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Potier R, Troubé S, Putois O. Vulnerability to Psychosis: A Psychoanalytical Perspective. The Paradigmatic Example of 22q11.2 Microdeletion Syndrome. Front Psychol 2020; 11:1613. [PMID: 33041876 PMCID: PMC7523241 DOI: 10.3389/fpsyg.2020.01613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 06/15/2020] [Indexed: 12/04/2022] Open
Abstract
This paper outlines a psychoanalytic contribution to a growing research field in psychiatry: that of psychotic vulnerability, and the related neurogenetic modeling of schizophrenia. We explore this contribution by focusing on recent studies concerning a neurodevelopmental disorder, the 22q11.2 microdeletion syndrome – which comprises DiGeorge syndrome in particular. It is one of the most common rare genetic syndromes, and the patients that it affects present a very high rate of psychotic symptoms (between 30 and 40%). For this reason, it has sparked an increasing number of clinical research projects which give it a paradigmatic status, as much for psychotic vulnerability as for potential neurobiological and genetic markers of schizophrenia. This syndrome illustrates one of the major stakes in contemporary psychopathology: the articulation of clinical, neurocognitive, and genetic approaches in a pluri-disciplinary manner. We seek to show that psychoanalysis, when it participates in this articulation, opens up specific hypotheses and research perspectives. In particular, based on the epidemiological observation of the role of anxiety as a predictor for psychosis, we underline the potential relevance of psychoanalytically oriented differential clinical practice and the psychodynamics of anxiety: they can contribute to studies and clinical follow-up on the 22q11.2 microdeletion syndrome and, more widely, to research on the detection and prevention of psychotic vulnerability.
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Affiliation(s)
- Rémy Potier
- Université Paris Diderot, Paris, France.,Département des Études Psychanalytiques, Institut des Sciences, Humaines, des Sciences et des Sociétés, Université Paris Diderot, Paris, France
| | - Sarah Troubé
- Laboratoire Interdisciplinaire Récits Cultures Et Sociétés (LIRCES EA 3159), Université Nice-Sophia Antipolis, Nice, France
| | - Olivier Putois
- Subjectivité, Lien Social et Modernité, Faculté de Psychologie, Université de Strasbourg, Strasbourg, France.,Service de Psychiatrie, Santé Mentale et Addictologie, CHU de Strasbourg, Strasbourg, France
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Zafran H, Mazer B, Tallant B, Chilingaryan G, Gelinas I. Detecting incipient schizophrenia: a validation of the Azima battery in first episode psychosis. Psychiatr Q 2017; 88:585-602. [PMID: 27804008 DOI: 10.1007/s11126-016-9482-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Early psychosis intervention aims to accurately detect adolescents and young adults at risk for major mental disorders, particularly schizophrenia, yet early biomedical diagnostic accuracy remains poor. However, phenomenological approaches focusing on eliciting and understanding the subjective experience of help-seeking youth better detect incipient schizophrenia. The Azima Battery is an occupational therapy projective assessment that uses expressive media in a standard setup, in order to phenomenologically elicit and describe the activity performance and narratives of individuals at risk of, or on, the psychotic-spectrum.The purpose of this study was to estimate the predictive validity of the Azima Battery with youth seeking help for a first episode of psychosis, and identify patterns of performance distinctive of a diagnosis of schizophrenia 1-year later. A mixed methods phenomenological approach was used to calculate the predictive validity of the Azima Battery in detecting incipient schizophrenia, and to qualitatively identify patterns of performance. Study results demonstrate that the diagnostic accuracy of the Azima Battery is greater than psychiatric interviewing for a future diagnosis of schizophrenia (N = 62: 88.7 % vs 42 %). Performance elements and patterns statistically distinctive of schizophrenia are described, and relate to the structure of the created objects. Therefore, the Azima Battery is a valid measure for clinical use by occupational therapists working in early intervention for psychosis as a complement to traditional psychiatric interviewing.
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Affiliation(s)
- Hiba Zafran
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, Quebec, H3G 1Y5, Canada. .,Institute of Community and Family Psychiatry, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal, Quebec, H3T 1E4, Canada.
| | - Barbara Mazer
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Jewish Rehabilitation Hospital, 3205 Place Alton Goldbloom, Laval, Quebec, H7V 1R2, Canada.,School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, Quebec, H3G 1Y5, Canada
| | - Beverlea Tallant
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, Quebec, H3G 1Y5, Canada
| | - Gevorg Chilingaryan
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, Quebec, H3G 1Y5, Canada.,Feil & Oberfeld/ CRIR Research Centre, Centre intégré de santé et de services sociaux de Laval, Hôpital juif de réadaptation, 3205, Place Alton-Goldbloom, Laval, Québec, H7V 1R2, Canada
| | - Isabelle Gelinas
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, Quebec, H3G 1Y5, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Jewish Rehabilitation Hospital, 3205 Place Alton Goldbloom, Laval, Quebec, H7V 1R2, Canada
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Consoli A, Brunelle J, Bodeau N, Louët E, Deniau E, Perisse D, Laurent C, Cohen D. Diagnostic transition towards schizophrenia in adolescents with severe bipolar disorder type I: an 8-year follow-up study. Schizophr Res 2014; 159:284-91. [PMID: 25217364 DOI: 10.1016/j.schres.2014.08.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 08/05/2014] [Accepted: 08/06/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The diagnosis of bipolar disorder-I (BD-I) is currently well-established. However, more studies exploring diagnostic stability and psychosocial adaptation during follow-up in adulthood are needed. OBJECTIVES We assessed factors at follow-up (FU): (1) the diagnostic stability of manic/mixed episodes from adolescence to adulthood, (2) psychosocial adaptation, and (3) factors associated with psychosocial adaptation. METHODS A sample of 80 adolescents hospitalized in a university hospital between 1993 and 2004 for a manic or mixed episode were contacted for an FU assessment on average 8 years after the index episode. Assessments included socio-demographic data, mortality, lifetime psychiatric diagnosis, the Social Adaptation Scale, negative life events and insight. RESULTS Of the 64 patients with available information, one patient died from a heart attack. Of the 55 patients available for an FU assessment, 35 (63.6%) still presented a diagnosis of BD-I at FU, whereas 20 (36.4%) had changed diagnosis towards a schizophrenia spectrum disorder. Psychosocial adaptation was moderate to poor for most patients, and 91% of the patients had at least one relapse. A low socio-economic status, intellectual disability, negative life events, a history of sexual abuse, and treatment with classical antipsychotics at FU were significantly associated with poorer psychosocial adaptation. In contrast, better insight, a family history of depression and a diagnosis of BD-I at FU were associated with better psychosocial adaptation. CONCLUSION BD-I in adolescent inpatients can lead to important morbidity and mortality during outcome. Diagnostic stability is high, but a high proportion of patients also show a transition towards a schizophrenia spectrum disorder.
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Affiliation(s)
- Angèle Consoli
- Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France; INSERM U-669, PSIGIAM, Paris F-75679, France.
| | - Julie Brunelle
- Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France; CRICM-CNRS, Institut du Cerveau et de la Moelle, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Nicolas Bodeau
- Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Estelle Louët
- Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Laboratoire de Psychopathologie clinique de l'adolescent, Université Paris V, Paris, France
| | - Emmanuelle Deniau
- Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Didier Perisse
- Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Claudine Laurent
- Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France; CRICM-CNRS, Institut du Cerveau et de la Moelle, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - David Cohen
- Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France; CNRS UMR 7222, Institut des Systèmes Intelligents et Robotiques, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
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Consoli A, Raffin M, Laurent C, Bodeau N, Campion D, Amoura Z, Sedel F, An-Gourfinkel I, Bonnot O, Cohen D. Medical and developmental risk factors of catatonia in children and adolescents: a prospective case-control study. Schizophr Res 2012; 137:151-8. [PMID: 22401837 DOI: 10.1016/j.schres.2012.02.012] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 01/30/2012] [Accepted: 02/10/2012] [Indexed: 10/28/2022]
Abstract
CONTEXT Rare diseases have been associated with more and more genetic and non genetic causes and risk factors. But this has not been systematically assessed in catatonia, one of the psychiatric syndromes, that is most frequently associated with medical condition. OBJECTIVE We sought to assess the medical and developmental risk factors of catatonia in children and adolescents. METHODS From 1993 to 2009, 58 youths aged 10 to 18 years were prospectively admitted for catatonia and were followed up after discharge. A multidisciplinary approach assessed patients' medical condition and developmental history. A causality assessment scored medical risk (maximum score=10; κ=0.91). We compared the prevalence of catatonia in these patients to that of 80 inpatients with bipolar I disorder admitted from 1993 to 2003 who were also followed up. RESULTS We found that 13 (22.4%) patients had medical conditions and 18 (31%) had a history of developmental disorder in the catatonia group, whereas 1 (1.3%) and 17 (22.6%) patients had the same conditions in the bipolar group (p<0.001; p=0.17, respectively). Medical conditions associated with catatonia included auto-immune encephalitis (systemic lupus erythematosus [N=3] and anti-NMDA-receptor encephalitis [N=1]), seizures (N=1), ciclosporin encephalitis (N=1), post hypoglycaemic coma encephalitis (N=1), and genetic or metabolic conditions (chorea [N=2], 5HT cerebrospinal fluid deficit [N=1], storage disease [N=1], fatal familial insomnia [FFI; N=1], and PRODH mutations [N=1]). Six patients responded to a specific treatment approach related to their medical condition (e.g., plasma exchange in the case of auto-immune encephalitis). CONCLUSION Catatonia in children and adolescents is associated with a high prevalence of medical conditions. This needs to be acknowledged as it may greatly delay the treatment of catatonia and the diagnosis of medically related catatonia. Tragically, this may deny patients treatment opportunities.
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Affiliation(s)
- Angèle Consoli
- Department of Child and Adolescent Psychiatry, Institut des Systèmes Intelligents et Robotiques, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
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Cohen D. Does experimental research support psychoanalysis? ACTA ACUST UNITED AC 2011; 105:211-9. [PMID: 21963530 DOI: 10.1016/j.jphysparis.2011.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The question of whether a psychodynamic view is compatible with experimental research is still a challenging issue-especially for child and adolescent psychopathology-despite the influence of psychoanalytic theory in this field until the 1980s. In this article, is explored the relationship between psychodynamic theory and experimental research using examples of evidence-based studies in the fields of (i) psychotherapeutic intervention assessment, (ii) placebo response in children and adolescents, (iii) unconscious lasting traumatic effects in children and adolescents, (iv) psychodynamic-oriented psychological testing. There are now a sufficient number of evidence-based studies to support the use of psychodynamic therapy in mental disorders, particularly in personality disorder and anxious/depressive disorder. In addition, placebo responses in children and adolescents with internalizing disorders are significantly higher in major depression compared to obsessive-compulsive disorder or other anxiety disorders, which highlights differential psychopathologies regarding the experience of loss. Also, using an experimental task, psychoanalysts are able to identify, without explicit knowledge and above the level of chance, healthy adults whose siblings had experienced cancer during childhood. This experiment suggests that implicit information regarding a participant's history is conveyed in interpersonal exchanges that can be intuitively perceived by judges experienced in listening to free associations from a psychodynamic perspective. Finally, psychodynamic-oriented psychological testing may predict the transition to schizophrenia in adolescents with a history of manic/mixed episodes. It can be concluded that there are no discrepancies between psychodynamic views and experimental data, whether one tests psychotherapeutic approaches, discusses data from other fields such as psychopharmacology, or designs experiments based on psychodynamic theory.
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Affiliation(s)
- David Cohen
- Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, CNRS UMR 7222, Institut des Systèmes Intelligents et Robotiques, GH Pitié-Salpétrière, AP-HP, Paris, France.
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