Les personnes atteintes de schizophrénie et la rechute

Introduction

In schizophrenia, relapse is a common event that affects more than half the patients within 2 years after a first episode [10]. It is a real setback for them and their relatives. Surprisingly, we do not have much information on how patients and their relatives experience the relapse.

Method

A national survey was conducted among 316 schizophrenic outpatients treated with antipsychotics, and 82 of their relatives. The survey assessed the following four aspects: disease history, last relapse history, hospitalization experiences, and relapse prevention.

Results

Regarding the disease history, the average psychiatric follow-up was 13 years and patients had been hospitalized five times on average. Relatives reported approximately the same history. Regarding the last relapse, 9/10 of relatives reported that this relapse led to hospitalization and 69% of patients understood that their hospitalizations were due to relapse. 4% of patients and 7% of relatives identified the end of the treatment as a precursor to relapse. While a lack of compliance was found in about four relapses out of 10. It has also been shown that patients confided primarily in the medical team and the relatives thought to be the first confidant of patients. Regarding the experience of hospitalization, 87% of patients and 86% of relatives judged the hospitalization useful. For both, hospitalization represented a solving step to manifestations of relapse. Regarding the relapse prevention, almost three patients out of four thought they knew what to do in order to avoid a new relapse, while only 52% of the relatives thought patients knew what to do for this matter. For more than one third of the patients, the last relapse (3 years ago) was still a painful event. Avoiding a new relapse was considered very important or important by 91% of patients and 100% of relatives. Relatives felt that regular appointments with the medical team helped avoid relapses. Fifty-nine per cent of relatives have said it was difficult to verify whether or not the treatment was taken by a schizophrenic patient. Relatives’ opinion on the injectable treatment was favorable and approximately 50% of the patients declared knowing of injectable treatments. Among these 72% felt that such treatment was reassuring, 69% said it was simpler than oral therapy, and 67% thought it was the most suitable to check the compliance. Only 31% considered it restricting for the patient, against 54% who were considering it not restricting. Finally 57% of patients were willing to take an injectable treatment in order to prevent further hospitalization.

Conclusion

This study brings us a better understanding of patients’ and relatives’ experience of relapse. These results demonstrate the potential impact of relapse on the patients and their relatives and highlight their motivation to avoid further relapses. Also revealed, the lack of importance given to the link between compliance and relapse by patients and relatives. These results underscore the complexity of this disease management in which each player has a key role.     

Le suivi psychologique de sportifs de haut niveau : enjeux et réalité

In recent years, numerous studies have shown that the intensive practice of sport was not without psychopathological risks. Act No. 99-223 of 23 March 1999 relative to the protection of athletes’ health and to the fight against doping has, for the first time, taken into consideration the psychological dimension of sport regardless of the concept of performance. Since then, the 16 June 2006 decree amending the decree of 11 February 2004 established the nature and frequency of medical examinations under Articles L.3621-2 and R.3621-3 of the Public Health Code. The interest of this review is to allow the athlete, who is an object of so many desires on the part of his parents, of his coach, of the public and of the society of spectacle, etc., to regain his place as an individual within the time of an interview. During this interview the professional will establish a link allowing the athlete to register his sport in a “life project” (athlete, academic, professional, family, etc.) and in a sphere of which sport is only an aspect. By allowing the athlete to “be”, during and after his sport career, the professional will try to locate him/her outside the “sports play-acting”, which is a source of vulnerability to the disease of “doing” (drug addiction, alcoholism, addiction gestures, etc.). Furthermore this interview is also an opportunity to seek personal vulnerabilities and to elaborate a psychopathological epidemiology of high-level sport, which has hitherto not been undertaken. This legislative progress integrated into the longitudinal medical monitoring is an important advance in the care of athletes who have gone from hero status to that of participating in an industry of recreation and sports spectacle. However, these texts leave many issues untreated, more especially that so far this assessment has been launched in a parsimonious and disparate way (method, processes, stakeholders, professional sportsmen, etc.) according to the sports federations and institutions that often resist its implementation.     

Effets de l’exercice physique et de l’entraînement sur la neurochimie cérébrale. Conséquence comportementale

Physical exercises and training play on cerebral neurochemistry. Their action on mood is acute immediately after muscular exercises, or chronic for training. Physical training is significantly associated with a decrease in anxiety and its physiological indicators and can reduce the prevalence of depression on large populations. It was recently shown that it could improve cognitive functions and more particularly learning and memory. The neurochemical axes influenced by muscular exercising are the serotoninergical axis, the dopaminergical path and the GABA metabolism. The influence of muscular exercises on the biochemical path of neurogenesis has recently been underscored.     

Compulsion au viol et répétition

The analysis of clinical case of authors of violence shows that they present sometimes post-traumatic disorders which can lead to interpret acting out behavior as an attempt of elaboration of the trauma and which the release of the act is less ritual than compulsive. This dimension is particularly locatable in the repetitive acts, of which sexual attacks or repeated rapes. Which consequences we can understand about of “dangerous behavior”? In this article, authors study the psychic dynamics of several rapists and sexual aggressors, and notably a case known for the literature (Balier [1988]) [1] who notably introduce compulsive characteristics, and tendency to the repetitiveness. It is more traits than of organization of the personality. The origin of acting out is associated by the subject himself to a rehearsal of one or several previous moments which, in a sense, crystallize in these acts. The trespass appears as taking place in a scenario of reviviscence and could be defused only by analyzing with the subject with kind of secondary profits he obtain from this scenario. But existence of this base which induce to repeat trespass interrogates about concept of “series” applied to these rehearsals.     

Carence en vitamine B12, ataxie cérébelleuse et troubles cognitifs

Introduction

Vitamin B12 deficiency is often associated with neurological disorders of which combined sclerosis of the spinal cord is a common manifestation.

Case report

We report the case of a woman who presented cerebellar ataxia and cognitive deficits associated with leukoencephalopathy on the brain MRI. These symptoms were associated with vitamin B12 deficiency due to Biermer's disease. Vitamin B12 supplementation led to symptom improvement. Later her treatment was discontinued and the patient's clinical status worsened to a bedridden status.

Conclusion

Ataxia cerebellar dementia and leukoencephalopathy can result from vitamin B12 deficiency. To limit the risks of sequelae, vitamin B12 supplementation should be started at an early stage.     

Les structures de réhabilitation : du secteur au réseau

Patients suffering from schizophrenia usually stay excluded from the society despite the development of the psychiatric system for the last 50 years. To look for root cause and to consider the organization to set around the concept of the fourth paradigm, it appears relevant to cross local experience gained from a team of psychiatric practitioners to theoretical thinking.     

Intérêt de l’imagerie dans le diagnostic des plexopathies

Recent advances in magnetic resonance imaging (MRI) technology has improved vizualization of the peripheral nerve system, enabling further explorations of plexopathy beyond the physical examination and electrodiagnostic studies. High-resolution MRI is a method of choice, showing diffuse or focal enlargement, hyperintensity on T2-weighted images, altered fascicular patterns, enhancement after gadolinium injection or masses causing infiltration or compression, and signs of muscle denervation. Other techniques are complementary. Ultrasonography can depict a spectrum of lesions and can be coupled with dynamic manoeuvres to explore entrapment syndromes. Positron emission tomography (PET) can be helpful to differentiate between tumor recurrence and postradiation plexopathy. In posttraumatic brachial plexopathy, postmyelographic tomography and MRI are complementary. Traumatic injury, tumor formation, entrapment syndrome, and other conditions illustrate the different techniques available for imaging. Adequate imaging of the brachial and lombosacral plexuses is a useful aid for diagnosis, preoperative assessment and therapeutic planning and follow-up.     

Toc résistant : caractéristiques cliniques, facteurs prédictifs et influence des tempéraments affectifs

Background

Despite significant advances in clinical research, Obsessive Compulsive Disorder (OCD) represents a difficult to treat condition. The French Association of patients suffering from OCD (AFTOC) is highly concerned by this issue. A new survey was implemented with the aim of exploring Resistant Obsessive Compulsive disorder (ROC).

Method

Patients with OCD and members of the “AFTOC” were included in the survey. A self-rated file was elaborated in order to get the maximum of information on the clinical and therapeutic aspects and conditions of OCD. The full version of “TEMPS-A” was also included for assessment of affective temperaments. Statistical analyses were performed for inter-group comparison between “ROC” (resistant OCD) and good responders. Logistic regression analyses with “ROC” method were used to search for independent predictive factors to “ROC”.

Results

The new survey of “AFTOC”, “TOC & ROC” selected a sample of 360 patients, who are members of the association. The rate of “ROC” was 44.2%, 25.3% of Good Responders (GR), and 30.5% in between. Inter-group comparisons (“ROC” versus GR) showed significant higher rates of psychiatric admissions (49% versus 28%), and suicide attempts (26% versus 13%), greater numbers of doctors consulted (5.5 versus. 3.2), compulsions (4.6 versus 3.4), and psychiatric comorbidity (2.8 disorders versus. 2.0; notably agoraphobia, social anxiety and worry about appearance) in the “ROC” group. Assessment by full “TEMPS-A” scale revealed, significantly higher rates of Cyclothymic Temperament (63% versus 43%; p: 0.0003), Depressive Temperament (72% versus 53%; p: 0.004), and Irritable Temperament (21% versus 9%; p: 0.02) in the ROC group. Moreover, the mean global score on each of these temperaments was significantly higher in the “ROC” group. No difference was obtained in the rate or the mean score on the hyperthymic temperament scale. The most predictive factors of “ROC” were represented by “slow continuous course”, “worsening under SRI”, “worry about appearance”, current age above 40 years and psychiatric admission.

Conclusion

Our data provides a more precise clinical picture of “ROC”, which should be initially explored through baseline severity, compulsive dominance, hoarding, special comorbidity such as recurrent depression, obsession of appearance, agoraphobia, social anxiety, and complex mixture of unstable affective temperament (cyclothymic, irritable, and depressive), and course of illness. Furthermore, vigilance towards the notion of worsening linked to drug therapy, and the increased suicide risk is warranted in the clinical management of “ROC”.     

Un trouble psychotique aigu révélant un lupus érythémateux systémique

Introduction

Psychotic disorders are classical in systemic lupus and are listed among American College of Rheumatology (ARA) criteria. They are rarely inaugural and can compromise diagnosis, especially if they are isolated.

Clinical case

A 20-old-year woman was hospitalized for an acute psychotic disorder of two weeks duration with a degradation of the general status. Physical examination revealed intense osteo-tendon reflexes with a right Babinski sign. Brain MRI visualized a nodular low signal T1, T2 and high signal T2 flair in the left centrum semi-ovale. Blood counts showed lymphopenia. Antinuclear antibody and anti-DNA native antibody were positive. The clinical course favorable after treatment using oral corticosteroids, an neuroleptic and an antidepressant.

Conclusion

Systemic lupus is a potential diagnosis for any atypical psychiatric symptoms in young women.     

Insight et neuro-imagerie : l’apport de l’étude des réseaux du repos

Insight, in the field of psychiatry, can be seen as a complex phenomenon involving the ability to recognize one's own mental illness and the need for a treatment, but also to attribute a cause to various symptoms and life events. Patients with schizophrenia appear to have a lack of insight, leading to a poor outcome. Several theoretical models postulate a link between insight on the one hand, and cognitive (executive and autobiographical) dysfunctions on the other hand. In the past decade, large amounts of work have been dedicated to a particular network: the Default-Mode Network. This network seems to support the spontaneous mental activity of a subject at rest. In particular, its activation seems to be elicited by thoughts dealing with self-awareness. In a functional Magnetic Resonance Imaging study, we highlighted several network alterations in patients with schizophrenia, and one of these seems to have a relationship with insight. In the light of these results and the existing literature, we propose a conceptual framework of lack insight in schizophrenia with implications for future research.     

La détection cérébrale précoce des émotions

Emotions comprise a somatic and a psychological dimension. Indeed, they are both behavioural responses to internal or external stimuli and subjective experiences or feelings. Emotional perception can be defined as the detection and the appraisal of the emotional value of encountered stimuli. Attention capture and perceptual amplification are two important properties of emotional perception, which can result in enhanced conscious perception and increased processing of emotional stimuli. It has been proposed that amygdala plays a central role in the early detection of emotional stimuli. This paper presents the evidence accumulated in support of this proposal. In particular, recent studies showing emotional modulation of early brain responses (C1 and P1) to visual stimuli with electro- and magneto-encephalography (EEG and MEG) are reviewed.     

Troubles des conduites alimentaires et maternité : analyse de forums sur Internet

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.     

Insight cognitif et schizophrénie

Schizophrenia is usually associated with severe and chronic lack of knowledge of mental illness. This lack of insight is found to be correlated to hypofrontality but not related to the disorder outcome or to the intelligence quotient. The cognitive insight was defined as the difference between self-reflectiveness and self-certainty. This ability is described as decreased in schizophrenia but increased in depression. Thus, schizophrenia with depressive comorbidity is associated with a higher level of insight. The authors discuss how greater awareness of psychotic illness can be lived as traumatic, which appears to be a risk factor for depression and suicide.     

Aspects nosologiques des troubles bipolaires maniaco-dépressifs. Considérations critiques

Critical revue of the concept of bipolar disorders and spectrum and the categories in DSM-IV and ICD10.     

Géographie et psychose : territoire et perte du corps commun

Faced with the observation of clinical stalemate that may cause psychotic subject's speech, the authors suggest an alternative methodology based on the report of the subject to its own geography and its faculty of “territorialisation”. Based on arguments coming from ethology and phenomenology, they suggest an epistemological reflection of the act for the practice of clinical psychology with psychotic patients. These acts consisting the refrain, the social adjustment, the emotional regulation or even the relational intuition are witnesses stating that the central problem of psychosis is within the broad spectrum and complex of the loss of common sense and common body.     

Information et vécu parental du diagnostic de l’autisme II. Effets des troubles et qualité de vie

This article is part two of a study whose aim is to provide the current state of knowledge concerning the parental contribution in early identification and diagnostic patterns of children with autism spectrum disorder. The first article was an update on the age of recognition of early symptoms by parents and the initial diagnosis as well as the nature of concerns. The purpose of this one is to evaluate the psychosocial repercussions of child's trouble on parents, and therefore on their quality of life and their strategies used to cope with the disorder. Our aim is also to analyze the factors that determine the differences. We assume that the knowledge of these effects is also involved in the knowledge and diagnosis of the autistic spectrum disorder.     

Information et vécu parental du diagnostic de l’autisme. I. Premières identifications et nature des premières inquiétudes

The purpose of the present study is to provide the current state of knowledge concerning the contribution of parental experiences in early identification and diagnostic patterns of children with autism spectrum disorder. As developmental disorder, professionals’ diagnosis is necessarily informed by parental recognition of symptoms and their nature. Timing of initial symptom recognition and parents’ initial concerns differ from timing of diagnosis. In addition, parental concerns are not confined to the specific symptoms of autism that professionals differ. We try to examine factors which determines whether early recognition and diagnosis of autistic disorder in children.     

Infarctus cérébral récidivant révélant une maladie de Biermer

Introduction

Biermer's disease is an autoimmune disorder characterized by vitamin B12 deficiency. Ischemic stroke is an uncommon complication of Biermer's disease, possibly though hyperhomocysteinemia.

Case report

A 58-year-old male presented with recurrent ischemic stroke. Extensive investigations were normal, except for a high plasma level of homocysteine in the context of pernicious anemia which was otherwise asymptomatic.

Discussion

Hyperhomocysteinemia is a known marker, and probably a risk factor, for stroke, fostering atherosclerosis and thrombosis. It can be found among individuals suffering from homocysteinuria, but also when there is deficiency of vitamin B12 or folic acid. Vitamin B12 supplementation would reduce homocysteine concentration which in turn would reduce the risk of ischemic stroke.     

L’insight et les croyances relatives aux médicaments influencent l’observance médicamenteuse dans la schizophrénie

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.