ABSTRACT
Homelessness is a multifactorial issue, influenced by structural and individual factors. These factors include health status, which has been reported to be poorer among people experiencing homelessness. Although the somatic and mental health of homeless individuals has already been studied in France, to our knowledge, no research has been conducted on neuropsychological functioning in this country. Studies out with France have identified cognitive impairments as highly prevalent among homeless people, and these impairments are likely affected by local structural factors, such as healthcare access. Therefore, we conducted an exploratory study in Paris to evaluate cognition and associated factors in homeless adults. The second objective was to identify methodological specificities to consider in a future larger-scale study and for the application of the outcomes. For this exploratory phase, 14 individuals were recruited from specific services and were interviewed regarding their social, neurological, and psychiatric history, before completing a set of cognitive tests. The results showed a high diversity of profiles in terms of demographic characteristics, including being a migrant and/or illiterate. A high proportion of participants had signs of traumatic brain injury, anxiety, depressive disorders, and post-traumatic stress disorders. Most cognitive scores were in the low average of normative data. No statistical association was found between identified risk factors and cognitive performance. Future studies should consider the sociodemographic specificities of the homeless population and design appropriate measurement tools to improve the understanding of neuropsychological profiles.
ABSTRACT
BACKGROUND: In 2008, the U.S. FDA approved rTMS as a treatment against medication-resistant depression. However, real-world rTMS outcomes remain understudied. This study investigates how rTMS for depression is delivered in routine clinical practice in France, and measures its effectiveness as well as its moderators. METHODS: Five centers provided retrospective data on patients who were treated with rTMS for treatment-resistant depression from January 2015 to December 2020. Patients were assessed twice using a hetero-questionnaire, with baseline and immediate post-treatment assessments. We conducted univariate analyses to study which factors were significantly associated with rTMS effectiveness. We then included age, gender, and significant factors in a multivariate model. RESULTS: We collected data from 435 patients with a mean age of 51.27 (14.91): 66 % were female, and 26 % suffered from bipolar depression. Stimulation was delivered using four different stimulation parameters: 1 Hz (7 % of the individuals), 10 Hz (43 %), 20 Hz (12 %), and 50 Hz (intermittent Theta Burst Stimulation, iTBS) (38 %). The mean improvement of depressive symptoms was 33 % (p < 0.001, effect-size: 0.79). Response and remission rates were of 31 % and 22.8 %, respectively. In the multivariate analysis, improvement in depressive symptoms was associated with higher baseline symptoms. CONCLUSION: This is one of the largest studies that investigates, with careful clinician-rated scales by trained psychiatrists, the effect of rTMS in naturalistic settings. Repetitive TMS appears to be effective in routine clinical practice, although its efficacy could be improved by analyzing predictors of response, as well as personalized targeting of specific brain areas.
Subject(s)
Depressive Disorder, Major , Humans , Female , Middle Aged , Male , Depressive Disorder, Major/therapy , Depressive Disorder, Major/etiology , Transcranial Magnetic Stimulation , Retrospective Studies , Depression/therapy , Brain , Treatment Outcome , Prefrontal Cortex/physiologyABSTRACT
Introduction: Metacognition is the ability to reflect on one's own cognitive processes, monitor and regulate them to enhance mental performance. Social cognition involves the capacity to perceive and respond to social cues from others. The study of metacognition and social cognition is an expanding research field in psychiatry. Both domains are related to neurocognition, symptoms and psychosocial functioning in schizophrenia. Understanding the relationship between social cognition and metacognition may be pivotal for enhancing the treatment of cognitive symptoms in schizophrenia. Methods: We conducted a PRISMA systematic review and meta-analysis on quantitative studies comparing metacognition to social cognitive outcomes in adult outpatients with a schizophrenia spectrum disorder. Reports were retrieved from the Medline, ScienceDirect and PsycINFO databases up to July 13th, 2023. Risk of bias was assessed with the Cochrane tool. Results: Our review included 1,036 participants across 17 reports, with 12 reports included in the meta-analysis. We found a significant positive correlation (r = 0.28, 95% CI: [0.14, 0.41]) between social cognition and metacognition. Subgroup analyses indicated that metacognition was specifically associated with theory of mind, attribution, and emotion processing. Different patterns of correlations were observed according to the assessment of metacognition and its subdimensions. Conclusion: Despite discrepancies among the included studies, no publication bias was detected. The results suggest that metacognition and social cognition are distinct but related constructs. Those processes should be assessed and treated together, along with neurocognition, in schizophrenia.
ABSTRACT
The burden of caregivers of patients with chronic diseases has been the subject of research for several years, but few studies have focused on the suffering of family members from the time of their first hospitalization in psychiatry. The identification of the determinants of this burden would allow us to propose early management aimed at improving the well-being of the patients' family and friends and maximizing intra-family resources.
