Origine et renouveau du concept de démence dans la schizophrénie

An increasing amount of current literature on schizophrenia is devoted to the role dementia may play in its course. This renewed interest had the way paved by the very history of the dementia concept. Before Kraepelin coined the term of "dementia praecox" as the hallmark of a common terminal state for hebephrenia, catatonia and paranoid psychosis, dementia acquired, as soon as the end of the 18th-century its cognitive meaning. In France, Pinel yet spoke of an "abolition of thinking", but in the same time considered dementia as one of the four forms of mental alienation, alongside with mania, melancolia and idiotism. During the 19-th century dementia was defined as an acquired deficit of intelligence supported by a brain disease, but which could be due to a mental illness. Owing to progress in neuropathology, several diseases such as Alzheimer or Pick illnesses were identified as causes of dementia, so that the concept was annexed by neurologists and received less interest from psychiatrists, during the last century. That seemed to change, twenty years ago, when clinical discussions emerged around the issues raised by depressive (pseudo) dementia. In psychiatry, the broader conceptualization of schizophrenia introduced by Bleuler in 1911 has not been widely adopted, many authors having been continuing sharing the Kraepelinian view that, at least one form of the disease, was a chronic progressive illness leading to severe impairments in cognitive and social functioning. Historical variations in diagnostic criteria used for schizophrenia had an impact on the way psychiatrists assessed outcome of the disease, leading some of them to consider schizophrenia as a nosological category without natural boundaries and propose to abandon the concept. However the use of narrow criteria is currently prevailing. Advances in neurocognitive testing and changes in theoretical models allowed, at the end of the last century, to document that schizophrenia was characterized by a broadly based cognitive impairment. Deficits were found in various domains: global and selective verbal memory, non-verbal memory, bilateral and unilateral motor performance, visual and auditory attention, general intelligence, spatial ability, executive function, language and interhemispheric tactile-transfer test performance. The hypothesis according to which the vast majority of these cognitive deficits had a neurodevelopmental origin was recently challenged by findings from longitudinal neurocognitive and neuroimaging studies. Some studies, for example, show that if first episode patients have smaller left hippocampal volumes as compared with controls, there is also an association of smaller right hippocampal volumes with increased illness duration in chronic schizophrenia. Others have shown that neuropsychological evaluations before treatment permitted differentiation of primary deficits from changes secondary to medication or chronicity. Clinicians reported that in some cases of chronic schizophrenic patients, dementia could be a complication of the disease, sharing common neuropsychological features with frontotemporal dementia. The effect of age was discussed too, as seeming to play sometimes a part. Even if the cause of the degenerative process that appears to occur in the brains of some schizophrenic patients remains largely unknown, advances in neuropathological models of degeneration in the brain as well as in mechanisms and factors underlying its process, gave rise to hypotheses liable to explain how degenerative dementia could occur in schizophrenia. Excess products of membrane degeneration which was evidenced by magnetic resonance spectroscopy suggests increased apoptosis in some schizophrenic patients. Deficits in neurotrophic factors, free radical oxidation, excess glutamate activity have been implicated as well as abnormalities in dopamine and cortisol metabolism. Growing evidence that some newer antipsychotics seem capable to interfere with these processes, slowing down their progression and even stopping it, has contributed to the renewal of the concept, opening new avenues to preventive strategies in the treatment of schizophrenia.     

Syndrome de la porte tournante en psychiatrie en 2006

The recent evolution of the public health system has led to a drastic decrease in the capacity of public psychiatric hospitals to receive patients. As patients can benefit from new drugs with better efficacy and higher safety, it has become possible for those who once were banished from the general population because of their symptoms, to live and to be accepted again in the city. But at the same time, the stress of social rehabilitation, precariousness of shelter and drug abuse behaviour contribute to constant relapses. Remission periods become shorter. Consequently the psychiatrists attend to a new phenomenon: A great number of patients are hospitalised for short periods, and return back to the hospital a few days after their exit. This phenomenon is called the revolving door syndrome. Our intervention aims to describe it and all its components and to estimate its reality in 2006. This paper is the result of a team work and the same crue as been working ten years ago on this subject, concerning the same topics. Inpatients with mental disease have specific and complex needs concerning their health but also concerning their material conditions for survival. The paradox is that solutions do exist and follow up is systematically proposed. However hospitalization seems to be the only solution that some patients can accept. Thus, the main question seems to be relative to the methods of follow-up. The patients do not always find the social and occupational support that the hospital provides.     

Résilience familiale et transmission transgénérationnelle du traumatisme de la Shoah

The clinical concepts developed in the present paper concern the resilience and the trans-generational transmission among families of Holocaust survivors. In physical terms, "resilience" is defined as the ability of a material to regain its shape or original position after having been compressed or stretched. In human sciences, “resilience” is the capacity of certain individuals either to adapt successfully to adversity, or to function in a competent manner when faced with a traumatic situation. The concept of trans-generational transmission of trauma is mentioned by numerous authors in explaining certain types of psychological suffering endured by several generations of the same family, notably among descendants of Holocaust survivors. In some traumatized families, all the energy is used by a mourning process and by strategies of survival. Memory of death is everywhere and memory of life is repressed. To help those families, psychotherapists have to inverse the situation by revealing the memory of life and by limiting the role of the memory of death. We present here several clinical observations that we made during therapy sessions with certain families of Holocaust survivors. These families consulted with us because of the symptoms presented by members of the third generation (the grandchildren of the Holocaust survivors) as adolescents. These symptoms were not specific, and included various categories such as dropping out of school, behavior problems, self-mutilation, eating disorders, drug abuse, depressive or anxiety disorders, and problems with aggression. These families presented some specific patterns in their relationships, which led us to consider that the symptoms presented by the third generation might be a consequence of the family's history and the trans-generational transmission of Holocaust trauma. We also describe here the clinical strategy that we developed to assist these families. This strategy was used in addition to classical individual and linear treatment of the symptoms and consisted of an attempt to reinforce the relationships between Holocaust survivors and their grandchildren with the aim of stimulating a structuring trans-generational transmission. In effect, at the liberation of the camps, certain Holocaust survivors used, as a mechanism of individual resilience, control over their memory and their emotions. In effect, their psychological survival was impossible without making sure that their terrible memories and inexpressible feelings could not occupy their consciousness. In stifling their memories and their history, they created a void in the parenting of their children and their grandchildren. In order to fill this void and to unblock familial memory, we make use of the privileged position occupied by the grandchildren of Holocaust survivors. In effect, Holocaust survivors generally adopt a more flexible attitude toward their grandchildren than toward their children. Therefore, we entrusted them with the task of reconstructing the history of their family before and after the Holocaust through consulting their grandparents, most of all, but also other members of the family, whether it be directly or by courier (eventually electronic, in the case of geographic separation). Our therapeutic approach improves the flexibility, adaptability and communication of the family. Moreover, it improves the bond between Holocaust survivors and their grandchildren and permits the latter, through a better knowledge of their family history, to acquire a trans-generational shadow.     

Le syndrome de Koro

Objective. - To investigate a rare psychiatric disorder called “Koro” which is usually described as a culture-specific syndrome in Asian cultures. This syndrome is manifested by intense anxiety associated with the fear of genital retraction and the belief that complete disappearance of the penis into the abdomen will result in death. Even though some cases have been reported in non-Asian subjects, it is often referred to as a culture-bound syndrome.Method. - A literature and case report review indexed 117 articles or summaries relating to the syndrome of Koro. In addition, the authors report six cases of Koro in Quebec from their clinical practice and open a discussion on clinical, epidemiological and etiological features.Results. - Koro is a relatively rare syndrome that is related to various etiological, clinical, diagnostic and cultural aspects leading to several controversial debates, letters to editors and comments on articles. This also includes the anthropological, psychodynamic and biological point of views. Even though only 19 cases in Hong Kong were diagnosed in fifteen years, this syndrome can sometimes take epidemic proportions as in Singapore where many cases appeared following a porcine infection or in Thailand where a thousand cases were listed after the Vietnam War. In the province of Juandong, two similar phenomena were clearly documented in 1984-1985 and 1987 where a total of two thousand cases were declared. This was also observed in India, a country culturally very different with a mainly Hindu and Muslim population. The authors also describe six cases in Quebec: 1- a 31-year-old man with no history of psychosis with anxiety related to problems in erection and ejaculation that had negative effects on his married life. Shortly after he reported that his penis retracted into his belly. 2- a 32-year-old American-Indian man, with history of violence and alcohol dependence developed Koro symptoms, which caused this patient to use strings around the penis to prevent its retraction into the belly. 3- an 18-year-old male diagnosed with paranoid schizophrenia expressed his extreme concern to see his penis decrease in size and retract during one of his hospitalisations. He believed that only masturbation and sex with prostitutes were capable of preventing this from happening. 4- a 25-year-old patient diagnosed with paranoid schizophrenia since the age of 16 arrived at the emergency with suicidal ideas. Upon interview, the patient was anxious and presented olfactory hallucinations of genital origin. He expressed concerns that his genitals would disappear inside his abdomen. 5- a 25-year-old man with paranoid schizophrenia presented with auditory hallucinations of death threats and fear that his penis would be removed by magic. After one month of hospitalisation, his anguish took an obsessive form that required him to go to the bathroom regularly to examine himself. 6- a 31-year-old man diagnosed with paranoid schizophrenia since the age of 19 arrived at the emergency with suicidal ideations under the influence of command hallucinations. He requested a treatment that would prevent his genitals from disappearing into his belly.Conclusion. - A distinction seems necessary between epidemic cases of Koro that are culture-specific and isolated cases, that given the right setting and stimulus could occur in any culture and are often present in comorbidity with severe psychopathologies or cerebral lesions.     

Apports de la neurobiologie en psychiatrie de l'enfant et de l'adolescent

Recent findings in neurosciences are reviewed and applied to the domain of child and adolescent psychiatry, especially ADHD and PTSD in childhood. Behavioral genetics studies highlight a bidirectional relationship between genetic and environmental factors which interact at a certain critical period during the child development. fMRI and cognitive studies in turn reveal the brain plasticity which reflects that interplay between genes and environment both at a cellular level and at the level of the neural circuitry. In keeping with those experiments, a new neurocognitive model emerges, the forward model, wherein motor and emotional aspects of an experience are imprinted in our neural networks. This neural template is then automatically and non-consciously activated when the person is interacting with another one. Applied to PTSD and ADHD, this model suggests that the therapeutic challenge which is carried along with such disorders is to prevent the youth from re-activating such a neural template. If our understanding of the child psychopathology is stimulated by neurosciences findings, the therapeutic apparatus is enlarged as well with such new venues as the computerized-assisted cognitive remediation for ADHD. Such computer devices are used to elicit the activation of new neural networks and to help out the youth inhibiting the activation of the non-adaptative previous neural pathways.     

De l’intérêt du profilage cytochromique en psychiatrie : à propos de trois situations cliniques

A successful drug treatment, and particularly psychotropic medication, depends on its biochemical action. Moreover, it varies according to reaction or modulation of the target organism with this molecule and its properties. Indeed, drug metabolism is very fluctuating from one individual to another. It follows in particular genetic variants of cytochrome-P450, which may result in abnormally fast or slow metabolizers profiles depending on the molecules used. However, this individual variability relates near one for five patients, and in the daily practice of a psychiatrist, it can be translated in terms of efficacy, safety, or worse like iatrogenic symptoms. After a short summary of current knowledge on the issue, the authors propose to illustrate three situations. It is current practice for three patients with mood disorders and atypical symptoms like negative symptoms of psychosis. It appears that the analysis of clinico-pharmacological history allows the hypothesis of side effects in the case of an individual with metabolic changes before to find an effective and well-tolerated treatment. These three situations illustrate the interest of the individual genotyping for cytochrome-P450 in daily practice of psychiatry, or, at least, how the inclusion of such possible variations is critical to justify psychopharmacological new strategies.     

Enquête sur la perception de l'observance dans la schizophrénie (EPOS)

From the patient's viewpoint, good quality compliance supposes a good relationship with his/her doctor; this relationship is directly linked to the therapist's heeding and interest shown to the patient, and not to the patient's symptoms alone. If individual motivation plays an important part at the outset, it will nevertheless be seriously influenced by the relationship between the doctor and his/her patient. It is one of the rare factors for which a positive correlation with compliance can be observed, as shown by practically all medical psychology research. To these well-known classical medical notions correspond average values of non-compliance, which may vary widely according to those concerned. These data are proof of the wide gap existing between what is expected and what is actually achieved. This discrepancy is felt by the patient as well as by his/her therapist, and involves many other factors linked to culture, to medical and religious background, medical anthropology, and the real or supposed proprieties of the Pharmakon. Compliance to antipsychotic medication in schizophrenia continues to be a significant and challenging question in terms of its prevalence as well as its significant impact on the rate of relapse and resource utilization. Most of the published reports, here again, confirm the significant contribution of attitudes towards treatment and their impact on adherence and clinical outcomes. Negative critical attitudes can be enduring and may require specific targeted behavioural interventions in addition to optimization of medication-based treatment. Systematic reviews and a meta-analysis of various approaches to enhance compliance with medication in schizophrenia have yielded inconsistent results, reflecting the many shortcomings of the studies included in the review and the meta-analysis. Most of the interventions tend to be rather complex and resource-intensive. One of the consistent findings has been the lack of impact of approaches based on psycho-education alone, without additional behavioural, family and economic support. Not only does the content of any compliance intervention approach seem to be important, but the time-course of outcome evaluation is also relevant. The need for “booster therapy” seems to be important for maintaining some of the beneficial effects of adherence-improvement therapies. Although second-generation anti-psychotics are subjectively better tolerated than first-generation anti-psychotics, their impact on compliance behaviour and improved attitudes towards treatment has not yet been systematically demonstrated in well-controlled studies. Similarly, differences between individual second-generation antipsychotic medications, in terms of impact on compliance behaviour, need to be explored. Our study aims at synthesizing the most recent data concerning this issue which is still at the core of numerous debates and hardly ever tackled in French language literature. Thanks to the summary of these data and to the testimony of 380 schizophrenic patients, we shall try to have a better understanding of what happens between the patient and his/her therapists from a relationships viewpoint.     

Le contingentement de la jouissance dans la paraphrénie

At 1913, in the eight edition of its Treatise, E. Kraepelin changed its own classification of chronics delirium because he wanted to insert in it the group of paraphrenias; at 1978, H. Ey, in its Treatise of hallucinations, showed that he had conserved some interest for this clinical type that he named delirious fantastic psychosis. At 1996, J.-C. Maleval introduced a progressive logic of delirium where paraphrenia appears as the end of therapeutic work of delirium. We study more precisely here the case of a paraphrene subject who had one's moment of glory at 1905 in Paris where he was the object of a hoax played by J. Romain: J.-P. Brisset was elected prince of thinkers. In this example, the evolution of paraphrenic delirium preserves the subject from the “jouissance de l'Autre”.     

Une phénoménologie de la dépendance à l'alcool. Une expérience primordiale de la « nostrité »

The phenomenological approach to alcoholism interestingly focuses on specific dynamics of interpersonal relationships displaying the founding of the Self from a primary “us” and its original basis in the human feast. Priorities for treatment intervention recommend to involve social setting and relationships of the patients, reaching their active participation to a motivational and long term group treatment, underlying the specific therapeutic effect of world exchanges. Biopsychosocial determination of alcoholism could be primarily based on components of interpersonal relationships. Regarding social background, drinking is one of the most famous supports for the achievement of the feast, a founding marker of present time. Taking an existential point of view, the feast appears as the heart of mankind because it presents a primary “us”, a plural state which indicates the beginning and founding of the Self from the others. During the feast, we regularly have to reach our Self from the “us” while avoiding two main dangers, drunkenness, an increase in the dizziness of upright verticality, and addiction, an opposite vertical surrender to alcohol and falling into in the alcoholic relapse, both situations imply a spatial domination and the disappearance of others. Treatment programs of alcohol addicts need to integrate the necessity of reaching the existential basic trust from the support of a group to the appropriation of the community which can be defined as an original “usness”.     

Faisabilité de l'autoévaluation dans le dépistage de l'hypomanie

The Hypomania Checklist (HC) is a 20-item questionnaire, which is easy to fill in and designed to help clinicians collect data for diagnosing bipolar disorder. This tool could be very useful in primary care where type II bipolar disorder is under-diagnosed, however, to date no suitable cut-off score correlating with a high probability of bipolar II disorder diagnosis has yet been validated.

Method

In a French clinico-epidemiological multi-center survey (EPIDEP) a national sample of patients with DSM-IV major depressive episode (MDE) was recruited and assessed at admittance and four weeks later. Diagnoses of unipolar or bipolar disorder were made according to a semi-structured interview adapted from the DSM-IV. In addition, the HC and questionnaires on affective temperament were administered at the second interview. In the analyses, the diagnostic accuracy was computed in terms of sensitivity, specificity, predictive positive value and predictive negative value, by varying cut-off scores on the HC. The Receiver Operating Characteristic (ROC) statistical technique was used to compare the diagnostic value of HC with the semi-structured interview adapted from the DSM-IV.

Results

Of the 493 patients with a MDE DSM-IV diagnosis, 468 filled in the HC, from which the six following groups were formed: strict unipolar disorder (UP, N = 201), bipolar I disorder (BP-I, n=39), bipolar II disorder (BP-II, N = 141), patients with mania or hypomania secondary to an antidepressant treatment (N = 51), cyclothymia (N = 14) and hyperthymia (N = 22). Comparing the BP-II patient group (N = 141) with the strict UP group (N = 201) the most discriminating HC score was 9, which identified 81% of patients correctly, with a sensitivity of 86.5, a specificity of 77.1, a predictive positive value of 72.6 and a predictive negative value of 89.1. Some cases identified as cyclothymic and hyperthymic temperaments by the affective temperament questionnaire but meeting DSM-IV criteria for major depressive disorder were included in the unipolar group (N = 237). The same score of 9 was validated, identifying a percentage of patients with correct diagnosis of unipolar depression of 78.3%, a sensitivity of 86.5, a specificity of 73.4, a predictive positive value of 66.0 and a predictive negative value of 90.1. If patients with mania or hypomania secondary to an antidepressant treatment were included as a subgroup of BP-II, a score of ten appeared as the most relevant, with a percentage of patients with correct diagnosis of 79.0 %, a sensitivity of 80.2, a specificity of 78.1, a predictive positive value of 74.8 and a predictive negative value of 83.0. ROC curves confirmed these values. Lastly when BP-I patients (N = 39) were compared to the strict UP group (N = 201) the most discriminating HC score was 11, with a percentage of patients with correct diagnosis of 86.3%, a sensitivity of 74.4, a specificity of 88.6, a predictive positive value of 55.8 and a predictive negative value of 94.7, but the BP-I group was too small to validate the score of 11.

Conclusions

These results indicate that a score of 9 on the HC is highly correlated with a BP-II diagnosis (and a score of 10 if patients with mania induced by antidepressants are considered as BP-II), and suggest that a wider use of the HC in primary care associated with strong GP/Psychiatrist networks could improve the detection, and with appropriate treatment, the prognosis of Bipolar II disorder.     

L' « Ouverture émotionnelle » dans les Troubles de la dépendance et les Troubles de la personnalité

Emotion processing is supposed to play an important role in psychological dysfunctions in alcohol and drug dependency disorders (DD), as well as in personality disorders (PD). The model of “Emotional Openness” (“Ouverture émotionnelle”) provides a multidimensional framework to analyze problematic patterns of emotion processing. Within this framework, it is suggested that drug- and alcohol-dependent patients as well as borderline and antisocial patients show reduced a) “cognitive/conceptual representation” of affective states; b) “emotion regulation”; and c) “expression and communication of emotion”; but d) increased “awareness of body internal indicators” of affectivity; and e) appropriate psychological treatment is supposed to improve these patterns. Drug-dependent patients with PD comorbidity (in particular borderline or antisocial) are supposed to present even stronger deficits in (a) and (b). The hypotheses are tested with the 36-item DOE questionnaire (“Dimensions of Openness to Emotional experiences”, trait version; [19]), assessing six main dimensions of emotion processing as represented by the subject (French and Italian version). The instrument presents satisfying reliability coefficients (mean alphas of the scales in two recent studies (N = 251; N = 435) vary between 0.74 and 0.82) and good factorial validity (6-factor PCA solutions with varimax rotation solutions in the two samples are highly coherent; the mean of Tucker's congruence coefficients is 0.93). Results of two clinical studies are presented, comparing N = 71 patients (21 drug-dependent without personality disorder; 30 drug-dependent with borderline or antisocial personality; 20 dependent in-patients receiving psychological therapy) with normal control subjects (N = 51 matched; N = 50 reference group), including one pre-post treatment comparison. Results confirm marked deficits of DD patients concerning “conceptual representation” and “emotion regulation”, as well as a reduction of “communication/expression of emotion” but an increased “awareness of body internal indicators” of affectivity. Differences of patients with a double diagnosis correspond to effect sizes of d = -1.33 for cognitive/conceptual representation of emotions and d = -1.25 for emotion regulation; differences in emotion communication and expression are also significant but less important d = -0.44. Awareness of body internal emotion indicators is increased (d = +0.27) but does not differ significantly from the control group. As supposed, patients with a double diagnosis (DD and PD) described significantly stronger deficits in conceptual representation and emotion regulation than the patients with dependency disorder only. In the second study, a group of DD patients receiving multi-component treatment, including individual and group therapeutic intervention, according to the client-centered approach, and working on emotion processing, showed marked differences from the reference group at the beginning of the treatment (d = -0.91 for cognitive/conceptual representation, d = -0.82 for emotion regulation and d = +0.46 for awareness of bodily internal indicators). As supposed, pre-post comparisons indicate improvement with change effect sizes of d = 0.99 for conceptual representation, d = 0.97 for emotion regulation, as well as d = 0.88 for emotion communication and expression. Furthermore, the changes following treatment are highly significant and substantial, except for the awareness of internal bodily indicators, which only slightly decreased. Patients “normalize” their emotion processing following treatment, describing increased conceptual representation and emotion regulation, as well as emotion communication and expression. Results underline the importance of dysfunctional modes of emotion processing in both pathologies, and underline the validity of applying the model and the DOE instrument. They are discussed with reference to the model of alexithymia.     

La psychologie de l'adolescence

It can be considered that the first book specifically devoted to a scientific psychological study of adolescence is the one written by Granville Stanley Hall (1844-1924), initially published in the United States in 1904. The text that has been reproduced here, which appeared in France in 1906, in the Revue Philosophique (volume LXI, pages 345 to 377), provides a detailed account of this innovative work. It bears witness to the positive reaction on the part of educational theoreticians in our country, to the new ideas provided by the American psychologist regarding adolescence and also the methods developed for studying it. The text thus includes a discussion that is full of praise for, albeit somwhat critical of, the themes that were dear to Stanley Hall, the founder of genetic psychology, who was also a philosopher, sociologist and teacher: the carrying out of large-scale surveys and research into facts; a general anthropological evolutionist approach, in the footsteps of Herbert Spencer; philosophical monism, and for the study of human psychology, rather than placing emphasis on introspection, focusing more on the body and its development: a view that was shared in France by the psychophysiological school of thought at the time, from Théodule Ribot to Alfred Binet. Jules-Gabriel Compayré (1843-1913) was an educational theoretician, one of the individuals who helped to develop the French ‘Republican School’ under the Third Republic, and not only the author of a large number of books on education, but on the history of education as well. His works were widely distributed and much read, and he held prestigious university posts (Rector of Lyon University, Member of the Institute). Regarding Stanley Hall, Compayré felt obliged to criticize the former's unduly atavistic approach, based on the theory of the primacy of ontogenesis over phylogenesis. However, in agreement with the some of the arguments of the American psychologist, he shared the idea that an efficient and intelligent educational approach should be based on firmly established prior knowledge of child and adolescent psychology, a ‘psychopedagogical’ view that was to be further developed by Maria Montessori, Édouard Claparède, Ovide Decroly and later by the New School.     

De quelques enjeux épistémologiques de l'usage de la notion d'analogie

The notion of analogy and the phenomena it refers to were poorly thought of in the cognitive psychology domain and in psychoanalytic theory as well during many years. The first domain, under a developmental paradigm influence, reduced most of the analogy time to a group of “primitive” processes of knowledge, to be overtaken by abstract reasoning. As for the second, most of the time it treated this notion as an imaginary expression, suspected of standing on the side of deception and delusion. But, for about twenty years now the situation has been moving in a relatively convergent way in the two areas. Analogy is being recognised again. The present article proposes bringing out some of the epistemological implications of this notion's renewal in the psychoanalytic theorisation area. The author explores three angles of research that resort to the notion of analogy. The first theorizes about transference (does it present an analogical structure or not?); the second theorizes about metaphor; the third theorizes about the signifying called “archaic”. This thought relies on a methodological process that distinguishes three levels of study among the analogical processes: a level that tries to study the analogical processes itself (cognitive psychology); a level that tries to study the relation between the subject and his own analogical processes; a level that questions analogy's contribution to scientific discovery. From such a methodological process, we can show the specificity of each one of the theoretical levels and we can envisage a dialogue. Using the analogy notion leads to a relativization of the specific binary thought of the structural processes and to restore the nobility of the thought processes implying references to space, to the body, to an illusion of continuity between the psyche and the world.     

Déficit de mémorisation d'information à contenu émotionnel chez le patient souffrant de schizophrénie

Studies in the relationship between cognition and emotion are still ongoing. This new perspective has led Andreasen, among others, to consider the disturbance of the cognition-emotion relationship in schizophrenic patients as a fundamental aspect of the illness. This aspect is central in the care of these patients, since the difficulties engendered by it have a great effect on their quality of life. This study examines the process of recalling information with an emotional content among schizophrenic patients. The participants were divided into two groups (a group of 15 schizophrenic subjects and a group of 14 comparison subjects) and were asked to listen to a story containing information with both emotional and factual content. This information was presented both explicitly and implicitly. The participants then had to provide instant and delayed recall of the information. The results underlined a marked deficit in the immediate and delayed recall of information with an emotional content for the group of schizophrenic subjects regardless of how the information was presented or how long the delay in retention was. This indicates that memory deficit among schizophrenic patients increases when they have to remember information that is emotionally charged. On the other hand, it seems necessary to develop some cohesion around the terms used (“emotional memory”, “memory of information with an emotional content”) to further this type of research.     

Un modèle de conscience de soi suggéré par la psychosociologie de l'invention

Knowledge in the making can be regarded as a relational system. Through concepts and apparatus linked to them, the scientist build a relation with nature that fits with the idea she has about it. This model can be applied to consciousness in general, apart from that form of consciousness induced by scientific knowledge. Like scientists, our consciousness is built through a fusion-differentiation process from other people leading to the building of culture as an ethnotheory. This process leads to a “consciousness in action” depending from the success or the failure of expected roles and real behaviors of nature and the energetic balance of these cycles. This model fits with a specific contemporary psychotherapy. It leads to phenomenology and anthropological psychiatry.