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Impulsivity is an important transdiagnostic feature of many psychiatric disorders, as well as a marker of poorer outcome. Topiramate is broadly used for reducing impulsivity in various neuropsychiatric disorders, but no systematic review or meta‐analysis has ever explored whether evidence supports this clinical use. We conducted a systematic review and meta‐analysis of the literature, using PubMed, PsycInfo and Cochrane databases. We included all studies assessing the efficacy of topiramate in adults with high levels of impulsivity, based on either psychometric or neuropsychological measures. Seven articles were included, involving 578 participants. Important heterogeneity in designs and quality features was observed. Topiramate lowered impulsivity levels in two of the studies that used the Barratt Impulsiveness Scale (BIS) (401 participants) and in one of the studies that used neuropsychological measures (63 participants). Four other studies found no effect of topiramate on impulsivity. A larger reduction in the BIS‐11 overall score, with a mean difference of 2.57 (95% confidence interval −4.12 to −1.02), was found in the topiramate group than the placebo group using a random effects model. However, one study accounted for the major part (85.5%) of it, and most included studies presented a high risk of bias. The use of a self‐assessment scale induced an additional risk of self‐report bias. No clear‐cut evidence was found for a transdiagnostic effectiveness of topiramate in reducing impulsivity levels. However, encouraging results were found in some specific disorders. [ABSTRACT FROM AUTHOR]

Background In the United States, first-generation immigrants ( FGIs) show lower prevalence rates of alcohol use disorders ( AUDs) than the native population, although they experience more psychosocial risk factors. This epidemiological phenomenon is called an 'immigrant paradox.' No previous study has investigated whether immigrants also exhibit a reduced risk of AUDs in Europe. In a study of the general population in France, we have assessed the adjusted risk of AUDs between nonimmigrants and FGIs, second-generation immigrants ( SGIs), and third-generation immigrants ( TGIs). Methods A cross-sectional survey based on face-to-face interviews was conducted among 39,617 French subjects recruited using a quota-sampling strategy. The sociodemographic data collected helped determine the subjects' immigration status. The AUD assessment was performed using the Mini International Neuropsychiatric Interview (version 5.0.0). A multivariable logistic regression model was used to define the independent risk factors for AUDs with backward selection. Results The overall prevalence of AUDs in the sample was 4.34%. AUDs were diagnosed in 3.82% of the native population versus 5.84% of the immigrant population: 4.67% of FGIs, 5.71% of SGIs, and 6.63% of TGIs ( p < 0.0001). The multivariable model showed that FGIs did not have a significantly different risk of AUDs compared to the native population ( p = 0.5936), whereas SGIs (odds ratio [OR] = 1.18; 95% confidence interval [CI] [1.01 to 1.39]; p = 0.0496) and, to a greater extent, TGIs ( OR = 1.38; 95% CI [1.17 to 1.63]; p = 0.0002) had a significantly greater risk of AUDs. The area under the curve of the model was 0.753. Conclusions Relative to French natives, a generational risk gradient for AUDs was found in the immigrant subjects, with a similar risk of FGIs, and an increased risk of SGIs and TGIs. In terms of the risk of AUDs, no 'immigrant paradox' existed in French population. These results are in line with other recent findings, suggesting that the 'immigrant paradox' is rarely found in Europe regarding many health-related issues. [ABSTRACT FROM AUTHOR]

A very simple question to screen for suicide risk Sleep complaints are associated with increased suicide risk independently of psychiatric disorders: results from a national 3-year prospective study. Nightmares in patients with major depressive disorder, bipolar disorder, and psychotic disorders: a systematic review. [Extracted from the article]

Objectives Kleine-Levin syndrome ( KLS) is a rare sleep disorder (1-2 reported cases per one million individuals) primarily affecting young subjects. Episodes are characterized by hypersomnia, cognitive impairment, feelings of derealization, and, less frequently, hyperphagia (66%), hypersexuality [53% (principally men)], and depressed mood [53% (predominantly women)]. KLS cases are frequently misdiagnosed and pose therapeutic challenges (i.e., amantadine and mood stabilizers are only marginally effective). The cause of KLS is unknown, but an association between KLS and mood disorders has been suggested by some clinical analogies. Methods We report the case of a 44-year-old Caucasian woman with bipolar I disorder referred by her psychiatrist to our psychiatric center for recurrent and resistant major depression according to DSM- IV- TR criteria. Results Following examination, we confirmed the diagnoses of bipolar I disorder and KLS. The patient experienced about 15 evenly distributed KLS episodes, each lasting about one week, which occurred during the six years following her first manifestation at age 18 years. An electroencephalogram was performed during a KLS episode and showed high-amplitude theta waves in the left and right temporal lobes, with predominance in the left hemisphere. The pronounced bipolar disorder symptomatology, starting at 15 years of age with major depression and a suicide attempt, had impeded the identification of KLS, which was not diagnosed until the age of 42. Conclusions Bipolar disorder may obscure KLS, with each condition adversely affecting the course of the other, and consequently, the co-occurrence of KLS and bipolar disorder may be underestimated. KLS and bipolar disorder may share common vulnerability factors, such as immune-inflammatory and circadian disturbances, and there may be a genetic predisposition for both. Additionally, mood stabilizers may be effective for KLS and bipolar disorder. [ABSTRACT FROM AUTHOR]

All relevant guidelines recommend monotherapy as the initial treatment for manic phases of bipolar disorder ( BD), with combination therapy reserved for severe cases or as a subsequent choice. However, in routine practice, monotherapy is often not sufficiently effective for acute and/or maintenance therapy. As a consequence, most patients are given combination therapies. An extensive search concerning combination treatment for manic episodes was conducted for relevant international randomized controlled studies, treatment guidelines and comprehensive reviews published since 1980. The scientific literature is sufficiently rich to validate the superiority of combination therapy over monotherapy in the manic phase in terms of efficacy and prevention of relapse; its safety profile is acceptable. Side effects are more frequent with combination therapy as a whole than with monotherapy, and discontinuation rates due to adverse events are higher. Continued administration of antipsychotics after a manic phase is controversial: drug classification, the course of the disease and the predominant polarity should all be considered before treatment is continued. Combinations including olanzapine and asenapine and to a lesser extent risperidone are associated with weight gain, those including quetiapine, haloperidol and asenapine with sedation, and those including aripiprazole with akathisia. This review of literature leads us to suggest that combination therapy including an atypical antipsychotic with lithium or valproate may be considered as a first-line approach. An appropriate algorithm for making decisions about combination treatment needs to be developed and included in future guidelines. [ABSTRACT FROM AUTHOR]

Summary Clozapine is effective in treatment‐resistant schizophrenia but with adverse effects including sedation. Excessive daytime sleepiness, a symptom of hypersomnolence, is the most frequently reported subjective side‐effect. The aim of this systematic review was to synthesise the literature evaluating the impact of clozapine on the objective assessment of hypersomnolence in people with schizophrenia. We systematically searched databases for articles evaluating hypersomnolence with electrophysiological or psychomotor/cognitive measures in clozapine‐treated patients with schizophrenia. Objective assessment of hypersomnolence was evaluated in six studies. All studies using polysomnography (PSG) found significantly longer total sleep time and shorter sleep onset latency in patients treated with clozapine at initiation of clozapine. The study with the multiple sleep latency test (MSLT) also found a shorter sleep onset latency. These observations did not persist 4–6 weeks after treatment initiation. Further investigations are needed. Longer total sleep time should be investigated with standardised long‐term PSG to investigate excessive sleep quantity. Shorter sleep onset latency should be investigated with the MSLT or the maintenance of wakefulness test to investigate the excessive propensity to fall asleep or ability to stay awake. Lastly, sleep inertia should be investigated specifically in the morning. [ABSTRACT FROM AUTHOR]

Summary Sleep trackers are used widely by patients with sleep complaints, however their metrological validation is often poor and relies on healthy subjects. We assessed the metrological validity of two commercially available sleep trackers (Withings Activité/Fitbit Alta HR) through a prospective observational monocentric study, in adult patients referred for polysomnography (PSG). We compared the total sleep time (TST), REM time, REM latency, nonREM1 + 2 time, nonREM3 time, and wake after sleep onset (WASO). We report absolute and relative errors, Bland–Altman representations, and a contingency table of times spent in sleep stages with respect to PSG. Sixty‐five patients were included (final sample size 58 for Withings and 52 for Fitbit). Both devices gave a relatively accurate sleep start time with a median absolute error of 5 (IQR −43; 27) min for Withings and −2.0 (−12.5; 4.2) min for Fitbit but both overestimated TST. Withings tended to underestimate WASO with a median absolute error of −25.0 (−61.5; −8.5) min, while Fitbit tended to overestimate it (median absolute error 10 (−18; 43) min. Withings underestimated light sleep and overestimated deep sleep, while Fitbit overestimated light and REM sleep and underestimated deep sleep. The overall kappas for concordance of each epoch between PSG and devices were low: 0.12 (95%CI 0.117–0.121) for Withings and VPSG indications 0.07 (95%CI 0.067–0.071) for Fitbit, as well as kappas for each VPSG indication 0.07 (95%CI 0.067–0.071). Thus, commercially available sleep trackers are not reliable for sleep architecture in patients with sleep complaints/pathologies and should not replace actigraphy and/or PSG. [ABSTRACT FROM AUTHOR]

A list of individuals who served as referees for articles submitted to the journal "Addiction" in 2014 is presented which includes Michelle Acosta, Kevin M. Beaver and Natale Canale.