The impact of aversive personality traits on the psychotic-spectrum of disorders.

OBJECTIVES: Though relatively unexplored in clinical populations, aversive personality traits have been shown to impact the expression, the management, and the outcomes of psychotic disorders. This paper seeks to gather and organize existing evidence of the complex interplay linking social ethics, personality and experiences of psychosis through the lens of the so-called Dark Triad personality model, comprising the three multidimensional constructs Machiavellianism, narcissism and psychopathy. METHODS: A semi-systematic review of major literature databases was conducted; search terms aimed at capturing each of the Dark Triad dimensions and their known relations with both clinical (with single-symptom approach) and non-clinical psychotic experiences. RESULTS: Reviewed studies suggest that all the components of the Dark Triad model present significant clinical implications in the management of psychotic disorders. CONCLUSIONS: Aversive personality traits interact with and modulate the experiences of psychosis. They can be shown to influence the clinical and functional outcomes of psychotic patients. Therefore, further research on this theme seems justified in that it may inform rehabilitative efforts.

Age at the time of onset of psychosis: A marker of specific needs rather than a determinant of outcome?

BACKGROUND: While there is suggestion that early onset of psychosis is a determinant of outcome; knowledge regarding correlates of later onset age is more limited. This study explores the characteristics of patients developing psychosis after age 26, towards the end of the usual age range of early intervention programs, in order to identify potential specific needs of such patients. METHODS: Two hundred and fifty-six early psychosis patients aged 18-35 were followed-up prospectively over 36 months. Patients with onset after 26 ("later onset", LO) were compared to the rest of the sample. RESULTS: LO patients (32% of the sample) had shorter DUP, were less likely to be male, had better premorbid functioning and were more likely to have been exposed to trauma. They had greater insight at presentation and less negative symptoms overall. The trajectories for positive and depressive symptoms were similar in both groups. Evolution of functional level was similar in both groups, but while LO patients recovered faster, they were significantly less likely to return to premorbid functional level. CONCLUSIONS: Later psychosis onset correlates with better premorbid functioning and higher rate of trauma exposure; the latter should therefore be a treatment focus in such patients. LO patients were less likely to return to premorbid functional level, which suggests that current treatment strategies may not be efficient to help patients maintain employment. The possibility of distinct illness mechanisms according to onset age and the more central role for trauma in patients with onset after age 26 needs to be further explored.

[Workaholism: between illusion and addiction]. / Boulomanie: entre illusion et addiction.

Workaholism surfaced some years ago as a veritable addiction in the wide sense of the term, dependence. It differs from other sorts of dependence in that it is very often viewed in a positive perspective in the sense that it conveys to the person concerned the illusion of well-being, as well as a motivation and dedication in their professional activity. During the past 30 years, several authors have attempted to define this concept and to determine its characteristics. Robinson believes that workaholics have an approach to life whereby their work feeds on time, energy and physical activity. This provokes consequences that affect their physical health and interpersonal relationships. They have a tendency to live in the future rather than in the present. For Scott, Moore and Micelli , the compulsion for work is not necessarily viewed as being detrimental to one's health. Spence and Robbins highlight the notion of the pleasure experienced at work in their theoretical approach. The prevalence of the dependence on work is estimated at between 27 and 30% in the general population. It is correlated to the number of hours of work per week and tends to be higher as annual revenue increases. The sex ratio is 1, and the parents of children 5 to 18 years of age are the most susceptible to considering themselves workaholics. The physical and psychological consequences of professional exhaustion are characterized primarily by the decrease in self-esteem, symptoms of fatigue, anxiety, depression, irritability and the manifestation of physical problems including cardiovascular ailments, as evidenced by hypertension, as well as heart and kidney complications. All the theoretical point of views, from the psychoanalytical models to the contemporary models, highlight self esteem as being the centerpiece of the question regarding the problem of workaholism. In fact, the narcissism articulated from the sociological evolution of our western way of life permits us to delineate the psychic identity of the individual better, and therefore, to understand this reconstructive attempt of one's self better. In characterizing the personality traits of workaholic individuals, the doctor/therapist is required to deal with this new form of dependence as early as possible, in order to anticipate and avert the numerous personal, professional, social, relational and sanitary complications. Faced with this large prevalence of dependence on work, it seems important to us to look for a symptomatology that would emanate a signal of workaholism so as to envisage and propose to workaholic patients a specific course of action that would be adapted to their needs.