Encephale-Revue De Psychiatrie Clinique Biologique et Therapeutique最新文献

{"title":"[Sleep disorders in children and adolescents: Clinical assessment and principles of management].","authors":"Julie Rolling, Thomas Zanfonato, Stéphanie Bioulac, Carmen M Schröder","doi":"10.1016/j.encep.2026.03.008","DOIUrl":"https://doi.org/10.1016/j.encep.2026.03.008","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":51042,"journal":{"name":"Encephale-Revue De Psychiatrie Clinique Biologique et Therapeutique","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dream tyranny: Hyperonirism diagnostic criteria.","authors":"Pierre A Geoffroy, Sammy Saadi, Sibylle Mauries, Emmanuelle Clerici, Michel Lejoyeux, Julia Maruani, Patrice Bourgin","doi":"10.1016/j.encep.2026.03.006","DOIUrl":"https://doi.org/10.1016/j.encep.2026.03.006","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Method: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":51042,"journal":{"name":"Encephale-Revue De Psychiatrie Clinique Biologique et Therapeutique","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleep and psychiatry: Toward clinical, pathophysiological, and organisational integration.","authors":"Pierre A Geoffroy","doi":"10.1016/j.encep.2026.03.009","DOIUrl":"https://doi.org/10.1016/j.encep.2026.03.009","url":null,"abstract":"","PeriodicalId":51042,"journal":{"name":"Encephale-Revue De Psychiatrie Clinique Biologique et Therapeutique","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147788047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleep as a pillar of mental health: Why do psychiatrists need to wake up right now?","authors":"Laura Palagini","doi":"10.1016/j.encep.2026.03.010","DOIUrl":"https://doi.org/10.1016/j.encep.2026.03.010","url":null,"abstract":"","PeriodicalId":51042,"journal":{"name":"Encephale-Revue De Psychiatrie Clinique Biologique et Therapeutique","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147787959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Towards sustainable psychiatry - Eco-prescription in action].","authors":"Matthias Brunn, Fabrice Berna, Frédéric Bounoure, Sébastien Taillemite, Guillaume Fond","doi":"10.1016/j.encep.2025.12.005","DOIUrl":"https://doi.org/10.1016/j.encep.2025.12.005","url":null,"abstract":"<p><p>While environmental concerns are becoming increasingly important in the field of health, drug prescription remains a blind spot in the ecological transition. In psychiatry, antidepressants are often prescribed for long periods, sometimes outside of approved indications, and their carbon impact is rarely taken into account. This article proposes the concept of eco-prescribing, defined as the choice of treatments with a lower environmental footprint and equivalent clinical efficacy. Using data from the Ecovamed® database, we compare the carbon footprint of several antidepressants at equivalent doses and show that their impact varies by a factor of two. We discuss the practical implications of these results for psychiatrists, emphasizing that eco-prescribing does not replace clinical reasoning, but complements it. Finally, we broaden the discussion to other levers of sustainable care: remote psychotherapy, psychonutrition, physical activity, and supervised use of honest placebos. Far from being marginal, environmental criteria could become a simple benchmark to guide therapeutic choices in psychiatry concerned with sustainability.</p>","PeriodicalId":51042,"journal":{"name":"Encephale-Revue De Psychiatrie Clinique Biologique et Therapeutique","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147655386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[LSD revisited: Mechanisms of action and therapeutic potential in mental health].","authors":"Amel Bouloufa, Sarah Delcourte, Thomas Delannay, Nasser Haddjeri","doi":"10.1016/j.encep.2026.02.008","DOIUrl":"https://doi.org/10.1016/j.encep.2026.02.008","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":51042,"journal":{"name":"Encephale-Revue De Psychiatrie Clinique Biologique et Therapeutique","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147655360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dreams and nightmares: Clinical aspects, management, and links to psychiatric disorders.","authors":"J Maruani, E Clerici, M Ambar Akkaoui, P A Geoffroy","doi":"10.1016/j.encep.2026.02.010","DOIUrl":"https://doi.org/10.1016/j.encep.2026.02.010","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objective: </strong>To offer a pragmatic, clinician-oriented framework for the evaluation and management of nightmare complaints within psychiatric practice.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":51042,"journal":{"name":"Encephale-Revue De Psychiatrie Clinique Biologique et Therapeutique","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147655404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleep disturbances in anxiety disorders: State of the art and management.","authors":"Sylvie Royant-Parola","doi":"10.1016/j.encep.2026.02.011","DOIUrl":"https://doi.org/10.1016/j.encep.2026.02.011","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":51042,"journal":{"name":"Encephale-Revue De Psychiatrie Clinique Biologique et Therapeutique","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147655538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Designing empirically-based personæ to support a human-sensitive implementation of national suicide prevention strategies.","authors":"Margot Morgiève, Charles-Édouard Notredame","doi":"10.1016/j.encep.2026.01.006","DOIUrl":"https://doi.org/10.1016/j.encep.2026.01.006","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Discussion: </strong>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.</p>","PeriodicalId":51042,"journal":{"name":"Encephale-Revue De Psychiatrie Clinique Biologique et Therapeutique","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147655382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of insomnia disorder in psychiatry: A practical guide for CBT-I based intervention.","authors":"Emilie Stern, Isabelle Poirot, Agnes Brion, Geoffrey Dufayet, Julia Maruani, Pierre-Alexis Geoffroy","doi":"10.1016/j.encep.2026.02.009","DOIUrl":"https://doi.org/10.1016/j.encep.2026.02.009","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":51042,"journal":{"name":"Encephale-Revue De Psychiatrie Clinique Biologique et Therapeutique","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147655471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}