder or in remission, to prevent relapse in case of associated complaints of insomnia, poor quality sleep or delayed sleep phase syndrome. During acute phases, melatonin could be used as an adjuvant treatment when there are insomnia symptoms, in mood disorders (bipolar disorder, major depressive disorder, seasonal affective disorder), in attention deficit hyperactivity disorder (ADHD), in peri-surgical anxiety and in schizophrenia. In somatoform disorders, melatonin is a possible treatment for painful symptoms in fibromyalgia, irritable bowel syndrome, functional dyspeptic syndrome and temporomandibular joint dysfunction.
38 citations
TL;DR: A significant empathy decline was displayed over time for medical students; women reported significant higher empathy scores than men; and, in their first year, medical students presented significant higher sympathy scores than commercials.
Abstract: Objectives Empathy is central in patient-physician interactions and understanding its development is decisive for education. However, scientific literatures report a striking decline of empathy among medical students during their study course. Firstly, we aimed to replicate this result on a Belgian population. Secondly, as well reported by literature, we expected higher empathy scores for women. Lastly, as central, we expected higher empathy levels for medical students than for “control” students (commercial students were used as a control group: social interactions without a curing aspect) at the beginning of their study course, suggesting that empathy drives students to select specific education fields. Methods Through a cross-sectional design, we assessed students from medical and commercial educations at different years of study with the Basic Empathy Scale (N = 1602). We compared: (1) empathy scores at different scholar levels for both populations; (2) scores between men and women; (3) empathy scores between medical and commercial students in their first year of study. Results As expected, a significant empathy decline was displayed over time for medical students; women reported significant higher empathy scores than men; and, in their first year, medical students presented significant higher empathy scores than commercials. Conclusions Replicating the empathy decline on several student populations is crucial, especially by using different tools. This decline is a multi-factorial process that mainly reflects self-representation changes. The empathy gender bias is a strong effect observed in several empathy-linked phenomena. Finally, empathy is not only central but also drives students to select specific education fields.
35 citations
TL;DR: The factors that should be taken into account in a transdisciplinary approach to evaluate the use of EEG NFB as a therapeutic tool in psychiatry are analyzed and neurofeedback is investigated, demonstrating that it can be considered as a fertile ground for innovative research in psychiatry.
Abstract: The clinical efficacy of neurofeedback is still a matter of debate. This paper analyzes the factors that should be taken into account in a transdisciplinary approach to evaluate the use of EEG NFB as a therapeutic tool in psychiatry. Neurofeedback is a neurocognitive therapy based on human–computer interaction that enables subjects to train voluntarily and modify functional biomarkers that are related to a defined mental disorder. We investigate three kinds of factors related to this definition of neurofeedback. We focus this article on EEG NFB. The first part of the paper investigates neurophysiological factors underlying the brain mechanisms driving NFB training and learning to modify a functional biomarker voluntarily. Two kinds of neuroplasticity involved in neurofeedback are analyzed Hebbian neuroplasticity, i.e. long-term modification of neural membrane excitability and/or synaptic potentiation, and homeostatic neuroplasticity, i.e. homeostasis attempts to stabilize network activity. The second part investigates psychophysiological factors related to the targeted biomarker. It is demonstrated that neurofeedback involves clearly defining which kind of relationship between EEG biomarkers and clinical dimensions (symptoms or cognitive processes) is to be targeted. A nomenclature of accurate EEG biomarkers is proposed in the form of a short EEG encyclopedia (EEGcopia). The third part investigates human–computer interaction factors for optimizing NFB training and learning during the closed loop interaction. A model is proposed to summarize the different features that should be controlled to optimize learning. The need for accurate and reliable metrics of training and learning in line with human–computer interaction is also emphasized, including targeted biomarkers and neuroplasticity. All these factors related to neurofeedback show that it can be considered as a fertile ground for innovative research in psychiatry.
32 citations
TL;DR: EDs and BD are frequently comorbid, suggesting the need for crossed screening of these pathologies, in particular for EDs with purging behaviours and for patients with early BD onset.
Abstract: OBJECTIVE:To assess the association between sub-types of bipolar disorder (BD) (types I and II) and sub-types of eating disorders (EDs) (Anorexia Nervosa, Bulimia Nervosa, Binge-eating disorders) as well as their relative order of occurrence.METHODOLOGY:A systematic review of articles estimating prevalence rates for BD among patients with ED and vice versa. We also analysed all articles assessing their relative order of occurrence.RESULTS:Comorbid BD is common among patients with an ED. From 0.6 to 33.3% of bipolar subjects have an eating disorder. Conversely, from 0 to 35.8% of subjects with an ED can present a BD. This co-occurrence has mostly been observed among patients with anorexia of the bulimic/purging type, with bulimia or with binge-eating disorders. The association is less frequent in cases of anorexia of the restrictive type. In contrast, the BD sub-type does not seem to have an impact on the association with EDs. Whilst age at BD onset is earlier in case of a comorbid ED, age at ED onset does not seem to be impacted by the presence of an associated BD. There has been little data on the relative order of occurrence of the two disorders or on the impact of the thymic phase on the expression of EDs.CONCLUSIONS:EDs and BD are frequently comorbid, suggesting the need for crossed screening of these pathologies, in particular for EDs with purging behaviours and for patients with early BD onset.
21 citations
TL;DR: The prevalence of burn out syndrome is high among university teaching staff in Cameroon and the practice of sport and physical activities and leisures has a protective effect against burnout syndrome.
Abstract: Objectives This study aimed to evaluate the epidemiology of burnout syndrome among university teaching staff in Cameroon; and to establish if the practice of physical activities and leisures could have preventive effect. Methods A cross-sectional study using a self-administered questionnaire on socio-demographic characteristics, socio-professional conditions, Maslach Burnout Inventory-Educator Survey (MBI-ES) to evaluate burnout syndrome, and Ricci-Gagnon metrics to assess level of physical activities practice among grades of teaching staff, in the various faculties of the University of Douala, Cameroon. Results Three hundreds and three teaching staff members aged 43 ± 7 years were included (69% males). The prevalence of burnout syndrome was 68%, distributed within the three dimensions as follows: emotional exhaustion (15.2%), depersonalization (32.1%) and loss of personal accomplishment (22.1%), with 57% low level, 38% moderate and 6% severe. Burnout affected respectively 55.4% lecturers, 38.3% senior lecturers and 6.3% professors. Burnout was significantly associated with poor working conditions (P = 0.0001), unsatisfactory salary (P = 0.0001), part time teaching in private university institutions (P = 0.027), sensation of strenuous job (P = 0.002), conflict with colleagues (P = 0.028), sedentariness (P = 0.007). Sport and physical activities showed significant protective effect against burnout (P = 0.004), the same with leisures (P = 0.016). Conclusion The prevalence burnout syndrome is high among university teaching staff in Cameroon. The practice of sport and physical activities and leisures has a protective effect against burnout syndrome.
20 citations
TL;DR: Notre et al. as discussed by the authors investigated the prevalence of symptomes depressifs chez les sujets âges diabetiques of type 2 diabete and found that 34% avaient depression.
Abstract: Resume Objectifs Notre etude avait pour objectifs d’estimer la prevalence des symptomes depressifs chez les sujets âges diabetiques et d’etudier leurs strategies de coping. Methodes Il s’agissait d’une etude transversale, descriptive et analytique, realisee aupres de 50 sujets âges suivis pour diabete de type 2. Nous avons utilise l’echelle « Activity of Daily Living » pour evaluer le degre de dependance, la « Geriatric Depression Scale » pour le depistage des symptomes depressifs et le « Brief Coping with Problems Experienced » pour l’evaluation des strategies de coping. Resultats Le score « Activity of Daily Living » moyen etait de 4,9. Les patients etaient autonomes dans 28 %, et dependants dans 4 % des cas. Le score « Geriatric Depression Scale » moyen etait de 9,7. Parmi nos patients, 34 % avaient des symptomes depressifs. Une correlation significative etait mise en evidence entre la presence de symptomes depressifs et le tabagisme (p = 0,04), l’absence d’activite de loisir (p = 0,035), les antecedents personnels psychiatriques (p = 0,031), le score ADL (p = 0,028), l’anciennete du diabete (p = 0,04) et la presence d’idee suicidaire (p = 0,013). La strategie de coping la plus mise en place etait celle centree sur le probleme (44 %). Les sujets presentant des symptomes depressifs etaient significativement plus susceptibles d’adopter des strategies de coping centrees sur l’emotion (p = 0,01). Conclusion Notre etude confirme la prevalence elevee de symptomes depressifs chez les sujets âges diabetiques. Ainsi, un depistage regulier d’une eventuelle depression ainsi qu’un accompagnement psychologique sont fortement recommandes, afin d’assurer un meilleur equilibre du diabete et d’ameliorer la qualite de vie.
16 citations
TL;DR: Un retour sur les 10 ans d’experience du reseau national des 10 centres experts schizophrenie Francais is proposed to be proposed, a travers une revue des principales publications scientifiques, toisent a formuler plusieurs recommandations.
Abstract: Resume Objectifs Le present article propose de faire un retour sur les 10 ans d’experience du reseau national des 10 centres experts schizophrenie Francais, a travers une revue des principales publications scientifiques qui en sont issues. Methodes A ce jour, les donnees de plus de 700 patients ont pu etre analysees. Globalement, cette population est composee de trois quarts d’hommes, est âgee en moyenne de 32 ans, la duree moyenne de maladie est d’environ 11 ans, l’âge moyen de debut de maladie est de 21 ans, la duree de psychose non traitee est d’environ un an et demi. 55 % des sujets sont consommateurs de tabac au moment de l’evaluation. Enfin, un focus sera fait sur les projets de recherche multicentriques collaboratifs deployes au sein de ce reseau. Resultats Les principales donnees obtenues peuvent etre resumees comme suit : le syndrome metabolique reste deux fois plus frequent dans la schizophrenie qu’en population generale et n’est pas correctement pris en charge ; des troubles cognitifs specifiques ont ete identifies chez les patients consommateurs de benzodiazepines et chez les patients presentant une inflammation peripherique. Des specificites liees au sexe ont egalement ete observees ; la depression comorbide reste tres frequente, elle est associee a une diminution de la qualite de vie et a une augmentation de la dependance nicotinique chez les fumeurs. Prendre en charge la depression et les symptomes negatifs pourraient fortement ameliorer la qualite de vie des patients ; le delai a l’instauration du traitement est plus long pour les schizophrenies se declenchant avant 19 ans et chez les consommateurs de cannabis. L’adhesion au traitement est diminuee chez les patients rapportant un ressenti subjectif negatif du traitement, independamment de la prise de poids ou d’un syndrome extrapyramidal. Enfin, l’akathisie est tres frequente et fortement associee a la polytherapie antipsychotique. Conclusions Ces resultats conduisent a formuler plusieurs recommandations. Le depistage du trouble et le traitement devraient etre renforces chez les adolescents et les consommateurs de cannabis. Tous les patients devraient beneficier d’une evaluation neuropsychologique au debut de leur trouble, apres stabilisation sous traitement, puis de facon plus espacee au cours de leur suivi. La prise en charge des parametres metaboliques, de l’alimentation et de l’activite physique devrait etre renforcee. La balance benefice/risque de la prescription de benzodiazepines doit etre reevaluee regulierement au regard de son impact notamment sur la cognition. La monotherapie antipsychotique est recommandee autant que possible pour limiter les effets indesirables. La depression reste sous-diagnostiquee et doit faire l’objet d’une evaluation systematique et d’un traitement specifique. La remediation cognitive doit egalement etre plus largement proposee chez les patients presentant des troubles cognitifs.
16 citations
TL;DR: In this paper, the authors propose a synthese des etudes recentes pour soutenir l'interet de maintenir ouverte une reflexion sur les modalites diagnostiques.
Abstract: Resume Introduction Les evolutions actuelles en sante publique amenent les autorites qualifiees a proposer, dans leurs recommandations de bonne pratique pour l’evaluation et le diagnostic des troubles du spectre autistique (TSA), des procedures qui s’appuient sur l’utilisation de l’Autism Diagnostic Interview-Revised (ADI-R) et l’Autism Diagnostic Observation Schedule (ADOS) consideres comme un « gold standard ». Cependant, la problematique du diagnostic differentiel reste pregnante dans la pratique clinique. Objectifs Notre objectif vise a souligner et nuancer les qualites metrologiques de l’ADI-R et de l’ADOS concernant le diagnostic differentiel des troubles autistiques, en proposant une synthese des etudes recentes pour soutenir l’interet de maintenir ouverte une reflexion sur les modalites diagnostiques. Methode Notre revue selective de la litterature recente met en avant les etudes qui confrontent l’ADI-R et l’ADOS, utilises independamment et en combinaison, a diverses problematiques differentielles en clinique adulte et infantile de l’autisme, afin d’en souligner les qualites et les limites. Resultats Les donnees issues de ces outils sont utiles dans le processus diagnostic des troubles du spectre autistique et constituent des preuves diagnostiques solides, a la condition d’une association avec un regard clinique critique. Cependant, ces elements demeurent insuffisants car ces outils manquent de finesse pour l’evaluation des formes autistiques heterogenes et des tableaux cliniques voisins. Conclusions La problematique de diagnostic differentiel reste au premier plan dans la clinique de l’autisme, des lors une formalisation des demarches diagnostiques doit pouvoir rester ouverte et accompagnee d’une demarche clinique creative, en particulier dans les situations complexes peu solubles par les outils diagnostiques classiques.
15 citations
TL;DR: The Arabic version of the MADRS has promising psychometric properties, and thus it is a good tool to use for the diagnosis of patients with depression in Lebanon and can readily be used to estimate the overall severity of depression among psychiatric patients in Lebanon.
Abstract: Aim To use the Arabic version of the MADRS in Lebanese depressed patients, check its validity and reproducibility compared to other versions of the questionnaire and assess risk factors affecting the total MADRS score. Methods This case-control study, performed between September 2016 and January 2017, included 200 patients (100 patients, 100 controls). The questionnaire included two parts, the first one concerning the socio-demographic characteristics another one that included the Montgomery-Asberg Depression Rating Scale (MADRS) questions, which was translated from English to Arabic through an initial translation and back translation process. Results The MADRS scale items converged over a solution of one factor that had an Eigenvalue over 1, explaining a total of 83.90% of the variance. A Kaiser-Meyer-Olkin measure of sampling adequacy of 0.953 was found, with a significant Bartlett's test of sphericity (P Conclusion This study shows that the Arabic version of the MADRS has promising psychometric properties, and thus it is a good tool to use for the diagnosis of patients with depression. Based on this study, health care professionals and researchers can readily use the MADRS questionnaire to estimate the overall severity of depression among psychiatric patients in Lebanon.
14 citations
TL;DR: The ESCAPE (Empirique des Particularites Sensori-psychomotrices dans l'Autisme) (EPSA) as discussed by the authors is a new outil clinique, presentant de bonnes qualites psychometriques.
Abstract: Resume Les troubles sensori-psychomoteurs font partie des signes cliniques necessaires au diagnostic de trouble du spectre de l’autisme. Ils viennent impacter tres precocement les fonctions perceptives et cognitives qui permettent la mise en place d’une communication sociale harmonieuse. Le manque d’outil clinique dans ce domaine a necessite la creation d’une nouvelle echelle : l’Echelle des Particularites Sensori-psychomotrices dans l’Autisme (EPSA). L’EPSA a pour objectif de mesurer l’intensite des atypies sensori-psychomotrices et ainsi d’objectiver des profils singuliers. L’EPSA se compose de 160 items regroupes en 20 variables : toucher, nociception, sensibilite vestibulaire, proprioception, vision, audition, multimodalite, tonus, posture, equilibre, coordination globale, motricite manuelle, schema corporel, conscience psychocorporelle, ajustement a l’autre, expression emotionnelle, utilisation des objets, espace, temps, regulation tonico-emotionnelle. Dans une large population de 111 enfants avec TSA, l’analyse factorielle a permis d’extraire trois facteurs principaux pertinents au niveau clinique et scientifique, intitules : « synchronisation sensori-emotionnelle », « integration multimodale », « competences motrices ». De plus, cette echelle presente une excellente fidelite inter-cotateurs, une bonne validite interne et externe. L’EPSA est un nouvel outil clinique, presentant de bonnes qualites psychometriques, au service du psychomotricien. Elle rend lisibles les particularites sensori-psychomotrices dans l’autisme, et ouvre ainsi de nouvelles perspectives tant pour preciser le projet therapeutique individualise que pour elaborer de nouvelles hypotheses de recherche.
TL;DR: In this paper, the authors propose an algorithm called ALGOS, which combines different strategies dans l'algorithme suivant, such as envois de courriers, remise de carte de crise comportant un numero d'urgence, rappels telephoniques, and envoi de cartes postales personnalisees mensuellement pendant 6 months in cas d'echec de l'appel.
Abstract: Resume Les tentatives de suicide constituent un facteur de risque majeur de recidives et de deces. Les comportements suicidaires sont polyfactoriels et rendent inefficace une strategie unique de prevention. L’adhesion aux soins est mauvaise dans un contexte ou les liens sociaux sont souvent en souffrance. Deux categories de programmes ont montre leur efficacite : les dispositifs d’intervention intensive et les dispositifs de veille. Ces derniers peuvent recouvrir differentes modalites : envois de courriers, remise de carte de crise comportant un numero d’urgence, rappels telephoniques. Un essai controle randomise, ALGOS, a combine ces differentes strategies dans l’algorithme suivant : delivrance d’une carte de crise pour les primosuicidants ; rappel telephonique des non-primosuicidants 15 jours apres leur sortie des urgences ; envoi de cartes postales personnalisees mensuellement pendant 6 mois en cas d’echec de l’appel ; information du medecin traitant. Cette etude a ete adaptee en soins courants en 2015 dans les departements du Nord et du Pas-de-Calais sous le nom de VigilanS. L’algorithme a ete legerement modifie par la remise de la carte de crise a tous. L’equipe de recontact, formee a la gestion de crise, gere tous les appels sortants et entrants vers les patients, leurs proches et leurs soignants. Un jeu de 4 cartes postales peut etre envoye en cas d’appel telephonique non concluant. S’appuyant sur une philosophie de veille, VigilanS a developpe un veritable savoir-faire de gestion de crise, necessitant une supervision medicale constante et de solides capacites de mise en reseau.
TL;DR: In this article, the authors determined the prevalence of troubles mentaux in the population generale au Burkina Faso and identifier les facteurs associes a la survenue of such troubles.
Abstract: Resume Objectifs Determiner a l’aide du « Mini-International Neuropsychiatric Interview » (MINI), la prevalence des troubles mentaux dans la population generale au Burkina Faso ; identifier les facteurs associes a la survenue de ces troubles. Materiel et methode Nous avons procede par une enquete transversale descriptive et analytique sur un echantillon representatif de la population generale âgee d’au moins 18 ans (n = 2587). Resultats Le taux de prevalence des troubles mentaux etait de 41,43 %. Il etait significativement plus eleve chez les femmes que chez les hommes (46,24 % versus 35,01 %; p ≤ 0,001). L’episode depressif etait le trouble le plus frequent au sein de la population enquetee.
TL;DR: L'Encephale -Sous presse as mentioned in this paper is a novel novel based on corrigues par l'auteur. Disponible en ligne depuis le mardi 10 juillet 2018
Abstract: L'Encephale - Sous presse. Epreuves corrigees par l'auteur. Disponible en ligne depuis le mardi 10 juillet 2018
TL;DR: In this paper, a certain nombre de philosophes lont legitime alors que d’autres lont condamne tout au long de l'histoire.
Abstract: Resume Si le suicide reste « le seul probleme philosophique vraiment serieux » (Camus), un certain nombre de philosophes l’ont legitime alors que d’autres l’ont condamne tout au long de l’histoire. Plus recemment, l’un d’entre eux, Michel Cornu (2000), a forge a son sujet l’expression « ethique de l’inquietude ». Cette absence de repos, au sens etymologique, peut s’entendre a la fois a un niveau epistemologique (absence de repos sur un seul savoir constitue, donc necessite d’une approche resolument interdisciplinaire de l’objet « suicide »), mais aussi comme une posture relationnelle, a savoir une absence de repos vis-a-vis de l’autre, autrement dit le souci de l’autre. Nous evoquerons ensuite les sources philosophiques du souci de l’autre depuis la cura de Saint Augustin jusqu’a la responsabilite de Levinas et la sollicitude de Ricœur, en passant par l’inquietude de Kierkegaard et la sollicitude ontologique de Heidegger. Nous terminerons en envisageant les tensions ethiques inherentes a une telle notion, oscillant entre bienveillance et surveillance, et entre justice et equite.
TL;DR: The role of the douleur psychologique in suicide is discussed in this article, where it is argued that l’approche de la problematique suicidaire par l'angle de la douleure and de la deconnexion sociale permet d'envisager des avancees pour ameliorer la qualite de l‒evaluation du risque suicIDAire, pour developper des strategies therapeutiques pharmacologiques ou non aux patients suicidaires and pour proposer des actions de
Abstract: Resume Avec un million de deces dans le monde, le suicide est un probleme de sante majeur. Malgre la recherche actuelle, les strategies therapeutiques efficaces font encore defaut. Les notes de suicide temoignent souvent de la presence d’une douleur intolerable, qu’elle soit physique et/ou psychologique. Les pathologies somatiques en particulier douloureuses sont reconnues comme facteur de risque suicidaire. En outre, malgre la complexite de sa definition, la douleur psychologique semble centrale dans le processus suicidaire. Enfin, considerer l’exclusion sociale (source de la douleur psychologique) peut aussi aider a comprendre la phenomenologie de l’acte suicidaire. La question du role de la douleur dans la survenue d’idees et de comportements suicidaires est donc centrale et ouvre de nouvelles voies de comprehension biologique, notamment a travers le systeme opioidergique ou l’etude du fonctionnement cerebral. Apres avoir expose les principales donnees de la litterature permettant de faire le lien entre phenomene douloureux et conduites suicidaires, nous tenterons d’apporter des arguments montrant que l’approche de la problematique suicidaire par l’angle de la douleur et de la deconnexion sociale permet d’envisager des avancees pour ameliorer la qualite de l’evaluation du risque suicidaire, pour developper des strategies therapeutiques pharmacologiques ou non aux patients suicidaires et pour proposer des actions de prevention.
TL;DR: A review of the clinical situations at different ages of life that could help with the screening and the referral of patients to specialized clinicians for diagnosis and appropriate treatment is proposed.
Abstract: Asperger's syndrome is a neurodevelopmental disorder which is part of the large family of autism spectrum disorders. People with Asperger's syndrome have difficulties in social interactions, verbal and non-verbal communication, and may display behavioural oddities, with stereotypies and limited interests. They show no language delay and their cognitive development is not marked by an overall delay but by specific impairments in certain areas such as the executive functions. The clinical presentations are very heterogeneous, varying according to age and psychiatric comorbidities. Screening, diagnosis and specialized treatment are not made any easier by the diversity of the clinical manifestations. Asperger's syndrome is often diagnosed belatedly, at 11 years of age on average and even in adulthood in some cases. This late diagnosis has a significant impact on the risks of depression and a poor quality of life. However, in adulthood or in adolescence, certain situations, personality traits and cognitive profiles or certain comorbidities should suggest the hypothesis of an Asperger-type autism spectrum disorder. We propose here a review of the clinical situations at different ages of life that could help with the screening and the referral of patients to specialized clinicians for diagnosis and appropriate treatment.
TL;DR: In this article, the authors evaluated l'addiction aux smartphones (IAT-smartphone), le temps passe et les types d’activites sur smartphone, l’addiction a internet (Internet Addiction Test), l'impulsivite (UPPS-P Impulsiveness Behavior Scale), les symptomes depressifs and anxieux (Hospital and Anxiety Depression scale), and determine ses facteurs associes (regression lineaire multiple).
Abstract: Resume Objectif Les objectifs de ce travail etaient de valider la version francaise de l’echelle d’addiction aux smartphones « Internet Addiction Test–version smartphone » (IAT-smartphone) ; d’etudier le lien entre addiction aux smartphones, addiction a internet, depression, anxiete et impulsivite. Methode Nous avons inclus 216 personnes (population non clinique) via une enquete en ligne. Nous avons evalue l’addiction aux smartphones (IAT-smartphone), le temps passe et les types d’activites sur smartphone, l’addiction a internet (Internet Addiction Test), l’impulsivite (UPPS-P Impulsiveness Behavior Scale), les symptomes depressifs et anxieux (Hospital and Anxiety Depression scale). Nous avons teste la validite de construit de l’IAT-smartphone (analyse factorielle exploratoire, consistance interne, correlations), et determine ses facteurs associes (regression lineaire multiple). Resultats L’âge moyen etait de 32,4 ± 12,2 ans, incluant 75,5 % de femmes. L’IAT- smartphone possedait une structure mono-factorielle (expliquant 42 % de la variance), une excellente consistance interne (α = 0,93) et etait associee avec les variables addiction a internet (ρ = 0,85 ; p Conclusions La version francaise de l’echelle Internet Addiction Test-smartphone semble etre un questionnaire valide et fiable pour evaluer l’addiction aux smartphones. Celle-ci apparait fortement liee a la symptomatologie anxio-depressive et a l’impulsivite. La forte association entre addiction aux smartphones et addiction a internet suggere que l’addiction aux smartphones pourrait etre une des formes cliniques d’addiction a internet.
TL;DR: Results confirm the motor peculiarities of children with ASD despite imitation tasks were adequately performed, and suggest that more work comparing the two conditions should be implemented, including analysis of kinematics and movement smoothness with sufficient measurement quality to allow spectral analysis.
Abstract: Background Autism spectrum disorder (ASD) is a heterogeneous group of neurodevelopmental disorders which core symptoms are impairments in socio-communication and repetitive symptoms and stereotypies. Although not cardinal symptoms per se, motor impairments are fundamental aspects of ASD. These impairments are associated with postural and motor control disabilities that we investigated using computational modeling and developmental robotics through human-machine interaction paradigms. Method First, in a set of studies involving a human–robot posture imitation, we explored the impact of 3 different groups of partners (including a group of children with ASD) on robot learning by imitation. Second, using an ecological task, i.e. a real-time motor imitation with a tightrope walker (TW) avatar, we investigated interpersonal synchronization, motor coordination and motor control during the task in children with ASD (n = 29), TD children (n = 39) and children with developmental coordination disorder (n = 17, DCD). Results From the human–robot experiments, we evidenced that motor signature at both groups’ and individuals’ levels had a key influence on imitation learning, posture recognition and identity recognition. From the more dynamic motor imitation paradigm with a TW avatar, we found that interpersonal synchronization, motor coordination and motor control were more impaired in children with ASD compared to both TD children and children with DCD. Taken together these results confirm the motor peculiarities of children with ASD despite imitation tasks were adequately performed. Discussion Studies from human-machine interaction support the idea of a behavioral signature in children with ASD. However, several issues need to be addressed. Is this behavioral signature motoric in essence? Is it possible to ascertain that these peculiarities occur during all motor tasks (e.g. posture, voluntary movement)? Could this motor signature be considered as specific to autism, notably in comparison to DCD that also display poor motor coordination skills? We suggest that more work comparing the two conditions should be implemented, including analysis of kinematics and movement smoothness with sufficient measurement quality to allow spectral analysis.
TL;DR: Identifying vulnerable spouses and providing them with appropriate support would help ensure better adherence to the care of their wives at different stages of the disease.
Abstract: Breast cancer is a chronic disease that affects both patients and their caregivers. Spouses, in particular, will generally assume the role of primary caregiver and experience significant physical, social, economic and emotional stress. In the face of cancer, being the spouse of a patient is synonymous with unmet psychosocial needs and a new role assignment, that of a primary caregiver. In addition, cancer confronts spouses with fear of partner loss. This leads to a set of adverse consequences such as depression, anxiety, uncertainty, stress, etc. Several studies have shown that breast cancer reduces the quality of life of patients' spouses and increases their emotional distress, their psychosocial needs, and their responsibilities within the family. Spouses may live a complex powerful emotional experience, which is equal to or greater than that experienced by patients during the diagnosis and treatment process. These multiple solicitations contribute to the heavy symptom burden. Therefore, in the context of breast cancer, identifying vulnerable spouses and providing them with appropriate support would help ensure better adherence to the care of their wives at different stages of the disease.
TL;DR: In this paper, the authors present an etude transversale portant sur 253 adolescents recrutes dans des lieux publics dans la ville de Sfax, in Tunisia.
Abstract: Resume Introduction La cyberaddiction, phenomene relativement nouveau, releve d’un champ de recherches recentes en sante mentale, particulierement juvenile. Elle parait interagir avec plusieurs facteurs individuels et environnementaux. Objectifs Reperer la cyberaddiction dans une population d’adolescents tunisiens, et d’etudier ses rapports avec les facteurs personnels, familiaux ainsi qu’avec les comorbidites anxieuses et depressives. Sujets et methodes Nous avons mene une etude transversale portant sur 253 adolescents recrutes dans des lieux publics dans la ville de Sfax, en Tunisie. Nous avons recueilli les donnees sociodemographiques ainsi que celles decrivant la dynamique familiale. La cyberaddiction a ete evaluee par le questionnaire de Young et les eventuelles comorbidites anxieuses et depressives a l’aide de l’echelle HADS. Resultats La prevalence de la cyberaddiction etait de 43,9 %. L’âge moyen des cyberdependants etait de 16,34 ans. Le sexe masculin etait lie au risque de cyberaddiction. La duree moyenne de connexion ainsi que les activites a vertu socialisante etaient significativement associees a la cyberaddiction. Les conduites rappelant les addictions sans substances etaient significativement associees a la cyberaddiction. L’attitude restrictive des parents et l’usage d’Internet par les parents et la fratrie etaient significativement associes au risque de cyberaddiction. La dynamique familiale etait un facteur determinant dans la cyberaddiction. L’anxiete etait significativement correlee au risque de cyberaddiction. Il n’y avait pas de correlation significative entre la depression ce risque. Conclusion L’adolescent tunisien semble a grand risque de cyberaddiction. Une action ciblee sur les facteurs modifiables notamment ceux touchant les interactions familiales serait d’une grande utilite dans la prevention.
TL;DR: In this article, an etude pilote et observationnelle a Bordeaux sur une periode d'un an was realized, where the liens parentaux chez a population d'enfants et d'adolescents presentant anorexie mentale.
Abstract: Resume Introduction L’anorexie mentale est une pathologie des troubles des conduites alimentaires grave et complexe de l’adolescence. La nature multifactorielle de l’anorexie mentale, la place importante de la famille et l’interet croissant pour la theorie de l’attachement dans les troubles des conduites alimentaires questionnent sur le lien parental dans l’anorexie mentale. L’objectif principal est d’analyser les liens parentaux chez une population d’enfants et d’adolescents presentant une anorexie mentale. L’objectif secondaire est d’etudier les differences en fonction de la tranche d’âge. Methodes Nous avons realise une etude pilote et observationnelle a Bordeaux sur une periode d’un an. Vingt-cinq jeunes filles souffrant d’anorexie mentale, âgees de 10 a 17 ans, hospitalisees, furent rencontrees individuellement pour repondre a une serie de questionnaires dont la Parental Bonding Instrument. Resultats Les resultats revelent des soins parentaux eleves, une surprotection maternelle elevee et paternelle faible avec un style parental « optimal » predominant suivi du style « contraint affectueux ». On retrouve des differences chez les patientes avec anorexie mentale avec une surprotection maternelle (p = 0,011) et paternelle (p = 0,085) chez les puberes. En analyse de correlation, il existe une correlation positive entre la protection maternelle et l’âge du diagnostic et une correlation negative entre les soins parentaux et la duree de la maladie. Conclusion Notre etude montre une cotation par les patientes avec anorexie mentale de parents chaleureux et comprehensifs, d’une mere surprotectrice et d’un pere encourageant a l’autonomie. Il existe une surprotection maternelle et paternelle chez les patientes pubertaires avec anorexie mentale comparees aux peripuberes.
TL;DR: Considering that rTMS outperformed electroconvulsive therapy in 2 patients, it deserves a more systematic assessment.
Abstract: Introduction Chronic and treatment resistant catatonias are orphans’ pathologies. No treatment has ever been developed or is currently in the pipeline for these conditions. As a toolbox, rTMS might correct abnormal brain activity in relation with psychomotor disorders provided the knowledge on where and how to modulate it using functional brain imaging (RETONIC, NCT03116425 ). Methods Twelve patients were recruited. Their abnormal regions were outlined thanks to 3 MRI sessions using ASL sequences performed during different tasks. They were compared to 38 normal controls (threshold P Results We report on the first 10 patients, 2 are currently finishing the study. Eight patients had the periodic catatonia phenotype according to Leonhard. All had the previously reported hyperperfusion in the left central and precentral cortices. The inhibitory modulation of this region improved all patients but one according to the Clinical Global Impression–Improvement scale (minimally to very much improved) mostly by alleviating apathy. More various anomalies were observed in the prefrontal regions which correction led to a minimal improvement in two patients. One patient much worsened under control stimulation. The two last patients had Leonhard's manneristic catatonia phenotype. Both had a complex pattern of hypoperfusion in the prefrontal regions. Its modulation much improved the most severely affected patient while the modulation of the placebo regions much worsened his condition. The other patient had no significant change whatever the treatment arm. Conclusion Considering that rTMS outperformed electroconvulsive therapy in 2 patients, it deserves a more systematic assessment.
TL;DR: In this article, the authors propose a strategy for prevention of suicide in France and Canada, with the aim of reducing the risk of suicide among French-Canadians in the province of Quebec.
Abstract: Resume Problematique Les personnes âgees sont une categorie de population a risque majeur de suicide. Dix-sept pour cent des deces par suicide dans le monde concernent les plus de 65 ans. La presence d’idees suicidaires dans cette tranche d’âge majore le risque de tentative de suicide dans l’annee. Les facteurs de risque retrouves concernent premierement les troubles de sante mentale, en particulier, l’episode depressif majeur puis les addictions, les demences, les douleurs et maladies. Parmi les facteurs de risque psychosociaux, la litterature insiste sur l’influence de l’isolement et du manque de soutien social. Enfin, pour les personnes âgees, les medecins generalistes sont les interlocuteurs privilegies. La population mondiale augmente et la duree de vie s’allonge, il faut donc penser la prevention du suicide des personnes âgees. Perspectives Les actions de prevention du suicide ayant fait leurs preuves a travers le monde sont integrees dans le cadre de strategies multimodales. Concernant le suicide des personnes âgees, les preconisations consensuelles associent les actions agissant sur la depression et la lutte contre l’isolement social articulees avec la formation des acteurs de premiere ligne. Sur ces bases, une strategie multimodale francophone de prevention du suicide des personnes âgees a ete elaboree : le programme Cooperation Quebec France sur la depression et l’isolement (CQFDi) qui sera implemente en France et au Quebec a partir de 2019. Conclusion Le programme CQFDi vise une population particulierement a risque de suicide et l’objectif a terme est de reduire les taux de suicide des personnes âgees en France.
TL;DR: In this article, the authors evaluated the sexual desire of medical trainees and the effect of burnout caused by the studies and the hospital work on this function, and found that there is a correlation going in the same direction: the more the burnout increases, the more sexual desire increases.
Abstract: Objectives The sexuality of doctors in training, interns and residents, is not well explored, especially in its relation to daily stress. The aim of this study is to evaluate the sexual desire of this population, and the effect of burnout caused by the studies and the hospital work, on this function. Methods Medical trainees from our institution (universite Saint Joseph de Beyrouth – Hotel-Dieu de France), interns and residents, were invited to complete a demographic questionnaire, questions about their work conditions, and validated questionnaires on burnout and sexuality. Selected instruments included “Maslach Burnout Inventory (MBI)” and “Sexual Desire Inventory (SDI)”. Statistical correlations were established using the Student's test, Spearmen's or Pearson's Correlations by type of dependent variable, Chi2 and Anova tests when needed. Results We obtained 262 responses from a population of 300 trainees (131 men and 131 women, mean age 25.1 years). Among them, 123 (46.9%) reported a high burnout score, 137 (52.3%) a high depersonalization score, and 120 (45.8%) a low professional achievement score. Regarding sexuality scores, 21% of men suffered from low sexual desire, compared to 70% of women. It seems that there is a correlation going in the same direction: the more the burnout increases, the more the sexual desire increases, especially among the male population. Conclusions These results provide insights into the sexual life of medical students. The rate of low sexual desire among women in medicine in our institution is higher than the world's standard. Additional research is needed.
TL;DR: The theoretical frameworks of the different emotional therapies used in the treatment of overweight or obesity will be presented: Mindfulness-Based for Eating Disorder, Acceptance and Commitment Therapy, and Acceptance-Based Behavioral Treatment for Weight Loss (ABT).
Abstract: Obesity has become a public health problem. But care, mainly diets, is often ineffective over the long term. Emotional therapies seem to be an interesting track especially for emotional eating. After defining two key concepts of emotional eating and acceptance, the theoretical frameworks of the different emotional therapies used in the treatment of overweight or obesity will be presented: Mindfulness-Based for Eating Disorder (MB-EAT), Acceptance and Commitment Therapy, and Acceptance-Based Behavioral Treatment for Weight Loss (ABT). The goal is to understand their usefulness in the treatment of overweight or obesity and perhaps avoid using contradictory techniques such as dieting with mindfulness. If current results are promising, the effectiveness of these therapies needs to be confirmed by new studies. Finally, the article points to the emergence of new "integrative" therapies that resemble the others presented and are related but are in fact the exact opposite. Control and acceptance are indeed antithetical.
TL;DR: The French National Institute of Health (INH) as discussed by the authors proposed a change in the nature of seclusion and restraint in the healthcare system Modernization Act of January 26th, 2016, with the aim to underline the freedom-destroying nature of these practices and the necessity of their regulation.
Abstract: Psychiatric care has always included patients in crisis who are potentially dangerous or agitated. Faced with the many issues they may encounter, the therapeutic relationship has always been prioritized over all other considerations. However, the practice of seclusion and restraint has been steadily increasing in the past few decades. Their use is becoming customary rather than exceptional and consequently fosters less thought by the care teams. In the Healthcare System Modernization Act of January 26th, 2016, the lawmakers sought to underline the freedom-destroying nature of these practices and the necessity of their regulation. This law represents a fundamental change in the nature of seclusion and restraint. What was but a simple prescription becomes a conscious decision of depriving someone of her or his freedom and must only be considered as a last resort. The changes in the Law and the recent changes in the recommendations for clinical practice by the French National Institute of Health invite reflection. Many questions remain about the origins of violence, the reasons for the increasing use of seclusion and restraint measures, and the alternatives that have been developed. Many theories suggest that the less stressful and constrained an environment is, the more empowered the patient will be. He is an actor in his own care and is considered a full active participant. The Law is reconciled with caregivers initiating a reflection on the benefits of these measures regarding the violation of fundamental freedoms. Reflection on psychiatric care and the quality of its management must be the focus when caring for patients in crisis.
TL;DR: In this article, the authors present an etude on the structure and activities of the soins medicaux generaux in UHSA, with the aim of effecting un etat des lieux des soins medecine generaux.
Abstract: Resume Les unites hospitalieres specialement amenagees (UHSA) accueillent des personnes detenues qui souffrent d’un trouble psychiatrique necessitant une prise en charge hospitaliere a temps complet. Les pathologies non psychiatriques sont surrepresentees chez les patients souffrant de troubles psychiatriques, mais aussi chez les personnes detenues. Les patients hospitalises en UHSA sont donc largement exposes a ces pathologies et il apparait indispensable de s’interesser a l’organisation de la medecine generale dans ces etablissements. L’objectif de cette etude est d’effectuer un etat des lieux des soins medicaux generaux en UHSA, au moyen d’une enquete par questionnaire menee aupres des medecins coordonnateurs de l’ensemble des etablissements. Les resultats montrent qu’au sein de chaque UHSA, il existe un poste de medecin generaliste, senior ou interne. L’examen physique, le bilan biologique et l’electrocardiogramme sont systematiquement realises a l’entree des patients dans 7, 5 et 9 etablissements, respectivement. Toutefois, plusieurs limites sont a soulever. D’abord, dans 3 UHSA seulement les medecins prennent contact avec le medecin traitant du patient. Ensuite, l’extraction du patient est systematique lorsqu’une consultation specialisee est demandee. Or, pour 6 UHSA, il n’est pas exceptionnel que certaines extractions soient annulees, sans qu’un avis medical ne soit systematiquement demande. Enfin, le respect du secret medical vis-a-vis de l’administration penitentiaire est parfois difficile a assurer au cours de ces extractions. A partir des observations realisees, des pistes d’amelioration pour l’organisation des soins medicaux generaux en UHSA sont proposees autour de quatre grands axes : la structure et l’organisation generale ; l’activite de medecine generale ; le lien avec les partenaires de soin et l’articulation avec l’administration penitentiaire.
TL;DR: L'Encephale -Sous presse. Epreuves corrigees par l'auteur as mentioned in this paper. Disponible en ligne depuis le lundi 8 octobre 2018
Abstract: L'Encephale - Sous presse. Epreuves corrigees par l'auteur. Disponible en ligne depuis le lundi 8 octobre 2018
TL;DR: Por les patients ayant un trouble psychotique l’hospitalisation sous contrainte prealable est egalement un facteur associe a une longue duree d’isolement a un isolement ≥ 7 jours.
Abstract: Resume Introduction L’isolement est une mesure indispensable a la prise en charge de certaines situations psychiatriques aigues, mais souleve de nombreuses questions cliniques et ethiques invitant a en limiter la frequence d’utilisation et la duree. Connaitre les facteurs associes a la duree des isolements pourrait permettre l’elaboration de mesures de reduction. Cette etude explore les facteurs predictifs d’une longue duree d’isolement. Methode L’etude EPIC est une etude multicentrique observationnelle prospective des mesures de contention et d’isolement de sept etablissements du sud-francilien. Notre objectif etait de determiner les facteurs predictifs d’une duree d’isolement ≥ 7 jours en s’appuyant sur des analyses statistiques descriptives, bivariees et multivariees. Resultats Deux cent trente-six mesures d’isolements ont ete incluses pour cette etude. Les analyses bivariees montrent que les diagnostics de trouble de l’humeur et de trouble psychotique, l’hospitalisation sous contrainte prealable et l’administration d’un traitement sedatif sont associes a un isolement ≥ 7 jours. Les analyses multivariees montrent que les diagnostics de trouble de l’humeur [OR = 2,7, IC95 % (1,4–4,9), p = 0,002] et de trouble psychotique [OR = 3,3, IC95 % (1,2–8,4), p = 0,01] sont associes a un isolement ≥ 7 jours. L’administration d’un traitement sedatif est egalement associee dans ces 2 modeles a une duree ≥ 7 jours [OR humeur = 8,1 et OR psychotique = 2,4]. Pour les patients ayant un trouble psychotique l’hospitalisation sous contrainte prealable est egalement un facteur associe a une longue duree d’isolement. Conclusion Les patients presentant un trouble de l’humeur ou un trouble psychotique necessitant un traitement sedatif lors de l’isolement pourraient etre une bonne cible de mesures de reduction de la duree en isolement.