Potential efficacy of dopaminergic antidepressants in treatment resistant anergic-anhedonic depression results of the chronic anergic-anhedonic depression open trial – CADOT

IntroductionAmong treatment-resistant depression (TRD), we identified anergic-anhedonic clinical presentations (TRAD) as putatively responsive to pro-dopaminergic strategies. Based on the literature, non-selective monoamine oxidase inhibitors (MAOI) and dopamine D2 receptor agonists (D2RAG) were sequentially introduced, frequently under the coverage of a mood stabilizer. This two-step therapeutic strategy will be referred to as the Dopaminergic Antidepressant Therapy Algorithm (DATA). We describe the short and long-term outcomes of TRAD managed according to DATA guidelines.MethodOut of 52 outpatients with TRAD treated with DATA in a single expert center, 48 were included in the analysis [severity – QIDS (Quick Inventory of Depressive Symptomatology) = 16 ± 3; episode duration = 4.1 ± 2.7 years; Thase and Rush resistance stage = 2.9 ± 0.6; functioning – GAF (Global Assessment of Functioning) = 41 ± 8]. These were followed-up for a median (1st – 3rd quartile) of 4 (1–9) months before being prescribed the first dopaminergic treatment and remitters were followed up 21 (11–33) months after remission.ResultsAt the end of DATA step 1, 25 patients were in remission (QIDS <6; 52% [38–66%]). After DATA step 2, 37 patients were in remission (77% [65–89%]) to whom 5 patients with a QIDS score = 6 could be added (88% [78–97%]). Many of these patients felt subjectively remitted (GAF = 74 ± 10). There was a significant benefit to combining MAOI with D2RAG which was maintained for at least 18 months in 30 patients (79% [62–95%]).ConclusionThese results support TRAD sensitivity to pro-dopaminergic interventions. However, some clinical heterogeneities remain in our sample and suggest some improvement in the description of dopamine-sensitive form(s)

Conséquences neuropsychiatriques de traumatismes crâniens répétés dans le cadre de violences conjugales en population adulte et âgée:revue de la littérature et séries de cas:thèse présentée pour le diplôme d'Etat de docteur en médecine, diplôme d'État, me

Médecine (psychiatrie)Durant la crise du COVID-19 une augmentation de violences conjugales physiques a pu être observée. Ces violences présentent des séquelles psychiatriques, psychologiques et sociales bien connues. Les séquelles en lien avec des traumatismes crâniens répétés dans ces contextes n'ont été considérées comme des conséquences notables que depuis récemment. Les séquelles de traumatismes crâniens répétées sont bien détaillées dans les contextes militaires et sportifs. Les principales séquelles de traumatismes crâniens répétés sont reprises ici : psychiatriques (syndrome de stress post-traumatique, troubles anxieux et dépressifs entre autres), cognitives (trouble de l’attention, de la mémoire de travail, des cognitions sociales, troubles exécutifs) et neurologiques (maladies neurodégénératives, encéphalopathie traumatique chronique). A travers 5 cas cliniques, les liens entre les symptômes des patients et des potentielles séquelles de traumatismes crâniens répétés dans des contextes de violences conjugales sont évoqués. Ceci permet de mettre en avant les adaptations possibles dans les prises en charge de ces patients : recherche systematique d’antécédents de violences psychologiques et physiques, évaluation de leur gravité lorsqu’ils sont présents par des questionnaires adaptés, prises en charge médicamenteuse et en rééducation adaptées à ces antécédents.During the COVID-19 crisis, an increase in physical intimate partner violence was observed. The psychiatric, psychological and social consequences of this violence are well known. Sequelae related to repeated traumatic brain injury in these contexts have only recently been considered as significant consequences. The sequelae of repetitive traumatic brain injury are well detailed in military and sports settings. The main sequelae of repeated traumatic brain injury are reviewed here: psychiatric (post-traumatic stress disorder, anxiety and depressive disorders, among others), cognitive (attention deficit, working memory, social cognition, executive disorders) and neurological (neurodegenerative diseases, chronic traumatic encephalopathy). Through 5 clinical cases, the links between the patients' symptoms and potential sequelae of repeated traumatic brain injury in the context of intimate partner violence are discussed. This makes it possible to highlight the possible adaptations in the management of these patients: systematic search for a history of psychological and physical violence, evaluation of their severity when present by means of adapted questionnaires, drug and rehabilitation management adapted to this history.Thèses et écrits académique

From one to many: Hypertonia in schizophrenia spectrum psychosis an integrative review and adversarial collaboration report.

Different types of resistance to passive movement, i.e. hypertonia, were described in schizophrenia spectrum disorders (SSD) long before the introduction of antipsychotics. While these have been rediscovered in antipsychotic-naïve patients and their non-affected relatives, the existence of intrinsic hypertonia vs drug-induced parkinsonism (DIP) in treated SSD remains controversial. This integrative review seeks to develop a commonly accepted framework to specify the putative clinical phenomena, highlight conflicting issues and discuss ways to challenge each hypothesis and model through adversarial collaboration. The authors agreed on a common framework inspired from systems neuroscience. Specification of DIP, locomotor paratonia (LMP) and psychomotor paratonia (PMP) identified points of disagreement. Some viewed parkinsonian rigidity to be sufficient for diagnosing DIP, while others viewed DIP as a syndrome that should include bradykinesia. Sensitivity of DIP to anticholinergic drugs and the nature of LPM and PMP were the most debated issues. It was agreed that treated SSD should be investigated first. Clinical features of the phenomena at issue could be confirmed by torque, EMG and joint angle measures that could help in challenging the selectivity of DIP to anticholinergics. LMP was modeled as the release of the reticular formation from the control of the supplementary motor area (SMA), which could be challenged by the tonic vibration reflex or acoustic startle. PMP was modeled as the release of primary motor cortex from the control of the SMA and may be informed by subclinical echopraxia. If these challenges are not met, this would put new constraints on the models and have clinical and therapeutic implications

Data_Sheet_1_Potential efficacy of dopaminergic antidepressants in treatment resistant anergic-anhedonic depression results of the chronic anergic-anhedonic depression open trial – CADOT.PDF

IntroductionAmong treatment-resistant depression (TRD), we identified anergic-anhedonic clinical presentations (TRAD) as putatively responsive to pro-dopaminergic strategies. Based on the literature, non-selective monoamine oxidase inhibitors (MAOI) and dopamine D2 receptor agonists (D2RAG) were sequentially introduced, frequently under the coverage of a mood stabilizer. This two-step therapeutic strategy will be referred to as the Dopaminergic Antidepressant Therapy Algorithm (DATA). We describe the short and long-term outcomes of TRAD managed according to DATA guidelines.MethodOut of 52 outpatients with TRAD treated with DATA in a single expert center, 48 were included in the analysis [severity – QIDS (Quick Inventory of Depressive Symptomatology) = 16 ± 3; episode duration = 4.1 ± 2.7 years; Thase and Rush resistance stage = 2.9 ± 0.6; functioning – GAF (Global Assessment of Functioning) = 41 ± 8]. These were followed-up for a median (1st – 3rd quartile) of 4 (1–9) months before being prescribed the first dopaminergic treatment and remitters were followed up 21 (11–33) months after remission.ResultsAt the end of DATA step 1, 25 patients were in remission (QIDS ConclusionThese results support TRAD sensitivity to pro-dopaminergic interventions. However, some clinical heterogeneities remain in our sample and suggest some improvement in the description of dopamine-sensitive form(s).</p