[Mindfulness-Oriented Recovery Enhancement (MORE): integrative treatment for chronic pain]. / Mindfulness-Oriented Recovery Enhancement (MORE) : traitement intégratif pour la douleur chronique.

Chronic pain requires an integrative approach. The prescription of opioids is increasing in Europe, including Switzerland, for the -treatment of chronic pain, despite their modest effectiveness. Mindfulness-based interventions have demonstrated their effectiveness in the management of chronic pain. The MORE program (Mindfulness-Oriented Recovery Enhancement) is an integrative therapy that uses mindfulness practices to help patients develop new positive beliefs and regain meaning, motivation and pleasure. The MORE program has been proven effective in reducing opioids and increasing well-being in patients suffering from chronic pain and thus constitutes a promising therapeutic approach.

La douleur chronique nécessite une approche intégrative. La prescription des opiacés augmente de plus en plus en Europe, y compris en Suisse, pour le traitement de la douleur chronique, malgré leur efficacité modeste. Les interventions basées sur la méditation de pleine conscience ont démontré leur efficacité quant à la prise en charge de la douleur chronique. Le programme MORE (Mindfulness-Oriented Recovery Enhancement) est une thérapie intégrative qui utilise des pratiques de pleine conscience afin d'aider les patients à développer des nouvelles croyances positives et de retrouver le sens, la motivation et le plaisir. Ce programme a été prouvé ­efficace quant à la réduction des opiacés et l'augmentation du bien-être chez les patients souffrant de douleurs chroniques. Il constitue ainsi une approche thérapeutique prometteuse.

One-year persistent symptoms and functional impairment in SARS-CoV-2 positive and negative individuals.

BACKGROUND: Persistent symptoms of SARS-CoV-2 are prevalent weeks to months following the infection. To date, it is difficult to disentangle the direct from the indirect effects of SARS-CoV-2, including lockdown, social, and economic factors. OBJECTIVE: The study aims to characterize the prevalence of symptoms, functional capacity, and quality of life at 12 months in outpatient symptomatic individuals tested positive for SARS-CoV-2 compared to individuals tested negative. METHODS: From 23 April to 27 July 2021, outpatient symptomatic individuals tested for SARS-CoV-2 at the Geneva University Hospitals were followed up 12 months after their test date. RESULTS: At 12 months, out of the 1447 participants (mean age 45.2 years, 61.2% women), 33.4% reported residual mild to moderate symptoms following SARS-CoV-2 infection compared to 6.5% in the control group. Symptoms included fatigue (16% vs. 3.1%), dyspnea (8.9% vs. 1.1%), headache (9.8% vs. 1.7%), insomnia (8.9% vs. 2.7%), and difficulty concentrating (7.4% vs. 2.5%). When compared to the control group, 30.5% of SARS-CoV-2 positive individuals reported functional impairment at 12 months versus 6.6%. SARS-CoV-2 infection was associated with the persistence of symptoms (adjusted odds ratio [aOR] 4.1; 2.60-6.83) and functional impairment (aOR 3.54; 2.16-5.80) overall, and in subgroups of women, men, individuals younger than 40 years, those between 40-59 years, and in individuals with no past medical or psychiatric history. CONCLUSION: SARS-CoV-2 infection leads to persistent symptoms over several months, including in young healthy individuals, in addition to the pandemic effects, and potentially more than other common respiratory infections. Symptoms impact functional capacity up to 12 months post infection.

Antibiomania: a case report of clarithromycin and amoxicillin-clavulanic acid induced manic episodes separately.

BACKGROUND: Antibiomania is a rare but recognized side effect with yet unclear definite pathogenesis although multiple hypotheses have been proposed. The novelty of this case is the suspected pharmacodynamic drug-drug interaction between clarithromycin and amoxicillin-clavulanic acid. CASE PRESENTATION: We present the occurrence of a brief manic episode concerning a 50-year-old man with no psychiatric history, first started on amoxicillin-clavulanic acid therapy and then switched to clarithromycin for left basal pneumonia. Shortly after the antibiotic prescription, he presented psychiatric symptomatology (logorrhea, elevated mood, irritability, increase in physical activity and delusions). The antibiotic was stopped and the patient received lorazepam (2.5 mg p.o.) to treat psychomotor agitation. Approximately 12 h after clarithromycin cessation, amelioration was already observed, supporting the diagnosis of a clarithromycin-induced manic episode. Amoxicillin-clavulanic acid was then reintroduced because of the pneumonia and psychiatric symptoms reemerged. This second antibiotic was also stopped, and 1 week later, the patient was symptom-free. CONCLUSION: The emergence of psychiatric side effects related to antibiotherapy, which is a common treatment, can greatly impact a patient's quality of life. Early recognition and intervention could substantially influence the administered medical care and recovery. Moreover, given the widespread use of antibiotics including in combination, we thought our case report might be clinically useful as a clinical reminder relevant to the use of antibiotic combinations.

Psychiatric emergency admissions during and after COVID-19 lockdown: short-term impact and long-term implications on mental health.

BACKGROUND: The 'lockdown' measures, adopted to restrict population movements in order to help curb the novel coronavirus disease 2019 (COVID-19) pandemic, contributed to a global mental health crisis. Although several studies have extensively examined the impact of lockdown measures on the psychological well-being of the general population, little is known about long-term implications. This study aimed to identify changes in psychiatric emergency department (ED) admissions between two 8-week periods: during and immediately after lifting the lockdown. METHODS: Socio-demographic and clinical information on 1477 psychiatric ED consultations at the University Hospital of Geneva (HUG) were retrospectively analyzed. RESULTS: When grouped according to admission dates, contrary to what we expected, the post-lockdown group presented with more severe clinical conditions (as measured using an urgency degree index) compared to their lockdown counterparts. Notably, after the lockdown had been lifted we observed a statistically significant increase in suicidal behavior and psychomotor agitation and a decrease in behavior disorder diagnoses. Furthermore, more migrants arrived at the HUG ED after the lockdown measures had been lifted. Logistic regression analysis identified diagnoses of suicidal behavior, behavioral disorders, psychomotor agitation, migrant status, involuntary admission, and private resident discharge as predictors of post-lockdown admissions. CONCLUSIONS: Collectively, these findings can have implications concerning the prioritization of mental health care facilities and access for patients at risk of psychopathological decompensation in time of confinement policies, but above all, provide a foundation for future studies focusing on the long-term impact of the pandemic and its associated sanitary measures on mental health. TRIAL REGISTRATION: Research Ethics Committee of Geneva, Registration number 2020-01510, approval date: 29 June 2020.

COVID-19 Related Fears of Patients Admitted to a Psychiatric Emergency Department during and Post-Lockdown in Switzerland: Preliminary Findings to Look Ahead for Tailored Preventive Mental Health Strategies.

Background and Objectives: While the impact on mental health of 2019 coronavirus (COVID-19) has been extensively documented, little is known about its influence on subjective fears. Here, we investigate the COVID-19 impact and its related restrictions on fears of patients admitted to a psychiatric Emergency Department (ED) during and post-lockdown. Materials and Methods: A retrospective study on 1477 consultations at the psychiatric ED of the University Hospital of Geneva (HUG) was performed using a mixed-methods analysis. The first analysis section was qualitative, aiming to explore the type of fears, while the second section statistically compared fears (i) during lockdown (16 March 2020-10 May 2020) and (ii) post-lockdown (11 May 2020-5 July 2020). Fears were also explored among different patient-age sub-groups. Results: 334 patients expressed one/more fears. Both in lockdown and post-lockdown, fears mostly pertained to "containment measures" (isolation, loneliness). When compared lockdown vs. post-lockdown, fears about "work status" (deteriorating, losing work) prevailed in lockdown (p = 0.029) while "hopelessness" (powerless feeling, inability to find solutions) in post-lockdown (p = 0.001). "Self around COVID-19" (dying, getting sick) fear was relatively more frequent in youth (p = 0.039), while "hopelessness" in the elderly (p < 0.001). Conclusions: Collectively, these findings highlight that lockdown/post-lockdown periods generated temporally and demographically distinct COVID-19 related fears patterns, with special regard to youth and elderly, two particularly vulnerable populations when faced with sudden and unexpected dramatic events. For this reason, the particular ED "front-line service" status makes it a privileged observatory that can provide novel insights. From a mental health perspective, these latter can be translated into pragmatic, more personalized prevention strategies to reinforce specific resilience resources and mitigate the current and long-term pandemic's impact.

[About the use of ketamine in emergency psychiatric settings]. / À propos de l'utilisation du traitement de la kétamine aux urgences psychiatriques.

Ketamine and its S-enantiomer, esketamine, have shown to be promising molecules for use in psychiatry. Widely investigated for the treatment of drug-resistant depression, they could be used in emergency conditions, due to their rapid onset of action, in two main conditions : 1) psychomotor agitation, and 2) acute suicidal ideation and behavior (suicidal crisis). In particular, intranasal administration offers a non-invasive, safe and very easy to administer option. An effect begins a few hours to a day after intake and lasts for about a week. These molecules present an innovative option for the future and their specific use in psychiatric emergencies.

La kétamine et son énantiomère S, l'eskétamine, se sont révélés être des molécules prometteuses pour leur utilisation en psychiatrie. Largement étudiées pour le traitement de la dépression pharmacorésistante, elles pourraient être utilisées dans des conditions d'urgence et, grâce à leur rapidité d'action, dans deux situations : 1) l'agitation psychomotrice, et 2) l'idéation et le comportement suicidaire aigus (crise suicidaire). En particulier, l'administration par voie intranasale offre une option non invasive, sûre et facile à utiliser. On observe un effet quelques heures à un jour après la prise, qui perdure pendant environ une semaine. Ces molécules représentent une option innovatrice pour le futur et pour une utilisation spécifique aux urgences psychiatriques.

Suicidality in Patients with Brain Tumors: A Brief Literature Review with Clinical Exemplar.

Background: Suicidality and brain tumors are two life-threatening conditions and, somewhat unexpectedly, the associations between them have scarcely been reported. Objective: In this study, we aimed to provide a brief literature review of epidemiological studies on suicidal ideation (SI) and suicidal behavior (SB) in patients with brain tumors. To illustrate various aspects of brain tumors that potentially underlie the emergence of suicidality, the review is supplemented with a clinical exemplar of a long-term survivor of brain tumor (glioblastoma) who experienced persistent SI. Furthermore, we discuss putative both neurobiological (including anatomical and immunological) and psychosocial mechanisms that might be accountable for the development of SI and SB in patients with brain tumors. Conclusions: While the etiology of this phenomenon appears to be multifactorial and still remains a subject of much debate, it is of critical importance to identify patients for which a psychiatric evaluation could recognize, in a timely manner, a possible suicide risk and alleviate the deep related suffering, by appropriate psychopharmacological and supportive and psychotherapeutic interventions.

Who Consult an Adult Psychiatric Emergency Department? Pertinence of Admissions and Opportunities for Telepsychiatry.

BACKGROUND AND OBJECTIVES: Psychiatric disorders constitute frequent causes of emergency department (ED) admissions and these rates are increasing. However, referring to ED a whole range of conditions that could or should be dealt with elsewhere is imposing itself as a problematic situation. We aimed: (1) to provide a descriptive picture of the socio-demographic and diagnostic characteristics of the visits among adults at the psychiatric ED; (2) to estimate the clinical pertinence of these visits. MATERIALS AND METHODS: Retrospective analysis of diagnostic/socio-demographic characteristics and clinical trajectories of patients admitted for a psychiatric condition at the adult psychiatric ED of the University Hospital of Geneva (HUG), Switzerland, during a 6-week timespan. RESULTS: In our sample (n = 763 total admissions for psychiatric conditions; n = 702 for inclusion of patients having received a medical evaluation), depression/anxiety, suicidal behavior (SB), psychotic episode, and substance use disorder (SUD), in descending order, were the most common diagnoses for referral. Patients belonged to younger age groups (≤65 years), had a familial status other than married/in couple, and did not present an unfavorable socio-demographic profile. Concerning the pertinence for a psychiatric ED, primary diagnosis of depression/anxiety is the only variable significantly associated with different grade of degree. By the examination of the patients' trajectory from admission to discharge, the clinical pertinence for a psychiatric ED admission existed for cases assigned to the Echelle Suisse du Tri (EST®) scale degree 1 (corresponding to most urgent and severe conditions), particularly for diagnoses of depression/anxiety associated with SB, SB as primary or comorbid diagnosis, and psychotic and manic/hypomanic episode. However, diagnoses of depression/anxiety without urgent and severe features (degrees 2, 3, 4) constituted the most frequent mode of presentation. CONCLUSIONS: Ambulatory and community-integrated settings could be more appropriate for the majority of patients admitted to adult psychiatric EDs. Moreover, the implementation of telepsychiatry strategies represents a very promising opportunity to offer these patients care continuity, reduce costs and filter the demand for psychiatric ED.

[Health crisis and suicidal crisis: mirrored lighting]. / Crise sanitaire et crise suicidaire†: éclairages en miroir.

The psychotherapeutic management of a suicidal crisis makes it possible to think of the health crisis linked to COVID-19 from a particular angle. In this article, we show the parallels but also the differences between these two types of crises. The sequential course of the crisis, the viral agent which acts as a triggering factor and the host of reactions which follow can thus evoke a suicidal crisis during which a subject often perceives an external event as a precipitating factor. However, unlike confinement in the case of the virus, it is the relationship, in particular the therapeutic relationship, which makes it possible to get through the crisis. This relationship should allow us to get to know our specific vulnerabilities, those on which the triggering factor has specifically acted.

La prise en charge psychothérapeutique d'une crise suicidaire permet de penser la crise sanitaire liée au COVID-19 sous un angle particulier. Dans cet article, nous montrons les parallèles mais également les différences entre ces deux types de crises. Le déroulement séquentiel de la crise, l'agent viral qui agit comme un facteur déclenchant et la foule de réactions qui s'ensuivent peuvent ainsi évoquer une crise suicidaire durant laquelle un sujet perçoit souvent un événement externe comme facteur précipitant. Toutefois, contrairement au confinement dans le cas du virus, c'est bien la relation, notamment la relation thérapeutique, qui permet de traverser la crise. Cette relation doit nous permettre de faire connaissance avec nos vulnérabilités spécifiques, celles sur lesquelles le facteur déclenchant a précisément agi.

[Demoralization and meaning in life in suicidal ideation†: a role for patients suffering from chronic pain?] / Démoralisation et sens dans la vie dans l'idéation suicidaire†: un role chez les patients douloureux chroniques†?

Chronic pain is strongly related to the emotional state of the individual and may be associated with suicidal ideation. The concepts of demoralization and meaning in life may have a role in suicidal ideation as a factor of crisis and resilience, respectively. Demoralization, and especially one of its elements, hopelessness, predisposes to suicidal behavior and is often associated with chronic pain conditions. In addition, the meaning that a patient with chronic pain attributes to his or her existence may also influence suicidal behavior. Follow-ups focused on demoralization and meaning in life may be a promising psychotherapeutic approach for patients suffering from chronic pain.

La douleur chronique est fortement liée à l'état émotionnel de l'individu et peut être associée à l'idéation suicidaire. Les concepts de démoralisation et de sens dans la vie peuvent avoir un rôle sur l'idéation suicidaire respectivement en tant que facteur de crise et de résilience. La démoralisation, et surtout l'un de ses éléments, le désespoir, prédispose au comportement suicidaire et est souvent associée à des états douloureux chroniques. En outre, le sens qu'un patient souffrant de douleurs chroniques peut attribuer à son existence peut également influencer le comportement suicidaire. Une prise en charge centrée sur la démoralisation et le sens dans la vie pourrait constituer une approche psychothérapeutique prometteuse pour les patients souffrant de douleurs chroniques.

[Eating Disorders assessment and care : a clinical experience in Geneva]. / Evaluation et prise en charge des troubles du comportement alimentaire : une expérience clinique à Genève.

In order to meet the needs of patients suffering from eating disorders and to follow the guidelines of experts, the specialised program for eating disorders of Liaison psychiatry and crisis intervention service in Geneva University Hospitals (HUG) has developed a detailed evaluation (multifactorial and multidisciplinary) and a program with a continuum between outpatient treatment, day care and hospitalisations. The psychotherapy is individualized and goals are regularly assessed. Somatic factors are part of evaluation and care in collaboration with general practitioners but weight (gain or loss) is not the only improvement target. Psychiatric treatment is multidisciplinary and takes into account patient's personal environment, social inclusion and the frequent psychological comorbidities.

Afin de répondre au mieux aux besoins des patients souffrant de troubles alimentaires, tout en tenant compte des recommandations d'organismes experts, les Espaces de soins pour les troubles du comportement alimentaire (ESCAL) du Service de psychiatrie de liaison et intervention de crise des HUG ont mis sur pied une évaluation approfondie (multifactorielle et multidisciplinaire), ainsi qu'un programme spécialisé avec des intensités de soins individualisées et des objectifs de prise en charge régulièrement réévalués. Les facteurs somatiques font partie intégrante de l'évaluation et de la prise en charge en collaboration avec les médecins généralistes mais le poids n'est pas le seul facteur d'évolution. Le suivi psychiatrique est multidisciplinaire et prend en compte l'entourage du patient, son insertion sociale, ainsi que les comorbidités psychiques qui sont fréquentes.

[Psychiatry : Swiss recommendations for treatment]. / Psychiatrie : recommandations thérapeutiques suisses.

The treatment of psychiatric disorders has been subject of numerous research, which are at the basis of international guidelines and recommendations. The Swiss Society for Psychiatry and Psychotherapy has decided to mandate various expert groups to develop Swiss recommendations. Such recommendations are now available for the main psychiatric disorders and this paper summarizes their main features in order to make them more visible.

La prise en charge des troubles psychiatriques a fait l'objet de nombreux travaux de recherche qui sont à la base de guidelines et recommandations internationales. La Société suisse de psychiatrie et psychothérapie a décidé de mettre à disposition des recommandations suisses et d'en confier la rédaction à des groupes d'experts. Elles existent maintenant pour les grandes pathologies psychiatriques et cet article en résume les points principaux afin de les rendre visibles.

[Obsessive compulsive disorder and deep brain stimulation, a future so close]. / Trouble obsessionnel compulsif et stimulation cérébrale profonde, un futur si proche.

The obsessive compulsive disorder (OCD) is a psychiatric disorder with a high prevalence (2­3 %), frequently causing a disabling condition. Drug and psychotherapeutic treatment is generally effective. However about 1/3 of the patients are treatment-resistant, suffering from chronic psychological distress with important sociofunctional repercussions. The identification of dysfunctional neural networks in this disease opens the door to the use of neuromodulation techniques, as deep brain stimulation (DBS). We discuss the clinical results of subthalamic nucleus DBS and the involvement of this nucleus in the pathophysiology of OCD. We emphasize the importance to confirm these results with a larger number of patients and to determine the benefits regarding the quality of life of implanted patients.

Le trouble obsessionnel compulsif (TOC) est une maladie psychiatrique fréquente (prévalence : 2­3 %) et invalidante. Le traitement pharmacologique et psychothérapeutique est globalement efficace. Un tiers des patients s'avèrent toutefois résistants, avec persistance de souffrance psychique et retentissement fonctionnel importants. L'identification précise de réseaux neuronaux dysfonctionnels dans cette maladie ouvre les portes à l'utilisation de techniques de neuromodulation, comme la stimulation cérébrale profonde (SCP). Nous discutons les résultats de la SCP du noyau sous-thalamique et l'implication de ce noyau dans la physiopathologie du TOC. Il est nécessaire de confirmer les premiers résultats de cette thérapeutique avec un nombre plus élevé de patients et de déterminer le bénéfice attendu en termes de qualité de vie.

[Prevention of suicide at Emergency Room: from the « Interpersonal Theory of Suicide ¼ to the connectedness]. / Prévenir le suicide aux urgences : de la « Théorie Interpersonnelle du Suicide ¼ à la connectedness.

Suicidal behavior (SB) has a dramatic epidemiological and clinical relevance in Switzerland. Both official reports and literature highlight SB prevention as a priority and recommend adopting new approaches, inspired by psychological models and ensuing in pragmatic interventions. Moreover, Emergency Room's (ER) role as a critical link in SB prevention chain is encouraged. Based on « Interpersonal Theory of Suicide ¼, « impossible situation ¼, and connectedness constructs, such interventions could be realized at ER through m-Health applications, with the main aim of reinforcing the patient's feeling of connectedness to his context. However, these applications have to be used with a critical view, because in no case they can be assimilated to clinical evaluation or human presence and interaction in the therapeutic relation.

Les conduites suicidaires ont une signification épidémiologique et clinique dramatique en Suisse. Les rapports officiels et la littérature font de leur prévention une priorité et recommandent de nouvelles approches, inspirées des modèles psychologiques et entraînant des interventions pragmatiques. En outre, le rôle des urgences, lien crucial dans la chaîne de prévention, est encouragé. Sur la base des postulats de la « Théorie Interpersonnelle du Suicide ¼, de la « situation impossible ¼ et de la connectedness, ces interventions pourraient s'opérer aux urgences à travers des applications m-Health. Cependant, il convient d'adopter une vision critique et attentive, car ces applications ne doivent en aucun cas se substituer à l'évaluation clinique ni à la présence et à l'interaction humaines dans la relation thérapeutique.

[Mentalizing in liaison psychiatry ?] / Mentaliser en psychiatrie de liaison ?

In the past few years, there has been an increased and widespread interest for Mentalization-Based Therapies (MBTs). Although originally developed by Anthony Bateman and Peter Fonagy for the treatment of Borderline Personality Disorder (BPD), the scope of MBTs has now been broadened and is relevant in liaison psychiatry, not only to cope with personality disorders or phenomena such as emotional dysregulation and suicidal behaviours, but also because being ill and expericencieng a dependency-laden relationship with health workers tend to reduce mentalization capacities, thereby increasing the probability of misunderstandings, conflicts, treatment drop-outs or medical errors. We provide clinicians with clues to identify failures and reboot the mentalization process among their patients and colleagues.

Les thérapies basées sur la mentalisation (TBM), développées pour le trouble borderline, ont connu ces dernières années un essor important. Les techniques des TBM pourraient être utiles en psychiatrie de liaison au-delà des troubles de la personnalité et de phénomènes comme la dérégulation émotionnelle ou les conduites suicidaires. En effet, le vécu de la maladie et la relation de soin, qui activent puissamment les représentations d'attachement, affaiblissent les capacités de mentalisation du patient et du soignant et, de ce fait, augmentent le risque de malentendus, de conflits, d'interruptions de traitements ou d'erreurs médicales. Nous proposons aux cliniciens quelques pistes pour déceler les failles et restaurer le processus de mentalisation dans le contexte de la psychiatrie de liaison.

[Bariatric surgery : psychiatric issues before and after surgery]. / Chirurgie bariatrique : enjeux psychiatriques avant et après l'intervention.

Bariatric surgery is currently the most effective therapy for the treatment of severe obesity (BMI ≥ 35 kg/m2). This article addresses psychiatric issues preceding and following this surgery, considering that weight loss is not the only criterion to be considered in assessing the quality of the postoperative course. Quality of life, the evolution of psychiatric and somatic comorbidities, compliance and long-term postoperative complications and possible interventions to optimize the psychological and psychiatric care for these patients are discussed.

La chirurgie bariatrique est aujourd'hui le traitement le plus efficace pour le traitement des obésités sévères (IMC ≥ 35 kg/m2). Cet article aborde les enjeux psychiatriques qui précédent et suivent ces interventions chirurgicales, en tenant compte que la perte de poids n'est pas le seul critère à prendre en considération dans l'évaluation de la qualité de l'évolution postopératoire. La qualité de vie, le devenir des comorbidités psychiatriques et somatiques, l'observance au long cours et les éventuelles complications postopératoire ainsi que les interventions visant à optimiser la prise en charge psychologique et psychiatrique de ces patients sont évoqués.

Impact of HSD11B1 polymorphisms on BMI and components of the metabolic syndrome in patients receiving psychotropic treatments.

BACKGROUND: Metabolic syndrome (MetS) associated with psychiatric disorders and psychotropic treatments represents a major health issue. 11ß-Hydroxysteroid dehydrogenase type 1 (11ß-HSD1) is an enzyme that catalyzes tissue regeneration of active cortisol from cortisone. Elevated enzymatic activity of 11ß-HSD1 may lead to the development of MetS. METHODS: We investigated the association between seven HSD11B1 gene (encoding 11ß-HSD1) polymorphisms and BMI and MetS components in a psychiatric sample treated with potential weight gain-inducing psychotropic drugs (n=478). The polymorphisms that survived Bonferroni correction were analyzed in two independent psychiatric samples (nR1=168, nR2=188) and in several large population-based samples (n1=5338; n2=123 865; n3>100 000). RESULTS: HSD11B1 rs846910-A, rs375319-A, and rs4844488-G allele carriers were found to be associated with lower BMI, waist circumference, and diastolic blood pressure compared with the reference genotype (Pcorrected<0.05). These associations were exclusively detected in women (n=257) with more than 3.1 kg/m, 7.5 cm, and 4.2 mmHg lower BMI, waist circumference, and diastolic blood pressure, respectively, in rs846910-A, rs375319-A, and rs4844488-G allele carriers compared with noncarriers (Pcorrected<0.05). Conversely, carriers of the rs846906-T allele had significantly higher waist circumference and triglycerides and lower high-density lipoprotein-cholesterol exclusively in men (Pcorrected=0.028). The rs846906-T allele was also associated with a higher risk of MetS at 3 months of follow-up (odds ratio: 3.31, 95% confidence interval: 1.53-7.17, Pcorrected=0.014). No association was observed between HSD11B1 polymorphisms and BMI and MetS components in the population-based samples. CONCLUSIONS: Our results indicate that HSD11B1 polymorphisms may contribute toward the development of MetS in psychiatric patients treated with potential weight gain-inducing psychotropic drugs, but do not play a significant role in the general population.