BACKGROUND: e-Health tools using validated questionnaires to assess outcomes may facilitate measurement-based care for psychiatric disorders. MoodFX was created as a free online symptom tracker to support patients for outcome measurement in their depression treatment. We conducted a pilot randomized evaluation to examine its usability, and clinical utility.
METHODS: Patients presenting with a major depressive episode (within a major depressive or bipolar disorder) were randomly assigned to receive either MoodFX or a health information website as the intervention and control condition, respectively, with follow-up assessment surveys conducted online at baseline, 8 weeks and 6 months. The primary usability outcomes included the percentage of patients with self-reported use of MoodFX 3 or more times during follow up (indicating minimally adequate usage) and usability measures based on the System Usability Scale (SUS). Secondary clinical outcomes included the Quick Inventory of Depressive Symptomatology, Self-Rated (QIDS-SR) and Patient Health Questionnaire (PHQ-9).
RESULTS: Forty-nine participants were randomized (24 to MoodFX and 25 to the control condition). Of the 23 participants randomized to MoodFX who completed the user survey, 18 (78%) used MoodFX 3 or more times over the 6 months of the study. The mean SUS score of 72.7 (65th-69th percentile) represents good usability. Compared to the control group, the MoodFX group had significantly better improvement on QIDS-SR and PHQ-9 scores, with large effect sizes and higher response rates at 6 months. There were no differences between conditions on other secondary outcomes such as functioning and quality of life.
CONCLUSIONS: MoodFX demonstrated good usability and was associated with reduction in depressive symptoms. This pilot study supports the use of digital tools in depression treatment.
E-health tools may be useful for measuring and tracking symptoms and other outcomes during treatment for depression. This study is a randomized evaluation of MoodFX, a free web-based app that helps patients track their symptoms using validated questionnaires, and also offers depression information and self-management tips. A total of 49 participants with clinical depression were randomized to using MoodFX or a health information website, for 6 months. In a survey, the participants that used MoodFX found it easy and useful to use. In addition, the participants that used MoodFX had greater improvement in depressive symptoms after 6 months, compared to those who used the health information website. These results suggest that MoodFX may be a useful tool to monitor outcomes and support depression treatment.

BACKGROUND: The purpose of this update is to add newly approved nomenclatures and treatments as well as treatments yet to be approved in major depressive disorder, thus expanding the discussions on the integration of resistance factors into the clinical approach.
METHODS: Unlike the first consensus guidelines based on the RAND/UCLA Appropriateness Method, the French Association for Biological Psychiatry and Neuropsychopharmacology (AFPBN) developed an update of these guidelines for the management of partially responsive depression (PRD) and treatment-resistant depression (TRD). The expert guidelines combine scientific evidence and expert clinicians\' opinions to produce recommendations for PRD and TRD.
RESULTS: The recommendations addressed three areas judged as essential for updating the previous 2019 AFPBN guidelines for the management of patients with TRD: (1) the identification of risk factors associated with TRD, (2) the therapeutic management of patients with PRD and TRD, and (3) the indications, the modalities of use and the monitoring of recent glutamate receptor modulating agents (esketamine and ketamine).
CONCLUSIONS: These consensus-based guidelines make it possible to build bridges between the available empirical literature and clinical practice, with a highlight on the \'real world\' of the clinical practice, supported by a pragmatic approach centred on the experience of specialised prescribers in TRD.

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OBJECTIVE: Despite international efforts to identify biomarkers of depression, none has been transferred to clinical practice, neither for diagnosis, evolution, nor therapeutic response. This led us to build a French national cohort (through the clinical and research network named SoPsy within the French biological psychiatry society (AFPBN) and sleep society (SFRMS)), to better identify markers of sleep and biological rhythms and validate more homogeneous subgroups of patients, but also to specify the manifestations and pathogeneses of depressive disorders. Before inclusions, we sought to provide a predefined, standardized, and robust set of data to be collected in all centers.
METHODS: A Delphi process was performed to achieve consensus through the independent rating of invited experts, the SoPsy-depression co-investigators (n=34). The initial set open for vote included 94 questionnaires targeting adult and child psychiatry, sleep and addiction.
RESULTS: Two questionnaire rounds were completed with 94% participation in the first round and 100% participation in the second round. The results of the Delphi survey incorporated the consensus opinion of the 32 members who completed both rounds. Nineteen of the 94 questionnaires achieved consensus at the first round and seventy of 75 at the second round. The five remaining questionnaires were submitted to three experts involved in the steering committee during a dedicated meeting. At the end, 24 questionnaires were retained in the mandatory and 26 in the optional questionnaire set.
CONCLUSIONS: A validated data collection set of questionnaires is now available to assess psychiatry, addiction, sleep and chronobiology dimensions of depressive disorders.

BACKGROUND: physical symptoms associated with anxiety-depressive disorders have been the subject of several studies for several decades given their frequencies and their consequences. The aim of our study was to specify the frequency of the major physical symptoms of anxiety disorders such as panic disorder (PD), generalized anxiety disorder (GAD), phobic disorder (PhD) and depressive disorder (major depressive episode (MDD) in the framework of a depressive disorder).
METHODS: we conducted a cross-sectional descriptive study on a sample of 202 consultants in a department of psychiatry.
RESULTS: the average age of patients was 42 years (19-70 years), with a slight female predominance (118; 58%). Anxiety-depressive disorders included MDD (113;56%), PD (61;30.2%), GAD (55; 27.2%) and PhD (30;14.9%). Patients with 2 to 5 and more than 5 symptoms accounted for 15.9% and 39.6% respectively (depressive disorders), and 9.5% and 62.9% (anxiety disorders). The most reported symptoms were cardiopulmonary symptoms (75%), general symptoms (73.8%) and neurological symptoms (65.8%).
CONCLUSIONS: physical symptoms associated with anxiety-depressive disorders are variable and often occur together. They can affect prognosis, making these psychiatric disorders difficult to treat. Early screening, paying particular attention to these physical symptoms, helps prevent these complications.

Our aim was to determine the reason for consultation and the clinical features of depressive disorders according to the diagnostic and statistical manual (DSM) 4th edition IV R in primary care and to identify if there is an association between sociodemographic characteristics and depressive pattern.
In a cross-sectional study conducted to determinate the prevalence of depressive disorders in primary care, at three urban centers in two cities Salé and Oujda by five physicians, we recruited primary care 396 patients of whom 58 were depressed, among these patients we screened for depressive disorders, their clinical features, the melancholic characteristics and suicidal ideation using the Mini International Neuropsychiatric Interview.
Mean age of the 58 depressive patients was 46±15 years. They were predominantly female, inactive and of low socio-economic level. Approximately one-third of the patients were illiterate and single. The symptoms frequently encountered were sadness (63.7%), anhedonia (62%), insomnia (45.7%), anorexia (60.9%), psychomotor retardation (60.9%) and asthenia (73.9%). Somatic symptoms were present 99%, the most common complaint was pain that exhibited 68.6% prevalence. Suicidal ideations were found in 36.2% of these depressive patients.
The accuracy of the clinical features of patients with depression in primary care will facilitate the detection of these disorders by general practitioners and improve management of depression.

BACKGROUND: Metacognition describes the process of thinking about one\'s own thought processes. This concept was introduced by Flavell in 1979 and has since been widely developed in the cognitive approach to mood and anxiety disorders. As it happens, many recent studies have underlined the links between metacognition and anxio-depressive symptoms, pointing out the interest of assessing its various dimensions. The short form of the Metacognitions Questionnaire is a brief multidimensional measure of a range of metacognitive processes and metacognitive beliefs about worry and cognition relevant to the vulnerability to and the maintenance of emotional disorders. The aim of this study was twofold: firstly to adapt and validate a French version of the short form of the Metacognitions Questionnaire (MCQ-30) and to assess its psychometric properties in a clinical sample, and secondly to investigate metacognitive predictors of anxiety and depression in this sample.
METHODS: The sample included 55 clinical participants (24 men, 31 women, mean age=51.33±14.62) with DSM-IV-TR psychiatric disorders (major depression, bipolar disorder and obsessive-compulsive disorder). Instrument reliability (internal consistency), construct validity (confirmatory factor analysis), and convergent validity were measured. The total score and the five subscale scores were also compared with previous results in non-clinical samples.
RESULTS: Reliability analyses indicated that the French version of the MCQ-30 possessed satisfactory internal consistency (Cronbach α=0.84), and confirmatory factor analysis supported the MCQ\'s original five-factor structure. Correlation with measurements of depression, anxiety and pathological worry demonstrated convergent validity (r=0.62, P<0.01 for anxiety; r=0.47, P<0.01 for rumination; r=0.33, P<0.05 for depression). Moreover, our clinical sample scored higher on the global scale when compared to previous non-clinical samples (mean score=71.85±13.57 while previous studies global scores ranged from 48.41±13.31 to 65.89±17.17). Consistent with others studies, negative beliefs about worry concerning uncontrollability and danger, as well as beliefs about the need to control thoughts were the strongest predictors of pathological worry (respectively r=0.68, P<0.01 and r=0.48, P<0.01) and depression (respectively r=0.45, P<0.01 and r=0.39, P<0.01), providing further support for the validity of the measure.
CONCLUSIONS: These findings provide general support for the internal consistency of the French version of the MCQ-30, as well as its five-factor structure and its good concurrent validity in a clinical sample. They also confirm that this version is a valuable tool for the assessment of various dimensions of metacognition, in relation to the anxio-depressive symptomatology and the subsequent management of patients.

BACKGROUND: Puberty is a developmental process characterized by hormonal and physical changes leading to the ability of reproduction. Precocious puberty, especially in girls, has been associated with an increased incidence of emotional and behavioral problems. Adolescence is a life stage influenced both by the biological changes of puberty and the emergence of new social challenges. In individuals facing these developmental issues at a younger age than expected, the exposure to internal and external stress factors may be greater than in other young people.
METHODS: This narrative review provides an overview of psychopathology associated with precocious puberty in order to raise awareness of clinicians dealing with adolescents at risk for adverse behavioral and emotional outcomes. Developmental challenges of standard puberty and adolescence will be outlined before a more detailed description of recent findings from clinical and epidemiological studies. Putative mechanisms underlying the association between precocious puberty and psychopathology will also be discussed.
RESULTS: Epidemiological studies have shown that an early onset of puberty in girls is associated with an earlier onset of sexuality, an earlier age of first birth and a lesser professional qualification regardless of cognitive abilities and socio-economic status. In both population studies and clinical cohorts, girls with an early age of puberty or in treatment for precocious puberty have more disruptive behavior disorders such as conduct disorders, more substance abuse disorders and delinquent behavior compared to their standard developing peers. Precocious puberty and behavioral problems may have common genetic and environmental risk factors. In young people with conduct disorders and early puberty, findings have emphasized the role of non-shared environmental factors. Low birth weight, obesity, exposure to endocrine-disrupting chemicals and adoption are potentially shared between both conditions. Early puberty in girls is also associated with psychosocial stressors and at-risk environments. The early development of secondary sexual characteristics in girls attracts older and more deviant peers, raising probability of sexual contacts but also of drug use and of a disengagement in school activities. Adolescence is the life stage during which prevalence of depressive disorders rises significantly, especially in girls. Hormonal changes and increase of the Body Mass Index leading to dissatisfaction with body image, have been put forward to explain this trend. Psychosocial challenges (emerging sexuality, instability of identity and social role) are other sources of stress at this particular period of life characterized by emotional hyper-reactivity. These stressors may have greater impact in young people showing a discrepancy between physical and affective maturation. Follow-up studies have shown that emotional and behavioral problems tend to lessen with time. Nevertheless, a heightened risk of depressive disorder remains in girls having had an early onset of puberty when other risk factors co-exist.
CONCLUSIONS: Early puberty, especially in girls, has been associated with a number of emotional and behavioral symptoms and difficulties in adaptive functioning. Even though these adverse outcomes seem to lessen with time, heightened risk for depression and negative impact on socio-professional outcomes persist in subjects with other risk factors. The impact of treatment of precocious puberty on psycho-behavioral outcomes is currently unknown. However, clinicians should be aware that the social and emotional challenges these adolescents with atypical pubertal development have to face put them at risk for psychopathology and are potentially accessible to preventive actions.

Major depressive disorder is a multifactorial chronic and debilitating mood disease with high lifetime prevalence and is associated with excess mortality, especially from cardiovascular diseases and through suicide. The treatments of this disease with tricyclic antidepressants and monoamine oxidase inhibitors are poorly tolerated and those that selectively target serotonin and norepinephrine re-uptake are not effective in all patients, showing the need to find new therapeutic targets. Post-mortem studies of brains from patients with major depressive disorders described a reduced expression of the gap junction-forming membrane proteins connexin 30 and connexin 43 in the prefrontal cortex and the locus coeruleus. The use of chronic unpredictable stress, a rodent model of depression, suggests that astrocytic gap junction dysfunction contributes to the pathophysiology of major depressive disorder. Chronic treatments of rats with fluoxetine and of rat cultured cortical astrocytes with amitriptyline support the hypothesis that the upregulation of gap junctional intercellular communication between brain astrocytes could be a novel mechanism for the therapeutic effect of antidepressants. In conclusion, astrocytic gap junctions are emerging as a new potential therapeutic target for the treatment of patients with major depressive disorder.

BACKGROUND: Smoking cessation intervention is among the most vital elements of the prevention of tobacco smoking. Our study aimed to describe the clinical profile of patients attending our smoking cessation unit.
METHODS: We conducted a cross-sectional study from December 2009 to June 2012. The patients were recruited in the Tobacco cessation unit of Sahloul Hospital (Sousse, Tunisia). The data were collected from the consultants\' records.
RESULTS: A total of 279 patients attended. They were mostly men (92.8 %). The mean age was 41.7 ± 13.4 years. Among medical conditions, a history of cardiovascular and respiratory disease was the most frequent (31 %). Anxiety was present in 46.2 % of patients. More than half of the patients (51.2 %) were heavy smokers and 50.5 % were strongly nicotine dependent (Fagerström\'s score>7). Seventy percent were motivated to stop smoking and 53.8 % had tried to quit at least once.
CONCLUSIONS: The majority of our patients could be considered as heavy smokers. Therapeutic combinations and medical treatment are suggested to assist practitioners trying to help them.