Défaite sociale et schizophrénie : hypothèses,arguments, mécanismes

There is growing evidence for a main role of environment in the occurrence of mental disorders such as a psychosocial risk factor, for example, childhood trauma, discrimination linked to minority status, or migrant status. One hypothesis is that social adversity factors influence the risk of schizophrenia through a common pathway: social defeat which could be defined as the impotence of a subject in the face of a situation of social adversity, with a consequential experience of devaluation on the social scale. This review proposes to explain the animal model of social defeat which provides an overview of the neurobiological consequences of chronic stress. Then, we expose this topic in humans, the assessment methods, and its psychopathological field. Finally, we expose epidemiologic and neurobiological evidences, in particular the dopaminergic sensitization process, which provide evidence of a significant role of social defeat in schizophrenia risk due to exposure to psychosocial factors. This etiopathogenic hypothesis has several issues. First, a common pathway to several environmental risk factors could allow an ethiopathogenic model more parcimonious for schizophrenia. It could also allow the assessment and prevention of adversity factors involved in social defeat so as to finally improve the outcome of subjects who have an individual risk for schizophrenia.     

Développements actuels de la « contribution à la classification psychiatrique » de D.W. Winnicott. Psychose et intersubjectivité

AimsThis article aims to link current research on intersubjectivity with psychoanalytical texts in order to reopen the debate on models for understanding the classical psychiatric classifications of psychoses (schizophrenia, paranoia, melancholy).MethodThis text is based on a comparison of current scientific publications on the different elements constituting intersubjective processes (indifferentiation, agentivity, theory of mind, empathy, inter-intentionality..) with D. W. Winnicott's 1959 paper, in which he proposes a psychiatric classification that takes into account the degree and quality of the distortion or deficiency of the links with the environment that may have occurred at a stage of maximum dependence.ResultsThe intersection of these two approaches may make it possible to make the role of intersubjective links in defensive organizations intelligible, allowing us to better distinguish the different forms of psychosis.DiscussionIt is possible to sketch a model linking psychotic pathologies with the expression of differentiated intersubjectivity disorders from three propositions. And thus, to take up, in a new form, the propositions articulated in 1959 by D. W. Winnicott. In schizophrenia, the expression of psychic suffering is accompanied by a blurring of the articulation between indifferentiation and intersubjectivity. In paranoia, the pathology is structured around a particular disorder in the search for the intention of others, a disorder of “inter-intentionality” as defined by R. Roussillon. Finally, melancholy can appear in a rupture of the empathic bond in the absence of the object.ConclusionThis modeling does not replace the major Freudian, Kleinian, and Lacanian psychoanalytical theoretical ensembles. It can, however, make it possible to develop a model that improves the intelligibility of the intersubjective links that are woven in the context of psychotherapeutic treatments of the various forms of psychosis, even though they generally take a chaotic form.     

A case of Déjerine-Sottas disease with schizophrenic symptoms. A clinical and pathological study.

A case of hypertrophic interstitial neuritis with a disturbance of intelligence and schizophrenic symptoms was reported. The patient, a 41-year-old male, showed monologia at the age of 14 and auditory hallucination at the age of 21. He was diagnosed as schizophrenia. Torsion of the head to the right side and muscular atrophy were also noticed at 21 years. Atrophy of the muscles progressed gradually, particularly in the distal parts of the upper and lower extremeties. Psychiatric examination revealed schizophrenic symptoms such as auditory hallucination, thought disorder, lack of spontaneity, autism, apathy, etc. There was also a disturbance of intelligence (imbecility). In neurological examination, the torsion of the head to the right side, slight exaggeration of the peripheral reflexes, muscular atrophy in the distal parts of the extremeties were noted. The bilateral ulnar nerves were markedly hypertrophied. The biopsy of the right ulnar nerve revealed a remarkable thickening of the endoneuria and "onion bulb" formations. A large amount of the interstitial accumulation of PAS positive substance, which showed metachromasia in cresyl violet staining, was also noted. Schwann cell processes were proved electron-microscopically to surround the myelin sheaths and some of them meandered and extended and into the metachromatic substance. The basement membrane of the sheath cell was hypertrophic in some portions and elongated into interstitium. The nucleus of the sheath cell was hyperchromic and showed marked atrophy. Histological examination of the biopsy specimen obtained from the gastrocnemius muscle suggested neurogenic muscular atrophy. The relationship among the hypertrophic interstitial neuritis, schizophrenic symptoms, disturbance of intelligence and torsion of the head was also discussed.