Objectif Explorer les limites des évaluations de la dangerosité psychiatrique en Belgique, France, Royaume-Uni et aux Pays-Bas, et examiner si une évaluation systématique et structurée du risque, soutenue par des compétences médico-légales et une interdisciplinarité renforcées, pouvaient améliorer les décisions de soins sans consentement. Méthodes Analyse comparative des cadres législatifs (loi belge du 26 juin 1990, modifiée en 2024 ; Code de la santé publique français ; Mental Health Act 1983 ; Wet verplichte geestelijke gezondheidszorg 2020) et des pratiques d’évaluation, basée sur la littérature et des données statistiques. Résultats Les mesures de contrainte augmentent fortement en Belgique, en France, au Royaume-Uni et aux Pays-Bas depuis plus de 10 ans. Les évaluations subjectives de la dangerosité, basées sur des critères légaux flous non révisés, présentent une variabilité importante en Belgique et en France, où les échelles de risque sont absentes, contrairement au Royaume-Uni et aux Pays-Bas, qui développent des initiatives autour de l’évaluation du risque, notamment avec le HCR-20 V3 pour structurer les décisions. Ces échelles offrent une précision validée, mais leur implémentation nécessitera une formation. Conclusions Une implémentation d’échelles de risque, combinée à une formation interdisciplinaire et médico-légale inspirée de la ligne Nixon, pourrait réduire les biais subjectifs, la stigmatisation et les traumas, sous réserve d’études confirmant leur efficacité.

OBJECTIVE:To explore the limitations of psychiatric dangerousness assessments in Belgium, France, the UK, and the Netherlands, and to assess whether systematic and structured risk assessment, supported by enhanced forensic psychiatry skills and interdisciplinarity, could improve involuntary care decisions. METHODS:Comparative analysis of legislative frameworks (Belgian law of 26 June 1990, amended in 2024; French Public Health Code; Mental Health Act 1983; Compulsory Mental Health Care Act 2020; Wet verplichte geestelijke gezondheidszorg 2020) and assessment practices based on literature and statistical data. RESULTS:Compulsory measures have been strongly increasing in Belgium, France, the UK, and the Netherlands for over a decade. Subjective dangerousness assessments, based on vague legal criteria not recently revised, show significant variability in Belgium and France where structured tools are absent, unlike the UK and the Netherlands which are developing initiatives around risk assessment, notably with the HCR-20 V3 to structure decisions. These tools demonstrate validated predictive accuracy but would require essential training for implementation. CONCLUSIONS:Implementing structured tools, combined with interdisciplinary and forensic psychiatry training inspired by the Nixon line, could reduce subjective biases, stigma, and trauma pending studies confirming their effectiveness.

There is considerable confusion between the terms multidisciplinarity, interdisciplinarity and transdisciplinarity. Multidisciplinarity suggests a juxtaposition of knowledge. The various specialists in their disciplines complement each other and intervene alongside each other around a common subject. This produces points of view, which are superimposed, without bringing out any real added value. Interdisciplinarity requires interaction and interrelation. The pooling of knowledge requires a greater intertwining of disciplines, minimizing the differences between them while preserving their specificities and their foundations. A specialist's robust monodisciplinary expertise enriches the other members of the team, allowing for a more global, more systemic approach. Refusing to approach complex problems through the categorial prism of individual disciplines, transdisciplinarity seeks to integrate disciplines to go between, through and beyond disciplines by completely dissolving traditional boundaries. One of the particularities of complex holistic care, such as that in psychiatry, is that it cannot be managed effectively by a single person or a single discipline. Hyperspecialization results in a segmentation of the human being by no longer taking into account the entirety of the person treated. By analyzing and harmonizing the links between the different disciplines, interdisciplinarity sheds light on complex situations and enriches the responses offered. It improves quality, offers a global approach to the patient by mobilizing knowledge from different disciplines and by defragmenting and decompartmentalizing their knowledge. Interdisciplinarity is not self-evident and it cannot be likened to a simple mode of coordination where complementarity is valued. To meet this challenge, communication, coordination and clarification of roles by the team leader, whose leadership is recognized and valued, are essential. The medical literature recognizes a real added value of interdisciplinary approaches in complex medical situations. Eventually, it may be necessary to go a step further. Nevertheless, transdisciplinarity is of such complexity and requires such maturity of the teams, that we do not support it as the first step toward implementing a patient holistic approach. By way of conclusion, we propose the metaphors that Choi and Pak developed. Multidisciplinarity is in a way a mathematical equation of the "2 + 2 = 4" type or, more daringly, a "salad bowl", juxtaposition and addition of ingredients or skills. Interdisciplinarity is likened to an equation of the "2 + 2 = 5" type or a "melting pot", which postulates that the result, due to an effective and harmonious interaction, is greater than the sum of the parts. Finally, they compare transdisciplinarity using a "2 + 2 = yellow" equation with the culinary metaphor of the "cake" highlighting integration. (c) 2023 Elsevier Masson SAS. All rights reserved.

Il existe une grande confusion entre les termes multidisciplinarité, interdisciplinarité et transdisciplinarité. Les soins complexes, comme ceux que nous rencontrons en psychiatrie, ne peuvent être gérés de façon efficace par une seule personne. Exigeante, l’interdisciplinarité analyse et harmonise les liens entre les différentes disciplines. Elle éclaire les situations complexes et enrichit les réponses proposées. Elle améliore la qualité, propose une approche globale de la personne en mobilisant les connaissances des différentes disciplines tout en défragmentant et décloisonnant leurs savoirs.

Background Attention-deficit/hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that often persists into adulthood and old age. Yet ADHD is currently underdiagnosed and undertreated in many European countries, leading to chronicity of symptoms and impairment, due to lack of, or ineffective treatment, and higher costs of illness. Methods The European Network Adult ADHD and the Section for Neurodevelopmental Disorders Across the Lifespan (NDAL) of the European Psychiatric Association (EPA), aim to increase awareness and knowledge of adult ADHD in and outside Europe. This Updated European Consensus Statement aims to support clinicians with research evidence and clinical experience from 63 experts of European and other countries in which ADHD in adults is recognized and treated. Results Besides reviewing the latest research on prevalence, persistence, genetics and neurobiology of ADHD, three major questions are addressed: (1) What is the clinical picture of ADHD in adults? (2) How should ADHD be properly diagnosed in adults? (3) How should adult ADHDbe effectively treated? Conclusions ADHD often presents as a lifelong impairing condition. The stigma surrounding ADHD, mainly due to lack of knowledge, increases the suffering of patients. Education on the lifespan perspective, diagnostic assessment, and treatment of ADHD must increase for students of general and mental health, and for psychiatry professionals. Instruments for screening and diagnosis of ADHD in adults are available, as are effective evidence-based treatments for ADHD and its negative outcomes. More research is needed on gender differences, and in older adults with ADHD.

Objectives. - Sexual sadism is associated with a high risk of sexual violence and general recidivism in sex offenders. However, its evaluation encounters vague diagnostic criteria and uses idiosyncratic methods that require evaluators to infer the individual's motivations and sadistic fantasies. The Sexual Sadism Scale (SESAS) is a cumulative scale that is based exclusively on elements of the crime scene. Both inter-rater agreement and scale reliability of this one-dimensional scale comprising 11 items is high. The items are coded dichotomously based on offenders's files. An individual would be classified as likely meeting the diagnostic criteria if at least 4 of the criteria are present. The objective of our study was the French validation of the SESAS. Methods. - From the sex offenders' population in our High Security Hospital "Les Marronniers", 62 participants were randomly selected. Participants signed a consent form. Inter-rater agreements were analyzed from two evaluators. Offender's files contained data concerning the offense(s), psychiatric expertises carried out for the courts in charge of the follow-up of the participants, and the psychiatric and social reports concerning the evolution of the patients. Results have been anonymized. Statistical analyzes were performed using the Statistical Package for Social Science (SPSS) software. In relation to the hypotheses of our study, the following analyzes were performed: Pearson's correlation coefficient (inter-rater agreement), Kappa coefficient (inter-rater agreement on items and inter-rater agreement on the established diagnosis), Alpha of Cronbach (Internal Consistency) and Principal Component Analysis (PCA) Results. - Of the 62 participants included, three met the diagnostic criteria for sexual sadism (4 or more criteria, 4.84%). The distribution of scores indicates that the 95% of the sample had 2 items or less, and the remaining 5% had 6 or more items. Of the 11 items in SESAS, the Pearson's correlation coefficient (r) is significant (r = 0.76, p < 0.001) and indicates a satisfactory positive association. Alpha of Cronbach is very satisfactory (alpha = 0.86). The items in the scale tend to represent a good internal consistency, meaning that the scale is in adequacy with the object of its measurement: the latent profile of sexual sadism. From the Principal Component Analysis, A two-factor structure can not be retained. Conclusions. - From this study, we were able to propose the French version of the SESAS as a useful scale in the evaluation of sexual sadism in a forensic population. We confirm the dimensional aspect of sexual sadism, as it tends to be described in the DSM-5 which distinguishes paraphilia from paraphilic disorder. Moreover, we show here, following the original studies, that an evaluation of sexual sadism based on the crime scene behavioral indicators allows to limit the bias of the idiosyncratic approaches, marked by the inference of individual's sadistic motivations and fantasies. (C) 2018 Elsevier Masson SAS. All rights reserved.

En Belgique, la loi de « Défense sociale » stipule qu’un inculpé « qui est soit en état de démence, soit dans un état grave de déséquilibre mental ou de débilité mentale le rendant incapable du contrôle de ses actions » peut être interné. L’établissement de défense sociale (EDS) de Tournai (Belgique) accueille 350 internés. En collaboration avec le centre de recherche en défense sociale, nous avons organisé une évaluation systématique des patients internés en EDS. Il s’agit de la première étude évaluant de manière prospective cette population. Sur l’ensemble, 229 patients ont signé un consentement informé. Nous avons mis en évidence que 48,8 % de nos participants avaient commis un délit à caractère sexuel (viol ou tentative de viol, attentat à la pudeur, outrage public aux mœurs ou mixte). Le Quotient Intellectuel moyen est de 71,4. Selon la MINI, 33,2 % des participants ne présentaient aucun trouble psychiatrique. Parmi les troubles psychiatriques, les troubles psychotiques sont les plus représentés (37,4 %). Évalués à la SCID, les troubles de personnalité étaient absents chez 26,8 % de nos participants. Les troubles de l’axe II les plus représentés sont les troubles de personnalité relatifs au cluster B (57,3 %) avec principalement le trouble de la personnalité antisociale (37,9 %). Ces données démontrent l’importante hétérogénéité de notre échantillon et la nécessité de la mise en place de trajets de soins spécifiques à chaque sous-population.

Background. - In Belgium, the law of "social defense" stipulates that an accused "which is either in a state of dementia or in a serious state of mental disturbance or mental deficiency, incapable of controlling his actions" can be interned. The establishment of social defense (ESD) in Tournai (Belgium) hosts 350 inmates.Objectives. - In collaboration with the Centre for research in social defense, we organized a systematic assessment of patients interned in ESD. This is the first study evaluating prospectively this population.Methods. - Of the total, 229 patients signed informed consent. Different scales of assessment (MINI, WAIS-III, SCID II) were used. Descriptive analyzes were applied (SPSS version 12).Results. - We show that 48.8 % of our participants had committed a sexual offense (rape or attempted rape, indecent assault, public outrage or mixed). The average intelligence quotient is 71.4. According to the MINI, 33.2 % of participants showed no psychiatric disorder. Among psychiatric disorders, psychotic disorders are the most represented (37.4 %). According to the SCID, personality disorders were absent in 26.8 % of our participants. Most of the axis II disorders are represented personality disorders related to cluster B (57.3 %) mainly with antisocial personality disorder (37.9 %).Conclusion. - These data demonstrate the significant heterogeneity of our sample and the need for the establishment of specific care routes to each subpopulation. (C) 2016 L'Encephale, Paris.

AbstractAdvances towards the understanding of the etiological mechanisms involved in mood disorders provide interesting yet diverse hypotheses and promising models. In this context, molecular genetics has now been widely incorporated into genetic epidemiological research in psychiatry. Affective disorders and, in particular, bipolar affective disorder (BPAD) have been examined in many molecular genetic studies which have covered a large part of the genome, specific hypotheses such as mutations have also been studied. Most recent studies indicate that several chromosomal regions may be involved in the aetiology of BPAD. Other studies have reported the presence of anticipation in BPAD and in unipolar affective disorder (UPAD). In parallel to these new developments in molecular genetics, the classical genetic epidemiology, represented by twin, adoption and family studies, provided additional evidence in favour of the genetic hypothesis in mood disorders. Moreover, these methods have been improved through models to test the gene-environment interactions. In addition to genetic approaches, psychiatric research has focused on the role of psychosocial factors in the emergence of mood disorders. In this approach, psychosocial factors refer to the patient's social life context as well as to personality dimensions. Abnormalities in the social behavior such as impairment in social relationships have been observed during episode of affective disorders, and implicated in the etiology of affective disorders. Further, gender and socio-economic status also emerged as having a possible impact on the development of affective disorders. Finally, the onset and outcome of affective disorders could also be explained by interactions between the social life context and the individual's temperament and personality. The importance of temperament and personality characteristics in the etiology of depression has been emphasized in various theories, although disagreement exists with regard to terminology and the etiology. While significant advances have been done in these two major fields of research, it appears that integrative models, taking into account the interactions between biological (genetic) factors and social (psychosocial environment) variables offer the most reliable way to approach the complex mechanisms involved in the etiology and outcome of mood disorders. This chapter will review some of the most promising genetic and psychosocial hypotheses in mood disorders that can be integrated in interactive models.

Transient receptor potential vanilloid type 1 (TRPV1), involved in multiple pathophysiological processes including inflammation, is a thermally activated, non-selective cation channel. It has been identified that TRPV1 is highly involved in some common respiratory diseases including allergic rhinitis, asthma, chronic obstructive pulmonary disease, and pulmonary infection by participating in neurogenic and immunogenic inflammation, sensitization, and oxidative stress. In recent years, the hypothesis of transient receptor potential (TRP) has been introduced in studies on the theory of five flavors and four properties of Chinese medicinal. However, the hypothesis is undetermined due to the multi-component and multi-target characteristics of Chinese medicinal. This study describes the relations between TRPV1 and four types of respiratory diseases based on the literature in recent five years. In the meantime, the therapeutic effect of Chinese medicinal by intervening TRPV1 was reviewed, in an attempt to provide certain evidence for future studies on the medicinal property-effect relationship, mechanism of drug action, the syndrome differentiation in traditional Chinese medicine (TCM) for respiratory diseases and to help for new drug development.

Résumé La loi de Défense Sociale spécifie que les délinquants qui, au moment des faits, présentaient un état de démence les rendant incapables du contrôle de leurs actes doivent être internés. L’Établissement de Défense Sociale de Tournai accueille 350 internés, dont près de 150 délinquants sexuels. Conscients des limites des prises en charge existantes, nous avons développé le projet « Épicéas ». Composé de soignants provenant d’horizons divers, notre projet développe une approche globale, tout en insistant sur les aspects humanistes et systémiques. L’abord des patients délinquants sexuels et de leurs familles, dans le cadre de la contrainte de l’internement, est un champ encore peu balisé par les systémiciens. Mais à côté des approches plus classiques, nous affirmons ici que l’outil systémique est particulièrement adapté à nos patients et à leurs familles.

OBJECTIVES. Evidence in favour of switching between selective serotonin reuptake inhibitor (SSRI) and tricyclic (TCA) antidepressants in treatment resistant depression has been tested in a few studies only, consequently a prospective study was undertaken to evaluate the impact of switching strategies. METHODS. One hundred eighty-nine patients who failed to respond to a previous antidepressant were randomised to four arms: firstly they received citalopram or desipramine for a 4-week period; secondly, those who failed to respond were treated for a further 4-week period with the same antidepressant (citalopram-citalopram and desipramine-desipramine arms) or switched to the alternate one (citalopram-desipramine and desipramine-citalopram arms). RESULTS. There was no difference in the first 4-week phase between patients receiving citalopram versus desipramine in Hamilton Rating Scale for Depression (HRSD), Montgomery-Asberg Depression Rating Scale (MADRS), and Clinical Global Impression (CGI) scores. In the second 4-week phase remitter rates were higher among non-switched patients (P = 0.04). Moreover, considering HRSD and MADRS, switched patients reported significantly higher scores (P ≤ 0.02 for both scales at each time-point). CONCLUSIONS. This study supports the thesis that switching from an SSRI to a TCA (and vice versa) in non-responders to a 4-week trial of an SSRI/TCA is not associated with improved response. The result goes in the opposite direction to that predicted by current guidelines.

OBJECTIVES:Dystrobrevin binding protein 1 (Dysbindin) is a plausible candidate gene for major depressive disorders (MDD) due to its involvement in synaptic signaling, plasticity and localization in the brain.METHODS:Two intronic SNPs of DTNBP1; rs760761 (P1320) and rs2619522 (P1763) were analyzed in 206 patients with DSM-IV MDD to investigate the functional impact of genotypes on susceptibility for depression and some clinical phenotypes. The Sequenom iPLEX assay (Sequenom, Cambridge, MA) was used for genotyping.RESULTS AND CONCLUSIONS:Despite the limited power of analysis, our results showed that these two SNPs in DTNPB1 gene were not related to clinical phenotypes such as melancholia, age at onset, suicidality and co-morbid anxiety disorders, as well as to treatment response phenotypes.

Objective: The management of treatment-resistant depression is a much debated issue. In particular, the evidence supporting the commonly suggested sequential use of antidepressants from 2 different pharmacological classes is weak.This retrospective study was undertaken to investigate whether there is a better response in nonresponders switched to a different class of antidepressants (across-class) compared with nonresponders switched to an antidepressant from the same class (within-class).Methods: Three hundred forty patients with primary major depressive disorder were recruited in the context of a European multicenter project. Subjects whose current depressive episode had failed to respond to a first antidepressant trial of adequate dose and duration were included.Results: There was no significant difference in response or remission rates between the across-class and within-class groups after controlling for possible confounders.Conclusions: In depressed nonresponders to a previous antidepressant treatment, switching to a different class of antidepressants was not associated with a better response or remission rate.

Brain-derived neurotrophic factor (BDNF), a member of the nerve growth factor family of neurotrophins, has pivotal roles in neuronal survival, proliferation, and synaptic plasticity in the brain. Both clinical and pharmacological studies have implicated the common single nucleotide polymorphism (SNP) at position 196, Val66Met in the pathophysiology of major depressive disorder (MDD), and antidepressant response. However, inconsistent results were found between Val66Met (rs6265) polymorphism and treatment response phenotypes in genetic association studies. The functional Val66Met polymorphism and seven other tagging SNP markers selected to capture the major allelic variations across BDNF locus were analyzed in depressed patients, treated with antidepressants, and 76 control patients. Two hundred and six patients with Diagnostic and Statistical Manual of Mental Disorders-IV MDD were recruited for this study and genotyped for eight BDNF tagging SNPs (rs11030096, rs925946, rs10501087, rs6265, rs12273363, rs908867, rs1491850, and rs1491851) to investigate the functional impact of genotypes/haplotypes in the susceptibility of depression and on treatment response. None of the eight SNPs, including the rs6265, were significantly associated with MDD after permutation correction. However, we found an association for rs10501087, rs6265 with nonresponse to antidepressant treatment (corrected permutation P: 0.03599; 0.0399 and power: 0.1420; 0.1492, respectively). Analysis of each two-marker, three-marker, and four-marker sliding window haplotypes showed significance in haplotype combinations. Especially rs10501087 (C), rs6265 (A), and rs1491850 (C) together or with the other SNP haplotypes showed a similar pattern in all treatment response phenotypes. Despite the limited power of analysis, our results suggest that these three SNPs may play a role in antidepressant treatment response phenotypes in MDD.

Catechol-O-methyltransferase (COMT) has been suggested to be involved in the pathogenesis and pharmacological treatment of affective disorders. The nonsynonymous single nucleotide polymorphism (SNP) in exon 4 (Val108/158Met; rs4680) influences the COMT enzyme activity. Inconsistent results were found between Val158Met polymorphism (rs4680) and treatment response phenotypes in genetic association studies. However, the haplotype combinations of alleles at the Val108/158Met SNP with the other synonymous SNPs in the COMT gene region have shown association between enzyme activity/amount and COMT-dependent phenotypes. We carried out this study to define the functional impact of COMT genotypes/haplotypes on susceptibility and on treatment response phenotypes of major depressive disorder (MDD). Three hundred and ninety-six patients with MDD diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [(DSM)-IV] and 295 healthy controls were recruited for this study and genotyped for the seven COMT SNPs (rs2075507, rs737865, rs6269, rs4633, rs4818, rs4680, and rs165599). This is the first study with all these SNPs to investigate for MDD and treatment response phenotypes. Our results show that none of the seven SNPs, including the rs4680, was significantly associated with MDD after permutation correction in single SNP analyses. Although several haplotype combinations showed significance, the combinations of G-T-G-G haplotype for rs6269, rs4633, rs4818 and rs4680 were only present in the MDD group (G-T 4.5%, corrected sim P=0.0001; G-T-G 3.87%, corrected sim P=0.001; G-T-G-G 3.3% corrected sim P=0.0025). In the treatment response phenotypes, the GG genotype of the rs2075507 SNP (located in the promoter region of MB-COMT) was less common in resistant patients in a single SNP analysis with low corrected sim P=0.052 and power=0.086. However, in the haplotype analysis, the haplotypes of exonic SNPs, rs4633, rs4818, and rs4680, were related to the treatment response phenotypes investigated, especially the phenotype of the response to antidepressant treatment. The C-C-A haplotype of these SNPs was overrepresented (almost four-and eight-fold) in the responders compared with the nonresponders and controls, respectively, after Bonferroni correction (corrected sim P=0.048, 0.0001, respectively). Both nonsynonymous and synonymous SNPs within haplotypes may be more relevant than the single SNP in conferring MDD susceptibility and treatment response phenotypes. Despite the limited power of our analysis, this finding suggests that the polymorphic COMT gene that influences catecholaminergic neurotransmission may play a role in the individual response to antidepressants.

Background Attention deficit hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that persists into adulthood in the majority of cases. The evidence on persistence poses several difficulties for adult psychiatry considering the lack of expertise for diagnostic assessment, limited treatment options and patient facilities across Europe. Methods The European Network Adult ADHD, founded in 2003, aims to increase awareness of this disorder and improve knowledge and patient care for adults with ADHD across Europe. This Consensus Statement is one of the actions taken by the European Network Adult ADHD in order to support the clinician with research evidence and clinical experience from 18 European countries in which ADHD in adults is recognised and treated. Results Besides information on the genetics and neurobiology of ADHD, three major questions are addressed in this statement: (1) What is the clinical picture of ADHD in adults? (2) How can ADHD in adults be properly diagnosed? (3) How should ADHD in adults be effectively treated? Conclusions ADHD often presents as an impairing lifelong condition in adults, yet it is currently underdiagnosed and treated in many European countries, leading to ineffective treatment and higher costs of illness. Expertise in diagnostic assessment and treatment of ADHD in adults must increase in psychiatry. Instruments for screening and diagnosis of ADHD in adults are available and appropriate treatments exist, although more research is needed in this age group.

Each year, one million people die of suicide. Among the different identified risk factors, genetic factors seem to be part of a multidimensional behavior, including psychiatric, psychosocial, biological factors and physical illness. Family studies have provided evidence for familial transmission in suicide, confirmed in twin and adoption studies. At a molecular level, serotonin seems to be one of the key neuro-transmitters implicated in suicidal behavior. Therefore, genes coding for proteins involved in serotonergic neurotransmission have been extensively studied in case-control association studies on suicide. Major findings concern Tryptophan hydroxylase (TPH) gene, particularly in violent suicidal behavior. Though they may seem contradictory; studies on Serotonin transporter (5-HTT), Monaomine oxidase (MAOA), Serotonin 2A and 2C receptors (5-HT2A and 5-HT2C) and Tyrosine hydroxylase (TH) genes are promising. In spite of those observations having some limitations, it appears that genetic factors are a serious risk factor, besides environmental aspects of suicidal behavior.