[Study of agency in the discourse of women suffering from post-traumatic stress disorder in the aftermath of domestic violence]. / Étude de l'agentivité dans le discours de femmes souffrant de trouble de stress post-traumatique dans les suites de violences conjugales.

INTRODUCTION: In the absence of appropriate care, psychotraumatic consequences (revival, hyperarousal, avoidance strategies, dissociation and other clinical forms of post traumatic symptoms) can take control of a large part of the subject's existence (psychological, physical, social) and affect the ability of the victim to regain ground on the intrusions that harass, and to take up new life projects. More objective than the current semiological and psychometric approaches, and in the absence of biomarkers that may be used in clinical practice, psycholinguistics opens up an epistemological renewal of the conception of trauma and its clinical consequences, in particular through the definition of the Psycho Linguistic Traumatic Syndrome (SPLIT). If such conceptions have been developed based on the analysis of traumatic accounts of subjects injured in war and attacks, other forms of psychotraumatic confrontations also deserve to be considered. In this paper, our objective was to better characterize the pronominal forms of agency in the traumatic and non-traumatic narratives produced by women victims of domestic and/or sexual violence. METHODS: Nineteen women aged 20 to 60 victims of domestic violence and diagnosed with post-traumatic stress disorder (Mini International Neuropsychiatric Interview) as well as a matched control group participated in the study. The subjects completed the French versions of Post Traumatic Checklist (PCL-5), Dissociative Experience Scale (DES) and Hospital and Anxiety Depression Scale (HAD). Traumatic and non-traumatic narratives were linguistically coded and scored on the SPLIT-10 scale. RESULTS: Traumatic narratives contained significantly more first person singular pronouns than the non-traumatic narratives of controls or the non-traumatic narratives of psychically injured people. Traumatic narratives contained significantly more of the direct object pronoun "me" as well as indirect object pronouns. In traumatic narratives, the frequency of use of the subject pronoun "I" tended to correlate negatively with the HAD-A, HAD-D and SPLIT-10, while the frequency of use of the direct object pronoun "me" tended to correlate positively with DES, HAD-A, HAD-D as well as SPLIT-10. Finally, traumatic narratives contained significantly more verbs in the passive voice than non-traumatic narratives. DISCUSSION: There was a gradient in the use of the first person singular pronoun that was inversely correlated to the degree of traumatic valence of the narratives: the control group used "I" less often than the psychically injured people who appeared to use this pronoun all the more as their narratives had a traumatic valence. In other words, even in the so-called "non-traumatic" narratives produced by subjects suffering from post-traumatic stress disorder, the trauma seemed to be inscribed in the discourse, testimony to dissociation, as the seen in the correlation of this pronominal expression dimension of "I" with the SPLIT-10 scale. The use of the direct object complement was correlated with greater psycho-traumatic morbidity (dissociative, depressive and anxious) than the use of the "I", the latter remaining however a pathological mark instead of the use of the pronouns "we" or "one". Saying "I" translated less symptomatology than saying "me", but it was when the subject said "we" or "one" that he appeared to have returned to a normal discourse, no longer suffering from the torments of reliving or pathological dissociation. The identification of linguistic markers deserves to be pursued in order to better objectively describe post-traumatic psychiatric disorders, to better identify them in clinical practice in the field and to monitor the efficiency of the recommended psychotherapies. More generally, we may put forward the hypothesis that the direct modification of the patient's language, thanks to the intervention of the practitioner, from a speech composed of linguistic markers testifying to the trauma towards a normalized speech could help to treat post-traumatic symptoms.

Post-concussion syndrome: Still forgotten? From the disappearance of the DSM-5 to a multidisciplinary consultation.

OBJECTIVES: Following the presence of both post-traumatic stress disorder (PTSD) and post-concussion syndrome (PCS) in the nosography since the publication of DSM-IV, large-scale studies investigated the links between these two entities: exposure to a mild traumatic brain injury was correlated with the presence of PTSD and vice versa, and the strongest factor associated with PCS was the presence of PTSD. But PCS entity was recently suppressed from the 5th edition of the American diagnostic and statistical classification of neuropsychiatric disorders (DSM-5, 2013). In the 11th edition of the CIM, PCS is also likely to be omitted. This elimination raises more questions if we take into consideration the emancipation of PTSD, which now includes the full category of "disorders related to trauma and stressors" to which PCS could have legitimately been added. METHODS: We discuss current scientific literature and clinical practices with a socio-anthropological point of view. RESULTS: Post-concussion and post-traumatic clinical entities often show similar anamnestic temporalities, with an initial acute phase where memory (amnesia following TBI; dissociative post-traumatic amnesia) and consciousness (initial loss of consciousness secondary to TBI; peri-traumatic psychic dissociation) impairments predominate, followed by a pauci-symptomatic latency phase. Finally, a symptomatic phase occurs in which similar symptoms for both entities are observed (sleep disorders, anxiety and depression, irritability, fatigue, attention disorder, tendency to avoidance). If similar therapies (pharmacological and psychological) are effective in treating the clinical consequences of head and mental trauma, this suggests that they have common etiopathogenic origins. CONCLUSIONS: Yet, post-concussion syndrome remains a clinical-biological reality. If a diffusion tensor imaging MRI in the acute phase is likely to provide predictive elements for subsequent cognitive dysfunctions, it would appear useful to consider combining biomarkers, and linguistics markers, with the creation of a clinical-radio-bio- neuropsychological score in order to differentiate benign outcomes from neuro- and/or psycho-traumatic disorders.

Written production in a case of locked-in syndrome with bilateral corticopontic degeneration.

Patients in locked-in syndrome show normal or near normal mental abilities that contrast with the limited motor capacity that hinders voluntary communication. However, eye movements and blinking are usually preserved and can be used to establish a communication system. We report an exceptional case of locked-in syndrome. The aetiology was basilar thrombosis consecutive to a cervical manipulation. In addition, brain MRI performed 23 years later showed a ventral pontine stroke with bilateral corticopontic degeneration. In this study the patient was able to produce written output using a chin-controlled Morse system decoded by a computer. A detailed linguistic analysis of text written over 20 years by the patient was carried out. The data demonstrate that improvements in language performance can be observed even in patients with brain lesions in areas associated with high-level cognitive processes. The data show a decrease of typing, grammatical and lexical errors over time, use of less frequent words, and an increase of more complex linguistic structures. This paper adds to previous findings confirming the value of daily practice and rehabilitation to enhance quality of life in this group of patients.