[Toward a better understanding of fatigue in schizophrenia]. / Vers une meilleure compréhension de la fatigue dans la schizophrénie.

Despite being one of the most common complaints of people with schizophrenia, fatigue remains largely unexplored in this population. The lack of knowledge regarding this complex symptom makes it often underdiagnosed and undertreated in schizophrenia. The aim of this brief perspective review is to outline the potential origins (distinguishing primary and secondary fatigue) and consequences of fatigue and to explore some potential treatments in this population. The current literature in schizophrenia has mainly investigated fatigue as a trait, using a self-administered questionnaire. Beyond this observational approach, which does not allow to capture the symptom in real life situations where high levels of fatigue can emerge rapidly, we propose to consider the state level of fatigue, for instance occurring after a prolonged period of cognitive activity (i.e. mental fatigue). We elaborate on the potential relationships between mental fatigue and negative symptoms of schizophrenia and propose some research avenues to test the effects of acute fatigue on effort intentions and behaviours. The consideration of the multidimensional aspects of fatigue will allow to move beyond the sole pharmacological approach to treat fatigue in schizophrenia. Targeting the cognitive as well as the performance components of fatigue through interventions such as concomitant aerobic exercise - mental training offers attractive prospects to reduce fatigue in this population and minimize its functional negative impact.

Automatic video monitoring system for assessment of Alzheimer's disease symptoms.

In order to fully capture the complexity of the behavioural, functioning and cognitive disturbances in Alzheimer Disease (AD) and related disorders information and communication techniques (ICT), could be of interest. This article presents using 3 clinical cases the feasibility results of an automatic video monitoring system aiming to assess subjects involved in a clinical scenario. METHOD AND POPULATION: The study was conducted in an observation room equipped with everyday objects for use in activities of daily living. The overall aim of the clinical scenario was to enable the participants to undertake a set of daily tasks that could realistically be achieved in the setting of the observation room. The scenario was divided in three steps covering basic to more complex activities: (1) Directed activities, (2) Semi-directed activities, (3) Undirected ("free") activities. The assessment of each participant of the study was done with an automatic video monitoring system composed of a vision component and an event recognition component. The feasibility study involved three participants: two AD patients and one elderly control participant. RESULTS: The first result of the study was to demonstrate the feasibility of this new assessment method from both the patient and the technical points of view. During the first step the control participant performed all these activities faster than the two AD participants. During the second step of the scenario AD participants were not able to follow the correct order of the tasks and even omitted some of them. Finally during the last step of the scenario devoted to free activities the control participant chose one of the proposed activities (reading) and undertook this activity for almost the entire duration. In contrast, the two AD participants had more difficulties choosing one of the suggested activities and were not able to undertake any one activity in a sustained manner. DISCUSSION: The automatic video monitoring system presented here analyzes human behaviours and looks for changes in activity through the detection of the presence of people and their movements in real time. Once the technique has been standardized, it could significantly enhance the assessment of AD patients in both clinical and clinical trial settings as well as providing further information regarding patient frailty that could enhance their safety and ease caregiver burden.

Diagnostic criteria for apathy in clinical practice.

BACKGROUND: Apathy is an important and distressing behavioural symptom in Alzheimer's disease and in various neuropsychiatric disorders. Recently, diagnostic criteria for apathy have been proposed. OBJECTIVES: In groups of patients suffering from different neuropsychiatric diseases, (i) to estimate the prevalence of patients meeting the proposed diagnostic criteria; (ii) to estimate the concurrent validity of the criteria with the neuropsychiatric inventory (NPI) apathy item; (iii) to identify the most frequently met criteria or sub-criteria in each specific neuropsychiatric disease and (iv) to estimate the inter-observer reliability of the diagnostic criteria for apathy. METHODS: This cross-sectional, multicentric, observational study was performed on 306 patients. Each of the participating centres had to check the presence of apathy according to the diagnostic criteria for apathy in consecutive patients belonging to the following diagnoses list: Alzheimer disease (AD), mixed dementia, mild cognitive impairment (MCI), Parkinson's disease (PD), Schizophrenia (DSM-IV) and major depressive episode. In addition to the clinical interview, the assessment included the Mini Mental Score Examination (MMSE) and the NPI. At the end of the visit, clinicians were required to check the diagnostic criteria for apathy. RESULTS: Using the diagnostic criteria for apathy, the frequency of apathy was of 53% in the whole population, 55% in AD, 70% in mixed dementia, 43% in MCI, 27% in PD, 53% in schizophrenia and 94% in major depressive episode. In AD, mixed dementia, MCI and PD, the NPI apathy score was significantly higher for patient fulfilling the apathy criteria. Goal-directed cognitive activity (criteria B2-Cognition) was the most frequently observed domain followed by goal-directed behaviour (criteria B1-Behaviour) and emotion (criteria B3), respectively. Inter-rater reliability was high for the overall diagnostic (κ coefficient = 0.93; p = 0.0001) and for each criteria. CONCLUSION: This study is the first one to test the diagnostic criteria for apathy in clinical practice. Results make the diagnostic criteria useful for clinical practice and research.