Premiers éléments pour une étude psychométrique de la fixation-régression avec la McGill Object Relations Scale

Introduction

Psychosexual development is generally assessed clinically, that is to say, in a qualitative manner (Piper and Duncan, 1999). Dymetryszyn, Bouchard, Bienvenu, De Carufel, and Gaston (1997) recently proposed a more quantitative approach based on the overall maturity of the subject's object relations.

Background

Object-relation maturity is quantified using a profile that defines a score for each stage of an individual's psychosexual development : oral-narcissistic, oral-objectal, anal, phallic pre-oedipal, oedipal, and genital. The McGill Object Relations Scale (MORS) (Dymetryszyn et al., 1997) was adapted (Combalbert, Vautier, Bourdet-Loubère, Favard, & Bouchard, 2002) and then used to obtain the quantitative scores. The relationship between overall object-relation maturity and psychosexual development is complex. Psychosexual development is considered here to be a constant latent dimension. Accordingly, the higher the level of development, the greater the individual's possibility of establishing the object relations that correspond to more evolved stages. Inversely, the lower the level of development, the more the individual is forced to rely on object relations corresponding to earlier stages of development. However, the connection between the object-relation maturity profile and psychosexual development is made even more complex by the existence of the well-known phenomenon of fixation-regression.

Objectives

This article attempts to determine how fixation-regression is reflected in the structure of the profiles of a sample of individuals whose clinical diagnosis suggests probable regression to the anal stage.

Methods

The subjects chosen had borderline personality disorder coupled with either perversion or psychopathy. The data were modelled using an unfolding model. MORS was used on 60 criminal subjects who had been charged with, or convicted of, crimes against persons. The nosographic diagnosis was based on the psychiatric assessment of the prisoners. DSM IV diagnostic criteria were used as a reference to confirm or refute the pronounced diagnosis. Only subjects who met at least five criteria for borderline personality disorder were included in the sample. To assess the reliability of the individual scores, two expert judges blindly scored the 60 protocols.

Results

The results obtained with an unfolding model support the hypothesis that the observed ordinates for the oral-narcissistic, oral-objectal, phallic pre-oedipal, oedipal, and genital stages obey a law of synchrony that complies with the postulate of a continuum in psychosexual development. The second main result was the fact that the observed ordinates for the level corresponding to the anal stage could not be described by the model. Furthermore, this finding did not come from a possible scoring error, since inter-judge reliability was 0.93 for that level.

Discussion

These results are encouraging for the utilization of MORS as a technique for quantifying object relations. This study on a sample of individuals with a high probability of anal stage fixation-regression suggests that this type of phenomenon can be objectified by means of MORS profiles. However, the present study has some limitations of its own. The main methodological drawback pertains to the subjective aspect of the protocol scoring. The two judges had a great deal of joint experience in scoring other protocols on the MORS grid. This could explain the particularly high inter-judge correlations, compared to the within-class correlations published by Dymetryszyn et al. (1997).

Conclusion

One cannot rule out the possibility that our analyses would have had different outcomes had other independent judges scored the 60 protocols. Moreover, our results cannot be generalized without replication. A critical test would be to replicate our analyses on similar data, and to examine the unfolding model's behavior on data from a sample of ordinary adults diagnosed as not having strong fixation-regression tendencies. If the synchrony laws defined by the unfolding model are correct, the anal stage should be included in the arc formed by projecting the six stages on the factorial plane of the principal component analysis. Fundamental research based on the psychosexual theory of the libido and supported by statistical data can objectify the vicissitudes of psychosexual development (such as fixation-regression) or developmental differences across groups of individuals. This makes a strong case for pursuing MORS-based investigations.     

APAP et relation médecin-malade : quelques éléments de réflexion

In recent years, the goals of treatment in schizophrenia have evolved from objective improvements in psychotic symptoms to encompass patient-related factors such as subjective response and quality of life. Patient satisfaction with antipsychotic therapy is influenced by multiple factors. The most frequently reported reasons for dissatisfaction include drug side effects, lack of involvement in treatment planning or decision-making and lack of involvement of family members in the care plan. The majority of studies have demonstrated that the APAP (long-Acting atyPical AntiPsychotics) are associated with significant improvements in quality of life, functional status and patient satisfaction compared with conventional agents. The therapeutic alliance is the key to achieving optimal outcomes, by providing information and education to meet patients' needs, while facilitating compliance with drug therapy to ensure better clinical outcomes. A APAP that can ensure medication delivery will provide a platform for psychosocial interventions, and thus may further increase patient satisfaction and, ultimately, improve long-term outcomes in schizophrenia. Attitudes towards APAP play an important part in the treatment for schizophrenia and related disorders. The effectiveness of APAP is evident in acute and maintenance treatment of these disorders, and most mental health professionals recognize APAP as a cornerstone in treating affected people. The doctor-patient relationship is one of the most important therapeutic tools in the treatment of disabling mental disorder. Today's focus on drugs tends to make that relationship oppositional. Effective treatment requires the continuation throughout the patient's illness of the same trusted therapeutic relationships wherever the patient is located; of reliance on activities which are truly mind-building (useful and satisfying) rather than basket-weaving or its equivalent; And, as much as possible, on the continuation of medication.     

Influence de la déambulation et des comportements moteurs inadéquats sur la prise en charge des déments à domicile par des aidants informels. L’étude PIXEL

Context. - Prospective study of the complaints, problems and requirements of the main caregiver providing home care for demented patients.Objectives. - To determine the weight of patients’aberrant motor comportment on home natural caregiver.Resources. - Self-administered questionnaire of 42 questions on the patient and caregiver, including socio-demographic information and a list of complaints facing the demented patient’s caring. Patient assessment by a neurologist, or a psychiatrist or a geriatrician.Results. - 408 records were compiled: 236 women (77.1 ± 0.47 years) and 172 demented men (75.7 ± 0.57 years). Inadequate motor comportment are present in 52 % of the cases. They worsen with the course of the disease. They increased the carer’s burden. Patient’consciousness of his troubles limit the risk for motor disorders. The main complaints concern violence, agitation, absence of inhibitions of the patient. In this situation, periods of respite are scarce for the carer.Discussion. - Demented patients with Inadequate motor comportment have more behavioural disorder. Caregivers have difficulties to monitor the home situations, and suffer health problems.Conclusions. - Caregivers need respite and information to monitor home care of demented patients.     

Trouble déficitaire attentionnel avec hyperactivité et trouble bipolaire. Une revue

The future of children suffering from Attention Deficit Hyperactivity Disorder (ADHD) remains discussed. This article questions about ADHD being a prodromal sign of adults'Bipolar Disorder (BD). Therefore we aim to clarify the links between these two disorders. It appears that there is an association between them. This is shown by an elevated comorbidity, a familial association, a higher risk of BD in the future of the ADHD patients. The presence of an ADHD (especially some sub-types) can be considered as a clinical predictive factor for a later BD. Moreover, BDs present some common features in this context. Finally, data from genetic familial studies suggest that the ADHD + BD association is a distinct familial sub-type and may be related to what some have termed childhood-onset BD. Thus these links raise nosological questions and may have important practical impacts.     

Le concept de test relationnel en psychothérapie : origines, développements et applications aux troubles de la personnalité

The test concept (Weiss and Sampson, 1986 [16]) is presented. Its origins in Freud's works are briefly evoked and its place within the theory of pathogenic beliefs by Weiss presented. We present also the remaining elements of Weiss’ psychoanalytic theory which are objectives, obstacles, traumas and insight. Every step of the reflection is illustrated with case examples, drawn from the literature. A recent development of the test concept is presented and applied to the psychotherapy of personality disorders (Sachse, 2003 [14]). Finally, the authors give brief examples of tests having occurred in their own practice as psychotherapists and discuss the models by comparing them among each other. Conclusions are drawn concerning the usefulness of the test concept for psychotherapy practice and research.     

États de mal épileptiques : épidémiologie, définitions et classifications

The annual incidence of status epilepticus based on the definitions of the International League Against Epilepsy (1993) ranges from 10.3 to 41 per 100,000 inhabitant. Half of the cases of status epilepticus concern epileptic patients. In all studies, incidence is higher in epileptic patients, young children and the elderly. It is estimated that 13% of patients with status epilepticus will experience recurrence during the two first years. The three leading etiologies are low-dose antiepileptic drugs, non-acute brain lesions and acute stroke. Seizures are generalized in 9 to 33% of patients and focal in 25 to 75%. Secondary generalized seizures can be observed in 19 to 66% of patients. Mortality ranges from 7.6 to 39% and varies as a function of inclusion of postanoxic encephalopathies and difference in initial care. The definition retained and the classification adopted for status epilepticus also affect mortality estimates. Status epilepticus is defined as the existence of a prolonged seizure or a series of seizures during which the patient does not recover, or incompletely recovers, consciousness. The duration parameter used to distinguish status epilepticus from a seizure remains controversial. At the present time, there is general agreement in the literature distinguishing two definitions based on different durations according to the clinical type of status epilepticus and its potential severity: (i) a status epilepticus is defined by a seizure lasting more than 30 minutes or recurrent seizures without recovery of consciousness over a period of 30 minutes; (ii) considering its severity, tonic-clonic status epilepticus has a specific definition leading to earlier therapeutic management. This operational definition is continuous, generalized, convulsive seizure lasting more than five minutes or two or more seizures during which the patient does not return to baseline consciousness. Several types of background can be used to establish a classification for status epilepticus: clinical manifestations, prognostic and therapeutic course, epidemiological data, pathophysiological mechanisms… At the present time, the classifications most commonly used in France for status epilepticus are derived from the syndromic epileptic classification, the seizure classification or the classification proposed by the French consensus workshop on status epilepticus. For routine clinical practice, an operational classification can be used to adopt therapeutic strategies adapted to probable prognosis: short-term life-threatening, mid-term life-threatening, not life-threatening.     

Recherche de sensations, désinhibition et pratique de sports à risque : quelques pistes de réflexion

Sensation seeking is at the root of different behaviours. Skydivers, artists, drug addicts and criminals somehow share the same need for stimulation. But are there drug-addicted skydivers? Are there different ways to seek sensations? Studies on risky sport practices and disinhibition are contradictory. While some find risk-taking athletes do not consume substances, others maintain these athletes are indeed the most uninhibited of all. Diversity and the type of activities supposedly depend on what exactly an athlete seeks from a psychological point of view. The analysis of different sensation seekers’ personality traits helps to better understand the choice and role of one or several sources of activation. Based on a review of studies, we will discuss three sensation seeker profiles. Depressed “escapists” primarily seek sensations through substance use in order to regulate their negative affects. This “passive” stimulation mode seems better suited than practising risky sports for these individuals lacking in energy. Conversely, extraverted “hedonists” comfort their positive affectivity by seeking multi-faceted pleasure in risky sports or the “social” use of substances. They are not characterized by negative affects but by alexithymia. Some probably bypass their difficulty to understand their feelings by seeking various readily available sensations that need not be mentally interiorised (purportedly found in disinhibition or risky sports). Finally, “compensatory” types are adventurers who seek sensations in high-risk sports only. They are not characterized by depression, anxiety, disinhibition, extraversion or alexithymia. They seek to enhance and build up their personality by confronting the natural environment and danger. While all athletes seek sensations, these might not be essential to escapist and compensatory types who use them only as a mere means to escape and compensate. Extraverted hedonists seem to be the “true” sensation seekers inasmuch as stimulations are worthwhile in themselves. This strong need for hedonistic sensations might lead to an addictive process, a common answer to psychic sufferings that may also derive from boredom or a need for sensations and pleasure.     

Étude de la dépression,des événements de vie,de l’impulsivité et du lieu de contrôle au sein d’une population nouvellement incarcérée

Introduction

During the first days of incarceration, the “shock prison” may encourage the appearance of symptomatology reaction with the presence of depressive disorders. Several studies in prisons showed the presence of certain socio-demographic characteristics, psychological and legal in this population life course singular susceptible to weaken against the event that represents an incarceration.

Objective

The present study is twofold. This is firstly to assess depression, life events, impulsivity and locus of control in a newly incarcerated population and secondly to compare the results with depressed people those do not show depression.

Method

Maintenance of semi-structured research was proposed to 46 inmates in the unit of outpatient consultations in a prison in 2010. This interview was completed by placing two questionnaires (Beck Depression Questionnaire, Eysenck Impulsivity Questionnaire) and scale (Multidimensional locus of control scale of Levenson).

Results

Of the forty four inmates incarcerated for less than 10 days, who participated in the study twenty-six had a depression, a significant number of incarceration, psychiatric history, certain life events (personal and maternal abuse, parental alcoholism), as well as significantly higher scores with regard to empathy and external locus of control type “powerful character”.

Conclusion

Home maintenance is a systematic critical time. Newly incarcerated population, with a depression score above the standard psychological characteristics show support from the idea of a unique formation of the personality associated with the presence of life events and highlights particularly difficult childhood susceptible to weaken, especially to cope with the event that is incarceration.     

Relations entre dimensions émotionnelles et symptômes somatiques : effets médiateurs de la dépression et de l’alexithymie

Objectives

The aim of the present study was first to complete previous research on negative affectivity, alexithymia, depression and somatic symptoms by testing a theoretical model of their relations. It was second to investigate potential mediating effect on the relations between negative emotionality (i.e. neuroticism) and somatic symptoms.

Patients and method

A sample of 309 subjects (77% F et 23% M; mean age = 20, 61 ± 1.55) completed the following questionnaires: the Positive and Negative Emotion questionnaire-31 items (EPN-31), the Toronto Alexithymia Scale 20 items (TAS-20), the Center for Epidemiological Studies Depression scale (CES-D), and the Symptom Check List Revised, 90 items (SCL-90 R). Theoretical model and mediating effects were tested using structural equation modeling, and bootstrapping method.

Results

Three measurement models were tested: First, a direct effect model did not fit the data. Second, a partially mediated model fit partially the data for some indices, but not for others, and was rejected for lack of parsimony. Finally, a full mediation model showed the best adjustment with results confirming the good fit of this structural model including (Chi² = 10.245, P = 0.069, ns; CFI = 0.989 > 0.95, RMSEA = 0.058 < 0.07 [90% IC = 0.000–0.100], SRMR = 0.026 < 0.08). So as, our results show that alexithymia and depression are full mediators of the negative affectivity–somatic symptoms relation. In other words, when depression and alexithymia are introduced in the relation between negative affectivity and somatic symptoms, the direct effect of negative affectivity becomes non-significant, and turns to an indirect effect. Moreover, depression as a stronger effect on somatic symptoms than alexithymia, which seems to confirm previous research on the distinction between both constructs. These results are compatible with that of previous works on somatic symptoms and negative affectivity, and on somatic symptoms and alexithymia.

Conclusion

The propensity to experiment negative emotional states may contribute to develop negative emotion regulation strategies such as alexithymia, which as a direct effect on somatic symptoms. But more precisely, we can hypothesize that alexithymia is not fully efficient as a defense against negative emotions, and that depression remains a strong characteristic of subjective emotional experience for some subjects, constituting a strong contributor to declarative somatic symptoms. Implications for psychotherapy are discussed, supporting the enhancement of negative emotions regulations strategies for subjects showing somatic complaints.