Les endophénotypes tempéramentaux

Emotion Dysregulation and Affective Temperaments in Opioid Use Disorder: the preliminary results of a prospective study

BACKGROUND

Substance use disorder is a growing health problem all over the world. The coexistence of substance misuse, affective temperaments, and emotion dysregulation has not been studied sufficiently.

OBJECTIVE

The present study aimed to evaluate the role of affective temperaments and emotion dysregulation on substance use disorder. The Emotion Dysregulation and Affective Temperaments in Opioid Use Disorder study was designed observational. This paper presents only the baseline assessments of the patient and control groups. One-year remission rates of the patients' group will be reported elsewhere after 1-year follow-up.

METHODS

Sixty-seven patients with opioid use disorder and 68 healthy controls enrolled. All participants were administered to The Structured Clinical Interview for DSM-5, Temperament Evaluation of Memphis, Pisa, Paris, San Diego Autoquestionnaire, Difficulties in Emotion Regulation Scale, Beck Anxiety Inventory, and Beck Depression Inventory.

RESULTS

Patients with opioid use disorder had higher scores from all temperamental scales and showed higher difficulties on emotion regulation than the control group. Even controlling the confounding effects of anxiety and depression levels, dysthymic and anxious temperament scores were found correlated with the emotion dysregulation score in the patient group.

CONCLUSIONS

The emotional traits (i.e., affective temperaments) and emotion regulation abilities play a crucial role in substance use disorder. While managing substance use disorder, being aware of affective temperament characteristics and/or interventions to improve emotion regulation skills may be helpful.

Phenomenological contribution to understanding of vocally disruptive behaviour: A clinical case study in a patient with dementia

BACKGROUND

Behavioural and psychological symptoms of dementia (BPSD) cause great suffering in patients and their families. Phenomenology can help clarify the diagnosis and propose some new therapeutic responses using Daseinsanalyse. Separation issues understood using the phenomenological description of the melancholic type (MT) by Tellenbach may further shed light on our understanding of depression in dementia.

SUBJECT AND METHODS

In a 90-year-old woman presenting with advanced (Clinical Dementia Rating 3) mixed dementia and BPSD in the form of vocally disruptive behaviour (VDB), we discuss separation anxiety as the aetiopathogenic hypothesis. Depression and BPSD were assessed using the Neuropsychiatric Inventory, Cornell scale, and Montgomery-Åsberg Depression Rating Scale to confirm our second phenomenological diagnostic hypothesis, ie, melancholy. The Big Five Inventory scale filled in by a proxy was also used to evaluate the patient's premorbid personality. We then propose an explanatory frame of VDB and depression through the standard phenomenological assessment of its relation to time, space, self, and other.

RESULTS

Confirming MT, we found an inhibited temperament and low openness to experience in the patient, as well as a symbiotic relationship with a close relative (the other).

CONCLUSION

Separation anxiety may well explain the patient's MT expressed by VDB. Melancholic type and her symbiotic relationship led to a situation unbearable to the patient and her close relative unable to delegate care to a specialized team.

RUNNING HEAD

Phenomenology in vocally disruptive behaviour in dementia. We have found new explanations in similar clinical cases in dementia as follows. A patient presenting with vocally disruptive behaviour has a melancholic type, a behavioural-inhibited temperament, and marital violence in the past. Phenomenology may help explain this profile with neurobiological disorders. The life trajectory, from childhood into older age, must be taken into account to understand behavioural and psychological symptoms of dementia.

[Typus melancholicus and melancholia: Theoretical synthesis using a clinical case]

OBJECTIVE

The aim of this paper is to propose, starting from the description of a clinical emblematic case, a theoretical synthesis of the work of phenomenological psychopathology dedicated to melancholia and typus melancholicus (TM), a clinical concept that describes the premorbid personality vulnerable to major depression ("melancholia" for the psychopathological tradition).

METHOD

This is a phenomenological analysis of a case study of melancholia, of its premorbid personality and pathogenic triggering situation. We adopt two main phenomenological keys to understand the development of melancholia: a role-identity theory and desynchronization theory. The former understands melancholia as a disorder of identity triggered by the loss of the social role with which one has previously over-identified. The latter sees melancholia as the effect of the desynchronization from the social environment that further develops into an inhibition of the cognative-affective dynamics of life. We present the case of Jonas (64 years old), whose mother (94 years old) recently died. Before his mother's death, Jonas' life was entirely orchestrated by the caring for his mother and synchronized in time with this (e.g., he used to go to her house every 4 hours, had all his meals with her, etc.). Jonas, in addition to being hyper-synchronized and hyper-syntonic, fulfills all diagnostic criteria for TM, including "orderliness", "conscientiousness", "hyper/heteronomia" and "intolerance of ambiguity". TMs attach a disproportioned importance to their social roles (or external representations of identity) at the expense of their own ego-identity.

RESULTS

The passage from premorbid personality to melancholia is triggered by the death of Jonas' mother that entails a profound depersonalization. Desynchronization and role loss cause Jonas' fall into this severe depersonalization, the core feature of which is the feeling of the loss of feeling.

CONCLUSIONS

This original contribution demonstrates that a clinical case can contribute to the construction and refinement of theoretical and conceptual frameworks (like princeps Tellenbach's studies). Over-synchronized tempo and over-identification with social role are emblematically in this case the two sides of the same coin. A parallelism can be established between synchronization (with the mother) and respect for the role at the expense of own identity. The clinical case of Jonas highlights a conceptual bridge between the model of melancholia as loss of social role and the model of melancholia as desynchronization.

The effect of temperament on the treatment adherence of bipolar disorder type I

BACKGROUND AND AIMS

Treatment adherence is one of the most important factors that may determine treatment response in patients with bipolar disorders (BD). Many factors have been described to be associated with treatment adherence in BD. Temperament that can influence the course of BD will have an impact on treatment adherence. The aim of this study is to investigate temperament effect on treatment adherence in euthymic patients with BD-I.

METHODS

Eighty patients with BD-I participated in the study. A psychiatrist used the Structured Clinical Interview for DSM-IV Axis-I Disorders to determine the diagnosis and co-morbidities. Hamilton Depression and Young Mania Rating Scale were used to detect the remission. We used the Temperament Evaluation of Memphis, Pisa, Paris, San Diego Autoquestionnaire and the 4-item Morisky Medication Adherence Scale to evaluate temperament and treatment adherence, respectively. The study group was divided into two groups as "treatment adherent" and "treatment non-adherent".

RESULTS

The cyclothymic and anxious temperament scores of the treatment non-adherent patients with BD-I were significantly higher than those of the treatment adherent group (p < 0.001, p = 0.006, respectively). Multiple linear regression analysis determined that cyclothymic temperament predicted treatment non-adherence (p = 0.009).

CONCLUSION

It should be kept in mind that BD-I patients with cyclothymic temperament may be treatment non-adherent and future studies should explore whether temperament characteristics deteriorate BD-I course by disrupting treatment adherence.