A multidimensional examination of affective and cognitive empathy in anorexia nervosa.

Socio-emotional features are crucial in the development and maintenance of anorexia nervosa (AN). The present study investigates the patterns of altered and preserved empathic abilities in AN. Empathy is an umbrella term that comprises the ability to recognise another's emotional state, take another's perspective, and fantasise (cognitive empathy), as well as the ability to experience vicarious emotions and signal them (affective empathy). These empathic abilities were measured in 43 AN patients and 33 healthy women through a multi-method approach comprising self-report measures, behavioural tasks and bodily correlates. Further, we assessed self-reported approach-avoidance attitudes towards suffering others. Results showed that, within the domain of cognitive empathy, AN patients reported impairment in recognising emotional expressions of anger and fantasising. Concerning affective empathy, they manifested lower sharing of others' positive emotions, higher self-reported distress, and higher facial expressiveness during a video depicting a suffering person. Finally, AN patients reported lower motivation to approach suffering others. Our results draw a complex picture of preserved and altered empathic abilities in AN and capture which are the deficits mediated by the higher levels of anxiety and depression reported by the AN population and those that seem to persist independently from these co-morbid conditions.

Grasping the mechanisms of narratives' incoherence in schizophrenia: an analysis of the temporal structure of patients' life story.

OBJECTIVE: Life narratives of patients with schizophrenia are characterized by impaired coherence so that the listener has often difficulties to grasp the life trajectory of the patients. In order to better understand what causes this reduced temporal coherence, we investigated the temporal structure of patients' life narratives through different temporal narrative elements (elaboration of beginnings and endings, local temporal indicators and temporal deviations from a linear order), across two complementary studies. METHODS: Life narratives were collected by means of two different methods; a free recall in study 1 and a more structured protocol, aiming at reducing the cognitive task demands in study 2. All narratives from the two studies were analyzed using the same validated method. RESULTS: Both studies showed that global temporal coherence is significantly reduced in patients with schizophrenia (ps.02). This is mainly due to their stronger tendency to temporally deviate from a linear temporal order without marking the deviation as such. We also observed significant correlations in the patient groups between global temporal coherence and executive dysfunction (p=.008) or their higher tendency to temporally deviate from a linear temporal order in their life narratives (p<.001). CONCLUSIONS: These results shed light on narrative correlates of temporal narrative incoherence in schizophrenia and highlight the central role of executive dysfunction in this incoherence.

Heart rate variability analysis as an index of emotion regulation processes: interest of the Analgesia Nociception Index (ANI).

Autonomic Nervous System (ANS) variations are strongly influence by emotion regulation processes. Indeed, emotional stimuli are at the origin of an activation of the ANS and the way an individual pass from a state of alert in the case of emotional situation to a state of calm is closely coupled with the ANS flexibility. We have previously described and developed an Analgesia Nociception Index (ANI) for real time pain measurement during surgical procedure under general anesthesia. This index, based on heart rate variability analysis, constitutes a measure of parasympathetic tone and can be used in several other environments. In this paper, we hypothesized that such an index could be used as a tool to investigate the processes of emotional regulation of a human subject. To test this hypothesis, we analyzed ANI's response to a negative emotional stimulus. This analysis showed that the index decreases during the emotion induction phase and returns to its baseline after 2 minutes. This result confirms that ANI could be a good indicator of parasympathetic changes in emotional situation.

Categorical and dimensional study of the predictive factors of the development of a psychotrauma in victims of car accidents.

OBJECTIVE: This study aimed to evaluate the predictive factors of the emergence of complete PTSD and subsyndromal PTSD (defined as individuals exposed to a traumatic event with at least one psychopathological impact, such as hyperarousal, avoidance or persistent re-experiencing) following a motor vehicle accident (MVA). METHODS: We recruited 155 adult MVA patients, physically injured and admitted to trauma service, over two years. In the week following the accident, patients were asked to complete questionnaires assessing their social situation (sex, age, marital and employment status, prior MVA or trauma), comorbidity (MINI), distress (PDI) and dissociation (PDEQ) experienced during and immediately after the trauma. An evaluation using the CAPS was conducted six months after the trauma to assess a possible PTSD. RESULTS: At six months, 25.8% of the participants developed subsyndromal symptoms and 7.74% developed complete PTSD. The three symptoms that best discriminated the groups were dysphoric emotion, perceived life threat and dissociation. Logistic regression results showed that the strongest predictor of PTSD was the perceived life threat. In addition, a dimensional approach to the results revealed significant correlations between (1) peritraumatic distress and persistent re-experiencing or hyperarousal and (2) dissociation score and avoidance strategy. The presence of a prior traumatic event reinforces avoidance strategies. CONCLUSIONS: Our results stress that peritraumatic factors (especially the perception of a life threat) are good predictors of PTSD development. A dimensional perspective allows better identification of psychological complications following an MVA.

[Overgeneralization of autobiographical memory strategies in cannabis users and multiple psychoactive substance consumers]. / Stratégies de surgénéralisation des souvenirs autobiographiques chez les consommateurs de cannabis et les polyconsommateurs de substances psychoactives.

OBJECTIVES: Psychoactive substance consumption induces cognitive impairments in terms of episodic memory and attentional and executive function deficits. This study aims to investigate whether the recall of autobiographical memories is disturbed in substance consumers, and in particular whether those patients tend to evoke memories at a general level rather than at a specific level when confronted by an emotional cue word. Furthermore, we aim to verify whether adopting a more general memory retrieving style is a dynamic phenomenon and if it depends on the type of substance consumed. DESIGN AND METHODS: The participants of this research were 51 cannabis users, including 17 occasional cannabis users, 17 cannabis abusers and 17 individuals addicted to cannabis. They were compared to 18 multiple substance-dependent individuals and to 38 nondependent individuals. Participants were subjected to the Williams and Scott (1988) [39] autobiographical memory test. After an assessment of the mode of substance consumption, several clinical dimensions were measured, such as depression (BDI), anxiety (STAI Y A and B), alexithymia (TAS 20) and episodic memory (RLS-15). RESULTS: The results show that the percentage of general positive and negative memories recalled increases progressively as the consumption takes on the characteristics of addictive behavior, while we observe no deficit in episodic memory. The level of alexithymia evolved in parallel with the percentage of general memories. These results are not dependent on the type of substance used and can not be explained by the level of depression. CONCLUSIONS: Overgeneralization is a phenomenon observable in psychoactive substance consumers, whatever the type of substances used, which sets in progressively as the dependence develops. Our results show that overgeneralization is not only due to an impairment of mnesic abilities, implying that this phenomenon could be underlined by several mechanisms. The role of overgeneralization as a functional avoidance established in attempt to protect individuals from emotion resurgence is discussed. Furthermore, the impact of deficits in executive functions on the recall of autobiographical memories in substance abusers has not been studied and would be an interesting path of research.

[Levels of emotional awareness in alcohol-dependent patients and abstinent alcoholics]. / Niveaux de conscience émotionnelle chez les sujets alcoolodépendants et abstinents.

BACKGROUND: Deficits in the communication and identifying of feelings are usually observed in addiction disorders. These dysfunctions vary according to the type of addiction and are particularly marked for alcoholic subjects. The prevalence of alexithymia evolves in a nearly linear manner according to the severity and the duration of the disorder. As the duration of alcoholism and the quantity of alcohol that is consumed increase, so will the subjects' scores of alexithymia. In addition, certain authors have observed a decrease in alexithymia in abstinent subjects. Subjects having been abstinent for a long period of time were more alexithymic than those having been abstinent for a shorter period of time. However, other studies failed to confirm these findings and did not observe an increase in the levels of alexithymia in polydrug patients. It seems however that the measures of alexithymia obtained using self evaluation tools (TAS 20) lack in precision due to the fact that, even though the subject is supposed to have a deficit in the identifying and the verbalisation of his emotional states, he is asked to do his own evaluation of the said emotional states. Hence, other tools such as the level of emotional awareness scale (LEAS) offer another approach to the measuring of alexithymia, based on the everyday situations and integrated in a general model of the differentiation of emotional states (or of emotional awareness). DESIGN OF STUDY: The purpose of the study is to describe the level of emotional differentiation of alcoholic subjects, and to evaluate the development of the emotional processes following alcohol cessation. Our sample consists of 88 subjects distributed in three groups: a group of alcoholic participants who are in the process of quitting alcohol (33 subjects), a group of alcoholic participants that have been abstinent for more than 6 months (20 subjects) and a group of control participants (35 subjects). The prevalence of alexithymia is estimated by the Toronto alexithymia scale (TAS 20) which measures three factors: the difficulty to identify one's feelings (TAS 1), the difficulty to express one's feelings (TAS 2), and thoughts which are directed towards the outside world (TAS 3). The levels of emotional consciousness are estimated by the LEAS which establishes 20 scenarios in order to measure three scores: emotional consciousness "for oneself" (LEAS 1), emotional consciousness "for others" (LEAS 2) and a total score (total LEAS). RESULTS: The results show a different level of emotional awareness and alexithymia between the three groups of participants. The alcoholic participants are less conscious of their feelings and have more difficulties identifying and expressing their feelings than the control subjects. With regards to the evolution of the emotional deficit linked to alcohol withdrawal, the abstinent subjects obtain weaker scores of alexithymia than the alcoholic subjects. However, abstinent subjects continue to present more difficulties expressing their feelings than control subjects (TAS 2). On the other hand, abstinent subjects' levels of emotional awareness are once again comparable to those of control subjects. Finally, the analysis of the correlations does not show any link between the scores of alexithymia and the scores of emotional consciousness, and this for all of the groups studied. Our major result concerns the recovery of the emotional deficit of abstinent subjects (global score of TAS 20 and the score of emotional consciousness), which underlines the importance of the implementation of therapeutic protocols that focus on the emotional awareness of alcoholic subjects.

[Dyadic Adjustment Scale: clinical interest of a revision and validation of an abbreviated form]. / Echelle d'ajustement dyadique: intérêts cliniques d'une révision et validation d'une version abrégée.

BACKGROUND: The problems associated with people interaction within a couple is one of the principal causes for consultations in individual psychotherapy. The Dyadic Adjustment Scale (DAS; J Marriage Fam 38 (1976) 15-28) is regarded as the most used evaluation tool of marital adjustment. To date, however, there is no fully satisfactory version of the test, either because the revised versions have undergone an over simplification of the underlying model, or the revised versions have remained faithful to the postulates of the DAS but have not been fully validated. Moreover, from a clinical point of view, marital therapy must be associated with the analysis of both convergences and divergences between the adjustment of each partner. Hence, the DAS could be viewed as a tool that is particularly adapted to such an evaluation. Nevertheless, a precise analysis of DAS is required in order to grasp both the individual profiles and the pattern differences between the individuals. DESIGN OF THE STUDY: We conducted a series of studies with the aim to (1) test once more the limits of the original DAS structure and, (2) identify a simple structure for the tool through exploratory factor analysis. First, we showed that our analyses provided the possibility to simplify the inventory. Hence, it was possible to decrease the number of scales as well as the number of items used. Contrary to the unidimensional tendency and the extreme simplification of the number of items, we were able to identify furthermore the precise constructs taken into account by the DAS, and to proceed in a rigorous and validated analysis of two distinct samples. Second, we examined the stability of the structure according to the sex of both respondents. Finally, we checked the relevance of this factorial structure for the better understanding of the differences between partner interactions within the couple. Participants' data were collected from a sample of 123 couples. Results showed that the structure reported by Spanier is not replicated. After a first elimination of items on criteria of asymmetry and a weak capacity for discrimination, we ran factor analysis with the answers of the sub sample of validation. We chose principal components analysis with orthogonal rotations in order to identify the most independent constructs. Sixteen items were preserved. RESULTS: Results showed that they were organized according to two dimensions that explain 52% of the variance. The first factor relates to the degree of agreement in couples (DA). Ten items present loadings with this component explaining 32% of the variance. The second dimension, made up of six items, corresponds to the quality of the dyadic interactions (IQ). This factor explains 20% of the variance. The correlation between the scales that were derived from this analysis was found to be r=0.50 (p<0.01). The cross-validation analysis performed on the subjects' answers was found to follow the same factorial structure, just as the male and female samples did. Our analyses further highlighted the relevance of a hierarchical structure and consequently, the possibility of calculating a total score. The coefficients of internal consistency were 0.89 for the total scale and the scale of degree of agreement, and 0.75 for the scale of quality of the interactions. As the DAS-16 was strongly correlated with the full DAS version, the possibility of score equivalence was thus confirmed. In conclusion, our results provide a unidimensional structure and a two-dimensional comprehension of marital adjustments. The factors were shown to be stable and similar for sex. Moreover, one of the weaknesses of the original version of the DAS was the lack of independence of the scales. Our version of the DAS allows the identification of factors that are moderately correlated. Finally, one of the originalities of our work is the validation of the abbreviated form that used as indicator the differences between partner interactions within a given couple.

[Dynamic paradigm in psychopathology: "chaos theory", from physics to psychiatry]. / Paradigme dynamique en psychopathologie: la "Théorie du chaos", de la physique à la psychiatrie.

For the last thirty years, progress in the field of physics, known as "Chaos theory"--or more precisely: non-linear dynamical systems theory--has increased our understanding of complex systems dynamics. This framework's formalism is general enough to be applied in other domains, such as biology or psychology, where complex systems are the rule rather than the exception. Our goal is to show here that this framework can become a valuable tool in scientific fields such as neuroscience and psychiatry where objects possess natural time dependency (i.e. dynamical properties) and non-linear characteristics. The application of non-linear dynamics concepts on these topics is more precise than a loose metaphor and can throw a new light on mental functioning and dysfunctioning. A class of neural networks (recurrent neural networks) constitutes an example of the implementation of the dynamical system concept and provides models of cognitive processes (15). The state of activity of the network is represented in its state space and the time evolution of this state is a trajectory in this space. After a period of time those networks settle on an equilibrium (a kind of attractor). The strength of connections between neurons define the number and relations between those attractors. The attractors of the network are usually interpreted as "mental representations". When an initial condition is imposed to the network, the evolution towards an attractor is considered as a model of information processing (27). This information processing is not defined in a symbolic manner but is a result of the interaction between distributed elements. Several properties of dynamical models can be used to define a way where the symbolic properties emerge from physical and dynamical properties (28) and thus they can be candidates for the definition of the emergence of mental properties on the basis of neuronal dynamics (42). Nevertheless, mental properties can also be considered as the result of an underlying dynamics without explicit mention of the neuronal one (47). In that case, dynamical tools can be used to elucidate the Freudian psychodynamics (34, 35). Recurrent neuronal networks have been used to propose interpretation of several mental dysfunctions (12). For example in the case of schizophrenia, it has been proposed that troubles in the cortical pruning during development (13) may cause a decrease in neural network storage ability and lead to the creation of spurious attractors. Those attractors do not correspond to stored memories and attract a large amount of initial conditions: they were thus associated to reality distorsion observed in schizophrenia (14). Nevertheless, the behavior of these models are too simple to be directly compared with real physiological data. In fact, equilibrium attractors are hardly met in biological dynamics. More complex behaviors (such as oscillations or chaos) should thus to be taken into account. The study of chaotic behavior have lead to the development of numerical methods devoted to the analysis of complex time series (17). These methods may be used to characterise the dynamical processes at the time-scales of both the cerebral dynamics and the clinical symptoms variations. The application of these methods to physiological signals have shown that complex behaviors are related to healthy states whereas simple dynamics are related to pathology (8). These studies have thus confirmed the notion of "dynamical disease" (20, 21) which denotes pathological conditions characterised by changes in physiological rhythms. Depression has been studied within this framework (25, 32) in order to define possible changes in brain electrical rhythms related to this trouble and its evolution. It has been shown that controls' brain dynamics is more complex than depressive one and that the recovery of a complex brain activity depends on the number of previous episodes. In the case of the symptoms time evolution, several studies have demonstrated that non-linear dynamical process may be involved in the recurrence of symptoms in troubles such as manic-depressive illness (9) or schizophrenia (51). These observations can contribute to more parcimonious interpretation of the time course of these illnesses than usual theories. In the search of a relationship between brain dynamics and mental troubles, it has been shown in three depressed patients an important correlation between the characteristics of brain dynamics and the intensity of depressive mood (49). This preliminary observation is in accordance with the emergence hypothesis according which changes in neuronal dynamics should be related to changes in mental processes. We reviewed here some theoretical and experimental results related to the use of "physical" dynamical theory in the field of psychopathology. It has been argued that these applications go beyond metaphor and that they are empirically founded. Nevertheless, these studies only constitute first steps on the way of a cautious development and definition of a "dynamical paradigm" in psychopathology. The introduction of concepts from dynamics such as complexity and dynamical changes (i.e. bifurcations) permits a new perspective on function and dysfunction of the mind/brain and the time evolution of symptoms. Moreover, it offers a ground for the hypothesis of the emergence of mental properties on the basis of neuronal dynamics (42). Since this theory can help to throw light on classical problems in psychopathology, we consider that a precise examination of both its theoretical and empirical consequences is requested to define its validity on this topic.

Depression as a dynamical disease.

Mathematical models are helpful in the understanding of diseases through the use of dynamical indicators. A previous study has shown that brain activity can be characterized by a decrease of dynamical complexity in depressive subjects. The present paper confirms and extends these conclusions through the use of recent methodological advances: first episode and recurrent patients strongly differ in their dynamical response to therapeutic interventions. These results emphasize the need for clinical follow-ups to avoid recurrence and the necessity of specific therapeutic intervention in the case of recurrent patients.

Temporal localization of the response selection processing stage.

Response choice is one of the stages in the information processing model proposed by Sanders. It is influenced by stimulus-response (S-R) compatibility. Segmentation of the processing window in intervals between RT and peak latencies and between peak latencies, was used to test the assumption that the decisional processes would be concomitant with the N200 rather than the P300 component. ERPs were recorded in ten subjects during a spatial S-R compatibility auditory task. The S-R compatibility effect is observed on P300 latencies but is only a trend on the N200 component. An effect also observed on the interval between RT and N200 and especially between N200 and P300 while no effect is observed on the interval between RT and P300. These results support the idea that the selection processes ending with P300 occurrence could start as early as the N200 peak component.

[Study of the organization of sensorimotor stages in man using delayed evoked potentials]. / Etude au moyen des potentiels évoqués tardifs de l'organisation des étapes sensorimotrices chez l'homme.

The main aim of this study was to test the relative organization of three of the stages of Sanders' 1990 information processing model: "features extraction", "response choice", and "motor adjustment". The variables influencing these stages: stimulus degradation, stimulus-response (SR) compatibility and preparatory period have been manipulated. Event related potentials (N100, N200, P300) and reaction time were recorded from ten healthy subjects, in a dichotic listening task. Reaction times are lengthened for degraded stimuli, in the absence of a preparatory period and for SR non compatible conditions. However, the interaction between preparatory period and stimulus degradation variables, suggests an overlapping of the corresponding stages contrary to Sanders' postulate. The non compatible condition increases the latency of N200 and P300 components. The results suggest that the response choice processing would be contemporary to the N200 component. They are discussed within the framework of models of early communication between sensory and motor systems.

Decrease of complexity in EEG as a symptom of depression.

Nonlinear dynamic analysis provides new methods for the processing of the electroencephalogram (EEG). We demonstrate here that the EEG dynamics of major depressive subjects is more predictable, that is less complex, than that of control subjects. Moreover, the consequence of treatment upon the EEG dynamics seems to be dependent on the appearance of the illness. Although the specificity of this dynamic signature for different stages of depression is to be confirmed, the assumption of a strong link between a healthy system and a high level of complexity in dynamics is further supported.

Time for reorienting of attention: a premotor hypothesis of the underlying mechanism.

The paradigm of the covert orienting of attention (COA) has shown that the displacement of visual attention may be assessed even in the absence of eye movement. Stimuli correctly cued before their presentation are usually detected faster than uncued stimuli. However, miscued stimuli induce an increased detection time, which has been attributed to the time required for the reorientation of attention from the incorrect to the correct spatial location. Currently, the mechanism of such a displacement of visual attention remains unknown. Rizzolatti et al. Neuropsychologia 25, 31-40 (1987) have suggested a premotor hypothesis which suggests that an oculomotor disprogramming and reprogramming is necessary to reorient visual attention, even if the eye movement is inhibited. Since shifting of auditory attention from one ear to the other does not require any motor control, we further investigated the model of COA in 20 normal subjects who performed two tasks requiring a reorienting of auditory attention: (1) a choice RT task that requires a response readjustment during the auditory reorienting; (2) a simple RT task that does not require a response readjustment during the auditory reorienting; (2) a simple RT task that does not require a response readjustment during the auditory reorienting. Results indicate that correctly cued stimuli significantly reduce the RT in both tasks and that this reduction is greater in the choice than in the simple RT task. This suggests that a correct cue may produce a pre-programming of the response, in addition to the pre-engagement of the perceptual attention.(ABSTRACT TRUNCATED AT 250 WORDS)