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Background: Violence is a common issue in psychiatry and has multiple determiners. The aim of this study is to assess the psychotic inpatients' violence in association with the violence of the neighborhood from which the patients are drawn and to estimate the impact of this environmental factor with regard to other factors., Method: A prospective multicenter study was led in nine French cities. Eligible patients were psychotic involuntary patients hospitalized in the cities' psychiatric wards. During their treatments, any kind of aggressive behavior by the patients has been reported by the Overt Aggression Scale (OAS)., Results: From June 2010 to May 2011, 95 patients have been included. Seventy-nine per cent of the patients were violent during their hospitalizations. In a bivariate analysis, inpatient violence was significantly associated with different factors: male gender, patient violence history, substance abuse, manic or mixed disorder, the symptoms severity measured by the BPRS, the insight degree and the city crime rate. In a multivariate analysis, the only significant factors associated with the patients' violence were substance abuse, the symptoms severity and the crime rates from the different patients' cities., Conclusion: These results suggest that violence within the psychotic patients' neighborhood could represent a risk of violence during their treatments., (Copyright © 2017 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Background: In the Western world, between 1940 and 1970, more than 2 million people were exposed in utero to diethylstilbestrol (DES). In exposed individuals, and in their descendants, adverse outcomes have been linked to such exposure, including cancers, genital malformations, and less consistently, psychiatric disorders. We aimed to explore whether prenatal DES exposure would be associated with DNA methylation changes, and whether these epigenetic modifications would be associated with increased risk of psychosis., Methods: From 247 individuals born from mothers exposed to DES, we selected 69 siblings from 30 families. In each family, at least one sibling was exposed in utero to DES. We performed a methylome-wide association study using HumanMethylation450 DNA Analysis BeadChip® in peripheral blood. We analyzed methylation changes at individual CpGs or regions in exposed (n = 37) versus unexposed individuals (n = 32). We also compared exposed individuals with (n = 7) and without psychosis (n = 30)., Results: There were more individuals with schizophrenia in the DES-exposed group. We found no significant differences between exposed and unexposed individuals with respect to differentially methylated CpGs or regions. The largest difference was in a region near the promoter of an ADAMTS proteoglycanase gene (ADAMTS9). Compared to exposed individuals without psychosis, exposed individuals with psychosis had differential methylation in the region encompassing the gene encoding the zinc finger protein 57 (ZFP57)., Conclusions: In utero exposure to DES was not associated with methylation changes at specific CpG or regions. In exposed individuals, however, psychosis was associated with specific methylomic modifications that could impact neurodevelopment and neuroplasticity.

Schizophrenia is a chronic illness with a progressive course that can be marked by resistance to antipsychotic treatment. This can make therapeutic support challenging for the practitioner, with results that are partial and unsatisfactory. In the literature, treatment with high-dose olanzapine (>20mg/day) appears to be a good alternative to clozapine, the gold standard for treatment-resistant schizophrenia. In the present observational prospective study, we studied the clinical and biological profiles of patients treated with olanzapine doses up to 100mg/day. In total, 50 patients were clinically and biologically assessed. We found a linear relationship between oral dose and serum concentration (Pearson's r=0.83, p<0.001) with effects of tobacco (p<0.05) and of coffee and tea consumption (p<0.01). Tolerance seemed to be good regardless of dose. No link was found between concentration and efficiency. Despite a nonexhaustive assessment of pharmacokinetic parameters, not least pharmacogenetic data (e.g., genotyping of cytochrome P450-1A2 or glycoprotein P Abcb1a), pharmacokinetic aspects alone cannot account for why the disease may sometimes be resistant to 20mg of olanzapine but respond to higher doses. A nuclear imaging study exploring brain occupancy by high-dose olanzapine, coupled with the abovementioned pharmacokinetic assessment, may prove a relevant experimental paradigm for studying the pathophysiological mechanisms of resistant schizophrenia., (Copyright © 2014 Elsevier B.V. All rights reserved.)

An accurate treatment of first episodes in schizophrenia and bipolar disorders has a significant impact on compliance and prognosis. However, existing therapeutic guidelines may be poorly respected and may concern only typical clinical situations. Medical attitudes in clinical practice have been collected and structured on the basis of small interactive meetings (Focus Group [FG]), and a synthesis of practical attitudes has been compared with updated guidelines. The FG method applied to treatment initiation in schizophrenia and bipolar disorder is seen as complementary to evidence-based guidelines. It reveals that, in a reflexive manner, clinical attitudes are often more diverse and frequently consider first treatments after global evaluation, taking more into account external factors such as clinicians' experience, patient's history and willingness, clinical setting, and environment. A symptomatic approach is sometimes preferred, and a better alliance is always considered as a main objective. The FG method could be a supplementary support to continuous medical education., (Copyright © 2012 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: The Brief Psychiatric Rating Scale was initially developed as a rapid method to assess symptom change in psychiatric inpatients of various diagnoses. The original version was expanded to an 18-item version and thereafter to a 24-item version to increase sensitivity to a broader range of psychotic and affective symptoms. The latest version of the expanded 24- item BPRS provides probe questions and detailed anchor points for the ratings for each item., Literature Findings: Studies have shown the expanded and anchored 24-item BPRS to be a sensitive and effective measure of psychiatric symptoms with good interrater reliability that can be maintained over time. To our knowledge, there are eight published papers including factor analyses of the BPRS-E(A). While many similarities are evident between these studies, inconsistencies are apparent that may have been due to sample size, characteristics and / or methodological differences in the factor analysis computation. Among these studies, six provided a four-factor solution. There was no French version of this scale available., Methods: After its translation into French and back translation, we investigated the validity of the French BPRS-E(A) version. We carried out a component analysis on the data of 111 participants of various diagnoses, mostly hospitalised for a first psychotic episode, yielding to a three-factor solution (positive symptoms--disorganisation; depression-anxiety and negative symptoms)., Results: A good internal consistency and interrater reliability were found. These results confirm the psychometric value of the BPRS-E(A) in its French version. We compared those findings to earlier reports; similarities and differences are discussed., (Copyright © 2009 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: Insight is more than frequently altered in schizophrenia, rupture of treatment being one the most known consequences of this impairment. Two different types of scales can be used to assess consciousness: self-questionnaires directly filled-in by the patient or questionnaires assessed by a psychiatrist after an interview. AIM OF THE STUDIES: The goal of this study was first to assess insight in schizophrenic patients with these two different types of scales and then try to find a link between insight impairment and schizophrenic symptoms. The self-questionnaire was the Marks et al. Self Appraisal of Illness Questionnaire (SAIQ) [Schizophr Res 45 (2000) 203-11], 17 items finally giving four scores (consciousness of illness, consequences of schizophrenia, need for treatment and worrying about illness) plus a total score of insight. The other questionnaire was the Amador Scale for assessment of Unawareness of Mental Disease [Amador XF, Strauss DH. The scale to assess unawareness of mental disorder (SUMD). Columbia University and New-York State Psychiatric Institute;1990], consisting in an interview with a psychiatrist who finally assesses four dimensions (consciousness of illness, symptoms, need for treatment and consequences of illness) plus a total score. In addition to these scores, Amador's scale gives the opportunity to score attribution a patient gives to illness for his symptoms., Patients: Thirty-one patients whose schizophrenia diagnosis had been previously made according to DSM-IV criteria were included. Half were outpatients, half inpatients. Drug prescriptions were controlled; all of the patients being medicated with an antipsychotic, a benzodiazepine and a sleep inducer. They were all assessed by the two scales previously mentioned and the Positive And Negative Syndrome Scale [Kay SR, Opler LA, Fiszbein A. Positive and negative syndrome scale. Traduction de Lepine JL. In: Guelfi JD, éditeur. Evaluation clinique standardisée, tome II. Castres : Editions médicales Pierre Fabre;1996]., Results: Total scores of insight scales were significantly correlated (p<0.001). For each questionnaire, the four different scores were independent from each other (p<0.001). There was no correlation found between insight scales and schizophrenic symptoms intensity., Conclusion: Considering symptom attribution, being unconscious of a symptom and being enable to attribute it to schizophrenia were linked, which could refer to Frith's theory of schizophrenia [Frith CD. Neuropsychologie de la schizophrénie. Psychiatrie ouverte. Paris: PUF;1996 (208p.)] and attribution impairment as a main dysfunction. The two different types of scales seem to be effective. The significant correlation between them suggests they assess the same dimension. This preliminary study will be followed by a validation study of the french translation of the SAIQ.

Among the second generation antipsychotics, aripiprazole presents a new pharmacological profile, basically differentiated by a partial agonist effect on the D2 and D3 dopaminergic receptors. Five short-term efficacy studies, conducted on 1648 patients presenting with schizophrenia or acute relapse of schizoaffective disorders, demonstrated the greater efficacy of aripiprazole than the placebo and comparable efficacy to that of haloperidol and risperidone. The short-term tolerance profile was characterised by a lesser incidence of the extrapyramidal side effects and drowsiness than with haloperidol. Two thousand six hundred and eighty five patients were followed-up over a period of 26 to 52 weeks in five clinical trials versus a placebo and haloperidol, olanzapine, quetiapine and risperiodone: demonstrated efficacy in maintaining the response to treatment and on the delay before relapse was comparable to the other antipsychotics. The classical side effects of antipsychotics decreased in the long-term. Versus olanzapine, a glucid and lipid profile, clearly in favour of aripiprazole, was completed by a lesser incidence of hyperprolactinaemia. Aripiprazole is effective on all the dimensions of schizophrenia: the positive and negative and depressive and anxious symptomatology. It appears to be of interest, notably on the cognitive dimension, which should motivate more in-depth exploration of its place in the treatment in the early stages of schizophrenia. Its therapeutic schedule and the methods of initiation are an essential criterion to the success of treatment, notably during the substitution of other antipsychotics. The clinical and pharmacological originality of aripiprazole would justify the terminology of a "third generation antipsychotic".

Introduction: In this study, we present seven case reports concerning patients suffering from schizophrenia or schizo-affective disorders, treated by aripiprazole., Study Design: Through these patient case reports, we have attempted to highlight the specificities of aripiprazole's action on schizophrenic symptoms, especially in the cognitive dimension. In acting as a regulator more than as a brake on the translation messages between neurons, aripiprazole does not increase cognitive disorders, but may have a procognitive affect., Results: We particularly noticed an improvement in attention abilities, both in selective attention - in order to take into account the context of the situation - and in sustained attention allowing patients to maintain a stable and appropriate level of efficiency while performing an activity. Case reports (n 2, n 3 and n 5) also seem to show the ability of aripiprazole to improve working memory: indeed, abilities of patients to maintain and recall information regarding different cognitive activities required in rehabilitation psychiatric care were noticed with aripiprazole while they were not with previous antipsychotic drugs used in the same patients., Discussion: Our sample, although too small for global consideration, suggests that aripiprazole provides stimulating properties for schizophrenic patients including those with primary deficient syndrome. This action, probably through cognitive improvement, needs some clarification in more precisely defining deficit features as juxtaposed by the classical criteria used on the SANS-SAPS and PANSS scales. Finally, we should stress aripiprazole's rapidity of effect. In half the cases, the reported improvement in our patients occurred during the first week of treatment. Hence, the patient should be informed of the short time-span effect for aripiprazole, in order to prevent the emergence of symptoms due to the rapid switch of medication and eventual side effects., Conclusion: Aripiprazole acts as a partial agonist of D2 receptors as well as a partial agonist of 5HT1A and an antagonist of 5HT2A. This drug constitutes the first that permits regulation of both the dopamine and serotonine systems: dopamine activity is blocked when D2 receptors are over-stimulated and increased when D2 receptors require stimulation; on the other hand, in the cortical region, the inactivation of 5HT2A allows for a release of dopamine firing, whereas in the striatum where the 5HT2A receptors density is increased, their blockage inhibits dopamine release and limits extrapyramidal symptoms. In addition, the synergy between 5HT1A antagonism and 5HT2A antagonism seems to provide aripiprazole with both anxiolytic and affective properties. Finally, the absence of an affinity for histamine, muscarinic and adrenergic alpha-1 receptors limits the side effects compared to other antipsychotic drugs.

Introduction: Psychiatric disorders are frequently reported in intensive care units (ICU). The occurrence of an acute psychotic decompensation in a patient opens the debate with several hypotheses., Case Report: A primary episode of acute psychotic decompensation occurred in a 27 year-old woman during hospitalisation in an intensive care unit due to attempted suicide following ingestion of propanolol and bronazepam., Discussion: Factors of stress can contribute to the onset of acute psychotic decompensation. The influence of pharmacological products can also explain the latter because of the iatrogenics of molecules ingested purposefully, but also the eventual responsibility of the treatments used in resuscitation. According to one hypothesis, a certain quantity of dopamine in this patient could have passed into the central nervous system that benefited from an alteration in the permeability of the haematoencephalic barrier secondary to severe hypoperfusion.