Long-term Outcomes of Individuals With Metabolic Diseases Identified Through Newborn Screening

BACKGROUND

Although extended newborn screening (NBS) programs have been introduced more than 20 years ago, their impact on the long-term clinical outcome of individuals with inherited metabolic diseases (IMDs) is still rarely investigated.

METHODS

We studied the clinical outcomes of individuals with IMDs identified by NBS between 1999 and 2016 in a prospective multicenter observational study.

RESULTS

In total, 306 screened individuals with IMDs (115 with phenylketonuria and 191 with other IMDs with a lifelong risk for metabolic decompensation) were followed for a median time of 6.2 years. Although the risk for metabolic decompensation was disease-specific and NBS could not prevent decompensations in every individual at risk (n = 49), the majority did not develop permanent disease-specific signs (75.9%), showed normal development (95.6%) and normal cognitive outcome (87.7%; mean IQ: 100.4), and mostly attended regular kindergarten (95.2%) and primary school (95.2%). This demonstrates that not only individuals with phenylketonuria, serving as a benchmark, but also those with lifelong risk for metabolic decompensation had a favorable long-term outcome. High NBS process quality is the prerequisite of this favorable outcome. This is supported by 28 individuals presenting with first symptoms at a median age of 3.5 days before NBS results were available, by the absence of neonatal decompensations after the report of NBS results, and by the challenge of keeping relevant process parameters at a constantly high level.

CONCLUSIONS

NBS for IMDs, although not completely preventing clinical presentations in all individuals, can be considered a highly successful program of secondary prevention.

Impaired cognitive self-awareness mediates the association between alexithymia and excitation/inhibition balance in the pgACC

BACKGROUND

Previous research showed that automatic emotion regulation is associated with activation of subcortical areas and subsequent feedforward processes to cortical areas. In contrast, cognitive awareness of emotions is mediated by negative feedback from cortical to subcortical areas. Pregenual anterior cingulate cortex (pgACC) is essential in the modulation of both affect and alexithymia. We considered the interplay between these two mechanisms in the pgACC and their relationship with alexithymia.

METHOD

In 68 healthy participants (30 women, age = 26.15 ± 4.22) we tested associations of emotion processing and alexithymia with excitation/inhibition (E/I) balance represented as glutamate (Glu)/GABA in the pgACC measured via magnetic resonance spectroscopy in 7 T.

RESULTS

Alexithymia was positively correlated with the Glu/GABA ratio (N = 41, p = 0.0393). Further, cognitive self-awareness showed an association with Glu/GABA (N = 52, p = 0.003), which was driven by a correlation with GABA. In contrast, emotion regulation was only correlated with glutamate levels in the pgACC (N = 49, p = 0.008).

CONCLUSION

Our results corroborate the importance of the pgACC as a mediating region of alexithymia, reflected in an altered E/I balance. Furthermore, we could specify that this altered balance is linked to a GABA-related modulation of cognitive self-awareness of emotions.

Impact d’un programme d’activité physique sur la symptomatologie schizophrénique : résultats d’une expérience menée au CHRU de Brest

Contexte

La schizophrénie reste une pathologie invalidante malgré une prise en charge médicamenteuse efficace. Il importe de développer d’autres stratégies adjuvantes efficaces sur les symptômes de la maladie en limitant les effets secondaires des traitements pharmacologiques. L’efficacité des activités physiques dans le traitement de la schizophrénie n’est pas démontrée mais des travaux soulignent des bénéfices sur les symptômes négatifs et dépressifs [1,2].

Objectif

Nous souhaitons évaluer l’impact clinique d’un programme d’activité physique sur une population de sujets atteints de schizophrénie.

Méthode

Un programme d’activités physiques supervisé par deux moniteurs a été élaboré. Il comprend une heure de multi-activités, 2 fois par semaine, pendant 12 semaines. L’intensité minimale de chaque séance était fixée à 50 % de la fréquence cardiaque de réserve. Des mesures comprenant les échelles PANSS, SANS, SAPS, CDSS, S-QoL, un bilan anthropométrique et biologique ont été réalisés à S 0, S 6, S 12 et S 16.

Résultats

Deux groupes de 5 patients (n = 10) ont réalisé le programme. Une amélioration clinique est retrouvée sur l’ensemble des échelles utilisées entre S 0 et S 16. Les changements observés ne sont pas en faveur d’une amélioration du syndrome métabolique et nous notons une prise de poids des sujets sur la période de l’étude. Le traitement statistique des données présente des résultats non significatifs (p > 0,05).

Nouvelles approches psychothérapiques dans la prise en charge des conduites suicidaires

En France, en 2010, 5,5 % des 15–85 ans ont déclaré avoir tenté de se suicider au cours de leur vie . En outre 3,9 % des personnes interrogées ont déclaré avoir pensé au suicide au cours des 12 derniers mois. Pourtant les stratégies nationales de prévention mises en place dans plusieurs pays ont abouti à des résultats variables et rarement pérennes. Ceci souligne l’importance d’identifier des stratégies transnosographiques de prévention, tant pharmacothérapiques que psychothérapiques. À ce jour, seule la thérapie comportementale dialectique a démontré une efficacité dans la prise en charge du risque suicidaire chez les sujets souffrant de trouble de la personnalité borderline. Le développement des techniques psychothérapiques dans le champ de la suicidologie est donc nécessaire, puisqu’elles représentent un outil supplémentaire dans la prise en charge des patients à haut risque suicidaire. Dr Martin Desseilles synthétisera les principales données de la littérature afin de comprendre la place des interventions psychothérapiques dans la prévention du risque suicidaire. Ensuite, Dr Ducasse présentera plus spécifiquement la thérapie d’acceptation et d’engagement. Cette thérapie a en effet montré son efficacité dans la réduction des idées suicidaires et la modification de facteurs de vulnérabilité associés aux comportements suicidaires . Enfin, Dr Olié exposera les arguments en faveur de l’intérêt, dans la crise suicidaire, d’exercices basés sur la psychologie positive. Ces derniers visent à cultiver et amplifier les états émotionnels et cognitifs positifs, tels que développer l’optimisme, générer un sentiment de gratitude et rétablir un sens de vie .

An Exploratory Study on the Central Nervous Correlates of Sexual Excitation and Sexual Inhibition

The Sexual Inhibition/Sexual Excitation Scales (SIS/SES) measure sexual excitation and sexual inhibition proneness. We used SIS and SES scores of 62 heterosexual teleiophilic men (M_age 34.3, SD = 9.9) to predict brain activation levels during the presentation of male and female visual sexual stimuli in a magnetic resonance imaging (MRI) scanner. Statistical analyses revealed significant correlations. SES and SIS1 scores were positively associated with brain activation in various brain regions during the presentation of both male and female stimuli. SIS2 turned out to be a weaker predictor of brain activation, still revealing one significant correlation in the right lateral orbitofrontal cortex. Significant regions for SES and SIS1 were, among others, primary and supplementary motor areas, the caudate nucleus, the dorsal anterior cingulate cortex, anterior insula, and prefrontal areas. Our study can be seen as an exploratory investigation of SIS and SES with means of functional brain imaging. The results provide a promising contribution to the assertion of neurophysiological systems of sexual inhibition and excitation proneness.

Adherence to treatment guidelines in clinical practice for using electroconvulsive therapy in major depressive episode

BACKGROUND

ECT is the most effective treatment of major depressive episode (MDE) but remains a neglected treatment. The French Society for Biological Psychiatry and Neuropsychopharmacology aimed to determine whether prescribing practice of ECT followed guidelines recommendations.

METHODS

This multicenter, retrospective study included adult patients with major depressive disorder (MDD) or bipolar disorder (BD), who have been treated with ECT for MDE. Duration of MDE and number of lines of treatment received before ECT were collected. The reasons for using ECT, specifically first-line indications (suicidality, urgency, presence of catatonic and psychotic features, previous ECT response, patient preference) were recorded. Statistical comparisons between groups used standard statistical tests.

RESULTS

Seven hundred and forty-five individuals were included. The mean duration of MDE before ECT was 10.1 months and the mean number of lines of treatment before ECT was 3.4. It was significantly longer for MDD single episode than recurrent MDD and BD. The presence of first-line indications for using ECT was significantly associated to shorter duration of MDE (9.1 vs 13.1 months, p<0.001) and lower number of lines of treatment before ECT (3.3 vs 4.1, p<0.001).

LIMITATIONS

This is a retrospective study and not all facilities practicing ECT participated that could limit the extrapolation of the results.

CONCLUSION

Compared to guidelines, ECT was not used as first-line strategy in clinical practice. The presence of first-line indications seemed to reduce the delay before ECT initiation. The improvements of knowledge and access of ECT are needed to decrease the gap between guidelines and clinical practice.

Molecular and genomic characterization of a novel equine molluscum contagiosum-like virus

Cases of pox-like lesions in horses and donkeys have been associated with poxviruses belonging to different genera of the family Poxviridae. These include the orthopoxviruses vaccinia virus (VACV), horsepoxvirus (HPXV) and cowpoxvirus (CPXV), as well as a potentially novel parapoxvirus and molluscum contagiosum virus (MOCV). However, with the exception of VACV, HPXV and CPXV, the genomic characterization of the causative agents remains largely elusive with only single short genome fragments available. Here we present the first full-length genome sequence of an equine molluscum contagiosum-like virus (EMCLV) directly determined from skin biopsies of a horse with generalized papular dermatitis. Histopathological analysis of the lesions revealed severe epidermal hyperplasia with numerous eosinophilic inclusion bodies within keratinocytes. Virions were detected in the lesions in embedded tissue by transmission electron microscopy. The genome sequence determined by next- and third-generation sequencing comprises 166 843 nt with inverted terminal repeats (ITRs) of 3473 nt. Overall, 20 of the predicted 159 ORFs have no equivalents in other poxviruses. Intriguingly, two of these ORFs were identified to encode homologues of mammalian proteins involved in immune signalling pathways, namely secreted and transmembrane protein 1 (SECTM1) and insulin growth factor-like family receptor 1 (IGFLR1), that were not described in any virus family so far. Phylogenetic analysis with all relevant representatives of the Poxviridae suggests that EMCLV should be nominated as a new species within the genus Molluscipoxvirus.

Liquid and Dry Swabs for Culture- and PCR-Based Detection of Colonization with Methicillin-Resistant Staphylococcus aureus during Admission Screening

Rapid detection of methicillin-resistant Staphylococcus aureus (MRSA) colonization status facilitates isolation and decolonization and reduces MRSA infections. Liquid but not dry swabs allow fully automated detection methods. However, the accuracy of culture and polymerase chain reaction (PCR) using liquid and dry swabs has not been analyzed. We compared different swab collection systems for routine nasal–throat MRSA screening in patients admitted to a tertiary care trauma center in Germany. Over 3 consecutive months, dry swabs (month 1), ESwabs (month 2), or MSwabs (month 3) were processed using Cepheid GeneXpert, Roche cobas and BD-MAX™ MRSA tests compared to chromogenic culture. Among 1680 subjects, the MRSA detection rate using PCR methods did not differ significantly between dry swabs, ESwab, and MSwab (6.0%, 6.2%, and 5.3%, respectively). Detection rates using chromogenic culture were 2.9%, 3.9%, and 1.9%, using dry, ESwab, and MSwab, respectively. Using chromogenic culture as the “gold standard”, negative predictive values for the PCR tests ranged from 99.2–100%, and positive predictive values from 33.3–54.8%. Thus, efficient and accurate MRSA screening can be achieved using dry, as well as liquid E- or MSwab, collection systems. Specimen collection using ESwab or MSwab facilitates efficient processing for chromogenic culture in full laboratory automation while also allowing molecular testing in automated PCR systems.

Psychiatric and physical outcomes of long-term use of lithium in older adults with bipolar disorder and major depressive disorder: A cross-sectional multicenter study

OBJECTIVE

Although lithium is widely used in current practice to treat bipolar disorder (BD) and treatment-resistant major depressive disorder (MDD) among older adults, little is known about its efficacy and tolerability in this population, which is generally excluded from randomized clinical trials. The objective of this study was to evaluate the efficacy and tolerability of long-term use of lithium among older adults with BD and MDD.

METHOD

Data from the Cohort of individuals with Schizophrenia and mood disorders Aged 55 years or more (CSA) were used. Two groups of patients with BD and MDD were compared: those who were currently receiving lithium versus those who were not. The effects of lithium on psychiatric (i.e., depressive symptoms severity, perceived clinical severity, rates of psychiatric admissions in the past-year), geriatric (overall and cognitive functioning) and physical outcomes (i.e., rates of non-psychiatric medical comorbidities and general hospital admissions in the past-year) were evaluated. All analyses were adjusted for age, sex, duration of disorder, diagnosis, smoking status, alcohol use, and use of antipsychotics, antiepileptics or antidepressants.

RESULTS

Among the 281 older participants with BD or MDD, 15.7% were taking lithium for a mean duration of 12.5(SD = 11.6) years. Lithium use was associated with lower intensity of depressive symptoms, reduced perceived clinical global severity and lower benzodiazepine use (all p < 0.05), without being linked to greater rates of medical comorbidities, except for hypothyroidism.

LIMITATIONS

Data were cross-sectional and data on lifetime history of psychotropic medications was not assessed.

CONCLUSION

Our results suggest that long-term lithium use may be efficient and relatively well-tolerated in older adults with BD or treatment-resistant MDD.

Association between depression subtypes and response to repeated-dose intravenous ketamine

OBJECTIVE

About half or more of treatment-resistant depressed patients do not respond to ketamine, and few clinical predictors to gauge the most likely antidepressant response have been proposed. We explored whether depression subtypes are associated with response to ketamine.

METHOD

Ninety-seven participants with depression were administered six repeated-dose intravenous ketamine and assessed for depression (Montgomery-Åsberg Depression Rating Scale, MADRS), anxiety (Hamilton Anxiety Rating Scale, HAMA), and suicidal ideation (Beck Scale for Suicidal Ideation, SSI) at baseline, 24 h after each infusion, and 2 weeks after the whole treatment. Participants were classified by melancholic/anxious subtype. Individuals who met criteria for neither or both subtypes were classified separately, resulting in four mutually exclusive groups.

RESULTS

Patients with melancholic or melancholic-anxious features were less likely to respond (e.g., day 13, melancholic-anxious vs. anxious, OR 0.138, 95% CI 0.032-0.584, P = 0.007) or remit (e.g., day 26, melancholic vs. no subtype, OR 0.182, 95% CI 0.035-0.960, P = 0.045) and took longer to achieve response/remission than those with anxious or no subtype features. Faster HAMA score reductions were observed in patients with anxious or melancholic-anxious features, and faster SSI score reductions were observed among those with melancholic-anxious features.

CONCLUSION

Our study shows promising results for ketamine as a novel antidepressant preferentially for the treatment of non-melancholic or anxious depression.

Interaction of Sex and Age on the Dissociative Effects of Ketamine Action in Young Healthy Participants

Ketamine is a drug that reduces depressive and elicits schizophrenia-like symptoms in humans. However, it is largely unexplored whether women and men differ with respect to ketamine-action and whether age contributes to drug-effects. In this study we assessed dissociative symptoms via the Clinician Administered Dissociative States Scale (CADSS) in a total of 69 healthy subjects aged between 18 and 30 years (early adulthood) after ketamine or placebo infusion. Dissociative symptoms were generally increased only in the ketamine group post-infusion. Specifically, within the ketamine group, men reported significantly more depersonalization and amnestic symptoms than women. Furthermore, with rising age only men were less affected overall with respect to dissociative symptoms. This suggests a sex-specific protective effect of higher age which may be due to delayed brain maturation in men compared to women. We conclude that it is crucial to include sex and age in studies of drug effects in general and of ketamine-action in specific to tailor more efficient psychiatric treatments.

Clinical Trial Registration: EU Clinical Trials Register (EudraCT), trial number: 2010-023414-31.

Clinical guidelines for the management of depression with specific comorbid psychiatric conditions French recommendations from experts (the French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental)

BACKGROUND

Recommendations for pharmacological treatments of major depression with specific comorbid psychiatric conditions are lacking.

METHOD

The French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental developed expert consensus guidelines for the management of depression based on the RAND/UCLA Appropriatneness Method. Recommendations for lines of treatment are provided by the scientific committee after data analysis and interpretation of the results of a survey of 36 psychiatrist experts in the field of major depression and its treatments.

RESULTS

The expert guidelines combine scientific evidence and expert clinician's opinion to produce recommendations for major depression with comorbid anxiety disorders, personality disorders or substance use disorders and in geriatric depression.

CONCLUSION

These guidelines provide direction addressing common clinical dilemmas that arise in the pharmacologic treatment of major depression with comorbid psychiatric conditions.

[The philosophical roots of "connectedness": The care clinic]

If suicide remains "the only really serious philosophical problem" (A. Camus), historically a certain number of philosophers have legitimized it while others have condemned it. Among the philosophers who admitted that suicide could be a possibility, some showed understanding and others remained more modest. Kierkegaard's philosophical stance, demonstrating that one can never decide for the other where existential problems are concerned, opens a third way. Following him, Michel Cornu coined the expression "ethics of concern". That restlessness, etymologically, can be understood at the same time at the epistemological level (lack of a single constituted knowledge, hence the need to resort to a fully interdisciplinary approach of the "suicide" object), but as a relational attitude as well, namely a restlessness vis-à-vis the other, in other words concern for the other. This concept of concern does not exist in philosophical literature as such, but it has been addressed by philosophers. Therefore, it is essential to begin with a differential reflection on the notions of concern, care and solicitude. Then three "philosophies of solicitude" will be developed, those of Heidegger (concern in itself), Ricœur (concern as reciprocity) and Levinas (concern as responsibility). The monitoring devices, which will be widely discussed in other articles of this special issue, are based on philosophical notions borrowed from Heidegger (thoughtful solicitude), or Ricœur (solicitude) and Levinas (responsibility) or Cornu (ethics of concern). In addition, throughout our text we have mentioned a certain number of tensions inherent to these notions themselves, such as that intrinsic to the term solicitude (both care and concern), or peculiar to the authors' work (substitutive solicitude - thoughtful solicitude for Heidegger), or related to the debate of ideas (solicitude for Ricœur - responsibility for Levinas). Implementing these monitoring devices in clinical practice as well as in the territories will raise other problems, in particular, between benevolence and monitoring, but also between justice and equity, which will be our conclusion.