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The Vancouver Obsessional Compulsive Inventory–Mental Contamination scale (VOCI-MC) and the Contamination Thought–Action Fusion scale (CTAF) are two self-report instruments that assess symptoms of mental contamination and fusion between thoughts, and feelings and behaviours associated with contamination, respectively. The aim of this study was to investigate the psychometric properties of the French version of these two scales in non-clinical and clinical samples. We included 79 participants diagnosed with obsessive-compulsive disorder (OCD), 31 diagnosed with anxiety disorders, who were recruited from the University Department of Adult Psychiatry in Montpellier, and 320 non-clinical participants recruited from the general population. Psychometric properties of the French VOCI-MC and CTAF were investigated. Results showed that the French versions of the VOCI-MC and the CTAF had high internal consistency, good convergent and divergent validity, as well as good temporal stability. Exploratory and confirmatory factor analyses showed a one-factor structure for the two scales in both non-clinical and OCD samples. Adequate discriminative validity was established by comparing OCD patients with contamination-related symptoms and OCD patients who did not report contamination-related symptoms. The French VOCI-MC and CTAF are valid and appropriate tools for measuring mental contamination in both clinical and research contexts.

Background: At the beginning of COVID-19 pandemic, specific COVID/PSY wards were created in France to provide care for inpatients with COVID-19 and psychiatric disorders. In this multi-center prospective study, we set out to assess the clinical features and risk factors of somatic aggravation in patients hospitalized in COVID/PSY wards. Methods: Data were collected between 28 February and 30 May, 2020. We collected demographic data, psychiatric diagnoses, medical data and COVID-19-related clinical data. Somatic aggravation was estimated by the number of patients transferred to intensive care or medicine units, the number of deaths and the number of patients presenting a confusional state. A multivariate logistic model was used to assess the risk factors of confusional state and transfer to intensive care or medicine units. The risk of death was analysed by the univariate predictors of this outcome. Outcomes: 350 patients were included in the study. The number of inclusions peaked one week after that of the general population and declined more slowly. Overall, 24 (7%) were transferred to medicine units, 7 (2%) died and 51 (15%) patients presented a confusional state. Severe respiratory symptoms predicted the transfer to a medicine unit (OR 17.1; CI 4.9-59.3). Older age, an organic mental disorder, a confusional state, and severe respiratory symptoms predicted mortality in univariate analysis. Age > 55 (OR 4.9; CI 2.1-11.4), an affective disorder (OR 4.1; CI 1.6-10.9), and severe respiratory symptoms (OR 4.6; CI 2.2-9.7) predicted a higher risk, while smoking (OR 0.3; CI 0.1-0.9) predicted a lower risk of a confusional state. Interpretation: COVID-19 patients with severe psychiatric disorders have multiple somatic comorbidities and a high risk of confusion. COVID/PSY wards may play a role in reducing the mortality of COVID-19 in patients with psychiatric disorders. Funding Statement: There was no funding source for this study. Declaration of Interests: There are no conflicts of interest to be declared. Ethics Approval Statement: This observational study was conducted according to the principles of the Declaration of Helsinki. In accordance with French bioethics laws, it was classified as a non- interventional study, since it concerned anonymized clinical data that are routinely compiled in medical records. Compliance with French regulations on personal data collection was supervised by the personal data referent of the Centre Psychotherapique de Nancy. Patients, and their legal guardian when appropriate, were informed in writing, in agreement with national regulations for observational studies.

International audience; Caffeine is the most consumed psychoactive substance worldwide. Previous studies suggested higher caffeine consumption in subjects with schizophrenia spectrum disorders (SSD) as well as associations with symptoms, medication and medication side-effects. In a large and well-characterized sample of SSD subjects we explored the association between caffeine consumption and clinical (psychosis related, severity, general health) as well as pharmacological (antipsychotic treatment, sedation potential) variables. Eight hundred four subjects with data on their caffeine (coffee and tea) consumption successively recruited were included in this study. After controlling for potential confounders (demographic variables, smoking) only the negative dimension of psychosis was associated with the amount of caffeine ingested. Less severe negative symptoms were associated with higher caffeine consumption. The effect size of this association was small (partial correlation coefficient = −0.12) but significant.

Background Tobacco use is common in subjects with schizophrenia (SZ) and has sometimes been associated with better functioning in short-term studies. Only few studies embrace an extensive examination of tobacco influence on clinical, cognitive and therapeutic characteristics in stabilized SZ outpatients. The objective of the present study was to assess the association between cognitive performances and smoking status in SZ subjects. Methods In total, 1233 SZ participants (73.9% men, mean age 31.5) were included and tested with a comprehensive battery. Tobacco status was self-declared (never-, ex-, or current smokers). Multivariable analyses including principal component analyses (PCA) were used. Results In total, 53.7% were smokers with 33.7% of them nicotine-dependent. Multiple factor analysis revealed that current tobacco smoking was associated with impaired general intellectual ability and abstract reasoning (aOR 0.60, 95% IC 0.41–0.88, p = 0.01) and with a lifetime alcohol use disorder (p = 0.026) and a lifetime cannabis use disorder (p < 0.001). Ex- and never-smokers differed for age, mean outcome, cannabis history and medication [ex-smokers being older (p = 0.047), likely to have higher income (p = 0.026), a lifetime cannabis use disorder (p < 0.001) and higher CPZeq doses (p = 0.005)]. Premorbid IQ in the three groups significantly differed with, from higher to lower: ex-smokers, never-smoker, current smokers (all p < 0.001). Conclusions This study is the largest to date providing strong evidence that chronic smoking is associated with cognitive impairment in SZ, arguing against the self-medication hypothesis as a contributor to the high prevalence of smoking in SZ. Ex-smokers may also represent a specific subgroup. Longitudinal studies are warranted to determine the developmental impact of tobacco on neurocognition.

The current literature has largely highlighted a deficit of effort-based decision-making for reward in schizophrenia. However, not all studies have dissociated effort from reward, while other studies emphasize that difficulty is the main determinant of effort rather than reward. In this study, 33 individuals with schizophrenia and 32 healthy controls were recruited to perform a decision-making isometric force task. According to motivational intensity theory, task difficulty (i.e., required force) but not reward was manipulated from easy to impossible. Accuracy between force exerted and force required, and choice to perform a task or not were our effort measures. Clinical variables including depression, defeatist beliefs, and apathy were assessed. Our results demonstrated that the schizophrenia group chose to perform easy, moderate, and difficult tasks and exerted the necessary effort to succeed similarly to the non-clinical group. No association between effort and clinical variables was found. Our findings provide new understandings related to effort mechanisms in schizophrenia.

This work was funding by local grant (Clinical research funding from CHU Montpellier), CNRS RHIAPS Project and DGA (Direction Générale des Armées).; International audience; The goal of this study was to analyze the interpersonal coordination of patients suffering from schizophrenia (SZ) using a humanoid robot NAO. NAO was controlled by a neurally-inspired model that enables motions synchronization between robot and human. Using a robot has the advantage in that it can be modified and controlled without being influenced by the human with whom they are interacting. More specifically, we were interested in non-intentional interpersonal coordination which has been found in previous studies to be preserved for SZ. We performed an experiment in which we asked patients and control participants to jointly perform fitness movements with the robot which was programmed to either synchronize with the human (a bidirectional condition) or move at a fixed frequency with them (a unidirectional condition). We showed that non-intentional interpersonal coordination was preserved for SZ during Human/Robot interaction (as for human/human interaction). Also, the best synchronization, stability and the best performance in term of speed were obtained with the bidirectional condition. Our results showed that, in this specific context of an interaction at preferential frequency of subject, there were only a few differences between SZ and controls in terms of interpersonal synchronization skills. Nevertheless, we observed more variability for SZ which could partly be explained by the weaker intrapersonal coordination that they exhibited.

International audience; Recent evidence suggests that people with schizophrenia are at high risk for severe COVID-19 and should be prioritized for vaccination. However, impaired decision-making capacities could negatively affect the uptake of COVID-19 vaccination in this population. Capacity to consent to COVID-19 vaccination was assessed in 80 outpatients with schizophrenia. Using the MacArthur Competence Assessment Tool for Treatment, 56.3% of the sample were classified as having diminished capacity to consent to the vaccination. Diminished capacity to consent to COVID-19 vaccination was associated with lower vaccination rates, poorer cognition and higher level of psychotic symptoms. Developing interventions for enhancing informed consent for vaccination is urgent within this population.

Schizophrenia is associated with early neurodevelopmental disorders, including most frequently learning disorders (LD), among them dyslexia and dyspraxia. Despite the demonstrated links between schizophrenia and LD, specific clinical patterns of the schizophrenia with a history of LD subgroup remain unknown. The aim of the present study was to investigate cognitive impairment, symptoms and functional outcome associated with a history of LD in a large cross-sectional, multicentric, sample of schizophrenia subjects. 492 community-dwelling subjects with schizophrenia (75.6% male, mean age 30.8 years) were consecutively included in the network of the FondaMental Expert Centers for Schizophrenia in France and received a thorough clinical assessment. The 51 (10.4%) subjects identified with a history of LD had significantly impaired general cognitive ability (Wechsler Adult Intelligence Scale Full Scale Total IQ: Cohen's d = 0.50, p = 0.001), processing speed (d = 0.19), verbal comprehension (d = 0.29), working memory (d = 0.31), cognitive inhibition and flexibility (d = 0.26), central executive functioning (d = 0.26), phonemic verbal fluency (d = 0.22) and premorbid intellectual ability (d = 0.48), as well as with a worse functional outcome (Global Assessment of Functioning, d = 0.21), independently of age, sex, education level, symptoms, treatments, and addiction comorbidities. These results indicate that a history of LD is associated with later cognitive impairment and functional outcome in schizophrenia. This suggests that history of LD is a relevant clinical marker to discriminate subgroups of patients with schizophrenia with different profiles in a precision psychiatry framework.

Avolition defined as a lack of interest or engagement in goal-directed behavior plays a key role in everyday functioning in schizophrenia and is considered as one of the main contributors to the burden of disease. The aim of this study was to 1) validate the self-report BIRT Motivation Questionnaire (BMQ-S) seldom used before in schizophrenia 2) examine the degree of agreement between the BMQ-S and its informant-report version 3) to assess its ability to predict real-world outcome at 12 month follow-up.One hundred and twenty-two (51.9% inpatients) adults with a diagnosis of schizophrenia were included. Exploratory Factor analysis was performed on the BMQ-S to identify the underlying structure. Real life functioning was measured with the Global Assessment of Functioning scale (GAF). Convergent validity was assessed with the Scale for Assessment of Negative Symptom (SANS) and the Lille Apathy Rating Scale (LARS).The main psychometric properties of the BMQ-S (internal consistency, test-retest reliability) were satisfactory. Exploratory factorial analysis revealed a 4-factor model which explained 76% of the overall variance. The BMQ-S correlated significantly with the LARS and the SANS avolition subscore suggesting adequate convergent validity. The correlation between the BMQ-S and the clinician-report version was 0.48. The global score and in particular the Initiation/disorganisation dimension was a significant predictor of global functioning at 12-months even when adjusted for age, chlorpromazine intake and depression.Our findings indicate that the BMQ-S has satisfactory psychometric properties and that schizophrenia patients can reliably assess their lack of motivation. Self-evaluation of avolition should be considered in the overall prediction of real-world functioning in schizophrenia.

Background:Assessing an individual’s capacity to consent to treatment is a complex and challenging task for psychiatrists and health-care professionals. Diminished capacity to consent to pharmacological treatment is a common concern in individuals with schizophrenia. The MacArthur Competence Assessment Tool for Treatment (MacCAT-T) is the most common tool used in individuals with schizophrenia to evaluate the decision-making abilities for judgments about competence to consent to treatment. This instrument assesses patients’ competence to make treatment decisions by examining their capacities in 4 areas: understanding information relevant to their condition and the recommended treatment, reasoning about the potential risks and benefits of their choices, appreciating the nature of their situation and the consequences of their choices, and expressing a choice. Despite its importance, there is no French version of this scale. Furthermore, its factor structure has never been explored, although validated measures are strongly needed to further detect deficits in patients’ decision-making abilities. The goal of this study was thus to empirically validate a French version of the MacCAT-T in a French sample of individuals with schizophrenia.Method:In this cross-sectional study, we included 125 inpatients with a diagnosis of schizophrenia from the University Department of Adult Psychiatry in Montpellier. The MacCAT-T was administered to patients by a trained psychologist. Patients were also assessed for severity of symptoms, insight into illness, and depressive and anxiety symptoms. Inter-rater reliability and psychometric properties including internal consistency, construct validity, and discriminant and divergent validity were also investigated.Results:The MacCAT-T’s internal consistency was high (Cronbach α of 0.91). A high degree of inter-rater reliability was found for all the areas of the MacCAT-T (intraclass correlation coefficient range, 0.92 to 0.98). Exploratory factor analysis revealed a 2-factor model. The factor analysis explained 50.03% of the total score variation. Component 1 included all subparts of “understanding.” Component 2 included all subparts of “appreciation” and “reasoning” and was therefore labeled “reflexivity.” After Bonferroni corrections, decision-making capacity was positively associated with insight and the severity of psychotic symptoms but not with sociodemographic variables except for education.Conclusions:The MacCAT-T demonstrated a high degree of inter-rater reliability and strong psychometric properties. The French version of the MacCAT-T is a valid instrument to assess the decision-making capacity to consent to treatment in a French sample of individuals with schizophrenia.

BackgroundThe determinants of quality of life (QoL) in schizophrenia are largely debated, mainly due to methodological discrepancies and divergence about the concepts concerned. As most studies have investigated bi- or tri-variate models, a multivariate model accounting for simultaneous potential mediations is necessary to have a comprehensive view of the determinants of QOL. We sought to estimate the associations between cognitive reserve, cognition, functioning, insight, depression, schizophrenic symptoms, and QoL in schizophrenia and their potential mediation relationships.MethodsWe used structural equation modeling with mediation analyses to test a model based on existing literature in a sample of 776 patients with schizophrenia from the FondaMental Foundation FACE-SZ cohort.ResultsOur model showed a good fit to the data. We found better functioning to be positively associated with a better QoL, whereas better cognition, better insight, higher levels of depression, and schizophrenic symptoms were associated with a lower QoL in our sample. Cognitive reserve is not directly linked to QoL, but indirectly in a negative manner via cognition. We confirm the negative relationship between cognition and subjective QoL which was previously evidenced by other studies; moreover, this relationship seems to be robust as it survived in our multivariate model. It was not explained by insight as some suggested, thus the mechanism at stake remains to be explained.ConclusionThe pathways to subjective QoL in schizophrenia are complex and the determinants largely influence each other. Longitudinal studies are warranted to confirm these cross-sectional findings.

International audience; Background: In people with schizophrenia, major areas of everyday life are impaired, including independent living, productive activities, social relationships and overall quality of life. Enhanced understanding of factors that hinder real-life functioning is vital for treatments to translate into more positive outcomes.Aim: The goal of the present study was to identify factors associated with motivation deficits in real-life schizophrenia, and to assess its contribution to impaired functioning and quality of life.Methods: Based on previous literature and clinical experience, several factors were selected and grouped into factors potentially explaining motivation deficits. Some of these variables were never investigated before in relationship with motivation deficits.Results: In 561 patients with schizophrenia of the national FACE-SZ cohort living in the community, 235(41.9%) reported severe motivation deficits. These deficits were found to be significantly associated with impaired socially useful activities, psychological and physical quality of life (in almost all domains), alcohol use disorder (aOR =2.141, p = 0.021), severe nicotine dependence (aOR =2.906, p < 0.001) independently of age and sex. No significant association was found for body mass index, metabolic syndrome or physical activity level. In the second model, we identified the following modifiable factors associated with motivation deficits: history of suicide attempt (aOR =2.297, p = 0.001), positive symptoms (aOR =1.052, p = 0.006), current major depressive episode (aOR =2.627, p < 0.001), sleep disorders (aOR =1.474, p = 0.024) and lower medication adherence (aOR =0.836, p = 0.001) independently of gender, current alcohol use disorder, second-generation antipsychotics and akathisia. No significant association was found for negative symptoms, childhood trauma and inflammation. These results were maintained after removing patients with schizoaffective disorders or those with major depressive disorder.Interpretation: Motivation deficits are frequent and remain persistent unmet need in real-world schizophrenia that should be addressed in future guidelines. Based on our results, literature and clinical experience, we recommend to address in priority major depression, sleep, suicide, positive symptoms (when present and as early as possible) and medication adherence to improve motivation deficits of schizophrenia.

International audience; Background: Peripheral inflammation is associated with impaired prognosis in schizophrenia (SZ). Highly sensitive C-reactive protein (hs-CRP) is the most used inflammatory biomarker in daily practice. However, no consensual cut-off has been determined to date to discriminate patients with peripheral inflammation from those without.Aims: To determine if patients with peripheral inflammation between 1 and 3 mg/L had poorer outcomes compared to those with undetectable CRP ( 1 mg/L is a reliable marker to detect peripheral inflammation in patients with schizophrenia.

High rates of non-right-handedness (NRH) including mixed-handedness have been reported in neurodevelopmental disorders. In schizophrenia (SZ), atypical handedness has been inconsistently related to impaired features. We aimed to determine whether SZ subjects with NRH and mixed-handedness had poorer clinical and cognitive outcomes compared to their counterparts.667 participants were tested with a battery of neuropsychological tests, and assessed for laterality using the Edinburg Handedness Inventory. Clinical symptomatology was assessed. Learning disorders and obstetrical complications were recorded. Biological parameters were explored.The prevalence of NRH and mixed-handedness was high (respectively, 42.4% and 34.1%). In the multivariable analyses, NRH was associated with cannabis use disorder (Non-right and mixed-handedness are very high in patients with SZ, possibly reflecting a neurodevelopmental origin. NRH is associated with learning disorders and cannabis use. Mixed-handedness is associated with positive symptoms, current depressive disorder, cannabis use and less akathisia. However, this study did not confirm greater cognitive impairment in these patients.

Severe impairment of social functioning is the core feature of schizophrenia that persists despite treatment, and contributes to chronic functional disability. Abnormal non-verbal behaviors have been reported during interpersonal interactions but the temporal coordination of co-speech gestures with language abilities have been poorly studied to date in this pathology. Using the dynamical systems framework, the goal of the current study was to investigate whether gestures and speech synchrony is impaired in schizophrenia, exploring a new approach to report communicational skill disorders. Performing the first continuous kinematic-acoustic analysis in individuals with schizophrenia, we examined gesture-speech synchrony in solo spontaneous speech and in sensorimotor synchronization task. The experimental group consisted of twenty-eight participants with a diagnosis of schizophrenia and the control group consisted of twenty-four healthy participants age-gender-education matched. The results showed that spontaneous gesture-speech synchrony was preserved while intentional finger tapping-speech synchrony was impaired. In sensorimotor synchronization task, the schizophrenia group displayed greater asynchronies between finger tapping and syllable uttering and lower stability of coordination patterns. These findings suggest a specific deficit in time delay of information circulation and processing, especially in explicit functions. Thus, investigating intrapersonal coordination in schizophrenia may constitute a promising window into brain/behavior dynamic relationship.

Background Obsessive-compulsive disorder (OCD) has long been considered as an anxiety disorder, disgust is the dominant emotion in contamination-based OCD. However, disgust seems resistant to exposure with response prevention partly due to the fact that disgust is acquired through evaluative conditioning. Aims The present research investigates a counter-conditioning intervention in treating disgust-related emotional responses in two groups of individuals with high (High contamination concerns, HCC, n = 24) and low (Low contamination concerns LCC, n = 23) contamination concerns. Methods The two groups completed a differential associative learning task in which neutral images were followed by disgusting images (conditioned stimulus; CS+), or not (CS-). Following this acquisition phase, there was a counter-conditioning procedure in which CS+ was followed by a very pleasant unconditional stimulus while CS- remained unreinforced. Results Following counter-conditioning, both groups reported significant reduction in their expectancy of US occurrence and reported less disgust with CS+. For both expectancy and disgust, reduction was lower in the HCC group than in the LCC group. Disgust sensitivity was highly correlated with both acquisition and maintenance of the response acquired, while US expectation was predicted by anxiety. Conclusion Counter-conditioning procedure reduces both expectations and conditioned disgust.

BackgroundCognitive impairments are extremely common in schizophrenia and strongly predict deficits in daily functioning, poor management of medication, and multiple hospitalizations. Cognitive remediation is recognized to have a positive impact on cognitive impairments by engaging preserved cognitive functions or by implementing environmental supports that sustain independent living.Velligan et al. [1] developed and tested a manualized intervention, called Cognitive Adaptation Training (CAT). In this program, trained mental health specialists implemented compensatory techniques such as environmental supports in the individual’s living environment in order to live more independently and achieve greater self-sufficiency.However, implementing this program requires a lot of professionals and time to maintain CAT effect. This type of intervention is not widely available in community care which may explain the large number of patients who are dependent on family members for daily living activities. Training family members in this form of intervention would be an appropriate way to resolve these issues. Family expressed a real interest in these types of home-support strategies that CAT offers. Recently, Kidd et al. [2] developed a CAT version for Families and created a manual accessible to people without any knowledge of cognitive deficits. This manual helps families to select specific cognitive-adaptative strategies with their relative to achieve targeted goals. This method has been translated in French.The aim of this study is to examine whether Web-based Family Cognitive Adaptation Training can improve functioning, medication adherence and negative symptoms for individuals with schizophrenia as well as reduce burden for the family members.Methods/DesignA total of 60 Dyads consisting of one caregiver and one supported individual with schizophrenia will be randomized to either Web-based family cognitive adaptation training or an internet-based control condition (psycho-education). The primary outcome measure will be the total score on the life skills profile. Secondary outcome measures will include the global score of the Zarit burden Interview, the PANSS negative score, the CAINS score, patient medication adherence, and patient and caregiver quality of life.DiscussionWe hope that this type of intervention could be developed in territorial areas where professionals are not trained to cognitive remediation and therefore substantially lower the barrier to the deployment of cognitive interventions with other psychosocial interventions for individuals with schizophrenia and their caregivers.Trial registration: ClinicalTrials.gov Identifier: NCT04173598. Registered on November 22th 2019

The interest in social cognition in schizophrenia is justified by the relationship between deficits in these skills and negative functional outcomes. Although assessment batteries have already been described, there is no consensus about which measures are useful in predicting patient functioning or quality of life (QoL). We investigated a set of five measures of recognition of facial emotions, theory of mind (ToM), and empathy in a cohort of 143 patients with schizophrenia or schizoaffective disorder at inclusion and, amongst whom 79 were reassessed 1 year later. The distribution was satisfactory for the TREF (Facial Emotion Recognition Task), V-SIR (Versailles-Situational Intention Reading), and QCAE (Questionnaire of Cognitive and Affective Empathy). Internal consistency was satisfactory for the TREF, V-SIR, V-Comics (Versailles Intention Attribution Task), and QCAE. Sensitivity to change was acceptable for the TREF. The TREF and V-SIR showed a cross-sectional relationship with functioning beyond the clinical symptoms of schizophrenia but not beyond neurocognition. Moreover, the TREF and V-SIR at inclusion could not predict functioning one year later, whereas most neurocognitive and clinical dimensions at inclusion could. Finally, only affective QCAE showed a significant cross-sectional, but not longitudinal, association with QoL. In conclusion, the TREF had satisfactory psychometric properties and showed a cross-sectional, but not longitudinal, association with objective outcome measures, thus appearing to be reliable in clinical practice and research. The V-SIR also showed promising psychometric properties, despite a possible weakness to detect change. However, these measures should be interpreted within the context of the good predictive power of the neurocognitive and clinical status on the outcome.

Grandiose delusions (GDs) are defined as false beliefs about having an inflated worth, power, or a special identity which are firmly sustained despite undeniable evidence to the contrary. Although it is the second most commonly encountered delusional beliefs, GDs have received little attention. Thus, in this study, we explored the role of future expectations and sensitivity to reward in GDs in schizophrenia (SZ) disorder. In total, 115 SZ patients completed measures of positive and negative symptoms, sensitivity to reward, depression, and a task in which individuals were asked to estimate the probability that positive, negative and neutral events will occur in the future. Correlation and Linear Regression analyses were performed in order to determine whether sensitivity to reward and future expectations are associated with GDs. Regressions showed that hallucinations and future positive expectations were significantly associated with GDs. In conclusion, the present study showed that higher optimism regarding the future might be important psychological processes associated with the maintenance of GDs in SZ patients. Moreover, it is possible that patients experiencing hallucinations may interpret this phenomenon as a kind of special ability or power, resulting in turn in GDs maintenance. Implications of these findings and directions for future research are discussed.

Purpose Beyond the effects of the coronavirus pandemic on the public's health, the length of lockdown and its possible psychological impacts on populations is heavily debated. However, the consequences of lockdown on psychotic symptoms have been poorly investigated. Methods An online survey was run from April 13 to May 11, 2020; a total of 728 French subjects from the general population were included in the study. We assessed the perceived impact of the COVID-19 outbreak, length of isolation, diagnosis/symptoms/hospitalisation related to the COVID-19 (oneself and family). Paranoid ideations and hallucination-like experiences were assessed via the Paranoia Scale and the Cardiff Anomalous Perceptions Scale, respectively. Self-reported measures of negative affect, loneliness, sleep difficulties, jumping to conclusion bias, repetitive thoughts, among others, were also included. Results Final regression model for paranoia indicated that socio-demographic variables (age, sex and education), loneliness, cognitive bias, anxiety, experiential avoidance, repetitive thoughts and hallucinations were associated with paranoia (R2 = 0.43). For hallucinations, clinical variables as well as the quality of sleep, behavioural activation, repetitive thoughts, anxiety and paranoia were associated with hallucinations in our sample (R2 = 0.27). Neither length of isolation nor the perceived impact of the COVID-19 pandemic were associated with psychotic experiences in the final models. Conclusions No evidence was found for the impact of isolation on psychotic symptoms in the general population in France one month after the lockdown. It nevertheless confirms the preeminent role of several factors previously described in the maintenance and development of psychotic symptoms in the context of a pandemic and lockdown measures.

International audience; Introduction: Deficits in theory of mind (ToM) can vary depending on the predominant schizophrenia symptoms, and though most neurocognitive functions are involved in ToM, all may not be associated with the same symptoms. With consideration to the relationships between symptoms, neurocognition and ToM, the aim of the present study is to identify the neurocognitive functions influencing ToM capacities according to symptomatic profile. Methods: The study is based on a sample of 124 adults with schizophrenia from a French national cohort. Patients were divided into two groups according to their scores on the five Wallwork factors of the Positive and Negative Syndrome Scale using hierarchical clustering before carrying out multivariable analyses. Results: The “disorganised group” (n = 89) showed high scores on the disorganised factor, and had a ToM associated with reasoning, visual recognition and speed of processing. The “positive group” (n = 35) showed high scores on the positive and depressive factors, and had a ToM associated with working memory. Conclusions: These results suggest that neurocognitive predictors of ToM in schizophrenia are different according to the predominant clinical dimension, thus refining our knowledge of the relationship between symptoms, neurocognition and ToM, and acknowledging their status as important predictors of patients’ functional status. © 2021 Informa UK Limited, trading as Taylor & Francis Group.

Background: Sleep disorders associated factors are under explored in schizophrenia while the literature suggests high and heterogeneous frequency. Aims: The objective of the present study was to determine the prevalence and risk factors of sleep disorders in the real-world FACE-SZ national cohort. Method: Stabilized schizophrenic outpatients were recruited in 10 expert centers for schizophrenia. Sleep quality was explored with the Pittsburgh Sleep Quality Index (PSQI) and sleep disorders was defined by a PSQI score > 5. Psychosis severity was measured with the Positive and Negative Syndrome Scale, current major depressive episode with the Calgary Depression Scale for Schizophrenia, verbal aggressiveness with the Buss-Perry Aggression Questionnaire, adherence to treatment with the Medication Adherence Rating Scale, akathisia with the Barnes Akathisia Scale. Current somatic comorbidities and body mass index were reported. Variables with P values

Treatment-resistant schizophrenia (TRS) affects around 30% of patients with schizophrenia (SZ) resulting in poor functioning, relapses, and reduced quality of life. Convergent findings show that inflammation could contribute to resistance. We thus search for immune signatures of patients with TRS/ultra TRS (UTRS) in a sample of community-dwelling outpatients with SZ. In total, 195 stabilized SZ patients (mean age = 31.2 years, 73% male gender) were consecutively included in the network of the FondaMental Expert Centers for Schizophrenia in France and received a thorough clinical assessment. At inclusion, psychotic symptomatology was evaluated by the Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Circulating serum/plasma levels of a large panel of markers reflecting the main inflammatory pathways were evaluated. TRS was defined by current treatment by clozapine (CLZ) and UTRS by current CLZ treatment + PANSS total score ≥ 70. The frequency of TRS and UTRS patients was, respectively, 20% and 7.7% and was defined using multivariable analysis elevated by high levels of interleukin (IL)-12/IL-23p40, IL-17A, IL-10, and beta 2 microglobulin (B2M) and IL-12/IL-23p40, IL-17A, IL-6, IL-10, IFNγ, and B2M, respectively. These observations suggest that resistance and ultra resistance to CLZ treatment are underpinned by pro-inflammatory molecules mainly belonging to the T helper 17 pathway, a finding making sense given the interplay between inflammation and antipsychotic treatment responses. If confirmed, our findings may allow us to consider IL-23/IL-17 pathway as a therapeutic target for patients with resistance to antipsychotics.

Background Fatigue is a well-known common clinical feature of numerous chronic diseases including various forms of cancer, neurological disorders such as multiple sclerosis, and psychiatric disorders. A significant proportion of people with schizophrenia (30–60%) reportedly experience fatigue, which impacts negatively on participation in various activities, including work, study, leisure, and social pursuits. Causes of fatigue in schizophrenia are poorly understood and there are no established treatments. Several evidence-based interventions for fatigue syndrome including psychoeducation, cognitive behavioral therapy, and graded exercise therapy have been shown to be effective in other medical conditions and could be adapted to address fatigue in schizophrenia patients. As there are no psychosocial or pharmacological interventions with proved efficacy for fatigue in schizophrenia, there is an urgent need for the development of strategies to improve fatigue management in schizophrenia. The aim of this project is to evaluate in a single blind randomized clinical trial the efficacy of a cognitive-behavioral therapy (CBT) intervention compared to treatment as usual (TAU) on fatigue as the main outcome in schizophrenia patients. Clinical symptoms, physical functioning, major cognitive functions, quality of life and functioning, treatment dosage, daily motor activity, biological markers with inflammatory markers are also considered as secondary outcomes. Methods/design Two hundred patients meeting the inclusion criteria will be randomized to either of the study arms (intervention or TAU). The ENERGY intervention will be delivered according to a standardized treatment manual comprising six modules addressing fatigue and sleep over 14 individual therapy sessions. The treatment encompasses core CBT principles of psycho-education, behavioral activation, behavioral experiments, cognitive restructuring, problem-solving, and relapse prevention. Sessions will follow the traditional CBT structure of agenda setting, review of homework tasks, and introduction of a new concept/technique with collaborative discussions on how to implement such strategies in the participant’s day-to-day environment. Our primary endpoint will be the severity of fatigue assessed at baseline and at the 9-month follow-up using the “Multidimensional Fatigue Inventory” (MFI). Discussion The trial will provide the first test of CBT intervention for fatigue for patients with schizophrenia. This study will also test to what extent the treatment can be implemented in everyday practice. Trial registration ClinicalTrials.govNCT04332601. Registered on 10 April 2020.

Acyl coenzyme A binding protein (ACBP), also known as diazepam binding inhibitor (DBI) is a multifunctional protein with an intracellular action (as ACBP), as well as with an extracellular role (as DBI). The plasma levels of soluble ACBP/DBI are elevated in human obesity and reduced in anorexia nervosa. Accumulating evidence indicates that genetic or antibody-mediated neutralization of ACBP/DBI has anorexigenic effects, thus inhibiting food intake and inducing lipo-catabolic reactions in mice. A number of anorexiants have been withdrawn from clinical development because of their side effects including an increase in depression and suicide. For this reason, we investigated the psychiatric impact of ACBP/DBI in mouse models and patient cohorts. Intravenously (i.v.) injected ACBP/DBI protein conserved its orexigenic function when the protein was mutated to abolish acyl coenzyme A binding, but lost its appetite-stimulatory effect in mice bearing a mutation in the γ2 subunit of the γ-aminobutyric acid (GABA) A receptor (GABAAR). ACBP/DBI neutralization by intraperitoneal (i.p.) injection of a specific mAb blunted excessive food intake in starved and leptin-deficient mice, but not in ghrelin-treated animals. Neither i.v. nor i.p. injected anti-ACBP/DBI antibody affected the behavior of mice in the dark–light box and open-field test. In contrast, ACBP/DBI increased immobility in the forced swim test, while anti-ACBP/DBI antibody counteracted this sign of depression. In patients diagnosed with therapy-resistant bipolar disorder or schizophrenia, ACBP/DBI similarly correlated with body mass index (BMI), not with the psychiatric diagnosis. Patients with high levels of ACBP/DBI were at risk of dyslipidemia and this effect was independent from BMI, as indicated by multivariate analysis. In summary, it appears that ACBP/DBI neutralization has no negative impact on mood and that human depression is not associated with alterations in ACBP/DBI concentrations.

Introduction: To explain motivational difficulties in schizophrenia (SZ), attention has focused on the reward system and effort-based decision-making deficits. However, according to motivational in...

International audience; Objective: Apathy, defined as reduced goal-directed behavior, is a frequent symptom in mental and neurological disorders but has been poorly studied in individuals with obsessive-compulsive disorder (OCD). The primary aim of this study was to examine levels of apathy between individuals with OCD, healthy control subjects, and individuals with schizophrenia, a mental disorder with high levels of apathy. The second aim was to assess whether the psychological factors that have been previously shown as underlying apathy in other mental disorders were associated with apathy in patients with OCD.Methods: This exploratory study included 25 individuals with OCD, 24 individuals with schizophrenia, and 24 healthy control subjects. Apathy was assessed using the Lille Apathy Rating Scale. Measures of depression, sensibility to punishment and reward, defeatist performance beliefs, and cognitive functioning were also assessed.Results: Individuals diagnosed with OCD and schizophrenia scored significantly higher than healthy control subjects on the apathy total score. Levels of apathy among OCD patients were mainly associated with depression but also dysexecutive functioning and defeatist beliefs.Conclusions: These findings suggest that motivational deficits could play a central role in disability caused by OCD. Similar to other mental disorders, various psychological factors, including depression, defeatist beliefs, and dysexecutive functioning, are involved in apathetic manifestations. However, the fact that depression is the variable most associated with apathy indicates that apathetic symptoms in patients with OCD must be considered mainly as secondary rather than primary symptoms.