Towards a Dimensional, Multifactorial, and Integrative Approach to Procrastination in Everyday Life: An Illustration through Interviews.

Procrastination is a widespread phenomenon that has been extensively studied but about which a clear and integrated picture is still lacking, as reflected in the multiplicity and diversity of its definitions, causes and consequences. In addition, its examination in everyday life has been somewhat overlooked. The aim of this paper is to further the understanding of procrastination, first by providing an overview of its various definitions, causes, and consequences. Using a qualitative approach, we then provide an in-depth descriptive account of procrastination episodes retrospectively reported by six participants from the general population in diverse situations of their daily life, focusing in particular on the definitions, causes, and consequences of procrastination behaviours. Finally, this descriptive account of procrastination is discussed in terms of a dimensional, multifactorial, and integrative approach.

[Eating Disorders assessment and care : a clinical experience in Geneva]. / Evaluation et prise en charge des troubles du comportement alimentaire : une expérience clinique à Genève.

In order to meet the needs of patients suffering from eating disorders and to follow the guidelines of experts, the specialised program for eating disorders of Liaison psychiatry and crisis intervention service in Geneva University Hospitals (HUG) has developed a detailed evaluation (multifactorial and multidisciplinary) and a program with a continuum between outpatient treatment, day care and hospitalisations. The psychotherapy is individualized and goals are regularly assessed. Somatic factors are part of evaluation and care in collaboration with general practitioners but weight (gain or loss) is not the only improvement target. Psychiatric treatment is multidisciplinary and takes into account patient's personal environment, social inclusion and the frequent psychological comorbidities.

Afin de répondre au mieux aux besoins des patients souffrant de troubles alimentaires, tout en tenant compte des recommandations d'organismes experts, les Espaces de soins pour les troubles du comportement alimentaire (ESCAL) du Service de psychiatrie de liaison et intervention de crise des HUG ont mis sur pied une évaluation approfondie (multifactorielle et multidisciplinaire), ainsi qu'un programme spécialisé avec des intensités de soins individualisées et des objectifs de prise en charge régulièrement réévalués. Les facteurs somatiques font partie intégrante de l'évaluation et de la prise en charge en collaboration avec les médecins généralistes mais le poids n'est pas le seul facteur d'évolution. Le suivi psychiatrique est multidisciplinaire et prend en compte l'entourage du patient, son insertion sociale, ainsi que les comorbidités psychiques qui sont fréquentes.

Procrastination as a Self-Regulation Failure: The Role of Impulsivity and Intrusive Thoughts.

Procrastination has been described as the quintessence of self-regulatory failure. This study examines the relationships between this self-regulatory failure and other manifestations of self-regulation problems, namely impulsivity and intrusive thoughts. One hundred and forty-one participants completed questionnaires assessing procrastination, impulsivity (in particular, the urgency and lack of perseverance dimensions), and intrusive thoughts (i.e., rumination and daydreaming). Main results show that urgency mediated the association between rumination and procrastination, whereas rumination did not mediate the relation between urgency and procrastination. Lack of perseverance mediated the association between daydreaming and procrastination, and daydreaming mediated the relation between lack of perseverance and procrastination. This study highlights the role of impulsivity and intrusive thoughts in procrastination, specifies the links between these self-regulation problems, and provides insights into their (potential) underlying mechanisms. It also opens interesting prospects for management strategies for implementing targeted psychological interventions to reduce impulsive manifestations and/or thought control difficulties accompanying procrastination.

Trajectory of disability and quality-of-life in non-geriatric and geriatric survivors after severe traumatic brain injury.

OBJECTIVE: The objective was to investigate disability and health-related quality-of-life (HRQoL) 3, 6 and 12 months after traumatic brain injury (TBI) in non-geriatric (≤ 65 years) and geriatric patients (> 65 years). METHODS: Patients ≥ 16 years who sustained a severe TBI (Abbreviated Injury Scale of the head region > 3) were included in this prospective, multi-centre study. Outcome measures were Glasgow Outcome Scale Extended (GOSE; disability), SF-12 (HRQoL). Mixed linear model analyses were performed. RESULTS: Three hundred and fifty-one patients (median age = 50 years; interquartile range (IQR) = 27-67) were included; 73.2% were male and 27.6% were geriatric patients. Median GOSE at 3, 6 and 12 months was 5 (IQR = 3-7), 6 (IQR = 4-8) and 7 (IQR = 5-8); this increase (slopetime = 0.22, p < 0.0001) was age dependent (slopeage*time = -0.06, p = 0.003). Median SF-12 physical component scale score at 3, 6 and 12 months was 42.1 (IQR = 33.6-50.7), 46.6 (IQR = 37.4-53.9) and 50.4 (IQR = 39.2-55.1); this increase (slopetime = 1.52, p < 0.0001) was not age dependent (slopeage*time = -0.30, p = 0.083). SF-12 mental component scale scores were unchanged. CONCLUSIONS: Disability decreased and HRQoL improved after TBI between 3-12 months. In geriatric patients this improvement was relevant for HRQoL only.

Procrastination, consideration of future consequences, and episodic future thinking.

Despite the intrinsic temporal nature of procrastination, little research has examined the link between this form of self-regulatory failure and the consideration of future consequences, and no study has addressed the link between procrastination and episodic future thinking. The aim of the present study was to explore these relationships. Participants were asked to project themselves into possible future events and to rate the amount of sensory-perceptual details and autonoetic consciousness associated with their representations. They were also asked to complete questionnaires that assessed procrastination, the consideration of future consequences, and negative affect. Results showed that both the consideration of future consequences and episodic future thinking were associated with procrastination, and in particular with procrastination-related decision making abilities and procrastination-related motivational dispositions, respectively.

Association between impulsivity, emotional/behavioural hyperactivation and functional outcome one year after severe traumatic brain injury.

OBJECTIVE: To examine impulsivity changes after a severe traumatic brain injury (TBI) and to explore the relationships between impulsivity dimensions (urgency, lack of premeditation, lack of perseverance, sensation seeking), emotional/behavioural hyperactivation and 12-month outcome. METHODS: Measures of emotional/behavioural hyperactivation and functional outcome were administered to 60 patients with severe TBI 12 months after the trauma. A scale designed to assess impulsivity changes after TBI was completed by the patients' significant others at the same time. RESULTS: Scores on urgency and lack of perseverance were higher after the trauma, whereas the score on sensation seeking was lower and the score on lack of premeditation remained stable. Urgency was the only dimension of impulsivity related to both emotional/behavioural hyperactivation and functional outcome. The relationship between urgency and functional outcome was mediated by emotional/behavioural hyperactivation, suggesting that a high level of urgency results in emotional/behavioural hyperactivation, which in turn impacts functional outcome. Lack of perseverance was significantly associated with functional outcome, indicating that the higher the lack of perseverance, the lower the functional outcome. CONCLUSION: The results contribute to a better understanding of the 12-month outcome in patients with severe TBI. They also open interesting perspectives on management strategies for implementing targeted psychological interventions to decrease impulsive manifestations.

Factor structure of a French version of the Eating Disorder Examination-Questionnaire among women with and without binge eating disorder symptoms.

The Eating Disorder Examination-Questionnaire (EDE-Q) is a self-report questionnaire that is widely used to investigate the core features of eating disorders. The EDE-Q is derived from the Eating Disorder Examination, a semi-structured interview considered as the "gold standard" in the assessment of eating disorders. To verify the factor structure of both instruments, originally composed of four subscales, factor analyses have been conducted with various samples. Heterogeneous results were found. Because no study had investigated the factor structure of the EDE-Q in individuals with binge eating disorder, the goal of our study was to fill this gap. We started with a review of the studies on the EDE and EDE-Q factor structure to decide which models to compare. Among 21 studies that were identified, three models had been replicated several times. We compared these three models-a 22-item, 3-factor model, a brief 7-item, 3-factor model and a brief 8-item, 1-factor model-in two samples of participants, one with threshold and subthreshold criteria for binge eating disorder (N = 116) and one without eating disorders (N = 161). Confirmatory factor analysis revealed a good fit for the brief 7-item, 3-factor model for both populations, whereas other solutions were not acceptable. Cronbach's alpha coefficients of the three factors were acceptable to good, ranging between 0.714 and 0.953. The group with binge eating disorder symptoms had significantly higher scores for each factor. This brief 7-item instrument might be useful for screening or short interventions.

Do emotional stimuli interfere with two distinct components of inhibition?

Emotions have recently been shown to interfere with the efficacy of inhibitory control. However, understanding their impact requires taking into account that inhibition is not a unitary construct, but consists of distinct functions underlain by specific mechanisms. In this study, 88 participants performed two emotional versions of classic laboratory tasks designed to assess (1) the ability to inhibit a prepotent response (a stop-signal task using faces with different emotional expressions) and (2) the capacity to resist the effect of proactive interference (PI; a recent negative task that included emotional words). Overall results showed that emotional stimuli interfered with inhibition capacities in both tasks. Although tending in the same direction, these results suggest that different underlying mechanisms (e.g., top-down vs. bottom-up processes) or consecutive differences in emotional processing (e.g., different interactions with stimulus/task properties, processing stages or motivational aspects) are at play in these two inhibition-related functions.

Validation of a French version of the pure procrastination scale (PPS).

Procrastination is a widespread phenomenon that affects everyone's day-to-day life and interferes with the clinical treatment of several psychopathological states. To assess this construct, Steel (2010) developed the Pure Procrastination Scale (PPS), a short scale intended to capture the general notion of dysfunctional delay. The aim of the current study was to present a French version of this questionnaire. To this end, the 12 items of the PPS were translated into French and data were collected from an online survey in a sample of 245 French-speaking individuals from the general population. The results revealed that one item had problematic face validity; it was therefore removed. Exploratory and confirmatory analyses performed on the resulting 11-item version of the French PPS indicated that the scale was composed of two factors ("voluntary delay" and "observed delay") depending on a common, higher-order construct ("general procrastination"). Good internal consistency and test-retest reliability were found. External validity was supported by specific relationships with measures of personality traits, impulsivity, and subjective well-being. The French PPS therefore presents satisfactory psychometric properties and may be considered a reliable and valid instrument for research, teaching and clinical practice.

Severe traumatic brain injury in a high-income country: an epidemiological study.

This adult cohort determined the incidence and patients' short-term outcomes of severe traumatic brain injury (sTBI) in Switzerland and age-related differences. A prospective cohort study with a follow-up at 14 days was performed. Patients ≥16 years of age sustaining sTBI and admitted to 1 of 11 trauma centers were included. sTBI was defined by an Abbreviated Injury Scale of the head (HAIS) score >3. The centers participated from 6 months to 3 years. The results are presented as percentages, medians, and interquartile ranges (IQRs). Subgroup analyses were performed for patients ≤65 years (younger) and >65 (elderly). sTBI was observed in 921 patients (median age, 55 years; IQR, 33-71); 683 (74.2%) were male. Females were older (median age, 67 years; IQR, 42-80) than males (52; IQR, 31-67; p<0.00001). The estimated incidence was 10.58 per 100,000 inhabitants per year. Blunt trauma was observed in 879 patients (95.4%) and multiple trauma in 283 (30.7%). Median Glasgow Coma Score (GCS) on the scene was 9 (IQR 4-14; 8 in younger, 12 in elderly) and in emergency departments 5 (IQR, 3-14; 3 in younger, 8 in elderly). Trauma mechanisms included the following: 484 patients with falls (52.6%; younger, 242 patients [50.0%]; elderly, 242 [50.0%]), 291 with road traffic accidents (31.6%; younger, 237 patients [81.4%]; elderly, 54 [18.6%]), and 146 with others (15.8%). Mortality was 30.2% (24.5% in younger, 40.9% in elderly). Median GCS at 14 days was 15 (IQR, 14-15) without differences among subgroups. Estimated incidence of sTBI in Switzerland was low, age was high, and mortality considerable. The elderly had higher initial GCS and a higher death rate, but high GCS at 14 days.

The prognostic significance of the serum biomarker heart-fatty acidic binding protein in comparison with s100b in severe traumatic brain injury.

The outcome after severe traumatic brain injury (TBI) is largely unfavorable, with approximately two thirds of patients suffering from severe disabilities or dying during the first 6 months. Existing predictive models displayed only limited utility for outcome prediction in individual patients. Time courses of heart-fatty acidic binding protein (H-FABP) and their association with outcome were investigated and compared with S100b. Forty-nine consecutive patients with severe TBI (sTBI; Head component of the Abbreviated Injury Scale [HAIS] >3) with mono and multiple trauma were enrolled in this study. Enzyme-linked immunosorbent assay measured blood concentrations of H-FABP and S100b at 6, 12, 24, and 48 h after TBI. Outcome measures were conscious state at 14 days (Glasgow Coma Scale), disability (Glasgow Outcome Scale Extended; GOSE), and mortality at 3 months. Univariate logistic regression analysis and receiver operating characteristic curves analysis were carried out. Maximal H-FABP and S100b concentrations were observed at 6 h after TBI (34.4±34.0 and 0.64±0.99 ng/mL, respectively). Patients with multi-trauma had significantly higher H-FABP concentrations at 24 and 48 h (22.6±25.6 and 12.4±18.2 ng/mL, respectively), compared to patients with mono trauma (6.9±5.1 and 3.7±4.2 ng/mL, respectively). In the first 48 h, H-FABP and S100b were inversely correlated with the GOSE at 3 months; H-FABP at 48 h predicted mortality with 75% sensitivity and 93% specificity. Early blood levels of H-FABP after sTBI have prognostic significance for survival and disability.

Matrix metalloproteinase 9 and cellular fibronectin plasma concentrations are predictors of the composite endpoint of length of stay and death in the intensive care unit after severe traumatic brain injury.

BACKGROUND: The relationship between severe traumatic brain injury (TBI) and blood levels of matrix metalloproteinase-9 (MMP-9) or cellular fibronectin (c-Fn) has never been reported. In this study, we aimed to assess whether plasma concentrations of MMP-9 and c-Fn could have predictive values for the composite endpoint of intensive care unit (ICU) length of stay (LOS) of survivors and mortality after severe TBI. Secondary outcomes were the state of consciousness measured with the Glasgow Coma Scale (GCS) of survivors at 14 days and Glasgow Outcome Scale Extended (GOSE) at 3 months. METHODS: Forty-nine patients with abbreviated injury scores of the head region ≥ 4 were included. Blood was sampled at 6, 12, 24 and 48 hours after injury. MMP-9 and c-Fn concentrations were measured by ELISA. The values of MMP-9 and c-Fn, and, for comparison, the value of the GCS on the field of the accident (fGCS), as predictors of the composite outcome of ICU LOS and death were assessed by logistic regression. RESULTS: There was a linear relationship between maximal MMP-9 concentration, measured during the 6-12-hour period, and maximal c-Fn concentration, measured during the 24-48-hour period. The risk of staying longer than 9 days in the ICU or of dying was increased in patients with a maximal early MMP-9 concentration ≥ 21.6 ng/ml (OR = 5.0; 95% CI: 1.3 to 18.6; p = 0.02) or with a maximal late c-Fn concentration ≥ 7.7 µg/ml (OR = 5.4; 95% CI: 1.4 to 20.8; p = 0.01). A similar risk association was observed with fGCS ≤8 (OR, 4.4; 95% CI, 1.2-15.8; p = 0.02). No relationship was observed between MMP-9, c-Fn concentrations or fGCS and the GCS at 14 days of survivors and GOSE at 3 months. CONCLUSIONS: Plasma MMP-9 and c-Fn concentrations in the first 48 hours after injury are predictive for the composite endpoint of ICU LOS and death after severe TBI but not for consciousness at 14 days and outcome at 3 months.

Post-traumatic stress symptoms in relatives in the first weeks after severe traumatic brain injury.

INTRODUCTION: Severe traumatic brain injury (STBI) can cause psychological stress in proxies in the long-term. This study assessed post-traumatic stress (PTS) symptoms in proxies of survivors of STBI in the short-term and investigated stress-associated factors. METHODS: Prospective cross-sectional study, conducted at three Swiss trauma centres over 1 year. Patient and proxy demographics, trauma data including Glasgow Coma Scale (GCS) and management data were collected. The proxies' PTS symptoms were assessed by applying the Impact of Event Scale-Revised (IES-R), once in the first month after the accident (median: 11 days). RESULTS: Sixty-nine proxies were included; 52 proxies were female (77.8%). Mean IES-R sum score for intrusions was 13.38 (SD=7.26), for avoidance 8.91 (SD=5.94), and for hyperarousal 9.07 (SD=6.75). Clinically significant PTS symptoms were observed in 36 proxies (52.2%); mean IES-R sum scores were significantly higher in women. IES-R sub-scale values were inversely related with GCS at the scene of the accident and on hospital admission. CONCLUSIONS: More than half of proxies had clinically significant PTS symptoms shortly after their relative's accident. More severe PTS symptoms were found in women and in proxies of patients with poorer initial GCS scores. Further research into risk groups in the short- and long-term and the long-term impact on patients of PTS syndrome in proxies is warranted.