Reconnaissance de l’émotion faciale et schizophrénie

A broad range of deficits in interpersonal skills characterizes schizophrenia. A natural way to tackle these deficits is to explore the ability of schizophrenic patients to process stimuli that have a well-established psychosocial content: faces, for instance. Schizophrenia deficits in facial recognition and discrimination have been studied extensively and most investigators have pointed out that patients with schizophrenia perform less well than non-patients and psychiatric controls in numerous facial paradigms, including facial identity, emotion and age recognition tests. The extent of the schizophrenic deficit suggests the alteration of a processing mechanism common to all kinds of facial information and the configural information extraction process has then been regarded as a probable candidate. Nevertheless, only a few studies directly tested the hypothesis. In what follows, we draw a general schema of the schizophrenia deficit in facial processing, next we present a series of studies investigating the putative implication of configural information in the abnormal processing of facial emotion in the disease.     

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.     

Approches cliniques et diagnostiques des premiers épisodes psychotiques

Schizophrenia is one of the most severe psychiatric diseases. Its evolution is still most often disabling for the patient. In recent years clinical research suggests that an early diagnosis and beginning of treatment may lead to a more favorable course of the disease. The detection of the first manifestations of the disease should be as early as possible, indeed at the very beginning of any psychotic symptoms or even during the prodromic phase. The main problem relative to these prodromes is their nonspecificity. Interest for the initial phases of schizophrenia and in particular for the prodromic phase, has opened the way to new prospects in terms of diagnostic and therapeutic approaches.     

Production d’émotions faciales dans la schizophrénie

Converging evidences revealed that facial pattern recognition is severely impaired in schizophrenia. The present article focuses on recognition of their own facial expression by patients with schizophrenia. It seems that schizophrenia is related with a dissociation between facial expression and emotional feeling. Recent experimental data are discussed.     

Mesurer la sévérité des problèmes des patients et leur évolution dans un secteur psychiatrique : une étude sur le terrain du Health of Nation Outcome Scales en français (HoNOS-F)

The Health of Nation Outcome Scales (HoNOS-F) are designed to measure severity of a large range of problems of psychiatric patients and their evolution. Behaviour, handicap, symptoms and social problems are considered. The aim of this field study is to examine the ability of the HoNOS-F to predict access to psychiatric care, use of services and mental health outcomes. 533 patients were evaluated in Lausanne in- and outpatient services. Results show a good acceptation of scales by clinicians ; grouping of problem profiles that suppose specific needs for some populations of patients ; differentiation of access to care through the number and severity of problems ; sensitivity to problems outcomes for inpatient care. Limitations of HoNOS are low tolerance to measurement errors, with only one scale for each dimension, and low progression margin when measuring change of moderate problems, particularly in outpatient psychiatric care.     

Schizophrénie et génétique : concepts et évidences

The relationship between the field of genetics and the social sciences has been fraught with difficulties. The philosophers were the first to predict that it would not be an easy matter, and genetics was used in psychiatry not as an aid to persons recognized as being vulnerable, but with the aim of putting a term to degeneration within the population (the theory of Morel). The hesitancy shown by psychiatrists toward this area of research can thus be well understood. However, genetics is first of all a powerful and original means of investigating psychic suffering. A certain number of misunderstandings explain why psychiatrists (French psychiatrists in particular, and to a greater degree than the patients themselves) show some reserve regarding genetic research into mental illnesses. Three concepts that are often poorly understood have been detailed in this article (genetic determinism, heritability, familial aggregation), then illustrated for schizophrenia through a review of familial studies and several candidate genes. The implications and limits of genetics as applied to schizophrenia should thus be better defined.     

Patients souffrant de schizophrénie en EHPAD : quel rôle pour l’équipe de psychiatrie de secteur ?

Old people's homes take in elderly persons who present more and more organic and/or psychic pathologies as they grow older. But what is the care proposed for residents suffering from psychiatric chronic pathologies such as schizophrenia and living in these establishments for several years? What are the difficulties met in these establishments (except the problem of psychiatric treatment and its effects) and which solutions can be envisaged? What will then be the role for a regional psychiatric team?     

Schizophrénie et vieillissement : aspects cliniques

The number of older people with chronic schizophrenia increases and is expected to double over the next two decades. Along with a reduction in positive schizophrenic symptoms with increasing age, a majority suffers from negative symptoms and cognitive deficits. Depression and comorbid medical problems are also frequent. These complex clinical and service needs have to be the focus of interest of psychiatrists to improve quality of care.     

Insight et capacité à consentir au soin et à la recherche : étude exploratoire et points de vue éthiques

In recent years, there has been a growing awareness that the process of obtaining informed consent is central to ethical research and clinical practice. Many studies have focused on the ability to consent for patients suffering from severe mental disorders such as schizophrenia. Several studies have focused on the association between impaired capacity to consent (to treatment or research) and diagnosis or symptoms. But one of the most important features of schizophrenia, the lack of insight has not been extensively studied in relation to capacity to consent. The aim of this study was to explore the relationship existing between the competence to consent and the level of insight in patients suffering from schizophrenia in a cross-sectional study. Participants included 60 outpatients with DSM-IV schizophrenia. Measures included the MacArthur Competence Assessment tool for Treatment (MacCAT-T), the Scale to Assess Unawareness of Mental Disorder (SUMD) and psychopathology rating scales including the Positive and Negative Syndrome Scale (PANSS). Our results showed that “understanding” dimension of MacCAT-T is not correlated to insight. However, a systematic negative correlation was observed between the MacCAT-T “Appreciation” and “Reasoning” dimensions and the five SUMD dimensions. We hypothesise that this strong correlation could be mediated by cognitive disorders in schizophrenia. After such results, prospective studies should be developped evaluating the courses of insight and capacity to consent during the illness and the links with cognitive deficits.     

Traduction et étude de validation de la version française de l’échelle d’expérience temporelle du plaisir (EETP, Temporal Experience of Pleasure Scale [TEPS], Gard et al., 2006) : étude chez 125 étudiants et chez 162 sujets présentant un trouble psychiatrique

Objectives

Using complementary methods, Gard et al. (2007) [13] reported that schizophrenia patients reported as much pleasure in the moment as controls in their daily lives and on a measure of trait consummatory pleasure (consummatory subscale of the Temporal Experience of Pleasure Scale [TEPS-CONS]) but the schizophrenia patients reported experiencing less trait pleasure in anticipation of future events (anticipatory subscale of the TEPS [TEPS-ANT]) compared to healthy controls. The aim of the present study was to replicate the Gard et al. (2007) [13] study using the French version of the TEPS.

Patients and method

Hundred and twenty-five university students were recruited as well as 162 inpatients with either schizophrenia or mood, neurotic or personality disorders. All participants completed the French versions of the following rating scales: the 18-item TEPS, the 61-item revised Physical Scale (PAS) and the 41-item Social Anhedonia Scale (SAS), the 14-item Snaith Hamilton Pleasure Scale (SHAPS) and the 21-item Beck Depression Inventory-II (BDI-II). We also created PAS anticipatory (PAS-ANT) and PAS consummatory (PAS-CONS) scales from the university student sample. Firstly, we examined the construct, concurrent validities and reliability of the TEPS using respectively confirmatory factorial analyses (CFA) to test the two-factor structure of the TEPS, Pearson's correlations between the ten-item TEPS-ANT or eight-item TEPS-CONS and the other anhedonia scales and Cronbach's alpha coefficients. Secondly, we compared the three groups (university students, schizophrenia subjects, other psychiatric subjects) using analyses of variance (ANOVA) on the measures of anticipatory and consummatory anhedonias.

Results

For the results of the CFA, we used three parameters to test the adequacy of the data to the model: the normed chi-square, the root mean square residual and the root mean square error of approximation. The three parameters were respectively for the university and psychiatric samples: 1.66, 0.09, 0.074 and 2.19, 0.09, 0.087. Cronbach's alpha coefficients were satisfactory (>0.7) for the TEPS-ANT. Significant correlations were observed between either the TEPS-CONS or the TEPS-ANT and the anhedonia scales suggesting satisfactory concurrent validities. Analyses of Variance (ANOVA) reported significant difference between groups for the TEPS-ANT but not for the TEPS-CONS. Similar results were observed using the PAS-ANT and PAS-CONS.

Conclusion

The French version of the TEPS had satisfactory psychometric properties and replicated the Gard et al. (2007) [13] study reporting that schizophrenic subjects had low anticipatory pleasure than healthy controls but did not differ on consummatory pleasure. Moreover, the difference on anticipatory pleasure between healthy and schizophrenic subjects was independent of depression and there was no difference between schizophrenic subjects and non-schizophrenic psychiatric controls concerning anticipatory pleasure. Further studies are needed to explore the hypothesis that specific subgroups of schizophrenic subjects (for exemple, deficit schizophrenic subjects) could be more anhedonic in either form of anhedonia (anticipatory and/or consummatory anhedonia), additionally comparisons should be further made with psychiatric controls without a schizophrenia diagnosis.