Mood congruence effect in explicit and implicit memory tasks: a comparison between depressed patients, schizophrenic patients and controls

This study investigates mood congruence effect in explicit and implicit memory tasks in 23 inpatients fulfilling DSM-III-R criteria for major depressive disorder. Performances were compared to those of 15 in- or outpatients fulfilling DSM-III-R criteria for schizophrenia, and 37 normal subjects serving as euthymics controls. All subjects were submitted to a standard cued recall test and to a word stem completion test devised to assess the effect of the initial presentation without the explicit retrieval of the words being necessary. The material used for these two tasks consisted of emotionally negative and positive words. The results show a mood congruence effect in the ;;;implicit;; memory task (and not in the ;;;explicit;; memory task) only in patients who had recovered from their major depressive episode (and not in depressed patients, schizophrenic patients, or controls). These results suggest that implicit and explicit emotional information processing differ from one another in certain respects.

The cortical serotonin2 receptors studied with positron-emission tomography and [18F]-setoperone during depressive illness and antidepressant treatment with clomipramine

BACKGROUND

Changes in serotonin (5-HT)2 receptor densities were reported in depression by postmortem studies and following treatment with tricyclic antidepressants in animal studies. Here, 5-HT2 receptors were studied in vivo in depressed patients.

METHODS

Cortical 5-HT2 receptors were investigated prospectively using positron-emission tomography and [18F]-setoperone in 7 depressed patients, before and after at least 3 weeks of clomipramine (CMI), 150 mg daily. They were compared to 7 age-matched controls.

RESULTS

There was no significant difference between the untreated patients and the controls, except in the frontal region, where the [18F]-setoperone specific binding was slightly lower in patients. After CMI treatment, depression scores significantly improved and [18F]-setoperone specific binding decreased in cortical regions, suggesting receptor occupancy and/or receptor regulation, by CMI; however, no clinical score correlated with the 5-HT2 receptor measurements either in the untreated or in the treated conditions.

CONCLUSIONS

These data substantiate the view that tricyclic antidepressants such as clomipramine significantly interact with cortical 5-HT2 serotoninergic receptors in actual therapeutic situations.

[Depression and somatic diseases. On one retrospective study of 210 patients with major depression hospitalized in a psychiatric hospital]

Associations between depression and somatic disorders are common and little studied. We present the results of a retrospective study including 210 psychiatric inpatients, suffering from a major depressive episodes (MDE-DSM III-R criteria). The purpose of this study was: first, to access the prevalence of comorbid MDEs with somatic illness, second to describe the clinical, therapeutic and evolutionary characteristics of MDEs secondary to a physical trouble, comparatively with primary depressions and depressions secondary to another psychiatric disorder. A somatic comorbidity was found in 55% of patients (n = 116), the physical illness being, in 6% of cases, causal regarding MDEs. MDEs with a somatic comorbidity (n = 55) are significantly different from primary MDEs (n = 36) and MDEs secondary to another psychiatric disorder (n = 58), regarding an older age at hospitalization and at first affective episode. Moreover, they are different from MDEs secondary to another psychiatric disorder through fewer past suicide attempts, more episodes with melancholic or psychotic characteristics and a lower frequency of tricyclic antidepressant use. Despite methodologically limited, these results confirm the frequency of physical comorbidity in depressed patients hospitalized in general hospitals, especially in elderly subjects. They also reflect the heterogeneity of the group of secondary depressions, MDEs associated with a somatic illness being closer to MDEs secondary to another psychiatric disorder than to primary MDEs.

Frontal dysfunction in neurologically normal chronic alcoholic subjects: metabolic and neuropsychological findings

BACKGROUND

Neuropsychological and imaging studies suggest that frontal dysfunction may occur in apparently normal chronic alcoholic subjects.

METHODS

To investigate this issue further, we performed neuropsychological and fluorodeoxy-glucose-PET studies in 17 chronic alcoholics without patent neurological and psychiatric complications.

RESULTS

Metabolic abnormalities were found in the mediofrontal and in the left dorsolateral prefrontal cortex, but not in the orbitofrontal cortex. Neuropsychological testing revealed significantly reduced verbal fluency and impaired performance on the Stroop test. The mediofrontal hypometabolism correlated with the reduction in verbal fluency and the time necessary to perform the interference condition of the Stroop test. The left dorsolateral prefrontal hypometabolism correlated with the number of errors on the Stroop test.

CONCLUSION

These data indicate that circumscribed frontal dysfunctions may occur in chronic alcoholic subjects before clinically obvious neurological complications, and may account for some of the alcohol-related neuropsychological and behavioural impairments.

Self-concept and mood: a comparative study between depressed patients with and without borderline personality disorder

Within the framework of Self-Structure Theory, this study investigated the relationship between depressed mood and Borderline Personality Disorder (BPD) on self and others descriptions, with a special emphasis on the self-structure's valence, that is, its affective, negative and/or positive content. Seventeen DSM-III-R unipolar depressed patients with associated BPD (DSM-III-R axis II) and twelve unipolar depressed patients without BPD were compared to eighteen non-psychiatric controls on four measures of evaluation and of affective discrepancy of descriptions of self and others. Subjects were administered the grid repertory technique. The analysis of the resulting two-way valence matrix, with attributions as columns, and self and others as rows, showed that depressed patients with and without BPD differed from the non-psychiatric controls with regard to negativity of the descriptions. As compared with the two other groups, depressed patients with BPD showed a distinctive pattern characterised by the joint presence of a negative view of self and a larger affective discrepancy for others, with others being conjunctively assigned positive and negative attributes. Despite some limitations, the distinctive pattern evidenced corroborates the conflicted interpersonal relationship and is in keeping with clinical theorising on BPD.

Apolipoprotein E gene polymorphism in early and late onset bipolar patients

To explore the involvement of apolipoprotein E gene (APO E) in major depression, we studied the APO E gene polymorphism in a sample of 156 unrelated bipolar patients and 91 healthy volunteers. This population was stratified for age at onset of the affective disorder (onset before 18 years, after 45 years and between 18 and 45 years). Early onset bipolar patients with psychotic symptoms exhibited a significant increase of epsilon4 allele frequency (28.9%) compared to either other bipolar patients (13.1%, chi2 = 6.52, df = 1, P < 0.02) or controls (12.1%, chi2 = 7.01, df = 1, P < 0.01). The association between epsilon4 and early onset bipolar disorder (BPD) with psychotic symptoms suggests that APO E gene is a risk factor for a subgroup of BPD, or influences the phenotypic expression (i.e. psychotic symptoms or age at onset) of manic depressive illness.

Presynaptic dopaminergic function in the striatum of schizophrenic patients

The dopaminergic hypothesis of schizophrenia postulates increased brain dopaminergic activity. Two previous studies reported increased 18F-DOPA uptake with positron emission tomography in schizophrenic patients (n = 5, n = 7). In the present study, striatal dopaminergic function was assessed in vivo in six untreated schizophrenics and seven control subjects, comparable for age and sex. The 18F-fluoro-L-DOPA (18F-DOPA) uptake rate constant Ki was determined in the caudate and putamen using coregistered positron emission tomography and magnetic resonance imaging. No difference between groups for mean Ki was found. The variability of the 18F-DOPA uptake values was higher in the caudate (p < 0.01) and in the putamen (p < 0.001) in schizophrenic patients than in control subjects, suggesting that schizophrenia is a disorder involving heterogeneous states of the striatal presynaptic dopaminergic function.

The comprehension of metaphors in schizophrenia

Metaphor comprehension was studied in schizophrenics as compared to psychiatric and nonpsychiatric controls. Subjects were asked in a two-condition forced-choice response task to detect the metaphor similar or contrary to a proverb with an abstract meaning. Schizophrenic patients were impaired in both conditions. However, the paranoid patients' performances did not differ from psychiatric and nonpsychiatric controls. These results are consistent with the hypothesis that the ability of metaphorizing is preserved in some schizophrenic patients.

[Mania in an elderly subject: II. -- the evolution of manic-depressive disease]

The occurrence of mania in the elderly is under-estimated. Mania may inaugurate a late-onset bipolar illness, extend a unipolar depressive disorder or rarely continue a early-onset bipolar illness. Early-onset bipolar illness frequently disappear after 60 years or is prolonged by reccurrent depression. Late-onset bipolar illness may be preceded by slight disturbances of mood. These modalities underline two of the various evolutions of bipolar illness. Only a prospective follow-up study could specify it.

[Mania in an elderly subject: I. -- manic-depressive disorders of late onset]

Late mania may inaugurate a late-onset bipolar illness. Atypical features and organic brain abnormalities are frequently associated. Late-onset bipolar illness is apparently characterized by a strong instability of mood and a super or subsensitivity to neuroleptics and antidepressant drugs. However, there is a strong efficacy of lithium salts and lithium may be used as a curative and preventive treatment or as a therapeutic test, especially in atypical cases. The occurrence of mania in elderly people involves a specifical etiologic, therapeutic and diagnostic approach.

[Mental representation of drugs: construction of two questionnaires to study patients treated with psychotropic or oral hypoglycemic drugs]

We have built two questionnaires in order to study the representation of drugs. Questionnaires have been established according to the results of an open study involving 78 subjects, whether receiving a treatment or not. These questionnaires were applied on a sample of 126 (psychiatric or diabetic) patients. In the future, we expect the questionnaires to help studying relationships between drugs representation and compliance.

Identity disturbances and self-other differentiation in schizophrenics, borderlines, and normal controls

The present study investigates identity disorders in schizophrenics and borderlines. Nineteen schizophrenics and 17 borderlines were compared with 18 normal controls. The technique used was an adapted version of the repertory grid test to describe the self and nine significant others (i.e., family members). Three indices were derived from the 10 person x 20 self-generated-attribute matrix to measure the extent to which self was differentiated from others: (1) overlap of salient attributes, (2) overlap of opposite attributes, and (3) degree of differentiation among others. Results showed that both schizophrenics and borderlines describe themselves more in terms of opposites than in terms of salient attributes. Differentiation among significant others was severely impaired in schizophrenics and preserved in borderlines. These findings were interpreted as a failure of the individuation process in schizophrenics and as an incomplete construal of self-identity in borderlines.

[Suicide attempts and panic disorder: a study of 62 hospitalized suicidal patients]

Suicidal behaviours are multifactorial behaviours. While, historically, anxiety has not been regarded as an important risk factor in suicidal behaviours, recent epidemiological studies carried out on general population or panic patients have evidenced the possible links between suicidal behaviours and the occurrence of panic attacks. The aim of our study was to validate the hypothesis which stipulates that panic disorder may contribute to an actualization of suicidal behaviour in trying to establish the prevalence of panic disorder in a population of suicidal attempters. The diagnoses were reached after an interview using the Schedule for Affective Disorders and Schizophrenia-Lifetime Version modified for the study of Anxiety disorders (SADS-LA). The medical seriousness of the suicide attempts was assessed with the Risk Rescue Rating Scale (RRRS) of Weissman and Worden and the suicidal intent with the Suicidal Intent Scale of Beck (SIS). In the 62 suicide attempters hospitalized after minor or slightly more serious suicide attempts, we found high current and life-time prevalence of panic disorder (17.7% and 22.6% respectively). Comorbidity with major depressive episodes and addictive behaviours in suicide attempters with panic disorder was high. Current comorbidity rates were 72.8% and 27.3% respectively; life-time comorbidity rates were 71.4% and 21.4%. Patients who suffered from major depressive disorder with related panic disorder were given to more impulsive suicide attempts, even if the difference with depressed patients without panic disorder was statistically insignificant.

Time course of prefrontal lobe dysfunction in severely depressed in-patients: a longitudinal neuropsychological study

The Stroop Colour-Word Test (SCWT) and the Verbal Fluency Test (VFT), two tests that have been suggested to be particularly sensitive to prefrontal dysfunction, were administered to 23 severely depressed in-patients. Both tests were impaired in patients at inclusion, but only verbal fluency normalized with successful treatment of depression. VFT impairment is consistent with the hypothesis of a left prefrontal cortex dysfunction in depression. Moreover, the persistence of an impaired performance on SCWT in patients at discharge suggests that a selective attention deficit may persist in patients beyond a clear clinical improvement.

[Drug discontinuation in depression]

Before stopping or starting medications in depression, the first step is a through assessment of the patient's mood disorder: past medical general and psychiatric history, psychological profile, past specific treatment history... Today some data are well demonstrated: antidepressant or lithium or carbamazepine discontinuation should be done gradually (over weeks or months) and with an intensive medical follow-up; after the acute treatment of the index depressive episode, a full therapeutic dose of the antidepressant agent should be continued for at least 4 to 6 months; antipsychotic drugs and minor tranquilizers use should be limited: combination of a neuroleptic and an antidepressant in depression with psychotic features, combination of a minor tranquilizer in depression with anxiety during the first three weeks if necessary. A contario the timing and the method of discontinuing maintenance treatment (lithium or antidepressant) have not been well studied. Literature data are discussed: frequency of recurrence during treatment discontinuation, even after long-term euthymia; possible risk for developing rapid-cycles or non response after lithium discontinuation. More precise clinical guidelines are necessary.

The dissociation of explicit and implicit memory in depressed patients

Twenty-three in-patients fulfilling DSM-III-R criteria for major depressive disorder were submitted to a standard cued recall test, and to a word-stem completion test devised to assess the effect of the initial presentation without the explicit retrieval of the words being necessary. Results show that depressed patients are impaired on the cued recall task in comparison with controls matched for sex, age, and educational level. However, the two groups do not differ in the word-stem completion task. This dissociation between explicit and implicit expressions of memory disappeared when patients recovered, although they were still hospitalized and under psychotropic medication. These results are examined in the light of the distinction between effortful and automatic processes.

Person identification and self-concept in the delusional misidentification syndrome. A case study

This study on a delusional misidentification patient with both Frégoli symptoms and intermetamorphosis investigates the cognitive structure of others and of the self-representations with a new clustering method (HICLAS conjunctive model). Results show that this patient, free from face recognition disorders, shows severe structural anomalies in the mapping of misidentified others, and of the self. Disturbances in the cognitive structure and person identification are discussed in reference to a psychopathological explanation of the misidentification syndrome.

[Validation of a French version of the General Health Questionnaire (GHQ-28) in a diabetic population]

The contrast between the great importance of psychiatric disorders and the fact that they are often not identified as thus in medical and surgical units has been emphasized during the last ten years. The prevalence of depression disorders in an hospitalised population of medical patients is generally estimated between 15% and 30%. It is admitted that one third to two third of theses cases are not diagnosed by non psychiatrist physicians. It is the reason why self questionnaires have been finalized in order to detect psychiatric troubles in medical populations. The General Health Questionnaire (GHQ), constructed by Goldberg, is surely the most internationality used, but no validation study has yet been undertaken in France. This study means the validation of a french version of GHQ-28 items, set on 46 diabetics (type 1 and type 2) selected in a week hospital. This validation is based on the comparison of the two principal scoring methods: "GHQ" (0,0,1,1); "CGHQ" (0,1,1,1 for negative items) and the determination of the best cut-off score in this specific population. The referring DSM III-R diagnoses were assessed by the Composite International Diagnostic Interview (CIDI; Robins et al., 1988), which is a highly structured psychiatric interview developed by the World Health Organisation. Sixteen patients out of the 46 diabetics showed criterions of depressive and/or anxious disorders, 6 of them presenting both. The analysis of the answers to the questionnaires was based upon the technic of the Relative Operating Characteristic (ROC) curves which takes all the sensitivity-specificity couples bound to each of the possible threshold-score into account.(ABSTRACT TRUNCATED AT 250 WORDS)

[Negative schizophrenic symptomatology and the P 300 potential]

We studied the latency and amplitude of the P 300 wave of event-related potentials (P 3) in 19 hospitalised schizophrenic patients. We used an odd ball paradigm procedure in acoustic stimulation. We found a negative correlation between the amplitude of P 3 and negative schizophrenic symptomatology, measured by the negative BPRS score and the SANS score. However, no link would appear to exist in our study between positive symptomatology and P 3 amplitude. The correlation with the negative BPRS score is found in both evaluations, at the beginning and at the end of the period of hospitalisation. P 3 latency would appear to be independent of either positive or negative schizophrenic symptomatology. It would thus appear to us that the negative symptomatology, rather than the positive, could be at the origin of marked changes in P 3, observable fro relatively simple experimental but parameters such as reaction time or error scores remain to be specified, even if they appear to intervene infrequently. The use of event-related potentials would thus appear pertinent in clinical research and could help in the homogenisation of schizophrenic populations studied.

[Special proceedings of a law project concerning "the accusation of dementia": case of Joseph Firmin nicknamed Retif (1794-1799)]

The study of a long neglected bill about the accused in a state of mental alienation debated by the legislative assembly of the french Directoire (1794-1799) following a ruling in the Joseph Firmin case. The parliamentary debate on this bill is of real historical interest, since for the first time after the french Revolution its thirteen sections propose to institute special proceedings in case of mental alienation, midway between the penal code of 1791, which does not contain such provisions and the napoleonic code of 1810, it opens the way for the wellknown section 64 of this later code which sets the rules for over a hundred and eighty years.

[Hyperthymic disorders]

Hyperthymia, as referring to the book by J. Delay: "les dérèglements de l'humeur" (1946), means from a clinical point of view, an exaggeration of the level of mood, as well on the one hand, expansive and joyful, as, on the other hand, distressing, within a withdrawn self. K. Schneider had described an hyperthymic personality in 1923: optimist, dynamic, taking initiatives, or more simply hypomanic. He opposed this type of personality to depressive personality types. Delay unified these two pathologic evolutions within a physiopathological and psychopathological unique concept. Conversely, H. Ey denied this unique affective conceptualization of the disease. From his physiopathologic jacksonian point of view, a certain level of destruction of consciousness explains, solely, both affective and noetic disorganization of these so called hyperthymias. Since the early eighties, Angst, Akiskal, Cassano, brought up to date the adjective hyperthymic. They assessed the correlation between premorbid personality disorder and mood disorder: a number of bipolar disorders are linked with premorbid hyperthymic disorders. This was the K. Schneider' position who linked traits and states, as Kraepelin did for the manic premorbid disposition. Choosing a dimensional approach, one question has to be asked: can hyperthymia be found as a previous personality trait of different other diseases? An anxious hyperthymia can be found linked to some panic attacks and other neurotic symptoms. A delusional hyperthymia is described by Janzarik who thinks that delusional ideas are linked to a kind of delusional mood. G. Petit, in 1933, subsumed the existence of a paranoid hyperthymia within the more general concept of the passional psychoses described by de Clérambault, Delmas and Borel.

[Self concept: toward a cognitive approach to identity disorders]

The development of the concept of self is one of the prominent facts of 20th-century psychology; its conceptualizations are diverse. Within the field of cognitive psychology, concurrent with growing interest in comprehensive theories of personality has been the recent emergence of the self-concept. The self-concept is viewed as the cognitive structure comprised of mental representations of oneself, and responsible for their integration and processing; it appears as the cornerstone of personality. The cognitive modelling of the self-concept currently opens new directions in the approach to identity processes and their psychopathologic disturbances.

Cognitive processing of contradictory statements: an experimental study of reasoning on proverbs in schizophrenia

Twenty schizophrenic patients and 20 normal subjects matched for age, sex and verbal level were asked to identify, from a list of alternatives, the statement that was the most contradictory to each of 8 proverbs. Schizophrenics (whether severely disturbed or not) were found to be less accurate in detecting the contradictions [F(1,18) = 29.21; p less than 0.0001]. No significant differences between undifferentiated and disorganized DSM-III subtypes were observed. The greatest tolerance of contradictory statements was interpreted in terms of violation of the 'no contradiction principle' and examined in the light of a deficit in logical abilities.

[Tianeptine in episodes of major depression with melancholia and signs of endogenicity]

The effectiveness and good acceptability of tianeptine have been demonstrated in episodes of major depression without melancholia or signs of psychosis which are the valided indications of the tianeptine. In a way of research program, a multicenter study was conducted in 30 patients with D.S.M. III criteria for major depression with melancholia and signs of endogenicity as defined by the Newcastle scale. The patients were treated in a double-blind trial for 42 days. Administration of a placebo for 4 days prior to beginning the study was designed to eliminate rapid responders to placebo. The antidepressant effectiveness was evaluated on the Hamilton (HDRS), Montgomery and Asberg (MADRS) and global clinical impression (GCI) scales. The effect was satisfactory and statistically significant. Seventeen of the 30 patients (57 percent) included in this study improved with tianeptine (CGI-item 2). Results were comparable whatever the diagnosis established on DSM III criteria: bipolar depression, major depression, recurrent or isolated forms. The acceptability evaluated from patient complaints, measurement of blood pressure and laboratory tests was very satisfactory. Treatment was withdrawn in 14 patients with no subsequent withdrawal symptoms. These findings show that tianeptine can be prescribed with success for major depression episodes with melancholia (DSM III) and signs of endogenicity, although it cannot be concluded that patients should be given this treatment in first intention for this type of depression.

[Formal thinking, logical-discursive operations and schizophrenia: experimental study of a clinical case]

This study, based on a single case experimental design, examined logical reasoning in a schizophrenic meeting the DSM-III criteria. The quantitative assessment carried out by 32 psychiatrists on a rating scale for logical thinking disorders (nine items, six points) of the retranscribed clinical interview showed 1. that the assessments varied in a statistically significant way according to items and psychiatrists, and that these variations were independent of their degree of experience--the correlations between the different items of the rating scale proved to be weak and not significantly different from zero; and 2. the study of the most contradictory statements carried out by a logician using reasoning analysis procedures concluded that there were in fact logical relationships between the subjects the schizophrenic talked about. The results are discussed in relation to the methodology of assessing formal thought in schizophrenia.

[Personal identity and multiple personality]

The present study analyses the internal organization of self concepts in a woman who meets the DSM III criteria of multiple personality disorder. The aim of this single case study, was to assess the personal identity of this patient, the degree of internal coherence and the hierarchical structure of the descriptions of self and others in the frame of cognitive theories of personality. After the clinical observation, the experimental procedure is presented. It consists in asking the patient to describe her different roles or alternated personalities (N = 12), as well as the target persons of her familial and social environment (N = 8) on the basis of a preestablished list of adjectives (extracted from the 16 P.F. Cattell sphere of personality). The factorial analysis of the contingency table: traits attributed x persons described shows a Guttman like hierarchical structure. Similarities and differences between the descriptions can be ordered on a unidimensional order, the multiple roles or personalities being no more complex nor simple than the target persons. The present results have been discussed in reference to cognitive theories of personality and their utility in studying personal identity and multiple personality.

[The Pleasure-Displeasure Scale. Use in the evaluation of depressive illness]

The Pleasure-displeasure Scale is a self-report instrument consisting of 82 items for measuring the intensity of subjects' affective responses to usually pleasant and unpleasant situations. 81 depressed inpatients were compared to 120 normal subjects. The responses of the depressed patients to the Pleasure sub-scale (French translation of the Fawcett-Clark's Pleasure Scale) are more anhedonic than those of the normal subjects; but the difference did not reach statistical significance. Pleasure scores in the depressive group are bimodally distributed; a distinct subset (11% of depressives) is characterised by an extremely anhedonic Pleasure score. The sensitivity to unpleasant stimuli is significantly greater in the depressive group; however this difference seems to be related rather to a low cultural level than to depression itself. Finally pleasure and displeasure scores are closely correlated: this could possibly imply that anhedonia is not an independent symptom but rather belongs to the wider constellation of affective anesthesia.

[Characteristics of benzodiazepine consumption in patients hospitalized in an internal medicine department]

We have studied benzodiazepines (BZD) intake among 129 patients admitted in an internal medicine unit. In this population, we have differentiated long term (over 4 months) users (n = 25), occasional users (n = 24), and non users (n = 80). Analysis of the results favoured the fact that BZD users were, more than non users, alike to have a history of cardiovascular and/or rheumatic diseases, to have had multiple surgical procedures and that these patients often took several other psychotropic and non psychotropic drugs. Particular characteristics of long term users are discussed next (prevalence, sex ratio, incidence of depression).