Apport du Multimorph à l’étude des processus de reconnaissance émotionnelle faciale (REF). Exemple de la personnalité borderline à l’adolescence

An increasing interest in the study of facial emotion recognition in many psychiatric disorders has emerged over the past few years. The morphing technique allowed opening new perspectives in experimentation, by using dynamic expressions of emotions, such as in the Multimorph task. Based on a literature review, we present here the interest of the Multimorph task. It includes 36 trials where a neutral (0%) face expresses increasing degrees of emotional intensity, slowly changing to a full-blend (100%) emotion. Then, the example of borderline personality disorder in adolescence is developed to examine how the observed pattern of results could account for the reported clinical characteristics. Limitations and prospects of the Multimorph are further discussed.     

Conduites à risques et variation de l’estime de soi chez les adolescents : l’exemple du parkour

The aim of this study was to explore the relationships between general self-esteem, physical self-worth, sport competence, physical condition, an attractive body, physical strength and the involvement in a risk-taking sport: The parkour. This sport may be included in gymnastics and acrobatics but it is practised outside of the gymnasium. Indeed, serious parkouristes are tremendous athletes who practice their stunts in a controlled environment such as a gymnasium, with mats, pads and foam pits. Many of these participants have some gymnastics or martial arts training, and they are also fully aware of the risks involved in practicing this sport. It consists of finding new and potentially dangerous ways to traverse the city landscape. Parkour is said to be the art of moving fluidly from one part of the environment to another. It may also be known as: the art of movement, free running, urban-running or obstacle coursing. This activity is a way of using obstacles in one's path in order to jump and perform acrobatics. It involves the scaling of walls, roof-running and leaping from building to building. These multiple acrobatics are submitted to peers appreciation considering fluidity, aesthetics and originality. Self-perception is of great importance in the construction of self-esteem. This concept has been identified as a state which evolved depending on spatiotemporal factors of the environmental context. It can be measured with the Physical-Self Inventory (PSI). This is a six-item questionnaire especially developed for repeated measurements. It measures six dimensions hierarchically organized Global Self-Esteem (GSE), Physical Self-Worth (PSW), Physical Condition (PC), Sport Competence (SC), Attractive Body (AB), Physical Strength (PS). Seventy-six male participants were asked to take part in the study: Group 1: Parkour (n = 32, M_age = 15.07 years, E.t. = 1.98) and Group 2: acrobatics (n = 41, M_age = 14.96 years, E.t. = 2.01). The PSI-6 was taken at three different times: Time 1 (T1, pre-test before practicing parkour), Time 2 (T2, just after having stopped the parkour), Time 3 (T3, two hours after T2). As expected, and with the exception of PC and PS, the data confirmed the prediction that, compared to Group 2, Group 1 would score significantly higher on each subscale of the PSI, including GSE, PSW, SC, and AB. That is to say, skydiving could de used as a way to regulate self-esteem, this confirms our assumption. Self-esteem has recurrently been invoked as a contributing or explanatory factor for socially problematic behavioural outcomes (i.e., risk-taking behaviours such as restrictive or dysfunctional eating, substance abuse, aggression). In relation to our results, sports could bring an extra dimension to studies on risk-taking especially among adolescents. Indeed, risk-taking sports are usually perceived as an intrinsically gratifying practice that is socially adapted and accepted. However, benefits in self-esteem regulation derived from an engagement in a risk-taking sport must be put into perspective. Although the results indicated for Group 1: a lower level of self-esteem before practice and a higher level after, the retention test shows that these results do not last more than two hours. This finding suggests that, even if the emotion regulation produced by parkour is positive, one session is not enough for adolescents to experience positive rewards from their engagement in a risk-taking behavior. Thus, in order to recreate the positive emotional state they were in, they may possibly put themselves in another risk-taking situation. However, the link with addiction cannot be made directly as it implies several factors which have not been measured in this study. Future research should take this interesting point in account and use a longitudinal methodology. This will authorize authors to draw out our assumptions and emphasize the possible link between addiction and risk-taking sports.     

Le concept de l’insight en psychiatrie

It was in France (particularly in the Société Médico-Psychologique 1869 to 1870) that the concept of insight into mental disorder began to appear around the middle of the 19^th century. Amongst other things, changing views concerning the nature of insanity, particularly the emergence of the notion of partial insanity, led to debates about the question of insight in patients with mental illness. Following a resurgence of interest in insight in psychiatry numerous empirical studies have sought to explore the relationship between patients’ insight and clinical variables. Results however have been variable and contradictory. Explanations for this can be found in the complexities inherent to the concept of insight. In order to tease these out, it is essential to distinguish between the concept and the phenomenon of insight and to view insight as a relational concept. Clarifying these issues around insight helps to define the ways and limits in which it is possible to capture insight empirically. In addition, it facilitates an understanding of insight as a mental state whose fluctuations are dependent on an interplay of psychological, pathological and wider sociocultural factors.     

What's new in immune-mediated neuropathies?

Many papers have been published in the field of immune-mediated neuropathies in 2010. Various topics have been covered: diagnostic criteria and clinical forms, pain and its risk factors, clinical evaluation and new immunological markers. Additionally, as nerve biopsy is still useful for evaluating patients with peripheral neuropathy, French and international guidelines have been published. This paper aims to summarize recent discoveries in the field of immune-mediated neuropathies.     

Efficacité à moyen terme de l’autogreffe de cellules souches hématopoïétiques périphériques sur la polyneuropathie du syndrome POEMS : expérience chez 5 cas

Introduction

POEMS syndrome (polyneuropathy, organomegaly, endocrynopathy, M-protein, and skin changes) is a rare multisystem disease associated with plasma cell dyscrasia. The efficacy of autologous peripheral blood stem cell transplantation (auto-PBSCT) reported in case series has been mainly based on hematologic criteria and clinical recovery of peripheral neuropathy dysfunctions but has not been specifically evaluated. This retrospective study aimed to analyze the efficacy of auto-PBSCT on disability and electrophysiological patterns in patients with POEMS syndrome.

Methods

Five patients presenting with POEMS syndrome received auto-PBSCT. Disability was evaluated before treatment and at 6 and 12 months using the Overall Neuropathy Limitation Scale (ONLS) and MRC sumscore of 28 muscles. Nerve conduction studies were performed before and one year after treatment, on median, ulnar, fibular and tibial nerves.

Results

Mean age was 60.6 years (49–70). Disease duration between first symptoms and auto-PBSCT was 15.4 months (2–33). Before auto-PBSCT, mean ONLS score was 4.2 (1–10) and mean MRC sumscore 115.8/140 (74–140). At M6, mean ONLS score decreased and mean MRC sumscore increased; both were improved in all patients at M12: mean ONLS score 3 (range 0–8) at M6 and 2.2 (range 0–7) at M12; mean MRC sumscore 118/140 (77–140) at M6 and 122.4/140 (80–140) at M12. Significant recovery in electrophysiological patterns was observed in all patients on ulnar and median nerves: before-after treatment differences were observed for motor conduction velocities (34.41 vs. 45.47 m/s; P < 0.001), distal CMAP amplitudes (5.04 vs. 5.96 mV; P = 0.004), and sensory conduction velocities (43.20 vs. 49.20 m/s; P = 0.001). Distal CMAP amplitude remained low in fibular and tibial nerves (0.41 vs. 0.17 mV).

Conclusions

Clinical and electrophysiological improvement is obvious in POEMS syndrome peripheral neuropathy within one year after treatment with auto-PBSCT, undoubtedly resulting from extensive remyelinisation and axonal regeneration. Further studies are required to examine long-term outcome in patients with POEMS syndrome given auto-PBSCT.     

Influence de l’insight sur l’efficacité de l’entretien motivationnel dans la prévention des rechutes chez des patients alcoolo-dépendants

Motivational interventions are effective in the treatment of alcoholism, especially in the early stages of the Prochaska and DiClemente model of change. In 62 alcohol dependent patients without cognitive disorders, in addition to treatment as usual, motivational interviewing effectiveness on relapse prevention was linked with the level of insight. We have retrieved a moderate effectiveness on relapse prevention in patients with poor insight and a significant adjunctive effectiveness in patients with good insight.     

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.     

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.     

Pertinence clinique du calcul d’un score global à l’échelle de Conscience des Troubles Mentaux (SUMD)

Introduction

Since 1990 rating scales assessing clinical insight have become the standard for empirical studies of lack of awareness in psychotic disorders. One of them, the Scale to assess Unawareness of Mental Disorder–SUMD is a semi-structured interview based on a dimensional and quantitative approach of clinical insight. The SUMD is founded on a modality specific view of insight that is to say that a patient can acknowledge the presence of some symptoms (e.g. anhedonia) but not others (e.g. blunted affect). However, presently, patients cannot be compared to each other based on the SUMD subscales total scores. In order to do so, patients would have to present the exact same symptoms.

Objective

The aim of this study is to make the use of the SUMD simpler and more clinically useful.

Method

This study involved 76 adult inpatients, diagnosed with schizophrenia (DSM-IV-TR criteria).

Results

Calculating SUMD Global Scores of the SUMD general items (items 1; 2 and 3) allowed us to reduce intra-individual variations and to compare patients’ level of insight.

Conclusions

Until now, the SUMD has proven to be a useful instrument to assess insight into schizophrenia for individual patients whereas our new statistical approach of the SUMD allows clinicians to compare level of insight between patients.     

Le botulisme alimentaire au Maroc, à propos de 15 cas. Valeur diagnostique de l’électrophysiologie

Introduction

Botulism is a rare but serious disease, which affects the peripheral autonomous nervous system, potentially with a fatal outcome. In Morocco, botulism is exceptional.

Patients and method

This was a prospective analysis of the epidemiological, clinical, neurophysiological and toxicological features of 15 cases of food-borne botulism identified among a series of 45 highly suspect cases collected in Morocco during an epidemic in August 1999.

Results

The 15 patients (eight females, seven males) included in the protocol were aged 3 to 49 years (average 18.8 years). One-third of the cases occurred in a familial context. The clinical presentation was typical and complete in nine cases; respiratory failure was noted in four patients. Botulinum toxins were found in nine cases. Outcome was less than favorable, with total recovery in seven cases, persistence of motor sequelae in three and death in five. Electrophysiological investigations showed an incrementing response at high frequency in 73.3%, a decrement at lower frequency in 60% and low motor amplitudes in 93%. These findings constituted a very sensitive and specific triad for botulism diagnosis.

Discussion/conclusion

These findings illustrate the gravity of botulism and the important diagnostic value of neurophysiological results, especially incrementation, which can provide a very pertinent diagnostic contribution, especially in seronegative patients.     

Dopage, limites et transgression. Rapports à l’individuel, à l’institutionnel et au juridique

The evolution of contemporary practices allowed us to consider doping as a new object of social discourse, placing this transgressive practice within the borders of medical, sociological and juridical prospects. The development of a legislation framing sporting practices leads to the installation of new institutions like to the emergence of concepts, such as “medical monitoring of sportspeople”, contributing to the introduction of new social control devices.     

La psychiatrie en milieu pénitentiaire : chronique d’une pratique psychiatrique au centre pénitentiaire de Bordeaux-Gradignan

We will start with a presentation of the prison population, followed by a review of aggravating factors for situations, which would be perceived as banal. We are confronted with the interface between, on the one hand, a rigid judicial and penitentiary structure and, on the other hand, according to the type of new inmates, can take many faces both from a clinical and a criminological viewpoint. The fact that new specialized bodies have been added (SMPR) and are still developing (UHSA) confirms the idea that prison cannot accommodate a specific psychopathological sample of our society which is then sent to a further exclusion-generating structure. As a result, prison is increasingly seen, as a factor for repetitive offending that is too often limited to a medical approach. The multiplication of legal texts centred around law-and-order is the expression of the current trend to push health professionals to go beyond their role of care.     

Présentation de l’Entretien Semi-structuré Multiregistres

Whereas instruments are available to diagnose various psychiatric disorders and to rate their severity, there is a lack of instruments to assess the phenomenology of these disorders, i.e., a set of mental phenomena that compose subjective experience. Our objective is to present a new type of psychopathological interview, aimed to study the phenomenology of mental activity. In developing the Assess_Mind, we tried to integrate within one single instrument the qualities of unstructured clinical interviews, such as openness to unexpected information, and the qualities of structured interviews, such as adequate psychometric properties. The basic principle of the Assess_Mind is to explore various “registers” of mental activity: affects, fears, desires, memories, and associations of ideas. This exploration is based on open, but standardized, questions. A rigorously defined algorithm for interviewing indicates which question is to be asked, dependent on the responses of the patient and on the chronological progression of the interview. After the interview is completed, a rating module comprising specific scales allows to assess clinical information that has been collected. We expect that the Assess_Mind will contribute to help clinicians to perform initial assessments of patients and to follow the course of their clinical state.     

Profil psychologique et comportemental de vulnérabilité à la dépendance à l’exercice et au risque de pratiques dopantes chez les sportifs amateurs : l’exemple des semi-marathoniens

Introduction

Most research on doping behaviors in sportsmen is relative to professionals. However, high-risk behaviors can also be observed in amateur sportsmen. Exercise dependence corresponds to an unsuitable practice of physical exercise which leads to complications characterized by a need to increase the amount of exercise significantly, the presence of tiredness or anxiety when discontinuing the exercise, the loss of control, the increase in the time spent in exercises, the restriction of other fields of activity and the maintenance of the exercise even with a recurring physical or mental problem (Veale, 1995). It appears that exercise dependent subjects have specific representations of physical activity (Davis et al. 1993, 1995). Our objective is to study the relationship between doping practices and behavioral dependence to physical exercise in amateur sportsmen. We hypothesize that high-risk doping amateur sportsmen have the following specific profile: A threshold of consumption of physical exercises, a particular representation of the sport, a restriction of the fields of activities apart from the sport.

Method

Mental representations and physical exercise habits of 317 semi-marathon runners were studied through semi-structured interviews. The sample consisted of 257 men and 60 women 20 to 60 years old. (i.e. 62 individuals from 20 to 30 years old, 116 from 30 to 40, 93 from 40 to 50, and 46 over 50 years old). All the participants were amateurs practicing foot racing in competition as principal sport. The participants were asked to answer to a self-questionnaire assessing: Their relation to physical activities, the number of hours of weekly physical exercises, the type of practice, the environment extra-sportsman, the representations of the sport, the importance given to the practice of the sport, the consumption of other products, the possibility of a consumption of doping products, their capacity to be abstinent to their physical activity. We determined an indicator of risk of doping, from different questions related to a possibility of consuming doping products. The indicator which appears most sensitive is the question: "Would you be ready to take doping products under medical control".

Results

The majority (75%) of the semi-marathonians practice their physical activity between 1 and 5 hours weekly whatever their age. The median observed is equal to 4. A discriminating analysis does not make it possible to show a good capacity of classification of the individuals saying it self ready to take doping products under medical control according to the only criterion of the number of hours of physical practice. 11.7% of the subjects reported that they would agree to take doping substances if they had the opportunity to do so under medical control. The mental representations and behavioral characteristics of this subgroup are the following: 1) A pervasive search of a surpassing of themselves through physical exercise; 2) An every day life predominantly focused on physical exercise; 3) The onset of negative feelings and irritability related to exercise discontinuation; 4) Paradoxically, a moderate amount of time spent exercising (59.5% reported exercising less than 5 hours weekly).

Discussion

In amateur sportsmen, the reported propensity to use doping substances is not correlated to the intensity of physical exercise measured by the amount of time weekly spent exercising. This propensity seems to occur in a specific sub-population of vulnerable subjects characterized by a behavioral dependence to physical exercise with a specific representation of their physical activity. These specific characteristics of high-risk individuals are independent from the age of the subjects. In a perspective of prevention, it is important to identify high-risk subjects to modify their manner of perceiving the sport, and to preserve other social investments.     

La consommation d’anabolisants à l’adolescence. Quelle réalité ? Quelle signification ?

Based on three national surveys (European School Survey on Alcohol and Other Drugs [ESPAD] 1999, ESPAD 2003, ESPAD 2007) on a representative sample of 16-year-old young people (N > 2500 for each survey), the author has observed an increase in the consumption of anabolic steroids, more important among girls (from 0.6% in 1999 to 1.6% in 2007, P < 0.001), than among boys (from 1.0% in 1999 to 1.6% in 2007, NS). Most of these youngsters participate actively in sports, athletics or exercising daily. Anabolic steroid consumers also have a high consumption rate of alcohol, tobacco or cannabis, and are known for violent behaviour. The authors conclude that a more global approach to youngsters is necessary to prevent consumption of anabolic steroids.     

La CFTMEA R 2010, présentation des modifications de l’axe I

The French Classification of Child and Adolescent Psychiatry is a multiaxial diagnostic system specifically devoted to these ages. Unlike the V^th chapter of ICD-10 and the DSM-IV, which are syndromic classifications, it is organized on a hierarchical basis. On axis I, five groups of principal categories are exclusive and correspond to psychopathological structures, in reference to psychodynamic concepts. Complementary categories are used to record significant clinical features, which have to be associated to one of the psychopathological structure. This new revision (CFTMEA R 2010) ensures an almost total compatibility with the V^th chapter of ICD-10; and brings more complementary items (one complete chapter has been added), while the general organization of the classification is maintained.     

La demande du tiers et la validité de l’hospitalisation à la demande d’un tiers : les difficultés à surmonter

This paper following another article aimed at the implementation of the hospitalization at the request of a third party (hospitalisation à la demande d’un tiers — HDT) shows that the third party request for hospitalization, a compulsory component for validity of the process of hospitalization at the request of a third party, proves sometimes to be a difficult stage, source of great teething troubles and cancellation of many hospitalizations, not to say start of legal proceedings. The legal jargon and rhetoric reveal after their interpretation, a big gap between the spirit of the law, the practice of care and the precedents. Then, are suggested amendments of the practice relating to the hospitalization at the request of a third party, even of the law that banned long ago, the words: Commitment, internment and placement. Mainly, we suggest an ease of the validity of the thirds liable to formulate the request and a concentration on the spirit of the law, aiming more at the protection of the patients than an unproductive suspicion of the staff.     

Relations entre dimensions émotionnelles et symptômes somatiques : effets médiateurs de la dépression et de l’alexithymie

Objectives

The aim of the present study was first to complete previous research on negative affectivity, alexithymia, depression and somatic symptoms by testing a theoretical model of their relations. It was second to investigate potential mediating effect on the relations between negative emotionality (i.e. neuroticism) and somatic symptoms.

Patients and method

A sample of 309 subjects (77% F et 23% M; mean age = 20, 61 ± 1.55) completed the following questionnaires: the Positive and Negative Emotion questionnaire-31 items (EPN-31), the Toronto Alexithymia Scale 20 items (TAS-20), the Center for Epidemiological Studies Depression scale (CES-D), and the Symptom Check List Revised, 90 items (SCL-90 R). Theoretical model and mediating effects were tested using structural equation modeling, and bootstrapping method.

Results

Three measurement models were tested: First, a direct effect model did not fit the data. Second, a partially mediated model fit partially the data for some indices, but not for others, and was rejected for lack of parsimony. Finally, a full mediation model showed the best adjustment with results confirming the good fit of this structural model including (Chi² = 10.245, P = 0.069, ns; CFI = 0.989 > 0.95, RMSEA = 0.058 < 0.07 [90% IC = 0.000–0.100], SRMR = 0.026 < 0.08). So as, our results show that alexithymia and depression are full mediators of the negative affectivity–somatic symptoms relation. In other words, when depression and alexithymia are introduced in the relation between negative affectivity and somatic symptoms, the direct effect of negative affectivity becomes non-significant, and turns to an indirect effect. Moreover, depression as a stronger effect on somatic symptoms than alexithymia, which seems to confirm previous research on the distinction between both constructs. These results are compatible with that of previous works on somatic symptoms and negative affectivity, and on somatic symptoms and alexithymia.

Conclusion

The propensity to experiment negative emotional states may contribute to develop negative emotion regulation strategies such as alexithymia, which as a direct effect on somatic symptoms. But more precisely, we can hypothesize that alexithymia is not fully efficient as a defense against negative emotions, and that depression remains a strong characteristic of subjective emotional experience for some subjects, constituting a strong contributor to declarative somatic symptoms. Implications for psychotherapy are discussed, supporting the enhancement of negative emotions regulations strategies for subjects showing somatic complaints.     

Réflexion psychopathologique sur la pédopornographie : le fantasme de l’altérité

Child pornography might be not only a support for pedophile's fantasies satisfaction. It might be a remedy against anxiety used by subjects in search of identity. Based on this idea, we made a reflection on the motivation to view this type of images. Analyzing the context in which the child pornographer acts, we conducted a parallel assessment with the analytical framework to understand what the purpose is if it is not sexual. He projects himself in the image. He becomes spectator and actor of the scene. Therefore, the child pornographer could have a control over images and looks. Images could be a support to the development of his childhood and teenage fantasies.