Hormonal therapy is associated with better self-esteem, mood, and quality of life in transsexuals.

Few studies have assessed the role of cross-sex hormones on psychological outcomes during the period of hormonal therapy preceding sex reassignment surgery in transsexuals. The objective of this study was to assess the relationship between hormonal therapy, self-esteem, depression, quality of life (QoL), and global functioning. This study incorporated a cross-sectional design. The inclusion criteria were diagnosis of gender identity disorder (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision) and inclusion in a standardized sex reassignment procedure. The outcome measures were self-esteem (Social Self-Esteem Inventory), mood (Beck Depression Inventory), QoL (Subjective Quality of Life Analysis), and global functioning (Global Assessment of Functioning). Sixty-seven consecutive individuals agreed to participate. Seventy-three percent received hormonal therapy. Hormonal therapy was an independent factor in greater self-esteem, less severe depression symptoms, and greater "psychological-like" dimensions of QoL. These findings should provide pertinent information for health care providers who consider this period as a crucial part of the global sex reassignment procedure.

Is hormonal therapy associated with better quality of life in transsexuals? A cross-sectional study.

INTRODUCTION: Although the impact of sex reassignment surgery on the self-reported outcomes of transsexuals has been largely described, the data available regarding the impact of hormone therapy on the daily lives of these individuals are scarce. AIMS: The objectives of this study were to assess the relationship between hormonal therapy and the self-reported quality of life (QoL) in transsexuals while taking into account the key confounding factors and to compare the QoL levels between transsexuals who have, vs. those who have not, undergone cross-sex hormone therapy as well as between transsexuals and the general population (French age- and sex-matched controls). METHODS: This study incorporated a cross-sectional design that was conducted in three psychiatric departments of public university teaching hospitals in France. The inclusion criteria were as follows: 18 years or older, diagnosis of gender identity disorder (302.85) according to the Diagnostic and Statistical Manual, fourth edition text revision (DSM-IV TR), inclusion in a standardized sex reassignment procedure following the agreement of a multidisciplinary team, and pre-sex reassignment surgery. MAIN OUTCOME MEASURE: QoL was assessed using the Short Form 36 (SF-36). RESULTS: The mean age of the total sample was 34.7 years, and the sex ratio was 1:1. Forty-four (72.1%) of the participants received hormonal therapy. Hormonal therapy and depression were independent predictive factors of the SF-36 mental composite score. Hormonal therapy was significantly associated with a higher QoL, while depression was significantly associated with a lower QoL. Transsexuals' QoL, independently of hormonal status, did not differ from the French age- and sex-matched controls except for two subscales of the SF-36 questionnaire: role physical (lower scores in transsexuals) and general health (lower scores in controls). CONCLUSION: The present study suggests a positive effect of hormone therapy on transsexuals' QoL after accounting for confounding factors. These results will be useful for healthcare providers of transgender persons but should be confirmed with larger samples using a prospective study design.

[Phenomenology of dreams]. / Phénoménologie du rêve.

A phenomenology of dreams searches for meaning, with the aim not only of explaining but also of understanding the experience. What and who is it for? And what about the nearly forgotten dream among the moderns, the banal returning to the nightmare, sleepiness, or dreamlike reverie. Nostalgia for the dream, where we saw a very early state of light, not a ordinaire qu duel. Regret for the dreamlike splendor exceeded by the modeling power of modern aesthetics--film and the explosion of virtual imaging technologies. Disappointment at the discovery of a cognitive permanence throughout sleep and a unique fit with the real upon awaking? An excess of methodological rigor where we validate the logic of the dream, correlating the clinical improvement in psychotherapy and the ability to interpret one's own dreams. The dangerous psychological access when the dream primarily is mine, viewed as a veiled expression of an unspoken desire, or when the dream reveals to me, in an existential conception of man, through time and space, my daily life, my freedom beyond my needs. Might its ultimate sense also mean its abolition? From the story of a famous forgotten dream, based on unexpected scientific data emerges the question: do we dream to forget? The main thing would not be consciousness but confidence, when " the sleeping man, his regard extinguished, dead to himself seizes the light in the night " (Heraclitus).

[Antidepressants in oncology: issues and clinical perspectives]. / Les antidépresseurs : enjeux et perspectives cliniques en cancérologie.

Antidepressants in oncology offer a wide range of applications in everyday supportive care while at the same time, they are often not well known by oncologists. Several recent studies suggest that depressive disorders have a negative impact on the overall survival in oncology. The care of the depressed patient in oncology would therefore request early detection prior to adapted drug treatment and psychotherapy interventions. This requires better knowledge of antidepressants whose effectiveness has been demonstrated in severe major depression. The use of antidepressants should also be part of the therapeutic armaments in the treatment of pain and hot flushes. However, their effectiveness in improving minor depressive disorders and cancer-related fatigue has not been proved yet.

Validation of a subjective quality of life questionnaire (S.QUA.LA) in schizophrenia.

We developed and validated a self-administered questionnaire (Subjective Quality of Life Analysis, S.QUA.L.A.) to measure subjective quality of life. S.QUA.L.A. is a multidimensional instrument. This scale includes 22 domains of life. It covers traditional areas (food, family relation etc)., and more abstract aspects of life (politic, justice, freedom, truth, beauty and art, love). For each domain, patients are asked to evaluate their degree of satisfaction. They have also to indicate how important this domain is for them. We questioned 92 patients with schizophrenia and 357 para-medical students. The research demonstrated reproducibility, high internal consistency reliability, and sensitivity to change. Principal components analysis with varimax rotation was performed. A five-factor solution was selected, showing a great contribution of different dimensions of the self. Determinants of quality of life were identified by using correlations with Lehman's Quality of Life Interview (QOLI), and with measures of psychopathology and social functioning. Satisfaction approach and QOLI showed the same construct. We confirmed the influence of symptoms of depression and anxiety on subjective quality of life assessment, and the poor impact of disease parameters.

Schizophrenia as a temporal mode of being: an existential "ante-festum" impatience.

We suggest in a phenomenological perspective to consider schizophrenia as a special form of human temporality. From this perspective, we view the symptoms of schizophrenia as actions undertaken by subjects to stabilize themselves in existence. From this vantage, we describe the clinical expression of the disorder as a type of "existential impatience", characterized by a painful and elusive "now". This present time posits the prime moment of the constitution of the person. Existential impatience reflects from our patients the persistence of excessive efforts towards individuation. Schizophrenia. In human life in general, individuation consists in an unceasing dynamic process of building up of the self. This process starts with the non-self and particularly with the other. Therefore, the emergence of any relation within the self is grounded in the relation with the other and is based on the relation the other establishes with himself. Schizophrenia distinctly displays the two constitutive moments of "being oneself." These moments are generally linked for all of us: an "unending coming to oneself" (difference of identity), and a "continuous maintenance of being a self" (identity of difference). Existential impatience is not only an irritability of a formal order. Existence itself is impatient in the schizophrenic experience as it hastens to reach human goals while trampling on an "ante-festum" temporal mode. This "before-the-feast" temporal structure is dominated by the shiver before an unknown future, a sign of a basic quest for a task. Schizophrenic "ante-festum" is both a constant fear of being unable to come to oneself and a desperate effort to reach this unknown future. If psychopathology claims to settle [establish] that "order" and "measure" would constitute the two fundamental anthropological bases of human being, impatience of existence draws the emblematic figure of the disorder of measure as a referential motion of the birth of any temporalisation. Such considerations suggest the value, in treatment and rehabilitation, of praising patience and focusing on building, or re-building, the past. The main objective is to reach a maieutics of the self based on relationships in the community and with care-givers, all within an accompanying structured, daily framework.

Brain perfusion in Alzheimer's disease with and without apathy: a SPECT study with statistical parametric mapping analysis.

Alzheimer's disease (AD) is clinically characterized by cognitive symptoms that, in combination with behavioral disturbances, significantly interfere with activities of daily living. These behavioral disorders contribute to the clinical heterogeneity of the disease and probably express different pathophysiological processes. Apathy is one of the most frequent behavioral disorders in AD. The aim of this study was to evaluate brain perfusion of AD patients with and without apathy (as determined by the Neuropsychiatric Inventory) compared with that in healthy elderly subjects. A total of 15 AD patients without apathy (AD/NA; mean age 76.6) and 15 AD patients with apathy (AD/A; mean age 77.6) were studied. Brain perfusion was measured by 99mTc-labeled bicisate (ECD) single-photon emission tomography (ECD SPECT). The images of the two AD subgroups were compared by means of statistical parametric mapping (SPM 99) to corresponding images of 11 healthy elderly control subjects (obtained from the Society of Nuclear Medicine database). Compared with the healthy elderly subjects, the apathy-free AD subgroup had significantly lower perfusion of inferior temporal regions (left fusiform gyrus, left parahippocampal area) and occipital regions (left gyrus lingualis). The apathy subgroup had significantly decreased perfusion of the left anterior cingulate, the right inferior and medial gyrus frontalis, the left orbitofrontal gyrus and the right gyrus lingualis. The differences in the brain areas with reduced perfusion between the apathy-free subjects (mainly the posterior regions) and the apathetic subjects (mainly the anterior regions) indicate that behavioral disorders such as apathy participate in the heterogeneity of brain perfusion in AD.