Formes cliniques du trouble bipolaire en fonction du sexe

L'importante hétérogénéité du trouble bipolaire n'est que partiellement prise en compte par les classifications diagnostiques actuelles. Le démembrement clinique du trouble bipolaire n'en est qu'à son tout début. l'étude de l'hétérogénéité du trouble bipolaire en fonction du sexe a déjà fait l'objet de nombreux travaux dont certains résultats demeurent contradictoires, le plus souvent en rapport avec des problèmes méthodologiques. Nous avons réalisé une étude portant sur 515 patients bipolaires, et comparé les femmes et les hommes pour les caractéristiques suivantes : présentation clinique, comportements suicidaires, comorbidités somatique et psychiatrique, agrégation familiale de maladies psychiatriques et réponse aux traitements. Ces résultats pourraient être utilement complétés par la réalisation d'études prospectives, qui permettraient de contrôler les biais de remémoration, principales limites des études rétrospectives pour l'analyse des caractéristiques de la maladie sur la vie entièreBipolar affective disorder (BPAD) is an heeterogeneous disease. However, research aiming at disentangling BPAD is at it early stage. Gender heterogneity in BAD has already been the subject of many studies. However, results remain conflicting due to heterogeneity in sampling procedures, diagnostic criteria to define subgroups and study design (retrospective or prospective). We investigated a sample of 515 patients with BPAD and compared male and female patients for the following characteristics : clinical presentation of thymic episodes, cyclicity, suicidal behaviour, therapeutic response, comorbid conditions and familial aggregation of psychiatric illnesses. Our results would require to be completed by the realization of other studies using a prospective methodology, in order to restrict recall bias wich are the principal limit of prospective studies, and to analyze life-time characteristics of the diseasePARIS12-CRETEIL BU Médecine (940282101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

: Suicide in bipolar disorders

International audienceBellivier F, Yon L, Luquiens A, Azorin J-M, Bertsch J, Gerard S, Reed C, Lukasiewicz M. Suicidal attempts in bipolar disorder: results from an observational study (EMBLEM). Bipolar Disord 2011: 13: 377-386. © 2011 The Authors. Journal compilation © 2011 John Wiley & Sons A/S. Objectives:  To compare patients with and without a history of suicidal attempts in a large cohort of patients with bipolar disorder and to identify variables that are associated with suicidal behavior. Methods:  European Mania in Bipolar Longitudinal Evaluation of Medication (EMBLEM) is a two-year, prospective, observational study that enrolled 3,684 adult patients with bipolar disorder and initiated or changed oral treatment for an acute manic/mixed episode. Of those, 2,416 patients were eligible for the two-year follow-up. Only baseline characteristics were studied in the present study, included sociodemographic data, psychiatric history and comorbidities, history of suicide attempts, history of substance use problems, compliance with treatment, inpatient admissions, and functional status. Symptom severity was assessed using the Clinical Global Impression-Bipolar Disorder (CGI-BP) scale, the Young Mania Rating Scale (YMRS), and the 5-item Hamilton Depression Rating Scale (HAMD-5). A logistic regression model identified baseline variables independently associated with a history of suicidal behavior. Results:  Of the 2,219 patients who provided data on their lifetime history of suicide attempts, 663 (29.9%) had a history of suicidal behavior (at least one attempt). Baseline factors associated with a history of suicidal behavior included female gender, a history of alcohol abuse, a history of substance abuse, young age at first treatment for a mood episode, longer disease duration, greater depressive symptom severity (HAMD-5 total score), current benzodiazepine use, higher overall symptom severity (CGI-BP: mania and overall score), and poor compliance. Conclusions:  These factors may be considered as potential characteristics to identify subjects at risk for suicidal behavior throughout the course of bipolar disorder

Patients’ Perspectives on Residual Symptoms in Bipolar Disorder

International audienc

Residual symptoms and functional performance in a large sample of euthymic bipolar patients in France (the OPTHYMUM study)

International audienc

Dramatic reduction of psychiatric emergency consultations during lockdown linked to COVID ‐19 in Paris and suburbs

International audienc

Significant Need for a French Network of Expert Centers Enabling a Better Characterization and Management of Treatment-Resistant Depression (Fondation FondaMental)

BackgroundMajor depression is characterized by (i) a high lifetime prevalence of 16–17% in the general population; (ii) a high frequency of treatment resistance in around 20–30% of cases; (iii) a recurrent or chronic course; (iv) a negative impact on the general functioning and quality of life; and (v) a high level of comorbidity with various psychiatric and non-psychiatric disorders, high occurrence of completed suicide, significant burden along with the personal, societal, and economic costs. In this context, there is an important need for the development of a network of expert centers for treatment-resistant depression (TRD), as performed under the leadership of the Fondation FondaMental.MethodsThe principal mission of this national network is to establish a genuine prevention, screening, and diagnosis policy for TRD to offer a systematic, comprehensive, longitudinal, and multidimensional evaluation of cases. A shared electronic medical file is used referring to a common exhaustive and standardized set of assessment tools exploring psychiatric, non-psychiatric, metabolic, biological, and cognitive dimensions of TRD. This is paralleled by a medico-economic evaluation to examine the global economic burden of the disease and related health-care resource utilization. In addition, an integrated biobank has been built by the collection of serum and DNA samples for the measurement of several biomarkers that could further be associated with the treatment resistance in the recruited depressed patients. A French observational long-term follow-up cohort study is currently in progress enabling the extensive assessment of resistant depressed patients. In those unresponsive cases, each expert center proposes relevant therapeutic options that are classically aligned to the international guidelines referring to recognized scientific societies.DiscussionThis approach is expected to improve the overall clinical assessments and to provide evidence-based information to those clinicians most closely involved in the management of TRD thereby facilitating treatment decisions and choice in everyday clinical practice. This could contribute to significantly improve the poor prognosis, the relapsing course, daily functioning and heavy burden of TRD. Moreover, the newly created French network of expert centers for TRD will be particularly helpful for a better characterization of sociodemographic, clinical, neuropsychological, and biological markers of treatment resistance required for the further development of personalized therapeutic strategies in TRD