[The psychosocial rehabilitation in addiction medicine]. / La réhabilitation psychosociale en addictologie.

OBJECTIVES: Addictive behaviors constitute complex behaviors that are usually related to social habits, such as substance use, gambling or gaming activities, or sexual or physical activity. They progressively overrun and stifle the routine habits of the concerned individuals, for example within their occupational or family spheres of life, as well as in their hobbies or in their main physiological functions, such as sleep or eating cycles. The rehabilitation approach of care integrates the objective of restoring the altered habits and functional rhythms, to optimize the clinical outcomes and improve quality of life of the concerned persons. METHODS: Using a focused and narrative literature review, we aimed to explain what psychosocial rehabilitation consists in, and why this approach is particularly relevant for the addiction care, although to date it has remained insufficiently developed in the routine practice of many facilities. RESULTS: The "rehab" approach, is first based on a structured and comprehensive assessment of the clinical and functional aspects of the patient, which secondarily allows to frame an individualized project of care that is closely built together with the patient. This project of care can integrate classical pharmacotherapeutic and psychotherapeutic tools, but it also emphasizes wider approaches for restoring some basic social and physiological functions of the concerned person, such as sleep, eating, social functioning, physical activity, or spiritual needs. Priorities among these different dimensions have to be defined by the concerned person. CONCLUSIONS: The "rehab" approach is particularly relevant in addiction medicine. It represents a more global conception of care that conceives the recovery of social and physiological functioning as a core treatment objective for the concerned persons. The consequences for care organization are that many additional professionals should be integrated into the treatment schemes for addiction, including peer counselors, occupational therapists, physical activity coaches, or dieticians.

A simple method for the assessment of electrophoretic mobility in porous media.

Developing paper-based electrophoretic methods involve dealing with significant uncertainty levels when compared to their capillary counterparts. Critical information for developing these kinds of methods are the electrophoretic mobility of background electrolytes and samples. This work presents the design and characterization of a device for measuring the electrophoretic mobilities of dyes in porous media. The device was developed with the aim of validating a previously presented model and also proposing a protocol for the straightforward determination of electrophoretic mobilities in porous media when open-channel values are already known. Whatman #1 paper was used as a model substrate as far as it is the most common porous medium substrate for paper-based electrophoresis. The device was designed using a numerical simulation-assisted approach, utilizing OpenFOAM® and specific solvers for capillary transport and electromigration, namely porousMicroTransport and electroMicroTransport, respectively. The electrophoretic mobilities of five dyes were analyzed experimentally with the proposed device. To establish appropriate comparative values at different pHs, experiments in fused silica capillaries were also performed. An effective parameter model for describing the electrophoretic behavior of dyes in porous media, that is, the constriction factor, was found consistent with previous reports for the Whatman #1 paper. This consistency was found after considering (via direct measurements) the chromatographic effect of the medium over each dye. Consequently, the recorded values hold significant worth due to their potential for direct application in designing new experiments or devices in Whatman #1 paper. With the validation of the model through the experiments with the proposed device, those researchers interested on developing electrophoretic methods in porous substrates can make use of the open-channel electrophoretic mobilities reported in the literature, or in the well-known software databases, and correct them for the media of interest just by performing two simple characterization steps.

Association of globalization with the burden of opioid use disorders 2019. A country-level analysis using targeted maximum likelihood estimation.

BACKGROUND: The "opioid crisis" has been responsible for hundreds of thousands deaths in the US, and is at risk of dissemination worldwide. Within-country studies have demonstrated that the rise of opioid use disorders (OUD) is linked to increased access to opioid prescriptions and to so-called "diseases of despair". Both have been related to the emergence of globalization policies since the 1980s. First, globalized countries have seen a reorganization of healthcare practices towards quick and easy answers to complex needs, including increased opioid prescriptions. Second, despair has gained those suffering from the mutations of socio-economic systems and working conditions that have accompanied globalization policies (e.g. delocalization, deindustrialization, and the decline of social services). Here, using data with high quality ratings from the Global Burden of Disease database, we evaluated the country-based association between four levels of globalization and the burden of OUD 2019. RESULTS: The sample included 87 countries. Taking into account potential country-level confounders, we found that countries with the highest level of globalization were associated with a 31% increase in the burden of OUD 2019 compared to those with the lowest level of globalization (mean log difference: 0.31; 95%CI, 0.04-0.57; p = 0.02). Additional analyses showed a significant effect for low back pain (mean log difference: 0.07; 95%CI, 0.02-0.12; p = 0.007). In contrast, despite sharing some of the risk factors of OUD, other mental and substance use disorders did not show any significant relationship with globalization. Finally, socio-cultural de jure globalization, which compiles indicators related to gender equality, human capital and civil rights, was specifically associated with the burden of OUD (mean log difference: 0.49; 95%CI: 0.23,0.75; p < 0.001). CONCLUSIONS: These findings suggest that OUD may have inherent underpinnings linked to globalization, and more particularly socio-cultural aspects of globalization. Key factors may be increased rights to access prescriptions, as well as increased feelings of despair related to the erosion of local cultures and widening educational gaps.

Further validation of the Cognitive Biases Questionnaire for psychosis.

BACKGROUND: Cognitive biases are recognized as important treatment targets for reducing symptoms associated with severe mental disorders. Although cognitive biases have been linked to symptoms in most studies, few studies have looked at such biases transdiagnostically. The Cognitive Bias Questionnaire for psychosis (CBQp) is a self-reported questionnaire that assesses cognitive biases amongst individuals with a psychotic disorder, as well as individuals with other severe mental disorders. The current study aims to validate a French version of the CBQp and to explore transdiagnostic cognitive biases in individuals with psychotic disorders, individuals with depression, and in healthy controls. METHODS: The CBQp was translated into French following a protocol based on international standards. Discriminant validity and internal consistency were determined for total score and each subscale score. Confirmatory factor analyses were performed to test construct validity. Finally, cluster analyses were conducted to investigate cognitive biases across diagnostic groups. RESULTS: Our results were similar to those of the original authors, with the one-factor solution (assessment of a general thinking bias) being the strongest, but the two-factor solution (assessing biases within two themes relating to psychosis) and the five-factor solution (assessment of multiple distinct biases) being clinically more interesting. A six-cluster solution emerged, suggesting that individuals with similar diagnoses score differently on all cognitive biases, and that individuals with different diagnoses might have similar cognitive biases. CONCLUSIONS: The current findings support the validity of the French translation of the CBQp. Our cluster analyses overall support the transdiagnostic presence of cognitive biases.

Contrasting the Social Cognitive and Metacognitive Capacities Among Patients With Schizophrenia and Autism Spectrum Disorders Enrolled in Psychiatric Rehabilitation.

ABSTRACT: Unique deficits in synthetic metacognition have been found in schizophrenia when compared with other psychiatric conditions and community controls. Although persons with autism spectrum disorders (ASD) display similar deficits in social cognition relative to those with schizophrenia, to date no study has compared metacognitive function between these groups. We aimed to compare the metacognitive capacities of persons with schizophrenia and ASD and their associations with other outcomes (neurocognition, social cognition, depression, and quality of life). Fifty-six outpatients with schizophrenia or ASD (mean age, 32.50 [9.05]; 67.9% male) were recruited from two French Centers of Reference for Psychiatric Rehabilitation of the REHABase cohort. Evaluation included the Indiana Psychiatric Illness Interview, Metacognition Assessment Scale-Abbreviated, Movie for the Assessment of Social Cognition, and a large cognitive battery. Compared with those with schizophrenia, participants with ASD had higher self-reflectivity ( p = 0.025; odds ratio, 1.38 [1.05-1.86]) in univariable analyses. Metacognitive deficits may be found in ASD with a profile that varies from what is found in schizophrenia. It is possible that methods for enhancing metacognitive abilities during psychiatric rehabilitation may be refined to assist adults with ASD to better manage their own recovery.

Precise electroosmotic flow measurements on paper substrates.

A novel method for electroosmotic flow (EOF) measurement on paper substrates is presented; it is based on dynamic mass measurements by simply using an analytical balance. This technique provides a more reliable alternative to other EOF measurement methods on porous media. The proposed method is used to increase the amount and quality of the available information about physical parameters that characterize fluid flow on microfluidic paper-based analytical devices (µPADs). Measurements were performed on some of the most frequently used materials for µPADs, i.e., Whatman #1 , S&S, and Muntktell 00A filter paper. Obtained experimental results are consistent with the few previously reported data, either experimental or numerical, characterizing EOF in paper substrates. Moreover, a thorough analysis is presented for the quantification of the different effects that affect the measurements such as Joule effect and evaporation. Experimental results enabled, for the first time, to establish well-defined electroosmotic characteristics for the three substrates in terms of the magnitude of EOF as funtion of pH, enabling researchers to make a rational choice of the substrate depending on the electrophoretic technique to be implemented. The measurement method can be described as robust, reliable, and affordable enough for being adopted by researchers and companies devoted to electrophoretic µPADs and related technologies.

Numerical simulations of paper-based electrophoretic separations with open-source tools.

A new tool for the solution of electromigrative separations in paper-based microfluidics devices is presented. The implementation is based on a recently published complete mathematical model for describing these types of separations, and was developed on top of the open-source toolbox electroMicroTransport, based on OpenFOAM® , inheriting all its features as native 3D problem handling, support for parallel computation, and a GNU GPL license. The presented tool includes full support for paper-based electromigrative separations (including EOF and the novel mechanical and electrical dispersion effects), compatibility with a well-recognized electrolyte database, and a novel algorithm for computing and controlling the electric current in arbitrary geometries. Additionally, the installation on any operating system is available due to its novel installation option in the form of a Docker image. A validation example with data from literature is included, and two extra application examples are provided, including a 2D free-flow IEF problem, which demonstrates the capabilities of the toolbox for dealing with computational and physicochemical modeling challenges simultaneously. This tool will enable efficient and reliable numerical prototypes of paper-based electrophoretic devices to accompany the contemporary fast growth in paper-based microfluidics.

Impact of anticholinergic load on functioning and cognitive performances of persons with psychosis referred to psychosocial rehabilitation centers.

BACKGROUND: Few studies have explored whether high-anticholinergic load may hamper rehabilitation in persons with schizophrenia. We aim to explore the associations between anticholinergic load of psychotropic treatment and functioning or cognitive performances of persons with psychosis engaged in psychosocial rehabilitation. METHODS: The study was performed using data collected at baseline assessment in the REHABase cohort including persons referred to a French network of psychosocial rehabilitation centers. The composite-rating scale developed by Salahudeen et al. was used to rate the anticholinergic load of psychotropic drugs prescribed at baseline assessment. The associations between total anticholinergic load score (categorized as 'low' <3 v. 'high' ⩾3) and functioning or cognitive characteristics were explored using multivariate analyses. RESULTS: Of the 1012 participants with schizophrenia spectrum disorders identified in the REHABase, half used at least two psychotropic drugs with anticholinergic activity and one out of three was prescribed at least one psychotropic drug with high-anticholinergic activity. High-anticholinergic load was significantly associated with lower stage of recovery [odds ratio (OR) = 1.70, 95% confidence interval (CI) 1.05-2.76, p = 0.03], poor mental well-being (OR = 1.55, 95% CI 1.02-2.33, p = 0.04) and poor self-rated medication adherence (OR = 2.14, 95% CI 1.29-3.53, p = 0.003). Regarding cognition, a high-anticholinergic score was associated with poorer delayed-episodic memory (OR = 1.69, 95% CI 1.01-2.85, p = 0.05) and at the trend level with faster completion time on the test exploring executive performance (OR = 0.67, 95% CI 0.43-1.04, p = 0.07). CONCLUSIONS: The psychosocial rehabilitation plan of persons with psychosis should integrate optimization of psychotropic treatment in order to lessen the functional and cognitive impact of high-anticholinergic load.

Characteristics associated with self-reported medication adherence in persons with psychosis referred to psychosocial rehabilitation centers.

The aim of the present study was to explore the characteristics of psychotropic treatment and of psychosocial functioning associated with self-reported medication adherence in persons with psychosis engaged in rehabilitation. The study was performed in the REHABase cohort including persons referred to a French network of psychosocial rehabilitation centers. Treatment adherence was assessed using the Medication Adherence Rating Scale (MARS). The associations between MARS score (categorized as "low" < 7 vs. "high" ≥ 7) and functioning or psychotropic treatment characteristics were explored using multivariate analyses in 326 participants with schizophrenia spectrum disorders. Regarding psychotropic treatment, high anticholinergic load was the only characteristic associated with poor medication adherence (adjusted OR, aOR 1.98, 95% CI 1.07-3.66). Regarding functioning measures, participants with poor medication adherence were more likely to present with lower stage of recovery (aOR 2.38, 95% CI 1.31-4.32), poor quality of life (aOR 2.17, 95% CI 1.27-3.71), mental well-being (aOR 1.68, 95% CI 1.03-2.72) and self-esteem (aOR 1.74, 95% CI 1.05-2.87), and higher internalized stigma (aOR 1.88, 95% CI 1.09-3.23). Self-reported poor medication adherence is a marker of poor functioning in persons with psychosis. The MARS is a quick and simple measure of adherence that may be helpful in clinical and rehabilitation settings to identify persons with specific rehabilitation needs.

Determinants of Therapeutic Alliance With People With Psychotic Disorders: A Systematic Literature Review.

Therapeutic alliance determines medical treatment adherence, the success of psychotherapy, and the effectiveness of care. This systematic review aims at better understanding its determinants. The electronic databases Pubmed, Cochrane Library, and Web of Science were searched, using combinations of terms relating to psychosis and therapeutic alliance. Studies were selected and data were extracted using a PRISMA statement. Forty-one studies were selected, including 20 cross-sectional studies, 10 cohort studies, five randomized controlled trials, four literature reviews, and two retrospective studies. The quality of therapeutic alliance correlates with clinical symptoms, insight, social and family support, the therapist's qualities, the availability of shared therapeutic decision making, and the types of hospitalization. Although current evidence needs to be completed with further studies, it is already clear that group and family psychoeducation, cognitive remediation, community-based psychiatric services, and shared therapeutic decision making are essential approaches in the management of patients with psychosis.

Is social cognitive training efficient in autism? A pilot single-case study using the RC2S+ program.

In high-functioning autism, deficits in emotional processing and theory of mind are relevant to understanding the particularities of social functioning. Here we used a multiple baseline and ABA single-case design to assess the efficacy of an individualized social cognitive training program using both pen-and-paper and computerized materials for an 18-year old patient. After the treatment phase, we found significant improvement in both emotional processes and theory of mind. These results provide further significant data showing that therapeutic tools based on digital relational simulation are a promising way for helping people with autism to compensate for their impaired social functioning.

Psychiatric advance directives for people living with schizophrenia, bipolar I disorders, or schizoaffective disorders: Study protocol for a randomized controlled trial - DAiP study.

BACKGROUND: Compulsory admission to psychiatric hospital is rising despite serious ethical concerns. Among measures to reduce compulsory admissions, Psychiatric Advance Directives (PAD) are the most promising, with intensive PAD (i.e. facilitated and shared) being the most effective. The aim of the study is to experiment Psychiatric Advance Directives in France. METHODS: A multicentre randomized controlled trial and qualitative approach conducted from January 2019 to January 2021 with intent-to-treat analysis. SETTING: Seven hospitals in three French cities: Lyon, Marseille, and Paris. Research assistants meet each participant at baseline, 6 months and 12 months after inclusion for face-to-face interviews. PARTICIPANTS: 400 persons with a DSM-5 diagnosis of bipolar I disorder (BP1), schizophrenia (SCZ), or schizoaffective disorders (SCZaff), compulsorily admitted to hospital within the last 12 months, with capacity to consent (MacCAT-CR), over 18 years old, and able to understand French. INTERVENTIONS: The experimental group (PAD) (expected n = 200) is invited to fill in a document describing their crisis plan and their wishes in case of loss of mental capacity. Participants meet a facilitator, who is a peer support worker specially trained to help them. They are invited to nominate a healthcare agent, and to share the document with them, as well as with their psychiatrist. The Usual Care (UC) group (expected n = 200) receives routine care. MAIN OUTCOMES AND MEASURES: The primary outcome is the rate of compulsory admissions to hospital during the 12-month follow-up. Secondary outcomes include quality of life (S-QoL18), satisfaction (CSQ8), therapeutic alliance (4-PAS), mental health symptoms (MCSI), awareness of disorders (SUMD), severity of disease (ICG), empowerment (ES), recovery (RAS), and overall costs. DISCUSSION: Implication of peer support workers in PAD, potential barriers of supported-decision making, methodological issues of evaluating complex interventions, evidence-based policy making, and the importance of qualitative evaluation in the context of constraint are discussed. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03630822. Registered 14th August 2018.

Neuroimaging Studies of Cognitive Function in Schizophrenia.

Persons suffering from schizophrenia present cognitive impairments that have a major functional impact on their lives. Particularly, executive functions and episodic memory are consistently found to be impaired. Neuroimaging allows the investigation of affected areas of the brain associated with these impairments and, moreover, the detection of brain functioning improvements after cognitive remediation interventions. For instance, executive function impairments have been associated with prefrontal cortex volume and thickness; cognitive control impairments are correlated with an increased activation in the anterior cingulate cortex, and episodic memory impairments are linked to hippocampal reduction. Some findings suggest the presence of brain compensatory mechanisms in schizophrenia, e.g. recruiting broader cortical areas to perform identical tasks. Similarly, neuroimaging studies of cognitive remediation in schizophrenia focus differentially on structural, functional and connectivity changes. Cognitive remediation improvements have been reported in two main areas: the prefrontal and thalamic regions. It has been suggested that those changes imply a functional reorganisation of neural networks, and cognitive remediation interventions might have a neuroprotective effect. Future studies should use multimodal neuroimaging procedures and more complex theoretical models to identify, confirm and clarify these and newer outcomes. This chapter highlights neuroimaging findings in anatomical and functional brain correlates of schizophrenia, as well as its application and potential use for identifying brain changes after cognitive remediation.

Dissociating Affective and Cognitive Theory of Mind in Recently Detoxified Alcohol-Dependent Individuals.

BACKGROUND: Emotional and interpersonal impairments have been widely described in alcohol dependence, and their role in relapse has been clearly established. However, several components of social cognition have not been well explored in this context. Particularly, Theory of Mind (ToM) abilities, which are critical social skills enabling one to understand others' perspectives, and which have been largely investigated in other psychiatric populations, remain to be measured using ecological tasks in individuals with alcohol dependence. This study evaluated ToM abilities in close to real-life situations among alcohol-dependent individuals and differentiated its affective and cognitive subcomponents. METHODS: Thirty-two alcohol-dependent individuals (in their third week of abstinence) and 32 matched healthy controls performed the Movie for Assessment of Social Cognition (MASC), a multiple-choice task requiring the identification of the emotions, thoughts, and intentions expressed in 45 short video sequences depicting real-life social interactions. RESULTS: Alcohol-dependent individuals showed a global ToM impairment, indexed by a reduced MASC global score. However, exploration of ToM's subcomponents showed that the overall deficit was driven by a massive reduction in affective ToM, with the cognitive subcomponent preserved. CONCLUSIONS: Ecological ToM evaluation shows that alcohol dependence is not related to a generalized ToM deficit but rather to dissociation between a preserved cognitive subcomponent and an impaired affective one. These results underscore the importance of ecological measures to precisely investigate each subcomponent of social cognition in alcohol-dependent individuals. They further show that alcohol dependence is closely associated with emotional-affective impairments, pointing to the need to develop rehabilitation programs focusing on these components in clinical settings.

Facial emotion perception by intensity in children and adolescents with 22q11.2 deletion syndrome.

Difficulties in the recognition of emotions in expressive faces have been reported in people with 22q11.2 deletion syndrome (22q11.2DS). However, while low-intensity expressive faces are frequent in everyday life, nothing is known about their ability to perceive facial emotions depending on the intensity of expression. Through a visual matching task, children and adolescents with 22q11.2DS as well as gender- and age-matched healthy participants were asked to categorise the emotion of a target face among six possible expressions. Static pictures of morphs between neutrality and expressions were used to parametrically manipulate the intensity of the target face. In comparison to healthy controls, results showed higher perception thresholds (i.e. a more intense expression is needed to perceive the emotion) and lower accuracy for the most expressive faces indicating reduced categorisation abilities in the 22q11.2DS group. The number of intrusions (i.e. each time an emotion is perceived as another one) and a more gradual perception performance indicated smooth boundaries between emotional categories. Correlational analyses with neuropsychological and clinical measures suggested that reduced visual skills may be associated with impaired categorisation of facial emotions. Overall, the present study indicates greater difficulties for children and adolescents with 22q11.2DS to perceive an emotion in low-intensity expressive faces. This disability is subtended by emotional categories that are not sharply organised. It also suggests that these difficulties may be associated with impaired visual cognition, a hallmark of the cognitive deficits observed in the syndrome. These data yield promising tracks for future experimental and clinical investigations.

Theory of mind in adolescents with early-onset schizophrenia: correlations with clinical assessment and executive functions.

OBJECTIVE: We examined Theory of Mind (ToM) abilities in adolescents with early-onset schizophrenia (EOS) and their correlation with clinical findings and Executive Functions (EF). METHODS: The ToM abilities of 12 adolescents with EOS were compared with those of healthy participants matched in age and educational level. The Moving Shapes Paradigm was used to explore ToM abilities in three modalities: random movement, goal-directed movement and ToM - scored on the dimensions of intentionality, appropriateness and length of each answer. EF was tested using Davidson's Battery and the clinical psychopathology with the Positive and Negative Syndrome Scale (PANSS). RESULTS: Adolescents with EOS were significantly more impaired than controls in the three dimensions evaluated for the goal-directed and ToM modalities. Regarding the random movement modality, the only difference was in appropriateness (p<0.01). No correlation with age or level of education was evident for ToM skills. Total PANSS score was negatively correlated with appropriateness score for the goal-directed (p=0.02) and ToM modalities (p=0.01). No correlation existed between performance in the ToM Animated Tasks and positive, negative or disorganisation PANSS subscores. No correlations were found among the three scores in the Moving Shapes Paradigm and any measures of the accuracy of the three tasks assessing EF. CONCLUSION: Our results confirm previous findings of ToM deficits in adult individuals with schizophrenia and attest the severity of these deficits in patients with EOS.

Face recognition in schizophrenia: do individual and average ROCs tell the same story?

INTRODUCTION: Many studies have shown that recollection process is impaired in patients with schizophrenia, whereas familiarity is generally spared. However, in these studies, the Receiver Operating Characteristic (ROC) presented is average ROC likely to mask individual differences. METHODS: In the present study using a face-recognition task, we computed the individual ROC of patients with schizophrenia and control participants. Each group was divided into two subgroups on the basis of the type of recognition processes implemented: recognition based on familiarity only and recognition based on familiarity and recollection. RESULTS: The recognition performance of the schizophrenia patients was below that of the control participants only when recognition was based solely on familiarity. For the familiarity-alone patients, the score obtained on the Scale for the Assessment of Positive Symptoms (SAPS) was correlated with the variance of the old-face familiarity. For the familiarity-recollection patients, the score obtained on the Scale for the Assessment of Negative Symptoms (SANS) was correlated with the decision criterion and with the old-face recollection probability. CONCLUSIONS: These results show that one cannot ascribe the impaired recognition observed in patients with schizophrenia to a recollection deficit alone. These results show that individual ROC can be used to distinguish between subtypes of schizophrenia and could serve as a basis for setting up specific cognitive remediation therapy for individuals with schizophrenia.

[Psychoeducation and cognitive remediation, which place in rehabilitation?]. / Psychoéducation et remédiation cognitive, quelle place dans la réhabilitation ?

Rehabilitation techniques aim to reduce the functional impact of severe psychological disorders. The recent development of techniques aimed at the manifestations of the pathology, such as psychoeducation and cognitive remediation, raise questions about how they differ from standard therapies. Beyond their functional purpose, the consideration of the individual's current or future action potential, seems to constitute one of the key aspects.

Perceptual hysteresis as a marker of perceptual inflexibility in schizophrenia.

People with schizophrenia are known to exhibit difficulties in the updating of their current belief states even in the light of disconfirmatory evidence. In the present study we tested the hypothesis that people with schizophrenia could also manifest perceptual inflexibility, or difficulties in the updating of their current sensory states. The presence of perceptual inflexibility might contribute both to the patients' altered perception of reality and the formation of some delusions as well as to their social cognition deficits. Here, we addressed this issue with a protocol of auditory hysteresis, a direct measure of sensory persistence, on a population of stabilized antipsychotic-treated schizophrenia patients and a sample of control subjects. Trials consisted of emotional signals (i.e., screams) and neutral signals (i.e., spectrally-rotated versions of the emotional stimuli) progressively emerging from white noise - Ascending Sequences - or progressively fading away in white noise - Descending Sequences. Results showed that patients presented significantly stronger hysteresis effects than control subjects, as evidenced by a higher rate of perceptual reports in Descending Sequences. The present study thus provides direct evidence of perceptual inflexibility in schizophrenia.

Identification of factors associated with hospitalization in an outpatient population with mental health conditions: a case-control study.

Introduction: Addressing relevant determinants for preserved person-centered rehabilitation in mental health is still a major challenge. Little research focuses on factors associated with psychiatric hospitalization in exclusive outpatient settings. Some variables have been identified, but evidence across studies is inconsistent. This study aimed to identify and confirm factors associated with hospitalization in a specific outpatient population. Methods: A retrospective monocentric case-control study with 617 adult outpatients (216 cases and 401 controls) from a French community-based care facility was conducted. Participants had an index outpatient consultation between June 2021 and February 2023. All cases, who were patients with a psychiatric hospitalization from the day after the index outpatient consultation and up to 1 year later, have been included. Controls have been randomly selected from the same facility and did not experience a psychiatric hospitalization in the 12 months following the index outpatient consultation. Data collection was performed from electronic medical records. Sociodemographic, psychiatric diagnosis, historical issues, lifestyle, and follow-up-related variables were collected retrospectively. Uni- and bivariate analyses were performed, followed by a multivariable logistic regression. Results: Visit to a psychiatric emergency within a year (adjusted odds ratio (aOR): 13.02, 95% confidence interval (CI): 7.32-23.97), drug treatment discontinuation within a year (aOR: 6.43, 95% CI: 3.52-12.03), history of mental healthcare without consent (aOR: 5.48, 95% CI: 3.10-10.06), medical follow-up discontinuation within a year (aOR: 3.17, 95% CI: 1.70-5.95), history of attempted suicide (aOR: 2.50, 95% CI: 1.48-4.30) and unskilled job (aOR: 0.26, 95% CI: 0.10-0.65) are the independent variables found associated with hospitalization for followed up outpatients. Conclusions: Public health policies and tools at the local and national levels should be adapted to target the identified individual determinants in order to prevent outpatients from being hospitalized.