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While the impact of the gut microbiota on brain and behavior is increasingly recognized, human studies examining this question are still scarce. The primary objective of the current study was to explore the potential relationships between the gut microbiota composition, motor cortical excitability at rest and during inhibitory control, as well as behavioral inhibition, in healthy volunteers and in patients suffering from alcohol use disorder. Motor cortical excitability was examined using a range of transcranial magnetic stimulation (TMS) measures probed at rest, including the recruitment curve, short and long intracortical inhibition, and intracortical facilitation within the primary motor cortex. Moreover, TMS was applied during a choice reaction time task to assess changes in motor excitability associated with inhibitory control. Finally, behavioral inhibition was investigated using a neuropsychological task (anti-saccade). Overall, our results highlight several interesting correlations between microbial composition and brain measures. Hence, higher bacterial diversity, as well as higher relative abundances of UGC-002 and Christensenellaceae R-7 group were correlated with stronger changes in motor excitability associated with inhibitory control. Also, higher abundance of Anaerostipes was associated with higher level of corticospinal excitability. Finally, relative abundances of Bifidobacterium and Faecalibacterium were positively related to performance in the neuropsychological task, suggesting that they might have a positive impact on behavioral inhibition. Although correlation is not causation, the present study suggests that excitatory and inhibitory brain processes might be related to gut microbiota composition.

info:eu-repo/semantics/nonPublished

Les problèmes de santé mentale représentent un enjeu majeur de notre époque. Il est démontré que les enfants ayant un parent souffrant d'une maladie mentale encourent un risque accru de développer un trouble psychique. Il en ressort la nécessité de mettre davantage en place de programmes de prévention à l'intention première de ces enfants. Il s'agit d'abord de repérer ces enfants, par exemple via les services de psychiatrie adulte, pour ensuite proposer des programmes adaptés sans stigmatiser les familles concernées. Dans cette perspective, une collaboration plus étroite entre psychiatrie adulte et psychiatrie infanto-juvénile est certainement à développer. Il est évident que la prévention peut aussi se réaliser à partir d'autres instances comme les institutions scolaires. Notre contribution propose un rapide tour d'horizon de différents programmes de prévention indiquant le développement d'initiatives intéressantes. Il reste cependant nécessaire de continuer à les implémenter et à les évaluer afin d'améliorer la vie et le devenir de ces enfants et de leurs parents., [What about prevention programs for children of mentally ill parents?$ Mental health problems are a major issue in today's world. It is proven that children of parents with mental illness are at higher risk of developing a mental disorder. We should therefore implement more prevention programs for such children. The first step is to identify them, for instance through the adult psychiatric units. Then, a specific program should be put forward without stigmatizing the families concerned. In the interest of those families, it is clear that a closer collaboration between adult psychiatry and child psychiatry should be developed. Prevention can obviously also be fomented in other areas, such as schools. Our contribution offers a quick overview of various prevention programs, highlighting the development of interesting initiatives. However, it is important to continue implementing and evaluating these programs in order to improve the life and future of these children and parents.

Alcohol use disorder (AUD) is a chronic relapsing disease associated with malnutrition, metabolic disturbances, and gut microbiota alterations that are correlated with the severity of psychological symptoms. This study aims at supplementing AUD patients with prebiotic fiber during alcohol withdrawal, in order to modulate the gut microbiota composition and to evaluate its effect on gastrointestinal tolerance, metabolism, and patient’s behavior. A randomized, double-blind, placebo-controlled study included 50 AUD patients assigned to inulin versus maltodextrin daily supplementation for 17 days. Biological measurements (fecal microbial 16S rDNA sequencing, serum biology), dietary intake, validated psychological questionnaires, and gastrointestinal tolerance assessment were performed before and after the intervention. Inulin significantly decreased the richness and evenness and induced changes of 8 genera (q < 0.1) including Bifidobacterium and Bacteroides. Prebiotic had minor effects on gastrointestinal symptoms and nutritional intakes compared to placebo. All patients showed an improvement in depression, anxiety, and craving scores during alcohol withdrawal regardless of the intervention group. Interestingly, only patients treated with inulin significantly improved the sociability score and had an increased serum level of brain-derived neurotrophic factor. This pilot study shows that inulin is well tolerated and modulates the gut microbiota and the social behavior in AUD patients, without further improving other psychological and biological parameters as compared to placebo. Gut2Brain study, clinicaltrial.gov: NCT03803709, https://clinicaltrials.gov/ct2/show/NCT03803709

Numerous risk factors have been involved in the pathogenesis of hypertension. The contribution of psychological factors, including post-traumatic stress disorder, remains largely underexplored, despite their potential role in hypertension. We compared the prevalence of trauma, post-traumatic stress and other psychological disorders between hypertensive and normotensive patients from Bukavu (Democratic Republic of Congo), a 25-year war-exposed city. In this case-control study, we assessed past traumatic events with the Stressful-Events-Scale, post-traumatic stress disorder through the post-traumatic diagnostic scale, depression and alcohol use disorder through the MINI-International-Neuropsychiatric-Interview, and emotion regulation through the Emotion-Regulation-Questionnaire in 106 hypertensive and 106 normotensive patients, enrolled at the Bukavu General Hospital. Compared with normotensive controls (73% women, age: 43 ± 14 years, BP: 121 ± 10/75 ± 8 mmHg), hypertensive patients (57% women, age: 42 ± 13 years, BP: 141 ± 12/82 ± 7 mmHg, on a median of two antihypertensive drugs) were exposed to more man-made traumas (61 vs. 13%, P < 0.001), used more expressive suppression (P = 0.05) and less cognitive reappraisal (P = 0.02) as emotional regulation strategies. They developed more frequent post-traumatic stress disorder (36 vs. 7%, P < 0.001) and major depressive disorder (37 vs. 13%, P = 0.001), often in association with alcohol use disorder (23 vs. 4%, P < 0.001). In multivariate logistic regression, post-traumatic stress disorder [OR = 3.52 (1.23-6.54)], man-made trauma [OR = 2.24 (1.15-4.12)], family history of hypertension [OR = 2.24 (1.06-4.44)], fasting blood glucose [OR = 1.85 (1.07-3.08)], BMI [OR = 1.28 (1.12-2.92)], expressive suppression [OR = 1.23 (1.11-2.23)] and cognitive reappraisal [OR = 0.76 (0.63-0.98)] were independent predictors of hypertension. In Congolese populations exposed to war, man-made trauma exposure and post-traumatic stress disorder

La question de la mesure du risque de passage à l’acte est un vaste débat dont la réponse n’est jamais binaire. La réflexion menée autour de cette question a pour visée d’approcher comment l’ancrage par le soin psychique amènerait à une évolution autre que meurtrière pour le sujet. Partir d’une situation clinique permet d’articuler les différents aspects d’une rencontre avec le soin. Nous aborderons ici quelles sont les possibilités de déplacements de la violence par le soin, c’est-à-dire par la « fonction de contention du cadre coercitif » et la « fonction de contenance du cadre soignant » (Morhain, 2012)3 . Nous développerons également l’aspect de la crise homicidaire comme le pendant de la crise suicidaire, ce qui permettra de venir questionner ce que le sujet cherche à atteindre dans l’autre.

Visuospatial impairments have long been reported in Severe Alcohol Use Disorder but remain poorly understood, notably regarding the involvement of magnocellular (MC) and parvocellular (PC) pathways. This empirical gap hampers the understanding of the implications of these visual changes, especially since the MC and PC pathways are thought to sustain central bottom-up and top-down processes during cognitive processing. They thus influ- ence our ability to efficiently monitor our environment and make the most effective decisions. To overcome this limitation, we measured PC-inferred spatial and MC-inferred temporal resolution in 35 individuals with SAUD and 30 healthy controls. We used Landolt circles displaying small apertures outside the sensitivity range of MC cells or flickering at a temporal frequency exceeding PC sensitivity. We found evidence of preserved PC spatial resolution combined with impaired MC temporal resolution in SAUD. We also measured how spatial and tem- poral sensitivity is influenced by the prior presentation of fearful faces – as emotional content could favor MC processing over PC one – but found no evidence of emotional modulation in either group. This spatio-temporal dissociation implies that individuals with SAUD may process visual details efficiently but perceive rapidly updating visual information at a slower pace. This deficit has implications for the tracking of rapidly changing stimuli in experimental tasks, but also for the decoding of crucial everyday visual incentives such as faces, whose micro-expressions vary continuously. Future studies should further specify the visual profile of individuals with SAUD to incorporate disparate findings within a theoretically grounded model of vision.

Visuo-perceptive deficits in severe alcohol use disorder (SAUD) remain little understood, notably regarding the respective involvement of the two main human visual streams, i.e., magnocellular (MC) and parvocellular (PC) pathways, in these deficits. Besides, in healthy populations, low-level visual perception can adapt depending on the nature of visual cues, among which emotional features, but this MC and PC pathway adaptation to emotional content is unexplored in SAUD. To assess MC and PC functioning as well as their emotional modulations in SAUD. We used sensitivity indices (d') and repeated-measures analyses of variance to compare orientation judgments of Gabor patches sampled at various MC- and PC-related spatial frequencies in 35 individuals with SAUD and 38 matched healthy controls. We then explored how emotional content modulated performances by introducing neutral or fearful face cues immediately before the Gabor patches and added the type of cue in the analyses. SAUD patients showed a general reduction in sensitivity across all spatial frequencies, indicating impoverished processing of both coarse and fine-scale visual content. However, we observed selective impairments depending on facial cues: individuals with SAUD processed intermediate spatial frequencies less efficiently than healthy controls following neutral faces, whereas group differences emerged for the highest spatial frequencies following fearful faces. Altogether, SAUD was associated with mixed MC and PC deficits that may vary according to emotional content, in line with a flexible but suboptimal use of low-level visual content. Such subtle alterations could have implications for everyday life's complex visual judgments.

Een recent rapport van het National Institute for Health and Care Excellence vernoemt oefentherapie in groep als eerstelijnsbehandeling voor volwassen patiënten met een depressie, ook voor ernstige gevallen. Het gaat erom tegelijk de symptomen van de depressie terug te dringen, maar ook de slechtere fysieke toestand van de patiënten te verbeteren. Bij adolescenten met een depressie wordt lichaamsbeweging voorgesteld maar niet erkend als aanvullende eerstelijnsbehandeling. Bemoedigende nieuwe studies toonden nochtans een duidelijk effect tegen depressie aan bij jongeren, vooral in psychiatrische ziekenhuizen. De antidepressieve effecten van oefening in groep zouden het gevolg kunnen zijn van neurobiologische (neuroplasticiteit, ontsteking, endocriene respons…) en psychosociale (lichaamsbeeld, gevoel van eigenwaarde, gevoel van zelfredzaamheid, sociale steun…) mechanismen. Een dergelijk oefenprogramma omvat begeleiding door opgeleid personeel en zorgt voor een kader en structuur met sessies die specifiek zijn afgestemd op mensen met een depressie. De lichaamsbeweging moet aeroob zijn, van matige intensiteit met ten minste twee sessies per week bij volwassenen en drie bij adolescenten gedurende ten minste tien weken. Er moet voor worden gezorgd dat het programma aantrekkelijk is en aangepast aan de fysieke en mentale moeilijkheden van elk individu om actieve deelname aan te moedigen.

Un rapport récent du National Institute for Health and Care Excellence inclut la thérapie par l’exercice en groupe parmi les traitements de première ligne auprès des patients adultes souffrant de dépression, y compris dans les cas graves. L’intérêt est à la fois de réduire les symptômes dépressifs mais aussi d’améliorer leur santé physique plus faible. Chez l’adolescent souffrant de dépression, la pratique de l’exercice physique est suggérée mais n’est pas reconnue comme faisant partie des traitements complémentaires de première ligne. Cependant, de nouvelles études encourageantes ont montré un effet antidépresseur notable chez les jeunes, notamment en milieu hospitalier psychiatrique. Les effets antidépresseurs de l’exercice en groupe pourraient être dus à des mécanismes neurobiologiques (neuroplasticité, inflammation, réponse endocrine…) et psycho-sociaux (image de son corps, estime de soi, sentiment d’auto-efficacité, support social…). Un tel programme d’exercices physiques implique une supervision par un personnel qualifié, assurant un cadre et une structure de séances spécialement conçus pour les personnes souffrant de dépression. L’exercice doit être aérobie, d’intensité modérée avec au moins 2 séances par semaine chez l’adulte et 3 chez l’adolescent pendant au moins 10 semaines. Il faudra veiller à ce que le programme soit attrayant et adapté aux difficultés physiques et psychiques de chaque individu pour favoriser sa participation active.

Coronavirus disease 2019 has spread rapidly over the globe and has put an unprecedent psychological pressure on health care workers (HCWs). The present study aimed at quantifying the psychological consequences of the COVID-19 pandemic on HCWs during and after the first wave and identify sociodemographic, situational, and psychological risk/protective factors for symptoms severity. An online survey was sent by e-mail to all nurses and physicians employed by a teaching hospital in Brussels, Belgium. 542 (20,62%) completed the survey. 47%, 55%, 32% and 52% of participants reported posttraumatic stress, anxiety, depression and insomnia symptoms, respectively, during the peak. Two to three months later, posttraumatic symptoms emerged in 54% of HCWs. It persisted in 89% of those presenting severe symptoms initially. Neuroticism was the strongest predictor of posttraumatic stress, anxiety, and insomnia. Work overload was the strongest predictor of depression and second predictor of posttraumatic stress, anxiety, and insomnia. Other significant predictors included being a nurse, the number of past traumatic experiences, avoidant coping style, and expressive suppression of emotions.

Non-alcoholic fatty liver disease (NAFLD) is a quickly expanding welfare disease. It has been associated with unhealthy high-sugar beverages containing fructose. Here we describe the case of a 64-year-old woman who has been followed at the endocrinology consultation for about 20 years, for a metabolic syndrome associating type 2 diabetes. Due to the development of liver test disturbances, the patient was referred to hepatology and the diagnosis of metabolic dysfunction-associated fatty liver disease (MAFLD) was made. Interestingly, the patient denied any major consumption of sweetened beverages or other processed food, but on thorough history mentioned an excessive and uncontrollable consumption of fruits. Psychiatric follow-up was then initiated. After a period of six months, the body weight remained stable, but we found a reduction of fruit consumption, a reduction of insulin resistance and a normalisation of liver blood tests and elasticity. We further describe how fructose has specific metabolic pathways that cause liver damage and similarities with alcohol in terms of addictive potential. In conclusion, this case shows the importance of a detailed and personalised care in NAFLD-MAFLD and considering food addiction (also for foods that are considered “healthy”) as a real substance-use disorder and a potential cause of liver disease.

Consistent data highlight the presence and clinical significance of social cognition impairments in severe alcohol use disorder (SAUD). However, social perception and knowledge (i.e., the ability to interpret social situations and to identify latent social rules), an important social cognition component, has not yet been explored in this disorder. 35 patients with SAUD and 35 healthy controls (HC) completed the Social Perception and Knowledge test (PerSo), an experimental task requiring participants to comprehensively describe social situations and to identify the social rules illustrated in 8 pictures. We performed group and single-case analyses. Patients with SAUD, as a group, spontaneously identified less relevant "where"/"who"/"what" aspects of the social situations (social perception) than HC. They were however able to provide these elements when explicitly asked to. They were also less able to identify the social rules that subtended the situations (social knowledge). Single-case analyses revealed that 23 % of patients were significantly impaired for social perception, and 34 % for social knowledge. We provide novel evidence that SAUD is associated with social perception and knowledge impairments at the group level, and that these impairments strongly vary across patients. Such results should lead to the integration of social perception and knowledge impairments in the conceptualization and treatment of socio-affective difficulties in SAUD.

Electroconvulsive therapy (ECT) is a highly effective treatment for depression but how it achieves its clinical effects remains unclear. We set out to study the brain's response to ECT from a large-scale brain-network perspective. Using a voxelwise analysis, we looked at resting-state functional connectivity before and after a course of ECT at the whole-brain and the between- and within-network levels in 17 patients with a depressive episode. Using a group-independent component analysis approach, we focused on four networks known to be affected in depression: the salience network (SN), the default mode network (DMN), the cognitive executive network (CEN), and a subcortical network (SCN). Our clinical measures included mood, cognition, and psychomotor symptoms. We found ECT to have increased the connectivity of the left CEN with the left angular gyrus and left middle frontal gyrus as well as its within-network connectivity. Both the right CEN and the SCN showed increased connectivity with the precuneus and the anterior DMN with the left amygdala. Finally, improvement of psychomotor retardation was positively correlated with an increase of within-posterior DMN connectivity. The limitations of our study include its small sample size and the lack of a control dataset to confirm our findings. Our voxelwise data demonstrate that ECT induces a significant increase of connectivity across the whole brain and at the within-network level. Furthermore, we provide the first evidence on the association between an increase of within-posterior DMN connectivity and an improvement of psychomotor retardation, a core symptom of depression.

Cette contribution nous invite à suivre quelques pans de l’accompagnement thérapeutique d’une adolescente en proie à des interrogations sur son histoire, ses liens, son identité, et à travers ces thématiques sur sa valeur et son estime de soi. Pour notre part, nous questionnons la portée traumatique des événements de vie de cette jeune qui s’énonce petit à petit en fonction des lieux de soins successifs. Dans ce décours, l’adolescente met en exergue différents biais et enjeux de l’identité de genre. À ce propos, nous ouvrons l’hypothèse du vécu transgenre comme modalité de positionnement identitaire à l’adolescence, tout en veillant à démarquer la notion de transidentité du champ pathologique. Nous rappellerons aussi quelques notions autour du trauma infantile, des aspects identitaires à l’adolescence et de l’évolution de la question transgenre au sein de la société et de la psychiatrie., [The questioning of identity in a traumatic life course in adolescence] This contribution invites us to follow some aspects of the therapeutic accompaniment of a teenager prey to questions about her history, her ties, her identity, and through these themes on her value and her selfesteem. For our part, we question the traumatic impact of the life events of this young woman, who speaks out little by little according to the successive places of care. In this ramble, the teenager highlights different biases and issues of gender identity. In this regard, we open the hypothesis of transgender experience as a modality of identity positioning in adolescence, while making sure to distinguish the notion of transidentity from the pathological field. We will also recall some notions around infant trauma, identity aspects in adolescence and the evolution of the transgender issue in society and psychiatry.

Metadehumanisation (i.e., the perception of being considered as less than human by others) is proposed to be widespread in stigmatised populations, such as people with severe alcohol use disorder (SAUD). However, the relations between metadehumanisation, self-dehumanisation (i.e., the self-perception of being less than human), and stigmatisation (i.e., the negative taint applied to some groups) remain unexplored. The aim of this research is thus to investigate the relations between these processes. Metadehumanisation, self-dehumanisation, self-stigma (and its subdimensions) and environmental satisfaction were assessed in 120 inpatients with SAUD and analysed in a mediational model. Stigma awareness was positively associated with metadehumanisation, whereas environmental satisfaction was negatively associated with metadehumanisation. Stigma's application to the self was associated with increased self-dehumanisation. Self-stigma and self-dehumanisation are closely intertwined phenomena. Self-dehumanisation seems to follow a multi-step process suggesting that some steps, such as dehumanisation awareness, are missing from current models of dehumanisation.

Prior studies suggest that IL-6 may be involved in the pathophysiology of psychomotor symptoms in depression. Electroconvulsive therapy (ECT), as yet the most effective biological treatment of severe depression, is known to improve psychomotor functioning, while recent studies have shown a decrease in the elevated IL-6 levels of depressed patients following ECT. This study investigates whether the improvement in psychomotor functions in patients with depression after ECT is related to changes in IL-6 levels. Peripheral IL-6 was quantified and the severity of psychomotor agitation and retardation determined using the CORE assessment of psychomotor symptoms in 62 patients with a (unipolar or bipolar) depressive episode within one week before and within one week after their course of ECT. IL-6 levels had decreased significantly following ECT and both psychomotor retardation and agitation had improved. The decrease in IL-6 levels was related to the improvement of psychomotor retardation, with post-hoc analysis revealing that higher baseline IL-6 levels positively correlated with higher psychomotor retardation scores. With this study, we provide the first evidence that the improvement of psychomotor retardation after ECT for depression is related to the immunomodulatory properties of the treatment, most specifically the decrease in IL-6 levels.

The coronavirus disease 2019 (COVID-19) pandemic considerably affects health, wellbeing, social, economic and other aspects of daily life. The impact of COVID-19 on blood pressure (BP) control and hypertension remains insufficiently explored. We therefore provide a comprehensive review of the potential changes in lifestyle factors and behaviours as well as environmental changes likely to influence BP control and cardiovascular risk during the pandemic. This includes the impact on physical activity, dietary patterns, alcohol consumption and the resulting consequences, for example increases in body weight. Other risk factors for increases in BP and cardiovascular risk such as smoking, emotional/psychologic stress, changes in sleep patterns and diurnal rhythms may also exhibit significant changes in addition to novel factors such as air pollution and environmental noise. We also highlight potential preventive measures to improve BP control because hypertension is the leading preventable risk factor for worldwide health during and beyond the COVID-19 pandemic.

Ce livre de référence sur les séparations parentales conflictuelles offre au lecteur, qu’il soit professionnel ou non, un panorama complet sur la thématique. Porté par des auteurs d’horizons différents, il évoque aussi bien le suivi psychologique des ex-partenaires et de leurs enfants, que les aspects sociaux ou encore juridiques et de médiation. Aujourd'hui, de plus en plus de couples en viennent à se séparer de manière conflictuelle. Les conséquences sont très variées et rejaillissent sur tous les acteurs (ex-partenaires, enfants, entourage) et dans tous les domaines de la vie (santé, psychologie, travail/école, relations sociales, etc.). Ce livre de référence dresse un panorama complet des différentes problématiques qui en découlent : du stress et de ses conséquences, à l'aliénation parentale, en passant par les difficultés financières, etc. Rassemblant les contributions de nombreux experts du domaine, il présente les différentes prises en charge possibles et l'accompagnement nécessaire aux ex-conjoints et à leurs enfants. Il propose également une réflexion sur les procédures judiciaires et l'impact qu'elles ont sur chacun. Les professionnels disposeront ainsi de tous les éléments nécessaires utiles pour envisager du mieux possible chaque situation et tenter de l'apaiser.

Following the recognition of 'internet gaming disorder' (IGD) as a condition requiring further study by the DSM-5, 'gaming disorder' (GD) was officially included as a diagnostic entity by the World Health Organization (WHO) in the 11th revision of the International Classification of Diseases (ICD-11). However, the proposed diagnostic criteria for gaming disorder remain the subject of debate, and there has been no systematic attempt to integrate the views of different groups of experts. To achieve a more systematic agreement on this new disorder, this study employed the Delphi expert consensus method to obtain expert agreement on the diagnostic validity, clinical utility and prognostic value of the DSM-5 criteria and ICD-11 clinical guidelines for GD. A total of 29 international experts with clinical and/or research experience in GD completed three iterative rounds of a Delphi survey. Experts rated proposed criteria in progressive rounds until a pre-determined level of agreement was achieved. For DSM-5 IGD criteria, there was an agreement both that a subset had high diagnostic validity, clinical utility and prognostic value and that some (e.g. tolerance, deception) had low diagnostic validity, clinical utility and prognostic value. Crucially, some DSM-5 criteria (e.g. escapism/mood regulation, tolerance) were regarded as incapable of distinguishing between problematic and non-problematic gaming. In contrast, ICD-11 diagnostic guidelines for GD (except for the criterion relating to diminished non-gaming interests) were judged as presenting high diagnostic validity, clinical utility and prognostic value. This Delphi survey provides a foundation for identifying the most diagnostically valid and clinically useful criteria for GD. There was expert agreement that some DSM-5 criteria were not clinically relevant and may pathologize non-problematic patterns of gaming, whereas ICD-11 diagnostic guidelines are likely to diagnose GD adequately and avoid pathologizing.

BACKGROUND & AIMS: Chronic alcohol consumption can cause malnutrition that may contribute to alcohol-induced organ injury and psychological disorders. We evaluated the link between nutrient intake, especially dietary fibers (DF) and different parameters reflecting mental health and well being, namely anxiety, depression, alcohol craving, sociability, fatigue and intestinal comfort in alcohol use disorder (AUD) patients. METHODS: Cross-sectional data from 50 AUD patients, hospitalized for a 3-week detoxification program were used. Three 24-h recalls allowed to calculate dietary habits and nutrient intakes, that was also assessed in healthy subjects (HS). Diet quality was measured using the NOVA score. Psychological factors and intestinal discomfort were evaluated using validated self-administered questionnaires. RESULTS: Energy intake (excluding alcoholic beverage), total fat, monounsaturated and polyunsaturated fatty acids, protein and DF intakes were lower in AUD subjects compared to HS. Ninety percent of patients had a DF intake below the recommendation. AUD patients consumed more than twice as much ultra-processed food than HS. Fructan intake was negatively associated with anxiety (p = 0.04) adjusted for main confounders. Total DF, insoluble, soluble DF and galacto-oligosaccharide intakes were associated with higher sociability score. Soluble DF intake was associated with better satisfaction of bowel function (p = 0.02) and a lower intestinal discomfort (p = 0.04). CONCLUSIONS: This study reveals that insufficient DF intake is part of AUD-related malnutrition syndrome, and is associated with higher anxiety, lower sociability score and intestinal discomfort. Our results suggest that an adequate intake of DF might be beneficial for recovery from AUD. TRIAL REGISTRATION: NCT03803709, https://clinicaltrials.gov/ct2/show/NCT03803709.

Metadehumanization, the perception of being treated as less than a human by others, is a pervasive phenomenon in intergroup relations. It is dissociated from stigmatization or stereotypes, and it has been recently identified as a critical process in severe alcohol use disorders (SAUD). Metadehumanization is associated with a wide array of negative consequences for the victim, including negative emotions, aversive self-awareness, cognitive deconstruction, and psychosomatic strains, which are related to anxiety and depression. This study aims to investigate if metadehumanization occurring among patients with SAUD is associated with clinical factors involved in the maintenance of the disease, namely symptoms of depression or anxiety and drinking refusal self-efficacy. A cross-sectional study was conducted among 120 patients with SAUD. Self-reported questionnaires measured metadehumanization, self-dehumanization (i.e., the feeling of being less than a human), anxiety, depression, drinking refusal self-efficacy, and demographics. Metadehumanization was significantly associated with self-dehumanization, anxiety, depression, and drinking refusal self-efficacy. Additionally, path analyses showed that self-dehumanization mediated the links between metadehumanization and clinical variables. These results indicate that metadehumanization and self-dehumanization could be essential factors to consider during SAUD treatment, as they are associated with increased psychiatric symptoms and reduced drinking refusal self-efficacy.

The gut-brain communication is mostly driven by the immune, metabolic and neural pathways which remained poorly explored in patients with alcohol use disorder (AUD). The metabolites arising from the tryptophan-kynurenine pathway have gained considerable attention since they are at the interface between intestinal bacteria, host immune response and brain functions. This study described the circulating levels of kynurenine metabolites in AUD patients, at the onset (T1) and end (T2) of a 3-week detoxification program, and tested correlations between those metabolites and inflammatory markers, the gut microbiota and the psychological symptoms. Increased concentration of the neurotoxic metabolite quinolinic acid (QUIN) and decreased levels of the neuroprotector metabolite kynurenic acid (KYNA) which both modulate glutamatergic neurotransmission were observed in AUD patients, particularly at T2. The inflammatory marker hsCRP was associated with several metabolic ratios of the kynurenine pathway. Tryptophan, KYNA and QUIN were correlated with depression, alcohol craving and reaction time, respectively. Analysis of gut microbiota revealed that bacteria known as short-chain fatty acid producers, as well as bacterial metabolites including butyrate and medium-chain fatty acids were associated with some metabolites of the tryptophan-kynurenine pathway. Targeting the glutamatergic neurotransmission through the modulation of the kynurenine pathway, by manipulating the gut microbiota, might represent an interesting alternative for modulating alcohol-related behavior.

OBJECTIFS : Dans notre Centre de référence des troubles du spectre Autistique, nous rencontrons des jeunes présentant à la fois un Syndrome d’Asperger et un profil intellectuel de type haut potentiel. L’objectif de cet article est d’ouvrir une réflexion sur le diagnostic tardif chez ces patients et d’analyser les raisons qui y mènent. MÉTHODE : Nous avons réalisé une étude rétrospective basée sur l’analyse des dossiers cliniques de patients âgés de 8 à 18 ans et présentant à la fois un diagnostic de Syndrome d’Asperger et un profil de Haut Potentiel Intellectuel, ayant bénéficié d’un bilan diagnostique dans notre service. Au départ des dossiers des patients, nous avons identifié plusieurs éléments : motif de la demande, personnes demandeuses, éventuels diagnostics antérieurs, signes cliniques de Troubles du Spectre Autistique. RÉSULTATS : Nous avons étudié une population de 17 jeunes. Les résultats nous permettent de repérer que les caractéristiques autistiques et les difficultés des patients sont plus facilement identifiables dans le contexte de l’ADOS et dans les observations libres que durant les autres épreuves standardisées. Nous notons également l’importance de l’intuition et l’expérience clinique. DISCUSSION : Nous proposons d’étendre la notion de stratégies de camouflage, initialement appliquée aux femmes avec un Syndrome d’Asperger, aux enfants et adolescents présentant à la fois un Syndrome d’Asperger et un Haut Potentiel Intellectuel. Le Haut Potentiel Intellectuel offrirait à ces jeunes la possibilité de compenser ou masquer certaines inaptitudes. CONCLUSION : Cette étude nous permet d’expliquer en partie les diagnostics tardifs de Syndrome d’Asperger avec Haut Potentiel Intellectuel par l’existence chez ces jeunes de stratégies de camouflages qui pourraient être d’autant plus performantes que ces jeunes présentent une intelligence supérieure à la moyenne., [Asperger Syndrome with High Intellectual Potential: Camouflage as a factor in late diagnosis?] BACKGROUND: The mission of our “Centre de référence des troubles du spectre autistique” is to evaluate children and adolescents for whom there is a suspicion of autistic spectrum disorder through a multidisciplinary diagnostic assessment. We encounter cases of patients presenting both Asperger syndrome and High Intellectual Potential. Those patients are frequently older than the norm. The objectives of our study are to understand the reasons leading to a late diagnosis for these patients and to question the value of giving such a diagnosis to children aged from eight to 18 years old. METHODS: We carried out a retrospective study based on the analysis of clinical files from patients presenting both AS and HIP, aged between eight and 18 years old. These patients were all previously seen in our center for a multidisciplinary diagnostic assessment. We analyzed several items from their clinical reports, such as the moment of and the motivation for the assessment; the person(s) asking for the assessment; the possible previous diagnosis; the evident and subtle characteristics of Asperger syndrome present in the speech, neuropsychological, and psychological (ADOS and projective tests) evaluations; psychomotricity; IQ score; the patients’ integration into their peer groups; and the possible associated psychiatric issues. RESULTS: We examined the files of 17 subjects presenting both Asperger syndrome and High Intellectual Potential profiles, aged between eight and 18 years old. The results show that autistic traits are more easily observed during the ADOS test and the informal assessments rather than during the other standardized analysis. We also noticed the importance of the clinical intuition and experience of the examiner. DISCUSSION: We propose to extend the notion of “camouflage” strategies, previously used to describe women with Asperger syndrome, to children and adolescents

Partant des nombreux ponts possibles entre une clinique de la transition adolescentaire et les impasses des personnes dépendantes à l’alcool, nous avons mis en avant la difficulté pour ces personnes de vivre les divers moments de transition en dehors d’un vécu de rupture et de fragilisation identitaire. Toute séparation ramène à une perte réelle de l’autre et, en miroir, de soi. Comment un cadre thérapeutique peut tenter de soutenir un certain travail autour de ces « passages » ? Pour ce faire, nous avons exploré le concept de transitionnalité, de préoccupation maternelle primaire, d’accrochage à un objet réel de dépendance afin d’aboutir sur les processus de séparation et d’individuation. Nous évoquons comment les différentes étapes et approches spécifiques d’un dispositif peuvent être autant d’occasions d’éprouver ces enjeux. La reprise dans les espaces de soin, de parole et de lien à l’autre réhumanisant (soignants et non-soignants) devrait rendre possible une transformation du patient lui permettant de renouer avec ses parts « capables », ouvrant la porte à d’autres investissements du côté d’une liberté nouvelle., [What would a successful hospital alcohol dependency program for patients in transition look like ?] Taking as a starting point the many possible connections between a teenage transition clinic and the roadblocks encountered in alcohol dependency, we stress the difficulty for anyone going through multiple moments of transition outside of the experience of fragile identity and breakdown. Each separation is a real loss of the other, and a part of oneself. How does a therapeutic framework attempt to work around these episodes? In an attempt to answer this question, we have explored the concepts of transitionality and primary maternal preoccupation, of transitional attachment, in order to get to grips with the processes of separation and individuation. We discuss how the different stages and specific approaches of a program can provide an opportunity to appreciate these challenges. Reestablishing speech and connecting to the other in caring spaces rehumanizes health professionals and nonhealth professionals alike, and should encourage patients to make changes enabling them to rediscover their inner strengths, also paving the way for them to reclaim their freedom. © 2021 Boeck Universite. All rights reserved.

BACKGROUND: Electroconvulsive therapy (ECT) is the most effective biological treatment for depression. Aside the well-known therapeutic effect on mood symptoms, it has also a unique positive impact on psychomotor agitation and retardation, which are core symptoms of depression. The neurobiology behind these effects, however, remains unclear. The basal ganglia are proposed to be important regions in the pathogenesis of psychomotor symptoms in depression. Since ECT can trigger neuroplasticity in these subcortical nuclei, we speculate that ECT-induced volumetric changes of the basal ganglia will positively influence psychomotor symptoms. METHODS: Psychomotor symptoms were analyzed in 17 patients with severe depression before and after an acute ECT course using a CORE assessment of the retardation, agitation, and non-interaction domains. The volumes of the caudate, putamen, pallidum, and accumbens regions were determined using magnetic resonance imaging one week before and after ECT. RESULTS: Psychomotor functions had improved significantly after ECT and significant volume increases were found for the accumbens region, the putamen, and pallidum. The volume increase of the nucleus accumbens correlated with an improvement of psychomotor retardation, while the volume increase of the pallidum correlated negatively with an improvement of the agitation subscore. CONCLUSION: Our findings support the notion of an association between the impact of ECT on depression-related psychomotor symptoms and volume increases of the accumbens region and pallidum, pointing to the importance of the basal ganglia in the therapeutic effect of ECT on psychomotor functioning. TRIAL REGISTRATION: ClinicalTrials.gov NCT02562846.

La maltraitance des enfants constitue un sujet de préoccupations qui concerne tant les professionnels de l’enfance, quelle que soit leur discipline, les particuliers, les familles, que la société en général. Partant de cinq vignettes cliniques pour illustrer la problématique et montrer toute la difficulté à penser l’intervention, l’article développe dans un premier temps des considérations sur le statut actuel de l’enfant. Si la reconnaissance des droits de l’enfant est aujourd’hui acquise dans nombre d’États, bien des risques menacent son intégrité et sa subjectivité. Puis, l’auteur aborde les répercussions sur le plan clinique de l’abus sexuel, présentant les différents champs symptomatiques concernés, discutant de la question de la répétition transgénérationnelle. Enfin, il propose un canevas de rencontres de parole centrées sur cette forme de maltraitance.

À l’heure où le travail en équipe et en réseau (voire en « open space ») est largement prôné, il n’est pas inutile de rappeler l’importance des relations fraternelles, terreau des liens transversaux ultérieurs de tout individu. Bien des aspects conscients et d’autres enfouis dans les histoires individuelles et familiales, parfois de très longue date, interviennent et définissent les liens fraternels. Chaque fratrie étant singulière, chacune évolue au gré des événements de vie, qu’ils soient intrinsèques aux membres de la famille ou non. Cette contribution développe quelques aspects de la fratrie dans laquelle un frère ou une sœur est surdoué(e), en soulignant certains paramètres de la dynamique fraternelle. Il est fréquent de constater d’âpres rivalités fraternelles dont un point d’origine se situe dans le « surdon » d’un enfant et dans lesquelles la génération parentale est habituellement impliquée., [In the shadow of the gifted brother or sister.] At a time when teamwork and networking (or even open space working) are widely advocated, it is worth recalling the importance of sibling relationships, the breeding ground for each individual’s subsequent transversal bonds. Many aspects—whether conscious or otherwise—buried in individual and family histories, sometimes dating back a very long time, intervene in and define sibling bonds. As every sibling relationship is singular, each evolves according to life events, whether they are intrinsic to the members of the family or not. This contribution develops some aspects of sibling relationships in which one brother or sister is gifted, highlighting certain parameters of sibling dynamics. It is common to observe bitter sibling rivalries whose origin lies in the “giftedness” of one child and in which the parental generation is usually involved.

La prévalence des situations de maltraitance sur enfants demeure importante, celles-ci intervenant habituellement dans le cadre familier de la jeune victime. Si de nombreux aspects théoriques et cliniques des formes de maltraitance sont aujourd’hui étudiés, peu de travaux se centrent sur les questions spécifiques des transgressions commises par les grands-parents. À partir d’une vignette clinique, l’auteur montre l’utilité d’une prise en charge s’appuyant sur les temps successifs que constituent l’évaluation et le traitement. Tenir un cadre et évaluer, c’est-à-dire faire émerger d’un côté les ressources, de l’autre les défaillances, représente par essence un temps constructif. Quatre catégories principales de fonctionnement psychique des grands-parents maltraitants sont retrouvées. Comme la plupart de ceux-ci relèvent de soins individuels et familiaux, on gagne en efficacité par une diffraction des tâches via un travail en réseau., [The abusive grandparent: theoretical-clinical issues and networking practice]The prevalence of child maltreatment situations remains high, usually in the home setting of the young victim. While many theoretical and clinical aspects of forms of abuse are now being studied, there is little work focusing on the specific issues of transgressions committed by grandparents. From a clinical case, the author shows the usefulness of management based on the successive times of evaluation and treatment. Maintaining a framework and evaluating (which means making resources emerge on one side and identifying failures on the other) is essentially a time for construction. Four main categories of psychic functioning of abusive grandparents are found. As most of these require individual and family care, the distribution of tasks through networking improves care management.

L’usage débordant des technologies actuelles par les adolescents les expose aux harcèlements et à d’autres expériences sidérantes vécues sur les réseaux sociaux. Les adultes sont souvent dépassés et éprouvent ainsi des difficultés à exercer une autorité nécessaire à l’adolescence. Partant d’un cas clinique, je propose une approche thérapeutique qui tienne compte de la subjectivité à soutenir eu égard à la réalité numérique d’aujourd’hui., [PLAYING WITH YOUR DATA IN ADOLESCENCE] The overuse of current technologies by teenagers exposes them to online bullying and other harrowing experiences on social networks. Adults are often out of their depth in this area and thus have difficulty exercising the authority that adolescence requires. Based on a clinical case, I propose a therapeutic approach that takes into account the subjectivity needed to deal with today’s digital challenges.

BACKGROUND: The BODY-Q is a new patient-reported outcome (PRO) instrument designed to measure patient perceptions of weight loss and/or body contouring procedure. A report regarding the translation procedure into French and its preliminary results has been previously published. We here describe the finalization of the translation process and cultural validation. MATERIALS AND METHODS: The translation process followed guidelines established by the International Society for Pharmacoeconomics and Outcome Research (ISPOR) and the World Health Organisation (WHO). The process included two forward translations, one backward translation, a review by a panel of expert and cognitive debriefing interviews with patients. RESULTS: The 26 scales of the BODY-Q were translated and adapted into French. Each step of the process allowed to make changes leading to a conceptually and culturally equivalent French version. Backward translation comparison to the English version led to the identification of 16 differences necessitating re-translation. Overall feedback from patients over the final version was excellent. CONCLUSIONS: The BODY-Q proved to be a reliable and suited PRO for bariatric and body contouring patients. The thorough method of translation and cultural adaptation allowed us to achieve a conceptually and culturally valid French translation of the BODY-Q.

ACHTERGROND Na tientallen jaren van onderzoek en klinische ervaring is duidelijk dat de autismespectrumstoornis (ass) heterogeen is in al haar aspecten, zoals fenotype en etiologie. Hoe kunnen we deze heterogene bevindingen over ass vertalen in informatie die bruikbaar en betekenisvol is voor ouders en clinici? DOEL Aanbevelingen formuleren voor de klinische zorg voor jonge kinderen met ass. METHODE We onderzochten met diepte-interviews hoe ouders (11 moeders en 6 vaders van 11 kinderen) en artsen (n = 16) een ass-diagnose bij een jong kind ervaren. De interviews werden in Nvivo 11 geanalyseerd volgens de richtlijnen van interpretatieve fenomenologische analyse. RESULTATEN De geïnterviewde ouders en artsen bleken evenveel belang te hechten aan psychorelationele als aan handelingsgerichte implicaties van een ass-diagnose. Een jaar nadat bij hun kind de diagnose ass gesteld werd, bracht een zekere ontnuchtering over deze implicaties de ouders tot een pragmatisch begrip van de diagnose. CONCLUSIE Zowel voor clinici als beleidsmakers bieden de resultaten handvatten voor de klinische praktijk voor jonge kinderen met ass. Een ass-diagnose blijkt op zich ouders en clinici beperkt te helpen. Wel kan deze zinvol zijn bij een hulpvraaggericht diagnostisch proces dat gebaseerd is op een communicatiemodel van gedeelde besluitvorming en waarbij een descriptief profiel van het kind opgemaakt wordt dat bruikbaar is in het verdere hulpverleningstraject.

From 1984 to 2018, 1120 paediatric liver transplantations (PLTs) have been performed, of which 438 with living donor (LD). We systematically conduct pre-transplant psychological assessments,which consist at least in a clinical family interview. We hypothesize that such approach may predict psychosocial difficulties for families in the course of the transplant. Methods: Content analysis of 130 pre-transplant reports written between 1/07/2014 and 31/10/2018, personal prospective notes by the psychologist and interviews of other members of the team. The results are based on the systematic analysis of the first 54 situations of living donor PLTs. After transplantation, 39/54 (72%) families did not experience particular psychosocial difficulties whereas 15 (28%) needed psychosocial support. Only 9 of these 15 situations had been identified as being at risk, through our clinical interview before trans-plantation. The red flags identified by the psychologist in relation to these families were in ade-quacy with the type of difficulties experienced after transplantation. Looking at the remaining 6 (11%) whose psychosocial risk had not been identified, we analysed whether it would have been possible to predict post-operative psychosocial adjustments. In 3 situations, medical complications were the main determinant of the non-predictable psychosocial difficulties. In 3 situations however, the risk might have been predicted if we had investigated morein-depth the larger environment of the family. Our results suggest that a systemic approach with at least a clinical family interview predicts in 89% psychosocial risks and points of attention for living donor candidates and their family before PLT.

From 1984 to 2018, 1115 paediatric liver transplantations have been performed, of which 433 with living donors. With patients coming from 13 different countries, our centre has a strong international dimension. The Live Organ Donor Consensus Group has formulated a statement according to which “a psychological evaluation is necessary for each potential donor”[i]. In our centre, we systematically conduct pre-transplant psychological assessments, which consist in a clinical family interview. The complexity of the family situations having increased over the last few years, we aimed to address the relevance and efficiency of our pre-transplant interviews. Methods: Content analysis of 130 pre-transplant reports written between 1/07/2014 and 31/10/2018 were reviewed, as well as personal prospective notes by the psychologist, in the follow-up of the families after transplantation during the same period, with a systemic attention to the transplanted child’s family. Results: Our reflective work sheds light on the evolution of our practice of pre-transplant interviews, which has evolved from family interviews focused on the living donor, to interviews that consider all the aspects of the family dynamics, including the cultural dimension. The analysis of our prospective notes revealed that the potential risks are not only related to personal characteristics of the living donor candidate, but can also be connected with his/her environment. Moreover, the psychosocial risk does not concern the donor candidate alone, but may well extend to other significant family members, including those who remained in the country of origin. We are receiving families who have experienced unique life circumstances, such as histories of intra-familial tensions or violence, death of previous children, experiences of war or jail … Family dynamics are affected differently by such circumstances, with psychosocial risks at various level and for different family members as a consequence. As a result of e