Estrogens and SERMS as adjunctive treatments for schizophrenia

More than thirty years have passed since sex and gender differences were noted in the age of onset, course and outcomes for schizophrenia. The ‘estrogen hypothesis” was coined in the 1990′s to describe neuroprotective effects of estrogen.Intervention studies in schizophrenia patients with estradiol and selective estrogen receptor modulators (SERMs) are promising but psychiatrists and other health practitioners do not generally take up this useful adjunctive treatment for their female patients with schizophrenia. The reasons for this are manifold, but overall a cultural shift in the practice of psychiatry is needed to recognise the specific needs of women with schizophrenia and tailor treatments, such as hormone adjuncts to improve the outcomes for this significant population.The two main aims of this article are to review the evidence and theory of estrogen treatments in schizophrenia and to recommend translation of adjunctive estrogen treatment into clinical practice for women with schizophrenia.     

Abolition du discernement : état des lieux des pratiques des experts psychiatres dans l’ouest de la France

ObjectivesThe goal of this study was to determine the characteristics of subjects considered to be criminally irresponsible due to abolition of judgment pursuant to article 122-1, 41 of the French Penal Code.Materials and methodsThis retrospective study gathered every forensic assessment in 2016 that concluded in criminal irresponsibility from eight forensic psychiatrists practicing in the west of France. We proceeded to study the frequency of abolitions, the socio-demographic characteristics of the subjects, the psychiatric pathologies as defined by the DSM-5, the crimes committed, the clinical justifications and the conclusions of the forensic psychiatrist concerning the potential forced hospitalisation of the subject, the psychiatric dangerousness, curability and the ability to readapt of the subject.ResultsThirty-eight assessments out of the 763 collected concluded in abolition of judgment, a frequency of 4.98%. The subjects suffered from a schizophrenia spectrum disorder or a paranoid delusional disorder (85.2%). The most present clinical elements were paranoid delusions of persecution (23.1%), from intuitive, interpretative, hallucinatory or mental automatism mechanisms (39.7%) and dissociative syndrome (10.7%). Subjects with abolished judgment weren’t always considered dangerous (for 34.3% of individuals) even if a schizophrenia diagnosis was correlated (f = 0.03). Forced hospitalisation was proposed in 50% of assessments and associated with the conclusion of dangerousness (f = 0.01).ConclusionsSchizophrenia spectrum disorders or paranoid delusional disorders are the most common pathologies in forensic psychiatric assessments concluding in abolition of judgment.     

Éléments de validation du Protocole d’Évaluation de la Cognition Sociale de Bordeaux (PECS-B) en population générale et dans la schizophrénie

ObjectivesIn recent years, social cognition has received growing interest in the international psychiatric and neurologic literature. Social cognition impairments are described in many different conditions and are associated with a poor functional outcome. Consequently, an accurate and valid assessment of social cognition abilities is necessary in clinical practice, so as to better understand individual functioning and define corresponding therapeutic interventions. The aim of the present study was to provide further elements of validation to the Bordeaux Social Cognition Assessment Protocol (Protocole d’Evaluation de la Cognition Sociale de Bordeaux: PECS-B) in the general population and in one with schizophrenia.MethodsA total of 131 healthy controls and 101 participants with schizophrenia or schizoaffective disorders between 18 and 60 years old were included. Sociodemographic variables (i.e., age, education level, sex), social cognition (i.e., emotional fluency, facial emotion recognition, theory of mind, emotional awareness and alexithymia with the PECS-B), neurocognition (i.e., processing speed, episodic verbal memory, short-term memory, working memory, selective and sustained attention, spontaneous and reactive flexibility), anxiety and depressive mood were assessed in both samples.ResultsResults show a good discriminative power for the PECS-B within the same population. Only “Attribution of Intention” and “Faux-Pas” tasks show ceiling effects in both samples. Structural validity is satisfactory in the general population sample and suggests that the social cognition structure consists of four factors: facial emotion recognition (1), emotional lexicon (2), explicit processing of sophisticated emotional information (3) and theory of mind (4). Structure validity is also satisfactory in the schizophrenia sample, after removal of the variable “Emotional fluency-Percentage of sophisticated words”. In this case, the social cognition structure consists of two factors: general social cognition (1) and explicit processing of sophisticated emotional information (2). Results show a good divergent validity in both populations, between close constructs such as neurocognition and anxiety/depression. Nevertheless, correlations between social cognition and neurocognition are more frequent in the schizophrenia sample. Internal consistency is satisfying in both samples. Finally, results reveal some effects of sociodemographic variables (i.e., age, education level and sex) both in the general population and schizophrenia samples. Norms are also presented for adults aged between 18 and 60.ConclusionStructural validity, divergent validity and internal consistency of the PECS-B are satisfactory in the general population and the schizophrenia one. The PECS-B presents with good psychometric qualities that permit its use for the assessment of adults’ social cognition in clinical practice as much as research.     

« Melting-PainTherapy » à l’unité pour malades difficiles de Cadillac : le patient est un artiste !

In Melting-PainTherapy workshop, we offer an innovative art therapy activity set in the unit for difficult patients in Cadillac, Gironde, France. Our hospital hosts patients with mental issues that let them, or may lead them, to commit one or more dangerous acts. Organized by nurses with a strong and highly developed artistic sensitivity, it is aimed towards patients who voluntarily participate, once, or more, or on a regular basis to our art project, while working alone with a nurse. In this workshop, the patient is an artist. He gets to create, express himself, realize and manage his possibilities, limitations, frustrations, constraints and relationship to himself and others. The Melting-PainTherapy concept revolves around the elaboration of collective art pieces meant to advance the individuals on rotative canvases.     

Dangerosité psychiatrique et responsabilité pénale atténuée : à propos de la condamnation à la réclusion à perpétuité d’un schizophrène auteur d’un homicide sexuel sadique

The second paragraph of article 122-1 of the French Criminal Code provides for a reduced penalty in criminal matters (Court of Assizes) when the offender is suffering at the time the act is committed from a mental disorder that reduces his liability. This legal provision is not always respected, as shown by the sentencing to life imprisonment of a chronic psychotic patient who committed a sexual homicide (sadistic rape). The Court of Assizes found that the great dangerousness of this schizophrenic, with a multiple criminal record and who had refused his treatment, justified his conviction, while the psychiatric expertise concluded that he should benefit from a reduction on his criminal liability. The sentence was passed without the level of severity of his mental state having been verified by a new expert. The author therefore questions the “ethical” nature of this court decision which, albeit legal, is contrary to the spirit of the law. There was no appeal against the sentence.     

Protéine C-réactive et agitation chez des patients atteints de schizophrénie : suivi d’une cohorte avec groupe témoin

BackgroundRecent studies first reported the relevant role of the immune system in the pathophysiology of schizophrenia and then the association between inflammation and agitation.ObjectivesIn this study, we aim to explore the relationship between CRP (C-reactive protein) levels and agitation in patients with schizophrenia.MethodsWe conducted a cohort study with a comparison group of 60 patients with a DSM5 diagnosis of schizophrenia who were followed by the Department of Psychiatry of the University Hospital of Marrakech in Morocco. Patients were divided into two groups according to the state of agitation evaluated by the PANSS Excitement scale. These two groups have been matched according to age and gender. A comparison of CRP level, clinical and laboratory characteristics between the two groups and a monitoring of CRP level in the agitated group after 3 weeks of treatment were performed.ResultsInpatients with agitation displayed a significantly high CRP (P < 0.0001), a high score of PANSS total (P < 0.0001), PANSS positive (P < 0.0001) and general PANSS (P < 0.0001). After treatment, there was a significant reduction in CRP (P < 0.0001) and PANSS excitement (P < 0.0001).ConclusionThese results confirm the role played by inflammation and immunity in agitation behavior in patients with schizophrenia and highlight the interest of the CRP assay at the time of admission of patients as a potential marker of agitation in hospitalized patients with schizophrenia.     

Target specific effects of direct current stimulation in schizo-obsessive disorder: A case report

Transcranial direct current stimulation (tDCS) is a type of non-invasive brain stimulation technique that is explored as an add-on treatment for the alleviation of symptoms across the diverse symptom domains in neuropsychiatric disorders. In psychiatry, data is emerging on the effects of tDCS as an add-on treatment in schizophrenia as well as obsessive-compulsive disorder (OCD). But despite high prevalence, the effectiveness of tDCS in co-morbid schizophrenia and OCD is lacking. This case report for the first time examines the clinical utility with target-specific effects of the add-on tDCS in a patient diagnosed with schizo-obsessive disorder.     

慢性精神分裂症患者合并肺部感染临床资料分析

目的：探讨慢性精神分裂症患者合并肺部感染的临床特征。方法对162例慢性精神分裂症合并肺部感染患者的临床资料进行回顾性分析。结果162例肺部感染者，其中节段性肺炎124例，慢性肺部感染38例。急性肺炎以中青年，精神病病程＜3 a居多，感染部位以右肺中叶和左肺舌叶为主，对症治疗后均痊愈；慢性感染以中老年多见，精神病病程＞3a，感染部位以两肺下叶、肺底及脊柱两旁慢性感染为主，对症治疗后痊愈率为71．1％，临床症状消失率为28．9％。结论精神分裂症患者合并肺部感染率较高，临床症状不典型，应制定有效的预防和控制对策，减少感染的发生。