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Chancel R, Lopez-Castroman J, Baca-Garcia E, Mateos Alvarez R, Courtet P, Conejero I. Biomarkers of Bipolar Disorder in Late Life: An Evidence-Based Systematic Review. Curr Psychiatry Rep 2024; 26:78-103. [PMID: 38470559 DOI: 10.1007/s11920-024-01483-7] [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] [Accepted: 01/09/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE OF REVIEW Review the current evidence on biomarkers for bipolar disorder in the older adults. We conducted a systematic search of PubMed MEDLINE, PsycINFO, and Web of Science databases using the MeSH search terms "Biomarkers", "Bipolar Disorder", "Aged" and and "Aged, 80 and over". Studies were included if they met the following criteria: (1) the mean age of the study population was 50 years old or older, (2) the study included patients with bipolar disorder, and (3) the study examined one type of biomarkers or more including genetic, neuroimaging, and biochemical biomarkers. Reviews, case reports, studies not in English and studies for which no full text was available were excluded. A total of 26 papers were included in the final analysis. RECENT FINDINGS Genomic markers of bipolar disorder in older adults highlighted the implication of serotonin metabolism, while the expression of genes involved in angiogenesis was dysregulated. Peripheral blood markers were mainly related with low grade inflammation, axonal damage, endothelial dysfunction, and the dysregulation of the HPA axis. Neuroanatomical markers reflected a dysfunction of the frontal cortex, a loss of neurones in the anterior cingulate cortex and a reduction of the hippocampal volume (in patients older than 50 years old). While not necessarily limited to older adults, some of them may be useful for differential diagnosis (neurofilaments), disease staging (homocysteine, BDNF) and the monitoring of treatment outcomes (matrix metalloproteinases). Our review provides a comprehensive overview of the current evidence on biomarkers for bipolar disorder in the older adults. The identification of biomarkers may aid in the diagnosis, treatment selection, and monitoring of bipolar disorder in older adults, ultimately leading to improved outcomes for this population. Further research is needed to validate and further explore the potential clinical utility of biomarkers in this population.
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Affiliation(s)
- R Chancel
- PSNREC, Univ Montpellier, INSERM, CHU de Montpellier, Montpellier, France
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
| | - J Lopez-Castroman
- Department of Psychiatry, Nimes University Hospital, Nimes, France
- Department of Signal Theory and Communications, Carlos III University, Madrid, Spain
- Institut de Génomique Fonctionnelle, University of Montpellier, CNRS-INSERM, Montpellier, France
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - E Baca-Garcia
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
- Department of Psychiatry, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
- Universidad Autónoma de Madrid, Madrid, Spain
- Department of Psychiatry, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
- Department of Psychiatry, Hospital Universitario Central de Villalba, Madrid, Spain
- Department of Psychiatry, Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain
- Universidad Católica del Maude, Talca, Chile
- CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
| | - R Mateos Alvarez
- Department of Psychiatry, University of Santiago de Compostela, Santiago de Compostela, Spain
- Psychogeriatric Unit, CHUS University Hospital, Santiago de Compostela, Spain
| | - Ph Courtet
- PSNREC, Univ Montpellier, INSERM, CHU de Montpellier, Montpellier, France
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
| | - I Conejero
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain.
- Universidad Autónoma de Madrid, Madrid, Spain.
- Department of Psychiatry, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
- Department of Psychiatry, CHU Nîmes, PSNREC, INSERM, University of Montpellier, Nîmes, France.
- Pôle de psychiatrie, CHU Nîmes, Rue du Professeur Robert Debré, 30900, Nîmes, France.
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Roger C, Ling L, Petrier M, Elotmani L, Atchade E, Allaouchiche B, Aubrun F, Constantin JM, Dahyot-Fizelier C, Delhaye N, Dupont H, Fischer MO, Garnier M, Gayat E, Ichai C, Jaber S, Morel J, Plaud B, Rimmelé T, Robin S, Saba R, Joynt GM, Lefrant JY, Fabbro-Peray P, Lipman J, Conejero I, Laupland K. Occurrences of post-traumatic stress disorder, anxiety, depression, and burnout syndrome in ICU staff workers after two-year of the COVID-19 pandemic: the international PSY-CO in ICU study. Ann Gen Psychiatry 2024; 23:3. [PMID: 38172994 PMCID: PMC10765831 DOI: 10.1186/s12991-023-00488-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/10/2023] [Indexed: 01/05/2024] Open
Abstract
PURPOSE The present study aimed at assessing the prevalences of post-traumatic stress disorder (PTSD) (main objective), anxiety, depression, and burnout syndrome (BOS) and their associated factors in intensive care unit (ICU) staff workers in the second year of the COVID-19 pandemic. MATERIALS AND METHODS An international cross-sectional multicenter ICU-based online survey was carried out among the ICU staff workers in 20 ICUs across 3 continents. ICUs staff workers (both caregivers and non-caregivers) were invited to complete PCL-5, HADS, and MBI questionnaires for assessing PTSD, anxiety, depression, and the different components of BOS, respectively. A personal questionnaire was used to isolate independent associated factors with these disorders. RESULTS PCL-5, HADS, and MBI questionnaires were completed by 585, 570, and 539 responders, respectively (525 completed all questionnaires). PTSD was diagnosed in 98/585 responders (16.8%). Changing familial environment, being a non-caregiver staff worker, having not being involved in a COVID-19 patient admission, having not been provided with COVID-19-related information were associated with PTSD. Anxiety was reported in 130/570 responders (22.8%). Working in a public hospital, being a woman, being financially impacted, being a non-clinical healthcare staff member, having no theoretical or practical training on individual preventive measures, and fear of managing COVID-19 patients were associated with anxiety. Depression was reported in 50/570 responders (8.8%). Comorbidity at risk of severe COVID-19, working in a public hospital, looking after a child, being a non-caregiver staff member, having no information, and a request for moving from the unit were associated with depression. Having received no information and no adequate training for COVID-19 patient management were associated with all 3 dimensions of BOS. CONCLUSION The present study confirmed that ICU staff workers, whether they treated COVID-19 patients or not, have a substantial prevalence of psychological disorders.
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Affiliation(s)
- Claire Roger
- Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nimes University Hospital, UR‑UM103 IMAGINE, University of Montpellier, Montpellier, France
| | - Lowel Ling
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Mélissa Petrier
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nimes, IDESP, INSERM, University of Montpellier, Nîmes, France
- Biostatistics Department, Centre Hospitalier Annecy Genevois, Annecy, France
| | - Loubna Elotmani
- Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nimes University Hospital, UR‑UM103 IMAGINE, University of Montpellier, Montpellier, France
| | - Enora Atchade
- Department of Anesthesiology and Critical Care Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France
| | - Bernard Allaouchiche
- Service d'Anesthésie Réanimation, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Frédéric Aubrun
- Department of Anesthesiology and Critical Care, Hôpital de la Croix Rousse, 69317, Lyon, France
| | - Jean-Michel Constantin
- Department of Anesthesiology, Critical Care and Perioperative Medicine, Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Hôpital Pitié-Salpetrière, Paris, France
| | - Claire Dahyot-Fizelier
- Department of Anesthesia, Intensive Care and Perioperative Medicine, University Hospital of Poitiers, Poitiers, France
- INSERM U1070, Pharmacologie des Agents Anti-Infectieux, Poitiers, France
| | - Nathalie Delhaye
- Department of Anesthesiology and Critical Care Medicine, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Hervé Dupont
- Anesthesiology and Critical Care Medicine, Centre Hospitalier Universitaire d'Amiens Picardie, Amiens, France
| | - Marc-Olivier Fischer
- Normandy University, UNICAEN, CHU de Caen Normandie, Ecole Doctorale NBISE 497, Service d'Anesthésie Réanimation, Caen, France
- Institut Aquitain du Coeur, Clinique Saint Augustin, Elsan, 114 Avenue d'Arès, 33074, Bordeaux Cedex, France
| | - Marc Garnier
- Département Médico-Universitaire DREAM, Sorbonne Université, GRC 29, AP-HP, Service d'Anesthésie-Réanimation et Médecine Péri-Opératoire Rive Droite Tenon-Saint Antoine, Paris, France
- CHU de Clermont-Ferrand, Université Clermont Auvergne, Service d'Anesthésie-Réanimation et Médecine Périopératoire, 58 Rue Montalembert, 63000, Clermont-Ferrand, France
| | - Etienne Gayat
- Department of Anesthesiology and Critical Care, APHP. Nord, DMU Parabol, Université de Paris, Paris, France
- UMR-S 942 "MASCOT," Inserm, Paris, France
| | - Carole Ichai
- Département Anesthésie-Réanimation, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Samir Jaber
- Department of Anaesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, INSERM U1046, CNRS UMR, 9214, Montpellier Cedex 5, France
| | - Jérome Morel
- Surgical ICU, Saint-Etienne University Hospital, Saint-Etienne, France
- Jacques Lisfranc Medical School, Saint-Etienne University, Saint-Etienne, France
| | - Benoit Plaud
- Université Paris Cité, AP-HP. Nord, Hôpital Saint-Louis, DMU PARABOL, Service d'Anesthésie-Réanimation-CTB, 75010, Paris, France
| | - Thomas Rimmelé
- Claude Bernard Lyon 1, Centre Lyonnais d'Enseignement par la Simulation en Santé (CLESS), Lyon, France
- EA 7426, PI3 (Pathophysiology of Injury-Induced Immunosuppression), Claude Bernard University Lyon 1-Biomérieux-Hospices Civils de Lyon, Lyon, France
- Service d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Sylvaine Robin
- Department of Anesthesia and Critical Care, France Université Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | - Renee Saba
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Gavin M Joynt
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Jean-Yves Lefrant
- Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nimes University Hospital, UR‑UM103 IMAGINE, University of Montpellier, Montpellier, France.
| | - Pascale Fabbro-Peray
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nimes, IDESP, INSERM, University of Montpellier, Nîmes, France
| | - Jeffrey Lipman
- Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nimes University Hospital, UR‑UM103 IMAGINE, University of Montpellier, Montpellier, France
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD, 4029, Australia
| | - Ismael Conejero
- Department of Psychiatry, Nimes University Hospital, Nimes, France
- Laboratory of Biochemistry and Molecular Biology, Nimes University Hospital, University of Montpellier, Nimes, France
- Institut de Génomique Fonctionnelle, University of Montpellier, CNRS-INSERM, Montpellier, France
| | - Kevin Laupland
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- Queensland University of Technology (QUT), Brisbane, QLD, Australia
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Conejero I, Thouvenot E, Hingray C, Hubsch C, El-Hage W, Carle-Toulemonde G, Rotge JY, Drapier S, Drapier D, Mouchabac S. [Understanding functional neurological disorders: From biological markers to pathophysiological models]. Encephale 2023:S0013-7006(23)00085-4. [PMID: 37394415 DOI: 10.1016/j.encep.2023.06.003] [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] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/06/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVES Functional neurological disorders have witnessed intense research activity in the fields of structural and functional neuroimaging for more than twenty years. Thus, we propose a synthesis of recent research findings and etiological hypotheses that have been proposed so far. This work should help clinicians to better understand the nature of the mechanisms involved, but also help patients to increase their knowledge about the biological features underlying their functional symptoms. METHODS We carried out a narrative review of international publications dealing with neuroimaging and biology of functional neurological disorders, from 1997 to 2023. RESULTS Several brain networks underlie functional neurological symptoms. These networks play a role in the management of cognitive resources, in attentional control, emotion regulation, in agency and in the processing of interoceptive signals. The mechanisms of the stress response are also associated with the symptoms. The biopsychosocial model helps to better understand predisposing, precipitating, and perpetuating factors involved. The functional neurological phenotype results from the interaction between: i) a specific pre-existing vulnerability resulting from biological background and epigenetic modifications, and ii) exposure to stress factors, according to the stress-diathesis model. This interaction causes emotional disturbances including hypervigilance, lack of integration of sensations and affects, and emotional dysregulation. These characteristics in turn impact the cognitive, motor and affective control processes related with the functional neurological symptoms. CONCLUSIONS A better knowledge of the biopsychosocial determinants of brain network dysfunctions is necessary. Understanding them would help developing targeted treatments, but is also critical for patients care.
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Affiliation(s)
- Ismael Conejero
- Département de psychiatrie, CHU de Nîmes, PSNREC, Inserm, université de Montpellier, Nîmes, France.
| | - Eric Thouvenot
- Département de Neurologie, CHU Nîmes, université de Montpellier, institut de génomique fonctionnelle, University Montpellier, CNRS, Inserm, Montpellier, France
| | - Coraline Hingray
- Pôle hospitalo-universitaire de psychiatrie d'adultes du Grand Nancy, centre psychothérapique de Nancy, Laxou, France
| | - Cécile Hubsch
- Département de neurologie, unité Parkinson, hôpital Fondation Adolphe-de-Rothschild, Paris, France
| | - Wissam El-Hage
- Clinique psychiatrique universitaire, CHRU de Tours, Tours, France
| | - Guilhem Carle-Toulemonde
- Cabinet de psychosomatique et stimulation magnétique transcrânienne, clinique Saint-Exupéry, 31400 Toulouse, France
| | - Jean-Yves Rotge
- Service de psychiatrie d'adultes, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne université, 47-83, boulevard de l'Hôpital, 75651 Paris, France
| | - Sophie Drapier
- Département de neurologie, CHU de Rennes, CIC Inserm 1414, Rennes, France
| | - Dominique Drapier
- Département de psychiatrie adulte, CH Guillaume-Régnier, université de Rennes, Rennes, France
| | - Stéphane Mouchabac
- Département de psychiatrie, CHU Saint-Antoine, AP-HP, iCRIN Psychiatry (Infrastructure of Clinical Research in Neurosciences-Psychiatry), Institut du cerveau et de la moelle (ICM), Université Sorbonne, Inserm, CNRS, Paris, France
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Conejero I, Petrier M, Fabbro Peray P, Voisin C, Courtet P, Potier H, Elotmani L, Lafont B, Lefrant JY, Lopez Castroman J, Arbus C, Blain H. Post-traumatic stress disorder, anxiety, depression and burnout in nursing home staff in South France during the COVID-19 pandemic. Transl Psychiatry 2023; 13:205. [PMID: 37322006 DOI: 10.1038/s41398-023-02488-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 12/20/2022] [Revised: 05/15/2023] [Accepted: 05/26/2023] [Indexed: 06/17/2023] Open
Abstract
The high mortality rate in nursing homes during the COVID-19 pandemic may be linked to psychological disorders in staff. Hence, we assessed the prevalence and associated factors of probable post-traumatic stress disorder (PTSD), anxiety, depression, and burnout of nursing home staff during the COVID-19 pandemic in a cross-sectional study including 66 randomly selected nursing homes in southern France. 537 of the contacted 3 821 nursing home workers (14.0%) responded between April and October 2021. We collected information on center organization, severity of COVID-19 exposure, and socio-demographic information in an online survey. The prevalence of probable PTSD (PCL-5), anxiety and depressive disorders (Hospital Anxiety Depression Scale) and the sub-scores of burnout syndrome (Maslach Burnout Inventory Human Services Survey for Medical Personnel) were assessed. Probable PTSD was reported in 115/537 responders (21.4% (95% CI [18.0%-24.9%])). After adjustment, low-level exposure to COVID-19 in nursing home residents (AOR, 0.5; 95% CI [0.3-0.9]), fear of managing COVID-19 residents (AOR, 3.5; 95% CI [1.9-6.4]), conflicts with residents (AOR, 2.3; 95% CI, [1.2-4.4]), conflicts with colleagues (AOR, 3.6; 95% CI [1.7-8.6]), cancellation of leave (AOR, 4.8; 95% CI [2.0-11.7]) and temporary worker employment (AOR, 3.4; 95% CI [1.7-6.9]) were associated with higher prevalence of probable PTSD. The prevalence of probable anxiety and depression were 28.8% (95% CI [24.9%-32.7%]) and 10.4% (95% CI [7.8%-13.1%]), respectively. Psychological disorders were observed in nearly one third of nursing home workers during the COVID-19 pandemic. Hence, continuous surveys and preventive measures are needed in this particularly at-risk population.
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Affiliation(s)
- Ismael Conejero
- Department of Psychiatry, CHU Nîmes, PSNREC, INSERM, University of Montpellier, Nîmes, France.
| | - Melissa Petrier
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nimes, IDESP, INSERM, University of Montpellier, Nîmes, France
| | - Pascale Fabbro Peray
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nimes, IDESP, INSERM, University of Montpellier, Nîmes, France
| | - Christelle Voisin
- Agence Régionale de Santé Occitanie, Services régionaux de Toulouse, Direction de l'offre de soins et de l'autonomie, Pôle médico-social, Unité politique du vieillissement, Toulouse, France
| | - Philippe Courtet
- PSNREC, Univ Montpellier, INSERM, CHU de Montpellier, Montpellier, France
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
| | - Hugo Potier
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nimes, IDESP, INSERM, University of Montpellier, Nîmes, France
| | - Loubna Elotmani
- UR-UM103, IMAGINE, Department of Anesthesia Critical Care Emergency and Pain Medicine, CHU Nimes, University of Montpellier, Nîmes, France
| | | | - Jean-Yves Lefrant
- UR-UM103, IMAGINE, Department of Anesthesia Critical Care Emergency and Pain Medicine, CHU Nimes, University of Montpellier, Nîmes, France
| | - Jorge Lopez Castroman
- Department of Psychiatry, Nimes University Hospital, Institut de Génomique Fonctionnelle, University of Montpellier, CNRS-INSERM, Montpellier, France
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Christophe Arbus
- Toulouse University Hospital, Toulouse, France
- Inserm U1214, University of Toulouse III, Toulouse, France
| | - Hubert Blain
- Department of Internal Medicine and Geriatrics, University Hospital of Montpellier, Montpellier University, Centre Antonin Balmes, Montpellier, France
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Zúñiga A, Muñoz-Guamuro G, Boivineau L, Mayonove P, Conejero I, Pageaux GP, Altwegg R, Bonnet J. A rapid and standardized workflow for functional assessment of bacterial biosensors in fecal samples. Front Bioeng Biotechnol 2022; 10:859600. [PMID: 36072290 PMCID: PMC9444133 DOI: 10.3389/fbioe.2022.859600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 07/05/2022] [Indexed: 11/17/2022] Open
Abstract
Gut metabolites are pivotal mediators of host-microbiome interactions and provide an important window on human physiology and disease. However, current methods to monitor gut metabolites rely on heavy and expensive technologies such as liquid chromatography-mass spectrometry (LC-MS). In that context, robust, fast, field-deployable, and cost-effective strategies for monitoring fecal metabolites would support large-scale functional studies and routine monitoring of metabolites biomarkers associated with pathological conditions. Living cells are an attractive option to engineer biosensors due to their ability to detect and process many environmental signals and their self-replicating nature. Here we optimized a workflow for feces processing that supports metabolite detection using bacterial biosensors. We show that simple centrifugation and filtration steps remove host microbes and support reproducible preparation of a physiological-derived media retaining important characteristics of human feces, such as matrix effects and endogenous metabolites. We measure the performance of bacterial biosensors for benzoate, lactate, anhydrotetracycline, and bile acids, and find that they are highly sensitive to fecal matrices. However, encapsulating the bacteria in hydrogel helps reduce this inhibitory effect. Sensitivity to matrix effects is biosensor-dependent but also varies between individuals, highlighting the need for case-by-case optimization for biosensors’ operation in feces. Finally, by detecting endogenous bile acids, we demonstrate that bacterial biosensors could be used for future metabolite monitoring in feces. This work lays the foundation for the optimization and use of bacterial biosensors for fecal metabolites monitoring. In the future, our method could also allow rapid pre-prototyping of engineered bacteria designed to operate in the gut, with applications to in situ diagnostics and therapeutics.
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Affiliation(s)
- Ana Zúñiga
- Centre de Biologie Structurale (CBS), INSERM U1054, CNRS UMR5048, University of Montpellier, Montpellier, France
- *Correspondence: Ana Zúñiga, ; Jerome Bonnet,
| | - Geisler Muñoz-Guamuro
- Centre de Biologie Structurale (CBS), INSERM U1054, CNRS UMR5048, University of Montpellier, Montpellier, France
| | - Lucile Boivineau
- Hepatogastroenterology and Bacteriology Service at CHU Montpellier, University of Montpellier, Montpellier, France
| | - Pauline Mayonove
- Centre de Biologie Structurale (CBS), INSERM U1054, CNRS UMR5048, University of Montpellier, Montpellier, France
| | - Ismael Conejero
- Department of Psychiatry, CHU Nimes, University of Montpellier, Montpellier, France
| | - Georges-Philippe Pageaux
- Hepatogastroenterology and Bacteriology Service at CHU Montpellier, University of Montpellier, Montpellier, France
| | - Romain Altwegg
- Hepatogastroenterology and Bacteriology Service at CHU Montpellier, University of Montpellier, Montpellier, France
| | - Jerome Bonnet
- Centre de Biologie Structurale (CBS), INSERM U1054, CNRS UMR5048, University of Montpellier, Montpellier, France
- *Correspondence: Ana Zúñiga, ; Jerome Bonnet,
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Conejero I, Collombier L, Lopez-Castroman J, Mura T, Alonso S, Olié E, Boudousq V, Boulet F, Arquizan C, Boulet C, Wacongne A, Heitz C, Castelli C, Mouchabac S, Courtet P, Abbar M, Thouvenot E. Association between brain metabolism and clinical course of motor functional neurological disorders. Brain 2022; 145:3264-3273. [PMID: 35445242 DOI: 10.1093/brain/awac146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/03/2022] [Revised: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 11/12/2022] Open
Abstract
Features of resting brain metabolism in motor functional neurological disorder are poorly characterized. This study aimed to investigate the alterations of resting brain metabolism in a cohort of patients experiencing a first episode of motor functional neurological disorder with recent symptom onset, and their association with persistent disability after 3 months. Patients eligible for inclusion were diagnosed with first episode of motor functional neurological disorder, were free from bipolar disorder, substance use disorder, schizophrenia, psychogenic non-epileptic seizure or any chronic or acute organic neurological disorder. Exclusion criteria included current suicidal ideation, antipsychotic intake and previous history of functional neurological disorder. Nineteen patients were recruited in Psychiatry and Neurology departments from 2 hospitals. Resting brain metabolism measured with 18F-fluorodeoxyglucose positron emission computed tomography at baseline and 3 months was compared to 23 controls without neurological impairment. Disability was scored using Expanded Disability Status Scale and National Institutes of Health Stroke Scale score at baseline and 3 months. Correlations were calculated with Spearman correlation coefficient. Hypometabolism was found at baseline in bilateral frontal regions in patients versus controls, disappearing by 3 months. The patients with Expanded Disability Status Scale score improvement showed greater resting state activity of prefrontal dorsolateral cortex, right orbito-frontal cortex and bilateral frontopolar metabolism at 3 months versus other patients. The resting state metabolism of the right subgenual anterior cingular cortex at baseline was negatively correlated with improvement of motor disability (measured with Expanded Disability Status Scale) between inclusion and 3 months (r=-0.75, p = 0.0018) and with change in motor symptoms assessed with the National Institutes of Health Stroke Scale (r=-0.81, p= 0.0005). The resting state metabolism of the left subgenual anterior cingular cortex at baseline was negatively correlated with improvement in Expanded Disability Status Scale and National Institutes of Health Stroke Scale scores between inclusion and 3 months (r= -0.65, p = 0.01 and r= -0.75, p = 0.0021, respectively). The negative association between the brain metabolism of the right subgenual anterior cingular cortex at baseline and change in National Institutes of Health Stroke Scale score remained significant (r=-0.81, p= 0.0414) after correction for multiple comparisons. Our findings suggest the existence of metabolic "state markers" associated with motor disability and that brain markers are associated with motor recovery in functional neurological disorder patients.
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Affiliation(s)
- Ismael Conejero
- Department of Psychiatry, CHU Nîmes, University of Montpellier, Nîmes, France.,IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Laurent Collombier
- Department of Nuclear Medicine, CHU Nimes, University of Montpellier, Nîmes, France
| | - Jorge Lopez-Castroman
- Department of Psychiatry, CHU Nîmes, University of Montpellier, Nîmes, France.,IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Thibault Mura
- Department of Biostatistics, Clinical Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Sandrine Alonso
- Department of Biostatistics, Clinical Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Emilie Olié
- IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France.,Department of Emergency Psychiatry & Acute Care, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Vincent Boudousq
- Department of Nuclear Medicine, CHU Nimes, University of Montpellier, Nîmes, France
| | - Fabrice Boulet
- Department of Psychiatry, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Caroline Arquizan
- Department of Neurology, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Charlotte Boulet
- Department of Psychiatry, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Anne Wacongne
- Department of Neurology, CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Camille Heitz
- Department of Neurology, CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Christel Castelli
- Department of Biostatistics, Clinical Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nîmes, Univ Montpellier, Nîmes, France
| | | | - Philippe Courtet
- IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France.,Department of Emergency Psychiatry & Acute Care, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Mocrane Abbar
- Department of Psychiatry, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Eric Thouvenot
- Department of Neurology, CHU Nîmes, Univ Montpellier, Nîmes, France.,Institut de Génomique Fonctionnelle, Univ. Montpellier, CNRS, INSERM, F-34094 Montpellier Cedex 5, France
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7
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Boulet C, Lopez-Castroman J, Mouchabac S, Olié E, Courtet P, Thouvenot E, Abbar M, Conejero I. Stress response in dissociation and conversion disorders: A systematic review. Neurosci Biobehav Rev 2021; 132:957-967. [PMID: 34740754 DOI: 10.1016/j.neubiorev.2021.10.049] [Citation(s) in RCA: 1] [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: 07/02/2020] [Revised: 09/14/2021] [Accepted: 10/28/2021] [Indexed: 12/28/2022]
Abstract
Dissociative disorders (DD) and conversion disorders (CD) are frequent in general and psychiatric populations. Some evidence suggest that the hypothalamic-pituitary axis (HPA) and autonomic nervous system (ANS) are dysregulated in both disorders. We carried out a systematic review of the literature to summarize the existing knowledge on the stress response, via HPA and/or ANS, in patients with DD, CD, or dissociative symptoms. We systematically searched Medline and Web of Science using the Medical Subject Headings related to stress axis, CD, DD, and dissociative symptoms following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results suggest that in participants without psychiatric history, high cortisol secretion is related to high dissociation scores. Conversely the stress system might be blunted in patients with post-traumatic stress disorder who develop dissociative symptoms. Stress response changes seem to be associated with the emergence and persistence of dissociative and conversion disorders. Hence, monitoring the stress response and examining closely the history of stress exposure in DD and CD should be encouraged in future larger studies.
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Affiliation(s)
- Charlotte Boulet
- Department of Psychiatry, Nîmes University Hospital, Nîmes, France
| | - Jorge Lopez-Castroman
- Department of Psychiatry, Nîmes University Hospital, Nîmes, France; IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Stéphane Mouchabac
- Saint-Antoine Hospital Center APHP, Department of Psychiatry, iCRIN Psychiatry (Infrastructure of Clinical Research in Neurosciences-Psychiatry), Brain and Spine Institute (ICM), Sorbonne University, INSERM, CNRS, 75013, Paris, France
| | - Emilie Olié
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital CHU Montpellier, IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Philippe Courtet
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital CHU Montpellier, IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Eric Thouvenot
- Department of Neurology, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Mocrane Abbar
- Department of Psychiatry, Nîmes University Hospital, Nîmes, France
| | - Ismael Conejero
- Department of Psychiatry, Nîmes University Hospital, Nîmes, France; IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France; Centre de Biochimie Structurale, University of Montpellier, Montpellier, France.
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8
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Mouchabac S, Maatoug R, Conejero I, Adrien V, Bonnot O, Millet B, Ferreri F, Bourla A. In Search of Digital Dopamine: How Apps Can Motivate Depressed Patients, a Review and Conceptual Analysis. Brain Sci 2021; 11:1454. [PMID: 34827453 PMCID: PMC8615613 DOI: 10.3390/brainsci11111454] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Depression is highly prevalent and causes considerable suffering and disease burden despite the existence of wide-ranging treatment options. Momentary assessment is a promising tool in the management of psychiatric disorders, and particularly depression. It allows for a real-time evaluation of symptoms and an earlier detection of relapse or treatment efficacy. Treating the motivational and hedonic aspects of depression is a key target reported in the literature, but it is time-consuming in terms of human resources. Digital Applications offer a major opportunity to indirectly regulate impaired motivational circuits through dopaminergic pathways. OBJECTIVE The main objective of this review was twofold: (1) propose a conceptual and critical review of the literature regarding the theoretical and technical principles of digital applications focused on motivation in depression, activating dopamine, and (2) suggest recommendations on the relevance of using these tools and their potential place in the treatment of depression. MATERIAL AND METHODS A search for words related to "dopamine", "depression", "smartphone apps", "digital phenotype" has been conducted on PubMed. RESULTS Ecological momentary interventions (EMIs) differ from traditional treatments by providing relevant, useful intervention strategies in the context of people's daily lives. EMIs triggered by ecological momentary assessment (EMA) are called "Smart-EMI". Smart-EMIs can mimic the "dopamine reward system" if the intervention is tailored for motivation or hedonic enhancement, and it has been shown that a simple reward (such as a digital badge) can increase motivation. DISCUSSION The various studies presented support the potential interest of digital health in effectively motivating depressed patients to adopt therapeutic activation behaviors. Finding effective ways to integrate EMIs with human-provided therapeutic support may ultimately yield the most efficient and effective intervention method. This approach could be a helpful tool to increase adherence and motivation. CONCLUSION Smartphone apps can motivate depressed patients by enhancing dopamine, offering the opportunity to enhance motivation and behavioral changes, although longer term studies are still needed.
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Affiliation(s)
- Stephane Mouchabac
- Department of Psychiatry, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, 75012 Paris, France
- iCRIN (Infrastructure for Clinical Research in Neurosciences), Brain Institute (ICM), Sorbonne Université, INSERM, CNRS, 75013 Paris, France
| | - Redwan Maatoug
- iCRIN (Infrastructure for Clinical Research in Neurosciences), Brain Institute (ICM), Sorbonne Université, INSERM, CNRS, 75013 Paris, France
- Sorbonne Université, AP-HP, Service de Psychiatrie Adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, 75013 Paris, France
| | - Ismael Conejero
- Department of Psychiatry, CHU Nîmes, University of Montpellier, 30090 Nîmes, France
- Inserm, Unit 1061 "Neuropsychiatry: Epidemiological and Clinical Research", 34000 Montpellier, France
| | - Vladimir Adrien
- Department of Psychiatry, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, 75012 Paris, France
- iCRIN (Infrastructure for Clinical Research in Neurosciences), Brain Institute (ICM), Sorbonne Université, INSERM, CNRS, 75013 Paris, France
| | - Olivier Bonnot
- CHU de Nantes, Department of Child and Adolescent Psychiatry, 44093 Nantes, France
- Pays de la Loire Psychology Laboratory, EA 4638, 44000 Nantes, France
| | - Bruno Millet
- iCRIN (Infrastructure for Clinical Research in Neurosciences), Brain Institute (ICM), Sorbonne Université, INSERM, CNRS, 75013 Paris, France
- Sorbonne Université, AP-HP, Service de Psychiatrie Adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, 75013 Paris, France
| | - Florian Ferreri
- Department of Psychiatry, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, 75012 Paris, France
- iCRIN (Infrastructure for Clinical Research in Neurosciences), Brain Institute (ICM), Sorbonne Université, INSERM, CNRS, 75013 Paris, France
| | - Alexis Bourla
- Department of Psychiatry, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, 75012 Paris, France
- iCRIN (Infrastructure for Clinical Research in Neurosciences), Brain Institute (ICM), Sorbonne Université, INSERM, CNRS, 75013 Paris, France
- Jeanne d'Arc Hospital, INICEA Korian, 94160 Saint-Mandé, France
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9
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Chang HJ, Zúñiga A, Conejero I, Voyvodic PL, Gracy J, Fajardo-Ruiz E, Cohen-Gonsaud M, Cambray G, Pageaux GP, Meszaros M, Meunier L, Bonnet J. Programmable receptors enable bacterial biosensors to detect pathological biomarkers in clinical samples. Nat Commun 2021; 12:5216. [PMID: 34471137 PMCID: PMC8410942 DOI: 10.1038/s41467-021-25538-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/12/2021] [Indexed: 12/17/2022] Open
Abstract
Bacterial biosensors, or bactosensors, are promising agents for medical and environmental diagnostics. However, the lack of scalable frameworks to systematically program ligand detection limits their applications. Here we show how novel, clinically relevant sensing modalities can be introduced into bactosensors in a modular fashion. To do so, we have leveraged a synthetic receptor platform, termed EMeRALD (Engineered Modularized Receptors Activated via Ligand-induced Dimerization) which supports the modular assembly of sensing modules onto a high-performance, generic signaling scaffold controlling gene expression in E. coli. We apply EMeRALD to detect bile salts, a biomarker of liver dysfunction, by repurposing sensing modules from enteropathogenic Vibrio species. We improve the sensitivity and lower the limit-of-detection of the sensing module by directed evolution. We then engineer a colorimetric bactosensor detecting pathological bile salt levels in serum from patients having undergone liver transplant, providing an output detectable by the naked-eye. The EMeRALD technology enables functional exploration of natural sensing modules and rapid engineering of synthetic receptors for diagnostics, environmental monitoring, and control of therapeutic microbes.
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Affiliation(s)
- Hung-Ju Chang
- Centre de Biologie Structurale (CBS), INSERM U1054, CNRS UMR5048, University of Montpellier, Montpellier, France
| | - Ana Zúñiga
- Centre de Biologie Structurale (CBS), INSERM U1054, CNRS UMR5048, University of Montpellier, Montpellier, France
| | - Ismael Conejero
- Centre de Biologie Structurale (CBS), INSERM U1054, CNRS UMR5048, University of Montpellier, Montpellier, France
- Neuropsychiatry: Epidemiological and Clinical Research, Inserm Unit 1061, Montpellier, France
- Department of Psychiatry, CHU Nimes, University of Montpellier, Montpellier, France
| | - Peter L Voyvodic
- Centre de Biologie Structurale (CBS), INSERM U1054, CNRS UMR5048, University of Montpellier, Montpellier, France
| | - Jerome Gracy
- Centre de Biologie Structurale (CBS), INSERM U1054, CNRS UMR5048, University of Montpellier, Montpellier, France
| | - Elena Fajardo-Ruiz
- Centre de Biologie Structurale (CBS), INSERM U1054, CNRS UMR5048, University of Montpellier, Montpellier, France
| | - Martin Cohen-Gonsaud
- Centre de Biologie Structurale (CBS), INSERM U1054, CNRS UMR5048, University of Montpellier, Montpellier, France
| | - Guillaume Cambray
- Centre de Biologie Structurale (CBS), INSERM U1054, CNRS UMR5048, University of Montpellier, Montpellier, France
| | - Georges-Philippe Pageaux
- Department of Hepatogastroenterology, Hepatology and Liver Transplantation Unit, Saint Eloi Hospital, University of Montpellier, Montpellier, France
| | - Magdalena Meszaros
- Department of Hepatogastroenterology, Hepatology and Liver Transplantation Unit, Saint Eloi Hospital, University of Montpellier, Montpellier, France
| | - Lucy Meunier
- Department of Hepatogastroenterology, Hepatology and Liver Transplantation Unit, Saint Eloi Hospital, University of Montpellier, Montpellier, France
| | - Jerome Bonnet
- Centre de Biologie Structurale (CBS), INSERM U1054, CNRS UMR5048, University of Montpellier, Montpellier, France.
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10
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Conejero I, Dubois J, Gutierrez LA, Delrieu J, Arbus C, Garcia M, Lopez-Castroman J, Courtet P, Gabelle A. Amyloid Burden and Depressive Symptom Trajectories in Older Adults at Risk of Developing Cognitive Decline. J Clin Psychiatry 2021; 82. [PMID: 34352166 DOI: 10.4088/jcp.20m13410] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: Little is known about the amyloid load impact on depressive symptoms or disorders, although it can modulate the cognitive trajectory in older adults. Here, we analyzed, in individuals at risk of Alzheimer's dementia, the relationship between amyloid load and depressive symptoms changes over time. Methods: This study included ≥ 70-year-old participants from the French Multidomain Alzheimer Preventive Trial (MAPT) (May 2008 to February 2011) who underwent brain amyloid load measurement by β-amyloid-[18F] florbetapir-PET at baseline and had spontaneous memory complaints and/or limitation in 1 instrumental activity of daily living or slow walking gait (N = 264). Symptoms of depression were measured with the Geriatric Depression Scale-15 items (GDS) at baseline and 6, 12, 24, and 36 months of follow-up. Four GDS factors were determined by principal component analysis (PCA): life satisfaction, level of apathy, self-esteem, and anxiety. Amyloid positive status was defined based on the amyloid load in 6 Alzheimer's dementia-related regions. Regional amyloid load was based on 3 dimensions defined by PCA. The longitudinal links between depressive symptomatology and amyloid load (ie, cortical AV45 and amyloid load dimensions) were analyzed using linear mixed-multivariate models. Results: At baseline, 11% of participants had depressive symptoms (GDS > 5) and 34% were amyloid-positive. The global amyloid load was not associated with worsening of the total GDS score but only with the impairment of self-esteem factor during the follow-up after adjustment for age, sex, education level, and drug intake, dementia, and Mini-Mental State Examination score (β = -0.029, 95% CI [-0.052 to -0.007], P = .003). Regional amyloid load in hippocampus and bilateral caudate nucleus protected significantly from self-esteem decrease during the 3-year follow-up. Conclusions: Although amyloid load shows no impact on GDS score in subjects at risk of Alzheimer's dementia, amyloid load may influence the progression of depressive dimension (self-esteem) with different effects according to the regional burden. Trial Registration: ClinicalTrials.gov identifier: NCT00672685.
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Affiliation(s)
- Ismael Conejero
- Nîmes University Hospital, Nîmes, France; IGF, Univ Montpellier, CNRS, INSERM, Montpellier, France.,Corresponding author: Ismael Conejero, MD, PhD, Department of Psychiatry, CHU Nîmes, Pl du Professeur Robert Debré, 30900 Nîmes, France
| | - Jonathan Dubois
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital CHU Montpellier, IGF, Univ Montpellier, CNRS, INSERM, Montpellier, France
| | - Laure-Anne Gutierrez
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital CHU Montpellier, IGF, Univ Montpellier, CNRS, INSERM, Montpellier, France
| | - Julien Delrieu
- INSERM UMR 1027, Toulouse, France; University of Toulouse III, Toulouse, France; Gérontopôle, Department of Geriatrics, Toulouse (University Hospital) CHU, Purpan University Hospital, Toulouse, France
| | - Christophe Arbus
- Toulouse University Hospital, Toulouse, France; Inserm U1214, University of Toulouse III, Toulouse, France
| | - Magalie Garcia
- INSERM UMR 1027, Toulouse, France; University of Toulouse III, Toulouse, France; Gérontopôle, Department of Geriatrics, Toulouse (University Hospital) CHU, Purpan University Hospital, Toulouse, France
| | - Jorge Lopez-Castroman
- Nîmes University Hospital, Nîmes, France; IGF, Univ Montpellier, CNRS, INSERM, Montpellier, France
| | - Philippe Courtet
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital CHU Montpellier, IGF, Univ Montpellier, CNRS, INSERM, Montpellier, France
| | - Audrey Gabelle
- Department of Neurology, Memory Research and Resources Center, Montpellier University Hospital, Montpellier, France
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11
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Mouchabac S, Conejero I, Lakhlifi C, Msellek I, Malandain L, Adrien V, Ferreri F, Millet B, Bonnot O, Bourla A, Maatoug R. Improving clinical decision-making in psychiatry: implementation of digital phenotyping could mitigate the influence of patient’s and practitioner’s individual cognitive biases. Dialogues in Clinical Neuroscience 2021; 23:52-61. [PMID: 35860175 PMCID: PMC9286737 DOI: 10.1080/19585969.2022.2042165] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
High stake clinical choices in psychiatry can be impacted by external irrelevant factors. A strong understanding of the cognitive and behavioural mechanisms involved in clinical reasoning and decision-making is fundamental in improving healthcare quality. Indeed, the decision in clinical practice can be influenced by errors or approximations which can affect the diagnosis and, by extension, the prognosis: human factors are responsible for a significant proportion of medical errors, often of cognitive origin. Both patient’s and clinician’s cognitive biases can affect decision-making procedures at different time points. From the patient’s point of view, the quality of explicit symptoms and data reported to the psychiatrist might be affected by cognitive biases affecting attention, perception or memory. From the clinician’s point of view, a variety of reasoning and decision-making pitfalls might affect the interpretation of information provided by the patient. As personal technology becomes increasingly embedded in human lives, a new concept called digital phenotyping is based on the idea of collecting real-time markers of human behaviour in order to determine the ‘digital signature of a pathology’. Indeed, this strategy relies on the assumption that behaviours are ‘quantifiable’ from data extracted and analysed through connected tools (smartphone, digital sensors and wearable devices) to deduce an ‘e-semiology’. In this article, we postulate that implementing digital phenotyping could improve clinical reasoning and decision-making outcomes by mitigating the influence of patient’s and practitioner’s individual cognitive biases.
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Affiliation(s)
- Stéphane Mouchabac
- Department of Psychiatry, Hôpital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Sorbonne Université, Hôpital de la Pitié Salpêtrière, iCRIN (Infrastructure for Clinical Research In Neurosciences), Brain Institute (ICM), INSERM, CNRS, Paris, France
| | - Ismael Conejero
- Department of Psychiatry, CHU Nîmes, University of Montpellier, Nîmes, France
- Inserm, Unit 1061 “Neuropsychiatry: Epidemiological and Clinical Research”, Montpellier, France
| | - Camille Lakhlifi
- PICNIC lab (Physiological investigation of clinically normal and impaired cognition), Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Université de Paris, Sorbonne Université, Paris, France
| | - Ilyass Msellek
- Sorbonne Université, Hôpital de la Pitié Salpêtrière, iCRIN (Infrastructure for Clinical Research In Neurosciences), Brain Institute (ICM), INSERM, CNRS, Paris, France
| | - Leo Malandain
- University Hospital Cochin (site Tarnier), Paris, France
| | - Vladimir Adrien
- Department of Psychiatry, Hôpital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Sorbonne Université, Hôpital de la Pitié Salpêtrière, iCRIN (Infrastructure for Clinical Research In Neurosciences), Brain Institute (ICM), INSERM, CNRS, Paris, France
| | - Florian Ferreri
- Department of Psychiatry, Hôpital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Sorbonne Université, Hôpital de la Pitié Salpêtrière, iCRIN (Infrastructure for Clinical Research In Neurosciences), Brain Institute (ICM), INSERM, CNRS, Paris, France
| | - Bruno Millet
- Sorbonne Université, Hôpital de la Pitié Salpêtrière, iCRIN (Infrastructure for Clinical Research In Neurosciences), Brain Institute (ICM), INSERM, CNRS, Paris, France
| | - Olivier Bonnot
- Department of Child and Adolescent Psychiatry, CHU de Nantes, Nantes, France
- Pays de la Loire Psychology Laboratory, Nantes, France
| | - Alexis Bourla
- Department of Psychiatry, Hôpital Saint-Antoine, Sorbonne Université, AP-HP, Paris, France
- Sorbonne Université, Hôpital de la Pitié Salpêtrière, iCRIN (Infrastructure for Clinical Research In Neurosciences), Brain Institute (ICM), INSERM, CNRS, Paris, France
- Jeanne d'Arc Hospital, INICEA Korian, Saint-Mandé, France
| | - Redwan Maatoug
- Sorbonne Université, Hôpital de la Pitié Salpêtrière, iCRIN (Infrastructure for Clinical Research In Neurosciences), Brain Institute (ICM), INSERM, CNRS, Paris, France
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Abstract
PURPOSE OF REVIEW The aim of this review was to analyze COVID-19 effect on the biological features of suicidal vulnerability and its interaction with suicide-related biological pathways. We carried out a narrative review of international publications on the interactions of COVID-19 with the biological bases of suicide. RECENT FINDINGS We hypothesize that SARS-CoV-2 interacts with multiple biological processes that underlie suicidal behavior, such as the renin-angiotensin system, nicotinic receptors, and central and systemic inflammation. Social distancing measures may also worsen subjective or objective social disconnection, thus increasing the risk of suicide. Interestingly, the drugs used to prevent suicide could be promising options to counteract brain damage caused by this coronavirus. SARS-CoV-2 interacts with multiple biological pathways involved in suicide and opens a new window for understanding the suicidal process. The development of suicide prevention treatments in the context of a pandemic may benefit from knowledge on these interactions.
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Affiliation(s)
- I Conejero
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France.
- PSNREC, Univ Montpellier, INSERM, CHU de Montpellier, Montpellier, France.
| | - B Nobile
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
- PSNREC, Univ Montpellier, INSERM, CHU de Montpellier, Montpellier, France
| | - E Olié
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
- PSNREC, Univ Montpellier, INSERM, CHU de Montpellier, Montpellier, France
- FondaMental Foundation, Créteil, France
| | - Ph Courtet
- Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
- PSNREC, Univ Montpellier, INSERM, CHU de Montpellier, Montpellier, France
- FondaMental Foundation, Créteil, France
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13
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Lengvenyte A, Conejero I, Courtet P, Olié E. Biological bases of suicidal behaviours: A narrative review. Eur J Neurosci 2019; 53:330-351. [PMID: 31793103 DOI: 10.1111/ejn.14635] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 11/05/2019] [Accepted: 11/28/2019] [Indexed: 12/13/2022]
Abstract
Suicidal behaviour is a multifaceted phenomenon that concerns all human populations. It has been suggested that a complex interaction between the individual genetic profile and environmental factors throughout life underlies the pathophysiology of suicidal behaviour. Although epidemiological and genetic studies suggest the existence of a genetic component, exposure to biological and psychosocial adversities, especially during critical developmental periods, also contributes to altering the biological responses to threat and pleasure. This results in amplified maladaptive cognitive and behavioural traits and states associated with suicidal behaviours. Alterations in the cognitive inhibition and decision-making capacity have been implicated in suicidal behaviours. Structural and functional changes in key brain regions and networks, such as prefrontal cortex, insula and default mode network, may underlie this relationship. Furthermore, the shift from health to suicidal behaviour incorporates complex and dynamic changes in the immune and stress responses, monoaminergic system, gonadal system and neuroplasticity. In this review, we describe the major findings of epidemiological, genetic, neuroanatomical, neuropsychological, immunological and neuroendocrinological studies on suicide behaviours to provide a solid background for future research in this field. This broad overview of the biological bases of suicide should promote neuroscience research on suicidal behaviours. This might lead to improved biological models and to the identification of evidence-based biomarkers, treatment options and preventive strategies.
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Affiliation(s)
- Aiste Lengvenyte
- Department of Emergency Psychiatry & Acute Care, CHU Montpellier, University of Montpellier, Montpellier, France.,Faculty of Medicine, Institute of Clinical Medicine, Psychiatric Clinic, Vilnius University, Vilnius, Lithuania
| | - Ismael Conejero
- Neuropsychiatry: Epidemiological and Clinical Research, Inserm Unit 1061, Montpellier, France.,Department of Psychiatry, CHU Nimes, University of Montpellier, Montpellier, France
| | - Philippe Courtet
- Department of Emergency Psychiatry & Acute Care, CHU Montpellier, University of Montpellier, Montpellier, France.,Neuropsychiatry: Epidemiological and Clinical Research, Inserm Unit 1061, Montpellier, France
| | - Emilie Olié
- Department of Emergency Psychiatry & Acute Care, CHU Montpellier, University of Montpellier, Montpellier, France.,Neuropsychiatry: Epidemiological and Clinical Research, Inserm Unit 1061, Montpellier, France
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14
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Conejero I, Thouvenot E, Abbar M, Mouchabac S, Courtet P, Olié E. Neuroanatomy of conversion disorder: towards a network approach. Rev Neurosci 2018; 29:355-368. [DOI: 10.1515/revneuro-2017-0041] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 09/16/2017] [Indexed: 01/22/2023]
Abstract
Abstract
The pathophysiology of conversion disorder is not well understood, although studies using functional brain imaging in patients with motor and sensory symptoms are progressively increasing. We conducted a systematic review of the literature with the aim of summarising the available data on the neuroanatomical features of this disorder. We also propose a general model of the neurobiological disturbance in motor conversion disorder. We systematically searched articles in Medline using the Medical Subject Headings terms ‘(conversion disorder or hysterical motor disorder) and (neuropsychology or cognition) or (functional magnetic resonance imaging or positron emission tomography or neuroimaging) or (genetics or polymorphisms or epigenetics) or (biomarkers or biology)’, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two authors independently reviewed the retrieved records and abstracts, assessed the exhaustiveness of data abstraction, and confirmed the quality rating. Analysis of the available literature data shows that multiple specialised brain networks (self-agency, action monitoring, salience system, and memory suppression) influence action selection and modulate supplementary motor area activation. Some findings suggest that conceptualisation of movement and motor intention is preserved in patients with limb weakness. More studies are needed to fully understand the brain alterations in conversion disorders and pave the way for the development of effective therapeutic strategies.
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Conejero I, Navucet S, Keller J, Olié E, Courtet P, Gabelle A. A Complex Relationship Between Suicide, Dementia, and Amyloid: A Narrative Review. Front Neurosci 2018; 12:371. [PMID: 29910709 PMCID: PMC5992441 DOI: 10.3389/fnins.2018.00371] [Citation(s) in RCA: 32] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/14/2018] [Indexed: 12/26/2022] Open
Abstract
Background: Suicide rates are high among older adults and many conditions have been related to suicide in this population: chronic illnesses, physical disabilities, cancer, social isolation, mental disorders and neurocognitive disorders. Objectives: Among neurocognitive disorders, analysis of the relationships between dementia and suicidal behaviors led to conflicting results and some questions are still without answer. Particularly, it is not known whether (i) Alzheimer's disease (AD) increases the risk of suicidal ideation and suicide attempts (SA) or the frequency of death by suicide; (ii) the presence of suicidal ideation or SA in people older than 65 years of age is an early dementia sign; and (iii) amyloid load in frontal areas facilitates SA by modifying the decision-making pathway. Methods: Therefore, in this narrative review, we searched the PubMed database using the medical subject heading (MeSH) terms (“Suicide” AND “Depression”) OR (“Amyloid” OR “Dementia”) to identify recent (from 2000 to 2017) original studies on the links between suicidal behavior, dementia and brain amyloid load. We also explored the clinical and pathophysiological role of depression in these relationships. Results and Discussion: The findings from these studies suggest that late stage dementia could protect against suicidal ideation and SA. Conversely, the risk of complete suicide is increased during the early phase of cognitive decline. Conclusions: Serious cognitive impairment and decline of executive functions could protect against negative thoughts related to cognitive disability awareness and against suicide planning.Several factors, including brain amyloid load, could be involved in the increased suicide rate early after the diagnosis of dementia.
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Affiliation(s)
- Ismael Conejero
- Department of Psychiatry, Caremeau Hospital, University Hospital of Nîmes, Nîmes, France.,Inserm U1061, Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, University of Montpellier, Montpellier, France.,Centre de Biochimie Structurale, University of Montpellier, Montpellier, France
| | - Sophie Navucet
- Department of Montpellier, Memory Resources Research Center, Gui De Chauliac Hospital, University of Montpellier, Montpellier, France
| | - Jacques Keller
- Department of Montpellier, Memory Resources Research Center, Gui De Chauliac Hospital, University of Montpellier, Montpellier, France
| | - Emilie Olié
- Inserm U1061, Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, University of Montpellier, Montpellier, France.,Department of Psychiatric Emergency and Post-Acute Care, Lapeyronie Hospital, University of Montpellier, Montpellier, France
| | - Philippe Courtet
- Inserm U1061, Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, University of Montpellier, Montpellier, France.,Department of Psychiatric Emergency and Post-Acute Care, Lapeyronie Hospital, University of Montpellier, Montpellier, France
| | - Audrey Gabelle
- Inserm U1061, Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, University of Montpellier, Montpellier, France.,Department of Montpellier, Memory Resources Research Center, Gui De Chauliac Hospital, University of Montpellier, Montpellier, France
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16
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Abstract
Suicidal behavior in older adults (65 years old and over) is a major public health issue in many countries. Suicide rates increase during the life course and are as high as 48.7/100,000 among older white men in the USA. Specific health conditions and stress factors increase the complexity of the explanatory model for suicide in older adults. A PubMed literature search was performed to identify most recent and representative studies on suicide risk factors in older adults. The aim of our narrative review was to provide a critical evaluation of recent findings concerning specific risk factors for suicidal thoughts and behaviors among older people: psychiatric and neurocognitive disorders, social exclusion, bereavement, cognitive impairment, decision making and cognitive inhibition, physical illnesses, and physical and psychological pain. We also aimed to approach the problem of euthanasia or physician-assisted suicide in older adults. Our main findings emphasize the need to integrate specific stress factors, such as feelings of social disconnectedness, neurocognitive impairment or decision making, as well as chronic physical illnesses and disability in suicide models and in suicide prevention programs in older adults. Furthermore, the chronic care model should be adapted for the treatment of older people with long-term conditions in order to improve the treatment of depressive disorders and the prevention of suicidal thoughts and acts.
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Affiliation(s)
- Ismael Conejero
- Institut National de la Santé Et de la Recherche Médicale (INSERM), University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France.,Department of Emergency Psychiatry and Post-Acute Care, Lapeyronie Hospital, Center Hospitalier Universitairere (CHU) Montpellier, Montpellier, France
| | - Emilie Olié
- Institut National de la Santé Et de la Recherche Médicale (INSERM), University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France.,Department of Emergency Psychiatry and Post-Acute Care, Lapeyronie Hospital, Center Hospitalier Universitairere (CHU) Montpellier, Montpellier, France.,FondaMental Foundation, Créteil, France
| | - Philippe Courtet
- Institut National de la Santé Et de la Recherche Médicale (INSERM), University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France.,Department of Emergency Psychiatry and Post-Acute Care, Lapeyronie Hospital, Center Hospitalier Universitairere (CHU) Montpellier, Montpellier, France.,FondaMental Foundation, Créteil, France
| | - Raffaella Calati
- Institut National de la Santé Et de la Recherche Médicale (INSERM), University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France.,Department of Emergency Psychiatry and Post-Acute Care, Lapeyronie Hospital, Center Hospitalier Universitairere (CHU) Montpellier, Montpellier, France.,FondaMental Foundation, Créteil, France
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Guillodo E, Berrouiguet S, Simonnet M, Conejero I, Courtet P, Baca Garcia E, Billot R, Lenca P, Walter M. Suicide sleep monitoring (SSleeM): A feasibility and acceptability study of a wearable sleep tracking monitoring device in suicide attempters. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.1800] [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: 11/26/2022] Open
Abstract
IntroductionSleep disturbances are associated with an increased risk of suicidal behavior. The evidence primarily stems from studies based on questionnaires about sleep quality. In recent years, the availability of wearable health technology has increased and offers an inexpensive, appealing, and accessible way to measure sleep.Our aim is to assess the feasibility and acceptability of wearable sleep tracking monitoring devices in a sample of suicide attempters.MethodsA prospective, open-label, 12-months study will be conducted in the emergency department (ED) and psychiatric unit (PU) of the university hospital of Brest, France. Inclusion criteria are male or female aged 18 or over, surviving a suicide attempt, discharged from ED or PU, and giving consent. The sleep tracker and a smartphone will be given to the patient after discharge. He or she will receive brief training on how to use the sleep tracker. Patient will be asked to monitor their sleep during the five days following the discharge. The feasibility will be explored by analyzing the data proceeding from the sleep tracker. The acceptability will be assessed during the five-days follow up visit, using a standardized questionnaire.ResultsPreliminary results of this ongoing study show that feasibility and acceptance may be related to technical features of wearable devices.DiscussionA better understanding of the bidirectional mechanism between sleep disturbances and suicide behavior will allow the design of tailored interventions to prevent suicide attempts.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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18
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Abstract
Suicidal behavior and its prevention constitute a major public health issue. Etiology of suicidal behavior is multifactorial. Whereas current research is mostly focused on clinical and biological risk factors, the sociodemographic risk factors for suicidal behavior, first highlighted by Durkheim, have received less attention. Besides the well-known impact of age and gender, sociodemographic variables such as marital and parental status, education, occupation, income, employment status, religion, migration or minority status, and sexual orientation are repeatedly reported to play an important role in suicidal behavior. This narrative review aimed to summarize recent research on sociodemographic risk factors for suicidal behavior and to elicit possible implications for suicide prevention.
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Affiliation(s)
- Ismael Conejero
- Department of Emergency Psychiatry, CHRU Montpellier, Montpellier, France
| | - Jorge Lopez-Castroman
- Department of Psychiatry, CHU Nimes, Nimes, France. .,Inserm U1061, Hôpital La Colombiere, Pavillon 42, 39 Av Charles Flauhault, BP: 34493, 34093, Montpellier, France. .,University of Montpellier 1, Montpellier, 34000, France.
| | - Lucas Giner
- Department of Psychiatry, University of Sevilla, Sevilla, Spain
| | - Enrique Baca-Garcia
- IIS-Fundacion Jimenez Diaz, Department of Psychiatry, CIBERSAM, Madrid, Spain.,Department of Psychiatry at the New York State Psychiatric Institute and Columbia University, New York, NY, USA
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