The brain-derived neurotrophic factor (BDNF) is a neurotrophin fundamentally involved in the differentiation and growth during brain development. BDNF has pathogenically been linked to the schizophrenia neurodevelopmental hypothesis. Several studies have found lower BDNF blood levels in chronic schizophrenia than controls. Few studies suggest that BDNF levels in first-episode psychosis (FEP) are lower than in healthy controls (HC).

Comparing serum BDNF levels in a group of antipsychotic-naive FEP with HC and determining the serum BDNF pattern during the first year illness evolution.

Serum BDNF levels at admission of 28 inpatients with FEP were compared with 28 age/gender matched HC. BDNF was also measured at discharge, three, six, nine and twelve months. After discharge, antipsychotics were gradually decreased. Results are presented as mean±sd. and BDNF levels in ng./ml.

At admission, patients BDNF levels were significantly lower than controls (18.06±4.06 vs 26.55±3.22, p>0.001). At discharge FEP levels increase until HC levels without significant differences between gropus (25.95±3.93 vs 26.55±3.22, p=0.539). Upon the following determinations, BDNF FEP levels progressively decreased, reaching the admission values, and being significantly lower than the controls and that levels at discharge (patients: three months: 19.68±3.88; six months: 19.02±4.13; nine months: 17.64±5.24; twelve months: 17.51±3.45 vs controls: 26.55±3.22, all p>0.001).

Our results confirm the studies that found lower BDNF levels in chronic schizophrenia. Serum BDNF levels could be considered as a biological marker of treatment and evolution of FEP. Further studies with FEP patients with and without treatment are warranted.

L’anhédonie a été évaluée avec l’échelle de l’expérience temporelle du plaisir (EETP) et la symptomatologie dépressive a été mesurée avec la MADRS. L’échelle EETP permet d’évaluer deux composantes d’anhédonie : le plaisir anticipatoire (PA) qui serait lié à la motivation et le plaisir consommatoire (PC) qui serait lié à l’expérience hédonistique au moment de la consommation. Six hommes et quatorze femmes âgés de 28 à 65 ans, sans antécédent psychotique et avec un score à la MADRS > 20, ont été inclus. Les corrélations entre l’âge du premier épisode dépressif et le score de PA, de PC et à la MADRS ont été étudiées avec le test de corrélation non paramétrique de Spearman.

Le score moyen à la MADRS était de 32,7 (DS = 7,3). L’âge du premier épisode dépressif est corrélé avec le PA (r = 0,68, p = 0,001), mais ni avec le PC (r = –0,22 ; p < 0,36), ni avec la MADRS (r = 0,4 ; p < 0,08).

La dépression à début précoce semble entraîner un plus grand déficit du plaisir anticipatoire dans les épisodes dépressifs ultérieurs. Ce déficit qui traduit une atteinte de la motivation contribue au maintien du trouble dépressif par le mécanisme d’impuissance apprise . Il pourrait être un facteur prédisposant à la plus longue durée d’un épisode dépressif, ainsi que probablement à la plus mauvaise qualité de rémission et à la vulnérabilité par rapport au développement des épisodes dépressifs ultérieurs.

Studies have indicated antidepressant effects of anti-inflammatory treatment; however, results have been conflicting and side effects may contraindicate anti-inflammatory treatment.

To systematically review the antidepressant and possible side effects of anti-inflammatory interventions.

To include trials published prior to December, 31st 2013, and evaluate depression scores after treatment and side effects.

We identified randomized, placebo-controlled trials assessing efficacy and side effects of pharmacological anti-inflammatory treatment in adults with depressive symptoms including adults fulfilling depression-criteria. We calculated standard mean difference (SMD) and Odds ratios (OR).

10 publications covering 14 trials (n=6,262) were included: 10 on non-steroidal anti-inflammatory drugs (NSAIDs) (n=4,258) and four on cytokine-inhibitors (n=2,004). Anti-inflammatory treatment reduced depression (SMD=−0.54; 95%-CI:-1.08 to −0.01; I2=68%) and depressive symptoms (SMD=−0.27; 95%-CI:−0.53 to −0.01; I2=93%). Sub-analyses particularly emphasized antidepressant properties for the selective cyclooxygenase-2 inhibitor celecoxib in general (SMD=−0.29; 95%-CI: −0.49 to −0.08; I2=73%), on remission (OR=7.89; 95%-CI: 2.94 to 21.17; I2=0%) and response (OR=6.59; 95%-CI: 2.24 to 19.42; I2=0%). Among 6 studies (n=2,523), we found no evidence of an increased number of gastrointestinalor cardiovascular events after 6 weeks nor infections after 12 weeks of anti-inflammatory treatment. All trials were associated with high risk of bias.

Anti-inflammatory treatment, in particular celecoxib, decreased depressive symptoms without increased risks of side effects. However, a high risk of bias and high heterogeneity made the mean estimate uncertain. This study supports a proof-of-concept concerning use of anti-inflammatory treatment in depression. Identification of subgroups that could benefit hereof might be warranted.

Une patiente âgée de 60 ans est adressée au CPOA pour troubles de la personnalité et du comportement chez l’adulte (F60–F69) dans un contexte de voyage pathologique.

L’histoire retrouve chez cette patiente un départ impromptu pour la Belgique. Elle présente dans ses antécédents un VIH non traité et un paludisme. Elle n’a pas d’antécédent psychiatrique. Un passage dans deux services d’urgences générales montre un examen clinique général normal et des examens biologiques et tomodensitométrique cérébral sans particularité. Elle se présente en état d’incurie et désorientée dans l’espace, avec une bizarrerie. Elle tient un discours désorganisé. Elle est persécutée et agitée de manière fluctuante, et en alternance rapide avec un état de perplexité sans autre symptôme thymique ou catatonique. Un diagnostic de confusion mentale est porté, une imagerie par résonance magnétique encéphalique est réalisée. Il montre un hypersignal FLAIR de la substance blanche péri-ventriculaire, profonde (supra- et infratentorielle) et du tronc cérébral, en faveur d’une leucoencéphalopathie multifocale progressive (LEMP) à VIH. Un transfert en médecine interne et des examens complémentaires confirment le diagnostic.

La LEMP est une affection démyélinisante due au virus JC qui survient généralement avec un taux de CD4+ < 100/mm3 . La littérature montre qu’une infection VIH peut s’exprimer par des troubles psychiatriques au stade SIDA avec une prévalence de 0,23 %–15,2 % . Les troubles psychotiques sont plus rares que les troubles thymiques . L’IRM est l’examen de choix pour confirmer le diagnostic de LEMP. Le traitement étiologique est la restauration immunitaire. Le traitement symptomatique de référence est la risperidone et la clozapine en raison d’une plus grande sensibilité aux effets secondaires extra-pyramidaux de ces patients.

Des troubles psychiatriques accompagnés de confusion mentale dans un contexte d’infection VIH doivent faire suspecter une atteinte neurologique, le diagnostic psychiatrique étant un diagnostic d’élimination.

The results obtained in the last decade suggest that cystatin C plays an important role in the development of Alzheimer´s disease (AD) by inhibiting the aggregation of β-amyloid and its deposition. Cystatin C also demonstrate protective role via inhibition of cysteine proteases or by induction of autophagy and induction of proliferation (1–3).

The aim of the study concerns the influence of the ovocystatin derived from the new generation of eggs on cognitive decline in AD mice model.

Animals: Mice B6C3-Tg(APPswe, PSEN1dE9)85Dbo/Mmjax–Genotype HEMI and NCAR (The Jackson Laboratories). Specimen and administration: Ovocystatin [40μg/mouse] were administered with drinking water by 22 weeks. The placebo group received drinking water. The locomotor activity were tested by IR Actimeter. The evaluation of learning and memory was determined by Morris Water Maze test (MWM) (4). The study „Innovative technologies of bio-preparations’ production on the base of new generation of eggs” was co-financed by the European Union from the European Regional Development Fund under the Operational Program Innovative Economy, 2007-2013.

Mice from group with ovocystatin administration with drinking water have traveled statistically longer distance [D%] at Target quadrant than Placebo mice in MWM (p>0,05).

Ovocystatin given with drinking water has influence on learning and memory in HEMI group.

1. 1. Gauthier S, Kaur G, Mi W, Tizon B, Levy E. Front Biosci (Schol Ed), 2011; 1(3):541-554.

2. 2. Kaur G, Levy E. Front Mol Neurosci, 2012; 6(5):79.

3. 3. Zerovnik E. BioEssays, 2009; (6):597-599.

4. 4. Bromley-Brits, K., Deng, Y., Song, W. J Vis Exp, 2011, (53):e2920.

Mme M. 74 ans est hospitalisée pour une recrudescence délirante d’une paranoia évoluant depuis 40 ans. Il s’agit de sa première hospitalisation en psychiatrie. À l’admission, le diagnostic est confirmé (elle présente une conviction délirante inébranlable parfaitement systématisée, de mécanisme interprétatif, de thème persécutif de thymie congruente), ayant eu des conséquences particulièrement malheureuses dans sa vie affective, professionnelle, sociale et familiale. Il est alors mis en évidence un délire de faux semblant tout à fait évocateur d’un syndrome de Capgras. Mme M. a constaté l’apparition de sosies de son époux qu’elle ne reconnaissait pas, de sa propre personne (depuis une agression – avérée – avec vol de ses papiers d’identité), et au cours de l’hospitalisation du médecin du service qui la prenait en charge. Le cas que nous présentons ici à un double intérêt. D’une part, il est décrit associé à une Paranoïa, ce qui n’est pas habituellement décrit dans la littérature, à notre connaissance. D’autre part, il répond de façon remarquable à la modélisation d’Ellis et Young.

Intervention in the prodromal phase of psychosis remains controversial due to poor specificity of current criterion and ethical issues arising when developing interventions. There is less controversy regarding the need for specialist first episode psychosis intervention programs.

In the context of the implementation of an early intervention strategy in Lausanne, we focused on a first episode psychosis program and checked if need for an early detection program for UHR subjects would emerge over time. We recently structured a specialist At Risk Mental State (ARMS) clinic.

Help seeking patients aged 14–35, referred for a 'prodromal psychotic state” are assessed with: Mini-SCID; SPI-A; SIPS-PANSS; MARDS; Yung Mania scale and classified as ARMS on the basis of SPI-Cy (COPER and COGDIS criteria) and SIPS criteria (APS; BLIPS or Genetic Criterion).

Since January 2014, twenty-four patients were addressed to our clinic, and diagnoses were: ARMS (33%); first episode psychosis (8%); schizotypal disorder (25%); other axis I or II diagnosis (13%); drop out before diagnosis (5%); still in investigation (16%).

Our data shows that there is a need for specialist ARMS clinic when developing early intervention programs. The proximity with a well implanted first episode program offers the possibility to treat patients who have already developed full blown psychosis or for those who make the transition. Ethically, it is our impression that having both structures is necessary in order to have adequate treatment to offer is patients develop full blown psychosis.

Considérant l’accès à l’université comme une situation potentiellement stressante (Boujut et Décamps, 2012 ; Grebot et Barumandzadeh, 2005 ; Neveu, 2010), nous avons l’objectif d’évaluer la relation entre le stress perçu et les traits de personnalités chez les étudiants à l’université.

Nous avons utilisé, via des questionnaires en ligne, l’échelle de stress perçu (PSS 10) et le Big Five Inventory français (BFI-Fr). La population est de (n = 483, M d’âge = 20,23, σ = 1,99) étudiants à l’université.

Les résultats montrent que 86,3 % d’entre eux souffrent d’anxiété et 79,3 % de symptômes dépressifs avec une moyenne de stress 30,48 (σ = 6,17) selon l’échelle de PSS 10. Les femmes sont plus stressées que les hommes. Nous avons trouvé également une corrélation entre le stress perçu et trois dimensions du Big Five (extraversion, agréabilité, conscience, névrosisme et ouverture).

Les résultats montrent une corrélation entre le stress perçu et les traits de personnalité, ainsi que le fait que le névrosisme et l’extraversion prédisaient un niveau élevé du stress perçu. À l’inverse, la conscience prédisait un niveau faible de stress perçu chez les étudiants.

Large variations in worldwide ECT utilization have been described (Leiknes et al. 2012) and concerns have been raised that ECT is being underused in some countries (with some patients being deprived of the most effective treatments available) While overused in certain locations (Smith et al. 1985).

To describe ECT utilization rates in European countries and to examine barriers difficulting its accesibility to ECT in Europe

A systematic review was conducted of studies which reported on ECT utilization rates in european countries in the last 25 years

Wide variations in the use of ECT have also been reported among neighbouring countries and even among different regions within the same country. For example, marked differences have been reported among baltic or nordic countries. In Norway, ECT utilization rate ranged from 1,83 to 3,44 treated per 10.000 inhabitants-year, in Belgium from in Flanders to 10,6 in Brussels and in Edinburgh 18-fold differences have been reported among different psychiatric teams within the same hospital. Lack of human and material resources, economic and legal restrictions, lack of agreement between psychiatrists and social prejudices against ECT might be behind these variations.

Action is needed that ensures a more uniform access to ECT. Health education campaigns, clinical practice guidelines development and implementation and ECT training courses promotion could contribute toward this.

ECT is an effective and safe treatment for severe psychiatric disorders including major depressive disorders, bipolar mania and depression and acute exacerbations of schizophrenia according to clinical guidelines. However, an overall decline in the use of ECT utilization has been reported worldwide and concerns have been raised that ECT is being underused in some countries.

To describe temporal trends in ECT utilization rates in european countries

A systematic review was conducted of studies which reported on ECT temporal trends in european countries in the last 25 years

Results

There had been a decrease in the use of ECT in recent years in Europe. However, recent publications suggest that its use may be stabilizing or even rebounding.

Early life adversities have been suggested to associate with immune dysregulation in later life. Nevertheless, most earlier studies have relied on retrospective self-reports of early adversity.

To investigate the association between serum high-sensitivity C-reactive protein (hsCRP) levels and objective and subjective measures of early adverse experiences in a population-based sample of 770 men aged 42–61 years.

To test whether objectively recorded early adversities associate with increased systemic inflammation more strongly than retrospectively self-reported early adversities.

Objective data on early adverse experiences were collected from primary and secondary school records. Subjective data were retrospectively inquired with a questionnaire at adulthood. The adverse experiences comprised family alcohol problems, parental divorce, and death of a family member. Having ≥ 1 adverse experiences was coded as having experienced early adversity. Serum hsCRP was measured with the Immulite High Sensitivity CRP Assay concurrently with the questionnaire data collection. Individuals with hsCRP>10 were excluded. The conducted logistic regression analyses were adjusted for age, marital status, education, smoking pack-years, alcohol use, maximal oxygen uptake, body mass index, cardiovascular disease, diabetes, regular pain medication, and depressive symptoms.

Objectively recorded early adversities (n=185) associated with hsCRP levels ≥ 3 (OR 1.73, 95% CI 1.02-2.95, p=0.04; reference hsCRP >1). No such association was detected with regard to subjectively reported early adversities (n=139; OR 1.63, 95% CI 0.92-2.92, p=0.10; reference hsCRP >1).

Objective measures of early adversity may more closely link with elevated systemic inflammation than self-reported retrospective measures of early adversity.

Research studies are increasingly interested in the factors that can contribute to a good outcome in psychosis, in order to develop effective interventions and preventive programs.

This study aims to analyze different aspects of the first-episode psychosis of subjects with a long-term favorable evolution.

The study included 40 subjects with a first-episode psychosis with an evolution of at least 10 years. They were chosen from the Case Register of Psychoses of the Psychiatric Clinic in Timisoara, based on demographic, clinical and social characteristics. All the subjects were re-assessed in 2014. 20 subjects have had a favorable evolution (no clinical relapses, a stable or better social and professional functioning after the episode). These cases were compared with 20 cases with similar clinical and demographic characteristics at onset, but with a less favorable outcome (frequent relapses, poor social and professional functioning).

Subjects with better outcome had less genetic heritage of mental disorders, significant social support, were more compliant to treatment and were more active professionally before and after the first episode of psychosis.

There are some characteristics of the persons having a first-episode psychosis which can guide the clinician regarding the prognosis.

Le syndrome de Tako Tsubo est un syndrome rare consistant en une myocardite survenant dans les suites d’un stress émotionnel, appelé par certains auteurs « myocardite des cœurs brisés ».

Illustrer par un cas clinique l’intérêt de la psychiatrie de liaison dans la prise en charge d’un syndrome de Tako Tsubo.

Nous rapportons le cas de Mme Mk âgée de 60 ans, sans antécédents, qui a été hospitalisé au service de cardiologie de l HMPIT pour exploration de douleurs thoraciques et lipothymies. Une IRM cardiaque a permis de mettre en évidence une forme rare du syndrome de Tako Tsubo à prédominance medio ventriculaire. Durant son hospitalisation, l’équipe de psychiatrie de liaison a été sollicité devant une symptomatologie dépressive : tristesse de l’humeur, isolement, difficultés d’endormissement avec anorexie évoluant depuis 8 mois, date du décès de son fils unique suite à une embuscade. Le diagnostic de trouble dépressif majeur compliquant un deuil pathologique a été retenu. Un traitement antidépresseur et anxiolytique a été initié associé à une psychothérapie de soutien. L’évolution était favorable.

La psychiatrie de liaison joue un rôle primordial dans la prévention et la prise en charge du syndrome de Tako Tsubo qui s’inscrit dans le cadre des manifestations psychosomatiques.

To investigate the symptom dimensions of psychosis using factor analyses/FA of lifetime symptoms of a sample of Portuguese psychotic patients.

FA of the OPCRIT items (56 signs and symptoms) of 684 patients

- Schizophrenia/Sz (73.8%), Other non-organic psychotic disorders/ONPD (6.0), Schizoaffective disorders/SzA (1.4%), Bipolar disorders/BP (18.1%) and Severe depression with psychosis/SDP (.8%) – assessed with the Diagnostic Interview for Genetic Studies.

Delusions of poverty, guilty delusions, nihilistic delusions, primary delusional perception, and somnolence, problems with appetite and weight and grandiosity were excluded from the final solution, as each were present in less than 10% of patients and did not load at any factor.

Following the Kaiser and the Cattel's Scree Plot criteria, a four factors structure was selected, which explained variance (EV) was of 60.25%. Based on items content, the meaningful four factors were denominated as follows: F1 Depression (EV 21.77%; a=.97); F2 Mania (5.72%; a=.97); F3 Delusions and hallucinations (2.97%; a=.92); F4 Disorganization and Negative symptoms (2.07%; a=.90). Mann-Whitney U tests revealed that the symptom dimensions that distinguished better between Dx categories were Delusions and hallucinations (only SDP vs. BP and Sc vs. SzA did not significantly differ) and Disorganization and Negative symptoms (only SDP vs. BP and SDP vs. ONPD did not significantly differ), with Sz patients presenting the highest scores.

This factorial structure is in accordance with other reports. Given the Schizophrenia (Sz) and Bipolar disorder (BP) heterogeneity and overlap, the present study contribute to phenotypic refinement and formulation of alternative psychosis phenotypes.

Schizotypy and Cluster A personality profiles are more represented in first-degree relatives of patients with schizophrenia than in the general population. This study presents two diagnostic instruments for the assessment of cluster A personality profiles: the Structured Clinical Interview for personality disorders Axis II (SCID-II) and the Shedler-Westen Assessment Procedure (SWAP 200).

1. 1) Verify sensitivity of SCID-II and SWAP-200 to detect schizophrenia spectrum personality traits;

2. 2) Assess the prevalence of the traits and personality disorders (PD) related to cluster A.

Evaluate diagnostic sensitivity of these instruments in detecting schizotypy and cluster A personality profiles, that are ultra high risk predictors for psychosis.

25 schizophrenic patients(SchzP), 18 their first-degree relatives(FdR), 23 healthy-control(HC) subjects, have been subjected to personality assessment. MANOVA and subsequent planned comparisons were assessed to detect difference between PD profiles in the three groups.

SchzP present significant scores relative to cluster A in both evaluations. FdR show statistically significant differences compared with HC, with higher mean scores relative to cluster A profiles measured with SWAP-200 [PD: Paranoid F(1,63)=7.02;p=0.01. Schizoid F(1,63)=6.56;p=0.013. Schizotypy F(1,63)=6.1;p=0.016; Q-Factor: Schizoid (F(1,63)=6.47;p=0.013; Paranoid F(1,63)=2.11;p=0.151], but not with SCID-II.

Data suggest low sensitivity of SCID-II to identify traits related to cluster A. FdR scored for traits related to schizophrenia spectrum greater than in the general population. SWAP-200 is able to accurately evidentiate the presence of schizotypal traits in FdR of patients with schizophrenia and suggests the importance of a clinical dimensional diagnosis for a more reliable identification of schizophrenia spectrum.

Dans la majorité des cas, la schizophrénie est précédée par des symptômes prodromiques à l’adolescence ou au début de l’âge adulte. Le bénéfice des centres de détection et d’intervention précoces destinés aux sujets présentant ces prodromes est aujourd’hui établi. À partir des données recueillies au C’JAAD, le centre pilote français, l’objectif de notre travail est de comprendre comment les sujets parviennent jusqu’à ce type de structures.

La recherche par les méthodes mixtes, courant méthodologique en plein essor, est particulièrement adaptée à notre problématique complexe. Nous avons intégré l’analyse quantitative de données issues de questionnaires remplis par les jeunes se présentant au C’JAAD et l’analyse qualitative d’entretiens.

Au total, 330 questionnaires et 8 entretiens ont été analysés. Il apparaît que l’accès aux soins est dépendant de nombreux déterminants. Les symptômes eux-mêmes, le modèle explicatif des troubles que le jeune retient, le sexe, la présence d’antécédents psychiatriques familiaux, le parcours scolaire, la dimension culturelle influencent la trajectoire de soins. Par ailleurs, l’entourage des sujets détient un rôle majeur. Parfois porteur de conduites stigmatisantes, l’entourage constitue le plus souvent un soutien important et ouvre la porte d’entrée vers les soins. Enfin, le degré de communication entre les différents professionnels de santé et le niveau de connaissance des intervenants sont déterminants dans le processus d’accès aux soins.

Favoriser l’accès aux soins des jeunes qui présentent une symptomatologie prodromique est primordial : on se situe à une période où les enjeux pour le futur sont majeurs. À notre connaissance, notre étude est la première à utiliser les méthodes mixtes pour explorer cette problématique. Toutefois, les données sont recueillies de manière rétrospective ce qui peut induire un biais de mémorisation. La lutte contre la stigmatisation, l’information du grand public et des professionnels doivent être une priorité pour favoriser cet accès aux soins.