La problématique du suicide est une question complexe aux Antilles car les derniers chiffres de prévalence de la mortalité par suicide indiquent une sous suicidalité dans cette région du monde. Il n’existe actuellement aucun chiffre sur la prévalence des tentatives de suicide (TS) et peu d’étude descriptive de cette population.

L’étude POSTA vise à établir un état des lieux de la population des sujets pris en charge au CHU de Martinique pour TS ou pour idéations suicidaires avec antécédent de TS.

Soixante-six patients ont été inclus en septembre/octobre 2013 (80 % pour TS et 20 % pour idéations suicidaires). On observe : 68,1 % de femmes, la population suicidante est plutôt jeune, avec une surreprésentation des personnes célibataires et divorcées, inactifs ou au chômage et plutôt avec un bon niveau scolaire comparativement à la population martiniquaise. La majorité n’est pas en contact avec le système de soin primaire de façon régulière. Trente-huit pour cent rapporte une addiction aux substances dont un quart sont pris en charge (37,7 % déclarent avoir consommé une substance au moment de l’acte). Deux tiers ont déjà été en contact avec le système de santé mentale. Deux tiers rapporte des évènements de vie à potentiel traumatique (30 % rapportent une agression sexuelle). La moitié a déjà réalisé une TS par le passé et 85 % des passages à l’acte sont réalisés de manière impulsive. Les premiers résultats montrent que les sujets consultants pour idéations suicidaires avec antécédents de TS sont majoritairement des hommes avec un score élevé à l’Hospital Anxiete Depression Scale (HADS), ce résultat est intéressant car cette population est à haut risque de suicide réussi.

Cette étude permettra de faire un état des lieux descriptifs de cette population avant la mise en place d’une étude modifiant la prise en charge de ces patients.

The efficacy of long-acting injectable antipsychotics in dual schizophrenia patients has been well established.

To investigate the efficacy of long-acting injectable paliperidone palmitate(PPLAI) in the psychopathology of dual psychotic patients. To examine the tolerability profile of PPLAI in dual psychosis.

An open-label, non-interventional, prospective study was conducted in 42 dual psychotic outpatients who received PPLAI in monotherapy. We used the Brief Psychiatric Rating Scale (BPRS) to assess psychotic symptoms and the Udvalg für Kliniske Undersogelser Scale (UKU) to evaluate treatment tolerability, at baseline, and after 3 and 6 months of treatment. Prolactin levels were also determined at the time of the study inclusion and after 6 months.

Thirty-five patients were included into the study. After 6 months of treatment, patients receiving PPLAI showed a significant improvement in positive symptoms (disorganisation, suspiciousness), negative symptoms (emotional withdrawal, motor retardation, blunted affect and confusion), affective symptoms (somatic concern, anxiety and depression) and in motor symptoms (unco-operativeness, excitement). When compared to the 3rd month assessment, after 6 months, statistically significant differences were found in items 4,11,14,17 and 18. Patients receiving PPLAI had lower rates of side effects assessed by UKU Scale (asthenia, sedation, failing memory, tension, insomnia, rigidity, tremor, weight gain and sexual dysfunction). Baseline prolactin levels ranged 11–122 (mean:38), at 6 months: 20–136 (mean:38.4).

After 6 months, patients receiving PPLAI had lower psychotic symptoms, a decrease in side effects, and a significant improvement in global functioning. No changes in prolactin levels were found.

Tuberous Sclerosis Complex (TSC) is a genetic inherited disease characterized by hamartomatous growths in several organs as brain, skin, kidneys, hearth and eyes. The estimated incidence is approximately 1:6000 live births. The diagnosis is made clinically. Seizures are present in 87% of patients. Psychiatric comorbidity has been reported.

We report the clinical course of two patients with previous diagnosis of TSC. Psychiatric symptoms start in the adulthood without seizures history and absence of Subependimal Giant Cells Tumor (SGCT). The evolution and clinical features are described.

Patient 1

Married 33-years-old woman with two children affected with TSC. She was diagnosed after headache presentation in 2011. Initial MRI showed periventricular glioneuronal hamartomas. In January 2013 start with self-injurious (swallowing of objects) and autistic behaviours as well as several hospital urgency room visits. In addition, the patient presented with dull mood, emotional indifference and intellectual impairment, with no response to medication.

Patient 2

Married 43-years-old woman with a daughter affected with TSC. Diagnosis was made in 1999 and psychotic symptoms (delusional beliefs and auditory hallucinations) started in 2011 without previous psychiatric history. The MRI in 2013 shown subependymal nodules. Treatment with risperidone was effective.

Psychiatric symptoms are very often associated to the physical findings on TSC, even in adulthood diagnoses.

Psychiatric comorbidities are well described in literature. about 10-20% adult patients with TSC present clinically significant behavioral problems as self-injuries, frequently associated with SGCT. The European Expert Panel recommended regular assessment of cognitive development and behaviour and symptomatic treatment.

A decline of recruitment into psychiatry has been observed in low and high income countries. It has been suggested that the negative image of psychiatrists may play a role in this issue. Thus, one mission of the AFFEP (French National Association of Psychiatric Trainees) is to improve the image of psychiatry and to fight the related stigma.

This study aimed to highlight prejudices about psychiatric trainees.

This study is a descriptive cross-sectional survey conducted toward French residents specialized in psychiatry, anaesthesia, neurology, paediatrics, orthopaedic surgery or general medicine, between June and July 2013. An invitation email and an anonymous web-based auto-questionnaire were sent to the residents through their national associations mailing-lists. AFFEP local representatives also disseminated the survey to psychiatric trainees. The survey, hosted by the MODALISA software was made of four sections:

– sociodemographic data;

– school records;

– prejudices from the other specialities towards psychiatric trainees;

– professional identity.

A statistical analysis was performed using MODALISA in order to describe and compare the data.

One thousand two hundred and ninty-six trainees participated in the study, including 760 psychiatrists, 253 residents in general practice, 123 anaesthetists, 60 neurologists, 57 paediatrics and 43 orthopaedics. 56% of the participants think that psychiatrists are odd trainees with previous history of mental health, 42% consider they are not doctors, and 37% describe them as lazy persons. Comparisons of personal history cases did not show any significant difference between psychiatric trainees and non-psychiatric trainees (12.6% vs. 9,3%, P = 0.074). Besides, the results show that almost all psychiatric trainees (95%) are happy becoming a psychiatrist.

These results suggest that prejudices about psychiatric trainees exist and are wrong. They will allow to work on the image of psychiatry and psychiatrists, to communicate about the great satisfaction of the psychiatric trainees and to break down old “cliché”.

In addition to somatic symptoms the acromegalic patients demonstrate psychosocial and personality changes, and occasionally the cooccurrence of mental disorders.

To ascertain the psychosocial profile of acromegalic patients a cross-sectional study was designed.

Forty two patients with acromegaly and thirty two with non-functioning adenomas underwent a cross-sectional assessment regarding their socio-demographic and clinic profiles, including the quality of life (ACROQOL and WHOQOL), psychiatric morbidity (General Health Questionnaire-28) and acceptance of illness (AIS).

The acromegaly group had predominance of urban married females (59.5%) with mean age 52.31 ± 14.81, and mean duration of illness since diagnosis of 8.71 ± 8.69 years. The average ACROQOL score was 55.38±16.33. Age, quality of life and acceptance of illness were not associated factors in acromegaly versus non-functioning adenomas comparison. Seventeen subjects in both groups scored positive indicating presence of psychiatric morbidity on the GHQ-28, that is 40.48% of acromegaly patients and 53.13% of non-functioning adenomas patients. Compared to the GHQ-negative group in all subjects, the GHQ-positive group had significantly poorer quality of life in physical health domain measured with WHO Quality of Life- BREF (p<0.001) and lower scores in AIS scale (p<0.01).

Our data revealed that pituitary adenomas may affect psychosocial aspects of the patients’ everyday lives and psychiatric morbidity may influence on physical perspective of quality of life, as well as on the acceptance of illness. There is no difference in psychosocial perspective between patients with acromegaly and non-functioning adenomas in the study group.

People on the autism spectrum are particularly vulnerable to various mental and somatic diseases. Admitting the health care system is, however, a prerequisite for appropriate diagnosis and treatment of these disorders. Substantial difficulties in accessing the heath care system are reported for all autistic people, independent from their intellectual ability.

The purpose of the work is first to assess various difficulties in accessing the health care system and second to provide strategies to overcome them.

Current barriers to the health care system and possible solutions were sampled from a collaboration of autistic self-advocates and professionals in Berlin, Germany. The findings were endorsed by a thorough Internet and literature research.

A comprehensive list of barriers to health care along with recommendations to facilitate access was compiled. Strategies considering the perceptual and communicative peculiarities of autism improved access to health care for autistic adults.

Providing access to the health care system may improve diagnosis and treatment of mental and somatic illnesses and hereby enhance quality of life in people on the autism spectrum. Recognition of the peculiarities and needs of adults with autism may serve as a model for other areas in society, such as education and employment. Data acquisition in this project is of special value because it results from collaboration of an autistic self-advocacy organization and professionals working in the field of intellectual disability, considering the experiences of autistic adults in the entire range of intellectual functioning.

La littérature internationale indique des prévalences de troubles psychotiques comprises entre 0,5 et 2 % en population générale. En l’absence de données précises en France, deux indicateurs nationaux sont présentés ici : la prévalence annuelle d’habitants pris en charge pour schizophrénie et autres troubles psychotiques par les établissements de santé ayant une activité psychiatrique (EP) et la prévalence de personnes en affection de longue durée (ALD) pour ces mêmes troubles.

Pour le 1er indicateur : l’analyse porte sur les données issues du RIM-P : prises en charge à temps complet ou partiel et activité ambulatoire. Le 2e indicateur réunit les données d’ALD23 des principaux régimes d’assurance maladie (CnamTS, RSI et MSA). Les codes CIM : F20 à F29 de schizophrénie et autres troubles psychotiques ont été sélectionnés pour ces deux indicateurs (diagnostics principaux et associés en EP).

En 2012 en France métropolitaine, 235 000 patients, soit 3,7 pour 1000 habitants, ont été pris en charge pour troubles psychotiques en EP, dont 62 % pour schizophrénie et 294 000 personnes (4,6 pour 1000) étaient en ALD pour troubles psychotiques, parmi lesquelles 45 % pour schizophrénie. Les prévalences sont globalement plus élevées chez les hommes que chez les femmes : 1,5 fois pour tous TP et 2 fois plus pour la schizophrénie. Ces prévalences étaient maximales entre 30 et 45 ans chez les hommes (taux de suivi en EP : 8,8 pour 1000 ; ALD : 10 pour 1000), et entre 40 et 60 ans chez les femmes (taux de suivi en EP : 5,1 pour 1000 ; ALD : 6,6 pour 1000). Les taux diminuent ensuite lentement avec l’âge chez les femmes, et de façon plus marquée chez les hommes, après 60 ans, les taux féminins sont supérieurs aux taux masculins.

Ces deux sources de données permettent de préciser la prévalence annuelle en France de personnes suivies pour schizophrénie et autres troubles psychotiques dans le système de soins. Elles ne couvrent néanmoins pas les patients suivis en libéral, qui ne seraient pas déclarés en ALD au titre de leur psychose, ni les malades en rupture totale de soins.

Neuroleptic malignant syndrome (NMS) is a life-threatening condition associated with the use of neuroleptic drugs and is characterized by a clinical syndrome of mental status change, muscle rigidity, fever, and autonomic instability. The incidence of NMS seems to has been decreasing, possibly due to increased awareness, changes in drug prescribing practices, the use of lower doses of dopamine blocking agents and atypical antipsychotics. The risk factors most consistently identified with precipitating NMS are prominent psychomotor agitation and incrementally higher doses of one or more parenterally administered neuroleptics. The use of atypical antipsychotics may be associated with: a decreased risk, decreased mortality, and atypical features of NMS.

To alert clinicians for atypical presentations of NM.

To report and discuss, based on online pubmed database, a case of a NMS with no muscle rigidity, in spite of an extremely elevated CK level, due to quetiapine.

Atypical cases of NMS without muscle rigidity and/or hyperthermia have been reported in database. With the widespread use of atypical antipsychotics, atypical presentations of NMS should be more frequent. While not yet proven, it has been hypothesized that such atypical cases are a prodrome of the disease and represent impending NMS with typical presentation.

Clinicians must be aware for this atypical presentation of the NSM since adherence to strict diagnostic criteria may lead to alternate and/or delayed diagnosis, with eventually poor outcomes. For this reason, a strong clinical suspicion based on clinical history is crucial for early diagnosis and treatment.

The aging of the population and popularisation of the long-term care institutions in Poland confronts us with the challenge of improving the quality of these institutions and to evaluate the current state of its functioning.

The aim of the study was to evaluate and analyze needs of residents living in nursing homes using the Polish version of the Camberwell Assessment of Need for Elderly (CANE).

A sample of 300 residents from three urban cities was investigating using the Polish version of CANE. Data were collected from users, rater and staff involved. Subjects ranged in age from 74 to 102 with a mean age of 83,36±5,88.

The most frequent unmet needs highlighted by users, rater as well as by staff were: psychological distress, company, intimate relationships, information, eyesight/hearing/communication and daytime activities. However, the comparison of total number of needs illustrated that overall users reported significantly fewer met needs compared with staff involved (Z=8,25; p<0,0001) and rater (Z=8,29; p<0,0001) and significantly more unmet needs comparing with staff involved (Z=6,36; p<0,0001).

This study provides us with better understanding of an individual perspective of residents living in nursing houses in Poland perceived from different points of views. The results illustrated the differences in the unmet needs perception and pointed out that taking into account only staff perception may lead to under recognition of unmet needs.

Long-acting atypical antipsychotics have been widely used in the treatment of substance use disorders and comorbid psychosis.

To investigate the impact of long-acting injectable paliperidone palmitate (PPLAI) on craving and satisfaction levels in dual psychotic patients.

An open-label, non-interventional, prospective study was conducted in 42 dual psychotic outpatients who received PPLAI in monotherapy. Craving and satisfaction levels in patients and relatives were assessed by using the Visual Analogue Scale (VAS). We used the Clinical Global Impression Scale (CGI) to assess clinical severity and global improvement, and the GAF scale to assess global functioning. 35 patients completed the study and underwent a systematic assessment at baseline and after 3 and 6 months.

After 6 months of treatment, mean craving scores decreased in patients treated with PPLAI when compared to baseline scores (4.9 vs 2.3). Mean satisfaction levels in dual psychotic patients increased (6.0 vs 9.1), and satisfaction levels in their relatives improved after 6 months (5.2 vs 9.5). Patients receiving PPLAI showed a statistically significant decrease in consumption relapses, had lower scores in CGI for clinical severity (CGISI), higher scores in global improvement (CGI-GI), and higher scores in global functioning.

After 6 months of PPLAI treatment, psychotic patients with substance use had lower craving levels. Satisfaction levels were higher in patients and their relatives. Consumption relapses decrease and patients had higher scores in global functioning.

People with intellectual disabilities (ID) make up to 3% of the general population. The prevalence of mental illness is higher among people with ID due to social and medical factors. The prevalence of Schizophrenia is 3%. Healthcare systems in Europe differ in how they meet the mental health needs of European citizens with ID. In services there are either specialists in ID or generalists to support people. In some systems, there is no identifiable healthcare model to meeting the specialist mental health needs of people with ID.

To describe mental healthcare systems in five states in Europe and the drivers of change.

A description of mental health systems for people with ID in Europe.

The mental healthcare models are diverse across Europe. There are specialist community and in-patient services in the UK and Ireland. In Romania mental healthcare in ID is often in institutional settings. In Croatia, there is an emerging provision of mental healthcare in ID in the community. In Hungary there is progress in providing community care in ID.

The mental health systems for people with ID in Europe employ a range of models. In general, there is a move from institution-based care to the adoption of community-based models. Healthcare systems are at different stages in their path to community provision. Healthcare policy and human rights legislation will shape healthcare models in mental health and ID that also rely on political will and advocacy on the needs of people with ID.