Trouble psychotique révélant une épilepsie associée à une tumeur dysembryoplasique neuroépithétliale de l’hippocampe gauche

Introduction

Psychotic symptoms are a rare but well-known complication of epilepsy. The prevalence is estimated between 4 and 9%.

Patient

We report a case of a 40-year-old patient, unrecognized epileptic, who presented an acute psychotic syndrome which seemed to be of functional origin, the EEG performed during the episode, and the cerebral CT scan being normal. Nevertheless, the clinical presentation, especially the sudden ending of delusions, led to further investigations. Careful history taking and repeated EEG recordings allowed the diagnosis of partial epilepsy that had begun 17 years earlier and symptomatic of a dysembryoplastic tumour of the left hippocampus revealed by MRI.

Discussion and conclusion

Search for an epileptic origin of an acute psychotic syndrome must always be undertaken by systematic EEG. The possibility of a symptomatic temporal tumor must not be overlooked.     

Validation study of the French schizotypal personality questionnaire in a sample of adolescents: a confirmatory factor analysis

Aims

This article aims to validate the schizotypal personality questionnaire in a sample of French speaking adolescents. Because early schizotypal manifestations are predictive of psychosis-proneness, reliable self-report measures are crucial for early detection of vulnerability to schizophrenia during adolescence. Unlike most existing self-reports, the questionnaire de personnalité schizotypique (SPQ) assesses individual differences in all nine feature of DSM-IV schizotypal personality (i.e. ideas of reference, excessive social anxiety, odd beliefs, unusual perceptual experience, odd behaviour, no close friends, odd speech, constricted affect and suspiciousness). Furthermore, it yields dimensional scores concerning the main schizotypal factors, which represent valuable information for the clinician's case formulation and can be used as a screening instrument in the general population.

Method

Our sample consisted of 174 adolescents (98 girls) between 12 and 17 years old. All completed the SPQ 74-item self-report. Participants were recruited in secondary schools in Switzerland, and through the child and adolescent community outpatient psychiatric service (office médico-pédagogique) affiliated to the University of Geneva's Psychiatry Department and to the Canton of Geneva Education Department. A confirmatory factorial analysis was conducted on our sample to test nine competing models of SPQ. The 3-factor model of Raine et al. was compared to concurrent 2, 3, and 4-factor models. Simple structure models of Raine et al. and Stefanis et al. were also tested.

Results

The following observations were highlighted in our results: (1) goodness-of-fit indices are better for structures allowing cross loadings than for simple structures; (2) amongst the simple structures, the best goodness-of-fit index was obtained for the Raine model and (3) the fit between our data and the Raine model is improved by a cross loading for suspiciousness subscale. The latter seems problematic for the global data fitting. This led us to test simple structures models of Siever and Gunderson, Raine et al., and Stefanis et al., based on eight subscales rather than nine. Without suspiciousness subscale, goodness-of-fit indices are enhanced in these three models. The 3-factor model yields the clearest and most reliable results in comparison with other competing models. In summary, the best goodness-of-fit indices were obtained for the 3-factor Raine model. Goodness-of-fit indices could be improved by the exclusion of the suspiciousness scale.

Conclusions

Consistent with earlier analyses by Raine et al. and Dumas et al., our data confirm the 3-factor model of the SPQ (cognitive-perceptive; interpersonal; disorganized) in a sample of French speaking adolescents. Our analyses confirm that two dimensions are insufficient to explain the structure of schizotypy during adolescence. These results further suggest the stability of a 3-factor structure during lifespan. We note that the inclusion of the suspiciousness subscales engenders statistical issues. Most studies to date have dealt with these issues by performing a cross-loading with this subscale, or by the inclusion of a paranoid factor which is linked with the negative and the cognitive-perceptive factors. We found that the most statistically sound strategy was reached without the inclusion of the suspiciousness subscale. Future studies with larger samples could investigate the SPQ structure at an item-level, which carries the benefit of reduced restrictions on the factorial analysis. In conclusion, the current study shows that the French version SPQ constitutes a reliable self-report questionnaire for the assessment of schizotypal trait expression during adolescence that may assist in the evaluation of psychosis proneness in youths.     

Dysphasie et/ou psychose ?

Many children are diagnosticated psychotics because they present language disorders. A delay of language is often evocated. This work attempts to interrogate specific language disorders from dysphasia in comparison with psychotics language disorders. According to international classifications, dysphasia excludes psychotics disorders (or “pervasive developmental disorders”). Therefore, this point of view doesn’t make unanimity. After a short French overview on this subject, we’ll see that a partition can be clearly distinguished between dysphasia and psychosis. The only symptomatology from language disorders can’t be an assured guide for the diagnostic. At the end, we’ll bring a conceptual bridge between dysphasia and “debility” according to specific meaning gived by J. Lacan.     

Les psychoses postictales

In epilepsy patients, psychotic states are related to a group of psychotic disorders with a specific phenomenology in which potential pathophysiological mechanisms are believed to be closely related to the epileptic disorder itself. Postictal psychosis is a very specific syndrome in relation to seizure activity: a clear temporal relationship exists between the psychotic state of sudden onset and a precipitating bout of complex partial or generalized seizures, with a characteristic lucid interval which lasts from two to 120 h. The psychotic state may be related to the withdrawal of anticonvulsants, often in connection with video-EEG monitoring. The phenomenology of the psychotic state is often pleomorphic, with abnormal mood, paranoid delusions and hallucinations, with some clouding of consciousness or no evidence of impaired consciousness. The outcome is characterized by a remission of the psychotic symptoms over several days (mean: 1 week), with or without neuroleptic treatment. The majority of the patients suffer from complex partial seizures with frequent psychic auras that secondarily become generalized. In the majority of cases, prepsychotic EEG abnormalities persist during the psychosis. Frequent bitemporal foci are recorded on the EEG and MRI abnormalities (including mesial temporal sclerosis) are seen in more than half of the cases. The results of clinical, morphologic and metabolic available studies will be briefly discussed.     

Claustration et collectionnisme : réflexions à propos d’un cas de syndrome de Diogène avec vols kleptomaniaques et vengeurs

Social withdrawal is a pathognomonic behaviour that is consistently associated with mental illnesses. Compulsive hoarding can also be interpreted as a pathological behaviour, even when it does not involve kleptomania. Diogenes syndrome (DS) was first described in 1975, and is characterized by both behaviours - social withdrawal and compulsive hoarding. Even though it is often the manifestation of a psychiatric condition, its aetiology is diverse. The most frequent ones are however: dementia, schizophrenia and mental retardation. In this study, we describe an atypical case presenting with DS. Il consists of a young man, seen in a forensic setting, who had been diagnosed with kleptomania in the past, presents with compulsive hoarding, and whose recent thefts were fuelled by revenge. Finally, to our knowledge, the way social withdrawal is viewed is seldom taken into account. We analyse its implication on social withdrawal.     

Travail psychique durant la grossesse, étude au travers d’un cas de psychose du post-partum

Post-partum psychosis occurs in one to two cases out of 1000 deliveries. Studies in prenatal psychiatry have improved our understanding of the symptoms. If the prognosis of the acute state is generally positive, the rate of recidivism remains important due to the risk of becoming chronic. Analysis of the data allows preventative work with mothers-to-be. From a psychodynamic perspective, pregnancy is a time of important psychological conflicts, identity crisis and awakening of infantile conflicts. The understanding of those psycho-emotional mechanisms related to pregnancy and the multidimensional approach appears to be indispensable in taking care of acute psychiatric post-partum states. The case of Mrs. O, hospitalised in adult psychiatrics for a post-partum manic episode shows how those theoretical models become relevant in order to elaborate intra-psychological conflicts. The anamnesis and the history of the patient revealed the existence of several risk factors for triggering the psychosis. The identification of the patient to her maternal lineage in association with revisiting her infantile past grounded the psychosis. We worked the issue of her place within her maternal lineage, with her husband and her place as a mother. The confusion about her own identity added to the patient's generational confusion was gradually amended and a work of separation/individuation could then be undertaken.     

Soigner la psychose. Le cadre de soin extrahospitalier : un objet à utiliser

The present article examines, through the evocation of a transference relationship between the author and a psychotic patient, the effects of an outcare setting based on the model of a Therapeutic Club. This structure was created during the institutional psychotherapy's era and was seen as a fundamental way of transforming the psychiatric institution. The personal decision of the patient to attend this kind of specific structure, i.e. without the interference of therapeutic injunction but with the nursing staff notifying this initiative, allows, in our opinion, to make a direct link with Winnicott's use of an object theory. This analysis puts emphasis on the dynamics articulating the inside and the outside and allowing thus to build, destroy, rebuild the outer setting towards the identification as object. The main hypothesis is that the process would help the psychotic patient towards re-entering into a libinal and progressive subjectivation by orchestrating an interaction between the patient and the object. The extra-care of the nursing staff, corollary with an internal need of reparation, leads to the emergence of a containing function. It works like a central component for the patient in the progress of self-individualization, in terms of indicator of his use of an object process.     

Madeleine Lebouc : se faire un corps sanctifié par la religion catholique

Madeleine Lebouc, alias Pauline Lair Lamotte, fascinated Pierre Janet. Her ecstasies, her stigmatas and the way she constantly walked on her tiptoes truly amazed him. How he raised her as a paradigmatic case in De l’angoisse à l’extase reveals this. Because she was hospitalised in a mental ward and set as an example to scientifically explain mysticism as the separation of the Church and the French State had just been achieved, Madeleine was rejected by the clergymen. Nevertheless, her religious commitment cannot be questioned and is actually worth analysing. Her existential orientation to Franciscan ideals helped her tame the torments of her cyclothymic psychosis until that defence collapsed, resulting in her being confined to La Salpêtrière. In her mystic delusion oscillating between melancholic unworthiness and manic ecstasy, Madeleine then adopted the ideal image Janet had of her. Without knowing it, Janet was indeed at the origin of her patient's stigmatas. By the use of these signs of Christ, worshipped in the Catholic religion, and by her physical elevation - walking on her tiptoes -, Madeleine tried, next to the famous psychologist, to attain a glorious body through an image of holiness right where from she felt cursed because of the sinful pleasure tormenting her.     

Analyse d'énoncés d'enfants autistes à partir de la psychanalyse, quelle ouverture pour une énonciation ?

We propose to question in this work the possibility of the study of autistic children statements in the line of the first remarks of Kanner lit by the contributions of the linguistics and Lacan. By not taking the quoted language communication, but while being centered on an enunciation theory, we look for the possibilities of demonstrations subjective at the autistic child and the conditions of its occurred. We leave the assumption that there is an autistic subject, but that he cannot occupy a subjective position, which would join a speech act, a statement. By taking into account this difficulty, it would be a question then, for the clinician, to associate the subject to an act of statement to be taken care to mean what the child meets. Freud had a clinical approach anchored in the language, which brought advanced on the place of the word in the psychoanalytical private clinic. After Saussure, Benveniste and Chomsky bring us the lighting of the linguistics which missed to Freud. Lacan, by forging its “linguistery”, united these various contributions. In his some remarks on the autism, he supplies us with elements, which cross the contribution of Kanner. The recent translation of unpublished work of Kanner allows us a new approach of the question. We so notice the conditions to an access possible for the language for these children, which does not amount to a simple custom of communication, but allows a subject to join the world.     

À propos de la notion de structure dans l’enseignement de Jacques Lacan : un éclairage par la clinique des psychoses

The work of Jacques Lacan is based on the concept of structure as much as it is a subversion of it. Introducing the dimension of the subject of the unconscious, Lacan makes it possible to question the very foundation of clinical approach: “what do we mean by talking”? “What do we call a dialogue”? The Lacan's teaching sets up a certain number of invariants in the nature of language: the network of signifiers, the place of the Other, the Name of the Father and object “a”, so many items that are revealed in their pure form in the clinic of psychosis. Today, these results enable us to isolate a number of purely structural entities in our practice, just as the authors emphasize the clinical validity of forgotten syndromes such as Cotard or Frégoli syndrome.