Déficits émotionnels chez des patients polytoxicomanes

Researches on troubles of emotional control in addictions have mainly focused their attention on alexithymia concept, defined by Sifneos in 1972. It was first characterized by a lack of words to express emotion (a: absence of; lexi: words; thymia: emotions, affects). Alexithymia's characteristics were described in patients with addictive behaviors by Wurmser in 1974 and Krystal in 1979. Since, many studies have shown there was a higher level of alexithymia in patients with addictive behaviour (alcoholism, drug addiction), when compared with normal controls. A recent large multicenter study (Jeammet, Corcos, Flamment, 2003) highlighted this assessment: 43,5% in drug addicts [N =124], 24,6% in normal controls [N =126]. Some authors think that alexithymia would be a risk factor for substances abuse, the patient using these ones in order to compensate a deficit in the ability to regulate and adjust one's emotions (primary or feature alexithymia). For others, alexithymia would develop following anxiety created by a somatic disease or a physical or psychological important trauma (secondary or state alexithymia). For Lane and Schwartz, alexithymia is linked to a deficit of emotional awareness. In 1987, the authors present a cognitive-developmental theory of emotional awareness that creates a bridge between normal and abnormal emotional states. Their primary thesis is that emotional awareness is a type of cognitive processing which undergoes five levels of structural transformation along a cognitive-developmental sequence derived from an integration of the theories of Piaget and Werner. The five levels of structural transformation are awareness of 1) bodily sensations; 2) the body in action; 3) individual feelings; 4) blends of feelings; and 5) blends of blends of feelings. The level of emotional awareness that an individual has reached can be assessed by the Levels of Emotional Awareness Scale (LEAS) which is an instrument presenting standardized emotion-evoking situations, asking the person how he or she would feel in each situation, and assigning a score to the responses based on the structural characteristics of the levels. The main objective of this research was to study the emotional treatment in 13 patients with multiple addictive behaviors according to DSM-IV criteria (drug addiction + alcoholism + smoking) and with a substitution treatment (methadone, Subutex^®). Those subjects were aged between 23 and 42 years. Our hypothesis was that subjects would present deficits in perception and regulation of emotions (alexithymia and low level of emotional awareness). Four rating scales were used to assess the emotional semiology and the possible presence of depression and/or anxiety: the Hamilton depression scale, 17 items version; the Tyrer's brief scale for anxiety; the Jouvent's rating scale of depressive mood and the Abrams-Taylor's scale of emotional blunting. Alexithymia was evaluated with the Toronto Alexithymia Scale, 20 items version (TAS-20), and the emotional awareness with the Levels of Emotional Awareness Scale (LEAS). Our results showed levels of alexithymia generally important. The prevalence of alexithymia in patients with addictive behaviors was 69% with a mean score to this scale of 57,8 ±11,5, which is above observed mean in the general population (46,2 ±10,52). The mean score to the LEAS was 49,6 ±6,5 and less than the one observed in patients with a depressive mood and normal controls by Berthoz in 2000, and same results were observed for scores « subject » and « other ». For eight patients, the total scores were between 51 and 59, showing a low level of emotional awareness corresponding to the second one, the sensorimotor enactive, in Lane and Schwartz's model. There was no significant correlation between intensity of depressive mood and anxiety (Hamilton's scale and Tyrer's scale) and the different scores of LEAS and TAS-20. On the other hand, there was a negative significant correlation between the score « subject » of LEAS and the intensity of emotional blunting assessed by the Abrams-Taylor's scale (R = -0.589, P <05). Furthermore, there was a tendency for significant correlation between the total score of LEAS and the intensity of emotional blunting (R =-0.543, P <0.10). The total score of TAS-20 was not related to the total score of LEAS. However, there was a positive significant correlation between the mean score of TAS-20 and the score « other » of LEAS (R =0.570, P <0.05). No significant correlation was observed between the three components of alexithymia and the different scores of LEAS. This study has shown troubles in emotions's treatment in a sample of patients with addictive behaviors. Levels of alexithymia were generally important (TAS-20), showing in these patients difficulties to identify and distinguish between feelings and bodily sensations, to describe feelings and presenting an externally-oriented thinking. Furthermore, subjects have a low level of emotional awareness, corresponding to the sensorimotor enactive level. At this level, emotion may be experienced as both a bodily sensation and an action tendency. Curiously, alexithymia is not related to LEAS scores: this may reflect different levels of emotional appraisal processes and consciousness in the two different instruments. However, the emotional deficit, when it is hetero-appraised by the clinician (Abrams-Taylor Scale), is related to weakness in the LEAS scores, in particular concerning awareness of one's own emotions.     

Caractéristiques psychologiques des patients coronariens en situation de gestion de la frustration

Objectives

The aim of the present study is to investigate psychological characteristics of frustration management and their consequences in coronary patients.

Methods

A sample of N = 58 myocardial infarction patients completed questionnaires measuring self-efficacy (Schwarzer), negative affectivity and social inhibition (type D, Denollet), coping strategies (Coping Questionnaire for Coronary Patients [CQCP], Maës); Anxiety and depression (Hospital Anxiety and Depression Scale [HADS], Zigmond and Snaith), quality of life after myocardial infarction (MacNew Heart Disease Health-related Quality of Life Questionnaire, Hillers) and frustration management (Picture Frustration Study [PFS], Rosenzweig).

Results

The results show that frustration management in coronary patients differs significantly from that of the reference population. During frustration management the coronary patients present comparatively higher levels of culpability (high I answers) or denial of the responsibility of others (high M answers), as well as lower levels of aggressiveness (low E answers) than the reference population. Furthermore, myocardial infarction patients tend to rather repress their feelings (few ED answers) and to look for active solutions (high NP answers) (Table 1). Patients with a high self-efficacy score look significantly more for active solutions in their frustration management (NP) (r = 0.27), whereas patients with negative affectivity and social inhibition look for fewer solutions (respectively r = -0.31, r = -0.26). The social inhibition is significantly associated with answers of “Obstacle Dominance” (OD) (r = 0.28). Within the four coping strategies studied, only the focusing on the problem resolution one is significantly linked to the frustration management responses. Patients using a problem-focused strategy show lower levels of “Ego Defence” for frustration management (r = -0.31) and higher levels of “Need-Persistence” (NP) (r = 0.31). Furthermore, results show that “Ego Defence” (ED) is positively related to anxiety (r = 0.27), whereas “Need persistence” (NP) is negatively linked to anxiety (r = -0.28) and negatively to depressive affects (r = -0.29). Patients indicating more extrapunitive answers (E) report significantly lower levels of quality of life (r = -0.29), whereas non-punitive answers (M) are associated with higher degrees of quality of life (r = 0.31). No other significant associations were found between frustration answers and quality of life.

Conclusions

Emotional repression may be a short-term efficient strategy for the patients, allowing a distancing from the myocardial infarction trauma and increasing the quality of life. In the long-term, however, high levels of emotional repression could have negative effects on the global quality of life and the health of the patients.     

Traduction et validation française du questionnaire de répression de Weinberger

In a cognitive perspective, repression is defined as a coping strategy whose objective is to extinguish awareness of subjective emotional experience, leading to restriction of subjective experience. It is characterized by avoidance of threatening and distressing information, minimization of negative affects and low tendency to anxiety. Several measures of repressive coping style have been developed and the Weinberger Adjustment Inventory (WAI) appears to be the most psychometrically sound measure of repression.

Objectives

The main aim of this study was to translate and validate a French version of the WAI in non-clinical individuals on general population. The secondary objectives were to investigate its relationship to independent measures of anxiety, depression and alexithymia.

Materials and methods

Subjects (n = 159) were asked to complete the WAI questionnaire. A principal component analysis was carried out. The internal consistency was measured by the Cronbach alpha coefficients, and discriminant validity was assessed by examining correlations between the scales of the WAI. Because there is no other French validated instrument assessing repression, convergent validity was studied with alexithymia (Bermond-Vorst Alexithymia Questionnaire), anxiety and depression (Hospital Anxiety Depression Scale).

Results

Our factorial structure of the French WAI resembles the Weinberger's one. The “Consideration for Others” subscale does not belong to the Self-Restraint dimension: this is consistent with literature findings. The others results show solid metrological properties. Cronbach alpha reliabilities for principal and secondary factors were ranged from 0.80 to 0.93 (from 0.65 to 0.85 for the subscales) and the intercorrelations were low. Correlations were found between the WAI, the HAD and the Bvaq-b. Anxiety and Depression (HAD) are positively correlated to Distress and negatively correlated to Restraint, Defensiveness and Composite score. The repressive style, characterized by high scores on Defensiveness and Composite score, is positively correlated to affective component of alexithymia and negatively correlated to the cognitive score of alexithymia.

Conclusion

Globally, findings replicate earlier findings obtained in the Anglo-American context. The French version of the WAI thus appears to be valid and will help studying repression in France, especially in its complex relationships to alexithymia.     

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.     

Bénéfice d’un programme cognitivo-comportemental et pluridisciplinaire de prise en charge de la maladie d’Alzheimer sur l’anxiété du conjoint : étude française ELMMA

Introduction

Over the last decade, several programs have been developed for caregivers of Alzheimer disease patients. In France however, studies exploring their effects are still scarce. We conducted a study to compare two different interventions: a structured multidisciplinary program versus a classical intervention designed for Alzheimer disease patients and their spouses.

Methods

Sixteen couples (Alzheimer's disease patient and spouse) residing in our administrative district participated in this monocentric study. For at least two years, these couples participated in a multidisciplinary program (n = 8 couples) or received usual care (n = 8 couples). The multidisciplinary program involved biannual consultations with a neurologist, a neuropsychologist and a psychologist, in addition to an annual meeting, stratified on the patient's MMSE score, for spouses). Usual care involved biannual consultations with the neurologist. The multidisciplinary program included a psychological intervention based on cognitive behavioral theories and centered on psycho-education, problem solving, adaptation strategies and on prevention of depression and anxiety. The spouses and the patients evaluated the 2-year follow-up during clinical interviews, completed by questionnaires. Sociodemographic data were noted for the patients and their spouses. Levels of depression and anxiety (Mini International Neuropsychiatric Inventory, Montgomery and Asberg Depression Scale, State-Trait Anxiety Inventory), perceived stress (Perceived Stress Scale) and care burden (Zarit Burden Inventory) were evaluated in spouses. Levels of cognitive impairment (Mini Mental State Examination), autonomy (Instrumental Activities of Daily Living), psychological state (Montgomery and Asberg Depression Scale, Covi Anxiety Scale), and behavioral symptoms frequency (Neuropsychiatric Inventory) were assessed in patients.

Results

The main significant result showed that the spouses’ state of anxiety was lower among participants in the multidisciplinary program, compared with the classical neurological intervention. It also was found that the spouses and the patients who participated in this multidisciplinary program were less depressed.

Conclusion

This study shows that a multidisciplinary structured intervention, with only two annual consultations and one annual meeting for spouses, can contribute to decrease significantly the spouses’ state of anxiety. Further studies including a larger number of subjects should be conducted to confirm these findings.     

Facteurs associés aux réadmissions psychiatriques des patients hospitalisés pour la première fois à Bingerville en 2001 (Cote d’Ivoire)

Objective

To ascertain the factors related to patients’ psychiatric readmissions at Bingerville.

Patients and method

It was a case-control study built on 436 files of patients who had been hospitalized for the first time in 2001 at Bingerville's psychiatric hospital. We called readmission all rehospitalization arisen 15 days after the end of the previous hospital stay. Sociodemographic and clinical characteristics of the patients who had been readmitted for at least a fold within 1st January 2001 and 31st December 2006 were compared to those who had not been readmitted during this period, by using the Chi-square test.

Results

Patients admitted for the first time at Bingerville psychiatric hospital were in majority less than 44 years old (87.8%) with mean age at 31.1 ± 10.9 years. More than half of them, had male gender (61.9%), was single or widowed or separated (70.6%), without a kid (55.5%). Numerous of them were not educated above secondary school (95.4%). In these first admitted patients, 50.9% did not earn a wage, 68.8% lived in Abidjan. Those who had both their mother and father alive represented 53.9% of the study sample. About two-third of the patients were younger in their siblings, as well in father's children as in mother's. Regarding the clinical features, schizophrenia and other psychotic disorders (59.2%) were the most frequent diagnosis, followed by mood disorders (19.0%). These mental disorders started during the month before first psychiatric hospitalization at Bingerville (47.2%). The majority (74.5%) of these patients were hospitalized 30 days at most. They were discharged with medical advice (85.8%) and less than two drugs prescribed (66.3%). The aftercare treatment did not last more than 26 weeks for most of the patients (79.6%). Readmission occurred at least a fold in 22.5% of the subjects, in majority during the first 2 years after being discharged in 2001 (68.4%). Patients characteristics related to readmission during the 6 years of study period were: being less than 21 years old (p = 9 × 10⁻⁴), younger in the siblings of mother's children (p = 10⁻³), having both mother and father alive (p = 3 × 10⁻³), a mood disorder diagnosis (p = 0.046) and a length of aftercare treatment exceeding 26 weeks (p = 4 × 10⁻³).

Conclusion

When they are repeated and closer, readmissions can worsen patients’ social reinsertion. The knowledge of factors related to these rehospitalizations is useful to prevent this consequence.     

Confirmation de l’intérêt de la biopsie cutanée dans la neuropathie des petites fibres. Résultats préliminaires

Introduction

In small-fiber neuropathy, skin biopsy reveals a reduction of intraepidermal nerve fiber density (IENFD), a feature often necessary for diagnosis. In France, this technique has not been widely used for this purpose.

Patient and method

To validate this method, we studied 13 patients with suspected small-fiber neuropathy, analyzed their nervous intra- and subepidermal network with a punch skin biopsy and compared our data with those of literature.

Results

Ten patients had pure small-fiber neuropathy and three an axonal polyneuropathy involving large-caliber nerve fibers. In the group of patients with pure small-fiber neuropathy, we found medium IENFD (11.6 ± 4.46 fibers per millimeter in the proximal thigh and 7.15 ± 3.59 fibers per millimeter in distal leg), well correlated with the electron microscopy quantitative and qualitative analysis of the unmyelinated subepidermal fibers.

Conclusion

This work demonstrated the good reproducibility of skin biopsy for analyzing the small-fibers in our cohort. These results require further confirmation in a larger cohort and validation in comparison with controls analyzed on a local level. Nevertheless, these techniques seem to be useful to assess the difficult diagnosis of small-fiber neuropathy.     

Évolution clinique de la dépression post-accident vasculaire cérébral à Kinshasa

Objectives

To describe the evolution of the clinical profile of post-stroke depression over a period of one year and to determine factors associated with changes in post-stroke depression.

Methods

Prospective cohort study with a follow-up of 1 year including 30 consecutive eligible patients. The severity of depression was assessed with the patient health questionnaire (PHQ9).

Results

The mean age was 55.87 ± 12.67 years. Seventy percent of patients were men. The two assessments for neurological status, perceived health status and test results of attention were not statistically different. The rate of depressive symptoms was 26.67% in 2011 and 20% in 2012. Disability and apathy were significantly improved. The average for disability increased from 2.77 ± 1.19 to 2.46 ± 2.19 (P = 0.002). From 66.7% in 2011, the proportion of patients able to walk without assistance rose to 93.3% in 2012 (P = 0.03). In addition, the proportion of patients apathetic decreased from 43.3% to 13.3% (P = 0.01). Greater age, female sex, sleep disorders and post-stroke apathy remained associated with DPAVC between the two assessments, with an increase in the strength of the association for apathy.

Conclusions

The frequency of post-stroke depression is high and remains stable over time. Disability is the clinical feature that evolved more favorably. The association with apathy, present at the beginning, of the study was strengthened one year later.     

Déficits des fonctions exécutives dans la schizophrénie selon les dimensions positive, négative et de désorganisation

The aim of this study was to examine whether executive deficits underlie positive, negative and disorganisation of schizophrenia. The sample comprised 34 patients (30 males, 4 females) diagnosed with DSM-IV criteria (mean age = 35 ± 9.5 years; mean duration of illness since first psychotic symptoms = 10.2 ± 7 years; mean years of education = 11.7 ± 2.6). Evaluation of patients was performed after achieved sufficient remission (clinically stable for 4 weeks at least, no depressive symptoms at moment of cognitive testing and no medication change during the three last weeks). Symptom dimensions were evaluated using items drawn from the Positive And Negative Symptoms Scale (PANSS). The Negative factor comprised N1 (blunted affect), N2 (emotional withdrawal), N3 (poor contact), N4 (passive, apathetic), N6 (lack of spontaneity), G7 (stereotyped thinking) and G16 (active social avoidance). The Positive factor comprised P1 (delusions), P3 (hallucinatory behaviour), P5 (grandiosity), P6 (suspiciousness) and G9 (unusual thought content). The Disorganisation factor comprised P2 (conceptual disorganisation), N5 (difficulty in abstract thinking), G10 (disorientation) and G11 (poor attention). The mean total PANSS score was 63.3 ± 16 (mean of positive score = 14.3 ± 4.7; mean of negative score = 18.1 ± 6.3; mean of general score = 30.9 ± 8.5). Executive functions were examined through the Wisconsin Card Sorting Test (WCST), the Hayling Test (Tunisian version) and two semantic verbal fluency tasks (simple with one category “animals” and alternating with two categories “fruits and clothes”). Partial correlations between syndrome scores and cognitive scores were examined while holding the effects of other symptoms, age and education level constant. Severity of disorganisation symptoms correlated with high number of perseverative errors (r = 0.47, P < 0.05) and total errors in the WCST (r = 0.37, P < 0.05) and with reduced score of alternating semantic verbal fluency (r = -0.39, P < 0.05). Severity of both negative and positive dimensions uncorrelated with performance of any of the executive tasks. Also, scores of the Hayling Test (time part B minus time part A; errors part B) and semantic simple verbal fluency (total of correct words) were uncorrelated with symptoms. The present study provides evidence that disorganisation dimension of the PANSS correlates specifically with impaired cognitive flexibility as reflected by high number of perseveration in the WCST and reduced set-shifting in semantic alternating verbal fluency.     

Dépendance physiologique et fonctionnement émotionnel chez les jeunes adultes : affectivité, intensité émotionnelle et alexithymie dans la consommation de substances psychoactives

Objectives

The objective of this study is to describe the emotional functioning of individuals addicted to psychoactive substances, and verify that the dependent subjects are more sensitive to emotional dimensions and variables considered as non-dependent subjects.

Patients and methods

We recruited 268 subjects students. They filled out a protocol, first, a questionnaire assessment measuring dependencies (tobacco, alcohol, cannabis), and a second part consisting of four questionnaires: the Hospital Anxiety Depression (HAD) scale (anxiety and depression), the Émotionalité Positive et Négative (EPN-31) (affectivity), the Affect Intensity Measure (AIM) (affect intensity), and the Toronto Alexithymia Scale (TAS-20) (alexithymia). The 268 subjects were divided into: 69 subjects dependent (D) representing 25.7% of the sample, and 199 non-dependent (ND) subjects, representing 74.3%. It consisted of 224 women and 44 men, mean age was 22.23 years (standard deviation [S.D.]: 5.45, range: 18–56 years). There was no significant difference in gender (P > 0.05) between groups or in age (P < 0.05). The scores of anxiety and depression were significantly different between groups. We therefore conducted analysis of covariance (ANCOVA) including the total score of anxiety-depression as a covariate and as dependent variables, scores of emotions, emotional intensity and alexithymia with SPSS 11.5^®.

Results

The results show that dependent subjects have scores more important to the HAD than non-dependents, depression has been well regarded as a confounding factor. After controlling for this variable, they are more emotionally responsive, more sensitive to the emotional intensity, and alexithymia more than non-dependent. Activation and the emotional intensity appear to be dispositional variables may play a central role in emotional processing in the dependent subjects, associated with alexithymia. They could be located upstream of the processing of emotion, they would account for the gross apprehension felt by the subject, leading secondarily to the representation of emotion. The proportion of alexithymic subjects is 44.9% in this group of subjects, while only 13.6% among non-dependent subjects. They have greater difficulty in identifying emotions. This supports the idea of the existence of an emotional deficit in individuals addicted to psychoactive substances. This proportion is also larger than that found in general population.

Conclusions

The alexithymia seems to be a central variable emotional functioning dependent subjects, regardless of its relationship with depression, it could match the emotional processing mode preferred by the subjects dependent. Personality in this study seemed to reflect a vulnerability factor, which alexithymia represents a secondary dimension, even defensive. This could account for a mode of emotional regulation. The limitations of the study and possible openings will be discussed.     

Déficit émotionnel et intelligence machiavélique : étude des interrelations entre l'échelle d'alexithymie de Toronto (TAS-20) et l'inventaire mach-iv dans une population de 201 étudiants

The aim of the study was to explore the relationship between alexithymia and machiavellianism in a group of 201 university students. The subjects filled out the TAS-20 and the MACH-IV forms. The results showed firstly, a significant correlation between the two total scores (r = 0.35, P < 0.05), and secondly between the identification of feelings subscale of the TAS-20 and the opinions about human nature subscale of the Mach-IV (r = 0.44, P < 0.05). The results were discussed in light of the different factors (depression, dependency, psychoticism…) that could explain the relationship between the two concepts.     

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.     

Relations paradoxales entre l’internalisation et l’externalisation en psychopathologie de l’enfant : exemples de l’hyperactivité et de la dépression avec idées suicidaires

Introduction

The difference between internalising disorders (anxious and depressive disorders) and externalising disorders (conduct disorder and oppositional defiant disorder) is largely accepted by clinicians and researchers. Although hyperactivity may seem linked with the externalising disorders, recent empirical research suggested it could be often comorbid with depression, and recent theoretical research suggested it could be, at least partially, founded on psychodynamic mechanisms intended to master separation anxiety. These works suggest that the internalising dimension of hyperactivity may have been underestimated in empirical research. The purpose of this paper is to assess the level of internalisation in hyperactivity.

Method

Twenty five hyperactive children were compared with children presenting anxious disorders (N = 22), depressive disorder without suicidal ideation (N = 28), with suicidal ideation (N = 20), and academic learning disorders (N = 23). All diagnoses were made according to the ICD-10 criteria, which are very similar to the DSM criteria for anxious, depressive, and academic learning disorders, but are more stringent regarding hyperkinetic disorder than the DSM criteria for attention-deficit/hyperactivity disorder. Internalisation and externalisation were assessed by the Child Behavior Checklist (completed by one of their parents), and the presence of suicidal ideation was assessed on the basis of the Children Depression Inventory item 9.

Results

Hyperactive children exhibit more internalisation problems than those with learning disorder, but less than those with anxious and depressive disorders. Unexpectedly, depressive children with suicidal ideation presented high levels of delinquent and aggressive behaviour, equal or superior to those of the hyperactive children.

Discussion

These findings bring partial support to the psychodynamic view of hyperactivity. But they also underscore the unexpectedly high rate of externalising symptoms among depressive-suicidal children, whose pathology is theoretically regarded as a typically internalising disorder. In conclusion, these results suggest the relationship between externalisation and internalisation could be more complex than is generally assumed, and support the possibility of simultaneous presence of high levels of externalisation and internalisation in some disorders.     

Les atteintes neurologiques au cours du xeroderma pigmentosum

Introduction

Xeroderma pigmentosum (XP) is an autosomal recessive disease characterized by abnormal sensitivity to sunlight which results in pigmentary changes, telangiectases, keratoses and eventually carcinomata. Additional neurological complications can be associated. The aim of our study was to analyze particularities of neurological abnormalities of Tunisian patients.

Method

We conducted a retrospective study in 62 patients suffering from XP included during the period 1992-2007. Patients were aged from 1 to 64 years (mean age: 17.6 ± 11.4 years). Thirty patients were female and 32 were male. The patients had severe (n = 16), variant (n = 15) and moderate (n = 31) XP.

Results

Neurological abnormalities were observed in 21 patients (33.9%). Mental retardation was observed in 15 of the 21 patients, pyramidal syndrome in five, cerebellar syndrome in two, extrapyramidal syndrome in two, microcephalia in two, choreoatetosis in three cases and a peripheral neuropathy in eight. No neurological disorder was observed in the XP-variant patients. Neurological abnormalities were more frequent in the patients with moderate XP (n = 17, 64.5%) than with severe XP (p = 0.051).

Conclusion

This difference in a group of Tunisian patients confirms the heterogeneous nature of XP and is probably due to genetic heterogeneity.     

Is alexithymia linked with marital satisfaction or attachment to the partner? A study in a pregnancy cohort of parents-to-be

Objective

To investigate possible associations of alexithymia with marital satisfaction and mutual attachment between the partners in a group of parents-to-be during pregnancy.

Methods

The present study was conducted in a pregnancy cohort. Cross-sectional data were available for 151 mothers and 106 fathers, and altogether 102 couples. The 20-item Toronto Alexithymia Scale (TAS-20) was used to assess alexithymia, the Index of Marital Satisfaction (IMS) to assess romantic relationship satisfaction and the Experiences in Close Relationships Scale (ECR) to evaluate attachment-related anxiety and avoidance. Kruskal–Wallis test was used for categorized variable comparisons. For continuous variables, Spearman correlation analyses and linear regression analyses were conducted.

Results

The TAS-20 total score, as well as, two of its dimensions, difficulties in identifying and describing feelings, were significantly correlated (p < 0.01) with both the IMS scores and the ECR anxiety and avoidance scores. In the regression analyses, the most significant predictive factor for the subjects' IMS scores was their partners' corresponding scores, although among fathers the IMS scores were partly explained by their own TAS-20 factor 1 scores (p = 0.004). The subjects' own TAS-20 scores explained the ECR anxiety and avoidance scores to a significant extent, but the fathers' TAS-20 factor 3 scores were also associated with the mothers' avoidance scores (p = 0.037).

Conclusion

Alexithymia was not directly related to marital satisfaction. However, alexithymia appears to have a significant effect on relationship-related anxiety and avoidance. This association should be further studied in parents and their offspring in a longitudinal setting.     

Intérêt de l’analyse factorielle discriminante pour classer les syndromes parkinsoniens à partir de la tomoscintigraphie d’émission monophotonique

Introduction

The objective was to assess the value of single photon emission computerized tomography (SPECT) and factorial discriminant analysis (FDA) in the differential diagnosis of Parkinson's disease (PD), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD).

Patients and methods

Sixty-two patients with clinical diagnoses of either CBD, PSP or PD were studied using brain HmPaO-SPECT. Thirteen pairs of regions of interest (ROIs) were drawn on the slices located 50 mm and 90 mm above the canthomeatal plane. Twenty-six uptake indices and 13 asymmetry indices were determined. FDA was performed in order to determine whether or not the patients could be classified into the correct clinical group on the basis of SPECT data alone. The most discriminant parameters were used to generate two predictive scores, which were tested in a second group of 15 patients.

Results

FDA of all 39 variables correctly classified all the patients. A subset of 10 variables was used to build predictive scores, which correctly classified 90% of PD patients, 100% of PSP patients and 86% of CBD patients. When tested in the validation group of 15 patients, these predictive scores correctly classified 87% of the individuals. The frontal medial, temporoparietal and parietal regions were the most discriminant.

Conclusion

Using SPECT data alone, this study enabled us to distinguish between PD, PSP and CBD in patients with clear clinical presentations of the diseases in question. This novel, statistical approach provides reliable information. However, a prospective study dealing with de novo parkinsonian syndromes will be necessary.