[Evolution in styles of romantic and interpersonal attachment in depressed adult women during hospitalization]. / Évolution des styles d'attachement romantique et interpersonnel au cours de l'hospitalisation chez des femmes adultes déprimées.

INTRODUCTION/OBJECTIVE: Bowlby (1984) regarded attachment as a model of psychological vulnerability to depression. Since then, a large number of studies have considered vulnerability to depression in light of the idea of attachment style. Attachment styles correspond to two dimensions observed in relationships (anxiety and avoidance) evoking ideally the internal operating models of self and other respectively, as first described by Bowlby (1984). Two types of adult attachment styles are evaluated in our study: romantic attachment (Hazan and Shaver, 1987) and interpersonal attachment (Bartholomew and Horowitz, 1991). The existing literature indicates that depression is associated with the insecure attachment styles, in both romantic an interpersonal relationships. Nevertheless, a question remains concerning the nature of the link between attachment style and depression: are attachment styles stable and independent of the depression or are they modified as the depression evolves? The aim of the present study was to investigate the relationships between attachment and depression in adult women hospitalized for depression; following up the evolution in their romantic and interpersonal attachment styles from the beginning to the end of their hospitalization. METHODOLOGY: The study population consisted of 50 women hospitalized for an episode of major depression (Axis I, DSM IV). Individuals exhibiting bipolar disorders and other pathologies linked to depression were not included in the population. Sixty-eight percent of the depressed women in our population had previously experienced depressive episodes and 42% of them also exhibited a personality disorder (Axis II, DSM IV). The clinical group participated in two psychological investigations, one at the beginning (T1) and one at the end of the hospitalization (T2), including each time a clinical interview during which the depression as well as the romantic (ECR, 1998) and interpersonal (RQ, 1991) attachment styles were evaluated. STUDY RESULTS: Our findings showed that depression is positively correlated with the "avoidant" dimension of the romantic attachment style and negatively with the "secure" dimension of the interpersonal attachment style. Between the beginning and the end of hospitalization, only the "secure" and "fearful" dimensions of the interpersonal attachment styles were modified, whereas the styles of romantic attachment remained stable. In terms of the links between attachment styles and the evolution of depression during hospitalization (between T1 and T2), we noted that an increase in security of attachment was correlated with a decrease in the depressive symptomatology. Conversely, the other romantic and interpersonal attachment styles were not linked with the evolution of the depressive symptomatology. DISCUSSION/CONCLUSION: Our results confirm that romantic and interpersonal styles of attachment constitute factors of vulnerability to depression. But more importantly, these findings open up new perspectives in terms of the nature of the relationships between attachment styles and depression. They provide matter for discussion concerning the stability or the change in romantic and interpersonal attachment styles. Indeed, we have revealed the stable and independent nature of romantic attachment styles in relation to depressive symptomatology. On the contrary, security in the interpersonal attachment style was shown to be a factor of change, associated with the evolution of the depressive symptomatology in progress. In the quest to take combined account of romantic and interpersonal attachment styles and their links with the evolution of depression, the present study results in a new understanding of depression, viewed from the perspective of the model of attachment in adults.

[Styles of attachment and social support perceived in depressed women]. / Styles d'attachement et soutien social perçu chez des femmes déprimées.

RESULTS: This study, inspired by the attachment model and research in the field of social support, attempts to reveal the link between styles of attachment, social support and depressive vulnerability. AIM OF THE STUDY: It investigates current styles of attach-ment and the quality of social support perceived by 35 hospitalized, depressed subjects compared to 35 control subjects who exhibited no pathology. After giving their consent, each subject took part in an in-depth psychological investigation consisting of a recorded clinical interview and various clinical scales. METHOD: The study presents only the responses to the Perception of Relations questionnaire which distinguishes between four styles of attachment (secure, detached, preoccupied and disorganized) and the Social Support Questionnaire (SSQ6) which contains two dimensions: social availability and social satisfaction. The results were subjected to statistical analyses: a comparative analysis between the two groups and a correlational analysis between the dimensions of social support and the dimensions of style of attachment. On the one hand, the study reveals that the social network is perceived to be less available by depressed subjects, together with the absence of a current intimate relationship with other people, the absence of people to confide in, and a relationship between this absence and the large number of losses experienced by depressed subjects, in particular the loss of figures of attachment (father and mother). On the other hand, depressed subjects tend to exhibit a preoccupied, disorganized style of attachment which is characterized by negative models of the self. DISCUSSION: The discussion addresses the way these styles of attachment should be understood: do they represent the consequence of the depressive pathology or an older relational style?

[Practice in electroconvulsive therapy]. / Réalisation de l'électroconvulsivothérapie.

The aim of this paper is to describe the practice of electroconvulsive therapy in CHU Dijon, according to the Anaes guidelines. Seven component procedures are listed, particularly from the standpoint of the psychiatrist.

[How are palliative care needs estimated in short-stay establishments? Apropos of an experience in Côte d'Or]. / Comment estimer les besoins en soins palliatifs dans les établissements de court séjour? A propos d'une expérience en Côte d'Or.

The evaluation of needs and means concerning the care of patients in palliative treatment is among the problems seen as priority by the High Committee for Public Health. We have thus tried to characterise, in a specific health sector, the patients receiving palliative care in short-stay establishments in order to evaluate their care needs. We carried out an exhaustive descriptive survey among all public and private short-stay establishments in the Côte d'Or region. Of the 2116 patients in the hospital on the day of the survey, roughly 30% were considered as eligible for palliative care (patients suffering from serious, chronic and progressive illnesses). The average age of these patients is 63.9 years (standard deviation 19.7). They mainly suffer from tumours (50%), circulatory pathologies (15%), mental illness (7%), or neurological illnesses (6%). Among the patients that may need palliative care, 38% say they feel pain despite treatment with pain-killers among 25.3% of them. The personnel providing care is insufficiently trained in palliative care or in pain, as only a maximum of 18% of nurses and 5% of doctors in short-stay establishments have been trained in these areas.

[Psychiatric hospitalizations after the June 27 1990 Law in a French department]. / Les hospitalisations psychiatriques depuis la loi du 27 juin 1990 dans un département français.

The law, edicted on the 27th june 1990, has introduced in France the without consent hospitalization, to replace the law of 30th june 1838 which was composed of confinements or psychiatric placings. On of the both new types of a without consent admission, called "by a third person request" hospitalization (HDT) containing a procedure called "usual" and another one called "situation emergency", appeared to us more and more used in our practice, particularly the "situation emergency" HDT. Therefore we compared on three periods, one before the law, the two others ones 3 and 6 years after it, the different types of psychiatric admissions in all of the seven psychiatric sectors of a french department. All the hospitalization's forms increase with the chronologic time in Côte d'Or. We notice too in this department an important increase of the HDT, but especially in the "situation emergency" ones, and this, with a statistically revealing way compared to the other types of admission. If this phenomena wasn't purely localized, which only the departmental commissions of psychiatric hospitalization, created by the 1990's law, can reveal by proceeding to an expected assessment of the law consequences, the legislator should fastly take this evolution into account.

[Effects, on early auditory evoked potentials, of road traffic noise, of benzodiazepine and their combination]. / Effects, sur les potentiels évoqués auditifs précoces, d'un bruit de trafic routier, d'une benzodiazépine et de leur conjugaison.

In this study, 30 young men and 30 young women (with the same proportion of anxious persons in each group) were submitted, in random order, to: i) a road traffic noise of 75 dBA for 15 min; ii) this same noise for 15 min, having ingested 0.25 mg of alprazolam (Xanax*) 1 h before; iii) uniquely 0.25 mg of alprazolam. The auditory brainstem evoked potentials (ABEP) were taken before and after exposure to noise (for the non-noise case, we respected the same time schedule). The alprazolam had an effect on the cochlea and can be considered as a noise adaptation factor on the auditory pathways explored by the ABEP.

[Attempted suicide and menstrual cycle. An epidemiologic study]. / Tentatives de suicide et cycle menstruel. Etude épidémiologique.

Relations between suicidal behaviours and menstrual cycle have been studied by various authors with different methodologies, from which miscellaneous and contradictory results. We have taken this relation again, about suicide attempts admitted in Dijon's emergency department. Were recorded for each suicidal woman aged 15 to 49 their sociodemographical and gynecological characteristics. The same data were collected among women admitted in such circumstances for various pathologies except suicidal disorders. Cases and witnesses were distributed in an ideal cycle of 28 days with the method called cycle adjusting. Statistic analysis reveals a significant difference between cases and witnesses for pre-ovulatory period but don't resist to the maximum bias hypothesis. Finally, our study emphasizes without our knowing, for the population concerned, cases and witnesses alike, an increase hospital-going during pre-ovulatory period.

[Guignol or the comedian's paradox]. / Guignol ou le paradoxe du comédien.

Our study is based on a puppet theatre performed with a group of children aged from six to eight who were experiencing a neurotic context. Guignol's playing reveals anguishes and defensive mechanisms as well as, regarding the actors, the ability to experience the comedy with authenticity without forgetting it is imaginary. The puppet theatre has allowed us to progress in a therapeutic process while continuing diagnostic exploration.

[Epidemiology of cerebrovascular accidents. According to Dijon's registry (1985-1988)]. / Epidémiologie des accidents vasculaires cérébraux. D'après le registre dijonnais (1985-1988).

The results of a 4-year prospective study of stroke in a community of 140,000 people are reported. Eight hundred and forty-two strokes were recorded, 70 per cent in University Hospitals, 20 per cent in private hospitals and 10 per cent at home. Ninety-four per cent of the patients had a CT scan. The annual incidence of stroke was 145/100,000 people, whereas the incidences of infarct, cerebral haemorrhage and subarachnoid haemorrhage were 121, 21 and 6.6/100,000 people respectively. These results, compared with those of other registers, clearly show the superiority of population-based registers over hospital-based registers.

[Incidence of cerebrovascular accidents in a medium-sized French town]. / Incidence des accidents vasculaires cérébraux dans une ville française moyenne.

Beginning in 1985, the Dijon Stroke Registry has identified every case of stroke occurring in this city of 140,000 inhabitants. The systematic use of a CT scan and multiple other sources of information ranging from hospital doctors to general practitioners make it possible for us to have virtually exhaustive data on stroke incidence. The gross incidence was 170 per 100,000 among men and 126 per 100,000 among women. Specific incidence by age and sex shows female predominance up to 30 years of age, and male predominance among victims from 30 to 80 years old. Beyond 80, rates were identical for both sexes. In 68% of the cases, the strokes were caused by infarct; in 12%, by lacunae; in 15%, by cerebral hemorrhage; in 5%, by subarachnoid hemorrhage. Significant differences existed in this distribution according to age, with a clear predominance of young people among those having subarachnoid hemorrhage, while, for those over 40, cerebral hemorrhages were frequent; the proportion of infarct increased with age for both sexes. A peak of incidence for infarct appeared during winter, while transient ischemic accident was more frequent in summer. Cerebral hemorrhage had a similar incidence throughout the year. Mortality was high during the first month (12.5% during the first week, 21.5% during the first month), and reached 30% during the first year. These results are comparable to those generally observed among white occidental populations. They confirm the limited incidence of hemorrhages (contrary to what has been observed in Japan), emphasize the important and often underestimated role of lacunar syndromes, and the seasonal variations specific to each mechanism.

[Chronicity, chronicization, systematization of delusions]. / Chronicité, chronicisation, systématisation des délires.

Chronicity in psychopathology is indicative of a term, a decay. Chronicization only leads the way to this term. Here, chronicization is taken literally as an inscription in the time course of delusions. The mechanism of systematization seems to be a central mark in the approach to chronic delusions. It is not an alienation or an irreversible closing but an attempted accommodation with reality in the life of psychotic subjects, irrespective of the delusional structure. The role of therapy and drug treatment as a follow-up may in that case assume another meaning.

[Activity and acceptability of indalpine in a double-blind study versus placebo]. / Activité et acceptabilité de l'indalpine en double aveugle contre placebo.

In this double-bind randomized study involving 35 depressed female inpatients, Indalpine proved significantly superior to placebo on all the criteria used: Hamilton scales for depression and anxiety, clinician's vectorial ratings. Its rapid onset of action was further confirmed by the rapid appearance of significance relative to placebo: as early as the third day of treatment, that is, during the optimum placebo effect period. The results are all more valuable if one considers the magnitude of the placebo effect obtained with daily infusions of isotonic sodium chloride-dextros solution, the possible adjunction of a benzodiazepine and the availability of placebo tablets as an adjunct to the infusions upon request. Acceptabilité was found to be good, especially at the cardiovascular and cholinergic levels.