Objectives. - In psychiatry, we often talk about therapeutic mediation, used in many group and individual therapies. We use a wide variety of mediating objects, cultural means and even people, their roles and the image they project, including the character of the clown. The word clown immediately sends us back the image of a comedian working in the circus world or in the royal courts. Yet, modern clowns are now taking different places. The 1980s marked the beginning of the era of "Doctor Clowns'' in hospitals. The character of the clown made his first appearance in hospital in pediatric units where the positive effects of his action are widely recognized. This "clown activity'' is nevertheless still not very widespread in psychiatric services where patients, who sometimes have difficulty accessing humor, or who are struggling with strong emotions that they cannot express, could benefit from its cathartic virtues. In this article, we first present the results of a mini-literature review on the place and role of the clown in the psychiatric care process. In the second part of the article, we present the results of our study whose objective was to measure the feeling of well-being of psychiatric patients by a visual analog scale (VAS) after two weeks of participation in the clown workshop. Materials and methods. - For the conduct of the research of scientific articles, we have chosen the databases according to their relevance in scientific, psychiatric and psychological research. These are the following areas: PubMed, PsycInfo, ScienceDirect, LiSSa... No time limit has been set given the low availability of articles in this area and its recent development. For the same reason, all types of scientific papers, as well as some books have been considered. We have selected the articles in French and English. Furthermore, our study is an open, prospective and monocenter pilot feasibility study that took place from June 2015 to December 2016 at the Full Time Hospitalization Unit of the EPS Ville-E ' vrard site in Saint-Denis, pole 93G03. Fifty-nine patients were included in the study after recruitment by an investigating physician responsible for verifying the inclusion and non-inclusion criteria. The aim was to offer hospital patients in psychiatry a group activity around the theme of humor. This mediation was coordinated by a professional clown with previous experience of hospitalized patients. The activity was 2 hours long, with 8 participants maximum. Description of a session: 1/Time to put on the "clown's outfit'' (hat, red nose, wigs...). 2/Relaxation with breathing exercises. 3/Self-presentation through games. 4/The "clown'' time which is articulated in two passages on stage, one individual and the other with several people. 5/The conclusion when everyone expresses their feelings about what they have experienced. The main endpoint, namely the participants' sense of well-being, was measured by a Visual Analogue State (VAS) before and after each clown workshop (D0 and D15), i.e. after two weeks of participation in the clown workshop. Results. - Analysis of the articles reviewed highlights patients' gains in terms of communication skills and emotion management. Furthermore, the results of our study did not show a statistically significant difference (P < 0.7). Conclusion. - Although the results did not show a statistically significant difference, this study highlighted the feasibility of this type of workshop within a psychiatric department. There was no worsening of the clinical condition of the patients during the protocol and no behavioral disorder caused a disruption of the sessions or their premature termination. In fact, all the sessions could be carried out. The patients who participated in the first session were also present during the second one 15 days later. It can be noted that in terms of feasibility, the patients were complacent and joined the group well. They cooperated in this foray into the imagination created by the character of the clown, allowed emotions to be expressed that they did not show during formal interviews. In conclusion, this study provides arguments in favor of the continuation of this activity over a longer period and within structures such as day hospital or part-time therapeutic activity center. (C) 2020 Elsevier Masson SAS. All rights reserved.

Background: Intermittent theta burst stimulation (iTBS) is a form of repetitive transcranial magnetic stimulation that has shown to be effective in treatment-resistant depression. Through studying the effect of iTBS on healthy subjects, we wished to attain a greater understanding of its impact on the brain. Our objective was to assess whether 10 iTBS sessions altered the neural processing of emotional stimuli, mood and brain anatomy in healthy subjects. Methods: In this double-blind randomized sham-controlled study, 30 subjects received either active iTBS treatment (10 sessions, two sessions a day) or sham treatment over the left dorsolateral prefrontal cortex. Assessments of mood, structural magnetic resonance imaging (MRI) and functional MRI (fMRI) were performed before and after iTBS sessions. During the fMRI, three different categories of stimuli were presented: positive, negative and neutral photographs. Results: This study showed that, during the presentation of negative stimuli (compared with neutral stimuli), 10 sessions of iTBS increased activity in the left anterior insula. However, iTBS did not induce any change in mood, regional gray matter volume or cortical thickness. Conclusions: iTBS modifies healthy subjects’ brain activity in a key region that processes emotional stimuli. (AFSSAPS: ID-RCB 2010A01032-37).

Background: Women have twice the rate of depression and anxiety disorders as men. Some studies suggest that this could be caused by women’s greater sensitivity to negative emotions. Few brain imaging studies have compared the brain activity of men to women during a presentation of emotional stimuli. Our objective was to investigate brain activations in men and women during an emotional task. We hypothesized that the pattern of brain activations would differ by gender and valence of the stimuli. Methods: We conducted a functional magnetic resonance imaging study in 30 healthy participants (15 men and 15 women). Positive, negative and neutral photographs were presented to the subjects. Participants subjectively rated the valence and intensity of the stimuli. Results: No significant gender-by-category interaction effect was observed for the intensity or valence of the stimuli. We found that, during the presentation of negative photographs, there was a higher activity in women’s right fusiform gyrus compared to men’s. Conclusion: Given the involvement of the fusiform gyrus in anxiety disorders, this study yields promising findings in order to better understand women’s vulnerability to anxiety disorders.