Relationship between childhood physical abuse and clinical severity of treatment-resistant depression in a geriatric population

Introduction: We assessed the correlation between childhood maltreatment (CM) and severity of depression in an elderly unipolar Treatment-Resistant Depression (TRD) sample. Methods: Patients were enrolled from a longitudinal cohort (FACE-DR) of the French Network of Expert TRD Centres. Results: Our sample included 96 patients (33% of the overall cohort) aged 60 years or above, with a mean age of 67.2 (SD = 5.7). The majority of the patients were female (62.5%). The Montgomery and Asberg Depression Rating Scale (MADRS) and Quick Inventory Depression Scale-Self Report (QIDS-SR) mean scores were high, 28.2 (SD = 7.49) [MADRS score range: 0–60; moderate severity≥20, high severity≥35] and 16.5 (SD = 4.94) [IDS-SR score range: 0–27; moderate severity≥11, high severity≥16], respectively. Mean self-esteem scores were 22.47 (SD = 6.26) [range 0–30]. In an age- and sex-adjusted model, we found a positive correlation between childhood trauma (CTQ scores) and depressive symptom severity [MADRS (β = 0.274; p = 0.07) and QIDS-SR (β = 0.302; p = 0.005) scores]. We detected a statistically significant correlation between physical abuse and depressive symptom severity [MADRS (β = 0.304; p = 0.03) and QIDS-SR (β = 0.362; p = 0.005) scores]. We did not observe any significant correlation between other types of trauma and depressive symptom severity. We showed that self-esteem (Rosenberg scale) mediated the effect of physical abuse (PA) on the intensity of depressive symptoms [MADRS: b = 0.318, 95% BCa C.I. [0.07, 0.62]; QIDS-SR: b = 0.177, 95% BCa C.I. [0.04, 0.37]]. Preacher & Kelly’s Kappa Squared values of 19.1% (k2 = 0.191) and 16% (k2 = 0.16), respectively for the two scales, indicate a moderate effect. Conclusion: To our knowledge, this is the first study conducted in a geriatric TRD population documenting an association between childhood trauma (mainly relating to PA) and the intensity of depressive symptoms

Assessment of Translocator Protein Density, as Marker of Neuroinflammation, in Major Depressive Disorder: A Pilot, Multicenter, Comparative, Controlled, Brain PET Study (INFLADEP Study)

Background: Major depressive disorder (MDD) is a serious public health problem with high lifetime prevalence (4.4–20%) in the general population. The monoamine hypothesis is the most widespread etiological theory of MDD. Also, recent scientific data has emphasized the importance of immuno-inflammatory pathways in the pathophysiology of MDD. The lack of data on the magnitude of brain neuroinflammation in MDD is the main limitation of this inflammatory hypothesis. Our team has previously demonstrated the relevance of [18F] DPA-714 as a neuroinflammation biomarker in humans. We formulated the following hypotheses for the current study: (i) Neuroinflammation in MDD can be measured by [18F] DPA-714; (ii) its levels are associated with clinical severity; (iii) it is accompanied by anatomical and functional alterations within the frontal-subcortical circuits; (iv) it is a marker of treatment resistance.Methods: Depressed patients will be recruited throughout 4 centers (Bordeaux, Montpellier, Tours, and Toulouse) of the French network from 13 expert centers for resistant depression. The patient population will be divided into 3 groups: (i) experimental group—patients with current MDD (n = 20), (ii) remitted depressed group—patients in remission but still being treated (n = 20); and, (iii) control group without any history of MDD (n = 20). The primary objective will be to compare PET data (i.e., distribution pattern of neuroinflammation) between the currently depressed group and the control group. Secondary objectives will be to: (i) compare neuroinflammation across groups (currently depressed group vs. remitted depressed group vs. control group); (ii) correlate neuroinflammation with clinical severity across groups; (iii) correlate neuroinflammation with MRI parameters for structural and functional integrity across groups; (iv) correlate neuroinflammation and peripheral markers of inflammation across groups.Discussion: This study will assess the effects of antidepressants on neuroinflammation as well as its role in the treatment response. It will contribute to clarify the putative relationships between neuroinflammation quantified by brain neuroimaging techniques and peripheral markers of inflammation. Lastly, it is expected to open innovative and promising therapeutic perspectives based on anti-inflammatory strategies for the management of treatment-resistant forms of MDD commonly seen in clinical practice.Clinical trial registration (reference: NCT03314155): https://www.clinicaltrials.gov/ct2/show/NCT03314155?term=neuroinflammation&cond=depression&cntry=FR&rank=

Organisation de l’offre de soin en psychiatrie

INTRODUCTION Les maladies mentales ont cette particularité qu’elles laissent souvent le malade étranger à la réalité de leurs existences. En effet, la plupart des malades souffrant de troubles psychiatriques ont du mal à reconnaître le caractère pathologique de leurs symptômes et de ce fait, refusent les soins qui peuvent leur être proposés et qui sont parfois indispensables. A en croire les interventions politiques les plus récentes (discours d’Antony de Nicolas Sarkozy du 2 ..

Les hallucinations du sujet âgé (prévalence des hallucinations et facteurs associés dans la maladie d'Alzheimer)

Les pathologies psychiatriques, neurologiques et neuro-dégénératives peuvent être à l'origine d'hallucinations chez le sujet âgé. Quatre vingt dix pour cent des patients atteints de la maladie d'Alzheimer développent des troubles psycho-comportementaux responsables d'une souffrance de l'aidant principal, d'institutionnalisation et d'accélération du déclin fonctionnel. Dans l'étude que nous avons réalisée, la prévalence des hallucinations dans une cohorte de 2442 patients atteints de la maladie d'Alzheimer a été estimée à 10,65%. L'agressivité et/ou l'agitation, le sexe féminin, les idées délirantes, la dépression, la provenance du domicile et les troubles du sommeil ont été identifiés comme des facteurs associés aux hallucinations. Identifier ces facteurs permet de mettre en place une prise en charge spécifique pour prévenir les hallucinations, limiter la souffrance de l'aidant principal et améliorer la qualité de vie des patients.TOULOUSE3-BU Santé-Centrale (315552105) / SudocSudocFranceF

La dépression chez les patients atteints de maladie d'Alzheimer (étude ELSA)

Objectif : Identifier les caractéristiques cliniques et démographiques des sujets présentant une symptomatologie dépressive, leur prévalence et l'incidence. Méthode : Une cohorte de 412 sujets issue de l'étude ELSA, population française de sujets atteints de maladie d'Alzheimer, a été suivie pendant deux ans. Résultats : La prévalence de la symptomatologie dépressive a été évaluée à 30%, et l'incidence à 22% par an. Cette symptomatologie dépressive s'associe à des comorbidités : altération cognitive, altération fonctionnelle et nutritionnelle et majoration des troubles du comportement qui ne sont pas toujours améliorées par le traitement. Le traitement antidépresseur ne semble pas toujours adapté à la symptomatologie dépressive. Conclusion : Les efforts doivent essentiellement se concentrer sur le diagnostic et la mise en place d'un traitement antidépresseur à bon escient. Parmi les comorbidités associées à la dépression, il est important d'insister sur celles qui sont réversibles.TOULOUSE3-BU Santé-Centrale (315552105) / SudocTOULOUSE3-BU Santé-Allées (315552109) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Who is doing what in emergency departments to ensure memory recovery after self-poisoning? A survey of university hospital centers in France

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