Comparaison de la qualité de vie de patients atteints d’atrophie multisystématisée et de maladie de Parkinson

Purpose

Quality of life (QoL) in multiple system atrophy (MSA) is thought to be poorer than in Parkinson's disease (PD), primarily because of motor impairment, autonomic dysfunction and depression. The aim of the study was to investigate QoL in 10 patients with probable MSA (parkinsonian subtype) compared with 10 PD patients matched for motor disability on UPDRS III motor score.

Methods

All patients were ambulatory and non-demented. Mean durations of disease in MSA and PD patients were respectively 3.6 and 9.0 years. QoL was assessed using the SF-36 health-related questionnaire and a life satisfaction visual analogue scale. Patients were also evaluated for cognitive function (Mattis Dementia Rating Scale [Mattis DRS], Wisconsin Card Sorting Test [WCST], Stroop, Fluencies), depression (Beck Depression Inventory-II [BDI-II]), apathy (Modified Apathy Evaluation Scale) and were screened for non-motor symptoms (NMS Quest).

Results

The only difference in QoL between MSA and PD patients matched for motor disability was that the SF-36 vitality subscore was more impaired in MSA and negatively correlated with interference index on Stroop word colour testing. Depression and non-motor symptoms were associated with poorer QoL in both groups. Among MSA patients, cognitive impairment (Stroop interference index) and apathy also had a negative impact.

Conclusion

There was no major difference in QoL between MSA and PD patients matched for motor disability with a disease duration about 5 years longer. The SF-36 vitality subscore was more impaired in MSA and associated with interference sensitivity.     

Validation de la version française de l’échelle de contrôle de Levenson (IPC), influence de variables démographiques et de la personnalité

We have examined the internal validity of the Levenson’s locus of control scale (IPC, Internal, Powerful others and Chances), translated by Loas et al. (1994). The impact of different demographic variables on the Levenson’s locus of control scales was assessed. We also studied the relation between the IPC scales and the NEO PI R, personality inventory that measures the “big five”. A large sample (n=200) of subjects of different age, gender and profession and a sample of Swiss students (n=161) responding anonymously were used. The reliability of the IPC scale is acceptable. The analysis of the impact of the demographic variables show that gender and level of education have an influence on the I (Intern) scale. Age, gender, level of education and profession have an impact on the P (Powerful others) scale. The analysis of the relationship between locus of control and personality showed that there was a negative correlation between I (Intern) and Neuroticism and a positive correlation between I and Extraversion and Consciousness. The P (Powerful others) scale correlate positively with Neuroticism and negatively with Openness and Agreability. The C scale (Chance) correlate positively with Neuroticism. Our study also gives the researchers and the practitioner a reference score table according to the gender, the age, the level of education and the profession.     

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.     

Enseignements de l’approche organo-dynamique de l’acouphène

Objective

In this article, we make a critical analysis of the Traité des Hallucinations by the French psychiatrist Henri Ey (1900–1977) and his organo-dynamic theory, that is focused on the functional pathology in contrast to the delirious hallucination. The analysis is dedicated in particular to the phenomenology of tinnitus (i.e. ringing in the ear[s]) that is currently labelled a “phantom auditory perception” by contemporary neurosciences.

Method

The analysis was conducted from a thorough reading of the psychiatric work of Henri Ey, mainly his important “Traité des Hallucinations” (2006), “Études psychiatriques” (2006) and “Neurologie et Psychiatrie” (1998). Following his warning regarding a pathological reality (hallucination) that cannot be seized “by draft and outlines”, in this report we address the understanding of the patient's discourse beyond its convergence with the experimental facts.

Results

Because he wanted to include in the pathogeny of his treatise the “most elementary one” – e.g. tinnitus in the auditory sense – Henri Ey felt in the conception he did not support himself, that is to compare hallucination to a “kind of” perception. Having distinguished the delirious from the functional hallucinations (that correlate with sensory deprivation), he could not avoid reifying them within the sensory deficit, leading again to the concept of perception. This remark can be applied to the contemporary neurophysiological model of the “phantom auditory perception”, which also casts the patient's discourse on a frame with its relativity and proportions that belong to the field of perception (“elementary” vs. “complex” phenomena).

Discussion

The paradox of drafting functional hallucination as an elementary perception supports a new perspective on suffering from tinnitus, that is not restricted to an understanding of the convergence between the subjective discourse and a sensory deficit. Beyond a reification of the subjective indication arising inside the body (i.e. tinnitus), the study of the individual enunciation of the suffering appears on the horizon of the organo-dynamic theory. A psychodynamic approach of this new issue on tinnitus has been supported by the author and a colleague.

Conclusions

Whilst today the magnetic resonance imaging seems to nullify the intersubjective reality, by showing visual correlates of this intangible phenomenon, Henri Ey allows us to recognize a surprisingly modern requirement: a psychotherapeutic listening to tinnitus patients has to be iconoclastic. If the aim is to set-up an individual dialogue with the tinnitus sufferer, the clinician must remove in his mind the images he created about it.     

L’agression de la victime,une modalité de gestion de la conflictualité psychique et de restauration d’une continuité interne

Objectives

This article deals about the psychical functions of victims in the psychical economy of the author of violent and sexual offences. We will show that for the subjects whom the dynamic of the aggression refers to a defensive reaction against identity and objectal anxiety, the recourse to the victim in the aggression, holds a function of internal continuity in facing the identity discontinuity.

Subjects, materials and methods

This article is based on penal expertises and researches about sexual and violent infractions. The subjects are authors of sexual or violent offences. The collection of the data is carried out by the Entretien d’Évaluation du Processus de Passage à l’Acte (EEPPA). Conceived in a chronological way refering to the periods preceding the infraction, the period of the infraction and the period after the infraction, the EEPPA reconstructing the course of the aggression, starting from the way in which the subject says having perceived, having lived and having behaved before, during and after the act. This analysis is completed with data issues from the penal files, and data relating to the history of life and the psychical operating mode of the subject (apprehended from the transnosographic psychodynamic point of view).

Results

In bond with the identity or narcissistic and objectal vulnerabilities, we recorded in a numerous life trajectories, the importance of the environment of life and the psychical functions assured by the objects within this one, in order to maintain a psychical stability and to avoid the emergence of anxiety. The identity or narcissistic and objectal vulnerabilities related to the difficulties of separation and individuation, can induce operations in externality and psychic phenomena of export. These drawing an “intermediate space” of psychic working. This borrows to the internal and external worlds. It constitutes a psychic space of substitution to which the subject recourse, in order to export there and to regulate himself through out this space the psychical conflictuality (or a-conflictuality) that can’t elaborate in their internal world. The analysis of the situational contexts before the act, show that the aggression of the victim can be a means of facing the appearance of major anxiety. Two psychic functions of the victim in the act are presented and illustrated with clinical labels. The anti-depressive function and the function of regulation and maintenance of the control relational.

Conclusions

The aggression of the victim constitutes a defensive movement on the psychic level related to major anxiety at the psychological level. This psychic movement, which is given to see at the behavioral level with the act of aggression, lead to “the fainding” of the victim at the intersubjective level, when, paradoxically, at the same time the subject needs it at the intra-psychic level.     

Conséquences psychopathologiques de l'épilepsie. À partir de l'analyse de 10 observations

From the analysis of clinical data and the viewpoint of the bibliographic data, bringing out the comorbidity epilepsy/mental health, frequency of personality disorders during epilepsy and constancy of behavioural troubles are outlined. However, results of works, dealing with behavioural disorders, are often contradictory. Association with mental retardation shows a problem of imputability. Depressive mood, often concomitant with anxiety disorders, represent the psychiatric comorbidity frequently associated with epilepsy; recent works assess the factors of seriousness of depression. As for the relationship between psychosis and epilepsy, the term ”epileptic psychosis” indicates today specific entity. Psychotic patients who suffer from epilepsy are not in that concept frame. Alcoholism does not seem more frequent in people suffering from epilepsy than in general population. The social disqualification assessed by the scales of quality of life is frequent with people suffering from epilepsy.     

Traitement médicamenteux de la maladie de Parkinson à la phase précoce (de novo et « lune de miel »)

In this article, we discuss the management of motor symptoms during the early phases of Parkinson's disease, excluding that of any other clinical manifestation. We relied primarily upon recently published data and do not describe older publications relating to anticholinergic drugs or amantadine. The initial pharmacological treatment of idiopathic Parkinson's disease (IPD) is symptomatic and remains based upon dopaminergic drugs. However, the development of new drugs has broadened the range of strategic options and improved overall patient management. Announcing the diagnosis is a critical moment, as pointed out by patients’ associations. Patients should be advised to maintain personal, professional, social and physical activities as long as possible. The potential benefit of early pharmacological treatment should be explained, focusing on the possible disease-modifying effect of drugs such as rasagiline. According to current guidelines, L-Dopa is preferred in patients above 65 years of age, while those below 65 should be treated with dopamine agonists. Like monoamine oxidase inhibitors B (MAOI-B), synthetic dopamine agonists exhibit several advantages: easy-to-use treatment with a once-daily administration, delayed L-Dopa initiation, significant efficacy on motor symptoms (although lower than that of L-Dopa). MOAI can be prescribed in association with L-Dopa or dopamine agonists. Rasagiline also delays L-Dopa initiation, and consequently motor complications.     

Fréquences de la consommation de substances psychoactives et de la psychopathologie chez de jeunes adultes en première année d’Université

Understanding the etiology of alcoholism and drug addiction requires knowledge of the frequency of substance use in young cohorts, as well as the role of specific vulnerabilities that may explain the later development of these disorders. In the public health domain, efficient programs of prevention depend on the understanding of substance use in general population. The present study examined these issues in a large sample of university students, with particular attention to the risk factor of comorbid psychopathology.A two-phase sampling plan was used with post-stratification on substances use. In the first stage, an initial sample of 1 517 students was pre-selected based on responses to a battery of self-questionnaires, including information concerning recent consumption of substances (alcohol, cannabis, cocaine, heroin, acid, solvents…). 224 subjects were then selected in the second phase to compose four groups of substance users: infrequent consumers (those who did not use any substance during the last month; N = 80); frequent consumers of alcohol only (with a consumption of alcohol of several times a week to several times a day, regardless of tobacco use but with no other substance use; N = 44), frequent consumers of cannabis (consumption of cannabis of several times a week to several times a day, regardless of tobacco and alcohol use but with no other substance use; N = 54) and consumers of other illicit substances (consumption of hallucinogens, cocaine, heroin, ecstasy, or other illicit substance at least once during the last month; N = 46). These representative subgroups of infrequent and frequent users were then administered a psychiatric diagnostic interview (Mini International Neuropsychiatric Interview; MINI, version 5.0) to assess affective and mood disorders and substance use disorders. At the end of the study, all participants received 75 € ($100).The findings indicate maintenance of trends observed in France since 2000 for the stabilisation of alcohol use, a decrease in tobacco use, and an increase in cannabis among this age cohort. Nevertheless, it’s important to note that these frequencies are based on frequent use of substances and, even if most of users do not fulfil criteria for abuse or dependence, such levels of consumption may have serious consequences for daily functioning and physical or mental health. In examining this issue, the percentage of comorbid psychopathology was found to be generally higher in substance using groups than in the control group, but these differences were significant only for consumers of illicit drugs. The findings are discussed in terms of consequences for the overall psychosocial functioning of young substance users and relative to the increased risk of developing a substance use disorder.     

Repercusión de la introducción de neurología en un hospital comarcal de Andalucía

Introduction

The stroke mortality rate in Andalusia is twice that of other autonomous communities. This could be associated with the absence of neurologists in most local hospitals in this community, unlike in the rest of Spain. The objective of this study was to evaluate the impact of incorporating a neurologist to evaluate and monitor stroke patients in a local hospital in Andalusia.

Methods

An observational study was conducted on stroke cases admitted in the first quarter of 2006. Quality indicators, mortality rates, and incapacity rates at follow-up were analysed, comparing groups with and without neurological care.

Results

A total of 116 stroke patients were admitted. There were significant differences in tests performed to diagnose patients (Doppler and echocardiography). The mean hospital stay was significantly lower with neurology care. There was a 39.1% absolute decrease in mortality and a 35.7% absolute increase in capacity for daily life activities was also observed. Neurological care and a lower incapacity level at admission were the only two factors independently associated with a decrease in length of hospital stay and mortality

Conclusion

Specialised care by a neurologist is effective in reducing length of hospital stay, mortality and incapacity. The incorporation of neurologists in local hospitals in Andalusia should be a priority to guarantee equal care in all autonomous communities in Spain. This objective should be included in the Plan Andaluz de Atención al Ictus as a first step in forming a network of stroke units and teams.     

Traduction et validation de la version française de l’échelle d’impulsivité non conformité de Chapman

Introduction

Impulsive traits are key characteristics in a lot of psychiatric disorders and are part of the “normal” behaviour spectrum. Although impulsivity is a controversial concept, some questionnaires have focused on its “dysfunctional” aspect. The Barratt Impulsive Scale (BIS-10) is the scale the most used to explore impulsiveness, but it does not explore antisocial or nonconform behaviour. The Chapman Impulsive and Nonconformity Scale (INCS) is a questionnaire of 51 items that measures the impulsivity and nonconformism. The INCS reflects “failure to internalize societal norms, lack of empathy for the pain of others, and an unrestrained yielding to impulse and self-gratification” and was originally designed to assess psychosis proneness. It has been validated in the USA, but has not yet been validated in France. Interestingly, although it was not predictive of psychosis, high scorers on INCS exceeded controls on depression, and on rates of substance abuse. Furthermore, participants scoring high on hypomanic personality scale and INCS were found to have an especially heightened risk for bipolar disorders.

Objective

To translate and determine reliability and validity of the French version of the Chapman Impulsive and Nonconformity Scale in young adults by comparison with the BIS.

Method

Chapman Impulsive and Nonconformity Scale has been back-translated into French, and filled out by 237 students (males: 104; females: 133; mean age: 20.4 [range 19–25]). BIS-10 was used for convergent validity. Each participant completed the two scales. Reliability and validity of the French form of INCS were assessed with the internal consistency (coefficient alpha of Cronbach and the split half reliability) and the convergent validity.

Results

In the French version of the INCS, the 51 items have high internal reliability (Cronbach's alpha = 0.81 and split half reliability = 0.80). Concerning the BIS, internal reliability is good (Cronbach's alpha = 0.72 and split half reliability = 0.66).Moreover, Pearson's r of the INCS/BIS is statistically significant (0.65) and underlines the concomitant validity of the INCS with the BIS.

Conclusion

The psychometric properties of the French version of the INCS are very similar to those of the English version. Hence, the INCS could provide a way to explore the two related dimensions: impulsivity and nonconformism.