A bidirectional association between type 2 diabetes and depression has been consistently reported. It is associated with worse biomedical outcomes and increased mortality. One possible question is whether the co-occurrence of type 2 diabetes and depression is due to genetic and/or environmental vulnerabilities in common to the two traits.

To examine the genetic relationship between type 2 diabetes and depression at a population level.

To quantify the genetic overlap between type 2 diabetes and depression using the Swedish Twin Registry.

The study included 43,565 twin pairs (12,363 monozygotic pairs and 31,202 dizygotic pairs). The primary outcomes were lifetime diagnosis of type 2 diabetes and depression from the Swedish National Hospital Discharge Registry. Standard bivariate twin models were fitted to the raw data to estimate the genetic and environmental (co)variance of the two traits.

Heritability estimates for lifetime diagnoses of type 2 diabetes and depression were similar to previous estimates, at 77% and 42% respectively. The phenotypic correlation between type 2 diabetes and depression was 0.14 (95%CI: 0.11-0.17), of which 58% was due to shared genetic influences. When covariates (age and gender) were included, the genetic contribution to the phenotypic correlation reduced to 51%.

This is the first study to demonstrate a small but significant genetic overlap between type 2 diabetes and depression at a population level, using hospital-registry records.

Schizophrenia is associated with an increased risk of violence. The successful identification of the illness specific factors that contribute to that risk could lead to the development of novel therapeutic risk management strategies.

To identify cognitive and emotion processing deficits that are linked to violence risk in schizophrenia.

Fifty male patients with DSM-IV schizophrenia and thirty-nine healthy controls were assessed across a range of intellectual, executive, emotion and social processing domains. Lifetime propensity to violence was quantified in terms of frequency, severity and victim outcome.

General intellectual ability and memory were not significantly associated with violence propensity. Violent patients showed significantly poorer response inhibition, after accounting for relevant clinical variables. A greater lifetime propensity to violence was associated with an attentional bias towards anger, a heightened sensitivity to the recognition of fear, with poorer complex Theory of Mind performance.

Our results allow us to propose a hypothetical model of the risk of violence in schizophrenia. We suggest that heightened sensitivity to environmental negative emotional cues and poorer understanding of complex social situations, combined with a poorer ability both to quickly process but also inhibit pre-potent responses, results in a greater propensity to violence in schizophrenia. We propose that this model sits alongside risk associated with other factors such as illicit drug use. These findings need replication but could have implications for more effective treatment and management of patients with schizophrenia.

Intégrés dans la prise en charge globale du trouble de l’usage d’alcool, les traitements addictolytiques présentent un réel intérêt mais restent relativement peu prescrits [1]. Afin de faciliter leur utilisation, nous proposons une mise au point sur les différentes possibilités pharmacologiques actuelles et les pistes thérapeutiques d’avenir. État des lieux : en partenariat avec le patient, deux types d’objectif de consommation peuvent être proposés : la réduction ou l’abstinence [1]. Dans le 1er cas, seul le nalméfène a actuellement l’AMM en France [2]. En cas d’objectif d’abstinence, la naltrexone, l’acamprosate et le disulfirame sont les traitements addictolytiques de 1er choix [2]. Encadré par son actuelle recommandation temporaire d’utilisation, le baclofène peut être employé en 2e intention [2] et nécessite certaines précautions d’emploi lors de son instauration et de son sevrage [3]. Les résultats de son évaluation dans les 2 types d’objectif (études Bacloville et Alpadir) devraient être éminemment diffusés [2]. D’autres travaux en cours permettront d’étayer nos connaissances sur les systèmes de neurotransmission et les potentialités thérapeutiques qui en découlent [4]. En complément du traitement addictolytique, une bonne relation soignant–malade reste une base indispensable du parcours de soins [2]. Ce dernier permettra au patient un suivi médical de type entretiens motivationnels, une psychothérapie, le traitement d’éventuelles comorbidités somatiques ou psychiatriques, et des entretiens avec des membres d’associations d’anciens buveurs [2].

Relativement peu prescrit, le traitement addictolytique nécessite une plus large diffusion et une meilleure utilisation en santé mentale et en médecine générale.

Phase I entailed the development of the Social Rituals Schedule (SRS). It is a semi-structured interview that rates the degree of changes observed across several domains determined as universal social rituals via extensive analysis of socio-anthropological studies and literature (e.g. personal appearance, sleeping habits, greeting rituals). During Phase II, the psychometric properties of the SRS were then evaluated and the instrument proved to have good inter-rater reliability and to be sensitive to changes characteristic of prodromal symptoms. In Phase III, the SRS was administered on 30 early episode psychosis patients and their carers and the results were comparatively analysed to determine the agreement between patient-carer observations of behavioural changes.

The hypothesised interconnectedness of altered performance of social rituals and impaired mental functioning was demonstrated. The SRS was established as a sensitive, feasible and reliable tool for measuring changes characteristic of prodromal symptoms. The project illustrated the clinical usefulness of the social rituals concept and its accompanying instrument in facilitating the early detection of mental disorders.

The onset of eating pathology has commonly been attributed to media influences. However, most of these studies have not included an experimental design and have mainly concentrated on Caucasian samples, with limited research on non-Western populations.

To assess whether exposure to either objectifying female media images or neutral images (e.g. chairs) had an impact on eating pathology and self-objectification and whether this effect was different for Australian and Asian females.

A total sample of 301 female participants [Caucasian Australians (n= 97); Asians grown up in Australia (n = 70), Asians currently residing in Australia (n = 60) and Chinese living in Hong Kong (n = 74)] were exposed to a slideshow of either objectifying women (n=147) or neutral (n=154) images. Variables associated with the objectification framework and eating pathology were assessed through self-report.

State self-objectification was higher in individuals who were exposed to the objectifying media images, regardless of ethnicity (p >0.01). Caucasians had significantly higher BMI and greater body surveillance compared to the Chinese population (p>0.01), and more trait self-objectification and body surveillance compared to Asians residing in Australia (p>0.05). Similarly, Asians who grew up in Australia demonstrated higher trait self-objectification compared to Asians residing in Australia (p>0.05), and body surveillance and food preoccupation compared to the Chinese sample (p>0.05).

The results indicate that self-objectification can be elicited from exposure to objectifying media images in women from varying cultural backgrounds. This understanding is crucial to the development of preventive measures of eating pathology.

Basic Self disturbances (BSD), including changes of the 'pre-reflexive' sense of self and the loss first-person perspective, are characteristic of the schizophrenic spectrum disorders and highly prevalent in subjects at 'ultra high risk' for psychosis (UHR). The current literature indicates that cortical midline structures (CMS) may be implicated in the neurobiological substrates of the 'basic self' in healthy controls.

Neuroanatomical investigation of BSD in a UHR sample

To test the hypotheses :(i) UHR subjects have higher 'Examination of Anomalous Self Experience, EASE' scores as compared to controls, (ii) UHR subjects have neuroanatomical alterations as compared to controls in CMS, (iii) within UHR subjects, EASE scores are directly related to structural CMS alterations.

32 HR subjects (27 antipsychotics-naïve) and 17 healthy controls (HC) were assessed with the 57-items semi-structured EASE interview. Voxel-Based Morphometry (VBM) was conducted in the same subjects, with a-priori Region of Interests (ROIs) defined in the CMS (anterior/posterior cingulate and medial-prefrontal cortex).

Despite high variability in the HR group, the overall EASE score was higher (t-test >0.01, Cohen's d =2.91) in HR (mean=30.15, SD=16.46) as compared to HC group (mean=1.79, SD=2.83). UHR subjects had gray matter reduction in CMS as compared to HC (p>0.05 FWE-corrected). Across the whole sample, lower gray matter volume in the anterior cingulate was correlated with higher EASE scores (p>0.05).

This study provides preliminary evidence that gray matter reductions in the CMS are correlated with BSD in UHR people.

Neuroimaging studies indicate that auditory hallucinations are associated with smaller grey matter volume in the auditory cortex in schizophrenia patients. However, reduced cortical volume can be the result of reduction in either cortical thickness or cortical surface area, and these two components may reflect different pathophysiological processes.

To measure cortical thickness and surface area of auditory cortex in schizophrenia spectrum patients and healthy controls and investigate putative association of cortical characteristics with auditory hallucinations.

To determine how thickness and surface area of the auditory cortex relate to auditory hallucinations in schizophrenia patients.

Schizophrenia spectrum patients and healthy controls from the Thematically Organized Psychosis study, Oslo, Norway, underwent 1.5 T MRI. General linear models were used to compare cortical thickness and surface area (obtained with FreeSurfer) in transverse temporal gyrus (TTG), planum temporale (PT), and lateral superior temporal gyrus (STG) between hallucinating (score > 3 on Positive and Negative Syndrome Scale, PANSS, item P3; n=82), non-hallucinating (n=139) schizophrenia spectrum patients, and healthy controls (n=323).

Both patient groups had thinner cortex bilaterally in PT and STG, as well as larger left STG surface area compared to controls. The hallucinating group showed reduced thickness in left TTG and trend reduction in left PT compared to non-hallucinating patients. No cortical surface area differences were found between hallucinating and non-hallucinating patients.

Our results indicate that auditory cortex volume reductions associated with auditory hallucinations in schizophrenia patients are driven by reductions in cortical thickness.

Les addictions posent un problème de santé publique. Le concept d’addiction comportementale est récent. Les données de la littérature concernent essentiellement les addictions au jeu. Peu de données sont disponibles en France sur la dépendance à l’exercice physique (DEP). Quelle est sa prévalence chez les sportifs en Picardie et dans le Nord pas de Calais ? Quelles sont les comorbidités psychiatriques et addictives associées ? Les motivations à la pratique sportive diffèrent-elles chez les sujets avec DEP ?

Nous avons réalisé une étude épidémiologique descriptive randomisée transversale en double aveugle et une étude transversale analytique. Nous avons étudié la DEP avec l’échelle EDQ d’Ogden et al.

Deux cent trente personnes (144 hommes et 86 femmes) issues de 8 associations sportives différentes ont participé. L’âge moyen était 41,31 ans ± 11,972. La prévalence de la DEP était de 18,26 %. La DEP concernait plus les sports individuels. Les liens entre la DEP et la souffrance psychologique, entre la DEP et l’antécédent de suivi psychiatrique ou psychologique, entre la DEP et la consommation de compléments alimentaires étaient significatifs. La motivation principale des sujets avec une DEP était la recherche de récompense positive tandis que les sujets sans DEP exerçaient surtout pour des raisons de santé.

Les données de la littérature sur la DEP sont controversées. L’association de la DEP uniquement à la souffrance psychologique, à un suivi psychiatrique ou psychologique, à la recherche de récompense et à la consommation de compléments alimentaires nous questionne quant à la pertinence de cette entité.

La DEP qui est un trouble fréquent chez les sportifs nécessite de meilleures sensibilisation et prévention.

Les troubles du comportement alimentaire (TCA) sont des pathologies fréquentes qui touchent principalement les femmes et dont le pronostic reste réservé. Les patientes souffrant de TCA sont beaucoup plus préoccupées par leur image corporelle et leur poids que le reste de la population [1]. De surcroît, les préoccupations corporelles seraient un facteur de risque dans le développement de TCA [1] et pourraient aussi constituer un facteur de risque de rechute lorsqu’elles sont intenses [2]. Les préoccupations concernant la silhouette et le poids font partie intégrante des critères diagnostiques des troubles du comportement alimentaire (anorexie mentale, boulimie nerveuse) dans le DSM-5 [3]. On constate cependant que leur intensité varie selon les patients. Nous avons cherché à évaluer si les patientes ayant des préoccupations corporelles importantes présentaient des caractéristiques cliniques particulières.

Notre étude a porté sur les évaluations initiales de 123 patientes souffrant de troubles du comportement alimentaire (anorexie restrictive pure, anorexie avec conduites de vomissements/laxatifs/hyperactivité et boulimie nerveuse) consultant au CHU de Nantes. Nous avons distingué les patientes ayant un score BSQ à 110 (préoccupation faible) de celles ayant un BSQ supérieur à 140 (préoccupation marquée). Nous avons comparé les caractéristiques cliniques de ces deux groupes. Une analyse multivariée a été utilisée pour cette comparaison.

Les préoccupations corporelles marquées étaient associées aux épisodes dépressifs majeurs (OR = 100,3), à un indice de masse corporel minimal plus élevé (OR = 1,73), à une utilisation de laxatifs (OR = 49,8), à un score élevé pour l’item « insatisfaction corporelle » de l’EDI-2 (OR = 1,7) et pour l’item « perte de contrôle » du DISQ (OR = 10,74).

Nous avons confronté nos résultats à notre expérience clinique ainsi qu’aux données de la littérature.

Le groupe de patientes ayant des préoccupations corporelles marquées présente des caractéristiques cliniques spécifiques.

Admission to a psychiatric hospital is a strong predictor for future adverse outcome such as imprisonment and death. There exists a large gender gap for this relationship for men and women.

To study sex difference in the time from admission to psychiatric hospital and time to imprisonment or death.

All patients over 18 years of age admitted for the first time to psychiatric in-patient care in a nationwide population were found through administrative registers in Iceland. A Cox proportional hazard ratio was calculated for a composite outcome variable of either imprisonment or death for 10 years following admission.

During a 27-year period, a total of 4,459 individuals were admitted to psychiatric services in Iceland out of which 2,303 were men (51.6%). The average age at first admission was 25.9 ± 5.7 for men and 25.8 ± 5.8 for women (p=0.64). Substance use disorder was the most common discharge diagnosis in 46% of admissions, mood disorder in 35.6%, personality disorder in 12.8% and schizophrenia and related disorders in 7.9%. A Cox proportional hazard model showed a hazard ratio (HR) of adverse outcome for men 2.52 (95%-confidence interval (95%-CI): 1.87–3.39, p>0.001). HR for substance use disorder was 3.08 (95%-CI: 2.31-4.11), personality disorders HR = 1.85 (95%-CI: 1.34-2.55), whereas older age at admission was protective HR 0.96 (95%-CI: 0.93-0.98, p=0.003) as was admission later in the period HR 0.96 (95%-CI: 0.93-0.98).

Men have a statistically worse prognosis when looking at hard endpoints such as imprisonment and death.

The changing epidemiological profile of population in recent decades is related to the socio-economic conditions of contemporaneity. Diabetes mellitus (DM) is positioned in the chronic non-communicable diseases spectrum as one of the most prevalent being responsible for high rates of morbidity and mortality. Therapeutic adhere is of crucial importance because there are high risks associated with non-adherence and it impacts on quality of life.

Identifying therapeutic adherence predictors in type 2 diabetes (DM2).

188 patients attending diabetology consultations at the Department of Endocrinology, Diabetes and Metabolism, at Centro Hospitalar e Universitário de Coimbra and at Associação Protetora dos Diabéticos de Portugal participated in the study. Participants completed the following set of self-report instruments: Beck Depression Inventory (BDI), the Diabetes Health Profile (DHP), the Rosenberg Self-Esteem (RSE), and the social relations dimension of the World Health Organization Quality of Life (WHOQOL). Therapeutic adherence was established base on HbA1C clinical criteria.

Multiple regression analyses revealed that the full model was statistically significant [c 2 (4, n = 188) = 20.79, p >0.001] explaining between 20% and 29.6% of total variance and 76.3% of the cases were correctly classified. The four variables significantly contributed to the model, especially the BDI and the RSE, registering an odds ratio of 1.104 and 1.203, respectively.

In DM2 predictors of non-adherence were depression and diabetes patient health profile while self-esteem and quality of life in social relations, emerged as predictors of adherence.

Elevated levels of C-reactive protein (CRP) have repeatedly been observed in schizophrenia (SZ) and related disorder but without clear description of the associated clinical variables. The objectives of this study were:

– to determine the prevalence of abnormal CRP levels in an observational sample of patients with SZ or schizoaffective disorders;

– to identify the clinical variables associated with elevated CRP levels as well as the effects of treatments.

Two hundred and nineteen stable patients with schizophrenia or schizoaffective disorder (mean age = 31.6 years, 75.3% male gender) were systematically included in the network of FondaMental Expert Center for schizophrenia and assessed with a dedicated electronic medical records including the Structured Clinical Interview for DSM-IV Axis I Disorders and validated scales for depressive and psychotic symptomatology. High sensitivity CRP (hs-CRP) was measured with an assay using nephelometry (Dade Behring). Abnormal CRP level was defined by levels > 3 mg/L. Metabolic syndrome was defined according to the International Diabetes Federation.

Overall, 63 patients (28.8%) were found to have abnormal CRP levels. In univariate analysis, abnormal CRP levels were found to be significantly associated with the DSM-IV-TR schizophrenia diagnosis compared to schizoaffective disorder (32.6% vs. 10.5%, P = 0.006). This association remained significant after adjustment for BMI (P = 0.007) and antidepressants (P = 0.043). Abnormal CRP levels were also found to be significantly associated with BMI (P < 0.0001), hypertriglyceridemia (P = 0.0015), high waist circumference (P < 0.0001), metabolic syndrome (P = 0.0011) and abdominal obesity (P < 0.0001), while current tobacco status, hypertension or high fasting glucose were not (all P > 0.05). All patients were treated by antipsychotics. Patients treated by antidepressant were found to have less abnormal CRP levels than others (P = 0.01), contrary to those treated by mood stabilizing agents (P > 0.05).

CRP may be considered as a biomarker of interest to differentiate schizophrenia from schizoaffective disorder, and as a marker of inflammation induced by perivisceral fat. Treatment with antidepressant appears as a protective anti-inflammatory agent.

To characterize brain perfusion in FEP.

To see if FEP exhibit modified perfusion in respect to healthy controls (HC), and identify the most affected brain areas.

We acquired T1 and DSC images of 35 FEP patients (45 +/- 10 years old) and 35 HC (42 +/- 8), using Gadolinium (0.1 mmol/Kg). We computed cerebral blood volume (CBV), cerebral blood flow (CBF) and mean transit time (MTT) [3] in the whole brain and in left and right frontal, parietal, temporal and occipital lobes, insula, caudate and cerebellum

Mean values of all quantities resulted lower in patients, up to 12% for CBV in right frontal lobe, 11% for CBF in left cerebellum and 16% for MTT in right frontal lobe. We used a support vector machine (SVM) to classify subjects on the basis of the histogram of perfusion values. We found that the classification reached accuracies over 80%, especially in the frontal brain areas.

FEP show altered perfusion parameters, which allow automatic classification with good accuracy, showing that brain vascular characteristics can be considered as marker of psychosis.

1. [1] Peruzzo et al (2011). J Neural Transm, 118, 4:563-70.

2. [2] Agarwal et al (2008). J Affect Disord, 110, 1-2:106-14.

3. [3] Ostergaard et al (1996). Magn Reson Med, 36, 5:715-25.

En 2009, à l’aube, le SNLE Le Triomphant est entré en collision avec le sous-marin britannique HMS Vanguard en immersion. Effet de surprise majeur (réveil brutal), absence de contrôle prolongée et menace vitale caractérisent le vécu des 110 sous-mariniers à bord. Une prise en charge trois mois après l’accident, comprenant évaluation psychométrique anonyme de la souffrance psychique au sein de l’équipage (ESPT [1], dépression [2]) et entretiens individuels par le service local de psychiatrie, a été réalisée. Sur les 92 sous-mariniers répondants, 17 % souffraient d’ESPT, et 20 % d’un syndrome dépressif léger à sévère. La sévérité clinique était en lien avec l’existence d’une dissociation péritraumatique au décours du choc [3], et l’intensité de la symptomatologie dépressive. En 2014, cinq ans après l’accident, un état des lieux a été réalisé au sein de cette même population.

Après une information téléphonique auprès de 92 marins portant sur l’objectif de l’étude d’un suivi anonyme de prévalence de l’ESPT, les mêmes auto-questionnaires (Post-Check List Scale1 ; échelle de Beck [2], 21 items) ont été envoyés par voie postale.

Soixante-sept sous-mariniers encore en activité dans les SNLE ont répondu. La prévalence de l’ESPT est de 11 % des répondants. Dix-huit pour cent de cette population souffre d’un syndrome dépressif léger à majeur. La sévérité clinique de l’ESPT n’était pas en lien avec l’intensité de la symptomatologie dépressive.

La prévalence de l’ESPT au sein de notre population a diminué. Elle est sensiblement identique à d’autres populations de militaire étudiées. Il existe probablement un biais de recrutement, à l’origine d’une sous-évaluation de la prévalence et suggérant l’existence d’une stigmatisation des troubles psychiques au sein des armées. La prévalence importante des syndromes dépressifs questionne l’interaction entre l’accident traumatogène et les conditions de vie à bord (manque de lumière et travail posté) [4].

La dopamine a un rôle important dans la physiopathologie de la schizophrénie. L’hypothèse d’une « attribution aberrante de saillance » dans la schizophrénie pourrait expliquer les symptômes positifs et négatifs de la schizophrénie [1]. Les processus de récompense composent la saillance motivationnelle, dans laquelle la dopamine est impliquée [2]. Ce travail a pour objectif de faire une méta-analyse des études d’activation cérébrale en IRM fonctionnelles, comparant les patients schizophrènes aux sujets sains lors des tâches de récompense.

Nous avons réalisé une recherche Pubmed, utilisant les mots clés : “schizophren* OR psychosis,” “fMRI OR PET,” “salienc* OR reward”. Au total, 171 études ont été sélectionnées, dont 12 comparant spécifiquement les patients schizophrènes et témoins durant les tâches de récompense. Elles comprenaient 480 sujets et 82 foci d’activation pour l’anticipation de récompense (30 foci), la réception de la récompense (14 foci) et l’erreur de prédiction (38 foci). La méthode utilisée est une estimation de la probabilité d’activation, réalisée à l’aide d’un algorithme implémenté sur le logiciel GingerALE Version 2.3.3 [3]. Nous avons utilisé un algorithme d’inférence par Cluster (p = 0,05) avec un p non corrigé pour le seuil de formation du cluster de 0,001.

Les patients schizophrènes montraient par rapport aux patients témoins un défaut d’activation dans l’aire tegmentale ventrale, le striatum ventral bilatéral, l’hippocampe, et le cortex cingulaire antérieur, lors de l’anticipation, la réception de récompense, et lors de l’erreur de prédiction.

Les patients schizophrènes montrent par rapport aux patients témoins un défaut d’activation dans les régions méso-limbiques impliquées dans les processus de récompense [4]. Cependant, le nombre de patient, notamment pour le contraste « réception de récompense » est encore faible.

Studies have shown that mental health risks related to military deployment depend on specific risk factors. Especially stressful experiences (SE) and lack of social support (SS) have been associated with deployment-related increases in mental disorders. Less is known about difficulties in emotion regulation (DER) in this context despite their well-known importance for the development and maintenance of mental disorders. To date, the number of prospective studies investigating the role of these potential risk factors for deployment-related psychopathology is limited.

To investigate risk factors for deployment-related increases in symptoms of common mental disorders.

To investigate associations between SE, SS and DER, and deployment-related increases in PTSD, major depression (MD) and alcohol use disorder (AUD) symptoms.

358 male soldiers were assessed before and 12 months following deployment using standardized diagnostic interviews (CIDI) and embedded questionnaires. Outcome measures were the number of PTSD, MD and AUD symptoms reported for the preceding 12 months at follow-up. Analyses were adjusted for baseline symptoms.

SE (incidence risk ratio (IRR)):1.06, p>0.001), SS (IRR:0.98, p=0.034) and DER (IRR:1.04, p=0.009) independently predicted increases in PTSD symptoms. SE (IRR:1.04, p=0.004) and SS (IRR:0.98, p=0.022) also predicted increases in MD symptoms. Increase in AUD symptoms was not predicted by SE, SS or DER, but by increase in PTSD symptoms (IRR:1.02, p=0.029).

Findings support the role of SE, SS and DER as risk factors for deployment-related disorders, particularly for PTSD symptoms. This knowledge might help to identify high-risk individuals and to develop targeted interventions.