[Environmental crisis and mental health]. / Crise environnementale et santé mentale.

Global warming threatens the survival of humanity and is the greatest challenge of our generation. While the consequences for physical health are well documented, the impact on mental health, while considerable, was too little studied. This unprecedented crisis is putting a strain on our health care systems and is mostly affecting vulnerable and precarious populations. There is an urgent need to rethink and improve our way of life, our work habits and the resilience of our health care system.

Le réchauffement climatique menace la survie de l'humanité et constitue le plus grand défi de notre génération. Alors que les conséquences sur la santé physique sont largement documentées, l'impact sur la santé mentale, bien que considérable, restait trop peu étudié. Cette crise sans précédent met sous tension nos systèmes de soins et touche majoritairement des populations déjà précarisées et vulnérables. Il est urgent de repenser et d'améliorer notre mode de vie, notre activité professionnelle et la résilience de nos systèmes de soins de santé.

[Deep brain stimulation as a treatment for severe multidrug-resistant obsessive compulsive disorder]. / La stimulation cérébrale profonde comme traitement du trouble obsessionnel compulsif sévère multi-résistant.

Obsessive compulsive disorder (OCD) is a common and disabling psychiatric condition. About 10 % of patients are considered to be severely affected and refractory to the usual treatments, combining antidepressants and psychotherapy. Deep brain stimulation (DBS) is a promising treatment, reserved for specialized university centers. It is based on the implantation of electrodes aimed at modulating dysfunctional cortico-striato-thalamo-cortical circuits. After studying the different targets to be used, it is now proposed to rethink DBS in terms of networks. The improvement of pathophysiological knowledge of OCD and the development of functional neuroimaging techniques should allow the design of individualized treatment protocols.

Le trouble obsessionnel compulsif (TOC) est une pathologie psychiatrique fréquente et invalidante. Environ 10 % des patients sont considérés comme très sévèrement atteints et réfractaires aux traitements habituels, combinant antidépresseurs et psychothérapies. Réservée à des centres universitaires spécialisés, la stimulation cérébrale profonde (SCP) est un traitement prometteur qui repose sur l'implantation d'électrodes visant à moduler des circuits cortico-striato-thalamo-corticaux dysfonctionnels. Après l'étude des différentes cibles à utiliser, il est aujourd'hui proposé de reconsidérer la SCP en termes de réseaux. L'amélioration des connaissances physiopathologiques du TOC et le développement de techniques de neuro-imagerie fonctionnelle devraient permettre de dessiner des protocoles de traitement individualisé.

[Obesity and eating disorders]. / Vignette thérapeutique de l'étudiant. Obésité et troubles du comportement alimentaire.

Obesity is a chronic disease that is difficult to manage and is often punctuated by treatment failure. Screening for eating disorders, the prevalence of which is high in overweight patients, is essential in order to minimize the risk of relapse and the «yoyo¼ phenomenon. As the reason for consulting obese subjects is rare to be eating disorders from the outset, it is necessary to assess this behaviour from the first consultations, in order to propose a specific therapeutic approach aimed at stable weight loss in the long term.

L'obésité est une maladie chronique dont la prise en charge est ardue et souvent ponctuée d'échecs. Le dépistage des troubles du comportement alimentaire, dont la prévalence est élevée chez les patients en surpoids, est indispensable afin de minimiser le risque de rechute et le phénomène «yoyo¼. Comme il est rare que le motif de consultation des sujets souffrant d'obésité soit d'emblée le désordre alimentaire, il est nécessaire d'évaluer ce comportement, dès les premières consultations, afin de proposer une approche thérapeutique spécifique, visant une perte de poids stable au long cours.

[Catatonia, complicated withdrawal from benzodiazepines]. / Vignette thérapeutique de l'étudiant Syndrome catatonique lié à un sevrage compliqué en benzodiazépines.

The article describes a clinical case of catatonic syndrome. We describe the manifestations of the syndrome, its diagnostic criteria and associated scales. The modalities of the challenge test, constituting a diagnostic test, and first line treatment are detailed. Clinical and paraclinical investigations are proposed to determine the etiology. The benzodiazepine withdrawal as an etiology of catatonic syndrome is detailed.

L'article expose un cas clinique de syndrome catatonique. Nous y décrivons les manifestations du syndrome, ses critères diagnostiques et échelles associées. Les modalités du «challenge test¼, constituant une épreuve diagnostique, et le traitement de première ligne sont détaillés. Des investigations cliniques et paracliniques sont proposées afin d'en déterminer l'étiologie. Le sevrage en benzodiazépines comme étiologie du syndrome catatonique est discuté.

[Innovative therapeutic approaches in psychiatry : neuromodulation. For whom, why and how ?] / Approches thérapeutiques innovantes en psychiatrie : neuromodulation Pour qui ? Pour quoi ? Comment ?

Recent technological advances have seen the resumption or the advent of new approaches in the field of psychiatry such as electroconvulsive therapy, repeated transcranial magnetic stimulation, transcranial direct current electrical stimulation or even deep brain stimulation. These new approaches offer a window into the understanding of the neurobiological mechanisms linked to mental illnesses. This review summarizes current knowledges in the field and the future directions for the treatment of depression or obsessive-compulsive disorder.

Des avancées technologiques récentes ont vu la reprise ou l'avènement de nouvelles approches dans le champ de la psychiatrie, telles que l'électroconvulsivothérapie, la stimulation magnétique transcrânienne répétée, la stimulation électrique transcrânienne à courant continu, ou encore, la stimulation cérébrale profonde. En parallèle, ces nouvelles approches offrent une fenêtre neurobiologique sur les mécanismes liés aux maladies mentales. Cet article synthétise les connaissances actuelles dans le domaine et les futures directions pour le traitement de la dépression et du trouble obsessionnel compulsif.

[Benefits and risks associated to lithium use in psychiatry]. / Vignette thérapeutique de l'étudiant. Bénéfices et risques de l'utilisation du lithium en psychiatrie.

The goal of the article was to provide some clinical recommendations for a secure use of lithium. We described the mechanism of action of lithium, that acts as a mood stabilizer but also has anti-suicidal and neuroprotective effects. We also described the toxics effects of lithium and the toxicological tools that help to prevent and to treat those effects. We concluded that lithium remains a first choice for the treatment of bipolar disorders.

L'article fournit des recommandations cliniques pour utiliser le lithium de façon efficace et sûre. Nous décrivons les mécanismes d'action du lithium, stabilisateur de l'humeur aux propriétés antisuicidaires et neuroprotectrices. Nous détaillons les effets toxiques du lithium et les outils de toxicologie clinique qui permettent de les prévenir et de les diagnostiquer. Le lithium reste le traitement de référence des troubles bipolaires.

[Pain complaints in a patient with schizophrenia]. / Vignette diagnostique de l'étudiant. Analyse critique des plaintes douloureuses du patient atteint de schizophrénie.

Schizophrenia is a complex pathology. Its prevalence reaches almost 1 %. Its semiology can be diversified. Sensorial perception can be altered included pain perception. Most of the studies conclude that psychotic patients have a hypoalgesia. It's important to consider this fact to avoid missing potentially grave somatic disease.

La schizophrénie est une pathologie complexe dont la prévalence avoisine 1 %. Sa sémiologie peut prendre de multiples formes. La discrimination sensorielle peut être altérée, y compris la perception douloureuse. La grande majorité des études réalisées à ce jour démontrent une hypoalgésie chez les patients atteints de schizophrénie. Il est important de tenir compte de ces données dans la prise en charge des patients exprimant des idées délirantes ou des hallucinations afin d'éviter de passer à côté d'affections non psychiatriques potentiellement graves.

[Conversion disorder : functional neuroimaging and neurobiological mechanisms]. / Vignette diagnostique de l'étudiant. Trouble de conversion : neuroimagerie fonctionnelle et mécanismes neurobiologiques.

Conversion disorder is a psychiatric disorder often encountered in neurology services. This condition without organic lesions was and still is sometimes referred as an imaginary illness or feigning. However, the absence of organic lesions does not exclude the possibility of cerebral dysfunction. The etiologic mechanisms underlying this disorder remain uncertain even today.The advent of cognitive and functional imaging opens up a field of exploration for psychiatry in understanding the neurobiological mechanisms underlying mental disorders and especially the conversion disorder. This article reports several neuroimaging studies of conversion disorder and attempts to generate hypotheses about neurobiological mechanisms.

Le trouble de conversion est une pathologie psychiatrique fréquemment rencontrée dans les services de neurologie. Cette pathologie «sans substrat¼ a été et est encore parfois qualifiée de maladie imaginaire ou de simulation. Cependant, l'absence de substrat «organique¼ n'exclut pas la possibilité d'un dysfonctionnement cérébral. Les mécanismes étiopathogéniques qui sous-tendent ce trouble sont longtemps restés incertains, encore aujourd'hui. L'avènement des sciences cognitives et de l'imagerie fonctionnelle ouvre un champ d'exploration pour la psychiatrie dans la compréhension des mécanismes neurobiologiques qui sous-tendent les troubles mentaux et, en particulier, le trouble de conversion. Cet article reprend plusieurs études de neuroimagerie sur le trouble de conversion et tente d'en dégager des hypothèses sur ses mécanismes neurobiologiques.

[ELECTRONIC LOGBOOK: LEARNING TOOL AND TEACHING AID FOR THE EVALUATION OF LEARNING ACTIVITIES]. / LogBook numérique: un carnet de bord réflexif comme outil d'apprentissage en contexte de stage.

A LogBook is a learning tool and teaching aid I where clinical settings lived during training courses are provided. A LogBook is basically a journal which evidences learning and skills. LogBook provides a means for monitoring student learning, both for the student and for the instructor. It provides a feedback loop for the evaluation of learning activities. This LogBook has been developed for the student's training in psychiatry but it may be extended to all medical disciplines. The authors have developed an electronic logbook to support learning and assessment. In the context of Europe, it has become necessary to set up a LogBook of uniform learning outcomes to assist medical students.

[50 Hz electric and magnetic fields and health: which message to the public?]. / Champs électriques et magnétiques 50 Hz et santé: quel message au grand public?

Scientific data of effects of 50 Hz electric and magnetic fields on health are inconclusive. This uncertainty raises numerous questions. In this paper, significant key concepts are described to better understand the potential effects of electric and magnetic fields on health. Everyday life exposure values are included, as well as courses of action to be taken in front of a patient asking questions on health effects of 50 Hz electric and magnetic fields.

[Depression as a common complication of systemic lupus erythematosus]. / La vignette diagnostique de l'etudiant. La dépression est une complication fréquente du lupus érythémateux disséminé: considérations épidémiologiques, pathogéniques et thérapeutiques.

Systemic lupus erythematosus (SLE) is an inflammatory disease with multiple and disabling consequences, including the psychological status. The prevalence of major depressive episodes among patients suffering from SLE is significantly higher than in healthy people, or people suffering from other inflammatory diseases. While it is obvious that its chronic disease status with a frequently pejorative ending, as well as the number of treatments it requires, are contributing factors, it is likely that due to its pathogenic mechanisms, SLE causes direct injury to the brain, leading to a depressive symptomatology. Numerous hypotheses are under consideration. We shall review them all, recall a few epidemiologic features, add histology and medical imaging contributions and discuss the importance of setting up a fitting therapy for such patients.

Additional intranasal oxytocin to escitalopram improves depressive symptoms in resistant depression: an open trial.

The aim of this open trial was to assess the antidepressant/anxiolytic effects of oxytocin used as an adjunct to antidepressant in treatment-resistant depression. Fourteen patients, who have not responded to 40mg of escitalopram, received intranasal synthetic oxytocin during 4 weeks, in association with antidepressant. This is the first open trial study suggesting OT in association with escitalopram significantly reduced scores on Hamilton Depression Rating Scale.

[Clinical study of the month: depressive pseudo-dementia]. / Le cas clinique du mois. Pseudo-démence dépressive.

We report the case of a man aged 62 suffering from a known type I bipolar disorder and referred by his attending psychiatrist because of a state of spatiotemporal disorientation, confusion and prostration evoking significant neurologic impairment. The interest of this case report is in the use of the 18-FDG PET-Scanner, which is increasingly widespread in clinical psychiatry, to support the differential diagnosis between a psycho-organic pathology like dementia or a functional psychiatric pathology like depressive pseudo-dementia (also named melancholic dementia), in which some patterns of dysfunction can now be identified by functional imaging.

[Depression and type 2 diabetes: etiopathogenic analysis of a frequent comorbidity]. / Dépression et diabète de type 2. Analyse étiopathogénique d'une comorbidité fréquente.

Recent advances in the neurobiology of depression have underlined the importance of markers of inflammation, neurotrophins, and hypothalamo-pituitary adrenal (HPA) axis dysfunction in the development of this pathology. These disorders could have some impact on other systems such as the glucose metabolism regulation with an increased risk of insulin resistance and type 2 diabetes. Type 2 diabetes is also frequently associated with a pro-inflammatory state that could favour the development of a depressive episode. Inflammatory phenomena and HPA axis dysfunction could be biological links between depression and type 2 diabetes and account not only for the frequent association between those two disorders, but also for the treatment-resistance to classical antidepressants.

[Antipsychotics in depression]. / Des antipsychotiques dans la dépression.

Depression is a major public health problem. In the treatment of depression, the main objectives must be complete remission and prevention of recurrence. However, the objective of remission remains difficult in clinical practice. Several pharmacological strategies exist to handle treatment resistant depression and achieve remission. Among these options, addition of an atypical antipsychotic has become a popular choice. Second generation antipsychotics have been investigated in clinical trials in treatment resistant depression and in bipolar depression. Scientific data are available particularly for aripiprazole and quetiapine XR.

[Psychiatric complications and addictions]. / Complications psychiatriques et addictions.

Psychiatric complications are clearly associated with substance abuse. Psychopathological symptoms appear during intoxication or in patients suffering from substance-induced psychiatric disorders. However, the assessment of the psychiatric symptomatology is particularly challenging in patients who express clear difficulties to accept that the disorder is favoured by substance abuse. Psychotic reactions, major depression and anxiety disorders are the main psychiatric issues observed in addict patients.

[Cocaine addiction]. / Addiction à la cocaïne.

Cocaine is the second most commonly used illicit drug after cannabis in the general population. Cocaine is a powerful stimulating agent of the central nervous system and a highly addictogenic drug. Somatic and psychiatric consequences of cocaine addiction are major and clinically relevant. The increasing consumption of cocaine and the importance of its consequences justify an update of our knowledge about cocaine addiction.

[Affective dependency]. / La dépendance affective.

Affective dependency is characterized by emotional distress (insecure attachment) and dependency to another person with a low self-esteem and reassurance need. The paper proposes a reflection on the definition of emotional dependency and the confusion caused by various denominations. Overprotective and authoritarian parenting, cultural and socio-environmental factors may contribute to the development of dependent personality. Psychological epigenetic factors, such as early socio-emotional trauma could > on neuronal circuits in prefronto-limbic regions that are essential for emotional behaviour.We also focus on the interrelations between dependent personality, domestic violence and addictions. The objective for the clinician is to propose a restoration of self-esteem and therapeutic strategies focused on autonomy.

[How to cope with the bad reputation of depression]. / Comment s'adapter à la mauvaise réputation de la dépression?

Today, the term depression has lost its meaning. Recent scientific data suggests a change in our classifications of mental disorders. Depression is frequently used to refer to "normal" sadness, anxiety disorders, personality disorders or adjustment disorders... Moreover, in our society, this diagnosis remains badly accepted. It is really time to be aware of the deterioration of the image of psychiatry, and particularly the bad image of depression and its treatment with antidepressants. This paper is a reflexion inviting general practicioners and psychiatrists to progressively avoid the term depression and rather use the diagnosis of unipolar mood disorder, a broader concept, more adapted to new scientific data, less stigmatizing, and closer to the evolution of our society.

[The acute management of agitation]. / Comment je traite ...la prise en charge de l'agitation en urgence.

Agitation in psychiatry is defined as "a request to which an answer cannot be deferred". If some types of controllable agitation can be solved by human means or psychotropic drugs, others may require the intervention of intensivists who will contribute to the onset of crisis resolution. In addition, an organic aetiology must be carefully excluded a before considering a psychiatric origin of agitation, especially in patients with no psychiatric history and in the elderly. Indeed, acute agitation can hide serious somatic traps and be life threatening.