Clinique possible d’une addiction à la caféine à partir de l’observation de 52 sujets et d’une revue de la littérature

Caffeine is the most widely consumed psychoactive substance in the world. In the scientific literature, caffeine abuse is usually called “caffeinism”, and can provoke symptoms of nervousness, excitement, anxiety and insomnia. The aim of this article, based on a previous study conducted in a research paper, is to observe if high-level consumption of caffeine can be considered as an addictive conduct. Three hypotheses were tested on 52 subjects (one study group with high consumption of caffeine [300 mg-1000 mg] and a control group with low consumption). They should present: (1) an addictive conduct towards caffeine; (2) a high level of anxiety; (3) few subjects would use caffeine as a weight control strategy among people suffering from eating disorders. To validate these hypotheses, we used a control group, the Goodman's definition's criteria, the anxiety scale state-trait STAI and, finally, the MINI diagnostic questionnaire. The results show us that 88 % of subjects presenting a high level of caffeine consumption would present an addictive conduct (the average subjects fulfilled 70 % of Goodman's criteria). This behaviour is characterized by impulsiveness and the persistence of the behaviour despite harmful consequences for the subject. The anxiety level was higher in the study group, compared to the control group and seven subjects used caffeine as appetite suppressant, in the case of eating disorders. Our study suggests that patients should be asked about their caffeine consumption level during a clinical anamnesis. It also paves the way for other studies, on for example, the link between caffeinism and eating disorders.     

L’anxiété préopératoire : manifestations cliniques, évaluation et prévention

Preoperative anxiety consists of physiological and psychological discomfort that manifests itself at the possibility of a surgical intervention. When the anxiety is weak or moderate, it is considered to be an adaptive response to a potentially anxiety producing situation. Prior research has established that high levels of preoperative anxiety increase the risk for postoperative complications as well as emotional and behavioral difficulties. Despite these sometimes severe medical and psychological consequences, very little literature exists aimed at French health care workers on the subject. The goal of this article is to synthesize the existing knowledge on preoperative anxiety, including its clinical manifestations and methods of evaluation and prevention.     

Bénéfice d’un programme cognitivo-comportemental et pluridisciplinaire de prise en charge de la maladie d’Alzheimer sur l’anxiété du conjoint : étude française ELMMA

Introduction

Over the last decade, several programs have been developed for caregivers of Alzheimer disease patients. In France however, studies exploring their effects are still scarce. We conducted a study to compare two different interventions: a structured multidisciplinary program versus a classical intervention designed for Alzheimer disease patients and their spouses.

Methods

Sixteen couples (Alzheimer's disease patient and spouse) residing in our administrative district participated in this monocentric study. For at least two years, these couples participated in a multidisciplinary program (n = 8 couples) or received usual care (n = 8 couples). The multidisciplinary program involved biannual consultations with a neurologist, a neuropsychologist and a psychologist, in addition to an annual meeting, stratified on the patient's MMSE score, for spouses). Usual care involved biannual consultations with the neurologist. The multidisciplinary program included a psychological intervention based on cognitive behavioral theories and centered on psycho-education, problem solving, adaptation strategies and on prevention of depression and anxiety. The spouses and the patients evaluated the 2-year follow-up during clinical interviews, completed by questionnaires. Sociodemographic data were noted for the patients and their spouses. Levels of depression and anxiety (Mini International Neuropsychiatric Inventory, Montgomery and Asberg Depression Scale, State-Trait Anxiety Inventory), perceived stress (Perceived Stress Scale) and care burden (Zarit Burden Inventory) were evaluated in spouses. Levels of cognitive impairment (Mini Mental State Examination), autonomy (Instrumental Activities of Daily Living), psychological state (Montgomery and Asberg Depression Scale, Covi Anxiety Scale), and behavioral symptoms frequency (Neuropsychiatric Inventory) were assessed in patients.

Results

The main significant result showed that the spouses’ state of anxiety was lower among participants in the multidisciplinary program, compared with the classical neurological intervention. It also was found that the spouses and the patients who participated in this multidisciplinary program were less depressed.

Conclusion

This study shows that a multidisciplinary structured intervention, with only two annual consultations and one annual meeting for spouses, can contribute to decrease significantly the spouses’ state of anxiety. Further studies including a larger number of subjects should be conducted to confirm these findings.     

Les troubles anxiodépressifs dans la maladie de Parkinson : une revue de la littérature

For a long time, depression and anxiety have been neglected in Parkinson’s disease in favour of motor impairments. Since the 70’s and the beginning of the dopatherapy, the psychopathological perturbations are more and more considered, including by the neurologists. The aim of this study is to review the main studies related to depression and anxiety in Parkinson’s disease. Four main topics are tackled in this review: The prevalence, the etiology and the semiology of the depression as well as the anxiety disorders; the assessment tools and methodological problems for assessing these troubles. Beside these main subjects, we adress some interesting questions, which concern patients as well as clinicians, like the relationship between the depression and/or anxiety and the motor impairments, the disease duration and the type of the Parkinson’s disease. We tackle also the question of the relationship between the depression and/or anxiety and the cognitive troubles and we focus about the main types of cognitive impairment found in Parkinson’s disease with depression and anxiety. We review some studies, which found a link between psychic disorders and depression. It is now obvious that the deep brain stimulation has become an efficient treatment of motor symptoms. In this review, we focus on the effect of the deep brain stimulation on depression. We also discuss the different treatment available for depression and anxiety in Parkinson’s disease. Because of their frequency and their impact on the quality of life, it is particularly important to give a specific attention to these troubles in Parkinson’s disease.     

Un cas de harcèlement moral au travail : approche transactionnelle

This communication presents a clinical application of the transactional model of stress due to moral harassment at work with questionnaires measuring hostile acts, the personality of the two partners and the evolution of permanent state of anxiety, and also evaluating the strategies for coping and the conscious by-products of defensive mechanisms. The representational work focalising on the personality of the harasser produced a diminution of permanent state of anxiety and a modification of defensive and adaptive strategies.     

Gestion de l’anxiété de performance orale et représentations mentales: Les propriétés structurales des représentations mentales comme outil de changement

Many techniques used in brief psychotherapies are based on the activation of mental representations and images. For example, cognitive-behavioural therapists confront the subject at their mental representation of the phobogenic situation. Exposition techniques and desensibilization method (Wolpe) used by cognitive-behavioural therapists activate visual mental representations and verbal representations through the medium of auto verbalizations or self-statements. The strategic therapeutics or hypnotherapists invent metaphors or suggestions that solicited the patient’s cognitive style. So, psychotherapists can learn from lot specific researches about mental representations, particularly analytic conceptions of visual imagery elaborated by Kosslyn and studies about auditory imagery (Reisberg) because these researches demonstrate that the cognitive capacities concern many « sub-capacities » in which the subjects manifest different abilities.Objective.- This investigation examines the effects of modifications of the structural properties of verbal, visual, and somesthetic representations in oral performance anxiety. The goal of the present study is to identify the structural properties (visual, auditory and somesthetic) capable of producing the greatest reduction in oral performance anxiety.Structural properties encompass the auditory characteristics of self-statements (e.g. volume, rhythm, and distance from stressful event); the characteristics of the visual image (e.g. size, brightness, and distance from stressful event); and the somesthetic properties (e.g. intensity, location, and area of uncomfortable feelings associated with social anxiety).Results. - Concerning the visual representation of the stressful event, the distancing from the image tended to reduce anxiety more than the other modifications (i.e. size or brightness). Concerning negative self-statements, our results indicate that reducing volume tend to diminue anxiety than the slowing down of the rhythm. Finally, the instructions encouraging a reduction of the intensity of sensations were more effective than other modifications (displacing and area of unpleasant sensation) in reducing anxiety.     

Un exemple singulier d'adaptation à l'anxiété d'anticipation : les rituels conjuratoires dans la pratique de la corrida

The man who runs his life with killing bulls in the strictly way of practising bull fighting, in facing real death, mythic animal’s one, has to confront himself with his own anxiety which deeply oversteps the bounds of his own death. Studies about the semiology of anxiety made from testimonies or accounts by “matadores”, in a litteral sense by “killers”, make obvious the preponderant use of obsessional defences that are borrowed from the obsessional register (superstitions, conjuring rituals). Beyond the anxiety felt by any artist or public intervenant which could be assimilated with stage-fright, there come some more specific and rationalized anxieties such at the fear of being wounded or of failing which is lived with affects of shame and also with some more unconscious anxiety: this “inner bull” is a still more threatening and more redoutable anxiety than the one that will happen in the ring and will be used as a projection shield against the inner anxiety. The specificity of bullfight could explain in a large way the passions it always breeds as well from its opposites as from the upholders of this using.     

Psychothérapies cognitivo-comportementales de l’hypocondrie

This paper reviews the cognitive-behavioural strategies of psychotherapy applied to hypochondria. Cognitive mechanisms of hypochondria are the tendency to amplify body manifestations (pain, fatigue…) and to interpret them in a catastrophic manner. The persistence of anxiety is due to a confirmatory bias, which increases the importance given to information congruent with anxiety. The exposure-response prevention model is an important technique in the treatment of hypochondria. This model has been validated in patients presenting obsessive compulsive disorders. Patients are invited to confront ideas or thoughts that induce fear. This confrontation is repeated or prolonged in order to induce the extinction of anxiety. Another cognitive approach is the step-by-step cognitive “modelling”. During the first step the patient assesses his stress-inducing thoughts concerning his health, he also has to assess the frequency of inadequate medical treatments. During the next step, the therapist helps the patient correct automatic thoughts and false beliefs concerning his illness. The last step is a phase of consolidation. The therapist identifies factors triggering anxiety and excessive medical care. All these behavioural cognitive therapies can be performed in individual or in-group processes. Therapies proposed to patients presenting generalized anxiety disorders can be adapted to hypochondriacs. Lastly, hypochondria can be understood and treated as a form of addiction to medicine characterised by a craving for medical care, for biological exams and for different forms of medication. According to this conception, the treatment can be conducted as a form of detoxification: patients identify the frequency of their pathological behaviour and find strategies to reduce and/or control them.     

Assessment of State and Trait Anxiety in Subjects with Anxiety and Depressive Disorders

The State-Trait Anxiety Inventory (STAI) is one of the most widely used scales for the evaluation of anxiety in medical and, to a lesser extent, psychiatric patients. Although there is a relatively large amount of STAI data about anxiety for individuals with a variety of psychiatric disorders, the results of many anxiety studies include only state or trait and many studies have been influenced by comorbidity and by variations in diagnostic criteria used. We studied state and trait anxiety and compared the revised form of the STAI (Form Y) with the original (Form X) to evaluate the anticipated improvement in the measure. In addition, we compared the STAI results with those of another self-report measure (the Symptom Checklist–90 anxiety and depression scales) and also with interviewer-rated measures of anxiety (Hamilton Rating Scale for Anxiety) and depression (Hamilton Rating Scale for Depression). Results indicate that the STAI does not clearly differentiate anxiety disorders from depressive disorders and support the use of multiple tests and of both self-report and interviewer ratings in the evaluation of anxiety and depression in psychiatric patients.     

Les thérapies utilisant la réalité virtuelle dans les troubles phobiques

For the past 15 years, virtual reality has been increasingly used as a therapeutic tool in psychiatry. In particular, virtual reality exposure therapy (VRET) has been developed from and proposed as an alternative to standard cognitive behavioural therapy (CBT) for the treatment of phobic disorders. Using real-time computer graphics and visual displays, the patient is immersed in different computer-generated virtual environments specifically designed for different types of phobia. As imaginative or in vivo exposure therapy, VRET consists in a gradual presentation of phobic stimuli. The desensitization through VRET has been found to be efficient in different types of anxiety disorder, and in particular in phobic disorders. Moreover, it presents most of the advantages of both in vivo and imaginative exposure therapies without most of the inconveniences. Indeed, VRET can be tailored to individual progression. It takes place in the privacy of the therapist's office, ruling out all the problems of confidentiality. It can be repeated or prolonged easily, even for rare or dangerous situations. It is less time-consuming for the therapist and really more acceptable by the patients. This report presents the preliminary results of a controlled and randomised study suggesting a comparable efficacy of VRET and standard CBT for the treatment of panic disorder with agoraphobia. Moreover, new therapeutic targets are investigated, like fear of falling. As a conclusion, VRET represents an interesting alternative therapeutic method to standard CBT for the treatment of phobic disorders, but it is generally not sufficient and has to be included in a more global therapeutic project.     

Association entre anxiété et hyperlaxité articulaire : revue de la littérature

Joint hypermobility is an exaggerate increase of the joint's mobility due to an inherited alteration in the collagen fibres. For decades, it has been observed that people with this condition show very often symptoms of anxiety. Empirical studies corroborate these clinical observations and associate the joint hypermobility principally with the endogenous anxiety, which suggest that is a biological base shared by both phenomena. The discovery of the connection between the two different fields, psychiatry and rheumatology, has important implications; it offers the possibility of identifying the most vulnerable patients suffering anxiety disorder, by exploring the signs and symptoms associated with joint hypermobility.     

Dépression et anxiété chez les femmes souffrant de cancers gynécologiques

Revealing a diagnosis of gynaecologic cancer generates various psychosocial and emotional responses: anxiety, denial, passivity, annihilation of long-term projects and personal responsibilities, worries about the near future and of death.In gynaecological cancer, alterations of sexuality and of representation of femininity can seriously complicate the psychic representation of disease and impair family life of the patients.The prevalence of depression among cancer increases with the severity of the disease and with the intensity of the symptoms such as pain and fatigue. Conversely, depression may interfere with the course of cancer in altering the adherence to medical treatment and in affecting the patient's endocrine and immune functions. Thus, serious medical and psychiatric comorbidities may be underestimated.Depression in patients with gynaecological cancers has been under-diagnosed and under-treated, partly because of the belief that depression is a normal and universal reaction to serious diseases and partly, because the neurovegetative signs or emotional and cognitive symptoms of depression are often attributed to the medical illness itself.Many recent studies have shown a decrease of depression by chemotherapy, psychotherapy or relaxation interventions. The complexity of psychological reactions of such patients, however, requires that a psycho-oncologist be included in the treatment team.These studies point to the importance of detecting depression and of treating the substantial minority of gynaecological cancer patients suffering from depression with therapies designed to improve their quality of life and their ability to cope with the cancer at every stage of their disease.     

Fonctionnement cognitivo-émotionnel : le rôle de l’intensité émotionnelle chez les individus anxieux

Anxiety is an emotional disorder widespread in the general population and it seems to be linked to depression symptoms. The aim of this study is to test the hypothesis of relations between cognitivo-emotional functioning, anxiety and depressive symptoms. The study sample was formed from a group of 50 female subjects, aged from 18 to 65. Participants completed the Hospital Anxiety and Depression scale (HAD), the Affect Intensity Measure (AIM), the Emotional Expressivity Scale (EES) and the Levels of Emotional Awareness Scale (LEAS). The results show that strong positive correlations between anxiety symptoms affect intensity, emotional expressivity and the level of emotional awareness. To conclude, these results point out the importance of emotional variables in the study and treatment of subjects suffering from anxiety symptoms.     

Application de la résolution de problème dans une unité de suicidants et suicidaires : premiers résultats auprès de 53 patients hospitalisés

Suicidal behaviour is a clinical problem that has posed major challenges to efforts in its understanding and treating. There are many studies on the various mental disorders presumed to underlie suicidal behaviour. Less than 50 randomized clinical trials have been conducted evaluating treatments aimed specifically at treating individuals with high suicidal risk. There is sparse data regarding treatments for primary mental disorders, which actually reduce the risk of suicide attempts or of suicidal ideation. The authors think that focussing efforts on treatment of suicidal behaviours may improve our understanding of the mechanisms related to suicidal behaviour and mining them for ideas will lead to effective interventions. For over a year the authors introduced the problem-solving therapy in their broad program for treating suicidal inpatients. In this pilot study the authors observed that assisting patients in developing a more positive problem-solving orientation may modify customary attitudes of avoiding problems and reduce tendencies to respond in an impulsive or careless manner.     

Balance émotionnelle dans les troubles anxieux et dépressifs

To date, few researches applied the emotional approach of the tripartite model of Watson and Clark, differentiating positive and negative affects, to the study of anxiety and depressive disorders. Nevertheless, the notion of emotional balance is interesting for the understanding of these pathologies and for the follow-up of treatments effects, both dimensions being independent and able to evolve differently according to the clinical syndromes. In our study, a large sample of outpatients with depressive and anxiety disorders was explored, with the Positive and Negative Emotionality (EPN-31) scale, and with other measures of anxiety and depressive symptoms. The results were in line with the tripartite model of emotions: high scores of negative affects in both categories of disorders, and low scores of positive affects especially in the depressive disorders. These results confirmed the relevance of an emotional approach of anxiety and depressive disorders, in particular for longitudinal studies and neuro-physiological correlations.     

Application de l’EMDR au deuil traumatique après une collision de train

The aim of this exploratory study is to test the application of therapy EMDR in case of traumatic bereavement. The traumatic bereavement, which corresponds to the brutal loss of “other significant”, answers a precise clinical picture whose principal characteristics are the intrusive thoughts concerning the late one and of the difficulties of adjustment to the loss (feeling of vacuum, difficulties of recognizing the death, irritability, lack of reactivity, etc). The eight participants all of this study are of the members of the family of the victims of the train collision, which took place on October 12, 2006 in Zoufftgen. The subjects, old on average 35.2 years (S.D. = 11.1) and including 75 % women, followed between eight to 15 meetings (m = 10.75, S.D. = 2.21) answering protocol EMDR. The effectiveness of the therapy was evaluated starting from several criteria including traumatic bereavement, anxiety, depression and psychological distress. Five evaluations were carried out: before the therapy (T0), after six meetings (T1), at the end of the therapy (T2), then in three months (T3) and 12 months (T4) after the end of the therapy. The principal results seem to indicate an effectiveness of the therapy EMDR. Indeed, we observe a reduction in all the indicators between the beginning (T0) and the end of the therapy (T2). Moreover, when this reduction does not continue to three and 12 months, it remains, at least, stable at one year. These observations are very encouraging especially when it is known that 10 to 15 % of the patient develops a chronic depression.     

Efficacy of escitalopram vs paroxetine on severe depression with associated anxiety: data from the "Boulenger" study

Several recent studies have underlined the importance of anxiety in major depressive disorders. It has been shown that anxiety was responsible for worsening of depression and reduction of the efficacy of the antidepressant treatment. While it is well known that SSRI are efficient in treating depression or anxiety disorders, the authors tried to determine the influence of baseline anxiety on the response to SSRI treatment in patients with severe depression receiving either escitalopram or paroxetine. In a 24-week double-blind clinical trial, 459 patients with a primary diagnosis of severe major depressive disorder were randomised to receive escitalopram (20mg) or paroxetine (40mg). Post hoc analyses of efficacy in patients with a baseline HAM-A total score less or equal to 20 (n=171) or greater than 20 (n=280) were based on analysis of covariance. (ANCOVA) (ITT, LOCF). At week 24, the mean change from baseline in MADRS total score was -24.2 for escitalopram-treated patients (n=141) and -21.5 for paroxetine treated patients (n=139) (p<0.05, between both groups) in high baseline anxiety patients (HAM-A>20) and the mean change from baseline in HAM-A total score was -17.4 (escitalopram) and -15.1 (paroxetine) (p<0.05, between both groups). As far as complete remitters (CGI-S=1) after 24-week treatment were concerned, their number was significantly higher with escitalopram in the case of marked baseline anxiety. No difference was shown in the low baseline anxiety group. Looking for the influence of baseline anxiety on SSRI treatment effects, the authors showed that antidepressant efficacy of 20mg escitalopram was better than 40mg paroxetine for patients highly depressed with comorbid anxiety symptoms and that, contrary to paroxetine, escitalopram maintained sustained antidepressant activity in patients featuring increased baseline anxiety levels.     

Étude des émotions chez les patients transplantés hépatiques

Objectives

In 2009, in France, 1047 have benefited of hepatic transplantation. Even if this treatment is more and more effective, it is a major event in patients’ and their relatives’ lives. Many emotional troubles have been observed such as anxiety, depression or alexithymia. So, we have studied the transplantation impact on the psychological state of hepatic transplantation recipients and their relatives.

Patients and methods

Our data anthology has been done with the TransHepate members: 73 patients and 50 relatives participated.

Results

Our results show anxiety and alexithymia for about a third of relatives. These one suffer more that transplanted recipients.

Conclusion

Hepatic transplantation includes many emotional disturbances in recipients. A psychological follow-up may be positive for the mental well being of patients and their relatives.     

Thérapie orientée schémas après évaluation de modifications sémantiques dans un rappel d’histoire

This is Yohann, 11 years, suffering from separation anxiety: we present his case as an example of a schema focused therapy. The therapeutic exercise to be done, is directly based on the theoric bases of the schema notion in cognitive psychopathology. It is more precisely a research for an easier mnesic work by modifying the informations. The material used is composed of the Early Schema Scale for Children (ISPE) and of a short text to be memorized; its aim is also an evaluation of the early maladaptive schemas. We give a summary of the construction and validation of this material. It is also a pretext to therapeutic exercises of Cognitive Restructuration, based on actual examples of Yohann’s errors of judgement.