Mood disorder after malaria prophylaxis with mefloquine (two case reports)

Introduction

Mefloquine (Lariam) is the drug of choice as malaria prophylaxis for travel to chloroquine-resistant areas. Severe neuropsychiatric side effects are rare. We report two clinical cases of mood disorders: mania and a major depressive episode with psychotic characteristics in two patients with mefloquine antimalarial prophylaxis.

First clinical case

A 31-year-old man had taken mefloquine at a rate of 250 mg/week as malaria prophylaxis for his mission in Democratic Republic of Congo. He developed mania with psychotic symptoms after taking five tablets of 250 mg of mefloquine. He exhibited an elevated mood and also developed delusions of grandeur, reference and persecution, with auditory hallucinations. The physical examination and the blood laboratory tests were normal. The patient was treated with an atypical neuroleptic (olanzapine 20 mg/d) leading to a complete resolution of symptomatology at the end of 3 weeks.

Second clinical case

A 27-year-old man presented a major depressive episode with psychotic symptoms after 1 week on his return from a stay in Democratic Republic of Congo, where he had taken mefloquine during 6 months as malaria prophylaxis (250 mg/week). His physical examination and investigations (full blood test, serology and MRN) were normal. The patient was treated with clomipramine (150 mg/d) and olanzapine (20 mg/d). The outcome was favorable after 4 weeks.

Discussion

Mefloquine is widely accepted as a safe and effective treatment and a prophylactic agent for chlorquine-resistant malaria. Common neuropsychiatric adverse effects of mefloquine can occur in up to 40% of patients, such as dizziness, sleep disturbances, anorexia, ataxia, and fatigue. Other more serious adverse reactions are rare. They are represented primarily by panic attacks, convulsions, acute psychosis, paranoid delusions, suicidal ideation, disorders of mood: major depressive episode and the manic excitation. The incidence of such neuropsychiatric effects is 1/10,000 to 1/15,000 during the prophylactic treatment. The causal mechanism for the side effects is not known. Several risk factors increasing the neurotoxicity of mefloquine can be identified, the patient with personal or family history of psychiatric disorders are more frequently concerned. Alcohol and the association with other drugs (like quinine) are two other risk factors.

Conclusion

It is relevant for medical practitioners to be aware of the severe neuropsychiatric side effects of mefloquine as malaria prophylaxis. It requires investigation of the risk factors such as personal or family history of psychiatric disorders.     

Spouses and bipolar disorder

Objective

To assess the quality of life of a population of spouses of bipolar patients compared with a control population.

Patients and methods

We conducted a cross-sectional study which included two groups: a group of 30 spouses of patients followed for bipolar I disorder according to DSM IV criteria and a second group of 30 subjects from the general population. Both groups were matched by age, sex, marital status and socioeconomic level. This device was designed to limit the differences between the two groups solely those of the bipolar illness. Evaluating the quality of life was achieved using the quality of life scale: SF-36. This is a scale that has already been translated and validated in dialect Arabic.

Results

Regarding sociodemographic variables, the two study groups differed only for: recreation, friendly relations and the couple relationship that included more and better skills among the control group. In the categorical approach, the quality of life was impaired in 60% of spouses and 40% of controls with a statistically significant difference. The following standardized dimensions: mental health (D4), limitation due to mental health (D5), life and relationship with others (D6) and perceived health (D8) and mental component (CM) were significantly altered in patients’ spouses compared to controls. We found significant differences between the two groups for: overall average score (51.1 vs. 68.2), mental health (D4), limitation due to mental health (D5), life and relationship with others (D6), perceived health (D8) and perceived health (D8) standards.

Discussion

The impairment of quality of life of bipolar patients’ spouses is related to the extra responsibility, stress, financial problems and health problems, stigma, and loss of security of the person loved.

Conclusion

Considering the consequences that the appearance of bipolar disorder on the patient's spouse may have, certain measures must be proposed to improve their quality of life.     

Les antiépileptiques dans le traitement préventif de la migraine de l’enfant

Migraine, according to the criteria of the International Headache Society, occurs in about 5 to 10% of children and adolescents. Pediatric migraine can cause a significant impact on quality of life. As stated by the American Academy of Neurology and Child Neurology Society's migraine guidelines, situations for prophylaxis consideration include recurring migraines that significantly interfere with daily activities, despite acute therapy; frequent headaches; contraindication, overuse, or failure of acute therapy; adverse reactions to acute therapy; cost of acute and preventive therapies; patient preferences; and presence of uncommon migraine conditions. Preventive therapy may be warranted in as many as 30% of young patients with migraine seen in tertiary headache centers. Headache related disability can be measured by scoring systems such as the Pediatric Migraine Disability Assessment Scale. Numerous medications have been studied to prevent migraines in children, including antihistamines, antidepressants, and antihypertensive agents. However, few high quality clinical trials actually demonstrate efficacy in this population. Recently, many studies dealt with the use of antiepileptic drugs in this indication but there is a paucity of placebo controlled studies. Both topiramate (TPM) and divalproex sodium have been studied in a randomized-controlled study. Only TPM showed efficacy, though, clearly, further controlled trials are needed to confirm these data. Besides unproven efficacy, adverse effects of valproic acid, such as weight gain, somnolence, and alopecia may limit its use. Additional studies are warranted before recommending levetiracetam (LVT), zonisamide (ZNS) and gabapentin (GBP) agents for migraine prophylaxis in children and adolescents.     

Fonctionnement de la mémoire chez les sujets avec autisme

Introduction

Autism is an early developmental disorder with cognitive impairments that leads to learning and social integration disabilities. The characterization of memory functions in individuals with autism has been the subject of numerous investigations, with widely varying conclusions. The notable differences between these studies can be attributed to variations in the age, intelligence and level of severity of the participants with autism.

Literature findings

The purpose of our review of the recent literature is to describe the memory function of individuals with autism. Some of the different memory subtypes are intact, others are impaired. Short-term memory (digit span) is not impaired while working memory is impaired in some of its components, but the findings are inconsistent. More recent studies demonstrate reduced spatial working memory abilities in autism and extend previous findings by demonstrating that these deficits are significant when tasks impose heavier demands on working memory. Episodic long-term memory, as measured by free recall, cued recall or recognition tasks, is intact, but participants with autism perform significantly less well than controls as the complexity of the verbal or visual material to be recalled increases. Source or contextual memory involves a variety of characteristics specifying the conditions under which specific items or facts are acquired: it has been investigated in individuals with autism with different methods. Deficits in source memory for temporal information have been found, but there were no reality monitoring deficits. Recent findings indicate that the nature of source memory confusion in autism does not appear to reflect a generalized deficit in attaching context to memories, but rather is dependant on the specific to-be-remembered information that involves social aspects of context. The self-reference effect is missing, with individuals with autism recalling events performed by themselves less well than the events performed by a peer, suggesting they have difficulties in relation to processes involving the self. Studies involving assessment of subjective states of awareness during recognition show less conscious recollection and more feelings of familiarity. Recent investigations are consistent in demonstrating memory impairments related to the failure of subjects with autism to use organizing strategies or meaning to support memory, an effect which grows with the increasing complexity of the material. Memory deficits in autism may be related more to retrieval and less to encoding, as deficit in source memory in participants with autism is largely eliminated when source was supported at test.

Discussion

The neuroanatomical basis of the specificities of memory impairment in autism is still uncertain, but it is suggested that autism involves an impairment in the conversion of limbic inputs into medial prefrontal outputs. Memory deficits found in individuals with autism may explain some of the clinical symptoms. Failure to encode all the information, especially its social aspects, may therefore contribute to dysfunction in the social, communication, and reasoning domains. Abnormal memory functioning in autism is also related to more general cognitive impairments, including executive function deficits and central coherence weakness. Evidence of the normality of certain memory capacities, at least in individuals with moderate autistic symptomatology, is encouraging for adaptive improvements in cognitive functioning.     

Délires de reduplication mnésique : connaissance de soi et perplexité identitaire

Objective

An inconsistency in the sense of self does not necessarily follow from a deficit of autobiographical memory.

Patients and methods

We report two cases of memory reduplication with delusion, one concerning an event reduplication memory, the other one a spatial reduplication memory.

Results

The first patient, J.M., presents with a confusion of identity, which forces him to search for some evidence in his imaginary memory. The second patient, R.B., remembered having juxtaposed two separate geographical sites, became aware of his false conviction, and finally attempted to find explanations for this perceptual illusion.

Conclusion

Impairment of self-knowledge can be caused not only by a memory deficit, but also by a difficulty of subject to incorporate an imaginary history in his memory (narrative identity), particularly when reality is not coherent with the imaginary history.     

Art-thérapie

Art-therapy came after psychopathology of expression. Its indications are now beyond psychiatry. It's a project of care, and life. It needs a frame and an organisation. Its orientations may be individual creation, or psychotherapy.     

Syndrome démentiel dans les suites d’une bipolarité

Introduction

Converging evidence suggests that people with bipolar disorder (BPD) exhibit persistent cognitive impairment independently from the emotional state. In old age BPD, the cognitive decline is more severe and can fulfill the criteria of dementia. However, the characteristics of bipolar disorder dementia are still unknown.

Aim of the study

The aim of the study was to characterise the cognitive and imaging profile of the dementia following bipolar disorder.

Method

Patients fulfilling criteria of dementia and followed-up in the memory unit for at least two years were included. Patients with substance abuse were excluded. A battery of specific (assessing verbal memory, attention, frontal executive function, construction and visuospatial impairment), and global (MMSE and Mattis dementia rating scale) neuropsychological tests, behavioural assessment using the frontotemporal behavioural scale, MRI and HMPAO–SPECT imaging were performed in all patients during euthymic state.

Results

We included 13 patients with bipolar disorder (9W/4M). The mean age was 70.8 years (±7.7). Dementia began in average 29.2 years (±10.1) after the onset of the bipolar disorder. The mean score of MMSE was 24.0 (±4.3). The mean score of the Mattis dementia rating scale was 122.5 (±8.9). After an average of 6.1 years (±2.8) of follow-up, the mean score of MMSE was 23.5 (±3.2). The annual MMSE score decrease was of 0.5 (±4.4) per year. In more than 75% of the patients, Trail-Making Test-part B, Go-nogo test, Stroop test, delayed free recall in verbal explicit long-term memory test, category fluency tasks and code test were impaired. In more than 50% of patients, free recall, delayed cued recall, clock test, visuospatial battery and temporal orientation were impaired. On the other hand, spatial orientation and recognition were within the standards. The mean of the BREF score was 10.6 (±3.2). A moderate frontal behavioural syndrome was observed, but never persistent hallucinations. Seven patients had been treated with lithium and seven with antipsychotics, but none during the neurological assessment. Moderate extrapyramidal signs were reported in 10 patients, of which the seven patients treated in the past with antipsychotics. MRI showed no focal atrophy and no vascular lesions. Functional imaging conducted in 10 patients always showed uptake decrease in the frontotemporal regions and sometimes in the parietal region too. After six years of follow-up, no patient fulfilled the probable criteria for the main dementia, Alzheimer disease, vascular dementia, frontotemporal dementia and dementia with Lewy bodies.

Conclusion

The data of this study support a possible specific dementia postbipolar disorder and not only mild cognitive decline. This hypothesis could be tested in a prospective study. Such dementia could be a main differential diagnosis from long lasting frontotemporal dementia. The pathogenic process of this dementia could also be determined.     

Depression and professional activity: results of the NEXTEP study

Background

Depression is one of the most common diseases. It is associated with a significant psychosocial disability and many studies have shown that it results in numerous sick-leaves, with substantial economic burden. However, most of the studies have been conducted in Northern Europe and the situation in France remains unknown.

Objectives

To describe the management of depressive patients and assess the impact of treatment on professional activity and sick-leave.

Methods

An epidemiological observational longitudinal study (NEXTEP) performed by TNS Healthcare in private practice psychiatrists.

Results

Data of 2516 patients included by 771 psychiatrists were analyzed. Patients aged 20 to 60 years, with professional activity and presenting with major depression were eligible if they were prescribed an antidepressant drug for the first time by this psychiatrist on the day of consultation. Women represented 65% of the cohort. Mean MADRS score at baseline was 34 ± 7.7/60 and 47% of patients had a severe depression; only 5% had mild depression. Professional activity was impaired in 95% of cases. A sick-leave certificate was granted to 35% of the patients at the end of the first visit (first sick-leave or renewal in 14% and 21% of cases, respectively), and 100% were prescribed a pharmacological treatment (antidepressant agent). After 2 months, MADRS scores had dramatically decreased (−21 points on average) and 50% of the patients were symptom free. Most patients (75%) perceived improvement in working capacity; only 13% of patients received a sick-leave certificate. Escitalopram was associated with a significantly greater improvement in depressive symptoms, along with a significantly lower number and duration of sick-leave certificates. In multivariate analysis, predictors of depression improvement were decreased in anxiety, improved in self-esteem, and escitalopram treatment.

Discussion

Frequency and duration of sick-leave appear lower than in other studies, notably those conducted in Scandinavian countries. However, employment laws are different, which may influence the physicians’ attitudes.

Conclusion

This study is the first that accurately describes the management of depressive patients and the impact of treatment on professional activity and sick-leave in France. It suggests that an appropriate management of depressive patients results in a rapid improvement of symptoms and work resumption in most cases.     

Insight et qualité de vie subjective chez les personnes souffrant de schizophrénie

The evaluation of subjective quality of life constitutes one of the indicators of the health conditions of the patients suffering from schizophrenia. The relations between insight and quality of life are contradictory in the literature. These differences can be explained by several factors: populations of studies, instruments of the insight and/or quality of life very diverse and often not very valid, factors of confusion. Among the factors of confusion, it seems that the cognitive disorders play a central role as certain studies show it. There remains however difficult to know how these various factors interact between them.     

Management, needs and expectations of patients suffering from bipolar I disorders (The ECHO study - France)

Aim

The ECHO study is the first French study directly asking patients with bipolar I disorders on the history and experiences of their disease, their perceptions of care, their sociofamilial relationships, and their expectations regarding what should be done by healthcare professionals and their environment.

Method

Three hundred euthymic patients suffering from bipolar disorder I were interviewed using a semi-standardized evaluation through telephone interviews. These patients were selected according to the quota method of nationally representative INSEE 99 to be representative of the French population.

Results

Ninety-nine percent of patients consulted at least once for psychological signs before the correct diagnosis was established. The average age at the time of diagnosis was of 30.1 years (±11.3). The average time between first consultation for psychological symptoms and diagnosis is about 5 years. In 92% of cases, the psychiatrist is the health professional that made the diagnosis; 74% of patients were also followed by a general practitioner. One hundred percent of participants had been hospitalized for manic episodes (criterion for inclusion in the study) and 86% were also hospitalized for depressive symptoms. The experience of hospitalization is positive (feeling of security for 84% of the sample, feelings of being helped for 81% of the sample), although these experiences are also associated with the perception of confinement (52% of the sample). At the time of the interview, 97% of these patients were followed by one or more health professionals. Only 34% of these patients were taking a mood stabilizer (lithium, anticonvulsant or atypical antipsychotic with indications in France for bipolar disorder), while 44% were taking an antidepressant and 38% were taking anxiolytics; 84% of patients had experienced side effects related to their current treatment. Acceptance of the disease is difficult and only 56% of patients personally feel they suffer from bipolar disorders. Patients believe that their mental health problems have a significant impact on their lives, including impact on their self-esteem and happiness. Relationships with family, friends but also sexual relations are affected. Even in the euthymic phase, 44% of patients have difficulties in their daily tasks. Three quarters of patients said they had already experienced rejection or discrimination related to their disease. Finally, patients gave a score of 6.4 out of 10 to assess the impact of the disorder on their quality of life. Patients request more dialogue with health professionals and a more personalized treatment, taking into account side effects. They also want more information on the treatment. They would also like to be supported, together with their families, and advised on how to cope with the disease.     

Therapeutic advances in pharmaceutical treatment of neuropathic pain

Neuropathic pain is difficult to treat. Recommended first-line treatments include tricyclic antidepressants and alpha2delta agonists pregabalin and gabapentin for multiple neuropathic conditions, the antidepressants duloxetine and venlafaxine in diabetic painful neuropathies and lidocaine patches for postherapetic neuralgia. Therapeutic prospects include focal therapy with sustained analgesic efficacy (capsaicin patches, botulinum toxin), treatments acting on new targets (i.e., cytokine inhibitors, metabotropic glutamate inhibitors, TRPV1 antagonists). The methodology of clinical trials also tends to take better into account the symptomatic profiles of patients, which should contribute to better prediction or responders to treatment.     

La psychothérapie dynamique dans la pratique psychiatrique : est-ce efficace ?

With the emergence of evidence-based medicine, the place of psychodynamic therapy in psychiatric practice has been questioned in recent years. This article proposes a critical review of the scientific literature on efficacy and effectiveness of brief, long-term dynamic psychotherapy and psychoanalysis in the context of psychiatric health services. An electronic search of Medline and Psychinfo was done with relevant keywords on the topic. An overview of the efficacy of psychodynamic approaches is then provided for various disorders of axis I and axis II according to the DSM-IV. The assessment of the efficacy and effectiveness of brief, long-term dynamic psychotherapy and psychoanalysis has substantially progressed in recent years. While some gaps remain to be filled in this area, it seems that psychodynamic approaches, especially brief dynamic therapy, have a comparable efficacy with other commonly used approaches.     

Validation study of the French schizotypal personality questionnaire in a sample of adolescents: a confirmatory factor analysis

Aims

This article aims to validate the schizotypal personality questionnaire in a sample of French speaking adolescents. Because early schizotypal manifestations are predictive of psychosis-proneness, reliable self-report measures are crucial for early detection of vulnerability to schizophrenia during adolescence. Unlike most existing self-reports, the questionnaire de personnalité schizotypique (SPQ) assesses individual differences in all nine feature of DSM-IV schizotypal personality (i.e. ideas of reference, excessive social anxiety, odd beliefs, unusual perceptual experience, odd behaviour, no close friends, odd speech, constricted affect and suspiciousness). Furthermore, it yields dimensional scores concerning the main schizotypal factors, which represent valuable information for the clinician's case formulation and can be used as a screening instrument in the general population.

Method

Our sample consisted of 174 adolescents (98 girls) between 12 and 17 years old. All completed the SPQ 74-item self-report. Participants were recruited in secondary schools in Switzerland, and through the child and adolescent community outpatient psychiatric service (office médico-pédagogique) affiliated to the University of Geneva's Psychiatry Department and to the Canton of Geneva Education Department. A confirmatory factorial analysis was conducted on our sample to test nine competing models of SPQ. The 3-factor model of Raine et al. was compared to concurrent 2, 3, and 4-factor models. Simple structure models of Raine et al. and Stefanis et al. were also tested.

Results

The following observations were highlighted in our results: (1) goodness-of-fit indices are better for structures allowing cross loadings than for simple structures; (2) amongst the simple structures, the best goodness-of-fit index was obtained for the Raine model and (3) the fit between our data and the Raine model is improved by a cross loading for suspiciousness subscale. The latter seems problematic for the global data fitting. This led us to test simple structures models of Siever and Gunderson, Raine et al., and Stefanis et al., based on eight subscales rather than nine. Without suspiciousness subscale, goodness-of-fit indices are enhanced in these three models. The 3-factor model yields the clearest and most reliable results in comparison with other competing models. In summary, the best goodness-of-fit indices were obtained for the 3-factor Raine model. Goodness-of-fit indices could be improved by the exclusion of the suspiciousness scale.

Conclusions

Consistent with earlier analyses by Raine et al. and Dumas et al., our data confirm the 3-factor model of the SPQ (cognitive-perceptive; interpersonal; disorganized) in a sample of French speaking adolescents. Our analyses confirm that two dimensions are insufficient to explain the structure of schizotypy during adolescence. These results further suggest the stability of a 3-factor structure during lifespan. We note that the inclusion of the suspiciousness subscales engenders statistical issues. Most studies to date have dealt with these issues by performing a cross-loading with this subscale, or by the inclusion of a paranoid factor which is linked with the negative and the cognitive-perceptive factors. We found that the most statistically sound strategy was reached without the inclusion of the suspiciousness subscale. Future studies with larger samples could investigate the SPQ structure at an item-level, which carries the benefit of reduced restrictions on the factorial analysis. In conclusion, the current study shows that the French version SPQ constitutes a reliable self-report questionnaire for the assessment of schizotypal trait expression during adolescence that may assist in the evaluation of psychosis proneness in youths.     

Apport des approches inspirées de la neuropsychologie au diagnostic d’autisme chez l’adulte : une étude de cas

Given that autism spectrum disorders are highly heterogeneous in their clinical presentation, diagnostic assessment in adults, whose symptoms may be complicated by the presence of various comorbidities and developmental trajectories, is not easily practiced in a clinical psychiatric setting. The present study aims at describing diagnostic assessments inspired by current research on cognition in autism. Core cognitive traits, such as theory of mind, executive function and weak central coherence, thought to be endophenotypic traits, are analyzed. Moreover, the utility of screening scales, constructed on the basis of these cognitive traits, is discussed. We describe the case of a 29-year-old French man, referred by his occupational physician, due to the onset of anxiety attacks in his workplace. During the first outpatient psychiatric assessment, he seemed inhibited, and revealed that social situations fueled his anxiety attacks. He was therefore diagnosed with personality avoidance disorder, depression and social anxiety. Although depression and anxiety decreased after Buspirone and Milnacipran were prescribed, some clinical symptoms, such as lack of interest in social situations, ritualized behavior, narrow specific interests (i.e., astronomy, history), and a very good memory for factual information, remained. According to the patient, these symptoms appeared during his infancy. These symptoms, consistent with Asperger Syndrome diagnosis, led to the administration of two screening scales: the Autism Quotient (AQ) and the Empathy Quotient (EQ). The results obtained in these scales were consistent with Asperger Syndrome diagnosis. They indicated the presence of qualitative difficulties in social interactions, a lack of spontaneous empathy and attention switching, among other behaviors. À comprehensive diagnostic assessment was then proposed. The Diagnostic Interview for Social and Communication disorders (DISCO), a semi-structured interview with parents, was used in order to gather developmental and behavioral information. A neuropsychological assessment was conducted with the patient. Both assessments revealed developmental and neurocognitive particularities consistent with Asperger Syndrome diagnosis. Among these cognitive traits, (i) episodic memory peculiarities, such as idiosyncratic encoding and retrieval strategies and impaired encoding of complex visual stimuli (ii) absence of significant difference between the verbal and the performance scales of the WAIS III, but significant differences among subtests, (iii) executive dysfunction found in flexibility and generativity tasks, (iv) perceptive focalization on details, and most importantly (v) significant impairment on theory of mind tasks are worth noting In conclusion, numerous adults with Asperger Syndrome were not diagnosed during childhood. This is probably due to the relatively recent changes in nosography, and their cognitive development, which is not characterized by language delay, in opposition to high functioning autism. Therefore, screening for autism spectrum disorders in a clinical psychiatric setting is important. Screening can lead to a more comprehensive assessment pinpointing developmental history, cognitive profile, and comorbidities, given that these three factors are indispensable for an effective therapeutic follow-up.     

Le ravage au féminin : une quasi-structure inscrite dans la logique de l’amour

The author proposes to show in what devastation does it is to be apprehended like a “quasi-structure” relative to female, registered in the logic of the love. Report/ratio with the mother with the report/ratio with the lover, the devastation is done put to the test of the love, highlighting a logic beyond the phallus and implying the body. The paradigm of adolescence and more particularly the symptom anorexic clarify the statute of the body and its pleasure for the female subject. Behind the pretences, when they are untied, emerges the reality of the devastation. The love leads to the devastation when he asks even more identity, to be even more. The devastation leads to the hainamoration, this zone of the analytical experiment that Jacques Lacan highlighted in the vein of what it names passions to be. Hatred as fundamental passion is questioned here in its statute to be rehabilitated in a contemporary social link, which is harnessed to evacuate the dimension of the lack and the otherness whereas the body, place of the Other par excellence, pays the price of them.     

Aspects nosologiques des troubles bipolaires maniaco-dépressifs. Considérations critiques

Critical revue of the concept of bipolar disorders and spectrum and the categories in DSM-IV and ICD10.     

Overgeneralization of autobiographical memory strategies in cannabis users and multiple psychoactive substance consumers

Objectives

Psychoactive substance consumption induces cognitive impairments in terms of episodic memory and attentional and executive function deficits. This study aims to investigate whether the recall of autobiographical memories is disturbed in substance consumers, and in particular whether those patients tend to evoke memories at a general level rather than at a specific level when confronted by an emotional cue word. Furthermore, we aim to verify whether adopting a more general memory retrieving style is a dynamic phenomenon and if it depends on the type of substance consumed.

Design and methods

The participants of this research were 51 cannabis users, including 17 occasional cannabis users, 17 cannabis abusers and 17 individuals addicted to cannabis. They were compared to 18 multiple substance-dependent individuals and to 38 nondependent individuals. Participants were subjected to the Williams and Scott (1988) [39] autobiographical memory test. After an assessment of the mode of substance consumption, several clinical dimensions were measured, such as depression (BDI), anxiety (STAI Y A and B), alexithymia (TAS 20) and episodic memory (RLS-15).

Results

The results show that the percentage of general positive and negative memories recalled increases progressively as the consumption takes on the characteristics of addictive behavior, while we observe no deficit in episodic memory. The level of alexithymia evolved in parallel with the percentage of general memories. These results are not dependent on the type of substance used and can not be explained by the level of depression.

Conclusions

Overgeneralization is a phenomenon observable in psychoactive substance consumers, whatever the type of substances used, which sets in progressively as the dependence develops. Our results show that overgeneralization is not only due to an impairment of mnesic abilities, implying that this phenomenon could be underlined by several mechanisms. The role of overgeneralization as a functional avoidance established in attempt to protect individuals from emotion resurgence is discussed. Furthermore, the impact of deficits in executive functions on the recall of autobiographical memories in substance abusers has not been studied and would be an interesting path of research.     

Le suivi psychologique de sportifs de haut niveau : enjeux et réalité

In recent years, numerous studies have shown that the intensive practice of sport was not without psychopathological risks. Act No. 99-223 of 23 March 1999 relative to the protection of athletes’ health and to the fight against doping has, for the first time, taken into consideration the psychological dimension of sport regardless of the concept of performance. Since then, the 16 June 2006 decree amending the decree of 11 February 2004 established the nature and frequency of medical examinations under Articles L.3621-2 and R.3621-3 of the Public Health Code. The interest of this review is to allow the athlete, who is an object of so many desires on the part of his parents, of his coach, of the public and of the society of spectacle, etc., to regain his place as an individual within the time of an interview. During this interview the professional will establish a link allowing the athlete to register his sport in a “life project” (athlete, academic, professional, family, etc.) and in a sphere of which sport is only an aspect. By allowing the athlete to “be”, during and after his sport career, the professional will try to locate him/her outside the “sports play-acting”, which is a source of vulnerability to the disease of “doing” (drug addiction, alcoholism, addiction gestures, etc.). Furthermore this interview is also an opportunity to seek personal vulnerabilities and to elaborate a psychopathological epidemiology of high-level sport, which has hitherto not been undertaken. This legislative progress integrated into the longitudinal medical monitoring is an important advance in the care of athletes who have gone from hero status to that of participating in an industry of recreation and sports spectacle. However, these texts leave many issues untreated, more especially that so far this assessment has been launched in a parsimonious and disparate way (method, processes, stakeholders, professional sportsmen, etc.) according to the sports federations and institutions that often resist its implementation.     

La connotation dans les paroles de patients atteints de la maladie d’Alzheimer : une méthode d’écoute

The change of the semantic memory in the Alzheimer's disease makes complex the understanding speech of patients. The very important lexical reduction in this disease does not allow to understand the sense of speech. These patients keep an intact phonological capacity. It will be separated of what is pronounced of the whole verbal exchange. The said is often qualified as semantic no sense. The questions of nurses and families to clarify the requests fail. The patient is only repeating his request. For example, the patients ask to see a dead person (her mother) or a requirement (take a taxi). The explicit, literal sense (denotation), does not any more allow to understand this phonological production. It is impossible to act for these pressing requests. For us, these words are full of sense but condensed. The concept of connotation (say it) allows to seize the wide sense of the intention. From clinical examples, we propose answers according to the connotation of what is pronounced. So, we determine a first method of care to understand the requests of these persons.     

Les conduites automutilatrices : étude portant sur 30 patients

Introduction

Deliberate self-injury is defined as the intentional, direct injuring of body tissue without suicidal intent. There are different types of deliberate self-mutilating behaviour: self cutting, phlebotomy, bites, burns, or ulcerations. Sometimes, especially among psychotic inpatients, eye, tongue, ear or genital self-mutilations have been reported. In fact, self-mutilation behaviour raises nosological and psychopathological questions. A consensus on a precise definition is still pending. Many authors consider self-mutilating behaviour as a distinct clinical syndrome, whereas others hold it to be a specific symptom of borderline personality disorder. Self-mutilating behaviour has been observed in 10 to 15% of healthy children, especially between the age of 9 and 18 months. These self mutilations are considered as pathological after the age of 3. Such behaviour is common among adolescents, with a higher proportion of females, and among psychiatric inpatients. Patients use different locations and methods for self-mutilation. Deliberate self harm syndrome is often associated with addictive behaviour, suicide attempt, and personality disorder.

Clinical material

We report on an observational study including 30 inpatients and we compared the data with the existing literature. As a matter of fact, until now, most of the papers deal with case reports or with very specific patterns of self-mutilation (eye, tongue or genital self-mutilations). Otherwise, papers report the relationships between self-mutilation and somatic or personality disorders (Lesh Nyhan syndrome, borderline personality disorder, dermatitis artefacta, self-mutilation in children following brachial plexus related to birth injury, mental retardation...). Our study included all self harmed patients who had been admitted to our psychiatric hospital (whatever the location and type of self-mutilation). Patients suffering from brain injury or mental retardation were excluded.

Results

In our sample, there was a higher percentage of women (29 women and 1 man) and the mean age was 18 (12 to 37). More than half of the patients were aged under 18. Single parent families were reported in 30% of cases. Thirty percent of patients had been physically or sexually abused during childhood. Sixty percent had a comorbid psychiatric disorder, 63% had been hospitalised previously (half of them twice or more). Seventy-three percent of patients had previously attempted suicide (notably deliberate self-poisoning and cutting) that was not considered as self-mutilating behaviour by the patients themselves. Each patient had self harmed themselves at least twice and most often different methods and locations were used (deliberate self harm of forearms 90%, thighs 26.7%, legs 16.7%, chest 10%, belly 10%, hands 6.9%, face 6.9%, arms 6.7%, and feet 3.3%). Addictive disorders, such as substance abuse (tobacco 46.7%; alcohol 23.3%; illicit drugs 16.7% mostly cannabis or cocaine) and eating disorders (33.3% and among them 50% of cases were restrictive anorexia nervosa) were often associated with a deliberate self harm syndrome. Three psychiatric diagnoses were often observed in our cohort: depressive disorder 36.7%; personality disorder 20%; psychosis 10% and depressive disorder associated with personality disorder 33.3%. In our sample, psychotic patients differed on several clinical aspects: the atypical location (abdomen, nails) and method (needles) of self-mutilating behaviour. None of them had been abused during childhood and none was suffering from addictive disorders.