L'Encephale[JOURNAL]
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200 papers
Comparison of attitudes toward individuals with intellectual disabilities between medical students and the general population using the ATTID Scale.
Safa A, Labaky J, Richa S
Encephale · 2026 Jun · PMID 42225466 · Publisher ↗
INTRODUCTION: Intellectual disability (ID) is a neurodevelopmental disorder characterized by significant limitations in intellectual and adaptive functioning. Globally, individuals with ID remain among the most marginali...
INTRODUCTION: Intellectual disability (ID) is a neurodevelopmental disorder characterized by significant limitations in intellectual and adaptive functioning. Globally, individuals with ID remain among the most marginalized populations, facing major barriers in health care, education, and social inclusion. Societal attitudes toward ID directly influence the quality of care and civic participation. This study aimed to compare attitudes toward individuals with ID between medical students and the general population, exploring cognitive, emotional, and interactional determinants using the ATTID scale. MATERIALS AND METHODS: A cross-sectional study was conducted between July and September 2025 with 230 participants divided into two groups: medical students (n=161) and individuals without medical training (n=69). The internationally validated ATTID questionnaire assessed five dimensions: discomfort, interaction, tenderness-sensitivity, knowledge of abilities and rights, and knowledge of causes. Data were analyzed using descriptive and inferential statistics (Student's t-test, Cohen's d effect size). RESULTS: Medical students demonstrated significantly more favorable attitudes in the domains of knowledge of causes (P<0.001; d=-0.536) and recognition of abilities and rights (P=0.0021; d=-0.237). No significant differences were found in discomfort, interaction, or tenderness-sensitivity. Both groups expressed a moderately distant emotional stance and moderate discomfort toward ID. DISCUSSION: Medical training appears to enhance etiological and legal knowledge related to ID but does not improve emotional or relational dimensions. This dissociation suggests that medical knowledge alone is insufficient to transform affective or interactional attitudes. These findings align with international observations indicating that direct, structured contact with individuals with ID is more effective than theoretical instruction alone. A professional posture emphasizing emotional neutrality may also limit the expression of sensitivity, despite frequent exposure to human vulnerability. CONCLUSION: This study highlights the need to enrich medical education with targeted modules on ID including clinical placements, life testimonies, and ethical and relational approaches. By contributing to a broader reflection on educational and clinical practices, it would pave the way for interventions that promote more inclusive, respectful, and person-centered care. These findings may nurture international initiatives aimed at improving professional attitudes toward individuals with ID.
First lessons from the evaluation of CoFoR, an adaptation of the recovery college model in France for mental health promotion, peer support, and recovery.
Gruau A, Grard J, Tinland A
Encephale · 2026 May · PMID 42150987 · Publisher ↗
INTRODUCTION: Recovery Colleges (RCs) are innovative educational programs based on peer-support and the promotion of mental health to support persons affected by mental disorders in their personal recovery journey. In Fr...
INTRODUCTION: Recovery Colleges (RCs) are innovative educational programs based on peer-support and the promotion of mental health to support persons affected by mental disorders in their personal recovery journey. In France, the Accompagnement à l'Autonomie en Santé (Support for Health Autonomy) initiative led to the emergence of the first RC: the CoFoR, whose preliminary evaluation results are reported in this article. METHODS: The evaluation was based on data collected from CoFoR participants, referred to as students, over four academic terms between 2018 and 2020, using a mixed-methods approach: (1) A quantitative study using self-reported questionnaires before and after one term of training, assessing self-stigma (using ISMI-10 scale), empowerment (using HEiQ and ES scale), and recovery (using RAS scale); (2) a qualitative study based on 12 semi-structured interviews, 16 collaborative maps from focus groups and more than 200hours of participatory observation; (3) a satisfaction survey conducted at the end of each term; (4) an assessment of fidelity to the Recovery College model using RECOLLECT scale. RESULTS: The pre-post comparison of CoFoR training modules highlighted a significant reduction in self-stigma among students, a significant improvement in empowerment in the subdomains of "skill and technique acquisition", "social integration", and "community activism and autonomy", as well as a significant improvement in recovery in the "hope and self-confidence" subdomain. Qualitative findings particularly emphasized enhanced mental health literacy, identity revaluation, and a shift in students' perspectives on healthcare professionals. The satisfaction rate remained consistently high throughout the two-year evaluation period. The CoFoR met the eligibility criteria, and its fidelity score to the Recovery College model was high (13/14). CONCLUSION: This evaluation provides initial insights into the adaptation of the Recovery College model in France and encourages its broader integration into mental health strategies.
[What do we know about compassion focused therapy for anxiety and depressive symptoms: A scoping review].
Morasse-Bégis M, Trottier-Duclos F, Ngô TL
Encephale · 2026 May · PMID 42150986 · Publisher ↗
OBJECTIVE: Anxiety and depressive disorders are among the most common psychiatric conditions and have a high comorbidity rate. While cognitive behavioral therapy (CBT) remains the gold standard psychotherapeutic treatmen...
OBJECTIVE: Anxiety and depressive disorders are among the most common psychiatric conditions and have a high comorbidity rate. While cognitive behavioral therapy (CBT) remains the gold standard psychotherapeutic treatment, its protocols which focus on a specific disorder have limitations when faced with clinical complexity. Transdiagnostic approaches aim to overcome these constraints by targeting processes common to different mental disorders. Compassion-Focused Therapy (CFT) is part of this approach. It is particularly aimed at patients with overwhelming shame and marked self-criticism, often linked to early adverse experiences and associated with resistance to treatment. Drawing on evolutionary psychology, attachment theory, and affective neuroscience, CFT seeks to restore the ability to self-soothe and cultivate self-compassion, which can reduce anxiety and depressive symptoms, among other benefits. This scoping review aims to synthesize the available data on the effectiveness of CFT in the treatment of anxiety and depressive disorders. METHOD: A scoping review was conducted using the PsycINFO, PubMed, CINAHL, Web of Science, and Google Scholar search engines, as well as gray literature to include unpublished studies, so as to systematically identify articles published between 1984 and 2024 on the effect of CFT on anxiety and depressive symptoms in adults. RESULTS: The included studies were highly heterogeneous in terms of methodology. The majority reported a significant reduction in anxiety (n=11), depression (n=14), and anxiety-depressive symptoms (n=30) after the intervention, while others showed no significant difference in anxiety (n=7), depression (n=2), or anxiety-depressive symptoms (n=3) compared to control groups (waiting list, usual treatment, other therapies). Participants came from a variety of populations: psychiatric patients (mood disorders, anxiety disorders, obsessive-compulsive disorder, post-traumatic stress disorder, psychotic disorder, personality disorder, bulimia, dementia) (51 %, n=32), non-clinical samples (students, parents, teachers, the general public) (31 %, n=20), or subjects with somatic conditions (irritable bowel syndrome, cancer, pain, chronic illness, acne, multiple sclerosis, cardiovascular disease) (14 %, n=9). CFT, most often delivered in groups (n=44, 70 %) of 8 to 12 sessions (n=22), generally lasting 90 to 120minutes (n=26), mainly incorporated compassionate imagery techniques (n=39), development of a compassionate self (n=37), and mindfulness practices (n=36). Self-compassion was the most frequently identified mechanism of action (n=21). Other mechanisms explored included self-criticism (n=14), self-reassurance (n=11), fears related to self-compassion (n=8), fear of compassion towards others (n=5), ability to receive compassion from others (n=5), ability to offer compassion to others (n=5), rumination (n=3), comparison between oneself and others (n=3), and physiological factors such as heart rate variability (n=2). These results suggest that CFT may exert its effects by promoting a more compassionate and accepting relationship with oneself and others, reducing self-criticism, and improving emotional regulation. CONCLUSION: CFT appears to be a promising approach for reducing anxiety and depression symptoms. However, the heterogeneity of the studies and the lack of randomized controlled trials limit the scope of the conclusions. Additional rigorously designed research is needed to confirm its effectiveness, clarify the conditions under which it is most effective, and specify its mechanisms of action.
[AVATAR Therapy: Toward a new psychotherapeutic era for treatment-resistant auditory verbal hallucinations].
Milano BA, Guzman Perez A, Sentissi O
Encephale · 2026 May · PMID 42142984 · Publisher ↗
Treatment-resistant auditory verbal hallucinations (AVH) represent a major challenge for modern psychiatry. Despite optimized pharmacological strategies, approximately one-third of patients with schizophrenia continue to...
Treatment-resistant auditory verbal hallucinations (AVH) represent a major challenge for modern psychiatry. Despite optimized pharmacological strategies, approximately one-third of patients with schizophrenia continue to hear intrusive voices persistently and daily, causing significant distress and lasting functional impairment. In this context, based on a simple yet revolutionary idea, AVATAR therapy offers a practical therapeutic alternative or a complementary tool for patients and clinicians. This technique combines digital voice modelling, graded exposure, and psychotherapeutic mediation: the patient co-creates and interacts with an embodied representation of their voice. This approach promotes reattribution of the phenomenon, reduces distress, and fosters greater control over the experience. All recent studies have converged on its clinically relevant efficacy and high patient acceptability. By combining technology, neuroscience, and personalization, AVATAR therapy exemplifies the transition toward person-centered precision psychotherapy.
[Sleep disorders in children and adolescents: Clinical assessment and principles of management].
Rolling J, Zanfonato T, Bioulac S … +1 more , Schröder CM
Encephale · 2026 Jun · PMID 42055909 · Publisher ↗
INTRODUCTION: Sleep disturbances in children and adolescents are a frequent reason for consultation in pediatrics, primary care, and child and adolescent psychiatry. Their clinical presentation is heterogeneous and lies...
INTRODUCTION: Sleep disturbances in children and adolescents are a frequent reason for consultation in pediatrics, primary care, and child and adolescent psychiatry. Their clinical presentation is heterogeneous and lies at the intersection of developmental, circadian, behavioral, psychological, and family-related factors. The aim of this review is to provide a structured clinical synthesis of the main sleep disorders in children and adolescents, as well as updated principles of their management. METHODS: This narrative review is based on a critical synthesis of the literature and other reference sources (expert consensus) devoted to sleep disorders in children and adolescents, their validated psychotherapeutic management, and pharmacological treatment options. Data were selected for their clinical relevance and organized according to a structured analytical framework focusing on sleep development, assessment tools, differential diagnoses, comorbidities, and therapeutic strategies. This approach was intended to provide an integrative, developmental, and clinically applicable overview. RESULTS: Management of sleep disorders in pediatric populations first relies on a thorough clinical assessment, including analysis of 24-hour sleep-wake patterns, individual sleep needs, chronotype, external synchronizers, and somatic or psychiatric comorbidities. The most frequent disorders are behavioral insomnia of childhood, insomnia comorbid with anxiety or mood disorders, and circadian rhythm sleep-wake disorders, particularly delayed sleep phase syndrome in adolescence. First-line interventions are based on parental psychoeducation, sleep hygiene among which consistent bedtime routines, and cognitive-behavioral approaches. Pharmacological treatments, among which melatonin, have a limited role (except for neurodevelopmental or neurogenetic disorders) after failure of well-conducted non-pharmacological measures, with particular attention to the benefit-risk ratio, regulatory framework, and comorbidities. CONCLUSIONS: Sleep disorders in children and adolescents require an integrative, developmental, and family-centered approach. Behavioral interventions and circadian rhythm regulation constitute the cornerstones of clinical management. The use of pharmacological treatments should remain individualized, and regularly re-evaluated. Better clinician training and wider dissemination of sleep psychoeducation and cognitive-behavioural therapies targeting insomnia could improve early identification and quality of care.
Dream tyranny: Hyperonirism diagnostic criteria.
Geoffroy PA, Saadi S, Mauries S … +4 more , Clerici E, Lejoyeux M, Maruani J, Bourgin P
Encephale · 2026 Jun · PMID 42055908 · Publisher ↗
BACKGROUND: Hyperonirism, or "epic dreaming," is an emerging clinical phenomenon characterized by excessive, vivid, and continuous dream activity associated with non-restorative sleep and daytime fatigue. Despite histori...
BACKGROUND: Hyperonirism, or "epic dreaming," is an emerging clinical phenomenon characterized by excessive, vivid, and continuous dream activity associated with non-restorative sleep and daytime fatigue. Despite historical descriptions, it remains poorly defined and unrecognized by current nosological systems. METHOD: We describe four patients assessed in expert sleep and psychiatry centers, presenting with persistent complaints of excessive dream activity not attributable to nightmares, REM sleep behavior disorder, or medication-induced parasomnias. Comprehensive clinical, psychiatric, and sleep evaluations, including polysomnography and actigraphy, were conducted. RESULTS: All patients described excessive, vivid, and intrusive dream activity occurring with high frequency and perceived as disproportionate to normal dreaming. This "dream overflow" was consistently linked to non-restorative sleep and persistent daytime fatigue, with additional complaints including reduced attention, cognitive inefficiency, and emotional distress. The phenomenological complaint was strikingly similar. Importantly, patients clearly differentiated this experience from nightmares, as dream content was not necessarily negative but continuous, vivid, unrelenting, and mentally exhausting. Psychiatric comorbidities such as depression, anxiety, or insomnia were frequent, yet insufficient to explain the hyperonirism. Objective sleep investigations were largely normal, underscoring the gap between subjective experience and conventional sleep measures. CONCLUSIONS: This case series supports the characterization of hyperonirism disorder as a distinct clinical entity at the crossroads of sleep medicine and psychiatry. We propose preliminary diagnostic criteria encompassing both nocturnal and diurnal dimensions. Recognition of hyperonirism disorder may improve clinical assessment of dream-related complaints and stimulate research into its neurobiological mechanisms and therapeutic management.
Sleep and psychiatry: Toward clinical, pathophysiological, and organisational integration.
Geoffroy PA
Encephale · 2026 Jun · PMID 42055907 · Publisher ↗
Abstract loading — click title to view on PubMed.
Sleep as a pillar of mental health: Why do psychiatrists need to wake up right now?
Palagini L
Encephale · 2026 Jun · PMID 42055906 · Publisher ↗
Abstract loading — click title to view on PubMed.
Sleep disorders in addictions: State of the art and management.
Mauries S, Davido G, Lejoyeux M … +1 more , Geoffroy PA
Encephale · 2026 Jun · PMID 41963185 · Publisher ↗
INTRODUCTION: Sleep complaints are frequent among patients suffering from addiction. Conversely, sleep disturbances have been identified as risk factors for developing an addiction. METHODS: This study is a narrative lit...
INTRODUCTION: Sleep complaints are frequent among patients suffering from addiction. Conversely, sleep disturbances have been identified as risk factors for developing an addiction. METHODS: This study is a narrative literature review aiming to provide an overview of the current scientific knowledge on the links between major addictions (alcohol, tobacco, cannabis, and gambling) and sleep disorders. RESULTS: The scientific literature confirms the presence of both objective and subjective sleep alterations in major substance use disorders and pathological gambling, during periods of consumption as well as during withdrawal. For instance, 60-70% of patients with alcohol use disorder present with insomnia, and alcohol consumption increases the risk of developing obstructive sleep apnea by 25%. These interactions between addictions and sleep disorders are bidirectional: sleep disorders are identified both as risk factors for developing an addiction and for relapse among patients attempting abstinence, while addictions are identified as factors impairing sleep quality. Cognitive Behavioral Therapy for Insomnia (CBT-I), the first-line treatment for insomnia, has demonstrated its effectiveness in the management of insomnia in the context of cannabis and alcohol use disorders, leading to improvements not only in sleep symptoms but also in addictive symptoms. CONCLUSIONS: Addictions and sleep disorders interact in a bidirectional manner. The specific management of sleep disorders in this population could represent an interesting therapeutic target. However, further studies are needed to develop specific and targeted therapeutic tools to improve both prognosis and quality of life in these patients.
Designing empirically-based personæ to support a human-sensitive implementation of national suicide prevention strategies.
Morgiève M, Notredame CÉ
Encephale · 2026 Apr · PMID 41963184 · Publisher ↗
INTRODUCTION: The World Health Organization (WHO) advocates for the adoption of Comprehensive National Suicide Prevention Strategies (CNSPS) which involve implementing and integrating evidence-based interventions guided...
INTRODUCTION: The World Health Organization (WHO) advocates for the adoption of Comprehensive National Suicide Prevention Strategies (CNSPS) which involve implementing and integrating evidence-based interventions guided by public health models, particularly in resource-constrained settings. However, policymakers often struggle to translate these complex, multisectoral frameworks into coordinated, contextually relevant actions. Moreover, such strategies risk becoming disconnected from the lived experiences of individuals in suicidal crisis. To address this gap, we explored the use of personæ - fictional yet realistic character profiles - as an innovative, human-centered tool to support CNSPS design and implementation. METHODS: We developed an original, structured, and iterative four-step methodology to create the personæ: (1) collection of empirical data through semi-structured interviews with suicidology experts and case studies of individuals with lived experience of suicidal crisis; (2) selection and clustering of key features, including sociodemographic data, life events, suicide-related experiences, and interactions with CNSPS components; (3) narrative and pathway crafting for each persona; and (4) refinement through co-design workshops involving both professional stakeholders and experts by experience. RESULTS: Five distinct, multimedia personæ were developed: Alban, Alina, Leïla, Marie, and Matthieu. Each included: (1) a first-person audio narrative performed by professional actors; (2) an identity sheet presenting demographic data and a full transcript of the narrative; and (3) an analytical pathway map detailing CNSPS components, received interventions, and interventional synergies. DISCUSSION: Personæ represent an innovative approach to illustrating and operationalizing national suicide prevention strategies. By bridging theoretical models with real-world experiences, they enhance stakeholder engagement, foster empathy, and support strategic decision-making. Adaptable to specific territorial or institutional contexts, they offer practical tools for mapping existing services, identifying unmet needs, and tailoring interventions. While not statistically representative, personæ provide a valuable heuristic for early-stage design and policy planning. Further research should assess their utility in training, service design, and implementation. Expanding this methodology to reflect a broader range of populations could strengthen the development of inclusive, human-sensitive suicide prevention policies.
Alterations in sleep and the biological clock in mood disorders: State of the art and therapeutic approaches.
Maruani J, Geoffroy PA
Encephale · 2026 Jun · PMID 41963183 · Publisher ↗
Sleep disorders such as insomnia, hypersomnolence, nightmares and circadian rhythm disorders play a critical role across all stages of mood disorders, including Chronos syndrome, and are recognized as significant risk fa...
Sleep disorders such as insomnia, hypersomnolence, nightmares and circadian rhythm disorders play a critical role across all stages of mood disorders, including Chronos syndrome, and are recognized as significant risk factors for their onset, relapse, and recurrence. Moreover, emerging evidence suggests that the co-occurrence of sleep or circadian disruptions with mood disturbances may represent a more severe and distinct clinical phenotype, likely associated with a poorer prognosis than when each condition occurs independently. Personalized interventions targeting sleep, circadian rhythms, and mood symptoms, are increasingly being developed and implemented across the various phases of mood disorders. These include Cognitive Behavioral Therapy for Insomnia (CBT-I) combined with chronotherapeutic approaches for insomnia disorder, chronotherapeutics for circadian rhythm disturbances, Imagery Rehearsal Therapy (IRT) for nightmares disorders, and wake-promoting agents for hypersomnolence. All of these treatments should be integrated with the optimization of mood disorder management, both preventive and curative, including the use of antidepressants, mood stabilizers, and chronotherapeutic strategies.
Sleep trajectories and behavioural development in children and adolescents.
Reynaud E, Mazza S, Plancoulaine S
Encephale · 2026 Jun · PMID 41963182 · Publisher ↗
OBJECTIVE: To summarize the main findings of publications studying sleep patterns in children and adolescents and the links between these sleep patterns and their behavioural development. METHOD: Literature review: 1) us...
OBJECTIVE: To summarize the main findings of publications studying sleep patterns in children and adolescents and the links between these sleep patterns and their behavioural development. METHOD: Literature review: 1) using methods for modelling sleep characteristic trajectories (duration, difficulty falling asleep, nighttime awakenings) by latent classes; 2) in typically developing preschool children or adolescents; 3) based on data collected via questionnaires or accelerometers; 4) and studying their links with behaviour. RESULTS: The results of the identified publications are presented. Overall, they show longitudinal changes or trajectories in sleep characteristics that differ between children. The same is true for adolescents. The less optimal sleep trajectories are associated with a higher risk of hyperactivity/inattention, with a possible bidirectional relationship. Other behavioural disorders have been little studied. CONCLUSION: Children and adolescents do not all have the same sleep characteristics or the same developments over time. The least optimal developments are associated with a higher risk of hyperactivity/inattention. Co-evolution is suggested.
Treatment of insomnia disorder in psychiatry: A practical guide for CBT-I based intervention.
Stern E, Poirot I, Brion A … +3 more , Dufayet G, Maruani J, Geoffroy PA
Encephale · 2026 Jun · PMID 41963181 · Publisher ↗
Insomnia disorder is highly prevalent among patients with psychiatric disorders and significantly impacts the course and prognosis of these disorders. Interventions based on cognitive behavioral therapy for insomnia (CBT...
Insomnia disorder is highly prevalent among patients with psychiatric disorders and significantly impacts the course and prognosis of these disorders. Interventions based on cognitive behavioral therapy for insomnia (CBT-I) are considered the first-line treatment for adults, both with and without psychiatric comorbidities. This article provides a practical guide for clinicians, beginning with a definition of insomnia and its diagnostic criteria, followed by a detailed description of the core components of CBT-I: psychoeducation, including the key information to convey to patients; behavioral strategies, with recommendations tailored to individuals with psychiatric comorbidities; and cognitive interventions aimed at addressing maladaptive beliefs and thought patterns related to sleep.
Sleep disturbances in posttraumatic stress disorder: Current knowledge and clinical management.
Saguin E, Rolling J
Encephale · 2026 Jun · PMID 41963180 · Publisher ↗
OBJECTIVES: Posttraumatic stress disorder (PTSD) is a psychiatric condition frequently associated with severe sleep disturbances, especially insomnia and trauma-related nightmares (TRNs). These symptoms are among the mos...
OBJECTIVES: Posttraumatic stress disorder (PTSD) is a psychiatric condition frequently associated with severe sleep disturbances, especially insomnia and trauma-related nightmares (TRNs). These symptoms are among the most frequent and persistent in both civilian and military populations, yet they remain under-assessed and under-treated. This expert review aims to provide a comprehensive and updated overview of the current understanding and management of sleep disturbances in PTSD. MATERIALS AND METHODS: This work is based on a critical synthesis of recent literature, combined with clinical expertise in military psychiatry and sleep medicine. The main areas examined include epidemiological data, diagnostic classifications, clinical characteristics, and therapeutic approaches. RESULTS: Sleep complaints in PTSD are often severe, with TRNs representing a key clinical hallmark. Polysomnographic findings remain non-specific and sometimes inconclusive. A bidirectional relationship is described between PTSD symptoms and sleep disturbances. Therapeutic approaches include both psychotherapeutic and pharmacological interventions, each with strengths and limitations. DISCUSSION: Sleep disturbances in PTSD play a central role in symptom persistence and overall functional impairment. Addressing them may improve both nocturnal symptoms and daytime functioning. In psychiatric populations, treatment of sleep complaints may offer a less stigmatizing entry point into mental health care. CONCLUSIONS: Sleep should be systematically assessed and specifically treated in PTSD. It constitutes a valuable clinical target and a potential lever for improving prognosis and global recovery.
[LSD revisited: Mechanisms of action and therapeutic potential in mental health].
Bouloufa A, Delcourte S, Delannay T … +1 more , Haddjeri N
Encephale · 2026 Apr · PMID 41963179 · Publisher ↗
Major depressive disorder (MDD) represents a colossal worldwide burden of health, affecting more than 350 million individuals. While traditional antidepressants with mechanisms of action at the serotonin, dopamine, or no...
Major depressive disorder (MDD) represents a colossal worldwide burden of health, affecting more than 350 million individuals. While traditional antidepressants with mechanisms of action at the serotonin, dopamine, or norepinephrine pathways are routinely prescribed, approximately one-third of patients fail to achieve adequate remission and develop treatment-resistant depression (TRD). This therapeutic shortfall underscores the necessity for novel approaches to treatment. Over the past two decades there has been a resurgence of scientific interest in psychedelics, such as lysergic acid diethylamide (LSD). LSD's primary pharmacological effect is modulation of the 5-HT2A serotonin receptor and the glutamatergic system, both of which have been involved in neuroplasticity. It has been hypothesized that it is these neurobiological effects that are likely to be behind the rapid and sustained antidepressant responses observed in the early clinical studies. Clinical trials are currently underway to determine the safety and efficacy of LSD for the treatment of MDD. However, psychedelic research is not without methodological hurdles, such as providing meaningful placebos to account for LSD's idiosyncratic subjective effects. Also, physicians need specialized training to help navigate these deeply psychologically immersive states experienced in the context of psychedelic-assisted therapy. While LSD-assisted therapy remains experimental, its therapeutic potential is increasingly recognized, especially given the limitations of available treatments for TRD. Continued rigorous research is necessary to achieve careful integration of psychedelic therapies into standard clinical practice.
Sleep and schizophrenia spectrum.
Gauld C, Hanin C
Encephale · 2026 Jun · PMID 41963178 · Publisher ↗
The relationships between sleep disorders and psychotic disorders, particularly schizophrenia, are extensively documented in the literature due to their shared diagnostic, prognostic, and therapeutic implications. This c...
The relationships between sleep disorders and psychotic disorders, particularly schizophrenia, are extensively documented in the literature due to their shared diagnostic, prognostic, and therapeutic implications. This chapter examines the relationships between sleep medicine and schizophrenia spectrum disorders, as well as the clinical high-risk (CHR) state. Sleep disorders such as insomnia, restless legs syndrome, sleep apnea, and circadian rhythm disturbances can exacerbate psychotic symptoms, negatively impacting quality of life and treatment response. Conversely, psychotic symptoms, along with certain treatments associated with these conditions, may worsen sleep disturbances. We discuss the implications of early intervention in preventing progression toward psychotic disorders, highlighting sleep as both a predictor and a potential therapeutic target. We also present general principles for managing sleep disturbances associated with psychotic disorders. The management of sleep in patients with psychotic disorders requires a personalized approach, integrating both pharmacological and non-pharmacological strategies.
Sleep disturbances in anxiety disorders: State of the art and management.
Royant-Parola S
Encephale · 2026 Jun · PMID 41963177 · Publisher ↗
Anxiety disorders are the most prevalent psychiatric conditions globally, affecting up to one in four individuals over a lifetime. A strong and bidirectional relationship exists between anxiety and sleep disturbances: an...
Anxiety disorders are the most prevalent psychiatric conditions globally, affecting up to one in four individuals over a lifetime. A strong and bidirectional relationship exists between anxiety and sleep disturbances: anxiety profoundly disrupts sleep, while poor sleep exacerbates psychological vulnerability, thereby exacerbating anxiety. This review provides a detailed exploration of how different anxiety disorders impact sleep and emphasizes the clinical importance of addressing both dimensions concurrently. This review demonstrates that sleep disturbances in anxiety disorders manifest heterogeneously, impacting sleep onset, maintenance, and depth. In generalized anxiety disorder (GAD), over 80% of patients suffer from insomnia, characterized by prolonged sleep latency, frequent awakenings, and non-restorative sleep. Panic disorder often involves nocturnal panic attacks that create anticipatory anxiety around sleep itself. PTSD is strongly linked to recurrent nightmares and hyperarousal, with significant polysomnographic evidence of disrupted sleep architecture. Obsessive-compulsive disorder (OCD) is also associated with delayed sleep onset due to compulsive rituals. The review highlights the importance of differential diagnosis, as sleep complaints in anxious patients may mask other conditions such as nocturnal epilepsy or obstructive sleep apnea. A thorough clinical approach, including detailed sleep history, psychometric evaluations, and targeted investigations such as polysomnography or EEG when indicated, is essential to distinguish these conditions. Ultimately, the review reinforces that anxiety must be systematically evaluated and treated in patients presenting with sleep disorders, as addressing anxiety can significantly improve sleep and overall functioning. It calls for integrative, patient-centered care to navigate the complex interplay of psychiatric symptoms and sleep physiology.
Dreams and nightmares: Clinical aspects, management, and links to psychiatric disorders.
Maruani J, Clerici E, Ambar Akkaoui M … +1 more , Geoffroy PA
Encephale · 2026 Jun · PMID 41963176 · Publisher ↗
BACKGROUND: Nightmare complaints are common among individuals with psychiatric disorders and are associated with significant emotional distress and functional impairment. Despite their clinical relevance, they remain fre...
BACKGROUND: Nightmare complaints are common among individuals with psychiatric disorders and are associated with significant emotional distress and functional impairment. Despite their clinical relevance, they remain frequently under-recognized and under-treated in psychiatric settings. OBJECTIVE: To offer a pragmatic, clinician-oriented framework for the evaluation and management of nightmare complaints within psychiatric practice. METHODS: This narrative synthesis draws from epidemiological, clinical, and translational research, with a focus on: (i) the relationship between nightmares and psychiatric disorders; (ii) a structured diagnostic approach tailored to cases involving psychiatric comorbidity; (iii) current treatment strategies, both pharmacological and non-pharmacological, emphasizing approaches adapted to comorbid psychiatric conditions. RESULTS: Nightmares affect an estimated 34-70% of individuals with psychiatric disorders and are linked to more severe psychopathology, including heightened depressive symptoms and suicidal ideation. Notably, nightmares are independently associated with increased suicide risk, regardless of the underlying diagnosis, underscoring the need to include them in suicide risk assessments. A four-step diagnostic care algorithm is proposed: Differentiating Nightmare Disorder from isolated nightmares; Assessing the four core dimensions of the disorder; Considering differential diagnoses; Identifying predisposing, precipitating, comorbid, and perpetuating factors, particularly psychiatric in nature. Effective treatment should address both the nightmare symptoms and any underlying or comorbid psychiatric or medical conditions. In cases where nightmares co-occur with psychiatric disorders, clinicians should first evaluate whether the primary condition is destabilized and optimize its management. Comorbidities that may sustain nightmares must also be identified and treated. Imagery Rehearsal Therapy (IRT) currently stands as the first-line treatment for Nightmare Disorder. However, while initial findings are promising, especially in comorbid contexts, more targeted and personalized therapeutic strategies are needed. Future research should aim to refine interventions based on comorbidity profiles and further delineate idiopathic versus comorbid nightmare disorders. CONCLUSIONS: Nightmares, frequently neglected in psychiatric care, demand systematic assessment and individualized treatment strategies, particularly when occurring alongside psychiatric disorders, to reduce emotional suffering and improve clinical outcomes.
Long-term consequences of childhood sexual abuse: An umbrella review of diagnostic meta-analyses.
Thomas P, Fauquert B, Kacenelenbogen N … +3 more , Briganti G, Kornreich C, Goderis G
Encephale · 2026 Apr · PMID 41963175 · Publisher ↗
BACKGROUND: Childhood sexual abuse (CSA) is a public health issue with an estimated worldwide prevalence of 12.7%, potentially leading to a host of lifelong and significant mental, physical, and behavioral health. The ai...
BACKGROUND: Childhood sexual abuse (CSA) is a public health issue with an estimated worldwide prevalence of 12.7%, potentially leading to a host of lifelong and significant mental, physical, and behavioral health. The aim of this study was to comprehensively map the long-term consequences of childhood sexual abuse on physical, psychiatric, and behavioral health outcomes. METHODS: An umbrella review of meta-analyses of observational studies, registered on PROSPERO, was conducted to examine the diverse repercussions of childhood sexual abuse on adult health. Three bibliographic databases (PsycINFO, PubMed and Scopus) were searched from the inception of the respective databases to November 1st, 2022. Thirty-eight meta-analyses representing about 20 million individuals were analyzed, revealing a range of long-lasting consequences associated with CSA. RESULTS: Among physical pathologies, cervical cancer and functional neurological syndromes emerged as the most prominent, exhibiting significantly elevated odds ratios (ORs) of 4.18 IC95% and 3.30 IC95%, respectively. Sleep disorders and borderline personality disorders were the most prevalent mental health disorders associated with CSA, with respective ORs of 16.17 IC95% and 5.96 IC95%. Early sexual initiation (OR=3.59 IC95%, sexual assault (OR=3.36 IC95%, and prostitution (OR=3.24 IC95%) emerged as the most common behavioral consequences. Notably, no significant differences in the consequences of CSA were observed between men and women, except for reproductive health outcomes. DISCUSSION: When faced with certain pathologies, clinicians should consider and discuss sexual abuse with their patients. The consequences of abuse have a multifactorial origin, which is a weakness, as are the problems of defining abuse. The strength of our study is that it lists the consequences published in high-quality studies. CONCLUSION: This umbrella review provides compelling evidence of the profound and far-reaching impact of childhood sexual abuse on a broad spectrum of physical, mental, and behavioral health issues.
Sleep disorders in the elderly and their management.
Kinugawa K
Encephale · 2026 Jun · PMID 41963174 · Publisher ↗
Sleep aging is a complex physiological process driven by changes in circadian regulation systems (phase advance, decreased melatonin secretion) while homeostatic drive remains largely preserved. In healthy older adults,...
Sleep aging is a complex physiological process driven by changes in circadian regulation systems (phase advance, decreased melatonin secretion) while homeostatic drive remains largely preserved. In healthy older adults, sleep is characterized by sleep fragmentation, a decrease in deep slow-wave sleep, and reduced sleep efficiency, though adaptation mechanisms often prevent significant complaints. Nevertheless, approximately 50% of older adults report sleep disturbances, frequently linked to geriatric comorbidities (neurocognitive disorders, heart failure, chronic pain), polypharmacy, or changes in external synchronizers (institutionalization, sedentary lifestyle). Management must be comprehensive, prioritizing non-pharmacological approaches such as Cognitive Behavioral Therapy for Insomnia (CBT-I) as first-line treatment, while maintaining vigilance for specific conditions like Restless Legs Syndrome or REM Sleep Behavior Disorder, which are prevalent in alpha-synucleinopathies.
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