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The objective of this study was to develop and validate the Knowledge of Suicide Scale (KSS), elaborated to assess adherence to myths about suicide.

•La prévention du suicide bénéficie à l’heure actuelle d’innovations dans les stratégies de soins des patients en crise suicidaire.•L’entretien clinique avec un patient en crise suicidaire doit être soigné car il est la première étape clé de la prévention.•Obtenir une alliance thérapeutique avec les patients à risque suicidaire est une priorité.•L’évaluation clinique de la douleur psychologique, de l’exclusion sociale et de l’anhédonie est pertinente.•Les innovations pharmacologiques sont prometteuses : antidépresseurs d’action rapide, agents opioïdergiques, psychédéliques.•Les dispositifs de veille permettant le maintien du lien (VigilanS) font partie des standards de soins des patients suicidants.

Les sujets souffrant d’un trouble de stress post-traumatique présentent fréquemment des troubles du sommeil tels qu’une insomnie chronique, des cauchemars traumatiques, mais aussi, de façon moins attendue, des troubles respiratoires du sommeil.

Post-traumatic stress disorder (PTSD) is difficult to treat but one promising strategy is to block memory reconsolidation of the traumatic event. This study aimed to evaluate the efficacy of traumatic memory reactivation under the influence of propranolol, a noradrenergic beta-receptor blocker, in reducing PTSD symptoms as well as comorbid major depression (MD) symptoms. We conducted a double blind, placebo-controlled, randomised clinical trial in 66 adults diagnosed with longstanding PTSD. Propranolol or a placebo was administered 90 min before a brief memory reactivation session, once a week for 6 consecutive weeks. Measures included the SCID PTSD module, the PTSD Check List (PCL-S) and the Beck Depression Inventory-II (BDI-II). PTSD symptoms decreased both in the pre-reactivation propranolol group (39.28%) and the pre-reactivation placebo group (34.48 %). During the 6 treatment sessions, PCL-S and BDI-II scores decreased to similar extent in both groups and there were no treatment differences. During the 3-month follow-up period, there were no treatment effects for the mean PCL-S and BDI-II scores. However, in patients with severe PTSD symptoms (PCL-S ≥ 65) before treatment, PCL-S and BDI-II scores continued to decline 3 months after the end of treatment in the propranolol group while they increased in the placebo group. Repeated traumatic memory reactivation seemed to be effective for PTSD and comorbid MD symptoms. However, the efficacy of propranolol was not greater than that of placebo 1 week post treatment. Furthermore, in this traumatic memory reactivation, PTSD symptom severity at baseline might have influenced the post-treatment effect of propranolol.

Améliorer la prise en charge de l’hypersexualité provoquée par un traitement anti-parkinsonien, ainsi que ses conséquences psychopathologiques chez des patients atteints de la maladie de Parkinson (MP). Si l’hypersexualité est une forme classique de trouble du contrôle des impulsions (TCI) observée dans la MP, sa fréquence est certainement sous-évaluée.

Les sujets souffrant d’un trouble de stress post-traumatique présentent fréquemment des troubles du sommeil tels qu’une insomnie chronique, des cauchemars traumatiques, mais aussi, de façon moins attendue, des troubles respiratoires du sommeil.

Le suicide est l’une des causes les plus importantes de décès en prison à travers le monde. En France, le taux de décès par suicide en prison est de 18,5 pour 10 000 (détenus), soit 7 fois plus qu’en population générale.

ABSTRACTBackground:Post-traumatic stress disorder (PTSD) with dissociative symptoms is now a full-fledged subtype of this disorder. The dissociative subtype is associated with a greater number of psychiatric comorbidities. To date, the impact of dissociation on the efficacy of PTSD treatment remains unclear.Objective:The aim of this study was to compare the efficacy of a traumatic memory reactivation procedure with the administration of propranolol or a placebo once a week for six consecutive weeks in reducing PTSD and MDE symptoms between PTSD subjects with or without high dissociative symptoms.Method:For that, we conducted a randomized clinical trial in 66 adults diagnosed with longstanding PTSD and measured the SCID PTSD module, the PTSD Checklist (PCL-S), Beck’s Depression Inventory-II (BDI-II), and the Dissociative Experiences Scale (DES).Results:Patients with and without high dissociative experience had significant improvement in their PCL-S scores over the 6 treatment sessions, and PCL-S scores continued to decline in all patients during the post-treatment period. However, there was no correlation between the presence/absence of high dissociative experiences and no specific effect of propranolol treatment. We found exactly the same results for MDE symptoms. Interestingly, patients with high dissociative experiences before treatment exhibited very significant improvement in their DES scores after the 6 treatment sessions, and patients maintained this improvement 3 months post-treatment.Conclusions:The traumatic memory reactivation procedure is an effective way to treat dissociative symptoms in patients with PTSD, and improvement of these dissociative symptoms was associated with a decrease in both PTSD and depression severity.

OBJECTIVE: To determine the effects over one year of contacting patients by telephone one month or three months after being discharged from an emergency department for deliberate self poisoning compared with usual treatment. Design Multicentre, randomised controlled trial. Setting 13 emergency departments in the north of France. Participants 605 people discharged from an emergency department after attempted suicide by deliberate self poisoning. Intervention The intervention consisted of contacting patients by telephone at one month or three months after discharge from an emergency department for attempted suicide to evaluate the success of recommended treatment or to adjust treatment. Control patients received treatment as usual, in most cases referral back to their general practitioner. MAIN OUTCOME MEASURES: The primary outcome measures were proportion of participants who reattempted suicide, number of deaths by suicide, and losses to follow-up at 13 months' follow-up. Secondary outcome measures were types and number of contacts with health care. RESULTS: On an intention to treat basis, the three groups did not differ significantly for further suicide attempts, deaths by suicide, or losses to follow-up: contact at one month (intervention 23% (34/147) v controls 30% (93/312), difference 7%, 95% confidence interval - 2% to 15%), three months (25% (36/146) v 30%, difference 5%, - 4% to 14%). Participants contacted at one month were less likely at follow-up to report having reattempted suicide (12% v 22% in control group, difference 10%, 2% to 18%). CONCLUSION: Contacting people by telephone one month after being discharged from an emergency department for deliberate self poisoning may help reduce the number of reattempted suicides over one year.

Les inhibiteurs de la monoamine-oxydase (IMAO) non sélectifs et irréversibles sont prescrits en 3e, voire 4eintention dans la prise en charge de la dépression résistante.

Le lithium figure parmi les stratégies de potentialisation les plus recommandées dans la prise en charge des patients déprimés ne répondant pas ou partiellement aux antidépresseurs standard.

Le changement d’antidépresseur peut s’avérer utile en cas d’inefficacité du traitement antidépresseur en cours.

La définition de la dépression résistante la plus couramment utilisée repose sur l’échec d’au moins deux essais successifs de traitement antidépresseur bien conduits en termes de dose et durée.

La couverture médiatique du suicide est associée à un risque d’augmentation de la morbi-mortalité suicidaire par effet d’incitation chez les personnes vulnérables : il s’agit de l’effet Werther.

La gestion des états d’agitation constitue une problématique courante dans les services d’urgences, suscitant un sentiment d’insécurité auprès du personnel soignant.

La gestion des états d’agitation constitue une problématique courante dans les services d’urgences, suscitant un sentiment d’insécurité auprès du personnel soignant.

La mise en place de soins sans consentementen psychiatrie (SSC) est basée sur une appréciation subjective de l’état du patient, mais certains critères cliniques ont été établis selon le type de trouble sous-jacent.

This study examined the mental health consequences of the January 2010 Haiti earthquake on Haitians living in Miami-Dade County, Florida, 2–3 years following the event. A random-sample household survey was conducted from October 2011 through December 2012 in Miami-Dade County, Florida. Haitian participants (N = 421) were assessed for their earthquake exposure and its impact on family, friends, and household finances; and for symptoms of post-traumatic stress disorder (PTSD), anxiety, and major depression; using standardized screening measures and thresholds. Exposure was considered as “direct” if the interviewee was in Haiti during the earthquake. Exposure was classified as “indirect” if the interviewee was not in Haiti during the earthquake but (1) family members or close friends were victims of the earthquake, and/or (2) family members were hosted in the respondent's household, and/or (3) assets or jobs were lost because of the earthquake. Interviewees who did not qualify for either direct or indirect exposure were designated as “lower” exposure. Eight percent of respondents qualified for direct exposure, and 63% qualified for indirect exposure. Among those with direct exposure, 19% exceeded threshold for PTSD, 36% for anxiety, and 45% for depression. Corresponding percentages were 9%, 22% and 24% for respondents with indirect exposure, and 6%, 14%, and 10% for those with lower exposure. A majority of Miami Haitians were directly or indirectly exposed to the earthquake. Mental health distress among them remains considerable two to three years post-earthquake.

La prescription de psychotropes présente des risques durant la grossesse. Il est légitime de mesurer la prescription de ces molécules chez la femme enceinte.

Cet article propose la construction d’une typologie des recours aux médicaments psychotropes et l’étude des facteurs reliés à leur consommation intense ou régulière. Les résultats s’appuient sur l’exploitation des bases des médicaments présentés au remboursement aux caisses primaires d’assurance-maladie par les assurés au régime général du Nord - Pas-de-Calais. Durant les années 2007 et 2008, 20,7 % de la population protégée (764 650 personnes) bénéficie de remboursements pour ce type de médicaments. Parmi les bénéficiaires, environ trois sur dix (30,5 %) ont un fort recours. L’âge, le bénéfice de la Couverture Maladie Universelle (CMU) et le fait d’être suivi ou non par un psychiatre sont les variables les plus influentes sur l’intensité et la régularité de consommation. La régularité observée du recours aux benzodiazépines est contraire aux recommandations actuelles.

Les médicaments psychoactifs présentés au remboursement de l’Assurance maladie constituent une source d’information sur certaines pathologies ou troubles psychiques, dans un contexte de surutilisation de ces molécules en France. En 2007, 576 493 personnes en bénéficient d’au moins un dans le Nord – Pas-de-Calais, pour un total de 5 070 160 prescriptions.

ObjectiveTo confirm the rapid onset anti-suicidal benefits of ketamine in the short term and at six weeks, overall and according to diagnostic group.DesignProspective, double blind, superiority, randomised placebo controlled trial.SettingSeven French teaching hospitals between 13 April 2015 and 12 March 2019.Eligibility criteria for participantsAged 18 or older with current suicidal ideation, admitted to hospital voluntarily. Exclusion criteria included a history of schizophrenia or other psychotic disorders, substance dependence, and contraindications for ketamine.Participants156 participants were recruited and randomised to placebo (n=83) or ketamine (n=73), stratified by centre and diagnosis: bipolar, depressive, or other disorders.InterventionTwo 40 minute intravenous infusions of ketamine (0.5 mg/kg) or placebo (saline) were administered at baseline and 24 hours, in addition to usual treatment.Main outcome measuresThe primary outcome was the rate of patients in full suicidal remission at day 3, according to the scale for suicidal ideation total score ≤3. Analyses were conducted on an intention-to-treat basis.ResultsMore participants receiving ketamine reached full remission of suicidal ideas at day 3 than those receiving placebo: 46 (63.0%) of 83 participants in the ketamine arm and 25 (31.6%) of 73 in the placebo arm (odds ratio 3.7 (95% confidence interval 1.9 to 7.3), P<0.001). This effect differed according to the diagnosis (treatment: P<0.001; interaction: P=0.02): bipolar (odds ratio 14.1 (95% confidence interval 3.0 to 92.2), P<0.001), depressive (1.3 (0.3 to 5.2), P=0.6), or other disorders (3.7 (0.9 to 17.3, P=0.07)). Side effects were limited. No manic or psychotic symptom was seen. Moreover, a mediating effect of mental pain was found. At week 6, remission in the ketamine arm remained high, although non-significantly versus placebo (69.5% v56.3%; odds ratio 0.8 (95% confidence interval 0.3 to 2.5), P=0.7).ConclusionsThe findings indicate that ketamine is rapid, safe in the short term, and has persistent benefits for acute care in suicidal patients. Comorbid mental disorders appear to be important moderators. An analgesic effect on mental pain might explain the anti-suicidal effects of ketamine.Trial registrationClinicalTrials.gov NCT02299440.

Pour un décès par suicide, on estime que l’on peut compter 6 endeuillés « directs » et 20 personnes au total en rapport plus indirect avec ce deuil. Si l’on applique à l’entourage des sujets ayant fait une tentative de suicide la même arithmétique que celle décrite pour les endeuillés, on aboutit à ce qu’entre 600 000 et 3 500 000 personnes soient concernées chaque année en France par la tentative de suicide d’un proche. Des changements dans l’entourage d’un suicidant peuvent souvent être retrouvés comme facilitateurs ou déclencheurs du geste suicidaire, et d’un autre côté, une tentative de suicide va retentir sur cet entourage, du moins cette partie de l’entourage à proximité immédiate du suicidant. Cette interpellation de l’entourage du suicidant est une question centrale. Dans les faits, une très grande majorité des tentatives de suicide dirigées vers les urgences hospitalières seront réadressées vers leur contexte de vie initial, moins de 24 heures après le geste ; pour d’autres, quelques jours après une hospitalisation dans une structure d’urgence ou dans un service de médecine, la sortie interviendra vers le circuit ambulatoire. En prenant une position très pragmatique, nous conclurons sur quatre questions qui devraient alors se poser systématiquement après une tentative de suicide : (1) existe-t-il un entourage ? ; (2) cet entourage est-il « suffisamment bon » (en reprenant la formule deWinnicott) ? ; (3) cet entourage est-il « suffisamment prêt » ? ; (4) faut-il prévoir d’accompagner cet entourage ?

Objective: We prospectively examined the relation between various peritraumatic responses (that is, fear, helplessness, horror, amnesia, and fright) and the development of posttraumatic stress disorder (PTSD) 2 months after a trauma.Method: Participants included 123 motor vehicle accident (MVA) victims consecutively hospitalized in a traumatology department for over 72 hours during a 16-month period. Between day 2 and day 5 of their hospitalization, a psychiatrist assessed the patients' peritraumatic responses and acute stress disorder (ASD). Two months after the accident, an experienced psychiatrist contacted the patients by telephone, and the PTSD symptoms and the diagnosis were assessed with a modified version of the Clinician-Administered PTSD Scale (CAPS).Results: Of the participants, 48 reported an immediate fright reaction when faced with the prospect of their own death. Participants who reported a fright experience had a 17 times greater risk of subsequently meeting the diagnostic criteria for PTSD (odds ratio 16.75). A fright reaction predicted PTSD development with a specificity of 0.93 and a sensitivity of 0.60.Conclusion: The immediate reactions described in criterion A2 of the DSM-IV (that is, fear, helplessness, and horror) did not seem to be equally relevant. An initial feeling of fright seems to be an essential qualitative factor in the clinical description of psychological trauma.

AbstractOver the last 10 years, Europe has witnessed the development of the ecstasy phenomenon; this term is used to describe several products sharing more or less the same effects. The most widely used and hence the most well known is 3,4 MDMA, but MDA, MDEA, MBDB and even 2CB or nexus are available. The psychopathological consequences of MDMA use in man are relatively poorly understood. The case reported here involves an acute psychotic episode with residual symptoms after six months, with a sudden onset at least 12 hours after taking alcohol and ecstasy without realising it, in an individual with no previous psychopathology other than a moderate anxiety disorder. Twelve cases of acute psychotic episodes after taking ecstasy have been reported in the literature; two after taking the drug on two occasions and one after a single use. No authors have examined the previous mental state or possible previous psychopathology with any precision. The present subject had not displayed any previous psychotic behavior when tested with a proven standardized interview technique; this was confirmed by his peers and his family. He did, however, show signs of social phobia. Although the personality of an individual is a factor in taking a drug, and probably in the quality of the psychotropic effects experienced, a host of arguments favor the appearance of psychotic symptoms de novo, which were probably related to direct toxicity by MDMA and/or its metabolites on the serotoninergic neurons.

Depuis la promulgation de la loi du 5 juillet 2011, les hospitalisations en soins psychiatrique sans consentement (SPSC) sont systématiquement contrôlées par le juge des libertés et de la détention (JLD). En cas d’irrégularité constatée dans la procédure, le JLD peut ordonner la mainlevée de la mesure. A notre connaissance, aucune étude ne s’est intéressée aux mainlevées des mesures de soins décidées pour les patients détenus hospitalisés sans leur consentement en unités hospitalières spécialement aménagées (UHSA). L’objectif de cette étude est de décrire les motifs de mainlevée des mesures de SPSC en UHSA, et de les comparer à ceux observés dans un service de psychiatrie générale. Cent quarante-six mainlevées ont été examinées entre 2011 et 2018, 73 concernaient les patients de l’unité de psychiatrie générale et 73 les patients de l’UHSA. Certains motifs ont été observés de manière équivalente en UHSA et en psychiatrie générale (absence de notification des droits aux patients, absence de publication de la délégation de signature, non-respect de la rédaction du certificat médical, absence d’examen somatique) alors que d’autres ont été spécifiquement retrouvés pour les patients de l’UHSA, comme l’impossibilité pour le patient de communiquer avec son avocat ou l’absence de dangerosité immédiate pour le patient ou pour autrui. Cette étude de 73 mainlevées consécutives en UHSA met en évidence certaines spécificités pour les SPSC en milieu pénitentiaire. Les futurs travaux devront répliquer ce type d’étude au niveau national mais également envisager finement les conséquences des mainlevées sur la santé mentale des personnes concernées et sur l’évolution des soins qui leur sont proposés.

Objectives To assess understudied, alternative suicide prevention modalities in a mental health care setting.Methods This was a prospective study of patients (n = 140, 68 cases and 72 controls) who were admitted to hospital or who contacted an SOS suicide crisis line for suicidal ideation or attempts. Psychiatric diagnoses (Mini-International Neuropsychiatric Interview) and intensity of anxiety/depression/suicidality (Hamilton Anxiety Rating Scale, Montgomery–Åsberg Depression Rating Scale, and Beck Scale for Suicidal Ideation) were assessed. All intervention group subjects received a crisis card with a crisis line number, interviews with psychologists or volunteers and a telephone call on days 10 to 21, then 6 months later. These subjects also had a choice between two further 4-month interventions: body contact care or mobile intervention team visits.Results The interventions significantly reduced the number of suicide attempts and suicide (3%) at 6 months compared with the control condition (12%). There were fewer losses to follow-up in the intervention group (7.35%) than in the control group (9.72%).Conclusions The results favour the implementation of integrated care and maintaining contact in suicide prevention.

ABSTRACTFrance has a rich history of exposure to large-scale traumas such as wars, disasters and terrorist attacks, and psychiatric teams specialized in emergency interventions for mass trauma have been created across the territory. However, no public resources are dedicated for long-term interventions or for individual trauma cases. This letter describes how a government supported model of care has been created and implemented in 2019. A national centre for resources and resilience (CN2R) and 10 regional ambulatory services specializing in psychotraumatology were created with the aim of improving public mental health-care delivery while providing a comprehensive suite of services for trauma victims from the most immediate to longer-term considerations.

Les comportements inadaptés d’hygiène de sommeil constituent les principaux facteurs de risque de trouble du sommeil chez le sujet jeune. Une altération du sommeil était présente chez 37,5 % des internes en médecine du Nord-Pas-de-Calais en 2015. Quels sont les facteurs prédictifs d’un trouble du sommeil dans cette population, soumise à un travail à horaires décalés ?

L’insomnie chronique est un problème de santé publique touchant 10 % à 20 % de la population générale selon les études, et survenant à tout âge. Les comportements inadaptés d’hygiène de sommeil constituent les principaux facteurs de risque de trouble du sommeil chez le sujet jeune. Qu’en est-il dans une population d’internes en médecine, soumise à un travail à horaires décalés (gardes et astreintes) ?