SY38-2IMPULSIVITY, MOTIVATIONS AND ADDICTION TO ONLINE GAMES

Introduction. Problematic engagement in online video gaming has been considered recently in the appendix of the DSM-5. Underpinning psychological factors are yet to be clarified, mostly in adult populations. We present data from two studies investigating links between motives to play and impulsivity in one hand and excessive gaming in another hand. Methods. Online studies have been conducted on adult gamers in France (n = 516) and Switzerland (n = 1057). Problematic engagement has been assessed in France by DSM-IV-TR adapted substance dependence criteria (DAS) and by IAT in Switzerland. Motivations have been investigated using Yee's model. Impulsivity has been evaluated using respectively BIS-10 and UPPS-P. The French sample has been compared to heroin users and to healthy controls regarding impulsivity. In the Swiss study, cluster analysis has been conducted to identify subgroups of players regarding their engagement in-game, their motivations to play and their impulsivity. Results. DAS has been found to be predicted by BIS high scores as well as by competition and advancement. Problematic gamers presented higher levels of impulsivity than controls but less than heroin dependents. Three of five clusters were identified to be problematic and linked to high levels of impulsivity, achievement and escapism. Conclusion. Achievement motives to play and high impulsivity have been linked to problematic engagement in online videogames in two different samples evaluated by two different methods. Addiction to online gaming showed a difference in impulsivity traits with substance dependence and healthy controls and subgroups of problem gamers has been characterized. These data could help to design tailored treatments for excessive online gamer

Efficacy and acceptability of transcranial direct current stimulation (tDCS) for major depressive disorder: An individual patient data meta-analysis

We evaluated the efficacy and acceptability of transcranial direct current stimulation (tDCS) for treating acute depressive episodes using individual patient data that provide more precise estimates than aggregate data meta-analysis. A systematic review of placebo-controlled trials on tDCS as only intervention was conducted until December-2018. Data from each study was collated to estimate odds ratio (OR) and number needed to treat (NNT) of response and remission, and depression improvement. Endpoints were pre-determined. Nine eligible studies (572 participants), presenting moderate/high certainty of evidence, were included. Active tDCS was significantly superior to sham for response (30.9% vs. 18.9% respectively; OR = 1.96, 95%CI [1.30–2.95], NNT = 9), remission (19.9% vs. 11.7%, OR = 1.94 [1.19–3.16], NNT = 13) and depression improvement (effect size of β = 0.31, [0.15–0.47]). Moreover, continuous clinical improvement was observed even after the end of acute tDCS treatment. There were no differences in all-cause discontinuation rates and no predictors of response were identified. To conclude, active tDCS was statistically superior to sham in all outcomes, although its clinical effects were moderate

Exploring venlafaxine pharmacokinetic variability with a phenotyping approach, a multicentric french-swiss study (MARVEL study).

It is well known that the standard doses of a given drug may not have equivalent effects in all patients. To date, the management of depression remains mainly empirical and often poorly evaluated. The development of a personalized medicine in psychiatry may reduce treatment failure, intolerance or resistance, and hence the burden and costs of mood depressive disorders. The Geneva Cocktail Phenotypic approach presents several advantages including the "in vivo" measure of different cytochromes and transporter P-gp activities, their simultaneous determination in a single test, avoiding the influence of variability over time on phenotyping results, the administration of low dose substrates, a limited sampling strategy with an analytical method developed on DBS analysis. The goal of this project is to explore the relationship between the activity of drug-metabolizing enzymes (DME), assessed by a phenotypic approach, and the concentrations of Venlafaxine (VLX) + O-demethyl-venlafaxine (ODV), the efficacy and tolerance of VLX. This study is a multicentre prospective non-randomized open trial. Eligible patients present a major depressive episode, MADRS over or equal to 20, treatment with VLX regardless of the dose during at least 4 weeks. The Phenotype Visit includes VLX and ODV concentration measurement. Following the oral absorption of low doses of omeprazole, midazolam, dextromethorphan, and fexofenadine, drug metabolizing enzymes activity is assessed by specific metabolite/probe concentration ratios from a sample taken 2 h after cocktail administration for CYP2C19, CYP3A4, CYP2D6; and by the determination of the limited area under the curve from the capillary blood samples taken 2-3 and 6 h after cocktail administration for CYP2C19 and P-gp. Two follow-up visits will take place between 25 and 40 days and 50-70 days after inclusion. They include assessment of efficacy, tolerance and observance. Eleven french centres are involved in recruitment, expected to be completed within approximately 2 years with 205 patients. Metabolic ratios are determined in Geneva, Switzerland. By showing an association between drug metabolism and VLX concentrations, efficacy and tolerance, there is a hope that testing drug metabolism pathways with a phenotypical approach would help physicians in selecting and dosing antidepressants. The MARVEL study will provide an important contribution to increasing the knowledge of VLX variability and in optimizing the use of methods of personalized therapy in psychiatric settings. ClinicalTrials.gov NCT02590185 (10/27/2015). This study is currently recruiting participants

Immuno-metabolic profile of patients with psychotic disorders and metabolic syndrome. Results from the FACE-SZ cohort

Background: Metabolic syndrome (MetS) is a highly prevalent and harmful medical disorder often comorbid with psychosis where it can contribute to cardiovascular complications. As immune dysfunction is a key shared component of both MetS and schizophrenia (SZ), this study investigated the relationship between immune alterations and MetS in patients with SZ, whilst controlling the impact of confounding clinical characteristics including psychiatric symptoms and comorbidities, history of childhood maltreatment and psychotropic treatments. Method: A total of 310 patients meeting DSM-IV criteria for SZ or schizoaffective disorders (SZA), with or without MetS, were systematically assessed and included in the FondaMental Advanced Centers of Expertise for Schizophrenia (FACE-SZ) cohort. Detailed clinical characteristics of patients, including psychotic symptomatology, psychiatric comorbidities and history of childhood maltreatment were recorded and the serum levels of 18 cytokines were measured. A penalized regression method was performed to analyze associations between inflammation and MetS, whilst controlling for confounding factors. Results: Of the total sample, 25% of patients had MetS. Eight cytokines were above the lower limit of detection (LLOD) in more than 90% of the samples and retained in downstream analysis. Using a conservative Variable Inclusion Probability (VIP) of 75%, we found that elevated levels of interleukin (IL)-6, IL-7, IL-12/23 p40 and IL-16 and lower levels of tumor necrosis factor (TNF)-α were associated with MetS. As for clinical variables, age, sex, body mass index (BMI), diagnosis of SZ (not SZA), age at the first episode of psychosis (FEP), alcohol abuse, current tobacco smoking, and treatment with antidepressants and anxiolytics were all associated with MetS. Conclusion: We have identified five cytokines associated with MetS in SZ suggesting that patients with psychotic disorders and MetS are characterized by a specific “immuno-metabolic” profile. This may help to design tailored treatments for this subgroup of patients with both psychotic disorders and MetS, taking one more step towards precision medicine in psychiatry. © 2022 The AuthorsImmuno-Génétique, Inflammation, retro-Virus, Environnement : de l'étiopathogénie des troubles psychotiques aux modèles animauxRéseau d'Innovation sur les Voies de Signalisation en Sciences de la Vi

Measuring circadian rhythm

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La réponse insuffisante : définition et implications

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[RTMS and depression: what is offered in the literature?]

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[RTMS and depression: what is offered in the literature?]

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[Diabetes and second-generation (atypical) antipsychotics]

International audienceSchizophrenia is a common psychiatric illness (1% of the general population), characterized by the association of positive and negative symptoms and cognitive disorders. Antipsychotics, typical or atypical, are known to induce in patients with schizophrenia weight gain and abnormalities in glucose and lipid metabolisms. These modifications, in addition to metabolic risk factors, intrinsic to the psychiatric illness (physical inactivity, smoking, diabetes), increase the risk of cardiovascular complications. Some antipsychotics are associated with a higher risk of metabolic disorders. Before starting such a medication, all risk factors must be taken into account. In case of even effectiveness, one should consider the risk of inducing metabolic disorders, as well as the intrinsic risk factors of the patient, in order to prescribe the medication associated with the lower metabolic risk. Regarding iatrogenic diabetes, the risk of occurrence seems different, depending on the molecules, being more marked for clozapine, olanzapine, risperidone, quietapine then amisulpride, aripiprazole and finally ziprasidone. The physiopathology seems to involve both an increase in insulin resistance and an alteration of insulin secretion. Nevertheless, the benefit/risk often remains largely in favour of treatment, the atypical antipsychotics are at least equally effective and better tolerated on the cognitive and neurological functions than conventional antipsychotics being. They have particularly far fewer extrapyramidal effects. The reversibility of pathologies induced by atypical antipsychotics led to the formulation of guidelines, leading to regular clinical and biological follow-up