Predicting post-traumatic stress disorder in veterans: Interaction of traumatic load with COMT gene variation

Background

Because post-traumatic stress disorder (PTSD) by definition can occur only after exposure to a traumatic event, military veterans who are at high risk for trauma exposure are a particularly relevant population for studying the interaction of trauma with genetic factors that may predispose for the disorder. A number of studies have implicated specific genes as possible risk factors in developing PTSD, including the catechol-O-methyltransferase gene (COMT).

Methods

Data from Iraq War veterans (n = 236) were used to examine the interaction between COMT and traumatic experiences in predicting later development of PTSD symptoms. Subjects were assessed for exposure to traumatic events both before and during deployment.

Results

The interaction between trauma load and COMT was a significant predictor of PTSD symptoms. Those with the heterozygous genotype (Val/Met) showed fewer symptoms associated with trauma exposure compared to those with either homozygous genotype. This interaction remained significant after controlling for other risk factors for PTSD, including personality dimensions of Internalizing and Externalizing.

Conclusions

COMT genotype affects risk for development of PTSD symptoms following exposure to trauma.     

Psychosis and trauma. Theorical links between post-traumatic and psychotic symptoms

Introduction

The co-occurrence between post-traumatic symptoms and psychotic symptoms is well described in the immediate suites of a trauma but can also be chronic. This symptomatic co-occurrence, rarely studied in the literature, is often approached under the sole angle of a primary post-traumatic stress disorder (PTSD) or of a primary psychosis, without federative will to unify the psychotic and post-traumatic symptoms within the same nosological framework. Individuals with schizophrenia or schizoaffective disorder report higher rates of trauma and assault than the general population.

Literature findings

High rates of PTSD have been noted in severe mental illness cohorts. Psychotic phenomena may be a relatively common manifestation in patients with chronic PTSD.

Aim

The purpose of this paper is to expose the various theorical psychopathological aspects between the symptoms of psychosis and PTSD. In populations of veterans, positive and negative symptoms of psychosis in PTSD are described as delusional thoughts and hallucinations often combat-specific.

Clinical findings

When a PTSD becomes established at a subject to the personality of neurotic structure, the intensity of the PTSD's symptoms lead to a psychotic expression which constitutes a factor of seriousness. Besides, PTSD often induces a risk of substance use disorder supplying psychotic symptoms. Cannabis increases the hallucinations, cocaine strengthens an underlying paranoid tone, and alcohol implies withdrawal hallucinosis. Moreover, such consumption could be a risk factor for the future development of chronic psychosis. From another point of view, by basing themselves on the plasma dopamine beta-hydroxylase activity, some authors made the analogy between psychotic major depression and PTSD with psychotic features (also characterized as a distinct psychotic subtype of PTSD). However, other studies found no correlation between PTSD with psychotic features and family predisposition for schizophrenia or schizoaffective disorder.

Discussion

The determination of the structure of personality seems fundamental in the understanding of the symptoms. A personality of psychotic structure increases the risk of traumatization and PTSD. At the same time, the fragility of this structure causes an increased sensitivity to the trauma, which takes on a particular echo. Moreover, a trauma can test a latent psychotic structure to reveal its existence. The experience of psychosis may be traumatic in itself for patients with, notably, seclusion and sedation during hospitalization. Lastly, the symptoms of this post-traumatic psychosis will be differentiated from neurological confusion caused by a traumatic brain injury. Clinicians often fail to screen routinely for trauma and PTSD symptoms in patients with severe mental illness because few systematic guidelines exist for the identification and treatment of this comorbidity.

Conclusion

The links between psychotic and psycho-traumatic symptoms are complex and multidirectional; this co-occurrence is a factor of seriousness. The clinician, while paying attention to these symptoms, has to distinguish the structure of the personality of the subject to articulate the psychotherapy and the pharmacological treatment. Further investigational studies may determine whether antipsychotics will enhance treatment response in PTSD patients with psychotic features.     

Lifetime mania is related to post-traumatic stress symptoms in high school students exposed to the 2009 L’Aquila earthquake

Background

Bipolar patients seem to be at high risk of trauma exposure and, when exposed, of PTSD. When comorbid, PTSD has shown a negative impact on the course of the bipolar illness. Conversely, a correlation between even manic symptoms and an increased risk for suicide has also been reported in PTSD patients. The aim of this study was to investigate the relationships between lifetime mood spectrum symptoms and PTSD in a sample of earthquake survivors.

Methods

A total of 475 young adults who survived the L’Aquila 2009 earthquake, 21 months earlier, were assessed by the Moods Spectrum-Self Report (MOODS-SR) and the Trauma and Loss Spectrum Self Report (TALS-SR).

Results

Significantly higher MOODS-SR and TALS-SR domain scores were found in PTSD survivors compared to those without. The mood depressive (O.R. = 1.17, 95% CI: 1.10–1.25), cognition depressive (O.R. = 1.07, 95% CI: 1.01–1.14) and energy manic (O.R. = 1.13, 95% CI: 1.02–1.25) MOODS-SR domains were significantly associated with an increased likelihood of PTSD.

Conclusions

Our data corroborate the strong relationship between mood disorder and PTSD highlighting a relationship between lifetime depressive and manic symptoms and PTSD, with a particular impact of the latter on the number of traumatic exposures and maladaptive behaviors.     

The contribution of threat probability estimates to reexperiencing symptoms: a prospective analog study

Background and objectives

Individuals with posttraumatic stress disorder (PTSD) are hypothesized to have a “sense of current threat.” Perceived threat from the environment (i.e., external threat), can lead to overestimating the probability of the traumatic event reoccurring (Ehlers &; Clark, 2000). However, it is unclear if external threat judgments are a pre-existing vulnerability for PTSD or a consequence of trauma exposure. We used trauma analog methodology to prospectively measure probability estimates of a traumatic event, and investigate how these estimates were related to cognitive processes implicated in PTSD development.

Methods

151 participants estimated the probability of being in car-accident related situations, watched a movie of a car accident victim, and then completed a measure of data-driven processing during the movie. One week later, participants re-estimated the probabilities, and completed measures of reexperiencing symptoms and symptom appraisals/reactions.

Results

Path analysis revealed that higher pre-existing probability estimates predicted greater data-driven processing which was associated with negative appraisals and responses to intrusions. Furthermore, lower pre-existing probability estimates and negative responses to intrusions were both associated with a greater change in probability estimates. Reexperiencing symptoms were predicted by negative responses to intrusions and, to a lesser degree, by greater changes in probability estimates.

Limitations

The undergraduate student sample may not be representative of the general public. The reexperiencing symptoms are less severe than what would be found in a trauma sample.

Conclusions

Threat estimates present both a vulnerability and a consequence of exposure to a distressing event. Furthermore, changes in these estimates are associated with cognitive processes implicated in PTSD.     

Contextual representations increase analogue traumatic intrusions: evidence against a dual-representation account of peri-traumatic processing

Background and objectives

Information processing accounts of post-traumatic stress disorder (PTSD) state that intrusive memories emerge due to a lack of integration between perceptual and contextual trauma representations in autobiographical memory. This hypothesis was tested experimentally using an analogue trauma paradigm in which participants viewed an aversive film designed to elicit involuntary recollections.

Method

Participants viewed scenes from the film either paired with contextual information or with the contextual information omitted. After viewing the film participants were asked to record for one week any involuntary intrusions for the film using a provided intrusions diary.

Results

The results revealed a significant increase in analogue intrusions for the film when viewed with contextual information in comparison to when the film was viewed with the contextual information omitted. In contrast there was no effect of contextual information on valence ratings or voluntary memory for the film, or on the reported vividness and emotionality of the intrusions.

Limitations

The analogue trauma paradigm may have failed to reproduce the effect of extreme stress on encoding that is postulated to occur during PTSD.

Conclusions

The findings have potential implications for trauma intervention as they suggest that the contextual understanding of a scene during encoding can be integral to the subsequent occurrence of traumatic intrusions. The pattern of results found in the study are inconsistent with dual-representation accounts of intrusive memory formation, and instead provide new evidence that contextual representations play a casual role in increasing the frequency of involuntary intrusions for traumatic material.     

Trauma and comorbid posttraumatic stress disorder in individuals with schizophrenia and substance abuse

Objectives

The aim of this study was to investigate the occurrence of trauma and comorbid posttraumatic stress disorder (PTSD) in dual diagnosis patients and whether the trauma was related to the patient's behavior or illness.

Method

One hundred ten patients with schizophrenia and comorbid substance or alcohol abuse were assessed for PTSD using self-report and structured interview. Traumatic events were classified as independent or dependent upon the patient's behavior, illness, or symptoms.

Results

One hundred patients (91%) reported at least 1 trauma (mean, 4.3). Sixty-three patients (57%) reported a traumatic event that met modified-criterion A for PTSD. Thirty-one patients (28%) met criteria for full PTSD, and 18 (16%) had a trauma directly related to their illness. Patients with PTSD had significantly higher scores on positive psychotic symptoms and depression.

Conclusions

Exposures to traumatic events and comorbid PTSD are high but are inflated by reactions to illness-related events such as hospitalization and psychotic symptoms.     

The association between number and type of traumatic life experiences and physical conditions in a nationally representative sample

Objective

Posttraumatic stress disorder (PTSD) is significantly and positively associated with several physical conditions. We aimed to examine whether the nature and number of trauma(s) experienced may be related to physical conditions using a population-based sample.

Methods

Data came from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (N= 34,653; age 20 years and older). Participants indicated lifetime trauma experiences and physical conditions experienced over the past year. Multiple logistic regressions examined the association between type and number of trauma(s) and physical conditions.

Results

After adjusting for sociodemographics, Axis I and II mental disorders, and all other trauma, injurious and witnessing trauma were significantly associated with all the assessed physical conditions. Psychological trauma was associated with cardiovascular and gastrointestinal diseases, diabetes and arthritis. Natural disaster/terrorism was associated with cardiovascular disease, gastrointestinal disease and arthritis only. Finally, combat-related trauma and other trauma were not positively associated with any physical condition. Our results also suggested a dose–response relationship between number of traumatic events and physical conditions.

Conclusion

These data suggest that the impact of certain types and number of traumas may differ with respect to their relationship with physical health problems independent of PTSD.     

Serum brain-derived neurotrophic factor in patients with trauma psychopathology

Objective

Brain-derived neurotrophic factor (BDNF) has an important role in learning, motivation and regulation of mood. The aim of this study was to investigate levels of serum BDNF in patients with trauma psychopathology (acute and post-traumatic stress disorder) when compared to age and gender matched controls.

Method

A consecutive sample of 34 patients was evaluated regarding socio-demographic and clinical variables by means of a standard protocol, Davidson Trauma Scale, Beck Depression Inventory, Clinical Global Impression and the Global Assessment of Functioning. BDNF serum levels were measured right after the intake interview.

Results

Patients had higher BDNF levels than controls. Those levels, however, were higher right after the traumatic event, decreasing over time. When two groups of patients (recent and remote trauma) were investigated in separate, the recent trauma group (less than 1 year since the traumatic event) had higher BDNF than controls, but this effect was not detected in the remote trauma group. The recent and remote trauma groups had different BDNF levels. Those findings persisted, even controlling for symptom severity, use of psychotropic medication, and history of psychiatric disease.

Conclusions

As far as we know this is the first report of elevated serum BDNF levels in patients with recent trauma. Based in animal models that implicate BDNF in memory formation and consolidation, higher BDNF in recent PTSD could be related to memory and learning disruption central in PTSD psychopathology.     

A feasibility pilot study on the use of text messages to track PTSD symptoms after a traumatic injury

Objective

Monitoring posttraumatic stress disorder (PTSD) symptoms after a traumatic injury is beneficial for patients and providers. Text messages can be used to automatically monitor symptoms and impose minimal burden to patients and providers. The present study piloted such a strategy with traumatic injury patients.

Method

An automated daily text message was piloted to evaluate PTSD symptoms after discharge from the hospital. Twenty-nine patients who experienced a traumatic injury received 15 daily texts and were then followed up at 1-month and 3-months after discharge.

Results

82.8% of the sample responded at least once and the average response rate per participant was 63.1%. Response rates were correlated with PTSD symptoms at baseline but not at any other time. Patient satisfaction with this approach was high.

Conclusion

Text messages are a viable method to monitor PTSD symptoms after a traumatic injury. Such an approach should be evaluated on a larger scale as part of a more comprehensive early intervention for traumatic stress.     

Perceived social support buffers the impact of PTSD symptoms on suicidal behavior: Implications into suicide resilience research

Background

A growing body of research has highlighted the importance of identifying resilience factors against suicidal behavior. However, no previous study has investigated potential resilience factors among individuals with Posttraumatic Stress Disorder (PTSD). The aim of this study was to examine whether perceived social support buffered the impact of PTSD symptoms on suicidal behavior.

Methods

Fifty-six individuals who had previously been exposed to a traumatic event and reported PTSD symptoms in the past month (n = 34, 60.7% participants met the full criteria for a current PTSD diagnosis) completed a range of self-report measures assessing PTSD symptoms, perceived social support and suicidal behavior. Hierarchical regression analyses were conducted to examine whether perceived social support moderates the effects of PTSD symptoms on suicidal behavior.

Results

The results showed that perceived social support moderated the impact of the number and severity of PTSD symptoms on suicidal behavior. For those who perceived themselves as having high levels of social support, an increased number and severity of PTSD symptoms were less likely to lead to suicidal behavior.

Conclusions

The current findings suggest that perceived social support might confer resilience to individuals with PTSD and counter the development of suicidal thoughts and behaviors. The milieu of social support potentially provides an area of further research and an important aspect to incorporate into clinical interventions for suicidal behavior in PTSD or trauma populations.     

Espace phobique et levier thérapeutique

Introduction

The spatial experience in phobic disorders needs to be better understood in order to account for the pathogenic effect of a local phobogenic situation on the whole subjective world. Such an understanding could be useful for the treatment of resistant phobias which are hampered by therapeutic blocks that require a global restructuration of the subjective world.

Objectives

Three objectives are addressed in this paper: (1) a clarification of the experience of space in phobic disorders; (2) an account of the impact power of the phobogenic situation; (3) an analysis of levers in cognitive psychotherapy that may help to overcome therapeutic blocks in resistant phobias. To tackle these objectives, we bring in the conceptual framework of representational spaces that proposes some tools to describe a subjective world as grounded in the spatial experience. According to the model of phobic disorders that we build up in this framework, the phobogenic situation behaves like a probe that reveals some strains disturbing in depth the subjective representational space. These strains depend on past traumatic situations that have resulted in the development of phobic cores. Thus, the phobogenic situation materializes some dimensions of the representational space that makes it vulnerable to a traumatic agent. In this framework, a therapeutic lever can be defined as a key-situation that favors a global reorganization of the representational space from a local work on it. Three conditions appear to be necessary to the works of such a lever: (1) the key-situation needs to resonate through the representational space with a central phobic core; (2) the patient should actively grasp the processes of the symbolic structuration of his/her space; (3) the therapeutic lever should only be operated at the suitable time of the therapeutic course by taking account of the subjective defences.

Patient and method

Our model is exemplified with a case study that describes the behavioral and cognitive therapy of a patient that suffers from a phobic disorder since his adolescence. The technical method notably uses a work on the cognitive schemas that starts from the patient story.

Results

The method used to overcome therapeutic blocks reveals some phobic cores that are related to traumatic situations in childhood and adolescence. Therapeutic levers are operated when key-situations relative to the familial story can be addressed and elaborated by an active work of the patient, with a feeling of global restructuration of his psychic space.

Conclusions

The conceptual framework of the representational spaces is interesting to clarify the spatial experience in phobic disorders and to explain the impact of the phobogenic situation. Moreover, in complex phobias, this framework offers some useful tools to conceptualize the therapeutic levers that could be efficient to move the whole subjective world. Such levels can only be used during a long-term therapy.     

Childhood traumatic events and adolescent overgeneral autobiographical memory: Findings in a UK cohort

Background

Overgeneral autobiographical memory has repeatedly been identified as a risk factor for adolescent and adult psychopathology but the factors that cause such over-generality remain unclear. This study examined the association between childhood exposure to traumatic events and early adolescent overgeneral autobiographical memory in a large population sample.

Methods

Thirteen-year-olds, n = 5,792, participating in an ongoing longitudinal cohort study (ALSPAC) completed a written version of the Autobiographical Memory Test. Performance on this task was examined in relation to experience of traumatic events, using data recorded by caregivers close to the time of exposure.

Results

Results indicated that experiencing a severe event in middle childhood increased the likelihood of an adolescent falling into the lowest quartile for autobiographical memory specificity (retrieving 0 or 1 specific memory) at age 13 by approximately 60%. The association persisted after controlling for a range of potential socio-demographic confounders.

Limitations

Data on the traumatic event exposures was limited by the relatively restricted range of traumas examined, and the lack of contextual details surrounding both the traumatic event exposures themselves and the severity of children's post-traumatic stress reactions.

Conclusions

This is the largest study to date of the association between childhood trauma exposure and overgeneral autobiographical memory in adolescence. Findings suggest a modest association between exposure to traumatic events and later overgeneral autobiographical memory, a psychological variable that has been linked to vulnerability to clinical depression.     

The development of a population-based automated screening procedure for PTSD in acutely injured hospitalized trauma survivors

Objective

This investigation aimed to advance posttraumatic stress disorder (PTSD) risk prediction among hospitalized injury survivors by developing a population-based automated screening tool derived from data elements available in the electronic medical record (EMR).

Method

Potential EMR-derived PTSD risk factors with the greatest predictive utilities were identified for 878 randomly selected injured trauma survivors. Risk factors were assessed using logistic regression, sensitivity, specificity, predictive values and receiver operator characteristic (ROC) curve analyses.

Results

Ten EMR data elements contributed to the optimal PTSD risk prediction model including International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) PTSD diagnosis, other ICD-9-CM psychiatric diagnosis, other ICD-9-CM substance use diagnosis or positive blood alcohol on admission, tobacco use, female gender, non-White ethnicity, uninsured, public or veteran insurance status, E-code identified intentional injury, intensive care unit admission and EMR documentation of any prior trauma center visits. The 10-item automated screen demonstrated good area under the ROC curve (0.72), sensitivity (0.71) and specificity (0.66).

Conclusions

Automated EMR screening can be used to efficiently and accurately triage injury survivors at risk for the development of PTSD. Automated EMR procedures could be combined with stepped care protocols to optimize the sustainable implementation of PTSD screening and intervention at trauma centers nationwide.     

Altered spontaneous neuronal activity of visual cortex and medial anterior cingulate cortex in treatment-naïve posttraumatic stress disorder

Background

Although no more traumatic stimuli exists, a variety of symptoms are persisting in chronic Posttraumatic Stress Disorder (PTSD) patients. It is therefore necessary to explore the spontaneous brain activity of treatment-naïve PTSD patients during resting-state.

Method

Seventeen treatment-naïve PTSD patients and twenty traumatized controls were recruited and underwent a resting functional magnetic resonance imaging (Rs-fMRI) scan. The differences of regional brain spontaneous activity between the participants with and without PTSD were measured by Amplitude of Low-frequency fluctuation (ALFF). The relationship between the altered brain measurements and the symptoms of PTSD were analyzed.

Result

Compared to traumatized controls, the PTSD group showed significantly altered ALFF in many emotion-related brain regions, such as the medial anterior cingulate cortex (MACC), dorsolateral prefrontal cortex (DLPFC), insular (IC), middle temporal gyrus (MTG), and ventral posterior cingulate cortex (VPCC). Interestingly this is the first report of a hyperactive visual cortex (V1/V2) during resting-state in treatment-naïve PTSD patients. There were significant positive correlations between ALFF values in the bilateral visual cortex and re-experiencing or avoidance in PTSD. Negative correlation was observed between ALFF values in MACC and avoidance.

Conclusion

This study suggested that the visual cortex and the MACC may be involved in the characteristic symptoms of chronic PTSD, such as re-experiencing and avoidance. Future studies that focus on these areas of the brain are required, as alteration of these areas may act as a biomarker and could be targeted in future treatments for PTSD.     

Genotype-controlled analysis of serum dopamine β-hydroxylase activity in civilian post-traumatic stress disorder

Background

Norepinephrine (NE) plays a central role in post-traumatic stress disorder (PTSD). Dopamine β-hydroxylase (DβH) converts dopamine (DA) to NE and its activity varies widely across individuals. Mustapic et al. (2007) reported a PTSD-associated deficit in serum DβH activity in a genotype-controlled analysis of combat veterans. We tested whether such a deficit would occur in a sample of civilians.

Methods

The severity of current adult PTSD symptoms and current DSM-IV diagnosis of PTSD were determined by the PTSD Symptom Scale (PSS). Adulthood trauma exposure was assessed using the Traumatic Experience Inventory (TEI). Serum DβH activity (sDβH) was assayed by HPLC with electrochemical detection and genotypes were determined using the Taqman® platform.

Results

Two hundred and twenty seven African American (AA) subjects were enrolled in this study, with a mean age (± SD) of 42.9 (± 12.9) years. We found a strong association between rs1611115 genotype and sDβH (p < 0.0001). After controlling for adulthood trauma exposure, there were no significant differences of sDβH between subjects who met a PTSD diagnosis and those who did not (p > 0.05) in any genotype group. No significant correlations were found between sDβH and PTSD severity, but sDβH significantly associated with the status of comorbid depression based on the cutoff of HAMD (p = 0.014) in subjects with PTSD.

Conclusions

We have replicated in this sample the prior finding that DBH rs1611115 genotype strongly associates with sDβH. No associations between sDβH and PTSD diagnosis or symptom severity were found in this civilian sample.     

Comorbid depressive symptoms in treatment-seeking PTSD outpatients affect multiple domains of quality of life

Purpose

No study has examined the impact of the comorbid Axis I conditions on the quality of life (QoL) of patients with a primary diagnosis of PTSD. Our goal was to investigate the influence of comorbid disorders on the QoL of treatment-seeking outpatients with PTSD.

Methods

The diagnoses of PTSD and of the comorbid disorders were established using the SCID-I. The 54 volunteers also completed the Posttraumatic Stress Disorder Checklist – Civilian Version, the BDI, the BAI, the Trauma History Questionnaire, and a socio-demographic questionnaire. Quality of life was assessed by means of the WHOQOL-BREF, a 26-item self-administered scale that measures four domains of QoL: psychological, physical, social, and environmental. Multiple linear regression models were fitted to investigate the relationship between the severity of post-traumatic, mood, and anxiety symptoms; the presence of specific current comorbid disorders and of psychotic symptoms, the number of current comorbid conditions, and a history of child abuse for each of the four domains of QoL, after adjusting for the effect of socio-demographic characteristics.

Results

The severity of PTSD symptoms impacted negatively on the psychological and physical domains. The severity of depressive symptoms correlated negatively with QoL in all domains, independently of sex, age, occupation, and marital status. The psychotic symptoms impacted negatively on the environmental domain. A history of child abuse was negatively associated with the psychological and the social domains.

Conclusions

The severity of comorbid depressive symptoms is one of the most important factors in the determination of the QoL in patients with PTSD.     

Étude comparative de dix sujets SDF fréquentant un centre d’hébergement d’urgence et de dix sujets SDF vivant uniquement dans la rue : acceptation et refus de l’hébergement d’urgence

Objectives

The last decades have seen an increasing number of homeless people (SDF) in Western societies. Public authorities have developed a solid assist device to treat this “homeless problem” by creating emergency shelter. Generally, this type of accommodation does not set any condition of admission and answers an immediate need of safekeeping of the person. Yet many homeless people refuse emergency shelter, even in winter. They prefer to sleep outside in extreme conditions. The purpose of this article is to help understanding the refusal and the acceptance of emergency accommodation for the homeless population.

Patients/materials and methods

In this study, a group of ten homeless subjects using emergency shelter (CHU) is compared to a group of ten homeless subjects who are refusing the emergency shelter and living only on the streets. To each subject, a semi-structured interview, an evaluation of the HAD scale (Zigmond AS and Snaith RP, 1983) and one of the self-esteem scale are conducted (Rosenberg, 1969). The analysis of data, collected during research interviews, will be completed with the statistical analysis of the results of the scale's test. Thereby we will highlight the similarities and the differences explaining the denial or the approval of emergency shelter.

Results

The common point between these two groups of subjects is the following: each of them has a traumatic or painful past. These subjects experienced many failures, dropouts, deficiencies which have seriously disrupted and affected them. The accumulation of chronic and traumatic life events made that the most recent event is identified by these subjects as the cause of their homeless situation. Survive from day to day involves a constant acting out in the street space, reflecting an impossible psychic crystallization or development. These two groups of subjects differ mainly in their ways of understanding their homeless situation. Thus, the acceptance/refusal of emergency shelter refers to an acceptance/refusal of the homeless identity, a fitting/misfitting to the homeless conditions, an acceptance/refusal of assistance, and acceptance/rejection of the collective space. In quantitative terms, there is a link between anxiety/depression and the denial of emergency shelter. Subjects refusing emergency shelter have a depression level significantly higher (10.3 against 7.1) and anxiety level significantly lower (11 against 14.1) than subjects users of emergency shelter.

Conclusions

This study allows us to consider the denial of accommodation of the homeless as a will not to passively suffer from their situation of social exclusion. Those homeless subjects voluntarily maintain a difficult lifestyle causing a greater psychological suffering than the ones using emergency shelter, and this not to settle in their situation. At the opposite, regular users find in emergency shelter a social frame and some new benchmarks. This leads to a relief and to a lower mental suffering that promote an over-adaptation of their living conditions.     

La nécessaire évolution de définition de la « conversion hystérique »

Background

Technology is omnipresent in our world today and mental disorders are examined using modern genetic, biological, neurophysiological and functional brain imaging exploratory techniques. Conversion is not just external, it can also be glimpsed at in images that look at brain functioning.

Objectives

Do modern biological and radiological investigation elements discuss classic psychopathological conceptions of conversion and hence offer a new definition?

Methods

Recently published neuroscientific studies have re-evaluated our traditional ideas of hysterical conversion with a critical eye.

Results

Freud had the intelligence of differentiating conversion and simulation as two nosological frameworks that could not be superimposed: neurobiology scientifically confirmed the intervention of distinct brain mechanisms. Freud had the merit of defining conversion using a positive psychopathological diagnostic strategy, and not just by simply eliminating the organicity: with the same positive ethics, a distinction between somatic illnesses and conversive disorders can be established with imaging techniques. Furthermore, the possibility of conversive attacks caused by a psychotraumatic mnemic determination has found an echo in very recent studies which have objectified, in the conversive physiopathology, the intervention of cerebral structures involved in emotional memories. Finally, research looking at neurofunctional mechanisms that determine dissociative and conversive disorders confirm their close relationship.

Discussion

The most recent neuroimaging studies validate the hypothesis of a biological carrier of conversive phenomena. If this new data should incite us to redefine conversion, it is also the definition of the signifier “psychogenic” which has evolved due to the advances in neuroimaging techniques. Is any psychological or somatic manifestation not also of neuronal and signified origin?

Conclusion

These studies show that science can validate or specify some of our classical psychopathological paradigms.     

La théorie du néo-organodynamisme : une nouvelle classification pratique des maladies mentales

Background

Dogmatically conflicting psychological and biological theories make the foundations of psychiatry fragile.

Methods

Traditional and Henri Ey's classifications of mental illness are discussed and the neo-organodynamism is proposed. The principle of the accessory pathway is also proposed.

Results

The acute phase of disease may only be a temporary modification of the basic mental illness, the nature of the latter can be expressed in terms of the depth of the organic degeneration. The psychotic state consists of the basic disorder and its acute aggregative phase that is in proportion to the degree of abnormal excitations of neural network. In my classification, mental illness is classified from a normal stage N to X. The degree of acute aggravation is staged from 0 to 7. The twelve stages of organic degeneration multiplied by the eight stages of acute aggravation results in a product of 96 mental stages. By applying this, we can accurately represent the conditions of psychiatric patients that change neo-organodynamically over time. At the same time, clinical comparative research, such as the effects of medicine and of biochemical changes at one time becomes possible. The mental automatism, the mechanism of acute psychosis and treatment concept are discussed with this theory. And this theory may explain what the mental illness is, what the delusion is and what the endogenous psychosis is. Mental pressures or ritual acts promote construction and the reorganization of neural network, and it is fixed by repeating itself. Coding to the subconsciousness of a new neural network namely bypass will be made, and it is immobilized as an accessory pathway like the bundle of Kent of the Wolff–Parkinson–White syndrome. This is the principle of the accessory pathway. When the accessory pathway is dominant, the patient cannot consider anything like himself. This condition shows the low level of his psychic energy (psychasthénie). The history of a mind hierarchy that is constructed with the accessory pathways may be a history of mind. And the history of a mind hierarchy should be what the psychic body is.

Treatment concept

From the viewpoint of the neo-organodynamism, the conception of organic degeneration is consisted of 1) tissue degeneration literally and 2) generation of accessory pathway by the reorganization of the synapse. The symptoms may be irreversible in the case of the tissue degenerations. But the symptoms that are induced by the accessory pathway may be reversible. If the conductivity of the main pathway becomes dominant as before, the symptom by the accessory pathway has a possibility of the improvement. But the accessory pathway will be remained even if the conductivity of the main pathway becomes dominant as before. One's usual personality is defined as a predominant state of the main pathway. Healing is to return to one's usual personality from the accessory pathway predominant state. In the organic degenerations that are the essence of mental illness, rehabilitation (psychotherapy, cognitive behavioral therapy, mental counseling, etc.) is essential to recuperate lost functions. For the positive symptoms, which are the secondary effects of organic degenerations, medication that focuses on the synaptic neurotransmitters will be effective. Theoretically, the anti-epileptics may be might be designated as the fundamental treatment for the acute aggravation phase because of the abnormal firings of the neuronal network.

Conclusions

Neo-organodynamism is proposed as a minimum clinical classification of mental illness for psychiatrists. By using this, we can understand that the psychosis is not the special disease, but everyone has the possibility of onset. Neo-organodynamism will eliminate the prejudice against mental illness.