To examine the predictive diagnostic value of affective symptomatology in a first-episode psychosis (FEP) sample with 5 years’ follow-up.

Affective dimensions (depressive, manic, activation, dysphoric) were measured at baseline and 5 years in 112 FEP patients based on a factor structure analysis using the Young Mania Rating Scale and Hamilton Depression Rating Scale. Patients were classified as having a diagnosis of bipolar disorder at baseline (BDi), bipolar disorder at 5 years (BDf), or “other psychosis”. The ability of affective dimensions to discriminate between these diagnostic groups and to predict a bipolar disorder diagnosis was analysed.

Manic dimension score was higher in BDi vs. BDf, and both groups had higher manic and activation scores vs. “other psychosis”. Activation dimension predicted a bipolar diagnosis at 5 years (odds ratio = 1.383; 95% confidence interval, 1.205–1.587; P = 0.000), and showed high levels of sensitivity (86.2%), specificity (71.7%), positive (57.8%) and negative predictive value (90.5%). Absence of the manic dimension and presence of the depressive dimension were both significant predictors of an early misdiagnosis.

The activation dimension is a diagnostic predictor for bipolar disorder in FEP. The manic dimension contributes to a bipolar diagnosis and its absence can lead to early misdiagnosis.

Prior studies have demonstrated an inter-relationship between the diagnosis of diabetes, obesity and depression. Our prior studies have shown that the diagnosis of diabetes or baseline body mass index (BMI) did not impact six month depression remission rates.

Our hypothesis was that level of control of diabetes (hemoglobulin A1c < 8.0%) in depressed diabetic patients would have no effect on depression remission rates six months after diagnosis.

This study was retrospective analysis of 451 diabetic primary care patients diagnosed with Major Depressive Disorder or Dysthymia with a PHQ-9 score of 10 or greater.

1. ▪ Outcome variable was clinical remission (PHQ-9 < 5) at six months.

2. ▪ Logistic regression modeling included the demographic variables of age, gender, marital status, the clinical variables of BMI, baseline PHQ-9 score, hemoglobin A1c level (at date of diagnosis of depression) and clinical diagnosis (recurrent or first episode of depression, or dysthymia).

78.5% (354) of depressed diabetics were in good control of diabetes (hemoglobin A1c< 8%) at enrollment. Obesity (BMI≥ 30) at baseline was not different between the controlled and uncontrolled diabetic patients at baseline (approximately 70%), p=0.36.

Figure 1

Odds ratio for clinical remission (PHQ-9<5) at six months in diabetic primary care patients, by variable (N=451).

Controlling for age, gender, marital status, race, clinical diagnosis and clinical site.

1. ▪ Baseline control of diabetes was not an independent predictor for depression outcome at six months.

This data suggests that poor diabetic control was not associated worsening clinical outcomes in depression management.

A substantial proportion of schizophrenia patients also meets DSM-IV criteria for obsessive-compulsive disorder (OCD). Schizophrenia with OCD (“schizo-obsessive”) patients are characterized by distinct clinical characteristics, treatment response and prognosis. Whether schizo-obsessive patients exhibit a distinct pattern of brain activation is yet unknown. To address this question, the present functional magnetic resonance imaging (fMRI) study explicitly compared alterations in brain activation and functional connectivity (FC) underlying a working memory deficit in schizophrenia patients with and without OCD.

fMRI was applied during the N-back working memory (WM) task in three groups: schizo-obsessive (n = 16), schizophrenia (n = 17) and matched healthy volunteers (n = 20). WM-related activation in the right dorsolateral prefrontal cortex (DLPFC) and the right caudate nucleus, brain areas relevant to schizophrenia and OCD, and FC analysis were used for the evaluation.

The two schizophrenia groups with and without OCD exhibited a similar reduction in activation in the right DLPFC and right caudate, as well as decreased FC compared to the healthy controls. Notably, reduced regional brain activation was not related to severity of schizophrenic or OCD symptoms.

Schizo-obsessive patients do not differ from their non-OCD schizophrenia counterparts in brain activation patterns during the N-back WM task. Cognitive paradigms taping alternative neural networks (e.g., orbitofrontal cortex) particularly relevant to OCD, are warranted in the search for potential distinctive brain activation patterns of the schizo-obsessive subgroup.

In patients with schizophrenia, premorbid psychosocial adjustment is an important predictor of functional outcome. We studied functional outcome in young clinical high-risk (CHR) patients and how this was predicted by their childhood to adolescence premorbid adjustment.

In all, 245 young help-seeking CHR patients were assessed with the Premorbid Adjustment Scale, the Structured Interview for Prodromal Syndromes (SIPS) and the Schizophrenia Proneness Instrument (SPI-A). The SIPS assesses positive, negative, disorganised, general symptoms, and the Global Assessment of Functioning (GAF), the SPI-A self-experienced basic symptoms; they were carried out at baseline, at 9-month and 18-month follow-up. Transitions to psychosis were identified. In the hierarchical linear model, associations between premorbid adjustment, background data, symptoms, transitions to psychosis and GAF scores were analysed.

During the 18-month follow-up, GAF scores improved significantly, and the proportion of patients with poor functioning decreased from 74% to 37%. Poor premorbid adjustment, single marital status, poor work status, and symptoms were associated with low baseline GAF scores. Low GAF scores were predicted by poor premorbid adjustment, negative, positive and basic symptoms, and poor baseline work status. The association between premorbid adjustment and follow-up GAF scores remained significant, even when baseline GAF and transition to psychosis were included in the model.

A great majority of help-seeking CHR patients suffer from deficits in their functioning. In CHR patients, premorbid psychosocial adjustment, baseline positive, negative, basic symptoms and poor working/schooling situation predict poor short-term functional outcome. These aspects should be taken into account when acute intervention and long-term rehabilitation for improving outcome in CHR patients are carried out.

This study investigates the effect of sex and childhood trauma on affective processing in bipolar disorder (BPD) patients.

In a sample of fifty-six BPD patients, we administered the Childhood Trauma Questionnaire (CTQ), and the Iowa Gambling Task (IGT) and the Affective Go/No-Go (AGNG) to measure affective processing. Analysis of Variance (ANOVA) was used to evaluate the effect of sex and childhood trauma on IGT; Repeated-Measures ANOVAs to measure accuracy and bias measures across conditions on the AGNG.

In the context of childhood abuse, females evidenced a more conservative cognitive style than males by selecting fewer cards from the disadvantageous decks [F(1, 49) = 14.218; P < 0.001] and showed an improvement throughout the task, as noted in a normal learning curve [F(1.49) = 4.385; P = 0.041)]. For the AGNG, an interaction specific to the negative valence stimuli on response bias measures was found. Abused females scored higher (mean = 8.38; SD = 6.39) than abused males (mean = 0.69; SD = 1.19) [F(1.46) = 6.348; P = 0.015].

Severity of childhood trauma was significantly different between sexes. In the context of a history of emotional abuse, male bipolar patients tended toward a more risk-taking behavior compared to female. Further investigations are needed to elucidate potential pathophysiological mechanisms underlying this interaction.

Increased levels of anxiety, depression and alcohol abuse are associated with unemployment. This study compares both DSM-IV-TR Axis-I and Axis-II mental disorders between a representative and a referred sample of unemployed youths aged 16.0 to 24.9.

One hundred subjects were randomly recruited on the premises of the vocational services centre in the urban region of Essen, Germany (representative sample, RS). One hundred and sixty-five subjects constituting the ‘clinical sample’ (CS) were preselected and referred by case managers to the on-site psychiatric liaison service. Structured Clinical Interviews for DSM-IV (SCID-I and -II), measures of psychopathology and health service utilization were administered.

Ninety-eight percent and 43% of CS and RS subjects fulfilled DSM-IV criteria for mental disorders. Mood-, anxiety- and substance-related disorders were the most common Axis-I disorders in both samples. Personality disorders were diagnosed significantly more frequently in the CS. Despite the more severe psychopathology in subjects with mental disorders from the CS compared to the RS, no differences were found for recent mental health service utilisation.

Because the sample of unemployed youths referred by case managers was significantly more disturbed in psychiatric terms, such a pre-selection is deemed useful in conjunction with a psychiatric liaison service on the premise of a job centre.

Le traitement de l’alcoolo-dépendance représente un enjeu majeur de santé publique en France. Le baclofène, myorelaxant d’action centrale, agoniste du récepteur GABA-B, dispose depuis 1974 d’une AMM pour le traitement de la spasticité musculaire. Devant une utilisation croissante du baclofène hors-AMM dans le traitement de l’alcoolo-dépendance, l’ANSM a organisé dès 2011 un suivi national de pharmacovigilance. Le RCP a été mis à jour le 27/11/13, introduisant de nouvelles précautions d’emploi, dont les troubles psychiatriques sévères, pouvant favoriser des dépressions majeures avec suicides et une sévérité accrue des effets indésirables. Une RTU, octroyée le 14/03/2014 par l’ANSM, permet désormais la prescription de baclofène dans deux indications spécifiées, après échec des autres traitements disponibles.

Rapporter les effets indésirables liés au baclofène dans le traitement de l’alcoolo-dépendance, conformément aux recommandations de l’ANSM, à travers l’étude de trois cas d’hypomanie, survenus à de faibles doses, chez des patients ayant des comorbidités psychiatriques, et tenter, au regard de la littérature, une approche analytique de ces données.

Ces épisodes, obligeant l’arrêt du traitement, ont évolué vers une guérison sans séquelle. Un seul cas est survenu dans le cadre de la RTU, objet d’une déclaration d’effet indésirable : le signalement d’hypomanie au CRPV a été considéré comme effet indésirable grave, non mentionné dans le RCP. La présence constante d’un antidépresseur interroge sur les interactions : leur utilisation concomitante, signalée comme association à prendre en compte, devrait-elle être déconseillée, par risque de virage hypomaniaque ?

Ces observations cliniques renforcent la question de l’efficacité du baclofène dans le traitement de l’alcoolo-dépendance en présence de pathologies psychiatriques associées par risque important d’effets indésirables graves. Le protocole de suivi de la RTU offre un cadre sécurisant et prometteur dans le système de pharmacovigilance. Les résultats d’études randomisées sont attendus prochainement.

Few studies have investigated the association between religiosity and self-injurious thoughts and behaviors specifically in adolescents, yielding inconsistent results. To date, no study has examined this relationship in a Jewish adolescent cohort.

Self-injurious thoughts and behaviors, as well as depression, were assessed in a nationally representative sample of Jewish adolescents (n = 620) and their mothers, using the Development and Well-Being Assessment Inventory (DAWBA) structured interview. Degree of religiosity was obtained by a self-report measure.

Using multivariate analysis, level of religiosity was inversely associated with self-injurious thoughts and behaviors (Wald χ2 = 3.95, P = 0.047), decreasing the likelihood of occurrence by 55% (OR = 0.45, 95% CI 0.2–0.99), after adjusting for depression and socio-demographic factors. This model (adjusted R2 = 0.164; likelihood ratio χ2 = 7.59; df = 1; P < 0.047) was able to correctly classify 95.6% of the patients as belonging either to the high or low risk groups.

This is the first study demonstrating religiosity to have a direct independent protective effect against self-injurious thoughts and behaviors in Jewish adolescents. This finding has clinical implications regarding risk assessment and suicide prevention. Further research can potentially elucidate the complex relationship between religiosity, self-injury and suicide in this population.

Few studies have examined rate and predictors of self-harm in discharged psychiatric patients.

To investigate the rate, coding, timing, predictors and characteristics of self-harm induced somatic admission after discharge from psychiatric acute admission.

Cohort study of 2827 unselected patients consecutively admitted to a psychiatric acute ward during three years. Mean observation period was 2.3 years. Combined register linkage and manual data examination. Cox regression was used to investigate covariates for time to somatic admission due to self-harm, with covariates changing during follow-up entered time dependently.

During the observation period, 10.5% of the patients had 792 somatic self-harm admissions. Strongest risk factors were psychiatric admission due to non-suicidal self-harm, suicide attempt and suicide ideation. The risk was increased throughout the first year of follow-up, during readmission, with increasing outpatient consultations and in patients diagnosed with recurrent depression, personality disorders, substance use disorders and anxiety/stress-related disorders. Only 49% of the somatic self-harm admissions were given hospital self-harm diagnosis.

Self-harm induced somatic admissions were highly prevalent during the first year after discharge from acute psychiatric admission. Underdiagnosing of self-harm in relation to somatic self-harm admissions may cause incorrect follow-up treatments and unreliable register data.

Current study aimed to investigate self esteem and attitude toward Appearance schema in patients with rhinoplasty.

In this pretest-posttest semi-experimental design, sample population was consisted of total patients who refered to AmirAlam hospital and a private doctor office for rhinoplasty during the first six-month of 2010. Sampling method was convenient which based on 2 patients per week; the sample size was estimated as 40 persons. The study scales were a demographic questionnaire included variables like age, sex, education, job and the number of rhinoplasty operations. Also, Cooper smith inventory and Appearance schema inventory were used for data gathering.

The sample was 40 patients whom 27.5% were male and 72.5% were female. Also 77.5% of them were singles and others were marries. 5% had lower diploma education level, 25% diploma and others had university degrees. Results showed rhinoplasty could not change their self esteem but the scores of attitude toward Appearance befor and after sergury were different (0.05≥p? 39=df? 3.012=t)

Before rhinoplasty operation, patients should be assessed psychologically and in should be considered that before rhinoplasty, psychological factors play an important role on increasing self esteem and promoting attitude toward Appearance.

Les addictions comportementales (AC), ou addictions sans drogues, ont en commun la perte de contrôle sur le comportement et la poursuite de ce comportement malgré les dommages. Les principales AC sont : le jeu pathologique, l’addiction sexuelle, l’exercice physique excessif, les achats compulsifs et certains troubles du comportement alimentaire. Associées à des comorbidités psychiatriques et addictives, à des conséquences sociales, leur prise en charge repose essentiellement sur des psychothérapies et des mesures sociales. L’utilisation des techniques de stimulation cérébrale est encore relativement récente, notamment dans le champ des addictions. La tDCS a principalement été testée dans les addictions avec substances, mais très peu dans les AC. Cette revue de la littérature a pour objectif de faire une mise au point méthodologique et clinique sur les premiers travaux couvrant cette question.

Une recherche bibliographique a été réalisée sur Pubmed et ScienceDirect, jusqu’au 30 juillet 2014. Les critères d’inclusion étaient : articles de revue, articles didactiques, essais thérapeutiques, études physiopathologiques.

Quatorze revues et études ont été retenues. Elles portent sur les troubles du comportement alimentaire, l’obésité, et les processus décisionnels et de prise de risque. Les études cliniques ont montré l’intérêt de la tDCS bilatérale dans la diminution de la prise de risque, et du craving alimentaire. La tDCS présente des avantages prometteurs dans le traitement des AC. Non invasive, bien tolérée, avec un dispositif portable, peu coûteuse comparée à la TMS, elle pourrait être dispensée dans un cadre ambulatoire.

Except in broad outline, little is known about the most likely symptomatic trajectories in prodromal schizophrenia. The aim of this study is to delineate these pathways.

Taking into account existing clinical knowledge, the causal relationships between the 12 prodrome scales of the Schizotypic Syndrome Questionnaire (SSQ) were examined in a general-population sample by applying the mathematical theory of directed graphs. Use was made of two discovery algorithms implemented in the Tetrad-4 program, as well as of the graphical DAGitty program to test whether a particular model holds.

A promising model was selected that may describe the causal pathways in schizophrenic prodromal unfolding. Testing this model by means of DAGitty, it was shown that the minimal testable implications, listed as conditional independences, and the direct and total effects in the model, identified after correction for bias, were as hypothesized. For practical reasons, a simpler version of the resulting SSQ model, containing only its principal pathways, was provided.

Although resembling an earlier model that was based on a series of LISREL analyses, the present model was believed to provide a more dependable description of schizophrenic prodromal unfolding, as it relies on methods that are less subject to the limitations involved in SEM.

Metabolic abnormality is common among schizophrenia patients. Some metabolic traits were found associated with subgroups of schizophrenia patients.

We examined a possible relationship between metabolic abnormality and psychosis profile in schizophrenia patients.

Three hundred and seventy-two chronic schizophrenia patients treated with antipsychotics for more than 2 years were assessed with the Positive and Negative Syndrome Scale. A set of metabolic traits was measured at scheduled checkpoints between October 2004 and September 2006.

Multiple regressions adjusted for sex showed negative correlations between body mass index (BMI) and total score and all subscales; triglycerides (TG) was negatively correlated with total score and negative syndrome, while HDLC was positively correlated with negative syndrome. When sex interaction was concerned, total score was negatively correlated with BMI but not with others; negative syndrome was negatively correlated with BMI and positively with HDLC. No metabolic traits were correlated with positive syndrome or general psychopathology.

Loss of body weight is a serious health problem in schizophrenia patients with severe psychosis syndrome, especially the negative syndrome. Schizophrenia patients with severe negative syndrome may have a distinct lipid pathophysiology in comparison with those who were less severe in the domain.

Post-stroke depression (PSD) is the most common psychiatric complication facing stroke survivors and has been associated with increased distress, physical disability, poor rehabilitation, and suicidal ideation. However, the pathophysiological mechanisms underlying PSD remain unknown, and no objective laboratory-based test is available to aid PSD diagnosis or monitor progression.

Here, an isobaric tags for relative and absolute quantitation (iTRAQ)-based quantitative proteomic approach was performed to identify differentially expressed proteins in plasma samples obtained from PSD, stroke, and healthy control subjects.

The significantly differentiated proteins were primarily involved in lipid metabolism and immunoregulation. Six proteins associated with these processes – apolipoprotein A-IV (ApoA-IV), apolipoprotein C-II (ApoC-II), C-reactive protein (CRP), gelsolin, haptoglobin, and leucine-rich alpha-2-glycoprotein (LRG) – were selected for Western blotting validation. ApoA-IV expression was significantly upregulated in PSD as compared to stroke subjects. ApoC-II, LRG, and CRP expression were significantly downregulated in both PSD and HC subjects relative to stroke subjects. Gelsolin and haptoglobin expression were significantly dysregulated across all three groups with the following expression profiles: gelsolin, healthy control > PSD > stroke subjects; haptoglobin, stroke > PSD > healthy control.

Early perturbation of lipid metabolism and immunoregulation may be involved in the pathophysiology of PSD. The combination of increased gelsolin levels accompanied by decreased haptoglobin levels shows promise as a plasma-based diagnostic biomarker panel for detecting increased PSD risk in post-stroke patients.