Dans les cas des troubles bipolaires, les taux de comorbidité avec un TDAH peut varier entre 9,5 % et 27 % [1]. Ces patients présentent un début de trouble plus précoce, avec plus d’épisodes dépressifs et des épisodes mixtes. Il existe peu d’étude sur le lien entre ces deux pathologies et les différentes dimensions de personnalité selon le modèle de Big Five.

Notre étude comporte 106 patients souffrant de dépression, 102 patients bipolaires et 120 témoins, tous homogènes vis-à-vis de leurs caractéristiques démographiques. Le diagnostic de TDAH se basait sur les critères DSM-IV-TR. Les traits de TDAH étaient autoévalués avec la Wender Utah Rating Scale (WURS), la Adult ADHD Self-rating Scale (ASRS) et la Brown Attention Déficit Disorder Scale (ADD). L’Inventaire de Personnalité-Révisé, le NEO PI-R, servait également à évaluer les dimensions de la personnalité au sein des groupes cliniques.

15,7 % des adultes souffrant d’un trouble bipolaire et 7,5 % souffrant d’une dépression sévère manifestaient une comorbidité d’un TDAH en comparaison avec seulement 3,3 % des témoins. Il existe des corrélations significatives entre des traits de personnalité et la présence d’un TDAH. Une analyse de régression logistique de l’ensemble des 208 sujets cliniques a montré que ceux avec des faibles niveaux de névrosisme manifestaient un taux moins important de comorbidité avec un TDAH.

Notre étude souligne le lien entre des troubles de l’humeur, notamment les troubles bipolaires, et la présence d’un TDAH chez des adultes. Nos résultats soutiennent la nécessité d’évaluer les sujets souffrant des troubles d’humeur sur une éventuelle comorbidité de TDAH en milieu clinique. Il faudra étudier d’une façon plus approfondie ces traits de personnalité et les liens entre des troubles de l’humeur et un TDAH afin de pouvoir adapter la prise en charge.

Neurosyphilis is a complication of syphilis, due to invasion into the central nervous system of Treponema pallidum, subspecies pallidus. Although neurosyphilis may remain asymptomatic, symptoms can develop at any time after initial infection. Early forms include syphilitic meningitis, meningovasculitis and ocular disease. Dementia paralytica, or “general paralysis of the insane”, and tabes dorsalis used to be the most frequent forms of late neurosyphilis. Several reports, however, suggest a changing clinical presentation of neurosyphilis. Atypical neuropsychiatric syndromes seem to be more prevalent than in the past. Inadvertent treatment with antibiotics prescribed for unrelated diseases and improved serological methods are probably the most important contributing factors. Accelerated progression from syphilis to neurosyphilis in HIV seropositive patients has also been reported.

This prospective study aims to investigate the clinical spectrum of neurosyphilis in patients whose cerebrospinal fluid was tested positive for neurosyphilis by the Laboratory for Infectious Diseases, a large reference laboratory in the North-East part of the Netherlands.

From 2004 to 2013 all patients with a new diagnosis of neurosyphilis, proven by cerebrospinal fluid serology, were included. Each patient’s clinical record was reviewed for demographic, clinical and laboratory data.

Our inclusion criteria were met by 24 patients, all male. The clinical spectrum ranged from asymptomatic to dementia paralytica. Age varied from 31 to 71. At the time of neurosyfilis diagnosis, 7 patients were HIV seropositive.

Further analysis is currently being done and definite results and conclusions will be presented at the meeting.

Acute intermittent porphyria (AIP) is a rare autosomal dominant inherited metabolic disease characterized by mutations in the porphobilinogen deaminase gene. This mutation may provoke neurotoxic levels of delta-aminolevulinic-acid and porphobilinogen, potentially resulting in an acute life-threatening clinical syndrome, characterized by psychiatric, in particular atypical psychotic, symptoms as well as severe neurological and gastrointestinal symptoms. Since the clinical presentation varies and symptoms are nonspecific, diagnosis is often made late.

Naming of alarm symptoms based on a recent case study.

Description of a recent case supplemented with data from the literature.

The patient is a 46 year old woman who was admitted in 2007 with abdominal pain, an epileptic seizure and weakness, interpreted as a Guillain-Barre syndrome. In 2011 she was readmitted with severe abdominal pain, diarrhea, volatile psychotic symptoms and seizures, following a short period of excessive alcohol consumption. During admission she developed progressive weakness in the upper arms, shooting pains in the limbs and a feeling of tightness. Impaired abdominal breathing was suspected. Again, Guillain-Barré syndrome was considered, but additional studies did not support this diagnosis. Because of the recurrent character of symptomatology following alcohol abuse, acute (intermittent) porphyria was considered diagnostically. The dark-colored urine indeed contained significantly increased delta-aminolevulinic-acid and porphobilinogen concentrations. Additional (genetic) diagnosis follows.

A recurrent disease course with severe gastrointestinal, neurological and psychiatric symptoms, following alcoholabuse, is suspect for AIP.

Ambulatory actigraphy is a simple and objective method for the evaluation of motor activity that is used in several neuropsychiatric disoders such as depression, agitation, apathy, and sleep disorders.

To evaluate the sensitivity (Se) and specificity (Sp) of actigraphic postural detection versus postural data gathered by observer during multiple guided activities.

A voluntary healthy subject was equipped with different actigraphs (Actiwatch®; MicroMini- Motionlogger®; MotionLog®; Movilis®) then realized multiple guided activities during a 7-hour diurnal period : walking, standing, sitting, decubitus with sleep. Actigraphs were worn on different locations (wrists, thorax, ankles, belt) and two of them included postural recognition in addition to motor activity monitoring. Se and Sp for postural recognition compared to ground-truth were obtained from table of confusion based on raw activity data recordings; error of attribution due to devices is detailed in confusion matrix.

Actigraphy postural recognition is efficient for lying position detection (MotionLog: Se 99% Sp 97%; Movilis: Se 80% Sp 72%). Standing position was mainly recognized as sitting position and therefore actigraphic detection lacks of accuracy for these positions. Walking is detected with 20% error.

Postural actigraphy is efficient for lying position detection and actigraphic postural recognition could improve detection and characterization of nocturnal awakenings and diurnal napping in clinical practice.

Combatants with PTSD demonstrate a considerable change of personal characteristics but changes related to sexuality are barely studied though this area determines adaption to microsocium, helps establish emotional relationships and so on. Correlations between combat-related PTSD symptoms and sexuality are indistinct.

We studied interrelation between sexuality as a central I-function and PTSD symptoms using ISTA test and The Mississippi Scale within the group consisting of 682 male combatants among which 149 respondents had expressed PTSD symptoms and 533 men had subclinical symptoms.

Sexuality in combatants with PTSD was characterized by rising destructive manifestations, deficit of constructive forms and constancy of deficiency. The group with subclinical PTSD symptoms showed insignificant rise in destructive activity compensated by increase of constructive components of sexuality while its deficiency components demonstrated considerable fall.

Combatants displayed malfunction in sexual sphere characterized by resort to abnormal and unaccepted norms, such sexual activity is often offensive both to partners and combatants and can result in sexual abuse. Personal disposition to establish relationships and derive enjoyment from intercourse is damaged at different levels and sometimes is retarded. These abnormalities are conditioned by intensity of manifested PTSD symptoms and may be part of other combat-related PTSD symptoms, such as impulsivity, aggression and others. Low values of PTSD indicate that combatants are apt to reduced prohibitions in sexual activity and moderate tendency to sexual abuse, but these trends are hypercompensated by an ability to establish mature sensual relationships and by understanding needs at different levels.

The Adult Attachment Interview (AAI) is considered the gold standard of attachment assessment, but is expensive and time consuming. The Relationship Scale Questionaire (RSQ) is a self-report assessment of attachment, but measures different constructs.

We investigated how each measure correlates with brain activity in attachment-related tasks: conscious valence and salience appraisal of mother's face.

28 female subjects ages 18–30 were given the AAI and RSQ. Using fMRI subjects viewed pictures of their mother and were asked to rate how good the image made them feel (valence rating) and how related they felt (salience rating). Brain activity correlating with AAI and RSQ measures of attachment security and dismissingness was determined by linear regression.

Salience processing and valence processing were associated with increased thalamo-striatal, posterior cingulate and visual cortex activity. Salience processing was associated with bilateral decrease in PFC activity. In salience processing AAI secure subjects had attenuated visual cortex response and increased lingual gyrus activity while RSQ secure subjects had decreased right temporal lobe activity and AAI dismissing subjects had enhanced left PFC deactiviation while RSQ dismissing subjects had increased left temporal pole and visual cortex activity. In valence processing RSQ secure subjects demonstrated increased left insula activity and AAI dismissing subjects demonstrated bilateral increase in thalamic and posterior cingulate activation.

AAI and RSQ measures of attachment measure different constructs with divergent patterns of associated brain activity. AAI measures of attachment tap midline structures (pre-reflective/unconscious attachment processing), while RSQ measures tap lateral structures (cognitive/conscious attachment processing).

La catatonie reste sous-diagnostiquée du fait de la diversité clinique qu’elle revêt [2].

Nous rapportons le cas d’une femme de 55 ans adressée en neurologie par un service psychiatrique pour aide diagnostique sur troubles du comportement de type apragmatisme. Ses antécédents comprennent 4 hospitalisations en psychiatrie sur 3 ans pour le même motif sans diagnostic précis, un syndrome malin des neuroleptiques et un traumatisme crânien sans complication somatique. En septembre 2012, la patiente est réhospitalisée pour récidive de troubles du comportement (apragmatisme, dyspraxies, stéréotypies gestuelles, fuite du regard) apparus sur une dizaine de jours. L’examen neurologique est normal. Les IRM cérébrales sans injection de 2007 à 2012 montrent des lésions de la substance blanche multiples sus-tentorielles aspécifiques, stables. Les scintigraphies cérébrales à 4 mois d’intervalle sont stables et montrent une hypoperfusion diffuse isolée du carrefour fronto-temporo-pariétal gauche. Le reste du bilan étiologique est négatif. L’hypothèse diagnostique de démence frontotemporale est retenue, cependant l’installation rapidement progressive évoque une étiologie psychiatrique. Malgré la mise en place d’un antidépresseur (IRS) depuis un mois son état s’aggrave. Après passation des échelles de Bush et Peralta objectivant des critères de catatonie, un test au lorazepam est réalisé montrant une amélioration clinique rapide et spectaculaire.

L’intrication des symptômes neurologiques et psychiatriques dans la catatonie conduit souvent à une impasse diagnostique, sachant que sans traitement efficace, sa morbi-mortalité est importante [1].

Tout syndrome neuropsychiatrique atypique avec bilan somatique non concluant doit conduire à l’utilisation des échelles diagnostiques de catatonie, et le cas échéant à un test au lorazepam, pour ne pas retarder la thérapeutique.

Il est aujourd’hui admis par la plupart des auteurs que les épisodes affectifs se caractérisent par une perturbation de l’estime de soi ; cependant, l’estime de soi en dehors des phases thymiques est sujette à controverses. On se propose dans notre travail d’évaluer l’estime de soi dans un groupe de patients bipolaires type I en phase euthymique.

Nous avons mené une étude transversale descriptive auprès de 60 patients bipolaires euthymiques suivis en ambulatoire. L’euthymie était vérifiée par l’échelle de dépression de Hamilton (score ≤ 7), et l’échelle de manie de Young (score ≤ 6). La mesure de l’estime de soi a été faite au moyen du Rosenberg Self-Esteem scale (RSE).

Notre échantillon était composé de 33,3 % femmes et 66,7 % hommes. La plupart des patients étaient mariés (46,7 %) et plus de la moitié (55,0 %) avaient un niveau d’enseignement secondaire. L’étendue des totaux possibles du RSE allant de 10 à 40, le score total moyen obtenu par les patients était de 28,3, soit dans la fourchette de l’estime de soi basse. Une estime de soi basse était associée au délai de prise en charge (p = 0,021) et au nombre d’hospitalisations (p = 0,032).

Les résultats impliquent la nécessité que toute notre attention se porte sur l’estime de soi dans nos interventions thérapeutiques.

The clinical diagnosis of personality disorder in adolescence tends to be conservative and unspecific.

To examine the prevalence of personality disorder, and the involvement of stigma effect in adolescents with Axis I psychiatric disorders.

A sample of 100 patients with psychiatric disorders (M = 15.8, SD = 0.9 years, range 15-17, 70% women), were assessed and diagnosed for personality disorders in a mental health public centre.

The prevalence of PD identified by clinicians (12%), differs from the prevalence identified by the semi-structured interview (34–37%) showing a greater number (p < .001) of people affected. In the present sample most of the cases identified by clinicians are related to personality disorders (PD) not otherwise specified, while with the implementation of semi-structured interviews, most of the sample met criteria for Cluster B PDs. Additionally, 11% of the sample has dimensional pathological features (probable PD) without complying categorically the criteria for a full PD.

In clinical settings, a considerable proportion of adolescents with psychopathology meet features for PD, although few of them have a confirmed clinical diagnosis. Considerations about impact of the stigma are discussed.

What are the FDA and EMEA approved Psychotropic Medications for Psychiatric Illnesses? What do these approval processes mean?

Describe the process for FDA/ EMEA approval of drugs used to treat psychiatric disordres, identify disorders of DSM-IV TR commonly seen in Medicine, present currently FDA/EMEA approved Psychotropic Medications for Psychiatric Illnesses in International Medicine.

To identify psychiatric disorders of DSM-IV TR commonly seen in Medicine and have access to a FDA/EMEA approved Psychotropic Medications.

The FDA and its European Counterpart, the EMEA are recognized for enforcing two of the world's most rigorous review processes, determining what medications are safe/effective, which makes their approval a meaningful title to patients. A readily accessible list of DSM-IV TR Psychiatric disorders with the corresponding FDA and EMEA approved medications listed would help communication between providers and patients and prevent bad outcomes. Currently, no such document is readily available.

Review of most commonly seen psychiatric disorders in International Medicine. Review of the current FDA Orange book for current FDA approved Psychotrop Medications for Common Psychiatric Illnesses.

A list of DSM-IV TR Psychiatric disorders commonly seen in Medicine with the corresponding FDA/EMEA approved medications listed.

To create a user friendly document listing common DSM-IV TR Psychiatric disorders seen in the US military setting with the corresponding FDA approved psychotropic medications to aid healthcare providers, and educate patients about the significance of using a medication for its FDA approved diagnoses versus “off-label” prescribing, and to compare this process to the EMEA process.

Kallmann syndrome (KS) is a genetically heterogenous and rare disorder characterized by the combination of hypothalamic hypogonadism and anosmia/hyposmia. In about one third of the patients, mutations have been identified in at least seven different genes. Apart from one published case report, virtually no data are available about possible neuropsychiatric symptoms in KS.

Studying the putative relationship between KS and schizophrenia.

Investigating the genetic etiology in a patient with a clinical diagnosis of KS and paranoid schizophrenia.

Detailed diagnostic evaluation including genetic analysis of an adult male patient with paranoid schizophrenia, hypogonadism and anosmia.

Psychiatric examination of the 28-years-old male patient disclosed negative psychotic symptoms only, following an acute paranoid schizophrenic episode one year before. He used 15mg aripiprazole daily and testosterone gel 20mg/gr. Hormonal panel showed extremely low levels of LH and FSH. MRI scanning of the brain demonstrated complete absence of the olfactory bulbs. Otolaryngeal examination disclosed complete anosmia. Neuropsychological assessment revealed subaverage intelligence distinctly disconcordant with premorbid functioning, markedly lowered speed of information processing, and impaired executive and social cognitive functions. Genome wide SNP array analysis and mutation analyses for the KAL1, FGFR1, PROK2, PROKR2, FGF8 and CHD7 genes, disclosed no genetic imbalance or any pathogenic mutation.

This first report on a patient with KS and paranoid schizophrenia in whom extensive genetic analyses were performed, stipulates the need for studying a possible increased risk for psychiatric symptoms in patients with KS.

Décrire le fonctionnement d’une équipe de psychiatrie de liaison, et son activité sur une période courte de 2 mois, au sein de l’hôpital de la Timone à Marseille.

Le protocole de demande d’avis est centré autour d’un formulaire informatique, rempli par le médecin somaticien demandeur, avec : Nom du médecin demandeur/Service/Nom du patient/Motif d’hospitalisation actuelle/Motif de la demande/Traitement en cours. Ce formulaire est utilisé par l’équipe de liaison pour rencontrer le médecin demandeur, puis le patient. Suite à cet entretien, le psychiatre fait un compte-rendu oral et écrit au médecin demandeur, avec une proposition de prise en charge. Les résultats ont été récoltés par l’étude de ces comptes-rendus écrits sur une période courte, du 1er juin 2013 au 31 juillet 2013.

La psychiatrie de liaison a pris en charge 47 patients du 1er juin 2013 au 31 juillet 2013. Trente-quatre patients ont bénéficié de soins psychiatriques, dont 19 avec adaptation ou mise en place d’un traitement psychiatrique (antidépresseur : 15, neuroleptique : 7), les 15 autres avec mise en place d’un suivi psychothérapeutique seul. 13 patients ont été évalués par l’équipe, sans que l’indication de soins psychiatriques ne soit retenue. Pour 11 de ces patients, les somaticiens doutaient sur une étiologie psychiatrie, pour les 2 autres la demande n’était pas centrée sur une problématique psychiatrique.

Les résultats montrent que le travail de psychiatrie de liaison est à la fois thérapeutique et diagnostique. Le travail conjoint psychiatre-somaticien permet d’améliorer la prise en charge du patient, même si de nombreuses pistes restent exploitables pour améliorer cette collaboration.

The Phelan-McDermid syndrome (PMD) is characterized by intellectual disability (ID), childhood hypotonia, severely delayed or absent speech, and autistic features without major dysmorphisms and somatic anomalies. Haploinsufficiency of the SH3 and multiple ankyrin repeat domains 3 (SHANK3) gene in 22q13.3 is thought to be causative for the PMD-phenotype comprising, in addition to sleep disturbances and deficits in language and communication, several behavioural abnormalities and increased reactivity to sensory stimuli. Data about neuropsychological dysfunctions or psychiatric symptoms are not available as yet.

Investigating the possible psychopathological phenotype of PMD.

Diagnostic evaluation of one geriatric female and two male adult patients.

Detailed neuropsychiatric and neuropsychological examination of 3 patients with genetically proven PMD.

In an adult male with a history of mood and behaviour fluctuations, psychiatric examination at the age of 24 disclosed symptoms of a severe major depression with irritability, loss of initiative, and marked sleep disturbances. Severe ID and marked deficits in expressive and receptive language were established. After addition of nortriptyline to valproic acid, depressive symptoms gradually remitted. His older brother has a similar history but with less severe symptomatology. The 70- years-old institutionalized female patient, had a history of affective and behavioural imbalance over many decades. Monotherapy with carbamazepine led to acceptable stabilization. Genetic evaluation in the two brothers and the female patient demonstated an identical loss of 2.15Mb and a 610kb deletion in 22q13.3, respectively, all including SHANK3 gene.

Provisonal diagnosis of atypical bipolar disorder could be made in all three patients.

Depression affects up to 20% of alle women entering perimenopause. The symptoms of depression are often debilitating and are related to the decrease of the steroid hormones progesterone and estrogen. Treatments such as SSRIS and SNRIs often worsen the physical symptoms of perimenopause such as hot flashes and there is some evidence that a decrease of estrogen inhibits the effectiveness of SSRIs. Thus, we investigated whether agomelatin was effective in treating perimenopausal depression without worsening hot flashes and other perimenopausal-related physical symptoms.

35 women with moderate to severe depression related to perimenopause as diagnosed by a typical hormonal constellattion and by systematic psychiatric assessment were treated with agomelatin for 6 weeks. Symptom change of both depression and of physical symptoms was evaluated weekly by several rating scales.

Agomelatin improved both depression and physical symptoms of perimenopause, particularly hot flashes and night sweats. After 6 weeks 70% of the women reported remission from depression and all said that their sleeping pattern had improved as well as their overall quality of life. They related this strongly to the significant improvment of hot flashes and night sweats.

Agomelatin improves both depressive and physical symptoms of perimenopause. Since hot flashes and night sweats are among the most debilitating symptoms of perimenpause and since about 80% of women suffers from them, agomelatin might be a good option for those women who do not want HRT.