[Network model of mental disorders: Application and interest in post-stroke depression]. / Modèle en réseau et troubles mentaux : application et intérêts dans la dépression post-AVC.

In contrast to the classic models in psychopathology, the network model considers that the temporal interactions between symptoms are the causes of their occurrence. This model could also be particularly suitable for understanding the processes involved in post-stroke depression. The aim of this paper is to perform a network analysis in order to describe the temporal dynamic of the links existing between depression symptoms during the acute phase after stroke. Twenty-five patients (64% male, mean age 58.1±14.9 years old) hospitalized for a minor stroke (no neurocognitive or motor impairment) were involved in an Ecological Momentary Assessment methodology-based study. They used a smartphone application in order to complete four brief questionnaires each day during the week after hospital discharge. The questionnaire included 7-point Likert scales to measure the severity of the following depressive symptoms: sadness, anhedonia, fatigue, diminished concentration ability, negative thoughts on oneself, pessimism. We used Multilevel Vector Autoregressive analysis to describe the temporal links between those symptoms. We used the software R 3.6.0 with the mlVAR package. The p-value was set at .05. The results show two independent symptoms networks. The first one involves the anhedonia, fatigue, negative thoughts on oneself and sadness. It shows that: anhedonia predicts the activation of later fatigue (ß=0.135, P=0.037) and later negative thoughts (ß=0.152, P=0.019); negative thoughts predict later negative thoughts (ß=0.143, P=0.028) and later sadness (ß=0.171, P=0.021); fatigue predicts later fatigue (ß=0.261, P<0.000). Pessimism and diminished concentration ability compose the second network, and the results show that pessimism predicts later pessimism (ß=0.215, P=0.012) and later diminished concentration ability (ß=0.178, P=0.045). On the one hand, anhedonia thus plays an important role in the initial and progressive activation of the other symptoms of its network. On the other hand, the cognitive symptoms (negative thoughts and pessimism) cause the deterioration of the mood and the deficit of attentional abilities. Using behavioral and cognitive strategies to support patients after hospital discharge would reduce the risk of depressive complications after a stroke. This study provides convincing empirical elements for the interest of the network model for research in psychopathology and the clinical implications and perspectives allowed by network analysis.

[Which psychiatric comorbidities in cannabis dependence during adolescence? Comparison of outpatients and controls]. / Quelles comorbidités psychiatriques dans la dépendance au cannabis à l'adolescence ? Comparaison de patients consultants et de témoins.

BACKGROUND: The use of illicit substances, in particular cannabis, among French adolescents and young adults has become an important public health concern. A better understanding of the mechanisms involved in pathological substance use is nowadays critical. Psychiatric comorbidities have been previously reported in adult substance abusers but are less documented in adolescents, especially regarding cannabis dependence. OBJECTIVES: We investigated mental health problems in adolescents and young adults, seeking treatment for their problematic cannabis use, comparatively to healthy controls, taking into account the participant's gender and age. Moreover, we explored the relationships between psychiatric diagnosis and substance use modalities. METHODS: In total, 100 young patients (80 males - mean age 18.2 (SD=2.9; [14 to 25] years old)) with a cannabis dependence (DSM-IV-TR criteria) seeking treatment in an addiction unit, and 82 healthy control subjects (50 males - mean age 18.3 (SD=3.4; [14 to 25] years old)) with no substance misuse diagnostic other than for alcohol, participated in the study. The MINI was administered to evaluate cannabis dependence, and DSM-IV axis I comorbid diagnosis, and a semi-structured interview was used to determine psychoactive substance use. RESULTS: Statistical analyses revealed that 79 % of the patients reported at least one other non-drug or alcohol comorbid diagnosis, versus 30.5 % in the control group (χ2=16.83; P<0.001). Logistic regression indicated that participants with a psychiatric diagnosis had an 8.6 times higher risk (P<0.001; OR 95 % CI=[4.38-16.81]) of being patients. Significant inter-group differences and OR were noted for several diagnoses: dysthymia over the previous 2years (χ2=14.06; P<0.001; OR=10.63; OR 95 % CI=[2.41-46.87]), life-time panic attack disorder (χ2=4.15; P<0.042; OR=3.59; OR 95 % CI=[0.98-13.19]), alcohol abuse (χ2=47.72; P<0.001; OR=66.27; OR 95 % CI=[8.87-495.11]) and dependence (V=0.230; P=0.001) and generalized anxiety disorder (χ2=7.46; P=0.006-OR=3.57; OR 95 % CI=[1.37-9.30]). On the whole, the females (n=20) of our clinical sample presented significantly more comorbid diagnoses than the males (n=80) (95 % versus 75 %; χ2=6.25, P=0.011). These significant gender differences were found for life-time eating disorder (V=0.352; P=0.007) and generalized anxiety disorder diagnoses (V=0.278; P=0.013). Moreover, young adult patients (19-25years old; n=35) presented, on the whole, significantly more comorbid diagnoses than adolescent patients (14-18years old; n=65) (70.8 % versus 94.3 %; χ2=7.58, P=0.006). These age inter-group differences were found for several diagnoses: alcohol dependence (6.2 % versus 20 %; V=0.211, P=0.047), dysthymia over the past 2years (13.8 % versus 34.3 %; χ2=5.73, P=0.017) and generalized anxiety disorder (12.3 % versus 40 %; χ2=10.17, P=0.001). Various associations were observed between psychiatric comorbid diagnosis and substance use indicators. CONCLUSION: This study demonstrates that cannabis dependence in adolescents and young adults is related to great psychological distress and puts emphasis on the importance of substance use prevention as early as middle school. Moreover, the psychiatric features of adolescents and young adults need to be taken into consideration for treatment planning.

[Psychometric approach of metacognition: Pilot study in clinical population]. / Approche psychométrique de la métacognition : étude pilote en population clinique.

BACKGROUND: Metacognition describes the process of thinking about one's own thought processes. This concept was introduced by Flavell in 1979 and has since been widely developed in the cognitive approach to mood and anxiety disorders. As it happens, many recent studies have underlined the links between metacognition and anxio-depressive symptoms, pointing out the interest of assessing its various dimensions. The short form of the Metacognitions Questionnaire is a brief multidimensional measure of a range of metacognitive processes and metacognitive beliefs about worry and cognition relevant to the vulnerability to and the maintenance of emotional disorders. The aim of this study was twofold: firstly to adapt and validate a French version of the short form of the Metacognitions Questionnaire (MCQ-30) and to assess its psychometric properties in a clinical sample, and secondly to investigate metacognitive predictors of anxiety and depression in this sample. METHOD: The sample included 55 clinical participants (24 men, 31 women, mean age=51.33±14.62) with DSM-IV-TR psychiatric disorders (major depression, bipolar disorder and obsessive-compulsive disorder). Instrument reliability (internal consistency), construct validity (confirmatory factor analysis), and convergent validity were measured. The total score and the five subscale scores were also compared with previous results in non-clinical samples. RESULTS: Reliability analyses indicated that the French version of the MCQ-30 possessed satisfactory internal consistency (Cronbach α=0.84), and confirmatory factor analysis supported the MCQ's original five-factor structure. Correlation with measurements of depression, anxiety and pathological worry demonstrated convergent validity (r=0.62, P<0.01 for anxiety; r=0.47, P<0.01 for rumination; r=0.33, P<0.05 for depression). Moreover, our clinical sample scored higher on the global scale when compared to previous non-clinical samples (mean score=71.85±13.57 while previous studies global scores ranged from 48.41±13.31 to 65.89±17.17). Consistent with others studies, negative beliefs about worry concerning uncontrollability and danger, as well as beliefs about the need to control thoughts were the strongest predictors of pathological worry (respectively r=0.68, P<0.01 and r=0.48, P<0.01) and depression (respectively r=0.45, P<0.01 and r=0.39, P<0.01), providing further support for the validity of the measure. CONCLUSION: These findings provide general support for the internal consistency of the French version of the MCQ-30, as well as its five-factor structure and its good concurrent validity in a clinical sample. They also confirm that this version is a valuable tool for the assessment of various dimensions of metacognition, in relation to the anxio-depressive symptomatology and the subsequent management of patients.

[Self-esteem, coping, perceived social support and substance use in young adults with a cannabis dependence disorder]. / Estime de soi, coping, soutien social perçu et dépendance au cannabis chez l'adolescent et le jeune adulte.

INTRODUCTION: Self-esteem, coping strategies and perceived social support play a role in the adaptive functioning of the human being: they allow the adjustment of the subject to his/her environment. These dimensions could be protective factors regarding multiple risks associated with adolescent development, and particularly substance use. Thus our objective was twofold: to evaluate self-esteem, coping strategies and perceived social support in adolescents and young adults with a cannabis dependence in comparison with subjects from the general population; to establish the correspondence between these psychological dimensions and the patients' substance use pattern. METHOD: Data from 43 young patients (36 males; mean age=19.6±3), consulting for their cannabis dependence, and 50 young adults from the general population (39 males; mean age=19.7±3.4) were included. Participants completed the Rosenberg Self-Esteem Inventory, the Social Self-Esteem Inventory of Lawson, the Coping Inventory for Stressful Situation of Endler & Parker, and the Perceived Social Support Questionnaire of Sarason. The MINI was administered to evaluate cannabis abuse or dependence; a semi-structured clinical interview was given to determine psychoactive substance use. RESULTS: Between-group comparisons (two independent sample t-tests) showed that the patients had significantly lower scores on global (P=0.002) and social (P=0.035) self-esteem, task-oriented coping (P<0.001) and both availability and satisfaction regarding perceived social support (respectively P=0.029 and P<0.001). Conversely, patients had significantly higher scores on emotion-focused coping subscale (P=0.003). Logistic regressions showed that the satisfaction regarding social support and task-oriented coping scores were the more powerful to distinguish the patients from the controls (respectively ß=1.16, P=0.043 and ß=1.06, P=0.015). Unvaried linear regression analyses revealed a negative association between the age of first cannabis use and the avoidant-social coping score (P=0.025), and positive associations between the length of daily cannabis use and emotion-focused coping score (P=0.028), and frequency of cannabis use and global self-esteem scores (P=0.028). Moreover, polysubstance misuse is associated with low distraction-avoidant coping scores. No association was found between clinical scores and tobacco and alcohol uses variables. CONCLUSION: These results suggest that cannabis dependent patients may present a lack in individual and interpersonal resources. This clinical study underscores the potential contribution of maladaptive coping to the development or maintenance of substance use in young adulthood.

[The role of inhibition in obsessional-compulsive disorders]. / Place de l'inhibition dans le trouble obsessionnel-compulsif.

INTRODUCTION: The nature of neuropsychological mechanisms underlying the clinical picture of obsessions and compulsions has not been clearly determined. A number of studies has emphasized the role of cognitive deficits, but diversity of methodology and overlapping of clinical sub-groups have not established a specific cognitive functioning of these patients. The studies carried out on executive functions have, however, helped to identify the important role that both inhibition and cognitive flexibility play in obsessive-compulsive (OC) symptoms. Most of them have found that a deficit of inhibition and alteration of cognitive flexibility could explain inflexibility and repetitive thoughts and actions typical of all types of OC disorders. The aim of the paper is to present the published data supporting the hypothesis of a specific role played by a deficit of inhibition and cognitive inflexibility. In the first, theoretical part, we present the neuropsychological approach emphasizing inhibition and lack of flexibility as a promising explanation of the functioning of OC disorders. In the second part, we will present studies using various measurements of inhibition and the results of which, therefore, support this hypothesis. ARGUMENTS AND DISCUSSION: On the theoretical level, it is the model of attention that was used in explaining the OCD hypothesis. In the model of attention control of action, described by Norman, Shallice and Burgess, three systems were emphasized: one that takes care of routine actions, and the second that takes over the first in situations where automatic activities must stop in order to establish an attention control and therefore inhibit automatic responses. When selection of everyday and automatic activities is not sufficient to accomplish a task, it is the third system, that of cognitive control, which takes over. This supervisory attentional system operates in non-routine and ambiguous activities. The cognitive control is charged with detecting potential or emitted cognitive errors and resolving ambiguous situations. Neurocognitive studies show that cingular anterior cortex and prefrontal lateral cortex are engaged in ambiguous and conflicting situations. These two regions are considered essential for inhibition of routine actions, adjustment to change and, more generally, for an efficient and flexible behaviour. Repetitive nature of verification rituals in OCD could be explained in terms of lack of relationship between two systems, leaving in action the one that regulates automatic activities. Therefore, the rituals are considered to be under particular influence of the system which, being in charge of automatic actions, has a deficit in disengagement. Another model of attention, described by Posner, gives a further explanation of OCD. Mental inhibition has the capacity to treat information, either by applying strategies to control it (i.e. trying not to remember an unpleasant event) or leaving it to automatic control (i.e. incapacity to experience an emotion in relation to a particular event). In this way, the effort to suppress an intrusive thought is considered as controlled and deliberate cognitive treatment of emotionally charged information. In OCD, in the context of heightened anxiety, the assumed negative valence of information would influence habitual suppression of thought during controlled treatment. As a result, controlled efforts to suppress obsessions in emotionally stressful situations, would lead to the production of repetitive thoughts, as controlled treatment of information has failed in this action. On a clinical and experimental level, these studies have led to a better understanding and conceptualization of OCD. In spite of some conflicting results, there are concordant data in favour of hypotheses of the role of sub-cortical and frontal regions and their function in inhibition/desinhibition implied in the onset and maintenance of OCD. Functional neuroimagery anomalies are also in favour of the role of sub-cortical-frontal region in clinical manifestations of OCD. They are often associated with low performance in cognitive tasks, especially those implying frontal functions, which are, in turn, dependent on a necessary level of attention in order to guide or inhibit motor and cognitive programs.

Coping strategies in multiple sclerosis patients with frontal cognitive disorders.

BACKGROUND: Many studies have demonstrated the relationship between multiple sclerosis (MS) and cognition disorder. The objective of this study was to investigate the coping style of patients with mild frontal cognitive disorder. METHODS: 135 patients with MS were divided into two groups as a function of their cognitive states ('mild frontal cognitive impairments' or 'without frontal cognitive impairments'). All were seen for a semi-structured interview in order to collect socio-demographic and clinical information, after which there was an assessment of their cognitive and mental states and fatigue (FAB, MADRS). Then, all patients completed three self-report questionnaires concerning their coping strategies (WCC, CHIP) as well as their fatigue state. RESULTS: No significant differences were observed between the two groups as to coping strategies and mood. However, patients with mild cognitive impairments tended to use more emotion-focused coping strategies, especially self-blame (F(133) = 2.2; p = 0.14) and diversion (F(133) = 1.35; p = 0.24) than patients without cognitive impairments. Patients with mild cognitive impairments were more fatigued than other patients. DISCUSSION: Our study showed that patients with mild cognitive impairments did not differ significantly of other MS patients with regard to coping strategies.

["Suicidal intentions": literature review and perspectives]. / Les « fonctions suicidaires ¼ : revue de la littérature et perspectives.

INTRODUCTION: Fifteen years ago, Baechler presented his "strategic theory of suicide". Following a viewpoint initiated at the end of the 1950's by Stengel and Cook, he proposed the more accomplished theoretical development of suicidal functions. We propose a critical review of international empiric literature following this approach. METHOD: We carried out a bibliographic research on PsychINFO(®) databank, crossing terms of suicide attempt, deliberate self-harm and parasuicide, to reasons, motivations, functions, intentions. Thirty-one articles were selected. They cover a period ranging from 1971 to 2008, and from Europe to the USA. RESULTS: Few studies have been conducted in France, but international literature has grown since 1970, and some questionnaires have been created: e.g. the Motives for Parasuicide Questionnaire (MPQ, Kerkhof et al., 1993 [28]) and the Reasons for Attempting Suicide Questionnaire (RASQ, Holden et al., 1998 [24]). The first intentions mentioned are internal perturbations type: to get relief, to escape, cannot endure situation or thoughts any longer, loss of control. They are often blended with interpersonal intentions: to make people understand what they felt, to seek help, to make things easier for others, while more aggressive, punitive or manipulative functions are seldom reported. Women report more reasons than men, but do not differ in their pattern of intentions. Suicide attempters report varying desire to die across studies. Some inconsistent distinctions can be made from age and gender but few from subjects' suicidal history. DISCUSSION: One can wonder if subject's answers are really honest, particularly in regards to social desirability. Links between internal perturbations and suicidal intent, hopelessness, and depression are logically found, which aims to give evidence that, at least for this dimension, subjects give true answers, but which also point out the redundant aspect of some items of the suicidant functions scales (e.g. "to die"). Today, it turns out that this kind of research should be managed in France, by creating tools and questionnaires, validating existing ones and, internationally, by taking into account gender, age, and subjects' suicidal history to obtain more clear results. CONCLUSION: So far, to our knowledge, this kind of review has never been conducted. Suicidal functions appear to be a rich and relevant approach to better understand suicide attempts, notably in a "suicidal crisis" perspective. In the future, some links with coping strategies and cathartic effect of the attempts could be made. We also point out that it could be relevant for psychotherapeutic care.

[Beneficial effect of a cognitive behavioral and multidisciplinary program in Alzheimer Disease on spouse caregiver anxiety: French study ELMMA]. / Bénéfice d'un programme cognitivo-comportemental et pluridisciplinaire de prise en charge de la maladie d'Alzheimer sur l'anxiété du conjoint : étude française ELMMA.

INTRODUCTION: Over the last decade, several programs have been developed for caregivers of Alzheimer disease patients. In France however, studies exploring their effects are still scarce. We conducted a study to compare two different interventions: a structured multidisciplinary program versus a classical intervention designed for Alzheimer disease patients and their spouses. METHODS: Sixteen couples (Alzheimer's disease patient and spouse) residing in our administrative district participated in this monocentric study. For at least two years, these couples participated in a multidisciplinary program (n=8 couples) or received usual care (n=8 couples). The multidisciplinary program involved biannual consultations with a neurologist, a neuropsychologist and a psychologist, in addition to an annual meeting, stratified on the patient's MMSE score, for spouses). Usual care involved biannual consultations with the neurologist. The multidisciplinary program included a psychological intervention based on cognitive behavioral theories and centered on psycho-education, problem solving, adaptation strategies and on prevention of depression and anxiety. The spouses and the patients evaluated the 2-year follow-up during clinical interviews, completed by questionnaires. Sociodemographic data were noted for the patients and their spouses. Levels of depression and anxiety (Mini International Neuropsychiatric Inventory, Montgomery and Asberg Depression Scale, State-Trait Anxiety Inventory), perceived stress (Perceived Stress Scale) and care burden (Zarit Burden Inventory) were evaluated in spouses. Levels of cognitive impairment (Mini Mental State Examination), autonomy (Instrumental Activities of Daily Living), psychological state (Montgomery and Asberg Depression Scale, Covi Anxiety Scale), and behavioral symptoms frequency (Neuropsychiatric Inventory) were assessed in patients. RESULTS: The main significant result showed that the spouses' state of anxiety was lower among participants in the multidisciplinary program, compared with the classical neurological intervention. It also was found that the spouses and the patients who participated in this multidisciplinary program were less depressed. CONCLUSION: This study shows that a multidisciplinary structured intervention, with only two annual consultations and one annual meeting for spouses, can contribute to decrease significantly the spouses' state of anxiety. Further studies including a larger number of subjects should be conducted to confirm these findings.

[Course of borderline personality disorder: literature review]. / Évolution du trouble de la personnalité borderline: revue de la littérature.

INTRODUCTION: Borderline personality disorder (BPD) is a serious mental disorder associated with severe emotional, behavioral, cognitive and interpersonal dysfunction, extensive functional impairment and frequent self-destructive behaviour, including deliberate self-harm and suicidal behaviour. For quite some time, BPD has been viewed as a chronic disorder and borderline patients as extremely difficult to treat, doomed to a life of misery. However, those views are changing and there is an increasing recognition that BPD has a far more benign course than previously thought. The purpose of this study is to show how those views changed over time by reviewing longitudinal studies of the course of BPD. METHODS: We have reviewed the literature published from 1968 to March 2009, using the following key words: borderline personality disorder, outcome, follow-up studies with some additional references. RESULTS: The aim of the longitudinal studies conducted prior to the DSM definition of BPD criteria was to determine whether borderline patients could become psychotic over time, but no such evidence was found even though their functioning was at a relatively low level. The studies conducted after the introduction of BPD in the DSM in 1980 tested the stability and the specificity of BPD diagnosis, concluding that the criteria were relatively stable in the short run since the majority of patients continued to meet them at the follow-up assessments. However, those studies had many methodological drawbacks which limited their generalizability such as small sample sizes, high attrition rates, the absence of comparison groups, etc. Four retrospective studies of the 15-year outcome of borderline patients obtained virtually identical results despite methodological differences, showing that the global functioning of borderline patients improved substantially over time with mean scores of the GAF scale falling within a mild range of impairment. One 27-year retrospective study showed that borderline patients continued to improve as they grew older, only 8% of the cohort still meeting criteria for BPD. Two recent carefully designed prospective studies showed that the majority of BPD patients experienced a substantial reduction in their symptoms far sooner than previously expected. After six years, 75% of patients diagnosed with BPD severe enough to be hospitalized achieve remission by standardized diagnostic criteria and after 10 years, the remission rate raises up to 88%. Recurrences are rare, no more than 6% over six years. The dramatic symptoms (suicidal behaviour, self-mutilation, queasy psychotic thoughts) resolve relatively quickly, but abandonment concerns, feeling of emptiness and vulnerability to dysphonic states is likely to remain in at least half the patients. DISCUSSION: This contrasts with the natural course of many Axis I disorders, such as mood disorders, where improvement rates may be somewhat higher and more rapid but recurrences are more frequent. The findings of longitudinal studies raise doubts about the validity of the definition in the DSM, which implies that personality disorders must necessarily be chronic. However, it should be noted that even the most encouraging findings do not show full recovery since the majority of patients seem to suffer from some residual symptoms. CONCLUSION: These findings have very important clinical implications and borderline patients should be told that they can expect improvement, no matter how intense their current emotional pain. However, we still lack evidence-based findings on mechanisms that lie behind the recovery process in BPD. Future research should explore the mechanisms of recovery in BPD.

[Validation of CHIP (a coping questionnaire) in French patients with neurological disorders]. / Validation du CHIP (questionnaire de coping) dans une population française atteinte de maladies neurologiques.

INTRODUCTION: While conceived in the 1960's by Lazarus, the concept of coping was a long time coming in the field of neurological diseases. So far, no valid instrument has been available in French for assessing the style of coping of patients with neurological diseases. METHODS: We used Coping with Health Injuries and Problems (CHIP), which was conceived for patients with chronic diseases. We proceeded to a factorial analysis in a population of 307 patients with multiple sclerosis (MS) or Parkinson's disease (PD) in order to identify the factors observed in this population. RESULTS: We finally retained a model with six factors, which saturated on 24 items and explained 48% of the total variance. Factors we found included palliative coping and distraction, both known for the original instrument, and four new factors: emotional regulation, seeking of well-being/self-preservation, seeking of information and cognitive avoidance. DISCUSSION: Tools for assessing coping in a setting of chronic diseases must be adapted to specific diseases. In this new validation, CHIP appeared to be well adapted to the specific features of neurological disorders. This instrument would be useful for the neurologist to better understand the specific ways by which patients cope with their disease. Such knowledge would certainly have a positive effect on the patient-neurologist relationship. Moreover, a better understanding of patients' coping strategies in neurological diseases could pave the way for specific preventive interventions focusing on using coping strategies to promote better adaptation.

To what extent does frontal type executive impairment affect coping strategies in Parkinson's disease?

BACKGROUND AND PURPOSE: Given the frequency of executive dysfunction in Parkinson's disease (PD), we wonder to what extent this fact might influence the coping strategies which are used. METHODS: A total of 135 PD patients with no dementia were divided into two groups according to their cognitive status ('with frontal type executive impairment' or 'without frontal type executive executive impairment'). All patients were seen for a semi-structured interview to collect sociodemographic and clinical information and to assess their cognitive and mental states (DSM-IV-TR, frontal assessment battery and Montgomery and Asberg Depression Rating Scale). Then, all patients completed two self-report questionnaires concerning their coping strategies (Ways of Coping Checklist and Coping with Health, Injuries and Problems Scale). RESULTS: After controlling the depression, we noticed a significant effect of cognitive status on positive re-evaluation (P = 0.02). Interestingly, except for instrumental strategies, patients with frontal type executive impairment used significantly more coping strategies than did patients without frontal type executive impairment. CONCLUSION: Our results suggest that neither executive impairment nor depression prevents patients from using coping strategies extensively.

Coping and quality of life in one hundred and thirty five subjects with multiple sclerosis.

INTRODUCTION: and objective The aim of this study was to compare coping strategies and quality of life (QoL) in multiple sclerosis (MS), as they relate to the course of the disease (relapsing-remitting (RR), secondary progressive (SP), primary progressive (PP)), while taking depression and anxiety into account. METHODS: A total of 135 MS subjects were seen for a semi-structured interview in order to collect socio-demographic and clinical information, after which there was an assessment of their mental and cognitive states (Mini International Neuropsychiatric Interview (MINI), Montgomery and Asberg Depression Rating Scale (MADRS), Depressive Mood Scale (EHD), Hamilton Anxiety (HAMA), Frontal Assessment Battery (FAB)). All subjects then completed three self-report questionnaires; two about coping strategies (Ways of Coping Checklist (WCC), Coping with Health, Injuries and Problems Scale (CHIP)) and one about QoL (SEP59). RESULTS: The mental health (depression and anxiety) and the psychological and social dimensions of QoL were relatively unaffected. However, after controlling for age and disability, the disease course had a strong effect on both mental health and QoL, with the poorest condition for SPMS and the best condition for PPMS. The SPMS patients tend to use emotional coping strategies extensively, while the PPMS patients use more instrumental strategies. DISCUSSION: Our study clearly demonstrated that psychological and social well-being were substantially affected by the disease course. These results encourage us to develop interventions focused on coping strategies and which are better adapted to individual patients.

[Mood and emotional disorders in Multiple Sclerosis: a literature review]. / Les troubles de l'humeur et des émotions dans la sclérose en plaques: une revue de la littérature.

INTRODUCTION: Even though mood and emotion are closely related concepts, they differ in some ways. This article aims to review the main mood and emotional disorders most often found in Multiple Sclerosis (MS). STATE OF ART: Studies related to four fields are presented and discussed: assessment tools and methodological problems; prevalence, etiology and symptoms of mood as well as emotional disorders in MS; relationship between cognition and emotion. Beside these main subjects, we tackle some interesting questions which concern patients as well as clinicians, such as the risk of depression and protective factors, the relationship between depression and fatigue and the impact of beta-interferon on depression. PROSPECTIVES: We focus on a new promising trend aiming to link neuroimaging data to psychological variables. CONCLUSIONS: These four fields cover a large portion of the questions about mood and emotional disorders in MS. Due to their frequency as well as to their impact on quality of life, specific attention should be given to these disorders.

[Sensation seeking in a French population of horse betting gamblers: comparison between pathological and regular]. / Recherche de sensations dans une population française de joueurs de courses de chevaux: comparaison entre des joueurs pathologiques et réguliers.

AIM: A theoretical position on the role of arousal in gambling comes in the form of Zuckerman's theory of sensation seeking. Zuckerman originally suggested a relationship between sensation seeking and gambling in which individuals entertain the risk of monetary loss for the positive reinforcement produced by states of high arousal during the periods of uncertainty, as well as the positive arousal produced by winning. However, this hypothesis has received inconsistent support. Results of the literature support the view that there is a difference between gambling form selection and use, suggesting that gambling cannot be viewed as an homogeneous activity. The aim of this study was to examine the personality trait sensation seeking in a French population of gamblers who bet on horses at the racetrack. Our results will discuss the disparities of the literature between pathological gambling and sensation seeking. HYPOTHESES: Pathological gamblers who go to the racetrack are higher sensation seekers than regular gamblers. Gamblers betting on many different forms scored higher on sensation seeking. METHOD: Two groups of gamblers were formed and recruited in five different hippodromes. One group of regular gamblers (n=72), from which pathological gamblers were extracted (n=42). The South Oaks Gambling Screen (SOGS) and the DSM-IV criteria for pathological gambling were used to assess the intensity of the gambling behavior, and sensation seeking was measured by Zuckerman's sensation seeking scale. RESULTS: The results showed that pathological gamblers obtained significantly higher scores of sensation seeking than regular gamblers. These results were significant for the global score of sensation seeking as well as for the factors of disinhibition, and boredom susceptibility. No correlation was found between the sensation-seeking scale total score and the number of regular games played. DISCUSSION: The sensation-seeking personality trait permits the discrimination of pathological from regular gamblers who go to the racetrack. In the literature, data came from gamblers who practice off-course betting. Nevertheless, pathological gamblers who go to the racetrack seemed to differ from those who practice off-course betting in terms of sensation seeking. The former are high sensation seekers whereas the latter are low sensation seekers. Racetrack gamblers are likely to be more involved in staking plans than off-course gamblers. One way of conceiving the distribution of sensation seekers within gambling forms might be to combine the relationships depicted with the dichotomy made between skills and luck games, or with the serious-recreational, casino-non-casino distinctions. There is a need to identify clinically distinct subgroups of gamblers who exhibit common, cardinal symptoms but, at the same time, who differ significantly with respect to key variables that are of etiological relevance and can be used in treatment and prognosis. To establish different subtypes, it is important to take into account the venue and the type of games as well as the sensation-seeking scores and the motivation of the gambler. These subtypes of gamblers are discussed.

[Psychological and psychopathological evaluation in amyotrophic lateral sclerosis]. / Evaluation psychologique et psychopathologique dans la SLA.

In the literature, few studies refer specifically to the psychological and psychopathological aspects of the ALS. However most of these studies mention the psychological specificities observed in ALS patients. In fact, they are not depressed, nor anxious, and they seem to accept surprisingly well the threathening diagnosis. Some authors have mentionned the presence of denial as an adaptive mechanism. It remains very difficult to compare the various studies. First, the stage of the evolution of the disease and the physical abilities of the patients differ greatly; in fact it has been demonstrated that at each stages the patient present specific psychological concerns. Second, the psychological concepts refer to different level of understanding. Some authors study depression or anxiety, others focus on the global psychological status and others focus on a psychological mechanism, such as denial for example. Third, the scales used to assess these psychological or psychopathological aspects are, on one hand, never specific to ALS and, on the other hand, are sometimes filled by the clinicien or sometimes self reports filled by the patient, his caregiver or even by the medical staff. Thus, many studies have created their own scales or interview, which are not validated. So, it appears necessary, in order to be able to compare the different results, to use validated scales which are recognized by the scientific community, while waiting for specific tools created and validated in populations of ALS patients.

African and European HIV-positive women: psychological and psychosocial differences.

The objectives were to study and compare the psychosocial and psychopathological aspects of HIV infection in African and European HIV-positive women living in France. All women included were seen in a semi-structured interview to assess personal history, history of their HIV infection, social and family relationships, preoccupation with childbearing and concerns about HIV infection and its prognosis. The comparison of psychological and psychosocial factors between HIV-positive African and European women showed certain significant differences. The demographic characteristics did not differ, except for current professional activity, with more African women being unemployed. The medical aspects of the HIV infection were similar to those described in the literature for the two populations. The most interesting findings were on the disclosure of HIV-positive status to family and friends, with significantly more European women informing friends and family, and on the desire to have children, which was much greater in African women; while they already had significantly more children, they still wanted to have even more. All these differences emphasize the need to adapt medical and psychosocial care to gender and to the ethnic and cultural background of the person.

[Distinction between anxiety state/trait in general practice: a descriptive study]. / Distinction trait/état et anxiété an médecine générale. Etude descriptive.

State-anxiety has been defined as a transitory emotional response involving unpleasant feelings of tension and apprehensive thoughts. Trait-anxiety, on the other hand, has been defined as a personality trait referring to individual differences in the likelihood that a person would experience state anxiety in a stressful situation. The aim of the present study was to assess trait and state-anxiety in a population of patients consulting physicians for anxious complaints. Thus, patients who stopped the benzodiazepine (BZD) treatment after three months and those who continued it for six months were compared. Included patients were evaluated at inclusion (D0), after three months (M3) and after six months (M6). The investigator filled the Covi anxiety scale, the Raskin depression scale and a CGI; patients were asked to fill the Spielberger state/trait-anxiety questionnaire. 1,112 patients have been included, 48% considered their anxiety as chronic, 50% said the evolution was progressive, 87% considered it resulting of a trigger factor, 69% received a benzodiazepine (BZD) treatment. At D0: Covi anxiety score was 5.3 +/- 2.3 points, STAI I (state-anxiety) score was 57.4 +/- 12.2 points and STAI II (trait-anxiety) score was 52.7 +/- 10.2 points. At M3, all scores decreased, and 85% were considered as ameliorated, but differences were significant (p = 0.0001) at M6. When comparing at D0 patients who stopped BZD treatment at M3 and those who continued it, some differences appeared. In fact subjects who stopped the treatment had lower score at the STAI II, presented significantly less flushes (p = 0.01), less tremor (p = 0.04) and less feverishness (p = 0.05). Their score at Covi tended to be lower (p = 0.11). The severity of the disease, evaluated with the CGI, was also lower for the patients who stopped the BZD treatment. The trait-anxiety appeared as a good predictor of the efficacy of the BZD treatment. In fact, the trait-anxiety refers to a tendency to be anxious and higher anxiety necessitates longer treatment. The treatment response was less important in the patients who continued the treatment at M3, indicating the presence of residual anxiety in these patients.

Psychopathological and emotional deficits in myotonic dystrophy.

OBJECTIVE: To evaluate psychopathological disturbances in patients with myotonic dystrophy (MD) and compare patients with MD to both patients with facioscapulohumeral dystrophy (FSHD) and healthy control subjects. METHODS: A semistructured interview was used to determine DSM III-R criteria for major depressive episodes, dysthymic episodes, and generalised anxiety. The Montgomery and Asberg and the Hamilton depressive scales, the Covi and Tyrer anxiety scales, the Abrams and Taylor scale for emotional blunting, and the depressive mood scale were all used in the study. Subjects were also asked to complete questionnaires for physical and social anhedonia. RESULTS: Fifteen patients with MD, 11 patients with FSHD, and 14 healthy subjects were studied. Patients with MD were not more depressed or anxious than healthy controls. Patients with FSHD were the most depressed and most anxious. However, patients with MD had significantly lower scores for expressiveness and significantly higher scores for anhedonia than the other two groups. CONCLUSION: Patients with MD did not present significant depressive or anxious symptomatology but rather an emotional deficit. This emotional deficit may be an adaptive reaction to the threatening implications of the disease, or the effect of the CNS lesions which occur with MD, or both.

Fava's Anger Attacks Questionnaire: evaluation of the French version in depressed patients.

The prevalence, symptomatology and correlates of anger attacks were studied in 103 depressed French patients, using a French version of the Anger Attacks Questionnaire. The prevalence of anger attacks during the previous month was 46.7%, and the most frequently reported symptoms were feeling of panic (85.1%), tachycardia (83.7%), and feeling out of control (81.3%). The occurrence of anger attacks was significantly associated with intensity of loss of control, and history of panic attacks. There was no significant association with age, gender, severity of depression or anxiety, history of suicidal attempts or mood disorder. Three weeks of treatment with serotoninergic antidepressants induced a significant decrease in anger attack prevalence.