No Effect of Serotoninergic Gene Variants on Response to Interpersonal Counseling and Antidepressants in Major Depression

Objective

Gene variants within the serotonin pathway have been associated with major depressive disorder (MDD) treatment outcomes, however a possible different modulation on pharmacological or psychological treatments has never been investigated.

Methods

One hundred sixty MDD patients were partially randomized to either inter-personal counseling (IPC) or antidepressants. The primary outcome was remission at week 8. Five serotonergic polymorphisms were investigated (COMT rs4680, HTR1A rs6295, HTR2A rs2224721, HTR2A rs7997012 and SLC6A4 rs421417).

Results

IPC (n=43) and antidepressant (n=117) treated patients did not show any difference in remission rates at week 8 (corrected for baseline severity, age and center). None of the studied gene variants impacted on response and remission rates at week 8 neither in the IPC nor in the antidepressant group. An analysis of the whole sample showed a trend of association between rs7997012 AA genotype and a better treatment outcome.

Conclusion

Our study confirms that IPC is an effective psychological intervention comparable to antidepressants in mild-moderate MDD. Polymorphisms related to the serotonin system did not exert a major effect on clinical outcomes in none of the treatment groups.     

药物联合心理治疗在难治性精神分裂症患者中的应用效果观察

目的探讨药物联合心理治疗对难治性精神分裂症患者的应用效果。方法随机选取2015年9月～2017年8月78例难治性精神分裂症患者为研究对象。根据随机数字表法将其随机分为心理组和对照组,每组39例。对照组采用利培酮联合喹硫平治疗,心理组联合心理治疗。比较两组治疗效果。结果心理组治疗后的BPRS评分明显低于对照组,治疗总有效率明显高于对照组,复发率及不良反应发生率均显著低于对照组,组间比较,差异均有统计学意义(P0.05)。结论药物联合心理治疗可提高难治性精神分裂症患者的疗效,降低复发率及不良反应发生率,值得临床推广。     

Une fiction,une réalité : réflexions autour de l’addiction à la pornographie

In this topic, we will raise the question of the processes underlying addiction to pornography. We will base our analysis on the parallel between two stories, Brandon's and Kevin's. Brandon is the protagonist of Steeve McQueen's movie, Shame, whereas Kevin is a true person met in individual psychotherapy. In history of each, we detected childhood traumas (in particular sexual) on which they remained fixed, thus disturbing their psychological development. These, only suggested in the movie, illustrate the informal nature of some traumas, impossible to be described. The psychological fragility they cause leads to a split within the self, which appears in two opposite views co-existing within each individual: one who continued his psychic structuring; the other remaining enclosed in the trauma. However, under the constraint of repetition, splitting elements constantly threaten the self to resurface, resulting in the compulsive watching of pornographic pictures. This extreme consumption could be understood both as an attempt to give form to the trauma (supported on real images) and as a mode of discharge of this one. We hypothesize that addiction to pornography reflects an attempt to incorporate genital sexuality, revealing the failure of introjection of “genitality”, hindered by the fixation to the trauma. Finally, we show that individual therapy can help the patient uncover the traumatic fragments of his personal history, and contribute to reinforce his narcissism whose integrity was threatened by split. More precisely, through sublimation, the therapy could allow the patient to quit addiction to pornography by transforming shame into exploration dedicated to self (re)construction.     

Enfants défenestrés,enfants « miraculés »: conséquences psychiques et dans la dynamique familiale. Á propos d’un cas

Objective

Child defenestration, a relatively common phenomenon, is a public health problem. According to statistics, over 80% of these children escape death. They are often seen by family or entourage as having been “miraculously saved” and the post-traumatic impact of the fall and of the child's survival despite the high risk can lead to distortions in intra-family relationships and in the construction of the identity of the child. This also calls for a reconsideration the patterns of psychological trauma for young children.

心理疗法对不同年龄患者正畸治疗合作性的影响

目的：探讨心理疗法对青少年和成年患者口腔正畸治疗的影响程度。方法：选取口腔正畸科80例错合畸形患者,分为实验组和对照组各40例。其中实验组分成20例青少年和20例成年人两个小组,对照组也由20例青少年和20例成年人组成。青少年年龄为11-15岁,成年人年龄为20-30岁。实验组里的青少年小组和成年人小组患者从第一次咨询口腔正畸治疗开始就进行系统的口腔正畸心理指导,并对实验组和对照组两组人员在治疗过程中口腔卫生状况、橡皮圈配戴情况、装置脱落情况、复诊依约情况进行记录分析。结果：实验组的理解性、主动性、配合性、满意度、复发性的情况均优于对照组。结论：心理疗法对青少年口腔正畸治疗合作性的影响较成年人明显。在正畸治疗的过程中,对青少年加强心理指导,能提高矫治的成效。     

Comment « défusionner » de la scène traumatique ? La pratique du « défusing » : trente ans de discours spécialisé psychiatrique et psychologique

BackgroundNotably organized by the medical-psychological emergency cells (CUMP) in France, the immediate care offered after confronting a potentially psychotraumatic event has been able to spill a lot of ink between those who adulate them or those who hate them, as much in the specialized press as through the media intended for the general public. Indispensable practice aimed at treating psychological wounds for some, charlatanism providing worsening of post-traumatic symptoms for others, medico-psychological recommendations have long remained cryptic in the face of the absence of studies of enough level of scientificity. Thirty years after its first formalizations, no study has offered a critical synthesis of the notion of “defusing”.ObjectivesOur main objective is to study the specialized discourse concerning “defusing” as defined and relayed by psychiatrists and psychologists in French-language journals. We seek to identify the stages of the construction of this treatment time, the maturation of its practice by synthesis of the “defusing type” and the theorization of its therapeutic mechanisms.MethodsFrench-language articles published between January 1, 1990 and December 31, 2019 were selected from the entry of the keyword “defusing” in five search engines as well as in the thesauri of the interuniversity library of medicine and the central library of the army health service. The extracted data combine: the number of article (s) per year of publication, the names of the journals and the authors (research team, place of practice, statutes). The titles, summaries and body of texts were examined by three speech analysis software programs with quantification of textual units and facilitation of return to text by keyword.ResultsLess than 30 articles mention the notion of “defusing” in French-speaking literature, of which only 2 are in their titles and finally, no reference is fully dedicated to it. Compared to the adjacent chapters dealing with the organization of CUMPs, the emergency clinic, and debriefing, the articles referenced do little to address the notion of “defusing”. If the conception of psychological trauma is popularized by its clinical and etiopathogenic dimensions (essentially psychopathological, ignoring neurobiological or socio-anthropological aspects), immediate treatment is only sketched out (by its organizational, theoretical and practical developments). All these notions turn out to be approached in a segmental fashion via adjacent paragraphs with no obvious links between them. Very few articulations are advanced with the concepts of psychiatry or general psychology, or the inclusion of defusing within a global theory of psychotherapy. Materializing numerous literal repetitions from one article to another, the synthesis organizing the qualitative data revealing the practical definition of defusing is rather brief. All references combined, only a few sentences briefly addressing the notions of language recovery and capacities of levels of representation can enlighten us on the supposed therapeutic processes. In addition, certain areas are barely addressed: little mention of family traumas, relative silence concerning specificities in children, absence of scientific studies concerning the effectiveness of defusing.DiscussionIn the referenced texts, if the part devoted to the organization of care is significant in terms of volume, it is because it participates conceptually in the appeasement by restitution of an environment allowing to get out of the traumatic scene. Then, the apparent simplicity of the therapeutic concepts in reality reveals cardinal prerequisites: clinical analysis, permanent adjustment of the right relational distance, ability to receive the suffering of others, sustained attention over time, technical skill in particular inter-transferential mobilizations, ability to develop adaptive skills. The attitude and words of the practitioner are based above all on their experiences in clinical analysis and psychotherapeutic care in general. This is undoubtedly the main reason for the absence of scientific studies on defusing facing the same material difficulties as the evaluation of psychotherapy. While only the nonspecific factors of effectiveness of psychotherapies appear to be recognized today, first and foremost the flexibility of the practitioner in the face of his theoretical references, would it be possible to recognize principles specifically effective in the treatment of post-traumatic symptoms?ConclusionWhile several authors still bring together defusing and debriefing to the point of speaking of “immediate and post-immediate debriefing”, the confusion induced is perhaps only relative in view of specific therapeutic mechanisms aimed at appeasing dissociation. Speech constitutes the tool, the cement allowing to bridge dissociative fractures, to connect the psychic, neuropsychic and social spaces which were previously disjointed. Prompted or even guided by the practitioner, this therapeutic word deserves to be qualified as “maieutics”, from the name of the science of childbirth: thought is not developed here prior to its elocution, but the inaugural word, as it arises, as it is expressed, creates thought. By “giving” his word, by “lending” his language, the practitioner actively listens to the mentally injured person and guides them to find the words that they are not able to speak spontaneously. Thanks to the development of a partly common discourse, resulting from intersubjectivity, the capacities of singular elaborations and mentalizations are enhanced, on the side of the patient, and on the side of the practitioner, without the created senses necessarily being the same.     

Long-term effects of transference interpretation in dynamic psychotherapy of personality disorders

Background

Only a few treatment studies of personality disorders (PD) patients are on longer-term psychotherapy, general outcome measures are used, and follow-up periods are usually short. More studies of long-term therapies, using outcome measures of core psychopathology, are needed.

Method

This study is a dismantling randomized controlled clinical trial, specifically designed to study long-term effects of transference interpretation. Forty-six patients with mainly cluster C personality disorders were randomly assigned to 1 year of dynamic psychotherapy with or without transference interpretations. The outcome measures were remission from PD, improvement in interpersonal functioning, and use of mental health resources in the 3-year period after treatment termination.

Results

After therapy with transference interpretation PD-patients improved significantly more in core psychopathology and interpersonal functioning, the drop-out rate was reduced to zero, and use of health services was reduced to 50%, compared to therapy without this ingredient. Three years after treatment termination, 73% no longer met diagnostic criteria for any PD in the transference group, compared to 44% in the comparison group.

Conclusions

PD-patients with co-morbid disorders improved in both treatment arms in this study. However, transference interpretation improved outcome substantially more. Long-term psychotherapy that includes transference interpretation is an effective treatment for cluster C personality disorders and milder cluster B personality disorders.     

107例HIV/AIDS感染者经性接触感染情况深入访谈调查分析

目的:对107例HIV感染者或艾滋病患者(HIV/AIDS)经性接触感染的方式、途径、感染状况等进行分析,为进一步的预防工作提供有效依据。方法:制定合理的调查提纲,与HIV/AIDS采取一对一的深入访谈式调查,获取经性接触感染的方式、途径、感染状况等,并自我剖析感染后的经验及教训,有效预防的方法及策略,今后HIV/AIDS在宣教方面的缺陷及完善方案等。结果:男男同性恋(MSM)人群、双性恋人群、多性伴人群仍是本地区HIV感染的高危人群,相当部分经性接触感染HIV/AIDS均未很好的采取安全措施,高危性行为后主动检测、性伴检出HIV感染后检测、出现症状后就医是发现HIV感染的主要原因。结论:不洁性行为中安全套的使用、高危性行为后主动检测、及时的性伴通知、有效的抗病毒治疗及心理辅导与心理治疗、参与性方法普及性健康知识及艾滋病知识等均是今后预防HIV感染的最佳手段,只有通过全社会的共同参与,才能达到全民防艾的目的。     

Nonpharmacologic Interventions for Family Caregivers of People Living With Dementia in Latin-America: A Scoping Review

ObjectiveDementia prevalence in Latin America (LATAM) is rapidly increasing, contributing to significant family burden. As families are responsible for care, supportive interventions are critical. To understand the state-of-the-science, a scoping review was conducted of non-pharmacologic interventions for caregivers of people living with dementia (PLWD) in LATAM.DesignEight databases were searched (PubMed, Embase, PsycINFO, Scopus, Scielo, Lilacs, Redalyc, Google Scholar) for nonpharmacological intervention studies published up to July, 2021 in LATAM reporting at least 1 caregiver outcome. A qualitative synthesis examined study designs, participants, and outcomes characteristics.ResultsForty-five studies were identified from 25.8% (n = 8/31) of LATAM countries (28 = Brazil, 4 = Chile, 4 = Cuba, 4 = México, 2 = Colombia, 1 = Perú, 1 = Ecuador, 1 = Argentina): 29% (n = 17) were randomized clinical trials (RCT), 7% (n = 3) nonrandomized comparison trials, 42% (n = 19) pre-post trials, 9% (n = 4) postintervention analyses, and 4% (n = 2) single case studies, comprising a total of 1,171 caregivers and 817 PLWD. For 20 RCT and nonrandomized comparison trials, 31 interventions were tested of which 48.4% (n = 15) targeted caregivers and 32.3% (n = 10) dyads. Most studies involved daughters with less than 12 years of education and tested multicomponent interventions involving disease education (90%), and cognitive behavioral coping (45%). Half of interventions (51.6%; n = 16/31) tested were adapted from other countries, and reported benefits for caregiver depression, quality of life, and burden.ConclusionStudies were conducted in a limited number of LATAM countries and few were RCTs. Results of RCTs showed benefits for socially vulnerable caregivers on psychosocial outcomes. There is an urgent need to rigorously evaluate more country/culturally specific interventions addressing unmet familial needs beyond psychosocial support.     

Clinical experience on treatment of cervical spondylosis with combined acupuncture, tuina and psychotherapy

Cervical spondylosis is common in the middleaged or senile population and can greatly affect their body-mind health. The common treatment methods include traction, tuina, acupuncture and medication. However, psychological factors, such as anxiety, depression or fear are often neglected during the treatment. The authors investigated the effect of combined psycho- therapy, acupuncture and tuina on the cervical spondylosis.