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Objective: To review the current evidence for efficacy of cannabidiol in the treatment of mood disorders. Methods: We systematically searched PubMed, Embase, Web of Science, PsychInfo, Scielo, ClinicalTrials.gov, and The Cochrane Central Register of Controlled Trials for studies published up to July 31, 2019. The inclusion criteria were clinical trials, observational studies, or case reports evaluating the effect of pure cannabidiol or cannabidiol mixed with other cannabinoids on mood symptoms related to either mood disorders or other health conditions. The review was reported in accordance with guidelines from Preferred Reporting Items for Systematic reviews and Meta-Analyses protocol. Results: Of the 924 records initially yielded by the search, 16 were included in the final sample. Among them, six were clinical studies that used cannabidiol to treat other health conditions but assessed mood symptoms as an additional outcome. Similarly, four tested cannabidiol blended with Δ-9-tetrahydrocannabinol in the treatment of general health conditions and assessed affective symptoms as secondary outcomes. Two were case reports testing cannabidiol. Four studies were observational studies that evaluated the cannabidiol use and its clinical correlates. However, there were no clinical trials investigating the efficacy of cannabidiol, specifically in mood disorders or assessing affective symptoms as the primary outcome. Although some articles point in the direction of benefits of cannabidiol to treat depressive symptoms, the methodology varied in several aspects and the level of evidence is not enough to support its indication as a treatment for mood disorders. Conclusions: There is a lack of evidence to recommend cannabidiol as a treatment for mood disorders. However, considering the preclinical and clinical evidence related to other diseases, cannabidiol might have a role as a treatment for mood disorders. Therefore, there is an urgent need for well-designed clinical trials investigating the efficacy of cannabidiol in mood disorders. [ABSTRACT FROM AUTHOR]

THE KARIBU UNIT IS A 14-BEDDED SECURE ADOLESCENT FORENSIC PSYCHIATRIC SERVICE, WHICH OPENED IN THE C.H.J. TITECA, BRUSSELS (BELGIUM) IN 2003. THIS SERVICE CATERS FOR THE NEEDS OF ADOLESCENT OFFENDERS PRESENTING EARLY-ONSET SCHIZOPHRENIA AND/OR MAJOR AFFECTIVE DISORDERS. DESCRIPTIVE DATA ABOUT POPULATION AND THE INTERDISCIPLINARY TREATMENT MODEL ARE PRESENTED IN THIS ARTICLE. THIS TREATMENT MODEL AIMS AT TAKING MULTIPLE ASPECTS INTO ACCOUNT, SUCH AS FAMILY AND INDIVIDUAL HISTORY, EDUCATION, AGGRESSIVENESS MANAGEMENT, AND A MULTISYSTEMIC APPROACH. A SPECIAL FOCUS IS PUT ON WELL-TREATMENT AND THE ESTABLISHMENT OF A FAITHFUL RELATIONSHIP WITH YOUNGSTERS. [ABSTRACT FROM AUTHOR]

Copyright of Sante Mentale au Quebec is the property of Revue Sante Mentale au Quebec and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Résumé Objectifs Des études récentes ont montré l’efficacité de la remédiation cognitive dans la dépression (Elgamal, McKinnon, Ramakrishnan, & Mac Queen, 2007 ; Naismith, Redoblado-Hodge, Lewis, Scott, & Hickie, 2010) mais le transfert des compétences cognitives réentraînées vers la vie quotidienne est modulé par des facteurs motivationnels et métacognitifs (Martin & Franck, 2012 ; Soumet-Leman, Jouvent, & Plagnol, 2015). Cette étude vise à proposer et tester un dispositif spécifique pour le suivi en remédiation cognitive assistée par ordinateur (RCAO) des dépressions, incluant un entretien motivationnel et un accompagnement soutenu de la métacognition. Méthodes Nous avons testé ce dispositif auprès de 10 patients ayant vécu des épisodes dépressifs récurrents, dont un épisode aigu dans les 6 mois précédant l’étude. Les 10 patients ont bénéficié d’un entretien motivationnel, de 7 semaines de RCAO comportant 4 séances hebdomadaires et d’un accompagnement métacognitif nécessitant l’utilisation d’un journal de bord thématique. Des évaluations avant et après traitement ont été effectuées afin d’observer l’efficacité du dispositif proposé. Résultats À l’issue de la RCAO, les sujets témoignent d’améliorations nettes à l’ensemble des échelles cliniques mais la variabilité inter-individuelle est importante : tandis que certains sujets y ont été particulièrement réceptifs, d’autres ne sont pas parvenus à atteindre pleinement les objectifs fonctionnels escomptés à l’issue des sept semaines de traitement. Conclusion Cette étude confirme l’efficacité de la RCAO chez les patients dépressifs. Les résultats font état de nettes améliorations au niveau de la gestion émotionnelle (humeur, anxiété) et des capacités cognitives et métacognitives. Néanmoins, ce dispositif s’est avéré moins pertinent pour les sujets plus âgés et/ou anxieux, qui ont eu du mal à transférer les compétences acquises dans leur vie quotidienne. Objectives Recent studies have shown the effectiveness of cognitive remediation in depression (Elgamal, McKinnon, Ramakrishnan, & Mac Queen, 2007; Naismith, Redoblado-Hodge, Lewis, Scott, & Hickie, 2010) but the transfer of cognitive skills re-trained towards daily life is modulated by motivational and metacognitive factors (Martin & Frank, 2012; Soumet-Leman, Jouvent, & Plagnol, 2015). This study aims to propose and test a specific device in computer-assisted cognitive remediation (CACR) for the care of depressions, including motivational interviewing and sustained support of metacognition. Methods We tested this device with 10 patients who experienced recurrent depressive episodes, including a severe episode in the six months before the study. The 10 patients participated in a motivational interview, 7 weeks of CACR with 4 weekly sessions and a metacognitive support requiring the use of a thematic logbook. Evaluations before and after treatment were performed to observe the effectiveness of the proposed arrangement. Results At the end of the CACR, subjects have shown significant improvements in all clinical scales but the inter-individual variability is important: while some subjects were particularly receptive, others failed to fully achieve the desired functional goals after seven weeks of treatment. Conclusion This study confirms the effectiveness of the CACR for depressed patients. The results show significant improvements in terms of emotional management (mood, anxiety) and cognitive and metacognitive abilities. Nevertheless, this device proved less relevant for older subjects and/or anxious, who struggled to transfer the skills learned in their daily lives. [ABSTRACT FROM AUTHOR]

Résumé: Objectifs: Déterminer les meilleures stratégies pour prévenir le suicide chez les adolescents reste un objectif difficile à atteindre. Depuis près de trois décennies, un grand nombre de programmes de prévention a vu le jour. Cependant, peu d’entre eux ont été évalués. Nous proposons ici une revue de la littérature des études portant sur l’évaluation des stratégies de prévention du suicide et des conduites suicidaires à l’adolescence. Méthode: Nous avons effectué une revue systématique de la littérature électronique publiée en français et en anglais, entre 1980 et mars 2013, via MEDLINE, Cochrane Library et PsychINFO. Les combinaisons suivantes ont été utilisées : ű suicide Ƈ AND (ű prevention Ƈ OR ű control Ƈ OR ű traitement Ƈ). Nous avons sélectionné 37 études portant sur l’évaluation des stratégies de prévention du suicide et des conduites suicidaires en population adolescente (12–18ans). Résultats: Les stratégies universelles telles que la restriction des accès aux moyens létaux et la formation des médecins généralistes au dépistage et au traitement des troubles de l’humeur ont montré les preuves de leur efficacité. Les stratégies de lutte contre la récidive ont besoin d’évaluations supplémentaires. Enfin, les programmes destinés à réduire la contagion suicidaire n’ont pas à ce jour montré leur efficacité. Conclusion: Bien que d’importants progrès aient été réalisés pour lutter contre le suicide des jeunes, les études d’évaluation sont peu nombreuses et leur généralisation difficile en raison des limites méthodologiques. [ABSTRACT FROM AUTHOR]

MOOD DISORDERS AND MAJOR DEPRESSIVE DISORDER (MDD) IN PARTICULAR REMAIN HEAVY BURDENS FOR PUBLIC HEALTH POLICIES IN GENERAL. HENCE, THERE IS AN ONGOING NEED FOR EFFICIENT AND INVENTIVE TREATMENT STRATEGIES WITHIN DAILY CLINICAL PSYCHIATRIC PRACTICE. AGOMELATINE PROPOSES SUCH A NOVEL MECHANISM OF ACTION WHICH IS NOT BASED ON MONOAMINERGIC REUPTAKE INHIBITION LIKE MOST COMMONLY USED ANTIDEPRESSANTS. THE PRESENT REVIEW SUMMARIZES RECENT CLINICAL LITERATURE, WHICH INVESTIGATED DIFFERENT ASPECTS OF DEPRESSION TREATMENT, BY MEANS OF CONSECUTIVE CONSIDERATIONS OF GLOBAL CLINICAL EFFICACY, ON KEY SYMPTOMS (ANHEDONIA, DYSSOMNIAS, CIRCADIAN DYSREGULATIONS, COGNITIVE EMOTION PROCESSING), IN DIFFERENT GROUPS OF PATIENTS AND ALSO REPORTED TOLERANCE PROFILE. UPON THE BASIS OF RECENTLY PUBLISHED CLINICAL DATA, WE CAN INDEED UNDERLINE THAT AGOMELATINE HAS SHOWN TO BE A CLINICALLY EFFICIENT ANTIDEPRESSANT TREATMENT IN MDD IN GENERAL BUT ALSO IN PATIENTS WITH SEVERE SYMPTOMS AND IN ELDERLY PATIENTS. AGOMELATINE REPEATEDLY SHOWED AT LEAST A NON-INFERIOR EFFICACY BUT ALSO A GREATER IMPROVEMENT OF KEY SYMPTOMS IN CERTAIN STUDIES, IN COMPARISON WITH ANTIDEPRESSANTS CONSIDERED AS BEING OF "SUPERIOR EFFICACY". THOSE STUDIES SHOWED A GREATER IMPROVEMENT OF KEY SYMPTOMS OF DEPRESSION WITH AGOMELATINE AS ANHEDONIA OR SLEEP DISORDERS, WHILE PRESENTING A FAVORABLE REPORTED TOLERANCE PROFILE, TAKING INTO CONSIDERATION THAT LIVER FUNCTION MUST BE MONITORED DURING TREATMENT. [ABSTRACT FROM AUTHOR]

Résumé: Sans limites et sans fin, les jeux en ligne multi-joueurs ont un fort potentiel addictogène, les modes de consommation dépassant souvent six heures par jour. Ils sont facilement accessibles puisqu’ils ne nécessitent qu’un accès Internet et sont disponibles en version d’essai gratuite. La surconsommation mène très rapidement à un isolement familial et social, à l’échec scolaire et au désinvestissement total d’autres formes d’activités. Les jeunes touchés se nomment entre eux ű no life Ƈ. La surconsommation de jeux multi-joueurs en ligne et d’Internet touche principalement les adolescents et jeunes adultes, de préférence de sexe masculin. L’étude des facteurs psychopathologiques plaide en faveur de l’existence d’une fragilité psychopathologique prédisposant à l’apparition de la consommation excessive des jeux en ligne. Sont à privilégier notamment les troubles de l’humeur, les styles et schémas cognitifs dysfonctionnels, les prodromes du trouble psychotique. L’analyse des motivations permet de dégager trois facteurs principaux qui mènent les individus à consommer : le souhait de réussir, la création de lien social, l’immersion dans un environnement qui permet de s’extraire de sa propre existence. Les thérapies cognitives et comportementales permettent une prise en charge efficace de ces troubles, mais rien ne permet de dire aujourd’hui, étant donné le peu de littérature disponible, si elles sont les seules. [ABSTRACT FROM AUTHOR]

Abstract: Oral glucocorticoids have been used for several decades and psychiatric side-effects may occur. This review will discuss relevant data of the clinical specificities, the incidence, the risk factors for the occurrence of these episodes and the preventive and curative medications of these episodes. We performed a literature review by using PubMed database. We selected and discussed articles and studies with high standard of evidence. The occurrence of psychiatric symptoms is quite frequent. The varying intensity of clinical features ranges from minor signs (impregnation) to acute psychotic episodes which may occur from 5 to 30% of patients. Affective symptoms or disorders are the most prominent clinical features. Delirium may occur and suicidal risk could be increased. The significant predictive factors are prednisone dosage more than 40mg/day, particularly weight-based dosage, and a history of psychiatric disorders. When a reduced dosage of glucocorticoids is not sufficient to control the symptomatology, curative medication is mainly based on atypical antipsychotics such as olanzapine. Studies about neuropsychiatric complications of glucocorticoids present various and heterogeneous results. Further prospective clinical studies should be based on a close cooperation between physicians and consultation liaison psychiatrists. This collaboration is required for an optimized management of the patient who receive glucocorticoids. [Copyright &y& Elsevier]

Résumé: La médecine technicienne considère la prescription d’un placebo comme une absence de traitement, une situation contrôle nécessaire pour valider les nouvelles thérapeutiques. Cependant, des études internationales récentes montrent que cette prescription entraîne des effets bénéfiques qui dépassent largement la guérison spontanée, en particulier concernant les états dépressifs et les troubles de l’humeur. Le présent article propose une revue de cette littérature et conclut que, sauf pour les cas les plus sévères, les antidépresseurs ne sont pas plus efficaces qu’un placebo. Les auteurs proposent ensuite une synthèse des travaux concernant les conditions qui modulent la taille de l’effet placebo. Ils soulignent que la conception étroitement biologique de la dépression et de son traitement, chez le patient comme chez le médecin, est moins favorable à la guérison. Ce constat oblige à penser l’effet placebo comme le résultat d’une relation interpersonnelle en référence au concept psychanalytique de transfert. Lors du traitement par un placebo, le patient échange la reconnaissance de son statut de malade contre une amélioration temporaire de ses symptômes, mais le transfert entre patient et médecin n’est pas pris en compte. De fait, les psychothérapies, qu’elles soient d’inspiration cognitivo-comportementale ou psychanalytique, entraînent des effets plus durables que le traitement par un placebo ou un antidépresseur. Selon les auteurs, le transfert assumé par le psychothérapeute, y compris dans toute sa charge affective, permettrait au patient d’accéder aux répétitions inconscientes issues de l’enfance et de s’en dégager. L’article conclut par des propositions concernant les pratiques de soin et la formation des soignants. [ABSTRACT FROM AUTHOR]

Objective: Bipolar affective disorder (BD) is a multifactorial disorder with heterogeneous clinical presentations, in particular according to age at onset (AAO). The relevance of such an indicator has been discussed as a potential specifier in future nosographical classification. Methods: We summarize available evidence of admixture analyses and biomarkers in early onset BD. Results: Numerous clinical arguments have led us to conclude that the early onset BD subgroup is clinically homogeneous, with particular, recurrent, and severe characteristics. Eight admixture studies have demonstrated the existence of 3 subgroups of patients with BD according to AAO (early, intermediate, and late AAO), with 2 cut-off points of 21 (21.33 [SD 1.41]) and 35 years (34.67 [SD 5.52]). Differential clinical features and outcome measures characterize the early onset subgroup: higher rate of suicide attempts, rapid cycling, alcohol and drugs misuse, psychotic symptoms, and comorbid anxiety disorders. This may partially explain the delayed diagnosis and late initiation of mood stabilizers. Genetic, biological, imaging, and cognitive arguments may be considered as potential markers in providing external validity of the existence of this early onset subgroup. Implementation of AAO in the algorithms of treatment may be discussed, although the level of proof for focused medication strategies remains to be consolidated. Conclusions: Given the high frequency (44.80%) of early onset BD, awareness of clinicians should be stimulated to provide an early and accurate detection, preventive strategies, and possibly specific treatments. The forthcoming DSM-5 should include AAO as a specifier, given its relevance for course and outcome. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: While the reception arrangements for child psychiatric emergencies seem increasingly frequented by adolescents, we sought to identify clinical and sociodemographic characteristics of these patients, yet poorly explored and understood. Methods: We conducted an analysis of the literature review listed from the major search engines. Results: Attendance at child psychiatric emergencies is increasing for over 20 years, with a predominance of adolescents and accompaniment by an overrepresentation of social assistance to children (child welfare): 22,7% to 43% of patients. The first emergency department visit patterns are agitation and violence. The main diagnoses that are registered are mood disorders and conduct disorders, including oppositional defiant disorder. A significant proportion of these adolescents come back to emergencies procedures within the year: nearly one third of adolescents, including a history of child welfare monitoring as a risk factor. Discussion: In the different studies, the same proportion of internalizing problems and externalizing problems are registered by clinician investigators. The most striking characteristics relate more to the environment of these teenagers, including a significant proportion who are followed by child welfare. For those teenagers consulting in an emergency service, a therapeutic issue is to reintegrate them into a sufficient long-term care, thanks to disponibility, accessibility and an essential preliminary work and partnership coordination between the various professionals who accompany them. Conclusion: Based on literature data, knowledge about clinical and sociodemographic adolescents referred for “psychiatric emergency services” need to be developed in order to better understand an important issue and to propose care projects closer to the needs of this high-risk population. [Copyright &y& Elsevier]

Objective: To compare mood disorder (MD) prevalence in Quebec in 2006, and compare health services and medication use, mortality and morbidity in patients with MD based on sex and the dwelling sector level of material and social deprivation. The objective was also to identify subgroups of individuals using health services in a larger proportion and having a higher risk of morbidity and mortality. Method: We conducted a secondary analysis of the Régie de l'assurance maladie du Québec medico-administrative data. The cohort is composed of adults diagnosed with MD and living in Quebec in 2006. Variables include: physician consultation, medication demand, consultation for substance or alcohol abuse, emergency visit, hospitalization for a mental disorder, and death. Dwelling sector types are defined by crossing Pampalon material and social deprivation quintiles. Results: MD prevalence in 2006 was 3.06% (177 850 patients), with prevalence In women 1.7-fold with respect to men. Findings show a higher MD prevalence as well as a higher mortality and morbidity rate in materially and socially deprived dwelling sectors. Young men also represent a specifically vulnerable subgroup for many study variables. Conclusion: Public policies aimed at improving material conditions (income, education, employment) and breaking out social isolation would have an important impact on the population mental health. Public health program development should pay close attention to young men population. [ABSTRACT FROM AUTHOR]

Abstract: AM retrieval is a reconstruction process that grounds the self by providing coherent narratives organized to elicit a sense of identity across the time. Major depression is associated with impairments of AM retrieval, combining a mood congruent recall, a lack of specificity, an increased prevalence of the third-person visual perspective and frequent intrusive memories, which are characterized by an involuntary, fast and effortless recall. Intrusive memories in depression relate to a broad range of negative life events and are usually vivid, distressful and associated with a poorer outcome as well as with typical depressogenic cognitive biases, especially with cognitive avoidance. To date, little is known about the neural bases of these memories. These bases are likely to partially mirror those of the depressive state, with a decreased cognitive control over unwanted thoughts by the prefrontal cortex and an increased amygdala activation. [Copyright &y& Elsevier]

AIM: REVIEW OF THE CORRELATION BETWEEN SOMATIZATION AND ALEXITHYMIA AND THE MEDIATING FACTORS BETWEEN THEM. METHODOLOGY: REVIEW OF LITERATURE BETWEEN 2000 AND 2010 ON THE MEDLINE DATA BASE. RESULTS: THE CORRELATION BETWEEN GENERAL ALEXITHYMIA AND SOMATIZATION DISAPPEARS WHEN THE NEGATIVE AFFECTIVITY IS CONTROLLED WHILE THE DIF (DIFFICULTY IDENTIFYING FEELINGS) DIMENSION STAYS CORRELATED TO SOMATIZATION. NEGATIVE AFFECTIVITY SEEMS TO MEDIATE THE CORRELATION BETWEEN ALEXITHYMIA AND SOMATIZATION. THIS DIMENSION IS ALSO SIGNIFICANTLY CORRELATED TO SOMATOSENSORY AMPLIFICATION. CONCLUSION: DIF CAN BE CONSIDERED AS THE STABLE PART OF ALXITHYMIA. THIS COGNITIVE DEFICIT MAY LEAD TO OTHER DIFFICULTIES AS SOMATOSENSORY AMPLIFICATION, STYLE ATTRIBUTION, HEALTHCARE SEEKING AND ILLNESS BEHAVIOR, AND MAY HAVE CONSEQUENCES ON BOTH SOMATIZATION AND NEVROSISM. [ABSTRACT FROM AUTHOR]

Abstract: A large number of psychotherapies were proposed to depressed patients. The behavioural and cognitive therapies showed their efficacity. This short-term therapy improves quickly the symptoms and prevent around 30% of relapse. Many patients having suffered from depression undergo unipolar depression relapses during the 5years following the treatment. Therefore international guidelines, including pharmacological and psychological interventions, were published to prevent these relapses. Nowadays a combined treatment is most often prescribed. This paper presents the behaviour and cognitive models of depression. This brief psychotherapy works on the depressed symptoms (engaging the patients in a large number of pleasant activities), on hopelessness cognitions and on the own psychological vulnerability (named cognitive schemata). The activation of depressed schemata is correlated with relapse. The indication of TCC in depressed patient is discussed after two ou three sessions (“case conceptualisation”) performed by a cognitive and behaviour therapist. This professional has preliminary learnt the theory and practice during a specific training. This article reviews main studies including the cognitive and behavioral therapy in depressed uni- and bipolar patients. Results are discussed in terms of acceptability, feasibility, and efficacy. A case study confirms the relevance of this approach. New cognitive and behaviour programmes were developed during 20years with recurrently depressed patients, these included additional booster sessions sometimes combined with well-being therapy and even with mindfulness-based cognitive therapy. The new approaches were assessed in pilot studies and their results will have to be confirmed. [Copyright &y& Elsevier]

Abstract: Introduction: It has been established that cannabis use is involved in the emergence and evolution of psychotic disorders. Although cannabis use is very frequent in mood disorders, there has been a considerable debate about the association observed between these two disorders. This review aims to clarify the relation between cannabis use and bipolar disorder, in order to unveil a possible causality and find the effect of cannabis on the prognosis and expression of bipolarity. Methods: The review used MedLine database using the keywords “cannabis” or “marijuana” and “bipolar” or “mania” or “depression”. This search found 36 articles who were clinically relevant to the subject and were included and discussed in this review. Results: The first studies discussing the link between cannabis use and psychotic disorders reveal manic features in the substance abuse group, hence suggesting a possible association between cannabis use and bipolar disorder, in favor of triggering a manic episode. According to the studies, between 25 and 64% of bipolar patients are cannabis users, and the prevalence is higher in younger and male patients. The risk of developing a mood disorder is higher among cannabis users compared to the general population. This substance abuse in bipolar disorders would increase the frequency and duration of manic episodes without changing the total duration of mood episodes. In a first episode of bipolar disorder, the use of cannabis would increase the rate of relapses of manic episodes and worsen the prognosis of the disorder. Discussion: The frequency of substance abuse in bipolar disorders is higher than the prevalence in the general population, and cannabis is one of the most used illegal substances in the worldwide. Hence, the association between cannabis use and bipolar disorders is frequent. Cannabis users may experience euphoria, relaxation and subjective feelings of well-being; this substance may also have antiepileptic effect, which may explain some of the effects of cannabis on bipolar disorders. In fact, the use of cannabis would increase the frequency and duration of manic episodes in bipolar patients without increasing the total duration of mood episodes, suggesting a possible antidepressing and mood stabilizing effects. This impact of cannabis on mood disorders and its possible pharmacological effect is still controversial and needs further experiencing to be proved. [Copyright &y& Elsevier]

Abstract: Homicide is an extreme outcome of violence which is infrequent in older adults, with a prevalence ranging from 1% to 4%. In those cases, homicide is usually followed by suicide. Homicide appears in different psychopathology contexts: Mood disorder, alcohol disorder and psychosis disorder. An association of mild to moderate dementia with homicide has been reported. The risk factors of homicide in demented patients remain unknown. Dysexecutive syndrome could be a cause of homicide in demented patients. The reported case highlights this issue and shows that neuropsychiatric evaluation of older murderers could be useful in understanding the murder. Clinical and criminological characteristics of elderly murderers with a dementia will also be discussed. [Copyright &y& Elsevier]

Abstract: Melancholia is an affection that has inspired both poets and scientists. Under different disguises, through centuries, it has remained a mystery that resists analysis. Mood disorders question the heuristic value of the psychoanalytic model of melancholia. This is the model we will use to grasp the unknown factors of the treatment of loss and passivity, particularly present during adolescence. Freud considered depressive vulnerabilitly central to the woman''s psychosexual development. Rather than study melancholia in women, we will question “the melancholic femininity” in both women and men. The impossible acceptance of a passive position, felt when confronted with the primal fantasies and all situations of exclusion and abandonment, leads certain types of organisations to give a “melancholic version” of the fantasy of seduction. We will examine this model using the projective tests of an adolescent presenting a severe mood disorder. We will demonstrate that, during adolescence, the “melancholic solution” is sometimes the only means to express the intensity of incestuous fantasies. Depression becomes the way to expiate these fantasies that had remained hidden behind the anxiety of loosing the object. [Copyright &y& Elsevier]

The present study investigated whether alexithymia mediated the effect of chronic pain on depression in a fi bromyalgic population. Both alexithymia and chronic pain have been linked to depression in fi bromyalgia but no mediational model has been proposed to account for those relations. Patients were assessed for pain, alexithymia and depression at the beginning of an interdisciplinary treatment for fi bromyalgia. The results support a model where the effect of pain on depression is totally mediated by alexithymia. Results are further discussed in terms of van Middendorp et al.'s (2008) assumption that non-processed emotions, like those related to the chronic pain condition, will later or soon express themselves, then leading to depression. Therapists should thus provide a secure environment so that the patient can feel free to express himself and the therapeutical work will focus on differenciating emotions from cognitions. This kind of therapeutic work can lead to health benefi ts, as signifi cative changes in alexithymia are associated with less depressive symptoms. [ABSTRACT FROM AUTHOR]

Abstract: The aim of the article is to present an overview of alexithymia. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To ascertain the factors related to patients’ psychiatric readmissions at Bingerville. Patients and method: It was a case-control study built on 436 files of patients who had been hospitalized for the first time in 2001 at Bingerville''s psychiatric hospital. We called readmission all rehospitalization arisen 15 days after the end of the previous hospital stay. Sociodemographic and clinical characteristics of the patients who had been readmitted for at least a fold within 1st January 2001 and 31st December 2006 were compared to those who had not been readmitted during this period, by using the Chi-square test. Results: Patients admitted for the first time at Bingerville psychiatric hospital were in majority less than 44 years old (87.8%) with mean age at 31.1±10.9 years. More than half of them, had male gender (61.9%), was single or widowed or separated (70.6%), without a kid (55.5%). Numerous of them were not educated above secondary school (95.4%). In these first admitted patients, 50.9% did not earn a wage, 68.8% lived in Abidjan. Those who had both their mother and father alive represented 53.9% of the study sample. About two-third of the patients were younger in their siblings, as well in father''s children as in mother''s. Regarding the clinical features, schizophrenia and other psychotic disorders (59.2%) were the most frequent diagnosis, followed by mood disorders (19.0%). These mental disorders started during the month before first psychiatric hospitalization at Bingerville (47.2%). The majority (74.5%) of these patients were hospitalized 30 days at most. They were discharged with medical advice (85.8%) and less than two drugs prescribed (66.3%). The aftercare treatment did not last more than 26 weeks for most of the patients (79.6%). Readmission occurred at least a fold in 22.5% of the subjects, in majority during the first 2 years after being discharged in 2001 (68.4%). Patients characteristics related to readmission during the 6 years of study period were: being less than 21 years old (p =9×10−4), younger in the siblings of mother''s children (p =10−3), having both mother and father alive (p =3×10−3), a mood disorder diagnosis (p =0.046) and a length of aftercare treatment exceeding 26 weeks (p =4×10−3). Conclusion: When they are repeated and closer, readmissions can worsen patients’ social reinsertion. The knowledge of factors related to these rehospitalizations is useful to prevent this consequence. [Copyright &y& Elsevier]

Abstract: Resistance to psychopharmacological and psychotherapeutic therapies is a frequent difficulty clinicians are confronted to, with a frequency of 20 to 30 % concerning depression disorders. Other therapeutic approaches hence seem unavoidable to optimize treatments: structured psychotherapies such as behavioural and interpersonal therapies have shown their efficiency in anxiety and depression disorders, psychoeducational approaches help better observance in chronic pathologies. Biological and non medicinal approaches such as electroconvulsive therapy are still a therapy of reference for treating mood disorders and remain an indication for resisting schizophrenic disorders. [ABSTRACT FROM AUTHOR]

Abstract: Repetitive transcranial magnetic stimulation (rTMS) is in psychiatry a recent noninvasive therapeutic tool and with few in particular cognitive side effects. Its principle rests on the stimulation of the cortical networks via a magnetic field applied to cranium. The depression is the psychiatric indication best documented today but the variability of the parameters of stimulation used and the methodological problems inherent in the technique return the results of the not easily comparable studies between them. Multicentric studies with a methodology rigorous and bearing on a great number of patients are still necessary to define the place of this new tool in the therapeutic arsenal in psychiatry. [Copyright &y& Elsevier]

Abstract: Objective: In neurological disorders, such as multiple sclerosis (MS) and Parkinson’ s disease (PD), psychological and adaptive processes have not been extensively investigated, it has, however, been demonstrated that they have a great impact on “quality of life” (QoL). Interestingly, even though these two diseases affect people of different ages, both of them have a substantial impact on mood and QoL. In these two diseases, the authors objective was to analyse the style of coping in relation with the QoL taking depression and anxiety into account. Methods: Two hundred and seventy MS and PD subjects were seen for a semistructured interview in order to collect sociodemographic and clinical information, after which there was an assessment of their mental and cognitive states using: the Mini International Neuropsychiatric Interview (MINI), the Montgomery and Asberg Depression Rating Scale (MADRS), the Depressive Mood Scale (EHD), the Hamilton Anxiety scale (HAMA) and the Frontal Assessment Battery (FAB). Then, all subjects completed three self-report questionnaires; two about coping strategies: the Ways of Coping Checklist (WCC), the Coping with Health, Injuries and Problems scale (CHIP), and one about QoL: the SEP 59 for MS and the French version of PDQ-39 for PD. Results: The studies show that the psychosocial dimension of QoL is preserved in the two diseases studied. They also demonstrated that in MS and PD the two factors associated with a poor QoL are depression and emotion-focused coping strategies. Furthermore, these variables are highly dependent on the clinical courses in MS and motor signs in PD. However, the MS patients tended to be more irritable and to lose the control of their emotions more easily than PD patients. Discussion: The report discusses the importance, first, of identifying these manifestations in patients with MS or PD and, second, of offering patients interventions tailored to the characteristics of each disorder. The authors propose some examples of psychotherapy, which could be used with neurological patients. The studies show that it is also important to work with MS and PD patients on both the expression and the management of their emotions in connection with their diseases. [Copyright &y& Elsevier]

Abstract: The distinction between bipolar disorder (BD) and Attention Deficit Hyperactivity Disorder (ADHD) is difficult because of their shared clinical features such as motor agitation, distractibility, impulsivity or irritability. In clinical practice, a rigorous assessment of affective symptoms can help to distinguish between BD (acute affective episodes) and ADHD (chronic irritability or low self-esteem without psychotic symptoms, elation or sexual desinhibition). Impaired cognitive functions have been shown in both diseases; however, some studies identified a major emotional dysregulation in BD by contrast to ADHD, whereas cognitive deficits could more specifically characterize the latter. Comorbid BD and ADHD is a frequent and severe condition. The coprescription of psychostimulants and mood stabilizers has shown its potential clinic and functional benefits. [Copyright &y& Elsevier]

Abstract: Critical revue of the concept of bipolar disorders and spectrum and the categories in DSM-IV and ICD10. [Copyright &y& Elsevier]

Abstract: Introduction: The current categorical split of mood disorders into bipolar disorders and depressive disorders has recently been questioned after the widening of the bipolar spectrum. Recent studies have suggested that clinicians may under-diagnose bipolarity in a substantial proportion of depressed patients, and have proposed the existence of a “pseudo-unipolar” depression. On the other hand, many studies were made to identify factors correlated to bipolarity in depressive disorders. They have shown that the main clinical factors correlated to bipolarity are: pharmacological hypomania, puerperal depression, early age of onset, psychotic features, hypersomnia and psychomotor inhibition. In this context, it should be interesting to study temperaments as predictive factors of bipolarity in depression and to explore their correlation with those clinical predictors. Objectives: The aims of this study were to assess affective temperaments in patients with recurrent depressive disorders, and to explore the correlations between these temperaments and clinical features of depressive disorders. Methods: The study was a cross-sectional one bearing on 91 recurrent depressive patients (40 men and 51 women, mean age: 46.8±10.1years), who were interviewed using the DSM-IV Structured Clinical Interview during the partial or total recovery period. Data was collected using available medical records. The evaluation of affective temperaments consisted in filling in the Akiskal and Mallya semi-structured questionnaire. Results: The depressive temperament obtained the higher mean score (12.3±4.74), followed by the hyperthymic temperament (7.8±4.5), the cyclothymic temperament (5.9±5.8) and the irritable temperament (4.9±3.3). A significant association was found between the onset of the first depressive episode during the postpartum period and the cyclothymic temperament score (7.4±6.9 versus 3.3±3.6, p =0.04). The psychotic features in the last depressive episode were significantly associated with the hyperthymic (p =0,001), the cyclothymic (p <10−3) and the irritable temperament scores (p <10−3). A significant link was found between suicide attempts during the last depressive episode and the cyclothymic temperament on the one hand (p <10−3) and the irritable temperament on the other hand (p =0.01). Conclusions: The recurrent depressive disorders with hyperthymic, cyclothymic and the irritable temperaments seem to have clinical features similar to those of bipolar disorders. These results point to the importance of evaluating these temperaments in depressed patients, considering the risk of polarity change and of misdiagnoses of unipolar depression. [Copyright &y& Elsevier]

Abstract: The aim of this exploratory study is to test the application of therapy EMDR in case of traumatic bereavement. The traumatic bereavement, which corresponds to the brutal loss of “other significant”, answers a precise clinical picture whose principal characteristics are the intrusive thoughts concerning the late one and of the difficulties of adjustment to the loss (feeling of vacuum, difficulties of recognizing the death, irritability, lack of reactivity, etc). The eight participants all of this study are of the members of the family of the victims of the train collision, which took place on October 12, 2006 in Zoufftgen. The subjects, old on average 35.2 years (S.D.=11.1) and including 75 % women, followed between eight to 15 meetings (m=10.75, S.D.=2.21) answering protocol EMDR. The effectiveness of the therapy was evaluated starting from several criteria including traumatic bereavement, anxiety, depression and psychological distress. Five evaluations were carried out: before the therapy (T0), after six meetings (T1), at the end of the therapy (T2), then in three months (T3) and 12 months (T4) after the end of the therapy. The principal results seem to indicate an effectiveness of the therapy EMDR. Indeed, we observe a reduction in all the indicators between the beginning (T0) and the end of the therapy (T2). Moreover, when this reduction does not continue to three and 12 months, it remains, at least, stable at one year. These observations are very encouraging especially when it is known that 10 to 15 % of the patient develops a chronic depression. [Copyright &y& Elsevier]

Abstract: Background: The aim of this paper is to describe the major results of two prospective studies on auditory hallucinations in prépubertal children and the case reports of two children followed three years after inclusion. Methods: Samples of out patients aged five to twelve years old were consecutively recruited over two differents period and followed subsequently twelve and six months. K-SADS interview was conducted to determine DSM-IV diagnoses and all children were interviewed using a questionnaire investigating auditory hallucinations. Results: 151 patients were recruited. Twenty-eight out of the 151 reported auditory hallucinations. For 13 children supportive therapy facilited the children’s full recovery from hallucinations within three months and all of these suffered from separation anxiety. For six children hallucinations persisted over the study period and five of these showed conduct disorders. Out of these six children, two presented a diagnostic of schizophrenia and/or schizophrenic affective disorder at age 14 and 15. Two cases followed three years after inclusions and from the two followed groups are presented and discuss. Conclusions: Our study provides further evidence of the high prevalence of auditory hallucinations in pre-pubertal children. In the majority of cases hallucinations seem non specific and may be a manifestation of anxiety. Although for four children herald the development of a diagnosis of the spectrum of schizophrenic disorders. [Copyright &y& Elsevier]

Abstract: Sensation seeking is at the root of different behaviours. Skydivers, artists, drug addicts and criminals somehow share the same need for stimulation. But are there drug-addicted skydivers? Are there different ways to seek sensations? Studies on risky sport practices and disinhibition are contradictory. While some find risk-taking athletes do not consume substances, others maintain these athletes are indeed the most uninhibited of all. Diversity and the type of activities supposedly depend on what exactly an athlete seeks from a psychological point of view. The analysis of different sensation seekers’ personality traits helps to better understand the choice and role of one or several sources of activation. Based on a review of studies, we will discuss three sensation seeker profiles. Depressed “escapists” primarily seek sensations through substance use in order to regulate their negative affects. This “passive” stimulation mode seems better suited than practising risky sports for these individuals lacking in energy. Conversely, extraverted “hedonists” comfort their positive affectivity by seeking multi-faceted pleasure in risky sports or the “social” use of substances. They are not characterized by negative affects but by alexithymia. Some probably bypass their difficulty to understand their feelings by seeking various readily available sensations that need not be mentally interiorised (purportedly found in disinhibition or risky sports). Finally, “compensatory” types are adventurers who seek sensations in high-risk sports only. They are not characterized by depression, anxiety, disinhibition, extraversion or alexithymia. They seek to enhance and build up their personality by confronting the natural environment and danger. While all athletes seek sensations, these might not be essential to escapist and compensatory types who use them only as a mere means to escape and compensate. Extraverted hedonists seem to be the “true” sensation seekers inasmuch as stimulations are worthwhile in themselves. This strong need for hedonistic sensations might lead to an addictive process, a common answer to psychic sufferings that may also derive from boredom or a need for sensations and pleasure. [Copyright &y& Elsevier]

Abstract: Practicing cognitive and behavioral therapy, one often observes a lack of readiness to change. This study seeks to identify factors tied to this lack of motivation: Dependence itself, temperament and character profile, affective disorders? How improve alcoholics’ inpatients readiness to change who have depressive and social anxiety disorders associated? To this end, we compared 12 separated alcoholics’ inpatients, with two other groups having a major depressive state or a social anxiety. We used a motivational interviewing guide built from the Prochaska and Di Clemente model, hetero- and autoquestionnaires, and the TCI. These three groups have the same depressive suffering and high scores of harm avoidance. The “non-ready” to change participants were distinguished from the “decided” ones by scoring different on two-character dimension of the TCI (self-directedness and transcendence). This study applies the model of readiness to change to others disorders than addictions. [Copyright &y& Elsevier]

Abstract: Background: Several studies have revealed an increased risk in the appearance of behavioural and psychological problems among adopted teenagers. Others noted their over-representation in psychiatric hospitals and in mental health consultations. Adolescence could be a crucial period on the basis of their subjective identity, and of the sudden appearance of psychological difficulties for the adopted adolescents consecutive to questions regarding their origin and role in the family. Some authors suggested that the influence of racial discrimination among adopted adolescents could play a role in the genesis of mental disorders. No studies concerning adopted adolescents in psychiatric hospital have ever been published in Belgium, and the differences in culture and in legislation do not justify a direct transposition of the conclusions of a study from one country to another. Aims: Our hypothesis is that the psychic disorders of adopted teenagers cannot be summarized by the difficulty of facing racial discrimination but that the difficulties related to the abandonment and adoption are expressed according to a specific diagnostic category, different from that of immigrant adolescents. Methods: This retrospective study concerns in-patients (12 to 20 years old), hospitalized from January 1, 2003 to December 31, 2004 in the service for adolescents and dissociative disorders of the Private Psychiatric Clinic Fond’Roy in Brussels. At first admission the prevalence of psychiatric diagnoses among adopted patients was compared according to age, sex, family origin, as well as to age of adoption. Three family origins were considered: Adopted, immigrant of 1st and the 2nd generations and native adolescents who had not been adopted. Among the adopted patients, we distinguished the internationally and nationally adopted adolescents. The internationally adopted adolescents were defined as originating from another continent and thus likely to be object of racial discrimination. Only three main diagnostic categories were considered: Conduct disorders or problems of externalisation, affective disorders or problems of internalisation, and psychotic disorders. To control the hypothesis of independence of the variables, the chi-square of Pearson was calculated for each comparison. Results: Eight patients could not be included in any of the diagnostic categories and were excluded from the study. The 148 selected patients in the study counted 81 boys (54.7%) and 67 girls (45.3%). 23 of them (15.5%) were between 12 to 14 years old, 73 (49.3%) from 15 to 17 years old and 52 (35.1%) from 18 to 20 years old. Seventeen patients were adopted ones (11.5%), 36 were immigrants who had not been adopted (24.3%) and 95 were native adolescents who had not been adopted (64.2%). There were 9 international adopted patients (52.9%) and 8 national ones (47.1%). Our study showed that, according to a rough estimate, among the hospitalized teenagers the percentage of adopted patients was 5 to 10 times superior to that of the Belgian general population. This important request for psychiatric treatment cannot be directly interpreted as a higher prevalence of mental disorders associated with adoption. Hospitalization can also be influenced by social and psychological factors specific to the adoptive families, as suggested by socio-medical authors. The behavioural disorders were more frequent than expected in the adopted patients group (47.1%), the psychotic disorders more frequent among the immigrants (52.8%) and affective disorders more frequent in the native patients who had not been adopted (60.0%), with P < 0.0001. These latest disorders were more frequent in girls (64.2%) and the psychotic disorders in boys (45.7%), with P < 0.00005. The behavioural disorders were more frequent in the 12–14-year group (52.2%) and slightly more frequent in the 15–17-year group (26.0%), the psychotic disorders were more frequent in the 18–20-year group (61.5%), with P < 0.00001. The behavioural disorders thus preferentially touch the adopted teenagers hospitalised in psychiatry, they tended to decrease as age increased and they did not show a relationship with the sex of the patients. These data can be interpreted as a tendency of the adopted patients to develop adolescent problems of externalisation when they encounter psychological difficulties. In Belgium, these disorders are interpreted by the psychosocial workers as a psychiatric reason for hospitalisation. In addition, a Dutch study described an increased incidence of anxio-depressive disorders in young adopted adults that were not hospitalized. This observation could be interpreted as the need for in-patient care in a safe environment for behavioural problems and as an increased possibility of out-patient care for affective disorders. The distribution of the diagnoses did not differ significantly among internationally and nationally adopted adolescents, with P > 0.05. These disorders would thus rather be influenced by the common status of the adopted patients and not by racial differences. However, the small number of patients included in the internationally adopted group did not allow a direct statistical comparison with the immigrant group. Broadly speaking one may say that adopted patients and immigrants were not hospitalised for the same psychiatric reasons. The age of adoption was mentioned in the files of 16 of the 17 adopted ones. Affective disorders were only observed for adoptions before the age of three (50.0%) and psychotic disorders for adoptions above the age of three (50.0%), with P < 0.05. However two problems prevented us examining the influence of a late age of adoption on the development of psychotic disorders: The small sample size of adopted children and the age of admission of the adopted patients. The 8 patients adopted after the age of three were all older than 15 years old and had thus a greater risk of presenting psychotic disorders. Conclusion: The etiology of the behavioural problems responsible for the psychiatric hospitalisation of adopted adolescents must preferentially be attributed to factors related to their abandonment and their adoption, rather than to a difference of physical appearance and racial discrimination. This conclusion raises the question of the choice of treatment in a psychiatric service for these patients. A research conducted in a wider population could contribute to the validity of our conclusion. It should examine the other possible factors influencing the need for hospitalisation, more particularly the motivations of the persons requesting hospital care. [Copyright &y& Elsevier]

Abstract: This work presents the results of a research with 63 obese patients. The objective is to wonder about the existence of specific clinical signs in Rorschach for this population, in particular in connection with the alexithymia. The analysis of protocols invites to think that all the obese patients do not present systematically an alexithymic constituent, but also that an alexithymical functioning can concern that certain sectors of the affective and relational life of the obese subjects. [Copyright &y& Elsevier]

Abstract: This report discusses two clinical cases. The first one concerns a patient presenting depressive disorders mimicking Parkinson''s disease, the second relates the case of a patient presenting a catatonic depression occurring during the evolution of Parkinson''s disease. Both patients showed total remission of psychiatric symptoms after electroconvulsive therapy. On the basis of these two clinical cases, the authors question the relation between Parkinson''s disease and depression. Beyond simple co-morbidity, arguments support the hypothesis of a common etiopathogeny between the two disorders. Some authors have even suggested that depression could be a neurological disease with psychiatric manifestations. This point of view is discussed and qualified. [Copyright &y& Elsevier]

Abstract: Many patients having suffered from depression undergo unipolar depression relapses during the five years following the treatment. Therefore international guidelines, including pharmacological and psychological interventions, were published to prevent these relapses. Nowadays a combined treatment is most often prescribed. This paper presents the results of cognitive and behaviour therapies in the prevention of relapses in uni-polar depressed patients. A psychotherapy associated with pharmacotherapy resulted in a better prevention than pharmacotherapy alone (with a gain of over than 35%). New cognitive and behaviour programmes were developed during ten years with recurrently depressed patients, these included additional booster sessions sometimes combined with well-being therapy and even with mindfulness-based cognitive therapy. The new approaches were assessed in pilot studies and their results will have to be confirmed. [Copyright &y& Elsevier]

Abstract: The aim of the study was to explore the relationship between alexithymia and machiavellianism in a group of 201 university students. The subjects filled out the TAS-20 and the MACH-IV forms. The results showed firstly, a significant correlation between the two total scores (r =0.35, P <0.05), and secondly between the identification of feelings subscale of the TAS-20 and the opinions about human nature subscale of the Mach-IV (r =0.44, P <0.05). The results were discussed in light of the different factors (depression, dependency, psychoticism…) that could explain the relationship between the two concepts. [Copyright &y& Elsevier]

Abstract: We were interested in awareness of illness in bipolar subjects during the inter-critical period. The study included 60 euthymic bipolar subjects of which 30 patients stabilized for several months and 30 seen at the end of a hospitalization period. We used the MDIS (Mood Disorder Insight Scale) to evaluate their insight; our patients were clinically euthymic, as checked by the Hamilton depression scale and the Young mania scale. Our results showed that bipolar patients stabilized for several months had a better insight score than patients in recent remission, most of the weakening of the insight score of the latter was due to a causal attribution of illness. Among those which had just relapsed, subjects who had recovered from a manic episode had the worse awareness. The probable persistence of infraclinical symptoms could explain the very close involvement and the deterioration of the insight scores. Finally, among factors studied only that of taking part in an association of patients showed a significant relation with a good insight score. [Copyright &y& Elsevier]

Abstract: The treatment barrier affects different modalities of opposition or resistance to the treatment process. It involves patients, medical or nursing teams, programs or institutions. An evaluation of the treatment barrier from the patient''s view was investigated using a twenty item auto-questionnaire relative to knowledge of the care process and negative opinions relative to treatment, to psychotherapeutic relationship or to fear of dependence. This questionnaire was administered to schizophrenic patients or inpatients with affective disorders. The mean duration of the illness was over nine years. The treatment barrier was high in both groups and significantly higher for schizophrenic subjects compared to patients with affective disorders. Test–retests revealed a reliable fidelity. This study confirms the important role of multiple resistances to treatment. [Copyright &y& Elsevier]

Abstract: The Hypomania Checklist (HC) is a 20-item questionnaire, which is easy to fill in and designed to help clinicians collect data for diagnosing bipolar disorder. This tool could be very useful in primary care where type II bipolar disorder is under-diagnosed, however, to date no suitable cut-off score correlating with a high probability of bipolar II disorder diagnosis has yet been validated. Method: In a French clinico-epidemiological multi-center survey (EPIDEP) a national sample of patients with DSM-IV major depressive episode (MDE) was recruited and assessed at admittance and four weeks later. Diagnoses of unipolar or bipolar disorder were made according to a semi-structured interview adapted from the DSM-IV. In addition, the HC and questionnaires on affective temperament were administered at the second interview. In the analyses, the diagnostic accuracy was computed in terms of sensitivity, specificity, predictive positive value and predictive negative value, by varying cut-off scores on the HC. The Receiver Operating Characteristic (ROC) statistical technique was used to compare the diagnostic value of HC with the semi-structured interview adapted from the DSM-IV. Results: Of the 493 patients with a MDE DSM-IV diagnosis, 468 filled in the HC, from which the six following groups were formed: strict unipolar disorder (UP, N =201), bipolar I disorder (BP-I, n=39), bipolar II disorder (BP-II, N =141), patients with mania or hypomania secondary to an antidepressant treatment (N =51), cyclothymia (N =14) and hyperthymia (N =22). Comparing the BP-II patient group (N =141) with the strict UP group (N =201) the most discriminating HC score was 9, which identified 81% of patients correctly, with a sensitivity of 86.5, a specificity of 77.1, a predictive positive value of 72.6 and a predictive negative value of 89.1. Some cases identified as cyclothymic and hyperthymic temperaments by the affective temperament questionnaire but meeting DSM-IV criteria for major depressive disorder were included in the unipolar group (N =237). The same score of 9 was validated, identifying a percentage of patients with correct diagnosis of unipolar depression of 78.3%, a sensitivity of 86.5, a specificity of 73.4, a predictive positive value of 66.0 and a predictive negative value of 90.1. If patients with mania or hypomania secondary to an antidepressant treatment were included as a subgroup of BP-II, a score of ten appeared as the most relevant, with a percentage of patients with correct diagnosis of 79.0 %, a sensitivity of 80.2, a specificity of 78.1, a predictive positive value of 74.8 and a predictive negative value of 83.0. ROC curves confirmed these values. Lastly when BP-I patients (N =39) were compared to the strict UP group (N =201) the most discriminating HC score was 11, with a percentage of patients with correct diagnosis of 86.3%, a sensitivity of 74.4, a specificity of 88.6, a predictive positive value of 55.8 and a predictive negative value of 94.7, but the BP-I group was too small to validate the score of 11. Conclusions: These results indicate that a score of 9 on the HC is highly correlated with a BP-II diagnosis (and a score of 10 if patients with mania induced by antidepressants are considered as BP-II), and suggest that a wider use of the HC in primary care associated with strong GP/Psychiatrist networks could improve the detection, and with appropriate treatment, the prognosis of Bipolar II disorder. [Copyright &y& Elsevier]

Abstract: This study examined some of the reasons for confusion and controversy surrounding the frequency of diagnosis of bipolar disorder, especially in prepubertal children. Four case vignettes are used to articulate questions surrounding manifestations of euphoria and grandiosity, informant variance, diagnostic implications of medication-induced behavioural toxicity, and treatment implications of family history. Although extended literature cited addresses some of the issues, specific research is needed for definitive answers. [Copyright &y& Elsevier]

Abstract: Recognition of bipolar disorder in adolescent is now clearly established. However, whether bipolarity exists in children is more controversial. We reviewed the literature on acute and prophylactic treatment of bipolar disorder in youth. Mainly, guidelines recommended in the treatment of bipolar disorder in children and adolescent are similar to those in adult practice. But no evidence based data support the use of mood stabilizers or atypical neuroleptics since we only found two placebo-randomised controlled trials testing the efficacy of lithium in the paediatric literature. Therefore, we support the view that prescriptions should be limited to the most typical cases. In fact, the use of mood stabilizers or atypical neuroleptics in the treatment of bipolar disorder in children and adolescents appears of limited interest in children when a comorbid condition, such as attention deficit hyperactivity disorder, occurs. [Copyright &y& Elsevier]

Abstract: The thesis of Esquirol devoted to «Passions Considered as Causes, Symptoms and Curative Means of Mental Derangement», (1805), is often regarded as the apogee of Pinel''s conception of «moral treatment» of mental derangement. The integration of passions (or of the affective faculty) in «clinical medicine» was an outline of the psychosomatic conception which led later to the concept of monomania itself destined to disappear at the end of the xixth century. Passions gave way to impulses with Freud (Trieb or Drive), to affective and mood disorders, to addictions with psychobiology and incidentally to disorders in the control of impulses. [Copyright &y& Elsevier]

Abstract: Nowadays specific cognitive and behaviourist therapies are proposed to patients with bipolar affective disorder. The purpose of those therapies is to improve pharmacological observance, to detect early prodromes and to better cope with stressors. Previous controlled studies confirmed these three improvements and furthermore showed an improvement in self-esteem. Cognitive and behaviour therapies may be performed in individual or in-group sessions. Most of the studies are based on the Lam treatment manual of therapy. We decided to choose a similar strategy these last two years in the Sainte-Anne Hospital of Paris, in the Razi Hospital of Tunis (Tunisia) and in the Rochd Hospital in Casablanca (Morocco). A clinical study in these three units was undertaken and we are now presenting the first results today. [Copyright &y& Elsevier]

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Abstract: Objective. – The aim of this study was to explore the relationships between emotional disorder, thymic disorder and risk-taking behaviours in adolescents. Subjects and method. – Our sample includes 56 subjects (sex-ratio 31B/25G; mean-age=14,76±0,63) taken from two high-schools of Provence, France, who where divided in two groups using a risk-taking behaviours questionnaire. The emotional functioning was assessed using the Level of Emotional Awareness Scale and the Toronto Alexithymia Scale-20, depressive intensity using the Beck Depression Inventory-13 and the cognitive functioning using the Dysfunctional Attitudes Scale form A. Results. – Adolescents showing risk-taking propensity have a lower level of emotional awareness than others adolescents, associated with a higher level of alexithymia. They have also a higher level of dysfunctional attitudes but no significant difference on the depression scale. Emotion regulation disorder associated with cognitive dysfunction is predisposing factor for repetitive risk-taking. Conclusion. – Risk-taking behaviours may be linked to a disability in using their emotions in regulating their behaviours (because of their lack of elaboration) and a function of generating sensations used as prototypical emotions, [Copyright &y& Elsevier]