Delphine Raucher-Chéné

Manic episode with psychotic symptoms in a patient with Parkinson's disease treated by subthalamic nucleus stimulation: improvement on switching the target.

Manic symptoms have been reported as adverse effects of bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) in patients with Parkinsons disease. In previous reports, manic symptoms were described as transient, not associated with psychotic features, and improved spontaneously or with medical adjustments. The medial part of the STN seems to play a key role in the occurrence of these manic symptoms. We report the case of a manic episode with psychotic symptoms in a patient with Parkinsons disease treated by STN DBS, which improved with a change in the stimulated target. This case demonstrates the efficacy of switching the stimulation target against a manic episode with psychotic features secondary to DBS.

Linear association between social anxiety symptoms and neural activations to angry faces: from subclinical to clinical levels

Social anxiety disorder (SAD), which is characterized by the fear of being rejected and negatively evaluated, involves altered brain activation during the processing of negative emotions in a social context. Although associated temperament traits, such as shyness or behavioral inhibition, have been studied, there is still insufficient knowledge to support the dimensional approach, which assumes a continuum from subclinical to clinical levels of social anxiety symptoms. This study used functional magnetic resonance imaging (fMRI) to examine the neural bases of individual differences in social anxiety. Our sample included participants with both healthy/subclinical as well as clinical levels of social anxiety. Forty-six participants with a wide range of social anxiety levels performed a gender decision task with emotional facial expressions during fMRI scanning. Activation in the left anterior insula and right lateral prefrontal cortex in response to angry faces was positively correlated with the level of social anxiety in a regression analysis. The results substantiate, with a dimensional approach, those obtained in previous studies that involved SAD patients or healthy and subclinical participants. It may help to refine further therapeutic strategies based on markers of social anxiety.

Self-defining memories in recently detoxified alcohol-dependent patients

Patients with alcohol dependence have been shown to be impaired in recalling specific autobiographical events, yet little is known on how changes in the memory of these events may impact their self-representation. In this study, we examined Self-Defining Memories (SDMs), a specific type of autobiographical memory that plays a key role in the construction of personal identity, in 25 patients with alcohol dependence, abstinent from alcohol from 10 days to 6 months, compared to 28 control subjects. We observed that SDMs in patients were significantly less specific and included more reference to alcohol than those of controls. Patients also reported more SDMs with negative emotional valence and higher emotional intensity. These results suggest that recently abstinent alcohol-dependent patients may be prone to define themselves by negative events referring to alcohol consumption, which may contribute to an unfavorable perception of their self and subsequently of their ability to remain abstinent. These findings should be taken into account to optimize psychological approaches in the treatment of alcohol-dependence.

Verbal fluency in bipolar disorders: A systematic review and meta-analysis.

BACKGROUND One of the main features of bipolar disorder (BD), besides mood dysregulation, is an alteration of the structure of language. Bipolar patients present changes in semantic contents, impaired verbal associations, abnormal prosody and abnormal speed of language highlighted with various experimental tasks. Verbal fluency tasks are widely used to assess the abilities of bipolar patients to retrieve and produce verbal material from the lexico-semantic memory. Studies using these tasks have however yielded discrepant results. The aim of this study was thus to determine the extent of the verbal fluency impairment in BD patients and to evaluate if the deficits are affected by the type of task or by mood states. METHODS A systematic literature search was conducted in MEDLINE, EBSCOHost and Google Scholar and relevant data were submitted to a meta-analysis. RESULTS Thirty-nine studies were retained providing data for 52 independent groups of BD patients. The overall meta-analysis revealed a moderate verbal fluency impairment in BD compared to healthy controls (effect size d=0.61). Comparisons between mood states showed significant differences only between euthymic and manic patients and only on category fluency performances. LIMITATIONS This review is limited by the heterogeneity between studies for the characteristics of BD populations. Also, few of the retained studies examined depressive or mixed episodes. CONCLUSIONS This work confirms that BD patients present with moderate verbal fluency impairments, and underlines the specific effect of mood state on category fluency. This emphasizes the need to distinguish semantic from phonological processes in verbal fluency assessments in BD.

Association study between reward dependence and a functional BDNF polymorphism in adult women offspring of alcohol-dependent probands.

Thirty-five healthy adult women offspring of alcohol-dependent probands (AWOA) were compared with 63 healthy controls to test whether personality dimensions on the Temperament and Character Inventory questionnaire were associated with the brain-derived neurotrophic factor Val66Met polymorphism in offspring. We found a significantly lower reward dependence score in AWOA compared with the controls. The brain-derived neurotrophic factor Val66Met polymorphism may be involved in this difference as the lower reward dependence score was found only in AWOA carrying the Val allele.

Impact of switching or initiating antipsychotic treatment on body weight during a 6-month follow-up in a cohort of patients with schizophrenia.

Objective Although weight gain is one of the most widely studied adverse effects of second-generation antipsychotics, only relatively few studies have specifically evaluated the long-term effect of switching antipsychotic medication on body weight. We aimed to evaluate the impact of switching antipsychotics on body mass index (BMI) during a 6-month follow-up period in a large cohort of patients with schizophrenia. Method Data came from a 6-month prospective naturalistic survey in 6007 patients with schizophrenia. Results We prospectively studied the effect on BMI of initiating or switching antipsychotic medication after 6 months of treatment among 3801 patients with schizophrenia in a real-life setting. Patients who were being treated with clozapine or olanzapine at baseline were more likely to experience a decrease in BMI during the follow-up period than the patients who were being treated with a conventional antipsychotic (odds ratio, 2.25 and 1.68, respectively). Patients treated with aripiprazole and, to a lesser extent, those treated with risperidone were more likely to experience a decrease in BMI during follow-up than patients treated with conventional antipsychotics (odds ratio, 2.96 and 2.06, respectively). Conclusions Our findings suggest that switching antipsychotics could be an effective strategy for reducing or preventing weight gain.

Depression, anxiety and personality dimensions in female first-degree relatives of alcohol-dependent probands.

A total of 136 with or without first-degree relatives with alcohol dependence were compared according to lifetime prevalence of psychiatric disorders and personality dimensions. Family history positive women showed significant higher prevalence rates of depression and agoraphobia, and exhibited lower scores on Reward Dependence, Self-Directedness and Cooperativeness dimensions.

Modulation of the N400 component in relation to hypomanic personality traits in a word meaning ambiguity resolution task

High levels of hypomanic personality traits have been associated with an increased risk of developing bipolar disorder (BD). Changes in semantic content, impaired verbal associations, abnormal prosody, and abnormal speed of language are core features of BD, and are thought to be related to semantic processing abnormalities. In the present study, we used event‐related potentials to investigate the relation between semantic processing (N400 component) and hypomanic personality traits.

Mental healthcare in older adults with schizophrenia: results from 118 French public psychiatric departments.

The increased life expectancy in people with severe and persistent psychiatric illness, such as schizophrenia or bipolar disorder, has been predicted to substantially affect mental healthcare system (Bartels et al., 2002) that must adapt to meet the needs of older adults (Jeste et al., 1999). Development of specialized geriatric psychiatry services is thus needed. In France, public mental health departments are organized into “sectors,” i.e. catchment areas defining mutually independent geographical areas, each of them comprising a mean population of 72,000 inhabitants. Catchment area healthcare teams cover all levels of service provision, i.e. primary, secondary, and tertiary care, and are responsible for the provision of healthcare services for all the inhabitants of the areas concerned. Apart from the planning and budgeting advantages of this method of organizing service, this approach leads to enhanced likelihood of providing continuity of care. However, it also implies that each sector healthcare team have the knowledge and the means required to adequately manage all mental disorders, limiting thus the development of services specialized in the care of specific disorders and in geriatric psychiatry (Verdoux and Tignol, 2003). In this report, we sought to give an overview on the global provision of psychiatric care for older adults in France and examine the proportion of older patients with schizophrenia among psychiatric patients followed up in France between 2008 and 2009. Data were collected in 118 public-sector psychiatric departments between 2008 and 2009. Each department was questioned about the total number of patients aged over 18 years old they had followed up during this period, their age, and the number of patients with an International Classification of Diseases, 10th Revision (ICD10) diagnosis of schizophrenia or schizoaffective disorder (F20–F25). Lastly, all departments were asked whether they offer specialized services for elderly patients. Study results indicate that one out of five (n = 376±303; 21%) patients was aged 60 years or older. Patients with a diagnosis of schizophrenia represented nearly 13% (n = 236±147) of the total number of patients, while the percentage of patients with schizophrenia aged 60 years and older was 1.5% (n = 26±15) of the total number of patients. More than one out of ten patients with schizophrenia was aged 60 years and older (11.1%). Less than four out of ten mental health departments (39.8%) provided specialized services for elderly patients. In these departments, 76% reported ambulatory care services, 42% consultation-liaison, 36% full-time hospitalization with an average of five beds dedicated to the elderly, and 19% day hospitalization. Mental health in older people has become a major issue in the European Union (EU) (Jané-Llopis and Gabilondo, 2008). The EU stresses the importance of promoting autonomy and independence for older people with mental health diseases by privileging community-based care and maintaining elderly subjects in their own environment. However, our results, in line with those of a recent study (Tucker et al., 2007), suggest that despite substantial improvements during the last decades, the development of mental health departments offering specialized services for older patients is insufficient to meet the impending crisis in geriatric mental health. Mental healthcare for older adults with mental illness, and particularly those with schizophrenia, needs to be accessible, affordable, culturally appropriate, and integrated into a comprehensive system of mental health services that ensures continuity and coordination of care. Despite evidence for the efficacy of a variety of interventions for mental disorders in the elderly, implementation of these interventions in usual care settings remains limited (Bartels et al., 2002). The main objectives for the next few years are to ensure equitable access to appropriate assessment and treatment of mental disorders in older individuals, develop the interface between specialist mental health services and generic services caring for older people, and provide adequate training to young psychiatrists and mental health staff. In France, the National Health Strategy plan recently presented by the government seeks to diminish care provision disparities, with a particular focus on the older population. In conclusion, although elderly patients represent one out of five psychiatric patients in France, only one-third of French public mental health departments provide services specialized in geriatric psychiatry. Given the rapid growth of

Neural Correlates of Semantic Inhibition in Relation to Hypomanic Traits: An fMRI Study

Objectives Language modifications are a core feature of mania, but little is known about the semantic mechanisms behind these disturbances. The aim of the present study was thus to identify deficits in semantic inhibition and their respective neural activation patterns in a sample of individuals assessed for hypomanic personality traits. Methods Thirty-six young adults with no neurological or psychiatric diagnoses were assessed for hypomanic personality traits with the Hypomanic Personality Scale (HPS) and underwent an fMRI task of semantic ambiguity resolution. Results Regression analyses revealed a positive association between the HPS score and activity in the left superior frontal gyrus, left inferior parietal lobule, and anterior cingulate gyrus during semantic ambiguity resolution. Conclusion We found a link between HPS scores and brain areas that are part of the cognitive control loop and semantic memory network during language processing in a nonclinical sample of individuals. The hyperactivation of these regions may reflect a compensatory neural response in a population with greater vulnerability to BD.