I am physician graduated in psychiatry, and researcher graduated in the field of neuroscience. I currently work at the University Hospital of Strasbourg and Inserm unit U1114 . My current main interest is attention deficit/hyperactivity disorder (ADHD) in adults, comorbid ADHD (association with mood disorder and personality disorders) and conditions associated with emotional deregulation. My research focuses on phenomenology of emotional dysregulation, clinical boundaries and ADHD comorbidity, I develop translational research to validate treatment in comorbid ADHD (i.e: methylphenidate and dialectical behavioral therapy), with psychometric, EEG and fMRI methods.
Research Items (43)
Background Suicidality has been under-researched in autism spectrum disorders (ASD). Most studies have linked increased suicidality in ASD to psychiatric comorbidities such as depression. Here we investigated, from a neuropsychological and clinical standpoint, the relationship between core ASD symptoms, i.e., restricted behaviors and social and communication impairments, and the suicidal behaviors in an adult male individual with ASD, with no psychiatric comorbidities. Case presentation We report the case of a 21-year-old male with ASD who attempted suicide twice, in the absence of other psychiatric diagnoses. His behavior and communication skills were rigid. His suicidality was characterized by a rigid, detailed, and pervasive thinking pattern, akin to restricted interests. Consistently, from a neuropsychological standpoint, we found below-average planning and attention skills, and mind-reading skills were rigid and lacked spontaneity. Conclusions Our case-study suggests that specific clinical and neuropsychological dimensions might be related to suicidal behaviors in ASD. Clinically, the repetitive and rigid suicide-oriented thinking of our patient was not part of a depressive episode. Instead, it followed a purely logical, inflexible, and pervasive reasoning pattern focused on a topic that fascinated him – i.e., suicide --, akin to restricted behaviors. From a neuropsychological standpoint, restrictive suicide-oriented thinking in our patient seems to be related to attention and executive anomalies that have been linked to repetitive and restricted behaviors in ASD. New tools need to be developed to assess persistent suicidal thoughts in this population, as they might be related to intrinsic features of ASD.
- Jan 2019
Objective: Our study aimed to provide empirical evidence on the usefulness of one of the most popular neuropsychological tests, the Continuous Performance Test (CPT), as a marker of ADHD severity and presentations among adults. Method: ADHD participants were recruited in a specialized center for the diagnosis and treatment of adults suffering from ADHD (n = 201). Measures included the CPT3™ and ADHD symptoms using a clinical interview and self-reported measures. Results: Only 51.7% of the participants were classified as likely to have a disorder characterized by attention deficit, such as ADHD, by the CPT. The relationships between CPT variables and ADHD symptoms were small. The classification error was 80.3% for the inattentive presentation and 22.5% for the hyperactive presentation when using the CPT to identify ADHD presentations. Conclusion: There was no evidence of the clinical utility of the CPT to assess or monitor ADHD in adult populations diagnosed and treated for ADHD.
- Dec 2018
Addictive disorders are characterized by impulsive behavior that leads to difficulties in preventing certain behaviors despite negative consequences. This symptom predisposes to a vulnerability in developing addictive disorders and is also aggravated by the addiction process itself. As such, understanding the underlying mechanisms of impulsivity is a challenge for understanding the pathophysiology of addiction. One common link between impulsivity and addiction is that both involve actions and decisions that are realized faster than they should be in time. Impulsive traits increase the tendency to choose immediate gratification instead of delayed gratification even when preferred. This observation suggests a relationship between impulsivity and time processing. To better understand this relationship, we reviewed the literature that describes the relationship between time processing and impulsivity in addictive disorders in humans. Despite a lack of literature concerning this question in alcohol, cannabis and gambling disorders, we highlight that addictive behaviors are a good model for understanding the pathophysiology of impulsivity, and could help us to better understand the relationship between time perception and impulsivity.
Objective: To analyze the psychometric properties of the French version of the Weiss Functional Impairment Rating Scale-Self Report (WFIRS-S) in a large clinical sample of adults with ADHD. Method: Patients ( N = 363) were diagnosed with ADHD according to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) criteria. Psychometric properties of the French version of the WFIRS-S were tested including construct validity with a confirmatory factor analysis, internal structural validity with Cronbach's alpha coefficient, external validity by correlations with the Beck Depression Inventory-II (BDI-II), and the EuroQol five-dimension (EQ-5D) questionnaire. Results: The confirmatory factor analysis found the following: root mean square error of approximation (RMSEA) = 0.061, 90% confidence interval (CI) = [0.058, 0.063]; comparative fit index (CFI) = 0.67. Cronbach's alpha coefficient was .91. Correlations with EQ-5D descriptive index, visual analogue scale (VAS) scores, and BDI-II scores were -0.48, -0.55, and 0.53, respectively. Conclusion: The French version of the WFIRS-S is a psychometrically acceptable self-reported questionnaire for the multi-domain evaluation of functional impairments in adults with ADHD, for research and clinical purposes.
The severity of depressive symptoms across two discrete mental disorders should be evaluated with the same psychometrically validated tools. In patients with schizophrenia the Calgary Depression Rating Scale (CDSS) is recommended for evaluating depressive symptoms. The aim of this study was to validate the CDSS in patients with major depressive disorder. The CDSS exhibit satisfactory psychometric properties for evaluating depressive symptoms in major depressive disorder. Clinicians and researchers now have a validated scale at their disposal to evaluate depressive symptoms in various mental disorders using a transdiagnostic approach.
Purpose: The Self-Efficacy Measure for Sleep Apnea (SEMSA) is a 26-item self-questionnaire composed of three factors: risk perception of obstructive sleep apnea syndrome (OSAS), benefit of continuous positive airway pressure (CPAP), and self-efficacy (the confidence to engage in CPAP use). It is used to evaluate health beliefs about OSAS and CPAP in order to optimize CPAP use. The purpose of this study was to design and validate a French version of the SEMSA. Methods: A forward-backward translation of the SEMSA was performed. Subjects with OSAS treated by CPAP and followed by our sleep clinic were invited to complete the questionnaire. The psychometric properties of the French SEMSA version were analyzed in terms of its construct validity (with confirmatory factor analysis, CFA), internal structural validity (Cronbach's alpha coefficient), and external validity (Pearson's correlation between SEMSA score and duration of CPAP use). Results: Two hundred eighty-eight subjects filled in the questionnaire. The mean age was 63.16 ± 12.73 years. The number of years since the beginning of CPAP treatment was 6.58 ± 6.03 years. The mean CPAP use duration was 6.19 ± 2.03 h/night. CFA was unsatisfactory (RMSEA = 0.066 and CFI = 0.88). The exploratory factor analysis revealed a fourth factor named "cardiovascular risk" factor. Cronbach's alpha coefficient was 0.886. The correlation between the "self-efficacy" factor and the duration of CPAP use was significant (r = 0.26, p ≤ 0.001). Conclusions: The French version of the SEMSA is a psychometrically acceptable self-report questionnaire for measuring health beliefs and behavior in French patients with OSAS treated with CPAP. Such translation and validation should lead to the adoption of validated psychosocial methods for improving CPAP use.
- Mar 2018
Schizophrenia as a single liability model was confronted to the multiple psychotic phenotypes model proposed by the Wernicke-Kleist-Leonhard school, focusing on two: periodic catatonia (PC) and cataphasia (C). Both are stable and heritable psychotic phenotypes with no crossed liability and are coming with the buildup of specific residual symptoms: impairment of psychomotricity for PC and a specific disorganization of thought and language in C. Regional cerebral blood flow (rCBF) was used as a biomarker. We attempted to refute the single phenotype model by looking at relevant and specific rCBF anomalies for PC and C, that would exceed anomalies in common relative to controls (CTR), i.e. looking for a double dissociation. Twenty subjects with PC, 9 subjects with C and 27 matched controls had two MRI QUIPSS-II arterial spin labeling sequences converted in rCBF. One SPM analysis was performed for each rCBF measurement and the results were given as the conjunction of both analysis. There was a clear double dissociation of rCBF correlates between PC and C, both being meaningful relative to their residual symptomatology. In PC: rCBF was increased in the left motor and premotor areas. In C: rCBF was decreased bilaterally in the temporo-parietal junctions. Conversely, in both (schizophrenia): rCBF was increased in the left striatum which is known to be an anti-psychotics' effect. This evidence refuts the single schizophrenia model and suggests better natural foundations for PC and C phenotypes. This pleads for further research on them and further research on naturally founded psychotic phenotypes. Clinical trial Name of the registry: ClinicalTrials.gov Identification: NCT02868879
- Jan 2018
Racing thoughts refer to an acceleration and overproduction of thoughts, which have been associated with manic and mixed episodes. Phenomenology distinguishes 'crowded' from 'racing' thoughts, associated with mixed depression and mania, respectively. Recent data suggest racing thoughts might also be present in healthy individuals with sub-affective traits and symptoms. We investigated this assumption, with a 34-item self-rating scale, the Racing and Crowded Thoughts Questionnaire (RCTQ), and evaluated its reliability, factor structure, and concurrent validity. 197 healthy individuals completed the RCTQ, the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego - autoquestionnaire (TEMPS-A), the Beck Depression Inventory (BDI), the Altman Self-Rating Mania scale (ASRM), and the Ruminative Response Scale (RRS). Exploratory factor analysis yielded a three-factor solution, labeled 'thought overactivation', 'burden of thought overactivation', and 'thought overexcitability'. Internal consistency of each of the three subscales of the RCTQ was excellent. The TEMPS-A cyclothymia score was associated with the three factors, suggesting good concurrent validity. The 'thought activation' subscale was selectively associated with current elated mood and included items conveying both the notion of increased amount and velocity of thoughts, whereas the 'burden of thought overactivation' subscale was associated with current low mood. The 'thought overexcitability' subscale included items conveying the notion of distractibility, and was associated with both elated and low mood. Rumination was not a significant predictor of RCTQ subscores. These results suggest that the RCTQ has good psychometric properties. Racing and crowded thoughts, as measured by the RCTQ, are a multi-faceted phenomenon, distinct from rumination, and particularly associated with mood instability even in its milder forms.
Patients with schizophrenia have difficulty in making sensory predictions, in the time domain, which have been proposed to be related to self-disorders. However experimental evidence is lacking. We examined both voluntary and automatic forms of temporal prediction in 28 patients and 24 matched controls. A visual cue predicted (temporal cue) or not (neutral cue) the time (400 ms/1000 ms) at which a subsequent target was presented. In both patients and controls, RTs were faster for targets presented after long versus short intervals due to the temporal predictability inherent in the elapse of time (“hazard function”). This RT benefit was correlated with scores on the EASE scale, which measures disorders of the self: patients with a high ‘self-awareness and presence’ score did not show any significant benefit of the hazard function, whereas this ability was preserved in patients with a low score. Moreover, all patients were abnormally sensitive to the presence of “catch” trials (unexpected absence of a target) within a testing block, with RTs actually becoming slower at long versus short intervals. These results indicate fragility in patients’ ability to continuously extract temporally predictive information from the elapsing interval. This deficit might contribute to perturbations of the minimal self in patients.
- Oct 2017
Emotion dysregulation and interpersonal hardships constitute core features of borderline personality disorder (BPD). Research has established the link between these core dysregulations and fluctuations in the capacity to appreciate the mental states that underlie behavior (mentalizing, operationalized as reflective functioning (RF)). As emotion dysregulation and interpersonal hardships also characterize adults with attention deficit hyperactivity disorder (ADHD), this study sought to examine the potential RF impairments affecting this population. 101 adults with ADHD, 108 with BPD and 236 controls were assessed using the RF questionnaire (RFQ), evaluating how individuals employ information about mental states to better understand their own and others’ behaviors. The RFQ comprises two dimensions, certainty (RF_c) and uncertainty (RF_u) about mental states. RF scores helped distinguish ADHD from controls, but also from BPD (F = 48.1(2/441); p < 0.0001 for RF_c and F = 92.5(2/441); p < 0.0001 for RF_u). The ADHD group showed intermediary RF scores compared to the controls (b = −0.70; p < 0.0001 and b = 0.89; p < 0.0001 for RF_c and RF_u) and BPD group (b = 0.44; p = 0.001 and b = −0.56; p = 0.001 for RF_c and RF_u). Lower RF scores correlated with poor anger control and high levels of impulsivity. Higher severity of ADHD (more attentional and hyperactive/impulsive symptoms) was correlated with RF impairments. In conclusion, RF may constitute an important process underlying attentional, hyperactive/impulsive as well as emotional symptoms in ADHD; it should therefore be considered in the assessment of these patients.
- Sep 2017
Background: A valid screening instrument is needed to detect attention-deficit/hyperactivity disorder (ADHD) in treatment-seeking borderline personality disorder (BPD) patients. We aimed to test the performance of the widely-used Adult ADHD Self-Report Scale v1.1 screener (ASRS-v1.1). Methods: 317 BPD subjects were systematically assessed for comorbid ADHD and completed the ASRS-v1.1. 79 BPD patients also completed the Wender Utah Rating Scale (WURS-25). Results: The prevalence of adult ADHD was of 32.4%. The overall positive predictive value of the ASRS-v1.1 was of 38.5%, the negative predictive value 77.0%, the sensitivity 72.8%, and the specificity 43.9%. Combining WURS-25 and ASRS-v1.1 improved sensitivity to 81.8% and specificity to 59.6%. Limitations: Cross-sectional study on treatment-seeking patients. Conclusions: We found a high prevalence of ADHD using structured interviews. The ASRS-v1.1 was not a sensitive screener for identifying possible ADHD cases in a BPD population, with a high number of false positives. When combined with the WURS-25, it offered improved screening.
- Jun 2017
The current study aims at documenting the psychometric properties of the Subjective Distress Associated with Adult ADHD-Self-Report (SDAAA-SR), a newly developed instrument for the assessment of psychological suffering in ADHD adults. The SDAAA-SR was administered to 247 students and 142 ADHD adults. Factor structure, internal consistency, test-retest reliability, convergent validity and discriminant validity were assessed. Sensitivity to change was examined in a subsample of 25 ADHD patients who participated in a 1-year therapy. The initial pool of 62 items was reduced to 33 items distributed in a three-component structure. Internal consistency was excellent for the "distress due to inattention/disorganization" subscale and good for the "distress due to hyperactivity/impulsivity" and "distress due to self-esteem deficit" subscales. Test-retest reliability in a subsample of 98 students was substantial for all three subscales. ADHD patients scored significantly higher than students on distress due to "inattention/disorganization" and "hyperactivity/impulsivity," but no difference was observed for "self-esteem deficit." The components "inattention/disorganization" and "hyperactivity/impulsivity" displayed moderate to large correlations with the corresponding dimensions of the Adult Self-Report Scale for ADHD (ASRS-V1.1). Distress due to "inattention/disorganization" and "self-esteem deficit" was significantly associated with lower satisfaction with social behaviors (QFS, social functioning questionnaire) and quality of life (WHOQOL-BREF). Distress due to "inattention/disorganization" and "self-esteem deficit" significantly decreased after a 1-year therapy. The SDAAA-SR represents a reliable and valid measure of adult ADHD-associated distress, an important but often undocumented parameter in the clinical setting. Its use as an outcome variable in psychological interventions deserves further investigation.
Objectives: Many adults with attention-deficit/hyperactivity disorder (ADHD) report sleeping difficulties. The relationship between sleep and ADHD is poorly understood, and shows discrepancies between subjective and objective measures. In order to determine the specificity of sleep-associated symptoms in ADHD, subjective sleep assessments among ADHD adult patients were compared with control subjects and with individuals suffering from borderline personality disorder (BPD). Methods: 129 outpatients with ADHD, 70 with BPD (including 17 patients with BPD and ADHD comorbidity), and 65 control participants were assessed for sleep quality, insomnia, and sleepiness, using the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), and the Epworth Sleepiness Scale (ESS). Results: ADHD- and BPD-sufferers achieved higher insomnia and lower sleep quality scores than control subjects. Clinical groups did not differ in terms of sleep quality, although insomnia was more severe among BPD patients. Depression scores explained most of sleep symptoms, but even when controlling for depression, ADHD sufferers showed higher sleep latency. Inattentive symptoms were associated with somnolence, while hyperactive/impulsive symptoms were associated with insomnia and lower sleep efficiency. Conclusion: Sleep-related symptoms associated with ADHD were partly explained by non-specific factors, especially depression symptoms. In a dimensional perspective, hyperactive and inattentive symptoms were associated with specific sleep symptoms.
Objectif Les plaintes concernant le sommeil sont très fréquentes chez les patients adultes avec TDA-H. Cependant leur origine est mal comprise et il existe une discordance entre les plaintes subjectives et les anomalies objectives. Ainsi, il n’est pas clair si les anomalies du sommeil sont spécifiques au diagnostic TDA-H ou s’ils sont liés au statut de population clinique. Méthodes 129 patients adultes avec TDA-H, 70 patients avec trouble de la personnalité borderline (TPB) (dont 17 avec comorbidité TDA-H) et 65 sujets contrôle ont évalué leur qualité du sommeil (PSQI), leur degré d’insomnie (ISI) et leur somnolence diurne (ESS). Résultats Les patients TPB avaient une altération du sommeil et un retentissement diurne plus marqués que les patients TDA-H, qui eux-mêmes étaient plus altérés que les contrôles. L’analyse multivariée a montré que le facteur explicatif principal des plaintes subjectives sur le sommeil était l’intensité des symptômes dépressifs. Les patients avec TDAH-H avaient une latence plus importante et une efficacité moindre même en ajustant sur le score de dépression. Les symptômes inattentifs étaient associés avec le degré de somnolence et les symptômes hyperactifs associés avec l’insomnie et une moindre efficacité. Conclusion Les plaintes concernant le sommeil chez les adultes avec TDA-H semblent en partie expliquées par des facteurs non spécifiques. Certaines anomalies du sommeil sont plus caractéristiques des troubles de l’attention, dans une perspective dimensionnelle, et peuvent être mises en lien avec les difficultés de régulation de la vigilance dans le TDA-H.
Background: Recognizing one’s own actions and body requires a prediction of the state of the body, then checking whether this prediction has been fulfilled. These mechanisms have been suggested to be impaired in patients with schizophrenia. However, not all kinds of predictive mechanisms are impaired, and it remains to be understood how agency and body ownership disorders arise. We suggested recently that patients are impaired at predicting visual information over very short delays, thereby disrupting the continuity of sensory processing. We wondered whether such temporal impairments could impact the sense of self. Methods: We used a visual detection and a manual pointing task to explore both perceptual and motor prediction. In the visual task, a target occurred 400 or 1000 ms after a fixation point. Expectation of target onset automatically increases as time passes, resulting in shorter RTs (reaction times) at longer delays, indexing increasing temporal predictability. The manual task also explored expectation mechanisms, in this case expectation that sensory feedback would occur as a result of manually pointing on a surface. The use of a virtual device allowed us to manipulate the timing of sensory feedback (delayed by 0, 15 or 65 ms). Impact on the sense of self was explored with the EASE scale in the first task, and by asking subjects to evaluate their feeling of control after each series of manual pointing movements in the second task. Results: Results from both tasks showed that patients had normal sensory expectation to some extent: RTs decreased in the visual task when the target occurred after a delay of 1000 ms rather than 400 ms; patients also felt more in control when the sensory feedback resulting from their pointing action was not delayed. However, as soon as some uncertainty was introduced into the task, expectation and aspects of the sense of self were impaired. When the target appeared in only 75% of trials in the visual task, RTs actually increased, rather than decreased, for delays of 1000 ms vs 400ms. Moreover, the RT difference between 1000 ms vs 400 ms significantly correlated with the minimal self, as evaluated by the EASE, even when the target appeared in 100% of the trials. In the motor task, patients’ feeling of control dropped when there was a 15 ms delay in the sensory feedback, which did not occur in controls. Conclusion: Together, these results suggest that although patients can predict sensory information in time to some extent, they cannot cope with deviations from this prediction. The results suggest a vulnerability related to temporal prediction that may be involved in agency and body ownership disorders.
- Feb 2017
Objective: Affective lability is an important dimension of adult ADHD, associated with marked impairments and worse outcomes. A valid and quick tool to measure affective lability may therefore be of interest. Method: In 187 adult ADHD patients, we explored psychometric properties of the Affective Lability Scale-Short Form (ALS-18 items). We analyzed the construct validity and the external validity of the scale. Patients were compared with 48 healthy adult controls. Results: The three-factor structure of the ALS-18 presented a good fit and a good internal consistency. The correlations between the ALS-18 and ADHD symptoms and other psychological dimensions were, respectively, low and moderate. ALS-18 scores were higher in patients than in healthy adults. Conclusion: ALS-18 showed good psychometric properties in ADHD adult patients, allowing us to recommend the implementation of ALS-18 in assessing affective lability for clinical and research purposes. Use of ALS-18 should improve the clinical assessment of affective lability in adult ADHD patients.
Child maltreatment (CM) worsens prognosis and quality of life in several psychiatric conditions. Meaning in life is a construct which relates to the sense of purpose that one can perceive in life, and is a key aspect of recovery in psychiatric patients. The lasting impact of CM on meaning in life and its mediating variables have not been studied in patients with chronic persistent psychiatric conditions. One hundred and sixty-six patients with bipolar disorder (N=35), psychotic disorder (N=73), anorexia nervosa (N=30) or borderline personality disorder (N=28) were assessed for meaning in life (revised version of the Life Regard Index (LRI-R)), for CM (Childhood Trauma Questionnaire (CTQ)) and for internalized/externalized psychopathology. CM was associated with a lower LRI score. Structural Equation Modeling showed that internalized psychopathology (depression, hopelessness and low self-esteem) was the main mediator of the impact of CM on meaning in life. The direct effect of CM on meaning in life was not significant. Having suffered from negligence or abuse during childhood is associated with lower meaning in life in adults with persistent and pervasive psychiatric disorders. Treating depressive symptoms and improving self-esteem may improve meaning in life in patients with severe mental disorders who were affected by CM.
- Jan 2017
- Neuropsychiatric Disorders and Epigenetics
Attention-deficit hyperactivity disorder (ADHD) is a highly heritable neurodevelopmental disorder. Besides genetic factors, several environmental factors occurring either before the emergence of the disorder (prenatally or perinatally), or when the disorder is already diagnosed, or close to its emergence, such as childhood maltreatment have been shown to play a major role in ADHD. Epigenetics has attempted to link these environmental factors to the disorder and its persistence in adulthood. Findings of epigenetic studies have implicated genes encoding: proteins involved in neurotransmission, namely dopamine receptor4 ( DRD4 ), serotonin transporter ( SLC6A4 ), serotonin receptor 3A ( 5-HT3AR ); proteins involved in the epigenetic machinery like histone deacetylase1 ( HDAC1 ) and methyl-CpG binding protein2 ( MeCP2 ); and proteins involved in brain development, namely vasoactive intestinal peptide receptor 2 ( VIPR2 ). Nevertheless the number of studies is limited and replications as well as new studies are still needed to better define the underlying neurobiological mechanisms of ADHD.
Introduction: Depression is a highly prevalent mental illness that is associated with high rates of morbidity and functional impairment. At the psychiatric unit of the University Hospital of Strasbourg, France, we have developed an open group that combines psychoeducation and cognitive-behavior therapy (CBT), the information, discovery, exchange and mobilization for depression group (IDEM-depression). IDEM-depression is composed of 17 thematic, structured, and independent sessions, which address different aspects of depression (i.e., rumination, pharmacological treatments). Because of its flexible format, patients with varying degrees of depression severity (from remission up to severe depressive symptoms) and whose depression might be bipolar or unipolar, are able to participate in the group. Thus, the group is well suited to a large number of patients with major depression. In the present study we aimed at describing the IDEM-depression group and presenting results regarding patients' overall satisfaction, assessed via two self-report questionnaires (the Client Satisfaction Questionnaire, the CSQ-8, and the IDEM ad hoc questionnaire), as well as its effect on mood following each session assessed via a visual analog scale (VAS) ranging from 0 up to 100. Method: Sixty-five patients participated in 50 sessions of the IDEM-depression group in two hospitals in Alsace. 61% of the patients had bipolar disorder, and 41% of them were inpatients. Sessions took place on a weekly basis, lasted 2hours and were proposed by a CBT-trained clinical psychologist. Patients were asked to fill-out the VAS at the beginning and at the end of each session. Moreover, they were asked to fill-out the CSQ-8 and the IDEM ad hoc questionnaire when they left the group. Other than one session ("yoga and mindfulness"), all the sessions (16 out of 17) were structured on a Powerpoint(©) presentation. During the first hour information was given regarding the topic (i.e., rumination), and a shared CBT conceptualization of the topic was formulated by the participants and the psychologist. For most sessions, the first hour was therefore communication and information-based, whereas during the second hour participants were asked to participate in in-session behavioral experiments and/or to evaluate specific aspects of their behavior (thoughts, emotions, activity, mindful behavior) during the last few days. The therapist manual and the slides for each session are available via e-mail to the first author. Results: Regarding the results, self-reported mood on the VAS was compared between the onset (225 VAS) and the end (225 VAS) of each session. Overall, results suggest that self-reported mood is significantly improved following the participation in sessions (t=-5. 87, P<0.001). Moreover, mean results on the CSQ-8 suggest that patients are highly satisfied with the group (M=24.46, SD=6.42). Among them, 82% reported a moderate-high satisfaction with the group. On the IDEM ad hoc questionnaire, patients reported an overall high satisfaction level regarding (i) the content of sessions, (ii) the duration of sessions, (iii) the frequency of sessions, (iv) how much they felt they could express themselves during sessions. In the qualitative comments of this questionnaire, patients reported that the group helped them to gain an understanding of the mechanisms involved in depression; to feel less isolated and guilty; and to learn about specific psychotherapeutic tools (i.e., mindfulness) and to try to implement them. Conclusion: Our results suggest that an IDEM-depression group is well suited to a wide-array of clinical pictures associated with depression (varying severity, bipolar or unipolar, inpatients and outpatients). This is probably due to its open-group format which is particularly well-adapted to the dynamic symptomatology associated with major depression, and may stimulate decentering in patients who have different levels of severity of symptoms but participate in the same session. Moreover, its impact on mood improvement, and the high satisfaction level reported by patients, seem to be related to its CBT and psychoeducation-based content on the one hand, which has shown its efficacy in depression. On the other hand, IDEM's structured open-group format might have also contributed to the improvement in mood and the overall good satisfaction reported by patients, through the social support provided by the group, improved feeling of self-efficiency, and its effect on stigmatization. Thus, IDEM-depression group is an efficacious, flexible, low-cost, and easy to implement (in different clinical settings) psychotherapeutic option for major depression.
Background: Attention deficit hyperactivity disorder (ADHD) is associated with marked impairments in familial, social, and professional functioning. Although stimulant treatments can be effective in adult ADHD, some patients will respond poorly or not at all to medication. Previous studies demonstrated that cognitive behavioural therapy- (CBT) and dialectical behavior therapy- (DBT) oriented interventions are effective in reducing the burden of the disease, which is mainly marked by depression, interpersonal difficulties, low self-esteem, and low quality of life. In order to determine the effectiveness of this intervention, we assessed the benefits of a CBT/DBT programme to reduce residual symptoms and help patients improve their quality of life. Subjects and methods: 49 ADHD-patients, poor responders to medication, were enrolled in a one-year programme where they received individual therapy, associated with weekly sessions of group therapy with different modules: Mindfulness, Emotion Regulation, Interpersonal Effectiveness and Distress Tolerance, Impulsivity/Hyperactivity and Attention. Each subject was assessed at baseline, at months 3 and 6, and at the end of the treatment for ADHD severity (ASRS v1.1), depression severity (BDI-II), hopelessness (BHS), mindfulness skills (KIMS), anger expression and control (STAXI), impulsivity (BIS-11), quality of life (WHOQOL-BREF), and social functioning (QFS). The 49 ADHD patients were compared with 13 ADHD subjects on a waiting list. Linear mixed models were used to measure response to treatment. Results: Overall, the psychotherapeutic treatment was associated with significant improvements in almost all dimensions. The most significant changes were observed for BDI-II (b=-0.30; p<0.0001), ASRS total score (b=-0.16; p<0.0001), and KIMS AwA (b=0.21; p<0.0001), with moderate to large effect sizes. Compared with the waiting list controls, ADHD patients showed a better, albeit non-significant, pattern of response. Conclusions: Individual and structured psycho-educational DBT/CBT groups support existing data suggesting that a structured psychotherapeutic approach is useful for patients who respond partially or not at all to drug therapy.
- Mar 2016
Background and Objectives: A woman’s lifetime risk of major depression is almost twice as high as that of a man. Major depression is associated with a high risk of recurrence, but the question of a differential risk of recurrence between genders is unclear. Based on a systematic review of the literature, this paper attempts to answer the following question: “Following a major depressive episode, do women and men have the same risk of recurrence?”. Methods: We prospectively collected all studies from the period 2005-2014 where the variable gender was considered a potential predictor of recurrence. The database has also been expanded with articles cited in the bibliography of the prospectively collected articles and with a PubMed Database search covering the period January 2005-August 2014. Results: Of the prospective studies (n = 98), most found no influence of gender on recurrence risk, but a minority, mostly large sample studies, found that female gender is a statistically significant risk factor for recurrence. Results suggest a probable female-to male relative risk of recurrence between 1.0 and 1.2. Given the heterogeneity of the studies (length of follow-up, populations, nature of the studies, choice of dependant variables, statistical methods, and available data) no meta-analyses were performed. There are many interfering variables (age of onset, subchronic evolution, treatments, etc.) that can influence the results of prospective studies. Conclusions: Women probably have a slightly higher risk of recurrence after a major depressive episode than men. This increased risk is much smaller than women’s much higher lifetime risk of depression.
- Feb 2016
La sémiologie psychiatrique présente des fondements complexes à la fois sur le plan historique et théorique, imposant de questionner la méthode pour organiser des termes sémiologiques. Le recueil sémiologique actuel est principalement tourné vers des diagnostics épidémiologiques, fondés sur des listes de symptômes, dont l’objectif est surtout d’aboutir à un diagnostic « athéorique » plus que vers une compréhension de leurs mécanismes et une prise en charge individualisée. Serait-il possible alors d’envisager une sémiologie compréhensive et scientifique, à la fois fondée sur la nosographie actuelle, mais autorisant également une prise en charge personnalisée en psychiatrie ? Cet article propose d’y répondre en questionnant la place des sciences cognitives dans cette perspective, selon la distinction fondamentale de la cognition au sens du contenu de pensées, dans une première partie, au travers des thérapies cognitivo-comportementales, et du contenant ou processus de pensée, dans une deuxième partie, au travers de la remédiation cognitive.
Objectives: The aim of the study was to explore geographical differences in drug prescriptions regarding bipolar disorder in Alsace, a region of 1.86 million inhabitants (3% of the French population). Methods: The study was conducted by using the French Insurance Healthcare databases. The investigation targeted patients, 20 years or older, who received, at least once in 2013, lithium, divalproex sodium or valpromide (two prodrugs of valproic acid). Results: 4,661 patients were treated with one of the 3 mood stabilizers mentioned above (0.26% of inhabitants). Lithium was less prescribed than the others. The proportion of patients treated with mood stabilizers among the patients treated for mood disorder was higher in the larger cities areas suggesting a possible better access to diagnosis and specific treatment. Conclusions: Our study contributed to a better understanding of medical practices relating to bipolar disorder in Alsace (France). Lithium is probably underused. Many patients with bipolar disorder may not receive the adequate treatment especially in rural areas. This result raises the question of the availability of information and/or specific training for psychiatrists but also for general practitioners who see a large number of bipolar patients.
- Dec 2015
Introduction Les lésions du splénium du corps calleux sont responsables de manifestations cliniques variées. Les étiologies du RESLES pour reversible splenial lesion syndrome sont nombreuses. Il peut s’agir de troubles métaboliques, de maladies démyélinisantes, de pathologies infectieuses et également de causes toxiques. Des cas de RESLES survenant sous traitement antiépileptique ou à l’arrêt sont décrits. Nous rapportons un cas de RESLES chez une jeune femme bipolaire. Observation Il s’agit d’une jeune femme de 26 ans, atteinte d’un trouble bipolaire, initialement traité par carbamazépine, haloperidol, cyamémazine, topiramate, quiétapine et bromazepam. Elle est hospitalisée en psychiatrie pour réévaluation de son traitement de fond. À l’admission, la patiente présentait des hallucinations visuelles et auditives, une sensation d’irréel et une anosmie, motivant la réalisation d’une IRM cérébrale. Celle-ci montrait la présence d’une lésion du splénium du corps calleux isolée, caractérisée par un aspect en demi-lune pratiquement symétrique avec un hyper signal T1 bien limité, une restriction de diffusion et l’absence de prise de contraste après injection du gadolinium. La prise en charge psychiatrique a consisté en l’arrêt du traitement antérieur. Seule la quiétapine a été poursuivie et un traitement par lithium a été introduit. La patiente décrivait une nette amélioration sous Lithium avec disparition des hallucinations. L’examen clinique et en particulier neurologique était normal, on ne retrouvait pas de point d’appel infectieux. Une pathologie maligne a été éliminée par la réalisation d’un TDM thoraco-abdomino-pelvien. Le bilan auto-immun était négatif, il n’y avait pas de troubles hydro-électrolytiques ni de syndrome inflammatoire. L’analyse du LCR était normal en dehors d’un protéinorachie à 0, 68 g/L, la culture était négative, l’examen histologique ne retrouvait pas de cellule néoplasique, absence également de synthèse intrathécale des immunoglobulines. À l’EEG on constatait une minime prédominance hémisphérique droite de quelques éléments lents. L’absence de lésion démyélinisante sur l’IRM cérébrale et médullaire a permis d’écarter une pathologie démyélinisante type acuite disseminated encephalomyelitis (ADEM). L’IRM cérébrale de contrôle, à j18, a montré une régression quasi-complète de la lésion du corps calleux. Aucun traitement n’a été introduit en l’absence de symptômes. Discussion La présence d’une lésion isolée du corps calleux dans un contexte de polymédication par psychotropes et la régression en moins de 3 semaines fait évoquer une origine toxique. On retrouve dans la littérature quelques cas de RESLES sous traitement antiépileptique et en particulier sous carbamazépine ou à l’arrêt de ce traitement. Nous imputons donc l’arrêt brutal de la carbamazépine. Il s’agit du premier cas dans la base de la pharmacovigilance nationale. La physiopathologie de ces lésions réversibles du splénium du corps calleux n’est pas très claire. Le plus souvent c’est un phénomène d’œdème vasogénique qui est évoqué. La carbamazépine augmente l’activité diurétique de la vasopressine, donc son arrêt brutal diminuerait cette activité créant ainsi un déséquilibre hydrique local responsable de l’apparition d’une lésion au niveau du corps calleux. La présence d’une restriction de diffusion à l’IRM conforte cette hypothèse. L’autre mécanisme évoqué serait des dysnatrémies sous carbamazépine, ce qui n’était pas le cas de notre patiente. Conclusion Devant la mise en évidence d’une lésion isolée du splénium du corps calleux il faut penser à une cause toxique comme la carbamazépine. Cette lésion est régressive en quelques semaines et aucun traitement n’est nécessaire en l’absence de symptômes.
Background: Mixed depression is a depressive syndrome characterized by the presence, along with the typical depressive symptoms of depression, of those of over activation and excitation. If sometimes this activation is expressed by classical hypomanic symptoms, it is often observed by means of more subtle expression: inner tension, crowded thoughts, dramatic expression suffering, and unproductive agitation. It is important to identify mixed depression because such patients are particularly at risk of suicidal behaviors, substance abuse and therapeutic resistance. Even if therapeutic strategies continue to be discussed, treatments should rely on mood stabilizers and antipsychotics instead of antidepressants as in pure depression. Even though the concept of mixed depression has been described for more than twenty years, first by Koukopoulos and then by other authors, it had been little studied, especially because it did not appear in international psychiatric classifications. The DSM-IV supported a very narrow conception of the mixed states because the criteria required simultaneous full manic and full depressive syndromes, corresponding only to some dysphoric manias. The recently published DSM-5 proposes modifications in mood and bipolar disorder classifications, and especially introduces the possibility to specify depressive and manic episodes with "mixed features". To diagnose depression with mixed features, a full depressive syndrome has to be present together most of time with three hypomanic symptoms, except symptoms that are considered as overlapping (that can be observed either in mania or in depression), i.e. agitation, irritability and distractibility. Methods: Critical analysis of DSM criteria and review of literature. Results: We first analyzed the clinical relevance of the definition of depression with mixed features which could correspond to mixed depression. The problem is that the hypomanic symptoms allowed by the manual lead to symptom associations that are rather illogical (as euphoria with depression) or improbable (as increased or excessive involvement in activities that have a high potential for painful consequences). Also, some more specific symptoms that can be observed in mixed depression are not mentioned (such as hypersensitivity to light or noise, absence of motor retardation, dramatic expressivity of suffering). The DSM-5, as did DSM-IV, refers to an understanding of mixed depression as a simple addition of depressive and manic symptoms. The classification does not take into account that the symptoms could be rather different from hypomania, as the expression of an overactive thought in a depressed mind. Secondly, we reviewed cohort studies using the DSM-5 criteria (or similar criteria with the exclusion of overlapping symptoms), and as a consequence of the poorly defined symptoms, we found that the diagnosis of mixed depression according to DSM-5 is almost impossible, either in unipolar or in bipolar depression. Conclusions: We think, with others, that the definition of the mixed depression by the DSM-5 is not clinically relevant and misses important information about the concept. Clinicians can be attentive to the identification of mixed character in depression, even if DSM-5 criteria are not fully met. Unfortunately, the DSM-5 definition could undermine research efforts for a better understanding of epidemiology, phenomenology and therapeutics of mixed depression. We propose and discuss alternative solutions for defining mixed depression, such as the absence of exclusion of "overlapping" symptoms, a more insighted phenomenology, or a dimensional approach.
High-dose baclofen is a promising treatment for alcohol use disorder, with a specific action on craving. A more general action on craving in other addictive disorders has been suggested based on the hypothesis of a common neurobiological pathway in addictions. We report the case of a woman diagnosed with both alcohol use disorder and bulimia nervosa. She responded well to high-dose baclofen on alcohol craving, but showed no response on food craving. The case illustrates that craving could be differentially responsive to anti-craving drugs.
Nous rapportons le cas d’un homme de 38 ans ayant présenté un épisode maniaque franc, dans les suites de l’ablation d’une tumeur kystique bénigne de l’hémisphère cérébelleux droit, compliquée d’hydrocéphalie. Cette lésion fut découverte suite à de violentes céphalées et des troubles de l’équilibre. Le tableau maniaque débuta progressivement dans la semaine suivant l’opération, alors que les suites opératoires furent simples. Un traitement associant olanzapine et divalproate améliora rapidement la symptomatologie. Si des lésions cérébelleuses ont déjà pu être décrites dans le déclenchement de troubles de l’humeur, dans notre cas, l’imagerie fonctionnelle (scintigraphie cérébrale) a suggéré l’implication de lésions frontales. Le syndrome frontal modéré a été confirmé par les tests neuropsychologiques, et par la présence à l’IRM de petites lésions en avant des ventricules latéraux, attribuées à une effusion de liquide céphalorachidien lors de l’hydrocéphalie. Au-delà de l’étiologie organique du syndrome maniaque, le cas clinique est particulièrement intéressant car le patient a présenté au décours de l’épisode maniaque un épisode dépressif majeur avec symptômes psychotiques congruents à l’humeur, alors que nous n’avons pas retrouvé d’antécédent de trouble de l’humeur. Nous discutons ainsi différentes hypothèses : – existence d’un trouble de l’humeur subsyndromique décompensé à la suite de la lésion, et particulièrement par le syndrome frontal ; – déclenchement par une lésion cérébrale d’un trouble psychiatrique épisodique et alternant ; – survenue du syndrome dépressif de manière consécutive à l’épisode maniaque, la physiopathologie de l’épisode maniaque incluant la survenue de la dépression sévère. Ces différentes hypothèses sont discutées sur des arguments neuropsychologiques, neuroanatomiques et psychopathologiques.
La dépression mixte correspond à un état dépressif où coexistent des éléments d’excitation de la lignée hypomaniaque. Si le tableau a déjà été décrit par les auteurs classiques, il a été remis à jour depuis les années 1990 et notamment par Koukopoulos. Cependant, jusqu’alors, les classifications internationales ignoraient totalement ce tableau puisque les critères du DSM-IV pour un état mixte étaient particulièrement étroits, requérant la présence d’un plein syndrome maniaque associé à un plein syndrome dépressif. La conséquence est une carence d’études sur la question et des incertitudes sur les principes de prise en charge. Le DSM 5 a annoncé et mis en œuvre un changement dans l’approche des états mixtes, et permettant notamment un diagnostic de dépression mixte : à un diagnostic d’épisode dépressif peut être associé un « spécificateur de caractéristiques mixtes ». Il requiert la présence de trois symptômes maniaques en plus de critères pour un épisode dépressif majeur. Mais sont exclus de la liste des symptômes maniaques l’agitation, l’irritabilité et la distractibilité : ils sont considérés pouvant être à part entière des symptômes de dépression. Nous passons en revue les arguments issus de la littérature suggérant que cette définition des dépressions mixtes est encore probablement trop restrictive, inadaptée par rapport à la réalité clinique, et présentant un certain nombre de contradictions. Ainsi, nous argumentons que ces nouveaux critères n’apportent pas plus de clarté dans le diagnostic de dépression mixte, et ne permettent pas d’améliorer ce diagnostic souvent méconnu. Cela pourrait avoir des incidences sur l’avancée des connaissances sur la caractérisation clinique, la thérapeutique et le pronostic des dépressions mixtes.
Do unconscious stimuli modify processes that are typically associated with consciousness? This question is of particular interest in schizophrenia in which there is both impairments of implicit processes and abnormalities of conscious processes. For instance patients have difficulties to initiate a strategy or to feel in control of their actions. For this purpose, we wanted to know to what extent the choice of a task set or the feeling of control over the action could be influenced by unconscious cues. We conducted two studies in healthy subjects showing that unconscious stimuli can influence the preparation of a task set. However, we have shown that there are limitations to these unconscious influences: the processing of unconscious stimuli must be uninterrupted for some time, and it is modulated by attentional mechanisms. Our third study analyzed the effect of subliminal distortions of the haptic feedback (tactile and kinesthetic) on motor adaptation and on the conscious sense of control over the action. We have shown that the feeling of control was modulated by subliminal distortions of the haptic feedback. Unconscious influences have an impact on conscious processes, but in limited and controlled circumstances.
- Apr 2013
Whether unconscious stimuli can modulate the preparation of a cognitive task is still controversial. Using a backward masking paradigm, we investigated whether the modulation could be observed even if the prime was made unconscious in 100% of the trials. In two behavioral experiments, subjects were instructed to initiate a phonological or semantic task on an upcoming word, following an explicit instruction and an unconscious prime. When the SOA between prime and instruction was sufficiently long (84ms), primes congruent with the task set instruction led to speedier responses than incongruent primes. In the other condition (36ms), no task set priming was observed. Repetition priming had the opposite tendency, suggesting the observed task set facilitation cannot be ascribed solely to perceptual repetition priming. Our results therefore confirm that unconscious information can modulate cognitive control for currently active task sets, providing sufficient time is available before the conscious decision.
Because this piece does not have an abstract, we have provided for your benefit the first 3 sentences of the full text. Buprenorphine, a partial μ-opioid agonist and κ-opioid antagonist, is frequently used in the treatment of heroin dependence and to prevent complications arising from intravenous injection and social consequences of heroin use. Psychosis occurring after discontinuation of buprenorphine or other opioids has been described, but is uncommon. Case report. Mr A, a 37-year-old man, was admitted to our psychiatric ward for acute psychotic symptoms with mystical and paranoid delusions and intense auditory hallucinations. J Clinical Psychiatry 2012; 73(6): 765 © 2012 Physicians Postgraduate Press, Inc.