Islamist terrorism is a major preoccupation in France as it poses a serious threat to safety. Pre-release assessment of convicted jihadi terrorists requires high-quality psychiatric expert reports to assist magistrates in deciding on post-sentence follow-up. In the literature, the quality of psychiatric expert reports in France has been questioned. This arises from a discrepancy between the number of expert reports that are requested and the number of experts available. We studied the quality of these reports, focusing on evaluation of dangerousness and the risk of recidivism.In this novel study, quantitative and qualitative data were extracted from 100 post-sentence expert reports, 15 s expert opinions and 10 supplemental reports. These reports were taken from 100 different case files exclusively concerning Islamist terrorism-related offenses. This study was carried out in partnership with the national counter-terrorism prosecutor's office, the Parquet National Antiterrorisme (PNAT).In order to study the quality of these reports, we developed conformity scores based on the general recommendations of the French National Authority for Health (Haute Autorité de Santé, HAS). These general conformity scores concerned the recommendations for all types of expert reports, while specific conformity scores related to post-sentence reports. Lastly, we proposed a list of risk factors for violent radicalization based on the data of the literature, and these enabled us to calculate conformity scores specifically related to Islamist terrorism.The mean conformity score of the expert reports was 86.7%, with scores varying between reports. The score decreased to 82.1% if criteria specific to terrorism were included. The experts often made no reference to a classification when making a diagnosis. They were reticent to use actuarial tools or structured professional judgments to assess the risk of recidivism. Their practice in searching for criteria specific to Islamist terrorism also appeared to vary.There is a need for training and working meetings between psychiatric experts to reach a consensus on the quality of expert reports. Meetings and exchanges between experts and magistrates would help clarify their respective missions.

BACKGROUND:Sexual dysfunction (SD) and attention-deficit/hyperactivity disorder (ADHD) are both prevalent in adults yet remain underdiagnosed, and their potential association has only recently received systematic attention. Emerging studies suggest a bidirectional link, but findings are heterogeneous across instruments, samples, and definitions. METHODS:We conducted a systematic search of PubMed/MEDLINE, ScienceDirect, and Google Scholar from inception to February 2025. We included observational studies of adults (≥18 years) reporting either SD in ADHD populations or ADHD in SD populations. Two reviewers independently screened and extracted data. Study quality was appraised with the modified Newcastle-Ottawa Scale. The review followed PRISMA guidance and was prospectively registered (PROSPERO CRD42024617591). RESULTS:Thirteen studies met inclusion criteria (sample sizes 64-943). In ADHD cohorts, the highest reported SD prevalences were 67.7% for female orgasmic dysfunction and 39% for premature ejaculation (PE) in men. In SD cohorts, ADHD prevalence reached 34.6% in women with orgasmic disorder and ∼42% in men with PE (versus 3.7-5% in controls). While most studies indicated a positive association, several reported no significant differences. Heterogeneity in measures and designs precluded quantitative pooling. CONCLUSIONS:Current evidence supports a probable bidirectional association between SD and ADHD in adults. Routine, reciprocal screening should be considered in psychiatric and sexual-medicine settings. Standardised, multicentre protocols using validated instruments and structured ADHD assessment are needed to refine estimates and clarify mechanisms.

Schizophrenia's substantial heterogeneity poses a major challenge for understanding its neurobiological mechanisms and predicting treatment response. Moving toward precision psychiatry, we identified clinically meaningful subtypes and characterised their neural and pharmacological profiles. Clustering of multidimensional clinical feature space revealed two distinct patient subtypes, primarily differentiated by degree of illness insight. In parallel, three symptom-severity groups defined by positive and negative psychopathology dimensions provided a complementary stratification framework. Resting-state fMRI analyses revealed that higher-insight patients exhibited greater dynamic reconfiguration of regional functional connectivity, emerging as the primary neuroimaging feature differentiating subtypes. Multivariate classification and feature importance analysis confirmed the discriminative value of neuroimaging metrics. Across both subtyping approaches, regional flexibility was spatially associated with cortical receptor density maps in a subtype-specific manner, particularly for D$\_{2}$ and 5-HT$\_{2A}$ when accounting for estimated antipsychotic receptor occupancies. Additionally, pharmacological-clinical associations were stronger and more spatially widespread in specific subtypes, indicating subtype-dependent pharmacodynamic relationships. Furthermore, structural equation modelling demonstrated that neuroimaging measures mediate receptor pharmacology's influence on clinical outcomes. These findings together show that integrating clinical, neuroimaging, and pharmacological data can uncover biologically grounded schizophrenia subtypes, identify functional biomarkers, and inform personalised therapeutic strategies. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by the A*MIDEX foundation (Aix-Marseille University Initiative of Excellence) through the 2021 Interdisciplinarity Call for Projects, under the project "REPORTS" (bRain modEling and PharmacOclinical Response To Schizophrenia). This project was carried out within Aix-Marseille University and its affiliated institutions, including the Institut de Neurosciences des Systemes (Inserm UMR 1106), the Centre for Magnetic Resonance in Biology and Medicine (CRMBM UMR 7339), and the Academic Department of Psychiatry at AP-HM (Schizophrenia Expert Center, FondaMental Foundation). In addition this research has received funding from the European Union's Horizon Europe Programme under the Specific Grant Agreement No. 101147319 (EBRAINS 2.0 Project) and No. 101137289 (Virtual Brain Twin Project). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. All authors report no biomedical financial interests or potential conflicts of interest. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The ethics committee of Aix-Marseille University gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors

BACKGROUND:Cyamemazine, a phenothiazine antipsychotic with anxiolytic and sedative properties, is commonly used in the management of severe mental disorders (SMDs) such as schizophrenia, bipolar disorder, and major depressive disorder. Despite its unique pharmacological profile, the impact of cyamemazine on clinical outcomes, treatment adherence, and quality of life (QoL) remains inadequately studied. This study addresses the significant gap in understanding the clinical impact of cyamemazine, a widely used yet under-researched antipsychotic. METHODS:This observational study was conducted at a university psychiatry unit in Marseille, France, involving patients with SMDs. Sociodemographic, clinical, and comorbid characteristics were assessed, along with treatment adherence, QoL, and side effects using validated instruments including the Medication Adherence Rating Scale (MARS) and the Schizophrenia Quality of Life Scale (SQoL-18). Multivariate analyses were performed to explore the associations between cyamemazine use and clinical outcomes. RESULTS:A total of 1,248 patients were included with 55 (4.4%) using cyamemazine. Cyamemazine users presented more severe clinical profiles, with higher anxiety, more hospitalizations, and poorer functioning. Although cyamemazine's anxiolytic effects may improve adherence, its sedative and metabolic side effects were associated with reduced QoL and functional impairment. CONCLUSIONS:The study highlights the need for personalized treatment strategies that weigh the benefits of cyamemazine against its potential risks. Integrating pharmacological and non-pharmacological interventions could enhance patient outcomes.

Background Psychotropic medications are critical in managing severe mental illnesses (SMI) such as schizophrenia, major depressive disorder (MDD) and bipolar disorder. However, these treatments often lead to adverse side effects that can impair patients’ quality of life (QoL) and affect treatment adherence.Objective This study aims to investigate the specific side effects of psychotropic treatments that contribute to a decline in QoL among patients with SMI, independently of treatment adherence.Methods We conducted a cross-sectional study with 1248 patients diagnosed with SMI, recruited from a university psychiatric unit in Marseille, France. QoL was assessed using the Schizophrenia Quality of Life Scale (SQoL-18), and side effects were measured using the UKU Side Effect Rating Scale. Treatment adherence was evaluated using the Medication Adherence Rating Scale (MARS). Statistical analyses included Pearson correlations and multiple linear regression models to identify predictors of QoL.Results The study found that side effects, as identified by the UKU scores, could significantly predict a reduction in QoL across multiple domains, including multiple dimensions of QoL and the overall QoL index, independent of treatment adherence. Patients on antipsychotics and benzodiazepines reported higher levels of adverse side effects, which correlated with lower QoL scores. An increase in the number of psychotropic treatment classes was also associated with a significant decline in QoL (p < 0.001).Conclusion Managing psychic side effects and minimising polypharmacy are critical to improving QoL in patients with SMI. Clinicians should consider these factors when developing personalised treatment strategies to enhance patient outcomes.

Improving access to medical transition for transgender and gender diverse (TGD) individuals is a priority, which requires data on the experience of medical transition during and after the process. However, no Patient-Reported Experience Measurement (PREM) questionnaire has been developed specifically for this population until now in the French context. The primary objective was to provide preliminary evidence of the psychometric properties regarding validity and reliability of the PREMIUM questionnaires among TGD individuals undergoing medical transition. The secondary objectives were to explore the relationships between different dimensions of the care experience during medical transition with socio-demographic and clinical characteristics. A national web survey was conducted from 2021 to 2022 including a set of PREMIUM questionnaires measuring respect and dignity, information received, access and care coordination, interpersonal relationships with providers and psychotherapy. Reliability was assessed using Cronbach’s alpha and corrected item-total correlations, and construct validity was assessed through exploratory factor analyses (EFA). Univariable and multivariable logistic regressions were used to assess the association between self-reported experience with sociodemographic and clinical data. A total of 168 individuals participated in the study, revealing through PREMIUM questionnaires critical areas for enhancement: informational gaps on initiatives and peer support, care access and coordination challenges marked by appointment delays and repetitive medical histories, respect and dignity concerns highlighted by intrusive questions and insufficient information, as well as deficiencies in interpersonal relationships with providers, evidenced by inadequate therapeutic alliance, encouragement for emotional expression, and limited provider engagement. Additionally, the psychotherapy domain indicated a need for improved availability, choice, and effectiveness of services. The psychometric properties of the questionnaires were satisfactory with high Cronbach’s alpha coefficients (> 0.70) and adequate corrected item-total correlations (≥ 0.30). The EFA results showed that the questionnaires were essentially unidimensional. An initial consultation with a surgeon and being older at the initial consultation were associated with a better care experience. In contrast, higher educational level, an initial consultation in a private practice, with an endocrinologist, were associated with a poorer care experience. This survey highlighted key areas for improving the experience of medical transition for TGD individuals in France. Systematic use of PREMIUM-TRANS questionnaires could enable tracking of experience-related parameters over time, providing useful insights for providers and policymakers.

Major depressive disorder is a complex neuropsychiatric disorder and one of the leading causes of disability in developed countries. Treatment-resistant depression is defined as the failure of at least two adequate treatment trials. The Muenke Syndrome is an autosomal dominant disorder caused by a mutation of the fibroblast growth factor receptor 3 (FGFR3). The fibroblast growth factor (FGF) family has often been implicated in mood disorders in the literature. We present here the case of a patient with a treatment-resistant depression and a concomitant Muenke Syndrome. We propose a relationship between the two pathologies as the expression of the FGF family has been shown to be dysregulated in depressed humans, post-mortem depressed human's brains and rodent's models of depression and anxiety. In particular, FGFR3 and its major ligand, FGF9, had been shown to be down-regulated and up-regulated, respectively, in cortical areas implicated in mood disorders. Since the FGF family plays a key role in neurodevelopment and neuroplasticity, among others things, a genetic mutation in a member of the family, such as FGFR3, could lead to depressive symptoms, as in our reported case. The implication is that the FGF family may be an important target for the treatment of neuropsychiatric disorders. We also conclude that depressive symptoms should be investigated in cases of Muenke Syndrome, as FGF dysregulation in depressed patients.

BACKGROUND:Benzodiazepines (BZ) are widely prescribed to patients with severe mental illnesses, yet their long-term impact on global health remains underinvestigated. While their symptomatic benefits are acknowledged, data on their associations with quality of life (QoL), metabolic comorbidities, and side effects are limited. METHODS:In this cross-sectional study, we analyzed clinical data from 1,248 patients with schizophrenia, bipolar disorder (BD), or major depressive disorder at a psychiatric center in Marseille, France. Associations between BZ use and key outcomes - including QoL (Short Form Health Survey [SF-36], EuroQol-5 Dimensions [EQ-5D], and Schizophrenia Quality of Life Questionnaire - 18 items [SQoL-18]), metabolic parameters, and treatment side effects (Udvalg for Kliniske Undersøgelser Side Effect Rating Scale [UKU scale]) - were examined using multivariate regression analyses. RESULTS:BZ use was significantly associated with lower QoL scores on physical and mental health domains of the SF-36 (p < 0.001), increased impairment across EQ-5D dimensions, and reduced subjective well-being (SQoL-18, p = 0.043). BZ users also presented higher rates of obesity, diabetes, and metabolic syndrome (all p < 0.05). Furthermore, BZ use was independently associated with a higher burden of side effects across UKU subscales, particularly in the psychiatric domain (emotional blunting, anxiety, and depressive symptoms; p = 0.003). CONCLUSION:These findings suggest that BZ use in severe psychiatric disorders may be linked to a substantial multidimensional health burden, including reduced QoL, greater side effect profile, and increased metabolic risk. These results highlight the need for evaluation of long-term BZ use and the promotion of safer alternative treatments.

Background/Objectives: Severe mental illnesses such as schizophrenia, major depressive disorder, and bipolar disorder are often accompanied by metabolic comorbidities. While the role of vitamins in physical health is well-established, their involvement in psychiatric disorders has garnered increasing attention in recent years. Methods: We conducted a cross-sectional analysis of 1003 patients diagnosed with severe mental illnesses. Vitamin D, B9, and B12 serum levels were measured, and deficiencies were defined using established clinical cutoffs. Multivariate regression analyses were performed to identify associations between vitamin deficiencies and clinical outcomes. Results: Our findings revealed that vitamin deficiencies were prevalent across all diagnostic groups, with particularly high rates in patients with schizophrenia and major depressive disorder. Vitamin D deficiency was significantly associated with worse psychiatric outcomes, including increased depressive symptoms (adjusted OR = 1.89, p = 0.018), lower Global Assessment of Functioning scores (adjusted OR = -0.18, p < 0.001), and higher rates of metabolic syndrome (adjusted OR = 1.97, p = 0.007). Folate and B12 deficiencies were also linked to greater psychiatric symptom severity and metabolic disturbances, including increased risks of obesity and dyslipidemia. Conclusions: Our study highlights the critical role of vitamins deficiencies in both psychiatric and metabolic health of patients with severe mental illnesses. These findings underscore the importance of routine screening and correction of these deficiencies as part of comprehensive care in psychiatric populations. The integration of nutritional interventions may offer a novel and holistic approach to improving both mental and physical health outcomes.

Background/Objectives: Modern therapeutic strategies incorporating virtual reality (VR) have emerged as potential treatments for generalized anxiety disorder (GAD), a prevalent and debilitating condition that is challenging to cure. This study aimed to evaluate the efficacy of VR combined with relaxation techniques in patients with GAD by comparing VR-based relaxation with standard mental imagery (MI) relaxation. Methods: Fifty-eight patients with GAD participated in a randomized comparative trial. Specific virtual environments were created using an inexpensive game engine/level editor (GLE). Psychometric scales and physiological instruments were employed to assess the effects of relaxation therapy on anxiety, depression, quality of life, presence within virtual environments and cybersickness. Results: Both the VR and MI groups demonstrated statistically significant improvements in anxiety, worry and mental quality of life scores. However, no significant differences were observed between the two groups in pre-post comparisons of psychometric scores. The VR group exhibited a noticeably higher protocol completion rate and a significant increase in heart rate variability during the therapy. The level of presence in the VR group was satisfactory and significantly correlated with physiological improvements and anxiety reduction, while cybersickness remained low. Participants' preferences for specific virtual environments for relaxation are also discussed. Conclusions: These findings suggest that teaching and practicing relaxation in VR holds therapeutic potential for the treatment of GAD. Further research leveraging advanced VR sensory equipment and artificial intelligence agents is warranted to enhance therapeutic outcomes and explore additional applications.

BackgroundThe care environment significantly influences the experiences of patients with severe mental illness and the quality of their care. While a welcoming and stimulating environment enhances patient satisfaction and health outcomes, psychiatric facilities often prioritize staff workflow over patient needs. Addressing these challenges is crucial to improving patient experiences and outcomes in mental health care. ObjectiveThis study is part of the Patient-Reported Experience Measure for Improving Quality of Care in Mental Health (PREMIUM) project and aims to establish an item bank (PREMIUM-CE) and to develop computerized adaptive tests (CATs) to measure the experience of the care environment of adult patients with schizophrenia, bipolar disorder, or major depressive disorder. MethodsWe performed psychometric analyses including assessments of item response theory (IRT) model assumptions, IRT model fit, differential item functioning (DIF), item bank validity, and CAT simulations. ResultsIn this multicenter cross-sectional study, 498 patients were recruited from outpatient and inpatient settings. The final PREMIUM-CE 13-item bank was sufficiently unidimensional (root mean square error of approximation=0.082, 95% CI 0.067-0.097; comparative fit index=0.974; Tucker-Lewis index=0.968) and showed an adequate fit to the IRT model (infit mean square statistic ranging between 0.7 and 1.0). DIF analysis revealed no item biases according to gender, health care settings, diagnosis, or mode of study participation. PREMIUM-CE scores correlated strongly with satisfaction measures (r=0.69-0.78; P<.001) and weakly with quality-of-life measures (r=0.11-0.21; P<.001). CAT simulations showed a strong correlation (r=0.98) between CAT scores and those of the full item bank, and around 79.5% (396/498) of the participants obtained a reliable score with the administration of an average of 7 items. ConclusionsThe PREMIUM-CE item bank and its CAT version have shown excellent psychometric properties, making them reliable measures for evaluating the patient experience of the care environment among adults with severe mental illness in both outpatient and inpatient settings. These measures are a valuable addition to the existing landscape of patient experience assessment, capturing what truly matters to patients and enhancing the understanding of their care experiences. Trial RegistrationClinicalTrials.gov NCT02491866; https://clinicaltrials.gov/study/NCT02491866

INTRODUCTION:Genetic polymorphisms in genes encoding enzymes metabolizing psychotropics drugs result in various isoenzymes with different catalytic efficacies. Of particular interest, some of these isoenzymes are highly catalytic leading to an ultrarapid metabolism (UM) of their substrate medication, which in turn results in lower medication concentrations and possibly poor clinical outcomes, including a higher risk for suicidal behavior. In this study, we investigate the role of CYP2D6 (metabolizing most antidepressant medications) and CYP2C19 (important in metabolizing antipsychotics) UM isoenzymes on suicidal behavior among a cohort of patients with schizophrenia. METHODS:One hundred and seventy-eight patients diagnosed with schizophrenia were recruited from the day hospital of a regional psychiatric academic hospital. Lifetime suicide attempts were compared between groups of patients stratified according to their enzymatic profile. Several socio-demographics and clinical covariates were controlled for. RESULTS:Among the 178 patients, 16 and 44 were UM as determined by their CYP2D6 and CYP2C19 genotype respectively. Univariate analysis showed a significant association between suicidal attempts and CYP2D6 and CYP2C19 UM status (P=0.041 and P=0.029 respectively). These associations remained significant in multivariate analyses (adjusted for age, sex, dose exposure and antidepressant use…) for both CYP2D6 (P=0.020, OR=4.096, 95% CI [1.25-13.48]) and CYP2C19 (P=0.016, OR=2.680, 95% CI [1.21-5.95]). CONCLUSION:This study suggests that the UM phenotypes for both CYP2D6 and CYP2C19 are associated with an increased risk for suicide attempts in patients with schizophrenia.

AbstractBackgroundSuccessful interventions have been developed for smoking cessation although the success of smoking relapse prevention protocols has been limited. Cognitive behavioural therapy (CBT) in particular has been hampered by a high relapse rate. Because relapse can be due to conditions associated with tobacco consumption (such as drinking in bars with friends), virtual reality cue exposure therapy (VRCE) can be a potential tool to generate 3D interactive environments that simulate risk situations for relapse prevention procedures.MethodsTo assess the effectiveness of VRCE with CBT, a comparative trial involving 100 smoking abstinent participants was designed with all required virtual environments (VE) created with an inexpensive graphic engine/game level editor.ResultsOutcome measures confirmed the immersive and craving eliciting effect of these VEs. Results demonstrated that more participants in the VRCE group did not experience smoking relapse and that VRCE is at least as efficacious as traditional CBT in terms of craving reduction and decrease in nicotine dependence. Dropout and relapse rate in the VRCE group was noticeably lower than the CBT group. Aside from mood scores, no significant differences were found regarding the other scales.ConclusionThe present clinical trial provides evidence that VRCE was effective in preventing smoking relapse. Improvement in technology and methodology for future research and applications is delineated.

About 30% of patients with major depressive disorder have treatment-resistant depression (TRD). Recently, intranasal esketamine was approved as a treatment option after the failure of two antidepressant trials. We report a patient with multiresistant depression that was successfully and safely treated with esketamine nasal spray. This 31-year-old inpatient with severe, chronic, and multi-TRD received an acute course of intranasal esketamine (84 mg). Previously, 14 different antidepressants, alone or in potentiation, and several neurostimulation techniques had been unsuccessful. Over 20 bi-weekly sessions, she had no significant adverse effects and was stabilized into remission. During the maintenance phase and 1 year after, she continues to be stable. This case report provides an example of a patient with severe TRD that showed significant improvement after treatment with intranasal esketamine.

Severe mental illness (SMI) patients often have complex health needs, which makes it difficult to access and coordinate their care. This study aimed to develop a computerized adaptive testing (CAT) tool, PREMIUM CAT-ACC, to measure SMI patients' experience with access and care coordination. This multicenter and cross-sectional study included 496 adult in- and out-patients with SMI (i.e., schizophrenia, bipolar disorder, or major depressive disorder). Psychometric analysis of the 13-item bank showed adequate properties, with preliminary evidence of external validity and no substantial differential item functioning for sex, age, care setting, and diagnosis, making it suitable for CAT administration. A post-hoc CAT simulation demonstrated that the tool was efficient and accurate, with an average of seven items, compared to the full item bank administration. Its use by clinicians can contribute to optimizing patient care pathways and transitioning towards more person-centered healthcare.

Virtual Reality Exposure Therapy (VRET) a form of exposure treatment that leverages the technology and immersive properties of virtual reality has been used in mental health for several decades with clinical efficacy. Nowadays, several companies propose ready to use virtual environments (VE) for clinicians. However, in practice, therapists or researchers may face rare demands such as patients exhibiting unusual phobias or OCD that require specific therapeutic VEs not available on the market. Therefore, empowering therapist with the tools of a "maker" to create therapeutic VEs themselves for rare cases may be a potential solution. Consequently, this trial involving 8 rare single cases was designed to test this assumption and has three objectives: to assess if a therapist with no coding skills can construct multiple specific therapeutic VEs with a free game engine, to measure the potential therapeutic efficacy of VRET and the VEs for rare cases of phobias and OCD, and to ensure these VEs yielded presence. Psychometric scales were used to assess the effects of the treatment. There was a discernible reduction of the distinct phobia and OCD for each case and a statistically significant improvement on anxiety, mood and mental quality of life scores. The presence level was satisfactory. Despite these promising results, these were single cases and further research on the game engine accessibility for clinicians and trials with a large sample of rare phobias or OCD are encouraged.

Background. - Crack consumption is a major public health issue in Martinique with a poor prognosis. A preliminary study has found a high prevalence of history of childhood ADHD (C-ADHD) in crack users. Objective. - To determine the prevalence of C-ADHD and adult ADHD (A-ADHD) in crack users and their potential associations with substance use behavior.Methods. - All consecutive patients consulting in the public academic hospital covering 376,000 inhab-itants were included in the present study and received a comprehensive battery measuring addictive behavior, psychiatric and somatic comorbidities. C-ADHD groups and A-ADHD groups were defined with the Wender-Utah Rating Scale-25 and the Brown ADD Rating Scale, respectively. Impulsivity was evaluated with the Barratt Impulsiveness Scale (BIS-11).Findings. - In total, 111 participants were evaluated. Among them, 50 (45%) were classified in the C-ADHD group and 20 (18%) in the A-ADHD group. Compared to the patients without ADHD, those with ADHD were found to have higher impulsivity (C-ADHD: BIS total score 67.90 (10.1) vs. 63.28 (10.5), P = 0.021, BIS attentional score 17.5 (3.6) vs. 15.3 (3.4), P = 0.002, A-ADHD: BIS total score 75.1 (11.3) vs. 63.4 (9.2), P < 0.001, BIS motor impulsivity 26.9 (5.3) vs. 22.6 (4.3), P < 0.001, BIS attentional score 19.3 (3.3) vs. 15.6 (3.5), P < 0.001, BIS planification 28.9 (5.7) vs. 25.10 (4.7), P = 0.003). Fifty percent of A-ADHD patients were found with high impulsivity vs. 15% of patients without A-ADHD (P < 0.001). However, ADHD was not associated with more severe addictive behavior or history of legal consequences.Interpretation. - ADHD prevalence is high in cocaine-crack users and associated with increased impulsiv -ity. However, neither ADHD nor impulsivity explains addictive behaviors or legal consequences.& COPY; 2022 L'Encephale, Paris.

BACKGROUND:Social metacognition is still poorly understood in schizophrenia, particularly its neuropsychological basis and its impact on insight and medication adherence. We therefore quantified social metacognition as the agreement between objective and subjective mentalization and assessed its correlates in a sample of individuals with schizophrenia spectrum disorders.METHODS:Participants consisted of 143 patients with schizophrenia or schizoaffective disorders who underwent a metacognitive version of a mentalization task, an extensive neuropsychological battery, and a clinical evaluation to assess their insight into illness and medication adherence. We studied potential interactions between confidence judgments and several neuropsychological and clinical variables on mentalization accuracy with mixed-effects multiple logistic regressions.RESULTS:Confidence judgments were closely associated with mentalization accuracy, indicative of good social metacognition in this task. Working memory, visual memory, and reasoning and problem-solving were the three neuropsychological dimensions positively associated with metacognition. By contrast, the two measures of medication adherence were associated with poorer metacognition, whereas no association was found between metacognition and clinical insight. The multiple regression model showed a significant positive impact of better working memory, older age at onset, longer duration of hospitalization, and worse medication adherence on social metacognition.CONCLUSIONS:We discuss possible mechanisms underlying the apparent association between social metacognition and working memory. Adherence should be monitored when remediating social metacognition, and psychoeducation should be given to patients with a high level of awareness of their capacity to mentalize.