Neonatal tuberculous meningitis in a patient with Asperger's syndrome.
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Asperger Syndrome↗
Biomedical subjects
A Pélissolo
Publications and source records attributed to A Pélissolo.
Personality dimensions in social phobics with or without depression.
OBJECTIVE: This study investigated the personality traits of social phobics using the Temperament and Character Inventory (TCI). METHOD: A sample of 178 social phobics was assessed with the TCI, and compared with controls. The patients were classified into two groups, according to the absence (SP group) or to the presence (SP+D group) of depression. RESULTS: We found significant elevated scores for harm avoidance (HA) in social phobics when compared with controls (16.2 +/- 2.7), in both the SP (26.2 +/- 3.5), and the SP+D (28.9 +/- 4.7), groups. Lower self-directedness scores were found in the SP and in the SP+D groups when compared with the controls. Patients with the generalized type of social phobia had higher HA scores as compared with other social phobics. CONCLUSION: The personality profile obtained in these social phobics, whatever their depressive symptomatology, reflects a dramatically anxious and avoidant temperament associated to an immature character.
Adult↗
Familial factors influencing the consumption of anxiolytics and hypnotics by children and adolescents.
Many hypotheses have been made to explain the high rate of benzodiazepine consumption in France, including a general cultural and/or familial tendency to use certain types of psychotropic drugs. This study explored the association between lifetime medication use by parents and their children. Two hundred and twenty-one young patients (158 boys and 63 girls) consulting at a child and adolescent psychiatry department, six to 16 years of age (mean = 9.7 years), were screened for lifetime use of psychotropic drugs using a structured interview. Parents were asked about their own consumption, as well as their children's. Lifetime consumption rates (at least once) were 22.2% in boys and 20.6% in girls, and 19.6% in children less than 11 years old. Higher rates were found in patients with emotional disorders (anxiety disorders and depression). In parents, 45.1% of mothers and 24.1% of fathers reported using medications at least once. A significant association was found between child and parental medication use: 34.1% of children had positive lifetime consumption when their mothers also used medications at least once versus only 13.6% in other children (odds ratio = 3.31 [1.68-6.50]; P = 0.001). The most significant association was found between medication use by girls and their mothers (odds ratio = 12.1 [2.38-61.5]; P = 0.003). These data point to the existence of a family pattern of psychotropic drug consumption, especially in females.
Adolescent↗
Normative data and factor structure of the Temperament and Character Inventory (TCI) in the French version.
We explored the psychometric features of the French Temperament and Character Inventory (TCI) in a 602-subject community sample (263 men and 339 women), representative of the French population. The factor structures of the temperament and character dimensions, explored separately, were in agreement with the hypothesized constructs, except for the scales Novelty Seeking NS1 (exploratory excitability), Persistence, and Self-Directedness SD4 (self-acceptance). The internal consistency of the main dimensions was good (Cronbach alpha coefficients between 0.68 and 0.82), but weak for Persistence (0.49). The mean scores of the temperament dimensions were notably different from those published in other normative data - especially lower for Novelty Seeking (16.4+/-5.6) and higher for Harm Avoidance (16.1+/-7.2) when compared with US data - suggesting cross-cultural differences in personality assessment, and the necessity to use specific normative values with each translated instrument.
Adult↗
Why take social anxiety disorder seriously?
Social anxiety disorder (social phobia) is a disabling psychiatric condition, characterized by a fear of negative evaluation by others. Epidemiological studies have shown a high prevalence of the condition in the general population; the disorder is more common in women than in men. Social anxiety disorder has a typical onset during adolescence and a chronic course; remission rarely occurs without therapeutic intervention. Comorbid psychiatric conditions such as depression and alcoholism commonly occur in patients with preexisting social anxiety disorder, and increase the burden of the condition. Two subtypes of social anxiety disorder have been identified: "nongeneralized" and "generalized"; the latter form causes greater disability and is more often associated with comorbidity. The socioeconomic impact of social anxiety disorder on both sufferers and the community is considerable. For a person with social anxiety disorder, quality of life is greatly reduced; work, social, and personal relationships are all affected. Social anxiety disorder demands increased recognition, so that sufferers receive the treatment they need, in order to improve their quality of life through better social functioning.
Adolescent↗
Social phobia in the community: relationship between diagnostic threshold and prevalence.
This paper investigates the prevalence of symptoms and various diagnostic criteria of DSM-IV social phobia in a French national representative population of 12,873 subjects, aged 15 or more. Respondents filled out a mailed questionnaire based on the social phobia section of the Munich-Composite International Diagnostic Interview (M-CIDI) in the year 1996. Response rate was 80.5%. Sixty-seven point one percent of the sample acknowledge having at least once in their lifetime a strong fear of one or more of the six prototypical social fear situations that are used as the CIDI social phobia stem items. However, only a few fulfilled all DSM-IV diagnostic criteria for social phobia. Depending on the type of diagnostic algorithms used and the stringency in which these criteria are applied, the resulting prevalence varied between 1.9 and 7.3%. These findings provide some further evidence about the considerable effects of varying diagnostic criteria and thresholds on prevalence rates for social phobia, explaining why most recent surveys have reported considerably higher rates of social phobia than those in the early 1980s.
Adolescent↗
S17.Personality inventories: an update.
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Journal Article↗
[Detection and diagnosis of anxiety].
Anxiety disorders are now defined by precise diagnostic criteria and their treatments are facilitated by the clinical and therapeutic studies undertaken during the past two decades with current classifications. However, their recognition in everyday clinical practice can be difficult because the patients do not always evoke their symptoms spontaneously, and the attention of the physician is generally attracted by other mental disorders, such as depressive syndromes. The high prevalence of anxiety disorders in the general population, and the handicap associated with severe forms, must incite to their systematic exploration, in order to propose specific therapeutic procedures to the patients. In addition to the clinical exploration of various anxiety syndromes, the clinician can be helped in this goal by assessment instruments, nowadays well validated and easily used, such as dimensional scales or structured diagnostic interviews.
Anxiety↗
[Use of hypnotics in children: description and analysis].
BACKGROUND: Sleep disorders are frequent in pre-school children and in the French population, often leading to the prescription of hypnotics or sedatives. Therefore, this represents an important health problem in this population. PATIENTS AND METHODS: We studied the hypnotic consumption in children, aged between 1 month to 4 years (23 +/- 11.3 months), who complained of insomnia. Parents completed 203 sleep questionnaires including information on the hypnotics consumption of their offspring (112 boys and 91 girls). The questionnaire was also related to the parent's sleep patterns and hypnotics consumption. Seventy percent of the sample had received medication, at least once before the evaluation, and at any age. A positive correlation between hypnotics consumption in mothers and children, particularly boys (odds-ratio = 4.8; 1.1-8.7) was found. CONCLUSION: These data confirm the early exposition to hypnotics of children in the French population, and the existence of a familial pattern of consumption, mostly influenced by the mother. These data should permit the identification of subgroups at risk for early exposition and to encourage non-pharmacologic approaches in the treatment of insomnia in young children.
Age Factors↗
[Acute anxiety attack. Diagnostic orientation and management in an emergency situation].
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Acute Disease↗
Social phobia and alcoholism: a complex relationship.
The relationship between social phobia and alcoholism is complex. Alcohol problems typically develop secondary to social phobia, with patients reporting that they find alcohol helpful in coping with the symptoms of anxiety. However, excessive alcohol consumption may actually precipitate anxiety symptoms, and thus a vicious circle of anxiety and alcoholism is established. The clinician must consider the possibility of comorbidity in patients presenting with either alcoholism or social phobia. Only when both components of the condition are adequately assessed and treated can the cycle of social phobia and alcohol abuse be broken.
Adult↗
Validation of a computerized version of the temperament and character inventory (TCI) in psychiatric inpatients.
We wrote a Basic program for Macintosh and IBM-compatible computers in order to administer the 226 questions of the French Temperament and Character Inventory (TCI) automatically, and to obtain a personality profile instantaneously. Validity was assessed by comparing the results of 32 psychiatric inpatients who used this program and the paper-and-pencil form of the TCI over an interval of 4.8 days on average. No acceptability problem was met with the computerized version. Correlation coefficients between computer and paper-and-pencil scores varied from 0.78 to 0.91 for temperament dimensions, and from 0.71 to 0.82 for character dimensions. The mean scores of the two versions were not significantly different. These results suggest that a computerized version of the TCI can be a reliable and acceptable instrument for the assessment of personality dimensions in psychiatric patients.
Adult↗
[Epidemiology of psychopathologic disorders in infectious diseases].
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AIDS Dementia Complex↗
Comorbidity and social phobia: clinical and epidemiological issues.
Both epidemiological and clinical studies indicate that social phobia is highly comorbid with anxiety and affective disorders and, to a lesser extent, with substance use disorders. In epidemiological surveys, about one in five subjects with social phobia has been reported as having no other lifetime disorder. Other patterns of comorbidity with eating disorders, personality disorders and medical morbidity have been studied more recently and are reviewed here. Comorbidity has a strong influence on impairment, health-seeking behavior and suicidality. These results have major implications for improving the recognition, assessment and treatment of this disorder by physicians and for the design of new research perspectives.
Comorbidity↗
[Patients with a complete or partial remission of Major Depressive Episode as part of Recurrent Major Depressive Disorder: description of ECLAIR study population].
Some guidelines and expert consensus consider the way of care management practices for the recurrent depressive disorder, particularly according to different identified risk factors for recurrence. But, few data are available about the way that these risk factors influence the care management of depressive recurrent patients during the partial or complete remission phase. Eclair study is a longitudinal observatory multicentric and national study, which describes the different risk factors that influence the psychiatrist decision about the following of patients suffering form Major Depressive Disorder (at least 3 Major Depressive Episode (MDE) according to DSM IV). This article presents the inclusion data (V0) of patients, with a focus on their demography characteristics and history of trouble, diagnosis, symptomatology evaluation (with CGI-S, HAM-D, Carroll scale and Sheehan scale) and Cloninger's personality questionnaire (TCI). A total of 596 patients with a recurrent depression either on partial remission (PaR) or complete remission (ToR) to their last episode at the selection, have been included. Complete remission was defined by the presence of a maximum of two criteria of MDE (according to DSM IV) excepted depressed mood and diminished interest or pleasure during at least two months with a HAM-D (17 items) score < 7 and partial remission was defined by the persistence of depressed symptoms but not sufficient to complete a diagnosis of MDE (according to DSM IV) associated with a HAM-D (17 items) score between 8 and 13 included. Mean HAM-D scores at V0 were 10.3 +/- 1.6 for PaR group and 4.0 +/- 1.9 for the ToR group. Free time since last episode was 6.5 +/- 10.5 months in ToR group and 11.2 +/- 16.9 months in PaR group (n = 385). Residual symptomatology between prior episodes was systematically present for 47.6% patients in PaR group, and for 26.7% patients ToR group. The feel to have a stressful daily life persisted for 62.5% of patient in PaR group and 34.3% in ToR group; 70.3% patients in PaR group and 57.9% patients in ToR group reported persistence of causal factor. The main collected risk factors for recurrence were the number of prior depressive episodes (64.9%), familial conflict existence (52.9%) and recent events of life (45.1%). In the TCI, a significant difference in comparison with the French normative data has been found for 3 dimensions: Harm Avoidance, Cooperativeness and Self-Directedness. Some differences were obtained for Novelty Seeking, Reward Dependence, and Self-Transcendence, but without sufficient clinical significance.This study confirms various characteristics about the unipolar depressive disorder, particularly the high risk of recurrence in patients with high number of previous episodes. In the research of predictive depressive recurrence signs, it would be interesting to focus on discriminating elements between complete remitted patients and partial remitted patients.
Adult↗
[Clinical and therapeutic characteristics of social phobia in French psychiatry (Phoenix study)].
Only few clinical epidemiologic studies have been conducted on social phobia in France to date. It is however a frequent disorder, with often severe alteration of social adaptation and quality of life, and for which effective treatments exist. Thus, it seems really important to further explore how these patients are nowadays identified and treated in psychiatry. It was the objective of the Phoenix study. In this observational multi-center study, 952 psychiatric in- or out-patients, with a primary diagnosis of social phobia according to DSM IV criteria, were included. Numerous diagnostic and psychometric evaluations were carried out, in order to evaluate the comorbidity (Mini International Neuropsychiatric Interview, Hospital Anxiety and Depression Scale), the intensity of social anxiety (Liebowitz Social Anxiety Scale), and various aspects of the functional and emotional impact (Various Impact of Social Anxiety scale, Sheehan Disability Scale, SF-36, Positive and Negative Emotionality scale). The patients were in majority females (57.6%), with a mean age 37.5 years, and with a mean duration of social anxiety disorder 12.5 years. The mean scores of social anxiety on Liebowitz scale was 40.3 +/- 12.6 for the fear factor, and 38.3 +/- 13.6 for the avoidance factor. The generalized social anxiety subtype (anxiety in most social situations) was present in 67.8% of the patients. A major depressive disorder was found in 47.7% of the sample, and the prevalence of agoraphobia was even higher (49.2%). As known in clinical practice and in other studies, the prevalence rates of current alcohol dependence and substances abuse were also important in this population (respectively 10.6% and 12.7%). Mean scores of the Hospital Anxiety and Depression (HAD) sub-scales were 13.9 +/-3.8 for anxiety and 9.1 +/-4.5 for depression. About 15% of the patients had a history of suicide attempt, and a suicidal risk was present in nearly 40% of the sample. The psychosocial impact and the alteration of quality of life (with especially a poor physical health perception) were very significant, in the family, educational or occupational and social domains. Mean scores of the Sheehan Disability Scale were 6.1 +/- 2.6 for professional impairment, 5.0 +/- 2.7 for familial impairment, and 6.6 +/- 2.3 for social life impairment. In addition to the disability due to social phobia intensity, an important part of the burden was due to depressive symptoms. Approximately 60% of the patients had already a psychiatric treatment at the time of the survey (since 1,7 years in average), but only 17% had a cognitive behavioral therapy (CBT), and 48% had an antidepressant treatment. These proportions increased in a significant way after the consultation during which the investigation was carried out: an antidepressant was prescribed to 72% of the patients, and a CBT is proposed to 48%. On the whole, this study confirmed the severity and the morbidity of social phobia in a very large sample of French psychiatric patients. The depressive disorders, suicidal risk, and social impairment associated with this condition should incite to more detect and treat it. Seeing the long duration of the disease in our sample, and the lack of specific therapies in many cases, the identification and the treatment of social phobia must be improved, and the role of the psychiatrists in this process seems very important.
Adult↗
[Behavior and cognitive therapies focused on The Young Personality Disorders Schemas: a pilot study of 14 cases].
INTRODUCTION: Personality disorders are very frequent in the general population, and especially in psychiatric patients. Various types of psychotherapy are proposed to treat these disorders, directly or not, but some specific cognitive-behavioural therapies (CBT) have been developed for all personality disorders or some of them such as borderline personality disorder. Among the most known models, one can quote Beck, Young and Linehan's approaches. Young therapies are based on the concept of "early maladaptive schemas", and associate cognitive-behavioural techniques and a very specific work on emotions. The procedure consists in, initially, identifying the cognitive schemas involved in the current disorders, as well as their sources in childhood, in particular through memories of traumatic or emotionally disturbing events. The techniques used to modify these early maladaptive schemas include emotional catharsis and corrective emotional experience methods (eg re-parenting). STUDY DESIGN: We carried out an exploratory and naturalistic study of the effects of this schemas therapy among 14 adult out-patients (12 women and 2 men) suffering of personality disorders according to DSM IV criteria. The majority of the disorders belonged to the clusters C (50%) and B (42.9%). The early maladaptive schemas, according to Young's classification, were especially those of the types "distrust/neglect" (35.7%), "neglect feeling" (21.4%) and "subjugation" (21.4%). RESULTS: The mean duration of the therapies was 13 month, with 26.2 consultations per subject. The primary efficacy criterion selected was the Social Adaptation Scale (SAS-SR, Weissman) score, showing a significant improvement at the end of the therapy (21.3 versus 27.9; p=0.003). This favourable evolution was confirmed by the other scales used, assessing anxious, depressive and general psychopathology symptomatology. CONCLUSION: As a conclusion, -schemas therapies represent a rich and complete psychotherapeutic approach, in particular for personality disorders. Further controlled studies on their efficacy and on the factors associated to a good response are necessary.
Adaptation, Psychological↗
Anxiolytic and hypnotic use by general hospital inpatients. The impact of psychopathology and general medical conditions.
This study explored the relative impact of general medical conditions and psychopathology on the current and lifetime use of anxiolytic and/or hypnotic drugs by general hospital inpatients. One hundred and five consecutive patients, admitted to an internal medicine department, were assessed by a structured interview about current and lifetime use of anxiolytic and/or hypnotic drugs, and with somatic and psychopathology scales. Eighty percent of patients reported using anxiolytics and/or hypnotics at least once in a lifetime, 62.9% in the last year, 55.2% in the last 3 months, and 42.9% in the last week. Correlations were found between drug use and current levels of anxiety and depression, but not somatic pathology. Psychological suffering appeared to be a major determinant for anxiolytic and/or hypnotic use by patients with general medical conditions. Consumption rates were higher than in the general population, but there was no direct link between somatic morbidity and drug use.
Adolescent↗