A new approach to discourse analysis in psychiatry, applied to a schizophrenic patient's speech.

OBJECTIVE: Progress in the science of data analysis and computer technology has led to the development of advanced methods for investigating structure discourse in the psychiatric field, where language constitutes a useful investigative and therapeutic tool. The purpose of this study was to present and use a computer-assisted method of discourse analysis (Alceste-software) to analyse the schizophrenic subject's oral contributions regularly collected for 3 months. METHOD: The method used consisted of modelling the main word distribution in spoken recordings pooled together and identifying the repetitive language patterns most frequently used by the speaker. RESULTS: Four main kinds of discourse emerged from the pool of schizophrenic's speech samples, on specific topics without any lack of ability to organize the material, but the technique analysis showed that the main kinds of discourse were interspersed with unexpected 'language satellites' consisting of a secondary short and specific discourse which was also well planned but had no relevance to the main discourse making for a lack of cohesion in the speech samples. This method allows us direct access to the inner experience of the patient. The technique highlighted a very poor pre-syntax linked to the choice of words and a tendency to make pronoun errors, possibly reflecting some confusion between the patient herself and others, mainly her mother, especially in the discourse about childhood. CONCLUSION: This method of discourse analysis made it possible to investigate various language disturbances at the same time and at different levels. It is particularly adapted for analysing the schizophrenic's speech. The data obtained were consistent with the assumption that schizophrenia involves 'thought disorders': these ones giving rise to the language impairments.

Possible involvement of the dopamine D3 receptor locus in subtypes of bipolar affective disorder.

The dopamine D3 receptor gene is of potential interest in the physiopathology of affective disorder because of its expression pattern in brain structures controlling various aspects of behaviour, cognition and emotions. Moreover, it encodes for a receptor protein that is a target for psychotropic drugs, which turn out to be efficient in the treatment of this disorder. Two polymorphisms have been described at this locus (the Bal I and the Msp I Restriction Fragment Length Polymorphisms) that are useful in genetic studies. We therefore researched these polymorphisms in 60 patients suffering from bipolar affective disorder who were compared with 60 healthy volunteers. No statistical difference was observed between the whole patient sample versus the controls. However, one subgroup [homozygous for the (2-2) Bal I polymorphism] exhibits a characteristic clinical pattern consisting of: manic monopolar form of bipolar disorder, low age of onset and initiation by an acute delusional episode. A gender distribution difference for the Bal I polymorphism (chi 2 = 6.61, degrees of freedom = 1, P = 0.01) was then noted, the bipolar females being preferentially heterozygous, and the males homozygous. These results could involve the dopamine D3 receptor locus as a minor effect gene in the manic depression condition.

Season of birth and schizophrenia: sex difference.

1. A statistically significant increased risk of schizophrenia for individuals born in winter has been reported. The increase risk is of the order of 5-15 percent. The seasonal effect is more marked among females. This winter birth effect suggests some environmental agents, probably a neuropathogen one, acting on the foetus. 2. The present study sought to test the environmental damage hypothesis by application of the family history of psychiatric disorder distinction to season of birth data divided according to sex and using a control population. 3. From computer records, all patients admitted to the psychiatric department of Marseilles Timone hospital between January 1984 and December 1989 who satisfied DSM III, DSM III R criteria for schizophrenia were identified. Patients were then classified into two groups: family history of psychiatric disorder versus no family history. Division according to the sex was carried on after two groups were formed. 4. The data show (I) a significant excess of births in the early months of the year (p < 0.05) for all patients with no family history of psychiatric disorder, (2) a significant excess of births for females (p < 0.05) with no family history. 5. These results provide indirect support for the neurodevelopmental theory of schizophrenia.

[Affective disorders, diabetes and carbohydrate metabolism]. / Troubles affectifs, diabète et métabolisme hydrocarboné.

In a medical and biological perspective, the authors analyse the relations existing between diabetes mellitus and affective disorders on the basis of clinical, therapeutic, metabolic, neuro-endocrinal and epidemiological arguments. Besides the presentation of an original clinical case, the principal data of literature are detailed and criticized; some orientations of the future research concerning the explaining of these relations are given as well.

[Relation between personality and spastic angina]. / Relations entre personnalité et angor spastique.

The personalities of 60 patients suffering from episodes of retrosternal pain were evaluated by means of psychological tests ( Cattel 's questionnaire and Eysenck's personality inventory) and semi-directive interviews. The patients fell into three groups: group I patients (n = 21) had atheromatous lesions of the coronary arteries detected at angiography; group II patients (n = 19) had normal or subnormal coronary arteries, but angiography demonstrated arterial spasm; group III patients (n = 20) had angiographically normal coronary arteries without spasm. A statistically significant difference (p less than 0.05) was noted between groups I and II, but not between groups II and III. Eleven of the 21 patients in group I presented with an obsessional personality which was not found in groups II and III where 13/19 and 16/20 patients respectively had a hysterical personality.

Increased sense of identity in delusional disorders.

Language, which is unique in each subject, can reflect how a patient copes with disease. The method ALCESTE used here made it possible at the same time to analyse the subject's verbal behavior and speech patterns at several levels. The present study was designed to analyse during a 3-mo. period the language production of subjects with paranoia exhibiting delusional disorder (nonbizarre delusions without any hallucination) of imaginative subtype. The subjects produced very specific speech without any semantic or syntactic impairment and disruption in language or thinking processes, but with a poverty of speech content. The main feature of the study was the analysis of the underlying syntactic processes showing that the tested patients presented a "hard" sense of identity: the patient found always a strong place for himself among the various types of discourse whatever their topics.

[Transsexualism]. / A propos du transsexualisme.

According to the literature, the transsexual phenomenon can be assessed as a distinct psychiatric illness. Transsexualism, a rare but spectacular disorder, realizes a gender identity reversal raising questions regarding systems of psychiatric diagnosis, nosology and treatment. A better clinical knowledge of this "experiment" and its follow-up allow studying processes contributory to marked deviation of gender identity and furthering concepts of development of masculinity and feminity. Current research deals with hypotheses that can be stated as testable propositions about underlying dynamics in various fields: learning factors, psychoanalytic components and psycho-biological data. Focusing on the early infantile development and the environmental influences reflects a variety of non specific psychogenetic precursors. The treatment of "gender dysphoria syndrom", i.e. hormonal treatment, sex-reassignment surgery and psychotherapic processes, aims towards réduction of psychic pain and social adjustment in the cross-gender role. Transsexual phenomenon largely overlaps the psychopathological area; beyond surgical and medical aspects, social implications and legal positions refer to an ethical problem.

Attachment of pneumococcal autolysin to wall teichoic acids, an essential step in enzymatic wall degradation.

High concentrations of choline and phosphorylcholine blocked the adsorption of pneumococcal autolytic enzyme to homologous cell walls and inhibited enzymatic cell wall hydrolysis in a noncompetitive manner. Enzyme adsorption had an absolute requirement for the presence of choline residues in the wall teichoic acid. Other amino alcohols and derivatives such as ethanolamine, monomethylaminoethanolamine , and phosphorylethanolamine had no effect on enzyme adsorption or hydrolytic activity. It is proposed that enzymatic hydrolysis of cell walls requires prior adsorption of enzyme molecules to the insoluble wall substrate and that cholin residues of the wall teichoic acid have the role of adsorption ligands in this process.

Clozapine in the treatment of psychotic refractory depression.

A 40-year-old woman suffering from major depression with psychotic features was unresponsive to conventional therapy. After the administration of a wide range of drug treatments and ECT, she received clozapine. Depressive symptoms improved and psychotic features disappeared. It is suggested that clozapine could be efficient in psychotic refractory depression.