Approche dimensionnelle de la personnalité schizotypique : étude comparative de deux populations estudiantines française et tunisienne

Object. - The schizotypal personality questionnaire (SPQ) conceived by Raine in 1992 is a psychometric assessment tool measuring the 9 DSM-IV features of schizotypal personality : “Ideas of reference”, “Magical thinking”, “Unusual perceptual experiences”, “Paranoid ideation”, “Social anxiety”, “No close friends”, “Constricted affect”, “Odd behaviour” and “Odd speech”. Validation of this questionnaire was studied on ethnically different populations. The aim of this study was to compare the SPQ scores (total scores and 9 subscales) between French and Tunisian students populations.Methodology. - It is about a comparative transverse study of two groups of students : a first group constituted by 198 students of the medicine university of Monastir (Tunisia). The second group containing 232 students of Lyon I University (France). We compared the mean total scores and mean scores at the 9 sub-scales of the SPQ between two groups.Results. - The mean total score in Tunisian group was higher 25.2 ± 12.3 vs 23.1 ± 12.1 in the French group. The difference was not significant (P < 0.07). Mean total score was significantly higher in Tunisian woman's group regard to French women group (26.6 ± 11,6 vs 22.3 ± 11.2, P = 0.005). There was no difference between Tunisian and French man's group. Concerning the scores in SPQ subscales, the Tunisian group scored significantly higher in: “social anxiety” (P = 0,001), “no close friends” (P < 0.0001), “constricted affect” (P < 0.001) and “paranoid ideation” (P < 0.0001), which corresponds to the negative dimension of schizotypy. While, French group scored significantly higher in: “unusual perceptive experiences” (P < 0.0001) and “odd speech” (P = 0.003), which corresponds to the positive dimension of schizotypy. Almost the same result was found in woman's and man's groups separately. Tunisian woman's group scored significantly higher in “social anxiety” (P = 0.01), “no close friends” (P < 0.0001), “constricted affect” (P < 0.0001) and “paranoid ideation” (P < 0.0001). French woman's group had significantly higher scores in “unusual perceptive experiences” (P = 0.04). Similarly, Tunisian man's group scored significantly higher in “social anxiety” (P = 0.03), “no close friends” (P < 0.0001) and “paranoid ideation” (P = 0.0002). French man's group scored significantly higher in “unusual perceptive experiences” (p < 0.0001) and “odd speech” (P = 0.001).Comments and conclusion. - Our results showed differences between French and Tunisian students in expression of schizotypy dimensions. Tunisian students seem to express more negative schizotypy and French students express more positive schizotypy. It evokes the possible influence of sociocultural context, which may be different between French and Maghrebian societies. Influence of drug use which is more frequent in European countries than in Maghreb, seems to be associated with positive symptoms of schizotypy. The results emphasize also the necessity of adaptation of such instruments : SPQ and other tool of assessment of personality disorders. The role of biological and especially the genetic factors in expression of schizotypy can be also evoked.     

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.     

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.     

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.     

L' « Ouverture émotionnelle » dans les Troubles de la dépendance et les Troubles de la personnalité

Emotion processing is supposed to play an important role in psychological dysfunctions in alcohol and drug dependency disorders (DD), as well as in personality disorders (PD). The model of “Emotional Openness” (“Ouverture émotionnelle”) provides a multidimensional framework to analyze problematic patterns of emotion processing. Within this framework, it is suggested that drug- and alcohol-dependent patients as well as borderline and antisocial patients show reduced a) “cognitive/conceptual representation” of affective states; b) “emotion regulation”; and c) “expression and communication of emotion”; but d) increased “awareness of body internal indicators” of affectivity; and e) appropriate psychological treatment is supposed to improve these patterns. Drug-dependent patients with PD comorbidity (in particular borderline or antisocial) are supposed to present even stronger deficits in (a) and (b). The hypotheses are tested with the 36-item DOE questionnaire (“Dimensions of Openness to Emotional experiences”, trait version; [19]), assessing six main dimensions of emotion processing as represented by the subject (French and Italian version). The instrument presents satisfying reliability coefficients (mean alphas of the scales in two recent studies (N = 251; N = 435) vary between 0.74 and 0.82) and good factorial validity (6-factor PCA solutions with varimax rotation solutions in the two samples are highly coherent; the mean of Tucker's congruence coefficients is 0.93). Results of two clinical studies are presented, comparing N = 71 patients (21 drug-dependent without personality disorder; 30 drug-dependent with borderline or antisocial personality; 20 dependent in-patients receiving psychological therapy) with normal control subjects (N = 51 matched; N = 50 reference group), including one pre-post treatment comparison. Results confirm marked deficits of DD patients concerning “conceptual representation” and “emotion regulation”, as well as a reduction of “communication/expression of emotion” but an increased “awareness of body internal indicators” of affectivity. Differences of patients with a double diagnosis correspond to effect sizes of d = -1.33 for cognitive/conceptual representation of emotions and d = -1.25 for emotion regulation; differences in emotion communication and expression are also significant but less important d = -0.44. Awareness of body internal emotion indicators is increased (d = +0.27) but does not differ significantly from the control group. As supposed, patients with a double diagnosis (DD and PD) described significantly stronger deficits in conceptual representation and emotion regulation than the patients with dependency disorder only. In the second study, a group of DD patients receiving multi-component treatment, including individual and group therapeutic intervention, according to the client-centered approach, and working on emotion processing, showed marked differences from the reference group at the beginning of the treatment (d = -0.91 for cognitive/conceptual representation, d = -0.82 for emotion regulation and d = +0.46 for awareness of bodily internal indicators). As supposed, pre-post comparisons indicate improvement with change effect sizes of d = 0.99 for conceptual representation, d = 0.97 for emotion regulation, as well as d = 0.88 for emotion communication and expression. Furthermore, the changes following treatment are highly significant and substantial, except for the awareness of internal bodily indicators, which only slightly decreased. Patients “normalize” their emotion processing following treatment, describing increased conceptual representation and emotion regulation, as well as emotion communication and expression. Results underline the importance of dysfunctional modes of emotion processing in both pathologies, and underline the validity of applying the model and the DOE instrument. They are discussed with reference to the model of alexithymia.     

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.     

Insight, dépression, estime de soi et satisfaction de vie chez des personnes souffrant de schizophrénie

Recent studies on insight in schizophrenia, mainly english-speaking, have shown that denial of mental disorder (lack of insight) is connected with a less good compliancy with treatment. Consequently, therapies, which increase insight, develop currently (psychoeducation and information of patients, for instance). Nonetheless, certain studies concluded that awareness of mental disorder has a negative effect on psychological dimensions like humor, self-esteem and quality of life. So we realize a pilot-study on 20 schizophrenic subjects (DSM-IV) (15 men and five women including 13 full-time inpatients and 7 days in-patients) from 22 to 61 years (m = 41.75; σ = 11.94). The aim of the study was to measure insight (IS and Q8), depressive experience (SCL90-R and CDSS), self-esteem (SEI) and satisfaction with life (SWLS), then to calculate correlation between insight and the three other dimensions. Data analysis confirmed a strong link between insight and deterioration of self-esteem (r = −0.6922; p = 0.001) and with an increase of depressive experience (r = 0.8134; p = 0.000 with SCL90-R and r = 0.6041; p = 0.006 with CDSS). Satisfaction with life is not significantly correlated with insight (r = −0.2047; p = 0.401). Those results show that clinicians must take into account the depressive effect of therapeutic strategies aiming at an increase in insight.     

Concurrent validity of Preschooler Gross Motor Quality Scale with Test of Gross Motor Development-2

Preschooler Gross Motor Quality Scale (PGMQ) was recently developed to evaluate motor skill quality of preschoolers. The purpose of this study was to establish the concurrent validity of PGMQ using Test of Gross Motor Development-2 (TGMD-2) as the gold standard. One hundred and thirty five preschool children aged from three to six years were recruited from three kindergartens in central Taiwan. Two independent evaluators who were unaware of each other's results evaluated all the children separately in their kindergartens using standardized setting and procedures. Concurrent validity was examined using correlation analysis with Pearson-Production Moment correlation coefficient. The results show that the total scores (r = .86, p < .001) and subscale total scores (r = .82 for locomotion, r = .76 for object manipulation, p < .001) of the two tests correlated well. Analysis of similar items in the locomotion subscale found significant but weak correlations in the running, jumping and galloping items of the two tests (r = .23-.25, p < .001). There were moderate to high correlations in hopping, sliding and leaping between the two tests (r = .52-.70, p < .001). Low to moderate correlations (r = .37-.54, p < .001) were found between the similar items in the object manipulation subscale of PGMQ and TGMD-2. Total scores of TGMD-2 also showed a high relation between the sum of the locomotion and object manipulation scores of PGMQ (r = .83, p < .001). The total scores of similar items in the locomotion subscale of PGMQ and TGMD-2 showed a similar high relation (r = .79, p < .001) likewise in the object manipulation subscale (r = .75, p < .001) The PGMQ proved to have adequate concurrent validity with TGMD-2.     

Complications obstétricales dans la schizophrénie : étude comparative en population tunisienne

The neurodevelopmental hypothesis in schizophrenia argues that this disorder may be a result of abnormal brain development due to genetic risk and or to environmental injury such as those due to obstetric complications. Very few studies from emerging countries have been published concerning obstetric complications in schizophrenia. However, meteorological, demographic and health factors in most of these countries are different from those in Western countries, and studies in this field may bring more findings. Our objectives were to compare the frequency of obstetric complications in a group of schizophrenic patients compared to two other groups: a group of first-degree relatives and a healthy control group, and to search for the relationships between these complications and the epidemiological and clinical features of schizophrenic patients. The study is a retrospective case-controlled one: a schizophrenic patient group (N = 55, 43 males and 12 females, median age = 30 years) was compared to a group of non-affected first degree relatives (N = 40, 31 males and 9 females, median age = 29 years) and to healthy controls without familial psychiatric history (N = 38, 25 males and 13 females, median age = 29 years), all matched according to age and sex. Obstetric complications were collected at home from the biological mothers at the time of a visit using the McNeil-Sjostrom questionnaire. Schizophrenic patients were clinically assessed using the Positive and Negative Symptoms (PANSS), the General Assessment of Functioning (GAF) and the Clinical Global Impressions (CGI). Obstetric complications frequency was significantly higher in schizophrenic patients: 67,3 versus 20,0% in their non affected relatives and 28,9% in the healthy controls (P < 0,001). The mean total score of obstetric complications was significantly higher in the schizophrenic group: 1,52 ± 1,47 versus 0,8 ± 1,77 in the non affected relatives and 0,5 ± 0,97 in the healthy controls (P < 0,001). In the schizophrenic patients, obstetric complications were more frequent during delivery period (50,9%) and neonatal period (45,5 %). More particularly in pre-term births (21,8%), low birth weight and fetal distress (18,2%) and premature rupture of the membranes (16,4%). A statistical relationship was established between obstetric complications frequency, autumn-wintry birth season, low school level and negative symptoms in the PANSS. However, no significant correlation was found between obstetric complications frequency, family psychiatric history and age of onset of schizophrenia. Through an investigation involving mental recall, our results proved a higher frequency of obstetric complications in schizophrenic patients. Our results support the role of obstetric complications in the etio-pathology of schizophrenia, in interaction with other environmental or genetic factors. This association favors the neuro-developmental hypothesis in schizophrenia. Further studies assessing influence of weather, specific infectious agents, and demographic factors could also be relevant.     

La schizophrénie à début précoce : caractéristiques cliniques et endophénotypiques

Early onset schizophrenia is commonly considered as severe, resistant to treatment, and associated with a poor prognosis. It offers an interesting field of research for the neuro-developmental theory of schizophrenia, which hypothesises a link between some neuro-developmental markers such as physical and neurological anomalies, morphological brain abnormalities, and specific cognitive disturbances, with the existence of a vulnerability to a further occurrence of schizophrenic disorders. These markers, proved to be more common in schizophrenic patients, are considered by some authors as endophenotypes of schizophrenia. The objective of this study was to specify the clinical and endophenotypical features of early-onset schizophrenia. A comparative study was carried out on two groups of patients with schizophrenia according to DSM-IV criteria, who were systematically recruited from the outpatient clinic of psychiatry of the University Hospital of Monastir during the second semester of 2003. Patients who did not meet exclusion criteria (age over 50 years at study time, age of onset between 15 and 20, medical history of cranial trauma, evidence of cerebral disorders or mental retardation, addiction to alcohol or to psychoactive substances) were divided into 2 groups: Group I: onset before the age of 14 (N = 15). With a mean age at the time of the study of 20.8 ± 8.1 years and a gender distribution of 8 male vs 7 female patients; and Group II: onset after the age of 20 (N = 35), with a mean age at the time of the study of 34.6 ± 6.2 years and a predominance of male patients (80 %). The following tests were administered to both groups: Positive and Negative Syndrome Scale (PANSS), Evaluation of Global Functioning (EGF), Clinical Global Impressions (CGI), Minor Physical Anomalies Scale (MPAS) and Neurological Soft Signs (NSS). In the early-onset schizophrenia group, the disorganised subtype was predominant (60 %), in the second group the paranoid subtype was the most frequent (43 %) (P = 0.2). The severity of the disorder and of psychotic symptoms were more important in the early-onset schizophrenia group. Negative symptoms were predominant in group I (PANSS negative score = 30.6 ± 10.1 vs 24.9 ± 8.4 in group II) (P = 0.04). The physical and the neurological anomalies were more frequent in the early-onset group, with a total score of MPAS of 5.8 ± 2.8 vs 4.2 ± 2.4 (P = 0.04), and a score of NSS at 24.5 ± 6.1 vs 19.6 ± 5.4 (P = 0.006) respectively. These results show neurodevelopmental anomalies to be more common in early-onset schizophrenia, which could be interpreted as an association between early damages to the brain and occurrence of severe and early forms of schizophrenia. These findings highlight the probability of neurodevelopmental determinism in schizophrenia.     

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.     

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

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

Validation d'une version abrégée du TCI (TCI-56) sur un échantillon de jeunes fumeurs et non-fumeurs

The psychobiological seven-factor model proposed by Cloninger et al. (1993) takes into account temperament and character dimensions to describe personality. Four of the dimensions are linked with biological, genetic and neuroanatomic structures, whereas the three other dimensions are related to the degree of individual, social and spiritual development. A study conducted by Wills et al. (1994) with adolescents showed that substance abuse was associated with high scores on Novelty Seeking and low scores on Harm Avoidance and Reward Dependence. The aim of the present study was, firstly, to create a short form of Cloninger’s temperament and character inventory (TCI) and, secondly, to study the impact of nicotine dependence as well as demographic variables on a sample of young adults. We created a short form of the TCI containing 56 items (TCI-56), eight for each scale. Responses are made on a five-point Likert type scale. A Swiss sample (n = 211), of 116 women and 95 men, aged from 15 to 30 years, participated in this study. Our population was divided into a group of 81 smokers and another of 130 non-smokers, according to their scores on the Fagerstörm test for nicotine dependence (1999). The structural validation consisted of two separate factor analysis with varimax rotations, one for the temperamental items, and the other, for the character ones. The first factor analysis conducted on the items of the temperament scales allowed to extract four factors explaining 40.7% of the variance. The correlations between factors and scales are the following: r = 0.71 for Novelty Seeking, r = 0.69 for Persistence, r = 0.95 for Harm Avoidance, r = 0.94 for Reward Dependence. The second factor analysis conducted on the items of the character scales allowed to extract three factors explaining 41.5% of the variance. The correlations between factors and scales are the following: r = 0.94 for Self-Directedness, r = 0.91 for Cooperativeness and r = 0.99 for Self-Transcendence. The internal consistencies range from α = 0.65 to α = 0.75 for the temperament scales, and from α = 0.71 to α = 0.83 for the three character scales. Concerning, the impact of the nicotine dependence, we observed that smokers have significantly higher scores for Novelty seeking, than non-smokers (P = 0.01). We found no difference for Harm Avoidance and Reward Dependence. Nevertheless, smokers seem to have the tendency to score higher on Transcendence (P = 0.06). Moreover, people having smoked more than 100 cigarettes in their life have significantly higher scores on this scale (P = 0.04) and the correlation between Transcendence and the Fagerstörm test is significant (r = 0.19). We also found gender differences: the women (N = 116) obtain significantly higher scores for Harm Avoidance (P < 0.001), for Reward Dependence (P < 0.001) and for Cooperation (P = 0.01). We further found a significant correlation between age and Self-Directedness, r = 0.34. We observed no interaction between gender and smoking or age and smoking on the dimensions of the TCI-56. The TCI short form (TCI-56) seems to be a valid and useful inventory to assess personality differences. Confirming the results of others about the relation between addiction and personality, we found that smokers have significantly higher scores for Novelty seeking, than non-smokers. But we were not able to find any significant differences for Harm Avoidance and Reward Dependence. This might be due to our sample that was made of young adults. This study also shows that Transcendence could be an interesting dimension for studies on tobacco smoking to consider. Concerning the impact of demographic variables, we observed that age and gender have specific and coherent influence on personality.     

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.     

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.