Electrophysiological approach of theory of mind impairments in the schizophrenic continuum : study of the intentional inference production

Les difficultés de théorie de l’esprit (ToM) associées à la schizophrénie (SZ) et la schizotypie (Szt) seraient dues à un trouble élémentaire de traitement du contexte. Or, traiter le contexte engagerait deux types de processus inégalement atteints dans la SZ: les processus prédictifs (génération de prédictions) seraient préservés et les processus intégratifs (intégration a posteriori des informations nouvelles avec le contexte) seraient altérés. Ces processus sont mobilisés lors de la production d’inférences et reflétés par la modulation de la N400 ou de la P600. À l’aide de mesures comportementales et électrophysiologiques, l’objectif de ce travail était de: a) vérifier l’inégale atteinte de ces processus dans la Szt, b) évaluer si ce pattern d’inégale atteinte est observé lors d’une tâche de production d’inférences intentionnelles (PII), c) faciliter la mobilisation des processus altérés par le renforcement du contexte (sémantique, ajout d’un indice social). L’étude réalisée avec un paradigme d’amorçage sémantique en contexte mot confirme l’altération spécifique des processus intégratifs dans la Szt. La suite des études, conduite autour d’une tâche de PII reposant sur les processus prédictifs ou intégratifs dans la SZ et la Szt, montre: 1) des difficultés de PII lorsqu’elle mobilise les processus intégratifs, 2) une réduction de ces difficultés par le renforcement sémantique et 3) que l’ajout d’un indice social pourrait faciliter le traitement du contexte. Ainsi, la PII n’est pas totalement altérée dans la Szt et la SZ. Les études futures devraient considérer cette inégale atteinte des processus en ToM pour aider les patients à attribuer des intentions à autrui.Theory of mind (ToM) impairments in schizophrenia (SZ) and in schizotypy (Szt) may stem from a context-processing deficit. However, treating the context would involve two types of processes differently affected impacted in SZ: predictive strategy (generation of expectations) would be preserved and integrative strategy (retroactive integration of new information with the context) would be altered. These processes are mobilized during inference generation tasks and reflected by modulations of the N400 and P600 components. Using behavioral and electrophysiological measures, the aim of this thesis was to: (a) confirm the unequal alteration of these processes in the Szt, (b) assess whether this pattern of unequal alteration is observed in intentional inference production tasks (IIP), and (c) facilitate the mobilization of altered processes by increasing the contextual constraints (semantic constraint, contextual reinforcement by social cue). Using a semantic priming task in word context, a first study showed that integrative processes are specifically altered in Szt. Subsequent studies were based on IIP task in which the inference production involved predictive processes or integrative processes. Results showed that: (1) difficulties were observed only when IIP involved integrative processes, (2) semantic constraints decreased these difficulties and (3) context processing may be facilitated by the addition of a social cue. Thus, IIP is not totally altered in Szt and SZ. Future studies should consider this unequal impact of ToM processes to help patients attribute intentions to others

An event-related potential study of predictive and integrative semantic context processing in subjects with schizotypal traits

International audienceContext processing abnormalities may explain thought disorder in schizophrenia/schizotypy. This study aimed to assess predictive and integrative context processing in subjects with high or low scores on the Schizotypal Personality Questionnaire (SPQ). The N400 amplitude was recorded during semantic judgment of sentence pairs ending with a lateralized expected or unexpected word from the same or a different category (related and unrelated violation). In both groups, the N400 amplitude was less negative for expected words versus unrelated violations, regardless of which hemisphere received the stimulus, and for related versus unrelated violations, but only for left-hemisphere stimuli. The N400 amplitude for unrelated violations was less negative in subjects with high SPQ scores for both hemispheres. These results indicate that subjects with schizotypal traits use context to predict or integrate congruent words, but fail to inhibit incongruent words

Caregiving-related experiences associated with depression severity and its symptomatology among caregivers of individuals with a severe mental disorder: an online cross-sectional study

Data and R-cod

Caregiving-related experiences associated with depression severity and its symptomatology among caregivers of individuals with a severe mental disorder: an online cross-sectional study

Caring for a relative with a severe mental disorder puts family caregivers to a great risk of depression. While overall caregiving burden is a strong predictor of depression, the contribution of the various dimensions of burden to caregivers' depression as well as their relationships with depressive symptoms has received little attention. 384 family caregivers completed a cross-sectional online survey including the Center for Epidemiological Studies Depression (CES-D) scale, the Zarit Burden Interview (ZBI), and the Brief Experience of Caregiving Inventory (BECI), measuring caregiving burden and experience. We estimated the structure of the relationships between caregiving experiences (i.e., ZBI and BECI subscales) and CES-D symptoms using a network approach. Negative Emotion/Consequences, (lack of) Positive Personal Experience, and Stigma/Effects on Family were the most connected caregiving dimensions to depression. To untangle the role of the Negative Emotion/Consequences component (by far the most central node in estimated networks), a secondary analysis incorporating its composing items was estimated. Losing control over life, feeling strained around the relative and impaired self-perceived health emerged as central nodes. Interestingly, these caregiving-related dimensions or experiences were differentially connected to depressive symptoms. We discuss how these findings might help future research and inform tailored psychoeducational interventions for family caregivers of people with a severe mental disorder

Mental Health of People with Dementia During COVID-19 Pandemic: What Have We Learned from the First Wave?

BACKGROUND: People with dementia (PWD) and their caregivers are populations highly vulnerable to COVID-19 pandemic and its consequences. A better knowledge of the living conditions during the first lockdown is necessary to prevent the risk of poor mental health (PMH) in this population. OBJECTIVE: The present study aimed to compare the mental health of caregivers of PWD living at home or in nursing-homes and to identify specific factors influencing their mental health. METHODS: We conducted an anonymous cross-sectional online survey in France from March 17 to May 11, 2020. Three hundred and eighty-nine caregivers accompanying a PWD living at home (HC) and 159 accompanying a PWD living in a nursing home (NHC) participated in the study. Caregivers' mental health including anxiety, depression, stress, and burden was assessed with self-reported standardized scales. RESULTS: Half of the caregivers exhibited PMH, including depression, anxiety, or self-reported stress. Similar PMH rates were provided whatever the PWD place of residence. Regarding HC, our results also highlighted a number of risk factors for PMH, including the fact that caregiver live with PWD, to give increased support to PWD, and to feel more isolated for managing PWD since lockdown. CONCLUSION: PMH was observed for caregivers of PWD during lockdown, whatever PWD living place, suggesting that concern for PWD may explain more of caregiver distress than increased material tasks. In the future, it will be necessary to pay attention to caregivers after the crisis by estimating the longer-term impact on their mental health

Modeling the Longitudinal Effects of Insight on Depression, Quality of Life and Suicidality in Schizophrenia Spectrum Disorders: Results from the FACE-SZ Cohort

International audienceBackground: Up to half of the patients with schizophrenia attempt suicide during their lifetime. Better insight is associated with better functioning but also with increased suicidality. The direction of the relationship between insight and suicidality is not clear, hence we aimed to provide new elements using structural equation modeling. Methods: Insight, quality of life (QoL), depression, and suicidality were measured at baseline and at 12 months in individuals with schizophrenia spectrum disorders. The relationships between these variables were investigated by latent difference score models, controlling for chlorpromazine doses, positive and negative symptoms, and general psychopathology. Results: 738 patients were included, and 370 completed the study. Baseline levels of insight predicted changes in suicidality, whereas baseline levels of suicidality did not predict changes in insight, suggesting that better insight underlies suicidality and predicts its worsening. Our results suggest this temporal sequence: better insight → worse QoL → increased depression → increased suicidality, while insight also affects the three variables in parallel. Conclusion: Better insight predicts a worsening of QoL, depression and suicidality. These findings contribute to our global understanding of the longitudinal influence of insight on suicidality. We advocate that insight-targeted interventions should not be proposed without the monitoring of depression and suicide prevention

The puzzle of quality of life in schizophrenia: putting the pieces together with the FACE-SZ cohort

International audienceBackground The determinants of quality of life (QoL) in schizophrenia are largely debated, mainly due to methodological discrepancies and divergence about the concepts concerned. As most studies have investigated bi- or tri-variate models, a multivariate model accounting for simultaneous potential mediations is necessary to have a comprehensive view of the determinants of QOL. We sought to estimate the associations between cognitive reserve, cognition, functioning, insight, depression, schizophrenic symptoms, and QoL in schizophrenia and their potential mediation relationships. Methods We used structural equation modeling with mediation analyses to test a model based on existing literature in a sample of 776 patients with schizophrenia from the FondaMental Foundation FACE-SZ cohort. Results Our model showed a good fit to the data. We found better functioning to be positively associated with a better QoL, whereas better cognition, better insight, higher levels of depression, and schizophrenic symptoms were associated with a lower QoL in our sample. Cognitive reserve is not directly linked to QoL, but indirectly in a negative manner via cognition. We confirm the negative relationship between cognition and subjective QoL which was previously evidenced by other studies; moreover, this relationship seems to be robust as it survived in our multivariate model. It was not explained by insight as some suggested, thus the mechanism at stake remains to be explained. Conclusion The pathways to subjective QoL in schizophrenia are complex and the determinants largely influence each other. Longitudinal studies are warranted to confirm these cross-sectional findings