; for the ODEX team IMPORTANCE There is a high prevalence of obesity in psychiatric patients, possibly leading to metabolic complications and reducing life expectancy. The CREB-regulated transcription coactivator 1 (CRTC1) gene is involved in energy balance and obesity in animal models, but its role in human obesity is unknown. OBJECTIVE To determine whether polymorphisms within the CRTC1 gene are associated with adiposity markers in psychiatric patients and the general population. DESIGN, SETTING, AND PARTICIPANTS Retrospective and prospective data analysis and population-based samples at Lausanne and Geneva university hospitals in Switzerland and a private clinic in Lausanne, Switzerland. The effect of 3 CRTC1 polymorphisms on body mass index (BMI) and/or fat mass was investigated in a discovery cohort of psychiatric outpatients taking weight gain-inducing psychotropic drugs (sample 1, n = 152). The CRTC1 variant that was significantly associated with BMI and survived Bonferroni corrections for multiple comparison was then replicated in 2 independent psychiatric samples (sample 2, n = 174 and sample 3, n = 118) and 2 white population-based samples (sample 4, n = 5338 and sample 5, n = 123 865). INTERVENTION Noninterventional studies. MAIN OUTCOME AND MEASURE Difference in BMI and/or fat mass between CRTC1 genotype groups. RESULTS Among the CRTC1 variants tested in the first psychiatric sample, only rs3746266A>G was associated with BMI (P adjusted = .003). In the 3 psychiatric samples, carriers of the rs3746266 G allele had a lower BMI than noncarriers (AA genotype) (sample 1, P = .001; sample 2, P = .05; and sample 3, P = .0003). In the combined analysis, excluding patients taking other weight gain-inducing drugs, G allele carriers (n = 98) had a 1.81-kg/m 2 lower BMI than noncarriers (n = 226; P < .0001). The strongest association was observed in women younger than 45 years, with a 3.87-kg/m 2 lower BMI in G allele carriers (n = 25) compared with noncarriers (n = 48; P < .0001), explaining 9% of BMI variance. In the population-based samples, the T allele of rs6510997C>T (a proxy of the rs3746266 G allele; r 2 = 0.7) was associated with lower BMI (sample 5, n = 123 865; P = .01) and fat mass (sample 4, n = 5338; P = .03). The strongest association with fat mass was observed in premenopausal women (n = 1192; P = .02). CONCLUSIONS AND RELEVANCE These findings suggest that CRTC1 contributes to the genetics of human obesity in psychiatric patients and the general population. Identification of high-risk subjects could contribute to a better individualization of the pharmacological treatment in psychiatry.

This cross-sectional survey adopting a multiple-informant perspective explores the factors that influence perceived quality (i.e., therapeutic alliance and satisfaction) in an outpatient setting within child and adolescent mental health services (CAMHS). A total of 1433 participants (parents, n = 770, and patients, n = 663) attending or having attended (drop-out) outpatient units participated in the study. The outcome measures were satisfaction (Client Satisfaction Questionnaire) and the therapeutic alliance (Helping Alliance Questionnaire). The determinants of these quality indicators were socio-demographic variables (e.g., age, gender, and mother's socio-economic status), factors related to the extent of difficulties (number of reasons for the consultation, number of people who referred the child to the CAMHS), the approach to treatment at outset (agreeing to the consultation, feeling reassured at the first appointment), the organizational friendliness (secretary, waiting room, waiting time for the first appointment) and the organization of the therapy (frequency of sessions, time for questions, change of therapist). The approach to treatment at outset, accessibility by phone, satisfaction with the frequency of the sessions and having enough time for questions were the factors that consistently explain the quality indicators from both perspectives (patients and parents). In contrast, the socio-demographic variables as well as the extent of difficulties and factors related to the organizational friendliness and the organization of the therapy (frequency of sessions, change of therapist) were not related to the quality indicators. This study identifies key determinants of the quality indicators from the perspective of patients and parents that should be considered to improve CAMHS care quality. First appointments should be carefully prepared, and clinicians should centre care on the needs and expectations of patients and parents.

ACT appears as a feasible intervention for hard-to-engage adolescents suffering from psychiatric disorders. The intervention seems to improve their mental health and functioning. This pilot study may serve as a basis to prepare a controlled study that will also take the costs of the intervention into account.

CACR can be successfully administered in this population; it proved to be effective over and above CG for the most intensively trained cognitive ability.

Objective: To investigate short-term outcomes of a computer-assisted cognitive remediation (CACR) for adolescents with psychotic disorders or at high risk for psychosis. Method: Cognitive abilities and clinical status were assessed at baseline (N = 32) and at 6-month follow-up (N = 22) after enrolment in either a CACR (treatment group) or a computer games (control group) program (8 weeks). Results: With regard to the cognitive abilities, no amelioration was found in the control group while, in the CACR group, significant improvements in inhibition (p = 0.040) and reasoning (p = 0.005) were observed. Furthermore, symptom severity decreased significantly in the control group (p = 0.046) and marginally in the CACR group (p = 0.088). Improvements in cognitive abilities were not associated with symptoms' amelioration. Finally, increase in reasoning abilities was related to the median effective work time in sessions of CACR (R = 0.64, p = 0.024). Conclusion: At follow-up, enhanced cognitive abilities (reasoning and inhibition), which are necessary for executing higher-order goals or adapting behaviour to the ever-changing environment, were reported in adolescents participants of the CACR. Thus, further studies are needed to confirm and extend these interesting results.