Since 2007 14 ACT-teams have been established in Norway. Despite the lack of clear evidence for efficacy, CTOs are used as a tool for supporting patients with severe mental illness that are difficult to engage to promote medication adherence and early identification of relapse. There is not much literature about the use of CTOs in ACT-teams.

This study explores the perceptions and experiences of users in Norwegian ACT-teams with recent experience of CTOs. According to the ACT-model establishing trust and a treatment alliance is of significant importance Beside exploring how CTOs influence upon the users‘life-situation and the relationship to the team-members, the study will also focus on the service users‘experience of whether their opinions and whishes are of importance to the treatment planning process.

In-depth interviews with 18 selected users from three ACT-teams will be analyzed by using a modified grounded theory approach, based upon initial, focused and theoretical coding and constant comparison.

The users perceive the uncertainty of the length of the CTO and the threat of being recalled to hospital if they don‘t comply with treatment difficult to accept. To receive support and respect from the ACT team has been important to increase their sense of safety and stability.

The results from this study can give useful information about how users‘perceive community treatment orders, which is important for how health personnel encounter ethical dilemmas and ambivalences that may accompany the use of committed community treatment.

Overweight and weight cycling represent common problems in individuals with bipolar disorder. Furthermore, substance dependency including alcoholism has been found to be a frequent co-morbid disorder, which affects the course and prognosis of bipolar disorder. Recently, substance use disorders have been related to weight cycling in a non-bipolar sample (Whyshak, 2006).

The study aimed to investigate the association between weight cycling (loosing and regaining weight in the last four years for at least three times) and substance abuse (drug and alcohol abuse) in patients with bipolar disorder.

The study took place at the Department of Psychiatry of the Medical University of Graz, Austria and 90 euthymic patients with bipolar disorder were included. Questionnaire data about weight and weight cycling were collected. A’SCID-I’ was conducted to evaluate bipolar symptomatology and co-morbid disorders.

Findings showed that bipolar patients with a history of weight cycling are prone to demonstrate a comorbid alcohol use disorder compared to non-weight cyclers (F1,87=5,531; p < .05). However, we could not find a significant relation between weight cycling and other drug or polydrug abuse in our bipolar sample (F1,87=1,548; p > .05).

Although, a relation between weight cycling and the co-morbidity of alcohol dependency has been detected, we do not know which phenomenon causes the other. Further studies on this topic including investigation of the relationship between alcohol abuse, weight cycling, and therapy outcome would be important. To conclude, the therapy of bipolar disorder should aim for a stable weight.

In bipolar disorder (BD), reduced white matter (WM) integrity in the corpus callosum has been reported, but its detailed localization difference has not been clarified. In this study, we examined fiber integrity in 7 segments of the corpus callosum and their relationships with clinical symptoms in BD.

Patients with BD (BD group, n = 17) and age-matched healthy controls (HC group, n = 24) were examined using diffusion tensor imaging tractography. The corpus callosum was divided into 7 segments (orbital frontal, anterior frontal, superior frontal, superior parietal, posterior parietal, temporal, and occipital) based on their cortical projection zones, and fractional anisotropy (FA) value of each segment was estimated. Differences in FA of each segment between the groups were examined using ANOVA with repeated measures. Correlations between FA of each segment and clinical symptoms (HAM-D, YMRS) were assessed using Spearman's rank correlation test in the BD group.

The BD group showed reduced FA in the orbital frontal, superior frontal, and posterior parietal-callosal segments compared to the HC group. In addition, the BD group showed a significant negative correlation between FA in the orbital frontal-callosal segment and HAM-D scores.

Our results suggest that WM integrity in the anterior part of the corpus callosum is reduced in BD and that orbital frontal-callosal disintegrity may be related with severity of bipolar depression.

La prise en charge des épisodes dépressifs caractérisés, se heurte à un taux de réponse à un premier traitement antidépresseur ne dépassant pas 30 à 45 %, et un taux de rémission n’excédant pas 30 % [1]. Devant ce constat, des stratégies thérapeutiques non-pharmacologiques sont légitimement en cours d’étude. C’est le cas par exemple, des chronothérapies, applications d’un modèle chronobiologique de la dépression élaboré dès le début des années 1980 [2].

Nous nous sommes intéressés à ce modèle et avons souhaité, à partir d’un exemple clinique, nous interroger sur la place des techniques thérapeutiques qui en découlent dans l’organisation hiérarchique des traitements de la dépression.

Nous présentons le cas d’un patient souffrant de dépression unipolaire résistante de stade V [3], présentant à l’admission un score de sévérité côté à 35 sur l’échelle de Montgomery et Asberg. Devant certaines caractéristiques cliniques de l’état dépressif suggérant une « susceptibilité chronobiologique », d’une part, et à la vue de données d’efficacité émanant de la littérature, d’autre part, nous avons décidé d’associer au traitement antidépresseur médicamenteux, un traitement par privation partielle de sommeil et luminothérapie matinale.

Au terme de cette prise en charge, nous avons constaté une rémission des symptômes dépressifs, avec un score MADRS de 6 après 5 semaines de traitement, et un maintien de la rémission clinique à 6 mois.

L’application et l’efficacité de ces thérapies renvoient à l’hypothèse d’un fondement chronobiologique de la dépression. Leur place dans les recommandations pour la pratique clinique et dans les algorithmes de traitement de la dépression reste limitée. Il n’apparaît pas impossible que le paradigme pharmacologique dominant la psychiatrie puisse en être une des explications [4]. Il s’agit pourtant d’alternatives thérapeutiques simples, dont l’efficacité et la tolérance sont démontrées dans une littérature de plus en plus abondante.

The epidemiology of suicidal behaviours (SB) reflects our lack of understanding of these complex behaviours, as well as our difficulty to predict them. It is now admitted that vulnerability to SB relies on the interaction between genetic predisposition and environmental factors. Serotoninergic genes and orbitofrontal cortex (OFC) dysfunction are potential biomarkers for SB.

Three groups of euthymic participants were included: 1) suicide attempters—individuals with a past history of both major depressive episode and suicidal behaviour; 2) affective comparison subjects—individuals with a past history of major depressive episode but no history of suicidal acts; 3) healthy comparison subjects—individuals with no past history of any DSM-IV axis I diagnosis. We compared neural activity using functional MRI while performing face processing (happiness, anger, sadness visualisation) and decision-making tasks (Iowa Gambling Task). We characterized of our sample for five genotypes: 5HTTLPR, TPH-1 rs1800532, TPH-1 rs7933505, MAOA u-VNTR, and TPH2 rs7305115. We performed a priori ROI analysis focused on OFC.

We found decreased activation during risky vs. safe choices and increased activation during wins vs. losses in left OFC in suicide attempters in comparison to controls. Left lateral OFC activation was correlated with IGT net score in suicide attempters. We found an increased activation of right lateral OFC cortex in suicide attempters in comparison to affective controls when viewing angry but not happy or sad faces vs. neutral faces. Lateral OFC activation was modulated by 5HTTLPR polymorphisms.

Based on OFC dysfunction, suicide attempters may overevaluate social negative signs and underevaluate deleterious consequences of short-term rewarded choices.

La schizophrénie reste une pathologie invalidante malgré une prise en charge médicamenteuse efficace. Il importe de développer d’autres stratégies adjuvantes efficaces sur les symptômes de la maladie en limitant les effets secondaires des traitements pharmacologiques. L’efficacité des activités physiques dans le traitement de la schizophrénie n’est pas démontrée mais des travaux soulignent des bénéfices sur les symptômes négatifs et dépressifs [1,2].

Nous souhaitons évaluer l’impact clinique d’un programme d’activité physique sur une population de sujets atteints de schizophrénie.

Un programme d’activités physiques supervisé par deux moniteurs a été élaboré. Il comprend une heure de multi-activités, 2 fois par semaine, pendant 12 semaines. L’intensité minimale de chaque séance était fixée à 50 % de la fréquence cardiaque de réserve. Des mesures comprenant les échelles PANSS, SANS, SAPS, CDSS, S-QoL, un bilan anthropométrique et biologique ont été réalisés à S 0, S 6, S 12 et S 16.

Deux groupes de 5 patients (n = 10) ont réalisé le programme. Une amélioration clinique est retrouvée sur l’ensemble des échelles utilisées entre S 0 et S 16. Les changements observés ne sont pas en faveur d’une amélioration du syndrome métabolique et nous notons une prise de poids des sujets sur la période de l’étude. Le traitement statistique des données présente des résultats non significatifs (p > 0,05).

Un pôle intersectoriel dédié aux patients dits longs séjours a été créé en 2010 au sein de l’hôpital psychiatrique de Dordogne. Une active politique de réhabilitation psycho-sociale a été élaborée pour les quatre années du contrat de pôle dans lequel s’engageait alors une petite équipe pluridisciplinaire déterminée à désinstitutionnaliser ces patients (30 % des « lits » du centre hospitalier).

Cure and care, socle de l’empowerment[1]. Des soins spécifiques, notamment la déclinaison originale de l’éducation thérapeutique du patient, la remédiation cognitive et l’apprentissage des habiletés sociales, ont porté un processus de rétablissement [2] ouvrant les portes de l’asile à des personnes hospitalisées depuis des années. Développement des partenariats au-delà des institutions sanitaires et médico-sociales, le soutien d’organismes publics et d’entreprises privées (associations, artisans) a redonné une présence citoyenne à ces malades dénommés chroniques dont la vie s’était longtemps limitée pour l’essentiel à l’enceinte de l’hôpital psychiatrique.

Notre association ARCHES a animé deux sections. La première, scientifique, a organisé trois colloques sur l’actualité des thérapies proposées dans les troubles psychiatriques chroniques et la déstigmatisation de la maladie mentale. La deuxième a oeuvré à développer la psychiatrie communautaire en soutenant l’installation des patients dans la cité et l’implication de nos partenaires profanes [3].

Quinze pour cent de notre patientèle est installée en appartement, 30 % en établissement médico-social. Les limites de nos actions, qui s’inscrivent dans le droit fil des rapports ministériels [4], sont tracées au sein de notre équipe, de notre institution et du contexte socio-économique.

Notre équipe pose une expertise loco-régionale en soins de suite et de réadaptation psychosociale après ses quatre années d’exercice dans un mouvement d’idées et d’actions que certains nomment psychiatrie citoyenne pour que les personnes souffrant de troubles mentaux chroniques réintègrent la vie communautaire autant que faire se peut.

Clonazepam is a benzodiazepine (BZD) authorized for treatment of epilepsy in France. Several evidences for clonazepam abuse liability and offlabel use were observed. Authorities changed the legislation to make clonazepam diversion more difficult. We asked if the three successive law changes between 2008 and 2011 have influenced clonazepam use and abuse.

To assess the impact of recent legislation changes on clonazepam abuse in the Paris Metropolitan Region.

A quantitative analysis of all clonazepam data from 2003 to 2012 of three epidemiological tools has been performed: NOT'S is a CEIP database of spontaneous NOTifications of drug abuse and dependence.

Observation of Illegal Drugs and Misuse of Psychotropic Medications (OPPIDUM), data from French health reimbursement system (FHRS) for all the country.

We aimed to compare clonazepam misuse and abuse evolution with diazepam and flunitrazepam to assess the legislation impact on clonazepam.

In NOT'S, between 2003 and 2007 the proportion of clonazepam misuse ans abuse seems to be stable (15% ±2 of all notifications). Clonazepam abuse increases between 2007 and 2010 (up to 30%) then starts to decrease after 2010 until now (23% of all notifications). These results are consistents with data from the FHRS, whereas in the OPPIDUM survey clonazepam use seems to be stable in addiction centres. Diazepam use is constantly increasing in the 3 epidemiologic tools whereas flunitrazepam use is stable or slowly decreasing.

Our results show an influence of the legislation on the misuse of clonazepam particularly in the untreated addicted population.

Mood disorders (MD) are disabling conditions throughout the world associated with significant psychosocial impairment. Affective temperaments, as well as hopelessness, may play a significant role in the pathophysiology of MD. The present study was designed to characterize patients with MD for their prevalent affective temperament and level of hopelessness.

559 consecutive adult inpatients were assessed using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego- Autoquestionnaire version (TEMPS-A), the Gotland Scale for Male Depression (GSMD), the Beck Hopelessness Scale (BHS) and the Mini International Neuropsychiatric Interview (MINI).

Higher cyclothymia (27.7% vs. 20.0%, < 0.05) and irritable (34.7% vs. 22.9%, p < 0.05) temperaments were found in bipolar disorder-I (BD-I) patients compared to those with other Axis I diagnoses. Major depressive disorder (MDD) patients had lower hyperthymia than BD-I and BD-II (22.9% vs. 44.6% vs. 40.7% p < 0.05) and higher anxiety than patients with other Axis I diagnoses (52.1% vs. 22.3%, p < 0.05). Severe’male’ depression was more common in BD-II patients compared to BD-I and MDD, respectively (33.7% vs. 16.3% vs. 22.9% p < 0.05). BD-I and patients with other axis I diagnoses reported lower BHS≥9 scores (41.6% and 36.6% vs. 61.6% and 62.5%, p < 0.05) than those with BD-II and MDD.

MDD patients were more likely to have anxious prevalent temperament, higher hopelessness and lower hypethimic temperament while BD-I patients had more frequently cyclothymic and irritable temperaments than patients with other Axis I diagnoses. The implications of the present results were discussed.

Kosovo war had a devastating effect in the country as evident in the increasing prevalence of depression and post-traumatic stress disorders in the population.

To investigate levels of Quality of Life and the presence of PTSD and Depression thirteen years after war at the most war-affected region of Kosovo-Drenica.

The study aimed to measure the levels of Quality of Life and explore correlations with the presence of PTSD and Depression.

The purposeful sample of general population of Drenica region have filled out PTSD questionnaires (adapted from DSM-IV), Beck Depression Inventory and The Quality of Life Scale. In the sample of 249 respondents (17-70yr, Mage=36, 6) 2/3 of them were males; 88% lived in rural regions; 18, 65% ex-soldiers; 66. All data was analyzed by SPSS 21.0 and Microsoft Excel 2007.

Results showed that 27% of the sample declared experiencing war trauma. We found PTSD in 17, 9% cases; depression at clinical level in 10, 7%. 38, 1% of the sample has perception of low level of Quality of Life. PTSD was significantly positively related with depression (r=.562; p<.01) and significantly negatively related with the level of Quality of Life (r=-.39; p<.01). Presence of PTSD predicted low level of Quality of Life while controlling for depression (r=-.26; p<.01)

The prevalence of PTSD in the specific region is still high and is obviously related to poor quality of life and depression. More effective programs are needed both to identify and treat PTSD and depression.

Studies in general and psychiatric populations have mainly reported higher rates of somatisation in immigrants. Cross-cultural studies, confirmed that East-Asian non-immigrant patients reported fewer psychological and more somatic symptoms in depression. However studies on somatisation in depression are lacking for Vietnamese migrants in Europe.

To explore whether Vietnamese outpatients, who utilized a psychiatric outpatient clinic in Germany had a tendency to present more somatic symptoms in depression.

For FG Vietnamese outpatients, psychological symptoms were assessed by depression-scale (PHQ-9) and somatic symptoms were assessed by the Somatic-symptom-scale (PHQ-15) in Vietnamese language by a Vietnamese psychiatrist. German outpatients who were assessed in the same outpatient clinic where matched for age, gender and diagnosis of MDE. Differences in PHQ-9 and PHQ-15 scales where analyzed with an ANOVA and single-item-differences of PHQ where analyzed with Mann-Whithney-Tests.

43 FG Vietnamese immigrants and 43 native german outpatients where included. While we found no differences on the total score of the PHQ-9 between both groups, FG-Vietnamese outpatients had an overall higher total score on somatic-symptom-scale PHQ-15. When analyzing somatic items FG-Vietnamese outpatients reported significantly more somatic symptoms of headache, chest-pain, dizziness and fainting.

Depressed Vietnamese outpatients reported psychological symptoms of depression at similar levels as matched native German outpatients. Vietnamese outpatients had a higher total score for somatic symptoms, and that difference was driven by a subset of somatic items. We concluded, that emphasis on somatic symptoms does not reflect a minimization of psychological symptoms in FG-Vietnamese outpatients seeking help for depression.

C’est une véritable alternative à l’hospitalisation « classique ». La capacité d’accueil est de 6 places. Les soins dispensés répondent aux critères :

– de coordination des intervenants ;

– de la fréquence des interventions ;

– de pluridisciplinarité ;

– de développement du réseau.

Ils se situent comme une alternative à l’hospitalisation à temps complet en amont ou en aval. Par ailleurs, ces soins peuvent préparer une hospitalisation ou raccourcir une durée d’hospitalisation par des soins à domicile ou être une aide au diagnostic.

Le relais de soins est effectué par le psychiatre traitant adresseur. Si le patient n’en a pas, il sera adressé au centre médico-psychologique ou à un psychiatre libéral afin de poursuivre les soins ambulatoires.

Ce mode d’hospitalisation s’adresse à tout patient âgé de plus de 18 ans, en souffrance psychique aiguë et résidant sur Nantes centre ville.

La durée maximum d’hospitalisation est de 21 jours, renouvelable une fois. Les patients ne peuvent pas être admis plus de trois fois dans l’année.

Le patient doit être consentant aux soins et vivre dans un environnement salubre. La présence d’un aidant familial comme partenaire de soins est recommandée. Les patients en programme de soins peuvent être admis.

Ce dispositif fonctionne du lundi au vendredi de 8 h 30 à 18 h et les week-ends/jours fériés de 9 h à 16 h 30.

Une infirmière passe entre une à deux fois par jour au domicile. Un à deux entretiens médicaux sont programmés par semaine.

Les équipes soignantes et sociales font aussi un travail de liaison avec les partenaires médicaux, sociaux et infirmiers habituels du patient.

The HCR-20 is the most widely used structured violence risk assessment tool in medium secure units in England and has good predictive validity for inpatient violence. However little is known about whether its predictive validity varies between different clinical and demographic groups.

1. 1) collect HCR-20 risk assessment and three month follow-up data for all eligible inpatients

2. 2) examine the ability of the HCR-20 to predict various indices of inpatient aggression using receiver operating characteristics (ROC), and

3. 3) compare AUC values derived from different groups (i.e. men vs. women)

determine if the HCR-20 performs equally across different clinical and demographic groups.

This study was conducted amongst inpatients at St Andrew's (N=505). Demographic (age, ethnicity, gender), clinical (diagnosis) and routinely collected risk assessment data (HCR-20) were collated. Incidents of aggression were coded using the OAS for the three months following assessment.

ROC analysis revealed that the HCR-20 total, Clinical scale and Risk Management scale were predictive of all types of aggression; the Historical scale was a significant predictor of verbal aggression and physical aggression towards objects but not physical aggression towards people. The predictive efficacy of the HCR-20 differed according to gender and diagnosis, with superior performance obtained with women and those with a diagnosis of personality disorder.

This study reveals differences in the HCR-20's efficacy between groups. Further development and optimisation of the HCR-20 may be required. Alternatively, interventions to prevent aggression may be more effective among some groups. Future research should address these issues.