A fenomenologia como base epistemológica e ética do movimento desalienista na frança e no Brasil / Phenomenology as an ethical and epistemological basis of the desalienist movement in france and in Brazil / La fenomenología como base epistemológica y ética del movimiento desalienista en francia y en Brasil

Este artigo tem como objetivo apresentar a fenomenologia como base epistemológica e ética do movimento desalienista da psicoterapia institucional na França e da Reforma Psiquiátrica no Brasil. Descrevemos estes dois movimentos e os principais nomes que fizeram parte de suas histórias em interlocução com a fenomenologia, refletindo sobre como esta pode ser considerada uma base para a prática de profissionais da saúde mental inseridos neste contexto que está em plena transformação. (Re)discutir tais bases nos parece de fundamental importância para reafirmar o sentido epistemológico e ético necessário que fundamenta ambos os processos. Concluímos que a fenomenologia se apresentou e ainda se apresenta como uma via de questionamento das práticas em saúde mental e oferece o fundamento para se pensar uma prática que busca o encontro com os sujeitos, e não somente com a doença mental, e para o processo de desinstitucionalização dos doentes mentais.

This article aims to present the phenomenology as the epistemological and ethical basis of the desalienist movement of institutional psychotherapy in France and the Psychiatric Reform in Brazil. We describe these two movements and the main names that were part of their stories in interlocution with phenomenology, reflecting on how this can be considered a basis for the practice of mental health professionals inserted in this context that is in full transformation. To discuss such bases seems to us to have a fundamental importance in order to reaffirm the necessary epistemological and ethical sense that underlies both processes. We conclude that phenomenology has been presented and still presents itself as a way of questioning mental health practices and offers the basis to think of a practice that seeks the encounter with the subjects and not only with the mental illness, as well as the process of deinstitutionalization of the mentally ill.

Este artículo tiene como objetivo presentar la fenomenología como base epistemológica y ética del movimiento desalienista de la psicoterapia institucional en Francia y de la Reforma Psiquiátrica en Brasil. Describimos estos dos movimientos y los principales nombres que formaron parte de sus historias en interlocución con la fenomenología, reflexionando sobre cómo ésta puede ser considerada una base para la práctica de profesionales de la salud mental insertados en este contexto que está en plena transformación. (Re)discutir tales bases nos parece de fundamental importancia para reafirmar el sentido epistemológico y ético necesario que fundamenta ambos procesos. Concluimos que la fenomenología se presentó y aún se presenta como una vía de cuestionamiento de las prácticas en salud mental y ofrece el fundamento para pensar una práctica que busca el encuentro con los sujetos y no sólo con la enfermedad mental y para el proceso de desinstitucionalización de los enfermos mentales.

Reassessing "Praecox Feeling" in Diagnostic Decision Making in Schizophrenia: A Critical Review.

The "Praecox Feeling" (PF) is a classical concept referring to a characteristic feeling of bizarreness experienced by a psychiatrist while encountering a person with schizophrenia. Although the PF used to be considered a core symptom of the schizophrenia spectrum, it fell into disuse since the spread of operationalized diagnostic methods (Diagnostic and Statistical Manual of Mental Disorders/International Classification of Diseases systems). In contemporary research on schizophrenia, it remains largely unaddressed. This critical review investigates the evolution of the PF in historical and contemporary literature and presents an exhaustive overview of empirical evidence on its prevalence in clinical decision making, its reliability and validity. The review demonstrates that the PF is a real determinant of medical decision making in schizophrenia, although, without further research, there is not enough evidence to sustain its rehabilitation as a reliable and valid clinical criterion. PF-like experiences should not be opposed to any criteriological attitude in diagnosis and would be clinically useful if the conditions of descriptive precaution and rigorous epistemology are maintained. The aim of teaching clinical expertise is to transform this basic experience into a well-founded clinical judgment. Finally, the article discusses the possible relevance of the PF for basic science and clinical research according to a translational approach inspired by phenomenology.

Multiple Realities and Hybrid Objects: A Creative Approach of Schizophrenic Delusion.

Delusion is usually considered in DSM 5 as a false belief based on incorrect inference about external reality, but the issue of delusion raises crucial concerns, especially that of a possible (or absent) continuity between delusional and normal experiences, and the understanding of delusional experience. In the present study, we first aim to consider delusion from a perspectivist angle, according to the Multiple Reality Theory (MRT). In this model inherited from Alfred Schütz and recently addressed by Gallagher, we are not confronting one reality only, but several (such as the reality of everyday life, of imaginary life, of work, of delusion, etc.). In other terms, the MRT states that our own experience is not drawing its meaning from one reality identified as the outer reality but rather from a multiplicity of realities, each with their own logic and style. Two clinical cases illustrate how the Multiple Realities Theory (MRT) may help address the reality of delusion. Everyday reality and the reality of delusion may be articulated under a few conditions, such as compossibility [i.e., Double Book-Keeping (DBK), in Bleulerian terms] or flexibility. There are indeed possible bridges between them. Possible links with neuroscience or psychoanalysis are evoked. As the subject is confronting different realities, so do the objects among and toward which a subject is evolving. We call such objects Hybrid Objects (HO) due to their multiple belonging. They can operate as shifters, i.e., as some functional operators letting one switch from one reality to another. In the final section, we will emphasize how delusion flexibility, as a dynamic interaction between Multiple Realities, may offer psychotherapeutic possibilities within some reality shared with others, entailing relocation of the present subjects in regained access to some flexibility via Multiple Realities and perspectivism.

Serotonin transporter gene expression predicts the worsening of suicidal ideation and suicide attempts along a long-term follow-up of a Major Depressive Episode.

The quest for biomarkers in suicidal behaviors has been elusive so far, despite their potential utility in clinical practice. One of the most robust biological findings in suicidal behaviors is the alteration of the serotonin transporter function in suicidal individuals. Our main objective was to investigate the predictive value of the serotonin transporter gene expression (SLC6A4) for suicidal ideation and as secondary, for suicide attempts in individuals with a major depressive episode (MDE). A 30-week prospective study was conducted on 148 patients with a MDE and 100 healthy controls including 4 evaluation times (0, 2, 8 and 30 weeks). Blood samples and clinical data were collected and SLC6A4 mRNA levels were measured from peripheral blood mononuclear cells using RT-qPCR. We first demonstrated the stability and reproducibility of SLC6A4 mRNA expression measures over time in healthy controls (F=0.658; p=0.579; η2=0.008; ICC=0.91, 95% CI [0.87-0.94]). Baseline SLC6A4 expression level (OR=0.563 [0.340-0.932], p=0.026) as well as early changes in SLC6A4 expression between baseline and the 2nd week (ß=0.200, p=0.042) predicted the worsening of suicidal ideation (WSI) in the following 8 weeks. Moreover, changes in SLC6A4 expression between the 2nd and 8th weeks predicted the occurrence of a suicide attempt within 30 weeks (OR=10.976 [1.438-83.768], p=0.021). Altogether, the baseline level and the changes in SLC6A4 mRNA expression during a MDE might predict the WSI and the occurrence of suicidal attempts and could be a useful biomarker in clinical practice.

New Insight into Affectivity in Schizophrenia: from the Phenomenology of Marc Richir.

BACKGROUND: According to Karl Jaspers, psychopathology requires a comprehensive method, understood as a systematic exploration of the first-person perspective of the patient's experience. At the same time, however, schizophrenia for Jaspers is characterized by its radical incomprehensibility. In addition, Rümke's so-called "praecox feeling" paradoxically combines the incomprehensibility of schizophrenic experience and the evidence of its pathological manifestation in the encounter. AIM: Through a re-examination of the notions of affectivity and interaffective contact we propose a coherent theoretical model to explain the clinician's paradoxical understanding of schizophrenia. METHOD: Phenomenological tradition regards affectivity as an encompassing phenomenon that connects body, self, world, and others. In our view, only a thorough and systematic link between corporeity and affectivity is able to explain embodied affective resonance as a basis of empathic comprehension. By drawing on the phenomenology of Marc Richir, we will systematically unfold the complex nature of affectivity and lead it back to a twofold constitution of corporeality. CONCLUSION: The Richirian account on affectivity can be fruitfully put into discussion with other recent phenomenological models on schizophrenia. It might be able to exhibit affectivity as the operative ground of minimal self-disturbance and thus argue for its intersubjective dimension.

How to: Measuring blood cytokines in biological psychiatry using commercially available multiplex immunoassays.

Cytokines produced by both immune and non-immune cells are likely to play roles in the development and/or progression of psychiatric disorders. Indeed, many investigators have compared the blood cytokine levels in psychiatric patients with those of healthy controls or monitored their levels in patients during disease progression to identify biomarkers. Nevertheless, very few studies have confirmed that such cytokines remain stable in healthy individuals through periods of weeks and months. This is an important issue to consider before using blood cytokine levels as biomarkers of disease traits, disease state, or treatment response. Although multiplex assay technology represents an advance in identifying biomarkers because it allows simultaneous examination of large panels of analytes from a small volume of sample, it is necessary to verify whether these assays yield enough sensitivity and reproducibility when applied to the blood from neuropsychiatric patients. Therefore, we compared two multiplex immunoassays, the bead-based Luminex® (Bio-Rad) and the electro-chemiluminescence-based V-plex® (MesoScaleDiscovery), for the detection and quantification of 31 cytokines, chemokines and growth factors in both the sera and plasma of patients with major depressive episodes (MDE) and age- and sex-matched healthy control subjects during a 30-week period. Although both platforms exhibited low coefficients of variability (CV) between the duplicates in the calibration curves, the linearity was better in general for the V-PLEX® platform. However, neither platform was able to detect the absolute values for all of the tested analytes. Among the 16 analytes that were detected by both assays, the intra-assay reproducibility was in general better with the V-PLEX® platform. Although it is not a general rule that the results from sera and plasma will be correlated, consistent results were more frequent with the V-PLEX® platform. Furthermore, the V-PLEX® results were more consistent with the gold standard ELISA simplex assay for IL-6 in both sera and plasma. The intra-individual variability of the measurements, among the sera and plasma for the 4 samples harvested from each healthy individual, was low for Eotaxin, G-CSF, IL-4, IL-7, IL-9, IL-12p40, IL-12p70, IL-15, MIP-1ß, PDGF-BB, TNF, TNF-ß and VEGF, but intermediate or high for IFN-γ, IL-6, IL-8, IL-10, and IP10. Together, these data suggest that extreme caution is needed in translating the results of multiplex cytokine profiling into biomarker discovery in psychiatry.

Natural speech comprehension in bipolar disorders: an event-related brain potential study among manic patients.

BACKGROUND: Thought and language disturbances are crucial clinical features in Bipolar Disorders (BD), and constitute a fundamental basis for social cognition. In BD, clinical manifestations such as disorganization and formal thought disorders may play a role in communication disturbances. However, only few studies have explored language disturbances in BD at a neurophysiological level. Two main Event-Related brain Potentials (ERPs) have been used in language comprehension research: the N400 component, elicited by incongruous word with the preceding semantic context, and the Late Positive Component (LPC), associated with non-specifically semantic and more general cognitive processes. Previous studies provided contradictory results regarding N400 in mood disorders, showing either preserved N400 in depression or dysthymia, or altered N400 in BD during semantic priming paradigm. The aim of our study was to explore N400 and LPC among patients with BD in natural speech conditions. METHODS: ERPs from 19 bipolar type I patients with manic or hypomanic symptomatology and 19 healthy controls were recorded. Participants were asked to listen to congruous and incongruous complete sentences and to judge the match between the final word and the sentence context. Behavioral results and ERPs data were analyzed. RESULTS: At the behavioral level, patients with BD show worst performances than healthy participants. At the electrophysiological level, our results show preserved N400 component in BD. LPC elicited under natural speech conditions shows preserved amplitude but delayed latency in difference waves. LIMITATIONS: Small size of samples, absence of schizophrenic group and medication status. CONCLUSIONS: In contrast with the only previous N400 study in BD that uses written semantic priming, our results show a preserved N400 component in ecological and natural speech conditions among patients with BD. Possible implications in terms of clinical specificity are discussed.

Longitudinal monitoring of the serotonin transporter gene expression to assess major depressive episode evolution.

BACKGROUND: Mood disorders are frequently characterized by uncertain prognosis and studying mRNA expression variations in blood cells represents a promising avenue of identifying biomarkers for mood disorders. State-dependent gene expression variations have been described during a major depressive episode (MDE), in particular for SLC6A4 mRNA, but how this transcript varies in relation to MDE evolution remains unclear. In this study, we prospectively assessed time trends of SCL6A4 mRNA expression in responder and nonresponder patients. METHODS: We examined SLC6A4 mRNA expression in blood samples from 13 patients treated for severe MDE and their matched controls by reverse transcription and quantitative PCR. All subjects were followed for 30 weeks. Patients were classified as either responders or nonresponders based on improvement of depression according to the 17-item Hamilton Depression Rating Scale. Using a longitudinal design, we ascertained mRNA expression at baseline, 2, 8, and 30 weeks and compared mRNA expression between responder and nonresponder patients, and matched controls. RESULTS: We observed a decrease of SLC6A4 mRNA expression in responder patients across a 30-week follow-up, while nonresponder patients exhibited up-regulated SLC6A4 mRNA. CONCLUSION: Peripheral SLC6A4 mRNA expression could serve as a biomarker for monitoring and follow-up during an MDE and may help to more appropriately select individualized treatments.

Toward an exploration of feeling of strangeness in schizophrenia: perspectives on acousmatic and everyday listening.

The aim of this study was to investigate abnormal perceptual experiences in schizophrenia, in particular the feeling of strangeness, which is commonly found in patients' self-reports. The experimental design included auditory complex stimuli within 2 theoretical frameworks based on "sensory gating deficit" and "aberrant salience," inspired from conventional perceptual scales. A specific sound corpus was designed with environmental (meaningful) and abstract (meaningless) sounds. The authors compared sound evaluations on 3 perceptual dimensions (bizarre, familiar, and invasive) and 2 emotional dimensions (frightening and reassuring) between 20 patients with schizophrenia (SCZ) and 20 control participants (CTL). The perceptual judgment was rated on independent linear scales for each sound. In addition, the conditioning-testing P50 paradigm was conducted on 10 SCZ and 10 CTL. Both behavioral and electrophysiological data confirmed the authors' expectations according to the 2 previous theoretical frameworks and showed that abnormal perceptual experiences in SCZ consisted of perceiving meaningful sounds in a distorted manner and as flooding/inundating but also in perceiving meaningless sounds as things that become meaningful by assigning them some significance. In addition, the use of independent scales to each perceptual dimension highlighted an unexpected ambivalence on familiarity and bizarreness in SCZ compatible with the explanation of semantic process impairment. The authors further suggested that this ambivalence might be due to a conflicting coactivation of 2 types of listening, that is, every day and musical (or acousmatic) listening.

Clinical variations modulate patterns of gene expression and define blood biomarkers in major depression.

The aim of the study is to compare the expression level of candidate genes between patients suffering from a severe major depressive episode (MDE) and controls, and also among patients during MDE evolution. After a comprehensive review of the biological data related to mood disorders, we initiated a hypothesis-driven exploration of candidate mRNAs. Using RT-qPCR, we analyzed peripheral blood mononuclear cells (PBMCs) mRNA obtained from a homogeneous population of 11 patients who suffered from severe melancholic MDE. To assess the evolution of MDE, we analyzed PBMC mRNAs that were collected on Day 1 and 8 weeks later. Data from these patient samples were analyzed in comparison to age- and sex-matched healthy controls. Among 40 candidate genes consistently transcribed in PBMCs, 10 were differentially expressed in at least one comparison. We found that variations of mRNA levels for NRG1, SORT1 and TPH1 were interesting state-dependent biological markers of the disease. We also observed that variations in other mRNA expression were associated with treatment efficacy or clinical improvement (CREB1, HDAC5, HSPA2, HTR1B, HTR2A, and SLC6A4/5HTT). Significantly, 5HTT exhibited a strong correlation with clinical score evolution. We also found a state-independent marker, IL10. Moreover, the analysis of 2 separate MDEs concerning a same patient revealed comparable results for the expression of CREB1, HSPA2, HTR1B, NRG1 and TPH1. Overall, our results indicate that PBMCs obtained at different time points during MDE progression represent a promising avenue to discover biological markers for depression.

Ultraviolet radiation in the rhône river lenses of low salinity and in marine waters of the northwestern mediterranean sea: attenuation and effects on bacterial activities and net community production.

The high content in nutrients of freshwater outflows induces highly productive and buoyant plumes spreading over marine waters (MW). As a consequence, the growth of organisms developing in these low-salinity waters (LSW) might be potentially affected by UV-R (280-400 nm). This study investigated the penetration of UV-R and its impact on net community production (NCP) and bacterial protein (B(PROT)S) and DNA (B(DNA)S) synthesis in mesotrophic-LSW formed from the Rhône River and in oligotrophic MW of the Northwestern Mediterranean Sea (Gulf of Lions) in May 2006. High concentrations of chlorophyll a (up to 8 microg L(-1)) measured in the LSW (<37.8 psu, 0-10 m) were the main factor influencing the diffuse attenuation coefficients (K(d)) of both UV-R and photosynthetically active radiation (PAR). The mean ratio of the K(d) measured between the LSW and the MW increased with wavelength from 2.4 at 305 nm to 2.9 at 380 nm and 3.1 for PAR indicating more similarity in the UV region. NCP was severely inhibited by UV-R at the surface of the LSW, whereas no effect was measured in the surrounding MW. In contrast, B(PROT)S and B(DNA)S were affected deeper by UV-R in the MW (up to 8 m depth) compared to the LSW where inhibition was only observed at the surface. Differences in response of bacteria in LSW and MW are largely explained by differences in UV-R transparency; however, transplant experiments indicate that bacterial assemblages from the MW were also more sensitive to UV-R than those present in the LSW. We also observed that higher activity of bacteria after nutrient additions increased their sensitivity to UV-R during the day, but favored their recovery during the night incubation period for both LSW and MW. Results suggest that riverine and nutrient inputs may alter the effects of UV-R on microbial activity by attenuating the UV-R penetration and by modifying the physiology of bacteria.

The "minimal self" in psychopathology: re-examining the self-disorders in the schizophrenia spectrum.

The notion of minimal, basic, pre-reflective or core self is currently debated in the philosophy of mind, cognitive sciences and developmental psychology. However, it is not clear which experiential features such a self is believed to possess. Studying the schizophrenic experience may help exploring the following aspects of the minimal self: the notion of perspective and first person perspective, the 'mineness' of the phenomenal field, the questions of transparency, embodiment of point of view, and the issues of agency and ownership, considered as different and less fundamental than the feeling of mineness. Two clinical vignettes of patients with the diagnosis of schizophrenia will be presented: the first one, illustrating early illness stages, and the second case, of chronic schizophrenia, symptomatically marked by persistent hallucinations. Through their analysis, we will discuss the experiential dimensions of minimal self.

Rebuilding reality: a phenomenology of aspects of chronic schizophrenia.

Schizophrenia, like other "pathological" conditions, has not been systematically included in the general study of consciousness. By focusing on aspects of chronic schizophrenia, we attempt to survey one way of remedying this omission. Some basic components of Edmund Husserl's phenomenology of human experience (intentionality, constitution, and unbuilding) are explicated in detail, and these components are then employed in an account of exemplary aspects of chronic schizophrenia. We maintain that in schizophrenic experience some very basic constituents of reality--constituents so basic we call them "ontological"--are lost so that the patient must try to explicitly re-constitute those ontological features of the world. Using Husserl's concepts such experiences are described as a weakening of "automatic mental life" so that much of the world that is normally taken-for-granted cannot continue to be so. This requires the patient to actively busy him or herself with re-laying the ontological foundations of reality.

Schizophrenia: two-faced meaning of vulnerability.

The authors stress the current two-faced meaning of vulnerability that conveys both an objective and a subjective direction of sense, leading to a naturalistic model as well as a humanistic one. These models are heirs of both the Kraepelinian and Bleulerian conceptions of schizophrenia. Coping strategies and resilience are core concepts of the humanistic model. Research on these protective factors may be of major importance in the current debate on prevention in schizophrenia.