[Relationship between defense mechanism and therapeutic alliance]. / Relation entre mécanismes de défense et alliance thérapeutique.

INTRODUCTION: The therapeutic alliance can be defined as a collaborative relationship between the patient and the practitioner. It represents an essential component of the psychotherapeutic process (Ambresin et al., 2007; Cungi, 2006; Martin et al., 2000). Some authors suggest that a good alliance can have a favorable impact on the therapeutic success (Barber et al., 2000; Hubble, Duncan, & Miller 1999; Horvath & Luborsky, 1993; Horvath & Symonds, 1991). This alliance can be influenced by psychological and behavioral factors (Cungi, 2006) Thus, some defense mechanisms could prevent change or, on the contrary could facilitate adaptation (Ambresin et al., 2007) and have an impact on the therapeutic success (Muris & Merckelbach, 1996). However, the relationship between therapeutic alliance and defense mechanisms represents an insufficiently explored field (Ambresin et al., 2007; Cungi, 2006). The aim of the present study was to examine the relationship between therapeutic alliance and twenty defense mechanisms in a sample of French psychiatric patients, by differentiating results in men and women. We also examined the positive and the negative therapeutic alliance. METHOD: Sixty patients aged from 18 to 58 (M=41.50; SD=11.03) completed the French versions of the Defense Style Questionnaire-40 (DSQ-40) and the Helping Alliance questionnaire-II (HAq-II). RESULTS: Therapeutic alliance was significantly associated with each defense style: mature (0.62), neurotic (0.45) P<0.01and immature (0.27) p<0.05. The mature defense style was a significant predictor of therapeutic alliance (R(2) adj=36, F=12.39, ß=0.65, P<0.01) and of positive therapeutic alliance (R(2) adj=36, F=12.34, ß=0.62, P<0.001). Among women, positive therapeutic alliance was significantly associated with all mature defenses, three neurotic defenses (reaction formation, pseudo-altruism, idealization) and four immature defenses (splitting, denial, somatization, passive aggression). Among men, three mature defenses were associated (anticipation, humor, sublimation), four neurotic (reaction formation, pseudo-altruism, idealization and undoing) and two immature (somatization and denial). The negative therapeutic alliance, in our total sample, was associated with two immature defenses (denial and dissociation). Among men, displacement was the only defense associated with negative alliance, among women no defenses was significant. DISCUSSION: These results highlight the relationship between therapeutic alliance and some defense mechanisms, like some authors have suggested (Ambresin et al., 2007; Bond & Perry, 2004; Bond, 2004). Moreover, some defenses appeared to be more associated with a positive or a negative therapeutic alliance, and could depend on the patient gender. CONCLUSION: The present study confirms the importance of taking into account the gender in the study of defense mechanisms, and to increase our knowledge about the relationship between therapeutic alliance and defense mechanisms.

Estimated magnitude of diversion and abuse of opioids relative to benzodiazepines in France.

INTRODUCTION: Prescription drug abuse is a major concern in several countries. France appears to be particularly prone to the abuse of opiate maintenance treatment (OMT) opioids and benzodiazepines (BZD), whereas the abuse of opioid analgesics (OA) is less commonly reported. To estimate the extent of psychoactive drug abuse, the French drug agency relies on different methods measuring various diversion indicators used as proxies for the detection of abuse/misuse: suspicion of abuse/dependence, illegal acquisition by patients seen in specialized care centers, prescription forgery and doctor shopping. The main objectives of the present study are to analyse the abuse and diversion of opioids (both OA and OMT), in comparison with those of BZDs, through the concurrent use of three different data sources. METHODS: Diversion and abuse of opioids were analysed using indicators of abuse and diversion derived from three data sources over the period 2006-2008. Then, opioids were compared to BZDs for the year 2008 using the same indicators. RESULTS: The analysis suggests that BZDs are more commonly dispensed than OAs and OMTs but that abuse and diversion are related mainly to OMT (particularly to buprenorphine), morphine and BZDs and less to OAs (except for morphine). CONCLUSION: This study presents an original approach, based on the use of multiple data sources, to evaluate and compare the estimated abuse and diversion of opioids and benzodiazepines. It provides health authorities with a global, comparative and summarized overall view of the importance of different patterns of diversion and abuse for different prescription drugs.

A dominant modifier of transgene methylation is mapped by QTL analysis to mouse chromosome 13.

The single-copy hepatitis B virus transgene in the E36 transgenic mouse strain undergoes methylation changes in a parent-of-origin, tissue, and strain-specific fashion. In a C57BL/6 background, the paternally transmitted transgene is methylated in 30% of cells, whereas it is methylated in more than 80% of cells in (BALB/c x C57BL/6) F1 mice. We established previously that several genetic factors were likely to contribute to the transgene methylation profile, some with demethylating and some with de novo methylating activities. Using quantitative trait loci (QTL) mapping, we have now localized one major modifier locus on chromosome 13 (Mod13), which explains a 30% increase in the methylation level of this transgene with no effect on the flanking endogenous sequences. No other QTL could be identified, except for a demethylating activity of low significance located on chromosome 12. Recombinant inbred mice containing a BALB/c allele of Mod13 were then used to show that the presence of Mod13 is sufficient to induce de novo methylation. A segregation between de novo methylation and repression of transgene expression was uncovered, suggesting that this genetic system is also useful for the identification of factors that interpret methylation patterns in the genome.