Early Detection of Patients at Risk of Developing a Post-Traumatic Stress Disorder After an ICU Stay.

OBJECTIVES: To evaluate the diagnostic accuracy of the Impact Event Scale-Revisited assessed following ICU discharge to predict the emergence of post-traumatic stress disorder symptoms at 3 months. DESIGN: Prospective cohort study. SETTING: Three medical or surgical ICU of a French university hospital (Lyon, France). PATIENTS: Patients greater than or equal to 18 years old, leaving ICU after greater than or equal to 2 nights of stay, between September 2017 and April 2018. INTERVENTIONS: Patients completed the Impact Event Scale-Revisited and the Peritraumatic Dissociative Experiences Questionnaire within 8 days after ICU discharge and the Impact Event Scale-Revisited again at 3 months by phone. Patients having an Impact Event Scale-Revisited greater than or equal to 35 at 3 months were considered as having post-traumatic stress disorder symptoms. MEASUREMENTS AND MAIN RESULTS: Among the 208 patients screened, 174 were included and 145 reassessed by phone at 3 months. Among the patients included at baseline, 43% presented symptoms of acute stress. At 3 months, 13% had an Impact Event Scale-Revisited greater than or equal to 35 and 17% had a score between 12 and 34. Regarding the performance of the Impact Event Scale-Revisited performed within 8 days after the ICU discharge to predict post-traumatic stress disorder symptoms at 3 months, the area under the curve was 0.90 (95% CI, 0.80-0.99), and an Impact Event Scale-Revisited greater than or equal to 12 had a sensitivity of 90%, a specificity of 71%, a positive predictive value of 32%, and a negative predictive value of 98%. History of anxiety disorder odds ratio = 3.7 (95% CI, 1.24-11.05; p = 0.02) and Impact Event Scale-Revisited greater than or equal to 12 odds ratio = 16.57 (95% CI, 3.59-76.46; p < 0.001) were identified as risk factors for post-traumatic stress disorder symptoms. CONCLUSIONS: Impact Event Scale-Revisited assessed at ICU discharge has a good ability for the detection of patients at risk of developing post-traumatic stress disorder symptoms. Patients with history of anxiety disorder and those presenting acute stress symptoms at ICU discharge are more at risk to develop post-traumatic stress disorder symptoms.

Does Change over Time in Delusional Beliefs as Measured with PDI Predict Change over Time in Belief Flexibility Measured with MADS?

Delusional beliefs and their behavioral consequences are predominant symptoms in patients with psychosis and play an important role in the treatment. Delusional beliefs are a multidimensional concept which can be divided into three components: distress, preoccupation and conviction of delusions. These can be measured using Peters delusions inventory (PDI-21). We question, whether changes in delusional beliefs over time during treatment measured with the PDI-21 can predict changes in belief flexibility measured with the Maudsley assessment of delusions schedule (MADS). We used a group of patients from a randomized controlled trial for a cognitive intervention for psychosis or psychotic symptoms. Aside standard treatment for psychosis, half of the patients took part in a group treatment "Michael's game". Patients were assessed at baseline (T1), at 3 months (T2), and at 9 months (T3). We measured delusional beliefs using PDI-21 and belief flexibility with the MADS. One hundred seventy-two patients were included in the analysis. We measured a main effect of PDI-21scores on belief flexibility measured with MADS. PDI-21 Conviction scores predicted outcomes for all measured MADS items. Increasing PDI Distress and Preoccupation scores were predictors for being more likely to dismiss beliefs and change conviction. Time itself was a predictor for changing conviction and being able to plan a behavioral experiment. Overall the changes in PDI scores predicted outcomes for belief flexibility measured with MADS items. The PDI-21 could be a simple and effective way to measure progress in treatment on delusional beliefs.

Persistent auditory hallucinations in out-patients with schizophrenia.

Objectives to estimate the prevalence of persistent auditory hallucinations (AHs) in a group of schizophrenic patients, to evaluate their dimensions and to identify their clinical associated factors. Method This was a cross-sectional study carried-on 144 out-patients followed for schizophrenia, according DSM-IV-TR criteria. The assessment was consisted by the collect of epidemiological, clinical and therapeutic data and the use of the Hoffman's auditory hallucinations rating scale (AHRS), and the positive and negative symptoms scale (PANSS). Results The prevalence of persistent AHs (AHRS score ≥ 5) was 40.3%. The mean total score of the AHRS was 10.7±7.8 for all patients and 19.4±7.7 for patients with persistent AHs. The AHs dimensions with higher sub-scores were the number, the influence and the reality of the voices. The PANSS items most related to the AHRS total score were P3 "hallucinatory activity", G1 "somatic concerns", G4 "tension" and the G5 "mannerisms and posture disorders". The clinical associated factors with persistent AHs after multivariate analysis were the absence of tobacco consumption, the hallucinatory onset of disorders, the notion of previous hospitalization and the continuous course. Conclusion Our results support the multidimensionality of AHs and confirm the existence of inter individual differences in the characteristics of these hallucinations. Persistent AHs were associated with poor prognosis, requiring more effective therapeutic strategies.

Efficacy of Cathodal Transcranial Direct Current Stimulation Over the Left Orbitofrontal Cortex in a Patient With Treatment-Resistant Obsessive-Compulsive Disorder.

Obsessive-compulsive disorder (OCD) is a disabling and frequent neuropsychiatric disorder. Forty percent to 60% of patients with OCD fail to respond to available treatments. Neuroimaging studies have highlighted an association between the severity of obsessive and compulsive symptoms and an increased activity of the left orbitofrontal cortex (OFC) in patients with OCD. Transcranial direct current stimulation (tDCS) is a powerful and easy-to-use tool to modulate brain activity. Cathodal tDCS (c-tDCS) is assumed to decrease cortical excitability in the targeted brain region. We hypothesized that c-tDCS applied over the left OFC alleviates symptoms in patients with treatment-resistant OCD. We report here the case of a patient who received 10 sessions (2 mA, 20 minutes) of c-tDCS. The tDCS sessions were delivered twice a day with a 2-hour interval, with the cathode (35 cm²) placed over the left OFC and the anode (100 cm²) placed over the contralateral occipital region. No adverse event was reported. One month after the completion of the tDCS sessions, we observed a 26% reduction in severity of obsessive and compulsive symptoms measured using the Yale-Brown Obsessive Compulsive Scale scores. These findings are consistent with a previous study reporting a similar reduction in obsessive and compulsive symptoms after a low-frequency repetitive transcranial magnetic stimulation was given to the left OFC. Our results indicate that c-tDCS applied over the left OFC may be a suitable and safe treatment in patients with treatment-resistant OCD.

Disrupting pre-SMA activity impairs facial happiness recognition: an event-related TMS study.

It has been suggested that the left pre-supplementary motor area (pre-SMA) could be implicated in facial emotion expression and recognition, especially for laughter/happiness. To test this hypothesis, in a single-blind, randomized crossover study, we investigated the impact of transcranial magnetic stimulation (TMS) on performances of 18 healthy participants during a facial emotion recognition task. Using a neuronavigation system based on T1-weighted magnetic resonance imaging of each participant, TMS (5 pulses, 10 Hz) was delivered over the pre-SMA or the vertex (control condition) in an event-related fashion after the presentation of happy, fear, and angry faces. Compared with performances during vertex stimulation, we observed that TMS applied over the left pre-SMA specifically disrupted facial happiness recognition (FHR). No difference was observed between the 2 conditions neither for fear and anger recognition nor for reaction times (RT). Thus, interfering with pre-SMA activity with event-related TMS after stimulus presentation produced a selective impairment in the recognition of happy faces. These findings provide new insights into the functional implication of the pre-SMA in FHR, which may rely on the mirror properties of pre-SMA neurons.

Effects of aripiprazole, risperidone, and olanzapine on 5-HT1A receptors in patients with schizophrenia.

To investigate the impact of various antipsychotic drugs on the 5-HT1A serotoninergic system, we performed a [F]4-(2-methoxyphenyl)-1-[2-(N-2-pirydynyl)-p-luorobenzamido]-ethyl-piperazine PET study in 19 schizophrenic patients treated with either aripiprazole, which has a partial agonist activity at 5-HT1A receptors, or second-generation antipsychotics (SGA) (olanzapine or risperidone), which do not demonstrate such property. We used a simplified reference tissue model to generate parametric images of [F]MPPF-binding potential (BPND). A significant reduction of [F]MPPF BPND was found in treated schizophrenic patients compared to age- and sex-matched healthy subjects. These modifications were mainly localized in the frontal and orbitofrontal cortex and may reflect either the pathophysiology of schizophrenia or medication effects. The schizophrenic patients treated with aripiprazole showed a reduction of global [F]MPPF BPND compared with healthy subjects and schizophrenic patients with SGA treatment. In addition, compared with matched controls, the reduction of regional [F]MPPF BPND was more marked in the schizophrenic patients treated with aripiprazole compared with those receiving SGA treatment, possibly reflecting the partial agonist of aripiprazole activity at 5-HT1A receptors.

Psychological impact on healthcare workers in obstetrics and gynecology in France in 18 French University Hospitals during the first Covid-19 lockdown: a prospective observational study.

PURPOSE: To assess the level of stress and anxiety in healthcare workers in the departments of obstetrics and gynecology in France during and after the first Covid-19 lockdown. METHODS: Two web-based cross-sectional surveys using several validated questionnaires (the HAD scale, the PSS-10 questionnaire and the Short Form 12 Questionnaire [SF-12]) were proposed to all staff of obstetrics and gynecologic departments in 18 French university hospitals. RESULTS: A total of 1565 respondents answered the first questionnaire and 1109 completed the second survey. Respondents reported greater levels of stress and impaired mental quality of life during the lockdown, followed by a significant improvement after the end of lockdown (respectively p < .0001 and p = .01). Anxiety was significantly higher among the older participants during the lockdown (p = .008). The potential putative factors related to impaired mental health status were personal protective equipment (PPE) deficit (<.0001), the fear of contracting the virus from the workplace and transmitting to their families (<.0001) and concerns about information given by media and hospitals (<.0001). CONCLUSIONS: Understanding the heavy mental repercussions of the Covid-19 pandemic on healthcare workers could lead to the identification of high-risk in medical and non-medical staff and the implementation of targeted psychological monitoring program.

How can cognitive remediation therapy modulate brain activations in schizophrenia? An fMRI study.

UNLABELLED: Cognitive remediation therapy (CRT) is a non biological treatment that aims to correct cognitive deficits through repeated exercises. Its efficacy in patients with schizophrenia is well recognized, but little is known about its effect on cerebral activity. Our aim was to explore the impact of CRT on cerebral activation using functional magnetic resonance imaging (fMRI) in patients with schizophrenia. Seventeen patients and 15 healthy volunteers were recruited. Patients were divided into two groups: one group received CRT with Rehacom® software (n=8), while a control group of patients (non-CRT group) received no additional treatment (n=9). The three groups underwent two fMRI sessions with an interval of 3months: they had to perform a verbal and a spatial n-back task at the same performance level. Patients were additionally clinically and cognitively assessed before and after the study. After CRT, the CRT group exhibited brain over-activations in the left inferior/middle frontal gyrus, cingulate gyrus and inferior parietal lobule for the spatial task. Similar but nonsignificant over-activations were observed in the same brain regions for the verbal task. Moreover, CRT patients significantly improved their behavioural performance in attention and reasoning capacities. We conclude that CRT leads to measurable physiological adaptation associated with improved cognitive ability. Trial name: Cognitive Remediation Theraphy and Schizophrenia. http://clinicaltrials.gov/ct2/show/NCT01078129. REGISTRATION NUMBER: NCT01078129.

Visuospatial processing in schizophrenia: does it share common mechanisms with pseudoneglect?

Schizophrenia patients demonstrate behavioural and cerebral lateralised anomalies, prompting some authors to suggest they exhibit a mild form of right unilateral neglect. To better describe and understand lateralised visuospatial anomalies in schizophrenia, three experiments were run using tasks often utilised to study visuospatial processing in healthy individuals and in neglect patients: the Behavioural Inattention Test (BIT), the manual line bisection task with and without a local cueing paradigm, the landmark task (or line bisection judgement), and the number bisection task. Although the schizophrenia patients did not exhibit the full-blown neglect syndrome, they did demonstrate marked spatial biases that differentiated them from controls on all but two tasks. More specifically, schizophrenia patients showed neither a simple perceptual deficit nor an asymmetry, but demonstrated (1) lateralised anomalies on a simple manual line bisection task; (2) unilateral attentional deficits for line bisection within a local cueing paradigm; and (3) a lateralised deficit in the visuospatial representations of numbers. Altogether, these results suggest a right hemineglect-like deficit in schizophrenia in attentional, representational, and motor-intentional processes. Yet it does not appear to be as strong a phenomenon. Indeed, it could be considered as an accentuation of the normal asymmetry in visuospatial processing.

Longitudinal MRI monitoring of brain damage in the neonatal ventral hippocampal lesion rat model of schizophrenia.

Rat with excitotoxic neonatal ventral hippocampal lesions (NVHL rats) is considered as a heuristic neurodevelopmental model for studying schizophrenia. Extensive study of this model is limited by the lack of clear validity criteria of such lesions and because ascertaining of the lesions is realized postmortem with histological examination after completing experiments. Here, in a first experiment, by assessing the locomotor response to amphetamine in adult NVHL rats, we further specify that the lesions must be bilateral and confined to the ventral hippocampus to obtain the validated behavioral phenotype. We then show a longitudinal magnetic resonance imaging (MRI) protocol suitable for the detection of brain structural changes in NVHL rats. The T(2)-weighted images acquired in adult NVHL rats reveal the same structural changes as those appraised with histological protocol. Moreover, we demonstrate that the lesion status in adulthood can be accurately predicted from the T(2)-weighted images acquired in the juvenile period. As technical advantages, our MRI protocol makes possible to select animals according to lesion criteria as soon as in the juvenile period before long-lasting experiments and gives access in vivo to a quantitative parameter indicative of the lesion extent. Finally, we show that the lesion size increases only slightly between juvenile and adult periods. These latter results are discussed in the context of the specific postpubertal emergence of the behavioral deficits in NVHL rats.

Neurological soft signs and schizotypal dimensions in unaffected siblings of patients with schizophrenia.

The objectives were to determine the neurological soft signs (NSS) scores in unaffected siblings of patients with schizophrenia compared with healthy controls and to examine their relationships with schizotypal dimensions. Participants comprised 31 unaffected siblings of patients with schizophrenia and 60 healthy controls matched according to age, gender and school level who were assessed by the Schizotypal Personality Questionnaire (SPQ) and the Krebs et al. NSS Scale. Higher NSS total scores and sub-scores were found in the unaffected siblings compared with the controls. The SPQ total score was significantly higher in unaffected siblings compared with control subjects. The NSS total score was positively correlated with the SPQ total score and the SPQ disorganization sub-score in unaffected siblings of patients with schizophrenia. Additionally, in unaffected siblings, motor coordination and integration abnormalities were positively correlated with the SPQ total score and the cognitive-perceptual sub-score. Motor integration abnormalities were also correlated with the SPQ disorganization sub-score. These results reveal that NSS, especially motor signs, are associated with some schizotypal dimensions in siblings of patients with schizophrenia, suggesting the value of using both assessments to study high risk populations.

Increased left striatal dopamine transmission in unaffected siblings of schizophrenia patients in response to acute metabolic stress.

A genetic alteration in sensitivity to stress, mediated by mesolimbic hyperdopaminergia, is thought to play a role in the onset, exacerbation and relapse of schizophrenia. Dopamine sensitivity to stress was tested in individuals at higher than average genetic risk for schizophrenia (siblings of patients). Using a PET paradigm of [(11)C]raclopride in a bolus plus constant infusion tracer injection, the central DA response to acute metabolic stress (bolus of 2-Deoxy-d-Glucose, 40mg/kg) in unaffected siblings of patients with schizophrenia (n=8) and healthy controls (n=10) was measured by BP(ND) of [(11)C]raclopride before and after the 2DG challenge. After metabolic stress, controls but not siblings displayed a significant decrease in BP(ND) of [(11)C]raclopride in the striatum; no such differences were apparent in the ventral striatum. Siblings but not controls displayed significant asymmetry (L>R) in the stress-induced DA release, especially in ventral striatum, which correlated strongly with psychometric measures of psychosis liability. The results suggest that asymmetry in the mesolimbic DA response to stress is associated with genetic risk for schizophrenia, possibly reflecting the functional consequences of structural disconnectivity underlying psychotic symptoms.

[Association of hemoglobinosis D-Punjab and ß-thalassemia in a Moroccan family]. / Association d'hémoglobinose D-Punjab et de ß-thalassémie dans une famille marocaine.

Hemoglobin D-Punjab is a common hemoglobin variant in India but very rare in Morocco. Often, its presence has minimal or no clinical impact. Its heterozygous association with ß-thalassemia is exceptional. The purpose of the study is to describe the epidemiological, diagnostic and prophylactic aspects of hemoglobinosis D-Punjab from a family case study. MATERIAL AND METHODS: Case study of hemoglobinosis D-Punjab in a Moroccan family, diagnosed at the Laboratory of Biochemistry-Toxicology of the Mohammed V Military Teaching Hospital. The biological study was based on iron and hemolysis checkups, hemogram and study of hemoglobin (electrophoresis in alkaline and acid medium, high performance liquid chromatography). The index patient also benefited from sequencing by molecular biology. RESULTS: The index patient was heterozygous D-Punjab/ß0-thalassemia, confirmed by molecular biology. Two of her sisters had the same hemoglobin profile. At electrophoresis, all three had hemoglobin D-Punjab higher than 90%, hemoglobin A less than 1% and hemoglobin A2 higher than 6%. The results of the three hemograms showed similar abnormalities (pseudo-polycythemia, hypochromia, microcytosis, anisopoikilocytosis). Six other members of the family had a thalassemic trait and another three had heterozygous hemoglobinosis D-Punjab. CONCLUSION: Hemoglobin D-Punjab remains extremely rare in Morocco and very poorly documented in the literature. The number of reported cases is expected to raise due to increasing migration. Biologist advisory services require a precise diagnosis in order to give correct genetic counseling.

Does the Beck Cognitive Insight Scale predict change in delusional beliefs?

OBJECTIVES: The Beck Cognitive Insight Scale (BCIS) is composed of two subscales, self-reflectiveness and self-certainty, assessing reflectiveness and openness to feedback, and mental flexibility. Delusions have previously been associated with low cognitive insight. The aim of this study was to determine whether changes in BCIS scores predict changes in delusional beliefs. METHODS: The study is a secondary analysis of a previously published randomized controlled trial. All participants had a psychotic disorder diagnosis and received treatment as usual, with half of them also receiving the cognitive restructuring intervention 'Michael's game'. Participants were assessed at three different times: at baseline (T1), at 3 months (T2), and at 9 months (T3). Cognitive insight was measured with the BCIS, belief flexibility with the Maudsley assessment of delusions schedule (MADS), and psychotic symptoms with the Brief Psychiatric Rating Scale (BPRS). RESULTS: A total of 172 participants took part in the trial. After using generalized estimating equation (GEE) modelling, we observed (1) significant main effects of BCIS self-certainty and Time and (2) significant Time × BCIS self-certainty and Time × treatment group interaction effects on belief flexibility. Improvements in self-certainty (i.e., decrease in scores) were associated with more changes in conviction over time, more accommodation, improved ability in ignoring or rejecting a hypothetical contradiction and increased use of verification of facts. Medication and BPRS total scores were controlled for in the GEE analyses at their baseline values. CONCLUSIONS: Overall improvement in BCIS self-certainty scores over time predicted better treatment outcomes as assessed with MADS items. PRACTITIONER POINTS: Treatments for patients with psychosis should focus on improving cognitive insight as this seems to improve overall treatment outcomes and recovery. The Beck Cognitive Insight Scale can be used to measure changes during treatment and can predict treatment outcomes.

Schizophrenia: from the brain to peripheral markers. A consensus paper of the WFSBP task force on biological markers.

Objective. The phenotypic complexity, together with the multifarious nature of the so-called "schizophrenic psychoses", limits our ability to form a simple and logical biologically based hypothesis for the disease group. Biological markers are defined as biochemical, physiological or anatomical traits that are specific to particular conditions. An important aim of biomarker discovery is the detection of disease correlates that can be used as diagnostic tools. Method. A selective review of the WFSBP Task Force on Biological Markers in schizophrenia is provided from the central nervous system to phenotypes, functional brain systems, chromosomal loci with potential genetic markers to the peripheral systems. Results. A number of biological measures have been proposed to be correlated with schizophrenia. At present, not a single biological trait in schizophrenia is available which achieves sufficient specificity, selectivity and is based on causal pathology and predictive validity to be recommended as diagnostic marker. Conclusions. With the emergence of new technologies and rigorous phenotypic subclassification the identification of genetic bases and assessment of dynamic disease related alterations will hopefully come to a new stage in the complex field of psychiatric research.

Transcranial direct current stimulation in patients with obsessive compulsive disorder: A randomized controlled trial.

BACKGROUND: Obsessive-compulsive disorder (OCD) is a severe mental disorder with poor response to the available treatments. Neuroimaging studies have identified dysfunctions within the orbito-fronto-striato-pallido-thalamic network in patients with OCD. Here, we assessed the efficacy and safety of transcranial direct current stimulation (tDCS) applied with the cathode over the orbitofrontal cortex (OFC) and the anode over the right cerebellum to decrease OCD symptoms in patients with treatment-resistant OCD. METHODS: In a randomized sham-controlled double-blind study, 21 patients with OCD were assigned to receive ten 20-min sessions (two sessions per day) of either active (2 mA) or sham tDCS. The clinical symptoms were measured using the Yale-Brown Obsessive and Compulsive Scale (YBOCS). Acute effects on the symptoms were measured from baseline to immediately after the 10 tDCS sessions. Long-lasting effects were measured 1 and 3 months after the 10th tDCS session. RESULTS: Compared with the sham tDCS, active tDCS significantly decreased OCD symptoms immediately after the 10th tDCS session (F(1,19) = 5.26, p = 0.03). However, no significant differences were observed between the active and sham groups in terms of changes in YBOCS score or the number of responders one and 3 months after tDCS. CONCLUSION: Despite significant acute effects, tDCS with the cathode placed over the left OFC and the anode placed over the right cerebellum was not significantly effective in inducing a long-lasting reduction of symptoms in patients with treatment-resistant OCD.

Well-informed but not aware: The P.A.C.T.® psychoeducation program for schizophrenia improves knowledge about, but not insight into, the illness.

BACKGROUND: Most individuals with schizophrenia (SZ) have little to no insight regarding the presence of their illness. Psychoeducational programs are state-of-the-art interventions that consist in delivering stabilized patients with accurate knowledge about their illness and its treatment. Evidence suggests a significant relationship between levels of illness-related knowledge and insight in SZ patients. However, the effect of psychoeducation on these related outcomes needs to be explored further. METHODS: In this open label study involving 30 French-speaking patients with SZ, we propose to compare levels of knowledge and insight before and after the French P.A.C.T.® psychoeducation program to investigate how this approach affects both outcomes. Knowledge levels were measured with the self-questionnaire "What do I know?". Insight levels were measured using the Scale to Assess Unawareness of Mental Disorder (SUMD). Symptoms were assessed with the Positive And Negative Syndrome Scale (PANSS). RESULTS: A large significant improvement of knowledge was observed (p < 0.001; d = 0.77). By contrast, the analysis reported no significant effect of psychoeducation on insight (p = 0.86; d = 0.07). PANSS total scores were significantly decreased after treatment (p = 0.001; d = 0.66). CONCLUSIONS: Although the P.A.C.T.® program is a promising tool for improving illness-related knowledge in SZ patients, its use is not sufficient to significantly improve insight levels.

Effects of acute metabolic stress on the dopaminergic and pituitary-adrenal axis activity in patients with schizophrenia, their unaffected siblings and controls.

A genetically mediated abnormal sensitivity to stress is thought to play a role in the onset, exacerbation and relapse of schizophrenia. In a double blind, placebo-controlled crossover study, peak increases in plasma ACTH (Delta ACTH) and homovanillic-acid, a dopamine metabolite, (Delta HVA) following exposure to a metabolic stressor(2DG) were studied in unaffected siblings of patients with schizophrenia (n=15), their patient relatives (n=15) and healthy controls (n=14). Siblings showed a stress response (both Delta ACTH and Delta HVA) that was significantly greater compared to controls and significantly less pronounced compared to patients. The results suggest that the genetic risk for schizophrenia may be characterized by an enhanced sensitivity to stress.

Transcranial Direct Current Stimulation for Obsessive-Compulsive Disorder: A Systematic Review.

Despite the advances in psychopharmacology and established psychotherapeutic interventions, more than 40% of patients with obsessive-compulsive disorder (OCD) do not respond to conventional treatment approaches. Transcranial direct current stimulation (tDCS) has been recently proposed as a therapeutic tool to alleviate treatment-resistant symptoms in patients with OCD. The aim of this review was to provide a comprehensive overview of the current state of the art and future clinical applications of tDCS in patients with OCD. A literature search conducted on the PubMed database following PRISMA guidelines and completed by a manual search yielded 12 results: eight case reports, three open-label studies (with 5, 8, and 42 participants), and one randomized trial with two active conditions (12 patients). There was no sham-controlled study. A total of 77 patients received active tDCS with a large diversity of electrode montages mainly targeting the dorsolateral prefrontal cortex, the orbitofrontal cortex or the (pre-) supplementary motor area. Despite methodological limitations and the heterogeneity of stimulation parameters, tDCS appears to be a promising tool to decrease obsessive-compulsive symptoms as well as comorbid depression and anxiety in patients with treatment-resistant OCD. Further sham-controlled studies are needed to confirm these preliminary results.

Impaired verbal source monitoring in schizophrenia: an intermediate trait vulnerability marker?

Patients with schizophrenia, particularly those with positive symptoms show impaired verbal source monitoring. Specific cognitive deficits have been observed during both active and remission phases of the illness as well as in groups of unaffected first degree relatives of patients with schizophrenia. This type of schizophrenia vulnerability marker may precede the onset of frank psychotic symptoms and contribute to their developments. The aim of this study was first to determine if unaffected siblings were impaired in discriminate internal vs. external generated events when compared to their remitted schizophrenics relatives and healthy subjects. Performances of healthy subjects were then compared with results from previous studies with acute hallucinating patients, acute non-hallucinating patients and patients with resistant auditory verbal hallucinations. Compared with healthy subjects, unaffected siblings are impaired (effect size, ES=0.7), remitted or acute non-hallucinating patients are more impaired than siblings (ES=1.4); patients with verbal auditory hallucinations (acute or resistant) are even more impaired than non-hallucinating patients (ES=2.1). Our results suggest that a source monitoring deficit could be considered as an intermediate vulnerability marker of schizophrenia.