[Bipolar disorders and multiple etiologies : a link with attachment disorders ?] / Troubles bipolaires et étiologies multiples : un lien avec les troubles de l'attachement ?

Bipolar disorders (BD) bring together different forms of mood disorders, characterized by the occurrence of depressive, manic, hypomanic and/or mixed episodes. They are recognized as the seventh cause of disability per year of life among 15 to 44 year old people by the World Health Organization (WHO). It is therefore a frequently encountered pathology. On the etiological level, the avenues currently accepted concerning BD are multiple, yet they still remain at the hypothesis stage. Each of these avenues therefore has therapeutic potential. It therefore seems interesting to address the different major hypotheses existing to date on the etiological level. We will first describe BD from historical, nosological and epidemiological points of view. We will then develop the genetic etiological aspects and the neural aspects through brain imaging research. Finally, we will propose a reflection on the specific relational etiology and the avenues of research that result from it.

Les troubles bipolaires (TB) regroupent différentes formes de troubles de l'humeur, caractérisés par la survenue d'épisodes dépressifs, maniaques, hypomanes et/ou mixtes. Ils sont reconnus comme la septième cause de handicap par année de vie parmi les personnes âgées de 15 à 44 ans par l'Organisation Mondiale de la Santé (OMS). Il s'agit donc d'une pathologie fréquemment rencontrée. Sur le plan étiologique, les pistes actuellement retenues concernant les TB sont multiples et restent encore au stade d'hypothèses. Chacune de ces pistes contribue à élargir le champ des ressources thérapeutiques possibles. Il nous semble, dès lors, intéressant d'aborder e les différentes hypothèses majeures existant à ce jour sur le plan étiologique. Nous resituerons préalablement les TB sur les plans historiques, nosologiques puis épidémiologiques. Nous développerons ensuite les aspects étiologiques génétiques et les aspects neurobiologiques à travers les recherches en imagerie cérébrale. Enfin, nous proposerons une réflexion sur l'étiologie spécifiquement relationnelle et les pistes de recherche qui en découlent.

Individual differences and personality traits across situations.

BACKGROUND: According to the Big Five theory, personality can be classified into five traits (i.e., extraversion, neuroticism, conscientiousness, agreeableness, and openness), and past research showed that situations impact personality. In the present study, (1) we measured which of these five personality traits changed according to different situations and (2) tested whether the across-situation variability (ASV; i.e., a continuous variable showing how much people change their personality traits according to situations) was significantly connected with specific personality domains, revealing a potential marker of personality disturbance. PARTICIPANTS AND PROCEDURE: We recruited 80 participants (40 women) to complete the five situation-version (family, work, friends, romantic partner, and hobbies/leisure) of the Big Five Inventory to measure whether personality traits significantly changed across these situations. In addition, we ran a network analysis to reveal how the ASV is related to personality traits. RESULTS: The findings showed that all traits significantly changed across the situations, except openness, which remained stable. The network analysis revealed that the ASV variable was especially connected with conscientiousness (in romantic partner and family situations). CONCLUSIONS: Most personality traits were flexible, showing how important it is to consider the role of situations in the study of personality. Openness appeared to be particularly stable and understanding its nature represents a challenge for future studies. Finally, the network analysis demonstrated that the ASV shows specific connections with conscientiousness and might be a potential psychopathology marker.

[Ulcerative Zoon's balanitis]. / Balanite de Zoon ulcérée.

Zoon's balanitis is a rare genital dermatosis of unknown etiology, usually presenting as a red-orange macule or plaque with a «cayenne pepper¼ appearance on the glans and/or foreskin. Unfortunately, atypical presentations are not uncommon, including vegetating or ulcerative lesions. Usually, it affects middle-age to older uncircumcised men. Although it is a benign pathology, Zoon's balanitis may be superimposed on another inflammatory or neoplastic dermatosis. As topical treatments are generally non satisfactory and relapses are usual on treatment with-drawal, circumcision remains an interesting option with usually a rapid and complete remission of the symptoms.

La balanite de Zoon est une dermatose génitale peu fréquente d'étiologie inconnue, se présentant habituellement par une macule ou une plaque de couleur rouge- orange avec un aspect en «poivre de cayenne¼, sur le gland et/ou le prépuce. Néanmoins, des formes atypiques, végétantes ou ulcérées, sont possibles. Elle touche plus souvent l'homme d'âge moyen à avancé et non circoncis. Il s'agit d'une pathologie bénigne, mais qui peut se surajouter à d'autres dermatoses inflammatoires ou néoplasiques. Les traitements topiques ne sont pas très efficaces et entraînent généralement une récidive à l'arrêt, tandis que la circoncision permet souvent une disparition rapide et complète des symptômes.

The role of empathy in trolley problems and variants: A systematic review and meta-analysis.

The role of empathy in morality is a subject of ongoing scientific debate due to the lack of systematic reviews and meta-analyses on this topic. To address this gap, we conducted a PRISMA-based systematic quantitative review to investigate the role of empathy in moral judgements, decision-making, and inclinations using trolley problems and variants, which are popular types of moral dilemmas that explore utilitarianism and deontology. We searched for articles in four databases (PsycINFO, Pubmed, WorldWideScience, and Scopus) and performed citation searches. Out of 661 records, we selected 34 that studied the associations between empathy and moral judgements, moral decision-making, and/or moral inclinations. Six meta-analyses and systematic reviews of these records consistently showed small to moderate associations between affective empathy and these moral parameters, particularly in personal moral dilemmas involving intentional harm (although some approaches highlighted more complex associations between these parameters). Regarding other empathy domains, most studies found limited or insignificant links between cognitive empathy domains and moral judgements, decision-making, and inclinations. We discuss the nuances and implications of these results.

[Hypochondriasis : the morbid fear of diseases ]. / L'hypocondrie : la peur maladive des maladies...

Hypochondriasis is characterized by the fear or belief of suffering from a serious illness, based on the subject's misinterpretation of physical symptoms or manifestations of bodily functions. This concept has always been a topic of debate and controversy regarding its definition, nature and nosography, which is still ongoing today. Its complex management, including psychotherapeutic and pharmacological interventions, challenges the therapeutic relationship. We will discuss the definition of hypochondriasis and the new diagnosis covering this notion in the DSM-5 and in the scientific literature, the characteristics of this disorder, its differential diagnosis, its management, and considerations on its expression in the present time by evoking cybercondria and the Covid-19 pandemic.

L'hypocondrie est caractérisée par la crainte ou l'idée d'être atteint d'une maladie grave, fondée sur l'interprétation erronée par le sujet de symptômes physiques ou de manifestations du fonctionnement corporel. Ce trouble a toujours fait l'objet de débats et controverses quant à sa définition, sa nature et sa nosographie qui continuent à l'heure actuelle. Sa prise en charge complexe, comprenant des interventions psychothérapeutiques et pharmacologiques, met à l'épreuve la relation thérapeutique. Nous aborderons la définition de l'hypocondrie et les nouveaux diagnostics recouvrant cette notion dans le DSM-5 et dans la littérature scientifique, les caractéristiques de ce trouble, son diagnostic différentiel, sa prise en charge et des réflexions sur son expression contemporaine en évoquant la cybercondrie et la pandémie de Covid-19.

Moral Decision-Making in Trolley Problems and Variants: How Do Participants' Perspectives, Borderline Personality Traits, and Empathy Predict Choices?

The aim of the present study was to demonstrate and extend the causal effect of participants' perspectives on moral decision-making using trolley problems and variants. Additionally, we investigated whether empathy and borderline (BDL) personality traits predicted participants' choices in these scenarios. We used both a classical trolley problem (a causing harm scenario) and an everyday trolley-like problem (a causing inconvenience scenario). Participants (N = 427, women: 54%) completed BDL traits and empathy questionnaires and, randomly, the two types of trolley problems, presenting both three different perspectives. Our study provided strong evidence that the perspective from which participants were enrolled in the trolley problem caused significant changes in their moral decision-making. Furthermore, we found that affective empathy and BDL traits significantly predicted participants' decisions in the causing inconvenience scenario, while only BDL traits predicted choices in the causing harm scenario. This study was original in providing new experimental materials, causal results, and highlighting the significant influence of BDL traits and affective empathy on moral decision-making. These findings raised fundamental questions, which are further developed in the discussion section.

Self-esteem and learning dynamics in nursing students: An existential-phenomenological study.

AIM: To describe nursing student self-esteem changes over time and its impacts on learning strategies. DESIGN: Existential phenomenology. METHODS: Interviews were conducted in Spring 2018 in a purposive sample of 39 nursing students, exploring events critical to self-esteem and their impacts. Transcriptions were analysed descriptively and interpretatively to decipher the process that links self-esteem, events and learning behaviour. RESULTS: What led to self-esteem changes were "relationships with nurses during internships" and "receiving evaluations." The students interpreted events and drew conclusions about their aptitude for nursing, which in turn prompted proactive or defensive learning behaviours. Their interpretations both depended on their self-esteem and impacted it, in a vicious or virtuous circle. Exploring self-esteem allows a better understanding of the importance of students' relationships with nursing teams, and of some of their defensive behaviours. Understanding the role of nursing student self-esteem in the learning process could help improve student well-being and competence.

Academic burnout among medical students: respective importance of risk and protective factors.

OBJECTIVES: Prior research has found a high prevalence of academic burnout among medical students (33-55%), and medical education institutions have begun to address the issue. In this research, we hypothesized an increase in academic burnout during medical education, as supported by previous findings. The second purpose was to identify the significant predictors (among perceived stress, empathy, and perceived social support) of academic burnout and determine their respective importance. STUDY DESIGN: The study design was a cross-sectional online and anonymous survey. METHODS: We recruited medical students (N = 342) from four education year-groups (i.e. Bachelor 1 and 3; Master 1 and 3). All participants voluntarily responded to our anonymous study and filled in four questionnaires assessing academic burnout, perceived stress, empathy, and perceived social support. We performed a multivariate analysis of variance on academic burnout and hierarchical regression analyses to determine the respective importance of risk and protective factors of academic burnout. RESULTS: We found that two academic burnout domains (i.e. emotional exhaustion and cynicism) significantly changed according to the study year. Cynicism increased as the academic years progressed (F(3,334) = 9.50; P < 0.001), and emotional exhaustion was highest at critical graduation moments during the academic curriculum (i.e. Bachelor 3 and Master 3; F(3,334) = 11.2; P < 0.001). Overall, women presented higher academic burnout traits than men (á´§ = 0.963; F(3,332) = 4.26; P = 0.006), but univariate analysis revealed that they especially displayed higher emotional exhaustion (F(1,334) = 12.1; P < 0.001). Hierarchical regression analyses showed that perceived stress, cognitive empathy, and perceived social support were significant predictors of academic burnout. We found that perceived stress was a major predictor of academic burnout (from 10% to 28% of the part of variance) in comparison to other factors such as empathy (around 5%) and perceived social support (around 6%). CONCLUSIONS: We found that emotional exhaustion and cynicism significantly changed over medical education and that women presented greater vulnerability than men for emotional exhaustion. Furthermore, risk and protective factors of academic burnout were identified: (1) perceived stress was a decisive risk factor; (2) paradoxically, cognitive empathy had a double edge nature (the two cognitive empathy domains had opposite effects); and (3) perceived social support was identified as a protective factor. Thus, a novel dimension of this research was to investigate and describe the importance of several predictors of academic burnout. The implications are crucial for education, and several recommendations are discussed to prevent academic burnout.

Focusing: A new challenger for improving the empathy skills of medical students.

OBJECTIVES: Studies of empathy among medical students reported an alarming significant decline during medical education. Some authors identified the third year of education as the most problematic one: empathy decreased significantly when the curriculum was shifting to patient-care activities. Scientists have tried to address the means and methods for improving empathy skills (e.g., by improving communication abilities), but investigations on this topic are missing. Based on the Damasio's hypothesis and scientific studies, we assume that Focusing (i.e., an embodied practice where one attends to a bodily felt sense and uses it to understand the self and situations) would be significantly and positively linked to empathy. METHOD: After their clinical internships, we selected third-year medical students (N = 121) and asked them to complete three questionnaires assessing empathy, Focusing, and social desirability. RESULTS: By controlling social desirability, findings confirmed that Focusing (especially the "having access to the felt body" component) was significantly and positively linked with empathy (i.e., Fantasy & Perspective-Taking), and positively predicted Fantasy, Perspective-Taking, and Empathic Concern. CONCLUSIONS: These preliminary results suggest that the felt body plays a role in increasing empathy (mainly on cognitive empathy). Few scientific studies have described constructs that significantly promote cognitive empathy and empathic concern (a deeply anchored trait of empathy), which suggests new avenues of investigation.

Relative stability of alexithymia and openness to emotions in one psychiatric day hospital setting.

Alexithymia (literally, difficulty finding words for emotions) and openness to emotions (OE: referring to the cognitive representation, communication, regulation, perception of internal and external bodily sensations, and social restriction of emotions) are strongly linked to psychopathology. The absolute and relative stability hypotheses were tested in order to determine whether significant changes occurred on these constructs after therapy, a condition where changes were expected for both constructs. Negative attitudes toward treatment (NTI) and perceived social support (PSS) were expected to significantly predict alexithymia and OE. Patients (N = 179) who participated in this longitudinal study filled in the Toronto Alexithymia Scale, the Dimensions of Openness to Emotions Scale, the NTI subscale, the Multidimensional Scale of Perceived Social Support, and the Social Desirability Scale. After treatment, we observed significant decrease of all alexithymia scores and significant increases of three OE scores, that is, cognitive representation, communication, and regulation of emotions. Regression analyses revealed that gender, age, NTI, and PSS were significant predictors of alexithymia and OE. NTI strongly predicted lower OE levels and higher alexithymia levels, whereas PSS had opposite predicting effects on these constructs. In conclusion, the significant changes, and the moderate to high correlational levels observed between before and after alexithymia and OE scores, strengthen the relative stability hypothesis for both constructs. In addition, PSS represents a protective factor and NTI a vulnerability indicator for therapists. Our aim is to optimize treatment by providing therapists treating emotion difficulties a more concrete array of variables that potentially either promote or subvert recovery.

The intergroup empathy bias among incoming medical students.

BACKGROUND: Previous studies revealed a significant empathy decline over time among medical students. Scientific literature also supports the influence of group belonging on the empathy expression. OBJECTIVE: Through this study, we aimed to demonstrate whether group belonging (peers or patients) significantly influences empathy levels before students undertake their education in medicine. DESIGN: A total of 194 incoming medical students participated in our study. All participants filled-in the Interpersonal Reactivity Index under three primed situations (a general; a peers' one; a patients' one) at three different points in time during a session of information. RESULTS: Analyses revealed significant main effects of: gender; situations; and empathy dimensions. We also obtained a significant interaction effect between dimensions and situations. CONCLUSIONS: We showed that empathy levels were modulated by group belonging (25% of the variance was explained by group belonging). Post hoc analyses showed that the differences between the peers' and patients' situations tend to reveal an appropriate professional attitude with regard to patients because they displayed: (1) lower scores on personal distress and fantasy; (2) higher scores on perspective taking (as for peers); (3) stable scores on empathic concern in peers' and patients' situations. However, integrating empathy lessons in the educational program of medical students remains a priority. In a long-term perspective, these findings suggest an investigation of the impacts of group belonging on the evolution of students' empathy scores through their medicine studies.

Humor Associated With Positive Outcomes in Individual Psychotherapy.

Considerable anecdotal evidence points to the usefulness of humor in the therapeutic process, but empirical evidence is lacking. The purpose of this study, conducted in Belgium, was to search for an association between humor and therapy outcomes in a population of 110 adult psychotherapy clients who attended at least 10 therapy sessions. Clients and their therapist evaluated the frequency and intensity of humorous events, as well as therapy effectiveness, therapeutic alliance, perceived hope, and pleasure in participating in therapy sessions. A strong positive correlation was observed between humor and therapy effectiveness, from both client (rs=0.40; p<0.001) and therapist perspectives (rs=0.37; p<0.001). The link between humor and therapy effectiveness remained significant in subgroups of clients with more severe illness, although these clients reported less humor in their therapy sessions. Further research is needed to determine whether humor enhances outcomes or whether positive outcomes trigger occurrence of humor.