Dans une cohorte de patients traités par méthadone, nous avons retrouvé 35 % de tentatives de suicide (TS) sur la vie, 53 % un trouble anxieux et 61 % un trouble de l’humeur. Presque tous étaient fumeurs quotidiens de tabac, les trois quart avaient soit une dépendance au cannabis, à l’alcool ou à la cocaïne associée sur la vie. Dans ce contexte, l’identification de facteurs de variabilité interindividuelle de sévérité et de comorbidité pourrait prédire le risque d’évolution péjorative chez les sujets jeunes ou moins comorbides. Outre les traumas dans l’enfance [1], les styles parentaux [2] semblent avoir un rôle important dans ces trajectoires, tout comme un âge de début (ADD) plus précoce des consommations de substances [3].

Nous avons ainsi recherché chez 85 patients stabilisés sous méthadone des associations entre les scores à la Measure of Parental Style (MOPS) [4] (séparés pour chaque parent) et l’ADD de tabac, alcool, cannabis, sédatifs et cocaïne ainsi que la présence de comorbidités addictives. Les caractéristiques sociodémographiques, les conduites suicidaires et les comorbidités addictives et psychiatriques (DSM IV) étaient évaluées par entretien semi-structuré.

Nous avons retrouvé des associations significatives (p < 0,00625) après corrections de Bonferroni pour huit tests effectués) entre indifférence paternelle et ADD inférieur du tabac, et entre abus maternel et ADD inférieur des sédatifs, mais pas entre MOPS et présence d’un TA comorbide. Après ajustement sur âge, sexe, dépression majeure et troubles anxieux en régression linéaire, l’abus maternel restait prédictif d’un ADD plus précoce des sédatifs (bêta = –0,24, p = 0,039), tout comme la dépression (bêta = –0,24, p = 0,045).

Malgré des limites dues à notre évaluation rétrospective et à la faible taille de l’échantillon, ces résultats soulignent l’importance de l’environnement précoce dans la variabilité des trajectoires addictives. Cela suggère l’intérêt d’une prévention primaire chez des patients jeunes présentant ces dysfonctionnements parentaux.

The aim of this study is to explore connectivity between Medial Prefrontal Cortex and others areas of the Default Mode Network, by Functional Magnetic Resonance Imaging during Resting State, in subjects affected by schizophrenia and unaffected relatives.

We recruited a group of 29 patients diagnosed with schizophrenia, who were treated with atypical antipsychotics, who are and were clinically stable in the last 6 months and had an illness duration range from 5 up to 15 years. Patients who had received either electroconvulsive therapy or clozapine were excluded. We also recruited a group of 23 unaffected relatives, without history of other mental, neurological or somatic disease and a group of 37 healthy volunteers. No subject in any of the three groups met criteria for substance use disorders .

All three groups were clinically evaluated, and a functional magnetic resonance during Resting State was performed.

Functional images were reoriented to the first scan, normalized to the MNI EPI template and smoothed with an 8 mm Gaussian kernel, with SPM. The CONN-FMRI Toolbox v1.2 was used to create individual subject seed-to-voxel connectivity maps, to the corresponding seeds of the default mode network.

There are significants differences in the conectivity between the Medial Prefrontal Cortex and the Default Mode Network in patiens with schizophrenia and the unaffected relatives

Une étude préliminaire a évalué la fréquence des tempéraments affectifs décrits par Akiskal et al. [1] dans une population de patients alcoolo-dépendants [2]. Dans cette étude, le score moyen à la sous-échelle du tempérament dépressif était significativement plus élevé dans un groupe de sujets alcoolo-dépendants par rapport à un groupe de témoins [2]. Les objectifs de notre étude étaient :

– déterminer si la dépression pouvait influencer le lien entre tempérament dépressif et alcoolodépendance ;

– comparer les tempéraments entre un groupe de patients alcoolo-dépendants déprimés et un groupe de patients alcoolo-dépendants non déprimés.

Cent dix-huit patients, consultant consécutivement, de juillet 2014 à mars 2015, dans le service d’addictologie de l’hôpital Sainte-Anne (Paris) pour alcoolo-dépendance, ont été inclus dans l’étude. Un groupe de sujets alcoolo-dépendants déprimés (n = 38) a été comparé à un groupe de sujets alcoolo-dépendants non déprimés (n = 80). Ils ont été évalués à l’aide de l’auto-questionnaire Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS-A), à 39 items, explorant les cinq sous-échelles du tempérament affectif :

– cyclothymique ;

– dépressif ;

– irritable ;

– hyperthymique ;

– anxieux [3].

Les troubles psychiatriques associés ont été évalués à l’aide du MINI et de l’échelle de dépression de Beck, à 13 items.

Le score total moyen à l’auto-questionnaire TEMPS-A était plus élevé dans le groupe des patients alcoolo-dépendants déprimés que dans le groupe des patients alcoolo-dépendants non déprimés (respectivement scores moyens : 19,24 ± 5,73 vs 14,25 ± 6, 41, p < 0,001). Les scores moyens aux sous-échelles dépressive, cyclothymique et anxieuse étaient significativement plus élevés dans le groupe de patients alcoolo-dépendants déprimés. En revanche, il n’y avait pas de différences significatives pour les sous-échelles irritable et hyperthymique.

La dépression peut constituer un facteur de confusion dans le lien retrouvé antérieurement entre tempérament dépressif et l’alcoolo-dépendance.

Integration of functional aspects in the treatment of schizophrenia is important; however, little knowledge exists whether the global assessment of functioning (GAF) predicts early clinical course.

To investigate associations between GAF and relapse.

To identify all adults (≥18 years) for the first-time diagnosed with schizophrenia in Denmark in 2004-2012 and calculate the risk of 2-year relapse.

Patients were categorized according to baseline GAF-scores (at initiation of outpatient or discharge from inpatient contact, respectively): 61-100, 46-60, 31-45 and 1-30. Relapse was the first schizophrenia (re)-hospitalization. We performed Cox regression analyses (hazard rate ratios (HRR), 95%-confidence intervals (95%-CI)) adjusted for: sex, age, substance abuse, duration of untreated psychosis (DUP), length of baseline hospitalization, index-year, antipsychotic treatment and side effects.

Among 5,674 incident patients, 5,184 (91.4%) had a valid baseline GAF-score. Lower GAF-scores were associated with longer DUP and baseline hospitalization. 2,278 (40.2%) experienced relapse, 428 (20.7%) of outpatients and 1,850 (51.3%) of inpatients. Lower GAF was associated with an increased risk for relapse in a dose-response relationship. Among inpatients, GAF≤30 (compared with GAF>60) was Associated with a 43% increased risk. Among outpatients, the relapse risk increase was HRR=1.22 (95%-CI=0.76; 1.97) with GAF=46-60; HRR=1.93 (95%-CI=1.24; 3.02) with GAF=31-45, and HRR=3.07 (95%-CI=1.84; 5.13) with GAF=1-30.

Lower baseline GAF was associated with increased 2-year relapse risk in a dose-response relationship. The clinically widely used GAF may be an important tool for prediction of early clinical course among incident adult schizophrenia patients, in particular in an outpatient setting.

L’impulsivité, souvent décrite comme élevée chez les patients alcoolo-dépendants (AD), est un concept complexe qui jouerait un rôle important dans le développement de l’AD [1] et augmenterait les risques de rechutes [2]. L’impulsivité est considérée, selon les auteurs, comme un facteur de vulnérabilité psychopathologique ou comme une conséquence de l’AD [3] potentiellement en lien avec l’altération fréquemment observée des fonctions exécutives. Les liens spécifiques entre impulsivité et anomalies cérébrales chez les sujets AD n’ont que très peu été étudiés à l’heure actuelle [4]. Cette étude a pour objectif d’étudier les liens entre impulsivité et fonctions exécutives dans l’alcoolo-dépendance.

Cinquante-sept patients AD sans complications neurologiques et 44 volontaires sains (VS), appariés en âge, sexe et années de scolarité, ont bénéficié d’une batterie de tests évaluant les fonctions exécutives. L’impulsivité a été mesurée par une échelle d’auto-évaluation (Barratt Impulsiveness Scale). Parmi ces 101 sujets, 21 AD et 15 VS ont bénéficié d’une IRM cérébrale 3 T.

Les AD déclaraient une impulsivité plus importante que les VS, et présentaient une altération de leurs fonctions exécutives. Seule l’inhibition était associée à l’impulsivité lorsque les deux groupes étaient examinés ensemble. Les AD présentaient une atrophie cortico-sous-corticale et des corrélations négatives entre impulsivité et volume de substance grise ont été retrouvées dans les régions frontales, préfrontales, et insulaires.

Nos données suggèrent que l’impulsivité serait en partie liée à l’inhibition. Chez les AD, l’impulsivité serait donc à la fois prémorbide et en lien avec l’altération des processus d’inhibition due à la consommation chronique d’alcool. Les atteintes cérébrales des AD pourraient être à l’origine de difficulté à s’autoévaluer et d’une atteinte de la métacognition.

Motor coordination of interacting people influences social cognitive functioning, impacting feelings of connectedness or interpersonal rapport and communication. Social interaction deficits are one of the most significant and defining features of schizophrenia but until recently no quantitative and objective measures of social motor coordination in schizophrenia have been proposed.

We aimed to investigate social motor coordination of patients suffering from schizophrenia and the implication of this paradigm in rehabilitation, using priming effects.

Interpersonal coordination was assessed with a hand-held pendulum task. In the first experiment we evaluated intentional social motor coordination in 20 schizophrenia patients and 20 healthy controls.

In the second experiment, hand-held pendulum task was realized after implicit exposure to pro-social, non-social or anti-social primes, in 45 patients and 45 healthy controls.

We found that intentional social motor coordination was impaired in patient suffering from schizophrenia with lower stability and the fact that patients never led the coordination. In the second experiment, we found that schizophrenia patients who received pro-social priming have greater stability during interpersonal coordination. Furthermore, pro-social priming induced, in their synchronization partner greater feelings of connectedness towards patients.

First we demonstrate that schizophrenic patients have a specific relational motor signature. Such findings may lead to the development of rehabilitation protocols improving social motor coordination and successful social exchanges of patients. This hypothesis is strengthened by the fact that pro-social priming can have a direct and important effect on improving social motor interaction in patients suffering from schizophrenia.

The study included Belarusians 18-35 years with acute psychotic disorder, resistant to pharmacotherapy, with the presence of side effects, lack of secondary resistance. Patients signed an informed consent form.

We determined the genetic polymorphism of cytochrome P-450 (CYP2D6*4, CYP2C19*2, CYP2C19*3, CYP1A2*F) and P glycoprotein (MDR-1 C3435T).

The study included 26 patients with acute psychotic disorder.

Mutation C3435T of MDR-1 gene, leading to severe impairment of P-glycoprotein, was detected in 17 patients (65%).

Among allelic variants of CYP2C19, associated with a phenotype of slow drug metabolism, CYP2C19*2 was detected in 5 patients (19%); CYP2C19*3 variant was not found in anybody.

Depending on the outcome of genotyping we changed neuroleptic dosage or replaced the drug to another, which is metabolized by other cytochrome P-450. In 22 patients (85%) we had a good therapeutic effect in the form of complete reduction of psychotic symptoms, improving the quality of social functioning. Among 18 patients with severe side effects, they disappeared completely in 17.

Preliminary results show the effectiveness of using pharmacogenetic technologies in psychiatric practice. Further research is needed to study the polygenic determination and prevalence of genetic polymorphisms in the Belarusian population.

Cultural competence is an essential component in rendering effective and culturally responsive services to culturally and ethnically diverse clients.

The aim of this study was to evaluate the reliability and validity of the Portuguese version of the Multicultural Mental Health Awareness Scale – MMHAS (Khawaja, Gomes &Turner, 2008).

After a process of translation and transcultural validation, the Portuguese version of MMHAS, along with a sociodemographic questionnaire, were applied to a sample of 306 Portuguese nurses, aged between 21 and 68 years, with an average age of 35,4 years and a standard deviation of 9.8 years; 25.2% female and 74.8% male. A psychometric research design was used with content and construct validity and reliability.

The factor analysis confirmed that the MMHAS has a three-factor of multicultural competencies (Cultural Awareness, Cultural Knowledgeand, Cultural Skills) explaining 59.51% of the total variance. The Portuguese version of MMHAS has a strong internal consistency, with a Cronbach's alpha of 0.958 for total scale.

The results supported the construct validity and reliability of the Portuguese version of MMHAS. The scale can be used to evaluate the effectiveness of the multicultural competency training programs in mental health nursing.

Depression is the most common mental health problem in late life.

To estimate the prevalence of depression in the elderly and to investigate associations with risk factors.

A cross-sectional study was conducted among the members of four day care centers for older people (KAPI), three in the municipality of Patras, West-Greece and in one KAPI in the municipality of Tripolis, Peloponnese-Greece. A total of 378 individuals took part in the study. A questionnaire was developed to collect basic demographic data. Moreover, to all participants the Greek validated version of the Geriatric Depression Scale (GDS-15) was applied, to screen for depressive symptoms.

According to GDS-15, 48.1% of the studied population screened positive for depressive symptoms (38.6 % moderate, 9.5% severe). In 139 members of KAPI of Tripolis, depressive symptoms were more frequent in women than in men (62.9% vs 45.5%, p=0.012), in not married (85.6% vs 38.9%, p>0.001), in participants without children (91.7% vs 49.2%, p>0.001), in subjects suffering from insomnia (88.6% vs 6.7%. p>0.001), in participants with low monthly income (63.7% vs 25.8%, p>0.001) and in older adults with co-morbidity (62.4% vs 4.5%, p>0.001). In 239 members of KAPI of Patras, depression were more frequent in women (54.6% vs37.4%, p=0.027), in not married (55.6% vs38.9%, p=0.038), in subjects living alone (62% vs38.1%, p=0.003) and in elderly with co-morbidity (50.8% vs27.5%, p=0.02).

The present study reveals high prevalence and several risk factors for developing depression in the specific population of the elderly.

Stigma is a phenomenon that has been evaluated according to endless numbers of attributes, health conditions and social groups. Research shows that mental illness is one of the most socially exclusive stigmata. Aukst Margetic underlines the importance of individual differences in personality as performing a key role in mediating between social and internalized stigma.

To gain the existing state of the art on personality correlates and to verify the knowledge of the clinical variables on the phenomenon of internalized stigma among patients with severe mental illnesses.

To answer the question whether there are any differences in internalized stigmatization among patients with severe mental illnesses in relation to the personality traits and illness-related factors.

Two-stages, cross-sectional study design. Stage I, a pilot study to check the reliability of psychometric instrument measured the internalized stigma – Internalized Stigma of Mental Illness (ISMI) scale by Ritsher [Boyd]. Stage II,to examine the internalized stigma in relation to personality and clinical correlates. The study is conducted among people of both sexes between 18 and 65 years old with diagnosis of psychotic disorders (F20-29) and mood disorders (F30-39) according to ICD-10.

Among used methods are: Personality Inventory NEO-FFI, Eysenck's Personality Questionnaire (EPQ-R), a Polish version of questionnaire of Internalized Stigma of Mental Illness (ISMI).

Data on relation between personality traits, clinical factors and internalized stigma.

In the future, the obtained results may contribute to the clinical and therapeutic fields, assuming that internalized stigma is strongly linked with the process of recovery.

The aim of the present study was to estimate the prevalence and forms of psychoactive substances among adolescent students in Assiut Governorate, Egypt.

This study was cross sectional community survey conducted during academic year (2010-2011). The sample size was 5476 students from preparatory and secondary schools were subjected to a standardized questionnaire of substance misuse questionnaire of Egypt in an Arabic version and modified Arabic version of socioeconomic scale .

22.9 % of sample stated that they used psychoactive substance. Substance use disorders in age group (12 – 16) was (50.0%), (> 16 – 19) was (49.68%), and (> 19) was (0.32%) . Males reported higher prevalence (94.59%) than females (5.41%). Substance use disorder was prevalent in Secondary Public schools (48.17%), Technical (24.84%), Preparatory (23.09%) and then Secondary Private (3.90%). Students from Rural areas reported higher prevalence (83.36%) than Urban areas (16.64%). Tobacco smoking in males (89.31%) and in females (98.53%), Marijuana (Hash)in males (5.56%), Alcohol in males (1.94%), Tramadol in males (1.60%), Marijuana (Bhang) in males (0.93%), Opium in males (0.34%)and in females (1.47%), Benzodiazepines (Clonazepam, Alprazolam)in males (0.25%),and lastly Amphetamine like (Foula) in males (0.08%). Recreational pattern (34.63%) that was higher in males than in females (36.20%−7.35%). Dependence was (28.50%) that was also higher in males than females.

Tobacco and Hashish were the major substance problem for most of Students, that needs to be addressed in treatment programs.

Severe alcohol use disorders (AUD, DSM5 criteria, 2013) are associated with changes in the dynamics of emotional processes and emotional experience [1]. The aim of the study was to compare emotional information processing in patients with AUD in short-term abstinence (STA, less than 1 month) and in long-term abstinence (LTA, at least 6 months) with control participants (C). We studied the parasympathetic branch of the autonomic nervous system with the heart rate variability (HRV) and more particularly high frequencies (HF). This indicator is recognized as a reliable marker of physiological activation in reaction to emotional stimuli and as a good marker of vulnerability to AUD [2].

The recording was performed for all participants during presentation of high emotional inducing stimuli presenting human interactions [3]. For each participant HRV was recorded before, during and after induction. Participants were asked to evaluate the intensity and the valence of emotional stimuli. In addition, a clinical and cognitive assessment was performed. We proposed in this study for abstinence in short- and in long-term to combine both behavioral and cognitive measures to this physiological indicator.

We observed:

– significant differences in HF-HRV between LTA and STA groups, controls and STA groups but not between LTA and C groups;

– significant correlations between craving scores [4] and HF-HRV results in LTA and STA groups.

The results support the relationship between the ability to process emotional information and the risk of relapse. HF-HRV results indicate specific deficits in regulation in STA group and also recoveries in LTA group. It suggests specific different therapeutic interventions in preventing the risk of relapse or maintenance of addiction.

High potency cannabis has been associated with greater risk, and earlier onset of psychosis. However, its effect on brain structure, particularly white matter (WM), has never been explored.

To elucidate the interplay between cannabis potency, pattern of use (frequency and age of first use) and CC microstructure; in patients with first-episode psychosis (FEP) and healthy controls.

56 FEP and 43 healthy controls underwent Diffusion-Tensor Imaging combined with WM mapping-tractography. CC was virtually dissected and segmented to calculate Fractional Anisotropy (FA), Mean Diffusivity (MD), Axial Diffusivity (AD) and Radial Diffusivity (RD) for each CC segment.

High potency cannabis users had higher Total CC MD and Total CC AD than both low potency users and those who never used (p=0.009 and p=0.02 respectively). Daily users also had higher Total CC MD and Total CC AD than both occasional users and those who never used (p=0.02 and p=0.01 respectively). Furthermore, daily/highpotency users had higher Total CC MD than those who never used or used weekly [F(2,57)=4.7, p=0.01]. There was no effect of diagnosis or diagnosis X potency/patterns of use interactions; neither differences between users who started before the age of 15 and those who started later were detected, in any diffusivity measures.

Frequent use of high-potency cannabis significantly affects callosal microstructure, regardless of the presence of a psychotic disorder. Given the increased availability and use of high potency preparations in Europe, raising awareness about some of their detrimental effects is an important avenue to pursue.