疑病症的预设信念冲突理论的研究进展

疑病症是一种充满争论且难以治疗的躯体形式障碍。近年来,研究者们开始关注心理创伤对心理健康的影响,并为创伤后应激障碍和强迫症等焦虑障碍构建了相应的理论。疑病症与心理创伤关系密切,而且在症状学上与一些焦虑障碍相似。现探索性地从心理创伤的角度提出疑病症的预设信念冲突理论。未来研究可对该理论的合理性进行验证,并在其基础上建立更为整合的模型。     

Jean Garrabé et l’histoire de la psychiatrie dans les Annales Médico-Psychologiques

Jean Garrabé has published about 40 historical articles in the Annales Médico-Psychologiques. He has written on the history of the classifications, on the evolution of clinical entities (bipolar disorders) and of theoretical matters (psychopathology, politics, mondialization, antipsychiatry), on the relationships of psychiatry with artistic, literary and musical creation. But he has above all written many biographical notices of practitioners of mental medicine in France from the beginning of the 17th century (Montalto) to the end of the 20^th (Ey, Lacan). The personage of Pinel often appears in his papers like a central figure of the psychiatry, analyzed far from both hagiography and demolition. Garrabé can be considered like a “psychiatrist-historian”, erudite as well as critical.     

L’avancée en âge des personnes atteintes de troubles du spectre de l’autisme. Éléments cliniques et psychopathologiques

ObjectivesThis article attempts, from a psychopathological perspective, to clarify the clinical evolution of patients with ASD during adulthood and into old age, and to assess the risks and the chances. In addition, the article also attempts to address the experiences of these people confronted with their own aging, the death of loved ones, and their own mortality. This study of a cohort of 314 elderly patients can provide some data concerning these changes.MethodThe study of the cohort of 314 adult and aging patients makes it possible to specify several aspects of ASD in adulthood: level of severity, associated disorders and co-morbidities (psychiatric disorders, intellectual deficit, epilepsy, neurosensory disorders, genetics). At the clinical and psychopathological level, the behavioral disorders are described therein with reference to the dominant psychopathological modes of functioning: typical autistic modalities (notion of post-autistic recourse), symbiotic modalities, acute anxious exacerbations, depressive and manic functionings.ResultsPropose an elucidation of challenging behaviors (or problem behaviors) and make it possible to address them; demonstrate that their evolution during advancing age is rather favorable while insisting on the permanent vulnerability of certain subjects. Specify the main courses of action, insisting on spatial, temporal, and relational security; on the central place of care procedures (fundamental physiological needs, consideration of somatic pathologies, specific care with psychotropic drugs, psycho-corporal approaches); and on the attention paid to everyday life, a major therapeutic mediator, through maintaining a reasonable amount of activity.DiscussionThe approach proposed here confirms that the main problem facing adults diagnosed with ASD is that of associated disorders and psychiatric co-morbidities, more than that of the fundamental symptomatic particularities necessary for the diagnosis of ASD (the autistic tripod). This requires going beyond the notion of challenge behavior and adopting a functional perspective that ultimately reveals sometimes major psychic suffering and the adaptive attempts that these patients make to cope with it.ConclusionThe clinical work with this particular population confirms the need for structured institutional work, the only thing that can ensure the coherence of the approaches to working with this diverse patient population, one that is diverse, with generally favorable developments, but which still remains very vulnerable.     

The “Territorial Self:” Theoretical Propositions for a Phenomenological Understanding of Schizophrenia

ObjectivesThis theoretical paper discusses the integration of a “territorial self” alongside the minimal and narrative selves most commonly described by contemporary phenomenology and used by phenomenological psychopathology.MethodsWe start from the schizophrenic experience and the tools for understanding it, in order to highlight some limitations in the use of vocal communication within the clinical system to evoke phenomena that are a priori pre-linguistic.ResultsThis theoretical path, which requires an openness to clinical observation and intersubjectivity, leads to nosographic and therapeutic implications that seem useful to us from a phenomenological perspective.DiscussionFrom a nosographic standpoint, we discuss the (non- systematic) crossovers between the schizophrenic experience and the psychotic experience; whereas, from a therapeutic standpoint, the proposal of the territorial self allows us to insist on the fact that the clinical relationship is characterized as much by an analysis of experience and a discussion about it as it is by a joint practice and an experiential experience requiring a common ground.ConclusionsThe “territorial self” proves to be a fruitful and heuristic theoretical proposal, enriching nosographic debates in the field of psychosis, and contributing to a reflection on the practice of psychotherapy.     

Exposition des enfants à la violence conjugale : troubles mentaux et facteurs de résilience. Étude transversale tunisienne

Conjugal violence is a social problem whose impact extends beyond the couple, to the children who are exposed.ObjectiveTo study the psychological impact of exposure to conjugal violence in children and adolescents in child psychiatry consultation and the factors associated with their capacity for resilience.Patients and methodsWe conducted a cross-sectional study on a sample of 30 children and adolescents, aged between 6 and 18 years and exposed to conjugal violence. Patients were recruited from the child psychiatry unit of the Hospital University of HediChaker of Sfax. We conducted clinical interviews to identify the psychological impact of conjugal violence on children. The resilience evaluation was done by self or hetero passation of the Child and Youth Resilience Measure (CYRM).ResultsChildren and adolescents exposed to conjugal violence suffered from trauma-related disorders and stressors in 40% of cases, mood disorders in 33.3% of cases and externalized disorders in 6.6% of cases. We found that children were more resilient than adolescents in the area of emotional care provided by their parents (12.66 ± 2.02 vs. 9.46 ± 2.69 among adolescents; P = 0.001). In contrast, adolescents were significantly more resilient than children in the area of contextual factors including spirituality (6.46 ± 1.4 vs. 4.53 ± 1.06; P = 0.000), education (11.13 ± 2.13 vs. 8.4 ± 1.54; P = 0.000) and culture (11.13 ± 2.13 vs. 8.4 ± 1.54; P = 0.000). The child's education and good mental health for the mother were associated with better resilience in the children. The child's exposure to conjugal violence by being both a witness and a victim was associated with a reduced capacity for resilience.ConclusionExposure to conjugal violence has a significant impact on the mental health of children exposed. The study of resilience and associated factors could thus be useful in order to limit the deleterious repercussions on children and provide them with harmonious development both on the somatic and psychological levels.     

Deviations from normative brain white and gray matter structure are associated with psychopathology in youth

Combining imaging modalities and metrics that are sensitive to various aspects of brain structure and maturation may help identify individuals that show deviations in relation to same-aged peers, and thus benefit early-risk-assessment for mental disorders. We used one timepoint multimodal brain imaging, cognitive, and questionnaire data from 1280 eight- to twenty-one-year-olds from the Philadelphia Neurodevelopmental Cohort. We estimated age-related gray and white matter properties and estimated individual deviation scores using normative modeling. Next, we tested for associations between the estimated deviation scores, and with psychopathology domain scores and cognition. More negative deviations in DTI-based fractional anisotropy (FA) and the first principal eigenvalue of the diffusion tensor (L1) were associated with higher scores on psychosis positive and prodromal symptoms and general psychopathology. A more negative deviation in cortical thickness (CT) was associated with a higher general psychopathology score. Negative deviations in global FA, surface area, L1 and CT were also associated with poorer cognitive performance. No robust associations were found between the deviation scores based on CT and DTI. The low correlations between the different multimodal magnetic resonance imaging-based deviation scores suggest that psychopathological burden in adolescence can be mapped onto partly distinct neurobiological features.     

The relationship of family characteristics and bipolar disorder using causal-pie models

Many family characteristics were reported to increase the risk of bipolar disorder (BPD). The development of BPD may be mediated through different pathways, involving diverse risk factor profiles. We evaluated the associations of family characteristics to build influential causal-pie models to estimate their contributions on the risk of developing BPD at the population level. We recruited 329 clinically diagnosed BPD patients and 202 healthy controls to collect information in parental psychopathology, parent-child relationship, and conflict within family. Other than logistic regression models, we applied causal-pie models to identify pathways involved with different family factors for BPD. The risk of BPD was significantly increased with parental depression, neurosis, anxiety, paternal substance use problems, and poor relationship with parents. Having a depressed mother further predicted early onset of BPD. Additionally, a greater risk for BPD was observed with higher numbers of paternal/maternal psychopathologies. Three significant risk profiles were identified for BPD, including paternal substance use problems (73.0%), maternal depression (17.6%), and through poor relationship with parents and conflict within the family (6.3%). Our findings demonstrate that different aspects of family characteristics elicit negative impacts on bipolar illness, which can be utilized to target specific factors to design and employ efficient intervention programs.     

Shall we use non-verbal fluency in schizophrenia? – A pilot study

Over the last few years, numerous studies have attempted to explain fluency impairments in people with schizophrenia, leading to heterogeneous results. This could notably be due to the fact that fluency is often used in its verbal form where semantic dimensions are implied. In order to gain an in-depth understanding of fluency deficits, a non-verbal fluency task – the Five-Point Test (5PT) – was proposed to 24 patients with schizophrenia and to 24 healthy subjects categorized in terms of age, gender and schooling. The 5PT involves producing as many abstract figures as possible within 1 min by connecting points with straight lines. All subjects also completed the Frontal Assessment Battery (FAB) while those with schizophrenia were further assessed using the Positive and Negative Syndrome Scale (PANSS). Results show that the 5PT evaluation differentiates patients from healthy subjects with regard to the number of figures produced. Patients? results also suggest that the number of figures produced is linked to the “overall executive functioning” and to some inhibition components. Although this study is a first step in the non-verbal efficiency research field, we believe that experimental psychopathology could benefit from the investigations on non-verbal fluency.     

Expertises judiciaires au pénal dans le contexte des désignations par le tribunal correctionnel

Transgressive antisocial acts, which are committed in particular by adolescents and young adults, are more frequent today in France, because the way of life in this changing world has been modified technologically, economically and ethically. This is due maybe to a widening of exchanges and the dissemination of transgressive images through social networks. In France, judges are increasingly calling on psychiatric experts for crimes. This recourse is even compulsory for subjects placed under the protection of justice. Conceptual psychoanalytic data allowed a better assessment of the psychopathological traits affecting the personality of the offenders. The psychiatrist who has to carry out forensic examinations must take into account the psychopathological aspects, personality traits and mixed symptomatology, as well as impulsive acts, aggression, violent affects, borderline states, sociopathic organization and addictions. He/she should also consider the determinism of their actions and the role of interactions with those around them. The goal the psychiatrists must be between protecting and caring before punishing. Courts want to better understand the mechanism of action (often impulsive) but also the nature of the care project promoting rehabilitation. Courts are concerned about the capacity for discernment and self-control, but also about the risk of recidivism.     

Protection or Vulnerability? A Meta‐Analysis of the Relations Between the Positive and Negative Components of Self‐Compassion and Psychopathology

Self‐compassion is increasingly explored as a protective factor in relation to psychopathology. The Self‐Compassion Scale (SCS) and its Short Form variant (SCS‐SF) are the most widely used instruments for measuring this psychological construct, and previous studies have indeed shown that the total score of this scale is negatively associated with psychopathology. In this article, we point out that half of the items of the SCS and SCS‐SF are positive indicators of self‐compassion and directly refer to the three key components of self‐kindness, common humanity and mindfulness, while the other half of the items are negative indicators of the construct and reflect the precise opposite of the key components, namely self‐judgment, isolation and over‐identification. A meta‐analysis was conducted including 18 studies that reported on the positive and negative indicators of self‐compassion as indexed by the SCS/SCS‐SF and their relations to various types of psychopathology. Results showed that positive indicators of self‐compassion were negatively associated with psychopathology, which confirms their hypothesized protective influence. However, the negative indicators were positively linked to psychopathology, suggesting that these scales tap increased vulnerability to mental health problems. Moreover, tests comparing the strength of the relations between various SCS/SCS‐SF counterparts (i.e., self‐kindness versus self‐judgment, common humanity versus isolation and mindfulness versus over‐identification) and psychopathology showed that the negative indicators were significantly stronger linked to mental health problems than the positive indicators. This provides support for the idea that the use of a total self‐compassion score of the SCS or SCS‐SF, which typically includes the reversely scored negative subscales, will probably result in an inflated relationship with symptoms of psychopathology. Copyright © 2016 John Wiley & Sons, Ltd.