Background: Cocaine Use Disorder (CUD) affects millions of individuals and is associated with profound neurocognitive deficits. Electroencephalography (EEG) offers a non-invasive tool to characterize neural dysfunction in CUD. This systematic review synthesizes event-related potential (ERP) and spectral EEG findings in CUD across active use and withdrawal. Methods: Following PRISMA guidelines, we searched for studies examining ERP or spectral EEG in individuals meeting DSM criteria for CUD. Thirty-three studies were included: 23 examining ERPs and 10 examining spectral analysis. Results: Most neurophysiological studies have focused on withdrawal. ERP findings reveal robust alterations across multiple processing stages. Early sensory encoding (P50, N100) shows reduced amplitudes and delayed latencies, suggesting impaired sensory gating. Performance monitoring components (ERN, Pe) are consistently blunted, reflecting deficits in error detection and cognitive control. Most notably, P300 amplitude reductions across both auditory and visual modalities indicate compromised attentional allocation and motivational processing. Late components (LPP, CNV) demonstrate enhanced amplitudes to salient stimuli, particularly during early withdrawal. Spectral EEG findings prove more heterogeneous and time dependent. Early withdrawal shows reduced theta and beta power in posterior regions, while delta and alpha show variable changes. Beyond two weeks, spectral alterations largely normalize, suggesting transient rather than enduring oscillatory dysfunction. Conclusions: These convergent findings establish EEG-based electrophysiological signatures of CUD spanning sensory processing, executive control, and motivational systems. The value of ERP components as potential objective biomarkers for withdrawal severity and treatment response, warrant further longitudinal investigation.

Depressive disorders are among the most prevalent and disabling psychiatric conditions, affecting up to 20% of the general population. Diagnosis still relies on clinical evaluation, and efforts to identify robust biomarkers are limited by the marked phenotypic heterogeneity of depressive disorders. Sleep and circadian disturbances are highly prevalent in major depressive episode (MDE) and represent promising candidate markers, yet their characterization across depressive subtypes remains incomplete. The SoPsy-Depression cohort is a nationwide, prospective, multicenter study designed to harmonize multimodal assessment of sleep and circadian alterations across depressive disorders in routine care. The cohort aims to enroll more than 1000 participants (adults and children) with a current MDE over 10 years across an expanding network of French psychiatric and sleep centres. A Delphi consensus established a standardized set of clinician-administered and self-report questionnaires assessing psychiatric symptoms, sleep, circadian rhythms and substance use. Subjective measures are complemented by objective assessments including actigraphy, polysomnography and biological circadian markers. This report presents the study rationale, design and first descriptive data after two years of inclusion. As of November 2025, 158 participants were enrolled (82% unipolar, 18% bipolar). Completion rates for adult mandatory questionnaires currently approach 70%. Preliminary data reveal high rates of insomnia, hypersomnia, poor sleep quality and psychiatric comorbidities. Objective sleep measures suggest alterations in sleep continuity and circadian patterns, consistent with previous reports in depression. The SoPsy-Depression cohort demonstrates the feasibility of large-scale harmonized multimodal assessment of sleep and circadian disturbances and provides a framework to identify clinically meaningful profiles across depressive phenotypes.

BACKGROUND:Temporary alcohol abstinence campaigns, such as Dry January, are increasingly promoted as population-level initiatives to encourage reductions in alcohol consumption, yet evidence on longer-term changes in alcohol consumption following participation remains limited. METHODS:A longitudinal online survey was conducted among French adults participating in Dry January 2024. Participants completed a baseline survey at the end of December and follow-up assessments at 1 month (February), 3 months (April), and 9 months (October). The final cohort included 1,886 participants. Alcohol consumption was measured using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) at baseline and at the 3-month and 9-month follow-ups. Changes in AUDIT-C scores were examined using linear mixed-effects models, while logistic regression models were used to identify baseline characteristics associated with reductions in drinking frequency, quantity, and heavy episodic drinking. RESULTS:AUDIT-C scores declined substantially from baseline to 3 months (Cohen's d = 0.68) and remained below baseline at 9 months (d = 0.57) despite a modest rebound, indicating sustained reductions in alcohol consumption. AUDIT-C scores decreased in all drinking risk groups, with larger reductions observed among participants classified as hazardous or harmful drinkers at baseline, compared to low-risk drinkers. Associations between baseline characteristics and alcohol reduction varied across outcomes and follow-up periods. Self-recognition of excessive drinking was the most consistent predictor of reductions across drinking frequency, quantity, and heavy episodic drinking, whereas higher baseline drinking risk was consistently associated with reductions in drinking quantity and heavy episodic drinking, but not drinking frequency. CONCLUSIONS:Participation in Dry January in France was associated with moderate but sustained reductions in alcohol consumption, up to nine months after the campaign. These findings support that temporary abstinence campaigns are a complementary population-level strategy for reducing alcohol-related harm.

Abstract Background In Europe, cocaine use has recently been on the rise among people who use drugs (PWUD). In parallel, cathinones, another type of psychostimulant that were once associated within the unique context of chemsex, are now spreading to broader patterns of use. Here, we examined trends in reported drug use, including cathinones, among PWUD attending the main harm reduction center in Lyon, France, between 2019 and 2023. Methods We conducted a year-by-year comparison of standardized assessments completed at entry and updated annually for all PWUD attending the harm reduction center. These assessments collected sociodemographic characteristics (i.e., age, sex, nationality, family, housing, and occupational status), and the types of drugs reported as used. We performed logistic regression models to compare the prevalence of each substance, used as the dependent variable, with year and sociodemographic characteristics of PWUD as independent variables. Adjusted odds ratios and their 95% confidence intervals (aOR [95% CI]) were reported. Results A total of 1,652 PWUD were analyzed. Between 2019 and 2023, the proportion of PWUD reporting cathinone use increased from 1.1% to 10.9%, and from 53.2% to 73.2% for cocaine (p < 0.001 for both). In parallel, the proportion of PWUD reporting alcohol use decreased from 29.5% to 12.8%, and from 72.1% to 39.9% for opioids (p < 0.001 for both). After adjusting for age, sex, and socioeconomic factors, and using 2019 as the reference year, we found significant increases in reported cathinone use in 2022 (aOR [95% CI] = 4.84 [1.35–31.05]) and 2023 (aOR [95% CI] = 4.90 [1.40-31.06]), along with significant decreases in opioid use in 2022 (aOR [95% CI] = 0.50 [0.28–0.88]) and 2023 (aOR [95%CI] = 0.39 [0.22–0.66]). The changes observed for alcohol and cocaine were no longer significant. Conclusions We observed a significant increase in the proportion of PWUD reporting cathinone use at harm reduction centers. This trend highlights the need for improved training for caregivers and adaptations in the services provided for these substances within these facilities. Further research is needed to gain a deeper understanding of the profiles of more vulnerable cathinone users and their motivations for use.

Background:The comparative liability for abuse and dependence of drugs used for attention deficit hyperactivity disorder (ADHD) has been poorly explored so far. Aims:To evaluate the relative potential of medications used for ADHD for generating spontaneous reports of abuse and dependence in international pharmacovigilance data. Methods:A disproportionality analysis was conducted using data recorded in VigiBase®, the World Health Organisation global database of individual case safety reports (ICSRs). ICSRs recorded between 1 January 2002 and 30 June 2023, referring to paediatric and adult subjects with known sex and aged ≥ 15 years and involving suspect drugs used for ADHD, were included. Reporting odds ratios (RORs) for 'Drug abuse and dependence', along with their 95% confidence intervals (CIs), were calculated using methylphenidate as the reference drug and with adjustment for age, sex, seriousness, reporter qualification and continent of reporting. Several sensitivity analyses were performed. Results:Among the 55 219 ICSRs included, 2633 were reports of drug abuse and dependence. The proportion of drug abuse and dependence reports was significantly lower for all studied drugs than for methylphenidate, except for lisdexamfetamine (ROR: 1.06, 95% CI 0.91-1.24). Sensitivity analyses yielded results comparable to the primary analysis, but with a slightly higher ROR for lisdexamfetamine when excluding US data (ROR: 1.26, 95% CI 1.03-1.54). Conclusions:Methylphenidate and lisdexamfetamine emerged as the two drugs with the highest likelihood of safety reports related to abuse and dependence. These findings challenge previous statements suggesting that the abuse potential of lisdexamfetamine was lower than that of other psychostimulant drugs used for ADHD and advocate for further pharmacoepidemiological studies in this field.

Alcohol use disorder (AUD) is associated with significant structural alterations in gray and white matter of the brain, which has potential implications for cognitive and emotional functions. These alterations appear to be related to alcohol use patterns. This study aims to systematically review voxel-based morphometry studies to identify consistent patterns of gray matter and white matter alterations in patients with AUD compared to healthy control subject and explore their associations with alcohol consumption patterns. A systematic review of neuroimaging studies was conducted, analyzing gray matter (GM) and white matter (WM) differences between healthy individuals and patients with AUD. Special attention was given to the relationship between alcohol consumption variables (e.g., duration, quantity, frequency) and GM and WM volumes. AUD patients showed significant GM alterations in the right cingulate (SDM-Z = -6.013), right insula (SDM-Z = -6.088) and left Heschl gyrus (SDM-Z = -5.254) compared to healthy control subject. WM alterations were found in the corpus callosum (SDM-Z = -3.537). Meta-regressions revealed dose-dependent associations: AUDIT scores (SDM-Z = -3.143), drinks/day (SDM-Z = -3.504), lifetime drinking (SDM-Z = 3.460), and years of dependence (SDM-Z = 3.063) were each negatively correlated with regional GM volume. Earlier age at first drink was associated with WM volume in the corpus callosum (SDM-Z = 3.229). Longer abstinence was correlated with larger WM volumes. This meta-analysis underscores the associations between alcohol consumption patterns and brain structure and provides evidence of dose-dependent associations between alcohol consumption and neuroanatomical differences.

Bright light therapy (BLT) is now established as an evidence-based treatment for several psychiatric and sleep disorders, with robust efficacy in seasonal affective disorder, non-seasonal, unipolar, and bipolar depression, insomnia and circadian rhythm sleep–wake disorders, including Delayed Sleep–Wake Phase Disorder. BLT-related mechanisms are multifactorial, combining circadian phase-shifting effects, stabilization of the sleep–wake cycle, improved homeostatic sleep pressure, and modulation of monoaminergic pathways. Beyond these effects, recent translational studies suggest that BLT also modulates the brain reward system through circadian-dopaminergic interactions, providing a neurobiological rationale for its use in disorders where motivation, reward sensitivity, and compulsive behaviors are disrupted. Despite these advances, BLT has been largely neglected in the field of addictive disorders, even though circadian disruption, sleep disturbances, and mood instability are central clinical features of addiction. This scoping review explores the therapeutic prospects of BLT in addictive disorders. We first summarize the established evidence supporting BLT for mood and sleep disorders, which provides a strong translational basis. We then discuss three potential applications in addiction: (1) alleviating comorbid or subthreshold mood and anxiety symptoms, which are highly prevalent and disabling in substance use and behavioral addictions; (2) improving sleep and circadian regulation, frequently impaired in these populations and closely linked to relapse vulnerability; and (3) directly modulating the reward system and core addictive behaviors. In conclusion, BLT offers many potential benefits for patients with addictive disorders. Well-designed trials are now needed to confirm efficacy, refine protocols, and integrate BLT into addiction care.

La consommation de cocaïne est associée à des perturbations marquées du sommeil, qui jouent un rôle important dans la souffrance des personnes dépendantes. Les travaux existants décrivent des modifications complexes de la structure du sommeil au cours des différentes phases du sevrage, mais restent limités par des approches souvent transversales et par une absence d’évaluation des rythmes biologiques. L’étude CokeSo explorera ces questions à travers une recherche clinique longitudinale menée auprès de personnes hospitalisées pour un sevrage de cocaïne. Elle combinera des questionnaires, enregistrements répétés du sommeil, des mesures continues de l’activité motrice et des analyses hormonales urinaires permettant de caractériser les rythmes biologiques. L’objectif principal sera d’évaluer l’évolution de l’efficacité du sommeil entre la période de consommation et les premiers jours de sevrage. Les objectifs secondaires incluront l’analyse des modifications du sommeil au cours du sevrage tardif, l’examen des marqueurs hormonaux du cycle veille-sommeil et l’étude des liens entre sommeil et maintien de l’arrêt à six mois. Cette étude fournira une description inédite et complète des modifications du sommeil et des rythmes biologiques au cours du sevrage de la cocaïne. Elle permettra d’identifier des éléments pronostiques pouvant contribuer à améliorer la prise en charge des troubles du sommeil dans le cadre de l’addiction et à mieux comprendre les mécanismes biologiques impliqués dans la rechute.

BACKGROUND AND AIMS:Current treatment options for alcohol use disorder are limited. Transcranial direct current stimulation has been proposed as a therapeutic approach, but evidence remains scarce. This study aimed to compare active vs. sham transcranial direct current stimulation to evaluate its efficacy and safety in reducing alcohol consumption in a large sample of individuals with alcohol use disorder. DESIGN:REDSTIM is a triple-blind, randomized, sham-controlled trial that was conducted from October 2015 to January 2022. Participants were followed up every 4 weeks for 24 weeks. SETTING:Fourteen sites in France and Monaco. PARTICIPANTS:356 adult outpatients with alcohol use disorder were assessed for eligibility, and 337 were enrolled and randomly assigned (1:1) to receive active or sham stimulation. At baseline, the randomized participants were primarily male (60.5%) with an average age of 51.3 ± 11.3 years. INTERVENTION AND COMPARATOR:Two daily stimulation sessions (anode F4, cathode F3, 2 mA) delivered over five consecutive days vs. sham stimulation. Direct currents were applied via a pair of 0.9% NaCl-soaked surface sponge electrodes (25 cm2). In the sham stimulation group, the initial ramp-up time of 15 s (also up to 2 mA) was immediately followed by a ramp down phase of 30 seconds. MEASUREMENTS:The co-primary outcomes were the change in the number of heavy drinking days (HDD) and total alcohol consumption (TAC) over the follow-up period. Exploratory secondary outcomes included alcohol craving, clinical and biological improvements, quality-of-life, mood, cognitive and safety assessments. FINDINGS:Over 24 weeks of follow-up, vs. sham, the active stimulation group reported statistically significant reductions in the number of HDD [-2.45 HDD/4 weeks, 97.5% confidence interval (CI) = -4.86 to -0.05, P = 0.022]. The reduction in TAC was not statistically significant (-5.96 g/day, 97.5% CI = -15.18 to 3.26, P = 0.147). The interpretation of these findings should take into account the proportion of missing data related to alcohol diary completeness and losses to follow-up. For secondary outcomes at 24 weeks, vs. sham, craving assessments were lower in the stimulation group (-0.36 95% CI = -0.65 to -0.07, P = 0.016), as were carbohydrate deficient transferrin levels (-0.33 95% CI = -0.65 to -0.01, P = 0.045). In the active vs. sham stimulation group, 69 (41.1%) and 62 participants (36.7%) experienced one or more adverse effects, resulting in 6 dropouts. CONCLUSIONS:Among adult outpatients with alcohol use disorder, active transcranial direct current stimulation resulted in a modest but sustained reduction in heavy drinking days over 24 weeks, while no statistically significant effect was observed for total alcohol consumption. The intervention was well tolerated.

Introduction Sleep apnea and substance use disorders appear to interact bidirectionally, negatively influencing each other. Obstructive sleep apnea syndrome (OSA) seems particularly prevalent among substance users. Methods This meta-analysis aims to evaluate the impact of the most commonly used substances (alcohol, tobacco, cannabis, opioids, and cocaine) on the apnea-hypopnea index (AHI) by comparing the mean AHI scores between users and non-users. Results 3,784 articles were identified from the PubMed search, and 28 studies were included in the meta-analysis. We found a higher AHI among alcohol users (SMD: 0.46, 95% CI [0.21-0.71] (z =3.62; p<0.001)) and a higher prevalence of central sleep apnea among opioid users (SMD: 0.44 95% CI 0.24-0.64] (z=4.37; p<0.001)). The AHI was also elevated among tobacco users, although this difference was not statistically significant. Regarding moderators effects, sex may influence alcohol’s impact, while both age and sex could affect the relationship between opioids and AHI. No studies compared the AHI of cocaine users to non-users, and only one study comparing the AHI of cannabis users to non-users were found. Conclusion This study highlights the importance of diagnosing and managing sleep apnea in patients with substance use, in order to improve addiction prognosis through specific treatment approaches.

Objectif Les internes sont exposés à des conditions de travail exigeantes incluant les gardes de nuit, susceptible d’altérer leur sommeil. Dans la 2e édition du Baromètre santé des internes de la subdivision de Lyon (BASIL-2), nous avons évalué les troubles du sommeil et l’accidentologie associés aux gardes. Méthodes L’enquête a été proposée aux internes en médecine/pharmacie/odontologie entre février et mars 2025. Un questionnaire en ligne recueillait des données sur les gardes (fréquence, durée, repos de sécurité), la gestion du sommeil par rapport aux gardes, la somnolence (ESS) et l’accidentologie. Un calage sur marges (sexe, spécialité) a corrigé la représentativité de l’échantillon, permettant des analyses descriptives pondérées et l’analyse des facteurs associés à la somnolence et à l’accidentologie. Résultats Sur 2092 internes sollicités, 592 ont répondu (61,3 % de femmes, âge moyen 27 ans). Parmi eux, 72,1 % réalisaient des gardes (moyenne 16/semestre, en général 14h après une journée de travail). En garde, 66,8 % dormaient<3h, avec un repos de sécurité respecté chez 88,5 %. Après une garde, 82,1 % dormaient en journée (moyenne 3h55min), 35,4 % se couchaient plus tôt le soir suivant. La plupart des internes ne changeaient pas d’habitudes de sommeil avant une garde de nuit mais 35,4 % rapportaient avancer le coucher et 14,4 % faire une sieste anticipatrice. En garde, les principales stratégies pour stimuler la vigilance étaient le café (86,6 %) et l’alimentation (55,1 %). Concernant l’accidentologie, 14,6 % déclaraient avoir eu un accident de la route depuis le début de l’internat (21,5 % pendant/après une garde/astreinte, 20 % liés à la somnolence) et 27,9 % un accident d’exposition au sang (AES) (30,1 % pendant une garde de nuit). La fréquence des gardes était associée aux accidents routiers (p=0,003) et aux AES (p=0,004). Le risque d’AES dépendait de la durée du sommeil en garde (risque minimal si durée nulle ou>6h, p=0,004). La somnolence était moindre chez les internes adoptant des stratégies de sommeil anticipatrices (p=0,03) et ceux dormant plus longtemps après une garde (p=0,047). Conclusion Les gardes de nuit exposent les internes à une restriction de sommeil et à une accidentologie accrue. Nos résultats soulignent l’intérêt de stratégies de prévention ciblant l’anticipation et la récupération du sommeil.

Background &amp; Hypothesis. Perceptual inference resolves the inherent ambiguity of sensory inputs by continuously integrating prior knowledge with upcoming sensory evidence. Disrupted inference is hypothesized to underlie positive symptoms in schizophrenia, such as erroneous percepts and beliefs. Bistable perception (alternation between two distinct interpretations when viewing an ambiguous stimulus) provides a tractable experimental framework for studying inferential processes. Computational models of bistability thus offer insights into normative inference and its impairments in schizophrenia. Methods. We used a validated experimental paradigm in which schizophrenia patients and healthy volunteers were continuously presented with a Necker Cube, and had to report their perceptual interpretation at regular auditory cues. We manipulated the available sensory evidence, biasing interpretations toward either a "Seen-from-above" (SFA) or "Seen- from-below" (SFB) Necker cube. We used the Circular Iframework to model bistable perception, in which recurrent information loops reverberate and amplify prior knowledge or sensory evidence, leading to deviations from exact inference. Results. In schizophrenia patients, we found a decreased effect of sensory cues and reduced perceptual stability, but no change in the hard-wired prior for the SFA interpretation. Computational modeling revealed that these observations were related to an overweigthing of sensory evidence compared to prior beliefs in patients, primarily driven by elevated sensory amplification and selectively associated with the strength of non-clinical beliefs. Conclusions. We provide evidence for increased sensory gain in schizophrenia during a low-level perceptual task. This paradigm opens perspectives for future imaging studies investigating the neural underpinnings of altered perceptual inference in schizophrenia.

BACKGROUND:Disability is a central outcome in alcohol use disorder (AUD), yet little is known about its determinants. METHODS:In the baseline data from the QUALIFACT multicenter prospective cohort study, which enrolled 157 recently detoxified patients with AUD between April 2021 and March 2024, Functional disability was assessed using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Clinical, psychiatric, and patient-reported variables were collected, including Diagnostic and Statistical Manual-5th edition (DSM-5) AUD criteria and the Alcohol Quality of Life Scale (AQoLS). To identify predictors of disability, we applied penalized linear regression with elastic net regularization, combined with nested cross-validation to ensure model robustness. RESULTS:Five predictors were consistently selected in predictive models: major depressive disorder (β = 4.97) and psychotic syndrome (β = 4.85) showed the strongest associations with higher disability scores followed by the AQoLS "Activities" dimension (β = 0.76), while anxiety disorder (β = 0.23) and antisocial personality disorder (β = 0.19) showed smaller but significant contributions. Notably, no markers of AUD severity such as DSM-5 criteria were retained as predictors. CONCLUSIONS:Disability in AUD appears to be driven primarily by psychiatric co-occurring psychiatric disorders and patient-perceived functional limitations, rather than by traditional markers of AUD severity. These findings suggest that WHODAS 2.0 captures dimensions of impairment not reflected in DSM-5 criteria and highlight the importance of integrated care approaches addressing co-occurring psychiatric disorders. Future studies should validate these findings in larger and more diverse AUD populations.

Chemsex refers to sexualized drug use among men who have sex with men (MSM). Chemsex practices lead to problematic substance use, but sexuality can also deviate toward loss of control and harmful consequences, leading to sexual addiction. However, the determinants of sexual addiction in chemsex have been poorly investigated so far. In a 353-individual sample of MSM seeking addiction treatment for problematic chemsex, sexual addiction was screened using the Sex Addiction Screening Test. Sociodemographic and clinical characteristics were also assessed, including an assessment of all drugs reported as problematic by participants, but also psychiatric history, including psychiatric hospitalizations, other medical conditions, and at-risk practices of chemsex (e.g., slam, that is, injection drug use), or previous history of overdose, respectively. Using a stepwise logistic regression model, we explored the factors associated with sexual addiction. Multivariable analyses found that, compared to other MSM, those with sexual addiction (n = 39, 11.0

Objectif Cette revue systématique visait à décrire les altérations objectives du sommeil associées au trouble de l’usage de la cocaïne (TUC) et à ses différentes phases de sevrage, chez l’humain et dans les modèles animaux. L’objectif secondaire était d’identifier des points de convergence et de divergence entre les espèces, afin d’éclairer les mécanismes translationnels impliqués. Méthodes Une recherche systématique a été menée selon les recommandations PRISMA dans les bases PubMed, PsycInfo et Google Scholar, depuis leur création jusqu’à décembre 2024. Les études incluses devaient rapporter des données objectives du sommeil (PSG, EEG, actimétrie) dans un contexte d’usage ou de sevrage de la cocaïne. Les études impliquant des consommations multiples (hors nicotine) ou des comorbidités psychiatriques majeures ont été exclues. L’évaluation du risque de biais a été réalisée à l’aide des grilles NIH (humains) et ARRIVE (animaux). Résultats Dix-neuf études ont été incluses (12 humaines, 7 animales). Le TUC est associé à une diminution du sommeil paradoxal (SP), du temps total de sommeil (TTS), de l’efficacité du sommeil (ES) et à une augmentation de la latence d’endormissement (LE). En début de sevrage, un rebond paradoxal du SP et une amélioration transitoire du sommeil sont souvent observés. Cependant, ces effets s’inversent après quelques jours, avec une détérioration progressive de la qualité du sommeil (SP et TTS ↓, ES ↓, LE et latence SP ↑), pouvant persister plusieurs semaines. Les données animales confirment globalement ces tendances, bien que plus hétérogènes méthodologiquement. Conclusion Il s’agit de la première revue systématique et translationnelle centrée exclusivement sur les mesures objectives du sommeil dans le TUC. Les troubles du sommeil associés à la cocaïne évoluent de façon dynamique, dépassant largement la phase aiguë du sevrage. Ces résultats renforcent la nécessité d’intégrer le sommeil dans la prise en charge des patients, et suggèrent son intérêt potentiel en tant que cible thérapeutique ou marqueur pronostique dans les troubles addictifs.

STUDY OBJECTIVES:Narcolepsy type 1 (NT1) is increasingly recognized as a multidimensional disorder in which psychiatric and psychosocial difficulties contribute to disability. Yet little is known about how these difficulties are perceived by patients compared with close informants. This study examined discrepancies between self-reported and informant-reported psychobehavioral symptoms in adults with NT1. METHODS:Within the multicenter French NarcoScol-NarcoVitae cross-sectional case-control study, 174 adults with NT1 (18-58 years) and 126 age- and sex-matched non-relative controls completed the Adult Self-Report (ASR), a standardized measure of adult psychobehavioral problems. A close informant completed the parallel Adult Behavior Checklist (ABCL), yielding 97 NT1 and 96 control ASR-ABCL dyads. T-scores were computed for internalizing and externalizing scales, and the total problems score. Between-group differences (NT1 vs non-relative controls) and within-individual discrepancies between self- and informant-reported symptoms were analyzed. Narcolepsy severity (NSS), sleepiness (ESS), age at diagnosis, and a composite professional prognosis score were compared across concordant and discordant dyads. RESULTS:Patients with NT1 reported significantly higher psychiatric symptom severity than controls across all ASR scales, with 44.8% versus 19.1% in the clinical range for internalizing difficulties. Informants generally rated patients' symptom severity as lower than patients' self-reports, particularly for internalizing symptoms. Discordant dyads in which informants rated internalizing symptoms as more severe than patients were characterized by lower NT1 symptom burden (NSS). Concordant patient-informant evaluations were associated with a more favorable professional prognosis. CONCLUSION:Adults with NT1 report substantial psychobehavioral impairments that are not consistently identified by close informants, especially internalizing difficulties. This perception gap highlights the complementary value of patient and informant perspectives and calls for improved recognition of less visible symptoms within patients' close environment. CLINICAL TRIALS:NCT03765892.

Objectif Les gardes de nuit exposent les internes à des prises de décisions médicales lors de réveils nocturnes. L’inertie du sommeil est physiologiquement majorée en cas de privation de sommeil, de réveil en sommeil lent profond, au creux circadien, et chez les sujets jeunes, soit typiquement les conditions des éveils en garde. Cette étude visait à estimer la prévalence des épisodes confusionnels (EC) en garde, à décrire leurs conséquences et à identifier les facteurs associés. Méthodes Dans le cadre du Baromètre santé des internes de la subdivision de Lyon-2 (BASIL-2), un questionnaire en ligne a été adressé aux internes en médecine/pharmacie/odontologie entre février et mars 2025. Les questions concernaient les antécédents d’éveils incomplets avec comportement confus en garde/astreinte et leur description, les comportements de sommeil, et la présence de troubles associés (insomnie, somnolence, chronotype, inertie, parasomnies). Un calage sur marges (sexe, spécialité) a corrigé la représentativité de l’échantillon. Les analyses descriptives pondérées ont été réalisées, ainsi qu’une analyse uni- et multivariée des facteurs associés aux EC. Résultats Sur 2092 internes sollicités, 592 ont répondu (61,3 % de femme, âge moyen 27 ans) : 20 % rapportaient avoir présenté au moins un (dont 69,7 % plusieurs) EC, majoritairement en milieu de nuit (76,3 %). La durée dépassait 2min chez 34,1 %, et 33,2 % n’en prenaient conscience que le lendemain. Les manifestations incluaient désorientation, altération de la compréhension/mémorisation, réponses incohérentes, erreurs de jugement. Dans 8,5 % des cas, ces épisodes avaient impacté la prise en charge (retard, erreur diagnostique ou de prescription). Par ailleurs, 12,7 % présentaient des parasomnies du sommeil lent profond (77,1 % éveils confusionnels, 44,2 % terreurs nocturnes, 21,5 % somnambulisme). En analyse multivariée, les EC en garde étaient associés à la dette de sommeil (OR=1,3 par heure de dette de sommeil, p=0,03) et au chronotype du matin (OR=2,2, p=0,04). Le nombre de gardes était plus élevé durant la période de survenue de l’EC que durant la période actuelle (26,5[23,9–29,1] versus 16,8[14,6–19,0]/semestre). Conclusion Les EC lors des gardes nocturnes sont fréquents chez les internes. Leurs conséquences potentielles sur la prise en charge des patients et leur lien avec la dette de sommeil soulignent la nécessité d’actions de prévention adaptées.