Mickael Ehrminger

Background: Informal carers provide most long-term care in Europe, and supporting them recently became a political topic. Yet two foundations policy remain unstable: knowing who is considered a carer and what support they need. Objective: To examine how the absence of a consensual definition of the informal carer and the limited operational value of burden measurement hinder designing, targeting and evaluating public support policies. Methods: A critical review of the concepts of burden and informal carers, primary conceptual, psychometric and empirical studies, and policy documents. Results: Definitions of the informal carer converge on non-professional help to a person with long-term needs within a personal relationship, but diverge on several aspects. Prevalence estimates consequently vary across surveys and are partly artefacts of definition. Burden is alternately treated as a stressor, an appraisal or an outcome, and is conflated with stress, strain and burnout. Instruments are numerous, capture mainly subjective strain, have rarely been developed with carers, and seldom demonstrate content validity or responsiveness; none offers thresholds anchored to specific support needs. Policies therefore rely on proxies, typically the care recipient’s dependency level. The French daily carer allowance illustrates this mismatch: nearly 270,000 private-sector employees were eligible, whereas 6,626 entitlements had been opened after 18 months. Conclusions: Conceptual ambiguity is not merely an academic concern: it propagates into identification, targeting and evaluation failures. We propose a definition with explicit reporting of boundaries, separation of objective load, subjective strain and consequences, and the development of COSMIN-compliant, context-specific instruments.

Les troubles bipolaires et la schizophrénie comptent parmi les troubles mentaux les plus sévères en termes de répercussions sur la vie quotidienne. L’approche adoptée pour la prise en charge des patients souffrant de ces troubles s’est récemment étendue d’une approche principalement médicale fondée sur la rémission des symptômes vers une approche plus intégrative visant la remédiation d’autres variables, telles que la qualité de vie et le fonctionnement psychosocial.Une collaboration entre les Ministères de la Santé et de la Recherche et la Fondation Fondamental a permis la création de cohortes de patients schizophrènes et bipolaires suivis sur plusieurs années avec recueil de données multidimensionnelles (cliniques, psychosociales, cognitives, …).Ce travail doctoral a consisté à exploiter la richesse des données recueillies par la Fondation Fondamental afin d’élaborer des modèles visant à expliquer des phénomènes observés dans ces deux pathologies, à l’aide des méthodes de modélisation par équations structurales. Dans un premier temps, nous nous sommes intéressés aux relations longitudinales entre cognition et fonctionnement psychosocial chez les patients bipolaires. Ensuite, nous avons modélisé les relations longitudinales entre insight, qualité de vie, dépression et suicidalité dans les troubles du spectre de la schizophrénie. Puis, nous avons modélisé les corrélats transversaux de la qualité de vie subjective dans la schizophrénie.Nos résultats nous ont permis de tirer quelques enseignements pour la pratique clinique et l’amélioration de la prise en charge des patients. Aussi, nous plaidons pour une extension de l’utilisation des modèles d’équations structurales en psychiatrie.

Not-yet-known not-yet-known not-yet-known unknown Personal recovery narratives in psychiatry have long been used to reduce public stigma. Nowadays, more and more such narratives are shared on social media and collected by content creators and journalists often without basic education in psychology. Although telling one’s story has positive effects on the person sharing, the question of adverse negative effects has been neglected so far. We investigated the impact, whether positive or negative, of telling one’s story in a narrative podcast with a wide audience. Participants (N = 27) were recruited from the guest pool of Les Maux Bleus podcast. They completed an online quantitative and qualitative ad hoc 15-question survey assessing the positive effects of their participation on their well-being, and asking for potential adverse effects they might have encountered after their participation. A third of the sample reported adverse effects of low-to-moderate severity, and 6 persons in the sample stated they felt the need to look for emotional and/or psychological assistance after their participation despite a very precautious process before and after recording. Those results highlight the necessity to elaborate guidelines for content creators collecting and broadcasting such narratives to make them beneficial and avoid potentially severe adverse events occurring.

Aim: The aim was to evaluate the effect of body actions on learning process, particularly semantic memory capabilities in drug-naïve children with attention deficit hyperactivity disorder (ADHD). Method: Thirty children had to listen to a story which was repeated three times in a row and then a fourth time five minutes later. After each listen, the child was asked what she/he remembered from the story. The whole sample was split randomly into three subgroups of equal IQ (mean 102.2 ± 12.7), age (mean age 8 ± 0.6 years), sex (ratio female to male 1:5) and severity of ADHD symptoms (34.2 ± 7.4); a G1 “Freeze” subgroup, which implied listening to the story while sitting on a chair without moving; a G2 “Minimal” subgroup, which implied listening to the story while sitting on a chair but free movement was allowed; a G3 “Prescribed movement” subgroup, which implied listening to the story standing up, while copying the experimenter movements that mimicked the actions told in the story. Results: Although our sample was limited in size, interestingly, children in the G3 subgroup showed the highest short-term semantic memory retention compared to G1. In all subgroups, repetition allowed an increase in performance. Conclusions: Our exploratory findings stress the positive role of movement in children with ADHD to increase semantic memorization. Hyperactivity may counteract the deficit of memorization related to attention impairment in children with ADHD. Our results may encourage parents or teachers to allow children with ADHD to move around during short-term memory-retention tasks.

Background: The determinants of quality of life (QoL) in schizophrenia are largely debated, mainly due to methodological discrepancies and divergence about the concepts concerned. As most studies have investigated bi- or tri-variate models, a multivariate model accounting for simultaneous potential mediations is necessary to have a comprehensive view of the determinants of QOL. We sought to estimate the associations between cognitive reserve, cognition, functioning, insight, depression, schizophrenic symptoms, and QoL in schizophrenia and their potential mediation relationships.Methods: We used structural equation modeling with mediation analyses to test a model based on existing literature in a sample of 776 patients with schizophrenia from the FondaMental Foundation FACE-SZ cohort.Results: Our model showed a good fit to the data. We found better functioning to be positively associated with a better QoL, whereas better cognition, better insight, higher levels of depression, and schizophrenic symptoms were associated with a lower QoL in our sample. Cognitive reserve is not directly linked to QoL, but indirectly in a negative manner via cognition. We confirm the negative relationship between cognition and subjective QoL which was previously evidenced by other studies; moreover, this relationship seems to be robust as it survived in our multivariate model. It was not explained by insight as some suggested, thus the mechanism at stake remains to be explained.Conclusion: The pathways to subjective QoL in schizophrenia are complex and the determinants largely influence each other. Longitudinal studies are warranted to confirm these cross-sectional findings.

Aims: Establishing the minimum clinically important difference (MCID) in functioning and cognition is essential to the interpretation of the research and clinical work conducted in bipolar disorders (BD). The present study aimed to estimate the MCID for the Functioning Assessment Short Test (FAST) and a battery of neuropsychological tests in BD. Methods: Anchor-based and distributive methods were used to estimate the MCID for the FAST and cognition using data from a large, multicentre, observational cohort of individuals with BD. The FAST and cognition were linked with the Clinical Global Impressions Scale-Severity (CGI-S) and Global Assessment of Functioning (GAF) using an equipercentile method. The magnitude of the standard error measurement (s.e.m.) provided another estimate of the MCID. Results: In total, 570 participants were followed for 2 years. Cross-sectional CGI-S and GAF scores were linked to a threshold ⩽7 on the FAST for functional remission. The MCID for the FAST equalled 8- or 9-points change from baseline using the CGI-S and GAF. One s.e.m. on the FAST corresponded to 7.6-points change from baseline. Cognitive variables insufficiently correlated with anchor variables (all ρ <0.3). One s.e.m. for cognitive variables corresponded to a range of 0.45 to 0.93-s.d. change from baseline. Conclusions: These findings support the value of the estimated MCID for the FAST and cognition and may be a useful tool to evaluate cognitive and functional remediation effects and improve patient functional outcomes in BD. The CGI-S and GAF were inappropriate anchors for cognition. Further studies may use performance-based measures of functioning instead.

Background: Longitudinal studies of the relationship between cognition and functioning in bipolar disorder are scarce, although cognition is thought to be a key determinant of functioning. The causal structure between cognition and psychosocial functioning in bipolar disorder is unknown.Aims: We sought to examine the direction of causality between cognitive performance and functional outcome over 2 years in a large cohort of euthymic patients with bipolar disorder.Method: The sample consisted of 272 adults diagnosed with bipolar disorder who were euthymic at baseline, 12 and 24 months. All participants were recruited via the FondaMental Advanced Centers of Expertise in Bipolar Disorders. We used a battery of tests, assessing six domains of cognition at baseline and 24 months. Residual depressive symptoms and psychosocial functioning were measured at baseline and 12 and 24 months. The possible causal structure between cognition and psychosocial functioning was investigated with cross-lagged panel models with residual depressive symptoms as a covariate.Results: The analyses support a causal model in which cognition moderately predicts and is causally primary to functional outcome 1 year later, whereas psychosocial functioning does not predict later cognitive performance. Subthreshold depressive symptoms concurrently affected functioning at each time of measure.Conclusions: Our results are compatible with an upward causal effect of cognition on functional outcome in euthymic patients with bipolar disorder. Neuropsychological assessment may help specify individual prognoses. Further studies are warranted to confirm this causal link and evaluate cognitive remediation, before or simultaneously with functional remediation, as an intervention to improve functional outcome.