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International audience; Purpose of Review: This review provides an overview of current knowledge and understanding of EEG Neurofeedback for anxiety disorders and post-traumatic stress disorders. Recent Findings: The manifestations of anxiety disorders and post-traumatic stress disorders (PTSD) are associated with dysfunctions of neurophysiological stress axes and brain arousal circuits, which are important dimensions of the research domain criteria (RDoC). Even if the pathophysiology of these disorders is complex, one of its defining signatures is behavioral and physiological over-arousal. Interestingly, arousal-related brain activity can be modulated by electroencephalogram-based neurofeedback (EEG NF), a non-pharmacological and noninvasive method that involves neurocognitive training through a brain-computer interface (BCI). EEG NF is characterized by a simultaneous learning process where both patient and computer are involved in modifying neuronal activity or connectivity, thereby improving associated symptoms of anxiety and/or over-arousal. Summary: Positive effects of EEG NF have been described for both anxiety disorders and PTSD, yet due to a number of methodological issues, it remains unclear whether symptom improvement is the direct result of neurophysiological changes targeted by EEG NF. Thus, in this work we sought to bridge current knowledge on brain mechanisms of arousal with past and present EEG NF therapies for anxiety and PTSD. In a nutshell, we discuss the neurophysiological mechanisms underlying the effects of EEG NF in anxiety disorder and PTSD, the methodological strengths/weaknesses of existing EEG NF randomized-controlled trials (RCTs) for these disorders, and the neuropsychological factors that may impact NF training success.

Study Objectives High rates of sleep and mental health problems have been reported during the COVID-19 pandemic, but most of the evidence is retrospective without pre-pandemic data. This study documented rates of prevalent, incident, and persistent insomnia and psychological symptoms during the COVID-19 pandemic (2020) compared to pre-pandemic data (2018). Methods Data were derived from a longitudinal, population-based study of insomnia in Canada. When the first lockdown started in the province of Quebec, a subsample of participants who had completed the latest 2018 follow-up were surveyed (April to May 2020) about their sleep, insomnia, and psychological symptoms since the beginning of the pandemic. Prevalence, incidence, and persistence rates of insomnia, and severity of stress, anxiety, and depressive symptoms were estimated, as well as their associations with confinement, loneliness, social support, use of electronics, and other lifestyle changes occurring during the pandemic. A sleep/health survey and validated questionnaires of insomnia, sleep quality, stress, fatigue, anxiety, and depression were administered at both assessments. Results The sample consisted of 594 adults (mean age: 48.3 ± 13.1 years; 64.0% women). Prevalence of insomnia increased from 25.4% to 32.2% (symptoms) and from 16.8% to 19% (syndrome) from 2018 to 2020, for an overall 26.7% increase in insomnia rates. Of those classified as good sleepers in 2018 (n = 343), 32.6% (n = 112) had developed new insomnia during the COVID-19 pandemic. Among participants who had insomnia in 2018, the persistence rate was 76.5% 2 years later. There was a significant worsening of sleep quality, fatigue, anxiety, and depression (all ps < .005) during the COVID-19 pandemic compared to 2018. Significant associations were found between sleep and psychological symptoms and with living alone and being in confinement, lower social support, increased time using electronic devices, reduced physical exercise, and higher financial stress. Conclusions The COVID-19 pandemic is associated with significant increases in insomnia and psychological symptoms compared to the pre-pandemic period. Large scale public sleep and mental health intervention programs should be prioritized during and after a pandemic such as the COVID-19.

This article presents research on the detection of pathologies affecting speech through automatic analysis. Voice processing has indeed been used for evaluating several diseases such as Parkinson, Alzheimer, or depression. If some studies present results that seem sufficient for clinical applications, this is not the case for the detection of sleepiness. Even two international challenges and the recent advent of deep learning techniques have still not managed to change this situation. This article explores the hypothesis that the observed average performances of automatic processing find their cause in the design of the corpora. To this aim, we first discuss and refine the concept ofsleepinessrelated to the ground-truth labels. Second, we present an in-depth study of four corpora, bringing to light the methodological choices that have been made and the underlying biases they may have induced. Finally, in light of this information, we propose guidelines for the design of new corpora.

International audience

Sleep is involved in the regulation of inflammation, healing, and digestion. The pathophysiology of Crohn’s disease (CD) is unclear, and the role of sleep disturbances has recently been suggested. The present study investigated a putative association between sleep disturbances and CD activity. We conducted a prospective observational monocenter translational study, recruiting major CD patients from 2013 to 2015. Disease activity was assessed by the Harvey-Bradshaw index and the CD activity index. Objective sleep quantity and quality were measured by wrist actigraphy over a period of 7 days. The primary objective was to look for an association between wrist actigraphy parameters and CD activity. Thirty-four CD patients, including 14 with active disease and 20 in remission, were included. Sleep efficiency measured by wrist actigraphy was lower in patients with active CD compared to patients in remission. Wake after sleep onset time best predicted CD activity with an AUROC of 0.83. Patients with active CD were more frequently characterized as “poor sleepers” and frequently suffered from excessive daytime sleepiness. Sleep efficiency is lower in patients with active CD than in those in remission. Further studies aimed at better characterizing CD patients’ sleep are warranted.

Objective: The study goal was to test whether induced stress during driving could be measured at the event level through electrodermal activity responses. Background: Stress measured in simulation scenarios could thus far show an overall change in the stress state, but not be well attributed to acute stressful events. Driving simulator scenarios that induce stress measurable at the event level in realistic situations are thus warranted. As such, acute stress reactions can be measured in the context of changing situational factors such as fatigue, substance abuse, or medical conditions. Method: Twelve healthy female participants drove the same route numerous times in a driving simulator, each time with different random traffic events occurring throughout. During one of the scenarios, unknown to the participants, 10 programmed neutral traffic events occurred, whereas in another scenario, at the same location, 10 stressful events occurred. Results: Electrodermal response results showed both effects of scenario type and of events. The amplitude of the electrodermal response was significantly correlated with subjective stress experience. Conclusion: We conclude that our developed ecological driving simulation scenarios can be used to induce and measure stress at the event level. Application: The developed simulator scenarios enable us to measure stress reactions in driving situations at the time when the event actually happens. With these scenarios, we can measure how situational factors, such as fatigue or substance abuse, can change immediate stress reactions when driving. We can further measure more specifically how induced driving stress can affect physical and mental functioning afterward.

Ce deuxieme article, d’une serie de deux portant sur l’approche physiologique de la semiologie psychiatrique, propose d’explorer la place de la physiologie et de la semiologie clinique suivant une approche de biologie systemique. Alors que l’approche de la semiologie psychiatrique a ete intiment liee a la construction des classifications contemporaines des troubles psychiatriques, deux approches tendant a se detacher des nosographies classiques ont ete proposees : le projet psychosystems et le modele de Cambridge. Pour chacune de ces approches seront presentes le principe general, le lien avec la physiologie et la semiologie, et les limitations principales. Il sera propose d’englober le projet psychosystems ainsi que le modele de Cambridge suivant une perspective de biologie systemique qui pourrait permettre de reintegrer la semiologie comme un niveau essentiel de l’approche des troubles mentaux, entre fait biologique et valeur sociale. Les enjeux de telles contraintes biologiques et sociales seront abordes suivant une approche epistemologique, notamment a travers les questions soulevees par la neurophenomenologie, afin de proposer une perspective de neurophysiologie clinique a la psychiatrie : c’est-a-dire d’une neurophysiologie qui prenne au serieux le savoir clinique historiquement constitue de la psychiatrie, mais aussi d’une clinique qui ne denigre pas les avancees en neurophysiologie sur la comprehension du fonctionnement cerebral.

Ce premier article, d’une serie de deux, portant sur l’approche physiologique de la semiologie psychiatrique, propose d’explorer la place de la physiologie et de la semiologie clinique dans trois systemes de classifications psychiatriques proposes actuellement en recherche : le Manuel diagnostique et statistique des troubles mentaux (DSM), le projet Research Domain Criteria (RDoC), et le projet Hierarchical Taxonomy of Psychopathology (HiTOP). Pour chacun de ces systemes sera presente le principe general, le lien avec la physiologie et la semiologie, et les limitations principales. La physiologie et la clinique occupent une place et un role variables dans ces trois systemes de classifications psychiatriques. Le DSM propose une liste de criteres semiologiques pertinents au regard de l’histoire clinique de la psychiatrie, mais le choix de ces criteres et leur organisation restent guides par des enjeux purement pratiques et nosographiques avec une place tres restreinte de la physiologie. Le projet RDoC ne propose pas de liste de criteres semiologiques. Sa pertinence clinique et pratique est donc clairement questionnable, mais ce projet a le merite de souligner l’importance de la physiologie dans l’approche medicale des troubles mentaux. Le projet HiTOP ne propose pas en soi de liste de criteres semiologiques, mais un cadre organisationnel hierarchise de la nosographie permettant d’associer un ensemble de signes et symptomes a des mecanismes psychopathologiques sous-jacents supposes. L’enjeu reste alors de raccrocher de maniere coherente ces mecanismes psychopathologiques a la physiopathologique des troubles mentaux dans une perspective integrative des troubles mentaux.

Obstructive sleep apnea (OSA) is one of the leading non-psychiatric comorbidities in bipolar disorders (BD). We sought to explore associations between risk of OSA in BD, clinical characteristics alongside with both subjective sleep complaints and objective sleep abnormalities.Euthymic patients with BD (n = 144) were assessed over a three-week period, by actigraphy, clinical interviews and questionnaires.Of the study sample, 32 (22%) individuals were at high risk of OSA (HR-OSA) and 112 (78%) had a low risk (LR-OSA), as assessed with the Berlin questionnaire. HR-OSA, compared to LR-OSA, were older (p = 0.031), had higher BMI (p 0.0005), larger neck circumference (p = 0.002), and more residual depressive symptoms (p 0.0005). HR-OSA was also associated with greater sleepiness (p = 0.003), poorer sleep quality (p = 0.003), insomnia complaints (p = 0.027), "languid" chronotype (p = 0.002), and higher actigraphy-derived fragmentation index (p = 0.015). Backward stepwise linear regression retained BMI and depressive symptoms (correct classification of 83% of participants). Classification increased up to 85.4% when adding sleepiness and languid-vigorous scales and up to 87.8% when adding fragmentation index. Combining ROC curve analysis and Youden Index provided best cut-offs (HR-OSA if cut-off greater than or equal to) of 29.84 for BMI (Sensibility(Se) = 0.47, Specificity(Spe) = 0.96) and 1.5 for MADRS total score (Se = 0.84, Spe = 0.58).No confirmation of OSA diagnosis with polysomnography.Higher BMI and residual depressive symptoms are the two best independent predictors of OSA in BD. Such information contributes to improving the screening and management of OSA in BD.NCT02627404.

Study Objectives To determine whether the feeling of having slept or not during the Maintenance of Wakefulness Test (MWT) is associated with the occurrence of self-reported sleep-related traffic near misses and accidents in patients with sleep disorders. Methods This study was conducted in patients hospitalized in a French sleep center to perform a 4 × 40 min MWT. Relationship between mean sleep latency on the MWT, feeling of having slept or not during MWT trials and sleep-related near misses and accidents reported during the past year was analyzed. Results One hundred and ninety-two patients suffering from OSAS, idiopathic hypersomnia, narcolepsy, restless leg syndrome or insufficient sleep syndrome were included. One hundred and sixty-five patients presented no or one misjudgment of feeling of having slept during MWT trials while 27 presented more than two misjudgments. Almost half of the latter (48.1%) reported a sleepiness-related traffic near miss or accident in the past year versus only one third (27.9%) for the former (p < 0.05). Multivariate logistic regression showed that patients with more than two misjudgments had a 2.52-fold (95% CI, 1.07–5.95, p < 0.05) increase in the risk of reporting a sleepiness-related near miss/accident. Conclusions Misjudgment in self-perceived sleep during the MWT is associated with the occurrence of self-reported sleepiness-related traffic near misses and accidents in the past year in patients suffering from sleep disorders. Asking about the perception of the occurrence of sleep during the MWT could be used to improve driving risk assessment in addition to sleep latencies.

International audience; Transcranial Electrical Stimulation (tES) is a promising non-invasive brain modulation tool. Over the past years, there have been several attempts to modulate sleep with tES-based approaches in both the healthy and pathological brains. However, data about the impact on measurable aspects of sleep remain scattered between studies, which prevent us from drawing firm conclusions. We conducted a systematic review of studies that explored the impact of tES on neurophysiological sleep oscillations, sleep patterns measured objectively with polysomnography, and subjective psychometric assessments of sleep in both healthy and clinical samples. We searched four main electronic databases to identify studies until February 2020. Forty studies were selected including 511 healthy participants and 452 patients. tES can modify endogenous brain oscillations during sleep. Results concerning changes in sleep patterns are conflicting, whereas subjective assessments show clear improvements after tES. Possible stimulation-induced mechanisms within specific cortico-subcortical sleep structures and networks are discussed. Although these findings cannot be directly transferred to the clinical practice and sleep-enhancing devices development for healthy populations, they might help to pave the way for future researches in these areas. PROSPERO registration number 178910.

Study objectives Emotional reactivity to negative stimuli has been investigated in insomnia, but little is known about emotional reactivity to positive stimuli and its neural representation. Methods We used 3 Tesla functional magnetic resonance imaging (fMRI) to determine neural reactivity during the presentation of standardized short, 10- to 40-seconds, humorous films in patients with insomnia (n = 20, 18 females, aged 27.7 +/− 8.6 years) and age-matched individuals without insomnia (n = 20, 19 females, aged 26.7 +/− 7.0 years) and assessed humor ratings through a visual analog scale. Seed-based functional connectivity was analyzed for the left and right amygdalas (lAMYG and rAMYG, respectively) networks: group-level mixed-effects analysis (FLAME; FMRIB Software Library [FSL]) was used to compare amygdala connectivity maps between groups. Results fMRI seed-based analysis of the amygdala revealed stronger neural reactivity in patients with insomnia than in controls in several brain network clusters within the reward brain network, without humor rating differences between groups (p = 0.6). For lAMYG connectivity, cluster maxima were in the left caudate (Z = 3.88), left putamen (Z = 3.79), and left anterior cingulate gyrus (Z = 4.11), whereas for rAMYG connectivity, cluster maxima were in the left caudate (Z = 4.05), right insula (Z = 3.83), and left anterior cingulate gyrus (Z = 4.29). Cluster maxima of the rAMYG network were correlated with hyperarousal scores in patients with insomnia only. Conclusions The presentation of humorous films leads to increased brain activity in the neural reward network for patients with insomnia compared with controls, related to hyperarousal features in patients with insomnia, in the absence of humor rating group differences. These novel findings may benefit insomnia treatment interventions. Clinical trial The Sleepless Brain: Neuroimaging Support for a Differential Diagnosis of Insomnia (SOMNET). ClinicalTrials.gov identifier: NCT02821234; https://clinicaltrials.gov/ct2/show/NCT02821234.

Introduction: Insomnia and circadian rhythm disorders, such as the delayed sleep phase syndrome, are frequent in psychiatric disorders and their evaluation and management in early stages should be a priority. The aim of this paper was to express recommendations on the use of exogenous melatonin, which exhibits both chronobiotic and sleep-promoting actions, for the treatment of these sleep disturbances in psychiatric disorders.Methods: To this aim, we conducted a systematic review according to PRISMA on the use of melatonin for the treatment of insomnia and circadian sleep disorders in neuropsychiatry. We expressed recommendations for the use of melatonin in psychiatric clinical practice for each disorder using the RAND/UCLA appropriateness method.Results: We selected 41 studies, which included mood disorders, schizophrenia, substance use disorders, attention deficit hyperactivity disorders, autism spectrum disorders, neurocognitive disorders, and delirium; no studies were found for both anxiety and eating disorders.Conclusion: The administration of prolonged release melatonin at 2–10 mg, 1–2 h before bedtime, might be used in the treatment of insomnia symptoms or comorbid insomnia in mood disorders, schizophrenia, in adults with autism spectrum disorders, neurocognitive disorders and during sedative-hypnotics discontinuation. Immediate release melatonin at

Resume Le champ de la psychiatrie computationnelle prend de l’ampleur depuis quelques annees. Dans cet article, nous proposons de distinguer trois champs de la psychiatrie computationnelle. Le premier champ correspond a la Digital Psychiatry, ou psychiatrie utilisant les outils numeriques, qui peut etre definie comme un champ de la psychiatrie qui utilise des outils connectes pour recueillir des donnees numeriques. Le deuxieme champ correspond a la Big Psychiatry, ou psychiatrie fondee sur les donnees massives, qui traite de grandes quantites de donnees, en particulier par des methodes d’apprentissage automatique, une des branches de l’intelligence artificielle. Le troisieme champ correspond a la Psychiatry Modeling, ou modelisation en psychiatrie utilisant notamment les neurosciences computationnelles, avec le developpement et l’utilisation de modeles formels (mathematiques) du fonctionnement (et dysfonctionnement) cerebral et cognitif, afin de caracteriser les mecanismes a l’origine des symptomes observes en clinique. Ces trois champs se completent et sont fortement dependants les uns des autres. Ainsi, l’acces aux donnees est fourni par la Digital Psychiatry ; le traitement des donnees est opere par la Big Psychiatry ; et la formalisation des hypotheses est offerte par la Psychiatry Modeling. Cette triple organisation de la psychiatrie computationnelle offre un cadre de reflexion robuste pour apprehender la psychiatrie personnalisee et de precision, articulee autour de methodologies statistiques et mathematiques, axee sur la prediction et l’explication et utilisant des donnees qualitativement et quantitativement variees – tout en s’adressant necessairement a un sujet commun, le patient de la clinique psychiatrique.

International audience; Study objective: To determine whether the objective level of alertness measured by the Maintenance of Wakefulness Test (MWT) is associated with the occurrence of self-reported sleepiness-related traffic near misses and accidents related to sleepiness in patients with sleep disorders.Methods: This case-control study was conducted over a three-year period in four French sleep centers during a 4∗40 min MWT in patients driving more than 5000 Km/year. Relationship between mean sleep latency on the MWT (MWT latency) and age, sex, driving, sleepiness-related near misses and accidents reported during the previous year, and sleep disorder characteristics was analyzed.Results: Of 377 patients suffering from OSAS, idiopathic hypersomnia, narcolepsy, restless leg syndrome or insufficient sleep syndrome, 176 were included. 74 cases reported an accident or near miss related to sleepiness at the wheel in the past year, and 102 reported no accident/near miss (control patients). Thirty-one (37.8 %) cases and 9 (8.8 %) controls reported being sleepy at the wheel more than once a week (p < 0.0001). After adjusted regression analyses, patients with MWT latency between 19 and 33 minutes had a 3.2- (CI 95%[1.5; 6.8], p < 0.0001) fold increase in risk of reporting a near miss/ accident and patients with MWT latency 33 min).Conclusions: MWT latency is associated with self-reported, sleepiness-related near misses and accidents related to sleepiness in the past year in patients routinely investigated in sleep clinics. The MWT could be used to assess driving risk together with clinical interviews assessing sleepiness at the wheel.

International audience; The main objective of this theoretical review is to systematically analyze the type of International Classification of Sleep Disorders-3 (ICSD-3) diagnostic criteria by labeling each of them in order to propose an overview of the way in which the diagnostic criteria are organized. Labeling of diagnostic criteria using a rigorous iterative process of "aggregation" and "generalization" was conducted and inter-rater reliability calculation (Cohen's Kappa with three raters) was calculated. 241 criteria from 43 main sleep disorders of the ICSD-3 were labeled into nine types (Clinical manifestation 86.0% of sleep disorders, Objective markers 53.5%, Distress 30.2%, Disability 30.2%, Duration 30.2%, Frequency 58.1%, Age in 18.6%, Exclusion condition 81.4% and Associated condition 34.8%), with a high inter-rater reliability (Cohen's Kappa = 0.85). This analysis assumes that the structuring of the ICSD-3 diagnostic criteria is based on the Harmful Dysfunction Analysis (HDA). Some criteria correspond to the dysfunction part of the HDA while others refer to the harmful part. However, the approach does not seem to be homogeneous across the nosological classification. The use of a structured definition of sleep disorder and a framework to organize the ICSD diagnostic criteria is discussed with regard to the reliability and validity of criteria for diagnosing sleep disorders.

Resume En plus de l’impact psychologique du confinement et de l’epidemie, il existe des repercussions sur le sommeil qu’il faut prendre en compte par la mise en place de strategies adaptees afin de maintenir un bon etat de sante mental et de sante general. Le confinement peut desorganiser le sommeil en impactant, d’une part, les rythmes circadiens par une diminution de l’intensite des synchroniseurs exterieurs et, d’autre part, peut favoriser l’insomnie dans cette periode de stress aigu. Enfin, le confinement peut etre source d’une privation de sommeil chez ceux qui sont en premiere ligne et qui gerent la crise. De plus, chez les enfants/adolescents le confinement peut egalement destructurer les journees et ainsi avoir un impact sur la sante en generale. Pour cela, il est important de mettre en place certaines strategies de preventions de ces perturbations de sommeil afin d’attenuer l’impact psychologique, infectieux et faire face de maniere optimale a cette situation que nous vivons tous.

Sleep apnea syndrome treatment relies primarily on continuous positive airway pressure, which requires a homecare follow-up. Excessive daytime sleepiness is a key symptom to be measured during follow-up, and there is a need for more easy-to-administer, ecological and engaging tools to assess it. Virtual agents have shown their effectiveness in performing clinical evaluation in a medical environment. A virtual agent assessing excessive daytime sleepiness via the Epworth Sleepiness Scale has been tested at home by 102 patients treated by continuous positive airway pressure (CPAP) and their homecare providers. Acceptance and trustworthiness of the agent, as well as the influence of demographics and clinical characteristics of patients, were investigated. Results showed that both patients and homecare providers reported a positive attitude towards the virtual agent, which was found to be usable, satisfactory, credible and benevolent. Homecare providers reported that it was not a burden to their working routine. Positive regression coefficients were found between patients' and homecare providers' attitudes towards the virtual agent. We found no influence of patients' demographics and clinical characteristics on their acceptance of the virtual agent. This shows that virtual agents are well accepted by patients and homecare providers, independently of their demographics and clinical characteristics. Positive regression coefficients observed between patients' and homecare providers' perceptions of the agent indicate that the opinions of both influence acceptance of the virtual agent in a homecare context. Virtual agents are new innovative digital solutions to be considered in homecare follow-up of apneic patients treated by CPAP.

While psychotic remission in schizophrenia (SZ) has been defined by consensus and associated with a rank of clinical predictive factors, there is a lack of data of factors associated with functional remission.To identify clinical and biological factors associated with impaired functional remission in a non-selected chronic stabilized SZ outpatients.This study was a cross-sectional study carried out on all admitted SZ stabilized outpatients in an academic daily care psychiatric hospital. Functional remission was defined by a global assessment of functioning score ≥61. Psychotic remission was defined according to international criteria. Depression was assessed with the Calgary Depression Rating scale for Schizophrenia. Sociodemographic variables, tobacco status, clozapine treatment and obesity were reported. Chronic peripheral inflammation was defined by a highly sensitive C-reactive protein serum level ≥3 mg/L and metabolic syndrome according to international recommendations.273 patients were included, among them 51 (18.7%) were classified in the functional remission group. In the multivariate analysis, higher rate of functional remission was associated with psychotic remission (adjusted Odd ratio = 18.2, p0.001), lower depressive symptoms (aOR=0.8, p = 0.018) and lower peripheral inflammation (aOR=0.4, p = 0.046). No association of functional remission with age, gender, illness duration, second-generation antipsychotics, clozapine treatment, tobacco smoking, obesity or metabolic syndrome has been found.Depressive symptoms and chronic peripheral inflammation are associated with impaired functional remission in SZ independently of psychotic remission. Future intervention studies should determine if improving depressive symptoms and chronic peripheral inflammation may improve SZ patients reaching functional remission.

Neurofeedback is going through a renaissance. Advances in brain imaging and computing have renewed efforts to modify brain activity and behaviour using this technique. Here, over 80 neurofeedback researchers present a consensus-derived checklist – CRED-nf – for reporting and experimental design standards in the field., Neurofeedback has begun to attract the attention and scrutiny of the scientific and medical mainstream. Here, neurofeedback researchers present a consensus-derived checklist that aims to improve the reporting and experimental design standards in the field.

Substance use disorders are under-detected and not systematically diagnosed or screened for by primary care. In this study, we present the acceptability and validity of an Embodied Conversational Agent (ECA) designed to screen tobacco and alcohol use disorder, in individuals who did not seek medical help for these disorders.Individuals were included from June 2016 to May 2017 in the Outpatient Sleep Clinic of the University Hospital of Bordeaux. DSM-5 diagnoses of tobacco and alcohol use disorders were assessed by human interviewers. The ECA interview integrated items from the Cigarette Dependence Scale-5 (CDS-5) for tobacco use disorder screening, and the "Cut Down, Annoyed, Guilty, Eye-opener" (CAGE) questionnaire for alcohol use disorder screening. Paper version of CDS-5 and CAGE questionnaires and acceptability questionnaire was also self-administered.Of the 139 participants in the study (mean age 43.0 [SD = 13.7] years), 71 were women, and 68 were men. The ECA was well accepted by the patients. Paper self-administered CDS-5 and CAGE scores had a strong agreement with the ECA (p 0.0001). The Receiver Operating Characteristic (ROC) analysis of the ECA interview showed AUC of 0.97 (95% CI, 0.93-1.0) and 0.84 (95% CI, 0.69-0.98) for CDS-5 and CAGE respectively with p-value0.0001.This ECA was acceptable and valid to screen tobacco or alcohol use disorder among patients not requesting treatment for addiction. The ECA could be used in hospitals and potentially in primary care settings to help clinicians to better screen their patients for alcohol and tobacco use disorders.

Resume L’article de Spitzer et Endicott de 1978 fait partie des travaux preparatoires de la troisieme edition du Manuel diagnostique et statistique de l’American Psychiatric Association (DSM-III). Cet article souligne la necessite de definir le concept general de trouble mental pour mieux identifier les principes directeurs permettant de determiner quels etats devaient etre inclus dans la classification, quels etats devaient etre exclus, et comment ces etats devraient etre delimites. L’article decrit une proposition de definition et les criteres generaux pour delimiter un trouble medical. La premiere originalite de cet article est de proposer un retournement : le trouble mental sera delimite a partir d’une definition generale des troubles en medecine. La deuxieme originalite est de proposer une position hybride : le trouble medical est defini a l’intersection d’une perspective physiologique (fondee sur les faits) et d’une perspective sociale reliee a la notion de handicap (notamment fondee sur les valeurs). Malgre les originalites des positions de Spitzer et Endicott et leurs interets persistant pour clarifier le debat actuel autour de la psychiatrie, la problematique majeure des criteres proposes semble l’absence de tentative de relier ensemble le niveau du dysfonctionnement physiologique suppose dans l’organisme avec celui du niveau du handicap. Cette absence pourrait etre liee au fait que les auteurs ne proposent pas une theorie de reference du fonctionnement cerebral ou mental. Nous analyserons donc comment le projet recent des Research Domain Criteria (RDoC) (pour « Criteres pour des domaines de recherche ») peut repondre a la limite du projet initial de Spitzer et Endicott. Il sera souligne cependant que les modeles d’explication en medecine ne sont pas entierement guides par le savoir physiologique mais restent fondamentalement un choix pragmatique, et ainsi il sera propose un niveau intermediaire d’explication physiologique entre le niveau d’explication du fonctionnement cerebral tel que les neurosciences le constituent, et le niveau de pratique de l’action medicale psychiatrique.

The Self-Efficacy Measure for Sleep Apnea (SEMSA) is a 26-item self-questionnaire composed of three factors: risk perception of obstructive sleep apnea syndrome (OSAS), benefit of continuous positive airway pressure (CPAP), and self-efficacy (the confidence to engage in CPAP use). It is used to evaluate health beliefs about OSAS and CPAP in order to optimize CPAP use. The purpose of this study was to design and validate a French version of the SEMSA. A forward-backward translation of the SEMSA was performed. Subjects with OSAS treated by CPAP and followed by our sleep clinic were invited to complete the questionnaire. The psychometric properties of the French SEMSA version were analyzed in terms of its construct validity (with confirmatory factor analysis, CFA), internal structural validity (Cronbach’s alpha coefficient), and external validity (Pearson’s correlation between SEMSA score and duration of CPAP use). Two hundred eighty-eight subjects filled in the questionnaire. The mean age was 63.16 ± 12.73 years. The number of years since the beginning of CPAP treatment was 6.58 ± 6.03 years. The mean CPAP use duration was 6.19 ± 2.03 h/night. CFA was unsatisfactory (RMSEA = 0.066 and CFI = 0.88). The exploratory factor analysis revealed a fourth factor named “cardiovascular risk” factor. Cronbach’s alpha coefficient was 0.886. The correlation between the “self-efficacy” factor and the duration of CPAP use was significant (r = 0.26, p ≤ 0.001). The French version of the SEMSA is a psychometrically acceptable self-report questionnaire for measuring health beliefs and behavior in French patients with OSAS treated with CPAP. Such translation and validation should lead to the adoption of validated psychosocial methods for improving CPAP use.

Virtual reality is a relatively new technology that enables individuals to immerse themselves in a virtual world. It offers several advantages including a more realistic, lifelike environment that may allow subjects to "forget" they are being assessed, allow a better participation and an increased generalization of learning. Moreover, the virtual reality system can provide multimodal stimuli, such as visual and auditory stimuli, and can also be used to evaluate the patient's multimodal integration and to aid rehabilitation of cognitive abilities. The use of virtual reality to treat various psychiatric disorders in adults (phobic anxiety disorders, post-traumatic stress disorder, eating disorders, addictions…) and its efficacy is supported by numerous studies. Similar research for children and adolescents is lagging behind. This may be particularly beneficial to children who often show great interest and considerable success on computer, console or videogame tasks. This article will expose the main studies that have used virtual reality with children and adolescents suffering from psychiatric disorders. The use of virtual reality to treat anxiety disorders in adults is gaining popularity and its efficacy is supported by various studies. Most of the studies attest to the significant efficacy of the virtual reality exposure therapy (or in virtuo exposure). In children, studies have covered arachnophobia social anxiety and school refusal phobia. Despite the limited number of studies, results are very encouraging for treatment in anxiety disorders. Several studies have reported the clinical use of virtual reality technology for children and adolescents with autistic spectrum disorders (ASD). Extensive research has proven the efficiency of technologies as support tools for therapy. Researches are found to be focused on communication and on learning and social imitation skills. Virtual reality is also well accepted by subjects with ASD. The virtual environment offers the opportunity to administer controlled tasks such as the typical neuropsychological tools, but in an environment much more like a standard classroom. The virtual reality classroom offers several advantages compared to classical tools such as more realistic and lifelike environment but also records various measures in standardized conditions. Most of the studies using a virtual classroom have found that children with Attention Deficit/Hyperactivity Disorder make significantly fewer correct hits and more commission errors compared with controls. The virtual classroom has proven to be a good clinical tool for evaluation of attention in ADHD. For eating disorders, cognitive behavioural therapy (CBT) program enhanced by a body image specific component using virtual reality techniques was shown to be more efficient than cognitive behavioural therapy alone. The body image-specific component using virtual reality techniques boots efficiency and accelerates the CBT change process for eating disorders. Virtual reality is a relatively new technology and its application in child and adolescent psychiatry is recent. However, this technique is still in its infancy and much work is needed including controlled trials before it can be introduced in routine clinical use. Virtual reality interventions should also investigate how newly acquired skills are transferred to the real world. At present virtual reality can be considered a useful tool in evaluation and treatment for child and adolescent disorders.

Objective: Virtual environments have been used to assess children with ADHD but have never been tested as therapeutic tools. We tested a new virtual classroom cognitive remediation program to improve symptoms in children with ADHD. Method: In this randomized clinical trial, 51 children with ADHD (7-11 years) were assigned to a virtual cognitive remediation group, a methylphenidate group, or a psychotherapy group. All children were evaluated before and after therapy with an ADHD Rating Scale, a Continuous Performance Test (CPT), and a virtual classroom task. Results: After therapy by virtual remediation, children exhibited significantly higher numbers of correct hits on the virtual classroom and CPT. These improvements were equivalent to those observed with methylphenidate treatment. Conclusion: Our study demonstrates for the first time that a cognitive remediation program delivered in a virtual classroom reduces distractibility in children with ADHD and could replace methylphenidate treatment in specific cases.

Background Depressive symptoms are frequently associated with schizophrenia symptoms. C - Reactive protein (CRP), a marker of chronic inflammation, had been found elevated in patients with schizophrenia and in patients with depressive symptoms. However, the association between CRP level and depressive symptoms has been poorly investigated in patients with schizophrenia. The only study conducted found an association between high CRP levels and antidepressant consumption, but not with depressive symptoms investigated with the Calgary Depression Rating Scale for Schizophrenia (CDSS). Objectives The aim of this study was to evaluate CRP levels and depressive symptoms in patients with schizophrenia, and to determine whether high CRP levels are associated with depressive symptoms and/or antidepressant consumption, independently of potential confounding factors, especially tobacco-smoking and metabolic syndrome. Methods Three hundred and seven patients with schizophrenia were enrolled in this study (mean age = 35.74 years, 69.1% male gender). Depressive symptoms was investigated with the CDSS. Patients were classified in two groups: normal CRP level (≤ 3.0 mg/L) and high CRP level (> 3.0 mg/L). Current medication was recorded. Results 124 subjects (40.4%) were classified in the high CRP level group. After adjusting for confounding factors, these patients were found to have higher CDSS scores than those with normal CRP levels in multivariate analyses (p = 0.035, OR = 1.067, 95% CI = 1.004–1.132). No significant association between CRP levels and antidepressants consumption was found. Limitations The size sample is relatively small. The cut-off point for high cardiovascular risk was used to define the two groups. CRP was the sole marker of inflammation in this study and was collected at only one time point. The design of this study is cross-sectional and there are no conclusions about the directionality of the association between depression and inflammation in schizophrenia. Conclusion This study found an association between high rates of CRP levels and depressive symptoms in patients with schizophrenia, but no association with antidepressant consumption. Further studies are needed to investigate the impact of inflammation in schizophrenia.

International audience; Recent population-based longitudinal studies concluded that most adults with attention deficit/hyperactivity disorder (ADHD) symptoms would not have a childhood history of ADHD, leading to the concept of adult-onset ADHD. In a large, well-characterized clinical population of 446 adults with a primary complaint of ADHD, we reported a low frequency of adult-onset ADHD (6.9%), being a primary isolated condition in 2.8%. They had less severe symptoms and tendencies for higher hypersomnolence disorder comorbidity than patients with typical childhood-onset ADHD. Our findings reinforce the requirement to exclude other disorders that might overlap with ADHD or mimic ADHD symptoms in adulthood onset patients.

The catatonic syndrome remains a syndrome whose definition and identification in clinical practice are little known, unfamiliar for many clinicians. The symptoms may be subtle and difficult to identify. The semiology of the catatonic syndrome results from an interaction between three groups of signs and symptoms: motor signs (immobility, stupor, mutism, fixity of gaze, withdrawal, refusal of food, posture, psychomotor agitation, impulsivity, facial expressions, stereotypy, mannerism, catalepsy, waxy flexibility, negativism, oppositionism), behavioral signs giving an impression of dependence on the environment (imitation behaviors, utilization behaviors, magnetization behaviors) and neurovegetative signs. This syndrome has become, in a widely accepted way today, a transnosographic clinical syndrome. It is imperative to recognize this semiology in order to treat it quickly. Indeed, the etiologies of this syndrome and the consequences of the syndrome, can engage the vital prognosis.; Le syndrome catatonique est un syndrome psychiatrique ancien dont la définition et le repérage en pratique clinique restent encore mal connus. Les symptômes et signes peuvent être discrets, subtils, et difficiles à identifier. Le syndrome catatonique souffre donc d’un retard d’identification. La sémiologie du syndrome catatonique résulte d’une interaction entre trois groupes de signes et symptômes : des signes moteurs (immobilité, stupeur, mutisme, fixité du regard, repli sur soi, refus alimentaire, prise de posture, agitation psychomotrice, impulsivité, maintien d’expressions faciales inadaptées, stéréotypie, maniérisme, catalepsie, flexibilité cireuse, négativisme, oppositionnisme), des signes comportementaux donnant une impression de dépendance à l’environnement (comportements d’imitation, comportements d’utilisation, attitudes d’aimantation) et des signes neurovégétatifs. Ce syndrome est devenu, de manière largement admise aujourd’hui, un syndrome clinique transnosographique. Il est impératif de le reconnaître afin de le traiter rapidement, car certaines étiologies à l’origine de ce syndrome et les conséquences du syndrome lui-même peuvent engager le pronostic vital.

Resume Le trouble de conversion constituerait-il un trouble a part ? Vecu comme une realite par le patient, l’absence de signes « objectifs » a l’examen l’a longtemps fait considerer comme une « pathologie sans substrat ». Or, si la clinique de ce trouble est bien connue, sa comprehension precise reste sujette a interpretation et les mecanismes exacts qui le produisent sont encore mal compris. Ainsi, le fait de ne pas retrouver de lesion explicative dans le cerveau exclut-il la possibilite d’un dysfonctionnement au sein de ce meme organe ? On qualifie bien souvent ce trouble de « maladie de l’imagination ou de la volonte », mais au final, on connait peu de chose sur le fonctionnement cerebral du mouvement volontaire et des representions mentales dans le trouble de conversion. Alors, dans cette optique, quel pourrait etre l’apport des moyens « modernes » d’investigation tels que l’imagerie fonctionnelle ? La mise en evidence d’anomalies fonctionnelles dans le cerveau ne permettrait-elle pas d’ouvrir de nouvelles perspectives theoriques pour ces patients ? L’imagerie fonctionnelle a permis d’explorer des mecanismes plus complexes, jusqu’a present peu accessibles (emotions, etats affectifs, volition, imagerie mentale, processus inconscients), et nous proposons dans cette communication de montrer comment, a l’aide de ces techniques, une pathologie consideree comme un diagnostic d’exclusion et de trouble sans substrat peut etre abordee differemment du fait d’explications neurophysiologiques « nouvelles ».

Resume Les crises non epileptiques psychogenes (CNEP) sont definies comme un changement brutal du comportement, des perceptions, des pensees ou des emotions d’un sujet pendant une duree limitee, qui ressemble a une crise d’epilepsie, mais sans l’activite concomitante electrophysiologique associee a une crise epileptique. Il existe une nette predominance feminine (75 %) dans la plupart des etudes. Le debut de la maladie se situe typiquement dans la deuxieme ou troisieme decennie. Environ 80 % des patients ont des antecedents de traumatismes ou de maltraitance. La comprehension des CNEP necessite l’analyse de trois types de facteurs, les 3 P : predisposants (de vulnerabilite), precipitants (declenchants) et perpetuants (de maintien). Ces facteurs ne sont pas toujours tous retrouves chez un patient donne. Il existerait une correlation entre le dysfonctionnement de certains reseaux cerebraux et les taux de dissociation chez des patients souffrant de CNEP. Il existerait une dysregulation emotionnelle complexe observee chez certains malades souffrant de CNEP. L’analyse semiologique en video-EEG permet d’identifier des associations caracteristiques de signes lors des crises permettant de distinguer cinq sous-types cliniques qui, associes a l’analyse semiologique des 3 P, permettent de poser le diagnostic de CNEP. L’annonce diagnostique des CNEP est une etape delicate, mais importante pour entamer une premiere phase therapeutique : elle conditionne le pronostic des patients souffrant de CNEP. L’annonce diagnostique et la prise en charge necessite une collaboration etroite entre neurologues et psychiatres.

Objective: Affective lability is an important dimension of adult ADHD, associated with marked impairments and worse outcomes. A valid and quick tool to measure affective lability may therefore be of interest. Method: In 187 adult ADHD patients, we explored psychometric properties of the Affective Lability Scale–Short Form (ALS-18 items). We analyzed the construct validity and the external validity of the scale. Patients were compared with 48 healthy adult controls. Results: The three-factor structure of the ALS-18 presented a good fit and a good internal consistency. The correlations between the ALS-18 and ADHD symptoms and other psychological dimensions were, respectively, low and moderate. ALS-18 scores were higher in patients than in healthy adults. Conclusion: ALS-18 showed good psychometric properties in ADHD adult patients, allowing us to recommend the implementation of ALS-18 in assessing affective lability for clinical and research purposes. Use of ALS-18 should improve the clinical assessment of affective lability in adult ADHD patients.

Claude Bernard, and his master François Magendie, by the constitution of physiological science, has brought the establishment of a unifying representation system in the field of medicine. According to these representations, the diseases and the therapeutics would be considered by medical doctors as following the same laws of physiology. Physiology would be the condition of a real scientific medicine. How this positioning may be applied to psychiatry? To answer this question, this article proposes first of all to summarize the principal concepts structuring clinical physiology since Claude Bernard. These concepts are those of the "milieu intérieur", its stability and its regulation. The principles of this regulation system introduced by Claude Bernard lead us to consider him as the first modern systemic physiologist. Moreover these principles of regulation offer the possibility to understanding in an original way the processes of adaptation and acclimatization of an organism. This article then to analyze how these physiological concepts can be applied to psychiatry, including a discussion on the distinction of normal and pathological (by underlining that the difficulty in defining the disease is not specific to mental disorders), by providing a physiological perspective of the notion of syndrome for linking together in a practical way, the requirements of scientific medicine to that of rigorous clinical medicine., Claude Bernard, et son maitre François Magendie, ont permis, par la constitution de la science physiologique, la mise en place d'un système de représentation unificatrice dans le champ de la médecine où la pathologie et la thérapeutique seraient considérées par les médecins comme suivant les mêmes lois de la physiologie. La physiologie serait ainsi la condition d'une véritable médecine scientifique. Comment ce positionnement peut il s'appliquer à la psychiatrie ? Afin de répondre à cette question, cet article se propose, tout d'abord de rappeler les concepts essentiels structurant la physiologie clinique depuis Claude Bernard. Ces concepts sont ceux de milieu intérieur, de sa constance et de sa régulation. Les principes de ce système de régulation introduis par Claude Bernard font de lui un précurseur de la physiologie systémique moderne et permettent de comprendre de manière originale les processus d'adaptation et d'acclimatation d'un organisme. Cet article se propose ensuite d'analyser comment ces concepts peuvent s'appliquer à la psychiatrie et notamment à la distinction du normal et du pathologique (et de souligner que la difficulté dans la définition de la maladie n'est pas propre aux troubles mentaux), en offrant une perspective physiologique à la notion de syndrome, concept permettant de lier ensemble, et de manière pratique, les exigences d'une médecine scientifique à celle d'une médecine clinique rigoureuse.

Emotional reactivity in insomnia is affected both subjectively and on a physiological level for negative emotional material, but little is known about reactions to positive stimuli. We here investigated whether in younger adult insomnia patients, presentation of short humorous films would lead to heart rate decreases during and after film viewing, as compared to heart rate changes when falling asleep. Investigating 20 participants with DSM-5-diagnosed insomnia and 18 participants without insomnia, we found that heart rate decreased when falling asleep, increased when watching humorous films and returned to normal values afterwards for all participants. Film-related heart rate increases were strongly related to humour ratings of the films. No differences were found between those with and without insomnia on subjective ratings of the films, film-related heart rate changes or when falling asleep. We conclude that the experience of positive daily life stimuli in younger adults is not affected by insomnia in our study, despite insomnia having a known more profound effect on negative stimuli. Future studies exploring insomnia-related autonomous nervous system responses combining different neurophysiological modalities should confirm our findings.

Thinking through other minds (TTOM) encompasses new dimensions in computational psychiatry: social interaction and mutual sense-making. It questions the nature of psychiatric manifestations (semiology) in light of recent data on social interaction in neuroscience. We propose the concept of “social physiology” in response to the call by the conceivers of TTOM for the renewal of computational psychiatry.

International audience; Objective: To analyze the psychometric properties of the French version of the Weiss Functional Impairment Rating Scale-Self Report (WFIRS-S) in a large clinical sample of adults with ADHD. Method: Patients (N = 363) were diagnosed with ADHD according to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) criteria. Psychometric properties of the French version of the WFIRS-S were tested including construct validity with a confirmatory factor analysis, internal structural validity with Cronbach's alpha coefficient, external validity by correlations with the Beck Depression Inventory-II (BDI-II), and the EuroQol five-dimension (EQ-5D) questionnaire. Results: The confirmatory factor analysis found the following: root mean square error of approximation (RMSEA) = 0.061, 90% confidence interval (CI) = [0.058, 0.063]; comparative fit index (CFI) = 0.67. Cronbach's alpha coefficient was .91. Correlations with EQ-5D descriptive index, visual analogue scale (VAS) scores, and BDI-II scores were -0.48, -0.55, and 0.53, respectively. Conclusion: The French version of the WFIRS-S is a psychometrically acceptable self-reported questionnaire for the multi-domain evaluation of functional impairments in adults with ADHD, for research and clinical purposes.

National audience; Contexte : L’entraînement neurofeedback consiste à apprendre à des patients à moduler volontairement des rythmes d’activité cérébrale spécifiques, sous-tendant des capacités cognitives/motrices d’intérêt. Le neurofeedback pourrait être un outil de remédiation cognitive prometteur. Cependant, actuellement, une large proportion de patients semble ne pas parvenir à moduler leur activité cérébrale grâce à ce type d’entraînement.Objectifs : Notre objectif est d’identifier et modéliser les facteurs cognitifs, psychologiques et neurophysiologiques influençant la capacité des patients à moduler leur activité cérébrale, afin de concevoir des procédures d’entraînement neurofeedback efficientes, adaptées à chaque patient.Méthodes : Pour ce faire, nous avons mené une étude de la littérature théorique et expérimentale, qui nous a permis de mettre en évidence trois familles de facteurs.Résultats : La première famille englobe des facteurs dits « spécifiques », qui dépendent du paradigme neurofeedback et de la stratégie adoptée par les patients pour moduler leur activité cérébrale (p. ex., facteurs liés aux habiletés spatiales en cas de recours à l’imagerie mentale). Les deux autres familles réunissent des facteurs dits « non spécifiques », liés d’une part au niveau d’acceptation de la technologie (p. ex., agentivité) et d’autre part à des aspects cognitifs et motivationnels. Parmi ces derniers, les ressources attentionnelles allouées à l’entraînement, qui sont fortement liées aux autres facteurs, semblent jouer un rôle important.Conclusion : Ce modèle intégratif, bien qu’encore incomplet, nous permet de mieux appréhender les processus impliqués dans l’apprentissage neurofeedback et d’entrevoir des leviers sur lesquels nous pourrions agir afin d’entraîner les patients à moduler leur activité cérébrale, pour potentiellement réduire certains symptômes cliniques.

Sleep disorders like sleep-related breathing disorders, sleep-related movement disorders, parasomnias, and central hypersomnia are frequently associated with psychiatric disorders. It is thus important to detect patients with comorbid sleep disorders and to refer them for an appropriate sleep exploration if necessary. Sleep explorations are noninvasive electrophysiological diagnostic tests to assess brain function and more generally to assess the cardiopulmonary, motor and behavioral functions that are major physiologic functions modified during sleep. Sleep explorations allow diagnosis of sleep disorders and the assessment of their severity. The objective of this article is: to provide basic knowledge to psychiatrists on the conduct, the interpretation, and the results of the main sleep explorations, and to highlight the principles of clinical screening of sleep disorders evaluated by the sleep explorations. Close collaboration between psychiatry and sleep medicine is needed to promote access to subjects suffering from mental disorder to sleep explorations with the aim to ensure quality of care., Les pathologies du sommeil de type troubles respiratoires du sommeil, mouvements anormaux liés au sommeil, comportements anormaux du sommeil (parasomnies) et hypersomnies centrales sont fréquemment associées aux troubles psychiatriques. Il apparaît important de savoir les dépister afin d’orienter les patients si cela est nécessaire sur une exploration du sommeil adaptée. Les explorations du sommeil sont des examens paracliniques électrophysiologiques non invasifs essentiels pour apprécier le fonctionnement cérébral et plus généralement des grandes fonctions physiologiques cardiorespiratoire, motrice et comportementale au cours du sommeil. Ces examens permettent le diagnostic des pathologies du sommeil ainsi que l’évaluation de leur sévérité. L’objectif de cet article est premièrement d’apporter un minimum de connaissances aux psychiatres concernant la réalisation et l’interprétation des résultats des principales explorations du sommeil, et deuxièmement de rappeler les principes de dépistage des pathologies du sommeil comorbides en psychiatrie évaluées par ces explorations du sommeil. Une collaboration étroite entre médecine du sommeil et psychiatrie est nécessaire afin de favoriser l’accès pour les sujets souffrant de troubles psychiatriques aux explorations du sommeil dans l’objectif de leur assurer une prise en charge de qualité.

The objective of this study was to evaluate the Neurological Disorders Depression Inventory-Epilepsy (NDDI-E) for Youth (NDDI-E-Y) for screening for major depressive disorder (MDD) in French youth with epilepsy (YWE), in order to (1) validate this tool in a separate population; (2) determine whether the 12-item NDDI-E-Y affords advantages over the 6-item adult NDDI-E; (3) measure psychometric performance of each item.Youth with epilepsy aged 11-17 years completed a 15-item questionnaire to calculate total scores for NDDI-E-Y (12 items) and NDDI-E (6 items). Gold standard for MDD was Children's Depression Inventory (CDI). Receiver operator characteristic (ROC) analyses for total NDDI-E-Y and NDDI-E scores were compared. Psychometric properties of each item were analyzed for: floor/ceiling effect, item-internal consistency, and ROC curve.Ninety-seven YWE were included; 21.6% had MDD (CDI 15). Correlation was very high between total NDDI-E-Y and NDDI-E scores, and high between NDDI-E-Y and CDI. Cutoff point for the NDDI-E-Y maximizing both sensitivity and specificity was 23 (original study cutoff 32). The ROC analysis of the NDDI-E-Y showed an area under the curve (AUC) 0.967 (95% confidence intervals [CI] 0.909-0.992); (p 0.0001). Sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) were 100% [83.9; 100], 82.9% [72.5; 90.6], 61.8 [43.6; 77.8], and 100% [94.3; 100], respectively. The NDDI-E-Y was not superior to NDDI-E according to pairwise comparison of ROC (p = 0.07). Psychometric analysis revealed marked differences between items. After eliminating items with poorer performance, a 6-item version of the NDDI-E-Y showed sensitivity, specificity, PPV, and NPV of 100% [85.5; 100], 85.5% [75.6; 92.5], 65.6 [46.8; 81.4], and 100% [94.5; 100], respectively. This was significantly better than the adult NDDI-E (p = 0.03) though not NDDI-E-Y (p = 0.07).Significant difference in cutoff indicates that the NDDI-E-Y cannot yet be recommended for widespread screening of MDD in YWE. Discrepancies in psychometric performance between items suggest that further work is needed to examine both validation of the original 12-item NDDI-E-Y and comparison with a shorter version.

This article proposes what we call an “EEG-Copeia” for neurofeedback, like the “Pharmacopeia” for psychopharmacology. This paper proposes to define an “EEG-Copeia” as an organized list of scientifically validated EEG markers, characterized by a specific association with an identified cognitive process, that define a psychophysiological unit of analysis useful for mental or brain disorder evaluation and treatment. A characteristic of EEG neurofeedback for mental and brain disorders is that it targets a EEG markers related to a supposed cognitive process, whereas conventional treatments target clinical manifestations. This could explain why EEG neurofeedback studies encounter difficulty in achieving reproducibility and validation. The present paper suggests that a first step to optimize EEG neurofeedback protocols and future research is to target a valid EEG marker. The specificity of the cognitive skills trained and learned during real time feedback of the EEG marker could be enhanced and both the reliability of neurofeedback training and the therapeutic impact optimized. However, several of the most well-known EEG markers have seldom been applied for neurofeedback. Moreover, we lack a reliable and valid EEG targets library for further RCT to evaluate the efficacy of neurofeedback in mental and brain disorders. With the present manuscript, our aim is to foster dialogues between cognitive neuroscience and EEG neurofeedback according to a psychophysiological perspective. The primary objective of this review was to identify the most robust EEG target. EEG markers linked with one or several clearly identified cognitive-related processes will be identified. The secondary objective was to organize these EEG markers and related cognitive process in a psychophysiological unit of analysis matrix inspired by the Research Domain Criteria (RDoC) project.

International audience; The association between restless legs syndrome (RLS), periodic leg movements during sleep (PLMS) and iron deficiency has been reported in children with attention-deficit/hyperactivity disorder (ADHD); however little is known in adults. The aim of this study was to assess frequencies of RLS, PLMS and other leg movements (LM) and iron deficiency and their relationships with ADHD phenotype in adults with ADHD.Methods: Two hundred adults with ADHD (112 males, median age 31 years) were evaluated on lifetime ADHD symptoms and sleep characteristics. RLS was diagnosed according to standard criteria. Serum ferritin levels were measured, with iron deficiency defined as

The current review aims at providing an overview of relevant aspects of anxiety symptoms and anxiety disorders (AD) in adults patients with epilepsy (PWE). Firstly, the appropriate diagnosis of type of anxiety symptoms and AD in PWE will be presented. Anxiety symptoms are often peri-ictal and classified in relation to their temporal occurrence to seizures. Anxiety symptoms are of three types: preictal (preceding a seizure), ictal (presenting as part of the seizure symptoms and signs), and postictal (occurring within 72 h of a seizure). AD are diagnosed in the interictal period and occur independently of seizures. Four specific AD in PWE can be objectified: anticipatory anxiety of epileptic seizures (AAS), seizure phobia, epileptic social phobia, and epileptic panic disorder. Secondly, the bidirectional pathophysiological relationship between anxiety and epilepsy will be described. Anxiety is a trigger for seizures in some patients, and the notion of stress and arousal is essential to understand the relationship between anxiety and seizure. Moreover, seizures arising from the limbic network especially involving amygdala, which may express fear-related semiology, provide insight into the pathophysiology of AD comorbidities. Thirdly, the methods of screening for AD and anxiety symptoms will be detailed. Fourthly, the pharmacological and psychobehavioral management of anxiety symptoms and AD in PWE will be presented. Arousal-based approaches for preictal and ictal symptoms and anxiety-based approaches for postictal and interictal symptoms will be presented. Despite lack of evidence-based approaches, it is recognized that management of epilepsy is not only about controlling seizures, but also depends heavily on detecting, correctly diagnosing, and appropriately managing anxiety symptoms and AD comorbidities, in order to maximize quality of life. Improving self-control and self-efficacy is of fundamental importance in the management of PWE. Further rigorously designed studies focusing on anxiety symptoms and AD are essential to improve the overall care of PWE.

International audience; Many Brain Computer Interface (BCI) and neurofeedback studies have investigated the impact of sensorimotor rhythm (SMR) self-regulation training procedures on motor skills enhancement in healthy subjects and patients with motor disabilities. This critical review aims first to introduce the different definitions of SMR EEG target in BCI/Neurofeedback studies and to summarize the background from neurophysiological and neuroplasticity studies that led to SMR being considered as reliable and valid EEG targets to improve motor skills through BCI/neurofeedback procedures. The second objective of this review is to introduce the main findings regarding SMR BCI/neurofeedback in healthy subjects. Third, the main findings regarding BCI/neurofeedback efficiency in patients with hypokinetic activities (in particular, motor deficit following stroke) as well as in patients with hyperkinetic activities (in particular, Attention Deficit Hyperactivity Disorder, ADHD) will be introduced. Due to a range of limitations, a clear association between SMR BCI/neurofeedback training and enhanced motor skills has yet to be established. However, SMR BCI/neurofeedback appears promising, and highlights many important challenges for clinical neurophysiology with regards to therapeutic approaches using BCI/neurofeedback

International audience; Objective: Recent research suggests that sleep disorders or changes in sleep stages or EEG waveform precede over time the onset of the clinical signs of pathological cognitive impairment (e.g., Alzheimer's disease). The aim of this study was to identify biomarkers based on EEG power values and spindle characteristics during sleep that occur in the early stages of mild cognitive impairment (MCI) in older adults.Methods: This study was a case-control cross-sectional study with 1-year follow-up of cases. Patients with isolated subjective cognitive complaints (SCC) or MCI were recruited in the Bordeaux Memory Clinic (MEMENTO cohort). Cognitively normal controls were recruited. All participants were recorded with two successive polysomnography 1 year apart. Delta, theta, and sigma absolute spectral power and spindle characteristics (frequency, density, and amplitude) were analyzed from purified EEG during NREM and REM sleep periods during the entire second night. Results: Twenty-nine patients (8 males, age = 71 +/- 7 years) and 29 controls were recruited at T0. Logistic regression analyses demonstrated that age-related cognitive impairment were associated with a reduced delta power (odds ratio (OR) 0.072, P < 0.05), theta power (OR 0.018, P < 0.01), sigma power (OR 0.033, P < 0.05), and spindle maximal amplitude (OR 0.002, P < 0.05) during NREM sleep. Variables were adjusted on age, gender, body mass index, educational level, and medication use. Seventeen patients were evaluated at 1-year follow-up. Correlations showed that changes in self-reported sleep complaints, sleep consolidation, and spindle characteristics (spectral power, maximal amplitude, duration, and frequency) were associated with cognitive impairment (P < 0.05).Conclusion: A reduction in slow-wave, theta and sigma activities, and a modification in spindle characteristics during NREM sleep are associated very early with a greater risk of the occurrence of cognitive impairment. Poor sleep consolidation, lower amplitude, and faster frequency of spindles may be early sleep biomarkers of worsening cognitive decline in older adults.

To assess the relationship between real and simulated driving performance and the objective level of alertness as measured by the Maintenance of Wakefulness Test (MWT) in patients suffering from narcolepsy or idiopathic hypersomnia.Twenty-seven patients (10 patients with narcolepsy, type 1 (n = 7) and type 2 (n = 3), and 17 patients with idiopathic hypersomnia, mean age = 33.8 ± 11.1 years, range = 18-65 y; four males) were recruited in a randomized, crossover, double-blind placebo-controlled trial, and compared to 27 matched healthy controls. Patients were randomly assigned to receive modafinil (400 mg) or placebo before the driving test (2 h of real and 2 h of simulated highway driving for each patient). Standard deviation of lateral position (SDLP) of the vehicle in real and simulated driving and mean sleep latency in a 4 × 40 min MWT were assessed.Untreated patients presented shorter sleep latencies on the MWT (20.8 (IQ range 16.1-32.9) vs. 34.9 min (IQ range 28.1-40.0)) and worse simulated driving performance (P 0.001) than treated patients. Nevertheless, treated patients still exhibited shorter mean sleep latencies on the MWT than controls (34.9 (IQ range 28.1-40.0) vs. 40 min (IQ range 37.1-40.0), P 0.05), but driving performance was identical in both groups. The SDLP of the vehicle in real driving conditions and the MWT score correlated with the SDLP in simulated driving (respectively, r = 0.34, P 0.05 and r = -0.56, P 0.001).In patients with narcolepsy/idiopathic hypersomnia, simulated driving and MWT explore different dimensions of fitness-to-drive and could be used complementarily to better evaluate sleep-related driving impairment.

RESUME Objectifs Cet article se donne pour objectifs, premierement de rappeler l’histoire de l’electroconvulsivotherapie (ECT) en psychiatrie et le passage dans ce contexte d’un niveau de preuve clinique fonde sur les descriptions phenomenologiques a la construction d’etudes controlees permettant d’etablir un lien de causalite, et deuxiemement d’analyser les conditions d’application de la relation dose-effet en ECT, critere clef de la causalite. Methodes Une revue de la litterature explorant l’utilisation de l’electricite, de l’ECT et de l’electroencephalographie (EEG) en psychiatrie a ete realisee. Les publications ont ete recensees a partir de la base de donnees electroniques Pubmed et GoogleScholar. Resultats Le rapport de 1784 redige par la commission Royale etablit par le Roi Louis XVI pour evaluer les pratiques de Mesmer concernant le magnetisme animal a joue un role central dans l’etablissement des criteres necessaires pour evaluer le niveau de preuve des therapeutiques electriques en psychiatrie. Depuis, des etudes randomisees controlees en aveugle ont confirme l’efficacite des ECT contre des ECT placebos pour la prise en charge des troubles psychiatriques. Une relation dose-effet peut etre mise en evidence par l’intermediaire d’une evaluation de la qualite EEG des crises induites par ECT. Conclusions Des outils de quantification de la qualite EEG des crises sont necessaires. Une echelle est proposee dans cet article. Des futures etudes devront etre menees pour la valider, mieux etablir la relation dose-effet des ECT, et ainsi renforcer la place de l’EEG comme element central pour la realisation d’ECT de qualite.

Resume La semiologie psychiatrique presente des fondements complexes a la fois sur le plan historique et theorique, imposant de questionner la methode pour organiser des termes semiologiques. Le recueil semiologique actuel est principalement tourne vers des diagnostics epidemiologiques, fondes sur des listes de symptomes, dont l’objectif est surtout d’aboutir a un diagnostic « atheorique » plus que vers une comprehension de leurs mecanismes et une prise en charge individualisee. Serait-il possible alors d’envisager une semiologie comprehensive et scientifique, a la fois fondee sur la nosographie actuelle, mais autorisant egalement une prise en charge personnalisee en psychiatrie ? Cet article propose d’y repondre en questionnant la place des sciences cognitives dans cette perspective, selon la distinction fondamentale de la cognition au sens du contenu de pensees, dans une premiere partie, au travers des therapies cognitivo-comportementales, et du contenant ou processus de pensee, dans une deuxieme partie, au travers de la remediation cognitive.