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1.
Background
Even effective drugs are useless when not taken. The aim of this study is to assess whether attitudes toward treatment were a better predictor of compliance than insight in schizophrenia.Methods
Ninety-eight inpatients diagnosed with schizophrenia were evaluated within 1 week after being admitted to a psychiatric ward.Results
Forty-nine percent of patients were non-compliant. Assessing jointly DAI and insight scores optimized the prediction of compliance to antipsychotic medication: results from a logistic regression indicated that compliance is better predicted by DAI factor 2 score “patient's assessment of need for medications” combined to SUMD G1 insight score “insight into mental disorder” (ROC AUC = 0.776).Discussion
It is possible that there is a conceptual overlap between patient's assessment of need for medication and clinical insight.Conclusion
Clinical insight and attitudes toward treatment are stronger predictors of compliance when combined. 相似文献2.
N. Jaafari M.-L. Daniel J. Lacoste M. Bacconnier D. Belin J.-Y. Rotge pour l’Insight Study Group 《Annales médico-psychologiques》2011,(7):453-456
Introduction
The role of insight in the symptomatic expression of obsessive-compulsive disorder (OCD) remains controversial. We sought to better investigate this issue and assessed potential relationships between the level of insight and some cognitive determinants of OCD symptoms. For this purpose, we used a behavioral task (the checking behavioral task) that allowed the expression of repetitive checking behaviors in OCD patients.Methods
The level of insight was assessed in 20 checking OCD patients with the Brown Assessment of Beliefs Scale (BABS). Patients were subjected to the checking behavioral task during which we assessed the “uncertainty cost” at the time of decision-making that lead to checking behavior.Results
We found a positive correlation between the level of insight and the uncertainty cost during decision-making leading to the performance of checking behaviors.Conclusion
These first experimental findings suggest the existence of a relationship between insight and cognitive determinants underlying OCD symptoms. 相似文献3.
Background
Early adolescence, which we also call prime adolescence, is marked by the transformations of puberty and the sexualisation of the body, changes in cognition and the progressive involvement in sexuality. This study is the continuation of an earlier work dealing with the construction and validation of a questionnaire on sexuality during adolescence (Courtois et al., 1998) [8].Methods
Population. The sample was composed of 312 middle-school students (7 to 9th grade) from four middle-schools in Tours and its suburbs (Indre-et-Loire, France): 164 girls (52.6%) and 148 boys (47.4%); with a mean age of 13.8 (S.D. = 1.02; from 10.7 to 16.9) (without significant differences between boys and girls). Material. The material was composed of 22 items calling for true or false answers and including 13 items from the initial questionnaire by Courtois et al. (1998) [7] and [8] structured in three dimensions (“Behavioral engagement in sexuality”, “Love and fidelity” and “Taste for flirting”). Procedure. The study was carried out in 2008 in the classroom (anonymity guaranteed).Results
The results of the factorial analysis (as the main component and by the method which maximizes variance, Varimax) made it possible to find three factors which explain 41% of total variance: “Going out with someone” (value of 4.6, explaining 21% of the total variance); “Giving priority to love” (value of 2.8 explaining 13% of the variance); “Flirting with the aim of having sexual relations” (value of 1.6 explaining 7% of variance). The Cronbach alphas are 0.79, 0.70 and 0.66 respectively. The first and third factors are correlated. In order to obtain a shorter final instrument and to favor the orthogonality between factors, we only retained the items which are strongly saturated by the factors (> 0.50). A confirmatory analysis revealed the good adequation of the model retained (Chi2: 162, 87 dof, P < 0.001; Goodness of fitness index [GFI] of Joreskog: 0.91; Root mean square error of aaproximation [RMSEA] = 0.05). Following these analyses, we are able to propose a shorter questionnaire (15 items), structured in three dimensions of sexuality significant in prime adolescence (in accordance with interests, emotions and relationships). The analyses were conducted according to gender and age. There is no significant difference for “Going out with someone” between boys and girls. On the other hand, there is a difference between “Giving priority to love”, which is more important for girls (P < 0.05) and for “Flirting with the aim of having sexual relations”, more important for boys (P < 0.001). However, as ages increase, we notice a rise in scores for “Going out with someone” for girls as well as for boys (P < 0.05); a drop in scores for “Giving priority to love” (for girls, (P < 0.05) and an increase in the scores for “Flirting with the aim of having sexual relations” (only for boys (p < 0.05).Discussion
This study allowed us to validate a scale of sexuality in prime adolescence that presents good psychometric qualities. It was carried out on a larger and more representative sample of this period than the initial study, although essentially finding the same results as previously. Thus, the use of this scale, coupled or not with the individual analysis of the items which make it up, could allow us to understand sexuality in prime adolescence in three significant dimensions of psychosexual development, as well as regarding risky sexuality, i.e., an excessive interest in genital sexuality, behavioral involvement and precocious sexual relations or an absence of feelings. 相似文献4.
Coëffec A 《L'Encéphale》2011,37(1):75-82
Introduction
Personality in the field of addiction has been the subject of many studies. The purpose of this article is to synthesize the data obtained with the Neuroticism Extraversion Openness – Personality Inventory – Revised (NEO-PI-R) and the NEO – Five-Factor Inventory (NEO-FFI) among the persons who drink and suffer from addiction to alcohol.Background
These tools, based on the theory of “The Big Five Factors”, assess the personality from a dimensional point of view. The five big dimensions addressed by these tools, are “Neuroticism” (general tendency to experience negative feelings), “Extraversion” (sociability, positive feelings, activity and self-confidence), “Openness” (imagination, intellectual curiosity, aesthetic sensitivity, attention paid to one's own feelings and no dogmatic behavior), “Agreeableness” (interpersonal tendencies) and “Conscientiousness” (forward planning, organization and task carrying out). According to Diagnostic and Statistical Manual of mental disorders (DSM-IV-TR), alcohol consumption is based on three dissimilar behaviors: utilization (alcohol consumption not leading to complications or damage), abuse (regular consumption likely to cause somatic, psycho-emotional or social damage for the individual or for his/her family circle) and dependency (excessive utilization leading to deterioration in functioning or clinically significant suffering).Literature findings
Alcohol consumption among young adults can thus be predicted through a high level of “Neuroticism” associated with a low level of “Agreeableness”. Persons having been addicted to alcohol (present or past) have a high level of “Neuroticism”, a low “Agreeableness” and a low level of “Conscientiousness”, contrary to patients who have never been addicted to alcohol. The NEO-PI-R also enables a more accurate analysis of the personality, since each of these five big dimensions is divided into six facets. Among the patients with a past or present diagnosis of alcohol abuse, we found a low score on facets “trust”, “achievement striving”, “self-discipline” and “dutifulness” and a high score on “impulsiveness”, “vulnerability”, and “excitement-seeking”. Although dimension and facet results measured by this tool can differ according to craving level or according to gender, the studies agree in that there are common aspects among the patients. 相似文献5.
6.
F. Kazour J. Rouhayem R. Chammay R. Haddad G. Haddad X. Laqueille S. Richa 《Annales médico-psychologiques》2011,(5):277-281
Introduction
It has been established that cannabis use is involved in the emergence and evolution of psychotic disorders. Although cannabis use is very frequent in mood disorders, there has been a considerable debate about the association observed between these two disorders. This review aims to clarify the relation between cannabis use and bipolar disorder, in order to unveil a possible causality and find the effect of cannabis on the prognosis and expression of bipolarity.Methods
The review used MedLine database using the keywords “cannabis” or “marijuana” and “bipolar” or “mania” or “depression”. This search found 36 articles who were clinically relevant to the subject and were included and discussed in this review.Results
The first studies discussing the link between cannabis use and psychotic disorders reveal manic features in the substance abuse group, hence suggesting a possible association between cannabis use and bipolar disorder, in favor of triggering a manic episode. According to the studies, between 25 and 64% of bipolar patients are cannabis users, and the prevalence is higher in younger and male patients. The risk of developing a mood disorder is higher among cannabis users compared to the general population. This substance abuse in bipolar disorders would increase the frequency and duration of manic episodes without changing the total duration of mood episodes. In a first episode of bipolar disorder, the use of cannabis would increase the rate of relapses of manic episodes and worsen the prognosis of the disorder.Discussion
The frequency of substance abuse in bipolar disorders is higher than the prevalence in the general population, and cannabis is one of the most used illegal substances in the worldwide. Hence, the association between cannabis use and bipolar disorders is frequent. Cannabis users may experience euphoria, relaxation and subjective feelings of well-being; this substance may also have antiepileptic effect, which may explain some of the effects of cannabis on bipolar disorders. In fact, the use of cannabis would increase the frequency and duration of manic episodes in bipolar patients without increasing the total duration of mood episodes, suggesting a possible antidepressing and mood stabilizing effects. This impact of cannabis on mood disorders and its possible pharmacological effect is still controversial and needs further experiencing to be proved. 相似文献7.
Context
The links between anorexia nervosa (AN) and anxiety disorders, and particularly social phobia, are little known. However, social phobia occurs frequently in AN. Some studies have shown reduction in anxious and depressive symptomatology in AN with re-nutrition. But, to our knowledge, no work has examined the evolution of social phobia symptoms during re-nutrition in AN.Objectives
To specify the links between AN, nutritional state, and social phobia.Method
The population consisted of 2 samples and the analysis was conducted using the SPSS 11.5. Sample 1 (N = 24 AN) was evaluated on admission and on leaving the hospital. Our evaluation used the body mass index (BMI), the Liebowitz scale, the Mini International Neuropsychiatric Interview (MINI), and the Yale-Brown Obsessive Compulsive Scale for Eating Disorders scale (Y-BOCS-ED) respectively to evaluate or diagnose the state of malnutrition, social anxiety symptomatology, social phobia in Diagnostic and Statistical Manual-4 (DSM-IV) and anorexic symptomatology. Sample 2 (N = 60) was assessed at the end of the hospitalization and then 6, 12 and 18 months later. We used the BMI, Liebowitz scale, MINI, and Eating Disorders Inventory (EDI) to assess anorexic symptomatology. In addition, the Morgan-Russell outcome assessment schedule (MR schedule) was used to assess the total clinical state of the patients.Results
Social anxiety symptomatology and actual diagnosis decreased throughout the treatment. However, regardless of the point at which the patient received care, there was no correlation between social phobia and nutritional state, as indicated by BMI. A correlation existed between social phobia and AN symptomatology, and between social phobia and total clinical state, during the out-patient care.Conclusion
A component of AN–social phobia comorbidity is still questionable. Is it linked to the clinical state of the subjects (question of an additional effect of under nutrition and cognition), or even to AN? Others indicators of under nutrition are of interest and warrant further evaluations. We therefore feel that a diagnosis of social phobia can only be confirmed after an acute state of AN, thus allowing for preferential treatments. Others studies must be conducted in order to continue to explore the links between social phobia and AN. 相似文献8.
Introduction
Serotonin (HT) and noradrenaline (NA) reuptake inhibitors (SNRIs) are commonly used as first line treatment of major depressive disorders (MDD). As compared to tricyclic antidepressants, they have proved similar efficacy and better tolerability. Milnacipran (MLN) (Ixel®) and venlafaxine (VLF) (Effexor®) are two SNRIs pharmacologically differing by their NA/HT ratio of potency: 1:1 and 1:30, respectively.Objectives
To investigate the efficacy and safety/tolerability of MLN and VLF administered at flexible doses (100, 150 or 200 mg/day) for 24 weeks (including 4 weeks of up-titration) in the outpatient treatment of adults with moderate-to-severe MDD.Design
Multicentre, randomised, double blind, 2-parallel-arm, 24-week exploratory trial conducted in France by 50 psychiatrists.Diagnosis and main inclusion criteria
Male or female outpatients, aged 18 to 70, meeting the DSM-IV-TR and related MINI criteria for recurrent, unipolar, moderate-to-severe MDD, with neither psychotic features nor severe suicidal risk. A Montgomery-Asberg depression rating scale (MADRS) score ≥ 23 was required at inclusion.Treatment schedule
Patients were randomised to receive either MLN or VLF (1:1 ratio) for 24 weeks in double-blind conditions. Regardless of the treatment received, the following dosing schedule was applied: during the initial 4-week up-titration phase, the dosage was progressively increased from 25 mg/day (qd administration) to 150 mg/day (bid administration). At week 4, the dosage was either maintained at 150 mg/day, or adapted to 100 or 200 mg/day, based on the investigator's clinical judgement. At any time during the 20 following treatment weeks, the dose could be lowered for safety concerns until a minimal threshold of 100 mg/day. From Week 24, the dosage was decreased by 50mg/day every five days. After randomisation, eight assessment visits were organised at 2, 4, 6, 8, 12, 18, 24 weeks, and at study end (after the 5–15 days of down-titration and 10 days free of treatment). Efficacy evaluation ratings included the MADRS and global disease severity (CGI-S) total scores. Rates of MADRS response (reduction of initial score ≥ 50%) and remission (score ≤ 10) were calculated at Week 8 and Week 24 in the full analysis set as well as in the subgroups of patients with depressive disorder of severe DSM-IV intensity and with a MINI evaluation of suicidal risk (rated as required ‘moderate’ at the worst).Statistical analysis
Standard distribution statistics (including mean and standard deviation [S.D.]) of scores and their changes from baseline, were calculated using the observed-case (OC) approach at all assessment times for the MADRS score, and the last-observation-carried-forward (LOCF) at 8 and 24 weeks for both MADRS and CGI-S scores. MADRS response and remission rates at 8 and 24 weeks were calculated using the LOCF approach by normal approximation of the binomial distribution. Bilateral exploratory statistical tests at 5% significance level were performed for results at 8 and 24 weeks of: (i) MADRS score changes from baseline, based on the score progress at each visit (mixed model for repeated measurements [MMRM]), and (ii) global MADRS response and remission rates (Chi2).Results and patients
A total of 195 patients were randomly assigned MLN (n = 97) or VLF (n = 98) and 134 (68.7%: 61.9%/MLN and 75.5%/VLF) completed the trial. At the end of the up-titration, patients received 100 mg/day (11.4%/MLN, 10%/VLF), 150 mg/day (30.4%/MLN, 43.8%/VLF), or 200 mg/day (58.2%/MLN, 46.3%/VLF). Totals of 177 patients (90/MLN and 87/VLF) and 181 patients (90/MLN and 91/VLF) were analysed for efficacy and safety, respectively. Treatment groups were similar for baseline characteristics except a higher proportion of MLN patients with a severe depressive episode (63.3% versus 54%).Results and efficacy
MADRS score (mean [S.D.] initial score: 31 [4.5]) progressively decreased all along the treatment course and similarly in both groups (Week 8-OC : –18.8 [7.7]/MLN and –18.6 [7.3]/VLF, pMMRM = 0.95 ; Week 24-OC : −23.1 [7.8]/MLN and –22.4 [7.3]/VLF, pMMRM = 0.37 ).At week 8-LOCF, MADRS response rates were similar in both groups (64.4%/MLN, 65.5%/VLF, pchi2 = 0.88) as well as remission rates (42.2%/MLN, 42.5%/VLF pchi2 = 0.97). At week 24 they remained non clinically and statistically different between groups (response rates: 70%/MLN, 77%/VLF, pchi2 = 0.29; remission rates: 52.2%/MLN, 62.1%/VLF, pchi2 = 0.19). In both “severe depressive episode” and “MINI mild or moderate suicidal risk” subgroups (n = 104 and 75, respectively), response and remission rates were non clinically different at both time points, however in the “MINI mild-to-moderate suicidal risk” subgroup, MLN tended to be more rapidly active (remission rate at week 8-LOCF: 44.7%/MLN, 35.1%/VLF). The changes in CGI-S were also indicative of a significant improvement of the global illness severity with both treatments.Results and safety/tolerability
The tolerability profile of both drugs was in line with their pharmacological activity. About 70% of patients in both groups experienced at least one adverse event (AE). In both groups, the most common AEs were nausea, dizziness, headache and hyperhidrosis, and, in the male patients, genito-urinary problems: orgasmic disorders (VLF only) and dysuria (MLN only). These AEs were mostly responsible for definitive treatment discontinuation for tolerability concerns. None of the 6 serious adverse events (SAEs) on MLN and 4 of the 8 SAEs on VLF were related to the test drug.Conclusion
MLN and VLF at flexible doses up to 200 mg/day globally exhibited similar efficacy and tolerability profiles in the long-term treatment of adults with MDD. 相似文献9.
Objective
While compulsive ordering and arranging, and a preoccupation with symmetry are common presentations of obsessive–compulsive disorder (OCD), little attention has been given to these types of symptoms in the assessment of patients with OCD. The goal of the present study was to develop and evaluate psychometric properties for the objective and quantitative measurement of compulsive symptoms related to symmetry and arranging.Methods
Thirty-five normal volunteers performed computer-simulated environment tasks under four different conditions with or without a target and distraction. Primary dependent variables included several indices of time and manipulation of arranging behaviors. We evaluated the validity of the task by comparing the novel behavioral measures with standardized measures such as the Symmetry, Ordering and Arranging Questionnaire (SOAQ), Obsessive Compulsive Inventory-Revised (OCI-R), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Barratt Impulsiveness Scale (BIS-11), and Quality of Life Scale (WHOQOL).Results
We found a significant positive correlation between the arrangement time (time to complete the task) with the SOAQ score and the “ordering” subscore of the OCI-R. In addition, the number of manipulations was positively correlated with the SOAQ score and the “ordering” subscore of the OCI-R. There were no significant correlations between behavioral parameters and other scales measuring constructs less relevant to the symptoms of OCD related to ordering/symmetry. There was only a significant main effect of the target on the arrangement time.Conclusion
This study demonstrates the good convergent and discriminant validity of this task as a novel behavioral measure for the assessment of arranging compulsion symptoms. We can infer from the results that subjects are likely to spend more time in compulsive arranging when the target for the task is given. 相似文献10.
S. Blanc-Foullu J. Brunelin M. Travart J.-M. Elchardus M. Saoud T. d’Amato 《L'Encéphale》2008,34(6):563-569
Introduction
Impulsive traits are key characteristics in a lot of psychiatric disorders and are part of the “normal” behaviour spectrum. Although impulsivity is a controversial concept, some questionnaires have focused on its “dysfunctional” aspect. The Barratt Impulsive Scale (BIS-10) is the scale the most used to explore impulsiveness, but it does not explore antisocial or nonconform behaviour. The Chapman Impulsive and Nonconformity Scale (INCS) is a questionnaire of 51 items that measures the impulsivity and nonconformism. The INCS reflects “failure to internalize societal norms, lack of empathy for the pain of others, and an unrestrained yielding to impulse and self-gratification” and was originally designed to assess psychosis proneness. It has been validated in the USA, but has not yet been validated in France. Interestingly, although it was not predictive of psychosis, high scorers on INCS exceeded controls on depression, and on rates of substance abuse. Furthermore, participants scoring high on hypomanic personality scale and INCS were found to have an especially heightened risk for bipolar disorders.Objective
To translate and determine reliability and validity of the French version of the Chapman Impulsive and Nonconformity Scale in young adults by comparison with the BIS.Method
Chapman Impulsive and Nonconformity Scale has been back-translated into French, and filled out by 237 students (males: 104; females: 133; mean age: 20.4 [range 19–25]). BIS-10 was used for convergent validity. Each participant completed the two scales. Reliability and validity of the French form of INCS were assessed with the internal consistency (coefficient alpha of Cronbach and the split half reliability) and the convergent validity.Results
In the French version of the INCS, the 51 items have high internal reliability (Cronbach's alpha = 0.81 and split half reliability = 0.80). Concerning the BIS, internal reliability is good (Cronbach's alpha = 0.72 and split half reliability = 0.66).Moreover, Pearson's r of the INCS/BIS is statistically significant (0.65) and underlines the concomitant validity of the INCS with the BIS.Conclusion
The psychometric properties of the French version of the INCS are very similar to those of the English version. Hence, the INCS could provide a way to explore the two related dimensions: impulsivity and nonconformism. 相似文献11.
M. Hubin-Gayte 《Annales médico-psychologiques》2011,(10):615-620
Eating disorders affect about 5–7% of women of child-bearing age. Very little is known about the impact of pregnancy on women with anorexia or bulimia nervosa. Some researches reported a generalized feeling of well-being during pregnancy once symptoms have passed. Other researches highlighted the fact that during pregnancy anxiety may worsen, they also found that women did not improve but their symptoms persisted or deteriorated. This lack of consensus is explained by the variety of methodologies used in these studies. Most studies in the literature are difficult to interpret as they rely on small samples, with heterogeneous, poorly described cases, and often use retrospective outcome measures or reports of ED symptoms. In our opinion, a very current tool appears to be missing from that plurality of approaches. Indeed, the use of Internet offers the possibility to women with eating disorders to share their experiences or their thoughts about pregnancy, and motherhood more generally. It is important to underline that not very many women inform their obstetrician or health care professional about their ED and a lot of them minimize or lie about their eating behaviours to family and friends.
Aim
The aim of this study is to show that those testimonies may constitute a new corpus of knowledge of interest to the psychologist clinician, but also to every researcher preoccupied with this field of research.Method
In order to do so we searched websites, using a very often used search engine, by typing keywords such as “anorexia and pregnancy”. Then, we consulted the first five sites put on the front page in which took place this type of group discussions. So, without any choice a priori, we printed the exchanges between the women. Our testimonies correspond to the interventions of 60 Internet users.Sample
The sample presents the following characteristics: they are 26 and half years old on average. Among them, approximately 1/3 are already pregnant, 1/3 already have children and 1/3 wish to become pregnant. A lot of them experience fertility problems, and have a hormonal treatment. It is also necessary to note the number of women who say they benefit from a psychological care (16.6%).Methodology
We used the methodology of the analysis of contents. It consisted in reading all the corpus of testimonies to analyse what was written, to transcribe it, and to report the main ideas or developed subjects. For that purpose, we elaborated a “thematic scale” to establish the different contents, the facts, the ideas, which are present in the testimonies; literary and theoretical knowledge about the subject was also needed. What we exactly wanted to show was the relevance of the clinical approach of psychoanalytical orientation in the analysis of the forums on Internet. In this article, we wanted to develop the main themes, which appear on the most regular basis in the testimonies of these women.Results
In our results, we found and exposed six themes: “For the love of a man”, “The wish to become pregnant”, “The singular relation with my body”, “To contain a baby or kilos too many”, “Pregnancy outcome”, “The intergenerational transmission of the symptoms of the mother to the child”. It was important to connect these testimonies with what we know on the subject through literature and different theories. The results of our investigation show the necessity to consider the richness of its testimonies. It is thus important that the psychologists neither ignore nor disdain this mode of communication, but on the contrary, take it into account in their psychopathologic approach of TCA. We can discuss the benefit of prevention during pregnancy, which is a period of vulnerability but of change too. 相似文献12.
Álvaro Frías Cárol Palma Núria Farriols Ana Salvador Judit Bonet Inma Bernáldez 《Comprehensive psychiatry》2014
Background
Epidemiological studies have found that obsessive-compulsive disorder (OCD) is estimated to occur in up to 12% of patients with schizophrenia. Furthermore, several etiopathogenic mechanisms have been postulated for understanding this co-occurrence. Whether this subgroup of “schizo-obsessive” patients may be posed as a clinical entity with a distinct psychopathological and functioning profile remains unclear.Method
A sample of adult patients who met DSM-IV criteria for both schizophrenia/schizoaffective disorder and OCD (n = 30) was compared with a “non-OCD schizophrenic” group (n = 37) and another subset of “non-schizophrenic OCD” patients (n = 30). The Positive and Negative Syndrome Scale (PANSS), the Scale to Assess Unawareness of Mental Disorder (SUMD), the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Brown Assessment of Beliefs Scale (BABS), the Clinical Global Severity scale (CGI), the Quality of Life Scale (QLS), and the Beck’s Depression Inventory (BDI) were used.Results
We found that “schizo-obsessive” subjects did not show significant differences in any outcome measures when compared to the “non-OCD schizophrenic” group. Furthermore, statistical analyses also revealed that the “non-schizophrenic OCD” group tended to have lower severity of psychopathology as well as greater quality of life than both psychotic groups.Conclusions
These findings indicate that comorbidity between schizophrenia/schizoaffective disorder and OCD does not comprise a distinct clinical entity, particularly when compared to “non-OCD schizophrenia” disorder. Discrepancies among previous studies may be justified by methodological divergences. 相似文献13.
Introduction
There is a general belief that physical activity and exercise have positive effects on mood and anxiety. Intervention studies describe an anxiolytic and antidepressive effect of exercise in healthy subjects and patients. However, the majority of published studies have substantial methodological inconsistencies. Our review of the literature showed the importance of distinguishing three items in studies regarding efficacy of physical exercise in psychiatry: operationalisation of concepts (duration, frequency, intensity, type of exercise), the type of disorder, the diagnosis, and exploratory hypotheses. The aim of this article is to demonstrate that physical exercise in the psychiatry department contributes to the improvement of the mental health of in-hospital patients.Methods
Sociodemographical data, the diagnosis and the physical exercise (duration, distance, type and frequency) of 283 in-hospital patients in the psychiatry department were listed. Physical exercise (cycling, long walks, short walks, soft and hard gymnastics) included in a database has been proposed to patients for many years in this hospital. After their hospitalisation, the members of the medical staff (20 persons) evaluated the patients on a visual analogic scale from 1 to 10 related to the improvement of their mental health. No experimental manipulation was made.Subjects
One hundred and twenty-eight men, mean age: 45.67 years (±13.59) exhibited the following disorders: major depressive disorder (117), anxious disorders (25), alcoholic addiction (85), toxicomania (10), psychotic decompensation (33), bipolar disorder (3) and others (10). Patients practised at least one exercise during their hospitalisation, mean duration of 15.93 (±9.18) working days. The frequency of physical exercises per patient was 5.65 (±6.20). The improvement of each patient was evaluated around six times (6.16 ± 3.83). The average amelioration score for all the patients was close to 50% (4.99 ± 1.65).Results
Correlations between the improvement of mental health and participation in physical exercises were all significant (frequency: r = 0.228; P < 0.001; duration: r = 0.236; P < 0.001; distance: r = 0.201, P = 0.001). In comparison with psychotic patients, drug addiction and alcoholic, depressive patients showed greater interest in physical exercise. This is similar for anxious disorders. According to the results, two groups were created regarding their improvement (cut out point: 5.08). We observed that patients suffering from major depression considerably improved thanks to physical exercise (P = 0.048), spent more time practising (P = 0.037) and walked or cycled greater distances (P = 0.038). Finally, cycling (frequency: P = 0.008; distance: P = 0.016; duration: P = 0.011) and “hard” gymnastics were the physical exercises which optimized the results.Discussion
Physical exercise is correlated with the improvement of mental health. The practice of physical exercise depends on the mental disorder. People suffering from major depressive disorder benefit more from physical exercise than other groups. Cycling and “hard” gymnastics are both exercises to be proposed in every programme.Conclusion
To practice physical exercise during hospitalisation in a psychiatric department has a positive influence on the symptomatology, and contributes to the improvement of mental health. 相似文献14.
Introduction
Forty to sixty percent of patients with obsessive compulsive disorder (OCD) are resistant to well conducted treatment with selective serotonin reuptake inhibitors (SSRIs) over 8 weeks. The data concerning effectiveness of the addition of antipsychotics in this indication is controversial.Aims of the study
To synthesize the neurobiological mechanisms at work in order to understand the action of pharmacological treatments in this disease and to propose a systematic review of the literature on effectiveness of different antipsychotic drugs according to their pharmacological profiles, in monotherapy or in combination with SSRIs in OCD.Method
We conducted a systematic review of the literature using the criteria according to the PRISMA research paradigm “obsessive compulsive disorder AND antipsychotic agents”. Research bases MEDLINE, Cochrane and Web of science have been explored.Results
Unlike the classical serotonergic hypothesis, OCD may result from striatal dopaminergic hyperactivity, modulated in some patients by an underlying serotonergic hypoactivity. Most studies report effectiveness of first-generation antipsychotics (amisulpride and haloperidol) and some second-generation antipsychotics (risperidone, olanzapine, aripiprazole, quetiapine) in combination with an SSRI in the treatment of resistant OCD. Recrudescence or onset of OCD in patients with schizophrenia have been described in a relay from first generation antipsychotic to olanzapine, risperidone, aripiprazole or clozapine in case reports, but not amisulpride and quetiapine. 相似文献15.
Objective
The literature on autism reports regularly the presence of a peak of ability on the visuospatial tasks. The classic interpretation of this result refers to the theoretical model proposed by Frith (1989) who evokes a “lack of central coherence” in persons with autism that is a deficit in the mobilization of global processing. The research reported here has for objective to propose a reflection on the relevance of this model by asking the following question: is global processing impaired in autism or simply not mobilized for the benefit of the almost exclusive appeal to local treatment?Methods
A group of children with high-functioning autism was compared with normally developping children (n = 15 per group), matched on age and global level of intelligence. The clinical group, 14 boys and a girl, had received a diagnosis of typical autism according to the criteria of the ICD-10 (F84.0) confirmed by ADI-R. These children all used a functional language at the time of inclusion within the study, however all of them initially presented a delay in language (mean age: 8 years and 6 months; mean total IQ: 98.07). The typically developping group, 12 boys and three girls, were from ordinary school (mean age: 9 years, mean total IQ: 106.2). Two tasks were employed for the collection of data: the Wechsler Intelligence Scale for Children-Third Edition (WISC-III) was used to estimate the total-, verbal- and performance-IQ scores of every child and to match both groups. It also permitted the evaluation and comparison of the performances of the children on the following visuospatial tasks: “picture completion”, “object assembly” and “block design”. The NEPSY scale permitted the estimation and comparison of the levels of performance of both groups on visuospatial functions.Results
In terms of scores, the tasks of the WISC-III, requiring visiospatial processing as well as the global evaluation of the visiospatial functions with the NEPSY, showed the absence of significant differences between children with high-functioning autism and typical children of the same age. However, differences of strategies appeared both between the groups and, in children with autism, according to the tasks to resolve. The comparison of subtests, “arrows” and “picture completion” on one hand, and “object assembly” and “block design” on the other, showed that children with autism are capable of mobilizing correct configural processing in the first ones but not in the second. The only factor which differentiates these tasks is the appeal or not to a motor coordination. It is possible that the lack of motor ease, often described in this type of children, sometimes leads them towards strategies of low level, i.e., to local adjustments, unlike the typical children who mobilize a strategy supported on a global representation of the purpose to be reached.Conclusion
If our results confirm the capacities of children with autism to resolve the tasks requiring a visiospatial processing, the strategies which they mobilize do not support the existence of a weakness of the central coherence. We suggest, in persons with autism, the idea of a priority granted to the local information treatment in the absence of a deficit of global or configural processing. 相似文献16.
E.G Hantouche J AngstF.J Kochman S LancrenonM.P Deleuze J.F Allilaire 《Annales médico-psychologiques》2002,160(1):25-33
Background - Recognition of Obsessive-Compulsive Disorder (OCD) in every day practice is a difficult task, especially in primary care, as few epidemiological surveys have been made of it in general medicine. Within this context, a recent survey was undertaken on a national level, involving more than 650 clinicians. The aim of the survey called « AR-TOC » was to show the feasibility of screening OCD in special population of patients presenting « Resistant Anxiety » to anxiolytics or to minor sedatives.Results - Data are presented in a cohort of 5?919 patients. They showed negative response on the screening questionnaire in 40,9 % of the total population, the presence of OCS (obsessive-compulsive syndrome) in 13,9 % and of OCD in 45,2 % (“probable OCD” in 31,2 % and “definite OCD” in 14 %).Principal component analyses were conducted in 3 498 cases presenting OCS or OCD. These analyses have concerned the clinical data which derived from clinician (OCD Screening Questionnaire, OCD-SQ) and self-rated questionnaires (Maudsley Obsessive-Compulsive Inventory, MOCI). Firstly, the results were concordant with the dimensional approach of OCD by identifying clinically meaningful separated subtypes. From the OCD-SQ, three factors were isolated such as “compulsive”, “obsessive” and “mixed” subtypes, and from the MOCI, four factors were identified such as “Property-Cleaning”, “Checking”, “Waste of Time” and “Obsessions with purity”. Factorial scores deriving from MOCI were highly correlated to respective OCD-SQ sub-types and capable to differentiate significantly the different diagnoses of OC phenomena (OCS, Probable OCD and Definite OCD).Conclusion - “AR-TOC” have succeeded to show the feasibility of screening OCD in patients suffering from resistant anxiety. Moreover, the use of dimensional analyses had resulted in the characterization of separate subtypes based on the dominant obsessive and/or compulsive symptomatology. 相似文献
17.
Introduction
Hallucinations are often defined as perceptions when there is no object to perceive. However, clinical practitioners only have access to what their patients tell them about their hallucinations. By cooperating in the construction of a meaning for the hallucination, practitioner and patient can reach a common ground. This “co-construction” produces “hallucinatory stories” that are narratives, which revolve around this phenomenon. This raises the question of where the voices are temporally and spatially in the structure of the narrative.Methods
Fourteen patients meeting the DSM-IV schizophrenia criteria were included and took part in a filmed standardized interview. The markers of temporal and spatial localization were listed and their occurrence in the narrative calculated (Student t test and Wilcoxon test).Result
The results revealed that:•
a significant difference between the present and perfect tenses. There is a distinction between what is happening now and what has happened in the past; •
a significant difference between the markers of temporal localization such as accomplishment and position. The hallucinatory phenomena repeat themselves. Furthermore, the subjects’ judgments concerning the moment at which the hallucinatory phenomenon arises are objective and are accompanied by a temporal reference associated with their story; •
a significant difference between the markers of spatial localization, with relative positions being preferred. The voices constitute a distinct, autonomous spatial reference for hallucinating subjects.
Conclusion
The narrative makes it possible to give the hallucinatory voices a place in the subject's story. The “hallucinatory stories” represent a transition from the private to the intersubjective world, a way for subjects to appropriate these experiences. When articulated in words, this experience is a product distinct from the self. This distinction between self and non-self, the hallucinating patient and his/her voices, seems to be conveyed in part by the markers of temporal and spatial position. 相似文献18.
19.
Objectives
Enhancement of pre-existing artistic talent as well as the emergence of a new artistic tendency has been associated with fronto-temporal dementia (FTD) but is an unusual finding in Parkinson's disease (PD). PD is typically characterized by loss of function and previous abilities, often accompanied by complications of treatment in the later stages of disease progression. Creativity has recently been described in Parkinson's disease as a symptom from the “dopamine dysregulation syndrome” (DDS) in association with pathological gambling, hypersexuality, compulsive shopping, binge eating, punding or hobbyism, or compulsive dopaminergic medication use.Patients and methods
We report two patients who developed artistic skills after changing of their dopamine treatment-dose. These two patients suffered from idiopathic Parkinson's disease; one became an accomplished writer and the other one developed embroidery creative activities. These case reports offer insight into the physiopathology of the artistic creativity.Results
Four main physiopathological hypotheses, which are not mutually exclusive, are currently proposed: (i) creativity is a mechanism of sublimation, (ii) creativity is due to hyperactivity and behavioural desinhibition, (iii) development of artistic activities is a consequence of enhancing premorbid personality or (iv) creativity is due to serotoninergic stimulation by dopamine agonists.Conclusion
A number of aetiological hypothesis on creativity exist. Although there are still many controversies among the experts in the field, we may infer that dopamine agonists should be drugs that enhance creativity in Parkinson's patients. 相似文献20.