la violence n'est pas univoque ni unidrectionnelle en Psychiatry
Dr Claude jean PARIS

Psychiatry Res. 2013 Aug 26. pii: S0165-1781(13)00402-2. doi: 10.1016/j.psychres.2013.07.027. [Epub ahead of print]

Comorbidity of schizotypy and psychopathy: Skin conductance to affective pictures.

Ragsdale KA, Mitchell JC, Cassisi JE, Bedwell JS.

Source

Department of Psychology, University of Central Florida, 4000 Central Florida Blvd., Orlando, FL 32816-1390, United States. Electronic address: katieragsdale@knights.ucf.edu.

Abstract

Prior research indicates a relationship between psychopathy and schizophrenia, elucidating a specific trajectory toward violence. Recent research has suggested that this relationship exists at the nonclinical trait level of schizotypy; however, this finding has not been examined objectively. To explore this relationship using both subjective and objective measures, 54 undergraduates (50% male; mean age 20.41) who endorsed a wide range of schizotypy on the Schizotypal Personality Questionnaire (SPQ) completed a laboratory-based protocol. Participants viewed 15 pictures (five neutral, five threatening, and five of others in distress) from the International Affective Pictures System while electrodermal activity was recorded. As expected, all participants exhibited increased skin conductance levels (SCL) to threat and distress pictures compared to neutral pictures; however, no difference in SCL was found between threat and distress pictures. A unique relationship between psychopathy and schizotypy was found (i.e., schizotypy was related to higher Self-Centered Impulsivity and lower Fearless Dominance); however, schizotypy was related to increased SCL in response to emotional and neutral pictures. Although results do not support autonomic hyporesponsiveness often found in clinical psychopathy, a positive relationship was found between schizotypy and self-reported physical aggression. Findings highlight the need to examine other trajectories of violence within the schizophrenia spectrum disorders.

© 2013 Elsevier Ireland Ltd. All rights reserved.

KEYWORDS:

Electrodermal activity, Schizophrenia, Schizotypy, Self-centered impulsivity, Skin conductance, Violence

Thérapies corporelles et Biodfeedback des liens à préciser
Dr Claude jean paris

J Clin Psychiatry. 2013 Jun;74(6):e520-6. doi: 10.4088/JCP.12m08246.

Neuropsychiatric symptoms and the use of mind-body therapies.

Purohit MP, Wells RE, Zafonte R, Davis RB, Yeh GY, Phillips RS.

Source

Spaulding Rehabilitation Hospital Network, 125 Nashua St, #720, Boston, MA 02114, USA. mpurohit1@partners.org

Abstract

OBJECTIVE:

Neuropsychiatric symptoms affect 37% of US adults and present in many important diagnoses including posttraumatic stress disorder, traumatic brain injury, and chronic pain. However, these symptoms are difficult to treat with standard treatments, and patients may seek alternative options. In this study, we examined the use of mind-body therapies by adults with neuropsychiatric symptoms.

METHOD:

We compared mind-body therapy use (biofeedback, energy healing, meditation, guided imagery, yoga, deep-breathing exercises, hypnosis, progressive relaxation therapy, qigong, and tai chi) between adults with and without neuropsychiatric symptoms (anxiety, depression, insomnia, headaches, memory deficits, attention deficits, and excessive daytime sleepiness) in the 2007 National Health Interview Survey (N = 23,393). Use of ≥ 1 of these therapies in the prior 12 months was the primary outcome of interest. We also examined prevalence and reasons for mind-body therapy use in adults with neuropsychiatric symptoms. We performed logistic regression to examine the association between neuropsychiatric symptoms and mind-body therapy use to adjust for sociodemographic and clinical factors.

RESULTS:

Adults with ≥ 1 neuropsychiatric symptom used mind-body therapies more than adults without symptoms (25.3% vs 15.0%, P < .001). Prevalence increased with increasing number of symptoms (21.5% for 1 symptom, 32.4% for ≥ 3 symptoms, P < .001); differences persisted after adjustment for potential confounders (odds ratios, 1.39 [95% CI, 1.26-1.53] and 2.48 [95% CI, 2.18-2.82]). Reasons for mind-body therapy use among adults with ≥ 1 symptom included the ineffectiveness or expense of conventional medicine (30.2%). Most adults (nearly 70%) with ≥ 1 symptom did not discuss their mind-body therapy use with a conventional provider.

CONCLUSIONS:

Adults with ≥ 1 neuropsychiatric symptom use mind-body therapies frequently; more symptoms are associated with increased use. Future research is needed to understand the efficacy of these therapies.

© Copyright 2013 Physicians Postgraduate Press, Inc.

PMID:

 

23842021

 

[PubMed - in process]

la musique réduit les symptômes de dépression et cette piste mérite d'être creusee
Dr Claude jean PARIS

Complement Ther Med. 2011 Dec;19(6):332-48. doi: 10.1016/j.ctim.2011.08.003. Epub 2011 Sep 22.

The effectiveness of music listening in reducing depressive symptoms in adults: a systematic review.

Chan MF, Wong ZY, Thayala NV.

Source

Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore. nurcmf@nus.edu.sg

Abstract

OBJECTIVES:

We aim to review trials of the effectiveness of music listening in reducing depressive symptoms in adults, and identify areas requiring further study.

BACKGROUND:

Little is known about the efficacy of music listening in the mediation of depressive symptoms.

METHODS:

We systematically search 9 databases and reviewed 17 studies included randomized controlled and quasi-experimental trails of music listening in reducing depressive symptoms in adults. The Joanna Briggs Institute-Meta Analysis of Statistics Assessment and Review Instrument was used for quality assessment of included studies.

RESULTS:

Music listening over a period of time helps to reduce depressive symptoms in the adult population. Daily intervention does not seem to be superior over weekly intervention and it is recommended that music listening session be conducted repeatedly over a time span of more than 3weeks to allow an accumulative effect to occur.

CONCLUSIONS:

All types of music can be used as listening material, depending on the preferences of the listener. So, it is recommended that the listeners are given choices over the kind of music which they listen to. There is a need to conduct more studies, which replicate the designs used in the existing studies that met the inclusion criteria, on the level of efficacy of music listening on the reduction of depressive symptoms for a more accurate meta-analysis of the findings and reflect with greater accuracy the significant effects that music has on the level of depressive symptoms.

Copyright © 2011 Elsevier Ltd. All rights reserved.

J Adv Nurs. 2012 Oct;68(10):2349-58. doi: 10.1111/j.1365-2648.2011.05936.x. Epub 2012 Jan 11.

Music in mind, a randomized controlled trial of music therapy for young people with behavioural and emotional problems: study protocol.

Porter S, Holmes V, McLaughlin K, Lynn F, Cardwell C, Braiden HJ, Doran J, Rogan S.

Source

School of Nursing and Midwifery, Queen's University Belfast, UK. s.porter@qub.ac.uk

Abstract

AIMS:

This article is a report of a trial protocol to determine if improvizational music therapy leads to clinically significant improvement in communication and interaction skills for young people experiencing social, emotional or behavioural problems.

BACKGROUND:

Music therapy is often considered an effective intervention for young people experiencing social, emotional or behavioural difficulties. However, this assumption lacks empirical evidence.

STUDY DESIGN:

Music in mind is a multi-centred single-blind randomized controlled trial involving 200 young people (aged 8-16 years) and their parents. Eligible participants will have a working diagnosis within the ambit of international classification of disease 10 mental and behavioural disorders and will be recruited over 15 months from six centres within the Child and Adolescent Mental Health Services of a large health and social care trust in Northern Ireland. Participants will be randomly allocated in a 1:1 ratio to receive standard care alone or standard care plus 12 weekly music therapy sessions delivered by the Northern Ireland Music Therapy Trust. Baseline data will be collected from young people and their parents using standardized outcome measures for communicative and interaction skills (primary endpoint), self-esteem, social functioning, depression and family functioning. Follow-up data will be collected 1 and 13 weeks after the final music therapy session. A cost-effectiveness analysis will also be carried out.

DISCUSSION:

This study will be the largest trial to date examining the effect of music therapy on young people experiencing social, emotional or behavioural difficulties and will provide empirical evidence for the use of music therapy among this population. Trial registration. This study is registered in the ISRCTN Register, ISRCTN96352204. Ethical approval was gained in October 2010.

© 2012 Blackwell Publishing Ltd.

PMID:

 

22235808

 

[PubMed - indexed for MEDLINE]

musicotherapie un element contributif
Dr Claude Jean Paris

Psychiatr Pol. 1994 Nov-Dec;28(6):719-28.

[Group psychotherapy of neuroses and personality disorders in regular soldiers].

[Article in Polish]

Araszkiewicz A, Florkowski A, Lucki Z.

Source

Katedry i Kliniki Psychiatrii AM, Lodzi.

Abstract

Environmental conditions cause neuroses and symptoms of personality disorders in regular soldiers. Military service in highly formalized and hierarchical conditions makes it impossible to: express emotions (particularly negative ones), to arrange one's own time, to choose the position and place of work. Another important psychotraumatic factor is excessive load of work and responsibility for the sake of "the service". Psychotherapy is the main part of neurotic and personality disorder therapy in regular soldiers. The social context is the bass for theoretical assumptions of psychotherapy carried out by the authors. Based on the theory of learning, the aims of the applied psychotherapy are: eagerness for the elimination of symptoms and changing the mode of behaviour. Group psychotherapy is carried out in stationary conditions, in groups of 8 to 13 patients, for 8-9 weeks. The applied methods are: debating psychotherapy, interaction-communicative methods, psychodrawing, musicotherapy, choreotherapy and relaxation techniques. As the result of the therapy, about 89% of symptomatic improvement and about 81% of the change of attitude and behaviour were obtained.

PMID:

 

7862758

 

[PubMed - indexed for MEDLINE]

Dr Claude JEAN paris
une revue recente des stratégies thérapeutiques dans les TOCS

J Am Acad Nurse Pract. 2009 Apr;21(4):207-13. doi: 10.1111/j.1745-7599.2009.00408.x.

Efficacy of treatments for patients with obsessive-compulsive disorder: a systematic review.

Choi YJ.

Source

Red Cross College of Nursing, 98 Saemoonan-Gil,Jongno-Gu, Seoul 110-102, Korea. Wisdom2323@gmail.com

Abstract

PURPOSE:

This systematic review examines the efficacy of pharmacological therapy for obsessive-compulsive disorder (OCD), addressing two major issues: which treatment is most effective in treating the patient's symptoms and which is beneficial for maintaining remission.

DATA SOURCES:

Seven databases were used to acquire articles. The key words used to search for the relative topics published from 1996 to 2007 were "obsessive-compulsive disorder" and "Yale-Brown obsession-compulsion scale." Based on the inclusion and exclusion criteria, 25 studies were selected from 57 potentially relevant studies.

CONCLUSIONS:

The effects of treatment with clomipramine and selective serotonin reuptake inhibitors (SSRIs: fluvoxamine, sertraline, fluoxetine, citalopram, and escitalopram) proved to be similar, except for the lower adherence rate in case of clomipramine because of its side effects. An adequate drug trial involves administering an effective daily dose for a minimum of 8 weeks. An augmentation strategy proven effective for individuals refractory to monotherapy with SSRI treatment alone is the use of atypical antipsychotics (risperidone, olanzapine, and quetiapine).

IMPLICATIONS FOR PRACTICE:

Administration of fluvoxamine or sertraline to patients for an adequate duration is recommended as the first-line prescription for OCD, and augmentation therapy with risperidone, olanzapine, or quetiapine is recommended for refractory OCD.

PMID:

 

19366379

 

[PubMed - indexed for MEDLINE]

Publication Types, MeSH Terms, Substances

Dr Claude jean Paris
Depression irritabilité liés fréquemment

 Pas facile de penser au diagnostic de dépression devant une irritabilité qui se traduit par de l'impatience et de l'intolérance a autrui.Il est parfois plus facilement évoqué un trouble du caractère  qui dégrade la qualité de vie  et entraine  des difficultés  dans la vie sociale

JAMA Psychiatry. 2013 Sep 11. doi: 10.1001/jamapsychiatry.2013.1957. [Epub ahead of print]

Overt Irritability/Anger in Unipolar Major Depressive Episodes: Past and Current Characteristics and Implications for Long-term Course.

Judd LL, Schettler PJ, Coryell W, Akiskal HS, Fiedorowicz JG.

Source

Department of Psychiatry, University of California, San Diego, La Jolla.

Abstract

IMPORTANCE Although symptoms of irritability or anger are not central to the diagnosis of unipolar major depressive episodes (MDEs), these symptoms have been found, in cross-sectional studies, to be highly prevalent and associated with increased comorbidity and depressive illness burden. OBJECTIVE To determine the prevalence of overtly expressed irritability/anger and its effect on intake presentation and the long-term course of illness. DESIGN A prospective, naturalistic investigation of patients with unipolar MDEs, studied systematically at intake and during up to 31 years of follow-up. SETTING Five US academic medical centers. PARTICIPANTS Patients entered the National Institute of Mental Health Collaborative Depression Study during an MDE in 1978, 1979, 1980, or 1981. Patients with unipolar MDE at intake (n = 536) were divided into those with and those without current comorbid overtly expressed irritability/anger. EXPOSURE In this observational, longitudinal study, patients received treatment that was recorded but not controlled. MAIN OUTCOMES AND MEASURES Groups were compared on illness severity and chronicity, psychosocial impairment, quality of life, suicidal behavior, lifetime comorbid diagnoses, impulse control, and measures associated with bipolarity. RESULTS Overt irritability/anger was present in 292 of 536 participants with a unipolar MDE at study intake (54.5%). It was associated with significantly increased depressive severity, longer duration of the index MDE, poorer impulse control, a more chronic and severe long-term course of illness, higher rates of lifetime comorbid substance abuse and anxietydisorder, more antisocial personality disorders, greater psychosocial impairment before intake and during follow-up, reduced life satisfaction, and a higher rate of bipolar II disorder in relatives. No association was found with increased suicidal ideation or behavior. Results were not explained by comorbidity or other manic spectrum symptoms. CONCLUSIONS AND RELEVANCE This study extends results of cross-sectional investigations and indicates that irritability/anger during MDEs is a highly prevalent clinical marker of a more severe, chronic, and complex depressive illness. Findings have important implications for assessment and treatment.

PMID:

 

24026579

 

[PubMed - as supplied by publisher]

Sélectionné par Dr Claude Jean PARIS 

 Des travaux importants pour faciliter l'accès aux soins 

 J Ment Health Policy Econ. 2013 Jun;16(2):55-65.

Cost-Effectiveness of Alternative Treatments for Depression in Low-income Women.

Beil H, Beeber LS, Schwartz TA, Lewis G.

Source

University of North Carolina at Chapel Hill, CB 7460, Chapel Hill, NC 27599-7590, hbeil@email.unc.edu.

Abstract

BACKGROUND:

Low-income mothers are more likely to experience depressive symptoms than their higher income counterparts, but they are less likely to receive treatment. One way to overcome common barriers to care for low-income women is to dotherapy in the mother's home.

AIMS OF THE STUDY:

The objective of this study was to compare the cost-effectiveness of in-home interpersonal therapy (IPT) to two standard therapies for depression treatment: office based cognitive behavioral therapy (CBT) and psychotropic medication.

METHODS:

This cost utility analysis used a Markov model with a 3-year time horizon to compare the cost-effectiveness of the alternate therapies from the public payer perspective. We followed a hypothetical cohort of 1,000 women age 19 to 35 years withdepressive symptoms who had an income level at or below 200% of the federal poverty level. Costs were based on the number of women who completed the therapy. We used data from published literature on clinical trials with low-income minority women to determine the completion rates, duration, and effectiveness of each type of therapy. Additionally, costs for in-home IPT were calculated from unpublished trial data. Costs were determined using 2011 North Carolina Medicaid reimbursement rates; utility weights were taken from published literature. The endpoint was the total outpatient medical cost (therapy and outpatient medical visits). The study outcomes were depression free days (DFD), which were translated into quality of adjusted life years (QALY). We calculated the incremental cost-effectiveness ratio (ICER) of each therapy based on the number of QALYs gained. We conducted deterministic and probabilistic sensitivity analyses to determine how robust the results were to uncertainty in the parameters.

RESULTS:

Treating patients with IPT resulted in an ICER of USD 13,479/QALY and USD 29,309/QALY as compared to CBT and medications, respectively. The results were most sensitive to the efficacy of IPT. Simulations showed that, with a threshold of USD 50,000/QALY, IPT was cost-effective 95% and 78% of the time as compared to CBT and medications, respectively. If policy makers were willing to pay USD 50,000 per QALY, IPT had a 0.586 probability of being the cost-effective option relative to medication and in-office CBT.

DISCUSSION:

Due to higher completion rates, in-home IPT cost more but resulted in more QALYs gained than the other therapies. Our results indicated that in-home IPT was cost-effective as compared to office-based CBT and at least as cost-effective as medication therapy. The analysis was based on limited data because there have been few randomized, controlled studies on treatments for depression in low-income women, however; additional studies are needed to improve the accuracy of the model.

IMPLICATIONS FOR HEALTH POLICY:

In coming years, the number of low-income women covered by public insurance should increase due to the Affordable Care Act. Given the high prevalence of depression in this population, it will be important to consider the value of potential resources spent on depression treatments. This study found that both in-home IPT and medication could be cost-effective treatments for depression. The results of this study support public payers reimbursing for in-home services.

PMID:

 

23999203

 

[PubMed - in process]

Sélectionné par Dr PARIS

How Does MBCT for Depression Work? Studying Cognitive and Affective Mediation Pathways.

Batink T, Peeters F, Geschwind N, van Os J, Wichers M.

Source

Department of Psychiatry and Psychology, Maastricht University Medical Centre, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht, The Netherlands.

Abstract

Mindfulness based cognitive therapy (MBCT) is a non-pharmacological intervention to reduce current symptoms and to prevent recurrence of major depressive disorder. At present, it is not well understood which underlying mechanisms during MBCT are associated with its efficacy. The current study (n = 130) was designed to examine the roles of mindfulness skills, rumination, worry and affect, and the interplay between those factors, in the mechanisms of change in MBCT for residual depressivesymptoms. An exploratory but systematic approach was chosen using Sobel-Goodman mediation analyses to identify mediators on the pathway from MBCT to reduction in depressive symptoms. We replicated earlier findings that therapeutic effects of MBCT are mediated by changes in mindfulness skills and worry. Second, results showed that changes in momentary positive and negative affect significantly mediated the efficacy of MBCT, and also mediated the effect of worry on depressive symptoms. Third, within the group of patients with a prior history of ≤ 2 episodes of MDD, predominantly changes in cognitive and to a lesser extent affective processes mediated the effect of MBCT. However, within the group of patients with a prior history of ≥ 3 episodes of MDD, only changes in affect were significant mediators for the effect of MBCT.

TRAIL REGISTRATION:

Nederlands Trial Register NTR1084.