Brain-derived neurotrophic factor Val66Met polymorphism moderates the relationship between impulsivity, negative emotions, and binge drinking intensity in university students.

Studies on the genetic factors involved in binge drinking (BD) and its associated traits are very rare. The aim of this cross-sectional study was to investigate differences in the association between impulsivity, emotion regulation and BD in a sample of young adults according to the rs6265/Val66Met variant in the brain-derived neurotrophic factor (BDNF) gene, a well-known candidate gene in alcohol use disorders. We recruited 226 university students (112 women), aged between 18 and 25 years old, from two centers in France. The participants completed measures related to alcohol consumption, depression severity, state anxiety levels, impulsivity (UPPS-P), and difficulties in emotion regulation [Difficulty in Emotion Regulation Scale (DERS)]. The relationship between the BD score and the clinical characteristics in the BDNF genotype groups was assessed by partial correlation analyses and moderation analyses. The partial correlation analyses showed that, in the Val/Val genotype group, the BD score was positively related to UPPS-P Lack of Premeditation and Sensation Seeking scores. In the Met carriers group, the BD score was positively related to UPPS-P Positive Urgency, lack of Premeditation, lack of Perseverance and Sensation Seeking scores and to Clarity score of the DERS. Moreover, the BD score was positively associated with depression severity and state anxiety scores. The moderation analyses revealed that BDNF Val/Met genotype moderated the relationship between several clinical variables and BD. The results of the present study support the hypothesis of common and specific vulnerability factors regarding impulsivity and emotion regulation difficulties associated with BD according to this BDNF rs6265 polymorphism.

Cluster analysis unveils a severe persistent respiratory impairment phenotype 3-months after severe COVID-19.

BACKGROUND: The mid-term respiratory sequelae in survivors of severe COVID-19 appear highly heterogeneous. In addition, factors associated with respiratory sequelae are not known. In this monocentric prospective study, we performed a multidisciplinary assessment for respiratory and muscular impairment and psychological distress 3 months after severe COVID-19. We analysed factors associated with severe persistent respiratory impairment, amongst demographic, COVID-19 severity, and 3-month assessment. METHODS: Patients with severe SARS-CoV-2 pneumonia requiring ≥ 4L/min were included for a systematic 3-month visit, including respiratory assessment (symptoms, lung function, CT scan), muscular evaluation (body composition, physical function and activity, disability), psychopathological evaluation (anxiety, depression, post-traumatic stress disorder-PTSD) and quality of life. A cluster analysis was performed to identify subgroups of patients based on objective functional measurements: DLCO, total lung capacity and 6-min walking distance (6MWD). RESULTS: Sixty-two patients were analysed, 39% had dyspnea on exercise (mMRC ≥ 2), 72% had DLCO < 80%, 90% had CT-scan abnormalities; 40% had sarcopenia/pre-sarcopenia and 31% had symptoms of PTSD. Cluster analysis identified a group of patients (n = 18, 30.5%) with a severe persistent (SP) respiratory impairment (DLCO 48 ± 12%, 6MWD 299 ± 141 m). This SP cluster was characterized by older age, severe respiratory symptoms, but also sarcopenia/pre-sarcopenia, symptoms of PTSD and markedly impaired quality of life. It was not associated with initial COVID-19 severity or management. CONCLUSIONS AND CLINICAL IMPLICATION: We identified a phenotype of patients with severe persistent respiratory and muscular impairment and psychological distress 3 months after severe COVID-19. Our results highlight the need for multidisciplinary assessment and management after severe SARS-CoV-2 pneumonia. Trial registration The study was registered on ClinicalTrials.gov (May 6, 2020): NCT04376840.

[Management of suicidal crisis in general practice: evaluation of care practices according to patient age]. / Crise suicidaire, évaluation des pratiques en médecine générale selon l'âge du patient.

Nearly 800,000 people die by suicide each year worldwide. Up to 75% of suicidal patients consulted their general practitioner in the months preceding their attempt. A study, conducted among 167 practitioners in Champagne-Ardenne in 2016-2017, aims to evaluate the practices of general practitioners in the management of suicidal crisis, particularly according to the age of the patient. It provides elements for reflection on their role in suicide prevention.

Investigation of the neural correlates of mentalizing through the Dynamic Inference Task, a new naturalistic task of social cognition.

Understanding others' intentions requires both the identification of social cues (e.g., emotional facial expressions, gaze direction) and the attribution of a mental state to another. The neural substrates of these processes have often been studied separately, and results are heterogeneous, in part attributable to the variety of paradigms used. The aim of the present study was to explore the neural regions underlying these sociocognitive processes, using a novel naturalistic task in which participants engage with human protagonists featured in videos. A total of 51 right-handed volunteers underwent functional magnetic resonance imaging while performing the Dynamic Inference Task (DIT), manipulating the degree of inference (high vs. low), the presence of emotion (emotional vs. nonemotional), and gaze direction (direct vs. averted). High nonemotional inference elicited neural activation in temporal regions encompassing the right posterior superior temporal sulcus. The presence (vs. absence) of emotion in the high-inference condition elicited a bilateral pattern of activation in internal temporal areas around the amygdala and orbitofrontal structures, as well as activation in the right dorsomedial part of the superior frontal gyrus and the left precuneus. On account of its dynamic, naturalistic approach, the DIT seems a suitable task for exploring social interactions and the way we interact with others, both in nonclinical and clinical populations.

Heterogeneity of Executive Function Abilities in Recently Detoxified Patients with Alcohol Use Disorder: Evidence from a Cluster Analysis.

BACKGROUND: Impairments of executive functions (EF) have been consistently reported in patients with alcohol use disorder (AUD), mostly in studies which were based on comparisons of means between groups. However, given the high heterogeneity in AUD patients, this approach could actually cover a wide range of EF patterns. In the present study, we addressed the paucity of the literature about cognitive heterogeneity in AUD by applying a cluster analytical approach on EF measures. METHODS: Seventy-eight withdrawn AUD patients and 77 healthy Control participants completed measures targeting a variety of EF components. We then used cluster analysis to identify subgroups of AUD patients. Furthermore, the AUD subgroups were compared to the Control group to establish their specific EF patterns. RESULTS: Findings showed that AUD patients could be divided into 3 clusters based on their EF performances. A first cluster accounting for half of the AUD sample was characterized by unimpaired EF (Cluster 1). The 2 other clusters displayed major EF deficits but differed regarding the deficient EF component. While Cluster 2 was mainly impaired on measures of rule deduction and mental flexibility, Cluster 3 was mainly characterized by a lower processing speed and impaired inhibition of an ongoing motor response. Differences in EF performances of AUD patients could be related to differences in premorbid cognitive reserve, impulsiveness patterns, and withdrawal complications. CONCLUSIONS: This study highlights the importance of the cognitive heterogeneity in AUD by showing that AUD patients display substantially different EF patterns. Future studies should try to go beyond mere group comparisons to further deepen our understanding about cognitive differences between AUD patients. In the long run, this could lead to more personalized prevention and treatment programs specifically tailored to the patient's impairments.

Neural Responses to the Implicit Processing of Emotional Facial Expressions in Binge Drinking.

AIMS: Emotional processing is a crucial ability in human and impairments in the processing of emotions are considered as transdiagnostic processes in psychopathology. In alcohol use disorder, numerous studies have investigated emotional processing and showed emotional deficits related to the perpetuation of alcohol use. Recent studies have also explored this topic in binge drinking, but few studies are available. In this paper, we explored whether emotional difficulties in binge drinking may be extended to implicit emotion processing. METHODS: We compared 39 binge drinkers (BD) and 40 non-binge drinkers who performed a gender categorization task while faces represented emotional expressions of anger, fear, happiness and sadness. Emotional brain responses were assessed thanks to functional magnetic resonance imaging. Emotional versus non-emotional conditions were first contrasted in the whole sample and groups were then compared. RESULTS: Emotional condition led to differential activations than non-emotional condition, supporting the validity of the paradigm. Regarding group comparisons, BD exhibited higher activations in the left posterior cerebellum (anger processing) and the right anterior cingulate (fear processing) as well as lower activations in the left insula (happiness), the right post-central gyrus, the right cingulate gyrus and the right medial frontal gyrus (sadness processing). CONCLUSIONS: Beyond emotional identification, BD presented differential brain responses following the implicit processing of emotions. Emotional difficulties in binge drinking might be related to a more automatic/unconscious processing of emotions.

Psychiatric symptoms and quality of life in older adults with schizophrenia spectrum disorder: results from a multicenter study.

The severity of psychopathology has a strong negative impact on quality of life (QoL) among older adults with schizophrenia spectrum disorder. However, because these subjects generally experience multiple psychiatric symptoms, it remains unclear whether decreased QoL in this population is due to specific symptoms (e.g., hallucinations), specific dimensions of psychopathology (e.g., negative symptoms), a general psychopathology dimension representing the shared effect across all psychiatric symptoms, or a combination of these explanations. Data were derived from the Cohort of individuals with Schizophrenia Aged 55 years or more (CSA) study, a large (N = 353) multicenter sample of older adults with schizophrenia spectrum disorder recruited from French public-sector psychiatric departments. We used structural equation modeling to examine the shared and specific effects of psychiatric symptoms on QoL, while adjusting for sociodemographic characteristics, general medical conditions, global cognitive functioning and psychotropic medications. Psychiatric symptoms and QoL were assessed face-to-face by psychiatrists using the Brief Psychiatric Rating Scale (BPRS) and the Quality of Life Scale (QLS). Among older adults with schizophrenia spectrum disorder, effects of psychiatric symptoms on QoL were exerted mostly through a general psychopathology dimension (ß = - 0.43, p < 0.01). Negative symptom dimension had an additional negative effect on QoL beyond the effect of that factor (ß = - 0.28, p < 0.01). Because psychiatric symptoms affect QoL mainly through two dimensions of psychopathology, i.e., a general psychopathology dimension and a negative symptom dimension, mechanisms underlying those dimensions should be considered as promising targets for therapeutic interventions to substantially improve quality of life of this vulnerable population.

Disentangling the Relationship Between Self-Esteem and Problematic Alcohol Use Among College Students: Evidence From a Cluster Analytic Approach.

AIMS: Investigation of the relationship between self-esteem and alcohol use among college students has yielded discrepant results. We hypothesized that these discrepancies could originate from a potential heterogeneity of self-esteem patterns among young adult with an alcohol use disorder (AUD). METHODS: A community sample of 343 college students was recruited and categorized with or without AUD using the Alcohol Use Disorders Identification Test cut-offs. College students were compared on the dimensions of the Coopersmith Self-Esteem Inventory (CSEI) as well as mood, impulsiveness, alcohol- and other substance-related measures, including drinking motives. RESULTS: A cluster analysis conducted among college students with AUD highlighted two subgroups characterized by contrasting patterns on the CSEI: one group with a high level of self-esteem and low levels of anxiety and depression symptoms and one group with a low level of self-esteem and high levels of impulsiveness, mood symptoms and drinking to cope motives. CONCLUSION: Findings caution against assuming that AUD is associated with low self-esteem, as reported in previous studies. These results rather emphasize a heterogeneity of self-esteem in college students, showing that high self-esteem was also related to AUD. Implications of these results are major for prevention purposes and clinical practice.

Disrupted Fear and Sadness Recognition in Binge Drinking: A Combined Group and Individual Analysis.

BACKGROUND: Binge drinking is a harmful pattern of alcohol consumption, associated with cognitive and cerebral impairments. Indeed, various cognitive processes have been identified as disrupted in binge drinking, ranging from perceptive to executive functions, but emotional processes have conversely been little investigated. Particularly, it is unclear to what extent binge drinkers (BD) present difficulties to recognize and categorize the emotions expressed by other individuals. Such an exploration would, however, offer a more comprehensive view of the deficits associated with alcohol-related disorders and potentially involved in the maintenance of this harmful habit. METHODS: Fifty-two BD and 42 control participants performed an emotional task assessing the ability to recognize 6 basic emotions (i.e., anger, contempt, disgust, fear, happiness, and sadness). Accuracy score and detection threshold were collected for each emotion. To explore the extent of emotion recognition difficulties, 2 analyses were conducted: (i) classical repeated measures analyses of variance, to compare groups' performance, and (ii) multiple single-case analyses (i.e., Crawford's t-tests), to determine the percentage of BD presenting genuine emotion recognition deficits. Correlations were also performed between alcohol consumption characteristics and emotional recognition scores. RESULTS: BD presented reduced performance for the recognition of fear and sadness. Multiple single cases highlighted that these deficits respectively concerned 21.15 and 15.38% of the binge drinking sample, and the relation between binge drinking and reduced sadness detection was supported by correlational analyses. CONCLUSIONS: These findings show that binge drinking is associated with a disrupted processing of emotional stimuli. By identifying heterogeneity in the impairments presented by BD, the present results also underline the usefulness of a combined group and individual Analysis.

Fibromyalgia patients make scarce reference to pain in self-defining memories.

OBJECTIVE: Self-defining memories (SDMs) are vivid, emotionally intense and well-rehearsed autobiographical memories that provide fundamental information about one's cognitive affective motivational representation of self. Exploring SDMs in fibromyalgia (FM) is of interest for understanding the psychopathology of this disorder and improving clinical interventions. Our aim was to compare patients and healthy controls (HC) on SDM characteristics. METHOD: We included 25 patients with FM and 24 HC matched for age, sex and education level. Each participant described five SDMs, which were coded for content, specificity, integration, tension, redemption, contamination, affective response, date, and reference to pain. We statistically controlled our results for the most plausible confounding factors related to FM that could affect SDM recall, namely depression, anxiety, cognitive inhibition, pain severity and medication. RESULTS: Compared with HC, patients retrieved less specific SDMs with a more negative emotional valence but less tension. They reported more relationship-related memories, and fewer redemptive ones, with less meaning-making. The number of memories referring to physical or psychological pain did not differ between groups. None of the confounding factors we analysed could explain (either alone or in combination) the statistical differences between groups for SDMs characteristics. CONCLUSION: We discuss functional avoidance and alexithymia as two main factors for poor reference to pain in patients' SDMs that further reveal affective dysregulation in FM. In clinical practice, remediating the way in which pain is integrated into SDMs in FM may help to mitigate its negative impact on everyday life.

Cloninger's Temperament and Character Dimensions of Personality and Binge Drinking Among College Students.

BACKGROUND: Temperament and character dimensions of personality remain largely unexplored in young adults exhibiting binge drinking (BD) patterns. Moreover, the available studies do not consider gender differences and dismiss possible personality heterogeneity among binge drinkers. In this study, we aimed to compare temperament and character dimensions between young binge drinkers and age- and sex-matched social drinkers. We further applied cluster analysis to investigate the potential heterogeneity of personality patterns among BD college students. METHODS: This study included 200 university students of 18 to 24 years of age, who were recruited via an invitation to take an alcohol use survey. These participants included 100 individuals (50 females and 50 males) with a BD pattern, and 100 participants (50 females and 50 males) with a social drinking (SD) pattern. These subjects were evaluated with regard to their use of alcohol and other substances, impulsiveness, sensation seeking, mood, and Cloninger's Temperament and Character Inventory. RESULTS: Between-group comparisons revealed that both male and female binge drinkers were characterized by high levels of novelty seeking, and low levels of persistence and self-directedness. However, cluster analyses within the binge drinker group revealed 2 distinct groups that differed between males and females. These groups shared similarities with Cloninger's type I (high harm-avoidance) and II (high novelty-seeking) alcoholism typology. CONCLUSIONS: The present findings support the subdivision of binge drinkers according to gender and personality dimensions. Male and female binge drinkers should not be considered a unitary group, but rather a population of individuals that encompasses at least 2 distinct personality patterns. These findings have major implications for prevention and treatment approaches.

Modulation of the N400 component in relation to hypomanic personality traits in a word meaning ambiguity resolution task.

AIM: High levels of hypomanic personality traits have been associated with an increased risk of developing bipolar disorder (BD). Changes in semantic content, impaired verbal associations, abnormal prosody, and abnormal speed of language are core features of BD, and are thought to be related to semantic processing abnormalities. In the present study, we used event-related potentials to investigate the relation between semantic processing (N400 component) and hypomanic personality traits. METHODS: We assessed 65 healthy young adults on the Hypomanic Personality Scale (HPS). Event-related potentials were recorded during a semantic ambiguity resolution task exploring semantic ambiguity (polysemous word ending a sentence) and congruency (target word semantically related to the sentence). RESULTS: As expected, semantic ambiguity and congruency both elicited an N400 effect across our sample. Correlation analyses showed a significant positive relationship between the Social Vitality subscore of the HPS and N400 modulation in the frontal region of interest in the incongruent unambiguous condition, and in the frontocentral region of interest in the incongruent ambiguous condition. CONCLUSION: We found differences in semantic processing (i.e., detection of incongruence and semantic inhibition) in individuals with higher Social Vitality subscores. In the light of the literature, we discuss the notion that a semantic processing impairment could be a potential marker of vulnerability to BD, and one that needs to be explored further in this clinical population.

Impact of hypomanic personality traits on brain functional connectivity during a dynamic theory-of-mind task.

Hypomanic personality traits are present in the general population and represent a risk factor for developing bipolar disorder. This personality style, notably its social component, is linked to difficulties in theory of mind (i.e., ability to infer mental states). Exploring the neural correlates of mental states' inference in individuals with these personality traits can provide meaningful insights into the development of bipolar disorder. The aim of the present study was therefore to investigate the potential impact of hypomanic traits on brain activation and task-based connectivity strength during a dynamic theory of mind task in a nonclinical population. A total of 52 nonclinical participants were recruited, and hypomanic traits were assessed with the Hypomanic Personality Scale. The severity of hypomanic traits was positively associated with right middle and inferior frontal gyri activations (in high vs. low inference in nonemotional condition and emotion vs. no emotion in high inference, respectively). It was also associated with stronger connectivity between the salience network (i.e., bilateral putamen and pallidum) and bilateral superior temporal gyri (high inference in nonemotional condition), and between cerebellar and temporal areas (high inference in emotional condition). These changes may either reflect adaptations or differential processing, and further studies are therefore mandatory.

Association Between Clozapine Plasma Concentrations and Treatment Response: A Systematic Review, Meta-analysis and Individual Participant Data Meta-analysis.

BACKGROUND AND OBJECTIVES: Although therapeutic drug monitoring of clozapine is recommended, its optimisation is often adjusted only on the basis of dosage. The aim of this study was to assess the link between clozapine plasma concentrations and clinical response by a meta-analysis of published studies and by an individual participant data meta-analysis. METHODS: We conducted a computerised search of bibliographic databases (EMBASE, PubMed, Clinical Trials, and Web of Science) to identify studies that assessed the relationship between clozapine serum or plasma concentrations and clinical efficacy. Using pooled data, we investigated the association between improvement of clinical outcome and clozapine or norclozapine plasma concentrations, the sum of clozapine and norclozapine plasma concentrations, and the coefficient of variation of clozapine plasma concentrations. Using available individual data, we assessed the relationship between clozapine plasma concentrations and clinical response (changes in the Brief Psychiatric Rating Scale score) and identified a threshold level for a favourable clinical response. RESULTS: Fifteen studies satisfied inclusion criteria. Our meta-analysis showed that responders had clozapine plasma concentrations that were, on average, 117 ng/mL higher than non-responders. The patients with plasma clozapine concentrations above the thresholds identified in each study had a higher likelihood of responding (odds ratio = 2.94, p < 0.001). Norclozapine plasma concentrations were not associated with a clinical response. The meta-analysis of individual data supported this result and confirmed the link between clozapine concentrations and a change in the Brief Psychiatric Rating Scale score and/or the probability of clinical response. Finally, with the analysis of the coefficient of variation of clozapine plasma concentrations, we found that a greater inter-individual fluctuation in plasma concentrations was associated with a loss of clinical response. CONCLUSIONS: Our work confirmed that, in contrast to clozapine doses, clozapine plasma concentrations were related to a favourable clinical response, with a mean difference between responders and non-responders of 117 ng/mL. A threshold for a treatment response of 407 ng/mL was determined, with a high discriminatory capacity, and a sensitivity and specificity of 71% and 89.1%, respectively.

Activation of the left medial temporal gyrus and adjacent brain areas during affective theory of mind processing correlates with trait schizotypy in a nonclinical population.

Schizophrenia, a severe psychiatric disorder, is associated with abnormal brain activation during theory of mind (ToM) processing. Researchers recently suggested that there is a continuum running from subclinical schizotypal personality traits to fully expressed schizophrenia symptoms. Nevertheless, it remains unclear whether schizotypal personality traits in a nonclinical population are associated with atypical brain activation during ToM tasks. Our aim was to investigate correlations between fMRI brain activation during affective ToM (ToMA) and cognitive ToM (ToMC) tasks and scores on the Schizotypal Personality Questionnaire (SPQ) and the Basic Empathy Scale in 39 healthy individuals. The total SPQ score positively correlated with brain activation during ToMA processing in clusters extending from the left medial temporal gyrus (MTG), lingual gyrus and fusiform gyrus to the parahippocampal gyrus (Brodmann area: 19). During ToMA processing, the right inferior occipital gyrus, right MTG, precuneus and posterior cingulate cortex negatively correlated with the emotional disconnection subscore and the total score of self-reported empathy. These posterior brain regions are known to be involved in memory and language, as well as in creative reasoning, in nonclinical individuals. Our findings highlight changes in brain processing associated with trait schizotypy in nonclinical individuals during ToMA but not ToMC processing.

Facial emotion recognition processes according to schizotypal personality traits: An eye-tracking study.

Facial emotion recognition has been shown to be impaired among patients with schizophrenia and, to a lesser extent, among individuals with high levels of schizotypal personality traits. However, aspects of gaze behavior during facial emotion recognition among the latter are still unclear. This study therefore investigated the relations between eye movements and facial emotion recognition among nonclinical individuals with schizotypal personality traits. A total of 83 nonclinical participants completed the Schizotypal Personality Questionnaire (SPQ) and performed a facial emotion recognition task. Their gaze behavior was recorded by an eye-tracker. Self-report questionnaires measuring anxiety, depressive symptoms, and alexithymia were administered. At the behavioral level, correlation analyses showed that higher SPQ scores were associated with lower surprise recognition accuracy scores. Eye-tracking data revealed that higher SPQ scores were associated with shorter dwell time on relevant facial features during sadness recognition. Regression analyses revealed that the total SPQ score was the only significant predictor of eye movements during sadness recognition, and depressive symptoms were the only significant predictor of surprise recognition accuracy. Furthermore, dwell time predicted response times for sadness recognition in that shorter dwell time on relevant facial features was associated with longer response times. Schizotypal traits may be associated with decreased attentional engagement in relevant facial features during sadness recognition and impede participants' response times. Slower processing and altered gaze patterns during the processing of sad faces could lead to difficulties in everyday social situations in which information must be rapidly processed to enable the successful interpretation of other people's behavior.

Neural basis of autobiographical memory retrieval in schizophrenia.

BACKGROUND: Autobiographical memory retrieval is impaired in schizophrenia. AIMS: To determine the neural basis of this impairment. METHOD: Thirteen patients with schizophrenia and 14 healthy controls performed an autobiographical memory retrieval task based on cue words during functional magnetic resonance imaging. Patients were selected on the basis of their ability to perform the task and all participants received training. RESULTS: Although patients and controls activated a similar brain network during autobiographical memory retrieval, patients displayed decreased activation in several of these regions, including the anterior cingulate cortex, left lateral prefrontal cortex, right cerebellum and ventral tegmental area (k≥10, P<0.001, uncorrected). In addition, activation of the caudate nuclei was negatively correlated with retrieval performance in controls but positively correlated with performance in patients. CONCLUSIONS: The autobiographical memory retrieval brain network is impaired in schizophrenia. Patients with schizophrenia display decreased activation of the cognitive control network during retrieval, possibly due to aberrant functioning of the dorsal striatum.

Depression, anxiety and personality dimensions in female first-degree relatives of alcohol-dependent probands.

A total of 136 with or without first-degree relatives with alcohol dependence were compared according to lifetime prevalence of psychiatric disorders and personality dimensions. Family history positive women showed significant higher prevalence rates of depression and agoraphobia, and exhibited lower scores on Reward Dependence, Self-Directedness and Cooperativeness dimensions.

[Bipolar disorders and somatic comorbidities: a focus on metabollic syndrome, diabetes and cardiovascular disease]. / Trouble bipolaire et comorbidités somatiques : diabète et troubles cardiométaboliques Données physiopathologiques.

Bipolar Disorders (BD) are currently regarded as a multidimensional disease involving both psychological and physical determinants. If mood dimension and thymic instability have usually been considered as the « core ¼ aspect of bipolar disorders, it's crucial to note that somatic problems frequently occur in BD, deeply worsening the prognosis of this affection. Indeed, comorbid somatic illnesses of bipolar disorder are mainly represented by cardiovascular and metabolic disorders, which are shortening life expectancy by 25 to 30 years as compared to the general population. In this review, the authors examine epidemiological data about this comorbidity, then they attempt to provide etiologic and physiopathologic hypotheses about the links between bipolar disorders and metabolic diseases. Despite the absence of strong scientific explanation for this link, its existence highlights the need for more integrated care and interdisciplinary collaboration in order to improve patients'outcome.

Faux Pas Recognition and Executive Processes in Patients with Alcohol Use Disorder: Toward an Investigation of Interindividual Heterogeneity.

OBJECTIVE: Impairment of executive functions (EF) has been documented for decades in patients with alcohol use disorders (AUD), while more recent studies have also reported impaired theory of mind. Both have been associated with negative outcomes, particularly a high risk of relapse. However, the interrelatedness of EF and theory of mind impairments remains subject to debate. METHOD: About 19 AUD outpatients and 20 healthy controls (HC) were asked to complete measures of motor inhibition, mental flexibility, and updating to assess EF, and the faux pas test to assess theory of mind. RESULTS: As expected, patients' mean performances on EF and faux pas measures were poorer than those of HC. Correlational analyses revealed that executive processes were differentially related to faux pas subscores. Additional single-case analyses corroborated the strong association between EF and faux pas interpretation, as patients with AUD mostly had congruent performances (i.e., both EF and faux pas impaired or both EF and faux pas preserved). CONCLUSIONS: This study highlights the interrelatedness of EF and faux pas performances in AUD, but also emphasizes the incomplete overlap of the cognitive processes involved in these tasks, with heterogeneous patterns of association. Based on these findings, tailored cognitive rehabilitation programs that simultaneously target EF and faux pas recognition could be developed to favor patients' social inclusion and reduce the risk of relapse. Results also argue in favor of systematic screening for EF and theory of mind impairments among AUD patients.