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International audience; Background: Patient suicide (PS) is known to be a frequent and challenging occupational hazard for mental health professionals. No study previously explored the prevalence and impact of PS in a large sample of French psychiatrists.Method: A national web-based survey was performed between September and December 2019 to assess (a) the prevalence of the exposure to PS, (b) the emotional, traumatic and professional impacts of PS, and (c) the perceived support in the aftermath of PS in French psychiatrists. Participants were contacted through email to answer the online 62-item questionnaire, including a measure of traumatic impact through the Impact of Event Scale-Revised. Emotional and professional impacts and perceived support were assessed through dedicated items.Results: A total of 764 psychiatrists fully completed the survey. Of them, 87.3% reported an exposure to PS and 13.7% reported PTSD symptoms afterward. Guilt, sadness and shock were the most frequent emotions. Among the exposed psychiatrists, 15.1% have temporarily considered changing their career path. The most emotionally distressing PS occurred during their ten first years of practice or during residency. A total of 37.1% of respondents felt unsupported and 50.4% reported that no team meeting had been organized in the aftermath. The feeling of responsibility for the death was strongly associated with negative impacts.Conclusion: Our results entail considerations to prevent negative mental health outcomes in psychiatrists after PS. Notably, our results advocate for the implementation of educational programs during psychiatric residency and postvention programs in healthcare settings to effectively help psychiatrists in dealing with PS.

Mémoire de stage de Master 1 Neurosciences - Sciences du comportement; Background: Animal-assisted interventions are new therapeutic approaches that are developing in health care systems. What about horse mediation? The study aimed to review the equine-assisted intervention effects on the biopsychosocial dimensions of psyciatric patients. Methods: The original studies were selected through systematic search from 9 databases (Bibliothèque de l’Université de Paris, Brill, CAIRN, CISMeF, Cochrane Library, DOAJ, EBSCOHost, PubMed and Science Direct) with the following keywords: « psychiatry and hippotherapy » and « psychiatry and equine-assisted therapy »..Results: Among the 30 articles selected, 70% concerned the effects of equine-assisted intervention (EAI) on children and adolescents (vs 30% on adults). The majority of the studies focused on neurodevelopmental disorders (53%) and especially on the autistic spectrum (40%). Most studies (77%) included ground and horseback riding activities. They highlight the positive effects of EAI on certain dimensions (79% of results). It should be noted that EAI programs are not standardised and that methodological biases have to be taken into account in the interpretation of the results.Conclusion: EAI is an original therapeutic approach in psychiatry. Our study shows that it is necessary to promote research in this field, particularly in adult populations, with a rigorous methodology, with a high level of proof, to scientifically validate its therapeutic efficacy.; Contexte : Les interventions assistées par l’animal constituent des nouvelles approches thérapeutiques en plein essor dans les dispositifs de soins. Qu’en est-il de la médiation par le cheval ? Cette revue systématique de la littérature a eu pour objectif de faire le point sur les études internationales ayant testé les effets de la médiation équine chez les patients suivis en psychiatrie.Méthodes : Les articles originaux sur le sujet ont été sélectionnées à partir d’une recherche systématique dans 9 bases de données (Bibliothèque de l’Université de Paris, Brill, CAIRN, CISMeF, Cochrane Library, DOAJ, EBSCOHost, PubMed et Science Direct) et les mots clefs « psychiatry and hippotherapy » et « psychiatry and equine-assisted therapy ».Résultats : Parmi les 30 articles sélectionnés, 70% concernaient des études réalisées chez les enfants/adolescents (vs 30% chez les adultes). Ont été en majorité étudiés les effets de la médiation équine sur les troubles neurodéveloppementaux (53%) et notamment ceux du spectre autistique (40%). La plupart des études (77%) ont intégré des activités à pied et montées à cheval. Elles mettent en évidence des effets positifs de la médiation équine sur certaines dimensions biopsychosociales (79% des résultats obtenus). A noter que les programmes ne sont pas standardisés et que des biais méthodologiques sont à considérer dans l’interprétation des résultats. Conclusion : La médiation équine pourrait constituer une approche thérapeutique originale en psychiatrie. Notre étude montre qu’il est cependant encore nécessaire de favoriser les recherches dans ce domaine, notamment dans les populations adultes, avec une méthodologie rigoureuse, à fort niveau de preuve, pour valider scientifiquement son efficacité thérapeutique.

International audience; Although Alzheimer s disease is classified as a neurodegenerative dementia, in Alzheimer s dementia there is increasing evidence of an association with vascular risk factors and vascular pathology. These observations are supported by epidemiological and pathological studies. Vascular factors may play a significant role in the pathogenesis of Alzheimer s dementia. Further research is needed to explore this relationship. Modification of vascular risk factors could make a significant impact towards prevention and treatment of Alzheimer s disease, which is a distressing and prevalent condition in the community. This article considers the relationship of these vascular risk factors and potential mechanisms associated with the aetiopathogenesis of Alzheimer s dementia.

International audience; Functional stereotaxy was introduced in the late 1940s to reduce the morbidity of lobotomy in psychiatric disease by using more focal lesions. The advent of neuroleptics led to a drastic decline in psychosurgery for several decades. Functional stereotactic neurosurgery has recently been revitalized, starting with treatment of Parkinson's disease, in which deep brain stimulation (DBS) facilitates reversible focal neuromodulation of altered basal ganglia circuits. DBS is now being extended to treatment of neuropsychiatric conditions such as Gilles de la Tourette syndrome, obsessive-compulsive disorder, depression and addiction. In this review, we discuss the concept that dysfunction of motor, limbic and associative cortico-basal ganglia-thalamocortical loops underlies these various disorders, which might now be amenable to DBS treatment.

International audience; The interactions between developing neurology and psychiatry in Paris are of interest, in a city which was the main center for studies on the nervous system and its disorders during the nineteenth century. Contrary to a common view, and in spite of an established tradition for mental diseases, emerging neurology had a much stronger influence on psychiatry ('alienism') than the reverse. This was largely due to the school built up by Jean-Martin Charcot, which was organized around the study and management of hysteria. Although Charcot himself always claimed his disinterest in mental medicine, he stimulated the development of an original scientific approach to nervous system conditions, along with a structured academic teaching, while alienism paradoxically remained stuck in organicism, after Antoine Bayle's report in 1822 of 'arachnitis' as the substratum of general paresis of the insane. Contrary to alienism, the young neurological school was able of self-criticism, and progressively underscored mental factors in hysteria. This led to the paradox that neurologists were active in a disease with a recognized lack of organic lesion, while alienists were postulating brain lesions in all mental disorders. The neurological activity thus indirectly and involuntarily led to the first developments of psychodynamic concepts in mental diseases. The academic evolution led to the launch of a faculty chair of mental and brain diseases in 1875, which was taken over for nearly half a century by direct pupils of Charcot: Benjamin Ball, Alix Joffroy, and Gilbert Ballet held the position until 1916, supporting the development of modern psychiatry in general hospitals, while alienism progressively disappeared at the turn of the century.

International audience; The Bordeaux Neuroscience Institute brings together all the disciplines that constitute the clinical and experimental neurosciences. Outside of the Paris region, the Institute represents the largest community of researchers working on the nervous system. The aim of this brief historical piece is to describe how neuroscientists in Bordeaux are the heirs to a long neuropsychiatric tradition established by pioneers of national and international renown. This tradition has been maintained, without interruption, through many generations. The careers and scientific work of these great neurologists and psychiatrists are briefly evoked, and particularly those of A. Pitres, E. Régis and E. Azam in the 19th century; and, in the 20th century, J. Abadie, H. Verger and R. Cruchet. The determining influence of P Delmas-Marsalet (1898-1977), Professor of Neuropsychiatry, on the development of modern neurosciences in Bordeaux is recalled through his work, his teachings, and his numerous students.

International audience

Moynihan describes the defeated efforts of a group of psychiatrists to free the annual Congress of the Royal Australia and New Zealand College of Psychiatrists from drug company sponsorship.1 These psychiatrists can take heart from the fact that the British Royal College of Psychiatrists conducted its 2008 annual meeting without reliance on any industrial sponsorship. The success of the conference shows that a …

International audience; Nowadays, catatonia is no more considered as a subtype of schizophrenia. Catatonia seems more frequently associated to mood disorders as well as general medical conditions. It is sometimes difficult to associate formally a medical etiology to this syndrome. But we found, in the literature, three groups of associated general medical conditions: neurological disorders, drug induced and toxic induced conditions, metabolic conditions. We present a prospective study of 12 clinical cases of catatonia due to general medical conditions we realized in the Consultation-Liaison Psychiatry Department of the University Hospital of LILLE (France) during a period of 5 months. We find coherent data with the literature. However, our results suggest that if medical conditions precipitate the catatonia syndrome, they are rarely its only etiology. We think that if somatic factors are co-morbid with psychiatric conditions they do not necessarily predominate as the target of treatment. The treatment of the catatonia must be a priority and remain symptomatic, to allow in parallel the specific treatment for the somatic disorder or the psychiatric disorder.

Olivier Cottencin4, Marc Lambert, Viviane Queyrel, David Launay, Sandrine Morell-Dubois, Eric Hachulla, Pierre Yves Hatron, Michel Goudemand, Silla M. Consoli Department of Consultation/Liaison Psychiatry, University of Medicine, Paris 5, AP-HP, European Georges Pompidou Hospital, Paris, France CNRS, UMR 8160, Lille, France Department of Internal Medicine, University of Lille 2 and University Hospital of Lille, Lille, France Department of Psychiatry, University of Lille 2 and University Hospital of Lille, Lille, France

International audience; One of the problems of consultation-liaison psychiatry is the absence of request of the patient. Indeed, the patients do not recognize their disorder and prefer to go to the emergency unit in a general hospital. Thus, we meet in the emergency unit or in medical unit (liaison psychiatry activity). This is the reason why this first meeting has to be prepared. Consultation-liaison Psychiatry proposes to provide medical staff with the competences developed by psychiatry, and the denomination: Consultation and Liaison Psychiatry, indicates the bipolarity of its practice according to whether the intervention is addressed to the patient (consultation) or to the staff (liaison). However collaboration is sometimes difficult and the psychiatrist often meets with resistance. This is the reason why psychiatrists must work on their integration in the general hospital. Indeed, the psychiatrist works in an institution which is unfamiliar and he/she must adapt and create new practices if it is going to work. It is now clearly established that consultation-liaison psychiatry is not limited to consultations with patients, but is based on collaboration with medical staff. There are various ways of studying human problems: psychoanalysis, cognitive therapy, behavioural therapy. It is also possible to focus interest on the communication between individuals. The systemic therapies are interested in the interactions more than with any other aspect of reality, and this always from a pragmatic point of view. This concept is based on a series of designs. First of all, an intervention by problem solving aims at a change: the question is to know how a problem is maintained, hic et nunc. Secondly, humans are a sum of training by tests and errors. Finally, what we call reality is only our perception of reality: the human conflicts emerge when two persons assign a different direction to a reality which is perceived jointly. The human relationship can be defined as interaction circles, which we propose to use in our practice of consultation-liaison psychiatry. The question is no longer to know why the subject has a problem but to know how to resolve it. The call for a consultation of psychiatry is often the result of an interaction between patient and staff. We propose an assessment of the consultation-liaison-psychiatry's demand so as to offer a concrete response to medical teams and patients. 1. First of all, the claimant should be known. This first question is to be asked before even meeting the patient. In the majority of cases, it is the medical staff that suffers from the situation (and wants a change). To work only on the patient, discredits the psychiatric intervention. 2. The definition of the problem is a concrete question, which we want based on the facts and not on the comments. That which requires the consultation (the patient, his/her family or the medical team) awaits concrete answers from the psychiatrist. It is important that the objectives of the intervention are defined before meeting the patient. These preliminary exchanges facilitate the consultation-liaison intervention. 3. By knowing the solutions tried before the request for psychiatric help, the psychiatrist will be able to know the measures already tried (whether they were effective or not). 4. By proposing minimal changes, it defines small but obtainable objectives, which will be as much as to increase therapeutic alliance and the tolerance of patients sometimes difficult to understand. 5. Finally, the consultation-liaison psychiatrist must know the language of his/her interlocutors. Interdisciplinary alliance is a fundamental condition for the success of the intervention: like the patients, the medical staff must feel understood to be able to cooperate. To develop this alliance and to inhibit resistance, it is important to speak the language of the claimant. The demand will progressively become interventions, more adapted, especially when the psychiatrist is recognized and appreciated by the team, like a good consultant, credible and concrete. Thus, mentally distressed patients can benefit from psychiatric care (although they do not request it). However, two phases appear essential. First, we have to define the demand and the claimant (environment, medical staff and patient) and second, we have to support the integration of the psychiatrist in the functioning of the medical unit. Our systemic vision of the consultation-liaison psychiatry proposes a pragmatic collaboration, centred on the problem. This approach allows the patient to prepare to meet the psychiatrist, and does not a priori discredit the intervention. Presented by the staff, who know the problem in concrete terms and are ready to answer it in a concrete way, this mode of intervention is only the first step of subsequent psychiatric care.

International audience; Depression is a frequent symptom in psychiatry, either isolated (major depression) or entangled with other psychiatric symptoms (psychotic depression, depression of bipolar disorders). Many antidepressant drugs are available with different pharmacological profiles from different classes: tricyclic antidepressants, monoamine oxydase inhibitors, selective serotonin reuptake inhibitors (SSRI). However, there are some limitations with these drugs because there is a long delay before relief for symptoms, some patients with major depression are resistant to treatment, there is a risk to induce manic symptoms in patients with bipolar disorders and these drugs have no effect on the psychotic symptoms frequently associated to major depression. The leading hypothesis for the search of more efficient new antidepressants has been the amine deficit hypothesis: noradrenaline and/or serotonin deficit and more recently dopamine deficit. Moreover, a dopamine deficit has been also hypothesized as the central mechanism explaining the negative symptoms of schizophrenia. These symptoms are the consequence of a deficit of normal behaviours and include affective flattening, alogia, apathy, avolition and social withdrawal. There is thus a great overlap between symptoms of depression and negative symptoms of schizophrenia. Atypical antipsychotics, in contrast with conventional neuroleptics, have been shown to decrease negative symptoms, most probably through the release of dopamine in prefrontal cortex, thus improving psychomotor activity, motivation, pleasure, appetite, etc. The dopamine deficit in cortical prefrontal areas was thus an unifying hypothesis to explain both some symptoms of depression and negative symptoms of schizophrenia. Studies in animal confirm this view and show that the association of an atypical antipsychotic drug and an SSRI (olanzapine plus fluoxetine) increases synergistically the release of dopamine in prefrontal areas. Moreover, most of the atypical antipsychotics have a large action spectrum, beyond the only dopamine receptors: their effects on the serotonin receptors--particularly the 5-HT2A and 5-HT2C receptors--suggest that their association to SSRI could be a promising treatment for depression. Indeed, SSRI act mainly by increasing the serotonin level in the synapse, thus leading to a non specific activation of all pre- and post-synaptic serotonin receptors. Among them, 5-HT2A/2C receptors have been involved in some of the unwanted effects of SSRI: agitation, anxiety, insomnia, sexual disorders, etc. The inhibition of these receptors could be thus beneficial for patients treated with SSRI. Amisulpride is an unique atypical antipsychotic that selectively blocks dopamine receptors presynaptically in the frontal cortex, possibly enhancing dopaminergic transmission. The antidepressant effect of amisulpride was shown in dysthymia in many clinical studies versus placebo, tricyclic antidepressants, SSRI or others. However, a shorter delay for symptom relief was not demonstrated for amisulpride as compared to comparative antidepressants. Other atypical antipsychotics (clozapine, olanzapine), which act on a large variety of receptors, have shown antidepressant effects--mainly in association with SSRI--in different psychiatric diseases: treatment-resistant major depression, major depression with psychotic symptoms and depression of bipolar disorders, with no increase of manic symptoms in this latter case. Moreover, the delay for symptom relief was greatly shortened. More comparative double-blind studies are required to confirm and to precise the antidepressant effects of atypical antipsychotics. Nevertheless, these studies suggest that atypical anti-psychotics could be of great value in depressive conditions reputed for their resistance to treatment with usual antidepressants. Particularly, new strategies emerge that combine atypical antipsychotics and antidepressants for greater efficacy and more rapid relief of depression symptoms.

International audience; This paper explores service users' experiences of a 'person-centred' mental health service. We describe the development of a model of social psychiatry that places the emphasis on the experiences of the person within social and political contexts. This establishes the foundations of a 'person-centred' approach, the values of which are described briefly. The results of interviews with 20 people are presented, in which their experiences of the service are explored in detail. These interviews reveal the struggle that lies at the heart of the professional-service user dialectic, which relates to issues of institutional power, roles and responsibility, and which places professional staff in conflict with the very notion of 'person-centredness'. No matter how 'person-centred' a mental health service may strive to be, there remain serious obstacles to the full realization of this approach. Despite this critique, there were many things that were valued by those who used the service. More detailed qualitative studies are required to explicate the complex relationships and paradoxes that emerged.

Government policies are beginning to change the ethos of mental health care in Britain. The new commitment to tackling the links between poverty, unemployment, and mental illness has led to policies that focus on disadvantage and social exclusion.1 These emphasise the importance of contexts, values, and partnerships and are made explicit in the national service framework for mental health.2 The service framework raises an agenda that is potentially in conflict with biomedical psychiatry. In a nutshell, this government (and the society it represents) is asking for a very different kind of psychiatry and a new deal between health professionals and service users. These demands, as Muir Gray has recently observed, apply not only to psychiatry but also to medicine as a whole, as society's faith in science and technology, an important feature of the 20th century, has diminished.3 According to Muir Gray, “Postmodern health will not only have to retain, and improve, the achievements of the modern era, but also respond to the priorities of postmodern society, namely: concern about values as well as evidence; preoccupation with risk rather than benefits; the rise of the well informed patient.”3 Medicine is being cajoled into accepting this reality, but psychiatry faces the additional problem that its own modernist achievements are themselves contested. Consider this: although patients complain about waiting lists, professional attitudes, and poor communication, few would question the enterprise of medicine itself. By contrast, psychiatry has always been thus challenged. Indeed, the concept of mental illness has been described as a myth.4 It is hard to imagine the emergence of “antipaediatrics” or “critical anaesthetics” movements, yet antipsychiatry and critical psychiatry are well established and influential.5 One of the largest groups of British mental health service users is called Survivors Speak Out. Psychiatry has reacted defensively …

Background: “Vascular depression” has recently been proposed. It is characterized by magnetic resonance imaging (MRI) T2-weighted subcortical lesions, a late onset of first episode of depression, and reduced heritability; a cerebrovascular etiology is suggested. The validity of “vascular depression” might be strengthened if an association was found between the subcortical lesions used to define it and particular depressive symptoms. Methods: A blinded cross-sectional examination of DSM-III-R depressive symptoms (American Psychiatric Association, 1987) and MRI T2-weighted subcortical lesions in 44 patients with late-life depression. Results: Many associations were found; however, because of multiple comparisons, their significance is viewed with caution. The most robust finding was that psychomotor retardation was independently related to total white-matter score. The odds of showing psychomotor retardation was increased 1.9 times for every point increase in severity of white-matter change. Conclusion: In late-life depression the clinical expression of the depression is influenced by the pattern of MRI T2-weighted subcorticallesions. This gives some validity to the concept of an MRI-defined “vascular” subtype of late-life depression and strengthens the argument for including neuroimaging in the classification of late-life depression.