[Prevalence of anxiety disorders and depression among junior doctors and their links with their work]. / Prévalences des troubles anxieux, de l'humeur et de la souffrance au travail des internes de médecine.

UNLABELLED: The caregivers are exposed to several occupational hazards, including psychosocial risks. Among these occupational groups, junior doctors have been little studied. The aim of this study was to evaluate the prevalence of depression and anxiety among junior doctors and their links with their work. METHODS: This is a prospective study using an anonymous online questionnaire between October 2011 and June 2012. Every junior doctor of Brest medical school was included without exclusion criteria. The questionnaire asked about demographic and health data. It included four validated scales: the Center for Epidemiologic Studies Depression Scale (CES-D), the Spielberger anxiety questionnaire, the Quality of Life Questionnaire of WHO (WHO-QOL) and the Job Content Questionnaire of Karasek. RESULTS: One hundred and ninety-two junior doctors were included; 68.2 % of them were women. They were 13.0 % suffering from depression; 28.7 % from anxiety; 32.8 % of junior doctors were in job strain and 29.7 % in iso strain. Depression was correlated with high psychological demands and anxiety. The lack of organizational support from senior doctors and competition between junior doctors increased the junior doctors' anxiety. CONCLUSION: A part of junior doctors is anxious and depressed, somehow due to the psychological demands of work and relationships with other junior doctors and with senior doctors.

[Acute and transient psychotic disorder at the onset of schizophrenia]. / La bouffée délirante aiguë au début de la schizophrénie.

Although the mode of onset of schizophrenia can be acute, it is important to remember that the disorder rarely starts as a "clap of thunder in a quiet sky", and that it is more often gradual and insidious, with negative and affective symptoms. Acute and transient psychotic disorder, on the other hand, is a short delusional episode forming suddenly and lasting a few days, sometimes a few hours. Schizophrenic evolution forms only part of the possible evolutions. It is therefore necessary to disassociate acute and transient psychotic disorder from schizophrenic disorders, which gives a wrong representation of the onset of schizophrenia.

Post-acute crisis text messaging outreach for suicide prevention: a pilot study.

Several post-suicide prevention strategies such as sending postcards or making phone calls have been used to keep in contact with suicide attempters. The continuity of care has been beneficial to the prevention of post-acute suicidal behaviors. The aim of the study was to evaluate the technical feasibility and acceptability of text messaging outreach in post-acute suicide attempters. Eighteen post-suicidal patients were included in a prospective, monocentric, open-label, 2 months pilot study. The text messages were sent from the intranet program that we specially developed for the study. Technical feasibility of this text message intervention was evaluated by the analysis of text message reports. Acceptability of such intervention was evaluated by a standardized phone interview. Our study showed that receiving text messages sent from an intranet program after a suicide attempt is technically possible. This post-crisis outreach program was accepted by the patients who found it to have a positive preventive impact. Text messaging outreach offers several advantages such as lower cost, and easier utilization compared to current post-acute care strategies. We suggest further randomized controlled trials in a large sample of suicidal patients to assess the efficacy of this novel outreach tool for prevention of post-acute suicide.

Prevalence of antiphospholipid antibodies in psychiatric patients users and non-users of antipsychotics.

Past reports have suggested that antiphospholipid (aPL) antibodies may emerge as a response to antipsychotics treatment, as a high prevalence of aPL antibodies in antipsychotics users has been observed. However, no control group of non-medicated psychiatric patients was included in these reports. In a cross sectional study we determined the prevalence of aPL antibodies in 333 psychiatric inpatients. We compared the proportions of positive aPL antibodytests between users and non-users of antipsychotics with adjustments for potential confounders. The proportion of antipsychotics users carrying at least one aPL antibody ranged from 10·8% to 27·0% compared with 6·8% to 27·2% in non-users (P = 0·24, P = 0·24) depending on the method of detection of lupus anticoagulant (LA). The prevalence of LA detected by dilute Russell viper venom time or partial thromboplastin time-LA was not different between antipsychotics users and non-users (8·1% vs. 5·4%, P = 0·53 and 18·4% vs. 18·2%, P = 0·22), as well as the prevalence of IgM and IgG anti-ß2-glycoprotein-I antibodies, IgM and IgG anti-cardiolipin antibodies(3·8% vs. 2·0%, P = 0·75, 0·0% vs. 0·0%, P = not applicable, 1·1 vs. 1·4%, P = 0·91, 2·7% vs. 3·4%, P = 0·71). In conclusion, aPL antibodies were frequently found in patients with psychiatric diseases and no significant increase in the prevalence of aPL antibodies was observed in antipsychotics users.

Evaluation of GPs diagnostic knowledge and treatment practice in detection and treatment of early schizophrenia: a French postal survey in Brittany.

AIMS: Evaluating French general practitioners (GPs) diagnostic knowledge and practice in the detection and treatment of early schizophrenia as well as needs and preferences with specialist services. METHODS: A postal survey comprising 27 questions was conducted among 2,039 GPs from three counties of Western France. Composite scores were calculated to determine a level of diagnostic knowledge. RESULTS: A total of 515 GPs (25.3%) responded to the survey. The mean score to determine a level of knowledge on the most important aspects in detecting early stages of schizophrenia was 5.3 ± 2.50 [median = 6 (range 0-10)]. The mean score to determine the overall knowledge of schizophrenia was 8.1 ± 2.98 [median = 8 (range 1-16)]. The majority of surveyed GPs (76.1%) would treat early schizophrenia pharmacologically. A majority of GPs (53.9%) advise an insufficient duration of anti-psychotic treatment for first episode psychosis. The vast majority (90.8%) were in favour of a specialized outpatient service. CONCLUSIONS: French GPs tend to have a deficit in diagnostic knowledge and practice in detection and treatment of early schizophrenia. It seems important to provide GPs with continuing medical education (CME) on detection and management of early schizophrenia and to set up relevant specialized outpatient services.

[Neuropsychiatric manifestations in multiple sclerosis (MS): Might psychotic symptoms signal the onset of the disease?]. / Manifestations neuropsychiatriques dans la sclérose en plaques : et si des symptômes psychotiques annonçaient le début de la maladie ?

Patients suffering from multiple sclerosis (MS) can often dysplay psychiatric symptoms throughout the disease. The frequency of those symptoms could be two or three times greater in MS patients compared to the general population. Psychotic symptoms could be an early sign of MS. At first, neurological symptoms can either be mild or altogether absent. MRI brain scans show cerebral lesions in frontal and temporal regions. New MRI sequencing techniques support the hypothesis that disseminated defects in the grey matter occur in MS. These defects could in turn be responsible for cognitive disorders. Patients presenting a first-episode psychosis must have a neurological examination. MS should be considered as an alternative diagnosis of psychosis, particularly in atypical cases where family history of psychosis is absent and where there is bad response to standard psychotropic treatment. Collaboration between neurologists and psychiatrists whilst caring for patients displaying neuropsychiatric manifestations of MS is crucial to enable more accurate diagnoses and try to improve treatment and overall prognosis.

[Towards early diagnosis of schizophrenia]. / Vers un diagnostic précoce de la schizophrénie.

Schizophrenia is a serious, chronic illness which, when treated early, can result in a better prognosis. The putting in place of treatment is often delayed because it is difficult to identify early schizophrenic disorders. At this stage of the illness, the doctor participates as much as the family and the patients themselves in the delay of the diagnosis. In order to encourage early diagnosis of people with schizophrenia, Brest regional university hospital has created a specialised consultation.

[Harassment in the workplace: clinic and psychopathological factors]. / Harcèlement et souffrance au travail, clinique et eléments de psychopathologie.

Harassment may be either moral, physical or sexual. It is defined as a phenomenon that happens repeatedly. It is underestimated in professional environments and probably even more so in private life. Without referring to a pathological personality, harassers have common pathological traits.

[Detecting the alarm signs of the suicidal crisis]. / Entretien d'alerte de la crise suicidaire.

Suicidal crisis is an escaping moment during which the subject shows a state of vulnerability and a lack of his/her defense abilities, putting him/her in a pain which is not always visible and that does not express itself through a plain nosographic context. Because of that, the practitioner's intervention is made more complicated. In this article, we offer a way to conduct the interview to detect the alarm signs of the suicidal crisis, insisting on the clinical, biographical and environmental elements that are to be looked for. Therefore, the analysis of the suicidal discourse (suicidal ideas expressed or hidden suicidal complaints), the search for risk and protective factors clearly identified, and the interest shown to the personal experiment of the crisis state, will make the evaluation and the determination of suicidal potentialities easier. This is based on the tripod Risk-Emergency-Dangerousness (RED), which will give a direction to the most efficient 24-48 hours care at the conclusion of the interview, whether it were ambulatory (low suicidal potentiality) or requiring an hospitalization (medium or high suicidal potentiality).

[Early stages of schizophrenia, challenges and prospects]. / Schizophrénie débutante, enjeux et perspectives.

Despite a relatively extensive treatment armamentarium, the evolution of schizophrenic patients overall remains unfavourable. Early treatment is essential and influences the prognosis. Facilitating access to care through the creation of specialised assessment centres to complement the current system of care is one of the possible avenues for improvement.

[Early diagnosis in schizophrenia: a mission for the general practitioners?]. / Diagnostic précoce dans la schizophrénie: une mission pour les médecins généralistes?

Schizophrenia represents a relatively frequent disease within the population with a prevalence of 1 %. Despite a consistent therapeutic equipment at doctors' disposal, the evolution of this disease remains globally rather unfavourable. For a long time, the classic concept from Magnan "bouffée délirante aiguë" was considered as the main mode of entrance of the schizophrenia. Now, in most cases, the beginning of the disease is progressive and insidious. Two phases in the evolution of the disease before appearance of true psychotic symptoms are described: a premorbid phase and a prodromic phase. The early care of this disease has a major impact for the prognosis. The Duration of Untreated Psychosis (DUP) is correlated to an unfavourable evolution of the disease. It is advisable to reduce the delay of first care by locating prematurely the patients developing a psychosis. Because of their central place in our health care system, the general practitioners have a major role in this screening. The clinical symptoms of the prodromic phase are rather heterogeneous and little specific. The general practitioners must be made sensitive to search the symptoms suggesting an entrance to the psychosis and to allow a care adapted to these patients. But they are relatively little exposed to the psychotic disorders and must be supported in their mission by specialized centers.