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Introduction Impaired neural plasticity may be an important mechanism in the pathophysiology of Major Depressive Disorder (MDD). The goal of that study was to assess cortical excitability in patients with MDD after they received 2 different transcranial Theta Burst (TBS) paradigms. Methods Cortical excitability was assessed using Transcranial Magnetic Stimulation (TMS) before and repeatedly for 30 minutes after TBS was applied on the primary left motor cortex. The effect of neural plasticity was investigated after intermittent TBS (iTBS) and continuous TBS (cTBS). Results In this single blind controlled study, 14 depressed subjects and 14 healthy controls were included. All participants were free for any psychotropic drug. Repeated Measure ANOVAS revealed a significant Group X Time interaction while participants received iTBS. iTBS induced a significant increase of MEP size in the healthy controls whereas no change of MEP size occurred in the depressed subjects. Contrastly there was not any significant change in MEP size neither in the depressed subjects nor in the healthy controls after cTBS. A large inter-individual variability was observed in both groups after iTBS and after cTBS. Conclusion As iTBS may be related to LTP-like mechanisms involving glutamatergic NMDA receptor pathway, these results suggest glutamatergic neurotransmission may be altered. An impaired GABAergic transmission may also explain the impaired response to iTBS in depressed subjects. cTBS may be less efficient to induce neural plasticity in patients with MDD.

Background Electroconvulsive therapy (ECT) is one of the most effective treatments for major depressive disorder (MDD), especially in cases of treatment-resistant MDD. Due to their pharmacological profiles, benzodiazepines (BZDs) are suspected to decrease the efficacy of ECT. Current recommendations from scientific societies suggest gradual reduction or discontinuation of BZDs before the first ECT [1] . However, some studies revealed that BZDs had no negative impact on clinical efficacy of ECT in patients with MDD [2] . The current study investigated the effect of BZDs on ECT-induced clinical outcomes and on ECT parameters in patients with MDD. Methods Seventy patients with MDD receiving ECT, using dose-titration method, were retrospectively included. Among them, 22 received BZDs. We investigated the effect of BZDs onECT-induced changes in severity of depression using the Montgomery–Asberg Depression Rating Scale (MADRS) and on seizure parameters (seizure threshold, clinical and EEG seizure duration). Primary outcome was the number of patients who achieved remission (MADRS Results In the non-BZDs, lower remission rates (52.0% versus 81.2%; P = 0.02; Figure 1 ) and smaller decreases in MADRS scores (mean −21.9 ± standard deviation 11.5 versus −28.9 ± 10.5; P = 0.02) were observed than in the BZDs group after ECT. There were no significant differences between the two groups regarding ECT parameters and number of responders. Conclusions BZDs increased the clinical efficacy of ECT when delivered using dose-titration method and bitemporal stimulation in patients with MDD. The concomitant use of GABAergic drugs such as BZDs may potentiate the GABAergic effect observed during ECT course. Further studied are needed to understand the interaction between BZDs and ECT on clinical outcomes.

Introduction Deficits in social cognition and interpersonal difficulties are key features in borderline personality disorder. Social cognition refers to the function of perceiving and adequately dealing with social signals, leading to the establishment and maintenance of healthy and positive social relationships. Evidence suggests that oxytocin (OT) may improve social cognition and human social behavior. Recently, several studies have highlighted the beneficial effects of oxytocin in several psychiatric conditions involving social cognition deficits such as schizophrenia, autism or social phobia. However, despite growing interest, the effects of oxytocin in patients with borderline personality disorder are far from being clearly demonstrated. Objective The objective of this work was to review and discuss studies investigating the interest of oxytocin in alleviating social cognition deficits in patients with borderline personality disorder (recognition of emotion, trust and cooperation, affective and cognitive empathy, emotional expression and social problem-solving). Method A systematic review of the literature was conducted up to September 31, 2016 on the Pubmed, Science direct, Medline and Scopus databases using “borderline personality disorder” and “oxytocin” as keywords. To be included, studies were to include patients with borderline personality disorder; to investigate social cognition and to investigate the effect of oxytocin on social cognition in patients with TPB. Results The initial search yielded 52 articles. Among them, 11 studies were selected according to the PRISMA criteria. The effect of oxytocin on social cognition in patients with borderline personality disorder was mainly investigated in relation to recognition of emotions and trust and cooperation. We did not find any studies investigating the effect of oxytocin on affective and cognitive empathy, emotional expression or social problem-solving abilities. In patients with borderline personality disorder, oxytocin had a beneficial impact on recognition and discrimination of emotions and on hypervigilance towards social threats. However, oxytocin could hinder trust and cooperation. Conclusions These data lead us to consider oxytocin as a treatment for emotion recognition deficit and hypervigilance towards social threats in borderline personality disorder. A beneficial effect of oxytocin of this nature may be obtained only in patients without deficits in trust and cooperation because of a risk of aggravating relational instability. There was no current evidence for the interest of oxytocin in enhancing affective and cognitive empathy in borderline personality disorder. Further studies are needed to evaluate the clinical interest of combining oxytocin with psychotherapeutic approaches such as dialectical behavioral therapy or mentalisation-based treatment.

Background Electro-convulsive therapy (ECT) is one of the most effective treatment for treatment resistant depression (TRD) with remission rates of 87% [1] . Despite such a significant clinical effect generally observed after 6 to 20 sessions, ECT is also accompanied by major cognitive side effects and no markers of remission are available to help practitioners deciding to continue or not to deliver ECT sessions. Evidence suggests that early improvements in emotional processing, a commonly observed cognitive deficits in depression, can predict later clinical response to antidepressant [2] . Based on these studies, we hypothesized that early enhancement in emotional processing would predict remission in patients receiving ECT. Methods In an open pilot study, 30 patients with TRD receiving ECT will be enrolled. A free-viewing eye-tracking paradigm will be used to measure preferential attention to positive, negative or neutral faces. In this task patients will have to passively watch 2 pictures of faces (one neutral and one emotional face) presented during 3.5 sec on a computer screen. Eye-gaze patterns and time spend to the affective and to the neutral face will be assessed twice, one time at baseline and one time after the 6th ECT session. Severity of depression will be assessed using the MADRS at baseline, after the 6th and after the last ECT sessions. Results We report preliminary results in 8 patients. At the 6th ECT session, attention to happy faces was improved by 27% after 6 ECT treatments as compared to baseline in future remitters (MADRS Conclusion Early modification at free-viewing eye-tracking paradigm measuring emotional attention could be a predictive marker of remission to ECT in patients with TRD. Further investigation are needed to confirm this hypothesis.

Introduction Despite electroconvulsive therapy (ECT) is a highly effective, safe, and well-tolerated antidepressant treatment option for geriatric patients, response rate highly varied across individuals. We hypothesized that, as seen with medication, vascular burden may in part explain those discrepancies. Objective The aim of this study was to compare response rates to ECT in elderly depressed patients presenting or not vascular risk factors (VRF). Method In a retrospective study, 54 elderly patients (age > 55; mean age 60.7 ± 13.6) with moderate to severe MDD (Montgomery–Asberg Depression Rating Scale MADRS score > 20) who received a course of ECT between March 2016 and May 2018 in our specialized unit were separated into 2 groups according to VRF. Patients of the VRF group (n = 21) should presented with at least 2 vascular risk factors among hypercholesterolemia, hypertension, smoking, diabetes mellitus, cardiovascular disease, and cerebral vascular accident/transient ischemic attack. Framingham score (10-year risk for developing a coronary heart disease) was calculated for each included subject. Our primary outcome was the number of responder to ECT (defined as 50% decrease of the MADRS following ECT course) observed between the two groups. As a secondary objective, we investigated the relationship between Framingham score and pre/post ECT MADRS score changes. Results There was no difference between the 2 groups regarding age, gender, cognitive functioning, depression severity, stage of treatment-resistant depression and illness duration. Elderly patients with vascular burden presented a lower rate of response to ECT (58.1%) than patients without vascular burden (86.7%; Chi2 = 5; P = 0.02). A negative correlation was found between Framingham score and pre/post ECT MADRS score changes (r = −0.39; 95% CI − 0.61–0.12; P = 0.01). Conclusion As observed with medication, elderly patient with vascular burden displayed a lower response rate to ECT than elderly patients without vascular burden. The more VRF increased, the less the antidepressant effect of ECT was observed.

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique increasingly used to modulate neural activity in the living brain. In order to establish the neurophysiological, cognitive or clinical effect of tDCS, most studies compare the effects of active tDCS to those observed with a sham tDCS intervention. In most cases, sham tDCS consists in delivering an active stimulation for a few seconds to mimic the sensations observed with active tDCS and keep participants blind to the intervention. However, to date, sham-controlled tDCS studies yield inconsistent results, which might arise in part from sham inconsistencies. Indeed, even if most studies report using similar approaches as described in an early study by Gandiga et al. (2006,) [1] , the original protocol (i.e., 10 s ramp-up followed by 30 s of active stimulation at 1 mA before manually turning off the stimulator) has been largely modified, adjusting (a) the intensity and duration of active current being delivered (from “no current” to 2 minutes at 1 mA), (b) the duration of ramp-in and ramp-out phases (e.g. 5–30 s), and (c) the number of ramps done throughout the stimulation. Therefore, this multiplicity of sham stimulation protocols, used in the tDCS research field, might have different biological effects beyond the intended transient sensations. Here, we seek to enlighten the scientific community to this possible confounding factor in order to increase reproducibility of neurophysiological, cognitive and clinical tDCS studies.

Auditory hallucinations (AH) are very frequent and disabling symptoms of schizophrenia. In 25% to 30% of these patients, AH will stay refractory to conventional medication, resulting in persistent distress and functional disability. In such cases, evidences suggest that transcranial direct current stimulation (tDCS) could improve AH in adults with schizophrenia. tDCS is a safe noninvasive brain stimulation technique that might modulate brain activity and connectivity in the living Humans. AH are also frequently reported in patients with childhood-onset schizophrenia (COS). While pharmacological treatment of AH in adolescents with COS often leads to multiple side effects, little is known regarding the clinical interest of tDCS in adolescents with AH. The aim of this pilot study is to evaluate the safety and the clinical interest of a tDCS in the treatment of refractory AH in adolescents with COS. In an open-label prospective study, adolescents with COS and refractory AH will received 10 sessions (twice a day for 5 consecutive weekdays) of tDCS (30 minutes, 2 mA). The anode will be placed over the left dorsolateral prefrontal cortex and the cathode over the left temporo-parietal cortex. The severity of AH and the functioning of patients will be assessed 4 times using the Auditory Hallucinations Rating Scale (AHRS), and the Global Assessment of Functioning (GAF): at baseline (V1), after tDCS sessions (V2), one (V3) and 3 months later (V4). Preliminary results in 6 patients showed that tDCS may alleviate AH severity and that tDCS is a safe approach in adolescents with COS. AHRS scores exhibited a 66% decrease (from mean = 25.1 ± standard deviation 3.8 to 8.1 ± 12.8 one month later after tDCS). The Friedman Test for Repeated-Measures indicated a significant effect of tDCS on AH measured with the AHRS; chi square = 9; P = .01. We also observed a significant improvement of functioning measured with the GAF scores in adolescents with COS and refractory AH. Further randomized controlled studies are needed to confirm these preliminary results.

Some 25–30% of patients with schizophrenia report auditory hallucinations (AH) that fail to respond adequately to antipsychotic treatments. In such cases, transcranial direct current stimulation (tDCS) has been explored as a therapeutic option. Recently, clinical studies have showed promise of tDCS for reducing AH in patients with schizophrenia, in particular when tDCS was delivered using a fronto-temporal montage. Some studies have tried to explain the therapeutic effects of tDCS by investigating its cognitive and neurophysiological effects in patients with AH and in healthy subjects. Altogether, these studies may provide new evidence on the pathophysiology of AH. The purpose of the symposium is to present recent findings from investigators working at the cutting edge of the field and to discuss how tDCS studies help us understand the brain mechanisms underlying AH. Sanne Koops will present recent findings from an RCT investigating the effects of 2 mA tDCS on medication-resistant auditory hallucinations, general symptoms of psychosis and cognitive function. Ganesan Venkatasubramanian will present findings on the: – effects of tDCS on corollary discharge, mismatch negativity, resting state brain connectivity (fMRI); – neuroplasticity gene correlates of tDCS effects as well as; – clinical utility of MRI-guided High-Definition tDCS (HD-tDCS) in schizophrenia patients with persisting AH. Frederic Haesebaert will present recent findings from a study investigating the effects of tDCS on basic auditory processing, source-monitoring performances, and auditory hallucinations in patients with schizophrenia. Clara Fonteneau will present findings from a recent simultaneous PET-MRI study investigating the effects of fronto-temporal tDCS on subcortical dopamine release (using [11 C] Raclopride PET imaging), brain perfusion (using Arterial Spin Labelling) and resting state functional connectivity (using fMRI) in healthy volunteers.

Resume L’autoquestionnaire d’impulsivite de Barratt constitue a ce jour l’outil psychometrique de reference pour l’evaluation de l’impulsivite. Toutefois, les dimensions abordant les aspects antisociaux ou non conformistes des comportements impulsifs n’etaient pas abordes dans cette echelle. L’echelle d’impulsivite/non conformite de Chapman a pour avantage de prendre en compte cet aspect. Dans ce travail, nous rapportons l’etude de validation de la version francaise de ce questionnaire dans une population de 237 etudiants des deux sexes, âges de 18 a 25 ans. La consistance interne est etablie a l’aide, a la fois du coefficient alpha de Cronbach qui s’eleve a 0,81, et de la coherence interne par bissection qui s’eleve a 0,80 apres correction. Une correlation significative entre l’echelle d’impulsivite de Barratt et de l’echelle d’impulsivite non conformite de Chapman a ete observee ( r = 0,65). Ces resultats indiquent que la version francaise de l’echelle d’impulsivite/non conformite est valide et peut etre utilisee desormais en France dans la pratique courante et pour la recherche.

Pour identifier cette vulnerabilite, trois types de marqueurs de la vulnerabilite, bases sur la dichotomie episode (etat) versus trait, ont ete proposes : – les marqueurs stables independants de la pathologie exprimee : ils existent avant, pendant et apres l’episode et demeurent inchanges au cours de ces phases ; – les marqueurs intermediaires preexistant au trouble mais intensifies par la pathologie et persistant au-dela de l’episode ; – les marqueurs specifiques de l’episode dependants de la pathologie et presents uniquement au cours de l’episode. Differents types de marqueurs ont ete identifies a partir d’une grande variete de perturbations reperees a la fois chez les patients schizophrenes et les sujets a haut risque (exemple : les apparentes de proposants schizophrenes). Sur le plan paraclinique, on observe : – des anomalies cerebrales structurales et fonctionnelles, – des perturbations cognitives, – des perturbations electrophysiologiques (ondes P50 et P300). Sur le plan clinique, on observe : – des troubles non specifiques du developpement psychomoteur, – des anomalies physiques mineures, des signes neurologiques mineurs (soft signs), – des troubles precoces du comportement, non specifiques, – des troubles ou traits de personnalite. Dans ce cas, s’agit-il de marqueurs de vulnerabilite ou d’une expression attenuee d’un etat deja pathologique ? Pour repondre a cette question, il convient d’analyser ces marqueurs de maniere diachronique, c’est-a-dire en les replacant dans l’histoire naturelle de la maladie.

Resume Depuis 10 ans, l’evaluation de l’interet therapeutique de la stimulation magnetique transcrânienne repetee (rTMS) fait l’objet d’un interet croissant. Basee sur le principe d’induction decouvert par Michael Faraday en 1831, la rTMS pourrait constituer une methode therapeutique antidepressive et, peut-etre, une alternative a l’electroconvulsivotherapie (ECT). Afin de faire le point des connaissances dans ce domaine, nous avons analyse les principaux travaux realisesa ce jour au travers de leur diversite methodologique par l’intermediaire d’une consultation de la banque de donnees informatisee Medline et d’une base de donnees disponible en ligne (ISTS), completee d’une recherche manuelle ; nous avons retenu 66 etudes qui font l’objet de cette revue. Malgre l’heterogeneite de ces publications en termes de methodologie et de parametres de traitements, les proprietes antidepressives de la rTMS semblent se dessiner (37 % de sujets repondeurs vs 20 % dans les groupes controles sur 30 etudes analysables) et ceci ouvre des perspectives interessantes, dans le traitement des depressions resistantes et peut-etre en tant que potentialisateur des antidepresseurs dans les autres formes de depression. Cependant, un grand nombre d’inconnues subsistent (methodologie du traitement et indications privilegiees), ce qui justifie le developpement de travaux d’evaluation structures sur de grands echantillons.