Joueurs de machines à sous dans une population française : étude de la dépression, de l’alexithymie et de la recherche de sensations

There are a multitude of factors implied in the acquisition, the development and the maintenance of gambling behavior. Among them, sensation seeking occupies an important place. Zuckerman originally suggested a relationship between sensation seeking and gambling. However, studies in this area have provided heterogeneous results. To explain these discrepancies, Zuckerman emphasized the fact that the type of gambling may be a crucial factor in the relationship with sensation seeking. Nevertheless, few studies have evaluated the link between the different types of gambling and problem behaviors. Furthermore, few studies were interested specifically on slot machines. While recent research has found high-levels of alexithymia in individuals with substance use and eating disorders only two studies have investigated the relationship between alexithymia and pathological gambling. Thus, these studies were focused on students. It is therefore important to study alexithymia in adult gamblers. Empirical data has shown that alexithymia levels may be influenced by negative mood states, especially depression. Some studies have found a positive correlation between alexithymia and depression scores, particularly in people with addictive behaviours. Nevertheless, studies found heterogeneous results. The main objective of this research was to evaluate scores on sensation seeking, alexithymia and depression (and the link between those variables) in gamblers of slot machines. Thus, slot machines gamblers were selected in the casino of Enghien-les-Bains, which is Paris nearest casino. Among them one distinguishes: regular gamblers (n = 45) from which were extracted pathological gamblers (n = 27), and occasional gamblers (n = 19). The South Oaks Gambling Screen and the criteria of the DSM-IV were used to measure the intensity of gambling behavior; sensation seeking was evaluated by the Sensation Seeking Scale form V; alexithymia by the Toronto Alexithymia Scale (TAS-20) and the depression by the Beck Depression Inventory. No differences appeared significant between the three groups of gamblers for the sensation seeking scores. Pathological gamblers obtained higher alexithymia scores than occasional gamblers. Nevertheless, these findings didn’t remain stable when controlling for the effect of depression. Among pathological gamblers, the BDI score is positively correlated to the ‘difficulty identifying feelings’ factor. This result is consistent with the literature, which shows that alexithymia is closely related to depression in addictive behaviors. Indeed, the ‘difficulty identifying feelings’ factor seems to be explained by depression severity. These results suggest that the emotional component of alexithymia would be thymo-dependent, whereas the cognitive component would be independent and constitute a stable clinical feature. Pathological gamblers who play slot machine are low sensation seekers who shun the more dramatic and extraverted form of sensation seeking. They play to reduce or avoid unpleasant emotional states like depression. Pathological gambling could therefore be in part a maladaptive coping strategy to deal with affective disturbances; the game may function as a self-medication to treat emotional states, which the gambler finds no other way of treating. According to previous studies, slot machine gambling is referred to as ‘escape’ gambling, where gamblers may dissociate.     

Alexithymie, dépression et incarcération prolongée

On the basis of an investigation by auto-questionnaires in a population of 230 prisoners condemned to prolonged prison sentences, the authors noted the strong prevalence of the alexithymy (42.86%), its correlation with the depression, but its absence of correlation with the duration of the sentence accomplished and of that remaining. They deduced from this that alexithymya is a stable feature of personality.     

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.     

Comparaison des dimensions de personnalité dans la dépendance à l’alcool et les addictions sans substance

Approaches in the assessment of personality were interested in addictive behaviours. For Cloninger, in 1987 [4], temperament characteristics considered to be hereditary and underlain by clinical, neurobiological and genetics hypothesis were: novelty seeking (NS), harm avoidance (HA), reward dependence (RD) and rersistence (P) and dimensions of character were self-directedness (SD), cooperativeness (C) and self-transcendence (ST). A new questionnaire evolved from the initial Cloninger's questionnaire: the Temperament and Character Inventory (TCI). This new questionnaire includes 226 items. The authors used this questionnaire on 79 patients in the Pr. Adès Psychiatry Unit of the University Hospital Center (CHU) Louis-Mourier. Of these patients, 48 consulted for alcohol's problems and 31 for behavioural addictions (pathological gambling, compulsive buying…). Analysis of the results showed that in general anxiety rating is higher for patients suffering from a behavioural addiction than for patients with an alcoholic addiction. This study follows the theme of personal vulnerability, due to personality dimensions, but also due to the context and to the product or behaviour. The results suggest that, regardless of product or behaviour, personality dimensions appear from patient profiles (NS; HA and C) with higher rates in the case of addictive behaviour, but usually profiles are more alike than different. It seems that patients prefer to strive for behaviour-related excitement, than for an excitement due to a product easy to obtain that would have less interpersonal stakes than gambling or compulsive buying. The authors analysed the common factors between alcohol dependences and other behavioural addictions in terms of personality dimensions.     

Régulation des émotions, dépression et conduites à risques : l’alexithymie, un facteur modérateur

The repetitive involvement in risk-taking behaviour is a major cause of somatic damage or accidents in adolescents and young adults. Previous research points out the importance of psychological factors such as personality variables and cognitive-emotional functioning. In this field, relationships between risk-taking, anxiety and depression have been well-established. However, few studies take into account emotion-regulation processes as implicated in risk-taking. According to Bonnet et al. (2003), risk-taking behaviours are similar to those of coping strategies for subjects maintaining a homeostatic state. Another perspective considers risk-taking as a consequence of an emotional processing deficit, a trait called alexithymia. Following this hypothesis, the aim of this study was to test a) differences between risk-takers and non risk-takers in depressive disorder and alexithymic functioning, b) relations between emotional functioning, depression and risk-taking. Two groups were formed from a sample of 259 subjects, aged from 18 to 25: an RT group (Risk-Taking, N = 123), and an NRT group (Non Risk-Taking, N = 136). Participants completed a risk-taking questionnaire (elaborated by the authors especially for this study), the Toronto Alexithymia Scale (TAS-20) and the Center for Epidemiologic Studies Depression Scale (CES-D). Our results show significant differences between the two groups: risk-takers seem to present more depressive symptoms than controls (P < 0.0001), and to be more alexithymic (P < 0.0001). Strong correlations (from 0.59 to 0.44) were found between alexithymia, depression and risk-taking behaviours. Finally in a model explaining 43% of the variance of risk-taking behaviours (R² = 0.43; F(3.258) = 66.103, P < 0.0001), multiple regression shows that alexithymia and depression might be risk factors for such conducts. There may be several interpretations of our results. In the first one, alexithymia could be considered as a part of a general depressive syndrome, which may be at the origin of the problematic behaviours. In this case, risk-taking would be used in order to diminish or suppress negative emotions. But this interpretation is not satisfying, because both depression and alexithymia have similar effects on risk-taking, and because we have been able to propose a statistical model in which alexithymia is a variable that explains depressive symptoms. These remarks lead us to consider alexithymia as a moderating variable, which allows subjects to avoid negative emotions, which cannot be processed. This process maintains risk-takers in a depressive state that they try to treat using risk-taking behaviours as illusory attempts to avoid negative feelings. Finally, limits and need for further research are discussed. In conclusion, our results point out the importance of emotional variables in the study and treatment of subjects involved in risk-taking behaviour.     

Proposition pour une échelle d’évaluation du risque de répétition d’accidents chez l’adolescent

When confronted with situations of repeated accidents among teenagers, organicist physicians (emergency physicians, orthopaedists and general practitioners) need tools to discern sub-jacent psychopathological problems such as depression and anxiety. We have elaborated an Evaluation Scale of Risk Behaviour of the Teenager (ECRA) and we have compared its results to those obtained with different recognized scales currently in use in psychiatry. We have observed that teenagers with antecedents of accidents have scores that are far higher than those of first accident teenagers, notably in the depression, anxiety and impulsivity scales as well as in the ECRA. The ECRA is quite efficient in distinguishing teenagers without antecedents of accidents from those having had repeated accidents. This simple and rapid scale could be used as a tool by organicist physicians for detection but also for prevention as they are the first to be confronted with young people.     

Modèles psycho-neuro-immunologiques de la dépression : une revue critique

Psycho-neuro-immunology (PNI) is based on the observation of interrelations systems, that can be sensitive to psychological as well as environmental factors. Numerous studies have shown a bi-directionnal communication between the nervous and immunity systems. Various models have been suggested to explain the physiopathological mecanisms of depression. The neuroendocrine model and the cytokine one differ because of the influence given to the corticotropine axis and the immune reaction ; however, results from various studies do not confirm PNI models. These results are often contradictory ; most of these studies show an increase of pro-inflammatory cytokines that could interact with the serotoninergic system, a modification of lymphocyte activity in depressed subjects and a corticotropin axis activation ; limits of PNI models are mostly due to the diversity of biological parameters involved in neuro-immunological regulations.     

Conscience de soi et conscience de la maladie dans la schizophrénie : relations avec l’anxiété et la dépression

Elevated rates of suicide in schizophrenia lead us to think that a lot of patients can’t cope with such a frightening, disorganizing or apragmatic experience. In contrast, we insist about the frequency of unawareness of illness as a characteristic of the schizophrenic patient, with paradoxically litlle or no effect on suicidal behaviour. Our study tended to precise the links between awareness of illness, anxiety and depression. We also rated self-consciousness, to see if this tendency could be correlated with other variables, and confirm if possible the hypothesis that awareness of illness relies on a broader tendency for self consciousness.In our population of 46 schizophrenic or schizoaffective inpatients, we failed to show any correlation between awareness of illness, anxiety or depression. Moreover, awareness of illness is not correlated with self-consciousness. On the other hand, anxiety and depression are correlated with self-consciousness. A tendency for high self reflection is frequently observed in autistic attitudes but also when the patient is in relation with others. Some patients sometimes feels like if a an “active” and a “reflexive” self were simultaneously present when they speak to others or even when they are doing daily life activities. The consequences are a loss of spontaneity, apragmatism, anxiety and depression. Those data are discussed in regard to phenomenological studies of Bin Kimura and to mescaline experiences described by the writer H. Michaux.     

Un croisement institutionnel entre la neuropsychologie et la psychopathologie dans l’évaluation cognitivoclinique d’un homme âgé

This article is about an 88 years old man's case, hospitalized because of a worrying somatic symptomatology: deterioration of a cardiac deficiency, oedema of bottom legs and anorexia. Actually the patient shows cognitive troubles, but one year ago he has been hospitalized, for a confusional state, associated with comportmental troubles and light temporospacial disorientation. At this time, the cerebral imaging showed a diffuse atrophy, prevalent in frontal level. In front of this case, the diagnostical question proves to be delicate because of the complicated interactions between depression, dementia and normal ageing in the very old age. The main object of this work tries to situate this patient's case in its structural and historical subjective globality, with the help of a clinical thought. The clinical thought of the authors includes an interface with neuropsychological and psychopathological approaches and tries to overtake the only quantitative point of view of a technical evaluation.     

Exploration de la fonction dopaminergique dans les dépressions bipolaires et unipolaires

Indirect observations suggest that dopamine function may be altered in depressed patients, notably in bipolar patients. The purpose of this study was to assess the dopamine receptor sensitivity at the hypothalamic-pituitary level in 19 drug-free DSM-IV major depressed patients: 10 bipolar depression (BP), 9 unipolar depression (UP), compared with 15 sex and age matched hospitalized controls (HC). We evaluated the multihormonal responses to the dopamine agonist apomorphine (APO, 0,75 mg SC) in order to obtain an indirect index of dopaminergic neurotransmission at the post synaptic level. We also examined, in the same subjects, prolactin (PRL) response to 8AM and 11PM protirelin challenges (TRH, 200μg IV) and cortisol response to dexamethasone suppression test (DST, 1 mg orally). No significant difference in cortisol, ACTH and GH values was found between controls, UP and BP patients (i.e. at baseline and in response to apomorphine test). However, BP had lower APO-induced PRL suppression than HC (P =0.0003) and UP (P =0.04). Taken together these results suggest that decreased APO-induced PRL suppression in bipolar depressed patients is not due to deficiency of pituitary lactrophs and/or increased HPA axis activity, but may reflect altered post synaptic receptor sensitivity D2 in the tuberoinfundibular dopamine system.     

Étude comparative de dix sujets SDF fréquentant un centre d’hébergement d’urgence et de dix sujets SDF vivant uniquement dans la rue : acceptation et refus de l’hébergement d’urgence

Objectives

The last decades have seen an increasing number of homeless people (SDF) in Western societies. Public authorities have developed a solid assist device to treat this “homeless problem” by creating emergency shelter. Generally, this type of accommodation does not set any condition of admission and answers an immediate need of safekeeping of the person. Yet many homeless people refuse emergency shelter, even in winter. They prefer to sleep outside in extreme conditions. The purpose of this article is to help understanding the refusal and the acceptance of emergency accommodation for the homeless population.

Patients/materials and methods

In this study, a group of ten homeless subjects using emergency shelter (CHU) is compared to a group of ten homeless subjects who are refusing the emergency shelter and living only on the streets. To each subject, a semi-structured interview, an evaluation of the HAD scale (Zigmond AS and Snaith RP, 1983) and one of the self-esteem scale are conducted (Rosenberg, 1969). The analysis of data, collected during research interviews, will be completed with the statistical analysis of the results of the scale's test. Thereby we will highlight the similarities and the differences explaining the denial or the approval of emergency shelter.

Results

The common point between these two groups of subjects is the following: each of them has a traumatic or painful past. These subjects experienced many failures, dropouts, deficiencies which have seriously disrupted and affected them. The accumulation of chronic and traumatic life events made that the most recent event is identified by these subjects as the cause of their homeless situation. Survive from day to day involves a constant acting out in the street space, reflecting an impossible psychic crystallization or development. These two groups of subjects differ mainly in their ways of understanding their homeless situation. Thus, the acceptance/refusal of emergency shelter refers to an acceptance/refusal of the homeless identity, a fitting/misfitting to the homeless conditions, an acceptance/refusal of assistance, and acceptance/rejection of the collective space. In quantitative terms, there is a link between anxiety/depression and the denial of emergency shelter. Subjects refusing emergency shelter have a depression level significantly higher (10.3 against 7.1) and anxiety level significantly lower (11 against 14.1) than subjects users of emergency shelter.

Conclusions

This study allows us to consider the denial of accommodation of the homeless as a will not to passively suffer from their situation of social exclusion. Those homeless subjects voluntarily maintain a difficult lifestyle causing a greater psychological suffering than the ones using emergency shelter, and this not to settle in their situation. At the opposite, regular users find in emergency shelter a social frame and some new benchmarks. This leads to a relief and to a lower mental suffering that promote an over-adaptation of their living conditions.     

Profils de personnalité et fonctionnement émotionnel dans les sports extrêmes : à propos d’une étude exploratoire chez des BASE-jumpers

This study examines relations between emotional factors (anxiety and depression), normal and pathological personality, and risk-taking behavior in 11 BASE-jumpers comparing to a control group (n = 11).

Method

All the subjects have been evaluated with self-report questionnaires measuring their emotional states before and after the jump, their involvement in risk-taking behavior, sensation seeking, personality disorders, anxious and depressive symptomatology. Results show a significant effect of BASE-jump practice on emotional state. They have higher scores on the thrill and adventure seeking subscale, they show more drug consumption and more accidents than control group. We found also clinical elements of pathological personality solely from cluster B of the DSM-IV-TR classification among BASE-jumpers. Emotional factors are correlated with borderline personality in this same group.

Discussion

We analyzed those results depending on emotional and behavioral dysregulation, and their specifics involvement in borderline personality, risk-taking behaviors, and also addiction. Sensation seeking could be especially reinforced on the base of a borderline personality with the possibility of a build-up of risk which may put individuals addict to it.