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Wang C, Shao X, Jia Y, Zhang B, Shen C, Wang W. Inhibitory brainstem reflexes under external emotional-stimuli in schizoid and histrionic personality disorders. PERSONALITY AND INDIVIDUAL DIFFERENCES 2020. [DOI: 10.1016/j.paid.2020.109843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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DSM-IV-TR Axes-I and II mental disorders in a representative and referred sample of unemployed youths – Results from a psychiatric liaison service in a job centre. Eur Psychiatry 2020; 29:239-45. [DOI: 10.1016/j.eurpsy.2013.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 04/11/2013] [Accepted: 06/06/2013] [Indexed: 11/15/2022] Open
Abstract
AbstractObjectives:Increased levels of anxiety, depression and alcohol abuse are associated with unemployment. This study compares both DSM-IV-TR Axis-I and Axis-II mental disorders between a representative and a referred sample of unemployed youths aged 16.0 to 24.9.Methods:One hundred subjects were randomly recruited on the premises of the vocational services centre in the urban region of Essen, Germany (representative sample, RS). One hundred and sixty-five subjects constituting the ‘clinical sample’ (CS) were preselected and referred by case managers to the on-site psychiatric liaison service. Structured Clinical Interviews for DSM-IV (SCID-I and -II), measures of psychopathology and health service utilization were administered.Results:Ninety-eight percent and 43% of CS and RS subjects fulfilled DSM-IV criteria for mental disorders. Mood-, anxiety- and substance-related disorders were the most common Axis-I disorders in both samples. Personality disorders were diagnosed significantly more frequently in the CS. Despite the more severe psychopathology in subjects with mental disorders from the CS compared to the RS, no differences were found for recent mental health service utilisation.Conclusion:Because the sample of unemployed youths referred by case managers was significantly more disturbed in psychiatric terms, such a pre-selection is deemed useful in conjunction with a psychiatric liaison service on the premise of a job centre.
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Morgiève M, N'Diaye K, Clair AH, Pelissolo A, Mallet L. [Can the efficacy of behavioral and cognitive therapy for obsessive compulsive disorder be augmented by innovative computerized adjuvant?]. Encephale 2016; 42:402-409. [PMID: 27109326 DOI: 10.1016/j.encep.2016.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 12/18/2014] [Indexed: 01/20/2023]
Abstract
AIM Cognitive behavioral therapy (CBT) is recognized as an effective treatment for obsessive-compulsive disorder (OCD). To maximize its effectiveness, we designed an "experimental" CBT defined by the addition of a computerized psychoeducative tool. METHOD In a participative process involving patients through meetings of the French OCD association (AFTOC) and therapists through methodological workshops, we built a therapeutic tool from an experimental checking task. This task, which had been published in an earlier work, was adapted for its psychoeducative dimension. We here report on a randomized double-blind trial which included 35 patients with a moderate to severe OCD (Yale-Brown obsessive-compulsive scale, YBOCS between 16 and 25) predominant checking symptoms, no comorbidities, and 2-month stabilized or no treatment. Patients were randomly assigned to either "standard" versus "experimental" CBT. Both therapies were conducted by four CBT-experienced therapists specialized in OCD through weekly individualized sessions over 3 months. Therapy sessions of the experimental CBT were conducted as the standard CBT except for a short exercise with the computerized psychoeducative tool performed by the patient and debriefed with the therapist at the end of the sessions. Patients were assessed before, during, after therapy and again 6 months later using standard clinical tools and a neurobehavioral assessment based on an original symptom-provocation task with anxiety ratings including three types of photographs: neutral, generic inducing obsessions (e.g., doorknobs, electric wires…) and personalized (taken by the patients in their own environment). RESULTS Clinically, "standard" and "experimental" CBT resulted in a significant but equivalent improvement (48% vs 45% reduction of the Y-BOCS score; P=0.36; d=0.12). Therapists were satisfied with the psychoeducative dimension of the computerized psychoeducative tool but reported variable acceptance across patients. Patients appreciated its usability. The clinical improvement was associated with a reduction of the task-induced anxiety (r=0.42, P<0.05), especially towards personalized items (-28,2% vs -20.41% for generic and -6.24% for neutral photographs, P<0.001). Mid-therapy response level was predictive of the final improvement (r=0.82, P<0.001). CONCLUSION The computerized tool may provide a well-accepted therapeutic adjuvant even though it doesn't improve the therapeutic effect. Using a personalized symptom-provocation task reveals the parallel evolution of symptoms and neurobehavioral markers through CBT. Despite the difficulty of improving an evidence-based therapy, mid-therapy results call for investigating the possible adjustments of treatment strategies at an early stage.
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Affiliation(s)
- M Morgiève
- Équipe Behavior, Emotion, and Basal Ganglia, CNRS UMR 7225, Inserm UMRS 975, hôpital de la Salpêtrière, institut du cerveau et de la moëlle épinière (ICM), université Pierre-et-Marie-Curie (UPMC), CHU Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France; Fondation FondaMental, 94000 Créteil, France.
| | - K N'Diaye
- Équipe Behavior, Emotion, and Basal Ganglia, CNRS UMR 7225, Inserm UMRS 975, hôpital de la Salpêtrière, institut du cerveau et de la moëlle épinière (ICM), université Pierre-et-Marie-Curie (UPMC), CHU Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France; Fondation FondaMental, 94000 Créteil, France
| | - A-H Clair
- Équipe Behavior, Emotion, and Basal Ganglia, CNRS UMR 7225, Inserm UMRS 975, hôpital de la Salpêtrière, institut du cerveau et de la moëlle épinière (ICM), université Pierre-et-Marie-Curie (UPMC), CHU Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - A Pelissolo
- Fondation FondaMental, 94000 Créteil, France; Pôle de psychiatrie, UPEC, Inserm U955, hôpitaux universitaires Henri-Mondor, AP-HP, 94000 Créteil, France
| | - L Mallet
- Équipe Behavior, Emotion, and Basal Ganglia, CNRS UMR 7225, Inserm UMRS 975, hôpital de la Salpêtrière, institut du cerveau et de la moëlle épinière (ICM), université Pierre-et-Marie-Curie (UPMC), CHU Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France; Fondation FondaMental, 94000 Créteil, France; Centre d'investigation clinique, CHU Pitié-Salpêtrière, 75013 Paris, France
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[Minimal emotional dysfunction and first impression formation in personality disorders]. DER NERVENARZT 2011; 82:25-36. [PMID: 21207002 DOI: 10.1007/s00115-010-3160-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
"Minimal cerebral dysfunctions" are isolated impairments of basic mental functions, which are elements of complex functions like speech. The best described are cognitive dysfunctions such as reading and writing problems, dyscalculia, attention deficits, but also motor dysfunctions such as problems with articulation, hyperactivity or impulsivity. Personality disorders can be characterized by isolated emotional dysfunctions in relation to emotional adequacy, intensity and responsivity. For example, paranoid personality disorders can be characterized by continuous and inadequate distrust, as a disorder of emotional adequacy. Schizoid personality disorders can be characterized by low expressive emotionality, as a disorder of effect intensity, or dissocial personality disorders can be characterized by emotional non-responsivity. Minimal emotional dysfunctions cause interactional misunderstandings because of the psychology of "first impression formation". Studies have shown that in 100 ms persons build up complex and lasting emotional judgements about other persons. Therefore, minimal emotional dysfunctions result in interactional problems and adjustment disorders and in corresponding cognitive schemata.From the concept of minimal emotional dysfunctions specific psychotherapeutic interventions in respect to the patient-therapist relationship, the diagnostic process, the clarification of emotions and reality testing, and especially an understanding of personality disorders as impairment and "selection, optimization, and compensation" as a way of coping can be derived.
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