Étude des représentations sociales de la schizophrénie dans la population générale et dans une population de patients schizophrènes

This study aims to compare social representations of schizophrenia in a sample of schizophrenics patients and in the general population. This question is of considerable interest in clinical practice and in psychosocial intervention. On the one hand, most of the schizophrenics patients have been informed about their diagnosis. On the other hand it is well known that stigmatisation attached to the labeling of schizophrenia has major repercussions on the acceptation of the diagnosis for the patient and his family, the compliance to treatment and the quality of life. Understanding social representations of schizophrenia in a sample of schizophrenics may be useful in adapting psychoeducation techniques and preventing relapses. We have investigated these reprentations in a sample of 20 schizophrenics who were informed of their diagnosis and in a 20 matched sample in the general population. We have excluded the persons who had a previous contact with a schizophrenic. Results show that medical representations of the trouble occur in general population, which can be considered as a positive evolution of the representation of schizophrenic people who are considered as ill persons rather than just “mad”. With regard to stigmatising representations, it is surprising to note that schizophrenics and the general population share the same representations. We hypothesize that this attitude in schizophrenics may result from an internalization of the supposed stigmatisation about their illness.     

Normalisation d’une batterie d’évaluation de l’imagerie mentale visuelle et de la perception visuelle

Introduction

The relationship between visual perception and visual mental imagery are at the center of a lively theoretical debate between those postulating common neurocognitive processes between perception and imagery and those who emphasize the differences between these two entities. Neuropsychology can make an important contribution to this debate, by assessing associations and dissociations between perceptual and imaginal deficits in patients with brain damage. However, currently there is no standardized test battery available for such assessments.

Material and methods

Here we present a battery of paper-and-pencil tests assessing different domains of visual mental imagery and visual perception abilities: object form and color, animals, orthographic material, numbers, faces, and space. We also explored the effects of age, educational level and gender on performance on a group of 103 participants free of neurological damage.

Results

The battery includes two parts: one composed of 14 tests assessing mental imagery and the second part composed of eight tests assessing the abilities of visual perception. We calculated the correlations between the tests, and found that, with the exception of orthographic material, there were generally poor correlations between imagery and perceptual tests.

Conclusion

This result seems inconsistent with hypotheses postulating a strict correspondence between perceptual and imagery abilities.     

Les représentations de la maladie et des effets secondaires du traitement antirétroviral comme déterminants de l’observance chez les patients VIH

One of the major axes of the current research in the field of HIV concerns the problems of adherence to the antiretroviral treatment (ART). It proves that a quasi-perfect adherence is necessary so that the treatment is effective. In this study, the authors studied one of the determinants of the adherence: the patient's representations relating to his/her disease, its treatment and its side effects. The self-regulation model proposed by Leventhal (1980) postulates that patients suffering from a chronic illness construct a representation of their disease containing several dimensions to give it sense. The impact of these dimensions on adherence to treatment was demonstrated in various chronic illnesses. In the field of HIV, two studies relate to this subject, but require to be deepened. Therefore, the authors set up a study to complete these data with 61 HIV patients under antiretroviral treatment recruited by means of the service of the infectious and tropical diseases of the hospital of Pitié-Salpêtrière in Paris. Illness representation and representation of treatment's side effects were evaluated using the self-administered questionnaire of illness representation: the IPQ-R (Revised Illness Perception Questionnaire [Psychol Health 17 (2002) 1-16]). Adherence to ART was evaluated using the self-administered questionnaire of adherence worked out by Tarquinio et al. [Rev Int Psychol Soc 2 (2000) 61-91] and revised by Gauchet [Les déterminants psychosociaux de l’observance thérapeutique chez les personnes infectées par le VIH : représentations et valeurs. Thèse de Doctorat non publiée. France: Université de Metz; 2005]. The results indicate that illness representation has an influence on adherence. Furthermore, HIV patients build a representation of the side effects which is different than the representation of symptoms attributed to the HIV. It turns out that the representation of personal control, the representation of the cause of contagion, as well as that of the side effects influence adherence to ART. These results indicate that the self-regulation model proposed by Leventhal provides a theoretical base to understanding the behavior of coping with illness in the case of HIV. Moreover, they give arguments in favour of the implementation and of the evaluation of the efficiency of behavioral and cognitive therapies or therapies of counseling to increase adherence of HIV patients.     

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

Introduction

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

Methods

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

Results

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

Conclusion

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

Lien entre anxiété et complications postopératoires en chirurgie dentaire

The study relates to the bond between anxiety and postoperative complications recorded in the recovery room in dental surgery among 45 patients (m = 18 years): 21 men and 24 women, operated under general anaesthesia for an extraction of wisdom teeth. The participants fill in the anxiety and state of anxiety STAI before the surgical operation. At the exit of the operating room, the anaesthetist fills in a grid evaluating the intensity of 15 physiological and behavioural parameters. The participant fills in the state of anxiety STAI, as well as a grid evaluating the intensity of 16 postoperative disorders. The results indicate a bond between the state of anxiety and postoperative disorders, whereas the role of anxiety does not appear. The state of anxiety generates somatosensory disorders which can be evaluated subjectively as well as objectively. However, evaluation implies different processes: the state of anxiety evaluated before the intervention by the care personnel is related to the expression of the disorders while that evaluated after the surgical operation by the patients is more directly related to the evaluation of subjective disorders, this raises the question of a somatosensory amplification. The two types of processes, although both implying anxiety, may explain the divergences between the evaluation made by the care personnel and that by the patients.     

Psychothérapies cognitivo-comportementales de l’hypocondrie

This paper reviews the cognitive-behavioural strategies of psychotherapy applied to hypochondria. Cognitive mechanisms of hypochondria are the tendency to amplify body manifestations (pain, fatigue…) and to interpret them in a catastrophic manner. The persistence of anxiety is due to a confirmatory bias, which increases the importance given to information congruent with anxiety. The exposure-response prevention model is an important technique in the treatment of hypochondria. This model has been validated in patients presenting obsessive compulsive disorders. Patients are invited to confront ideas or thoughts that induce fear. This confrontation is repeated or prolonged in order to induce the extinction of anxiety. Another cognitive approach is the step-by-step cognitive “modelling”. During the first step the patient assesses his stress-inducing thoughts concerning his health, he also has to assess the frequency of inadequate medical treatments. During the next step, the therapist helps the patient correct automatic thoughts and false beliefs concerning his illness. The last step is a phase of consolidation. The therapist identifies factors triggering anxiety and excessive medical care. All these behavioural cognitive therapies can be performed in individual or in-group processes. Therapies proposed to patients presenting generalized anxiety disorders can be adapted to hypochondriacs. Lastly, hypochondria can be understood and treated as a form of addiction to medicine characterised by a craving for medical care, for biological exams and for different forms of medication. According to this conception, the treatment can be conducted as a form of detoxification: patients identify the frequency of their pathological behaviour and find strategies to reduce and/or control them.     

Actualités et perspectives dans la prise en charge de l’hémiplégie cérébrale infantile en médecine physique et de réadaptation

Hemiplegic (or spastic unilateral) cerebral palsy accounts for about 30% of all cases of cerebral palsy. With a population prevalence of 0.6 per 1000 living births, it is the most common form of cerebral palsy among children born at term and the second most common type among preterm infants. Precocity of care at observation of the first symptoms allows preventing orthopaedic disorders and furthermore the installation of pathological patterns. Before any therapeutic intervention, it is necessary to evaluate the lower and upper limb function by means of reliable, valid and reproducible tools. This helps define precise and mutual objectives for child and family as well as therapists, therefore allowing an objective evaluation of the results. This principle applies as much in fundamental techniques (physiotherapy, occupational therapy, psychomotricity, orthesis…) as in more recent developments such as botulinum toxin, exercise programs, constraint-induced therapy, motor mental imagery or virtual reality. These recent therapies present, at various degrees, scientific evidence of their efficiency in the improvement of limb function and are now an integral part of the usual care of children with hemiplegic cerebral palsy.     

Représentations étiologiques et problématique identitaire dans la schizophrénie : tentatives de sortie du tourbillon psychotique

This work explores identity in schizophrenia and the role of etiological representations in self-constitution. Identity of the schizophrenic patients is often regarded as defective. This vision, by its reifying aspect, does not take into account the dynamics of any identity constitution and the possibilities of leaving the psychotic crisis. The identity of patients is more a suspended or syncopated identity. Plunged in the swirl of schizophrenic crisis, patients try to reconnect with their own history. Among the means, which they use, representations of the causes of the disease have a paradigmatic place. Patients try to get back to the everyday life of the world, by using social representations of their ill being. But this exchange of representations they engage with their entourage is not a simple way of communication. Using Ricœur's analysis, we show that etiological representations are metaphorical utterances. Considering their central position in the creation of the plot, the etiological representations allow to re-open the constitution of narrative identity, and so the harmonious articulation between the two poles: sameness and ipseity.     

Un anxiolytique naturel : l’hydrolysat trypsique de caséine alpha-s1 de lait bovin. Son intérêt en médecine humaine et vétérinaire

Tryptic hydrolysate from bovine milk alpha-s1 casein (THC), a natural product, contains a specific active decapeptide called alpha-casozepine which shows interesting pharmacological properties. Preclinical and clinical trials, as well as tests carried out on both humans and animals (rats, dogs, cats) demonstrated certain qualities of this hydrolysate. It shows a marked affinity for GABA-A receptors with a benzodiazepine-like profile and a tranquilizing and antistress activity associated with good tolerance characterized, in particular, by the absence of any habituation, dependence, sedation, memory impairment and toxicity. THC is a nutritional supplement (French regulatory status) which cannot be used as a substitute for psychotropes, such as benzodiazepines, in the treatment of severe anxiety and sleep disorders in respect of the medical recommendations. However, it could be effective in cases of slighter signs of these disorders. It could also be appropriate in the medical prevention and follow-up of subjects who have difficulty adapting to changes and stressful situations of daily life. An original pilot clinical trial respecting good practice and representative of the cases observed by General Practitioners (GPs) showed the interest of a global management program for benzodiazepine withdrawal. This global management program which included the use of THC opened a new application for it in general practice. As a result of a certain neuropsychiatric similarity between man and the domestic dog, we took the opportunity of presenting this natural tranquillizer in its application in both human and veterinary medicine.     

L’attrition de l’espace de représentation dans les syndromes traumatiques

Traumatic syndroms raise several questions: delay of onset, repetition and extension of symptoms, characteristics of the traumatic scene. These questions cannot be solved by existing models without a conceptual framework to analyze interactions between memory and the traumatic scene. However, such a framework can be outlined within the recent theory of representation. A subjective universe is considered as a representational space displayed from memory. In traumatic syndromes, a deathly scene cannot be integrated within the representational space, breaking a basic principle of unification. An attrition process can be described: the deathly scene is settled in the center of the representational space and hit foundations in an insolvable way. Subjective vulnerability to trauma can also be analyzed within this conceptual framework.     

Vérification de la structure factorielle d’une traduction française de l’Inventaire de l’Anxiété État-Trait pour Enfants

This study was designed to verify the factorial structure of a French version of the State-Trait Anxiety Inventory for Children (STAI-C). This inventory being one of the most widely utilised to measure children's anxiety levels, it was believed necessary to obtain statistical clarification concerning this translation and its construction in order to extend its use. The present French version of the STAI-C was administered to 242 eight- to ten-year-old children. The results showed excellent internal consistency for both state anxiety and trait anxiety scales of the inventory. Furthermore, the three-factor model obtained in the original version of the test was confirmed, demonstrating good psychometric properties of this French version. It is hoped that the present translation, here supported by preliminary statistical results, will allow, once further tested, a greater use of the State-Trait Anxiety Inventory for Children in French-speaking environments.     

Association entre anxiété et hyperlaxité articulaire : revue de la littérature

Joint hypermobility is an exaggerate increase of the joint's mobility due to an inherited alteration in the collagen fibres. For decades, it has been observed that people with this condition show very often symptoms of anxiety. Empirical studies corroborate these clinical observations and associate the joint hypermobility principally with the endogenous anxiety, which suggest that is a biological base shared by both phenomena. The discovery of the connection between the two different fields, psychiatry and rheumatology, has important implications; it offers the possibility of identifying the most vulnerable patients suffering anxiety disorder, by exploring the signs and symptoms associated with joint hypermobility.     

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

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

Évolution des attentes et des représentations en clinique dans les rapports entre psychiatrie et justice

Relationships are difficult between psychiatry and Justice. Psychiatry is regarded either as an enemy of freedom or as too liberal. One criticizes it for its disengagement from the hospital and for its responsibility regarding a so-called excess of hospital beds. The responsibility of Psychiatry in the accumulation in jails of mental patients is often denounced. However, since the birth of the diagnosis of mental disorders, psychiatry evolves by extending its field of competence beyond the recognized psychoses to an operative clinic in the borderline disorders. Our societies are not satisfied and ask the psychiatrist to be present in any violence and with each delinquent. Crime and psychiatric disorders are regularly confused. Are our societies sick of their fears while confusing in its representations crime and madness, care and punishment?     

Secteurs psychiatriques et circuits de l'information en matière de précarité

The public service for mental health has been facing a conjuncture with necessary modifications to be made. In this context, we felt that it would be appropriate to carry out a survey in 2000, and then in 2002, on how much psychiatric districts know and are informed about access to general medical care and rehabilitation. Psychiatric staff seemed indeed to pay particular attention to those who may benefit from existing social systems and not only in connection to new legislations. According to our estimates, 19 % of patients under psychiatric care benefit from the Universal Medical Coverage (Couverture Médicale Universelle, CMU). The CMU was considered to be a good measure for patients by most medical and social partners polled. The latter emphasised the relevance of covering hospital fees and making access to general medical and dental care, which is otherwise often disregarded, easier. Moreover, districts themselves suffer from institutional “precariousness”. Tensions occur in the first place when, despite their willingness to deal with issues or problems, they are unable to do so.     

Un exemple singulier d'adaptation à l'anxiété d'anticipation : les rituels conjuratoires dans la pratique de la corrida

The man who runs his life with killing bulls in the strictly way of practising bull fighting, in facing real death, mythic animal’s one, has to confront himself with his own anxiety which deeply oversteps the bounds of his own death. Studies about the semiology of anxiety made from testimonies or accounts by “matadores”, in a litteral sense by “killers”, make obvious the preponderant use of obsessional defences that are borrowed from the obsessional register (superstitions, conjuring rituals). Beyond the anxiety felt by any artist or public intervenant which could be assimilated with stage-fright, there come some more specific and rationalized anxieties such at the fear of being wounded or of failing which is lived with affects of shame and also with some more unconscious anxiety: this “inner bull” is a still more threatening and more redoutable anxiety than the one that will happen in the ring and will be used as a projection shield against the inner anxiety. The specificity of bullfight could explain in a large way the passions it always breeds as well from its opposites as from the upholders of this using.     

Enjeux actuels de l’évaluation psychologique dans la clinique de l’enfant et de l’adolescent : vers une approche intégrée de la psychopathologie

This article will discuss different theoretical approaches and methods of data collection in view of the psychological assessment of children and adolescents. There are generally two different approaches; one being the single case study using a subjective method and the second consisting of clinical interviews and psychological tests using the objective method. In our opinion, psychological assessments should rely on two main axes. The first should be based on an updated knowledge of psychopathology, integrating new models and scientific findings with the methodology of Evidence Based Medicine (EBM). The second axis should be concerned with the psychological assessment combining subjective and objective methods. For example, the use of standardized tools such as scales or projective tests is essential to understand the interaction between multiple clinical variables influencing child psychopathology as well as to understand family and social interactions. The diversity of risk factors (e.g. family, personality, social, biological factors, etc.), implicated in mental illness shows the multi-dimensional aspects of psychopathology. Different theoretical approaches have been developed to study psycho-pathological mechanisms (neuro-psychology, psychoanalysis, biological psychiatry approaches, etc.). Therefore an integrative approach of psychopathology using different models and factors is needed to understand psychiatric disorders. A thorough psychological assessment is essential to the comprehension of mental illness in children and adolescents and is the first step to tailor treatments to individual needs. In order to answer these objectives, psychological assessments must be multi-modal, multi-disciplinary and multi-source: - Multi-disciplinary: For a better clinical assessment, psychologists and psychiatrists will need information from other professionals such as speech therapists, psychomotor therapists, neurologists… - Multi-modal: This aspect is crucial in clinical assessment. It characterizes all tools that clinicians will use in their assessment practice: Psychological tests, clinical interviews or clinical scales. - Multi-source: A comprehensive assessment of child and adolescent psychopathology includes assessments of different informants and sources (family, teachers…). These different approaches will be discussed in the perspective of the actual stakes of psychological assessment in children and adolescents. Developing integrative assessment approaches seems to be a promising field for the future in mental health services, allowing the tailoring of specific therapeutics for each child.