Modality-specific and modality-independent neural representations work in concert in predictive processes during sequence learning.

Probabilistic sequence learning supports the development of skills and enables predictive processing. It remains contentious whether visuomotor sequence learning is driven by the representation of the visual sequence (perceptual coding) or by the representation of the response sequence (motor coding). Neurotypical adults performed a visuomotor sequence learning task. Learning occurred incidentally as it was evidenced by faster responses to high-probability than to low-probability targets. To uncover the neurophysiology of the learning process, we conducted both univariate analyses and multivariate pattern analyses (MVPAs) on the temporally decomposed EEG signal. Univariate analyses showed that sequence learning modulated the amplitudes of the motor code of the decomposed signal but not in the perceptual and perceptual-motor signals. However, MVPA revealed that all 3 codes of the decomposed EEG contribute to the neurophysiological representation of the learnt probabilities. Source localization revealed the involvement of a wider network of frontal and parietal activations that were distinctive across coding levels. These findings suggest that perceptual and motor coding both contribute to the learning of sequential regularities rather than to a neither-nor distinction. Moreover, modality-specific encoding worked in concert with modality-independent representations, which suggests that probabilistic sequence learning is nonunitary and encompasses a set of encoding principles.

The neural signature of reality-monitoring: A meta-analysis of functional neuroimaging studies.

Distinguishing imagination and thoughts from information we perceived from the environment, a process called reality-monitoring, is important in everyday situations. Although reality monitoring seems to overlap with the concept of self-monitoring, which allows one to distinguish self-generated actions or thoughts from those generated by others, the two concepts remain largely separate cognitive domains and their common brain substrates have received little attention. We investigated the brain regions involved in these two cognitive processes and explored the common brain regions they share. To do this, we conducted two separate coordinate-based meta-analyses of functional magnetic resonance imaging studies assessing the brain regions involved in reality- and self-monitoring. Few brain regions survived threshold-free cluster enhancement family-wise multiple comparison correction (p < .05), likely owing to the small number of studies identified. Using uncorrected statistical thresholds recommended by Signed Differential Mapping with Permutation of Subject Images, the meta-analysis of reality-monitoring studies (k = 9 studies including 172 healthy subjects) revealed clusters in the lobule VI of the cerebellum, the right anterior medial prefrontal cortex and anterior thalamic projections. The meta-analysis of self-monitoring studies (k = 12 studies including 192 healthy subjects) highlighted the involvement of a set of brain regions including the lobule VI of the left cerebellum and fronto-temporo-parietal regions. We showed with a conjunction analysis that the lobule VI of the cerebellum was consistently engaged in both reality- and self-monitoring. The current findings offer new insights into the common brain regions underlying reality-monitoring and self-monitoring, and suggest that the neural signature of the self that may occur during self-production should persist in memories.

Advancing clinical response characterization to frontotemporal transcranial direct current stimulation with electric field distribution in patients with schizophrenia and auditory hallucinations: a pilot study.

Transcranial direct current stimulation (tDCS) has been proposed as a therapeutic option for treatment-resistant auditory verbal hallucinations (AVH) in schizophrenia. In such cases, repeated sessions of tDCS are delivered with the anode over the left prefrontal cortex and the cathode over the left temporoparietal junction. Despite promising findings, the clinical response to tDCS is highly heterogeneous among patients. Here, we explored baseline differences between responders and nonresponders to frontotemporal tDCS using electric field modeling. We hypothesized that responders would display different tDCS-induced electric field strength in the brain areas involved in AVH compared to nonresponders.Using baseline structural MRI scans of 17 patients with schizophrenia and daily AVH who received 10 sessions of active frontotemporal tDCS, we constructed individual realistic whole brain models estimating electric field strength. Electric field maps were compared between responders (n = 6) and nonresponders to tDCS (n = 11) using an independent two-sample t test. Clinical response was defined as at least a 50% decrease of AVH 1 month after the last tDCS session.Results from the electric field map comparison showed that responders to tDCS displayed higher electric field strength in the left transverse temporal gyrus at baseline compared to nonresponders (T = 2.37; p = 0.016; 32 voxels).These preliminary findings suggested that the strength of the tDCS-induced electric field reaching the left transverse temporal gyrus could play an important role in the response to frontotemporal tDCS. In addition, this work suggests the interest of using electric field modeling to individualize tDCS and increase response rate.

Frontal Transcranial Direct Current Stimulation Induces Dopamine Release in the Ventral Striatum in Human.

A single transcranial direct current stimulation (tDCS) session applied over the dorsolateral prefrontal cortex (DLFPC) can be associated with procognitive effects. Furthermore, repeated DLPFC tDCS sessions are under investigation as a new therapeutic tool for a range of neuropsychiatric conditions. A possible mechanism explaining such beneficial effects is a modulation of meso-cortico-limbic dopamine transmission. We explored the spatial and temporal neurobiological effects of bifrontal tDCS on subcortical dopamine transmission during and immediately after the stimulation. In a double blind sham-controlled study, 32 healthy subjects randomly received a single session of either active (20 min, 2 mA; n = 14) or sham (n = 18) tDCS during a dynamic positron emission tomography scan using [11C]raclopride binding. During the stimulation period, no significant effect of tDCS was observed. After the stimulation period, compared with sham tDCS, active tDCS induced a significant decrease in [11C]raclopride binding potential ratio in the striatum, suggesting an increase in extracellular dopamine in a part of the striatum involved in the reward-motivation network. The present study provides the first evidence that bifrontal tDCS induces neurotransmitter release in polysynaptic connected subcortical areas. Therefore, levels of dopamine activity and reactivity should be a new element to consider for a general hypothesis of brain modulation by bifrontal tDCS.

Pertinence of Titration and Age-Based Dosing Methods for Electroconvulsive Therapy: An International Retrospective Multicenter Study.

BACKGROUND: Although the dosage of electroconvulsive therapy (ECT) stimulus has a major impact on the efficacy and safety of this treatment, the method used to determine an optimal dosage remains a matter of debate. OBJECTIVE: We investigated factors influencing the seizure threshold (ST) in a large-sample study and compared age-based and titration dosing methods in terms of charge. METHODS: A retrospective study examined data from 503 patients across France and Canada. The patients underwent right unilateral (RUL) or bitemporal (BT) ECT during a titration session before undergoing ECT. Seizure threshold and charge differences between age-based and titration-predicted methods were derived for each RUL and BT patient and compared according to sex, age, and anesthetic agents. RESULTS: Based on our results, ST is a function of electrode placement, sex, age, and anesthetic agents. Titration and age-based methods led to completely different patterns of charges for the same electrode placement, especially in elderly and in women in the RUL group. Regression models showed that differences between the age-based and titration methods varied with respect to age, sex, and anesthetic agent. Specifically, significant effects of sex and age were observed for RUL ECT and of sex and anesthetics for BT ECT. CONCLUSIONS: This study revealed that several factors significantly influence the prediction of ECT dose, depending on individuals and treatment modalities. Caution should be exercised when using nonindividualized methods to calculate ST.

[Does Prefrontal Noninvasive Brain Stimulation Alleviating Symptoms in Depression and Schizophrenia Impact Mood and Emotion Processing?]. / Neurostimulation du cortex préfrontal dorsolatéral : quels effets sur la symptomatologie, l'humeur et les émotions dans la dépression et la schizophrénie ?

Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are noninvasive brain stimulation techniques currently used as therapeutic tools in various psychiatric conditions. Applied over the dorsolateral prefrontal cortex (DLPFC), they showed their efficacy in reducing drug-resistant symptoms in patients with major depression and in patients with schizophrenia with predominantly negative symptoms. The DLPFC is a brain structure involved in the expression of these symptoms as well as in other dysfunctional functions observed in theses conditions such as emotional processes. The goal of this review is to establish whether or not a link exists between clinical improvements and modulation of emotional processes following the stimulation of the DLPFC in both conditions. The data collected show that improved emotional processes is not linked to a clinical improvement neither in patients with depression nor in patients with negative schizophrenia. Our results suggests that although sharing common brain structures, the brain networks involved in both symptoms and in emotional processes would be separate.

Validation of the French Version of the Auditory Hallucination Rating Scale in a Sample of Hallucinating Patients with Schizophrenia.

OBJECTIVE: The aim of this study was to validate the French version of the 7-item Auditory Hallucination Rating Scale (AHRS) so as to facilitate fine-grained assessment of auditory hallucinations (AH) in native French-speaking patients with schizophrenia (SZ) in clinical settings and studies. METHOD: Patients (N = 66) were diagnosed with SZ according to the Diagnostic and Statistical Manual of Mental Disorders. The French version of the AHRS was developed using a forward­backward translation procedure. Psychometric properties of the French version of the AHRS were tested including (i) construct validity with a confirmatory one-factor analysis, (ii) internal validity with Pearson correlations and Cronbach α coefficients, and (iii) external validity by correlations with the Scale for Assessment of Positive Symptoms (SAPS-H1), the Positive and Negative Syndrome Scale (PANSS-P3; concurrent), the PANSS-Negative subscale and age of subjects (divergent), and inter-rater intraclass correlation coefficients (ICCs). RESULTS: (i) The confirmatory one-factor analysis found a root mean square error of approximation (RMSEA) = 0.00, 90% confidence interval = [0.000 to 0.011], and a comparative fit index = 0.994. (ii) Correlations between AHRS total score and individual items were mostly ≥0.4. Cronbach α coefficient was 0.61. (iii) Correlations with PANSS-P3 and SAPS-H1 were 0.42 and 0.53, respectively. In a subset of participants (N = 16), ICC values were extremely high and significant for AHRS total and individual item scores (ICCs range 0.899 to 0.996). CONCLUSION: The French version of the AHRS is a psychometrically acceptable instrument for the evaluation of AH severity in French-speaking patients with SZ.

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.

Mechanistic account of the left auditory cortex for tone-matching in schizophrenia: A pilot transcranial random noise stimulation (tRNS) sham-controlled study.

OBJECTIVE: Deficits in the ability to match tones following brief delay and their contribution to higher-order cognitive alterations have been repeatedly documented in schizophrenia. The aim was to explore if left fronto-temporal high-frequency transcranial random noise stimulation (hf-tRNS), with electrodes placed over brain regions involved in tone-matching would significantly modulate performances in participants with schizophrenia. METHODS: In a randomized, double-blind sham-controlled study, 10 participants with schizophrenia were allocated to receive ten sessions of either active or sham hf-tRNS. The anode was placed over the left prefrontal cortex and the cathode over the left temporoparietal junction. A tone-matching task was administered before and after the hf-tRNS. RESULTS: We calculated the changes in tone-matching performance before and after hf-tRNS session in each group. A significant between-group difference was observed for the difficult tone-matching conditions (W= 14.500, p = 0.032), with tone-matching improvement in the sham group and no improvement in the active group. DISCUSSION: hf-tRNS could disrupt the test-retest learning effect in the tone-matching task in individuals with schizophrenia. It is likely that this disruption resulted from cathodal-induced inhibition of the functional coupling between auditory cortical areas that correlates with tone-matching performance in patients. CONCLUSION: The findings contribute to our understanding of hf-tRNS effects on early auditory processing in schizophrenia.

Functioning, clinical severity, education and sex moderate the inverse relationship between insight and quality of life in patients with schizophrenia.

BACKGROUND: In schizophrenia, insight, the recognition that one has a medical illness that requires treatment, has long been related to deteriorated quality of life, a phenomenon that has been described as the "insight paradox". Here, we aimed to determine whether certain socio-demographic and clinical characteristics strengthen or weaken this negative relationship. METHODS: We used data from the French network of rehabilitation centers REHABase (N = 769). We explored mean differences in quality-of-life scores between patients with good insight vs. poor insight. We also explored modifying effects of socio-demographic and clinical characteristics (sex, education, age, functioning, clinical severity, duration of illness). RESULTS: Patients with good insight had a decreased quality-of-life total score. Similar effects were found for the following sub-dimensions of quality of life: autonomy, physical and psychological well-being, and self-esteem. The negative effect of insight on quality of life was attenuated for people who had >12 years of education and for people with a higher level of functioning. By contrast, the negative effect of insight on quality of life was accentuated in people with greater clinical severity. Functioning and clinical severity showed similar modifying effects for other quality-of-life dimensions: autonomy, physical and psychological well-being, and self-esteem. Finally, males demonstrated an increased negative association between insight and self-esteem. CONCLUSIONS: The relationship between insight and quality of life is moderated by socio-demographic and clinical circumstances. Future inquiries may utilize our findings by integrating socio-demographic and clinical factors in treatment programs designs to conjointly improve insight and quality of life.

Contribution of socio-demographic and clinical characteristics to predict initial referrals to psychosocial interventions in patients with serious mental illness.

AIMS: Psychosocial rehabilitation (PSR) is at the core of psychiatric recovery. There is a paucity of evidence regarding how the needs and characteristics of patients guide clinical decisions to refer to PSR interventions. Here, we used explainable machine learning methods to determine how socio-demographic and clinical characteristics contribute to initial referrals to PSR interventions in patients with serious mental illness. METHODS: Data were extracted from the French network of rehabilitation centres, REHABase, collected between years 2016 and 2022 and analysed between February and September 2022. Participants presented with serious mental illnesses, including schizophrenia spectrum disorders, bipolar disorders, autism spectrum disorders, depressive disorders, anxiety disorders and personality disorders. Information from 37 socio-demographic and clinical variables was extracted at baseline and used as potential predictors. Several machine learning models were tested to predict initial referrals to four PSR interventions: cognitive behavioural therapy (CBT), cognitive remediation (CR), psychoeducation (PE) and vocational training (VT). Explanatory power of predictors was determined using the artificial intelligence-based SHAP (SHapley Additive exPlanations) method from the best performing algorithm. RESULTS: Data from a total of 1146 patients were included (mean age, 33.2 years [range, 16-72 years]; 366 [39.2%] women). A random forest algorithm demonstrated the best predictive performance, with a moderate or average predictive accuracy [micro-averaged area under the receiver operating curve from 'external' cross-validation: 0.672]. SHAP dependence plots demonstrated insightful associations between socio-demographic and clinical predictors and referrals to PSR programmes. For instance, patients with psychotic disorders were more likely to be referred to PE and CR, while those with non-psychotic disorders were more likely to be referred to CBT and VT. Likewise, patients with social dysfunctions and lack of educational attainment were more likely to be referred to CR and VT, while those with better functioning and education were more likely to be referred to CBT and PE. CONCLUSIONS: A combination of socio-demographic and clinical features was not sufficient to accurately predict initial referrals to four PSR programmes among a French network of rehabilitation centres. Referrals to PSR interventions may also involve service- and clinician-level factors. Considering socio-demographic and clinical predictors revealed disparities in referrals with respect to diagnoses, current clinical and psychological issues, functioning and education.

Evidence for a competitive relationship between executive functions and statistical learning.

The ability of the brain to extract patterns from the environment and predict future events, known as statistical learning, has been proposed to interact in a competitive manner with prefrontal lobe-related networks and their characteristic cognitive or executive functions. However, it remains unclear whether these cognitive functions also possess a competitive relationship with implicit statistical learning across individuals and at the level of latent executive function components. In order to address this currently unknown aspect, we investigated, in two independent experiments (NStudy1 = 186, NStudy2 = 157), the relationship between implicit statistical learning, measured by the Alternating Serial Reaction Time task, and executive functions, measured by multiple neuropsychological tests. In both studies, a modest, but consistent negative correlation between implicit statistical learning and most executive function measures was observed. Factor analysis further revealed that a factor representing verbal fluency and complex working memory seemed to drive these negative correlations. Thus, the antagonistic relationship between implicit statistical learning and executive functions might specifically be mediated by the updating component of executive functions or/and long-term memory access.

Differential associations between insight and quality-of-life dimensions among individuals with schizophrenia.

PURPOSE/OBJECTIVE: In schizophrenia, insight, the recognition that one has a medical illness that requires treatment, has long been related to deteriorated quality of life. Yet, insight and quality of life are broad constructs that encompass several dimensions. Here, we investigated differential associations between insight and quality-of-life dimensions using a psychological network approach. RESEARCH METHOD/DESIGN: We extracted data from the French network of rehabilitation centers REHABase (January 2016 to December 2022, N = 1,056). Our psychological network analysis modeled insight and quality of life as a network of interacting dimensions: three insight dimensions (awareness of illness, reattribution of symptoms to the disease, and recognition of treatment need) and eight quality-of-life dimensions (autonomy, physical and psychosocial well-being, relationships with family, friends and romantic partners, resilience, and self-esteem). RESULTS: Insight was negatively associated with quality of life. Our psychological network analysis revealed a strong negative association between awareness of disease and self-esteem. Both dimensions were the strongest nodes in the overall network. Our network analysis also revealed a significant but positive connection between recognition of treatment needs and resilience. CONCLUSION/IMPLICATIONS: While insight and quality of life are overall negatively associated, we found both negative and positive connections between insight and quality-of-life dimensions. The negative relationship between insight and quality of life may reflect the deleterious effects of diagnostic labeling on a patient's self-esteem. Yet, acknowledgment of treatment needs may have positive effects on quality of life and may promote recovery, perhaps because it emphasizes the need for support rather than labels and abnormalities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Basic auditory processing and its relationship with symptoms in patients with schizophrenia: A systematic review.

Processing of basic auditory features, one of the earliest stages of auditory perception, has been the focus of considerable investigations in schizophrenia. Although numerous studies have shown abnormalities in pitch perception in schizophrenia, other basic auditory features such as intensity, duration, and sound localization have been less explored. Additionally, the relationship between basic auditory features and symptom severity shows inconsistent results, preventing concrete conclusions. Our aim was to present a comprehensive overview of basic auditory processing in schizophrenia and its relationship with symptoms. We conducted a systematic review according to the PRISMA guidelines. PubMed, Embase, and PsycINFO databases were searched for studies exploring auditory perception in schizophrenia compared to controls, with at least one behavioral task investigating basic auditory processing using pure tones. Forty-one studies were included. The majority investigated pitch processing while the others investigated intensity, duration and sound localization. The results revealed that patients have a significant deficit in the processing of all basic auditory features. Although the search for a relationship with symptoms was limited, auditory hallucinations experience appears to have an impact on basic auditory processing. Further research may examine correlations with clinical symptoms to explore the performance of patient subgroups and possibly implement remediation strategies.

Predictors of mental well-being over the first lockdown period due to the COVID-19 pandemic in France. A repeated cross-sectional study.

Introduction: Numerous studies have investigated the positive and negative effects of potential predictors of well-being during lockdowns due to COVID-19. Yet, little is known on whether these effects significantly changed with time spent in lockdown. In the current study, we described the association of mental well-being with a large number of background characteristics (e.g., socio-demographic or health-related factors), COVID-related factors, and coping strategies, over the duration of the first lockdown due to COVID-19 in France. Methods: A nationwide online survey was conducted over 7 of the 8 weeks of the 1st lockdown in France, i.e., from 25 March 2020 to 10 May 2020. The level of mental well-being was reported using the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS). We also measured various background characteristics (e.g., age, sex, education, health issues), COVID-related factors (e.g., health and economic risks, agreement with lockdown), and coping strategies. Our analytical strategy enabled us to disentangle effects aggregated over the study period from those that linearly vary with time spent in lockdown. Results: Our final dataset included 18,957 participants. The level of mental well-being dropped gradually from the third to the eighth week of lockdown [49.7 (sd 7.9) to 45.5 (sd 10.6)]. Time in lockdown was associated with a decrease in well-being (for each additional 10 days of lockdown: B = -0.30, 95%CI: -0.62, -0.15). Factors that showed significantly negative and positive effects on well-being as time in lockdown progressed were (for each additional 10 days of lockdown): having current psychiatric problems (B = -0.37; 95%CI: -0.63, -0.04), worries about having access to personal protective equipment (B = -0.09; 95%CI: -0.18, -0.01), coping by having positive beliefs about the future of the pandemics (B = 0.29; 95%CI: 0.04, 0.62), being supported by neighbors (B = 0.24; 95%CI: 0.04, 0.44), and being involved in collective actions (B = 0.23; 95%CI: 0.04, 0.46). Discussion: Participants from our sample saw a drop in their mental well-being throughout the first period of COVID-19 lockdown. Policymakers should be mindful of factors contributing to greater deterioration of mental well-being over time, such as having current psychiatric issues. Promoting collective actions and local support from neighbors may alleviate the deterioration of mental well-being over time.

Efficacy and auditory biomarker analysis of fronto-temporal transcranial direct current stimulation (tDCS) in targeting cognitive impairment associated with recent-onset schizophrenia: study protocol for a multicenter randomized double-blind sham-controlled trial.

BACKGROUND: In parallel to the traditional symptomatology, deficits in cognition (memory, attention, reasoning, social functioning) contribute significantly to disability and suffering in individuals with schizophrenia. Cognitive deficits have been closely linked to alterations in early auditory processes (EAP) that occur in auditory cortical areas. Preliminary evidence indicates that cognitive deficits in schizophrenia can be improved with a reliable and safe non-invasive brain stimulation technique called tDCS (transcranial direct current stimulation). However, a significant proportion of patients derive no cognitive benefits after tDCS treatment. Furthermore, the neurobiological mechanisms of cognitive changes after tDCS have been poorly explored in trials and are thus still unclear. METHOD: The study is designed as a randomized, double-blind, 2-arm parallel-group, sham-controlled, multicenter trial. Sixty participants with recent-onset schizophrenia and cognitive impairment will be randomly allocated to receive either active (n=30) or sham (n=30) tDCS (20-min, 2-mA, 10 sessions during 5 consecutive weekdays). The anode will be placed over the left dorsolateral prefrontal cortex and the cathode over the left auditory cortex. Cognition, tolerance, symptoms, general outcome and EAP (measured with EEG and multimodal MRI) will be assessed prior to tDCS (baseline), after the 10 sessions, and at 1- and 3-month follow-up. The primary outcome will be the number of responders, defined as participants demonstrating a cognitive improvement ≥Z=0.5 from baseline on the MATRICS Consensus Cognitive Battery total score at 1-month follow-up. Additionally, we will measure how differences in EAP modulate individual cognitive benefits from active tDCS and whether there are changes in EAP measures in responders after active tDCS. DISCUSSION: Besides proposing a new fronto-temporal tDCS protocol by targeting the auditory cortical areas, we aim to conduct a randomized controlled trial (RCT) with follow-up assessments up to 3 months. In addition, this study will allow identifying and assessing the value of a wide range of neurobiological EAP measures for predicting and explaining cognitive deficit improvement after tDCS. The results of this trial will constitute a step toward the use of tDCS as a therapeutic tool for the treatment of cognitive impairment in recent-onset schizophrenia. TRIAL REGISTRATION: ClinicalTrials.gov NCT05440955. Prospectively registered on July 1st, 2022.

Mental well-being in young people with psychiatric disorders during the early phase of COVID-19 lockdown.

BACKGROUND: Mental health and well-being were seriously impacted by the COVID-19 lockdown especially among young people and people with psychiatric disorders. This study aimed to identify factors associated with well-being in young people with psychiatric disorders, during early phase of COVID-19 lockdown in France. METHODS: A national cross-sectional online study started on the 8th day of COVID-19 lockdown in France (during March 25-30, 2020). We included young people aged from 16 to 29 who responded to the questionnaire, living and being confined in France, with past or current psychiatric treatment. The questionnaire was accessible online and explored demographics and clinical factors, well-being, stress, situation during lockdown. Well-being was measured by the Warwick-Edinburg Mental Well-Being Scale (WEMWBS). Simple and multiple linear regression analyses were carried out. RESULTS: 439 individuals were included with 262 (59.7%) previously treated and 177 (40.3%) currently treated. WEMWBS total score were 42.48 (9.05). Feeling of useful was the most affected dimension. Well-being was positively correlated with: currently working on site, physical activity, abilities to cope with difficulties, family and social supports (p<0.05). It was negatively correlated with: elevated stress level, anxious ruminations, dissatisfaction with information, difficulties to sleep or reorganize daily life, feeling supported by medicines (p<0.05). No individual factor was correlated with well-being. The stepwise linear multivariate model had simple R2 coefficient of determination of 0.535. CONCLUSION: In the specific population of young people with psychiatric disorders, factors associated with well-being at early stage of lockdown were mainly psychosocial and related to brutal disorganisation of daily life.

Ten Sessions of 30 Min tDCS over 5 Days to Achieve Remission in Depression: A Randomized Pilot Study.

Although transcranial Direct Current stimulation (tDCS) shows promise in the treatment of major depressive episodes, the optimal parameters and population to target remain unclear. We investigated the clinical interest of a 10 session tDCS regimen in patients with mild to severe treatment-resistant depression, in a pilot double-blind, randomized sham-controlled trial. tDCS was delivered over 5 consecutive days (two 30 min sessions per day separated by at least 2 h, 2 mA). The anode and cathode were placed over the left and the right dorsolateral prefrontal cortex, respectively. One month after tDCS, we observed significantly fewer patients who achieved remission (MADRS10 < 10) in the sham group (0 out of 18 patients) than in the active group (5 out of 21 patients; p = 0.05). However, no significant difference was observed between the groups regarding the mean scores of severity changes throughout the study period. Bifrontal add-on tDCS delivered twice per day over 5 days, in combination with antidepressant medication, can be a safe and suitable approach to achieve remission in patients with mild to severe treatment-resistant major depressive disorder. However, in regards to the pilot nature and limitations of the present study, further studies are needed before any frank conclusions can be made regarding the use of tDCS with the proposed parameters in clinical settings.

Efficacy and safety of topiramate for reducing impulsivity: A transdiagnostic systematic review and meta-analysis of a common clinical use.

Impulsivity is an important transdiagnostic feature of many psychiatric disorders, as well as a marker of poorer outcome. Topiramate is broadly used for reducing impulsivity in various neuropsychiatric disorders, but no systematic review or meta-analysis has ever explored whether evidence supports this clinical use. We conducted a systematic review and meta-analysis of the literature, using PubMed, PsycInfo and Cochrane databases. We included all studies assessing the efficacy of topiramate in adults with high levels of impulsivity, based on either psychometric or neuropsychological measures. Seven articles were included, involving 578 participants. Important heterogeneity in designs and quality features was observed. Topiramate lowered impulsivity levels in two of the studies that used the Barratt Impulsiveness Scale (BIS) (401 participants) and in one of the studies that used neuropsychological measures (63 participants). Four other studies found no effect of topiramate on impulsivity. A larger reduction in the BIS-11 overall score, with a mean difference of 2.57 (95% confidence interval -4.12 to -1.02), was found in the topiramate group than the placebo group using a random effects model. However, one study accounted for the major part (85.5%) of it, and most included studies presented a high risk of bias. The use of a self-assessment scale induced an additional risk of self-report bias. No clear-cut evidence was found for a transdiagnostic effectiveness of topiramate in reducing impulsivity levels. However, encouraging results were found in some specific disorders.

Pregnancy, Mental Well-Being and Lockdown: A Nationwide Online Survey in France.

The objective of this study was to compare the mental well-being of French women who were and were not pregnant during the first COVID-19 pandemic lockdown. We performed a nationwide online quantitative survey including all women between 18 and 45 years of age during the second and third weeks of global lockdown (25 March-7 April 2020). The main outcome measure was mental well-being measured by the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS). This study analysed 275 responses from pregnant women and compared them with those from a propensity score-matched sample of 825 non-pregnant women. In this French sample, the median WEMWBS score was 49.0 and did not differ by pregnancy status. Women living in urban areas reported better well-being, while those with sleep disorders or who spent more than an hour a day watching the news reported poorer well-being. During the first lockdown in France, women had relatively low mental well-being scores, with no significant difference between pregnant and non-pregnant women. More than ever, health-care workers need to find a way to maintain their support for women's well-being. Minor daily annoyances of pregnancy, such as insomnia, should not be trivialised because they are a potential sign of poor well-being.