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Despite national and international recommendations and while there is no evidence for increased efficacy of higher doses, several studies suggested that the prescribed doses in routine practice are higher than the maximal recommended doses in 20–40% of schizophrenia patients worldwide. Methods: the aims of the present study were: (1) to describe the patterns of antipsychotic daily dose prescriptions in routine clinical practice in a large and representative cohort of French schizophrenia patients and, (2) to study the characteristics of patients receiving higher doses. Results: in all cases, regardless of the antipsychotic treatment used, the average dose was greater than 1.0 defined daily dose (DDDeq), which is the average recommended dose. For SGA, the mean DDDeq ranged from 1.2 for aripiprazole to 1.6 for olanzapine and clozapine, respectively. For a given patient, the mean ± S.D. total daily cumulative dose (TCD) of antipsychotic was 1.9 ± 2.4 DDDeq. A “high dose” was defined as a TCD ≥ 1.5 DDDeq, 789 (45.2%) patients received a “high dose”. Patients in the “high dose” group were more frequently suffering from a more severe paranoid schizophrenia, had more often a comorbid antisocial personality disorder and/or a substance use disorder. Conclusions: the present study suggests that in France, antipsychotic drugs doses prescribed by psychiatrists are higher, compared to other countries. All recommendations agree on the fact that the preferential dose should be the “minimum-effective” dose. Optimizing prescribing practices would be important to optimize the benefit/risk ratio and to minimize the risks side effects.

The COVID-19 pandemic brought challenges to governments, healthcare systems (including, mental healthcare services), clinicians and researchers in the EU and worldwide. A range of neurological (e.g., brain fog, encephalitis, myalgia) and psychiatric (e.g., affective disorders, delirium, cognitive disturbances) complications of a novel nature have been observed in patients during the acute phase of illness, which often persist as a Long-COVID state for months after the primary recovery. The pandemic has progressed to a psychodemic and syndemic, affecting communities with social distress, panic, fears, increased home violence, and protest movements that derive from conspiracy theories and hostile attitudes towards vaccination and lockdown measures. In response to this complex scenario of major social changes, universities must face the need to equip the new generation of doctors with novel special skills.The study course (50 hours duration; 20 lectures, three webinars, three e-discussion forums, five local seminars, two social events, three intermediate assessments and a final test for certification; bilingual Russian/English hybrid format, information materials, video-content, interactive web-page and social media) was developed by the team of the International Centre for Education and Research in Neuropsychiatry (ICERN), and is unique for the EU. The course integrates the most relevant data on SARS-Cov-2-related neuropsychiatry, and COVID-19' pandemic impact on mental health and society, including assignment of the vulnerable groups of students and healthcare professionals. The major topics covered during the course are (i) Novel virus, (ii) Brain, (iii) Society. The project takes place originally in Samara State Medical University. The ICERN Faculty includes academic staff from France, Hungary, Italy, Russia, Switzerland, invited speakers from the WHO Regional Office for Europe and World Psychiatric Association (EU Zones) members, some of them employed at ICERN by remote work contracts. The format of the educational process for students is hybrid suggesting both remote and face-to-face events. Distant learning participants and EU lecturers are to attend on-line via zoom platform, whereas local participants and staff work face-to-face in the ICERN video-conference room. The course is addressed to a broad audience of doctors, undergraduate and postgraduate students, and researchers from EU wishing to upgrade their knowledge in the pandemic-associated neuropsychiatry.The evaluation process supposes three intermediate assessments and a final test for certification. On-line assessment is to be performed at the project web-page - 10 randomly selected questions with scoring from 1 to 10 each. The Pass Score is 70-100. At the end of the course all the participants receive certificates of Samara State Medical University according to the ERASMUS policy book, as planned in 2021.We formatted this course as essential for the target audience to improve their resources of professional adaptability in the field of neuropsychiatry and mental healthcare management during challenging times. The ICERN course in pandemic-related neuropsychiatry is essential for early career health professionals and targets the principles of "academia without borders" in the context of international medical knowledge exchange. In the conditions of the changing social situation this educational content is necessary for the young doctors to acquire the add-on skills on flexibility to switch toward new professional approaches in the times of need. The long-term outcomes in pandemic-related neuropsychiatry are still to be seen, though the first feedback on the course content is already promising for the academic community.

Introduction: A significant increase in psychoactive drugs use was observed in women of childbearing age and during the perinatal period worldwide. Yet, the use of illicit drugs, alcohol and tobacco during pregnancy is a serious health risk for the mother, developing fetus and newborn. Methods: This review of current trends and consequences of psychoactive substance use in the general population and in pregnant women was conducted using the English and French literature published during the years 2000 to 2022, supplemented by guidelines, meta-analyses and reviews. Results: According to current rates of prenatal substances use, it was calculated that 380,000 offspring were exposed to illicit substances, more than 500,000 to alcohol and over one million to tobacco during uterine life. Alarmingly, drug-related pregnancy-associated mortality has shown a staggering 190% rise between 2010 and 2019 in the USA. Different drugs of abuse, when used during pregnancy, increase the risk of stillbirth, neonatal abstinence syndrome and sudden infant death. Adverse effects on pregnancy include premature rupture of membranes, placental abruption, preterm birth, low birth space? weight and small-for-gestational-age infants. There is also an increased risk of morbidity and mortality for the pregnant women. Long-term negative adverse effects of perinatal exposure to substances also include a number of neurocognitive, behavioral and emotional dysfunctions in infants. Each type of substance has its own specificities, which will be briefly summarized. Conclusion: All childbearing age women must be informed about the potential harm of the prenatal use of psychoactive substances and should be encouraged to stop their use when pregnancy is planned and, at least, when pregnancy is known. Questioning women about their alcohol consumption should be systematic at the first prenatal visit and then at every prenatal visit until delivery. Multidisciplinary prevention approaches as well as intervention measures targeted to each type of psychoactive substance can save mothers’ lives and mitigate serious adversities to the offspring.

Summary Objectives Patients who survive a suicide attempt present an increased risk of relapse during the three months after discharge from a hospital, referred to herein as the post-discharge period. Developing and assessing the efficacy and safety of methods that reduce the risk of relapse in the post-discharge period is critical for professionals in the field of suicide prevention. This study aimed to compare the efficacy of a new Intensive Psychosocial Care (IPC) program after discharge for a suicide attempt with a Standard Care Program (SCP) in non-hospitalized patients. Methods We conducted a open-label prospective trial to compare the outcome of patients who have attempted suicide for a duration of 6 months according to whether they were included in care program group IPC or SCP after discharge from the emergency department. Results Using the Beck Depression Inventory short-form (BDI-SF), the IPC program was significantly associated with both a decrease of the total score of the scale at 6th month, and a trend towards a decline in the time lag between discharge and the improvement of depressive symptoms. When compared to SCP, patients receiving the IPC had also a lower drop-out rate (43% versus 15% in the 6th month) and a higher adherence to treatment until the 3rd month (56% versus 41.7%). Median time to reattempt was 83.7 [95%CI: 45.8–121.7] days for IPC as compared to 75.6 [95%CI: 38.8–112.4] days for SCP, respectively. Conclusions Personalized follow-up with close contacts by the same caregivers as those who initially assessed the patient in the emergency room improved adherence to care and reduced depressive symptoms more intensely and faster after a suicide attempt.

Objectives: The primary aim of these guidelines is to evaluate the role of pharmacological agents in the treatment and management of patients with paraphilic disorders, with a focus on the treatment of adult males. Because such treatments are not delivered in isolation, the role of specific psychotherapeutic interventions is also briefly covered. These guidelines are intended for use in clinical practice by clinicians who diagnose and treat patients, including sexual offenders, with paraphilic disorders. The aim of these guidelines is to bring together different views on the appropriate treatment of paraphilic disorders from experts representing different countries in order to aid physicians in clinical decisions and to improve the quality of care. Methods: An extensive literature search was conducted using the English-language-literature indexed on MEDLINE/PubMed (1990−2018 for SSRIs) (1969−2018 for hormonal treatments), supplemented by other sources, including published reviews. Results: Each treatment recommendation was evaluated and discussed with respect to the strength of evidence for its efficacy, safety, tolerability, and feasibility. The type of medication used depends on the severity of the paraphilic disorder and the respective risk of behaviour endangering others. GnRH analogue treatment constitutes the most relevant treatment for patients with severe paraphilic disorders. Conclusions: An algorithm is proposed with different levels of treatment for different categories of paraphilic disorders accompanied by different risk levels.

Summary Introduction Crack cocaine use disorder (CCUD) is a major public health with a strong heritability component. Objectives This study was aimed to investigate the putative association between the dopamine transporter gene (DAT1/SLC6A3) and crack-cocaine use disorders (CCUD) as well as the possible involvement of attention-deficit hyperactivity disorder (ADHD), impulsivity and sensation-seeking. Methods Seventy-seven male subjects with CCUD were compared with 60 male control subjects of Afro-Caribbean origin. The Barratt Impulsivity Scale, the Wender Utah scale Scale-25 item and the Zuckerman Sensation-Seeking Scale were used. The subjects’ DNAs were genotyped by quantitative PCR (TaqMan method). Results We found an association with two SNPs (rs6347 and rs27048) of the DAT gene in crack-cocaine use disorder, and a significantly lower frequency of one of the three haplotype blocks of the DAT gene (AT haplotype, defined by the two previous SNPs) and CCUD. Conclusion DAT1 rs6347 and rs27048 polymorphisms seem to be associated with CCUD. The risk-effect of these polymorphisms appeared to be specific to individuals who are crack users rather than being driven by impulsivity or ADHD.

Forensic mental health experts play a crucial role in criminal responsibility evaluations. However, the quality of these assessments has at time come under scrutiny and has been heavily criticized. A literature review revealed significant differences between countries concerning legal frameworks and procedures for conducting these assessments. The findings suggest that although some countries can be seen as a "role model", there still is room for improvement.

Chemsex is an escalating public health issue among men who have sex with men, with potentially severe somatic and psychiatric consequences. Given the limited knowledge and lack of treatment recommendations available in this area, we proposed the use of noninvasive brain stimulation in order to reduce problematic chemsex behavior. This is the first open-label case report of a positive effect of transcranial direct current stimulation (tDCS) in a patient who was complaining of severe chemsex addiction. Total disappearance of chemsex behavior occurred after 5 days of daily sessions of right prefrontal cortex stimulation and did not return after 8 months of follow-up. The strengthening of dorsolateral prefrontal cortex activity may have modulated limbic pathways and reduced incentive salience and craving of both sexual addiction and concomitant illicit drug use. .El Chemsex es un problema de salud pública creciente entre los hombres homosexuales, con consecuencias somáticas y psiquiátricas potencialmente graves. Dados el conocimiento limitado y la falta de recomendaciones de tratamiento disponibles en esta área, propusimos el uso de estimulación cerebral no invasiva para reducir los comportamientos problemáticos relacionados con el chemsex. Este es el primer informe de caso clínico abierto que muestra un efecto positivo de la estimulación transcraneal de corriente directa (tDCS) en un paciente que se quejaba de una adicción grave al chemsex. La desaparición total de los comportamientos relacionados con el chemsex se produjo después de 5 días de sesiones diarias de estimulación de la corteza prefrontal derecha y no regresó después de 8 meses de seguimiento. El aumento de la actividad de la corteza prefrontal dorsolateral puede haber modulado las vías límbicas y reducido la prominencia del incentivo y los antojos asociados tanto con la adicción sexual como con el uso concurrente de drogas ilícitas.Le chemsex est un problème de santé publique croissant chez les hommes ayant des relations homosexuelles, aux conséquences somatiques et psychiatriques potentiellement graves. Compte tenu des connaissances limitées et du manque de recommandations de traitement disponibles dans ce domaine, nous avons proposé l'utilisation de stimulation cérébrale non invasive afin de réduire les comportements problématiques liés au chemsex. C'est le premier rapport de cas clinique ouvert montrant un effet positif du courant continu transcrânien stimulation (tDCS) chez un patient qui se plaignait d'une grave dépendance au chemsex. La disparition totale des comportements liés au chemsex est survenue après 5 jours de séances quotidiennes de stimulation du cortex préfrontal droit et n'est pas revenue après 8 mois de suivi. Le renforcement de l'activité du cortex préfrontal dorsolatéral peut avoir modulé les voies limbiques et réduit la saillance incitative et les état de manque liés tant à la dépendance sexuelle qu’à l’usage concomitant de drogues illicites.

Objectives: These practice guidelines for the treatment of alcohol use disorders during pregnancy were developed by members of the International Task Force of the World Federation of Societies of B...

Current mental health services across the world remain expert-centric and are based on traditional workflows, mostly using impractical and ineffective electronic record systems or even paper-based documentation. The international network for digital mental health (IDMHN) is comprised of top-level clinicians, regulatory and ICT experts, genetic scientists, and support organizations. The IDMHN has been formed to enable the implementation of digital innovations in clinical practice, hereby facilitating the transformation of current mental health services to be more personalized and more responsive to patients and healthcare needs. This consensus statement summarizes the consortium’s vision and strategy for further development of digital mental health.

International audience; No abstract available

The use of cannabis as a drug has undergone a remarkable change of direction: considered as a symbol of countercultures in past decades, it is presently being hailed as a cure for any number of diseases and conditions. Thus, despite concerns about the safety of cannabis and cannabinoids, quite a few drugs that contain cannabinoids have recently been approved by several drug agencies, and the medicinal and recreational use of cannabis has been legalized in various countries and states. The promise of cannabinoids for therapeutic use, as well as potentially detrimental health risks and regulatory issues, will need to be carefully weighed. .El consumo de cannabis como droga ha experimentado un notable cambio de dirección: considerado como un símbolo de las contraculturas en las últimas décadas, actualmente está siendo aclamado como cura para una serie de enfermedades y afecciones. Por lo tanto, a pesar de las preocupaciones sobre la seguridad del cannabis y de los cannabinoides, bastantes medicamentos que contienen cannabinoides han sido recientemente aprobados por varias agencias de edicamentos, y el uso medicinal y recreativo del cannabis se ha legalizado en varios países y estados. La promesa de los cannabinoides para uso terapéutico, así como los riesgos potencialmente perjudiciales para la salud y cuestiones reglamentarias, deberán ser cuidadosamente evaluados.L'usage du cannabis en tant que drogue a subi un changement d'orientation remarquable: considéré comme un symbole des contre-cultures au cours des dernières décennies, il est actuellement salué comme remède pour un certain nombre de maladies et pathologies. Ainsi, malgré les inquiétudes concernant la sécurité du cannabis et des cannabinoïdes, de nombreux médicaments contenant des cannabinoïdes ont récemment été approuvés par plusieurs agences de médicaments, et l'usage médicinal et récréatif du cannabis a été légalisé dans divers pays et états. La promesse des cannabinoïdes à usage thérapeutique, ainsi que des risques sanitaires potentiellement néfastes et les questions réglementaires devront être soigneusement pesées.

Objectives : Cocaine dependence has a strong heritability component. The aim of this study was to investigate the putative association between the serotonin 2B receptor gene (HTR2B), crack use disorders and impulsivity. Methods : A French Caribbean male population of patients with crack use disorders (n=80) w as compared to healthy male controls (n=60). Comorbid ADHD and impulsivity were assessed. Five Single Nucleotide Polymorphisms (SNPs) in the HTR2B gene on chromosome 2 were selected: rs643700, rs 6736017, rs1549339, rs17586428 and rs3806545 Thes e five SNPs were chosen to cover most of the linkage disequilibrium (LD) blocks in HTR2B. The French translation of the Baratt Impulsivity Scale BIS -11 was used to evaluate impulsivity. Comorbid ADHD was diagnosed using the Wender Utah Rating Scale-25 item for the Attention Deficit-Hyperactivity Disorder. Results : We have found a positive association between the rs6736017 polymorphism and crack use disorders in a French Afro-caribbean male population. Conclusion : The risk effect of HTR2B rs6736017 appeare d to be specific to individuals who are crack users rather than being driven by impulsivity alone or ADHD alone

The digital revolution has changed, and continues to change, our world and our lives. Currently, major aspects of our lives have moved online due to the coronavirus pandemic, and social distancing has necessitated virtual togetherness. In a synopsis of 10 articles we present ample evidence that the use of digital technology may influence human brains and behavior in both negative and positive ways. For instance, brain imaging techniques show concrete morphological alterations in early childhood and during adolescence that are associated with intensive digital media use. Technology use apparently affects brain functions, for example visual perception, language, and cognition. Extensive studies could not confirm common concerns that excessive screen time is linked to mental health problems, or the deterioration of well-being. Nevertheless, it is important to use digital technology consciously, creatively, and sensibly to improve personal and professional relationships. Digital technology has great potential for mental health assessment and treatment, and the improvement of personal mental performance. .La revolución digital ha cambiado y continúa cambiando nuestro mundo y nuestras vidas. Actualmente, los principales aspectos de nuestras vidas han migrado hacia el funcionamiento “online” debido a la pandemia del coronavirus, y el distanciamiento social ha requerido de cercanías virtuales. En una sinopsis de 10 artículos, se presenta una amplia evidencia de que el empleo de la tecnología digital puede influir en el cerebro y en el comportamiento humano de manera negativa y positiva. Por ejemplo, las técnicas de imágenes cerebrales muestran alteraciones morfológicas concretas en la primera infancia y durante la adolescencia, las cuales están asociadas con el empleo intenso de medios digitales. En apariencia, la utilización de la tecnología afecta las funciones cerebrales, como la percepción visual, el lenguaje y la cognición. Numerosos estudios no pudieron confirmar las preocupaciones comunes en cuanto a que el tiempo excesivo de pantalla esté relacionado con problemas de salud mental o el deterioro del bienestar. Sin embargo, es importante emplear la tecnología digital de manera consciente, creativa y sensata para mejorar las relaciones personales y profesionales. La tecnología digital tiene un gran potencial para la evaluación y el tratamiento de la salud mental, y el aumento del rendimiento mental personal.La révolution numérique a modifié et continue à modifier notre monde et nos vies. La pandémie actuelle due au coronavirus a fait basculer en ligne de nombreux pans de notre existence et la distanciation sociale a imposé la virtualité des rassemblements. Les données des dix articles présentés ici attestent de l’influence de la technologie numérique sur les cerveaux et les comportements, de manière positive et négative. Par exemple,l’imagerie cérébrale montre des altérations morphologiques concrètes apparaissant tôt dans l’enfance et pendant l’adolescence lors d’une pratique intensive des media numériques. Cela concernerait certaines fonctions cérébrales comme la perception visuelle, le langage et la cognition. Des études approfondies n’ont pas confirmé les inquiétudes courantes quant aux répercussions d’un temps excessif passé devant un écran en termes de santé mentale ou de qualité de vie. Il est néanmoins important de privilégier une utilisation consciente, créative et raisonnable des technologies numériques afin d’améliorer les relations personnelles et professionnelles. Ces technologies ont un grand potentiel dans l’évaluation et le traitement de la santé mentale ainsi que dans l’amélioration des performances mentales personnelles.

International audience; Les effets psychologiques de l’isolement ont déjà été décrits dans la littérature (expéditions polaires, sous-marins, prison). Néanmoins, l’échelle du confinement mis en œuvre à l’occasion de la pandémie à COVID-19 est inédite. Il nous faut non seulement relire les études publiées, mais aussi anticiper les problèmes psychologiques qui pourraient survenir pendant ou à distance du confinement. Nous avons fait le choix d’aller au-delà de la littérature COVID-19 pour examiner les implications des conséquences connues du confinement : l’ennui, l’isolement social, le stress, le manque de sommeil. L’anxiété, le trouble de stress post-traumatique, la dépression et les conduites suicidaires, les conduites addictives, les violences domestiques sont des effets décrits du confinement, mais les mécanismes d’émergence de ces troubles et leurs interrelations restent à étudier. Par exemple, quels sont les mécanismes d’émergence du trouble de stress post-traumatique dans le cadre du confinement ? Nous rappelons aussi les points de vigilance à garder sur des conséquences telles que les troubles des conduites alimentaires, les hallucinations, curieusement ignorées dans la littérature sur le confinement, alors qu’une vaste littérature fait le lien entre isolement social et hallucinations. Du fait de conséquences psychopathologiques larges, il nous faut partir à la recherche des différents symptômes pour permettre leur prise en charge. Nous résumons rapidement les approches diagnostiques et thérapeutiques déjà mises en place, comme la télémédecine, qui connaît un développement rapide à l’occasion de la crise du COVID-19.

These updated guidelines are based on a first edition of the World Federation of Societies of Biological Psychiatry Guidelines for Biological Treatment of Schizophrenia published in 2005. For this 2012 revision, all available publications pertaining to the biological treatment of schizophrenia were reviewed systematically to allow for an evidence-based update. These guidelines provide evidence-based practice recommendations that are clinically and scientifically meaningful and these guidelines are intended to be used by all physicians diagnosing and treating people suffering from schizophrenia. Based on the first version of these guidelines, a systematic review of the MEDLINE/PUBMED database and the Cochrane Library, in addition to data extraction from national treatment guidelines, has been performed for this update. The identified literature was evaluated with respect to the strength of evidence for its efficacy and then categorised into six levels of evidence (A-F; Bandelow et al. 2008b, World J Biol Psychiatry 9:242). This first part of the updated guidelines covers the general descriptions of antipsychotics and their side effects, the biological treatment of acute schizophrenia and the management of treatment-resistant schizophrenia.

The neurophysiological components that have been proposed as biomarkers or as endophenotypes for schizophrenia can be measured through electroencephalography (EEG) and magnetoencephalography (MEG), transcranial magnetic stimulation (TMS), polysomnography (PSG), registration of event-related potentials (ERPs), assessment of smooth pursuit eye movements (SPEM) and antisaccade paradigms. Most of them demonstrate deficits in schizophrenia, show at least moderate stability over time and do not depend on clinical status, which means that they fulfil the criteria as valid endophenotypes for genetic studies. Deficits in cortical inhibition and plasticity measured using non-invasive brain stimulation techniques seem promising markers of outcome and prognosis. However the utility of these markers as biomarkers for predicting conversion to psychosis, response to treatments, or for tracking disease progression needs to be further studied.

Schizophrenia is a severe mental disorder and many patients are treated in primary care settings. Apart from the pharmacological management of disease-associated symptoms, the detection and treatment of side effects is of the utmost importance in clinical practice. The purpose of this publication is to offer relevant evidence-based recommendations for the biological treatment of schizophrenia in primary care.This publication is a short and practice-oriented summary of Parts I-III of the World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia. The recommendations were developed by the authors and consented by a task force of international experts. Guideline recommendations are based on randomized-controlled trials and supplemented with non-randomized trials and meta-analyses where necessary.Antipsychotics of different chemical classes are the first-line pharmacological treatments for schizophrenia. Specific circumstances (e.g., suicidality, depression, substance dependence) may need additional treatment options. The pharmacological and non-pharmacological management of side effects is of crucial importance for the long-term treatment in all settings of the healthcare system.This summary of the three available evidence-based guidelines has the potential to support clinical decisions and can improve treatment of schizophrenia in primary care settings.

International audience; Purpose of review: We reviewed recent data on sexual addiction and its treatment. We examined the different definitions of this disorder, related to the pathophysiological mechanisms. We addressed the pharmacological treatment of sexual addiction.Recent findings: Hypersexual behavior can be considered an addictive disorder. Sexual addiction is accompanied by significant psychiatric and addictive comorbidities and is responsible for life impairment. A comprehensive and efficient treatment must be proposed. Selective serotonin reuptake inhibitors seem the first-line pharmacological treatment for sexual addiction. Naltrexone could be another therapeutic option. Summary: Psychotherapy and preferentially cognitive-behavioral therapy should be used in association with pharmacotherapy and treatments of comorbidities.Selective serotonin reuptake inhibitors seem the first-line pharmacological treatment for sexual addiction. Naltrexone could be another therapeutic option. Psychotherapy and preferentially cognitive-behavioral therapy should be used in association with pharmacotherapy and treatments of comorbidities.

International audience; no abstract

International audience; Many pregnant women, in the world, drink caffeine-containing beverages. Maternal caffeine consumption during pregnancy may have adverse effects on foetus but results are conflicting. Our goals were to estimate the prevalence of caffeine use in a cohort of French pregnant women using maternal self-reports and to evaluate the association between caffeine consumption during pregnancy and delivery and newborn characteristics. All pregnant women who gave birth in a large French urban area during a limited period of time were included (in total 724 mothers were included). Coffee, tea or cola consumption as well as pregnancy and neonate characteristics were analysed. The mean consumption of caffeine per day slightly decreased from the first to the third trimester of pregnancy: 587 caffeine users, with a consumption of caffeine of 59.2 ± 61.5 mg/day during the first trimester as compared to 577 consumers (54.3 ± 55.4 mg/day) during the third trimester, respectively. A significant decrease of neonates' birth length was observed when mothers were using at least 100 mg/day (or two cups) of caffeine during the second and third trimesters but this difference was no longer significant after adjustment on potential confounding factors such as tobacco use. The potential existence of other confounders (e.g. poorer dietary habits or other lifestyle variables) that might also be associated with reduced birth length, may not be excluded. Caffeine use during pregnancy was associated with reduced birth length but this effect was no longer significant after adjustment on potential confounding variables.

Reasons for using antipsychotic polypharmacy (APP) in routine clinical practice, despite a potentially unfavorable risk-benefit ratio, are poorly understood. This research aimed to determine (1) if severe courses of schizophrenia were associated with APP and (2) if a schizophrenia-related acute event would predict a switch to APP in the short term. Observational prospective data (at baseline and 6months) were drawn from a French nationwide cohort ("Cohorte Générale Schizophrénie"), which included 1859 inpatients and outpatients with schizophrenia. APP was defined as the prescription of ≥2 antipsychotic drugs (there being different active substances). Early-onset schizophrenia, legal guardianship, higher lifetime maximal severity of illness and comorbid antisocial personality were used as proxies for severe courses of schizophrenia. Schizophrenia-related acute events included hospitalization and recent suicide attempts. Logistic regression models were used to determine (1) whether the use of APP at baseline (vs. monotherapy) was associated with a severe course of schizophrenia or not, independent of acute events, and (2) if a switch to APP at 6months (vs. remaining on monotherapy) was associated with acute events, independent of severe courses of schizophrenia. Increased odds of APP use at baseline were independently associated with legal guardianship (OR=1.6; 95%CI=1.3, 2.0) and higher lifetime maximum severity of illness (OR=1.3; 95%CI=1.2, 1.5). A switch to APP at 6months was predicted by a hospitalization occurring since baseline (OR=6.1; 95%CI=3.9, 9.4). In routine clinical practice, APP is more likely prescribed to patients with severe courses of illness, possibly indicating the difficulty to manage these patients.

OBJECTIVES: Schizophrenia is a severe psychiatric disease affecting about 1% of the general population. The relative contribution of genetic factors has been estimated to be up to 80%. The mode of inheritance is complex, non-Mendelian, and in most cases involving the combined action of large numbers of genes.METHODS: This review summarises recent efforts to identify genetic variants associated with schizophrenia detected, e.g., through genome-wide association studies, studies on copy-number variants or next-generation sequencing.RESULTS: A large, new body of evidence on genetics of schizophrenia has accumulated over recent years. Many new robustly associated genetic loci have been detected. Furthermore, there is consensus that at least a dozen microdeletions and microduplications contribute to the disease. Genetic overlap between schizophrenia, other psychiatric disorders, and neurodevelopmental syndromes raised new questions regarding the current classification of psychiatric and neurodevelopmental diseases.CONCLUSIONS: Future studies will address especially the functional characterisation of genetic variants. This will hopefully open the doors to our understanding of the pathophysiology of schizophrenia and other related diseases. Complementary, integrated systems biology approaches to genomics, transcriptomics, proteomics and metabolomics may also play crucial roles in enabling a precision medicine approach to the treatment of individual patients.

The traditional categorical classification system and new diagnostic systems will be discussed in this issue. .Mettre la traduction ES.Mettre la traduction FR.

Europe is the heaviest drinking and smoking region in the world. Tobacco and alcohol use are gradually increasing in women with a close prevalence of tobacco and heavy alcohol use in girls and boys. Pharmacokinetics and pharmacodynamics differences, reward process specificities and female hormones play a major role in gender differences in addictive behaviors. Therefore, health consequences differ according to gender. Further research is needed on gender differences in addiction. Information, education on the impact of hazardous alcohol consumption and related harm as well as on the consequences of tobacco use is urgently required in girls and childbearing age women.

Central nervous system disorders are traditionally dichotomized between early-onset neurodevelopmental and late-onset neurodegenerative diseases. Yet, there are commonalities in the mechanisms operating in both neurodevelopmental and neurodegenerative diseases.

Tobacco and/or alcohol use during pregnancy is a major public health concern. The aim of our study was to identify risk factors associated to maternal alcohol and tobacco use assessed by maternal self-reports combined with biological measurements in meconium samples of cotinine and ethylglucuronide which reflect fetal exposure to tobacco and alcohol, respectively, during the 3rd trimester of pregnancy. We conducted a prospective study in three maternity hospitals in a large urban area during consecutive weeks (2010 and 2011). Maternal sociodemographic and clinical characteristics were assessed after delivery, using the French version of the Addiction Severity Index. Cotinine and ethylglucuronide were measured in meconium samples. Seven hundred and twenty-four women were included, and 645 meconium samples collected. Using multivariate analyses, we found that not being married or having a smoking partner predicts maternal tobacco use. In contrast, a decreased risk was associated with higher education level and wanted pregnancy. The risk for alcohol use increased when the mother had been in conflict with any relative or her partner for a long time throughout her life, as well as in case of previous treatment for any mental or emotional disorder. Using multivariate analyses and cotinine presence in meconium samples, the risks were similar except for marital status, which was not associated to cotinine presence. Community education and prevention programs should urgently be improved for all women of childbearing age with a special focus on those with past histories of mental or emotional disorders and addictive disorders. Smoking cessation should be recommended to both parents.

Recently, there has been a major shift in the field of psychiatry towards the exploration of complex relationships between blood-based biomarkers and the pathophysiology of psychiatric and neuropsychiatric disorders. However, issues with study reproducibility, validity and reliability have hindered progress towards the identification of clinically relevant biomarkers for psychiatry. The achievement of laboratory validity is a crucial first step for the posterior development of clinical validity. There is evidence that the variability observed in blood-based research studies may be minimised with the implementation of standardised pre-analytical methods and uniform clinical protocols (i.e., pre-venipuncture). It has been documented that errors made in the pre-analytical phase account for 46–68.2% of laboratory testing errors. Thus, standardising clinical assessment, ethical procedures and pre-analytical phase of clinical research is essential for the reproducibility, validity and reliability of blood marker assessment, and reducing the risk of invalid test results. Various other areas of research have already moved towards guidelines for the standardised collection of blood-based biomarkers. Here we aim to provide a set of guidelines that we believe would improve biomarker research: (1) pre-venipuncture information and documentation, (2) ethics of participant consent and (3) pre-analytical methods. Ultimately, we hope this will assist study planning and will improve data comparison across studies allowing for the discovery of biomarkers in psychiatry with both laboratorial and clinical validity.

Individuals learn by comparing the outcome of chosen and unchosen actions. A negative counterfactual value signal is generated when this comparison is unfavorable. This can happen in private as well as in social settings—where the foregone outcome results from the choice of another person. We hypothesized that, despite sharing similar features such as supporting learning, these two counterfactual signals might implicate distinct brain networks. We conducted a neuropsychological study on the role of private and social counterfactual value signals in risky decision-making. Patients with lesions in the ventromedial prefrontal cortex (vmPFC), lesion controls, and healthy controls repeatedly chose between lotteries. In private trials, participants could observe the outcomes of their choices and the outcomes of the unselected lotteries. In social trials, participants could also see the other player's choices and outcome. At the time of outcome, vmPFC patients were insensitive to private counterfactual value signals, whereas their responses to social comparison were similar to those of control participants. At the time of choice, intact vmPFC was necessary to integrate counterfactual signals in decisions, although amelioration was observed during the course of the task, possibly driven by social trials. We conclude that if the vmPFC is critical in processing private counterfactual signals and in integrating those signals in decision-making, then distinct brain areas might support the processing of social counterfactual signals.

These practice guidelines for the treatment of alcohol use disorders during pregnancy were developed by members of the International Task Force of the World Federation of Societies of Biological Psychiatry and the International Association for Women's Mental Health.We performed a systematic review of all available publications and extracted data from national and international guidelines. The Task Force evaluated the data with respect to the strength of evidence for the efficacy and safety of each medication.There is no safe level of alcohol use during pregnancy. Abstinence is recommended. Ideally, women should stop alcohol use when pregnancy is planned and, in any case, as soon as pregnancy is known. Detecting patterns of alcohol maternal drinking should be systematically conducted at first antenatal visit and throughout pregnancy. Brief interventions are recommended in the case of low or moderate risk of alcohol use. Low doses of benzodiazepines, for the shortest duration, may be used to prevent alcohol withdrawal symptoms when high and chronic alcohol intake is stopped and hospitalisation is recommended. Due to the low level of evidence and/or to low benefit/risk ratio, pharmacological treatment for maintenance of abstinence should not be used during pregnancy. At birth, foetal alcohol spectrum disorders must be searched for, and alcohol metabolites should be measured in meconium of neonates in any doubt of foetal alcohol exposure.

Cocaine dependence has a strong heritability component. The aim of this study was to investigate the putative association between the serotonin 2B receptor gene (A French Afro-Caribbean male population of patients with crack use disorders (We have observed a positive association between the rs6736017 polymorphism and crack use disorders in a French Afro-Caribbean male population.In our population, the risk effect of

Guidelines for pharmacological treatment of patients with paraphilic disorders have been developed by a working group of the World Federation of Societies of Biological Psychiatry (Thibaut et al., 2010). With an increasing duration of experience and number of treated patients as well as aging patients, change of or withdrawal from testosterone-lowering medications (TLM) has become an important issue. The current study aimed to assess the quality of a structured professional judgment procedure that helps switching or discontinuing TLM in patients with paraphilic disorders. We used the Delphi method to estimate the quality of 10 factors originally proposed by the authors. A total of 30 experts participated in the first stage; 18 experts participated in the second stage. The experts' assessment resulted in an instrument of 15 factors that can be used to structure the process of changing or discontinuing TLM. These factors can be grouped into five broader categories: age and duration of treatment; therapeutic alliance; psychopathology and risk factors; motivation; and compliance and level of control. The developed COSTLow-R Scale provides an instrument that can be used to structure the process of changing or discontinuing TLM in patients with severe paraphilic disorders.

Sexual offences are committed by a very heterogeneous population, within which we can distinguish paraphilic and non-paraphilic sex offenders (SOs). In addition, paraphiliacs vary in multiple factors, such as the target, origin, recurrence and intensity of their sexual fantasies, arousal or behaviours. Compared to other types of offenders, convicted SOs usually stay longer in forensic care, have more severe legal sanctions (e.g. community registration, residential restriction, extended supervision) and are perceived by the community as more dangerous. As a result, this affects their length of stay in care facilities. That is why accurately predicting recidivism is extremely important when it comes to SO. Actuarial instruments and professional guidelines help assessing the likelihood of a SO to reoffend in order to carefully make decisions that might seriously affect them and/or the community, such as their length of stay. Treatments should be chosen based on multiple factors, including demographic variables, information about the type of paraphilia, comorbidity with mental disorders, medical examination, past experiences, recidivism risk and risk of violence, personal and interpersonal factors and many others (even more so in adolescents). Combinations of pharmacological (i.e. SSRIs, antiandrogen treatment) and psychological (i.e. BT, CBT) interventions have proven their efficacy in reducing recidivism risk among SOs. Despite the profound social cost of paraphilic behaviour, paraphilic disorder is still under-researched.

Many facilities involved in caring people diagnosed with mental health disorders who committed crime had to adapt to COVID-19 pandemic in France. Particularly, the impact of the COVID-19 pandemic on incarcerated people was the subject of many concerns. The COVID-19 pandemic also posed major challenges in secure psychiatric hospitals and for psychiatrist experts. Rapid changes in working practices occurred. Finally, the lockdown period was associated with an increase in domestic violence, especially gender-based violence and child abuse and neglect. Overall, the COVID-19 pandemic emphasized the well-known limitations of the French mental health system to manage people diagnosed with mental health disorders who committed crime and the urgent need for better recognition of forensic psychiatry in France., Highlights • Facilities involved in caring people diagnosed with mental health disorders who committed crime adapted to COVID-19 pandemic. • The impact of the COVID-19 pandemic on incarcerated people was the subject of many concerns. • The lockdown period was associated with an increase in domestic violence, especially gender-based violence and child abuse.

The treatment of people diagnosed with mental disorders who committed crimes differ greatly in countries around the world because of the long histories of criminal justice and psychiatry specific to each country. As a result, it is often difficult to grasp the specificities of each system. The main objective of this paper is to provide a narrative review of the interactions between the French mental health and judicial systems. Subsequently, we will discuss how the concept of forensic psychiatry does not yet exist in France and how it can be applied.