Background: The 39-item TEMPS-A self-rated questionnaire assesses affective temperaments. We examined the factorial structure of its French version in a large sample of young adults and examined the relation to schizotypy, depression and anxiety.Method: University students were enrolled during their mandatory preventive health visit in the University medical facility (n = 3807, 19.9 +/- 2.5 y.o.). They answered to the 39-TEMPS-A questionnaire, the Schizotypal Personality Questionnaire (SPQ) and the Hospital Anxiety Depression Scale (HADS). We performed an exploratory Factorial Component Analysis (FCA) with varimax rotation of the 39-TEMPS-A in half of the sample, randomly selected, followed by a Confirmatory Factor Analysis (CFA) in the remaining subsample. TEMPS-A dimensions were correlated to HADS and SPQ sub-scores.Results: A five-factor structure was found by PCA and confirmed by the confirmatory analysis. The scale showed a good internal consistency (whole scale Cronbach's alpha: 0.83 and from 0.78 to 0.59 for Cyclothymic, Depressive, irritable, Hyperthymic, Anxious subscales). Depressive and Anxious TEMPS-A subscales were moderately correlated to HADS Depression and Anxiety subscales (Spearman rho = 0.37 to 0.33). Cyclothymic and Depressive TEMPS-A subscales were respectively correlated to SPQ Paranoid (rho = 0.53) and Negative dimensions (rho = 0.52).Limitation: Representativity of the sample (higher education, response rate).Conclusion: We confirmed the five factor structure of the 39-item TEMPS-A in a large non-clinical population of young adults and found consistent correlations with anxiety - depression state markers and schizotypal traits. (C) 2011 Elsevier B.V. All rights reserved.

Cognitive remediation is an innovative psychosocial therapy which can provide a substantial benefit, especially for schizophrenic patients. As its name implies, the aim of cognitive remediation is to restore cognitive functions. Most cognitive domains (attention, memory and executive functions) are impaired in schizophrenia. Remediation therapy must be administered by an expert, and is based on cognitive training on the one hand, and on learning of cognitive strategies on the other hand. With these techniques the patient is better able to solve complex cognitive problems and to apply these new skills to everyday situations. Several techniques are available in France, using either computer-based or paper/pencil approaches. The programs are administered over several months, with one or more sessions per week. Cognitive remediation itself provides only a modest cognitive benefit, which must be enhanced by the adjunction of other therapies such as behavioral therapy, learning of social skills, or a vocational program during the first months of employment.

In addition to classical delusional, negative, and cognitive deficit, schizophrenia has consistently been associated with impairments in saccadic eye movements, e.g., an increased error rate in the antisaccade task. We hypothesized that a deficit in inhibitory control is a core defect in untreated patients with schizophrenia leading to impairment in different oculomotor paradigms. Ten drug-free or drug-naïve patients with schizophrenia were matched in age and gender to 11 healthy controls with no psychoactive substance use or abuse. They were explored using reflexive saccades with unpredictable targets with or without the gap procedure, predictive saccades and a fixation/distracter paradigm. Patients with schizophrenia displayed shorter latency in reflexive and predictive saccades. In the GAP condition, patients made more anticipatory saccades, fewer regular saccades, and had a shorter latency of express saccades than controls. In addition, patients had an increased error rate in the fixation/distracters task. Altogether, these results provide new evidence of reduced prefrontal inhibitory regulation of subcortical and brainstem systems involved in the control of saccades.

This retrospective chart review of a clinical cohort of 19 refractory schizophrenic or schizoaffective patients treated with maintenance electroconvulsive therapy addresses the indications for this treatment, its efficacy, and its impact on daily functioning and hospitalizations. Maintenance electroconvulsive therapy combined with medication appears to be an efficient alternative to pharmacological treatment alone.

OBJECTIVE:Some studies have found that high levels of impulsivity and sensation seeking, particularly disinhibition are associated with substance abuse in patients with schizophrenia, as in the general population. However, no study has assessed impulsivity and sensation seeking specifically in schizophrenia patients with alcohol abuse or dependence.MATERIALS AND METHODS:We compared impulsivity and sensation seeking in a group of schizophrenia patients (DSM-III-R criteria) with lifetime alcohol abuse or dependence (n = 34) and in a group without lifetime substance abuse or dependence (n = 66). The patients were assessed using the composite international diagnostic interview (CIDI) for DSM-III-R disorders, the positive and negative syndrome scale (PANSS), the Barratt impulsivity scale (BIS), the Zuckerman seeking sensation scale (SSS), and the physical anhedonia scale (PAS).RESULTS:The mean scores for impulsivity and sensation seeking were higher in the group with lifetime alcohol abuse or dependence than in the group without substance abuse or dependence (BIS: 63.4 ± 18.7 vs 51.3 ± 14.2 respectively, ANOVA: F = 11.12, p = 0.001; SSS: 17.6 ± 5.9 vs 13.5 ± 6.7 respectively, ANOVA: F = 7.45, p = 0.008). There was no significant difference between the two groups on PAS score.CONCLUSION:Increased impulsivity or sensation seeking may be a link between schizophrenia and alcohol abuse or dependence.

There is now compelling evidence that cannabis consumption might precipitate psychosis onset. The objective of the present study was to assess the role of individual sensitivity to the psychotogenic effect of cannabis in male patients with schizophrenia. The lifetime diagnosis, disease and substance-use history were determined using a standardized interview in 190 patients with schizophrenia. Of patients with lifetime cannabis use (n=121), 44 were characterized as Cannabis-sensitive (CS) patients if the onset of psychotic symptoms occurred within 1 month following the initiation of cannabis consumption, or following a marked rise of cannabis consumption, or marked aggravation of psychotic symptoms each time the subject used cannabis. Age at onset of psychosis was not different in patients with lifetime cannabis use compared to non-users. By contrast, the first psychotic episode occurred 2.6 yr earlier in CS compared to Non-cannabis-sensitive (NCS) patients (p=0.006). Moreover, a specific excess of family history of psychotic disorder was found in CS patients, but not of any other psychiatric disorder, as well as an earlier age at exposure to cannabis (16.7 +/- 2.5 yr, p=0.03). Sensitivity to psychotogenic effects of cannabis in schizophrenia patients could be related to both genetic vulnerability to schizophrenia and the influence of cannabis on brain maturation and could modulate the influence of cannabis on the onset of schizophrenia.

The following is a case of Niemann-Pick disease (NPD) type B associated with a psychiatric disorder. A 27-year-old male was admitted to the hospital with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision criteria for paranoid schizophrenia. He was ameliorated after initiation of treatment by amisulpiride 400 mg/day. Auditory hallucinations, persecutory delusions, depersonalization, and derealisation regressed and was able to work. He was followed up for >10 years. The patient had typical history of NPD type B (hepatosplenomegaly and pulmonary infiltrates) diagnosed at 3 years of age.

In France the total cost of medicinal products reimbursed by health insurers in 2007 was over 25 thousand million euros, and access to new drugs is neither restricted nor rationed, despite the unfavorable economic situation. In 2007 and 2008 the Transparency Commission (TC) of the French National Authority for Health (Haute Autorite de Sante) approved the reimbursement of 97% of new drugs and new indications for existing products, within 90 days on average. The 3% of medicinal products that were not approved did not represent therapeutic advances and could be considered to be of dubious utility. If evaluation of new drugs is to be an independent process, then HAS must not only be independent of the decision-maker, funding bodies and commercial firms, but must also be a purely medical and technical organization. This implies removing all financial consideration from the picture, including the size of the target population that may qualify for a new treatment. This system could be further improved by creating special procedures to promote funding for innovations outside the marketing authorization system, thereby providing patients with faster access to the drugs they need; these procedures would include temporary authorisation, temporary treatment protocols, and a special-case function for treatment of chronic and rare conditions. Currently, new treatments produced by the pharmaceutical industry are paid for by national funding bodies and, from this point of view, it is difficult to argue that drug innovation is under-supported in France. On the other hand, it is well known that France has long been the largest consumer of medicinal drugs, both in Europe and worldwide. Two behavioral patterns partially explain this situation: one is a tendency to believe that drugs are the answer to all health concerns, and the other is a preference for new, more expensive drugs, even though never is not necessarily better.

in France about 700 psychiatrists are licensed to determine criminal responsibility before the courts, in other words to assess whether a criminal was capable of knowing what he or she was doing or of controlling him or herself Criminals who are considered irresponsible are committed to psychiatric hospitals. Criminals who are considered to have diminished judgment or control may nonetheless be prosecuted and jailed Psychiatric experts may also be asked to predict aggressive behaviour, and to identify determinants of crime. Too often the answers are not fully grounded in science, and this is not made sufficiently clear. There are 26 psychiatric wards in French prisons, which only treat inmates who accept to be treated. When prisoners are prescribed compulsory treatment, they are discharged from prison and transferred to a psychiatric ward. This situation is more and more frequent but is not the most convenient: it delays treatment and does not facilitate long-term therapeutic relationships. Responsibility or pragmatism? About 20% of French prison inmates are psychotic, and these individuals are at risk of repetitive violent behaviour if left untreated. The main question is not one of criminal responsibility, but rather the most effective response to antisocial behaviour: is punishment or medical treatment the most effective way of preventing future crimes and protecting society? Ethical aspects: the situation could be improved by a number of measures. For example, training in forensic psychiatry should be obligatory before accreditation before a Court, and psychiatric diagnoses should be based systematically on the ICD10. Psychiatrists have a special duty to inform on advances and uncertainties in their field, in terms of diagnosis, prognosis and treatment.

Current situation : in France about 700 psychiatrists are licensed to determine criminal responsibility before the courts, in other words to assess whether a criminal was capable of knowing what he or she was doing or of controlling him or herself Criminals who are considered irresponsible are committed to psychiatric hospitals. Criminals who are considered to have diminished judgment or control may nonetheless be prosecuted and jailed Psychiatric experts may also be asked to predict aggressive behaviour, and to identify determinants of crime. Too often the answers are not fully grounded in science, and this is not made sufficiently clear. There are 26 psychiatric wards in French prisons, which only treat inmates who accept to be treated When prisoners are prescribed compulsory treatment, they are discharged from prison and transferred to a psychiatric ward. This situation is more and more frequent but is not the most convenient : it delays treatment and does not facilitate long-term therapeutic relationships. Responsibility or pragmatism ? About 20 % of French prison inmates are psychotic, and these individuals are at risk of repetitive violent behaviour if left untreated The main question is not one of criminal responsibility, but rather the most effective response to antisocial behaviour : is punishment or medical treatment the most effective way of preventing future crimes and protecting society ? Ethical aspects: the situation could be improved by a number of measures. For example, training in forensic psychiatry should be obligatory before accreditation before a Court, and psychiatric diagnoses should be based systematically on the ICD10. Psychiatrists have a special duty to inform on advances and uncertainties in their field, in terms of diagnosis, prognosis and treatment.