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Font H, Roelandt JL, Behal H, Geoffroy PA, Pignon B, Amad A, Simioni N, Vaiva G, Thomas P, Duhamel A, Benradia I, Rolland B. Prevalence and predictors of no lifetime utilization of mental health treatment among people with mental disorders in France: findings from the 'Mental Health in General Population' (MHGP) survey. Soc Psychiatry Psychiatr Epidemiol 2018; 53:567-576. [PMID: 29619580 DOI: 10.1007/s00127-018-1507-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 03/28/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE No lifetime utilization of mental health treatment (NUMT) is an indicator of the treatment gap among people in need of treatment. Until now, the overall prevalence and predictors of NUMT have never been explored in France. METHODS In a 39,617-respondent survey, participants were assessed for NUMT, i.e., no lifetime psychotherapy, psychopharmacotherapy, or psychiatric hospitalization. Mental disorders were investigated using the Mini International Neuropsychiatric Interview (MINI 5.0.0). MINI diagnoses were grouped into five categories: mood disorders (MDs); anxiety disorders (ADs); alcohol use disorders (AUDs); substance use disorders (SUDs); and psychotic disorders (PDs). Using multivariable logistic regression models, we explored the factors associated with NUMT among the MINI-positive respondents. The odds ratio and 95% confidence interval were calculated for each factor. RESULTS In total, 12,818 (32.4%) respondents were MINI-positive, 46.5% of them reported NUMT (35.6% for MDs, 39.7% for PDs, 42.8% for ADs, 56.0% for AUDs, and 56.7% for SUDs). NUMT was positively associated with being male [OR 1.75 (1.59-1.91)] and practising religion [OR 1.13 (1.02-1.25)] and negatively associated with ageing [per 10-year increase: OR 0.88 (0.85-0.91)], being single [OR 0.74 (0.66-0.84)], being a French native [OR 0.67 (0.60-0.75)], and experiencing MDs [OR 0.39 (0.36-0.43)], ADs [OR 0.47 (0.43-0.52)], AUDs [OR 0.83 (0.73-0.96)], SUDs [OR 0.77 (0.65-0.91)], or PDs [OR 0.50 (0.43-0.59)]. CONCLUSIONS In France, NUMT rates were the highest for AUDs and SUDs. Additionally, suffering from MDs or ADs increased the lifetime treatment utilization for people having any other mental disorder. This finding emphasizes the need to better screen AUDs and SUDs among people treated for MDs or ADs.
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Charpeaud T, Genty JB, Destouches S, Yrondi A, Lancrenon S, Alaïli N, Bellivier F, Bennabi D, Bougerol T, Camus V, D'amato T, Doumy O, Haesebaert F, Holtzmann J, Lançon C, Lefebvre M, Moliere F, Nieto I, Richieri R, Schmitt L, Stephan F, Vaiva G, Walter M, Leboyer M, El-Hage W, Haffen E, Llorca PM, Courtet P, Aouizerate B. [French Society for Biological Psychiatry and Neuropsychopharmacology and Fondation FondaMental task force: Formal Consensus for the management of treatment-resistant depression]. Encephale 2018; 43:S1-S24. [PMID: 28822460 DOI: 10.1016/s0013-7006(17)30155-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Major depression represents among the most frequent psychiatric disorders in the general population with an estimated lifetime prevalence of 16-17%. It is characterized by high levels of comorbidities with other psychiatric conditions or somatic diseases as well as a recurrent or chronic course in 50 to 80% of the cases leading to negative repercussions on the daily functioning, with an impaired quality of life, and to severe direct/indirect costs. Large cohort studies have supported that failure of a first-line antidepressant treatment is observed in more than 60% of patients. In this case, several treatment strategies have been proposed by classical evidence-based guidelines from internationally recognized scientific societies, referring primarily on: I) the switch to another antidepressant of the same or different class; II) the combination with another antidepressant of complementary pharmacological profile; III) the addition of a wide range of pharmacological agents intending to potentiate the therapeutic effects of the ongoing antidepressant medication; IV) the association with appropriate psychological therapies; and, V) the use of non-invasive brain stimulation techniques. However, although based on the most recently available data and rigorous methodology, standard guidelines have the significant disadvantage of not covering a large variety of clinical conditions, while currently observed in everyday clinical practice. From these considerations, formalized recommendations by a large panel of French experts in the management of depressed patients have been developed under the shared sponsorship of the French Association of Biological Psychiatry and Neuropsychopharmacology (AFPBN) and the Fondation FondaMental. These French recommendations are presented in this special issue in order to provide relevant information about the treatment choices to make, depending particularly on the clinical response to previous treatment lines or the complexity of clinical situations (clinical features, specific populations, psychiatric comorbidities, etc.). Thus, the present approach will be especially helpful for the clinicians enabling to substantially facilitate and guide their clinical decision when confronted to difficult-to-treat forms of major depression in the daily clinical practice. This will be expected to significantly improve the poor prognosis of the treatment-resistant depression thereby lowering the clinical, functional and costly impact owing directly to the disease.
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Pignon B, Schürhoff F, Szöke A, Geoffroy PA, Jardri R, Roelandt JL, Rolland B, Thomas P, Vaiva G, Amad A. Sociodemographic and clinical correlates of psychotic symptoms in the general population: Findings from the MHGP survey. Schizophr Res 2018; 193:336-342. [PMID: 28689754 DOI: 10.1016/j.schres.2017.06.053] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 06/26/2017] [Accepted: 06/27/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND We aimed to explore the sociodemographic and psychiatric correlates of psychotic symptoms in a large general population sample. METHODS The French Mental Health in the General Population cross-sectional survey interviewed 38,694 individuals using the Mini International Neuropsychiatric Interview. We looked for associations between the presence of lifetime psychotic symptoms, sociodemographic characteristics (including migrant status over three generations) and clinical characteristics. We then looked for associations regarding only hallucinations, delusional symptoms, and the co-occurrence of both hallucinations and delusional symptoms. To test the psychosis continuum hypothesis, associations with sociodemographic characteristics were compared with the characterized psychotic disorders' associations. RESULTS We found that 22.3% of the population declared psychotic symptoms without psychotic disorders, including 5.7% who declared hallucinations, 20.5% delusional symptoms, 4.0% both hallucinations and delusional symptoms, and 2.8% characterized psychotic disorders. The presence of psychotic symptoms was associated with young age, migrant status (over three generations), secondary education level, low-income level and never-married and separated marital status. Hallucinations, delusional symptoms and the co-occurrence of both hallucinations and delusional symptoms showed the same correlates, and hallucinations were also associated with elementary education level. Characterized psychotic disorders showed the same correlates. Concerning clinical outcomes, the presence of psychotic symptoms, hallucinations and delusional symptoms was associated with all non-psychotic disorders, i.e., bipolar, depressive, alcohol use, generalized anxiety, social phobia, panic and post-traumatic stress disorders and dysthymia (except dysthymia, which was not associated with hallucinations). CONCLUSIONS Our results indicate that psychotic symptoms are associated with broad psychopathologies and support the continuum model of psychosis.
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Notredame CE, Grandgenèvre P, Vaiva G, Séguin M. At least one more reason why. Eur Child Adolesc Psychiatry 2018; 27:259-260. [PMID: 28744718 DOI: 10.1007/s00787-017-1033-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 07/19/2017] [Indexed: 10/19/2022]
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Leroy A, Petyt G, Pignon B, Vaiva G, Jardri R, Amad A. Research Letter: Auto-activation deficit in schizophrenia: a case report. Psychol Med 2018; 48:525-527. [PMID: 28835308 DOI: 10.1017/s0033291717002252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Tebeka S, Pignon B, Amad A, Le Strat Y, Brichant-Petitjean C, Thomas P, Vaiva G, Roelandt JL, Benradia I, Etain B, Rolland B, Dubertret C, Geoffroy PA. A study in the general population about sadness to disentangle the continuum from well-being to depressive disorders. J Affect Disord 2018; 226:66-71. [PMID: 28963866 DOI: 10.1016/j.jad.2017.08.085] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/23/2017] [Accepted: 08/28/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Sadness is both a common experience in general population and one of the main criteria of major depressive disorder (MDD). We tested the hypothesis of a depressive continuum using sadness as an intermediate experience between well-being and disorder. METHODS A French cross-sectional Mental Health survey in General Population interviewed 38,694 individuals. We examined prevalences and compared sociodemographic correlates and psychiatric disorders of individuals in 3 independent groups 1) MDD, 2) sadness without MDD, and 3) controls. RESULTS The prevalence of sadness was of 29.8% in the whole sample and of 93% in subjects suffering from MDD (n = 4976). The "sadness" group shared the same sociodemographic patterns as the "MDD" group. All psychiatric disorders assessed (i.e. bipolar disorder, anxiety disorder, alcohol use disorder, psychotic disorder and suicide attempts) were significantly associated with both "sadness" and "MDD" groups compared to "controls". Individuals with sadness, compared to those with MDD, were significantly less likely to meet the criteria for all psychiatric disorders. MDD's sensitivity of sadness was 94,2%. LIMITATIONS Even though we used a quota sampling method, the sample was not strictly representative of the general population. CONCLUSION Sadness validates the depressive continuum hypothesis, since it is more frequent in the general population than MDD itself and at the same time shares with MDD the same sociodemographic and clinical correlates. A gradual association from controls to MDD was observed for psychiatric comorbidities. Finally, the high sensitivity of sadness may suggest its use to screen at-risk individuals converting from well-being to full psychiatric disorders.
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Servant D, Leterme AC, Barasino O, Rougegrez L, Duhamel A, Vaiva G. Efficacy of Seren@ctif, a Computer-Based Stress Management Program for Patients With Adjustment Disorder With Anxiety: Protocol for a Controlled Trial. JMIR Res Protoc 2017; 6:e190. [PMID: 28970192 PMCID: PMC5643843 DOI: 10.2196/resprot.7976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/27/2017] [Accepted: 08/01/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Adjustment disorder with anxiety (ADA) is the most frequent and best characterized stress-related psychiatric disorder. The rationale for prescription of benzodiazepine monotherapy is a public health issue. Cognitive behavioral stress management programs have been studied in many countries. Several reports have shown beyond reasonable doubt their efficiency at reducing perceived stress and anxiety symptoms and improving patient quality of life. Considering the number of people who could benefit from such programs but are unable to access them, self-help programs have been offered. First presented as books, these programs became enriched with computer-based and digital supports. Regrettably, programs for stress management based on cognitive behavioral therapy (CBT), both face-to-face and digital support, have been only minimally evaluated in France. To our knowledge, the Seren@ctif program is the first French language self-help program for stress management using digital supports. OBJECTIVE The aim of this study is to assess the effectiveness of a 5-week standardized stress management program for reducing anxiety conducted via eLearning (iCBT) or through face-to-face interviews (CBT) with patients suffering from ADA compared with a wait list control group (WLC). These patients seek treatment in a psychiatric unit for anxiety disorders at a university hospital. The primary outcome is change in the State Trait Anxiety Inventory scale trait subscale (STAI-T) between baseline and 2-month visit. METHODS This is a multicenter, prospective, open label, randomized controlled study in 3 parallel groups with balanced randomization (1:1:1): computer-based stress management with minimal contact (not fully automated) (group 1), stress management with face-to-face interviews (group 2), and a WLC group that receives usual health care from a general practitioner (group 3). Programs are based on standard CBT principles and include 5 modules in 5 weekly sessions that include the following topics: stress and stress reaction and assessment; deep respiration and relaxation techniques; cognitive restructuring, mindfulness, and acceptance; behavioral skills as problem solving; and time management, healthy behaviors, and emotion regulation. In the Internet-based group, patients have minimal contact with a medical professional before and after every session. In the first session, a flash memory drive is supplied containing videos, audio files, a self-help book portfolio in the form of an eGuide, and log books providing the exercises to be completed between 2 sessions. The patient is encouraged to practice a 20-minute daily exercise 5 or 6 times per week. In the face-to-face group, patients receive the same program from a therapist with 5 weekly sessions without digital support. Interviews and self-assessments were collected face-to-face with the investigator. RESULTS The feasibility of this program is being tested, and results show good accessibility in terms of acceptance, understanding, and treatment credibility. Results are expected in 2018. CONCLUSIONS To our knowledge, this is the first French study to examine the effectiveness of a computer-based stress management program for patients with ADA. The Seren@ctif program may be useful within the framework of a psychoeducative approach. It could also be advised for people suffering from other diseases related to stress and for people with a clinical level of perceived stress. TRIAL REGISTRATION Clinicaltrials.gov NCT02621775; https://clinicaltrials.gov/ct2/show/NCT02621775 (Archived by WebCite at http://www.webcitation.org/6tQrkPs1u).
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Berrouiguet S, Courtet P, Larsen ME, Walter M, Vaiva G. Suicide prevention: Towards integrative, innovative and individualized brief contact interventions. Eur Psychiatry 2017; 47:25-26. [PMID: 29096129 DOI: 10.1016/j.eurpsy.2017.09.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/06/2017] [Accepted: 09/10/2017] [Indexed: 10/18/2022] Open
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Kiesmann E, Grandgenèvre P, Mallet J, Dubertret C, Vaiva G. Impact of emotional and cognitive saliency on visual search in post-traumatic stress disorder. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.02.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
IntroductionPatients with post-traumatic stress disorder (PTSD) have shown disturbances in visual information treatment. However, most of studies demonstrated attentional bias towards emotional stimuli by using non-ecological paradigm. The paradigm of change blindness offers the possibility of studying sensitivity to the sudden irruption of visual information with ecological stimuli.Objectives/AimsTo compare the explicit detection with the implicit detection by using respectively motor response and eye tracking in patients with PSTD and controls.MethodsFifteen patients with PTSD and fifteen healthy controls had to detect changes in 96 scenes with (1) no change, (2) one neutral change or (3) one emotional pleasant or unpleasant change. We measured the participant's speed and accuracy in explicitly reporting the changes via motor responses, and their capacity to implicitly detect changes via eye movements.ResultsThe patients showed a trend towards slower explicit detection for the emotional change (P = 0.06) and more specifically for unpleasant change (P = 0.054). The two groups did not differ for implicit detection.ConclusionPatients tend to explicitly detect more slowly emotional change (but not neutral), especially for unpleasant change. This could be the result of a lack of access to consciousness of the emotional information. The emotional visual information treatment in PSTD could require more attentional processes than the non-emotional visual information and then lead to a decrease of the available attentional resources for the explicit task.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Pignon B, Geoffroy PA, Thomas P, Roelandt JL, Rolland B, Morgan C, Vaiva G, Amad A. Prevalence and clinical severity of mood disorders among first-, second- and third-generation migrants. J Affect Disord 2017; 210:174-180. [PMID: 28049102 DOI: 10.1016/j.jad.2016.12.039] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 10/27/2016] [Accepted: 12/17/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND The role of migration as a risk factor remains unknown for mood disorders because of poor data. We sought to examine the prevalence and severity of mood disorders (bipolar disorder (BD), unipolar depressive disorder (UDD) and dysthymia) in first, second, and third generation migrants in France. METHODS The Mental Health in the General Population survey interviewed 38,694 individuals. The prevalence of lifetime mood disorders, comorbidities, and clinical features was compared between migrants and non-migrants and by generation. All analyses were adjusted for age, sex and level of education. RESULTS The prevalence of any lifetime mood disorder was higher in migrants compared with non-migrants (OR = 1.36, 95% CI [1.27 - 1.45]). This increased prevalence was significant for UDD (OR = 1.44, 95% CI [1.34 - 1.54]), but not for BD (OR = 1.15, 95% CI [0.96 - 1.36]) or dysthymia (OR = 1.09, 95% CI [0.94 - 1.27]), although the prevalence of BD was increased in the third generation (OR = 1.27, 95% CI [1.01 - 1.60]). Migrants with BD or UDD were more likely to display a comorbid psychotic disorder compared to non-migrants with BD or UDD. Cannabis-use disorders were more common in migrant groups for the 3 mood disorders, whereas alcohol-use disorders were higher in migrants with UDD. Posttraumatic stress disorder was more frequent among migrants with UDD. LIMITATIONS The study used cross-sectional prevalence data and could be biased by differences in the course of disease according to migrant status. Moreover, this design does not allow causality conclusion or generalization of the main findings. CONCLUSION Mood disorders are more common among migrants, especially UDD. Moreover, migrants with mood disorders presented with a more severe profile, with increased rates of psychotic and substance-use disorders.
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Yrondi A, Bennabi D, Haffen E, Garnier M, Bellivier F, Bourgerol T, Camus V, D'Amato T, Doumy O, Haesebaert F, Holtzmann J, Lançon C, Vignaud P, Moliere F, Nieto I, Richieri RM, Domenech P, Rabu C, Mallet L, Yon L, Schmitt L, Stephan F, Vaiva G, Walter M, Llorca PM, Courtet P, Leboyer M, El-Hage W, Aouizerate B. Significant Need for a French Network of Expert Centers Enabling a Better Characterization and Management of Treatment-Resistant Depression (Fondation FondaMental). Front Psychiatry 2017; 8:244. [PMID: 29225582 PMCID: PMC5706526 DOI: 10.3389/fpsyt.2017.00244] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 11/06/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Major depression is characterized by (i) a high lifetime prevalence of 16-17% in the general population; (ii) a high frequency of treatment resistance in around 20-30% of cases; (iii) a recurrent or chronic course; (iv) a negative impact on the general functioning and quality of life; and (v) a high level of comorbidity with various psychiatric and non-psychiatric disorders, high occurrence of completed suicide, significant burden along with the personal, societal, and economic costs. In this context, there is an important need for the development of a network of expert centers for treatment-resistant depression (TRD), as performed under the leadership of the Fondation FondaMental. METHODS The principal mission of this national network is to establish a genuine prevention, screening, and diagnosis policy for TRD to offer a systematic, comprehensive, longitudinal, and multidimensional evaluation of cases. A shared electronic medical file is used referring to a common exhaustive and standardized set of assessment tools exploring psychiatric, non-psychiatric, metabolic, biological, and cognitive dimensions of TRD. This is paralleled by a medico-economic evaluation to examine the global economic burden of the disease and related health-care resource utilization. In addition, an integrated biobank has been built by the collection of serum and DNA samples for the measurement of several biomarkers that could further be associated with the treatment resistance in the recruited depressed patients. A French observational long-term follow-up cohort study is currently in progress enabling the extensive assessment of resistant depressed patients. In those unresponsive cases, each expert center proposes relevant therapeutic options that are classically aligned to the international guidelines referring to recognized scientific societies. DISCUSSION This approach is expected to improve the overall clinical assessments and to provide evidence-based information to those clinicians most closely involved in the management of TRD thereby facilitating treatment decisions and choice in everyday clinical practice. This could contribute to significantly improve the poor prognosis, the relapsing course, daily functioning and heavy burden of TRD. Moreover, the newly created French network of expert centers for TRD will be particularly helpful for a better characterization of sociodemographic, clinical, neuropsychological, and biological markers of treatment resistance required for the further development of personalized therapeutic strategies in TRD.
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Ameller A, Picard A, D'Hondt F, Vaiva G, Thomas P, Pins D. Implicit Recognition of Familiar and Unfamiliar Faces in Schizophrenia: A Study of the Skin Conductance Response in Familiarity Disorders. Front Psychiatry 2017; 8:181. [PMID: 29033855 PMCID: PMC5624991 DOI: 10.3389/fpsyt.2017.00181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 09/07/2017] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Familiarity is a subjective sensation that contributes to person recognition. This process is described as an emotion-based memory-trace of previous meetings and could be disrupted in schizophrenia. Consequently, familiarity disorders could be involved in the impaired social interactions observed in patients with schizophrenia. Previous studies have primarily focused on famous people recognition. Our aim was to identify underlying features, such as emotional disturbances, that may contribute to familiarity disorders in schizophrenia. We hypothesize that patients with familiarity disorders will exhibit a lack of familiarity that could be detected by a flattened skin conductance response (SCR). METHOD The SCR was recorded to test the hypothesis that emotional reactivity disturbances occur in patients with schizophrenia during the categorization of specific familiar, famous and unknown faces as male or female. Forty-eight subjects were divided into the following 3 matched groups with 16 subjects per group: control subjects, schizophrenic people with familiarity disorder, and schizophrenic people without familiarity disorders. RESULTS Emotional arousal is reflected by the skin conductance measures. The control subjects and the patients without familiarity disorders experienced a differential emotional response to the specific familiar faces compared with that to the unknown faces. Nevertheless, overall, the schizophrenic patients without familiarity disorders showed a weaker response across conditions compared with the control subjects. In contrast, the patients with familiarity disorders did not show any significant differences in their emotional response to the faces, regardless of the condition. CONCLUSION Only patients with familiarity disorders fail to exhibit a difference in emotional response between familiar and non-familiar faces. These patients likely emotionally process familiar faces similarly to unknown faces. Hence, the lower feelings of familiarity in schizophrenia may be a premise enabling the emergence of familiarity disorders.
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Guardia D, Salleron J, Roelandt JL, Vaiva G. [Prevalence of psychiatric and substance use disorders among three generations of migrants: Results from French population cohort]. Encephale 2016; 43:435-443. [PMID: 27644920 DOI: 10.1016/j.encep.2016.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 06/15/2016] [Accepted: 06/16/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Mental health of migrant populations has become a major public health issue since these populations more often suffer from mental health problems than host populations. The influence of the migration process on the emergence of these disorders and its impact on future generations is uncertain. This study provides an estimate of the prevalence of mental disorders among three generations of migration. METHOD The study was conducted in the general population by the French Collaborating Center of the World Health Organization, in France, on a sample of 37,063 people aged 18 and older. The subjects interviewed were selected by a quota sampling method and, thus, were representative of the general population in the 47 study sites in France. This method develops a sample of subjects with the same characteristics as the general population on predefined issues, such as age, sex, educational level and socioprofessional category. The designation of migrant status was based on the country of birth of the subject, the subject's parents and the subject's grandparents. We defined a migrant as first generation (a subject born abroad; n=1911), second generation (at least one parent born abroad; n=4147), or third generation (at least one grandparent born abroad; n=3763) of migrants. The diagnostic tool used was the Mini International Neuropsychiatric Interview (MINI). The MINI is a brief structured diagnostic interview developed by psychiatrists for ICD-10 and DSM-IVTR psychiatric disorders in the general population. The comparisons by generation of migrants were performed by chi-square test for qualitative variables and by an analysis of variance for quantitative variables. The same tests were used to compare the presence of mental disorders according to the characteristics of the population. Factors with a P-value less than 0.2 were entered in a multivariable logistic regression to assess the relationship between the generation of migrants and the presence of mental disorders, adjusting for the confounding factors. RESULTS Thirty-eight per cent of migrant subjects have psychological difficulties, versus 30 % in the host population. These results are observed on three successive generations of migrants. Migration status increases risk of depressive disorders (OR=1.555), bipolar disorder (OR=1.597, CI=1.146-2.227), post-traumatic stress disorder (OR=1.615), substance abuse (OR=2.522) and alcohol abuse (OR=1.524), and drug dependence (OR=2.116). This risk is maintained at the second and third generation. The migration process affects mental health of population regardless of socioeconomic status or geographic origin. CONCLUSION The consideration of migration and generation of migration shows a specific psychopathological risk profile. This is related to the joint action of a migratory past and precarious socioeconomic situation.
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Geoffroy PA, Duhamel A, Behal H, Zouitina-Lietaert N, Duthilleul J, Marquette L, Ducrocq F, Vaiva G, Rolland B. Factors Affecting the Agreement Between Emergency Psychiatrists and General Practitioners Regarding Involuntary Psychiatric Hospitalizations. Sci Rep 2016; 6:28134. [PMID: 27324574 PMCID: PMC4914958 DOI: 10.1038/srep28134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 05/25/2016] [Indexed: 11/23/2022] Open
Abstract
Important discrepancies exist between physicians in deciding when to perform involuntary hospitalization measures (IHMs). The factors underlying these differences are poorly known. We conducted a two-year single-center retrospective study in France on patients who were referred to the emergency department (ED) with an IHM certificate written by a private-practice General Practitioner (GP). For each consultation, the official IHM motive was categorized into four groups: Suicide; Psychosis, Mania, or Melancholia (PMM); Agitation; and Other. The alcohol status of the patient was also noted. The factors underlying the ED psychiatrists’ confirmation of the use of IHMs were determined using a logistic regression model. One hundred eighty-nine cases were found (165 patients; 44.2 ± 16 years, 41.3% women). The ED psychiatrists confirmed the use of IHMs in 123 instances (65.1% agreement rate). Multivariate analyses found that IHM disagreement was significantly associated with patient alcohol status and the reason for referral. Specifically, there was an increased risk of IHM disagreement when the patient had an alcohol-positive status (OR = 15.80; 95% CI [6.45–38.67]; p < 0.0001) and when the motive for IHM was “agitation” compared with “suicide” (OR = 11.44; 95% CI[3.38–38.78]; p < 0.0001). These findings reflect significant disparities between GPs and ED psychiatrists regarding the decision to proceed to an IHM.
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Benard V, Vaiva G, Masson M, Geoffroy P. Lithium and suicide prevention in bipolar disorder. Encephale 2016; 42:234-41. [DOI: 10.1016/j.encep.2016.02.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 03/27/2015] [Indexed: 11/16/2022]
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Servant D, Rougegrez L, Barasino O, Demarty AL, Duhamel A, Vaiva G. [Interest of computer-based cognitive behavioral stress management. Feasability of the Seren@ctif program]. Encephale 2016; 42:415-420. [PMID: 27126141 DOI: 10.1016/j.encep.2016.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 03/24/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Cognitive-behavioural stress management programs have been studied in many countries. Many reports have shown beyond a doubt their efficacy to reduce perceived stress, anxiety symptoms and to improve quality of life of patients. Considering the very large number of people who could benefit from such programs but are unable to reach them, self-help programs have been offered. First presented as books (bibliotherapy), these programs then became enriched by computing and digital supports. Regrettably, many of the programs of stress management based on the Cognitive behavioural therapy (CBT) both in face-to-face and on digital support have been little evaluated in France. To our knowledge, the Seren@ctif program is the first French language self-help program of stress management proposed on digital support. AIM OF THE STUDY We led a feasibility study of this program on 10 patients responding to the diagnosis of adjustment disorder with anxiety according to the DSM IV criteria. METHODS The program includes 5 weekly sessions that the patient follows in our unit from a web site. He benefits from minimal contact with a medical member of staff before and after every session. Right from the first session an USB key is supplied to the patient containing videos, audio files, self-help book portfolio in the form of an e-guide, and log books with the exercises to be realized between each sessions of the 5 session program. The patient is encouraged to practice 20 minutes of exercises 5 or 6 days per week. The program's feasibility has been assessed in accordance with a standard satisfaction scale. Anxiety symptomatology has been quantified thanks to the Spielberger State-Trait Anxiety Inventory (STAI-Y-S). RESULTS After the scheduled 5 weeks, good results were found in terms of acceptability and attractiveness. The average score to the satisfaction survey was at least equal to 4 out of 5 for each item. The mean score on the STAI-State decreased from 53,4 (SD: 8,29) to 44,2 (SD: 7,73) following the intervention. DISCUSSION The Seren@ctif program may be useful within the framework of a psychoeducative approach. It could also be advised for people suffering from anxiety related to stress. Soon, the program will be tested on patients with usual care suffering from adjustment disorder with anxiety in order to precisely assess its benefits.
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Fovet T, Geoffroy P, Vaiva G, Adins C, Thomas P, Amad A. Psychiatrie du sujet âgé en milieu pénitentiaire. Encephale 2016; 42:177-82. [DOI: 10.1016/j.encep.2015.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 09/15/2014] [Indexed: 11/28/2022]
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Fovet T, Micoulaud-Franchi JA, Vaiva G, Thomas P, Jardri R, Amad A. [Serious game as a therapeutic tool in psychiatry: A systematic review]. Encephale 2016; 42:463-469. [PMID: 27017317 DOI: 10.1016/j.encep.2016.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 02/02/2015] [Indexed: 10/22/2022]
Abstract
CONTEXT The growing field of new technologies offers new ways to tackle psychiatric disorders (e.g. virtual reality therapy, neurofeedback, etc.). Serious games (SG) are computer applications combining serious aspects with the fun side of video games. This kind of new media could find applications to treat psychiatric disorders. OBJECTIVE This paper summarizes available data in the literature about therapeutic interventions using SG in psychiatry. METHOD A Medline search was conducted in May 2014 using the following Medical Subject Headings (MESH) terms: "video games", "mental disorders", and "psychotherapy". RESULTS Only 10 relevant references were identified according to our inclusion criteria. These studies show that SG are very interesting tools to improve the management of psychiatric disorders. However, only low-level evidence is available to support treatment with SG in patients suffering from psychiatric disorders. Indeed, randomized controlled trials are rare in this field of research. CONCLUSION SG provide promising therapeutic innovations for the management of psychiatric disorders. Moreover, they could easily be developed in accordance with current dimensional approaches. Finally, major issues to facilitate the implementation of future work on SG in psychiatry are discussed.
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Saba G, Nieto I, Bation R, Allaïli N, Bennabi D, Moliere F, Richieri R, Holtzmann J, Bubrovszky M, Camus V, Charpeaud T, Courtet P, Courvoisier P, Haesebaert F, Doumy O, El-Hage W, Garnier M, d'Amato T, Bougerol T, Lançon C, Haffen E, Llorca PM, Vaiva G, Bellivier F, Leboyer M, Aouizerate B. [Other therapeutic strategies]. Presse Med 2016; 45:350-9. [PMID: 26995510 DOI: 10.1016/j.lpm.2016.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Non-selective and irreversible MAOI have become as third or fourth-line strategy for the management of treatment-resistant depression. Non-selective and irreversible MAOI requires careful monitoring of drug interactions and dietary restrictions. Nutritional supplements such as omega-3 have been found to produce beneficial effects in the management of treatment-resistant depression when administered in combination with the ongoing antidepressant treatment. The glutamate antagonist ketamine has been found to produce beneficial effects in the management of treatment-resistant depression while administered alone. Dopamine and/or norepinephrine agonists, such as methylphenidate, modafinil or pramipexole, have been found to produce beneficial effects in the management of treatment-resistant depression when administered in combination with the ongoing antidepressant treatment.
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Charpeaud T, Moliere F, Bubrovszky M, Haesebaert F, Allaïli N, Bation R, Nieto I, Richieri R, Saba G, Bellivier F, Bennabi D, Holtzmann J, Camus V, Courtet P, Courvoisier P, d'Amato T, Doumy O, Garnier M, Bougerol T, Lançon C, Haffen E, Leboyer M, Llorca PM, Vaiva G, El-Hage W, Aouizerate B. [Switching and combining strategies of antidepressant medications]. Presse Med 2016; 45:329-37. [PMID: 26995511 DOI: 10.1016/j.lpm.2016.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Switching antidepressant medication may be helpful in depressed patients having no benefit from the initial antidepressant treatment. Before considering switching strategy, the initial antidepressant treatment should produce no therapeutic effect after at least 4 weeks of administration at adequate dosage. Choosing an antidepressant of pharmacologically distinct profile fails to consistently demonstrate a significant superiority in terms of effectiveness over the switching to another antidepressant within the same pharmacological class. Augmenting SSRI/SNRIs with mirtazapine/mianserin has become the most recommended strategy of antidepressant combinations. Augmenting SSRI with tricyclic drugs is now a less recommended strategy of antidepressant combinations given the increased risk for the occurrence of pharmacokinetic drug-drug interactions and adverse effects.
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Corruble E, Swartz HA, Bottai T, Vaiva G, Bayle F, Llorca PM, Courtet P, Frank E, Gorwood P. Telephone-administered psychotherapy in combination with antidepressant medication for the acute treatment of major depressive disorder. J Affect Disord 2016; 190:6-11. [PMID: 26480205 DOI: 10.1016/j.jad.2015.07.052] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 07/20/2015] [Accepted: 07/20/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Telephone-administered psychotherapies (T-P) provided as an adjunct to antidepressant medication may improve response rates in major depressive disorder (MDD). The goal of this study was to compare telephone-administered social rhythm therapy (T-SRT) and telephone-administered intensive clinical management (T-ICM) as adjuncts to antidepressant medication for MDD. A secondary goal was to compare T-P with Treatment as Usual (TAU) as adjunctive treatment to medication for MDD. METHODS 221 adult out-patients with MDD, currently depressed, were randomly assigned to 8 sessions of weekly T-SRT (n=110) or T-ICM (n=111), administered as an adjunct to agomelatine. Both psychotherapies were administered entirely by telephone, by trained psychologists who were blind to other aspects of treatment. The 221 patients were a posteriori matched with 221 depressed outpatients receiving TAU (controls). The primary outcome measure was the percentage of responders at 8 weeks post-treatment. RESULTS No significant differences were found between T-SRT and T-ICM. But T-P was associated with higher response rates (65.4% vs 54.8%, p=0.02) and a trend toward higher remission rates (33.2% vs 25.1%; p=0.06) compared to TAU. LIMITATIONS Short term study. CONCLUSIONS This study is the first assessing the short-term effects of an add-on, brief, telephone-administered psychotherapy in depressed patients treated with antidepressant medication. Eight sessions of weekly telephone-delivered psychotherapy as an adjunct to antidepressant medication resulted in improved response rates relative to medication alone.
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Notredame CÉ, Pauwels N, Walter M, Danel T, Vaiva G. Le traitement médiatique du suicide : du constat épidémiologique aux pistes de prévention. Presse Med 2015; 44:1243-50. [DOI: 10.1016/j.lpm.2015.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 06/01/2015] [Accepted: 07/08/2015] [Indexed: 10/23/2022] Open
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Faure C, Cottencin O, Drumez E, De Pourtales MA, Molenda S, Warembourg F, Brelinski-Biencourt L, Pages V, Consoli S, Bougerol T, Chantelot C, Grégory T, Théry D, Cordonnier D, Berger A, Demarty AL, Duhem S, Vaiva G. Intérêt d’un outil de dépistage infirmier d’un état de stress post-traumatique (ESPT) après un accident de la voie publique (AVP) : étude DEPITAC. Eur Psychiatry 2015. [DOI: 10.1016/j.eurpsy.2015.09.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Les AVP sont le principal pourvoyeur d’ESPT (Kupchik et al., 2007), dont la prévalence fluctue de 6 à 45 % entre les études (Heron-Delaney et al., 2013). En l’absence de repérage clinique, l’ESPT peut se chroniciser (Kessler et al., 1995). Les outils actuels permettent son diagnostic (Jackson et al., 2011), mais pas de dépister précocement les sujets à risque de développer un ESPT post-AVP en aigu (8 semaines) comme en chronique (6 mois) ou en tardif (1 an). Nous présentons une étude longitudinale réalisée sur 274 patients répartis sur 6 centres de traumatologie ayant pour objectif principal de valider un outil infirmier de dépistage précoce d’ESPT après un AVP (DEPITAC). Dix questions ont été soumises à tout patient hospitalisé dans les 15 jours après un AVP, ainsi qu’une PDI et un MINI DSM-IV. La PCL-S (cut-off à 44) a permis le diagnostic à 8 semaines, 6 mois et 1 an. L’analyse statistique a été réalisée avec le logiciel SAS Institute 9.4. Le score total DEPITAC était significativement associé au diagnostic d’ESPT à 1 an (OR : 1,43 ; IC95 % : 1,14–1,79) avec un pouvoir discriminant de 0,64 (IC95 % : 0,56–0,72). DEPITAC était corrélé à l’échelle PDI (p < 0,0001) avec un faible coefficient de corrélation (r = 0,32) montrant une faible redondance. Seules 3 questions après analyses bivariées s’avèrent significatives : « présence d’autres blessés ou décédés lors de l’AVP », « présence d’une dissociation post-AVP » et « s’être vu mourir lors de l’AVP » avec un pouvoir discriminant de 0,65 (IC95 % : 0,57–0,73). Aucun effet centre n’a été mis en évidence (p = 0,90). Nos résultats semblent montrer qu’à l’aide de seulement 3 questions de dépistage, les équipes infirmières pourraient repérer les patients à risque de développer un ESPT aigu ou tardif, leur permettant ainsi d’alerter précocement les équipes psychiatriques de liaison ou de pschotraumatologie.
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Vaiva G. Associer les types de recontact du suicidant pour élargir la cible de prévention. Eur Psychiatry 2015. [DOI: 10.1016/j.eurpsy.2015.09.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
IntroductionFaut-il veiller sur une crise suicidaire dès lors qu’un sujet a été rencontré au décours d’une TS ? Nous prônons la simple idée de revenir un peu à distance, sur le compromis de sortie des urgences qui avait été conclu avec le patient suicidant. Nous présentons l’enchaînement des recherches internationales et françaises, quantitatives et qualitatives, qui nous permet aujourd’hui de proposer de tester un nouveau dispositif de soins.MatérielRevue d’essais thérapeutiques randomisés comparatifs. L’objectif principal était pour tous la réduction des conduites suicidaires à 6 ou 12 mois, en comparaison d’un groupe contrôle sans intervention spécifique. Un focus particulier sur le PHRC ALGOS et son étude qualitative et sociologique : ÉQUATION.RésultatsL’efficacité de l’algorithme baptisé ALGOS, jointe aux appropriations par les patients et les partenaires de soin des éléments du processus de veille, nous permettent de proposer un nouveau dispositif de suivi posthospitalier des suicidants : Vigilan S. Ce dispositif associe une « carte ressource prévention » en 0 800 distribuée à tous suicidants quittant le système hospitalier, un suivi téléphonique plus intensifié pour les patients ayant déjà connu une TS auparavant et un rappel téléphonique de tous à 6 mois. Le dispositif est centralisé pour une région donnée et un partenariat très étroit a été tissé avec les Samu/centre 15 qui accueillent les recontacteurs.Discussion et perspectivesCe programme se déploie en Nord–Pas-de-Calais depuis le début de cette année et 24 sites sont déjà associés au programme ; en cette fin d’année 2015, 4 autres régions rejoignent le NPC pour un essai populationnel pilote de trois ans, au terme desquelles la DGS associée à la CNAMTS prendront la décision ou non de proposer sa généralisation à tout le territoire français.
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