Fiabilité et validité de l’enquête des facteurs de risque de la CFTMEA

The French Classification of the Mental Disorders of the Child and Teenager (CFTMEA), has an Interview of Risk Factors (FR), able to produce psychopathological Signals of Alarm (SA), which hasn’t been modified in the revision 2000-R.

Objective

To show the reliability and the validity of the FR interview of the CFTMEA. Subjects: 64 children and teenagers, 32 of them are children of parents with severe mental disorder and the other 32 are children of parents of the general population, paired by age and sex.

Material

All the subjects are explored with the FR interview of the CFTMEA, the Observational Scale of the Development of Secadas (EOD), the Scale of Psychopathology of Childhood and the Adolescence of Silva and Martotell (EPIJ-EPC), and the Interview of Psychopathological Alarms for Childhood and Adolescence (ESAPIA).

Method

Psychometrics statistical techniques are used to show the reliability and the validity of the FR interview of the CFTMEA.

Results

The reliability measured by alpha of Cronbach is high for the FR of the environment (0.8660) and a little minor for FR organics (0.6320).The validity established by the discriminator analysis, like capacity of FR to classify the case in psychiatric or not psychiatric, is more than 80%.The validity established by the correlation between the number of FR in the school age (6-11 years) and the number of sa in adolescence (12-17 years) is high (r = 0.75).

Conclusion

The reliability and the validity of the FR investigation of the CFTMEA are high. Their use can be advised in order to detect populations with mental health in risk, singularly at the school age (6-11 years). The FR Interview of the CFTMEA can be used for research, by taking into account that the total number of FR collected by the CFTMEA, is different according to the context, due to the fact that certain FR tend to join others, according to the context.     

Moral objections to suicide and suicidal ideation among mood disordered Whites, Blacks, and Hispanics

Understanding the beliefs that protect individuals against suicide can help to enhance suicide prevention strategies. One measure of suicide non-acceptability is the moral objections to suicide (MOS) sub-scale of the reasons for living inventory (RFLI). This study examined the MOS and suicidal ideation of White, Black, and Hispanic individuals with mood disorders. We expected minority individuals to have stronger objections to suicide.

Method

Eight hundred and four, White (588), Black (122) and Hispanic (94) participants with DSM-IV diagnoses of MDD or bipolar disorder were administered the scale for suicide ideation, the reasons for living inventory and several measures of clinical distress.

Results

Higher suicidal ideation was modestly correlated with lower MOS scores overall (r = 0.15, p = 0.001). Among Blacks however the relationship was inverted: despite having higher suicidal ideation than Whites or Hispanics, Blacks reported the least accepting attitudes toward suicide.

Conclusion

These results suggest that attitudes regarding the acceptability of suicide may be independent of suicidal ideation.     

Qualité de vie de la fratrie d’enfants atteints de mucoviscidose : le point de vue des parents et des enfants

Objectives

The impact of the presence of a child with cystic fibrosis in the family on the siblings is rarely studied. Moreover, the available empirical data are not clear. This study aims at evaluating the siblings’ quality of life according to the assessments performed by, on the one hand, the parents and, on the other hand, the brothers and/or the sisters of the sick child.

Methods

Thirty families took part in this study for which we used two instruments. The parents filled out the Child Behavior Checklist, which is a questionnaire intended to assess the behavioral and emotional problems of their nonsick children. The parents and their nonsick children filled out the Duke Health Profile which is a questionnaire intended to assess the quality of life in three fields: physical health, social health, and mental health.

Results

The parents and their nonsick children differently assess this quality of life. The parents tend to over-estimate the physical health of their nonsick children and to incorrectly evaluate the risks of suffering that are—differently—expressed by their sons and/or their daughters. In particular, while they correctly estimate the social health of their sons, they overestimate their mental health (p < 0.02). At the contrary, while their evaluations of their daughters’ mental health are quite well adjusted, they overestimate their social health (p < 0.03).

Conclusion

As most of the parents directly provide affective support and follow-up care for their child with cystic fibrosis, it remains necessary to more precisely specify how their perceptions of the health of the different members of the family fall under the family dynamics of adjustment to the disease. This conclusion goes for the research level as well as for the services for educational and psychological aid one.     

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.     

De la non-expression à la surexpression des émotions ou comment l’expérience émotionnelle repose la question des liens entre sexe, alexithymie et répression

Objectives

Alexithymia, considered as a disorder of affect regulation, is well known for its consequences on the vulnerability to negative emotions, but nevertheless it raises the question of the repressive dimension according to Myers’ (1995) and Newton and Contrada’s (1994) researches. If, under certain conditions, alexithymia refers to this dimension we should observed traces of this repressive behaviour on emotional distress. We thus studied the influence of alexithymia scores on trait anxiety, state anxiety and depression, and this relatively to the gender of the participants.

Methodology

We first compared the mean scores of distress of our three groups of subjects (low alexithymia, N = 32; moderate alexithymia, N = 62, high alexithymia, N = 33) with the norms of the general population. Secondly, we studied the consequences of alexithymia intensity on depressive symptoms, trait and state anxiety, with regard to the gender differences. We used 1) the State-Trait Anxiety Inventory (Spielberger) to assess dispositional and acute anxiety, 2) the Center for Epidemiological Scale for Depression (Radloff) to evaluate depressive symptomatology and 3) the Toronto Alexithymia Scale (Bagby) for the alexithymia construct.

Results

In the lower alexithymia group, the total mean scores of depression for men or women (men: 8.06 ± 7.06; women: 8.88 ± 6.84) were significantly lower than those in the general population (men: 12.73 ± 3.02; women: 13.97 ± 3.62). We obtained the same pattern of consequences of a low alexithymia with regard to trait anxiety (men: 32.73 ± 10.20 versus 41.86 ± 9.48; women: 37.17 ± 8.48 versus 45.09 ± 11.11). Finally, there was no difference between the lower alexithymia group mean scores and the general population references, regardless of gender. In addition, in our group of women, the higher the alexithymia mean scores, the more important were the depression (F(2,68) = 21.13, P ≤ 0.000), trait anxiety (F(2,68) = 12.51, P ≤ 0.000) and state anxiety (F(2,68) = 6.72, P ≤ 0.002) mean scores. The male participants did not show a particular vulnerability to the alexithymia intensity, except for trait anxiety in the moderate condition (t(43) = -2.30, P ≤ 0.026).

Conclusion

Our results support the reality of the emotional repression in the condition of lower alexithymia and raise the question of the links between alexithymia and gender. Indeed, emotional experience follows different and surprising ways, inviting us to think about the relevance of a differentiation of the type of alexithymia according to whether one is a man or a woman.     

Le modèle du tempérament et du caractère de Cloninger appliqué dans le trouble bipolaire de l’adulte : recension de la littérature d’une approche tempéramentale

Context

Although psychiatric research uses clear diagnostic criteria to describe bipolar disorders, therapists in clinical practice are often confronted with patients presenting a number of symptoms with different degrees of intensity and belonging to more than one diagnostic category. With respect to this actual clinical complexity, there is an increasing interest in a dimensional approach of psychopathological traits to gain better understanding of mental disorders. In the 1980s, Robert Cloninger elaborated on a psychobiological model to explain personality in clinical groups as well as in general population. His model was then operationalised with a questionnaire evaluating temperament (harm avoidance, novelty seeking, reward dependence and persistence) and character (self-directeness, cooperativeness, self-transcendence): the Temperament and Character Inventory (TCI).

Objective

To review all studies conducted in adult bipolar samples on temperament and character according to Cloninger's psychobiological model.

Materials and methods

A search was conducted on MedLine and PsycInfo for all articles written in English or French, between 1986 and September 2008, on temperament and character in bipolar disorder. The words bipolar disorder or mania had to be associated with the following keywords temperament, TCI, Cloninger, TPQ, harm avoidance, novelty seeking, reward dependence.

Results

Across studies, compared to the general population, bipolar subjects have significantly higher harm avoidance, higher novelty seeking and lower self-directness. Some studies have investigated differences between bipolar disorders and other psychopathologies like depression, and borderline personality disorder. Among studies on depression and bipolar disorder, there is no consensus on the findings. Compared to borderline personality disorder patients, bipolar disorder subjects have lower harm avoidance and higher self-directness and cooperativeness. This finding is consistent with Cloninger's hypothesis that all personality disorders have lower self-directness than any axis I disorder. With respect to other temperament and character traits, studies yielded results either contradictory or non-significant. No difference was found when the bipolar group was subdivided according to the clinical presentation (type I vs II) and the suicidal risk, apart from harm avoidance. Bipolar subjects with substance related disorders displayed higher novelty seeking and lower persistence, which might be explained by a low dopaminergic activity that had to be compensated with drug intake. Low persistence causes greater difficulties to overcome substance dependence. However, it is not possible to determine whether these temperament characteristics are specifically linked to bipolar disorder, substance related disorders, or both. Similar limitations apply to bipolar patients with comorbid anxiety disorders, who presented higher harm avoidance and lower self-directness.

Conclusions

Across studies, there are limitations which impede the generalization of the findings to other clinical populations. Age, gender, cultural characteristics, mood status during evaluation, group size, versions of the TCI questionnaire, suicidal risk, clinical type (BP I vs II) and comorbidity differ from one study to another. These methodological variables should be controlled in future studies. Nevertheless, adult bipolar patients appear to present a different temperamental profile than other clinical groups and general population. Therefore, Cloninger's psychobiological model of temperament remains an interesting avenue for future researches in bipolar disorder.     

Relation entre styles d’attachement, perception du soutien social et dépression

Objectives

Previous research has proved that some types of attachment styles as well as poor social support are critical risk factors for depression. This study aims to examine the relation between attachment style, social support and vulnerability to depression.

Materials and methods

The authors compared 80 patients suffering from mood depressive disorder, diagnosed on the basis of the DSM-IV TR criteria, to 80 normal controls. The importance of depression was evaluated in patients using the Hamilton depression scale. All the subjects completed two self-report scales: the Relationship Questionnaire designed to evaluate the attachment models in adult close relationships, and the Social Support questionnaire assessing perceived number of social supports and satisfaction with available social support.

Results

The sex ratio in our sample was 1,7 women for one man; and the mean age was 44 years in patients and 34 years in controls. A significant difference was found between the two groups concerning attachment style (p < 0,001): only 29% of depressed patients had secure attachment versus 56% in normal controls, and fearful/avoidant attachment was more frequent in patients (25%) than in controls (1%). Depressed subjects received less social support than their controls (p = 0,014), and had less satisfaction with perceived social support (p < 0,001).

Conclusions

In depressed subjects social network features were characterized by insecure attachment and poor social support.     

Les idéations suicidaires chez les nouveaux arrivants en maison d’arrêt

Suicide in prison is in increase for several years and participates in a major problem of public health. The number of suicide in prison arises mainly during first moment of incarceration, in particular under fifteen days. Eighty percent of the subjects who attempt to commit suicide or commit suicide express such ideas months before. So the expression of suicidal ideations is a risk factor of suicide and their detection is crucial. This study has investigated suicidal risks in prisoners with the assessment of the rate of suicidal ideation as well as their link with risk factors such as depressive disorders, individual factors or life's event's life, etc. Participants were recruited from all-male adults, who just arrived in prison since one week in prison of Hauts-de-Seine, Nanterre, France. One hundred prisoners able to read and fill in the scales in autonomy way were evaluated from March to June 2007 using a structured interview, Beck Depression inventory (BDI), Scale of suicidal ideation by Beck (SSI) and a short version of Mini International Neuropsychiatric Interview (MINI). The SSI assesses precisely the presence of suicidal ideations and suicidal risk as well as its severity and the score gives some information on the severity of the suicidal risk. The BDI assesses the presence of depressive symptoms as well as the severity of depression according to a classification: Light, medium or severe depression. Eleven out of 100 prisoners have suicidal ideations in SSI. They are not connected significantly to the incarceration (χ² = 3.52, P = 0.05). The scores go from 3 to 27 (the maximum score for this scale is 36) and the medium score is 8.81: four people have scores around the medium score, four people have a score smaller than 5, three people have a score higher than 9. The group of prisoners who have suicidal ideations (n = 11) was compared with the group of prisoners without suicidal ideations (n = 89). Suicidal ideations are in link with the severity of depression in BDI (χ² = 12.53, P < 0.001) but not with its presence only: Prisoners who have suicidal ideations have a medium score of depression higher than prisoners who have not suicidal ideations (16.45 against 6.01, the maximum score for this scale is 39). Ninety-one percent of prisoners who have suicidal ideations suffer from medium or severe depression against 35 % of prisoners without suicidal ideations. Nevertheless, the difference is not significant if we compare the two groups with all types of depression-light, medium or severe (χ² = 2.74, P < 0.05). Moreover anxious and psychotics symptoms, in particular hallucinations in MINI are linked significantly with suicidal ideation (anxiety: χ² = 22.62, P = 0.00001; psychosis: χ² = 6.639, P = 0.01; hallucinations: χ² = 12.8, P = 0.001). Significant risk factors for suicidal ideation in prisoners are life's event such as personal suicidal attempt (χ² = 25.58, P < 0.000001) and substance use history (χ² = 7.76, P < 0.01) and the lack of family support (χ² = 8.7, P < 0.01). It is not the case for suicidal attempt in family (χ² = 1.663, P < 0.05) and a recent death (χ² = 1.24, P < 0.015). Prisoners, who are more than 35 years old, are married, have children and are in prison for murder(s) or rape(s) have significantly more suicidal ideations. Some prisoners who have not suicidal ideation in the SSI have a suicidal risk in the MINI. So we can think these ideas are under-expressed in the SSI because prisoners can feel uncomfortable to express such ideas. Moreover there is more than the half of prisoners who present some signs of depression in BDI for less than one third of prisoners in MINI: Depression can be over-expressed in BDI, what explain it is the severity of depression which is in link with suicidal ideations and no only its presence because a lot of prisoners (with or without suicidal ideations) seem to have a depression with the assessment of BDI. The results must be used with care because the population of the study is quite small, in particular for prisoners who have suicidal ideations. Furthermore it is very heterogeneous and judging origins of the link between suicidal ideations and risk factors is very difficult. In conclusion, these results cannot be generalised to the whole prison; they are specifics to this place of research. Symptoms of depression, anxiety and psychosis as well as personal history of suicidal attempt, substance use and a lack of family support are risk factors for suicidal ideations in prisoners. The precocious detection of suicidal ideation and risk factors would prevent from suicide and reduce the risks.     

Sleep problems and suicidality in the National Comorbidity Survey Replication

Objective

Links between sleep problems and suicidality have been frequently described in clinical samples; however, this issue has not been well-studied in the general population. Using data from a nationally representative survey, we examined the association between self-reported sleep difficulties and suicidality in the United States.

Methods

The WHO Composite International Diagnostic Interview was used to assess sleep problems and suicidality in the National Comorbidity Survey Replication (NCS-R). Relationships between three measures of sleep (difficulty initiating sleep, maintaining sleep, early morning awaking), and suicidal thoughts, plans, and attempts were assessed in logistic regression analyses, while controlling for demographic characteristics, 12-month diagnoses of mood, anxiety and substance use disorders, and chronic health conditions.

Results

In multivariate models, the presence of any of these sleep problems was significantly related to each measure of suicidality, including suicidal ideation (OR = 2.1), planning (OR = 2.6), and suicide attempt (OR = 2.5). Early morning awakening was associated with suicidal ideation (OR = 2.0), suicide planning (OR = 2.1), and suicide attempt (OR = 2.7). Difficulty initiating sleep was a significant predictor of suicidal ideation and planning (ORs: 1.9 for ideation; 2.2 for planning), while difficulty maintaining sleep during the night was a significant predictor of suicidal ideation and suicide attempts (ORs: 2.0 for ideation; 3.0 for attempt).

Conclusions

Among community residents, chronic sleep problems are consistently associated with greater risk for suicidality. Efforts to develop comprehensive models of suicidality should consider sleep problems as potentially independent indicators of risk.     

Caractérisation sociodémographique, clinique et criminologique d’une population de 210 meurtriers

Introduction

After a saturated media coverage of some murders, questions were raised about the mentally ill and their dangerous and violent nature which may sometimes culminate in homicide. The popular idea that someone who kills an unknown person in the street is mentally ill is firmly rooted in the collective consciousness. Yet, epidemiological data are reassuring: only 15% of such murders are committed by the seriously mentally ill (schizophrenia, paranoia, melancholia).

Aim

To describe the sociodemographic, clinical and forensic characteristics of a convicted population of 210 murderers.

Method

Consecutive series of cases of people convicted of murder in Angers between 1975 and 2005. Information on sociodemographic and clinical characteristics of perpetrators of homicide was collected from psychiatric reports prepared for the courts. This retrospective study identifies several types of pathological murders (schizophrenia, paranoiac delirious disorder, affective disorder: melancholia and hypomania, drugs abuses, personality disorders).

Results

The murderers were men whose mean age was 33. Most were single, living alone and jobless. Two thirds of them had psychiatric records and one third a record of violence against persons. There were 14 cases of schizophrenia (6.7%), eight cases of persistent delusional disorder, 15 cases of affective disorder, 11 cases of mental disorder, five cases of neurological symptomatology, 44 cases of personality disorder and 35 cases of alcohol abuse or alcohol dependency disorder. A third of the murderers did not have any kind of mental disorder (n = 73). Fifty-two (24%) were mentally ill. Two thirds had a history of mental illness and one third had a record of previous convictions of violence. Crimes were mostly committed at nighttime and in the house of the victim. The most common method of killing was stabbing. Fourteen percent had symptoms of mental illness at the time of the offence. The 217 victims were, in decreasing order, a family member, a current or former spouse/partner (53%), an acquaintance (30%) or a stranger (17%). The forensic and juridical consequences (via the application of former article 64 or the present article 122-1 of the French Criminal Code) were envisaged in less than 10% of the cases.

Conclusions

These data allowed the authors to determine the general risk factors of homicidal violence (male gender, youth and alcohol abuse) as well as some more specific factors (mental illness, comorbidities…). The dynamic characteristics of the meeting of the crime protagonists should be added to these factors.     

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.     

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.     

Corrélations anatomocliniques des neuropathies périphériques cryoglobulinémiques secondaires à l’hépatite C. Série consécutive de 22 cas

Introduction

Cryoglobulinemic neuropathies caused by hepatitis C virus are frequent and may have severe clinical outcomes. The aim of this study was to clarify the clinical and anatomical correlations of these neuropathies.

Methods

Between 1992 and 2007, 22 consecutive patients with cryoglobulinemic neuropathies caused by hepatitis C virus were retrospectively included. Patients were evaluated clinically, electrophysiologically and underwent a neuromuscular biopsy. The group of patients with vasculitis on nerve biopsy was compared with the group without vasculitis.

Results

All the neuropathies were axonal with 11 polyneuropathies and 11 mononeuropathies multiplex. The seven patients with medium-sized vasculitis on the nerve biopsy presented an acute sensorimotor mononeuropathy multiplex in six cases (85%), with ischemic conduction block in three cases (42%) and wallerian degeneration in four cases (57%). Among the four patients with small-sized vasculitis, two had a mononeuropathy multiplex (50%) without conduction block (0%) and with wallerian degeneration in one case (25%). The 11 patients without vasculitis (nine lymphocytic perivascular infiltrates and two non inflammatory biopsies) had a polyneuropathy in eight cases (72%) without conduction block and wallerian degeneration (0%). The type of neuropathy was different in the group of patients with vasculitis compared with the group without vasculitis. The neuropathies with vasculitis were significantly different with more frequent mononeuropathies multiplex (p < 0.05), acute early stage (p < 0.01), disability (p < 0.05) and wallerian degeneration (p = 0.01).

Conclusion

Among hepatitis C patients with cryoglobulinemia, neuropathies with small-sized vasculitis show a pattern between severe mononeuropathies multiplex with medium-sized vasculitis and moderate polyneuropathies with lymphocytic perivascular infiltrates. In cryoglobulinemic vasculitis with hepatitis C, the severity of the neuropathy depends on the nature of the cellular inflammation and the size of the vessel involvement.     

Comparaison de l’échographie et de l’électroneurographie pour le diagnostic du syndrome du canal carpien en pratique courante

Introduction

Many studies had been performed in the last years to prove the usefulness of ultrasonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome (CTS). We wanted to determine its reliability and to compare this technology with electromyography (EMG) in ordinary diagnostic conditions.

Methods

The study involved 90 wrists with suspected CTS, 35 controlateral wrists and 52 control wrists. The diagnosis of CTS was confirmed in 81 cases by the hand symptom diagram and the Tinnel and Phalen sign. The EMG examination evaluated medianulnar sensory latency difference to the ring finger and wrist-to-palm sensory conduction velocity. For the ultrasound diagnosis, the cross sectional area of the median nerve at the level of the pisiform bone, was considered. The sensitivity and specificity of the two techniques was calculated.

Results

Sensitive electroneurographic parameters showed a sensibility and specificity respectively of 79 and 80%. The cut-off point for ultrasound sensibility and specificity using ROC analysis was 11 mm² for mean cross-sectional area. Sensitivity and specificity found in this way were 72% and 56%. Reliability was good with intra- and inter-reader intraclass correlation coefficients of 0.99, and interobserver coefficient of 0.88. Sonography found seven CTS among the 17 clinical CTS with normal electrophysiological findings. A statistically correlation was found between the cross-sectional section and the sensitive electrophysiologic parameters (r = 0.43, p < 0.001).

Conclusions

In our study, ultrasonographic diagnostic value are not as good as electrophysiological value, like found in recent literature, probably because of the composition of our group of patients which is including many causes of acroparesthesias. This can mean that in clinical practice, sonography is a complementary tool instead, for example in cases of equivocal EMG.     

Faisabilité de l'autoévaluation dans le dépistage de l'hypomanie

The Hypomania Checklist (HC) is a 20-item questionnaire, which is easy to fill in and designed to help clinicians collect data for diagnosing bipolar disorder. This tool could be very useful in primary care where type II bipolar disorder is under-diagnosed, however, to date no suitable cut-off score correlating with a high probability of bipolar II disorder diagnosis has yet been validated.

Method

In a French clinico-epidemiological multi-center survey (EPIDEP) a national sample of patients with DSM-IV major depressive episode (MDE) was recruited and assessed at admittance and four weeks later. Diagnoses of unipolar or bipolar disorder were made according to a semi-structured interview adapted from the DSM-IV. In addition, the HC and questionnaires on affective temperament were administered at the second interview. In the analyses, the diagnostic accuracy was computed in terms of sensitivity, specificity, predictive positive value and predictive negative value, by varying cut-off scores on the HC. The Receiver Operating Characteristic (ROC) statistical technique was used to compare the diagnostic value of HC with the semi-structured interview adapted from the DSM-IV.

Results

Of the 493 patients with a MDE DSM-IV diagnosis, 468 filled in the HC, from which the six following groups were formed: strict unipolar disorder (UP, N = 201), bipolar I disorder (BP-I, n=39), bipolar II disorder (BP-II, N = 141), patients with mania or hypomania secondary to an antidepressant treatment (N = 51), cyclothymia (N = 14) and hyperthymia (N = 22). Comparing the BP-II patient group (N = 141) with the strict UP group (N = 201) the most discriminating HC score was 9, which identified 81% of patients correctly, with a sensitivity of 86.5, a specificity of 77.1, a predictive positive value of 72.6 and a predictive negative value of 89.1. Some cases identified as cyclothymic and hyperthymic temperaments by the affective temperament questionnaire but meeting DSM-IV criteria for major depressive disorder were included in the unipolar group (N = 237). The same score of 9 was validated, identifying a percentage of patients with correct diagnosis of unipolar depression of 78.3%, a sensitivity of 86.5, a specificity of 73.4, a predictive positive value of 66.0 and a predictive negative value of 90.1. If patients with mania or hypomania secondary to an antidepressant treatment were included as a subgroup of BP-II, a score of ten appeared as the most relevant, with a percentage of patients with correct diagnosis of 79.0 %, a sensitivity of 80.2, a specificity of 78.1, a predictive positive value of 74.8 and a predictive negative value of 83.0. ROC curves confirmed these values. Lastly when BP-I patients (N = 39) were compared to the strict UP group (N = 201) the most discriminating HC score was 11, with a percentage of patients with correct diagnosis of 86.3%, a sensitivity of 74.4, a specificity of 88.6, a predictive positive value of 55.8 and a predictive negative value of 94.7, but the BP-I group was too small to validate the score of 11.

Conclusions

These results indicate that a score of 9 on the HC is highly correlated with a BP-II diagnosis (and a score of 10 if patients with mania induced by antidepressants are considered as BP-II), and suggest that a wider use of the HC in primary care associated with strong GP/Psychiatrist networks could improve the detection, and with appropriate treatment, the prognosis of Bipolar II disorder.     

Concept actuel de paraphrénie et lien avec les troubles thymiques

Objectives

From a clinical observation, firstly we will discuss the clinical value of such diagnosis of paraphrenia. Secondly, we will describe possible associations between paraphrenia and affective disorder.

Observation

We present the clinical observation of M. B., 42 years, hospitalized in psychiatric department against his will for behavioral troubles and delusional ideas. He previously suffered twice from depression that needed hospitalizations (in 1995 and 2010). After the last hospitalization, a treatment by escitalopram was prescribed but the patient didn’t follow this treatment. When he was rehospitalised, he showed a psychomotor excitation, a depressive mood and insomnia without fatigue. He also had systematized delusions centered on his family, with imagination and interpretation mechanisms and megalomania and persecution thematics. The patient was not desorganised. A treatment by risperidone and valproic acid was prescribed and resulted in a good regression of the different symptoms within two months.

Discussion

If we apply the international classification like the ICM 10, this patient could be diagnosed: “persistent delirium and bipolar disorder”. But if we apply other criteriae such as those of Ravidran and al., M. B. could be considered as presenting a paraphrenia. If we consider the euphoria and the psychomotor excitation as being a part of confabulatory paraphrenia, the affective disorder could be considered as a recurrent depressive disorder rather than a bipolar disorder. Thus, this clinical observation may link paraphrenia to affectives disorders and this link could be supported by four hypotheses. First, paraphrenia can be an affective disorder. Two observations support this hypothesis: the cyclic evolution and some symptoms, like the psychomotrice excitation, which are common between paraphrenia and mania. Second, paraphrenia may be considered as a kind of evolution of affectives disorders as a delusional reconstruction scarring. Nodet even described the paraphrenia post-mania and the paraphrenia post-depression. Third, patient with a paraphrenia may be more prone to develop an affective disorder and the delusional disorder mixing reality and imaginary elements may result in difficulties for the adaptation to environmental stress. Fourth, same risks factors such as genetic or epigenetic factors, emotional deprivation and/or social isolation are common to paraphrenia and affective disorder. However, paraphrenia is frequently associated with cluster A personality disorder (paranoiac and schizoid) while affective disorder are more linked to cluster B personality disorder (borderline).

Conclusion

The efficacy of a treatment combining neuroleptic and mood stabilizers and the preservation of social insertion are important and indicate a therapeutic strategy that is different from schizophrenia. Thus, the determination of a link between paraphrenia and affective disorders could allow better therapeutic strategy and better follow-up on the long run.     

Thrombolyse intraveineuse par rt-PA des accidents vasculaires cérébraux ischémiques : l’expérience de l’unité neurovasculaire de Nice

Introduction

Intravenous thrombolysis with rt-Pa in stroke has been approved in France since 2002. We report an evaluation of our practice. We have tried to identify predictive factors of dependence and death, and to compare our results with the data of the literature.

Patients and method

All patients treated with intravenous rt-PA within the first 270 min after the stroke onset were included. Univariate, then multivariate analyses were performed to determine the variables influencing the functional outcome at 3 months follow-up, according to a dichotomy established from the modified Rankin scale.

Results

One hundred and forty-two patients were included in this study (mean initial National Institute of Health Stroke Scale [NIHSS]: 15). Fifty percent had a Rankin score higher than 2 at 3 months follow-up. NIHSS above 12, glycemia of at least 120 mg/l, and systolic blood pressure above 160 mmHg at admission were identified as independent predictive factors of poor functional outcome. Less than 4 points decrease of NIHSS proved to be a simple and early predictor of poor functional outcome at 3 months follow-up.

Conclusions

In terms of safety and efficacy the data issuing from the daily activity of our stroke unit are comparable with those of clinical trials.