Sleep and dreaming are for important matters.

Recent studies in sleep and dreaming have described an activation of emotional and reward systems, as well as the processing of internal information during these states. Specifically, increased activity in the amygdala and across mesolimbic dopaminergic regions during REM sleep is likely to promote the consolidation of memory traces with high emotional/motivational value. Moreover, coordinated hippocampal-striatal replay during NREM sleep may contribute to the selective strengthening of memories for important events. In this review, we suggest that, via the activation of emotional/motivational circuits, sleep and dreaming may offer a neurobehavioral substrate for the offline reprocessing of emotions, associative learning, and exploratory behaviors, resulting in improved memory organization, waking emotion regulation, social skills, and creativity. Dysregulation of such motivational/emotional processes due to sleep disturbances (e.g., insomnia, sleep deprivation) would predispose to reward-related disorders, such as mood disorders, increased risk-taking and compulsive behaviors, and may have major health implications, especially in vulnerable populations.

[Chronic delusional psychosis]. / Les psychoses délirantes chroniques.

The current Anglo-Saxon trend is to consider that schizophrenia includes all psychoses. However, far from being a uniform set, there is a lot of different clinical presentations of patients with psychosis. Chronic delusional psychosis, as a paradigm, show that subtyping psychosis on a clinical basis is useful for therapeutic and prognosis purposes.

[Obsessive compulsive disorder (OCD)]. / Trouble obsessionnel-compulsif (TOC).

Obsessive compulsive disorder (OCD) is a frequent and disabling psychic illness. Along psychiatric history, several etiological models have been successively hypothesized to explain the obsessive compulsive symptoms from a psychological, behavioural or biological point of view. This review aims at presenting OCD etiological models as well as describing OCD clinical and therapeutic aspects.

[The electroconvulsive therapy in 2008]. / L'électroconvulsivothérapie en 2008.

Electroconvulsive therapy (formerly called sismotherapy, electronarcosis or shock therapy) is a therapeutic tool used in several psychiatric illnesses. It consists in the induction of a generalized convulsive seizure by a transcranial electric stimulation. If it is true that this tool continues to stigmatise the collective imagination in giving rise to dread and suspicion (considered by some people as a barbarian or obsolete therapy), it is however an effective (sometimes irreplaceable) and well tolerated treatment. Over the last decades, ECT has generated renewed interest in psychiatric therapy. It constitutes today the oldest biological therapeutic tool still in use in psychiatry.

Hemodynamic cerebral correlates of sleep spindles during human non-rapid eye movement sleep.

In humans, some evidence suggests that there are two different types of spindles during sleep, which differ by their scalp topography and possibly some aspects of their regulation. To test for the existence of two different spindle types, we characterized the activity associated with slow (11-13 Hz) and fast (13-15 Hz) spindles, identified as discrete events during non-rapid eye movement sleep, in non-sleep-deprived human volunteers, using simultaneous electroencephalography and functional MRI. An activation pattern common to both spindle types involved the thalami, paralimbic areas (anterior cingulate and insular cortices), and superior temporal gyri. No thalamic difference was detected in the direct comparison between slow and fast spindles although some thalamic areas were preferentially activated in relation to either spindle type. Beyond the common activation pattern, the increases in cortical activity differed significantly between the two spindle types. Slow spindles were associated with increased activity in the superior frontal gyrus. In contrast, fast spindles recruited a set of cortical regions involved in sensorimotor processing, as well as the mesial frontal cortex and hippocampus. The recruitment of partially segregated cortical networks for slow and fast spindles further supports the existence of two spindle types during human non-rapid eye movement sleep, with potentially different functional significance.

[One-year follow-up and mobility assessment of schizophrenic patients in the Liege psychiatric care network]. / Evaluation d'un an de parcours de patients schizophrènes en service psychiatrique liégeois.

OBJECTIVE: The study was aimed at assessing the clinical evolution and mobility of schizophrenic patients within the healthcare network of the Psychiatric Platform of Liege (Belgium) after a one-year follow-up period. MATERIAL AND METHODS: The study material consisted of a random sample of 184 patients with schizophrenia drawn from the population of schizophrenic patients treated in the Liege psychiatric care network. The characteristics of these patients have been described previously (18). The 184 patients were followed-up for one-year and reassessed at the end of this period. Mobility (ie, changes between psychiatric care institutions, including home) was recorded for each patient within the institutional network. The diagnosis of schizophrenia was based on the DSM IV. Demographic, social and global functioning (GAF scale) data were collected from the "Résumé psychiatrique Minimum (RPM)", a clinical summary which has been imposed by the Belgian Ministry of Public Health for each psychiatric hospital stay. Symptom components were derived from the Psychosis Evaluation tool for Common Use by Caregivers (PECC). RESULTS: Among the 184 patients enrolled in the initial analysis, 6 refused to participate in the follow-up study. The 178 remaining schizophrenic patients included 131 men (74%) and 47 women (26%) with a mean age of 43.1 +/- 13.6 and 48.8 +/- 14.9 years, respectively (p<0.05). The majority of patients (53%) suffered from paranoid schizophrenia. At baseline, 63% of the patients were hospitalised full-time, 6% part-time and 31% received ambulatory care. During the one-year follow-up period, 4 patients died, including one from suicide. When considering mobility, 48% of the patients experienced at least one change of institution, whereas 52% of the patients didn't change at all (see figure 1). The total number of changes over the 1-year period amounted 189, yielding a mean value of 1.1 changes per patient per year. Changes mostly occurred between institutions of similar care setting (see figure 2). Transfers (30%) were also observed directly between hospital and home. A multivariate Poisson regression analysis showed that the number of changes was unrelated to gender and initial care setting but decreased with age (p<0.0001). It was also higher for patients with schizo-affective disorders (2.5 +/- 1.9, p<0.01) or with residual type (1.2 +/- 1.8; p<0.05) than for patients with other types of schizophrenia (ranging from 0.3 +/- 0.5 to 0.9 +/- 1.4). No association was found with initial GAF or PECC, except for negative symptoms (p<0.05). After one year, despite the high proportion of institutional changes (48% of the patients), the distribution of the patients according to care setting remained the same (p=0.77). However, GAF scores significantly improved from 39.7 +/- 16.1 to 44.4 +/- 16.1 (p<0.0001) and likewise for total PECC scores (70 +/- 19.1 vs 63.2 +/- 19.4, p<0.001). Excitatory and disease perception items of the PECC remained unchanged. CONCLUSION: The present study reveals that mobility within the institutional network did affect about half of the schizophrenic patients. Mobility was related to age, type of schizophrenia and disease evolution. Changes occur mainly between psychiatric structures of similar care setting but also directly from hospital to home without passing through an intermediate care structure. Further efforts should be made to provide schizophrenic patients with a more coordinated care provision throughout the course of their disease.

A role for sleep in brain plasticity.

The idea that sleep might be involved in brain plasticity has been investigated for many years through a large number of animal and human studies, but evidence remains fragmentary. Large amounts of sleep in early life suggest that sleep may play a role in brain maturation. In particular, the influence of sleep in developing the visual system has been highlighted. The current data suggest that both Rapid Eye Movement (REM) and non-REM sleep states would be important for brain development. Such findings stress the need for optimal paediatric sleep management. In the adult brain, the role of sleep in learning and memory is emphasized by studies at behavioural, systems, cellular and molecular levels. First, sleep amounts are reported to increase following a learning task and sleep deprivation impairs task acquisition and consolidation. At the systems level, neurophysiological studies suggest possible mechanisms for the consolidation of memory traces. These imply both thalamocortical and hippocampo-neocortical networks. Similarly, neuroimaging techniques demonstrated the experience-dependent changes in cerebral activity during sleep. Finally, recent works show the modulation during sleep of cerebral protein synthesis and expression of genes involved in neuronal plasticity.

Regional organisation of brain activity during paradoxical sleep (PS).

Human brain function is regionally organised during paradoxical sleep (PS) in a very different way than during wakefulness or slow wave sleep. The important activity in the pons and in the limbic/paralimbic areas constitutes the key feature of the functional neuroanatomy of PS, together with a relative quiescence of prefrontal and parietal associative cortices. Two questions are still outstanding. What neurocognitive and neurophysiological mechanisms may explain this original organization of brain function during PS? How the pattern of regional brain function may relate to dream content? Although some clues are already available, the experimental answer to both questions is still pending.

Memory processing during human sleep as assessed by functional neuroimaging.

Sleep is believed to participate in memory consolidation, possibly through off-line processing of recent memory traces. In this paper, we summarize functional neuroimaging data testing this hypothesis. First, sleep deprivation disrupts the processing of recent memory traces and hampers the changes in functional segregation and connectivity which underpin the gain in performance usually observed in subjects allowed to sleep on the first post-training night. Second, experience-dependent changes in regional brain activity occur during post-training sleep. These changes are shown to be related to the processing of high-level material and to be modulated by the amount of learning achieved during the training session. These changes do not involve isolated brain areas but entire macroscopic cerebral networks. These data suggest a role for sleep in the processing of recent memory traces.

[Diagnostic, symptomatic and sanitary assessment of schizophrenic patients in Liege psychiatric institutions]. / Analyse diagnostique, symptomatologique et sanitaire des patients schizophrènes en service psychiatrique liégeois.

This study was designed to provide a diagnostic, symptomatologic and sanitary assessment of schizophrenic patients in the network of institutions of the Plate-Forme Psychiatrique Liégeoise (Liège, Belgium). The diagnosis of schizophrenia was based on the DSM IV. Demographic, social and global functioning (GAF scale) data were collected from the Résumé Psychiatrique Minimum (RPM) , a clinical summary which has been imposed for each psychiatric hospital stay by the Belgian Ministry of Public Health. Symptoms components were derived from the Psychosis Evaluation tool for Commom Use by Caregivers (PECC). In the 44 participating institutions, 793 cases of schizophrenia were reported (533 men and 260 women) with a mean age of 46.1 14.4 years. The study confirmed the predominance of men in schizophrenia (67%) but revealed that women were about 6 years higher than men. PECC symptoms were studied in a random sample of 184 patients extracted from the 793 initial patients and analysed with respect to age, sex and type of care (full-time or part-time hospitalization, ambulatory care). Negative, cognitive and total PECC scores did not vary with sex but were positively correlated with age. Hospitalized patients were significantly older than the others. The cognitive deficit was significantly higher in hospitalized patients than in other patients, while the perception of the disease tended to be more apparent in ambulatory than in hospitalized patients. Data were also related to social information and global functioning. The GAF scores increased with age but were comparable in men and women. Moreover, GAF scores were significantly lower in catatonic type schizophrenia patients than in others.

[A psychiatric key: the day hospital]. / Une clé psychiatrique: l'hôpital de jour.

After being the first structure of this type in Belgium, the day hospital "La Clé" from the University of Liège exhibit the modalities of its functioning with some comments. It is considered as a dynamic structure in the view of a intergrated psychiatry. The specificity of the day hospital is discussed.

[Controlled therapeutic study of spontaneous bucco-linguo-facial dyskinesias (author's transl)]. / Etude thérapeutique contrôlée des dyskinésies bucco-linguo-faciales spontanées.

A triple blind study has been conducted according to an original methodology to compare the effects of thioproperazine and tiapride on the spontaneous bucco-linguo-facial dyskinesias in the elderly. Side effects have been balanced to obtain a quantitative evaluation. Thioproperazine (3 x 3 mg/day) and tiapride (3 x 100 mg/day) reduce both significantly the number of dyskinesias, the former being more active than the latter. On the other hand, side effects of thioproprerazine are significantly higher than those of tiapride which are themselves not different from those induced by the placebo. Taking into account these results and the fact that dyskinesias represent a benign condition, the tiapride appears to be the first choice drug.

[Abnormal involuntary movements in the elderly and their treatment (author's transl)]. / Les mouvements anormaux observés chez les vieillards et leur traitement.

In the elderly, there are two main types of abnormal involuntary movements: tremors on one hand and dyskinesias on the other. Among tremors, senile and parkinsonian types have to be separated because they have different semeiologic signs and distinct therapeutics. Senile tremor is present during movements and tonically maintained attitude. It affects upper extremities (often asymmetrically) and the head; it is reduced by alcohol. When possible (in the absence of contrindications) its best treatment is by beta-blockers. Parkinsonian tremor is typically present at rest and is reduced by a voluntary movement. L-dopa is active but in the elderly the dosis has to be reduced. Dyskinesias are repetitive but not rythmic involuntary movements which are made at the speed of a normal movement. There are at least two types of dyskinesias: spontaneous and post neuroleptics (i.e. tradive). Spontaneous dyskinesias essentially involve the axial muscles and are chiefly bucco-linguo-facial. They are well controlled by various neuroleptics. If eventual side effects are taken into account, tiapride appears to represent the good choice. Tardive dyskinesias do not disappear when responsible neuroleptics are stopped and are usually permanent. Paradoxically, when necessary, their treatment consists in resuming a neuroleptic prescription.

Spontaneous buccolinguofacial dyskinesia in the elderly.

Buccolinguofacial dyskinesia consists of repetitive, non-rhythmic abnormal movements which occur at the speed of normal voluntary movement. To the observer they do not suggests a normal activity of mastication or phonation. This type of dyskinesia was evidenced in 88 patients out of a total of 240 elderly examined. It is more frequent in females than in males. Incidence does not increase with age. Frequency is highly variable individually. Every subject seems to have a comparatively stable frequency of his own. Dyskinesia is reduced or suppressed by neuroleptics, whereas stereotyped movements of the limbs are not affected. Individualization of bucolinguofacial dyskinesia from other abnormal movements should consequently rest on both its clinical features and its pharmacological sensitivity.

Droperidol in acutely agitated patients. A double-blind placebo-controlled study.

Forty-one acutely agitated patients received an i.v. injection of 4 ml of a double blind solution containing either 10 mg of droperidol or placebo. The need for further medication (5 mg of haloperidol after 3 minutes or individually adapted psychotropics after 30 minutes) was used as a parameter for the evaluation of the results. Three minutes after the injection, haloperidol was needed by only six out of 19 patients of the droperidol group, but by 19 patients of the control group. Thirty minutes after the first injection, further medication was needed by only four droperidol patients and 10 placebo patients. No side effects could be attributed to the double blind medication.