Formulation de cas dans la psychose débutante : Quels outils pour le travail en équipe? [Case Formulation in Early Psychosis: What are the Tools for Teamwork?]

Nous présentons d’abord brièvement le programme TIPP et les concepts généraux de la prise en charge précoce dans la psychose débutante. Un des objectifs de l’intervention dans la phase précoce des troubles psychotiques est notamment de proposer des soins spécifiques adaptés à cette phase de la maladie. En début de prise en charge, l’équipe de soins et en particulier le gestionnaire de cas (case manager), chef d’orchestre de la prise en charge, sont confrontés à une quantité importante d’information dont il faut dégager les lignes de forces pour mettre en place une prise en charge adaptée. Cet article propose un modèle qui peut constituer un outil de travail précieux pour les équipes travaillant dans l’intervention précoce pour faire émerger une formulation de cas et synthétiser les situations cliniques des patients, en extraire une histoire qui fasse sens et ainsi faciliter la mise en place d’un projet thérapeutique

Internal and Predictive Validity of the French Health of the Nation Outcome Scales: Need for Future Directions.

The Health of the Nation Outcome Scales (HoNOS) is a widely used measure of health and social functioning of people with mental illness. The goals of this study were to verify the internal validity of the one factor and several four-factor scoring structures and to evaluate the predictive validity of HoNOS items with regards to duration of hospitalization, probability of readmission in the following year and time before readmission. 6175 hospital stays at the department of psychiatry of Lausanne University Hospital were screened and the first HoNOS of each patient was taken into account (N = 2722). Data were analyzed through Confirmatory Factor Analysis (CFA) and the predictive validity of HoNOS items was evaluated with two approaches: item level regressions and latent class analysis (LCA). CFA indicated that the suggested factor structures were not supported by the data. Predictive validity of the 12 items was weak but LCA revealed five distinct and meaningful profiles that were related to length of stay or readmission. HoNOS may be more adapted to the evaluation of patients case-mix rather than to the individual level and concepts such as predictive validity may be more appropriate than internal validity to guide its use

Implication of the glutamate-cystine antiporter xCT in schizophrenia cases linked to impaired GSH synthesis.

xCT is the specific chain of the cystine/glutamate antiporter, which is widely reported to support anti-oxidant defenses in vivo. xCT is therefore at the crossroads between two processes that are involved in schizophrenia: oxidative stress and glutamatergic neurotransmission. But data from human studies implicating xCT in the illness and clarifying the upstream mechanisms of xCT imbalance are still scarce. Low glutathione (GSH) levels and genetic risk in GCLC (Glutamate-Cysteine Ligase Catalytic subunit), the gene of limiting synthesizing enzyme for GSH, are both associated with schizophrenia. In the present study, we aimed at determining if xCT regulation by the redox system is involved in schizophrenia pathophysiology. We assessed whether modulating GCLC expression impact on xCT expression and activity (i) in fibroblasts from patients and controls with different GCLC genotypes which are known to affect GCLC regulation and GSH levels; (ii) in rat brain glial cells, i.e., astrocytes and oligodendrocytes, with a knock-down of GCLC. Our results highlight that decreased GCLC expression leads to an upregulation of xCT levels in patients' fibroblasts as well as in astrocytes. These results support the implication of xCT dysregulation in illness pathophysiology and further indicate that it can result from redox changes. Additionally, we showed that these anomalies may already take place at early stages of psychosis and be more prominent in a subgroup of patients with GCLC high-risk genotypes. These data add to the existing evidence identifying the inflammatory/redox systems as important targets to treat schizophrenia already at early stages. ANTIOXIDANT DEFICIT INCREASES A KEY NEUROTRANSMITTER TRANSPORTER: Deficit of antioxidant synthesis in schizophrenia leads to oxidative stress and changes in neurotransmitter transporter. Led by Kim Do, a team of researchers from Lausanne University in Switzerland investigated the role of the cell-surface transport protein xCT in schizophrenia. They found that an enzyme responsible for antioxidant production is disturbed in patients. This leads to decreased antioxidant levels and consequently to oxidative stress-i.e. the accumulation of reactive oxygen molecules, damaging the cells component and impairing cell functioning-which in turn affects the functioning of the antioxidant pathway, including xCT. xCT, which exports the neurotransmitter glutamate, is thus overproduced in schizophrenia. The resulting increase of neurotransmitter activity, alongside the increase in oxidative stress, is thought to play a major role in the pathophysiology of schizophrenia, including at early stages of the disease

The non-linear stochastic wave equation in high dimensions

We propose an extension of Walsh’s classical martingale measure stochastic integral that makes it possible to integrate a general class of Schwartz distributions, which contains the fundamental solution of the wave equation, even in dimensions greater than 3. This leads to a square-integrable random-field solution to the non-linear stochastic wave equation in any dimension, in the case of a driving noise that is white in time and correlated in space. In the particular case of an affine multiplicative noise, we obtain estimates on p-th moments of the solution (p> 1), and we show that the solution is Hölder continuous. The Hölder exponent that w

Non elliptic SPDEs and ambit fields: existence of densities

Relying on the method developed in [debusscheromito2014], we prove the existence of a density for two different examples of random fields indexed by (t,x)\in(0,T]\times \Rd. The first example consists of SPDEs with Lipschitz continuous coefficients driven by a Gaussian noise white in time and with a stationary spatial covariance, in the setting of [dalang1999]. The density exists on the set where the nonlinearity $\sigma$ of the noise does not vanish. This complements the results in [sanzsuess2015] where $\sigma$ is assumed to be bounded away from zero. The second example is an ambit field with a stochastic integral term having as integrator a L\'evy basis of pure-jump, stable-like type.Comment: 23 page

Age at the time of onset of psychosis: A marker of specific needs rather than a determinant of outcome?

While there is suggestion that early onset of psychosis is a determinant of outcome; knowledge regarding correlates of later onset age is more limited. This study explores the characteristics of patients developing psychosis after age 26, towards the end of the usual age range of early intervention programs, in order to identify potential specific needs of such patients. Two hundred and fifty-six early psychosis patients aged 18-35 were followed-up prospectively over 36 months. Patients with onset after 26 ("later onset", LO) were compared to the rest of the sample. LO patients (32% of the sample) had shorter DUP, were less likely to be male, had better premorbid functioning and were more likely to have been exposed to trauma. They had greater insight at presentation and less negative symptoms overall. The trajectories for positive and depressive symptoms were similar in both groups. Evolution of functional level was similar in both groups, but while LO patients recovered faster, they were significantly less likely to return to premorbid functional level. Later psychosis onset correlates with better premorbid functioning and higher rate of trauma exposure; the latter should therefore be a treatment focus in such patients. LO patients were less likely to return to premorbid functional level, which suggests that current treatment strategies may not be efficient to help patients maintain employment. The possibility of distinct illness mechanisms according to onset age and the more central role for trauma in patients with onset after age 26 needs to be further explored