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Nicolas Franck

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Nicolas Franck is a university professor and hospital practitioner at Lyon university hospital since 2005. At Le Vinatier hospital, he is the director of the resource center for psychosocial rehabilitation and cognitive remediation (CRR) and head of the « Centre rive gauche » department. He coordinates the teaching of psychiatry (third cycle of medical studies) in Lyon. He also manages several university degrees (topics: psychosocial rehabilitation; cognitive remediation; psychoeducation; peer working; case management). He is the scientific director of EMC-Psychiatrie (Elsevier) since 2013 and wrote or coordinated the writing of books intended for professionals or the general public.
Address: Pôle Centre rive gauche
57 rue Etienne Richerand
69003 Lyon
France

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Nicolas Hoertel

Columbia University

Jean-luc Roelandt

Université Bordeaux

IRDES

Camille Lancelevee

EHESS-Ecole des hautes études en sciences sociales

Anne M . Lovell

Inserm U988 (Cermes3)

Inserm

marie-stella Marehin

Université Omar BONGO

APHM

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Papers by Nicolas Franck

Le centre d'accueil d'évaluation et d'orientation en psychiatrie et en santé mentale

L'Encéphale, 2023

Lettre à la rédaction Le centre d'accueil d'évaluation et d'orientation en psychiatrie et en sant... more

Further validation of the Cognitive Biases Questionnaire for psychosis

BMC Psychiatry

Background Cognitive biases are recognized as important treatment targets for reducing symptoms a... more Background Cognitive biases are recognized as important treatment targets for reducing symptoms associated with severe mental disorders. Although cognitive biases have been linked to symptoms in most studies, few studies have looked at such biases transdiagnostically. The Cognitive Bias Questionnaire for psychosis (CBQp) is a self-reported questionnaire that assesses cognitive biases amongst individuals with a psychotic disorder, as well as individuals with other severe mental disorders. The current study aims to validate a French version of the CBQp and to explore transdiagnostic cognitive biases in individuals with psychotic disorders, individuals with depression, and in healthy controls. Methods The CBQp was translated into French following a protocol based on international standards. Discriminant validity and internal consistency were determined for total score and each subscale score. Confirmatory factor analyses were performed to test construct validity. Finally, cluster analy...

Effect of Psychiatric Advance Directives Facilitated by Peer Workers on Compulsory Admission Among People With Mental Illness

JAMA Psychiatry

; for the DAiP Group IMPORTANCE Reducing the use of coercion in mental health care is crucial fro... more ; for the DAiP Group IMPORTANCE Reducing the use of coercion in mental health care is crucial from a human rights and public health perspective. Psychiatric advance directives (PADs) are promising tools that may reduce compulsory admissions. Assessments of PADs have included facilitation by health care agents but not facilitation by peer workers. OBJECTIVE To determine the efficacy of PADs facilitated by peer workers (PW-PAD) in people with mental disorders. DESIGN, SETTING, AND PARTICIPANTS A multicenter randomized clinical trial was conducted in 7 French mental health facilities. Adults with a DSM-5 diagnosis of schizophrenia, bipolar I disorder, or schizoaffective disorder who had a compulsory admission in the past 12 months and the capacity to consent were enrolled between January 2019 and June 2020 and followed up for 12 months. INTERVENTIONS The PW-PAD group was invited to fill out a PAD form and meet a peer worker who was trained to assist in completing and sharing the form with relatives and psychiatrists. MAIN OUTCOMES AND MEASURES The primary outcome was the rate of compulsory admission at 12 months after randomization. The overall psychiatric admission rate, therapeutic alliance, quality of life, mental health symptoms, empowerment, and recovery outcomes were also investigated. RESULTS Among 394 allocated participants (median age, 39 years; 39.3% female; 45% with schizophrenia, 36% bipolar I disorder, and 19% schizoaffective disorder), 196 were assigned to the PW-PAD group and 198 to the control group. In the PW-PAD group, 27.0% had compulsory admissions compared with 39.9% in the control group (risk difference, −0.13; 95% CI, −0.22 to −0.04; P = .007). No significant differences were found in the rate of overall admissions, therapeutic alliance score, and quality of life. Participants in the PW-PAD group exhibited fewer symptoms (effect size, −0.20; 95% CI, −0.40 to 0.00), greater empowerment (effect size, 0.30; 95% CI, 0.10 to 0.50), and a higher recovery score (effect size, 0.44; 95% CI, 0.24 to 0.65), compared with those in the control group. CONCLUSIONS AND RELEVANCE Peer worker-facilitated PADs are effective in decreasing compulsory hospital admissions and increasing some mental health outcomes (self-perceived symptoms, empowerment, and recovery). Involving peer workers in the completion of PADs supports the current shift of mental health care from substitute decision-making to supported decision-making. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03630822

The central role of self-esteem in the quality of life of patients with mental disorders

Scientific Reports

In psychiatry, recent years have seen a change of focus from a clinician- to a patient-centered p... more In psychiatry, recent years have seen a change of focus from a clinician- to a patient-centered perspective that emphasizes quality of life as a treatment target. As a complex construct, quality of life is composed of multiple dimensions that interact with one-another (e.g. physical and psychological well-being, relationships, autonomy, self-esteem). Here, we used data from the REHABase cohort, which includes N = 2180 patients from 15 psychosocial rehabilitation centers in France, to explore networks of quality-of-life dimensions among six psychiatric disorders: schizophrenia, neurodevelopmental, bipolar, depressive, anxiety, and personality disorders. Stronger connections (edges) involved the Self-Esteem dimension, such as Self-Esteem–Physical Well-Being, Self-Esteem–Autonomy, Self-Esteem–Psychological Well-Being, and Self-Esteem–Resilience. Self-esteem was also consistently retrieved as the most central node (the dimension with the most connections within each network). Between-gr...

Investigating non lexical markers of the language of schizophrenia in spontaneous conversations

Proceedings of the 2nd Workshop on Computational Approaches to Discourse, 2021

We investigate linguistic markers associated with schizophrenia in clinical conversations by dete... more We investigate linguistic markers associated with schizophrenia in clinical conversations by detecting predictive features among Frenchspeaking patients. Dealing with humanhuman dialogues makes for a realistic situation, but it calls for strategies to represent the context and face data sparsity. We compare different approaches for data representation-from individual speech turns to entire conversations-, and data modeling, using lexical, morphological, syntactic, and discourse features, dimensions presumed to be tightly connected to the language of schizophrenia. Previous English models were mostly lexical and reached high performance, here replicated (93.7% acc.). However, our analysis reveals that these models are heavily biased, which probably concerns most datasets on this task. Our new delexicalized models are more general and robust, with the best accuracy score at 77.9%.

Convergent and Concurrent Validity between Clinical Recovery and Personal-Civic Recovery in Mental Health

Journal of Personalized Medicine, 2020

Several instruments have been developed by clinicians and academics to assess clinical recovery. ... more Several instruments have been developed by clinicians and academics to assess clinical recovery. Based on their life narratives, measurement tools have also been developed and validated through participatory research programs by persons living with mental health problems or illnesses to assess personal recovery. The main objective of this project is to explore possible correlations between clinical recovery, personal recovery, and citizenship by using patient-reported outcome measures. All study participants are currently being treated and monitored after having been diagnosed either with (a) psychotic disorders or (b) anxiety and mood disorders. They have completed questionnaires for clinical evaluation purposes (clinical recovery) will further complete the Recovery Assessment Scale and Citizenship Measure (personal-civic recovery composite index). Descriptive and statistical analyses will be performed to determine internal consistency for each of the subscales, and assess converge...

Objectifs et enjeux de l’intervention cognitive en psychologie

Neuropsychologie clinique et appliquée, 2017

L’intervention cognitive est une pratique émergente de plus en plus utilisée par les professionne... more L’intervention cognitive est une pratique émergente de plus en plus utilisée par les professionnels en psychologie. Cependant, la place de l’intervention cognitive en psychologie demeure à l’heure actuelle assez ambiguë. L’Ordre des psychologues du Québec (OPQ) propose une définition de la psychothérapie dans laquelle le terme « cognition » apparaît. Cependant, cette définition ne permet ni de positionner l’intervention cognitive comme étant une psychothérapie, ni de l'insérer dans la liste des interventions non psychothérapeutiques. Le titre de psychothérapeute étant requis pour pratiquer la psychothérapie, ceci amène les psychologues à se questionner au sujet de l’intervention cognitive. Une proposition de définition de l’intervention cognitive et de réponse quant à sa réglementation est examinée dans une perspective neuropsychologique.

Investigation par méthodes d’apprentissage des spécificités langagières propres aux personnes avec schizophrénie (Investigating Learning Methods Applied to Language Specificity of Persons with Schizophrenia)

Nous présentons des expériences visant à identifier automatiquement des patients présentant des s... more Nous présentons des expériences visant à identifier automatiquement des patients présentant des symptômes de schizophrénie dans des conversations contrôlées entre patients et psychothérapeutes. Nous fusionnons l’ensemble des tours de parole de chaque interlocuteur et entraînons des modèles de classification utilisant des informations lexicales, morphologiques et syntaxiques. Cette étude est la première du genre sur le français et obtient des résultats comparables à celles sur l’anglais. Nos premières expériences tendent à montrer que la parole des personnes avec schizophrénie se distingue de celle des témoins : le meilleur modèle obtient une exactitude de 93,66%. Des informations plus riches seront cependant nécessaires pour parvenir à un modèle robuste.

$Research paper thumbnail of Analyse lexicale outill{\'e}e de la parole transcrite de patients schizophr{\`e}nes$

Analyse lexicale outill{\'e}e de la parole transcrite de patients schizophr{\`e}nes

arXiv: Quantitative Methods, 2015

This article details the results of analyses we conducted on the discourse of schizophrenic patie... more This article details the results of analyses we conducted on the discourse of schizophrenic patients, at the oral production (disfluences) and lexical (part-of-speech and lemmas) levels. This study is part of a larger project, which includes other levels of analyses (syntax and discourse). The obtained results should help us rebut or identify new linguistic evidence participating in the manifestation of a dysfunction at these different levels. The corpus contains more than 375,000 words, its analysis therefore required that we use Natural Language Processing (NLP) and lexicometric tools. In particular, we processed disfluencies and parts-of-speech separately, which allowed us to demonstrate that if schizophrenic patients do produce more disfluencies than control, their lexical richness is not significatively different.

The spatial distribution of eye movements predicts the (false) recognition of emotional facial expressions

PLOS ONE, 2021

Recognizing facial expressions of emotions is a fundamental ability for adaptation to the social ... more Recognizing facial expressions of emotions is a fundamental ability for adaptation to the social environment. To date, it remains unclear whether the spatial distribution of eye movements predicts accurate recognition or, on the contrary, confusion in the recognition of facial emotions. In the present study, we asked participants to recognize facial emotions while monitoring their gaze behavior using eye-tracking technology. In Experiment 1a, 40 participants (20 women) performed a classic facial emotion recognition task with a 5-choice procedure (anger, disgust, fear, happiness, sadness). In Experiment 1b, a second group of 40 participants (20 women) was exposed to the same materials and procedure except that they were instructed to say whether (i.e., Yes/No response) the face expressed a specific emotion (e.g., anger), with the five emotion categories tested in distinct blocks. In Experiment 2, two groups of 32 participants performed the same task as in Experiment 1a while exposed ...

Dysfunctional connectivity in posterior brain regions involved in cognitive control in schizophrenia: A preliminary fMRI study

Journal of Clinical Neuroscience, 2020

Dysfunctional connectivity in posterior brain regions involved in cognitive control in schizophre... more

Ecological study of the association between mental illness with human development, income inequalities and unemployment across OECD countries

BMJ Open, 2020

ObjectivesRecent studies have demonstrated worsened mental health in relatively highly developed ... more ObjectivesRecent studies have demonstrated worsened mental health in relatively highly developed countries impacted by social inequalities and unemployment. Here, we investigate (1) whether mental health issues are differently or similarly affected by these social factors and (2) whether their effects on mental health are related or unrelated to each other.SettingAnalysis at the country level among Organization for Economic Cooperation and Development (OECD) countries (n=36). Data on social indicators were collected from OECD and the United Nations Development Programme databases. Data on the prevalence of mental issues were obtained from the Institute for Health Metrics and Evaluation’s Global Burden of Disease study 2017.ParticipantsNo involvement of participants.Primary and secondary outcome measuresUsing linear regression models, we investigated the relative contribution played by human development (as measured by the Human Development Index (HDI)), social inequalities (Gini ind...

Self-stigma in serious mental illness and autism spectrum disorder: Results from the REHABase national psychiatric rehabilitation cohort

European Psychiatry, 2020

Background. Self-stigma is a major issue in serious mental illness (SMI) and is negatively associ... more Background. Self-stigma is a major issue in serious mental illness (SMI) and is negatively associated with patient outcomes. Most studies have been conducted in schizophrenia (SZ). Less is known about self-stigma in other SMI and autism spectrum disorder (ASD). The objectives of this study are: (i) to assess the frequency of self-stigma in a multicentric nonselected psychiatric rehabilitation SMI and ASD sample; and (ii) to investigate the correlates of elevated self-stigma in different SMI conditions and in ASD. Methods. A total of 738 SMI or ASD outpatients were recruited from the French National Centers of Reference for Psychiatric Rehabilitation cohort (REHABase). Evaluations included sociodemographic data, illness characteristics, and standardized scales for clinical severity, quality of life, satisfaction with life, wellbeing, personal recovery, a large cognitive battery, and daily functioning assessment. Results. 31.2% of the total sample had elevated self-stigma. The highest...

Psychiatric advance directives for people living with schizophrenia, bipolar I disorders, or schizoaffective disorders: Study protocol for a randomized controlled trial – DAiP study

BMC Psychiatry, 2019

Background Compulsory admission to psychiatric hospital is rising despite serious ethical concern... more Background Compulsory admission to psychiatric hospital is rising despite serious ethical concerns. Among measures to reduce compulsory admissions, Psychiatric Advance Directives (PAD) are the most promising, with intensive PAD (i.e. facilitated and shared) being the most effective. The aim of the study is to experiment Psychiatric Advance Directives in France. Methods A multicentre randomized controlled trial and qualitative approach conducted from January 2019 to January 2021 with intent-to-treat analysis. Setting Seven hospitals in three French cities: Lyon, Marseille, and Paris. Research assistants meet each participant at baseline, 6 months and 12 months after inclusion for face-to-face interviews. Participants 400 persons with a DSM-5 diagnosis of bipolar I disorder (BP1), schizophrenia (SCZ), or schizoaffective disorders (SCZaff), compulsorily admitted to hospital within the last 12 months, with capacity to consent (MacCAT-CR), over 18 years old, and able to understand French...

28.3 Minimal Self in Schizophrenia: The Time Perspective

Schizophrenia Bulletin, 2018

Background: The feeling of being one continuous individual in time is a natural evidence, which s... more Background: The feeling of being one continuous individual in time is a natural evidence, which seems to be lost for patients with schizophrenia who display 'minimal' or 'bodily' self disorders. The continuity in time is a property of the 'minimal' self and its alteration could disrupt the sense of self. It has long been proposed that patients with schizophrenia experience a breakdown of the experience of time continuity. This proposal relies on the patients' self-reports and the phenomenological analysis of their verbal descriptions. We will discuss to which extent recent experimental evidence supports this proposal and provides insight on the mechanisms underlying the perturbation of the experience of time continuity Methods: We used two original experimental approaches to test the link between the sense of self and time disorders in stabilized patients with schizophrenia and controls. The first relies on the parallel measure of time expectation and minimal self disorders, as evaluated with the EASE (phenomenological scale). Time expectation is indexed by the ability to benefit from the passage of time to react to a visual target: expectation increases with time, leading to shorter reaction times. The second approach consists in asking subjects to evaluate their feeling of control when tapping with a stylus on a virtual surface. The feeling of control is a component of agency, i.e. related to the bodily self. It can be altered even when subjects know the action to be their own, and may thus show alterations in the absence of delusions. In order to test the link between the feeling of control and timing, the haptic feedback (tactile and kinesthetic) was manipulated, with perceptible or imperceptible delays. Results: Both tasks show that patients can expect sensory signals and react to unusual events to some extent: they increase their reaction times after trials with missing targets, and their feeling of control decreases when sensory feedbacks are delayed. However, the patients who feel as not being immersed in the world (EASE) do not benefit from the passage of time, consistent with previous results suggesting that patients have a difficulty to fluently follow the events flow. In the motor task, contrary to controls the patients' feeling of control drops as soon as there is an imperceptible delay in the haptic feedback, and patients have difficulty to adjust sensory anticipation in case of delayed haptic feedback Discussion: The results suggest a link between timing and minimal self disorders. The patients are able to expect well-learned sensory signals. However, the patients with minimal self disorders (altered immersion in the world) display time disorders consistent with a breakdown of time continuity. All patients display disrupted time expectation when events become unusual or uncertain. Expecting events in time helps to link events with one another and thus participates to transform a chain of discontinuous events in a continuous flow. Conversely, fragile time expectations may lead to a sense of discontinuity, which could disrupt perceptions and especially the flow of bodily signals, thus contributing to bodily self disorders.

Exploratory case study of monozygotic twins with 22q11.2DS provides further clues to circumscribe neurocognitive markers of psychotic symptoms

NeuroImage: Clinical, 2019

Variation in facial emotion processing abilities may contribute to variability in penetrance for ... more Variation in facial emotion processing abilities may contribute to variability in penetrance for psychotic symptoms in 22q11.2DS. However, the precise nature of the social cognitive dysfunction (i.e., facial expression perception vs. emotion recognition), the potential additional roles of genetic and environmental variabilities, and consequently the possibility of using this neurocognitive marker in clinical monitoring remain unclear. The present case study aimed at testing the hypothesis that when confounding factors are controlled, the presence of psychotic symptoms in 22q11.2DS is associated, at the individual level, with a neural marker of facial expression perception rather than explicit emotional face recognition. Two monozygotic twins with 22q11.2DS discordant for psychiatric manifestations performed (1) a classical facial emotion labelling task and (2) an implicit neural measurement of facial expression perception using a frequency-tagging approach in electroencephalography (EEG). Analysis of the periodic brain response elicited by a change of facial expression from neutrality indicated that the twin with psychotic symptoms did not detect emotion among neutral faces while the twin without the symptoms did. In contrast, both encountered difficulties labelling facial emotion. The results from this exploratory twin study support the idea that impaired facial expression perception rather than explicit recognition of the emotion expressed might be a neurocognitive endophenotype of psychotic symptoms that could be reliable at a clinical level. Although confirmatory studies should be required, it facilitates further discussion on the etiology of the clinical phenotype in 22q11.2DS.

A reflection upon methods to explore timing in patients with schizophrenia

PsyCh Journal, 2019

Phenomenologists have provided a detailed description of the disorders of the subjective experien... more Phenomenologists have provided a detailed description of the disorders of the subjective experience associated with minimal‐self disorders in patients with schizophrenia. Those patients report a range of distortions of their conscious experiences, including a sense of inner void, confusion between self and others, and, sometimes, a disruption of the sense of time. These reports have been interpreted as distortion of the first‐person perspective and a lack of immersion in the world, associated with a breakdown of the temporal structure of consciousness, and especially a disruption of the sense of time continuity. Further, it has been proposed that these disruptions are based on a difficulty to retain past information and to predict future information, that is, the mechanisms that help to relate events with one another and to reach a sense of time continuity. Experimental psychology results seem to converge to similar conclusions, inasmuch as some results in patients with schizophreni...

An implicit and reliable neural measure quantifying impaired visual coding of facial expression: evidence from the 22q11.2 deletion syndrome

Translational Psychiatry, 2019

Although various psychiatric disorders present with social-cognitive impairment, a measure assess... more Although various psychiatric disorders present with social-cognitive impairment, a measure assessing social-cognitive processes implicitly and reliably, with high selectivity and with enough signal-to-noise ratio (SNR) for individual evaluation of any population at any age, is lacking. Here we isolate a neural marker quantifying impaired visual coding of facial expression in individuals with 22q11.2 deletion syndrome (22q11DS) using frequency-tagging with electroencephalography (EEG). Twenty-two 22q11DS participants and 22 healthy controls were presented with changes of facial expression displayed at low, moderate, and high intensities every five cycles in a stream of one neutral face repeating 6 times per second (i.e., at a 6 Hz base rate). The brain response to expression changes tagged at the 1.2 Hz (i.e., 6 Hz/5) predefined frequency was isolated over occipito-temporal regions in both groups of participants for moderate- and high-intensity facial expressions. Neural sensitivity ...

M32. Impaired Time Prediction as a Mechanism for Agency and Body Ownership Disorders?

Schizophrenia Bulletin, 2017

assessed WSLS by quantifying trial-by-trial choice behavior following wins and losses. Total Win-... more assessed WSLS by quantifying trial-by-trial choice behavior following wins and losses. Total Win-Stay refers to the proportion of times the same deck was chosen immediately after a reward, whereas Total Lose-Shift is the proportion of choice-shifts after receiving a loss. Additionally, Advantageous Win-Stay and Lose-Shift variables were calculated in order to index optimal decision-making on the IGT. Results: Group comparisons revealed that patients demonstrated significantly lower Total Win-Stay rates (t = −3.3, P = .001), but higher Total Lose-Shift rates (t = 2.3, P = .026) compared to controls. This same effect was also seen for Advantageous WSLS rates. Further, patients made more disadvantageous choices, shifted their choices more often, and performed significantly worse on the task overall compared to controls. However, groups did not differ in total number of rewards or losses received. After partialling out the effects of working memory, correlational analyses revealed that for patients, depression and apathy severity were significantly related to lower Total Win-Stay rates, and higher levels of choice-shifting overall. Further, overall performance on the IGT was correlated with WSLS rates for both groups. Conclusion: The results of this study suggest that patients with schizophrenia experience impaired reward-driven decision-making in the context of multiple choices with concurrent gains and losses. This appears to be driven by a reduced propensity for Win-Stay behavior, accompanied by excessive Lose-Shift behavior. With the importance of reward processing and decision-making in generating goal-directed behavior, these findings suggest a potential mechanism contributing to the motivation deficits seen in schizophrenia.

Le centre d'accueil d'évaluation et d'orientation en psychiatrie et en santé mentale

L'Encéphale, 2023

Lettre à la rédaction Le centre d'accueil d'évaluation et d'orientation en psychiatrie et en sant... more

Further validation of the Cognitive Biases Questionnaire for psychosis

BMC Psychiatry

Background Cognitive biases are recognized as important treatment targets for reducing symptoms a... more Background Cognitive biases are recognized as important treatment targets for reducing symptoms associated with severe mental disorders. Although cognitive biases have been linked to symptoms in most studies, few studies have looked at such biases transdiagnostically. The Cognitive Bias Questionnaire for psychosis (CBQp) is a self-reported questionnaire that assesses cognitive biases amongst individuals with a psychotic disorder, as well as individuals with other severe mental disorders. The current study aims to validate a French version of the CBQp and to explore transdiagnostic cognitive biases in individuals with psychotic disorders, individuals with depression, and in healthy controls. Methods The CBQp was translated into French following a protocol based on international standards. Discriminant validity and internal consistency were determined for total score and each subscale score. Confirmatory factor analyses were performed to test construct validity. Finally, cluster analy...

Effect of Psychiatric Advance Directives Facilitated by Peer Workers on Compulsory Admission Among People With Mental Illness

JAMA Psychiatry

; for the DAiP Group IMPORTANCE Reducing the use of coercion in mental health care is crucial fro... more ; for the DAiP Group IMPORTANCE Reducing the use of coercion in mental health care is crucial from a human rights and public health perspective. Psychiatric advance directives (PADs) are promising tools that may reduce compulsory admissions. Assessments of PADs have included facilitation by health care agents but not facilitation by peer workers. OBJECTIVE To determine the efficacy of PADs facilitated by peer workers (PW-PAD) in people with mental disorders. DESIGN, SETTING, AND PARTICIPANTS A multicenter randomized clinical trial was conducted in 7 French mental health facilities. Adults with a DSM-5 diagnosis of schizophrenia, bipolar I disorder, or schizoaffective disorder who had a compulsory admission in the past 12 months and the capacity to consent were enrolled between January 2019 and June 2020 and followed up for 12 months. INTERVENTIONS The PW-PAD group was invited to fill out a PAD form and meet a peer worker who was trained to assist in completing and sharing the form with relatives and psychiatrists. MAIN OUTCOMES AND MEASURES The primary outcome was the rate of compulsory admission at 12 months after randomization. The overall psychiatric admission rate, therapeutic alliance, quality of life, mental health symptoms, empowerment, and recovery outcomes were also investigated. RESULTS Among 394 allocated participants (median age, 39 years; 39.3% female; 45% with schizophrenia, 36% bipolar I disorder, and 19% schizoaffective disorder), 196 were assigned to the PW-PAD group and 198 to the control group. In the PW-PAD group, 27.0% had compulsory admissions compared with 39.9% in the control group (risk difference, −0.13; 95% CI, −0.22 to −0.04; P = .007). No significant differences were found in the rate of overall admissions, therapeutic alliance score, and quality of life. Participants in the PW-PAD group exhibited fewer symptoms (effect size, −0.20; 95% CI, −0.40 to 0.00), greater empowerment (effect size, 0.30; 95% CI, 0.10 to 0.50), and a higher recovery score (effect size, 0.44; 95% CI, 0.24 to 0.65), compared with those in the control group. CONCLUSIONS AND RELEVANCE Peer worker-facilitated PADs are effective in decreasing compulsory hospital admissions and increasing some mental health outcomes (self-perceived symptoms, empowerment, and recovery). Involving peer workers in the completion of PADs supports the current shift of mental health care from substitute decision-making to supported decision-making. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03630822

The central role of self-esteem in the quality of life of patients with mental disorders

Scientific Reports

In psychiatry, recent years have seen a change of focus from a clinician- to a patient-centered p... more In psychiatry, recent years have seen a change of focus from a clinician- to a patient-centered perspective that emphasizes quality of life as a treatment target. As a complex construct, quality of life is composed of multiple dimensions that interact with one-another (e.g. physical and psychological well-being, relationships, autonomy, self-esteem). Here, we used data from the REHABase cohort, which includes N = 2180 patients from 15 psychosocial rehabilitation centers in France, to explore networks of quality-of-life dimensions among six psychiatric disorders: schizophrenia, neurodevelopmental, bipolar, depressive, anxiety, and personality disorders. Stronger connections (edges) involved the Self-Esteem dimension, such as Self-Esteem–Physical Well-Being, Self-Esteem–Autonomy, Self-Esteem–Psychological Well-Being, and Self-Esteem–Resilience. Self-esteem was also consistently retrieved as the most central node (the dimension with the most connections within each network). Between-gr...

Investigating non lexical markers of the language of schizophrenia in spontaneous conversations

Proceedings of the 2nd Workshop on Computational Approaches to Discourse, 2021

We investigate linguistic markers associated with schizophrenia in clinical conversations by dete... more We investigate linguistic markers associated with schizophrenia in clinical conversations by detecting predictive features among Frenchspeaking patients. Dealing with humanhuman dialogues makes for a realistic situation, but it calls for strategies to represent the context and face data sparsity. We compare different approaches for data representation-from individual speech turns to entire conversations-, and data modeling, using lexical, morphological, syntactic, and discourse features, dimensions presumed to be tightly connected to the language of schizophrenia. Previous English models were mostly lexical and reached high performance, here replicated (93.7% acc.). However, our analysis reveals that these models are heavily biased, which probably concerns most datasets on this task. Our new delexicalized models are more general and robust, with the best accuracy score at 77.9%.

Convergent and Concurrent Validity between Clinical Recovery and Personal-Civic Recovery in Mental Health

Journal of Personalized Medicine, 2020

Several instruments have been developed by clinicians and academics to assess clinical recovery. ... more Several instruments have been developed by clinicians and academics to assess clinical recovery. Based on their life narratives, measurement tools have also been developed and validated through participatory research programs by persons living with mental health problems or illnesses to assess personal recovery. The main objective of this project is to explore possible correlations between clinical recovery, personal recovery, and citizenship by using patient-reported outcome measures. All study participants are currently being treated and monitored after having been diagnosed either with (a) psychotic disorders or (b) anxiety and mood disorders. They have completed questionnaires for clinical evaluation purposes (clinical recovery) will further complete the Recovery Assessment Scale and Citizenship Measure (personal-civic recovery composite index). Descriptive and statistical analyses will be performed to determine internal consistency for each of the subscales, and assess converge...

Objectifs et enjeux de l’intervention cognitive en psychologie

Neuropsychologie clinique et appliquée, 2017

L’intervention cognitive est une pratique émergente de plus en plus utilisée par les professionne... more L’intervention cognitive est une pratique émergente de plus en plus utilisée par les professionnels en psychologie. Cependant, la place de l’intervention cognitive en psychologie demeure à l’heure actuelle assez ambiguë. L’Ordre des psychologues du Québec (OPQ) propose une définition de la psychothérapie dans laquelle le terme « cognition » apparaît. Cependant, cette définition ne permet ni de positionner l’intervention cognitive comme étant une psychothérapie, ni de l'insérer dans la liste des interventions non psychothérapeutiques. Le titre de psychothérapeute étant requis pour pratiquer la psychothérapie, ceci amène les psychologues à se questionner au sujet de l’intervention cognitive. Une proposition de définition de l’intervention cognitive et de réponse quant à sa réglementation est examinée dans une perspective neuropsychologique.

Investigation par méthodes d’apprentissage des spécificités langagières propres aux personnes avec schizophrénie (Investigating Learning Methods Applied to Language Specificity of Persons with Schizophrenia)

Nous présentons des expériences visant à identifier automatiquement des patients présentant des s... more Nous présentons des expériences visant à identifier automatiquement des patients présentant des symptômes de schizophrénie dans des conversations contrôlées entre patients et psychothérapeutes. Nous fusionnons l’ensemble des tours de parole de chaque interlocuteur et entraînons des modèles de classification utilisant des informations lexicales, morphologiques et syntaxiques. Cette étude est la première du genre sur le français et obtient des résultats comparables à celles sur l’anglais. Nos premières expériences tendent à montrer que la parole des personnes avec schizophrénie se distingue de celle des témoins : le meilleur modèle obtient une exactitude de 93,66%. Des informations plus riches seront cependant nécessaires pour parvenir à un modèle robuste.

$Research paper thumbnail of Analyse lexicale outill{\'e}e de la parole transcrite de patients schizophr{\`e}nes$

Analyse lexicale outill{\'e}e de la parole transcrite de patients schizophr{\`e}nes

arXiv: Quantitative Methods, 2015

This article details the results of analyses we conducted on the discourse of schizophrenic patie... more This article details the results of analyses we conducted on the discourse of schizophrenic patients, at the oral production (disfluences) and lexical (part-of-speech and lemmas) levels. This study is part of a larger project, which includes other levels of analyses (syntax and discourse). The obtained results should help us rebut or identify new linguistic evidence participating in the manifestation of a dysfunction at these different levels. The corpus contains more than 375,000 words, its analysis therefore required that we use Natural Language Processing (NLP) and lexicometric tools. In particular, we processed disfluencies and parts-of-speech separately, which allowed us to demonstrate that if schizophrenic patients do produce more disfluencies than control, their lexical richness is not significatively different.

The spatial distribution of eye movements predicts the (false) recognition of emotional facial expressions

PLOS ONE, 2021

Recognizing facial expressions of emotions is a fundamental ability for adaptation to the social ... more Recognizing facial expressions of emotions is a fundamental ability for adaptation to the social environment. To date, it remains unclear whether the spatial distribution of eye movements predicts accurate recognition or, on the contrary, confusion in the recognition of facial emotions. In the present study, we asked participants to recognize facial emotions while monitoring their gaze behavior using eye-tracking technology. In Experiment 1a, 40 participants (20 women) performed a classic facial emotion recognition task with a 5-choice procedure (anger, disgust, fear, happiness, sadness). In Experiment 1b, a second group of 40 participants (20 women) was exposed to the same materials and procedure except that they were instructed to say whether (i.e., Yes/No response) the face expressed a specific emotion (e.g., anger), with the five emotion categories tested in distinct blocks. In Experiment 2, two groups of 32 participants performed the same task as in Experiment 1a while exposed ...

Dysfunctional connectivity in posterior brain regions involved in cognitive control in schizophrenia: A preliminary fMRI study

Journal of Clinical Neuroscience, 2020

Dysfunctional connectivity in posterior brain regions involved in cognitive control in schizophre... more

Ecological study of the association between mental illness with human development, income inequalities and unemployment across OECD countries

BMJ Open, 2020

ObjectivesRecent studies have demonstrated worsened mental health in relatively highly developed ... more ObjectivesRecent studies have demonstrated worsened mental health in relatively highly developed countries impacted by social inequalities and unemployment. Here, we investigate (1) whether mental health issues are differently or similarly affected by these social factors and (2) whether their effects on mental health are related or unrelated to each other.SettingAnalysis at the country level among Organization for Economic Cooperation and Development (OECD) countries (n=36). Data on social indicators were collected from OECD and the United Nations Development Programme databases. Data on the prevalence of mental issues were obtained from the Institute for Health Metrics and Evaluation’s Global Burden of Disease study 2017.ParticipantsNo involvement of participants.Primary and secondary outcome measuresUsing linear regression models, we investigated the relative contribution played by human development (as measured by the Human Development Index (HDI)), social inequalities (Gini ind...

Self-stigma in serious mental illness and autism spectrum disorder: Results from the REHABase national psychiatric rehabilitation cohort

European Psychiatry, 2020

Background. Self-stigma is a major issue in serious mental illness (SMI) and is negatively associ... more Background. Self-stigma is a major issue in serious mental illness (SMI) and is negatively associated with patient outcomes. Most studies have been conducted in schizophrenia (SZ). Less is known about self-stigma in other SMI and autism spectrum disorder (ASD). The objectives of this study are: (i) to assess the frequency of self-stigma in a multicentric nonselected psychiatric rehabilitation SMI and ASD sample; and (ii) to investigate the correlates of elevated self-stigma in different SMI conditions and in ASD. Methods. A total of 738 SMI or ASD outpatients were recruited from the French National Centers of Reference for Psychiatric Rehabilitation cohort (REHABase). Evaluations included sociodemographic data, illness characteristics, and standardized scales for clinical severity, quality of life, satisfaction with life, wellbeing, personal recovery, a large cognitive battery, and daily functioning assessment. Results. 31.2% of the total sample had elevated self-stigma. The highest...

Psychiatric advance directives for people living with schizophrenia, bipolar I disorders, or schizoaffective disorders: Study protocol for a randomized controlled trial – DAiP study

BMC Psychiatry, 2019

Background Compulsory admission to psychiatric hospital is rising despite serious ethical concern... more Background Compulsory admission to psychiatric hospital is rising despite serious ethical concerns. Among measures to reduce compulsory admissions, Psychiatric Advance Directives (PAD) are the most promising, with intensive PAD (i.e. facilitated and shared) being the most effective. The aim of the study is to experiment Psychiatric Advance Directives in France. Methods A multicentre randomized controlled trial and qualitative approach conducted from January 2019 to January 2021 with intent-to-treat analysis. Setting Seven hospitals in three French cities: Lyon, Marseille, and Paris. Research assistants meet each participant at baseline, 6 months and 12 months after inclusion for face-to-face interviews. Participants 400 persons with a DSM-5 diagnosis of bipolar I disorder (BP1), schizophrenia (SCZ), or schizoaffective disorders (SCZaff), compulsorily admitted to hospital within the last 12 months, with capacity to consent (MacCAT-CR), over 18 years old, and able to understand French...

28.3 Minimal Self in Schizophrenia: The Time Perspective

Schizophrenia Bulletin, 2018

Background: The feeling of being one continuous individual in time is a natural evidence, which s... more Background: The feeling of being one continuous individual in time is a natural evidence, which seems to be lost for patients with schizophrenia who display 'minimal' or 'bodily' self disorders. The continuity in time is a property of the 'minimal' self and its alteration could disrupt the sense of self. It has long been proposed that patients with schizophrenia experience a breakdown of the experience of time continuity. This proposal relies on the patients' self-reports and the phenomenological analysis of their verbal descriptions. We will discuss to which extent recent experimental evidence supports this proposal and provides insight on the mechanisms underlying the perturbation of the experience of time continuity Methods: We used two original experimental approaches to test the link between the sense of self and time disorders in stabilized patients with schizophrenia and controls. The first relies on the parallel measure of time expectation and minimal self disorders, as evaluated with the EASE (phenomenological scale). Time expectation is indexed by the ability to benefit from the passage of time to react to a visual target: expectation increases with time, leading to shorter reaction times. The second approach consists in asking subjects to evaluate their feeling of control when tapping with a stylus on a virtual surface. The feeling of control is a component of agency, i.e. related to the bodily self. It can be altered even when subjects know the action to be their own, and may thus show alterations in the absence of delusions. In order to test the link between the feeling of control and timing, the haptic feedback (tactile and kinesthetic) was manipulated, with perceptible or imperceptible delays. Results: Both tasks show that patients can expect sensory signals and react to unusual events to some extent: they increase their reaction times after trials with missing targets, and their feeling of control decreases when sensory feedbacks are delayed. However, the patients who feel as not being immersed in the world (EASE) do not benefit from the passage of time, consistent with previous results suggesting that patients have a difficulty to fluently follow the events flow. In the motor task, contrary to controls the patients' feeling of control drops as soon as there is an imperceptible delay in the haptic feedback, and patients have difficulty to adjust sensory anticipation in case of delayed haptic feedback Discussion: The results suggest a link between timing and minimal self disorders. The patients are able to expect well-learned sensory signals. However, the patients with minimal self disorders (altered immersion in the world) display time disorders consistent with a breakdown of time continuity. All patients display disrupted time expectation when events become unusual or uncertain. Expecting events in time helps to link events with one another and thus participates to transform a chain of discontinuous events in a continuous flow. Conversely, fragile time expectations may lead to a sense of discontinuity, which could disrupt perceptions and especially the flow of bodily signals, thus contributing to bodily self disorders.

Exploratory case study of monozygotic twins with 22q11.2DS provides further clues to circumscribe neurocognitive markers of psychotic symptoms

NeuroImage: Clinical, 2019

Variation in facial emotion processing abilities may contribute to variability in penetrance for ... more Variation in facial emotion processing abilities may contribute to variability in penetrance for psychotic symptoms in 22q11.2DS. However, the precise nature of the social cognitive dysfunction (i.e., facial expression perception vs. emotion recognition), the potential additional roles of genetic and environmental variabilities, and consequently the possibility of using this neurocognitive marker in clinical monitoring remain unclear. The present case study aimed at testing the hypothesis that when confounding factors are controlled, the presence of psychotic symptoms in 22q11.2DS is associated, at the individual level, with a neural marker of facial expression perception rather than explicit emotional face recognition. Two monozygotic twins with 22q11.2DS discordant for psychiatric manifestations performed (1) a classical facial emotion labelling task and (2) an implicit neural measurement of facial expression perception using a frequency-tagging approach in electroencephalography (EEG). Analysis of the periodic brain response elicited by a change of facial expression from neutrality indicated that the twin with psychotic symptoms did not detect emotion among neutral faces while the twin without the symptoms did. In contrast, both encountered difficulties labelling facial emotion. The results from this exploratory twin study support the idea that impaired facial expression perception rather than explicit recognition of the emotion expressed might be a neurocognitive endophenotype of psychotic symptoms that could be reliable at a clinical level. Although confirmatory studies should be required, it facilitates further discussion on the etiology of the clinical phenotype in 22q11.2DS.

A reflection upon methods to explore timing in patients with schizophrenia

PsyCh Journal, 2019

Phenomenologists have provided a detailed description of the disorders of the subjective experien... more Phenomenologists have provided a detailed description of the disorders of the subjective experience associated with minimal‐self disorders in patients with schizophrenia. Those patients report a range of distortions of their conscious experiences, including a sense of inner void, confusion between self and others, and, sometimes, a disruption of the sense of time. These reports have been interpreted as distortion of the first‐person perspective and a lack of immersion in the world, associated with a breakdown of the temporal structure of consciousness, and especially a disruption of the sense of time continuity. Further, it has been proposed that these disruptions are based on a difficulty to retain past information and to predict future information, that is, the mechanisms that help to relate events with one another and to reach a sense of time continuity. Experimental psychology results seem to converge to similar conclusions, inasmuch as some results in patients with schizophreni...

An implicit and reliable neural measure quantifying impaired visual coding of facial expression: evidence from the 22q11.2 deletion syndrome

Translational Psychiatry, 2019

Although various psychiatric disorders present with social-cognitive impairment, a measure assess... more Although various psychiatric disorders present with social-cognitive impairment, a measure assessing social-cognitive processes implicitly and reliably, with high selectivity and with enough signal-to-noise ratio (SNR) for individual evaluation of any population at any age, is lacking. Here we isolate a neural marker quantifying impaired visual coding of facial expression in individuals with 22q11.2 deletion syndrome (22q11DS) using frequency-tagging with electroencephalography (EEG). Twenty-two 22q11DS participants and 22 healthy controls were presented with changes of facial expression displayed at low, moderate, and high intensities every five cycles in a stream of one neutral face repeating 6 times per second (i.e., at a 6 Hz base rate). The brain response to expression changes tagged at the 1.2 Hz (i.e., 6 Hz/5) predefined frequency was isolated over occipito-temporal regions in both groups of participants for moderate- and high-intensity facial expressions. Neural sensitivity ...

M32. Impaired Time Prediction as a Mechanism for Agency and Body Ownership Disorders?

Schizophrenia Bulletin, 2017

assessed WSLS by quantifying trial-by-trial choice behavior following wins and losses. Total Win-... more assessed WSLS by quantifying trial-by-trial choice behavior following wins and losses. Total Win-Stay refers to the proportion of times the same deck was chosen immediately after a reward, whereas Total Lose-Shift is the proportion of choice-shifts after receiving a loss. Additionally, Advantageous Win-Stay and Lose-Shift variables were calculated in order to index optimal decision-making on the IGT. Results: Group comparisons revealed that patients demonstrated significantly lower Total Win-Stay rates (t = −3.3, P = .001), but higher Total Lose-Shift rates (t = 2.3, P = .026) compared to controls. This same effect was also seen for Advantageous WSLS rates. Further, patients made more disadvantageous choices, shifted their choices more often, and performed significantly worse on the task overall compared to controls. However, groups did not differ in total number of rewards or losses received. After partialling out the effects of working memory, correlational analyses revealed that for patients, depression and apathy severity were significantly related to lower Total Win-Stay rates, and higher levels of choice-shifting overall. Further, overall performance on the IGT was correlated with WSLS rates for both groups. Conclusion: The results of this study suggest that patients with schizophrenia experience impaired reward-driven decision-making in the context of multiple choices with concurrent gains and losses. This appears to be driven by a reduced propensity for Win-Stay behavior, accompanied by excessive Lose-Shift behavior. With the importance of reward processing and decision-making in generating goal-directed behavior, these findings suggest a potential mechanism contributing to the motivation deficits seen in schizophrenia.

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