Cannabis et trouble bipolaire : recherche d’une association à partir d’une revue de la littérature

Introduction

It has been established that cannabis use is involved in the emergence and evolution of psychotic disorders. Although cannabis use is very frequent in mood disorders, there has been a considerable debate about the association observed between these two disorders. This review aims to clarify the relation between cannabis use and bipolar disorder, in order to unveil a possible causality and find the effect of cannabis on the prognosis and expression of bipolarity.

Methods

The review used MedLine database using the keywords “cannabis” or “marijuana” and “bipolar” or “mania” or “depression”. This search found 36 articles who were clinically relevant to the subject and were included and discussed in this review.

Results

The first studies discussing the link between cannabis use and psychotic disorders reveal manic features in the substance abuse group, hence suggesting a possible association between cannabis use and bipolar disorder, in favor of triggering a manic episode. According to the studies, between 25 and 64% of bipolar patients are cannabis users, and the prevalence is higher in younger and male patients. The risk of developing a mood disorder is higher among cannabis users compared to the general population. This substance abuse in bipolar disorders would increase the frequency and duration of manic episodes without changing the total duration of mood episodes. In a first episode of bipolar disorder, the use of cannabis would increase the rate of relapses of manic episodes and worsen the prognosis of the disorder.

Discussion

The frequency of substance abuse in bipolar disorders is higher than the prevalence in the general population, and cannabis is one of the most used illegal substances in the worldwide. Hence, the association between cannabis use and bipolar disorders is frequent. Cannabis users may experience euphoria, relaxation and subjective feelings of well-being; this substance may also have antiepileptic effect, which may explain some of the effects of cannabis on bipolar disorders. In fact, the use of cannabis would increase the frequency and duration of manic episodes in bipolar patients without increasing the total duration of mood episodes, suggesting a possible antidepressing and mood stabilizing effects. This impact of cannabis on mood disorders and its possible pharmacological effect is still controversial and needs further experiencing to be proved.     

Validation d’un questionnaire interactif sur la santé mentale des enfants de 6 à 11 ans

The “Dominic Interactive” is a computerized pictorial questionnaire used for the assessment of 6 to 11 years-old children’s mental health. The pictures illustrate the abstract emotional and behavioural content of most frequent mental health problems based on DSM-IV symptomatology. The cederom-based “Dominic Interactive” was given to 253 community children from voluntary Aix-en-Provence schools and to 150 children from 4 child psychiatric clinics. In the child psychiatric clinics referred children also received clinical diagnoses. Prevalence estimates and symptom scores yielded by the “Dominic Interactive” in referred children were significantly higher than those in general population. Since the “Dominic Interactive” is like a playful practical game of very easy use, its acceptability by both children and professionals was excellent.     

Phénomènes d’allure télépathique dans la relation thérapeutique avec des patients schizophrènes : hypothèse d’une potentielle nocivité de la pensée soignante

Telepathic phenomena within the transference relationship with psychotic patients are regularly described by many authors, well-known serious psychoanalysts; many examples will be proposed. Telepathy was a noted subject of scientific studies between the end of the 19 and the beginning of the 20-century. Many examples got from the author's clinical experience will show that in the frame of a long-term therapy with psychotic patients, some telepathic-like phenomena can occur. We propose to name “telepathic identification” such moments when the therapist stops to pay attention to his patient's speech, monopolized by a sudden concern, and when the patient begin to talk about this very concern as if it was one of his own. Many explanatory hypotheses will be developed. The author emphasizes also the possible iatrogenical influence of the therapist's mental objects, as well his concerns as his theoretical models. At last, the hypothesis of a “telepathic identification” is considered as a manner to avoid being abandoned by the therapist, a mechanism, which originates in the early mother-infant interactions.     

La « MOTO », dispositif d’aide aux activités au sol pour les enfants IMC très atteints dans leur motricité ou polyhandicapés

The position on the knees on W (or “TV sitting”) presents orthopaedic inconveniences but is very interesting for the activities on the ground. Considering the importance of their disorders, some children PC (IMC very affected and all the more the multi-handicapped) cannot adopt this position. The “motorcycle” is a foam device, which is inspired of “trotte-lapin”, to which is added a thoracic support. It allows the children very affected in their motricity to reach the activities on the ground in comfortable and active situation, even in the company of other children, valid or less affected: the thoracic support helps the relaxation and the mobility of upper limbs – in connection with the visual activity – while allowing the emergence of the antigravity response of the axis of the body. The “motorcycle” can be considered as a supplement to the various installations and the reeducational situations.     

Conscience de Soi, maintien du Soi et identité humaine au cours de la maladie d’Alzheimer

Identity is a part of self-consciousness, which is also expressed as “being in the world” which one in turn shows to others as the Self. The assessment of the Self in a population of patients with Alzheimer's disease, according to a multidimensional definition (physical, social, spiritual), showed that the social self was impaired, and the severity of impairment of the self was correlated to apathy and lack of semantic autobiographical memory. It also appears that ipseity is selectively affected by the disease.     

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.     

Hypothèse idiographique concernant la médiation cognitive à partir du Rorschach « non valide » d’un patient schizophrène en phase de stabilisation symptomatique

After reflexion about “short” and “invalid” protocols in the Rorschach Comprehensive System, the author analyses a protocol of a schizophrenic patient in symptomatic stabilization. This Rorschach does not meet the criteria of validity (less than 14 answers and 3 rejections of cards) and therefore does not allow to achieve a complete structural psychopathological analysis. The hypothesis of this contribution is to achieve a phenomenological study of this protocol centered on the cognitive mediation process. The implicit approach of “false perception” suggested to the patient (“what might this be?”) seems hardly tolerable and could, in part, explain the refusal of cards and the systematic questioning of the response and finally their rejection. This “methodical doubt” is similar to the exercises of cognitive remediation based on knowledge of disorder and his associated symptoms. Finally, the analysis of the Rorschach gives us interesting information about symptomatology stabilization and residual component of the schizophrenic disorder. These observations appear to be incompatible with homeostatic hypothesis and demonstrate the usefulness of residual schizophrenia diagnosis.     

Toc résistant : caractéristiques cliniques, facteurs prédictifs et influence des tempéraments affectifs

Background

Despite significant advances in clinical research, Obsessive Compulsive Disorder (OCD) represents a difficult to treat condition. The French Association of patients suffering from OCD (AFTOC) is highly concerned by this issue. A new survey was implemented with the aim of exploring Resistant Obsessive Compulsive disorder (ROC).

Method

Patients with OCD and members of the “AFTOC” were included in the survey. A self-rated file was elaborated in order to get the maximum of information on the clinical and therapeutic aspects and conditions of OCD. The full version of “TEMPS-A” was also included for assessment of affective temperaments. Statistical analyses were performed for inter-group comparison between “ROC” (resistant OCD) and good responders. Logistic regression analyses with “ROC” method were used to search for independent predictive factors to “ROC”.

Results

The new survey of “AFTOC”, “TOC & ROC” selected a sample of 360 patients, who are members of the association. The rate of “ROC” was 44.2%, 25.3% of Good Responders (GR), and 30.5% in between. Inter-group comparisons (“ROC” versus GR) showed significant higher rates of psychiatric admissions (49% versus 28%), and suicide attempts (26% versus 13%), greater numbers of doctors consulted (5.5 versus. 3.2), compulsions (4.6 versus 3.4), and psychiatric comorbidity (2.8 disorders versus. 2.0; notably agoraphobia, social anxiety and worry about appearance) in the “ROC” group. Assessment by full “TEMPS-A” scale revealed, significantly higher rates of Cyclothymic Temperament (63% versus 43%; p: 0.0003), Depressive Temperament (72% versus 53%; p: 0.004), and Irritable Temperament (21% versus 9%; p: 0.02) in the ROC group. Moreover, the mean global score on each of these temperaments was significantly higher in the “ROC” group. No difference was obtained in the rate or the mean score on the hyperthymic temperament scale. The most predictive factors of “ROC” were represented by “slow continuous course”, “worsening under SRI”, “worry about appearance”, current age above 40 years and psychiatric admission.

Conclusion

Our data provides a more precise clinical picture of “ROC”, which should be initially explored through baseline severity, compulsive dominance, hoarding, special comorbidity such as recurrent depression, obsession of appearance, agoraphobia, social anxiety, and complex mixture of unstable affective temperament (cyclothymic, irritable, and depressive), and course of illness. Furthermore, vigilance towards the notion of worsening linked to drug therapy, and the increased suicide risk is warranted in the clinical management of “ROC”.     

Le comportement d’observance des patients atteints de schizophrénie : impact du diagnostic et du traitement. Analyse phénoménologique de trois attitudes

The aim of this study is to analyze the different characteristics of three patient clusters defined according to their relationship toward their disease. Based on the 40 patients collected data, we were able to identify three patient groups: 23 patients were qualified as “active” as they showed a more collaborative participation in career venues and higher acceptance of comprehensive treatment plans (57.5 %). Seven patients were qualified as “passive” as they had less autonomy and therefore were less concerned with the treatment modalities (17.5 %). Ten patients were qualified “ambivalent” as they had a more conflicted understanding and insight of their disease, of their careers and their family dynamics (25 %). “Active” patients had a higher level of understanding of their diagnosis, were more aware of prescribed treatments and of the negative consequences of poor compliance. “Passive” patients were more willing to learn about their diagnosis, while having a significantly lower baseline knowledge of it, were more often prescribed an atypical neuroleptic and reported higher satisfaction with their medical treatment. “Ambivalent” patients had a higher propensity for disagreeing with the negative consequences of their disease, were more often prescribed two classic neuroleptics, reported higher rate of self-discontinuation of treatment and were overall less satisfied with their treatment. It appears that the disagreement with the understanding of the disease and its seriousness has a major impact on the acceptance of the treatment modalities and leads to reduced adherence to treatment plan.     

Le suicide dans la maladie de Huntington : état actuel des connaissances

Objectives

In 1872, George Huntington was the first to describe a genetic disease combining three types of disorder symptoms viz: motor, cognitive - evolving to cortical dementia and psychiatric. The purpose of this paper is to provide a selective review of the major issues and findings concerning suicide in Huntington's disease. The aim was to understand why patients with Huntington's disease have a higher suicide rate than those suffering from other neuro-developmental diseases.

Materials and methods

The present review is based on a MEDLINE survey of the relevant literature. The terms used in the search were: “Suicide”, “predictive genetic testing”, “suicidal risk factors” and “suicide attempt” all in combination with “Huntington's disease”. All abstracts were read and potentially relevant articles were examined in full. Various other important cross-references were included.

Results

Most of the authors found that suicidal occurrence in Huntington patients was four times higher than that in the general population. No specific individual risk factor was found except a lack of offspring and of psychological support. This review also considered the patient's attitude towards predictive genetic testing and its results. Reactions varied from psychological relief to paradoxical suicidal resurgence.

Conclusion

This paper emphasizes the need of appropriate psychiatric care for Huntington's patients in order to try to prevent suicidal behaviour.     

Prévalence de l’hypomanie dans les dépressions majeures récurrentes ou résistantes : enquêtes Bipolact

Bipolar II disorder is officially recognized as a mental disorder in DSM-IV-TR and defined by the presence of hypomanic episodes alternating with major depression. Despite data supporting clinical complexity and high morbidity and mortality rates, BP-II disorder is often overlooked or misdiagnosed as unipolar major depression or personality disorder. Moreover, many clinicians still regard it as a milder form of manic-depressive illness. These unsolved problems propose to investigate hypomania prevalence rates in resistant and recurrent depressions, at a large national scale, by means of three large surveys (Bipolact Surveys) carried out in both psychiatric and primary care settings. This research is a part of a national project for medical education on bipolar disorders established in September 2004. Screening of hypomania was done by self-assessment with the hypomania checklist HCL-20; hypomania cases were defined by a score greater or equal to 10 on the HCL-20. Inter-group comparisons (BP-II versus unipolar depression) and multiple logistic regression analyses were conducted on all demographic and clinical factors obtained. Data obtained in the “real world” medical practice (in total, 623 physicians and 2396 patients with major depression) revealed a high rate of hypomania around 62% in both recurrent depression samples (primary care and psychiatric settings) and 55% in resistant major depression. Additionally, the inter-group comparative data allowed drawing the BP-II disorder profile by selecting the most significant differences versus unipolars. “Ups and Downs” (cyclothymic traits) represented the most important and common (in all three different logistic models) risk factor of hypomania. In recurrent major depression, “ups and downs” seemed to act independently from another important risk factor, i.e. “family history of bipolarity”. “Mood switching” was the major risk factor for hypomania in patients with resistant depression; further risk factors were “substance abuse”, “young age of onset”, “agitated - mixed - atypical forms of depression”. These factors are meaningful at clinical and phenomenological levels, and can validate the dimensional approach of hypomania and the cut-off score on the HCL-20.     

Big five-factor contributions to addiction to alcohol

Introduction

Personality in the field of addiction has been the subject of many studies. The purpose of this article is to synthesize the data obtained with the Neuroticism Extraversion Openness – Personality Inventory – Revised (NEO-PI-R) and the NEO – Five-Factor Inventory (NEO-FFI) among the persons who drink and suffer from addiction to alcohol.

Background

These tools, based on the theory of “The Big Five Factors”, assess the personality from a dimensional point of view. The five big dimensions addressed by these tools, are “Neuroticism” (general tendency to experience negative feelings), “Extraversion” (sociability, positive feelings, activity and self-confidence), “Openness” (imagination, intellectual curiosity, aesthetic sensitivity, attention paid to one's own feelings and no dogmatic behavior), “Agreeableness” (interpersonal tendencies) and “Conscientiousness” (forward planning, organization and task carrying out). According to Diagnostic and Statistical Manual of mental disorders (DSM-IV-TR), alcohol consumption is based on three dissimilar behaviors: utilization (alcohol consumption not leading to complications or damage), abuse (regular consumption likely to cause somatic, psycho-emotional or social damage for the individual or for his/her family circle) and dependency (excessive utilization leading to deterioration in functioning or clinically significant suffering).

Literature findings

Alcohol consumption among young adults can thus be predicted through a high level of “Neuroticism” associated with a low level of “Agreeableness”. Persons having been addicted to alcohol (present or past) have a high level of “Neuroticism”, a low “Agreeableness” and a low level of “Conscientiousness”, contrary to patients who have never been addicted to alcohol. The NEO-PI-R also enables a more accurate analysis of the personality, since each of these five big dimensions is divided into six facets. Among the patients with a past or present diagnosis of alcohol abuse, we found a low score on facets “trust”, “achievement striving”, “self-discipline” and “dutifulness” and a high score on “impulsiveness”, “vulnerability”, and “excitement-seeking”. Although dimension and facet results measured by this tool can differ according to craving level or according to gender, the studies agree in that there are common aspects among the patients.     

Deux curiosités historiques : l’hôpital civil et les cellules de Compostelle de l’asile d’aliénés de Cadillac

In 1617, the first duke d’Épernon founded Cadillac hospital and granted it financial autonomy on two conditions: (1) that 12 beds should serve for the free treatment of ill local people; (2) that six other beds should be used for the free accommodation for one or two nights of travelers and pilgrims on the road to Santiago de Compostella. The “civil hospital” was the beginning of the Cadillac lunatic asylum, of which it was to become an “annex”. Right up to its closure in 1972, it was still used for its original purpose: to provide general medical care. However, to this day, two of the six original cells for travelers are still operational as such. Hence, almost four centuries after its foundation, Cadillac hospital continues to serve its original purpose as a temporary place of accommodation for pilgrims that its founder wished it to serve.     

Les contraintes en rééducation : réflexions d’une psychologue

Motor reeducation of children with cerebral palsy comprehends some constraints, both physical and psychological. Through the observation of a number of young patients, we wish to show how they feel about these constraints, what are the motives and the aims of their participation and how their psychological development can be affected. We shall then consider what the use of these constraints implies for the health care team. Finally, the notion of “therapeutic alliance” will be presented and distinguished from “compliance”.     

Autisme, psychose précoce, troubles envahissants du développement

In the new revision of the French classification of mental disorders in children and adolescents (CFTMEA-R2010), the concept of early psychosis has been preserved in the category “pervasive developmental disorders” (PDD), as defined by the international classifications (DSM-IV and ICD-10). Within PDD, diagnostic categories “Early psychosis with retardation” (and “mental retardation with autistic or psychotic disorders”) and “multiple and complex development disharmony (MCDD) – psychotic disharmony” are still individualized. A special effort was made to facilitate connections of the diagnostic categories between CFTMEA-R2010 and ICD-10. These connections are useful for activity computerized recording (RIM-Psy) and international research programs.     

L’« originalité » perceptive d’un sujet pervers au test de Rorschach

The author starts with a discussion about two notions appearing into the Rorschach test: the perception and the apperception. By this way, it is suggest ways for a phenomenological study of the Rorschach test. These proposals are consistent with those of the Comprehensive System (Proposed by John E. Exner). Then the author proposes a protocol analyzing of a patient with a perverse psychological functioning. In one hand, the result obtained by the Form Quality (FQ) is detailed in particular regarding to the status of unusual perceptions. According to the Comprehensive System proposed by J.E. Exner, a significant proportion of responses “u” (46 % for this protocol) indicates that the person is not influenced by any social request or any expectation and some of his behaviors could ignore or avoid any question about social convention. From an other point of view, when analyzing these data, an adaptive dimension for these unusual perceptions is identified. The pervert perceives the stimuli that “really exists” according to him not everyone can perceive it. This advantage allows a better adaptation to the environment and the ability to change this environment. The manipulation (a particular skill that is most of the time attributed to the perverse person) is probably a consequence of having an original perception of reality. It is also discussed the interpretation of the “anatomical content” in connection with this adaptive hypothesis. In addition, the author also discusses a particular answer of the protocol: the answer “shoes” that presents a specific perceptual characteristic.     

Le politiquement incorrect en psychiatrie : l’expérience d’une vie professionnelle

The author criticizes theorists show, phenomenon of “administrative ecstasy”, and dominance of political correctness against truth and scientifically established facts. He tells three professional experiences where he refuses the official position, preferring the politically incorrect: mental report, AIDS in prisons, care reform in his own prison psychiatric department.     

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.