Vers une meilleure compréhension de la fatigue dans la schizophrénie

Despite being one of the most common complaints of people with schizophrenia, fatigue remains largely unexplored in this population. The lack of knowledge regarding this complex symptom makes it often underdiagnosed and undertreated in schizophrenia. The aim of this brief perspective review is to outline the potential origins (distinguishing primary and secondary fatigue) and consequences of fatigue and to explore some potential treatments in this population. The current literature in schizophrenia has mainly investigated fatigue as a trait, using a self-administered questionnaire. Beyond this observational approach, which does not allow to capture the symptom in real life situations where high levels of fatigue can emerge rapidly, we propose to consider the state level of fatigue, for instance occurring after a prolonged period of cognitive activity (i.e. mental fatigue). We elaborate on the potential relationships between mental fatigue and negative symptoms of schizophrenia and propose some research avenues to test the effects of acute fatigue on effort intentions and behaviours. The consideration of the multidimensional aspects of fatigue will allow to move beyond the sole pharmacological approach to treat fatigue in schizophrenia. Targeting the cognitive as well as the performance components of fatigue through interventions such as concomitant aerobic exercise - mental training offers attractive prospects to reduce fatigue in this population and minimize its functional negative impact.     

Cognition sociale dans la schizophrénie et les troubles du spectre de l’autisme : points de convergences et différences fonctionnelles

Introduction

Schizophrenia and autistic spectrum disorder (ASD) are two neurodevelopmental disorders that have different symptom presentations, ages of onset and developmental courses. Both schizophrenia and ASD are characterized by marked deficit in communication, social interactions, affects and emotions. Social cognitive impairments in ASD and schizophrenia were demonstrated separately in both disorders. It was reported that these impairments have direct relation with social deficits of both disorders. The apparent similarity between social cognition impairments in ASD and schizophrenia highlights questions about the existence of common or different neurocognitive mechanisms related to social dysfunctions. In order to examine these questions, the present article provides a comprehensive review of all published studies which directly compare individuals with ASD and schizophrenia on the same cognitive tasks of social cognition.

Rétablissement dans la schizophrénie et sens de soi

The concept of recovery in mental health, especially in schizophrenia, comes from the encounter between several societal, scientific and therapeutic factors. In its experiential understanding, recovery has to be distinguished from an evolutionary modality of the disease. It refers rather to a personal and singular process which opens to the possibility of satisfying and useful life, and to exit the role of “schizophrenia patient”. This process will appear despite the persistence of symptoms and disorder limitations. A number of qualitative studies describes the recovery process as an experience of personal transformation. However, most theoretical approaches to schizophrenia report this psychopathology to a fundamental, or even more irreversible, disorder of identity. Therefore, we maintain that the paradigm of recovery breaks with these conceptions, by highlighting the patients’ subjective experience, and by attesting the possibility of meaningful identity rearrangements in schizophrenia. The transformations of sense of self will be approached from the angle of narrativity. We will illustrate these identity changes with the results of a qualitative research, which will allow us to identify some psychotherapeutic implications.     

Pour une clinique différentielle des psychoses et des usages du pharmakon. Les cas particuliers de la schizophrénie et de la mélancolie

Aims

This paper focuses on self-medication, drug addiction, and their ambivalent effects, justifying a return to the concept of the pharmacon. More specifically, it addresses the way in which schizophrenic or melancholic subjects use the pharmacon concept to cope with their respective issues.

Modèles animaux dans la maladie de Charcot-Marie-Tooth et applications de la compréhension de la maladie chez l’homme

Charcot-Marie-Tooth neuropathies (CMT) are inherited neuromuscular disorders caused by length-dependent neurodegeneration of peripheral nerves. More than 900 mutations in 60 different genes are responsible for Charcot-Marie-Tooth neuropathy. Despite significant progress in therapeutic strategies, the disease remains incurable. The increasing number of genes linked to the disease, and their considerable clinical and genetic heterogeneity renders the development of these strategies particularly challenging. In this context, cellular and animals models provide powerful tools. Efficient motor and sensory tests have been developed to assess the behavioral phenotype in transgenic animal models (rodents and fly). When these models reproduce a phenotype comparable to CMT, they allow therapeutic approaches and the discovery of modifiers and biomarkers. The majority of these models concern the demyelinating form (type 1) of the disease. The axonal form (type 2) is less common. Both forms can further be divided into multiple subtypes reflecting the heterogeneity of the disease. In this review, we describe the most convincing transgenic rodent and fly models of CMT and how some of them led to clinical trials.     

Penser la formation des familles et de l’entourage d’une personne atteinte de schizophrénie

Shifting care from hospitals to the community has significantly changed the perception on families. The family home is now the primary means of hosting patients. Given this radical change in psychiatric care approach, training programs dedicated to the patient's entourage have developed. We question the large number of these programs and we aim to analyze whether there are important variations from one to another. It is about detecting differences but also convergence points between these programs in order to understand and better address the specific needs and difficulties encountered by families of persons with psychiatric disorders. In this article, we will take the profile of the designers of these programs as a variable. We will compare two training programs designed by professional caregivers and two other training programs designed within family associations by families themselves, who therefore are both designers and recipients of these programs. We will see how the designer profile has an impact on training goals, on the substance but also on how this information is passed, as well as on the assessment criteria of these trainings. In addition, we will see that the very concept of “entourage” and “family” varies according to the nature and function of the designer. Secondly, we will see how this comparative approach helps us to better understand the impact of changes in psychiatric care on families and to detect new arising questions such as: “Are entourage members intended to become care assistants?”, “Should family carers be professionalized?”, “Should the family home be considered as a place of care?”, “How to define the patient's family?”, “Who are the people concerned by the changes in caring and hence by these trainings?” This original comparative approach allows us to take into account the complexity of these changes and to detect how strong their impact can be on the schizophrenic person's entourage. It raises the question of training to other stakeholders, including in the social and medical-social sectors, since families cannot handle by themselves the shifting of care to the community.     

Le rapport de la schizophrénie au désir dans l’enseignement de Lacan

Objectives

In psychoanalytic research on psychosis, the tendency in Lacan's thinking, as well as among his readers and commentators, is to focus work on paranoia. However, it is here counterbalanced by a specific approach to schizophrenia. It is also against the current trend of positioning Desire in psychosis as a deficiency that we explore what might be the “desiring” economy of the schizophrenic.

Henri Baruk et l’hypothèse colibacillaire de la schizophrénie…

In the first part of the twentieth century, after his first highly successful work on experimental catatonia in collaboration with the Dutchman De Jong, Henri Baruk (1897–1999) developed his research on catatonigenic substances and the etiopathogenesis of schizophrenia. For him, one of the candidate substances is a neurotropic toxin extracted from an Escherichia coli. In addition to his laboratory research, Baruk reports clinical observations that allow him to confirm the hypothesis of catatonic syndromes by hepatic (biliary) poisoning. Continuing in this direction, he also describes cases of schizophrenia which he attributes the symptoms to an infection with E. coli and which seems to have been cured by an appropriate antibiotic treatment. These facts prompted Baruk challenged the uniqueness of the concept of schizophrenia. Throughout his career, he defended the interest of looking behind the psychotic manifestations, the possible biological causes, especially toxic and infectious. This approach was very controversial, even totally despised at the time, before progressing gradually to the rank of (pseudo) scientific curiosity disconnected from the daily clinical reality. But recent discoveries on the influence of the immune system, inflammation, digestive system, and especially the microbiota, on the nervous system, brain and mental state, necessarily question this observation, perhaps not so wacky…     

Les marqueurs linguistiques dans l’amélioration du modèle prédictif de la transition vers la schizophrénie

Over the past twenty years, research in psychiatry has focused primarily on the early detection of schizophrenia. The objective has been to engage the patient with prodromal symptoms in a trajectory of care. It has also been a question of being able to offer treatment as soon as the patient “at risk” of schizophrenia triggered a possible first psychotic episode. Standardized clinical tools were developed and now allow identification of subjects at risk of developing psychotic disorders. However, the reliability of predictions of the psychotic transition, which is between 15 and 25%, remains insufficient. In order to improve care, it is now necessary to highlight markers to refine the prediction of the risk of developing schizophrenia. Some teams are trying to identify linguistic anomalies in UHR subjects (disorganized speech, illogical thoughts, poor speech, altered semantic verbal fluencies…). Some of these abnormalities could be specific to the transition to psychosis. The severity of these markers could be proportional to the progressive stage of the disorder, consistent with the hypothesis of a continuum from normal to pathological in schizophrenia. In addition, automated speech analysis techniques in UHR subjects allow identification of subtle semantic and syntactic anomalies (a decrease in semantic coherence, but also the use of possessive pronouns and a poverty of speech) predictive in 79% of cases of psychotic transition. Some authors demonstrate the value of using linguistic markers and automated speech analysis methods to improve the predictive model of the transition to schizophrenia. However, from reification of language to desubjectification of the individual, this transformation in clinical practice raises ethical and epistemological challenges.     

Le problème de l’analyse des troubles de la pensée dans le discours avec la personne schizophrène : proposition méthodologique

ObjectiveWe are designing the beginnings of a methodology for the analysis of discursive disorders that will have the particularity of helping to pinpoint the discontinuous sequences that are most likely to signal the presence of thought disorders. We anticipate the development of a modeling system based on principles of pragmatic linguistics and formal semantics, which, applied to carefully selected discontinuous discourse sequences, will have a good chance of revealing the nature of the underlying thought disorders.MethodWe proceed to the analysis of the experimental literature in cognitive psychopathology that aims at identifying the cognitive processes, in this case related to semantic memory and executive functions, which are believed to define thought disorders. We confront this paradigm with other approaches in cognitive psychology and the philosophy of language that explore the language of thought. The combined theoretical and empirical findings allow us to arrive at a set of conjectures that anticipate the pragmatic and semantic properties of discourse transactions that are likely signs of disorders.ResultsWe compare these conjectures with the results of a previous study on the discovery of four “proven” types of discontinuous sequences; and we show which of these sequences can thus be considered as symptomatic of thought disorders. In continuity, we analyze some of these sequences by testing some principles of semantic modeling in order to identify the nature of the disorders and thought operations underlying the relevant discontinuous sequences.DiscussionWe show that discursive thought disorders should not be considered simply as an expression of a dysexecutive syndrome but also as a device that is likely to affect more complex thought operations, such as the inferences involved in the representation system of the conversational context, in the meaning calculus of the utterances, and in the speaker's meaning calculus. Improving the heuristics of formal systems for recognizing discourse disorders and interpreting thought disorders on the basis of more appropriate and accurate semantic modeling may lead to the development of more discriminating and effective diagnostic tools.ConclusionThe format of the formal systems that we have created will allow us to represent the interlocutory structure of the disorder in its natural context of expression with increasing precision, and should lead to the development of computerized tools to assist in diagnosis. Finally, the increased precision of formal modeling applied to communication disorders should also allow us to test the hypothesis according to which certain discursive configurations are based on thought disorders (in a broad sense) whereas others reveal cognitive dysfunctions that have to do, rather, with the conditions of possibility of discourse.     

Évaluation de l’autonomie sociale et de ses facteurs associés chez des patients tunisiens suivis pour schizophrénie

IntroductionSocial autonomy concerns specific areas that people with chronic psychiatric disorders, such as schizophrenia, face daily when they live in the community. The degree of social autonomy is one of the principal determinants of success of the therapeutic project for patients suffering from schizophrenia. However, the domains of social autonomy would depend on the socio-cultural context and the familial and professional environment of the country.ObjectivesThe objectives of this study were to evaluate the social autonomy level and to research its associated factors in a sample of Tunisian out-patients with schizophrenia.MethodsIt was a cross-sectional study of 115 out-patients (mean age: 37.6 ± 10.2 years, 75.7% male), followed for schizophrenia according DSM-IV diagnostic criteria and treated with long-term antipsychotics, mainly first generation (81%), with a mean daily dosage of 1130 ± 875 mg in chlorpromazine equivalent. Data were collected during interviews with patients and their family members and supplemented by the review of medical records. Degree of social Autonomy was assessed by the Leguay's 17-items Social Autonomy Scale (EAS), exploring five dimensions: personal care, management of daily life, resource management, relationship with outside and affective and social relations. Global functioning level was assessed by the Global Assessment of Functioning (GAF) scale.ResultsThe total EAS score ranged from 14 to 90 with a mean score of 56.6 ± 16.8. Higher sub-scores indicating a poor social autonomy concerned the dimensions of “relationship with the outside world”, “resource management” and “management of daily life”. A negative correlation was found between the EAS total score and the GAF score (r = −0.78, P < 0.0001). Thus, the lower GAF score suggesting impaired global functioning was associated to the higher EAS score in favor of altered social autonomy. Altered social autonomy was associated with low school level (P = 0.02), lack of regular professional activity (P = 0.001), disorganized subtype (P = 0.002), negative symptoms at the last hospitalization (P = 0.03), continuous course (P < 0.0001) and daily dosage of antipsychotic medication (P = 0.02). However, age or gender of the patients, psychiatric family history, age of onset, duration of untreated psychosis, number and duration of previous hospitalizations, antipsychotic treatment generation were not associated with social autonomy in our sample.ConclusionsDespite therapeutic advances in recent decades, the social autonomy of our patients with schizophrenia remains precarious. Several socioeconomic and clinical factors seem to be involved. Further interventions will be needed to enable our patients to function more actively and autonomously in society.     

Neurones miroirs,substrat neuronal de la compréhension de l’action?

In 1992, the Laboratory of Human Physiology at the University of Parma (Italy) publish a study describing “mirror” neurons in the macaque that activate both when the monkey performs an action and when it observes an experimenter performing the same action. The research team behind this discovery postulates that the mirror neurons system is the neural basis of our ability to understand the actions of others, through the motor mapping of the observed action on the observer's motor repertory (direct-matching hypothesis). Nevertheless, this conception met serious criticism. These critics attempt to relativize their function by placing them within a network of neurocognitive and sensory interdependencies. In short, the essential characteristic of these neurons is to combine the processing of sensory information, especially visual, with that of motor information. Their elementary function would be to provide a motor simulation of the observed action, based on visual information from it. They can contribute, with other non-mirror areas, to the identification/prediction of the action goal and to the interpretation of the intention of the actor performing it. Studying the connectivity and high frequency synchronizations of the different brain areas involved in action observation would likely provide important information about the dynamic contribution of mirror neurons to “action understanding”. The aim of this review is to provide an up-to-date analysis of the scientific evidence related to mirror neurons and their elementary functions, as well as to shed light on the contribution of these neurons to our ability to interpret and understand others’ actions.     

Éléments de validation du Protocole d’Évaluation de la Cognition Sociale de Bordeaux (PECS-B) en population générale et dans la schizophrénie

ObjectivesIn recent years, social cognition has received growing interest in the international psychiatric and neurologic literature. Social cognition impairments are described in many different conditions and are associated with a poor functional outcome. Consequently, an accurate and valid assessment of social cognition abilities is necessary in clinical practice, so as to better understand individual functioning and define corresponding therapeutic interventions. The aim of the present study was to provide further elements of validation to the Bordeaux Social Cognition Assessment Protocol (Protocole d’Evaluation de la Cognition Sociale de Bordeaux: PECS-B) in the general population and in one with schizophrenia.MethodsA total of 131 healthy controls and 101 participants with schizophrenia or schizoaffective disorders between 18 and 60 years old were included. Sociodemographic variables (i.e., age, education level, sex), social cognition (i.e., emotional fluency, facial emotion recognition, theory of mind, emotional awareness and alexithymia with the PECS-B), neurocognition (i.e., processing speed, episodic verbal memory, short-term memory, working memory, selective and sustained attention, spontaneous and reactive flexibility), anxiety and depressive mood were assessed in both samples.ResultsResults show a good discriminative power for the PECS-B within the same population. Only “Attribution of Intention” and “Faux-Pas” tasks show ceiling effects in both samples. Structural validity is satisfactory in the general population sample and suggests that the social cognition structure consists of four factors: facial emotion recognition (1), emotional lexicon (2), explicit processing of sophisticated emotional information (3) and theory of mind (4). Structure validity is also satisfactory in the schizophrenia sample, after removal of the variable “Emotional fluency-Percentage of sophisticated words”. In this case, the social cognition structure consists of two factors: general social cognition (1) and explicit processing of sophisticated emotional information (2). Results show a good divergent validity in both populations, between close constructs such as neurocognition and anxiety/depression. Nevertheless, correlations between social cognition and neurocognition are more frequent in the schizophrenia sample. Internal consistency is satisfying in both samples. Finally, results reveal some effects of sociodemographic variables (i.e., age, education level and sex) both in the general population and schizophrenia samples. Norms are also presented for adults aged between 18 and 60.ConclusionStructural validity, divergent validity and internal consistency of the PECS-B are satisfactory in the general population and the schizophrenia one. The PECS-B presents with good psychometric qualities that permit its use for the assessment of adults’ social cognition in clinical practice as much as research.