37 research outputs found
Relationship between childhood physical abuse and clinical severity of treatment-resistant depression in a geriatric population
Introduction: We assessed the correlation between childhood maltreatment (CM) and severity of depression in an elderly unipolar Treatment-Resistant Depression (TRD) sample. Methods: Patients were enrolled from a longitudinal cohort (FACE-DR) of the French Network of Expert TRD Centres. Results: Our sample included 96 patients (33% of the overall cohort) aged 60 years or above, with a mean age of 67.2 (SD = 5.7). The majority of the patients were female (62.5%). The Montgomery and Asberg Depression Rating Scale (MADRS) and Quick Inventory Depression Scale-Self Report (QIDS-SR) mean scores were high, 28.2 (SD = 7.49) [MADRS score range: 0–60; moderate severity≥20, high severity≥35] and 16.5 (SD = 4.94) [IDS-SR score range: 0–27; moderate severity≥11, high severity≥16], respectively. Mean self-esteem scores were 22.47 (SD = 6.26) [range 0–30]. In an age- and sex-adjusted model, we found a positive correlation between childhood trauma (CTQ scores) and depressive symptom severity [MADRS (β = 0.274; p = 0.07) and QIDS-SR (β = 0.302; p = 0.005) scores]. We detected a statistically significant correlation between physical abuse and depressive symptom severity [MADRS (β = 0.304; p = 0.03) and QIDS-SR (β = 0.362; p = 0.005) scores]. We did not observe any significant correlation between other types of trauma and depressive symptom severity. We showed that self-esteem (Rosenberg scale) mediated the effect of physical abuse (PA) on the intensity of depressive symptoms [MADRS: b = 0.318, 95% BCa C.I. [0.07, 0.62]; QIDS-SR: b = 0.177, 95% BCa C.I. [0.04, 0.37]]. Preacher & Kelly’s Kappa Squared values of 19.1% (k2 = 0.191) and 16% (k2 = 0.16), respectively for the two scales, indicate a moderate effect. Conclusion: To our knowledge, this is the first study conducted in a geriatric TRD population documenting an association between childhood trauma (mainly relating to PA) and the intensity of depressive symptoms
Assessment of Translocator Protein Density, as Marker of Neuroinflammation, in Major Depressive Disorder: A Pilot, Multicenter, Comparative, Controlled, Brain PET Study (INFLADEP Study)
Background: Major depressive disorder (MDD) is a serious public health problem with high lifetime prevalence (4.4–20%) in the general population. The monoamine hypothesis is the most widespread etiological theory of MDD. Also, recent scientific data has emphasized the importance of immuno-inflammatory pathways in the pathophysiology of MDD. The lack of data on the magnitude of brain neuroinflammation in MDD is the main limitation of this inflammatory hypothesis. Our team has previously demonstrated the relevance of [18F] DPA-714 as a neuroinflammation biomarker in humans. We formulated the following hypotheses for the current study: (i) Neuroinflammation in MDD can be measured by [18F] DPA-714; (ii) its levels are associated with clinical severity; (iii) it is accompanied by anatomical and functional alterations within the frontal-subcortical circuits; (iv) it is a marker of treatment resistance.Methods: Depressed patients will be recruited throughout 4 centers (Bordeaux, Montpellier, Tours, and Toulouse) of the French network from 13 expert centers for resistant depression. The patient population will be divided into 3 groups: (i) experimental group—patients with current MDD (n = 20), (ii) remitted depressed group—patients in remission but still being treated (n = 20); and, (iii) control group without any history of MDD (n = 20). The primary objective will be to compare PET data (i.e., distribution pattern of neuroinflammation) between the currently depressed group and the control group. Secondary objectives will be to: (i) compare neuroinflammation across groups (currently depressed group vs. remitted depressed group vs. control group); (ii) correlate neuroinflammation with clinical severity across groups; (iii) correlate neuroinflammation with MRI parameters for structural and functional integrity across groups; (iv) correlate neuroinflammation and peripheral markers of inflammation across groups.Discussion: This study will assess the effects of antidepressants on neuroinflammation as well as its role in the treatment response. It will contribute to clarify the putative relationships between neuroinflammation quantified by brain neuroimaging techniques and peripheral markers of inflammation. Lastly, it is expected to open innovative and promising therapeutic perspectives based on anti-inflammatory strategies for the management of treatment-resistant forms of MDD commonly seen in clinical practice.Clinical trial registration (reference: NCT03314155): https://www.clinicaltrials.gov/ct2/show/NCT03314155?term=neuroinflammation&cond=depression&cntry=FR&rank=
Organisation de l’offre de soin en psychiatrie
INTRODUCTION Les maladies mentales ont cette particularité qu’elles laissent souvent le malade étranger à la réalité de leurs existences. En effet, la plupart des malades souffrant de troubles psychiatriques ont du mal à reconnaître le caractère pathologique de leurs symptômes et de ce fait, refusent les soins qui peuvent leur être proposés et qui sont parfois indispensables. A en croire les interventions politiques les plus récentes (discours d’Antony de Nicolas Sarkozy du 2 ..
Les hallucinations du sujet âgé (prévalence des hallucinations et facteurs associés dans la maladie d'Alzheimer)
Les pathologies psychiatriques, neurologiques et neuro-dégénératives peuvent être à l'origine d'hallucinations chez le sujet âgé. Quatre vingt dix pour cent des patients atteints de la maladie d'Alzheimer développent des troubles psycho-comportementaux responsables d'une souffrance de l'aidant principal, d'institutionnalisation et d'accélération du déclin fonctionnel. Dans l'étude que nous avons réalisée, la prévalence des hallucinations dans une cohorte de 2442 patients atteints de la maladie d'Alzheimer a été estimée à 10,65%. L'agressivité et/ou l'agitation, le sexe féminin, les idées délirantes, la dépression, la provenance du domicile et les troubles du sommeil ont été identifiés comme des facteurs associés aux hallucinations. Identifier ces facteurs permet de mettre en place une prise en charge spécifique pour prévenir les hallucinations, limiter la souffrance de l'aidant principal et améliorer la qualité de vie des patients.TOULOUSE3-BU Santé-Centrale (315552105) / SudocSudocFranceF
La dépression chez les patients atteints de maladie d'Alzheimer (étude ELSA)
Objectif : Identifier les caractéristiques cliniques et démographiques des sujets présentant une symptomatologie dépressive, leur prévalence et l'incidence. Méthode : Une cohorte de 412 sujets issue de l'étude ELSA, population française de sujets atteints de maladie d'Alzheimer, a été suivie pendant deux ans. Résultats : La prévalence de la symptomatologie dépressive a été évaluée à 30%, et l'incidence à 22% par an. Cette symptomatologie dépressive s'associe à des comorbidités : altération cognitive, altération fonctionnelle et nutritionnelle et majoration des troubles du comportement qui ne sont pas toujours améliorées par le traitement. Le traitement antidépresseur ne semble pas toujours adapté à la symptomatologie dépressive. Conclusion : Les efforts doivent essentiellement se concentrer sur le diagnostic et la mise en place d'un traitement antidépresseur à bon escient. Parmi les comorbidités associées à la dépression, il est important d'insister sur celles qui sont réversibles.TOULOUSE3-BU Santé-Centrale (315552105) / SudocTOULOUSE3-BU Santé-Allées (315552109) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF
Who is doing what in emergency departments to ensure memory recovery after self-poisoning? A survey of university hospital centers in France
Mise en place et évaluation préliminaire d’un séminaire de formation à l’entretien motivationnel pour des internes de psychiatrie de première année
Introduction : La formation spécialisée en psychiatrie vise l’acquisition de savoirs et de compétences. L’acquisition de capacités en liens avec les techniques d’entretien en constitue une composante importante. Parmi elles, l’entretien motivationnel est une technique d’entretien spécifique dont la maîtrise devrait être acquise durant l’internat. Objectif : Rapporter la planification et l’évaluation préliminaire des effets d’un dispositif d’enseignement de l’entretien motivationnel destiné à des internes en première année de diplôme d’études spécialisées (DES) en psychiatrie. Méthodes : Un séminaire de deux demi-journées, comportant une partie théorique et un enseignement pratique à base de jeux de rôle, a été élaboré et mis en œuvre pour les internes de première année du DES de psychiatrie de l’Université de Toulouse. Les apprentissages et la satisfaction des participants ont été évalués en recourant à des questionnaires administrés avant le séminaire, après le séminaire et trois mois après sa fin. Résultats : Dix-huit internes ont participé à au moins une des deux sessions. Les taux de réussite moyen au test d’évaluation des connaissances déclaratives étaient respectivement de 45,4 %, 94,5 % et 87,8 % avant le séminaire, à la fin du séminaire et trois mois après la fin du séminaire. Trois mois après le séminaire, 77,7 % des internes considéraient avoir utilisé souvent ou très souvent l’entretien motivationnel dans leur pratique courante et 66,6 % que l’amélioration de leur niveau de compétence en entretien avait été importante ou très importante. Conclusion : Un dispositif pédagogique de durée courte, spécifiquement dédié à l’enseignement et l’apprentissage de l’entretien motivationnel, a permis des apprentissages significatifs, en répondant aux attentes de formation des étudiants concernés et en améliorant leur sentiment de compétence en entretien motivationnel
The association between reattempted suicide and incoming calls to the brief contact intervention service, VigilanS: a study of the clinical profile of callers
Abstract Background Suicide is a major health problem globally. As attempted suicide is a major risk factor for suicide, specific prevention strategies have been designed for use thereafter. An example is the brief contact intervention (BCI). In this regard, France employs a composite BCI, VigilanS, which utilizes three types of contact: phone calls, postcards and a ‘who to contact in a crisis’ card. Previous studies have found that this system is effective at preventing suicide. Nevertheless, VigilanS was not effective in the same way for all the patients included. This observation raises the question of specific adaptation during follow-up for populations that were less receptive to the service. In consideration of this issue, we identified one study which found that incoming calls to the service were linked with a higher risk of suicide reattempts. However, this study did not document the profiles of the patients who made these calls. Better understanding of why this population is more at risk is important in terms of identifying factors that could be targeted to improve follow-up. This research therefore aims to bring together such data. Methods We performed a retrospective analysis of 579 patients referred to VigilanS by Toulouse University Hospital (France). We examined the sociodemographics, clinical characteristics, and follow-ups in place and compared the patients who made incoming calls to the service versus those who did not. Subsequently, we conducted a regression analysis using the significantly associated element of patients calling VigilanS. Then, in order to better understand this association, we analyzed the factors, including such calls, that were linked to the risk of suicide reattempts. Results We found that 22% of the patients in our sample called the VigilanS service. These individuals: were older, at 41.4 years versus 37.9 years for the non-callers; were more likely to have a borderline personality disorder (BPD) diagnosis (28.9% versus 19.3%); and had a history of suicide attempts (71.9% versus 54.6%). Our analysis confirmed that incoming calls to VigilanS (OR = 2.9) were associated with reattempted suicide, as were BPD (OR = 1.8) and a history of suicide attempts (OR = 1.7). Conclusion There was a high risk that the patients calling VigilanS would make another suicide attempt. However, this association was present regardless of the clinical profile. We postulate that this link between incoming calls and reattempted suicide may arise because this form of contact is, in fact, a way in which patients signal that a further attempt will be made
Peritraumatic Assessment of Autobiographical Memory After Exposure to a Traumatic Event
International audienceAbstract Posttraumatic stress disorder (PTSD) is commonly acknowledged to be associated with reduced specificity of autobiographical memory (AM). However, very few studies have assessed AM in the peritraumatic phase. The aim of the present study was to examine whether the AM impairment reported in PTSD is present a few days after a traumatic event. We assessed AM in 41 participants who had recently been exposed to trauma, and 34 controls who had never experienced a traumatic situation. The trauma‐exposed participants also completed the Impact of Event Scale‐R (IES‐R), the Inventory of Peritraumatic Distress, and the Peritraumatic Dissociative Experiences Questionnaire. Results showed that autobiographical memories cued by negative words were significantly less specific in the group of trauma‐exposed participants than in the control group ( p = .008; d = 0.40). Thus, mild AM impairment was already present three days after trauma exposure, long before acute PTSD set in.Resumen Spanish Abstracts by the Asociación Chilena de Estrés Traumático (ACET) Evaluación peritraumática de la memoria autobiográfica después de la exposición a un evento traumático MEMORIA AUTOBIOGRAFICA DESPUES DE LA EXPOSICION A TRAUMA El trastorno de estrés postraumático (TEPT) es comúnmente conocido por asociarse a una reducida especificidad de la memoria autobiográfica (MA). Sin embargo, muy pocos estudios han evaluado la MA en la fase peritraumática. El objetivo del presente estudio fue examinar si el deterioro de la MA reportado en el TEPT está presente unos pocos días después de un evento traumático. Evaluamos la MA en 41 participantes que habían estado recientemente expuestos a trauma, y 34 controles que nunca habían experimentado una situación traumática. Los participantes expuestos a trauma también completaron la Escala de Impacto del Evento Revisada (IES‐R), el Inventario de Sufrimiento Peritraumático (PDI) y el Cuestionario de Experiencias Disociativas Peritraumáticas (PDEQ). Los resultados mostraron que las memorias autobiográficas señaladas por palabras negativas fueron significativamente menos específicas en el grupo de participantes expuestos a trauma que en el grupo control ( d =0.40). Por lo tanto, un deterioro leve de la MA ya estaba presente tres días después de la exposición al trauma, mucho antes que se estableciera el TEPT agudo
Evaluation de la mémoire autobiographique chez le schizophrene
TOULOUSE3-BU Santé-Centrale (315552105) / SudocTOULOUSE3-BU Santé-Allées (315552109) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF