Le ralentissement psychomoteur (RPM) est une dimension clinique présente dans de nombreuses maladies mentales. S’il est l’un des symptômes cardinaux de la dépression unipolaire, on le retrouve ...également dans le trouble bipolaire et la schizophrénie mais sans qu’il y ait une véritable différence sémiologique selon la pathologie concernée. Le RPM se caractérise non seulement par une composante motrice mais également psychique et langagière, qui inclut des processus perceptifs et cognitifs impliqués dans le contrôle, la planification, la programmation et l’exécution du mouvement. Les outils d’évaluation disponibles (imagerie cérébrale, analyse génétique, analyse rythmique, analyse par tracker vidéo, explorations neuropsychologiques) permettent aujourd’hui de mieux caractériser l’ensemble de ses dimensions. L’hypothèse d’un dysfonctionnement dopaminergique est étayée par de nombreux travaux avec des atteintes fonctionnelles au niveau des circuits sous-corticaux et pré-frontaux. Le RPM s’accompagne d’une altération fonctionnelle majeure et requiert ainsi une attention particulière en termes d’ajustement thérapeutique d’autant que se pose à l’heure actuelle la question de son impact pronostique (persistance en dehors des épisodes aigus, réponse aux traitements, rechute et récurrence).
Since the discovery of psychopharmacological treatments in the early 1950s, followed by the development of second-generation antidepressants, biological psychiatry has not achieved much progress. ...Recent technological advances in the field of non-invasive brain stimulation open new perspectives in the treatment of depressive disorders (MDD). Amongst them, transcranial direct current stimulation (tDCS) modulates cortical excitability and induces long-lasting effects. Here, we aimed at evaluating whether tDCS has potential to be developed as an innovative treatment in psychiatry. We conducted several studies in humans and animal models, exploring clinical and cognitive effects, especially in MDD. Our findings indicated beneficial clinical effects of tDCS. The data published to date are promising and supports the use of tDCS as a treatment for MDD. However, its place regarding other treatments still has to be determined before becoming a routine clinical treatment.
At the time of writing (December 2020), coronavirus disease 2019 (COVID-19) has already caused more than one million deaths worldwide, and therefore, it is imperative to find effective treatments. ...The "cytokine storm" induced by Severe Acute Respiratory Syndrome-Coronavirus type 2 (SARS-CoV-2) is a good target to prevent disease worsening, as indicated by the results obtained with tocilizumab and dexamethasone. SARS-CoV-2 can also invade the brain and cause neuro-inflammation with dramatic neurological manifestations, such as viral encephalitis. This could lead to potentially incapacitating long-term consequences, such as the development of psychiatric disorders, as previously observed with SARS-CoV. Several pathways/mechanisms could explain the link between viral infection and development of psychiatric diseases, especially neuro-inflammation induced by SARS-CoV-2. Therefore, it is important to find molecules with anti-inflammatory properties that penetrate easily into the brain. For instance, some antidepressants have anti-inflammatory action and pass easily through the blood brain barrier. Among them, clomipramine has shown very strong anti-inflammatory properties
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(animal models) and human studies, especially in the brain. The aim of this review is to discuss the potential application of clomipramine to prevent post-infectious mental complications. Repositioning and testing antidepressants for COVID-19 management could help to reduce peripheral and especially central inflammation and to prevent the acute and particularly the long-term consequences of SARS-CoV-2 infection.
Highlights • Transcranial direct current stimulation (tDCS) efficacy in pharmacotherapy-resistant depression is limited. • tDCS did not induce clinically relevant effect on psychomotor and ...neuropsychological functioning. • More research on the fundamental neurobiological effects of brain electrical stimulation will help these new techniques continue to improve and evolve.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Le diagnostic et la prise en charge de la dépression sont confrontés à de nombreux enjeux :
– les maladies dépressives sont fréquentes et dans un grand nombre de cas diagnostiquées, mais leur prise ...en charge mérite d’être optimisée selon la forme clinique, la sévérité, le stade évolutif et les co-morbidités. On estime actuellement que 60 à 70 % des patients souffrant de dépression ne présentent pas de rémission complète (absence de restitution ad integrum) (Sackeim 2001) ;
– en second lieu, la fragmentation des soins et la moins bonne prise en compte des pathologies somatiques chez les patients atteints de dépression en particulier résistante expliquent le manque d’une approche globale systématique de la maladie ;
– en troisième lieu, ainsi que l’indiquait un rapport d’information remis au Sénat en 2006, la difficulté d’application des recommandations internationales de bonnes pratiques pour les prescriptions de traitements pharmacologiques est avérée.
Le risque évolutif d’un épisode dépressif vers la chronicisation ou la résistance est important, et représente plus de 30 % des coûts globaux de la dépression (Greenberg et al., 1993). Ces formes cliniques, particulièrement invalidantes, ont un impact majeur sur le fonctionnement du sujet et son environnement, avec une morbimortalité et un impact sociétal élevés. Aussi, pour répondre à ces enjeux, la Fondation FondaMental propose un dispositif innovant et précurseur d’une politique de soins et de prévention : les Centres Experts. Hébergés au sein de services hospitaliers ou de cliniques, les Centres Experts sont spécialisés dans l’évaluation, le diagnostic et l’aide à la prise en charge d’une pathologie psychiatrique spécifique. Ils sont conçus comme des structures de niveau 3, c’est-à-dire au service des psychiatres libéraux ou hospitaliers et des médecins généralistes pour les aider à améliorer le dépistage, faciliter le diagnostic et optimiser la prise en charge de leurs patients. À ce jour, il existe 11 Centres Experts dépression résistante en France.
Introduction
Depression is a leading cause of disability, worldwide. Recently, WHO highlighted the negative impact of recent crises (COVID-19 pandemic, war in Ukraine, economic crisis).
Although most ...international guidelines recommend psychotherapies as first-line treatment of depression, access remains scarce in France due to limited availability of trained clinicians (notably those with CBT certification), high cost for patient in a context of non-reimbursement and fear of stigmatization (Coldefy M. HCAA, 2022/04,19). Therefore, online blended psychological treatment such as deprexis® could increase access to care for people with depression. It presents several advantages such as easy access, scalability, and a proven efficacy (Twomey et al. PLoS One. 2020;15(1):e022810).
Objectives
This study aims to test real-life acceptability of deprexis® for people with depression in France outside a reimbursement pathway.
Primary objective of this cross-sectional study is to measure acceptability of deprexis® a new digital therapy in France.
Questionnaire includes acceptability of deprexis® assessed with patient willingness to complete deprexis® course, reasons of refusal, when needed, demographics and depression characteristics.
The secondary objectives are to study 1/ acceptability according to type of center (Hospital based, Community Based or private practice) and type of practitioners (psychiatrists or psychologists), 2/ differences in acceptability according to severity’s level (evaluated with PHQ 9), 3/ differences in acceptability according to administration or not of a treatment (including psychotherapy), 4/ differences in acceptability according to prescriber’s profile (age, sex, place and type of practice), 5/ identification of reasons for refusal , and 6/ analyze refusal rate over time.
Methods
DARE is as a cross-sectional study in which deprexis® is suggested to any patient meeting the inclusion criteria over the fixed inclusion period June-December 2022
Inclusion criteria are: 1/ depression, 2/ age between 18 and 65 years, 3/ speak French sufficiently, 4/ access to Internet with a device to connect to deprexis® platform.
Exclusion criteria are diagnosis of bipolar disorder, psychotic symptoms and/or suicidal thoughts during the current episode.
All investigators received a video-based training on deprexis® before inclusion to make sure they all have same level of information and understanding on the program.
Results
The study is currently recruiting. Data will be available for EPA congress.
Conclusions
It is a first time a digital therapy is completing the current therapeutic options for the treatment of depression in France. Acceptability of this innovation by both patients and Healthcare providers is a first step.
DARE may allow to have a better understanding of the acceptability of a digital therapy in the treatment of depression in France and identify the different factors influencing it in a natural setting.
Disclosure of Interest
O. Amiot Consultant of: Ethypharm Digital Therapy, A. H. Clair Consultant of: Ethypharm Digital Therapy, P. Courtet Consultant of: Ethypharm Digital Therapy, E. Fakra Consultant of: Ethypharm Digital Therapy, V. Narboni Employee of: Ethypharm Digital Therapy, F. Gheysen Consultant of: Ethypharm Digital Therapy, E. Haffen Consultant of: Ethypharm Digital Therapy, D. Drapier Consultant of: Ethypharm Digital Therapy, L. Lecardeur Consultant of: Ethypharm Digital Therapy
Clear guidance for successive antidepressant pharmacological treatments for non-responders in major depression is not well established.
Based on the RAND/UCLA Appropriateness Method, the French ...Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental developed expert consensus guidelines for the management of treatment-resistant depression. The expert guidelines combine scientific evidence and expert clinicians' opinions to produce recommendations for treatment-resistant depression. A written survey comprising 118 questions related to highly-detailed clinical presentations was completed on a risk-benefit scale ranging from 0 to 9 by 36 psychiatrist experts in the field of major depression and its treatments. Key-recommendations are provided by the scientific committee after data analysis and interpretation of the results of the survey.
The scope of these guidelines encompasses the assessment of pharmacological resistance and situations at risk of resistance, as well as the pharmacological and psychological strategies in major depression.
The expert consensus guidelines will contribute to facilitate treatment decisions for clinicians involved in the daily assessment and management of treatment-resistant depression across a number of common and complex clinical situations.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Converging sources of evidence point to a role for inflammation in the development of depression, fatigue and cognitive dysfunction. More precisely, the tryptophan (TRP) catabolism is thought to play ...a major role in inflammation-induced depression. Mastocytosis is a rare disease in which chronic symptoms, including depression, are related to mast cell accumulation and activation. Our objectives were to study the correlations between neuropsychiatric features and the TRP catabolism pathway in mastocytosis in order to demonstrate mast cells' potential involvement in inflammation-induced depression. Fifty-four patients with mastocytosis and a mean age of 50.1 years were enrolled in the study and compared healthy age-matched controls. Depression and stress were evaluated with the Beck Depression Inventory revised and the Perceived Stress Scale. All patients had measurements of TRP, serotonin (5-HT), kynurenine (KYN), indoleamine 2,3-dioxygenase 1 (IDO1) activity (ratio KYN/TRP), kynurenic acid (KA) and quinolinic acid (QA). Patients displayed significantly lower levels of TRP and 5-HT without hypoalbuminemia or malabsorption, higher IDO1 activity, and higher levels of KA and QA, with an imbalance towards the latter. High perceived stress and high depression scores were associated with low TRP and high IDO1 activity. In conclusion, TRP metabolism is altered in mastocytosis and correlates with perceived stress and depression, demonstrating mast cells' involvement in inflammation pathways linked to depression.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Psychiatric comorbidities and suicide attempts are highly prevalent in Bipolar Disorders (BD). We examined the associations between childhood maltreatment, psychiatric comorbidities, and suicide ...attempts, in terms of lifetime prevalence, sequence of onset, and current symptoms.
We assessed 3,047 individuals with BD for suicide attempts, anxiety disorders, substance use disorders, and eating disorders. Participants completed a self-report for the assessment of childhood maltreatment. Associations between childhood maltreatment and characteristics of comorbidities (lifetime prevalence, current symptoms, and age at onset) were examined using logistic regressions and network analyses.
Psychiatric comorbidities were frequent with a mean number per individual of 1.23 (SD = 1.4). Most comorbidities occurred prior to the onset of BD. Participants who reported higher levels of childhood maltreatment had more frequent and multiple comorbidities, which were also more currently active at inclusion. Childhood maltreatment did not decrease the age of onset of comorbidities, but was associated with a faster accumulation of comorbidities prior to the onset of BD. Logistic regression and network analyses showed that emotional abuse and sexual abuse might play a prominent role in the lifetime prevalence of psychiatric comorbidities and suicide attempts.
Childhood maltreatment was associated with suicide attempts, and with frequent, multiple, and persistent psychiatric comorbidities that accumulated more rapidly prior to the onset of BD. Hence, childhood maltreatment should be systematically assessed in individuals with BD, in particular when the course of the disorder is characterized by a high comorbid profile or by a high suicidality.
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