Vagus nerve stimulation allows to cease maintenance electroconvulsive therapy in treatment-resistant depression: a retrospective monocentric case series.

Context: The use of vagus nerve stimulation (VNS) to reduce or stop electroconvulsive therapy (ECT) in treatment-resistant depression seems promising. The aim of this study was to investigate the efficacy of VNS on the reduction of ECT sessions and mood stabilization. Methods: We conducted a monocentric retrospective case series of patients who suffered from treatment-resistant depression, treated with ECT and referred to our center for VNS. We investigated the number and the frequency of ECT sessions before and after VNS implantation. Secondary criteria consisted in the Montgomery Åsberg Depression Rating Scale (MADRS) score, number of medical treatments, dosage of the main treatment and length of hospital stays before and after VNS. Additionally, we sent an anonymous survey to psychiatrists and other physicians in our institution to investigate their knowledge and perception of VNS therapy to treat treatment-resistant depression. Results: Seven patients benefited from VNS: six (86%) were female (mean age of 51.7 +/- 16.0 years at surgery), and five (71%) suffered from bipolar depression (three type I and two type II). All patients were followed up at least 2 years post-implantation (range: 27-68 months). Prior to VNS, six patients were treated by maintenance ECT. After VNS, three (43%) patients did not require maintenance ECT anymore, and three (43%) patients required less frequent ECT session with a mean 14.7 +/- 9.8 weeks between sessions after VNS vs. 2.9 +/- 0.8 weeks before VNS. At last follow-up, 4 (57%) patients had stopped ECT. Five (71%) patients implanted with VNS were good responders (50% decrease relative to baseline MADRS). According to the survey, psychiatrists had a significantly better perception and knowledge of ECT, but a worse perception and knowledge of VNS compared to other physicians. Conclusion: VNS is a good option for treatment-resistant depression requiring maintenance ECT dependence. Larger on-going studies will help broaden the implanted patients while strengthening psychiatrists' knowledge on this therapy.

Morphing analysis of facial emotion recognition in anorexia nervosa: association with physical activity.

PURPOSE: Anorexia Nervosa (AN) has been linked to emotion processing inefficiencies, social cognition difficulties and emotion dysregulation, but data on Facial Emotion Recognition (FER) are heterogenous and inconclusive. This study aims to explore FER in patients with AN using a dynamic and ecological evaluation, and its relationship with Physical Activity (PA), an important aspect of AN that could impact emotional processing. METHODS: Sixty-six participants (33 patients with AN and 33 healthy controls) performed a morphed facial emotional recognition task and 49 of them wore an accelerometer during seven days to assess PA. Axis-I disorders and depressive symptoms have been assessed. RESULTS: No difference was found regarding time to recognize facial emotions. However, patients with AN correctly recognize emotions more frequently than controls. This was specific to disgust, although there was also a tendency for sadness. Among patients, higher depressive scores are associated with a faster and more accurate recognition of disgust, while a higher level of PA is associated to decreased accuracy in recognizing sadness. CONCLUSION: Patients with AN are capable of recognizing facial emotions as accurately as controls, but could have a higher sensitivity in recognizing negative emotions, especially disgust and sadness. PA has opposite effects and, thus, could be considered as an emotional regulation strategy against negative affect. LEVEL OF EVIDENCE II: Controlled trial without randomization.

[Anorexia in males]. / L'anorexie au masculin.

Anorexia nervosa is often considered as a women disease, whereas 10% of the cases are men. There are much more researches in this field for a couple of decades. "Bigorexia", which combines food control and need for muscles, seems to be more frequent above men.

["Family groups" for relatives of patients with anorexia nervosa]. / Les "groupes famille" pour les proches de patients souffrant d'anorexie mentale.

Anorexia nervosa affects mainly young adults. During care, caregivers seek alliance with patients' friends and family to be able to relate to the patients' symptoms and also their environment. Collaborative work with families helps build confidence. The "family group" is an example of well-intended partnership.

[Early identification of anorexia nervosa]. / Repérage précoce de l'anorexie mentale. Un dépistage simple peut prévenir chronicité et complications.

Early identification of anorexia nervosa. Early identification of anorexia nervosa is a public health issue. It would limit or prevent morbidity and mortality from this disorder that affects girls and young women in priority. Systematic screening is based on quick interview and simple physical examination, that every doctor should know. Screening has to be adapted to the patient's age.

Repérage précoce de l'anorexie mentale. Le repérage précoce de l'anorexie mentale est un enjeu de santé publique dans le sens où il permettrait de limiter la morbi-mortalité de ce trouble qui touche les adolescentes et les jeunes femmes en priorité. Il repose sur un interrogatoire et un examen clinique, simples et rapides, que chaque médecin se doit de connaître. Le dépistage doit être adapté à l'âge du patient.