BACKGROUND:The 2024 French Haute Autorité de santé (HAS) guidelines introduced the concept of an "ADHD-specialized physician" calling for competency-based models to support broader, evidence-based ADHD care for children and adolescents. However, no standardized assessment currently exists to evaluate the clinical reasoning required for this role. OBJECTIVE:This study describes the development and initial validation of a Script Concordance Test (SCT) designed to assess clinical reasoning in ADHD management, with potential applications as both a pedagogical and certification tool. METHODS:Following international standards for SCT design, the test was constructed using a structured blueprint aligned with HAS 2024 guidelines. A panel of 25 national experts completed the full version (72 items); after reviewing the items and excluding those with low consensus, 43 items were retained. Inter-rater agreement was analyzed using Kendall's coefficient of concordance (W=0.67). Qualitative validation was achieved through iterative expert consensus ensuring clarity, relevance, and representativeness. RESULTS:The expert panel demonstrated substantial concordance (Kendall's W=0.67) consistent with previous SCT validation studies in psychiatry and pediatrics. Qualitative reviews confirmed the clarity, representativeness, and clinical relevance of the retained items. CONCLUSIONS:This SCT provides a valid and adaptable method to assess higher-order clinical reasoning in ADHD care. By operationalizing the competencies implied in the HAS 2024 guidelines, it may support the emerging role of the "ADHD-specialized physician" and contribute to competency-based certification models similar to those used in other regulated medical practices.
BACKGROUND:This study focused on the phenomenon of demoralization, an experience of emotional distress frequently observed in patients with severe chronic illnesses, particularly those with cancer. OBJECTIVES:The aims of this study were to adapt a standard instrument for assessing demoralization - the Demoralization Scale I (DS-I) - into French and to examine its content validity. METHODS:First, we developed a French version of the Demoralization Scale I through forward and backward translation procedures. Second, we conducted a qualitative thematic study based on cognitive interviews with 12 French patients with cancer to assess the content validity of our French translation of the Demoralization Scale I. RESULTS:Our French version of the Demoralization Scale I seemed satisfactory in light of the COSMIN methodological recommendations for the translation of instruments. Our version of the Demoralization Scale I also demonstrated an acceptable content validity through the cognitive interviews conducted with patients. CONCLUSIONS:Our findings suggest that further validation of the French version of the Demoralization Scale I should be continued in future studies. This would ensure rapid diagnosis of demoralization in affected patients and the initiation of therapeutic interventions.
Defined as a complex syndrome combining attentional and behavioral difficulties, Attention Deficit Hyperactivity Disorder (ADHD) is a widespread condition affecting approximately 5.3% of children worldwide. Treatments mainly include psychotherapy and amphetamine derivative-based pharmacotherapy. Respiratory biofeedback may represent an additional, promising non-pharmacological approach for ADHD, in addition to neurofeedback, biofeedback's actual main application protocol based on cerebral activity. However, to date, there are few studies regarding other physiological rhythms, such as breathing. This study explored the potential effects of a therapeutic intervention based on respiratory, haptic and visual biofeedback, aiming to reduce the intensity of attentional dysfunction symptoms in children with ADHD aged 8 to 11 years. In this crossover protocol, we set two intervention groups: an immediate group and a delayed group. The intervention phase consisted of five weekly respiratory biofeedback sessions focused on attention processes, along with the monitoring of symptomatic manifestations using validated psychometric tools. Among the 17 participants, the results showed a significant overall decrease in ADHD evaluation scale scores both immediately after the intervention and at the 30-day follow-up, indicating short-term benefits from the sessions. However, these benefits were attenuated in the medium term, possibly due to the limited number of biofeedback sessions. In conclusion, respiratory biofeedback was well accepted, and few sessions decreased in the short term symptomatic manifestations and functional impacts related to ADHD. However, treatment effects, permanence and acceptability need to be assessed in larger and longer cohort studies. Thus, a multimodal biofeedback approach based on respiratory feedback is an innovative preliminary but promising emerging perspective for children presenting ADHD.
In the context of medication shortages, the creation of a list of essential medications (EML) is becoming necessary in France, as it is in other industrialized countries newly affected by this issue. This approach differs from the World Health Organization's EML and is thought of as an extension of the definition of medications (and therapeutic classes) of major therapeutic importance as outlined in the public health code. The principle behind this list is to maintain a high standard of care. The first EML for French psychiatry was formalized by the French Association of Biological Psychiatry and Neuropsychopharmacology (AFPBN) in June 2023. It was initially compiled by a steering committee of five mental health practioners and proposed to a panel of 31 experts who were asked to rate their degree of approval for each medication (Delphi method) along with the level of criticality in the event of a shortage. Based on 163 medications, the AFPBN selected 98, after validation by its expert group. (June 2023). The Directorate General of Health later removed 18 medications from this list, including molecules with no medical benefit, mainly substances under compassionate use authorization, or those with an insufficient, low, or moderate medical benefit. This first EML for French psychiatry can obviously be improved but is proposed as a working basis for future modifications.
OBJECTIVES:Mental health disorders and suicidal behaviors are a major public health issue worsened by the COVID-19 pandemic. Social prescribing initiatives such as Art on Prescription aim to integrate artistic activities into healthcare to promote well-being and reduce depressive symptoms. This pilot study aimed to assess the impact of an Art on Prescription program on individuals at risk of suicide. METHODS:An AoP program was implemented in Montpellier coordinated by the Department of Emergency Psychiatry and Acute Care at Montpellier University Hospital, in partnership with MO.CO. (Montpellier Contemporain). Fifty-one adults, referred after an emergency visit for suicidal ideation or a suicide attempt, were enrolled between 2022 and 2024. The program was delivered through five successive cycles. Each participant was enrolled in one cycle only, led by an artist, and included one museum visit followed by five weekly creative sessions. Depressive symptoms (PHQ-9, Patient Health Questionnaire-9) and well-being (WEMWBS, Warwick-Edinburgh Mental Wellbeing Scale) were assessed at the end of each of the five creative sessions. Wilcoxon tests and Generalized Estimating Equations (GEE) were used for analysis. RESULTS:Among the 29 participants with complete data from the first to the fifth creative sessions, a significant improvement in well-being was observed (mean WEMWBS increase: +2.24; P=0.02), whereas the decrease in depressive symptoms was not statistically significant (PHQ-9: -0.79; P=0.12). In the full sample (n=51), the comparison between the first and third creative sessions showed a significant decrease in depressive symptoms (-0.65; P=0.05), but a non-significant increase in well-being (+1.22; P=0.11). GEE models confirmed a significant negative association between PHQ-9 and WEMWBS scores (β=-1.1; P<0.001), with no significant effect of time or interaction. CONCLUSIONS:The Art on Prescription program appears to have a positive impact on well-being and depressive symptoms in individuals at risk of suicide. These findings support the potential value of innovative, non-pharmacological interventions as a complement to traditional psychiatric care, aligned with recovery-oriented approaches.
BACKGROUND:Post-traumatic stress disorder (PTSD) is a common consequence of traumatic experiences in children, highlighting the need for culturally adapted screening instruments. The objective of this study was to translate and validate the self-report questionnaire, the Children's Revised Impact of Event Scale-13 (CRIES-13), into Tunisian Arabic. METHODS:We conducted a cross-sectional study among children aged eight to 18 years, recruited from the Child and Adolescent Psychiatry Department of Mongi Slim Hospital between February 2024 and February 2025, who had experienced a stressful life event. Non-inclusion criteria included insufficient cognitive or linguistic abilities to complete the questionnaire. Exclusion criteria were refusal to participate and incomplete questionnaires. The CRIES-13 questionnaire was translated using the forward-backward translation method. Its psychometric properties were evaluated in terms of content validity, reliability, and construct validity. The internal structure was assessed using confirmatory factor analysis. For preliminary external validation, the Tunisian version of the Clinician-Administered PTSD Scale for Children and Adolescents, Fifth Edition (CAPS-CA-5), was used. RESULTS:A total of 300 children were included in the study. The translated version was deemed satisfactory. Internal consistency was good, with a Cronbach's alpha of 0.841. Item - subscale correlations were statistically significant and conceptually coherent. Confirmatory factor analysis supported the three-factor model and demonstrated acceptable model fit indices, as follows: χ2/df=2.78; root mean square error of approximation (RMSEA)=0.077; Standardized Root Mean Square Residual=0.092; Comparative Fit Index=0.897; Tucker-Lewis Index=0.871; Goodness-of-Fit Index=0.918; Adjusted Goodness-of-Fit Index=0.880; and Akaike Information Criterion=230. Statistically significant correlations were found between the CRIES-13 and its external validator, the Clinician-Administered PTSD Scale for Children and Adolescents, Fifth Edition (CAPS-CA-5) (r=0.897; P<0.01). CONCLUSION:The Tunisian Arabic version of the CRIES-13 demonstrated satisfactory psychometric properties. It can be considered a reliable and valid screening tool for PTSD among Tunisian children.
Major depressive disorder remains a leading cause of disability worldwide, and current antidepressant treatments are limited by a delayed onset of action, modest remission rates, and residual symptoms. Emerging evidence suggests that selective targeting of specific serotonergic receptors may offer faster and more precise therapeutic strategies. Among these targets, the serotonin type 4 (5-HT4) receptor has gained increasing attention due to its involvement in corticolimbic circuits regulating mood, cognition, and stress responses. Preclinical studies demonstrate that 5-HT4 receptor agonists produce rapid antidepressant- and anxiolytic-like effects, accompanied by early neuroplastic adaptations. Prucalopride, a highly selective 5-HT4 receptor agonist approved for chronic idiopathic constipation, has recently emerged as a promising candidate for drug repurposing in psychiatry. Converging evidence from animal models, experimental human studies, and epidemiological analyses suggest that prucalopride may modulate mood-related neural circuits and cognitive processes. This perspective discusses the translational potential of 5-HT4 receptor agonism as a novel therapeutic avenue for mood disorders.
INTRODUCTION:Antidepressants are widely used to treat depression, PTSD, and generalized anxiety disorder. However, the side effects of antidepressants, which may affect treatment adherence and patient prognosis, are challenging to manage due to their overlap with psychiatric symptoms. In the same way as in the general population, side effects seem to have an impact on compliance with antidepressant treatment in military personnel which in turn affects their health and operability. The Udvalg for Kliniske Undersøgelser (UKU) Side Effect Rating Scale for Clinicians (UKU-SERS-Clin) is a comprehensive tool for evaluating side effects but is time-consuming for clinical practice. The UKU-SERS-Pat, a self-assessment version, could provide a more efficient method for side effect detection. OBJECTIVE:The present study aimed to translate and validate the UKU-SERS-Pat into French and assess its reliability and validity in patients with antidepressant prescription. METHODS:Thirty-two military patients completed both the UKU-SERS-Pat and UKU-SERS-Clin scales 4-8 weeks after starting antidepressant treatment. RESULTS:Spearman's correlations demonstrated strong agreement between UKU-SERS-Clin and UKU-SERS-Pat for psychic (ρ=0.671, P<0.001), neurological (ρ=0.737, P<0.001), and autonomic side effects (ρ=0.666, P<0.001). Patients tended to report side effects more frequently and severely than clinicians. Significant differences were noted for several items, including asthenia, failing memory, inner unrest and male sexual side effects (all P<0.01). CONCLUSION:The study confirmed the validity of the French UKU-SERS-Pat, demonstrating strong correlations with the assessments of clinicians. This tool is particularly valuable for identifying side effects that patients may underreport during clinical interviews, such as sexual dysfunction, and side effects like weight gain, or altered alertness which are of particular concern among military personnel. Further research with larger samples and diverse populations is recommended to confirm these findings and explore the scale's applicability in different clinical contexts.
When we look at our recovery journey, it is essential to think of Empowerment which refers to the process by which individuals gain greater control over their treatments, their overall health, and their illness. This concept, originated in sociology, is particularly important to study addictions, disorders which cause great suffering and difficulties that can impact various areas of a person's life. How can one regain a sense of control over their destiny and control over their life when they live with one or more addictive disorders which are primarily defined by loss of control and several physical, social, personal, and psychological consequences? In this article, we focus on the concept of Empowerment: its origins, theoretical models, and methods of evaluation, and on research conducted specifically in the field of addictology, while also discussing how our ideas and methods might help promote or develop it.
Conspiratorial thinking has been linked to lower acceptance of public health recommendations, including vaccination and disease prevention. However, the relationship between conspiracy mentality (CM) and smoking behavior remains largely unexplored. This study investigates the association between CM and smoking status with a focus on perceptions of tobacco harm, industry conspiracy, and related beliefs. A total of 407 adults residing in francophone Europe completed a questionnaire assessing demographics, smoking status, COVID-19 vaccination status, conspiracy mentality (via the Conspiracy Mentality Questionnaire), and beliefs about tobacco. Smoking status was categorized as current smoker (S), former smoker (FS) or non-smoker (NS). Associations were analyzed using ANOVA, chi-square and correlation analyses. CM scores were significantly higher among S (35±10) compared to FS (31±10) and NS (28±8). Smokers were more likely to believe that substances such as vaccines, pesticides and antidepressants are more harmful than tobacco, and they were more likely to endorse the idea that tobacco is harmless due to its natural origin. High scores were also positively correlated with a belief in scientific data manipulation and the tobacco industry conspiracy and negatively associated with a belief in tobacco-related cancer risk, smoking bans and tobacco price increases. Individuals with higher CM were more likely to smoke and to minimize the risks associated with tobacco use. Their scepticism toward science-based health information and tobacco control measures suggests a need for adapted cessation strategies that consider conspiratorial beliefs.
INTRODUCTION:In the FondationSanté desEtudiants de France (FSEF) "Soins-études" refers to therapeutic residential care. It concerns long-term psychiatric hospitalisations that include schooling provided by the national education system, the duration of which is often questioned. A tool for assessing the relevance of continuing hospitalisation for each patient was developed and scored during multidisciplinary meetings at various stages of the hospitalisation. The aim of this study was to describe the use of this tool in determining the extent to which the clinical decision to discharge is related to non-relevance scores and the clinical characteristics of the young people. MATERIALS AND METHODS:All young people hospitalised in therapeutic residential care at the FSEF clinic in Aire-sur-l'Adour between 01/01/2011 and 31/12/2017 were included. A composite indicator of non-relevance of hospitalisation was constructed from the clinical scores of the assessment tool. At each multidisciplinary meeting, the subjects were divided into three groups based on whether continuing hospitalisation was deemed relevant, and if not, whether discharge actually occurred. These three groups were compared based on their clinical characteristics using Kruskal-Wallis and Fisher's exact tests. RESULTS:The study included 219 young people, aged 16.7 years (± 1.4) and hospitalised for an average of 13.7 months (± 9.18). About half of the adolescents were discharged after their stay was deemed non-relevant according to the assessment tool. The relevance of continuing hospitalisation and discharge were linked to the psychiatric diagnosis at the first meeting and to age at the third meeting. CONCLUSION:Evaluating a non-relevance indicator enables hospitalisation duration to be regularly assessed to avoid prolonging care when the risk-benefit ratio is no longer favourable. This tool thus promotes the adaptation of care plans throughout hospitalisation.
Objectifs Le trouble dysphorique prémenstruel (TDPM), forme sévère du syndrome prémenstruel, est caractérisé par des symptômes émotionnels et physiques cycliques affectant la qualité de vie. Le trouble bipolaire (TB), quant à lui, se manifeste par des alternances d’épisodes maniaques, hypomaniaques et dépressifs. Cette revue vise à explorer la comorbidité entre TDPM et TB. Méthodes Une revue systématique de la littérature (PRISMA) a été conduite à partir des données PubMed et Embase jusqu’en juin 2025 portant sur la comorbidité TDPM-TB. Résultats Dix-huit articles (13 études originales et 5 cas cliniques) ont été inclus. Le TDPM et le TB sont fréquemment comorbides, avec alors des conséquences notables sur la fréquence et l’intensité des épisodes thymiques. Les interactions entre ces troubles semblent multiples et en partie liées aux fluctuations hormonales, notamment aux variations d’œstrogènes et de progestérone. L’efficacité des traitements pharmacologiques, hormonaux ou psychothérapeutiques reste encore peu étudiée. L’analyse des données souligne la nécessité d’une prise en soins individualisée, intégrant la cyclicité des symptômes. Conclusions La comorbidité TDPM-TB constitue une entité clinique spécifique, largement sous-reconnue en pratique courante malgré ses conséquences pronostiques. Il apparaît primordial de poursuivre l’exploration de cette comorbidité, en intégrant les fluctuations hormonales et les vulnérabilités thymiques, afin de pouvoir mieux la diagnostiquer et la traiter, et ainsi améliorer la qualité de vie à travers des stratégies thérapeutiques personnalisées.
La réhabilitation psychosociale chez l’enfant ne fait pas l’objet en France d’un consensus clinique et ce en dépit d’expériences internationales validant le concept. Soutenir l’espoir et la parentalité lorsque les enfants sont en situation de handicap, faciliter l’inclusion scolaire, évaluer les forces cognitives et émotionnelles de l’enfant dans son environnement culturel sont au cœur de cette approche. Respecter le choix des enfants, des parents et leur proposer des outils personnalisés facilite l’empouvoirement parental et le développement de celui des enfants. L’existence des plateformes psychosociales pour personnes adultes doit être le tremplin du développement de plateformes adaptées à l’enfant.
OBJECTIVE:To explore how professionals implement support for parenthood when a parent lives with psychiatric or somatic illness or disability, and to identify conditions that enable or hinder consistent, coordinated, and non-stigmatizing care. METHODS:A secondary qualitative analysis was carried out of a corpus of 51 semi-structured interviews with health and social-care professionals working in perinatal, psychiatric, and community settings. Sociodemographic data were summarized descriptively. An inductive thematic analysis was conducted by an independent researcher using NVivo software, with a focus on three domains: (i) characteristics of care provision; (ii) limits to care; and (iii) intra/interpersonal difficulties reported by professionals. RESULTS:Seven subthemes characterized care: multidisciplinary teamwork, imperative nature of intervention, listening and adaptation, anticipation (ideally antenatal), graded child-placement options (including partial/temporary arrangements), parental self-efficacy, and empowerment. Four constraints limited implementation: insufficient parent-infant-qualified structures and long waits, shifts to child-protection logics under perceived risk, limited compliance or disagreement with recommendations, and missed/irregular appointments. Professionals reported strong emotional reactions and feelings of powerlessness, being challenged by families, and - where teams were cohesive and trained - absence of difficulties. CONCLUSION:Professionals strive for protective, coordinated, and adaptive care, yet structural scarcity and engagement challenges narrow individualization of perinatal care. Priorities include strengthening network capacity (parent-infant -adapted care pathways and early antenatal referral), operationalizing shared decision-making, and embedding reflective supervision.
Psychiatric nosology serves both clinical and research needs by providing a common language and informing healthcare planning. However, a movement toward transdiagnostic approaches is growing for assessments and care management of neurodevelopment disorders. During childhood and adolescence, symptoms appear as developmental delays. They often overlap across disorders, making the diagnosis difficult. To account for the multidimensional symptomatology, we propose a visualization of neurodevelopmental disorders phenomenology that would make it easier to analyze an individual as a network of diagnostic criteria whose interactions can compensate for each other and determine a pathological, at-risk or healthy impact. Such spatial organization would allow for the diagnostic criteria to be ordered over time, prioritized, and shared more effectively beyond the categorial diagnosis. Symptoms for neurodevelopmental disorders were grouped according to a hierarchy of phenomenological and symptomatological terms found in the main reference manuals and in the didactic consensus reported in the latest international reviews. They fall into four major domains: cognition, emotion, behavior and motricity while the operational diagnostic criteria were organized into a multiscalar hierarchy with a notion of order following a circular tree structure: the 'sunburst'. A graphic, visual, dynamic and hierarchical organization was proposed to handle all the phenomenology terms used in children, adolescents and young adults (aged 5-25) more easily and to convey them to the parties involved. Far from being exhaustive, this visual representation aims to facilitate the use of psychiatric phenomenology while maintaining a critical, dynamic and evolving approach to scientific knowledge and clinical practice.
The relationship between domestic violence and mental health is intricate and complex. Domestic violence can be categorised into intimate partner violence and family violence. While most studies have focused on the former, less is known about the prevalence and the characteristics of family violence among adult mental health patients. Moreover, data is lacking on the needs of mental healthcare users who are victims of domestic violence, in terms of specific (legal and social) support. The present study aims to assess the prevalence and the characteristics of recent (<12 months) domestic violence in its two forms among a population of adult outpatients undergoing intensive psychiatric follow up. The sample included 206 participants, mostly women (71%), aged 19 to 64 (mean age 36, SD 11.8). The extended version of the Hit, Insult, Threat and Scream Scale (E-HITS) was used to screen intimate partner violence and domestic violence. The prevalence of recent domestic violence was 29.1%. Specifically, 16.5% had been victims of intimate partner violence and 12.6% of family violence. Women showed a statistically higher risk of facing domestic violence. No significant differences were observed in other socio-demographic characteristics (living conditions, marital status, residence permit, employment, education) or in previous recourse to emergency care. FV was especially prevalent among young patients, even though statistical significance was not reached. While previous disclosure rates were surprisingly high among the victims of intimate partner violence and family violence (70%), the victims of family violence (7.7%) were given significantly less specific support than the victims of intimate partner violence (41%). These findings confirm the notion that domestic violence is highly prevalent in mental health settings, and that violence is not limited to couples. Clinicians should be careful when detecting family violence especially among young patients, whose self-protection could be hindered by psychological and material boundaries.
Motivation is one of the important determinants of functional outcomes in schizophrenia, yet its conceptualization and measurement remain heterogeneous. The literature reflects two predominant orientations: a psychiatric (nosological) perspective which construes motivation primarily as a deficit linked to negative symptoms, and a psychological perspective, mostly grounded in Self-Determination Theory (SDT), which emphasizes intrinsic motivation, the quality of regulation, and the satisfaction of basic psychological needs - autonomy, competence, and relatedness. Psychiatric approaches often conflate symptoms and motivational states and lack specificity regarding the object of motivation (e.g., goals, tasks, social engagement), whereas SDT brings to light environmental and interpersonal determinants. Although both approaches document altered motivational profiles, intermediate forms of regulation and context-specific motivations remain underexplored. This narrative review synthesizes these perspectives, examines measurement approaches, and argues that integrating SDT principles can refine assessment, clarify mechanisms, and inform interventions to enhance engagement, well-being, and functional recovery in schizophrenia.
