[Early intervention for emerging mental illness in young adults : the Geneva model]. / Prise en charge des troubles psychiques débutants chez le jeune adulte, modèle genevois.

Mental illness often emerges in young adulthood, usually before the age of 25 years. Early detection and intervention have a positive impact on the evolution of mental illness and quality of life. Specific interventions for this age group are recommended with a focus on ease of access to health care, adaptation to problems facing the young adult, using an integrated medical psycho-social approach. Furthermore, for this population, determination of a specific medical diagnosis does not seem essential, the concept of early stages of mental illness with less specific symptoms often being more useful. The Young Adult Psychiatry Unit in Geneva is built around these concepts and aims to offer, for the young adult with emerging mental illness, a large range of mental health services that are easily accessible.

Les troubles psychiques émergent fréquemment à l'âge du jeune adulte, souvent avant 25 ans. Une détection et une intervention précoces ont un impact positif sur l'évolution des troubles et la qualité de vie. Il est recommandé une prise en charge spécifique à cette tranche d'âge mettant le focus sur la facilité d'accès aux soins, l'adaptation aux problématiques du jeune adulte, avec approches médicale et psychosociale intégrées. En même temps, pour cette population, la détermination d'un diagnostic médical précis ne semble pas essentielle, avec un concept de stade précoce de troubles psychiques sans grande spécificité symptomatique souvent plus adapté. L'Unité de psychiatrie du jeune adulte à Genève s'inspire de ces concepts en visant à proposer aux jeunes adultes présentant des troubles psychiques débutants un large éventail de services, facilement accessibles.

Event-related potentials and changes of brain rhythm oscillations during working memory activation in patients with first-episode psychosis.

BACKGROUND: Earlier contributions have documented significant changes in sensory, attention-related endogenous event-related potential (ERP) components and θ band oscillatory responses during working memory activation in patients with schizophrenia. In patients with first-episode psychosis, such studies are still scarce and mostly focused on auditory sensory processing. The present study aimed to explore whether subtle deficits of cortical activation are present in these patients before the decline of working memory performance. METHODS: We assessed exogenous and endogenous ERPs and frontal θ event-related synchronization (ERS) in patients with first-episode psychosis and healthy controls who successfully performed an adapted 2-back working memory task, including 2 visual n-backworking memory tasks as well as oddball detection and passive fixation tasks. RESULTS: We included 15 patients with first-episode psychosis and 18 controls in this study. Compared with controls, patients with first-episode psychosis displayed increased latencies of early visual ERPs and phasic θ ERS culmination peak in all conditions. However, they also showed a rapid recruitment of working memory-related neural generators, even in pure attention tasks, as indicated by the decreased N200 latency and increased amplitude of sustained θ ERS in detection compared with controls. LIMITATIONS: Owing to the limited sample size, no distinction was made between patients with first-episode psychosis with positive and negative symptoms. Although we controlled for the global load of neuroleptics, medication effect cannot be totally ruled out. CONCLUSION: The present findings support the concept of a blunted electroencephalographic response in patients with first-episode psychosis who recruit the maximum neural generators in simple attention conditions without being able to modulate their brain activation with increased complexity of working memory tasks.

Magnetic resonance imaging correlates of first-episode psychosis in young adult male patients: combined analysis of grey and white matter.

BACKGROUND: Several patterns of grey and white matter changes have been separately described in young adults with first-episode psychosis. Concomitant investigation of grey and white matter densities in patients with first-episode psychosis without other psychiatric comorbidities that include all relevant imaging markers could provide clues to the neurodevelopmental hypothesis in schizophrenia. METHODS: We recruited patients with first-episode psychosis diagnosed according to the DSM-IV-TR and matched controls. All participants underwent magnetic resonance imaging (MRI). Voxel-based morphometry (VBM) analysis and mean diffusivity voxel-based analysis (VBA) were used for grey matter data. Fractional anisotropy and axial, radial and mean diffusivity were analyzed using tract-based spatial statistics (TBSS) for white matter data. RESULTS: We included 15 patients and 16 controls. The mean diffusivity VBA showed significantly greater mean diffusivity in the first-episode psychosis than in the control group in the lingual gyrus bilaterally, the occipital fusiform gyrus bilaterally, the right lateral occipital gyrus and the right inferior temporal gyrus. Moreover, the TBSS analysis revealed a lower fractional anisotropy in the first-episode psychosis than in the control group in the genu of the corpus callosum, minor forceps, corticospinal tract, right superior longitudinal fasciculus, left middle cerebellar peduncle, left inferior longitudinal fasciculus and the posterior part of the fronto-occipital fasciculus. This analysis also revealed greater radial diffusivity in the first-episode psychosis than in the control group in the right corticospinal tract, right superior longitudinal fasciculus and left middle cerebellar peduncle. LIMITATIONS: The modest sample size and the absence of women in our series could limit the impact of our results. CONCLUSION: Our results highlight the structural vulnerability of grey matter in posterior areas of the brain among young adult male patients with first-episode psychosis. Moreover, the concomitant greater radial diffusivity within several regions already revealed by the fractional anisotropy analysis supports the idea of a late myelination in patients with first-episode psychosis.

Working memory impairments in first-episode psychosis and chronic schizophrenia.

Working memory (WM) impairments are core cognitive deficits in patients with schizophrenia linked to prefrontal cortical dysfunctions. Determining the differences between early phases of illness allows a better understanding of its course and constitutes an important guide for treatment. The present cross-sectional study examined differences of working memory functions between 33 first-episode and 29 chronic schizophrenic patients, as well as 64 healthy controls. On the basis of a two-back visual-verbal computerized working memory task, reaction time was slower and accuracy was worse in both patient groups than in controls. Test variables, however, were not significantly different between the patient groups, suggesting stability of the deficits over time. Effect size accuracy variables nevertheless showed larger deficits in chronic patients.

Are there clinical differences between inner, outer or dual spatial locations of auditory verbal hallucinations?

The aim of the present exploratory study was to examine the clinical differences of Auditory Verbal Hallucinations (AVHs) according to their spatial localization. Sixty-six outpatients were divided into three separate groups: inner, external and dual AVHs. The three groups were compared on sociodemographic variables (age, gender, education, marital status, living situation, employment, social disability), on clinical psychiatric characteristics (diagnosis, medication, comorbidities, illness onset, illness duration and hospitalizations) and on the measure yielded by the clinical assessments (Brief Psychiatric Rating Scale-Expanded, version 4.0; Maastricht Voices Interview for Adults; Belief About Voices Questionnaire Revised, the Clinical Global Impression, the Global Assessment Functioning Self-Esteem Rating Short Form, the World Health Organisation Quality of Life-Bref). Gender, living situation, social quality of life and some items regarding beliefs about AVHs raised significant difference, however most of the other comparisons failed to reach significance. Taken together, our findings suggest that all AVHs subtypes have equal clinical significance in patients presenting a chronic mental illness. However, the power of the study limits the generalization of the findings. Clinical implications of the findings are proposed.