Tolérance à la détresse et expérience de la douleur chronique

IntroductionChronic pain is a highly prevalent condition that is associated with distressing somatic and emotional experiences. Consequently, an individual's distress tolerance, the perceived capacity to tolerate negative psychological and physical states, may influence their pain experience. This effect could be explained in part by a reduction in the catastrophic interpretation of pain which is associated with increased pain intensity and interference in everyday activities.AimsThe first aim of this study was to explore the association between the components of the 5-factor model of distress tolerance and (1) pain intensity and (2) pain interference in everyday activities. The secondary aim was to assess the potential mediating effect of pain catastrophizing in the eventual association between components of distress tolerance and (1) pain intensity or (2) pain interference in everyday activities.MethodThis is a cross-sectional study of adult (18 years or older) university students and staff with chronic pain (3 months). They were invited to complete the online questionnaire through an email invitation. Pain intensity and interference in everyday functioning were assessed with the corresponding subscales of the Brief Pain Inventory. The following instruments were used to assess the components of the 5-factor model of distress tolerance: Ambiguity Tolerance Scale (tolerance to ambiguity), Intolerance to Uncertainty Scale (reversed score: tolerance to uncertainty), Discomfort Intolerance Scale (reversed score: discomfort tolerance), Distress Tolerance Scale (tolerance to negative emotions), Frustration Discomfort Scale (tolerance to frustration). Participants also completed the Pain Catastrophizing Scale.ResultsEighty participants were recruited (57 % women, mean age = 33.09; standard deviation = 12,87). Tolerance to negative emotions was the only component of distress tolerance that was associated with pain (ß = ?0.04; 95% CI): ?0.07–?0.01; t (78) = ?3.06, p < 0.01) or pain interference in everyday functioning (ß = ?0.07; 95% CI: ?0.10–?0.03; t (78) = ?3.97, p < 0.01), independently of the others. Combined with age, these factors explained 16.2 % of the variance in pain intensity and 19.4 % of the variance in pain interference. Pain catastrophizing partially mediated the association between tolerance to negative emotions and pain interference in everyday functioning, but it was not involved in the association between tolerance to negative emotions and pain intensity.ConclusionTolerance to negative emotions appears to be the most relevant aspect of distress tolerance in the context of chronic pain and is a potential clinical target that is independent and complementary from pain catastrophizing.     

Origine et évolution de la bipédie

During around five millions years our ancestors, who were arboreal primates, became progressively occasional, frequent and permanent terrestrial bipeds. Thus, they restricted their locomotor repertoire from polyvalence to specialization. We show that the adaptation to bipedalism is the result of two different processes, the result of natural selection and the result of learning to walk. The characters of our skeleton, heritage of natural selection, affected first pelvis and vertebral column and then cranial base, body proportions and feet. Since reaching bipedal balance is a very demanding constraint in the face of gravity, we describe the “epigenetic” characters which develop in association with learning to walk. Important femoral angular modifications result in the adduction of lower limbs. The angle of pelvic incidence, which defines the sagittal pelvic morphology, increases with gait acquisition in tight association with the formation of lumbar curvature. A link can be established between these genetic modifications and these epigenetic acquisitions. As an illustration we show how the pelvis and spine became a functional unit during the transition from facultative to permanent bipedalism, probably during the evolution of the large group of Homo erectus.     

Histoire de la kétamine et du psychédélisme

Ketamine's history begins in the fifties in Detroit, at Parke-Davis laboratories. In 1956, Maddox synthetized phencyclidine or PCP. Domino studied PCP effects in animals and in 1958, Greifenstein made the first trials of PCP in humans under the name of Sernyl. Sernyl elicited severe excitation with a prolonged postoperative recovery. Because of its psychedelic effects, it became a street-drug under the name of “angel dust”. Calvin Stevens synthesized ketamine in 1962. The drug was studied in humans in 1964, by Domino and Corssen who described the so-called “dissociative anesthesia”. Ketamine was patented in 1966 under the name of Ketalar for human use and was administered to soldiers during the Vietnam war. The psychedelic effects and the arrival of propofol prompted the shelving of ketamine. However, the discovery of the NMDA-receptor and its non-competitive inhibition by ketamine revolutionized the pathophysiology of hyperalgesia and mental functioning. In early 1990s, the discovery of opioid-induced hyperalgesia elicited a paradigm shift in the management of pain, and a comeback of ketamine, as an anti-hyperalgesic drug. Ketamine is nowadays under the spotlight in the field of treatment-resistant depression and has been proposed as a potential fast antidepressant in patients with high suicidal risk.     

La place de la compréhension des proverbes et des métaphores dans la compréhension des troubles du cours de la pensée dans la schizophrénie : apport de l’évaluation clinique,de l’imagerie cérébrale fonctionnelle et de la neurophysiologie

According to Bleuler (1911), language impairments were indicative of thought disorders, a fundamental feature of schizophrenia. The objectives of the present review are twofold: (1) to present the clinical interest of the use of the tests of proverbs and metaphors comprehension for the evaluation of the characteristics of thought disorders in schizophrenia, and to highlight the heterogeneity of the forms of their interpretations; (2) to present the results from neuroimaging and neurophysiological studies of metaphor comprehension in order to identify the neurocognitive mechanisms underlying metaphorical language comprehension of patients with schizophrenic disorders. Results from the reviewed clinical applications of proverbs tests showed that thought disorders in individuals with schizophrenia are illustrated by different forms of proverb interpretations: literal, concrete, idiosyncratic, over-inclusiveness and unconventional. Results from the reviewed brain imaging and neurophysiological studies showed that these different forms of figurative misinterpretations may be related to different neurocognitive mechanisms: concreteness appears to be related to the dysfunction of the left inferior frontal gyrus and inverted brain lateralization during metaphor processing in individuals with schizophrenia compared to healthy individuals. During novel metaphor comprehension, which is highly effortful, individuals with schizophrenia, relative to controls, demonstrate increased activation of the right precuneus, a region that mediates complex and highly integrated functions including retrieval of episodic memory and mental imagery. These results may suggest that individuals with schizophrenia use mental imagery to support comprehension of both literal and metaphoric language. Furthermore, it was demonstrated that over-inclusive thinking, which is exhibited by individuals with schizophrenia during figurative language comprehension, could be related to very early right hemispheric hyper-activation (when a left early activation is expected) and to reduced bilateral brain activity during semantic processing. Such as reversed brain activation may explain why the individuals with schizophrenia are relatively over reliant on early-stage coarse or large semantic processing and may be prone to form meanings that are idiosyncratic and highly unconventional.     

Impact de la durée de psychose non traitée sur la qualité de vie et les fonctions cognitives

ObjectivesThe duration of untreated psychosis is defined as the interval between the first psychotic symptoms and the first starting treatment. The duration of untreated psychosis is highly variable but often prolonged and may be influenced by several factors. Some studies suggested that duration of untreated psychosis is associated with poor outcome. The objectives of this study were to assess the duration of untreated psychosis in a Tunisian cohort and its impact on the quality of life and the cognitive functions of schizophrenic patients at 2 years.MethodsWe conducted a cross sectional study at Razi Hospital between January 2014 and June 2014 that included patients with Schizophrenia diagnosis as defined in the DSMIV-TR with regular monitoring for at least 2 years. Eligible participants are those who had been hospitalized for the first time, between January 2011 and December 2012 for a first psychotic episode. Data were collected from medical records and by interviewing the patients and their family. Duration of untreated psychosis was determined using the Symptom Onset in Schizophrenia Inventory. The quality of life was assessed by the ‘Short Form-36 Health Survey’ scale in its Arabic version. All patients were evaluated with ‘The Tunisian Cognitive Battery’ composed of 7 tests. Patient scores are expressed as ‘Z scores’, which represents the position of the scores in a term of standard deviation from the mean of healthy subjects established by the authors of the battery. We divided the population into two groups based on the duration of untreated psychosis median. A short duration of untreated psychosis was lower than the median, and a long duration of untreated psychosis was equal to or greater than the median.ResultsOur sample involved 42 patients with a mean age of 31.38 years. The average duration of untreated psychosis was 75.38 weeks with a range from 2 to 364 weeks and a median duration of 47.5 weeks. Patients with a short duration of untreated psychosis had a better quality of life with better scores for the majority of the dimensions and a significant difference in the limitations score due to the mental state (P = 0.01). For cognitive function, the short duration of untreated psychosis was significantly correlated with a free recall of ‘Hopkins Verbal Learning Test’.ConclusionOur study suggest that the average duration of untreated psychosis in Tunisia is comparable to the one reported in the literature and that a short duration of untreated psychosis is correlated with better outcomes in terms of quality of life and verbal learning.     

Délire de revendication et quérulence : une revue de la littérature

Objective

This literature review set out to describe the history and the evolutions in German-, English- and French-speaking countries of a psychiatric notion, “litigious delusion”. The author focuses on a subgroup taking the form of querulent delusion or querulousness (a pathological tendency towards litigious behaviors).

Expériences et enjeux de la psychiatrie militaire en opération

For the French army, Afghanistan is a new challenge, especially for the French health service. That theatre is very different from other which the army knows better like Africa or Yugoslavia. The threat is constant, provided by fight, improvised explosive device, terrorism in the cities and rockets aiming the bases. Since 2009, a French military psychiatrist is based with the NATO Hospital at Kabul Airport. The mains problems are the consequences of three threats: fight with Talibans, risk of explosion on the road by improvised devices and attack by rockets on the camps. For each, the psychic reactions are different. Combats provide among the men postoperational stress and for some of them a risk of moral disengagement. But for the most part of them theses symptoms disappears quickly. The improvised explosives devices are the threat feared the most by troops, especially for the logistic convoy. The frequent symptoms are burn out, exhaustion and stress. Rockets like explosives devices are a blind threat and aren’t feared. But when some of them fall on a camp, the people presents sleep troubles, continual stress and PTSD. Alcohol or moral disengagement are not specific of Afghanistan but constitute other challenges. Each of the cases we described is an illustration of these observations of our experience during three months in Afghanistan.     

Impact de la formation théorique et clinique sur les attitudes de stigmatisation des étudiants en médecine envers la psychiatrie et la pathologie psychiatrique

Objective

The aim of the study was to explore whether a medical student education program and clinical posting in psychiatry had an impact on medical students’ stigmatizing attitudes towards psychiatry and psychiatric disorders.

Pour une clinique différentielle des psychoses et des usages du pharmakon. Les cas particuliers de la schizophrénie et de la mélancolie

Aims

This paper focuses on self-medication, drug addiction, and their ambivalent effects, justifying a return to the concept of the pharmacon. More specifically, it addresses the way in which schizophrenic or melancholic subjects use the pharmacon concept to cope with their respective issues.

Sur la régulation neurovégétative de territoire et de système des vaisseaux

Résumé Les variations réflexes du tonus vasculaire, provoquées par la stimulation directe des vaisseaux, peuvent s'étendre à tous les vaisseaux d'un territoire vasculaire, ou bien se produise seulement dans les limites du système vasculaire stimulé; autrement dit il existe un réflexe vasculaire de territoire et un réflexe vasculaire de système. Il semble que les réflexes de territoire puissent être provoqués par la stimulation de l'adventice des artères et des veines, tandis que les réflexes de système semblent répondre à des stimulations de l'intime.

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Summary The reflex variations of the vascular tonus which may be caused by direct stimulation of the vessels may affect all the vascular sections or be limited to the regional vessels. We have namely a regional reflex and a systemic reflex. The regional reflex seems to be caused by stimulation of the arteries or veins adventitia, while the system reflexes seems to be caused by stimulation of the intima.

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Zusammenfassung Die reflektorischen Veränderungen des Gefäßtonus, die durch direkte Reizung der Gefäße hervorgerufen werden, können entweder alle entsprechenden Gefäße des Kreislaufsystems betreffen oder nur auf die des gereizten Bezirkes beschränkt bleiben.Man kann also einen regionalen und einen Systemreflex unterscheiden. Die regionalen Reflexe scheinen durch Reizungen der Adventitia ausgelöst zu werden, während die Systemreflexe mehr durch eine Reizung der Intima verursacht scheinen.

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Riassunto Le variazioni riflesse del tono vasale, provocabili con stimolazioni dirette dei vasi, possono estendersi a tutti i vasi di un territorio vasale, come possono verificarsi nei limiti del sistema vasale stimolato; si ha cioè un riflesso di territorio vasale e un riflesso di sistema vasale. I riflessi di territorio sembrano provocabili con stimolazioni dell'avventizia delle arterie e delle vene, mentre i riflessi di sistema sembrano provocabili con stimolazioni dell'intima.

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Avec 8 figures     

Expressions cliniques et projectives de la distorsion et de la répression de l’affect chez les femmes victimes d’inceste

ObjectivesThe originality of our work lies in the fate of affects in adult women who have been repeatedly sexually abused by their fathers during their childhood and/or adolescence. We are particularly interested in the effects of their emotional life trauma.MethodsA qualitative methodology was chosen, combining clinical research interviews and a projective Rorschach test for three women followed in a victim support association. After they had given their consent, we made sure they were followed by a therapist because the research could reactivate dramatic memories and cause them to feel unwell.ResultsFrom the Rorschach, we can identify the lack of connection between affect and representation in our patients. For two patients, the affect is volatile, which can be of a pleasant nature and then quickly switch to displeasure or generate anxiety. In the third patient, it is repressed. This repression prevents the expression of affects, which would fail to be taken care of by the psyche because of their disorganizing character.DiscussionWomen who have lived through a traumatic experience such as incest, seem to have their emotional life affected. At the end of this research, the term distortion is discussed, referring on the one hand to deformation and on the other hand to imposed movement. It thus cumulates the idea of constraint by the other and discontinuity (touching on the mode of quality). We can put forward the hypothesis that the affect would be distorted, due to an early impossibility of the environment to give meaning to the experiences of the young child. The latter was caught early in the desire of the incestuous parent, leading him to submit to the expectations of the aggressor and to forget himself. In addition to distortion, another way may be possible, that of repression where the affect is repressed, the subject withdrawing from his psychic and emotional life in order to no longer feel. Emotional distortion and repression seem to be associated with the self clivage as the subject cuts himself off from a part of himself by refusing to recognize parts of his emotional life (repression), or to identify affects as if he had lost his ability to discriminate (the good/bad). Can’t this be seen as an effect of identification with the aggressor?ConclusionRecognizing the fates of affect (distortion and repression) in women who have suffered from incest encourages us to question the classic therapeutic accompaniment modalities based on free association. Initially, this call for associativity could resemble a threat to which the subject would respond either by withdrawing or withdrawing (affective anaesthesia), or by a feeling of dilution of limits. In order to arrange the therapeutic framework, the clinician, relying on transference and counter-transference, could offer words to qualify the incest emotional experience abused by incest. Indeed, the latter could redouble the difficulty in identifying and recognizing what is good, bad, pleasant, or on the contrary unpleasant in relation to primary experiences, which have hindered the reflexive function.     

Apathie et stimulation cérébrale profonde dans la maladie de Parkinson

Apathy was defined by Marin as diminished motivation not attributable to diminished level of consciousness, cognitive impairment, or emotional distress. Up to 42% of Parkinson's disease patients could be concerned. It has a pejorative impact on quality of life and could be predictive of cognitive decline. It has been shown that deep brain stimulation in Parkinson's disease may induce apathy. It seems directly related to the stimulation target, i.e. the subthalamic nucleus, since such an effect has not been observed so far in thalamic and pallidal stimulation. It should certainly not make us question the remarkable effectiveness of subthalamic stimulation in Parkinson's disease patients, but encourages us to be very careful about operability criteria. We must, in this sense, improve identification of at risk patients, seeking a thoroughly diminished motivation, loss of interest or blunting affects.