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Leurent M, Ducasse D, Courtet P, Olié E. Efficacy of 12-step mutual-help groups other than Alcoholics Anonymous: a systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci 2024; 274:375-422. [PMID: 37755487 DOI: 10.1007/s00406-023-01667-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 07/31/2023] [Indexed: 09/28/2023]
Abstract
This paper offers a systematic review of quantitative and qualitative studies on the main twelve-step mutual-help (TSMH) groups (excluding Alcoholics Anonymous) and four meta-analyses exploring the correlation between (i) duration or involvement in TSMH groups and; (ii) severity of symptoms or quality of life. Systematic review was conducted following PRISMA guidelines. Searches of databases (MEDLINE, PsychInfo), a register (ClinicalTrials) and citations were conducted, from inception through November 01 2022. Fifty five articles were included (24 quantitative, 27 qualitative, 4 mixed-methods), corresponding to 47 distinctive studies. 68% of these studies were conducted in North America, 17% in Middle East, 11% in the European Union and 4% in Australia. The most studied TSMH group were Gamblers Anonymous (28% of the 47 studies), Narcotics Anonymous (26%), Double Trouble in Recovery (15%), Overeaters Anonymous (19%) and TSMH groups for compulsive sexual behaviors (11%). The four meta-analyses pooled data from 9 studies. Pooled mean age ranged from 36.5 to 40.5. 80-81% of participants were male. TSMH attendance and involvement were negatively correlated with severity of symptoms (high and medium levels of evidence) and positively correlated with quality of life (low levels of evidence). Twenty-one qualitative papers reported factors influencing recovery: Social (n = 15), emotional (n = 9), spiritual (n = 8), self-identification or psychological (n = 6) factors. Review provides characteristics of TSMH groups others than Alcoholics Anonymous, with implications for both research and healthcare practice. The perspective to implement TSMH groups targeting ontological addiction, at the root of all addiction, is discussed.Protocol registration: Prospero registration number: CRD42022342605.
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2
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Leurent M, Ducasse D. [Discrimination, stigma and identity: A literature review]. Encephale 2023; 49:632-639. [PMID: 37357050 DOI: 10.1016/j.encep.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/13/2023] [Accepted: 04/20/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE This study aimed to update the scientific knowledge concerning the relationship between discrimination, stigma and self-concept. METHODS A review was conducted and allowed to include 15 peer-reviewed articles for qualitative analysis, consisting of 13 unique samples (n=2830; Mage=37.6). The search was conducted on Pubmed and PsychInfo following this research protocol: "de stigmatization" ([Title/Abstract] or "destigmatization" [Title/Abstract] or "self-stigma" [Title/Abstract] or "Perceived stigma" [Title/Abstract] or "anticipated discrimination" [Title/Abstract] or "experienced discrimination" [Title/Abstract]) and (identi*[Title] or "self-concept" [Title]). The search resulted in 43 articles, plus three articles identified from other sources. Thirty-one articles were excluded because they did not align with the aim of the review. RESULTS Among the 15 articles included, there were 11 quantitative studies, two qualitative studies, one literature review and one theoretical article. The stigma was related to a mental disorder (n=8), a physiological or ethnic difference (n=5) or sexual orientation and gender identity (n=2). Among the 11 quantitative studies based on unique samples, all included both males and females (n=2616; Mage=36.7; 61.1% of women). Four studies established a significant impact of perceived stigma on social identity. This impact was negative when there was at least one other parallel social identity perceived favorably by the individual, and positive otherwise. In two studies, this impact was moderated by the importance of the stigmatized social identity in the self-concept. In one study, social identity was correlated to psychological distress. The sign, positive or negative, of this correlation depended on self-stigma. When self-stigma was high (i.e., self-concept is strongly perceived through the prism of negative stereotypes associated with the social identity), then social identity was positively associated with psychological distress. Otherwise, the sign of this association was negative. In one study, four distinct variables were predictors of suicidal ideation: experienced discrimination, perceived stigma, anticipated discrimination and self-stigma. Experienced discrimination predicted suicidal ideation through anticipatory discrimination and self-stigma; and perceived stigma predicted suicidal ideation through anticipated discrimination. Self-stigma and anticipatory discrimination predicted suicidal ideation at the same level. CONCLUSIONS The results suggest that a key variable to address in order to reduce the negative consequences of discrimination and stigmatization is self-stigma, i.e., the fact of conceiving the self-concept through the filter of the negative stereotypes associated with the characteristic perceived as discriminated. The altered self-concept should therefore be a main transnosographic diagnostic and therapeutic target. An easy-to-use proxy to detect the altered self-concept is the propensity to feel the emotion of shame, which is correlated to self-stigma.
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Affiliation(s)
- Martin Leurent
- Service de psychiatrie adulte, centre de thérapies des troubles de l'humeur et émotionnels/Borderline, La Colombière, CHU de Montpellier, 34000 Montpellier, France
| | - Déborah Ducasse
- Service de psychiatrie adulte, centre de thérapies des troubles de l'humeur et émotionnels/Borderline, La Colombière, CHU de Montpellier, 34000 Montpellier, France; Département d'urgences et post-urgences psychiatriques, CHRU de Montpellier, Montpellier, France; IGF, université de Montpellier, CNRS-Inserm, 34000, Montpellier, France.
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Ducasse D, Brand-Arpon V, Tralbaut F, Ollivier V, Courtet P, Olié E, Jørgensen CR. How to target disturbed identity in borderline patients? Self-identification program: A case study. Encephale 2023; 49:596-605. [PMID: 36253170 DOI: 10.1016/j.encep.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/22/2022] [Accepted: 08/25/2022] [Indexed: 11/05/2022]
Abstract
Borderline personality disorder (BPD) is a severe and relatively prevalent psychiatric disorder, responsible for high rates of suicidal behaviors. Disturbed identity appears as at the very core of this disorder, being inter-related with all other BPD features. Notably, from a dimensional perspective on mental disorders, one should realize that it is from our usual self-representation that we live all our daily experiences. Then, if the understanding of self-concept (or identity) is impaired, all the interventions implemented to decrease the self's suffering will subsequently be impaired. The purpose of the present case study was to illustrate the nine identity diffusion categories described by Jørgensen & Bøye (2022) and how the level of identity function can be improved in a third-wave cognitive and behavioral therapy targeting progressive correct self-identification.
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Affiliation(s)
- D Ducasse
- Department of Emergency Psychiatry and Post Acute Care, CHRU de Montpellier, Montpellier, France; IGF, Université Montpellier, CNRS-Inserm, Montpellier, France; Therapy Center for Mood and Emotional Disorders, Department of adult psychiatry, La Colombière, CHU de Montpellier, Montpellier, France.
| | - V Brand-Arpon
- Therapy Center for Mood and Emotional Disorders, Department of adult psychiatry, La Colombière, CHU de Montpellier, Montpellier, France
| | - F Tralbaut
- Therapy Center for Mood and Emotional Disorders, Department of adult psychiatry, La Colombière, CHU de Montpellier, Montpellier, France
| | - V Ollivier
- Centre médico-psychologique, Carcassonne, USSAP Aude, France
| | - P Courtet
- Department of Emergency Psychiatry and Post Acute Care, CHRU de Montpellier, Montpellier, France; IGF, Université Montpellier, CNRS-Inserm, Montpellier, France
| | - E Olié
- Department of Emergency Psychiatry and Post Acute Care, CHRU de Montpellier, Montpellier, France; IGF, Université Montpellier, CNRS-Inserm, Montpellier, France
| | - C R Jørgensen
- Department of Psychology, Aarhus University, Aarhus, Denmark
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Ducasse D, Alacreu-Crespo A, Lacourt L, Jung C, Hidalgo M, Brand-Arpon V, Courtet P, Olié E. Sexual orientation, gender: Where is the problem? Nowhere! Correct self-identification and minority stigma. Encephale 2022; 48:714-718. [DOI: 10.1016/j.encep.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/13/2022] [Accepted: 03/15/2022] [Indexed: 10/15/2022]
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Barrows P, Shonin E, Sapthiang S, Griffiths MD, Ducasse D, Van Gordon W. The Development and Validation of the Ontological Addiction Scale. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00840-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Abstract
Ontological Addiction Theory is a metaphysical theory of mental illness which conceptualises psychological suffering in terms of excessive ego-centeredness. This study aimed to develop and validate the Ontological Addiction Scale (OAS) and compare OAS scores with mental health measures. A 31-item prototype scale was developed based on traditional Buddhist theory and contemporary models of addiction. An ego-centeredness form of the Five-Factor Narcissism Inventory (FFNI) was the main criterion measure. For mental health measures, the Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder Scale (GAD-7) and Rosenberg Self-Esteem Scale (RSES) were used. The prototype OAS and two shorter versions showed excellent internal consistency and test–retest reliability. Construct validity was evidenced by medium to large correlations with criterion measures. OAS scores showed strong correlations with PHQ-9, GAD-7 and RSES, suggesting a clear relationship between OAS and mental health. The OAS appears to be a valid and reliable instrument suitable for assessing OA.
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St-Amour S, Cailhol L, Kingsbury C, Ducasse D, Landry G, Bernard P. [Physical activity, sleep, and substance use in adults reporting a borderline personality disorder in France and Canada: An online study]. Sante Ment Que 2022; 47:41-67. [PMID: 37279315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Introduction Borderline personality disorder (BPD) is associated with many unhealthy behaviors. Psychoactive substance (alcohol and drugs) use is present in 78% of adults with BPD. Moreover, a poor sleep seems linked to the clinical profile of adults with BPD. Finally, some physical comorbid disorders like obesity, cardiovascular diseases, and diabetes are linked to physical inactivity and sedentary behaviors. However, to this day no study analyzed these behaviors in French-speaking individuals with BPD. Objectives This study's goal is to document health behaviors in adults with BPD in Canada and in France. Method This cross-sectional study consists of an online survey on the LimeSurvey platform including validated questionnaires distributed in France and Canada. To measure physical activity, we used the "Global Physical Activity Questionnaire." Insomnia was measured with the "Insomnia Severity Index." Substance use was measured with the "Alcohol, Smoking and Substance Involvement Test." Descriptive statistics (N,% and mean) are used to describe previously mentioned health behaviors. Five regression models have been realized to find the main associated variables (age, perceived social status, education level, household income, body mass index, emotional regulation difficulties, BPD symptoms, depression level, previous suicide attempts and psychotropic medication use) to health behaviors. Results A total of 167 participants (92 Canadians, 75 French; 146 women, 21 men) filled out the online survey. In this sample, 38% of Canadians and 28% of French reported doing less than 150 minutes of physical activity weekly. Insomnia affected 42% of Canadians and 49% of French. Tobacco use disorder affected 50% of Canadians and 60% of French. Alcohol use disorder affected 36% of Canadians and 53% of French. Cannabis use disorder affected 36% of Canadians and 38% of French. All tested variables were linked to physical activity (R² = 0.09). Insomnia was only linked with BPD symptoms (R² = 0.24). Tobacco use disorder was linked to social status and alcohol use disorder (R² = 0.13). Alcohol use disorder was linked to social status, body mass index, tobacco use disorder, and depression (R² = 0.16). Finally, cannabis use disorder was linked to age, body mass index, tobacco use disorder, depression, and past suicide attempts (R² = 0.26). Conclusion These results are essential to design health prevention interventions in French-speaking adults with BPD in Canada and in France. They help identify the main factors associated with these health behaviors.
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Affiliation(s)
- Samuel St-Amour
- Département des sciences de l'activité physique, Université du Québec à Montréal, Canada; Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Québec, Canada
| | - Lionel Cailhol
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Québec, Canada; Faculté de médecine, Département de psychiatrie et d'addictologie, Université de Montréal, Québec, Canada
| | - Célia Kingsbury
- Département des sciences de l'activité physique, Université du Québec à Montréal, Canada; Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Québec, Canada; École de santé publique, Université de Montréal, Québec, Canada
| | - Déborah Ducasse
- Département d'Urgences et Post-Urgences Psychiatriques, CHU Montpellier, France; IGF, Université de Montpellier, CNRS-INSERM, France; Centre de Thérapies Troubles de l'Humeur et Émotionnels/Borderline, Département de Psychiatrie Adulte, La Colombière, CHU Montpellier, France
| | - Gabrielle Landry
- Faculté de médecine, Département de psychiatrie et d'addictologie, Université de Montréal, Québec, Canada
| | - Paquito Bernard
- Département des sciences de l'activité physique, Université du Québec à Montréal, Canada; Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Québec, Canada
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Richard-Devantoy S, Bertrand JA, Béziat S, Jaussent I, Cazals A, Ducasse D, Greenway KT, Guillaume S, Courtet P, Olié E. Psychological pain and depression: it's hard to speak when it hurts. Int J Psychiatry Clin Pract 2021; 25:180-186. [PMID: 33275047 DOI: 10.1080/13651501.2020.1836225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate the neuropsychological features of depressed patients reporting high level of psychological pain. METHODS Sixty-two inpatients were included and divided into two groups according to the level of psychological pain assessed by a Likert scale. Cognitive abilities were assessed using the Trail Making Test, the Stroop test, and Verbal Fluency Test (semantic and phonemic verbal fluency). Univariate and multivariate analyses were performed to determine neuropsychological factors associated with a high level of psychological pain. RESULTS The median level of psychological pain was 8/10. High level of psychological pain was associated with poor phonemic verbal fluency performance in men (p = 0.009), but not in women, even after controlling for confounding factors (age, level of depression, anxiety). Groups did not differ on the Trail Making Test, the Stroop test, or the semantic verbal fluency measure. CONCLUSION Psychological pain is a specific clinical entity that should be considered to be more significant than just a symptom of depression. High level of psychological pain appears to be associated with a deficit of phonemic verbal fluency in depressed men. This finding could help to target psychotherapeutic treatments and improve screening.Key pointsPatients with high psychological pain do not differ on the Trail Making Test, the Stroop Test or the Sematic Verbal Fluency Measure to patients with low psychological painHigh psychological pain is associated with a deficit in phonemic verbal fluency in depressed menFuture research should aim to clarify gender differences in psychological pain in participants with and without major depressive disorder, as well as explore the complex relationship between cognition and the different forms of pain (psychological, physical and psychosomatic).
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Affiliation(s)
- Stéphane Richard-Devantoy
- McGill Group for Suicide Studies, McGill University & Douglas Mental Health University Institute, Montréal, Canada.,CISSS des Laurentides, Saint-Jérôme, Canada
| | - Josie-Anne Bertrand
- CISSS des Laurentides, Saint-Jérôme, Canada.,Douglas Mental Health University Institute, Montréal, Canada
| | - Séverine Béziat
- Psychiatric Emergency and Post Emergency Department, Hospital Lapeyronie, CHU Montpellier, Montpellier, France
| | - Isabelle Jaussent
- Université Montpellier, Montpellier, France.,Inserm U1061, Montpellier, France
| | - Aurélie Cazals
- Psychiatric Emergency and Post Emergency Department, Hospital Lapeyronie, CHU Montpellier, Montpellier, France.,Université Montpellier, Montpellier, France
| | - Déborah Ducasse
- Psychiatric Emergency and Post Emergency Department, Hospital Lapeyronie, CHU Montpellier, Montpellier, France.,Université Montpellier, Montpellier, France
| | - Kyle T Greenway
- McGill Group for Suicide Studies, McGill University & Douglas Mental Health University Institute, Montréal, Canada
| | - Sébastien Guillaume
- Psychiatric Emergency and Post Emergency Department, Hospital Lapeyronie, CHU Montpellier, Montpellier, France.,Université Montpellier, Montpellier, France.,Inserm U1061, Montpellier, France
| | - Philippe Courtet
- Psychiatric Emergency and Post Emergency Department, Hospital Lapeyronie, CHU Montpellier, Montpellier, France.,Université Montpellier, Montpellier, France.,Inserm U1061, Montpellier, France
| | - Emilie Olié
- Psychiatric Emergency and Post Emergency Department, Hospital Lapeyronie, CHU Montpellier, Montpellier, France.,Université Montpellier, Montpellier, France.,Inserm U1061, Montpellier, France
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8
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Ducasse D, Dubois J, Jaussent I, Azorin JM, Etain B, Gard S, Henry C, Bougerol T, Kahn JP, Aubin V, Bellivier F, Belzeaux R, Dubertret C, Dubreucq J, Llorca PM, Loftus J, Passerieux C, Polosan M, Samalin L, Leboyer M, Yrondi A, Bennabi D, Haffen E, Maruani J, Allauze E, Camus V, D'Amato T, Doumy O, Holtzmann J, Lançon C, Moliere F, Moirand R, Richieri RM, Horn M, Schmitt L, Stephan F, Genty JB, Vaiva G, Walter M, El-Hage W, Aouizerate B, Olié E, Courtet P. Association between anhedonia and suicidal events in patients with mood disorders: A 3-year prospective study. Depress Anxiety 2021; 38:17-27. [PMID: 32652874 DOI: 10.1002/da.23072] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/30/2020] [Accepted: 06/13/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND As almost all mental disorders are associated with increased suicidal-related behavior, anhedonia might be a trans-diagnostic dimension to target for suicide prevention. METHODS For this 3-year-long prospective study, 2,839 outpatients with mood disorders were recruited. They were divided in: (a) two groups according to the occurrence or not of suicidal ideation during the follow-up, and (b) two groups according to the occurrence or not of suicide attempts during the follow-up. Anhedonia was assessed using a composite score (the French version of the 14-item Snaith-Hamilton Pleasure Scale and item 13 of the Quick Inventory of Depressive Symptomatology scale) at inclusion and at 6, 12, 24, and 36 months after inclusion. RESULTS Patients with mood disorders and anhedonia at least at one follow-up visit had a 1.4-fold higher risk of suicidal ideation (adjusted odds ratio = 1.35; 95% confidence interval [1.07, 1.70]), even after adjustment for confounding factors of suicide risk (i.e., bipolar or unipolar disorder, sex, age, marital status, education level, antidepressant intake, personal history of suicide attempt, at least one childhood trauma, and mean of the maximum depression score during the follow-up). Conversely, association between anhedonia and suicide attempt did not remain significant after adjustment. CONCLUSIONS The significant association between anhedonia and suicide ideation in patients with mood disorders stresses the need of targeting hedonia in mood disorders, and of research focusing on the position to pleasure in life through eudaimonia.
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Affiliation(s)
- Déborah Ducasse
- CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU, Montpellier, France.,Inserm, U1061 Montpellier, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France.,Fondation FondaMental, Créteil, France
| | - Jonathan Dubois
- Inserm, U1061 Montpellier, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Isabelle Jaussent
- Inserm, U1061 Montpellier, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Jean-Michel Azorin
- Fondation FondaMental, Créteil, France.,AP HM, Psychiatric Pole, Marseille, France
| | - Bruno Etain
- Fondation FondaMental, Créteil, France.,Université Paris-Est, Hopital Henri Mondor, DHU PePSY and AP-HP, Créteil, France
| | - Sébastien Gard
- Fondation FondaMental, Créteil, France.,Charles Perrens Hospital, Bordeaux, France
| | - Chantal Henry
- Fondation FondaMental, Créteil, France.,Université Paris-Est, Hopital Henri Mondor, DHU PePSY and AP-HP, Créteil, France
| | - Thierry Bougerol
- Fondation FondaMental, Créteil, France.,Service de Psychiatrie de l'adulte, CS 10217, Centre Expert Dépression Résistante FondaMental, CHU de Grenoble, Hôpital Nord, Grenoble, France
| | - Jean-Pierre Kahn
- Fondation FondaMental, Créteil, France.,Brabois Hospital, Academic Hospital of Nancy, Vandoeuvre Les Nancy, France
| | - Valérie Aubin
- Fondation FondaMental, Créteil, France.,Department of Psychiatry, Princesse-Grace Hospital, La Colle, Monaco
| | - Frank Bellivier
- Fondation FondaMental, Créteil, France.,Hospital Saint-Louis-Lariboisière-Fernand Widal, AP-HP, Paris, France
| | - Raoul Belzeaux
- Fondation FondaMental, Créteil, France.,AP HM, Psychiatric Pole, Marseille, France
| | - Caroline Dubertret
- Fondation FondaMental, Créteil, France.,Department of Psychiatry, Louis Mourier Hospital, AP-HP, INSERM U894, School of Medicine, Paris Diderot University, Sorbonne Paris Cité, France.,Department of Psychiatry and Clinical Psychology, Psychotherapy Center of Nancy and School of Medicine, Lorraine University, Lorraine, France
| | - Julien Dubreucq
- Fondation FondaMental, Créteil, France.,Service de Psychiatrie de l'adulte, CS 10217, Centre Expert Dépression Résistante FondaMental, CHU de Grenoble, Hôpital Nord, Grenoble, France
| | - Pierre-Michel Llorca
- Service de Psychiatrie de l'adulte B, Centre Expert Dépression Résistante FondaMental, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Josephine Loftus
- Fondation FondaMental, Créteil, France.,Department of Psychiatry, Princesse-Grace Hospital, La Colle, Monaco
| | - Christine Passerieux
- Fondation FondaMental, Créteil, France.,Academic Hospital of Versailles, Le Chesnay, France
| | - Mircea Polosan
- Fondation FondaMental, Créteil, France.,Service de Psychiatrie de l'adulte, CS 10217, Centre Expert Dépression Résistante FondaMental, CHU de Grenoble, Hôpital Nord, Grenoble, France
| | - Ludovic Samalin
- Service de Psychiatrie de l'adulte B, Centre Expert Dépression Résistante FondaMental, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Marion Leboyer
- Fondation FondaMental, Créteil, France.,Université Paris-Est, Hopital Henri Mondor, DHU PePSY and AP-HP, Créteil, France
| | - Antoine Yrondi
- Fondation FondaMental, Créteil, France.,Service de Psychiatrie et de Psychologie Médicale de l'adulte, Centre Expert Dépression Résistante FondaMental, CHRU de Toulouse, Hôpital Purpan, Toulouse, France
| | - Djamila Bennabi
- Fondation FondaMental, Créteil, France.,Service de Psychiatrie clinique, Centre Expert Dépression Résistante FondaMental, EA 481 Neurosciences, Université de Bourgogne Franche Comté, Besançon, France
| | - Emmanuel Haffen
- Fondation FondaMental, Créteil, France.,Service de Psychiatrie clinique, Centre Expert Dépression Résistante FondaMental, Centre Investigation Clinique 1431-INSERM, EA 481 Neurosciences, Université de Bourgogne Franche Comté, Besançon, France
| | - Julia Maruani
- Fondation FondaMental, Créteil, France.,Service de Psychiatrie adulte, Centre Expert Dépression Résistante FondaMental, Hôpital Fernand-Widal, Paris, France
| | - Etienne Allauze
- Fondation FondaMental, Créteil, France.,Service de Psychiatrie de l'adulte B, Centre Expert Dépression Résistante FondaMental, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Vincent Camus
- Clinique Psychiatrique Universitaire, Centre Expert Dépression Résistante FondaMental, Inserm U1253 Imaging and Brain, CHRU de Tours, Tours, France
| | - Thierry D'Amato
- Service Universitaire de Psychiatrie adulte, Centre Expert Dépression Résistante FondaMental, Centre Hospitalier Le Vinatier, Bron cedex, France
| | | | - Jérôme Holtzmann
- Service de Psychiatrie de l'adulte, CS 10217, Centre Expert Dépression Résistante FondaMental, CHU de Grenoble, Hôpital Nord, Grenoble, France
| | - Christophe Lançon
- Pôle Psychiatrie, Centre Expert Dépression Résistante FondaMental, CHU La Conception, Marseille, France
| | - Fanny Moliere
- CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU, Montpellier, France
| | - Rémi Moirand
- Service Universitaire de Psychiatrie adulte, Centre Expert Dépression Résistante FondaMental, Centre Hospitalier Le Vinatier, Bron cedex, France
| | - Raphaëlle Marie Richieri
- Pôle Psychiatrie, Centre Expert Dépression Résistante FondaMental, CHU La Conception, Marseille, France
| | - Mathilde Horn
- Service de Psychiatrie adulte, Centre Expert Dépression Résistante FondaMental, CHRU de Lille, Hôpital Fontan 1, Lille, France
| | - Laurent Schmitt
- Service de Psychiatrie et de Psychologie Médicale de l'adulte, Centre Expert Dépression Résistante FondaMental, CHRU de Toulouse, Hôpital Purpan, Toulouse, France
| | - Florian Stephan
- Service de Psychiatrie de l'adulte, Centre Expert Dépression Résistante FondaMental, CHU de Brest, Hôpital de Bohars, Bohars, France
| | - Jean-Baptiste Genty
- Service de Psychiatrie de l'adulte B, Centre Expert Dépression Résistante FondaMental, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Guillaume Vaiva
- Service de Psychiatrie adulte, Centre Expert Dépression Résistante FondaMental, CHRU de Lille, Hôpital Fontan 1, Lille, France
| | - Michel Walter
- Service de Psychiatrie de l'adulte, Centre Expert Dépression Résistante FondaMental, CHU de Brest, Hôpital de Bohars, Bohars, France
| | - Wissam El-Hage
- Clinique Psychiatrique Universitaire, Centre Expert Dépression Résistante FondaMental, Inserm U1253 Imaging and Brain, CHRU de Tours, Tours, France
| | | | - Emilie Olié
- CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU, Montpellier, France.,Inserm, U1061 Montpellier, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France.,Fondation FondaMental, Créteil, France
| | - Philippe Courtet
- CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU, Montpellier, France.,Inserm, U1061 Montpellier, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France.,Fondation FondaMental, Créteil, France
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9
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Godin O, Leboyer M, Belzeaux R, Bellivier F, Loftus J, Courtet P, Dubertret C, Gard S, Henry C, Llorca PM, Schwan R, Passerieux C, Polosan M, Samalin L, Olié E, Etain B, Henry C, Olié E, Leboyer M, Haffen E, Llorca PM, Barteau V, Bensalem S, Godin O, Laouamri H, Souryis K, Hotier S, Pelletier A, Drancourt N, Sanchez JP, Saliou E, Hebbache C, Petrucci J, Willaume L, Bourdin E, Bellivier F, Carminati M, Etain B, Maruani J, Marlinge E, Meyrel M, Antoniol B, Desage A, Gard S, Jutant A, Mbailara K, Minois I, Zanouy L, Bardin L, Cazals A, Courtet P, Deffinis B, Ducasse D, Gachet M, Henrion A, Molière F, Noisette B, Olié E, Tarquini G, Belzeaux R, Correard N, Groppi F, Lefrere A, Lescalier L, Moreau E, Pastol J, Rebattu M, Roux B, Viglianese N, Cohen R, Schwan R, Kahn J, Milazzo M, Wajsbrot‐Elgrabli O, Bougerol T, Fredembach B, Suisse A, Halili B, Pouchon A, Polosan M, Galliot A, Grévin I, Cannavo A, Kayser N, Passerieux C, Roux P, Aubin V, Cussac I, Dupont M, Loftus J, Medecin I, Dubertret C, Mazer N, Portalier C, Scognamiglio C, Bing A. Non-alcoholic fatty liver disease in a sample of individuals with bipolar disorders: results from the FACE-BD cohort. Acta Psychiatr Scand 2021; 143:82-91. [PMID: 33011976 DOI: 10.1111/acps.13239] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 09/02/2020] [Accepted: 09/21/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Non-Alcoholic fatty liver disease (NAFLD) is becoming the most common liver disease in Western populations. While obesity and metabolic abnormalities are highly frequent in bipolar disorders (BD), no studies have been performed to estimate the prevalence of NALFD in individuals with BD. The aim of our study is to estimate the prevalence of NAFLD and to identify the potential associated risk factors in a large sample of BD individuals. METHODS Between 2009 and 2019, 1969 BD individuals from the FACE-BD cohort were included. Individuals with liver diseases, Hepatitis B or C, and current alcohol use disorders were excluded from the analyses. A blood sample was drawn from participants. Screening of NAFLD was determined using fatty liver index (FLI). Individuals with FLI> 60 were considered as having NAFLD. RESULTS The prevalence of NAFDL in this sample was estimated at 28.4%. NAFLD was observed in 40% of men and 21% of women. NAFLD was independently associated with older age, male gender, sleep disturbances, and current use of atypical antipsychotics or anxiolytics. As expected, the prevalence of NALFD was also higher in individuals with overweight and in those with metabolic syndrome. CONCLUSIONS This study reinforces the view that individuals with BD are highly vulnerable to metabolic and cardiovascular diseases. The prevalence of NAFLD in individuals with BD was two times higher than the prevalence reported in the general population. The regular screening of the MetS in individuals with BD should be therefore complemented by the additional screening of NAFLD among these vulnerable individuals.
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Affiliation(s)
- Ophelia Godin
- Fondation FondaMental, Créteil, France.,Inserm U955, IMRB, Laboratoire Neuro-Psychiatrie Translationnelle, Université Paris Est Créteil, Créteil, France.,AP-HP, HU Henri Mondor, Département Medico-Universitaire de Psychiatrie et d'Addictologie (DMU ADAPT), Fédération Hospitalo-Universitaire de Médecine de Precision (FHU IMPACT), Créteil, France.,Fondation FondaMental, Créteil, France
| | - Marion Leboyer
- Fondation FondaMental, Créteil, France.,Inserm U955, IMRB, Laboratoire Neuro-Psychiatrie Translationnelle, Université Paris Est Créteil, Créteil, France.,AP-HP, HU Henri Mondor, Département Medico-Universitaire de Psychiatrie et d'Addictologie (DMU ADAPT), Fédération Hospitalo-Universitaire de Médecine de Precision (FHU IMPACT), Créteil, France.,Fondation FondaMental, Créteil, France
| | - Raoul Belzeaux
- Fondation FondaMental, Créteil, France.,Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, Marseille, France.,INT-UMR7289, CNRS Aix-Marseille Université, Marseille, France
| | - Frank Bellivier
- Fondation FondaMental, Créteil, France.,Assistance Publique des Hôpitaux de Paris (AP-HP), GHU Saint-Louis - Lariboisière - Fernand Widal, DMU Neurosciences, Département de Psychiatrie et de Médecine Addictologique, INSERM UMRS 1144, Université de Paris, Paris, France
| | - Joséphine Loftus
- Fondation FondaMental, Créteil, France.,Pôle de Psychiatrie, Centre Hospitalier Princesse Grace, Monaco, France
| | - Philippe Courtet
- Fondation FondaMental, Créteil, France.,Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France.,PSNREC, Univ Montpellier, INSERM, CHU Montpellier, Montpellier, France
| | - Caroline Dubertret
- Fondation FondaMental, Créteil, France.,AP-HP, Groupe Hospitalo-universitaire Nord, DMU ESPRIT, Service de Psychiatrie et Addictologie, Hopital Louis Mourier, Colombes, France.,Inserm U1266, Faculté de Médecine, Université de Paris, Paris, France
| | - Sebastien Gard
- Fondation FondaMental, Créteil, France.,Centre Expert Troubles Bipolaires, Service de Psychiatrie Adulte, Hôpital Charles-Perrens, Bordeaux, France
| | - Chantal Henry
- Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, Paris, France
| | - Pierre-Michel Llorca
- Fondation FondaMental, Créteil, France.,CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Raymund Schwan
- Fondation FondaMental, Créteil, France.,Inserm U1114, Centre Psychothérapique de Nancy, Université de Lorraine, Nancy, France
| | - Christine Passerieux
- Fondation FondaMental, Créteil, France.,Service Universitaire de Psychiatrie d'Adultes, Centre Hospitalier de Versailles, Le Chesnay, Université Paris-Saclay, UVSQ, Inserm, CESP, Team "DevPsy", Villejuif, France
| | - Mircea Polosan
- Fondation FondaMental, Créteil, France.,Grenoble Institut des Neurosciences (GIN) Inserm U 1216, CHU de Grenoble et des Alpes, Université Grenoble Alpes, Grenoble, France
| | - Ludovic Samalin
- Fondation FondaMental, Créteil, France.,CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Emilie Olié
- Fondation FondaMental, Créteil, France.,INT-UMR7289, CNRS Aix-Marseille Université, Marseille, France
| | - Bruno Etain
- Fondation FondaMental, Créteil, France.,Assistance Publique des Hôpitaux de Paris (AP-HP), GHU Saint-Louis - Lariboisière - Fernand Widal, DMU Neurosciences, Département de Psychiatrie et de Médecine Addictologique, INSERM UMRS 1144, Université de Paris, Paris, France
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10
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Godin O, Leboyer M, Mazroui Y, Aouizerate B, Azorin JM, Raoul B, Bellivier F, Polosan M, Courtet P, Dubertret C, Henry C, Kahn JP, Loftus J, Olié E, Passerieux C, Costagliola D, Etain B, Llorca P, Barteau V, Bensalem S, Laaidi M, Laouamri H, Souryis K, Hotier S, Pelletier A, Drancourt N, Sanchez J, Saliou E, Hebbache C, Petrucci J, Willaume L, Bourdin E, Carminati M, Etain B, Marlinge E, Meheust J, Antoniol B, Desage A, Gard S, Jutant A, Mbailara K, Minois I, Zanouy L, Abettan C, Bardin L, Cazals A, Deffinis B, Ducasse D, Gachet M, Henrion A, Martinerie E, Molière F, Noisette B, Tarquini G, Belzeaux R, Correard N, Consoloni JL, Groppi F, Lescalier L, Montant J, Rebattu M, Viglianese N, Cohen R, Milazzo M, Wajsbrot-Elgrabli O, Bougerol T, Fredembach B, Garçon S, Grignon P, Perrin A, Galliot A, Grévin I, Cannavo A, Kayser N, Roux P, Aubin V, Cussac I, Dupont M, Medecin I, Mazer N, Portalier C. Trajectories of functioning in bipolar disorders: A longitudinal study in the FondaMental Advanced Centers of Expertise in Bipolar Disorders cohort. Aust N Z J Psychiatry 2020; 54:985-996. [PMID: 32779531 DOI: 10.1177/0004867420945796] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE We aimed at identifying distinct trajectories of functioning and at describing their respective clinical characteristics in a cohort of individuals with bipolar disorders. METHODS We included a sample of 2351 individuals with bipolar disorders who have been followed-up to 3 years as part as the FondaMental Advanced Centers of Expertise in Bipolar Disorders cohort. Global functioning was measured using the Functioning Assessment Short Test. We used latent class mixed models to identify distinct longitudinal trajectories of functioning over 3 years. Multivariable logistic regression models were used to identify the baseline factors that were associated with the membership to each trajectory of functioning. RESULTS Three distinct trajectories of functioning were identified: (1) a majority of individuals (72%) had a stable trajectory of mild functional impairment, (2) 20% of individuals had a stable trajectory of severe functional impairment and (3) 8% of individuals had a trajectory of moderate functional impairment that improved over time. The membership to a trajectory of stable severe versus stable mild functional impairment was associated with unemployment, a higher number of previous hospitalizations, childhood maltreatment, a higher level of residual depressive symptoms, higher sleep disturbances, a higher body mass index and a higher number of psychotropic medications being prescribed at baseline. The model that included these seven factors led to an area under the curve of 0.85. CONCLUSION This study enabled to stratify individuals with bipolar disorders according to three distinct trajectories of functioning. The results regarding the potential determinants of the trajectory of severe functional impairment needs to be replicated in independent samples. Nevertheless, these potential determinants may represent possible therapeutic targets to improve the prognosis of those patients at risk of persistent poor functioning.
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Affiliation(s)
- Ophelia Godin
- Fondation FondaMental, Créteil, France.,Université Paris Est Créteil, Inserm U955, IMRB, Laboratoire Neuro-Psychiatrie Translationnelle, Créteil, France.,AP-HP, HU Henri Mondor, Departement Medico-Universitaire de Psychiatrie et d'Addictologie (DMU ADAPT), Federation Hospitalo-Universitaire de Médecine de Precision (FHU IMPACT), Paris, France
| | - Marion Leboyer
- Fondation FondaMental, Créteil, France.,Université Paris Est Créteil, Inserm U955, IMRB, Laboratoire Neuro-Psychiatrie Translationnelle, Créteil, France.,AP-HP, HU Henri Mondor, Departement Medico-Universitaire de Psychiatrie et d'Addictologie (DMU ADAPT), Federation Hospitalo-Universitaire de Médecine de Precision (FHU IMPACT), Paris, France
| | - Yassin Mazroui
- Laboratoire de Probabilités, Statistiques et Modélisation (LPSM), Sorbonne Université, Paris, France
| | - Bruno Aouizerate
- Fondation FondaMental, Créteil, France.,Centre Expert Troubles Bipolaires, Service de Psychiatrie Adulte, Hôpital Charles-Perrens, Bordeaux, France
| | - Jean-Michel Azorin
- Fondation FondaMental, Créteil, France.,Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, Marseille, France.,CNRS Aix-Marseille Université, Marseille, France
| | - Belzeaux Raoul
- Fondation FondaMental, Créteil, France.,Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, Marseille, France.,CNRS Aix-Marseille Université, Marseille, France
| | - Frank Bellivier
- Fondation FondaMental, Créteil, France.,Assistance Publique des Hôpitaux de Paris (AP-HP), GHU Saint-Louis-Lariboisière-Fernand Widal, DMU Neurosciences, Département de Psychiatrie et de Médecine Addictologique, INSERM UMRS 1144, Université de Paris, Paris, France
| | - Mircea Polosan
- Fondation FondaMental, Créteil, France.,Université Grenoble Alpes, CHU de Grenoble et des Alpes, Grenoble Institut des Neurosciences (GIN) Inserm U1216, Grenoble, France
| | - Philippe Courtet
- Fondation FondaMental, Créteil, France.,Département Urgence et Post-urgence Psychiatrique, CHU Montpellier, INSERM U1061, Université de Montpellier, Montpellier, France
| | - Caroline Dubertret
- Fondation FondaMental, Créteil, France.,AP-HP, Groupe Hospitalo-Universitaire Nord, DMU ESPRIT, Service de Psychiatrie et Addictologie, Hopital Louis Mourier, Colombes, Inserm U1266, Faculté de Médecine, Université de Paris, Paris, France
| | - Chantal Henry
- Fondation FondaMental, Créteil, France.,Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, Paris, France
| | - Jean-Pierre Kahn
- Fondation FondaMental, Créteil, France.,Université de Lorraine, CHRU de Nancy et Pôle de Psychiatrie et Psychologie Clinique, Centre Psychothérapique de Nancy, Nancy, France
| | - Josephine Loftus
- Fondation FondaMental, Créteil, France.,Pôle de Psychiatrie, Centre Hospitalier Princesse Grace, Monaco, France
| | - Emilie Olié
- Fondation FondaMental, Créteil, France.,Département Urgence et Post-urgence Psychiatrique, CHU Montpellier, INSERM U1061, Université de Montpellier, Montpellier, France
| | - Christine Passerieux
- Fondation FondaMental, Créteil, France.,Service Universitaire de Psychiatrie d'Adultes, Centre Hospitalier de Versailles, Le Chesnay, Université Paris-Saclay, UVSQ, Inserm, CESP, Team 'DevPsy', Villejuif, France
| | - Dominique Costagliola
- INSERM, Sorbonne Université, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Bruno Etain
- Fondation FondaMental, Créteil, France.,Assistance Publique des Hôpitaux de Paris (AP-HP), GHU Saint-Louis-Lariboisière-Fernand Widal, DMU Neurosciences, Département de Psychiatrie et de Médecine Addictologique, INSERM UMRS 1144, Université de Paris, Paris, France
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11
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Ducasse D, Van Gordon W, Courtet P. If «Me» is not as it seems, what about diagnosing and treating mental illness? Explore (NY) 2020; 16:206-207. [PMID: 32387129 DOI: 10.1016/j.explore.2020.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 02/20/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Déborah Ducasse
- Lapeyronie Hospital, Department of Emergency Psychiatry and Post Acute Care, CHRU, Montpellier, France; INSERM U1061, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France.
| | - William Van Gordon
- Human Sciences Research Centre, University of Derby, Kedleston Road, Derby, Derbyshire DE22 1GB, United Kingdom
| | - Philippe Courtet
- Lapeyronie Hospital, Department of Emergency Psychiatry and Post Acute Care, CHRU, Montpellier, France; INSERM U1061, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
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12
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Henrion A, Courtet P, Arpon-Brand V, Lafrancesca A, Lacourt L, Jaussent I, Guillaume S, Olié E, Ducasse D. PEPSUI, a Psychoeducational Program for the Management of Suicidal Patients: A Qualitative Study From a Randomized Controlled Trial. Front Psychiatry 2020; 11:500447. [PMID: 33132924 PMCID: PMC7561374 DOI: 10.3389/fpsyt.2020.500447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 09/02/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Suicide prevention after a recent suicide attempt remains a major issue for clinicians. Indeed, these patients are at risk of new attempts and also less prone to interact with mental health services. As psychoeducation-based interventions are strongly recommended for patients with severe or chronic disorders and poor adherence, we developed the first French program of suicide psychoeducation (PEPSUI). METHODS We started a large multicenter randomized controlled trial in outpatients who attempted suicide in the last year (i.e., current suicidal behavior disorder) to assess the feasibility, acceptability, and effectiveness of a 10-week psychoeducational program (PEPSUI group: scientific information on suicidal behavior, and third-wave cognitive behavioral therapies) compared with a 10-week relaxation program (control condition), in a naturalistic setting. Here, we present the qualitative part of this study. Participants in both groups completed a narrative interview with questions on their general impressions about the therapy process and outcomes, specific areas of change in their life since inclusion, and knowledge and perceptions about suicide and mental health services. Interviews were audiotaped, transcribed, and coded using inductive and deductive thematic analysis with a constant comparative approach. Participants were consecutively included until data saturation. RESULTS The interviews of 18 patients (n=10 in the PEPSUI group, and n=8 in the relaxation group) were analyzed. Qualitative analyses revealed some common points, and many differences between groups that are relevant for suicide prevention. Patients in both groups were satisfied with the programs. Group modality and therapeutic alliance with the instructors were considered useful in both groups. Participation was related to improved perception of mental health units (particularly in the PEPSUI group). Both groups reported the acquisition of stress management skills and distress tolerance. Relaxation was an easy way to survive stress. Conversely, the PEPSUI program had deeper implications for daily life through effective positioning towards internal events (thoughts and emotions) as a consequence of mindfulness-derived practices, enhancement of value-based commitments, improvement of the meaning in life and internal locus of control, increased contact with the present moment, use of a matrix (a decision-making tool), and acquisition of scientific knowledge on suicidal behavior. CONCLUSION Through specific processes for targeting suicidal risk and reducing the stigma, the PEPSUI program may represent a promising intervention for suicide prevention.
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Affiliation(s)
- Audrey Henrion
- CHU Montpellier, Lapeyronie Hospital, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France
| | - Philippe Courtet
- CHU Montpellier, Lapeyronie Hospital, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France.,INSERM U1061, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Véronique Arpon-Brand
- CHU Montpellier, Lapeyronie Hospital, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France
| | - Audrey Lafrancesca
- CHU Montpellier, Lapeyronie Hospital, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France
| | - Laetitia Lacourt
- CHU Montpellier, Lapeyronie Hospital, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France.,INSERM U1061, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Isabelle Jaussent
- INSERM U1061, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Sébastien Guillaume
- CHU Montpellier, Lapeyronie Hospital, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France.,INSERM U1061, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Emilie Olié
- CHU Montpellier, Lapeyronie Hospital, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France.,INSERM U1061, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Déborah Ducasse
- CHU Montpellier, Lapeyronie Hospital, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France.,INSERM U1061, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
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Affiliation(s)
- Déborah Ducasse
- CHU Montpellier, Lapeyronie Hospital, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France; INSERM U1061, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France.
| | - William Van Gordon
- Human Sciences Research Centre, University of Derby, Kedleston Road, Derby, Derbyshire DE22 1GB, United Kingdom
| | - Philippe Courtet
- CHU Montpellier, Lapeyronie Hospital, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France; INSERM U1061, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Emilie Olié
- CHU Montpellier, Lapeyronie Hospital, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France; INSERM U1061, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
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14
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Ducasse D, Holden RR, Boyer L, Artéro S, Calati R, Guillaume S, Courtet P, Olié E. Psychological Pain in Suicidality: A Meta-Analysis. J Clin Psychiatry 2019; 79. [PMID: 28872267 DOI: 10.4088/jcp.16r10732] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 01/09/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Perform a meta-analysis to quantify the association between psychological pain and current or lifetime history of suicidal ideation or suicide attempt. DATA SOURCES Search MEDLINE, Web of Science, and PsycINFO from 1965 to 2015 for (psychache OR mental pain OR psychological pain) AND (suicid*). STUDY SELECTION Observational case-control studies addressing the difference in psychological pain between individuals with and without current or lifetime history of suicidal ideation or suicide attempt. DATA EXTRACTION Data were independently extracted into a standard electronic form. All authors were contacted for unpublished data related to current or lifetime history of suicide ideation or attempt. DATA SYNTHESIS Twenty studies were included. Comparisons concerned 760 subjects with versus 8,803 subjects without lifetime history of suicide attempt; 344 subjects with versus 357 patients without current suicide attempt; 262 patients with versus 64 patients without lifetime history of suicidal ideation; and 551 subjects with versus 7,383 subjects without current suicidal ideation. The intensity of psychological pain was higher (1) in both subjects with lifetime history of suicide attempts and subjects with current suicide attempts versus without (effect sizes = 0.72, P < 10⁻² and 0.66, P < 10⁻², respectively) and (2) in both subjects with lifetime history of suicide ideation and subjects with current suicidal ideation versus without (effect sizes = 1.49, P = .01 and 1.15, P < 10⁻², respectively). Association between psychological pain and suicidality remained significant even when depression levels were not different between subjects. CONCLUSIONS Higher psychological pain levels are associated with suicidal ideation and acts. Considering psychological pain to be at the core of suicidality is important for daily clinical practice and for the promotion of innovative therapeutic strategies for suicide prevention.
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Affiliation(s)
- Déborah Ducasse
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, Montpellier, France. .,Department of Psychiatric Emergency and Acute Crisis, Lapeyronie Hospital, Montpellier, France.,INSERM U1061, Montpellier, France.,Fondamental Foundation, France
| | - Ronald R Holden
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Laurent Boyer
- Aix-Marseille University, Research Unit-Public Health, Chronic Diseases, and Quality of Life, Marseille, France
| | | | - Raffaella Calati
- Fondamental Foundation, France.,INSERM U1061, La Colombière Hospital, University of Montpellier, UM1, Montpellier, France
| | - Sébastien Guillaume
- Department of Psychiatric Emergency and Acute Crisis, Lapeyronie Hospital, Montpellier, France.,University of Montpellier, Montpellier, France.,INSERM U1061, Montpellier, France
| | - Philippe Courtet
- Department of Psychiatric Emergency and Acute Crisis, Lapeyronie Hospital, Montpellier, France.,University of Montpellier, Montpellier, France.,INSERM U1061, Montpellier, France.,Fondamental Foundation, France
| | - Emilie Olié
- Department of Psychiatric Emergency and Acute Crisis, Lapeyronie Hospital, Montpellier, France.,University of Montpellier, Montpellier, France.,INSERM U1061, Montpellier, France.,Fondamental Foundation, France
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15
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Ducasse D, Dassa D, Courtet P, Brand-Arpon V, Walter A, Guillaume S, Jaussent I, Olié E. Gratitude diary for the management of suicidal inpatients: A randomized controlled trial. Depress Anxiety 2019; 36:400-411. [PMID: 30657226 DOI: 10.1002/da.22877] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/05/2018] [Accepted: 12/10/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The management of suicidal crisis remains a major issue for clinicians, driving the development of new strategies. METHODS We conducted a randomized controlled trial based on a 7-day add-on positive psychology program: gratitude diary (intervention) versus food diary (control) in adults hospitalized for current suicidal ideation or a suicide attempt. The primary effectiveness outcome was between-group differences for mean change of current psychological pain, between the beginning and the end of the 7-day intervention. We measured between-group differences for mean change of suicidal ideation, hopelessness and optimism, and depression and anxiety between inclusion and after the completion of the 7-day intervention. We compared mean change of current psychological pain, suicidal ideation, and hopelessness and optimism between immediate pre and post daily journal completion. RESULTS Two hundred and one participants were enrolled and randomized. Between pretherapy and posttherapy: There were no significant between-group differences for mean change of severity and intensity of suicidal ideation and current hopelessness. Between-group difference for mean change of current psychological pain was trending (P = 0.05). Mean change of depression, anxiety, and optimism was significantly higher in the intervention than in the control group. Between immediate pre and post daily journal completion: Between-group differences favored gratitude (vs. food) diary for all outcomes (psychological pain, suicidal ideation, and hopelessness and optimism; P < 10-3 ). Participants found the intervention to be more useful than the food diary. CONCLUSIONS Through gratitude diary appears a very straightforward intervention that could be developed as an adjunctive strategy for suicidal patients.
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Affiliation(s)
- Déborah Ducasse
- CHU Montpellier, Lapeyronie Hospital, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, Montpellier, France.,INSERM U1061, Neuropsychiatry, Epidemiological and Clinical Research, Montpellier, France
| | - Déborah Dassa
- CHU Montpellier, Lapeyronie Hospital, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, Montpellier, France
| | - Philippe Courtet
- CHU Montpellier, Lapeyronie Hospital, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, Montpellier, France.,INSERM U1061, Neuropsychiatry, Epidemiological and Clinical Research, Montpellier, France
| | - Véronique Brand-Arpon
- CHU Montpellier, Lapeyronie Hospital, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, Montpellier, France
| | - Audrey Walter
- CHU Montpellier, Lapeyronie Hospital, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, Montpellier, France
| | - Sébastien Guillaume
- CHU Montpellier, Lapeyronie Hospital, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, Montpellier, France.,INSERM U1061, Neuropsychiatry, Epidemiological and Clinical Research, Montpellier, France
| | - Isabelle Jaussent
- INSERM U1061, Neuropsychiatry, Epidemiological and Clinical Research, Montpellier, France
| | - Emilie Olié
- CHU Montpellier, Lapeyronie Hospital, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, Montpellier, France.,INSERM U1061, Neuropsychiatry, Epidemiological and Clinical Research, Montpellier, France
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Ducasse D, Jaussent I, Arpon-Brand V, Vienot M, Laglaoui C, Béziat S, Calati R, Carrière I, Guillaume S, Courtet P, Olié E. Acceptance and Commitment Therapy for the Management of Suicidal Patients: A Randomized Controlled Trial. Psychother Psychosom 2018; 87:211-222. [PMID: 29874680 DOI: 10.1159/000488715] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 03/22/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND The management of suicidal crisis remains a major issue for clinicians, driving the development of new strategies to improve suicide prevention. METHODS We conducted a randomized controlled trial comparing a 7-week acceptance and commitment therapy (ACT) versus relaxation group, as adjunct to treatment as usual for adult outpatients suffering from a current suicidal behavior disorder. The primary outcome was the rate of change in the Columbia Suicide Severity Rating Scale suicidal ideation subscore (adding severity and intensity subscores). Secondary outcomes were the rates of change for depressive symptomatology, psychological pain, anxiety, hopelessness, anger, quality of life, and therapeutic processes. Assessments were performed in the 2 weeks preceding the beginning of the treatment (pretreatment assessment), and within 1 week (posttherapy assessment) and 3 months (follow-up assessment) after therapy completion. RESULTS Forty adults were included and randomized. The rate of change in ACT for suicidal ideation at the posttherapy assessment was higher than in the relaxation group (β [SE] = -1.88 [0.34] vs. -0.79 [0.37], respectively; p = 0.03). ACT effectiveness remained stable at the 3-month follow-up. We found a similar pattern of change for depressive symptomatology and anxiety, psychological pain, hopelessness, anger, and quality of life. Therapeutic processes improved more in the ACT group than in the relaxation group. Treatment adherence was high in the ACT group, all participants reported satisfaction with the program. CONCLUSIONS Through its effectiveness in reducing suicidal ideation and improving the clinical dimensions associated with suicidal risk in patients suffering from a suicidal behavior disorder, ACT could be developed as an adjunctive strategy in programs for suicide prevention.
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Affiliation(s)
- Déborah Ducasse
- Department of Emergency Psychiatry and Postacute Care, Lapeyronie Hospital, CHU Montpellier, CHRU Montpellier, Montpellier, France.,Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France.,Fondation FondaMental, Créteil, France
| | - Isabelle Jaussent
- Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France
| | - Véronique Arpon-Brand
- Department of Emergency Psychiatry and Postacute Care, Lapeyronie Hospital, CHU Montpellier, CHRU Montpellier, Montpellier, France
| | - Marina Vienot
- Department of Emergency Psychiatry and Postacute Care, Lapeyronie Hospital, CHU Montpellier, CHRU Montpellier, Montpellier, France
| | - Camelia Laglaoui
- Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France
| | - Séverine Béziat
- Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France
| | - Raffaella Calati
- Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France.,Fondation FondaMental, Créteil, France
| | - Isabelle Carrière
- Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France
| | - Sébastien Guillaume
- Department of Emergency Psychiatry and Postacute Care, Lapeyronie Hospital, CHU Montpellier, CHRU Montpellier, Montpellier, France.,Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France
| | - Philippe Courtet
- Department of Emergency Psychiatry and Postacute Care, Lapeyronie Hospital, CHU Montpellier, CHRU Montpellier, Montpellier, France.,Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France.,Fondation FondaMental, Créteil, France
| | - Emilie Olié
- Department of Emergency Psychiatry and Postacute Care, Lapeyronie Hospital, CHU Montpellier, CHRU Montpellier, Montpellier, France.,Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France.,Fondation FondaMental, Créteil, France
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17
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Ducasse D, Loas G, Dassa D, Gramaglia C, Zeppegno P, Guillaume S, Olié E, Courtet P. Anhedonia is associated with suicidal ideation independently of depression: A meta-analysis. Depress Anxiety 2018; 35:382-392. [PMID: 29232491 DOI: 10.1002/da.22709] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 10/27/2017] [Accepted: 11/13/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Anhedonia is considered a suicide risk factor in patients with major affective disorders. Here, we wanted to quantify the association between anhedonia and current suicidal ideation according to the absence/presence of between-group differences for depressive scores and psychiatric disorders. METHODS We performed a meta-analysis of data on studies retrieved from Medline, Web of Science, and PsycINFO from 1965 to 2016 using, among others, the terms (suicid* or depression) and anhedonia. RESULTS We identified 15 observational case-control studies that investigated the anhedonia differences in individuals with and without current (i.e., within the past week, independently of the lifetime suicidality status) suicidal ideation (defined as thoughts of killing oneself). Overall, 657 subjects with and 6,690 subjects without current suicidal ideation could be compared. Anhedonia level was higher in the group with current suicidal ideation than in the group without, with a medium effect size (standardized mean difference = 0.57, z = 5.43, P < 0.001, 95% confidence interval, CI = 0.37-0.79). The association between anhedonia and current suicidal ideation remained significant when controlling for depression and psychiatric disorders. The anhedonia scales used in the selected studies did not allow investigating consummatory and motivational anhedonia separately. CONCLUSION Our major finding is the robust association between anhedonia and current suicidal ideation, independently of depression. This is highly relevant for the clinicians' daily practice and might help improving suicidal risk detection and the development of new therapeutic strategies for suicide prevention.
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Affiliation(s)
- Déborah Ducasse
- Department of Psychiatric Emergency & Acute Crisis, Lapeyronie Hospital, CHU Montpellier, Montpellier, France.,INSERM U1061, Montpellier, France.,Fondamental Foundation, Créteil, France
| | - Gwenolé Loas
- Department of Psychiatry & Laboratory of Psychiatric Research (ULB 266), Cliniques Universitaires de Bruxelles, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Déborah Dassa
- Department of Psychiatric Emergency & Acute Crisis, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
| | - Carla Gramaglia
- Psychiatry Institute, Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Novara, Novara, Italy
| | - Patrizia Zeppegno
- Psychiatry Institute, Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Novara, Novara, Italy.,SCDU Psichiatria, AOU Maggiore della Carità, Novara, Novara, Italy
| | - Sébastien Guillaume
- Department of Psychiatric Emergency & Acute Crisis, Lapeyronie Hospital, CHU Montpellier, Montpellier, France.,INSERM U1061, Montpellier, France.,Fondamental Foundation, Créteil, France.,University of Montpellier, Montpellier, France
| | - Emilie Olié
- Department of Psychiatric Emergency & Acute Crisis, Lapeyronie Hospital, CHU Montpellier, Montpellier, France.,INSERM U1061, Montpellier, France.,Fondamental Foundation, Créteil, France.,University of Montpellier, Montpellier, France
| | - Philippe Courtet
- Department of Psychiatric Emergency & Acute Crisis, Lapeyronie Hospital, CHU Montpellier, Montpellier, France.,INSERM U1061, Montpellier, France.,Fondamental Foundation, Créteil, France.,University of Montpellier, Montpellier, France
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18
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Ducasse D, Jaussent I, Guillaume S, Azorin JM, Bellivier F, Belzeaux R, Bougerol T, Etain B, Gard S, Henry C, Kahn JP, Leboyer M, Loftus J, Passerieux C, Olié E, Courtet P. Affect lability predicts occurrence of suicidal ideation in bipolar patients: a two-year prospective study. Acta Psychiatr Scand 2017; 135:460-469. [PMID: 28260234 DOI: 10.1111/acps.12710] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of our study was to investigate, in bipolar patients, whether affect lability was associated with suicidal ideation incidence during 2-year follow-up, and which subtype of affect lability was associated with suicidal ideation. METHOD A total of 319 euthymic or mildly depressed bipolar outpatients recruited in the French FondaMental Advanced Centres of Expertise for Bipolar Disorder were divided into two subgroups according to the occurrence of suicidal ideation during a 2-year follow-up. Affect lability was assessed by the French version of the Affect Lability Scale. RESULTS Bipolar patients with high affect lability were more likely to report suicidal ideation during follow-up, even after adjustment for age, study level, rapid cycling, current depression level, anxiety disorder, and lifetime history SA (OR = 2.47; 95% CI [1.15-5.30], P = 0.01). The risk of suicidal ideation increased with the level of affect lability. More specifically, the propensity to switch from neutral to elation affect, from anxious to depressive affect (or inversely), and from neutral to anger affect predicted suicidal ideation. CONCLUSION Reducing affective lability could become a new therapeutic target of suicidal prevention in bipolar disorder.
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Affiliation(s)
- D Ducasse
- CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, Montpellier, France.,Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France.,Fondation FondaMental, Créteil, France
| | - I Jaussent
- Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France
| | - S Guillaume
- CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, Montpellier, France.,Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France.,Fondation FondaMental, Créteil, France
| | - J M Azorin
- Fondation FondaMental, Créteil, France.,AP HM, Psychiatric Pole, Sainte Marguerite, Marseille, France
| | - F Bellivier
- Fondation FondaMental, Créteil, France.,Hospital Saint-Louis - Lariboisière - Fernand Widal, AP-HP, Paris, France
| | - R Belzeaux
- Fondation FondaMental, Créteil, France.,AP HM, Psychiatric Pole, Sainte Marguerite, Marseille, France
| | - T Bougerol
- Fondation FondaMental, Créteil, France.,Academic Hospital of Grenoble, Grenoble, France
| | - B Etain
- Fondation FondaMental, Créteil, France.,Université Paris-Est, Hopital Henri Mondor, DHU PePSY and AP-HP, Créteil, France
| | - S Gard
- Fondation FondaMental, Créteil, France.,Charles Perrens Hospital, Bordeaux, France
| | - C Henry
- Fondation FondaMental, Créteil, France.,Université Paris-Est, Hopital Henri Mondor, DHU PePSY and AP-HP, Créteil, France
| | - J P Kahn
- Fondation FondaMental, Créteil, France.,Brabois Hospital, Academic Hospital of Nancy, Vandoeuvre Les Nancy, France
| | - M Leboyer
- Fondation FondaMental, Créteil, France.,Université Paris-Est, Hopital Henri Mondor, DHU PePSY and AP-HP, Créteil, France
| | - J Loftus
- Fondation FondaMental, Créteil, France.,Department of Psychiatry, Princesse-Grace Hospital, Monaco
| | - C Passerieux
- Fondation FondaMental, Créteil, France.,Academic Hospital of Versailles, Le Chesnay, France
| | | | - E Olié
- CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, Montpellier, France.,Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France.,Fondation FondaMental, Créteil, France
| | - P Courtet
- CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, Montpellier, France.,Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France.,Fondation FondaMental, Créteil, France
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19
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Aubert E, Jaussent I, Olié E, Ducasse D, Azorin JM, Bellivier F, Belzeaux R, Bougerol T, Etain B, Gard S, Henry C, Kahn JP, Leboyer M, Loftus J, Passerieux C, Lopez-Castroman J, Courtet P. Effect of early trauma on the sleep quality of euthymic bipolar patients. J Affect Disord 2016; 206:261-267. [PMID: 27517134 DOI: 10.1016/j.jad.2016.07.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 06/20/2016] [Accepted: 07/09/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Poor quality of sleep is frequent in euthymic bipolar patients and conveys worse clinical outcomes. We investigated the features of euthymic bipolar patients associated with poor sleep quality, with a focus on the effect of childhood trauma. METHOD 493 euthymic patients with DSM-IV-defined bipolar disorders were recruited in FondaMental Advanced Centers of Expertize for Bipolar Disorders (FACE-BD) between 2009 and 2014. Clinical variables were recorded. Subjective sleep quality and history of childhood trauma were respectively measured by the Pittsburgh Sleep Quality Index (PSQI) and the Childhood Trauma Questionnaire (CTQ). RESULTS Poor sleepers were older, less professionally active, had significantly higher anxiety levels, took more anxiolytic drugs and did endorse more suicide attempts and suicidal ideas than good sleepers after adjusting for anxiety levels and age. Emotional abuse was associated with poor sleep quality after adjustment for BMI, age, professional activity, and bipolar disorders (BD) type (OR=1.83; 95% CI [1.30; 3.10]; p=0.02). However, this association was lost after adjustment for anxiety levels, anxiolytic treatment and suicide ideation/attempts. LIMITATIONS The main limitation was the type of sleep assessment, which only measured the subjective part of sleep complaints. CONCLUSION A history of emotional abuse might underlie sleep problems in many bipolar patients but anxiety seems to act as a confounding factor in this relationship. New studies are needed to elucidate the role of childhood maltreatment on poor sleep among bipolar patients.
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Affiliation(s)
- E Aubert
- CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France; Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France.
| | - I Jaussent
- Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France
| | - E Olié
- CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France; Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France
| | - D Ducasse
- CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France; Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France
| | - J M Azorin
- FondaMental Foundation, Créteil, France; AP HM, Psychiatric Pole, Sainte Marguerite, Marseille, France
| | - F Bellivier
- FondaMental Foundation, Créteil, France; Hospital Saint-Louis - Lariboisière - Fernand Widal, AP-HP, Paris, France
| | - R Belzeaux
- FondaMental Foundation, Créteil, France; AP HM, Psychiatric Pole, Sainte Marguerite, Marseille, France
| | - T Bougerol
- FondaMental Foundation, Créteil, France; Academic Hospital of Grenoble, Grenoble, France
| | - B Etain
- FondaMental Foundation, Créteil, France; Université Paris-Est, Hopital Chenevier and AP-HP, Créteil, France
| | - S Gard
- FondaMental Foundation, Créteil, France; Charles Perrens Hospital, Bordeaux, France
| | - C Henry
- FondaMental Foundation, Créteil, France; Université Paris-Est, Hopital Chenevier and AP-HP, Créteil, France
| | - J P Kahn
- FondaMental Foundation, Créteil, France; Brabois Hospital, Academic Hospital of Nancy, Vandoeuvre Les Nancy, France
| | - M Leboyer
- FondaMental Foundation, Créteil, France; Université Paris-Est, Hopital Chenevier and AP-HP, Créteil, France
| | - J Loftus
- FondaMental Foundation, Créteil, France; Department of Psychiatry, Princesse-Grace Hospital, Monaco
| | - C Passerieux
- FondaMental Foundation, Créteil, France; Academic Hospital of Versailles, Le Chesnay, France
| | - J Lopez-Castroman
- CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France; Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France
| | - Ph Courtet
- CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France; Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France
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Ducasse D, Jaussent I, Olié E, Guillaume S, Lopez-Castroman J, Courtet P. Personality Traits of Suicidality Are Associated with Premenstrual Syndrome and Premenstrual Dysphoric Disorder in a Suicidal Women Sample. PLoS One 2016; 11:e0148653. [PMID: 26863007 PMCID: PMC4749223 DOI: 10.1371/journal.pone.0148653] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 01/21/2016] [Indexed: 11/22/2022] Open
Abstract
Objective Both Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) might increase the risk of suicidal behavior. The aim of this study was to assess the relationship between personality dimensions specifically involved in suicidal vulnerability and PMS/PMDD. Method We collected data from 232 women consecutively hospitalized after a suicide attempt. We examined the relationship between impulsivity, aggressiveness/hostility, hopelessness, trait anger, affect intensity, emotional lability, and PMS/PMDD. Notably, we created an algorithm from the shortened Premenstrual Assessment form in order to assess PMDD status. Results The proportions of PMS and PMDD among female suicide attempters were 50% and 23% respectively. Women with PMS or PMDD were more likely to endorse most of these personality traits to than those without even after controlling for potential confounders. We found an impulsive-aggressive pattern of personality in women with PMS or PMDD, independently from the time of the menstrual cycle. Interestingly, trait anger remained associated with both PMS and PMDD independently of every other personality traits. The higher the anger level, the higher the risk was to suffer from both PMS and PMDD. Conclusions This study demonstrates a strong, independent association between PMS/PMDD and trait anger among a representative sample of female suicide attempters. It is of major interest for clinicians in view of addressing a substantial public health problem among women of reproductive age.
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Affiliation(s)
- Déborah Ducasse
- Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
- Inserm U1061, University of Montpellier UM1, Montpellier, France
- Fondamental Foundation, Créteil, France
- * E-mail:
| | | | - Emilie Olié
- Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
- Inserm U1061, University of Montpellier UM1, Montpellier, France
- Fondamental Foundation, Créteil, France
| | - Sébastien Guillaume
- Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
- Inserm U1061, University of Montpellier UM1, Montpellier, France
- Fondamental Foundation, Créteil, France
| | - Jorge Lopez-Castroman
- Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
- Inserm U1061, University of Montpellier UM1, Montpellier, France
- Fondamental Foundation, Créteil, France
| | - Philippe Courtet
- Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
- Inserm U1061, University of Montpellier UM1, Montpellier, France
- Fondamental Foundation, Créteil, France
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Ducasse D, Courtet P, Sénèque M, Genty C, Picot MC, Schwan R, Olié E. Effectiveness of the first French psychoeducational program on unipolar depression: study protocol for a randomized controlled trial. BMC Psychiatry 2015; 15:294. [PMID: 26578205 PMCID: PMC4650332 DOI: 10.1186/s12888-015-0667-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 10/29/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Major Depressive Disorder (MDD) is highly prevalent and was associated with greater morbidity, mortality (including suicide), and healthcare costs. By 2030, MDD will become the leading cause of disability in high-income countries. Notably, among patients with a previous experience of a major depressive episode, it was indeed estimated that up to 85 % of those patients will suffer from relapse. Two main factors were associated with a significantly higher risk of relapse: poor medication adherence and low self-efficacy in disease management. Interestingly, these issues could become the targets of psychoeducational programs for chronic diseases. Indded psychoeducational program for depression are recommended in international guidelines, but have not yet been proposed in France. METHODS/DESIGN We propose to evaluate the first French psychoeducational program for depression "ENVIE" in a multicenter randomized controlled trial. The group intervention will include 9 weekly sessions. Its aim is to educate patients on the latest knowledge on depression and effective treatments through didactic and interactive sessions. Patients will experiment the latest innovating psychological skills (from acceptance and commitment therapy) to cope with depressive symptoms and maintain motivation in behavioral activation. In total, 332 unipolar non-chronic (<2 years) outpatients with moderate to severe depression, without psychotic features, will be randomly allocated to the add-on ENVIE program (N = 166) or to a waiting list (N = 166). The follow-up will last 15 months and include 5 assessment visits. The primary endpoint will be the remission rate of the index episode at 15 months post-inclusion, defined by a Montgomery and Asberg Depression Rating Scale (MADRS) score ≤ 12 over an 8-week period, and without relapse during follow-up. We will also assess the response rate and relapse at 15 months post-inclusion, hospitalization rate and adherence to treatment during the follow-up period, quality of life and global functioning upon inclusion and at 9 and 15 months post inclusion. DISCUSSION If the proposed trial shows the effectiveness of the intervention, but also an increased remission rate in depressed outpatients at 15-months post-inclusion, in addition to improved treatment adherence in patients, it will further promotes arguments in favor of a wide dissemination of psychoeducational programs for depression. TRIAL REGISTRATION This trial is registered under number 2015-A00249-40 (PURE clinical trial: NCT02501226 ) (June 30th, 2015).
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Affiliation(s)
- Déborah Ducasse
- Department of Emergency Psychiatry and Post Acute Care, CHU Montpellier, Hôpital Lapeyronie, 371 Avenue Gaston Giraud, 34295, Montpellier, France. .,Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France. .,FondaMental Foundation, ᅟ, France.
| | - Philippe Courtet
- Department of Emergency Psychiatry and Post Acute Care, CHU Montpellier, Hôpital Lapeyronie, 371 Avenue Gaston Giraud, 34295, Montpellier, France. .,Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France. .,FondaMental Foundation, ᅟ, France.
| | - Maude Sénèque
- Department of Emergency Psychiatry and Post Acute Care, CHU Montpellier, Hôpital Lapeyronie, 371 Avenue Gaston Giraud, 34295, Montpellier, France. .,Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France. .,FondaMental Foundation, ᅟ, France.
| | - Catherine Genty
- Department of Emergency Psychiatry and Post Acute Care, CHU Montpellier, Hôpital Lapeyronie, 371 Avenue Gaston Giraud, 34295, Montpellier, France. .,Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France. .,FondaMental Foundation, ᅟ, France.
| | | | | | - Emilie Olié
- Department of Emergency Psychiatry and Post Acute Care, CHU Montpellier, Hôpital Lapeyronie, 371 Avenue Gaston Giraud, 34295, Montpellier, France. .,Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France. .,FondaMental Foundation, ᅟ, France.
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Fond G, Ducasse D. [Motivational interview: supporting change]. Soins Psychiatr 2015:41-3. [PMID: 26143220 DOI: 10.1016/j.spsy.2014.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The motivational interview aims to help patients to resolve their ambivalence regarding problematic behaviors and to guide them into change. It differs from other therapeutic approaches mainly through the attitude of the therapist. In motivational interviewing, the therapist defends the statu quo. By reactance, the patient defends the change and enhance her/his motivation. This article provides a summary of the other concepts of motivational interviewing and its applications in the psychiatric daily practice.
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Affiliation(s)
- Guillaume Fond
- GHU Mondor, DHU Pe-psy, Université Paris-Est, Inserm U955 Eq 15, Fondation FondaMental, hôpital Chenevier, Pavillon Hartmann, 40, rue de Mesly, 94000 Créteil, France.
| | - Déborah Ducasse
- CHRU Montpellier, Inserm 1061, 295, bd Charles-Flahault, 34093 Montpellier, Cedex 5, France
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Ducasse D, Arpon-Brand V, Vienot M, Laglaoui C, Calati R, Guillaume S, Courtet P, Olié E. La thérapie d’acceptation et d’engagement dans la prise en charge des conduites suicidaires. Eur Psychiatry 2015. [DOI: 10.1016/j.eurpsy.2015.09.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
ContexteLes conduites suicidaires (CS) constituent un problème de santé publique majeur à travers le monde. Elles présentent une vulnérabilité propre, et sont maintenant considérées comme une entité diagnostique indépendante dans le DSM5. La thérapie d’acceptation et d’engagement (ACT) est une thérapie intégrative ayant démontré son utilité dans une grande variété de troubles psychiatriques, à travers une diminution de l’évitement expérientiel et une amélioration de la flexibilité psychologique (socles communs à l’ensemble des troubles psychiatriques) .InnovationNous avons conduit une étude pilote suggérant la faisabilité de la thérapie ACT, sous forme de groupes, chez les patients suicidants (CHRU de Montpellier, Pr Courtet) . À travers la présentation des processus thérapeutiques utilisés dans la thérapie ACT, nous aborderons les hypothèses d’action de la thérapie ACT dans les conduites suicidaires. Puis nous présenterons l’étude IMPACT, en cours de réalisation dans le service urgences et post-urgences psychiatriques (CHRU de Montpellier, Pr Courtet). Il s’agit de la première étude contrôlée randomisée recherchant des biomarqueurs neuroanatomiques et fonctionnels de réponse à la thérapie ACT chez des patients ayant un trouble des conduites suicidaires. Nous aborderons enfin, de façon pratique, comment présenter la thérapie ACT à un patient, à travers une matrice . Il s’agit d’une analyse fonctionnelle permettant de faire percevoir au patient le fonctionnement actuel dans lequel il se sent enlisé, de mettre en lumière ce qui est important dans sa vie, et donc d’avoir un outil motivationnel simple et efficace pour l’accompagner vers le changement.PerspectivesLa thérapie ACT semble être une thérapie prometteuse dans la prise en charge des conduites suicidaires. L’étude IMPACT servira à accroître les connaissances sur les conduites suicidaires par l’identification de biomarqueurs de réponse thérapeutique et la mise en évidence des régions cérébrales associées aux processus thérapeutiques.
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Guyodo J, Ducasse D, Olié E, Seneque M, Picot M, Schwan R. ENVIE : le premier programme français de psychoéducation dans la dépression unipolaire. Eur Psychiatry 2015. [DOI: 10.1016/j.eurpsy.2015.09.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
ContexteL’épisode dépressif majeur (EDM) est hautement prévalent, et est associé à une augmentation de la morbidité, de la mortalité (incluant le suicide), et des coûts de santé publique. En 2030, la dépression devrait être la première cause d’invalidité dans les pays développés. Même si une amélioration est observée chez 60–70 % des individus traités par antidépresseurs, seulement 35 % atteindront la rémission. De plus, parmi les patients qui ont expérimenté un EDM, il est estimé que 85 % présenteront une rechute. Deux principaux facteurs sont associés à l’augmentation du risque de rechute : la faible observance médicamenteuse, et la faible confiance dans ses compétences à gérer un nouvel épisode. Ces deux facteurs sont justement les cibles prioritaires des programmes de psychoéducation . En outre, la psychoéducation est recommandée dans les guidelines , mais aucun programme n’était disponible en France.InnovationNous avons développé le premier programme français de psychoéducation dans la dépression unipolaire, appelé « ENVIE ». Cette intervention de groupe se compose de neuf séances hebdomadaires. Son objectif est d’enseigner aux patients les connaissances actuelles sur la dépression unipolaires et les traitements efficaces, grâce à des séances didactiques et interactives. Au cours des séances, les patients sont également encouragés à expérimenter des compétences psychologiques innovantes (issues de la thérapie ACT) pour faire face à la symptomatologie dépressive, et maintenir leur motivation dans l’activation comportementale au cours du temps [3,4]. L’objectif global est que les patients deviennent experts et acteurs de leur maladie.PerspectiveDans le cadre d’un PHRC national, 332 patients déprimés unipolaires non chroniques (< 2 ans), d’intensité modérée à sévère, sans éléments psychotiques, seront randomisés en 2 groupes : programme ENVIE en add-on (n = 166) ou liste d’attente (n = 166). Le critère de jugement principal sera le taux de rémission (MADRS ≤ 12 sur 8 semaines sans rechute) à 15 mois. Démontrer l’intérêt du programme ENVIE permettrait sa diffusion plus large comme traitement adjuvant de la dépression unipolaire.
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Richieri R, Ducasse D, Doumy O, Holtzmann J. Psychothérapies et dépression. Eur Psychiatry 2015. [DOI: 10.1016/j.eurpsy.2015.09.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
La prise en charge classique de la dépression unipolaire repose généralement sur l’association d’antidépresseurs et/ou psychothérapie . Dans un premier temps, nous présenterons le programme ENVIE, premier programme français de psychoéducation indiqué dans le traitement de la phase aiguë de la dépression unipolaire. Son objectif est d’enseigner aux patients les connaissances actuelles dont nous disposons sur la dépression unipolaire et les traitements efficaces, grâce à des séances didactiques et interactives . Dans un second temps, nous évaluerons l’intérêt des psychothérapies dans le traitement des symptômes dépressifs résiduels et la prévention de la rechute. En effet, malgré le développement de nouvelles molécules au cours des dernières décennies, de nombreux patients souffrant de dépression unipolaire montrent une amélioration importante encore que partielle avec la persistance de symptômes infracliniques connus pour favoriser la rechute . L’approche psychothérapique de la dépression s’est parallèlement construite à travers notamment la thérapie cognitive. Devant l’intérêt grandissant représenté par la psychothérapie de la dépression, de nouveaux courants sont plus récemment apparus à travers la thérapie d’acceptation et d’engagement et la thérapie cognitive basée sur la pleine conscience . Enfin, malgré une efficacité établie, l’accès à une psychothérapie peut être long et coûteux. La prise en charge par Internet pourrait pallier aux inconvénients des soins classiques et permettre un traitement de la dépression unipolaire de très bonne qualité à un prix abordable. Dans ce contexte, nous nous proposons d’aborder « E-COMPARED » en tant que un projet de recherche européen visant à évaluer deux modes de prise en charge de la dépression chez l’adulte : la prise en charge classique (face-à-face) et combinée (face-à-face et Internet). Cet essai clinique sera réalisé, pour la France, au sein des 11 centres experts du réseau dépression résistante (Fondation FondaMental). En conclusion, ce symposium devrait apporter un éclairage nouveau sur l’importance de l’approche psychothérapique sous ces différentes formes dans la prise en charge thérapeutique de la dépression unipolaire.
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Courtet P, Jaussent I, Genty C, Dupuy AM, Guillaume S, Ducasse D, Olié E. Increased CRP levels may be a trait marker of suicidal attempt. Eur Neuropsychopharmacol 2015; 25:1824-31. [PMID: 26032768 DOI: 10.1016/j.euroneuro.2015.05.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 05/11/2015] [Indexed: 01/06/2023]
Abstract
Suicide is a leading cause of death worldwide. Identifying biomarkers will help enhance our understanding of suicidal pathophysiology and improve its prevention. Therefore, we investigated CRP levels in 600 depressed inpatients: 520 patients had a lifetime history of suicide attempts and 80 patients did not have any history of suicide attempts. For all patients, we assessed socio-demographic features, lifetime Axis I DSM-IV diagnoses, depression intensity, suicidal ideation, characteristics of suicidal history, and history of childhood trauma. The day following admission, fasting blood tests yielded samples collected for the measurement of high sensitivity hs-CRP. CRP levels were associated with a history of suicide attempts. The risk of suicide attempts increased with higher levels of CRP in a dose-response way before and after adjustments for age, gender, chronic diseases, addiction and anxiety comorbidities, antidepressants use, smoking status and sexual abuse. Noteworthy, the association between CRP levels and history of suicide attempts remained significant after having excluded patients with chronic diseases. There was no significant difference in CRP levels between patients who attempted suicide more or less than a week before plasma sampling, and no significant difference in CRP levels was evidenced between high vs low suicidal ideation. In conclusion, this is the first study suggesting that CRP may be a trait marker for suicidal vulnerability by associating CRP levels and a lifetime history of suicide attempts in depressed inpatients. Therefore, determining the inflammatory marker profile of individuals exhibiting suicidal behaviors could be relevant for anticipating behaviors and refining new therapeutic opportunities.
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Affiliation(s)
- Ph Courtet
- CHU Montpellier, HôpitalLapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France; Inserm, U1061 Montpellier,University of Montpellier, Montpellier, France; FondaMental Foundation, France
| | - I Jaussent
- Inserm, U1061 Montpellier,University of Montpellier, Montpellier, France; FondaMental Foundation, France
| | - C Genty
- CHU Montpellier, HôpitalLapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France; Inserm, U1061 Montpellier,University of Montpellier, Montpellier, France; FondaMental Foundation, France
| | - A M Dupuy
- Inserm, U1061 Montpellier,University of Montpellier, Montpellier, France; Department of Biochemistry, CHRU de Montpellier, Montpellier, France
| | - S Guillaume
- CHU Montpellier, HôpitalLapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France; Inserm, U1061 Montpellier,University of Montpellier, Montpellier, France; FondaMental Foundation, France
| | - D Ducasse
- CHU Montpellier, HôpitalLapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France; Inserm, U1061 Montpellier,University of Montpellier, Montpellier, France; FondaMental Foundation, France.
| | - E Olié
- CHU Montpellier, HôpitalLapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France; Inserm, U1061 Montpellier,University of Montpellier, Montpellier, France; FondaMental Foundation, France
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Ducasse D, Jaussent I, Guillaume S, Azorin JM, Bellivier F, Belzeaux R, Bougerol T, Etain B, Gard S, Henry C, Kahn JP, Leboyer M, Loftus J, Passerieux C, Courtet PH, Olié E. Increased risk of suicide attempt in bipolar patients with severe tobacco dependence. J Affect Disord 2015; 183:113-8. [PMID: 26001671 DOI: 10.1016/j.jad.2015.04.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 04/22/2015] [Accepted: 04/22/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND The aim of our study was to investigate, in bipolar patients, the association between tobacco status (use and dependence) and history of suicide attempt, and to assess the possible role of inflammation as a missing link in the association between smoking status and history of suicide attempt. METHODS A total of 453 adult bipolar out-patients recruited in the French FondaMental Advanced Centres of Expertise for Bipolar Disorder were divided into two subgroups: 274 patients without past history of suicide attempt (non-SA), and 179 patients with a past history of suicide attempt (SA). Tobacco use and dependence, psychiatric and somatic comorbidities, history of childhood abuse, family history of suicide were assessed. Fasting blood tests yielded samples collected for the measurement of high sensitivity (hs-)CRP. RESULTS The risk of suicide attempt increased with smoking dependence. Notably, bipolar patients with a history of suicide attempt were three times more likely to have severe tobacco dependence, independently of confounding factors. However, we failed to find arguments promoting the hypothesis of inflammatory markers (through hs-CRP measure) in the link between tobacco dependence and suicidal behavior. CONCLUSIONS We found a significant association between severe tobacco dependence and history of suicide attempt, but not with level of CRP, independently of confusing factors. Longitudinal studies taken into account all these potential confusing factors are needed to confirm our results.
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Affiliation(s)
- D Ducasse
- CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France; Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France.
| | - I Jaussent
- Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France
| | - S Guillaume
- CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France; Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France
| | - J M Azorin
- FondaMental Foundation, Créteil, France; AP HM, Psychiatric Pole, Sainte Marguerite, Marseille, France
| | - F Bellivier
- FondaMental Foundation, Créteil, France; Hospital Saint-Louis - Lariboisière - Fernand Widal, AP-HP, Paris, France
| | - R Belzeaux
- FondaMental Foundation, Créteil, France; AP HM, Psychiatric Pole, Sainte Marguerite, Marseille, France
| | - T Bougerol
- FondaMental Foundation, Créteil, France; Academic Hospital of Grenoble, Grenoble, France
| | - B Etain
- FondaMental Foundation, Créteil, France; Université Paris-Est, Hopital Chenevier and AP-HP, Créteil, France
| | - S Gard
- FondaMental Foundation, Créteil, France; Charles Perrens Hospital, Bordeaux, France
| | - C Henry
- FondaMental Foundation, Créteil, France; Université Paris-Est, Hopital Chenevier and AP-HP, Créteil, France
| | - J P Kahn
- FondaMental Foundation, Créteil, France; Brabois Hospital, Academic Hospital of Nancy, Vandoeuvre Les Nancy, France
| | - M Leboyer
- FondaMental Foundation, Créteil, France; Université Paris-Est, Hopital Chenevier and AP-HP, Créteil, France
| | - J Loftus
- FondaMental Foundation, Créteil, France; Department of Psychiatry, Princesse-Grace Hospital, Monaco
| | - C Passerieux
- FondaMental Foundation, Créteil, France; Academic Hospital of Versailles, Le Chesnay, France
| | - P H Courtet
- CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France; Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France
| | - E Olié
- CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France; Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France
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Ducasse D, René E, Béziat S, Guillaume S, Courtet P, Olié E. Acceptance and commitment therapy for management of suicidal patients: a pilot study. Psychother Psychosom 2015; 83:374-6. [PMID: 25323551 DOI: 10.1159/000365974] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 07/15/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Déborah Ducasse
- Department of Psychiatric Emergency and Acute Crisis, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
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Ducasse D, Olié E, Guillaume S, Artéro S, Courtet P. A meta-analysis of cytokines in suicidal behavior. Brain Behav Immun 2015; 46:203-11. [PMID: 25678163 DOI: 10.1016/j.bbi.2015.02.004] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 01/27/2015] [Accepted: 02/01/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND We conducted the first meta-analysis of studies comparing the plasma and CSF concentrations of cytokines in suicidal patients vs. non-suicidal patients or healthy controls. METHODS We searched Medline, Web of Science, and PsycINFO from 1965 to November 2014 for relevant studies. Manual searches of references and unpublished data were also included. Suicidal patients included severe suicide ideators and suicide attempters. RESULTS Eleven articles were available for the meta-analysis, for a total sample size of 494 suicidal patients, 497 non-suicidal patients and 398 healthy controls. Levels of 6 independent plasma cytokines (IL2, IL6, TNFalpha, IFNgamma, IL4, TGFbeta) were meta-analyzed for plasma studies comparing suicidal vs. both controls. IL8 level was meta-analyzed for cerebrospinal fluid studies comparing suicidal patients with healthy controls. We reported with medium effect size, that suicidal patients had: (1) lower IL2 plasma levels than both non-suicidal patients and healthy controls (medium effect size); (2) lower IL4 and higher TGFbeta plasma levels than healthy controls. CONCLUSION Our results promote the hypothesis of altered inflammatory markers in suicidal patients, for both pro-inflammatory (IL2) and anti-inflammatory (IL4 and TGFbeta) cytokines.
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Affiliation(s)
- Déborah Ducasse
- Department of Psychiatric Emergency & Acute Crisis, Lapeyronie Hospital, CHU Montpellier, Montpellier, France; University of Montpellier UM1, Montpellier, France; INSERM U1061, Montpellier, France; Fondamental Foundation, France.
| | - Emilie Olié
- Department of Psychiatric Emergency & Acute Crisis, Lapeyronie Hospital, CHU Montpellier, Montpellier, France; University of Montpellier UM1, Montpellier, France; INSERM U1061, Montpellier, France; Fondamental Foundation, France
| | - Sébastien Guillaume
- Department of Psychiatric Emergency & Acute Crisis, Lapeyronie Hospital, CHU Montpellier, Montpellier, France; University of Montpellier UM1, Montpellier, France; INSERM U1061, Montpellier, France; Fondamental Foundation, France
| | | | - Philippe Courtet
- Department of Psychiatric Emergency & Acute Crisis, Lapeyronie Hospital, CHU Montpellier, Montpellier, France; University of Montpellier UM1, Montpellier, France; INSERM U1061, Montpellier, France; Fondamental Foundation, France
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Ducasse D, Denis H. [Pathological nighttime fears in children: Clinical specificities and effective therapeutics]. Encephale 2014; 41:323-31. [PMID: 25542451 DOI: 10.1016/j.encep.2014.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 08/04/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Pathological nighttime fears in children have been little studied. However, this disorder is commonly encountered in medical consultations and is discomforting and dysfunctional for both the child and the family. Most nighttime fears are part and parcel of normal development, and emanate from increasingly sophisticated cognitive development in the growing child. Thus, most children report a variety of coping strategies generally helpful in reducing their anxiety, which resolves spontaneously in the growing child. Nevertheless, in about 10% of children, nighttime fears are related to one or more anxiety disorders according to Diagnostic and Statistical Manual of Mental Disorders criteria. Then, it is estimated that severe nighttime fears and sleep problems occur in 20-30% of children. This problem is not transient and has to be treated. This study aims to review clinical features of nighttime fears and possible treatments for these patients and their families. METHOD This systematic review follows the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement guidelines. Two databases (Medline and Web of Science) were searched combining the search terms: nighttime fears AND children. English and French languages were imposed. There were no publication date or publication status limitations. RESULTS Pathological nighttime fears are responsible for emotional (crying, panic, tantrums at bedtime, loss of confidence, self-disparaging negative statements, and feeling of social embarrassment) and behavioral (wandering alone in the house at night, calls for parental or sibling comfort, bed sharing with parents or siblings, light source at night, refusal to go to the toilet alone at night) disturbances. This leads to a poor quality of sleep interfering with school learning, and also affects social development and family functioning. A full assessment has to be made to eliminate organic causes, have a baseline functioning, and search for comorbid anxiety diseases. The treatments which have proved effective are some cognitive-behavioral techniques: systematic desensitization (with relaxation or emotive imagery), reinforcement (gain of points and techniques of self statement), and cognitive techniques (reinforcing self-statements, reducing the aversive aspects of being in the dark, involving reality-testing statements, and active control are preferred in children older than 6 years, whereas the "anti-monster letter" and the techniques using a doll are preferred in children under 6 years old). The modelling technique seems to be appropriate at any age. CONCLUSION We have explained the clinical features of pathological nighttime fears and the way to assess this disease, and we have pointed out the treatments whose effectiveness has been evaluated in this indication.
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Affiliation(s)
- D Ducasse
- Inserm U1061, hôpital La Colombière, pavillon 42, 39, avenue Charles-Flahault, BP 34493, 34093 Montpellier cedex 5, France; Université Montpellier 1, 5, boulevard Henri-IV, CS 19044, 34967 Montpellier cedex 2, France; Service universitaire de psychiatrie de l'enfant, hôpital Peyre-Plantade, hôpital La Colombière, CHRU Montpellier, 39, avenue Charles-Flahault, 34295 Montpellier cedex 5, France.
| | - H Denis
- Inserm U1061, hôpital La Colombière, pavillon 42, 39, avenue Charles-Flahault, BP 34493, 34093 Montpellier cedex 5, France; Université Montpellier 1, 5, boulevard Henri-IV, CS 19044, 34967 Montpellier cedex 2, France; Service universitaire de psychiatrie de l'enfant, hôpital Peyre-Plantade, hôpital La Colombière, CHRU Montpellier, 39, avenue Charles-Flahault, 34295 Montpellier cedex 5, France
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Abstract
Borderline personality disorder (BPD) is a common psychiatric disorder, the core features of which are affective dysregulation, identity disturbances, and problems in social interaction, with an intense fear of loss, abandonment, or rejection by social partners. Self-injurious behaviors (SIB), such as superficial cutting, occur in 70-80 % of BPD patients, which are associated with emotional relief. Intriguingly, the majority of BPD patients report reduced or no pain associated with SIB, whereas BPD patients are over-represented in chronic pain patients. Thus, studying pain perception in such patients may help to understand the pathophysiology of BPD, but also the interaction between affective and physical dimensions of pain. We conducted a systematic review dealing with physical and social pains in BPD patients, with a special focus on neuroimaging data. SIB appear to be an inadequate strategy to regulate negative emotions that may be related to social/psychological pain, by increasing dorsolateral prefrontal cortex activation in order to regulate amygdala activation. In addition, abnormal hyperactivation of the insula is a possible trait marker of BPD, and might contribute to modified pain sensitivity. When considering psychological pain in BPD patients, neuroanatomical studies have shown a hyper-responsive subcortical limbic network and a deficient regulatory control system operating through anterior brain regions. Promising therapeutic strategies should target neuroanatomical and neurobiological dysfunctions, which lead to altered pain perception in BPD patients.
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Affiliation(s)
- Déborah Ducasse
- Department of Psychiatric Emergencies and Post Emergencies, Lapeyronie Hospital, Academic Hospital of Montpellier, UM1 University of Montpellier, INSERM U1061, 191 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France,
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Ducasse D, Fond G. [Communicating effectively: neuro-linguistic programming in the psychiatric interview]. Soins Psychiatr 2014:36-39. [PMID: 24741829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Neuro-linguistic programming is a set of practices and knowledge which seeks to "model" and then imitate the best communication practices. Applying the key concepts to the care relationship in mental health care helps to improve the quality of the contact, the clarity of the communication and to create an openness to change.
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Ducasse D, Fond G. Troubles obsessionnels compulsifs résistants et antipsychotiques : données neurobiologiques et thérapeutiques actuelles. Annales Médico-psychologiques, revue psychiatrique 2013. [DOI: 10.1016/j.amp.2013.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Fond G, Micoulaud-Franchi JA, Macgregor A, Ducasse D. [Manipulation in the exercise of psychiatric interviews]. Encephale 2013; 40:203-7. [PMID: 23810754 DOI: 10.1016/j.encep.2013.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 02/04/2013] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The term "manipulation" is defined as "getting someone to behave otherwise than he spontaneously would". Unlike cognitive therapies, it does not involve cognitive functioning and may increase psychotherapies' efficiency. METHOD In the absence of data in the scientific literature (Medline and Web of Science), we propose a synthesis of theoretical data from social psychology with a reflection on its applications in the daily practice of psychiatry. RESULTS Firstly we present auto-manipulation: the "chilling effect" is the fact that people tend to keep to a decision and to duplicate it, even if it does not work. The commitment of the patient, i.e., the degree to which he/she identifies with his/her act, will be even stronger if the patient's sense of freedom is high. The rationalization process is the ability for individuals to revisit their beliefs after being forced to issue a behavior (that he/she did not adhere to) to justify it a posteriori. In the second part, we present techniques for hetero-manipulation. Priming is to ask about a low effort to "initiate" the behavior. The lure technique is to hide convenience or invent fictitious benefits of a product, but is not ethical. The labeling technique is to assign an individual to a positive value regardless of his or her behavior, which increases the probability of emission of positive behaviors. The touch technique, whatever the cultural context, encourages a patient to have more confidence in his/her therapist and to make them friendly towards the person involved by creating a positive mood, reduces stress in patients before surgery, and improve the academic performance of students. DISCUSSION AND CONCLUSION We propose reflections on the application of these concepts in daily practice in the psychiatric interview. These techniques seem fundamental in improving therapeutic alliance and the likelihood of good compliance in our patients, and should be known to all practitioners.
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Affiliation(s)
- G Fond
- Inserm U955, Éq. psychiatrie génétique, Fondation FondaMental (Fondation de coopération scientifique en santé mentale), pôle de psychiatrie du groupe des hôpitaux universitaires H.-Mondor, hôpital A.-Chevenier, université Paris Est-Créteil, 40, rue de Mesly, 94010 Créteil, France; Inserm 1061, service universitaire de psychiatrie, université Montpellier 1, CHU, 34000 Montpellier, France.
| | - J-A Micoulaud-Franchi
- Unité de neurophysiologie, psychophysiologie et neurophénomenologie (UNPN), Solaris, pôle de psychiatrie universitaire, hôpital Sainte-Marguerite, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France; UMR CNRS 7291, laboratoire de neurosciences cognitives (LNC), 31 Aix-Marseille université, site St-Charles, 3, place Victor-Hugo, 13331 Marseille cedex 3, France
| | - A Macgregor
- Inserm 1061, service universitaire de psychiatrie, université Montpellier 1, CHU, 34000 Montpellier, France
| | - D Ducasse
- Inserm 1061, service universitaire de psychiatrie, université Montpellier 1, CHU, 34000 Montpellier, France
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Ducasse D, Olie E, Courtet P. 987 – Burning mouth syndrome: current clinical,physiopathologic and therapeutic data. Eur Psychiatry 2013. [DOI: 10.1016/s0924-9338(13)76123-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Fond G, Ducasse D, Attal J, Larue A, Macgregor A, Brittner M, Capdevielle D. [Charisma and leadership: new challenges for psychiatry]. Encephale 2012; 39:445-51. [PMID: 23246329 DOI: 10.1016/j.encep.2012.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 08/06/2012] [Indexed: 11/26/2022]
Abstract
INTRODUCTION New challenges arise in medicine, particularly in psychiatry. In the near future, psychiatrists' role may evolve into management of mental health care teams (GPs, nurses, psychologists…) thus creating the need for charisma and leadership. Charisma is defined as « a quality that allows it's possessor to exercise influence, authority over a group »; leadership as « the function, the position of chief, and by extension, a dominant position ». AIM OF THE STUDY To offer some reflections on charisma and leadership and the ways to develop them in three situations common in clinical practice: dual communication (between caregivers or with patients), oral communication (e.g., during a symposium) and managing a mental health care team. METHOD Medline (1966-hits) and Web of Science (1975-hits) were explored according to the PRISMA criteria. The research paradigm was [(psychiatrist OR physician) AND mental health AND (leadership OR charisma)]. RESULTS Two hundred and eighty articles were found, but only 34 corresponded to our subject and were included in the qualitative analysis. The leader must first ask himself/herself about his/her vision of the future, so as to share it with passion with his/her mental health team. Charisma and leadership are based on several values, among which we can mention: providing understandable, personalized care for the patient, in continuity and confidentiality; adapting care to the general population's request, maintaining one's own physical and mental health, submitting one's daily practice to peer review, engaging in continuous improvement of one's practices in response to new requirements, and recognizing that research and instruction are part of an M.D's professional obligations. The clinician will work on ways to develop his/her own charisma, through interactions with peers and team members, the care of his/her appearance (especially for first meetings) and workplace, and through positive reinforcement (some cognitive-behavioral techniques like assertiveness have been proposed to enhance the charisma, e.g., visualization and affirmation). Leadership does not depend on hierarchical position and administrative responsibilities: leaders should learn to manage and harmonize the different types of personalities within his/her team, paying special attention to passive-aggressive attitudes. We recall here some techniques to improve charisma during oral communication, such as making relationships with people by calling them by their names, making reference to things and people that the audience can identify with (like sport or cooking), using one's own style without trying to imitate someone else, focusing on one major idea, being brief and using anecdotes, using silences effectively and finally having good non-verbal communication. The conclusion should never be neglected, as an audience especially remembers the beginning and the end of a presentation. Although some features are common to all charismatic leaders (dominance, self-confidence, high energy level), a recent theory of leadership (called contingency theory) seeks to examine how different leadership styles can adapt to circumstances. This theory focuses more on the vision, passion, determination and courage of the leader and depends not only on their intrinsic qualities. No research has indeed shown individual characteristics that differentiate leaders from followers. However, doctors have not been prepared in their training to acquire leadership skills that they can use to adapt to the circumstances of their clinical practice. The most important qualities expected of a leader according to the current leadership theorists are: listening, communication, stress management, development of other's capacities, feedback, introspection and risk taking. Moreover, leadership involves positive reinforcement of the team while maintaining the feeling of individual autonomy, and being able to take an innovative decision alone with shared optimism. There is no need to have great management responsibilities in order to succeed in leadership. We reiterate the importance for a charismatic leader to smile, to be able to mock oneself and to regulate one's emotions. CONCLUSION Charisma seems to be an essential dimension for effective leadership and team management. Beyond psychiatry, we believe these reflections to be useful for all branches of medicine.
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Affiliation(s)
- G Fond
- Université Montpellier 1, Montpellier 34000, France; Institut national de la santé et de la recherche médicale (Inserm), U1061, Montpellier 34093, France; Service universitaire de psychiatrie adulte, hôpital La Colombière, CHU de Montpellier, 39, avenue Charles-Flahault, 34295 Montpellier cedex 05, France.
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Ducasse D, Capdevielle D, Attal J, Larue A, Macgregor A, Brittner M, Fond G. [Blood-injection-injury phobia: Physochophysiological and therapeutical specificities]. Encephale 2012; 39:326-31. [PMID: 23095595 DOI: 10.1016/j.encep.2012.06.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 06/27/2012] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Seventy-five percent of patients with blood-injection-injury phobia (BII-phobia) report a history of fainting in response to phobic stimuli. This specificity may lead to medical conditions remaining undiagnosed and untreated, incurring considerable cost for the individual and society. The psychophysiology of BII-phobia remains poorly understood and the literature on effective treatments has been fairly sparse. Aims of the systematic review: to synthesize the psychophysiology of BII-phobia and to propose a systematic review of the literature on effectiveness of different treatments evaluated in this indication. RESULTS Firstly, the most distinct feature of the psychophysiology of BII-phobia is its culmination in a vasovagal syncope, which has been described as biphasic. The initial phase involves a sympathetic activation as is typically expected from fear responses of the fight-flight type. The second phase is characterized by a parasympathetic activation leading to fainting, which is associated with disgust. Subjects with syncope related to BII-phobia have an underlying autonomic dysregulation predisposing them to neurally mediated syncope, even in the absence of any blood or injury stimulus. Many studies report that BII-phobic individuals have a higher level of disgust sensitivity than individuals without any phobia. Secondly, behavioral psychotherapy techniques such as exposure only, applied relaxation, applied tension, and tension only, have demonstrated efficacy with no significant difference between all these techniques. The disgust induction has not improved effectiveness of exposure. CONCLUSION We have explained the psychophysiology of BII-phobia, the understanding of which is required to study and validate specific techniques, in order to improve the prognosis of this disorder, which is a public health issue.
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Affiliation(s)
- D Ducasse
- Inserm U1061 neuropsychiatrie, recherche épidémiologique et clinique, université Montpellier 1, 34000 Montpellier, France; Institut national de la santé et de la recherche médicale (Inserm), U1061, 34093 Montpellier, France; Service universitaire de psychiatrie adulte, hôpital La Colombière, CHU de Montpellier, 39, avenue Charles-Flahault, 34295 Montpellier cedex 05, France
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Fond G, Capdevielle D, Macgregor A, Attal J, Larue A, Brittner M, Ducasse D, Boulenger JP. [Toxoplasma gondii: a potential role in the genesis of psychiatric disorders]. Encephale 2012; 39:38-43. [PMID: 23095600 DOI: 10.1016/j.encep.2012.06.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 03/14/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Toxoplasma gondii is the most common protozoan parasite in developed nations. Up to 43% of the French population may be infected, depending on eating habits and exposure to cats, and almost one third of the world human's population may be infected. Two types of infection have been described: a congenital form and an acquired form. Although the medical profession treats these latent cases as asymptomatic and clinically unimportant, results of animal studies and recent studies of personality profiles, behavior, and psychomotor performance have led to reconsider this assumption. PRECLINICAL DATA Among rats: parasite cysts are more abundant in amygdalar structures than those found in other regions of the brain. Infection does not influence locomotion, anxiety, hippocampal-dependent learning, fear conditioning (or its extinction) and neophobia in rats. Rats' natural predator is the cat, which is also T. gondii's reservoir. Naturally, rats have an aversion to cat urine, but the parasite suppresses this aversion in rats, thus influencing the infection cycle. Tachyzoites may invade different types of nervous cells, such as neurons, astrocytes and microglial cells in the brain, and Purkinje cells in cerebellum. Intracellular tachyzoites manipulate several signs for transduction mechanisms involved in apoptosis, antimicrobial effectors functions, and immune cell maturation. Dopamine levels are 14% higher in mice with chronic infections. These neurochemical changes may be factors contributing to mental and motor abnormalities that accompany or follow toxoplasmosis in rodents and possibly in humans. Moreover, the antipsychotic haloperidol and the mood stabilizer valproic acid most effectively inhibit Toxoplasma growth in vitro with synergistic activity. CLINICAL DATA The effects of the parasite are not due to the manipulation in an evolutionary sense but merely due to neuropathological or neuroimmunological effects of the parasite's presence. Toxoplasmosis and schizophrenia: epidemiological studies point to a role for toxoplasmosis in schizophrenia's etiology, probably during pregnancy and early life, this association being congruent with studies in animal models indicating that animal exposures of the developing brain to infectious agents or immune modulating agents can be associated with behavioral changes that do not appear until the animal reaches full maturity. Psychiatric patients have increased rates of toxoplasmic antibodies, the differences between cases and controls being greatest in individuals who are assayed near the time of the onset of their symptoms. The increase of dopamine in the brain of infected subjects can represent the missing link between toxoplasmosis and schizophrenia. Toxoplasmosis and Obsessive Compulsive Disorder (OCD): the seropositivity rate for anti-T. gondii IgG antibodies among OCD patients is found to be significantly higher than the rate in healthy volunteers. Infection of basal ganglia may be implicated in the pathogenesis of OCD among Toxoplasma seropositive subjects. Toxoplasmosis and personality: infected men appear to be more dogmatic, less confident, more jealous, more cautious, less impulsive and more orderly than others. Conversely, infected women seem warmest, more conscientious, more insecure, more sanctimonious and more persistent than others. It is possible that differences in the level of testosterone may be responsible for the observed behavioral differences between Toxoplasma-infected and Toxoplasma-free subjects. CONCLUSION In the future two major avenues for research seem essential. On one hand, prospective studies and research efforts must still be carried out to understand the mechanisms by which the parasite induces these psychiatric disorders. On the other hand, it has not yet been demonstrated that patients with positive toxoplasmic serology may better respond to haloperidol's or valproic acid's antiparasitic activity. These results may appear as a major issue in the drug's prescribing choices and explain variability in response to the treatment of patients with schizophrenia that is not explained by the genetic polymorphism.
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Affiliation(s)
- G Fond
- Université Montpellier 1, 34006 Montpellier, France.
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Fond G, Macgregor A, Attal J, Larue A, Brittner M, Ducasse D, Capdevielle D. Antipsychotic drugs: pro-cancer or anti-cancer? A systematic review. Med Hypotheses 2012; 79:38-42. [PMID: 22543071 DOI: 10.1016/j.mehy.2012.03.026] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 03/04/2012] [Accepted: 03/22/2012] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Important data was recently published on the potential genotoxic or carcinogenic effects of antipsychotics, as well as on their cytotoxic properties on cancer cells, that must be considered by psychiatrists in the benefit/risk ratio of their prescriptions. AIM OF THE STUDY To answer whether or not antipsychotics, as a class or only some specific molecules, may influence cancer risk among treated patients. METHODS ELIGIBILITY CRITERIA: All studies (in vitro, animal studies and human studies) concerning effects of antipsychotic drugs on cancer development were included. The search paradigm [neoplasms AND (antipsychotic agents OR neuroleptic OR phenothiazine)] was applied to Medline (1966-present) and Web of Science (1975-present). RESULTS Ninety-three studies were included in the qualitative synthesis. Results can be summarized as follows: (1) patients with schizophrenia may be less likely to develop cancer than the general population, (2) antipsychotics as a class cannot be considered at the moment as at risk for cancer, even if some antipsychotics have shown carcinogenic properties among rodents, (3) phenothiazines seem to have antiproliferative properties that may be useful in multidrug augmentation strategies in various cancer treatments, but their bad tolerance may decrease usage amongst non-psychotic patients, and (4) clozapine appears to have a separate status given that this molecule shows antiproliferative effects implied in agranulocytosis as well as a potential increased risk for leukemia. CONCLUSION Benefit/risk ratio regarding cancer risk is in favor of treating patients with schizophrenia with antipsychotic drugs. The practicing clinician should be reassuring on the subject of cancer risk due to antipsychotic drugs.
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Affiliation(s)
- G Fond
- Université Montpellier 1, Montpellier F-34000, France.
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