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.

Changes in human respiratory sensation induced by acute high altitude hypoxia.

Respiratory sensation was studied in European low-landers at an altitude of 4382 m after a helicopter flight in order to investigate the acute and prolonged effects of high altitude hypoxia. At rest the ability to detect four inspiratory resistive loads can be used to create a sensitivity index P(A) without taking the response bias (B) into account, based on the Sensory Decision Theory. In 6 subjects respiratory sensitivity increased significantly under acute and prolonged hypoxia after 3-4 days of high altitude exposure. The respiratory sensitivity increased with the hyperventilation and mouth pressure increase induced by hypoxia. Hypoxia might also have feedback effects on the peripheral and central nervous integration of the respiratory sensation stimuli. One subject suffering from acute mountain sickness showed a severe decrease in his sensitivity index P(A) under hypoxic conditions, while the parameters of his cardiorespiratory function evolved in the same classical way as the other subjects who adapted well to altitude hypoxia. The increase in respiratory sensation may be the first necessary step in altitude acclimatization and might serve as a useful marker of this adaptation.

Response of the exocrine pancreas to graded doses of secretin in calcium-treated and normal dogs.

Persisting modifications induced by repeated intravenous calcium infusion (acute hypercalcaemia) were investigated in 6 Thomas fistula dogs: 4 controls and 4 calcium-treated dogs, two of which were studied as controls. (a) The pancreatic response to graded doses of synthetic secretin (water and bicarbonate outputs) was significantly reduced in calcium-treated dogs when compared with controls. As both the D50 for secretin-induced response increased, and the maximal secretory response decreased, if may be concluded that calcium treatment decreased the sensitivity of duct cells to secretin and reduced their secretory capacity. (b) A similar dose-response relationship was observed between secretin and pancreatic calcium outputs in controls and calcium-treated dogs. The secretin induced pancreatic calcium secretion was independent of protein secretion and latter not being modified by secretin. Thus it may be assumed that the secretory fluid calcium originated form a protein independent pool and had a dose-dependent relationship to secretin. (c) These results help to illuminate the aetiology of chronic pancreatitis induced by acute hypercalcaemia and by hyperparathyroidism.

Nutritional profiles of chronic alcoholics.

An epidemiological study of 58 variables from 300 chronic alcoholic and normal subjects was carried out in the Cardiology, Gastroenterology, Neurology, Psychiatry and Alcohology Departments in order to research, within this chronic alcoholic population, a correlation between diet, alcohol intake, tobacco use and the various alcohol-related diseases. A standardized questionnaire (previously tested) was used to relate dietary intakes (proteins, fats, carbohydrates, water and energy) to drinking and smoking habits. Discriminant analyses were used as appropriate. The alcoholic population is made up of subjects with strong oral-intake behaviour and can be classified in relation to their alcohol-related diseases. The alcoholics with cardiovascular and digestive diseases have the two (1st and 2nd) richest diets, respectively, consisting mainly of saturated fats and animal proteins, together with the lowest daily alcohol intake, the highest recorded total quantities of alcohol intake and the longest period of alcohol abuse before alcohol-related disease diagnosis. The 4th and 5th places can be reserved for the alcoholics with neurological and psychiatric diseases with opposite eating and drinking behaviours, i.e. with the poorest diet (less in terms of proteins and fats, although more than the normal population), the highest daily alcohol intake, the lowest quantities of total alcohol intake and the shortest time of alcohol abuse before disease diagnosis. The alcoholic population with subjects free of alcohol-related disease including mixed subjects, who either had not yet started or will never present any alcohol-related disease, occupy the intermediate place (3rd) in this classification.

Repeated I. V. injections of calcium salts give rise to increased exocrine pancreatic cell sensitivity to caerulein and urecholine in the dog.

The persisting modifications induced by repeated intravenous infusion of calcium salts were investigated in five dogs with Thomas fistulae. Five control dogs were also tested. In calcium treated dogs the pancreatic secretion stimulated by graded doses of either caerulein or urecholine showed: a) an increase in the sensitivity of acinar cells to caerulein and urecholine and potentiation by caerulein of the water and bicarbonate response to secretin, in contrast to the decreased sensitivity to secretin alone reported previously. b) an inhibition of water and bicarbonate secretion with urecholine stimulation, c) an inhibition of calcium secretion which was significant with caerulein. These findings could explain the data previously observed on basal pancreatic secretion of calcium treated dogs such as protein hypersecretion with protein precipitates and reduced bicarbonate secretion which are similar to modifications observed in chronic alcoholic dogs and men. These results have a clinical relevance to the understanding of the pathology of chronic pancreatitis.

The sensation of respiration in men experiencing high-altitude chronic hypoxia.

Respiratory sensation was studied in seven European lowlanders during a Himalayan expedition at over 6000 m. At rest, the ability to detect added inspiratory resistive loads can be used to create a sensitivity index P(A) taking response bias (B) into account based on Sensory Decision Theory. The data indicate that respiratory sensitivity may be involved in successful adaptation to hypoxia. Respiratory sensitivity improved during the first stages of exposure to altitude and returned to baseline after 17- and 27-day stays under chronic hypoxic conditions. The improvement in respiratory sensation could be a primary signal in the physiological and psychological adaptation to high altitude and change in sensation may reflect the degree of altitude adaptation.

Personality factors, stoicism and motivation in subjects under hypoxic stress in extreme environments.

Previous studies on the physiological and psychological adaptation of subjects to survival conditions involving high-altitude hypoxia (>6,500 m) have shown that personality factors are important in this adaptation. We, therefore, proposed personality traits assessments in two groups of subjects engaged in sporting activities under extreme hypoxic environmental conditions: a group of mountaineers at high altitudes (>5,500 m) and a group of free-lung divers at great depths (<30-60 m). These subjects were compared with two control groups: a group of subjects practicing no sport and another one practicing various competitive athletic activities involving speed constraints. The personality traits assessed concerned mainly the subjects' attitudes and their propensities to act out their feelings and fantasies; they were assessed using projective procedures, the Hand Test and Clark's Situational Pain Questionnaire based on the Sensory Decision Theory. Subjects trained in mountaineering and free-lung diving under extreme environmental conditions displayed a high degree of stoicism. These individuals shared some personality traits with other sportsmen, particularly aggressive tendencies and introversion although not to an extent which interfered with normal interpersonal relationships. However, at least when practicing these extreme sports, the subjects did retreat from society. One of our questions concerns the grounds for this social withdrawal, that is, whether it derives from a inner compulsion founded on personality factors or if it is merely an artifact of our perceptions of the subjects, created by the confluence of the individualistic nature of these sports and the extreme environments in which they are performed.

Effects of different stay durations on attentional performance during two mountain expeditions.

BACKGROUND: Hypoxia-induced deficits in intellectual performance are linked to the altitude level reached, the speed of the ascent and the time spent at high altitude. This study analyzes attentional changes during adaptation to two different types of stay at high altitude on two different expeditions: one involving a 16-d trip between 2,000 m and 5,600 m, followed by a 2-d ascent to 6,440 m and back again; the other, a 21-d stay at 6,542 m. We tested the hypothesis that, at similar high altitudes, decrements in attentional performance would only occur during a long duration stay. METHODS: Indexes for attentional performance were calculated for two experimental groups under normoxia before the climb, under acute and chronic hypoxia during the climb, and under normoxia after the climb. They were compared for two control groups tested only under normoxia. RESULTS: The altitude stay was found to have an effect on the 6,542 m group when compared with the controls. Group performance differed at 2 d and 21 d after their arrival at 6,542 m and after their return to normoxia. When all the test administrations were pooled together for this expedition we noted an interaction between the level of difficulty of the task and the experimental and control groups: namely the difference between the groups was greater for the difficult task than it was for the easy task. No effect was found for the other expedition (at 5,600 m) when the group tested was compared with the controls. CONCLUSION: For a 21-d stay at an altitude of 6,542 m with the same ascent protocol as a group climbing to a lower altitude (16 d between 2,000 m and 5,600 m followed by a 2 d ascent to 6,440 m and back again), subjects appeared to suffer from attentional performance deficits which persisted for several days after the subjects returned to normoxic conditions.

Psychological changes during altitude hypoxia.

We examined the effects of altitude hypoxia on the subject's cognitive functions and psychological state. Two assessment approaches were used, a cognitive-motor task and a structured interview. An experimental group of six subjects was tested three times: once under conditions of normoxia, once 8-20 h after a rapid climb to an altitude of 4383 m, and once 48-60 h after ascent to that altitude. A comparison of the experimental group's performance on the cognitive-motor task with that of a control group showed a difference on the second administration: the experimental group's performance did not improve, whereas the control group's performance did. This difference recovered on the third administration. A comparison of the subjects' verbalizations during the three interviews showed that they experienced a strong crisis during the first period at altitude, which improved partially during the second period. Evidence for use of certain defense mechanisms, e.g. self-concern, was found 8-20 h after ascent; both dependent measures were adversely affected. These measures recovered after 48-60 h.

Criteria for psychological adaptation to high-altitude hypoxia.

The purpose of this study was to test an ascent program for ideal psychological adaptation to high altitudes. A psychological approach was used to test a model describing a gradual step-by-step ascent. Seven subjects spent nine days between 3,500 m and 4,400 m altitude, followed by eight days climbing 500 m each day from 3,500 m to 5,400 m. They performed a cognitive-motor task three times, once under normoxia, once under acute hypoxia, and once under chronic hypoxic conditions. Durations for these subjects were compared with those obtained by a control group tested under normoxia. Subjects' emotional state was assessed by analyzing their remarks during an interview conducted at 5,400 m and by calculating from the answers given to the three questions, a mood index for each subject. Analysis showed that the performances of both groups improved on the second and third administrations of the test. There was, however, no interaction between the group and the time of administration. Mood indexes indicated that the majority of the subjects had no trouble in adapting to the situation and few cognitive or emotional disturbances were observed. These findings may be attributed to the ascent being well designed and planned thereby preventing various possible forms of mountain sickness and other pathologies from developing in the subjects.

Comparison of textual analysis applied to two lectures written three years apart by one author: the language satellites.

A comparative textual analysis was carried out on two essays "Thanatol" and "Double Talk," by F. Perrier, which were originally lectures given three years apart by the author, a psychoanalyst. This study involved the use of the ALCESTE software program, a computer-assisted method of discourse analysis. It consists of modelling the distribution of the main words occurring in speeches or texts with a view toward identifying the repetitive language patterns most frequently used by a speaker or writer. This method is described in the first part of the paper. Various types of discourse emerged from analysis along with specific topics. There were three types in the case of Thanatol and four in that of Double Talk. Upon comparing the separate results obtained on each corpus, a pool of significant words observed in the corpus Thanatol was also present in Double Talk. These words were organised into groups called "language satellites" which were dispatched in the various types of discourse. Considering the underlying language structure (the enunciation), they formed another discourse running between the lines of two lectures. This supplementary discourse was recurrent and could be said to label the author and his thoughts. The ALCESTE method brings to light in the textual production of an author a recurrent pattern of discourse which might hold some clues for the analysis of texts and speech and even about the author as evident in his own ideas and thoughts.

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.

Simultaneous mechanisms on exocrine pancreatic secretion initiated by alcohol in the conscious dog.

Modifications of pancreatic secretion induced by the infusion of alcohol were investigated in seven Thomas fistula dogs. Acute intravenous injections of low doses of alcohol induced a significant increase of all parameters of pancreatic secretion. On the contrary the acute intravenous injection of high doses of alcohol induced a significant decrease of pancreatic secretion. A prolonged-alcohol intravenous infusion producing a stable blood alcohol level provoked at first a decrease of pancreatic secretion, significant only for protein output, followed by a significant increase of all parameters of pancreatic secretion. A spontaneous return to prealcohol values of pancreatic secretion was observed in all cases even if the blood alcohol level remained high and stable and despite four hours of experimentation. Upon the background of a stable blood alcohol level, pentolinium did not suppress alcohol-induced stimulation of water and bicarbonate outputs but did abolish the postalcohol changes in protein secretion. Furthermore, atropine abolished all postalcohol changes in pancreatic secretion. Consequently, there are two responses (inhibition and stimulation) to alcohol which coexist in normal dogs. They are related to the blood alcohol levels and are transitory. These responses involve the vagus nerves. Alcohol appears to stimulate the exocrine pancreas through receptors at different levels of the nervous system.

A comparison of nutritional profiles of patients with alcohol-related pancreatitis and cirrhosis.

A multifactorial study of 58 variables of alcohol, dietary and tobacco habits of 106 chronic alcoholic and normal subjects was conducted over 2 years. The alcoholic population included subjects with either calcifying chronic pancreatitis (CCP) or cirrhosis (Ci). A standardized, previously validated questionnaire was used to investigate dietary intakes, drinking and smoking habits. The patients with CCP consumed a richer diet than those with Ci, consisting mainly of saturated fats and animals proteins. Although the alcoholics with CCP drank the same total quantity of alcohol as the alcoholics with Ci, they drank it over a shorter time period (less than 20 years) before diagnosis. Differences in the nutritional profiles of the two groups indicate that the population with alcohol-related digestive diseases is made up of subjects with different drinking and eating habits. These behavioural differences with respect to dietary and alcohol intake indicate that the alcoholic patients with CCP or Ci belong to different subgroups.

The respiratory sensation at high altitude.

The respiratory sensation was studied in Nepal at four different altitudes, 1377 m before and after the ascension, 2800 m, 3900 m and 530 m. Dyspnea was noted at each altitude for the nine subjects. They had to rate 4 external resistive loads between 2.5 and 13 cm H2O.l-1.s, presented in 2 pairs, a low and a high one. The discrimination between the loads i.e. the subject's sensitivity was obtained from Sensory Decision Analysis. These subjects were compared to six normal ones observed at sea level while breathing air, an hypoxic mixture (FIP2:11%) and air in a cold environment (-6 degrees C). In these protocols, the load perception was not modified. The 2 populations exhibited a similar sensitivity when observed in normal conditions. At exertion and with altitude, the nine subjects demonstrated a progressive increase in dyspnea, rated with visual analog scales. At rest, the perception of the loads was not altered but slightly improved with altitude for 6 subjects. The other 3 subjects (2 subjects with clinical impairment, important dyspnea and pulmonary oedema) showed an impairment of the perception. The sensitivity to the loads was similar before and after the ascension for the well adapted subjects to altitude. In conclusion, the respiratory sensation is not impaired with altitude in well adapted subjects and transient hypoxia does not result in change in load perception. An impairment in load perception observed in some subjects is probably related to the secondary effects of chronic hypoxia, i.e. cerebral and/or pulmonary suboedema.

Dose-dependent, and long-lasting, effects of repeated intravenous injections of calcium on the canine secretin-stimulated pancreatic juice secretion.

The effects of repeated intravenous calcium administration on pancreatic juice secretion were investigated in four Thomas fistula dogs. During stimulation by 1.0 U kg-1h-1 GIH secretin, three Ca doses were administered: 2, 4 and 8 mu mol kg-1 min-1 during 1 h, saline being used in control tests; one dose only was tested per day. It was found that Ca administration induced both acute and long-lasting effects. Acute effects were characterized by an increased response to secretin stimulation. Fluid, HCO3(-), protein and Ca outputs increased significantly in a dose-dependent manner, the increase of protein output being the most dramatic. Long-lasting effects, until now unrecognized, were characterized by a progressive increase of protein secretion during the first hour of secretin stimulation. This increase kept going during the 3 months of repeated calcium injections. Although protein plugs were observed in the juice, sometimes stopping the flow of juice, no pancreatic lesion was found. A second protocol showed that, after discontinuing calcium injections, the long-lasting effects decreased progressively, but protein hypersecretion was still significant 3.5 months later. The importance of these findings regarding chronic pancreatitis due to hyperparathyroidism is discussed.

Pain perception under chronic high-altitude hypoxia.

Following studies of respiratory sensory functions during high-altitude adaptation, pain perception investigations were carried out on European lowlanders during an expedition on the Bhrikuti peak, Himalaya (first ascent). Perception thresholds and discrimination performances of electrical stimuli applied to the skin were determined with a constant stimulus method. Additionally, Clark's Situational Pain Questionnaire was used to measure discriminability and response bias of the subjects' reports of pain. The tests were performed in the field under normoxic conditions, before and after ascent, and under hypoxic conditions at altitudes of 3500 and 5600 m. The tests were also performed in a control group under normoxic conditions and similar ambient temperatures. Under normoxic conditions, the expedition group differed from the control group and demonstrated a more stoic attitude and a lower pain threshold. At high altitudes, pain thresholds decreased through improved sensory discrimination performances. Hypoxia is supposed to be the main cause of this sensory adaptive reaction to altitude as psychological attitude remained unchanged and a decrease in ambient temperature was without effect on pain perception in the control group. Increased discrimination in pain perception may be a component of a general improvement in sensory processing during the early stages of altitude acclimatization.

Discursive strategies of subjects with high altitude hypoxia: extreme environment.

A discourse analysis was carried out on nine European lowlanders during a 2-month scientific expedition at high altitude including a 3-week stay in extreme survival conditions at the summit of Mt. Sajama (6542 m), in order to contribute to the understanding of psychological adaptation to extreme environments. This discourse analysis was part of a wide-ranging scientific investigation involving 12 scientific and medical research protocols which targeted human adaptation to high altitude chronic hypoxia. The objective of this study is to better understand the presence of linguistic markers capable of translating the subject's psychological state when faced with a threatening environment. This study was based on a method of propositional speech analysis developed by Ghiglione and Blanchet which emphasizes the cognitive function of verb categories, modalizers and adjuncts used by subjects. The method was developed in conjunction with psychopathological studies of the depressive state. Speech was recorded at time T1, 4 days after reaching the summit of Mt Sajama, and at time T2, 2 days before descending the mountain peak. These results revealed that in the absence of depression in any psychopathological sense of the word, normal subjects would react to their environment with a depressive component. However, the results of this study equally illustrate for some subjects a correspondence between those states with a depressive component and a physiological incomplete adaptation to high altitude. This correspondence could reflect the pathogenic effect of an adaptation deficit or could be in keeping with the literature concerning an incomplete adaptation effect induced by a latent depressive state.

Persisting modifications of dogs' basal exocrine pancreatic secretion after repeated intravenous calcium injections.

Biochemical, histological and crystallographic studies were carried out on the pure exocrine pancreatic juice of calcium treated dogs and of normal dogs. 1. A long-lasting effect of repeated intravenous calcium injections was observed on the protein basal secretion (output and concentration) with intraductal plug formation. 2. The ionic equilibrium was changed leading to modifications of protein and calcium solubilities with formation of protein and calcium precipitates. 3. Plugs were further studied: three components were identified, (a) cells mostly of ductal origin, (b) calcium salt already crystallized in the plug on coming out of the duct, (c) protein material in the central part of the plug. The importance of these data is in relation with pancreatic disorders by hypercalcaemia and hyperparathyroidism.

Pancreatic basal secretion in alcohol-fed and normal dogs.

Biochemical, histological, and crystallographic studies were carried out on basal pancreatic secretion of 4 dogs fed alcohol for 12-15 months and 11 control dogs. The results in alcohol-fed dogs when compared to normals showed that: (1) protein concentration was higher, (2) fluid was decreased; (3) conductivity was decreased leading to differences in ionic distribution: Cl- and H+ ion concentrations increased, HCO3 concentrations and output decreased, total Ca, Mg, and Zn soluble in the juice did not change and therefore Ca, Mg, and Zn to protein ratios decreased. In the basal secretion of alcoholic dogs, numerous plugs were found of which three components were identified: (1) cells mostly of ductal origin; (2) calcium already crystallized; (3) protein material in the center of these plugs. Thus a change in Donan equilibrium led to modifications of protein and calcium solubilities with formation of precipitates. These findings are relevant to the study of chronic pancreatitis due to alcohol consumption.