https://aliamad-lab.github.io Articles, lectures cliniques et documents utiles autour de la psychiatrie. fr Sun, 16 Aug 2026 10:42:39 GMT https://www.sciencedirect.com/science/article/abs/pii/S0165178126004373#access-box 10.1016/j.psychres.2026.117377 Sun, 16 Aug 2026 12:00:00 GMT catatonie Phénoménologie https://doi.org/10.1001/jamapsychiatry.2025.1811 10.1001/jamapsychiatry.2025.1811 Thu, 13 Aug 2026 12:00:00 GMT psychosis troubles de l'humeur dopamine IMPORTANCE : There is limited neurobiological or trial evidence guiding treatment of comorbid affective syndromes in psychotic disorders. Given the use of dopamine-blocking antipsychotics, understanding dopamine function across these mood states is warranted. OBJECTIVE : To test for differences in dopamine synthesis capacity (Kicer) between affective syndromes across psychotic disorders and for association with psychotic symptom severity. DESIGN, SETTING, AND PARTICIPANTS : In this cross-sectional study using fluorine F 18-labeled fluorodopa (18F-DOPA) positron emission tomography (PET), individuals with first-episode psychosis and comorbid affective syndromes, including a current major depressive episode (MDE) or mixed/mania syndromes, and matched controls were recruited from early intervention services in inner-city London, United Kingdom. Data were collected from March 2013 to February 2022 and analyzed from October 1, 2023, to January 1, 2025. EXPOSURE : Striatal Kicer measured by 18F-DOPA PET. MAIN OUTCOMES AND MEASURES : Striatal Kicer and scores on the Positive and Negative Syndrome Scale, Hamilton Depression Rating Scale, Montgomery-Åsberg Depression Rating Scale, and Young Mania Rating Scale were determined. RESULTS : The study included a total of 76 individuals (38 with first-episode psychosis and comorbid affective syndromes [25 with MDE and 13 with mixed/mania syndromes] and 38 matched controls). The mean (SD) age was 27.2 (8.9) years overall, 30.7 (12.8) years among those with MDE, 23.7 (3.1) years among those with mixed/mania syndromes, and 26.0 (6.0) years among controls. Sex distribution did not differ (MDE, 13 [52%] male; mixed/mania syndromes, 8 [62%] male; controls, 25 [66%] male; P = .56). Kicer (controlling for age and sex) was significant across groups in whole striatum (F2,71 = 4.04; P = .02; R2 = 0.13). People with psychosis and MDE had lower Kicer compared with those with psychosis and mixed/mania syndromes (β [SE], 0.014 [0.001]; P = .02), with the largest difference observed in the limbic striatum (Cohen d = 1.57; P < .001). In the overall psychosis sample, higher striatal Kicer was associated with greater positive psychotic symptoms (R2 = 0.13; β [SE], 0.000066 [0.000030]; P = .03), notably in the associative striatum (R2 = 0.15; P = .02). No significant association was found in the limbic striatum. CONCLUSIONS AND RELEVANCE : Kicer was lower in psychosis and comorbid MDE than mixed/mania syndromes, and transdiagnostically, greater positive psychotic symptoms were associated with higher Kicer in the associative, but not limbic, striatum. This subregion dopamine dysregulation has relevance for dopamine-modulating therapeutic agents and drug discovery. https://doi.org/10.1176/appi.neuropsych.20260107 10.1176/appi.neuropsych.20260107 Wed, 12 Aug 2026 12:00:00 GMT catatonie Phénoménologie https://doi.org/10.1136/bmj-2026-100216 10.1136/bmj-2026-100216 Wed, 12 Aug 2026 12:00:00 GMT trouble bipolaire Thérapeutique OBJECTIVES : To systematically evaluate the certainty of evidence for treatment strategies across age groups and mood phases in bipolar disorder, and develop an open access web platform to facilitate shared decision making. DESIGN : Living umbrella review, evaluation, analysis, and communication hub (U-REACH) project. DATA SOURCES : PubMed, PsycInfo, and Cochrane library databases, from inception to 19 November 2024. ELIGIBILITY CRITERIA FOR SELECTING STUDIES : Systematic reviews with network or pairwise meta-analyses of randomised controlled trials of pharmacological, nutraceutical, psychosocial, brain stimulation, or circadian rhythm based treatments, administered as monotherapy (without concurrent interventions), augmentation treatment (interventions added to an ongoing treatment regimen), or combination treatment (simultaneous initiation of two different interventions), examining any age group, bipolar disorder phase (ie, acute bipolar depression, mania or mixed episodes, or maintenance), treatment, control, or outcome. RESULTS : 77 studies met the inclusion criteria (21 network meta-analyses and 56 pairwise meta-analyses), including 116 unique pharmacological (n=74), brain stimulation (n=18), nutraceutical (n=13), psychosocial (n=8), and circadian rhythm based (n=3) treatments as monotherapy, augmentation, or combination therapy, along with five control interventions. These studies covered 133 unique outcomes (45 efficacy outcomes and 88 safety outcomes) resulting in 2510 meta-analyses with Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) ratings of the certainty of the evidence as high (n=236), moderate (n=827), low (n=986), and very low (n=461). A communication hub, the Evidence Based Interventions for Bipolar Disorder (EBI-BD) platform, was developed and the full results are freely available (https://ebibd-database.org), including the preference based tool (12 interventions and 17 safety outcomes). Interventions effective across outcomes varied by phases. For bipolar depression, effective interventions in adults were cariprazine, divalproex or valproate, fluoxetine, ketamine (augmentation), lamotrigine, lumateperone, lurasidone, olanzapine, olanzapine with fluoxetine, and quetiapine, whereas effective interventions in children and adolescents were lurasidone and olanzapine with fluoxetine. For mania episodes, effective interventions in adults were aripiprazole, asenapine, carbamazepine, cariprazine, divalproex or valproate, haloperidol, lithium, olanzapine, paliperidone, quetiapine (also augmentation), risperidone (also as augmentation), tamoxifen, and ziprasidone, whereas effective interventions in children and adolescents were aripiprazole, asenapine, olanzapine, quetiapine, and risperidone. For maintenance, interventions effective across outcomes in adults were aripiprazole (also the long acting injectable formulation), asenapine, divalproex or valproate, lithium, olanzapine, group psychoeducation (augmentation), quetiapine, and risperidone long acting injectable formulation. Interventions effective across phases were aripiprazole (also as augmentation and as a long acting injectable formulation), asenapine, cariprazine, cognitive behavioural therapy (augmentation), divalproex or valproate, lamotrigine, lithium, olanzapine (also as augmentation), paliperidone, quetiapine (also as augmentation), and risperidone (also as augmentation and the long acting injectable formulation) (adults). Treatment effects by neuroscience based nomenclature classes are also reported. CONCLUSIONS : The EBI-BD tool can help clinicians make evidence based, personalised treatment decisions for bipolar disorder. This resource can inform clinical guidelines and provides a foundation for continuously improving bipolar disorder care as new evidence emerges. TRIAL REGISTRATION : Open Science Framework https://osf.io/pjmvn/ READERS' NOTE: This is a living systematic review and may be updated in the next two years if additional evidence emerges. https://doi.org/10.1111/bdi.70151 10.1111/bdi.70151 Fri, 31 Jul 2026 12:00:00 GMT lithium bipolar elderly OBJECTIVES : Lithium is recommended as the first-line maintenance treatment for older adults with bipolar disorder (OABD). However, age-related reduction in renal clearance, heightened sensitivity to adverse effects, and drug interactions increase the risk of toxicity and necessitate lower therapeutic serum levels in this population. Despite expert consensus supporting age-adjusted targets, most clinical laboratories still do not report age-specific therapeutic ranges. We conducted a systematic review on recommended serum lithium levels in OABD to update evidence supporting age-specific therapeutic ranges for safe and effective lithium management. METHODS : We searched Medline, PsycINFO, Embase, and Cochrane Central Register of Controlled Trials since 2017 for studies analyzing lithium serum levels in individuals with bipolar disorder ≥ 60 years. Two reviewers independently screened titles, abstracts, and full texts. We used the National Institutes of Health Quality Assessment Tool to assess methodological quality. RESULTS : Fourteen studies, including 8808 older adults using lithium, met inclusion criteria. All studies were observational with cross-sectional or cohort designs. Mean or median lithium levels ranged from 0.47-0.67 mmol/L. Levels of 0.82-1.00 mmol/L were associated with increased side effects or early toxicity signs, while levels of 1.20-1.25 mmol/L were overtly toxic. Impaired renal function and concomitant use of diuretics, ACE inhibitors, and NSAIDs required closer monitoring for toxicity. CONCLUSIONS : These findings are consistent with age-adjusted lithium therapeutic targets in older adults and provide additional observational support for clinical laboratories to adopt age-specific therapeutic ranges. Clinicians should consider individualized monitoring accounting for age-related physiological changes and medication interactions to ensure safer and effective lithium therapy. https://www.programme-sante-tabac-hdf.fr/76/le-projet-retaba-c-blissement https://www.programme-sante-tabac-hdf.fr/76/le-projet-retaba-c-blissement Tue, 21 Jul 2026 12:00:00 GMT Addicto tabac Guide "La boite à outils Rétabacblissement" https://doi.org/10.1101/2025.06.17.25329750 10.1101/2025.06.17.25329750 Wed, 15 Jul 2026 12:00:00 GMT chronobiologie chronothérapie Trouble bipolaire BACKGROUND : Circadian dysfunction is involved in the pathophysiology of bipolar disorders (BD), and circadian-based interventions are gaining recognition in their management. Moreover, basic and epidemiologic research has generated findings inspiring circadian-informed self- and clinician-management strategies. Despite these gains, many Clinical Practice Guidelines and clinical training programs have not incorporated this evidence in their recommendations and curricula. AIMS : This International Society for Bipolar Disorders (ISBD) Chronobiology and Chronotherapy Task Force position paper reports a Delphi study-based international consensus statement on what is essential for mental health clinicians to know about the chronobiology and chronotherapy of BD. METHODS : An initial pool of statements was derived via review of academic and grey literatures. Statements were rated on a 5-point scale (essential; important; don't know/depends; unimportant; should not be included). Consensus was reached when statements were rated as essential or important by ≥80% of experts. Two young persons with lived experience of BD gave feedback on acceptability. RESULTS : Thirty experts from 15 countries in Europe, North and South America, and the Asia Pacific participated (mean age 55.3 years [SD=11.8]; 40% female; 83% psychiatrists; mean clinical and research experience of 26 [SD=10.8] and 22 years [SD=12.6], respectively). Eight-hundred-and-forty-seven ratings occurred across 12 core constructs and three rounds; 470 statements were discarded after one round and 35 were discarded after rerating. Consensus was reached on 342 statements spanning four themes: basic circadian science; circadian health and disruption; chronobiology of BD; and six chronotherapies (e.g., key protocols, outcomes, side effects, risks/contraindications). CONCLUSIONS : This position paper summarises an international consensus statement on the essential information about the chronobiology and chronotherapy of BD that is intended to help clinicians optimise their management of individuals with BD. This knowledge is available online ( https://osf.io/agk9y ) and its dissemination is expected to enhance the training and efficacy of clinicians globally. https://doi.org/10.1016/j.genhosppsych.2026.07.003 10.1016/j.genhosppsych.2026.07.003 Mon, 13 Jul 2026 12:00:00 GMT catatonie benzo lorazepam OBJECTIVE : Catatonia is a neuropsychiatric disorder that can respond rapidly to treatment with benzodiazepines. Historically, lorazepam is the most used agent for "the lorazepam challenge test" (LCT), but comparative evidence for alternative benzodiazepines remains limited. A temporary intravenous (IV) lorazepam shortage within our health system created a natural experiment by restricting access to lorazepam. We use this natural experiment to compare a single dose of IV diazepam vs. IV lorazepam for the acute treatment of catatonia in a LCT. METHODS : Retrospective comparative effectiveness study of adults with clinically diagnosed catatonia treated during a period of IV lorazepam shortage (July-November 2025) who received IV diazepam and had Bush-Francis Catatonia Rating Scale (BFCRS) assessments before and after benzodiazepine administration. These patients were compared with an equal number of patients treated with IV lorazepam in adjacent non-shortage periods. The primary outcome was change in BFCRS following a single dose of benzodiazepine. Between-group differences in change scores were analyzed using Welch's t-test, with Mann-Whitney U test sensitivity analysis. RESULTS : Twenty patients met inclusion criteria (10 diazepam; 10 lorazepam). Baseline BFCRS severity was similar between groups (overall mean 15.6 ± 6.2). Across the full cohort, benzodiazepine administration produced a large within-subject improvement in catatonia severity (mean BFCRS change -5.8 ± 5.0; p < 0.001; Hedges' g = 1.12). Mean BFCRS change was -6.8 ± 6.6 in the diazepam group and - 4.9 ± 2.6 in the lorazepam group. The between-group difference in improvement (diazepam - lorazepam) was -1.90 BFCRS points (95% CI -6.83 to +3.03), corresponding to a negligible effect size and was not statistically significant (p = 0.42). Any improvement occurred in 9 diazepam-treated patients and all lorazepam-treated patients. CONCLUSIONS : In this quasi-experimental cohort, a single dose of IV diazepam produced short-term reductions in catatonia severity comparable in magnitude to a single dose of IV lorazepam in the LCT. Although underpowered to establish equivalence, these findings provide preliminary empirical support for IV diazepam as a viable acute treatment option when lorazepam is unavailable. https://doi.org/10.1097/yct.0000000000001225 10.1097/yct.0000000000001225 Mon, 29 Jun 2026 12:00:00 GMT ECT neuropsychiatrie Electroconvulsive therapy (ECT) is an established treatment strategy for a range of psychiatric disorders, including depression, mania, psychosis, and catatonia. A growing body of evidence suggests that ECT may affect motor symptoms in movement disorders. In a systematic review, we aim to review the evidence on the use of ECT in movement disorders. We searched PubMed, SCOPUS, Cochrane, Web of Science, and Embase to identify relevant publications. Fifty-eight papers were retained for data extraction. The existing evidence suggests a beneficial impact of ECT on both motor and nonmotor symptoms across various movement disorders, with the most substantial findings reported for Parkinson disease. Conversely, the evidence pertaining to Huntington disease and related disorders cannot rule out a potentially negative effect. Given that the data reviewed are constrained in both quantitative and qualitative rigor, predominantly derived from case reports, further research through the publication of case reports and the conduct of standardized clinical trials is warranted. https://www.sciencedirect.com/journal/lencephale/vol/52/issue/3/suppl/S https://www.sciencedirect.com/journal/lencephale/vol/52/issue/3/suppl/S Sat, 27 Jun 2026 12:00:00 GMT sommeil https://doi.org/10.1111/acps.70116 10.1111/acps.70116 Fri, 19 Jun 2026 12:00:00 GMT ECT Cognition OBJECTIVE : For decades, a persistent claim has been that autobiographical memory loss after electroconvulsive therapy (ECT) for depression might actually contribute to ECT efficacy by reducing or even eliminating autobiographical memories. To test this claim, the primary aim of this study is to examine the association between autobiographical memory loss and remission of depression. The hypothesis is that remitted patients have more autobiographical memory loss after ECT compared to non-remitted patients. METHODS : In 71 patients with major depressive disorder undergoing ECT, autobiographical memory consistency (Kopelman Autobiographical Memory Interview) and depression severity (Montgomery-Åsberg Depression Rating Scale) were assessed before and within 1 week after treatment. Logistic regression analyses were conducted to examine the association between both autobiographical memory loss (i.e., memory consistency) and remission (MADRS < 10), including age, episode duration, baseline MADRS score, and treatment condition as covariates. RESULTS : All logistic regression models were significant. The overall autobiographical memory consistency-score (OR = 1.072, 95% CI [1.018-1.130], p = 0.009) and the consistency-score for recent memories (OR = 1.043, 95% CI [1.006-1.082], p = 0.021) were significantly associated with the odds of remission but in the opposite direction of the hypothesis. A higher age and shorter episode duration further increased the likelihood of remission. Additionally, post hoc analyses showed that the trajectories of autobiographical memory performance over time differed between remitters and non-remitters, indicating a slight decrease in autobiographical memories for more recent events in non-remitters and no change in remitters. CONCLUSIONS : This study shows that, contrary to the hypothesis, remitted patients have less autobiographical memory loss, particularly for recent memories than non-remitters. This refutes the premise that the loss of autobiographical memories contributes to the therapeutic effectiveness of ECT. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2849585 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2849585 Sun, 14 Jun 2026 12:00:00 GMT classification Nosographie Calypso Tue, 09 Jun 2026 12:00:00 GMT ECT schizophrenie https://doi.org/10.1016/j.euroneuro.2026.112863 10.1016/j.euroneuro.2026.112863 Wed, 03 Jun 2026 12:00:00 GMT tdah There is a lack of consensus in the field about the indefinite use of psychostimulants for adult ADHD and the circumstances under which their deprescribing warrants consideration. To address this gap in knowledge, the American Society of Clinical Psychopharmacology (ASCP) convened a Task Force on the deprescribing of psychotropic medications, including stimulant medications for adult ADHD, which entailed a focused literature review and 2-round Delphi survey querying 45 international psychopharmacology experts on factors related to deprescribing. Consensus (≥75% agreement, defined by endorsements of "strongly agree" or "moderately agree") was reached on 10 of 11 (91%) Delphi statements. Survey responses plus literature review suggest that stimulant deprescribing may be appropriate when 1) the diagnosis of ADHD is deemed incorrect upon reevaluation unless another stimulant-responsive condition is evident; 2) cognitive complaints have other more likely etiologies for which stimulant medications are inappropriate; 3) cognitive benefits are absent; 4) stimulant medications exacerbate medical or other psychiatric comorbidities; 5) adverse effects, if present, are non-remediable; 6) stimulant medications are misused; and 7) untreated comorbid non-cannabis substance use disorders are present. Panelists just fell short of consensus in perceiving regular use of cannabis as an insufficient reason to deprescribe stimulant medications in adult ADHD patients. In sum, clinical circumstances and rationales can be identified that support decisions to deprescribe stimulant medications for adult ADHD. Deliberate stimulant misuse or abuse, comorbid medical or psychiatric contraindications, and diagnostic inaccuracy pose strong reasons to consider deprescribing stimulants, potentially in favor of alternative pharmacotherapies and psychotherapies for adult ADHD. https://drees.solidarites-sante.gouv.fr/communique-de-presse-jeux-de-donnees/jeux-de-donnees/250511_hospitalisations-pour-tentatives-de-suicide https://drees.solidarites-sante.gouv.fr/communique-de-presse-jeux-de-donnees/jeux-de-donnees/250511_hospitalisations-pour-tentatives-de-suicide Wed, 20 May 2026 12:00:00 GMT suicide https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/lithium-challenges-of-being-king/EE9CD74362BF7E10A54B8B7BBAE14026 https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/lithium-challenges-of-being-king/EE9CD74362BF7E10A54B8B7BBAE14026 Mon, 11 May 2026 12:00:00 GMT bipolarité lithium https://doi.org/10.1016/s0140-6736(26)00201-1 10.1016/s0140-6736(26)00201-1 Sun, 03 May 2026 12:00:00 GMT dépression Depression is a common illness that affects people within every society around the world. It afflicts the young and the old and everyone in between, and as such poses an immense global burden. New interventions and a deeper understanding of this illness are emerging, but improving the use of existing treatments is equally important and might be a more efficient and effective strategy to addressing depression. Therefore, it is imperative that we improve the diagnosis of depression and its clinical management. https://doi.org/10.1186/s40345-026-00423-z 10.1186/s40345-026-00423-z Thu, 30 Apr 2026 12:00:00 GMT OBJECTIVE: This expert opinion paper addresses the critical balance between lithium’s therapeutic efficacy in recurrent mood disorders and its potential renal side effects. The objective is to provide evidence-based guidelines to enhance clinical decision-making, prevent emergence of, and mitigate risks associated with lithium-induced renal impairment. METHODS: An extensive review of epidemiological, observational, and experimental studies on lithium-induced renal impairment, focusing on its pathophysiology, clinical manifestations, and risk factors was conducted. Expert consensus and recent data were integrated to develop a management algorithm for renal monitoring and intervention. RESULTS: Lithium remains the gold standard for mood stabilization in bipolar disorders, with robust evidence supporting its role in recurrence prevention and suicide risk reduction. While mild to moderate renal impairment is recognized as a risk factor, newer studies show a lower incidence of severe outcomes, such as end-stage kidney disease, necessitating dialysis treatment and renal transplantation, especially with appropriate monitoring, as compared to older studies. This paper addresses pathophysiological mechanisms, including arginine vasopressin resistance and chronic interstitial nephritis, alongside risk factors like rapid initial decline in glomerular filtration rate, early age at treatment initiation, cumulative dosage, mean serum levels of lithium and episodes of lithium intoxication. Effective management strategies, including judicious dosing, routine monitoring, and early nephrology referral, can significantly improve outcomes. CONCLUSIONS: Lithium remains an invaluable treatment for recurrent mood disorders, and its benefits often outweigh the risks when managed appropriately. This paper provides a practical framework for clinicians to address renal concerns, emphasizing the importance of systematic monitoring and individualized care. The paper underscores the need for continued research and education of clinicians and patients to optimize lithium use while safeguarding patient health. https://sciencesinfusent.univ-lille.fr/actualites/detail-actualite/les-visages-de-la-depression https://sciencesinfusent.univ-lille.fr/actualites/detail-actualite/les-visages-de-la-depression Wed, 29 Apr 2026 12:00:00 GMT Notre exposition "Les visages de la dépression" ouvre bientôt ! 🎨 De l'Antiquité à l'intelligence artificielle, venez explorer la dépression sous un angle historique, scientifique et artistique — et découvrir comment l'IA aide aujourd'hui à mieux comprendre cette maladie. 📍 Salle du Conclave – Palais Rihour, Lille 🗓 Du 20 mai au 14 juin 2026 🎟 Entrée libre Partagez autour de vous ! 🙌 https://doi.org/10.1038/s41380-026-03607-2 10.1038/s41380-026-03607-2 Wed, 22 Apr 2026 12:00:00 GMT TND Neurodevelopmental disorders (NDDs) are common, frequently co-occur, and impose a substantial burden, yet the extent to which early-life risk factors differ across the spectrum of NDDs remains unclear. Using the EPI-MERES register, derived from the French National Health Data System, we conducted a nationwide cohort study of all 6.8 million children born in France between 2010 and 2018, followed until September 2024. We investigated prenatal and perinatal risk factors, including gestational age, small for gestational age (SGA), neonatal hypoxia, congenital malformations, parental age, maternal alcohol and tobacco exposure, maternal obesity, and socioeconomic disadvantage, in relation to five major NDDs: communication disorders, specific learning disorders, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and intellectual disability (ID). Models were estimated both with and without adjustment for co-occurring NDDs. Overall, 506,505 children (7.5%) were identified with at least one NDD over a median follow-up of 9.6 years. Co-occurrence was frequent, especially for ID (54.5%), ASD (52.2%), and ADHD (34.9%). In models not adjusted for NDD co-occurrence, several factors were common across disorders, including male sex, prematurity, SGA, congenital malformations, maternal obesity, prenatal alcohol and tobacco exposure, and young maternal age. In addition, some exposures showed disorder-specific associations, most notably with ID: extreme prematurity, SGA, congenital malformations, neonatal hypoxia, and advanced parental age. After adjustment for co-occurring NDDs, several associations were attenuated, indicating that some risk factors contribute simultaneously to multiple disorders; for example, the male predominance in ID and the association of extreme prematurity with ASD were substantially reduced. These findings delineate shared and disorder-specific prenatal and perinatal risk profiles and emphasize the importance of considering co-occurring diagnoses in understanding etiological pathways and informing early prevention strategies.