Cold Spring Harbor Laboratory - bioRxiv, Oct 17, 2022
Background: The cerebellum critically contributes to higher-order cognitive and emotional functio... more Background: The cerebellum critically contributes to higher-order cognitive and emotional functions such fear learning and memory. Prior research on cerebellar volume in PTSD is scant and has neglected neuroanatomical subdivisions of the cerebellum that differentially map on to motor, cognitive, and affective functions. Methods: We quantified cerebellar lobule volumes using structural magnetic resonance imaging in 4,215 adults (PTSD n= 1640; Control n=2575) across 40 sites from the from the ENIGMA-PGC PTSD working group. Using a new state-of-the-art deep-learning based approach for automatic cerebellar parcellation, we obtained volumetric estimates for the total cerebellum and 28 subregions. Linear mixed effects models controlling for age, gender, intracranial volume, and site were used to compare cerebellum total and subregional volume in PTSD compared to healthy controls. The Benjamini-Hochberg procedure was used to control the false discovery rate (p-FDR < .05). Results: PTSD was associated with significant grey and white matter reductions of the cerebellum. Compared to controls, people with PTSD demonstrated smaller total cerebellum volume. In addition, people with PTSD showed reduced volume in subregions primarily within the posterior lobe (lobule VIIB, crus II), but also the vermis (VI, VIII), flocculonodular lobe (lobule X), and cerebellar white matter (all p-FDR < 0.05). Effects of PTSD on volume were consistent, and generally more robust, when examining symptom severity rather than diagnostic status. Conclusions: These findings implicate regionally specific cerebellar volumetric differences in the pathophysiology of PTSD. The cerebellum appears to play an important role in high-order cognitive and emotional processes, far beyond its historical association with vestibulomotor function. Further examination of the cerebellum in trauma-related psychopathology will help to clarify how cerebellar structure and function may disrupt cognitive and affective processes at the center of translational models for PTSD.
Objective-Metabolic syndrome is associated with elevated risk for cardiovascular disease and diab... more Objective-Metabolic syndrome is associated with elevated risk for cardiovascular disease and diabetes, and has increased prevalence in low-income African-Americans, which constitutes a significant health disparity. The mechanisms responsible for this disparity remain unclear; the current study investigated the relationship between Posttraumatic Stress Disorder (PTSD) and metabolic syndrome. Method-We assessed childhood and adult trauma history, Major Depressive Disorder (MDD), PTSD, and the components of metabolic syndrome in an urban population. We recruited 245 low socioeconomic status (SES), primarily African American subjects from general medical clinics in an inner-city hospital. Results-Trauma exposure was extremely prevalent, with 90.6% of subjects reporting at least one significant trauma, and 18.8% of subjects meeting criteria for a current PTSD. Metabolic syndrome was also prevalent in this population (33.2%), with significantly higher rates among patients with current PTSD (47.8%, p<.05). After controlling for demographics, smoking history, antipsychotic use, depression, and exercise, current PTSD remained the only significant predictor of metabolic syndrome (p=0.006). Conclusions-PTSD is associated with increased rates of metabolic syndrome within a traumatized, impoverished urban population. Further studies should investigate if PTSD treatment may reduce the rates of metabolic syndrome, improve overall health outcomes, and decrease healthcare disparities in minority populations.
Previous cross-sectional studies found excessive Brain Tissue Pulsations (BTP) in mid-life depres... more Previous cross-sectional studies found excessive Brain Tissue Pulsations (BTP) in mid-life depression, which could constitute a mechanism of brain damage in depression. However, it remains unclear whether successful antidepressant therapy restores BTP amplitudes. In this prospective study, we investigated longitudinal changes in BTP in patients with a major depressive episode (MDE), among responders and non-responders to escitalopram. Fifty-two individuals with a MDE, free of antidepressants at baseline, were included in an 8-week open-labeled escitalopram trial. Ultrasound Tissue Pulsatility Imaging (TPI) was applied to measure resting BTP and BTP reactivity in an orthostatic challenge, at baseline and at week 8. TPI data were available for 48 participants divided into responders (n = 28, 58.3%) and non-responders (n = 20, 41.7%) according to change in the MADRS score. MaxBTP significantly decreased between baseline and week 8, only in responders. In addition, changes in MaxBTP during the orthostatic challenge were no longer significant at week 8 but only in responders. Because excessive BTP constitutes a potential mechanism for brain damage, our results suggest that a successful pharmacotherapy could benefit patients to lower the risk of brain damage in individuals with depression, a population exposed to stroke, small arteries disease and brain atrophy. TPI could provide a surrogate biomarker to monitor antidepressant response and brain health in depression in clinical routine.
Journal of Neurology, Neurosurgery & Psychiatry, 2021
Functional seizures (FS) known also as psychogenic non-epileptic seizures or dissociative seizure... more Functional seizures (FS) known also as psychogenic non-epileptic seizures or dissociative seizures, present with ictal semiological manifestations, along with various comorbid neurological and psychological disorders. Terminology inconsistencies and discrepancies in nomenclatures of FS may reflect limitations in understanding the neuropsychiatric intricacies of this disorder. Psychological and neurobiological processes of FS are incompletely understood. Nevertheless, important advances have been made on underlying neuropsychopathophysiological mechanisms of FS. These advances provide valuable information about the underlying mechanisms of mind–body interactions. From this perspective, this narrative review summarises recent studies about aetiopathogenesis of FS at two levels: possible risk factors (why) and different aetiopathogenic models of FS (how). We divided possible risk factors for FS into three categories, namely neurobiological, psychological and cognitive risk factors. We ...
Background: The mental health impact of the COVID-19 crisis may differ from previously studied st... more Background: The mental health impact of the COVID-19 crisis may differ from previously studied stressful events in terms of psychological reactions, specific risk factors, and symptom severity across geographic regions worldwide. Objective: To assess the impact of COVID-19 on a wide range of mental health symptoms, to identify relevant risk factors, to identify the effect of COVID-19 country impact on mental health, and to evaluate regional differences in psychological responses to COVID-19 compared to other stressful events. Method: 7034 respondents (74% female) participated in the worldwide Global Psychotrauma Screen-Cross-Cultural responses to COVID-19 study (GPS-CCC), reporting on mental health symptoms related to COVID-19 (n = 1838) or other stressful events (n = 5196) from April to November 2020. Results: Events related to COVID-19 were associated with more mental health symptoms compared to other stressful events, especially symptoms of PTSD, anxiety, depression, insomnia, and dissociation. Lack of social support, psychiatric history, childhood trauma, additional ARTICLE HISTORY
This study aims to determine if resting-state functional connectivity may represent a marker for ... more This study aims to determine if resting-state functional connectivity may represent a marker for the progression of posttraumatic stress disorder (PTSD) in women victims of sexual assault. Participants were 25 adult women recruited three weeks following exposure to sexual assault (T1) and 19 age-matched healthy, non trauma-exposed controls (HC). Among the victims, 10 participants met (PTSD) and 15 did not meet (trauma-exposed controls, TEC) DSM-IV criteria for PTSD six months post-trauma (T2). At both visits, patterns of intrinsic connectivity, a measure of network centrality at each voxel of the brain, were derived from resting-state functional magnetic resonance imaging. Compared to both the HC and TEC groups, victims who developed PTSD at T2 showed higher centrality in the right middle/superior occipital gyrus at T1, while reduced centrality of the posterior cingulate cortex (PCC)/precuneus at T1 was found for the TEC group, compared to the HC group only. There were no differences in intrinsic connectivity at T1 between the TEC and PTSD groups. There were no significant between-group differences in intrinsic connectivity at T2, and no significant group-by-time interaction. This study indicates that increased occipital centrality three weeks post-trauma exposure may represent a marker of the later development of PTSD. On the other hand, reduced centrality of the PCC/precuneus may represent a marker of resilience to trauma exposure.
Recent etiopathogenic models place emotional dysregulation at the core of psychogenic nonepilepti... more Recent etiopathogenic models place emotional dysregulation at the core of psychogenic nonepileptic seizure (PNES). Our purpose was to assess physiological, cognitive, and behavioral emotional responses of PNES patients. Methods: This study compared three types of emotional responses to visual emotional stimuli between 34 female PNES group and 34 matched healthy controls: physiological response measured by skin conductance response (SCR) (rate, amplitude and latency) and heart rate deceleration; cognitive response measured by valence and arousal elicited by the images; and behavioural response measured by latency of ratings. The groups were characterized on psychiatric comorbidities, traumatic history, alexithymia, and dissociation. Results: Compared to controls, PNES group displayed lower SCR for all images (p = 0.038), shorter amplitude of heart rate deceleration (p = 0.024) and faster arousal rating for all images (p = 0.019), but no difference on cognitive rating of images. Within-groups analyses showed only in PNES subjects increased rate (+19.35%, p = 0.046) SCR for negative stimuli with strong arousal compared to negative with low arousal. PNES physiological response (SCR and heart rate deceleration) was negatively correlated to dissociation tendency (r=-0.48, p = 0.0083) and alexithymia (r=-0.44, p = 0.012)). For cognitive response, no correlation was found. Conclusion: These results are in favour of a lower physiological emotional response but with an over-reactivity at behavioral level contrasting with similar cognitive assessment. For strong aversive stimuli, PNES might present a trend to overreact at physiological and behavioural levels. Our results suggest that dissociation and difficulty in describing feelings are associated with an altered physiological response in PNES women only. 1. Introduction Psychogenic non-epileptic seizures (PNES) are paroxysmal repetitive episodes which may superficially resemble epileptic seizures, in relation to unconscious psychogenic processes and without excessive neuronal discharge. [1]. With respect to PNES, the prevalence is estimated at 4.9 / 100000 / year [2] with an estimated incidence between 2 and 33/100000 [3]. The main problems of this pathology are the differential diagnosis with epilepsy and the unnecessary prescription of anti-epileptics drugs [4,5] and the heavy impacts on the quality of life [1]. The etiopathogeny of PNES is complex and multifactorial, including predisposing, precipitating, and perpetuating factors. Roughly, two mechanisms are most often mentioned: a neurobiological predisposition and dissociation [6]. In addition, recent etiopathogenic models have placed emotional dysregulation at the core of this pathology [7]. Emotions are classically composed of three dimensions [8,9]: the cognitive (subjective) component, the behavioral expression/actions, and the physiological autonomic component [10]. It is currently recognized that all three spheres, cognitive, behavioral, and autonomic, are affected in PNES. Regarding the cognitive component, alexithymia (difficulty to identify and describe the emotions) reached 85% of the PNES patients [11,12] and suggest a difficulty in coping with emotions [13]. Bakvis [14,15] and Pick [16] found attentional biases in PNES patients to images conveying negative emotions. They also observed
Background: Clear guidance for successive antidepressant pharmacological treatments for non-respo... more Background: Clear guidance for successive antidepressant pharmacological treatments for non-responders in major depression is not well established. Method: Based on the RAND/UCLA Appropriateness Method, the French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental developed expert consensus guidelines for the management of treatment-resistant depression. The expert guidelines combine scientific evidence and expert clinicians' opinions to produce recommendations for treatment-resistant depression. A written survey comprising 118 questions related to highly-detailed clinical presentations was completed on a risk-benefit scale ranging from 0 to 9 by 36 psychiatrist experts in the field of major depression and its treatments. Key-recommendations are provided by the scientific committee after data analysis and interpretation of the results of the survey. Results: The scope of these guidelines encompasses the assessment of pharmacological resistance and situations at risk of resistance, as well as the pharmacological and psychological strategies in major depression. Conclusion: The expert consensus guidelines will contribute to facilitate treatment decisions for clinicians involved in the daily assessment and management of treatment-resistant depression across a number of common and complex clinical situations.
The European countries have a long history of exposure to large-scale trauma. In the early 1990s ... more The European countries have a long history of exposure to large-scale trauma. In the early 1990s the increasing awareness of the consequences of trauma within the mental health community led to the foundation of local societies for psychotraumatology across Europe and the European Society of Traumatic Stress Studies (ESTSS), which celebrated its 25th anniversary in 2018. The focus of this article is to describe the current state of care for survivors of trauma in the 15 European countries where ESTSS member societies have been established. Brief descriptions on the historical burden of trauma in each country are followed by an overview of the care system for trauma survivors in the countries, the stateof-the-art of interventions, current challenges in caring for survivors and the topics that need to be most urgently addressed in the future. The reports from the different countries demonstrate how important steps towards a better provision of care for survivors of trauma have been made in Europe. Given the cultural and economic diversity of the continent, there are also differences between the European countries, for instance with regard to the use of evidence-based treatments. Strategies to overcome these differences, like the new ESTSS training curricula for care-providers across Europe, are briefly discussed.
Introduction: The perinatal period is an at-risk period for the emergence or decompensation of ps... more Introduction: The perinatal period is an at-risk period for the emergence or decompensation of psychiatric disorders. Transcranial electrical stimulation (tES) is an effective and safe treatment for many psychiatric disorders. Given the reluctance to use pharmacological treatments during pregnancy or breastfeeding, tES may be an interesting treatment to consider. Our study aims to evaluate the efficacy and safety of tES in the perinatal period through a systematic literature review followed by three original case reports. Method: Following PRISMA guidelines, a systematic review of MEDLINE and ScienceDirect was undertaken to identify studies on tES on women during the perinatal period. The initial research was conducted until 31 December 2021 and search terms included: tDCS, transcranial direct current stimulation, tACS, transcranial alternating current stimulation, tRNS, transcranial random noise stimulation, pregnancy, perinatal, postnatal, and postpartum. Results: Seven studies re...
International Journal of Environmental Research and Public Health, 2022
A The COVID-19 pandemic has had a considerable impact on the organization of psychiatric care. Th... more A The COVID-19 pandemic has had a considerable impact on the organization of psychiatric care. The present study examines how care professionals experienced this period and faced these new constraints weighing on their professional practices. Based on a qualitative research methodology, 13 group interviews with healthcare professionals working in psychiatric wards were conducted in five countries in western Europe. To complement this, 31 individual interviews were carried out in Belgium and France. Public health measures hindered certain therapeutic activities, jeopardized communication, and obliged healthcare professionals to modify and adapt their practices. Confronted with a transformation of their usual roles, healthcare professionals feared a deterioration in the quality of care. Impossible to continue in-person care practices, they resorted to online videoconferencing which went against their idea of care in which the encounter holds an essential place. The lockdown contradict...
Many authors have studied the links between cognition and emotions, including the links between c... more Many authors have studied the links between cognition and emotions, including the links between cognitive distortions and emotional cognitive regulation strategies. Nevertheless, the explorations of these two instances in a clinical population presenting a posttraumatic stress disorder have very little been explored. The literature on this subject suggests that a specific profile could emerge in these subjects compared to a different clinical population and / or non-clinical. 184 subjects divided into three groups (60 subjects exposed to a traumatic event with PTSD, 61 subjects exposed to a traumatic event without PTSD, 63 control subjects) passed the CERQ, PCL-5 and a cognitive distortions scale. The main results, which are preliminary results. highlight the presence of a profile distinguishing subjects with PTSD. They have difficulties in managing their emotions, as well as increased use of cognitive distortions, but they do not use them the most. The results lead us to question the cognitive functioning of people with PTSD but also the importance and consequences of therapeutic and drug monitoring of these patients.
International Journal of Environmental Research and Public Health, 2021
The Schizophrenia Coping Oral Health Profile and Index (SCOOHPI) was developed to assess oral hea... more The Schizophrenia Coping Oral Health Profile and Index (SCOOHPI) was developed to assess oral health coping strategies in people with schizophrenia. We show that the difficulty and discrimination indices of 18 items, selected for the final version, are acceptable according to the Rasch model, as are the inter-item (0.25) and inter-score (α = 0.85) correlations. This scale can be considered as an index, giving a global score between 0 and 72, with a Likert scale with five response modalities. This is also a profile with the following three dimensions of coping-related oral health, emerging independently of each other: (1) physical well-being strategies (α = 0.72); (2) moral well-being strategies (α = 0.60); (3) access strategies for oral well-being (α = 0.79). The sub-scores, ranging from 0 to 24, specify populations focused on the themes of coping strategies that may be most affected, depending on the subject’s characteristics and their clinical oral health status. The validation st...
International Journal of Environmental Research and Public Health, 2021
The Schizophrenia Oral Health Profile questionnaire was developed to assess the oral health-relat... more The Schizophrenia Oral Health Profile questionnaire was developed to assess the oral health-related quality of life among individuals with schizophrenia based on their perceptions rather than from caregivers. A 5-point Likert scale was used to self-report on 42 items. In the present study, different analyses were conducted to determine the dimensional structure of the final scale: (1) inter-item correlation analysis and Cronbach’s α coefficient, (2) Rasch model analysis, (3) exploratory factor analysis and (4) confirmatory factor analysis. The final version of the Schizophrenia Oral Health Profile questionnaire consisted of 20 items and an internal structure composed of three dimensions: (1) emotions related to oral health, (2) oral pain and discomfort and (3) self-image, others’ views and the need for care. We showed that the difficulty and discrimination indices of each of the 20 selected items were acceptable according to the Rasch model, as well as their inter-item and inter-sco...
International Journal of Environmental Research and Public Health, 2021
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Post‐traumatic stress disorder (PTSD) is a chronic, disabling condition. Our main objective is to... more Post‐traumatic stress disorder (PTSD) is a chronic, disabling condition. Our main objective is to investigate the association between trait mindfulness and PTSD over a period of 54 months. The secondary objective is to provide an exhaustive description of PTSD trajectories after the Bataclan attack.
Objectif La therapie par rescenarisation d’images mentales (IRT, Imagery Rescripting Therapy) est... more Objectif La therapie par rescenarisation d’images mentales (IRT, Imagery Rescripting Therapy) est recommandee pour le traitement des cauchemars. L’objectif de cette etude est de la valider en France, de confirmer sa faisabilite par visioconsultation pour des cas de cauchemars chroniques idiopathiques ou comorbides a un trouble traumatique. Methodes Cette etude prospective a inclus 48 adultes residant dans 28 departements differents qui ont suivi l’IRT standardise a distance. Des mesures standardisees ont ete realisees avant, 3 mois et 6 mois apres le traitement. Resultats Les ameliorations cliniques surviennent a 3 mois et sont maintenues a 6 mois : reduction de la frequence et de l’intensite des cauchemars, amelioration de la qualite du sommeil, et reduction des autres symptomes du trouble traumatique pour les patients qui en souffraient. Les tailles d’effets sont elevees et comparables a ceux des protocoles IRT en face a face. La dynamique des changements oniriques sera presentee. Une partie des resultats a ete publies dans Psychotherapy & Psychosomatics. Conclusion L’IRT est realisable a distance aussi bien pour les cauchemars idiopathiques que pour ceux symptomatiques d’un etat de stress post-traumatique.
Cold Spring Harbor Laboratory - bioRxiv, Oct 17, 2022
Background: The cerebellum critically contributes to higher-order cognitive and emotional functio... more Background: The cerebellum critically contributes to higher-order cognitive and emotional functions such fear learning and memory. Prior research on cerebellar volume in PTSD is scant and has neglected neuroanatomical subdivisions of the cerebellum that differentially map on to motor, cognitive, and affective functions. Methods: We quantified cerebellar lobule volumes using structural magnetic resonance imaging in 4,215 adults (PTSD n= 1640; Control n=2575) across 40 sites from the from the ENIGMA-PGC PTSD working group. Using a new state-of-the-art deep-learning based approach for automatic cerebellar parcellation, we obtained volumetric estimates for the total cerebellum and 28 subregions. Linear mixed effects models controlling for age, gender, intracranial volume, and site were used to compare cerebellum total and subregional volume in PTSD compared to healthy controls. The Benjamini-Hochberg procedure was used to control the false discovery rate (p-FDR < .05). Results: PTSD was associated with significant grey and white matter reductions of the cerebellum. Compared to controls, people with PTSD demonstrated smaller total cerebellum volume. In addition, people with PTSD showed reduced volume in subregions primarily within the posterior lobe (lobule VIIB, crus II), but also the vermis (VI, VIII), flocculonodular lobe (lobule X), and cerebellar white matter (all p-FDR < 0.05). Effects of PTSD on volume were consistent, and generally more robust, when examining symptom severity rather than diagnostic status. Conclusions: These findings implicate regionally specific cerebellar volumetric differences in the pathophysiology of PTSD. The cerebellum appears to play an important role in high-order cognitive and emotional processes, far beyond its historical association with vestibulomotor function. Further examination of the cerebellum in trauma-related psychopathology will help to clarify how cerebellar structure and function may disrupt cognitive and affective processes at the center of translational models for PTSD.
Objective-Metabolic syndrome is associated with elevated risk for cardiovascular disease and diab... more Objective-Metabolic syndrome is associated with elevated risk for cardiovascular disease and diabetes, and has increased prevalence in low-income African-Americans, which constitutes a significant health disparity. The mechanisms responsible for this disparity remain unclear; the current study investigated the relationship between Posttraumatic Stress Disorder (PTSD) and metabolic syndrome. Method-We assessed childhood and adult trauma history, Major Depressive Disorder (MDD), PTSD, and the components of metabolic syndrome in an urban population. We recruited 245 low socioeconomic status (SES), primarily African American subjects from general medical clinics in an inner-city hospital. Results-Trauma exposure was extremely prevalent, with 90.6% of subjects reporting at least one significant trauma, and 18.8% of subjects meeting criteria for a current PTSD. Metabolic syndrome was also prevalent in this population (33.2%), with significantly higher rates among patients with current PTSD (47.8%, p<.05). After controlling for demographics, smoking history, antipsychotic use, depression, and exercise, current PTSD remained the only significant predictor of metabolic syndrome (p=0.006). Conclusions-PTSD is associated with increased rates of metabolic syndrome within a traumatized, impoverished urban population. Further studies should investigate if PTSD treatment may reduce the rates of metabolic syndrome, improve overall health outcomes, and decrease healthcare disparities in minority populations.
Previous cross-sectional studies found excessive Brain Tissue Pulsations (BTP) in mid-life depres... more Previous cross-sectional studies found excessive Brain Tissue Pulsations (BTP) in mid-life depression, which could constitute a mechanism of brain damage in depression. However, it remains unclear whether successful antidepressant therapy restores BTP amplitudes. In this prospective study, we investigated longitudinal changes in BTP in patients with a major depressive episode (MDE), among responders and non-responders to escitalopram. Fifty-two individuals with a MDE, free of antidepressants at baseline, were included in an 8-week open-labeled escitalopram trial. Ultrasound Tissue Pulsatility Imaging (TPI) was applied to measure resting BTP and BTP reactivity in an orthostatic challenge, at baseline and at week 8. TPI data were available for 48 participants divided into responders (n = 28, 58.3%) and non-responders (n = 20, 41.7%) according to change in the MADRS score. MaxBTP significantly decreased between baseline and week 8, only in responders. In addition, changes in MaxBTP during the orthostatic challenge were no longer significant at week 8 but only in responders. Because excessive BTP constitutes a potential mechanism for brain damage, our results suggest that a successful pharmacotherapy could benefit patients to lower the risk of brain damage in individuals with depression, a population exposed to stroke, small arteries disease and brain atrophy. TPI could provide a surrogate biomarker to monitor antidepressant response and brain health in depression in clinical routine.
Journal of Neurology, Neurosurgery & Psychiatry, 2021
Functional seizures (FS) known also as psychogenic non-epileptic seizures or dissociative seizure... more Functional seizures (FS) known also as psychogenic non-epileptic seizures or dissociative seizures, present with ictal semiological manifestations, along with various comorbid neurological and psychological disorders. Terminology inconsistencies and discrepancies in nomenclatures of FS may reflect limitations in understanding the neuropsychiatric intricacies of this disorder. Psychological and neurobiological processes of FS are incompletely understood. Nevertheless, important advances have been made on underlying neuropsychopathophysiological mechanisms of FS. These advances provide valuable information about the underlying mechanisms of mind–body interactions. From this perspective, this narrative review summarises recent studies about aetiopathogenesis of FS at two levels: possible risk factors (why) and different aetiopathogenic models of FS (how). We divided possible risk factors for FS into three categories, namely neurobiological, psychological and cognitive risk factors. We ...
Background: The mental health impact of the COVID-19 crisis may differ from previously studied st... more Background: The mental health impact of the COVID-19 crisis may differ from previously studied stressful events in terms of psychological reactions, specific risk factors, and symptom severity across geographic regions worldwide. Objective: To assess the impact of COVID-19 on a wide range of mental health symptoms, to identify relevant risk factors, to identify the effect of COVID-19 country impact on mental health, and to evaluate regional differences in psychological responses to COVID-19 compared to other stressful events. Method: 7034 respondents (74% female) participated in the worldwide Global Psychotrauma Screen-Cross-Cultural responses to COVID-19 study (GPS-CCC), reporting on mental health symptoms related to COVID-19 (n = 1838) or other stressful events (n = 5196) from April to November 2020. Results: Events related to COVID-19 were associated with more mental health symptoms compared to other stressful events, especially symptoms of PTSD, anxiety, depression, insomnia, and dissociation. Lack of social support, psychiatric history, childhood trauma, additional ARTICLE HISTORY
This study aims to determine if resting-state functional connectivity may represent a marker for ... more This study aims to determine if resting-state functional connectivity may represent a marker for the progression of posttraumatic stress disorder (PTSD) in women victims of sexual assault. Participants were 25 adult women recruited three weeks following exposure to sexual assault (T1) and 19 age-matched healthy, non trauma-exposed controls (HC). Among the victims, 10 participants met (PTSD) and 15 did not meet (trauma-exposed controls, TEC) DSM-IV criteria for PTSD six months post-trauma (T2). At both visits, patterns of intrinsic connectivity, a measure of network centrality at each voxel of the brain, were derived from resting-state functional magnetic resonance imaging. Compared to both the HC and TEC groups, victims who developed PTSD at T2 showed higher centrality in the right middle/superior occipital gyrus at T1, while reduced centrality of the posterior cingulate cortex (PCC)/precuneus at T1 was found for the TEC group, compared to the HC group only. There were no differences in intrinsic connectivity at T1 between the TEC and PTSD groups. There were no significant between-group differences in intrinsic connectivity at T2, and no significant group-by-time interaction. This study indicates that increased occipital centrality three weeks post-trauma exposure may represent a marker of the later development of PTSD. On the other hand, reduced centrality of the PCC/precuneus may represent a marker of resilience to trauma exposure.
Recent etiopathogenic models place emotional dysregulation at the core of psychogenic nonepilepti... more Recent etiopathogenic models place emotional dysregulation at the core of psychogenic nonepileptic seizure (PNES). Our purpose was to assess physiological, cognitive, and behavioral emotional responses of PNES patients. Methods: This study compared three types of emotional responses to visual emotional stimuli between 34 female PNES group and 34 matched healthy controls: physiological response measured by skin conductance response (SCR) (rate, amplitude and latency) and heart rate deceleration; cognitive response measured by valence and arousal elicited by the images; and behavioural response measured by latency of ratings. The groups were characterized on psychiatric comorbidities, traumatic history, alexithymia, and dissociation. Results: Compared to controls, PNES group displayed lower SCR for all images (p = 0.038), shorter amplitude of heart rate deceleration (p = 0.024) and faster arousal rating for all images (p = 0.019), but no difference on cognitive rating of images. Within-groups analyses showed only in PNES subjects increased rate (+19.35%, p = 0.046) SCR for negative stimuli with strong arousal compared to negative with low arousal. PNES physiological response (SCR and heart rate deceleration) was negatively correlated to dissociation tendency (r=-0.48, p = 0.0083) and alexithymia (r=-0.44, p = 0.012)). For cognitive response, no correlation was found. Conclusion: These results are in favour of a lower physiological emotional response but with an over-reactivity at behavioral level contrasting with similar cognitive assessment. For strong aversive stimuli, PNES might present a trend to overreact at physiological and behavioural levels. Our results suggest that dissociation and difficulty in describing feelings are associated with an altered physiological response in PNES women only. 1. Introduction Psychogenic non-epileptic seizures (PNES) are paroxysmal repetitive episodes which may superficially resemble epileptic seizures, in relation to unconscious psychogenic processes and without excessive neuronal discharge. [1]. With respect to PNES, the prevalence is estimated at 4.9 / 100000 / year [2] with an estimated incidence between 2 and 33/100000 [3]. The main problems of this pathology are the differential diagnosis with epilepsy and the unnecessary prescription of anti-epileptics drugs [4,5] and the heavy impacts on the quality of life [1]. The etiopathogeny of PNES is complex and multifactorial, including predisposing, precipitating, and perpetuating factors. Roughly, two mechanisms are most often mentioned: a neurobiological predisposition and dissociation [6]. In addition, recent etiopathogenic models have placed emotional dysregulation at the core of this pathology [7]. Emotions are classically composed of three dimensions [8,9]: the cognitive (subjective) component, the behavioral expression/actions, and the physiological autonomic component [10]. It is currently recognized that all three spheres, cognitive, behavioral, and autonomic, are affected in PNES. Regarding the cognitive component, alexithymia (difficulty to identify and describe the emotions) reached 85% of the PNES patients [11,12] and suggest a difficulty in coping with emotions [13]. Bakvis [14,15] and Pick [16] found attentional biases in PNES patients to images conveying negative emotions. They also observed
Background: Clear guidance for successive antidepressant pharmacological treatments for non-respo... more Background: Clear guidance for successive antidepressant pharmacological treatments for non-responders in major depression is not well established. Method: Based on the RAND/UCLA Appropriateness Method, the French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental developed expert consensus guidelines for the management of treatment-resistant depression. The expert guidelines combine scientific evidence and expert clinicians' opinions to produce recommendations for treatment-resistant depression. A written survey comprising 118 questions related to highly-detailed clinical presentations was completed on a risk-benefit scale ranging from 0 to 9 by 36 psychiatrist experts in the field of major depression and its treatments. Key-recommendations are provided by the scientific committee after data analysis and interpretation of the results of the survey. Results: The scope of these guidelines encompasses the assessment of pharmacological resistance and situations at risk of resistance, as well as the pharmacological and psychological strategies in major depression. Conclusion: The expert consensus guidelines will contribute to facilitate treatment decisions for clinicians involved in the daily assessment and management of treatment-resistant depression across a number of common and complex clinical situations.
The European countries have a long history of exposure to large-scale trauma. In the early 1990s ... more The European countries have a long history of exposure to large-scale trauma. In the early 1990s the increasing awareness of the consequences of trauma within the mental health community led to the foundation of local societies for psychotraumatology across Europe and the European Society of Traumatic Stress Studies (ESTSS), which celebrated its 25th anniversary in 2018. The focus of this article is to describe the current state of care for survivors of trauma in the 15 European countries where ESTSS member societies have been established. Brief descriptions on the historical burden of trauma in each country are followed by an overview of the care system for trauma survivors in the countries, the stateof-the-art of interventions, current challenges in caring for survivors and the topics that need to be most urgently addressed in the future. The reports from the different countries demonstrate how important steps towards a better provision of care for survivors of trauma have been made in Europe. Given the cultural and economic diversity of the continent, there are also differences between the European countries, for instance with regard to the use of evidence-based treatments. Strategies to overcome these differences, like the new ESTSS training curricula for care-providers across Europe, are briefly discussed.
Introduction: The perinatal period is an at-risk period for the emergence or decompensation of ps... more Introduction: The perinatal period is an at-risk period for the emergence or decompensation of psychiatric disorders. Transcranial electrical stimulation (tES) is an effective and safe treatment for many psychiatric disorders. Given the reluctance to use pharmacological treatments during pregnancy or breastfeeding, tES may be an interesting treatment to consider. Our study aims to evaluate the efficacy and safety of tES in the perinatal period through a systematic literature review followed by three original case reports. Method: Following PRISMA guidelines, a systematic review of MEDLINE and ScienceDirect was undertaken to identify studies on tES on women during the perinatal period. The initial research was conducted until 31 December 2021 and search terms included: tDCS, transcranial direct current stimulation, tACS, transcranial alternating current stimulation, tRNS, transcranial random noise stimulation, pregnancy, perinatal, postnatal, and postpartum. Results: Seven studies re...
International Journal of Environmental Research and Public Health, 2022
A The COVID-19 pandemic has had a considerable impact on the organization of psychiatric care. Th... more A The COVID-19 pandemic has had a considerable impact on the organization of psychiatric care. The present study examines how care professionals experienced this period and faced these new constraints weighing on their professional practices. Based on a qualitative research methodology, 13 group interviews with healthcare professionals working in psychiatric wards were conducted in five countries in western Europe. To complement this, 31 individual interviews were carried out in Belgium and France. Public health measures hindered certain therapeutic activities, jeopardized communication, and obliged healthcare professionals to modify and adapt their practices. Confronted with a transformation of their usual roles, healthcare professionals feared a deterioration in the quality of care. Impossible to continue in-person care practices, they resorted to online videoconferencing which went against their idea of care in which the encounter holds an essential place. The lockdown contradict...
Many authors have studied the links between cognition and emotions, including the links between c... more Many authors have studied the links between cognition and emotions, including the links between cognitive distortions and emotional cognitive regulation strategies. Nevertheless, the explorations of these two instances in a clinical population presenting a posttraumatic stress disorder have very little been explored. The literature on this subject suggests that a specific profile could emerge in these subjects compared to a different clinical population and / or non-clinical. 184 subjects divided into three groups (60 subjects exposed to a traumatic event with PTSD, 61 subjects exposed to a traumatic event without PTSD, 63 control subjects) passed the CERQ, PCL-5 and a cognitive distortions scale. The main results, which are preliminary results. highlight the presence of a profile distinguishing subjects with PTSD. They have difficulties in managing their emotions, as well as increased use of cognitive distortions, but they do not use them the most. The results lead us to question the cognitive functioning of people with PTSD but also the importance and consequences of therapeutic and drug monitoring of these patients.
International Journal of Environmental Research and Public Health, 2021
The Schizophrenia Coping Oral Health Profile and Index (SCOOHPI) was developed to assess oral hea... more The Schizophrenia Coping Oral Health Profile and Index (SCOOHPI) was developed to assess oral health coping strategies in people with schizophrenia. We show that the difficulty and discrimination indices of 18 items, selected for the final version, are acceptable according to the Rasch model, as are the inter-item (0.25) and inter-score (α = 0.85) correlations. This scale can be considered as an index, giving a global score between 0 and 72, with a Likert scale with five response modalities. This is also a profile with the following three dimensions of coping-related oral health, emerging independently of each other: (1) physical well-being strategies (α = 0.72); (2) moral well-being strategies (α = 0.60); (3) access strategies for oral well-being (α = 0.79). The sub-scores, ranging from 0 to 24, specify populations focused on the themes of coping strategies that may be most affected, depending on the subject’s characteristics and their clinical oral health status. The validation st...
International Journal of Environmental Research and Public Health, 2021
The Schizophrenia Oral Health Profile questionnaire was developed to assess the oral health-relat... more The Schizophrenia Oral Health Profile questionnaire was developed to assess the oral health-related quality of life among individuals with schizophrenia based on their perceptions rather than from caregivers. A 5-point Likert scale was used to self-report on 42 items. In the present study, different analyses were conducted to determine the dimensional structure of the final scale: (1) inter-item correlation analysis and Cronbach’s α coefficient, (2) Rasch model analysis, (3) exploratory factor analysis and (4) confirmatory factor analysis. The final version of the Schizophrenia Oral Health Profile questionnaire consisted of 20 items and an internal structure composed of three dimensions: (1) emotions related to oral health, (2) oral pain and discomfort and (3) self-image, others’ views and the need for care. We showed that the difficulty and discrimination indices of each of the 20 selected items were acceptable according to the Rasch model, as well as their inter-item and inter-sco...
International Journal of Environmental Research and Public Health, 2021
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Post‐traumatic stress disorder (PTSD) is a chronic, disabling condition. Our main objective is to... more Post‐traumatic stress disorder (PTSD) is a chronic, disabling condition. Our main objective is to investigate the association between trait mindfulness and PTSD over a period of 54 months. The secondary objective is to provide an exhaustive description of PTSD trajectories after the Bataclan attack.
Objectif La therapie par rescenarisation d’images mentales (IRT, Imagery Rescripting Therapy) est... more Objectif La therapie par rescenarisation d’images mentales (IRT, Imagery Rescripting Therapy) est recommandee pour le traitement des cauchemars. L’objectif de cette etude est de la valider en France, de confirmer sa faisabilite par visioconsultation pour des cas de cauchemars chroniques idiopathiques ou comorbides a un trouble traumatique. Methodes Cette etude prospective a inclus 48 adultes residant dans 28 departements differents qui ont suivi l’IRT standardise a distance. Des mesures standardisees ont ete realisees avant, 3 mois et 6 mois apres le traitement. Resultats Les ameliorations cliniques surviennent a 3 mois et sont maintenues a 6 mois : reduction de la frequence et de l’intensite des cauchemars, amelioration de la qualite du sommeil, et reduction des autres symptomes du trouble traumatique pour les patients qui en souffraient. Les tailles d’effets sont elevees et comparables a ceux des protocoles IRT en face a face. La dynamique des changements oniriques sera presentee. Une partie des resultats a ete publies dans Psychotherapy & Psychosomatics. Conclusion L’IRT est realisable a distance aussi bien pour les cauchemars idiopathiques que pour ceux symptomatiques d’un etat de stress post-traumatique.
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Papers by Wissam El-Hage