Primary headaches and individual variables : attachment, mentalization and psychosomatic functioning

L'Organisation Mondiale de la Santé (OMS) classe les céphalées parmi les vingt premières causes d'invalidité dans le monde. L'INSERM évalue que 15% de la population générale est concernée. De nombreuses études ont mis en avant l’implication de facteurs psychologiques tels que l’anxiété, la dépression ou le stress dans l’étiopathogénie de la migraine (Lantéri-Minet et al., 2007). La théorie psychosomatique considère la migraine comme une somatisation qui doit être pensée en fonction de l’économie psychosomatique générale du sujet (Debray, 1997 ; Marty, 1951). Par ailleurs, quelques travaux sur les modalités d'attachement des patients douloureux chroniques et des patients migraineux mettent notamment en avant une corrélation entre la qualité de l'attachement et la perception/expression de la douleur, la relation médecin/malade et l'adhésion du sujet aux soins (Maunder, Hunter, 2008, Mistycki, Guédeney, 2007 ; Wearden, Lamberton, Crook, Walsh, 2005). Deux recherches auprès de patients migraineux au CHRU de Besançon ont été conduites : une étude quantitative (N=101) et une recherche quantitative-qualitative longitudinale (N=32). Nos résultats quantitatifs mettent en avant que les patients migraineux présentent un profil psychologique spécifique et différent de la population générale sur l’ensemble des indicateurs mesurés (anxiété, dépression, stress, soutien social, détresse psychologique et alexithymie), et ce que la symptomatologie migraineuse soit chronique ou épisodique. Une très grande majorité des patients rencontrés présentent un profil d’attachement insécure et des capacités de mentalisation incertaines. Les études de cas permettent d’affiner ces résultats et d’apprécier la place de la symptomatologie migraineuse dans le fonctionnement global de chaque sujet. Les résultats nous conduisent à proposer une modélisation de l’évaluation de la place du symptôme migraineux dans l’économie psychosomatique globale, celle-ci rapportée au contexte inter-subjectif, groupal et sociétal dans lequel le sujet s’inscrit. Cette modélisation permettra de proposer la meilleure option thérapeutique à chaque patient afin d’aboutir à une prise en charge individualisée au cas par cas.According to World Health Organization, headaches are one of the first twenty causes of disability in the world and affect 15 % of the world population. A lot of psycho-medical researches have raised the links between headaches and depression, anxiety or stress (Lantéri-Minet et al., 2007). Psychosomatic theory considers migraine as a somatization which must be thought according to the general psychosomatic functioning of each person (Debray, 1997; Marty, 1951). In addition, some promising but general work on attachment theory in chronic pain and migraine show a correlation between attachement and perception/expression of pain doctor/patient relationship and the subject's commitment to care (Maunder, Hunter, 2008 ; Mistycki, Guédeney, 2007; Wearden, Lamberton, Crook, Walsh, 2005).Two researches with migraine patients at the Besançon Hospital were conducted: a quantitative study (N=101) and a quantitative-qualitative longidunal study (N=32).Our quantitative results highlight that migraine patients have a specific psychological profile, different from the general population on all indicators measured (anxiety, depression, stress, social support, psychological distress and alexithymia), and that is the same results that the symptomatology is chronic or episodic. A majority of patients have an insecure attachment profile and uncertain mentalization’s abilities. The case studies help to refine these results and to appreciate the place of migraine in the psychosomatic functioning of each person.The results lead us to propose a modeling of the evaluation of the place of migraine in the global psychosomatic functioning. This must be related to the inter-subjective, groupal and societal context in which the subject fits. This modeling will make it possible to propose the best therapeutic option to each patient, to arrive at an individualized care in case by case

Céphalées primaires et variables individuelles : attachement, mentalisation et économie psychosomatique

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Accès à la grand-parentalité et remaniements psychiques au Rorschach : à propos d’un cas clinique

International audienceL’accès à la grand-parentalité engage des remaniements identitaires profonds du fait notamment de l’inscription dans une nouvelle forme de filiation et de la découverte d’un rôle social et familial inédit. L’ensemble de ces mouvements psychiques reconvoque des liens conscients et inconscients du sujet à lui-même, à ses enfants mais aussi à ses propres parents et grands-parents. Cet article propose d’exposer le cas de Catherine, rencontrée dans le cadre d’une recherche longitudinale auprès de patients migraineux, ceci à titre d’illustration du parcours individuel d’un sujet devenu grand-parent pendant la période de ladite recherche. L’épreuve projective Rorschach lui a été proposée à deux temps différents, au début de la prise en charge de sa symptomatologie migraineuse et huit mois plus tard. Entre temps, la symptomatologie s’est très nettement améliorée et les protocoles Rorschach ont révélé des remaniements psychiques denses sous-tendus par l’accès à la grand-parentalité

Migraine, qualité de l’attachement et mentalisation : étude de la dynamique psychique à partir du cas de Sylvie

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The Value of the Rorschach Method in Clinical Assessment of Migraine Patients

International audienceApproximately 15% of the world’s population suffer from migraine. This affliction is recognized as one of the 20 leading causes of disability globally and therefore constitutes a public health problem. Psychological factors such as depression, anxiety, and stress are involved in migraine. However, mentalization abilities are considered a protective factor against physical illness. The last study of migraine in adults using the Rorschach test goes back to 2001 in Italy. We propose to update the data in a French sample comparing migraine patients ( N = 32) with standards focusing on the mentalizing factors defined by de Tychey, Diwo, and Dollander (2000) . The results highlight significant differences between migraine patient functioning in the Rorschach and the general population: There are few representations and affective expression is restricted. Migraine patients have difficulties to mentalize excitations. In conclusion, mentalization-based treatment could be a beneficial intervention for migraine patients

Relevance of Neonatal Behavior Assessment Scale for Infants With Somatic Disorders: Comparison on One Matched Group of Control

International audienceObjective: To compare the Neonatal Behavior Assessment Scale results in two groups of infants with or without somatic disorder ( N = 26). Method: The Neonatal Behavior Assessment Scale was administered to two groups (clinical and control) of 13 infants each, aged from 5 to 18 weeks, matched 2 by 2 according to sex, age, rank among siblings, and parental socio-professional category. The first group includes infants with somatic disorder (clinical) and is matched with a second group of “healthy infants” (control). Results: Results indicate that the mean score of the control group is significantly higher than that of the clinical group. Most of the items are affected by the presence of a somatic disorder. Indeed, five out of the six categories present a statistically significant difference in favor of the control group, more specifically for the items “state regulation,” “motor system,” and “orientation/interaction.” Conclusion: This exploratory research enables a precise description of infants' difficulty in regulating excitations and the impact of somatic disorders on their development. This innovative knowledge will assist pediatricians and health professionals in the understanding of infants' characteristics to develop an adapted-care

Social and emotional cognition in patients with severe migraine consulting in a tertiary headache center: a preliminary study

International audienceTwenty-three severe migraine participants were studied to investigate social and emotional cognition features and explore their relationship with depression, anxiety and alexithymia. In comparison to normative data, 74% were under the norm for the Faux Pas subtest, 13% for the facial emotion recognition subtest and 52% for the overall composite score of the mini- SEA. Factor 1, Factor 3, and the total score of the TAS-20 were negatively correlated with the Faux Pas subtest. Our preliminary study shows that severe migraine patients present difficulties in inferring mental states, which could be related to alexithymia. It would be useful to identify these impairments in order to improve the quality of care provided

Motherhood specificities with the Rorschach method: Results of a nonconsulting French population in the postnatal phase.

International audienceAbstract. Motherhood, listed by the World Health Organization as a period of fragility and vulnerability, involves significant changes at the individual, family and social level. Becoming a mother entails a number of risk factors to take into account. It is therefore necessary to carry out studies on general populations not suffering from psychopathological disorders to better understand these risk factors linked to motherhood. This study was carried out in France with a nonconsulting population in the postnatal phase ( N = 30) using the Rorschach test, as it presents numerous advantages to appreciate the psychic and corporeal transformations linked to birth. The quantitative results of the test were compared with recently updated norms ( De Tychey et al., 2012 ). Eight values of the psychogram remained normative (F%, F+%, W%, Dd%, M, C, H%, P) reflecting the characteristics of a general population; conversely, eight other values of the psychogram (R, D%, S%, A%, RC%, m, E, Anguish Index%) differed significantly from general population norms. These results increase knowledge to help appreciate the complexity of the psychic processes at work during the postnatal period, and to prevent psychopathological disorders. It is thus possible to distinguish these disorders from those that are transitory and classically linked to the upheaval caused by the onset of motherhood

Evaluation of Attachment Style and Social Support in Patients With Severe Migraine. Applications in Doctor-Patient Relationships and Treatment Adherence

International audienceObjectives: The aim of this observational study was to describe social support and patterns of attachment among patients with migraine. We hypothesized that in comparison to the general population, insecure attachment is overrepresented in migraine patients, and that these patients have less social support. We also aimed to study the specific relationship between attachment and social support. We hypothesized that patients with an insecure attachment style have less social support than patients with a secure attachment style. Methods: A total of 101 consecutive patients (88.1% women) aged between 25 and 60 (average age = 41.4) were recruited at the Specialized Center for the Consultation of Primary Headaches at the Regional University Hospital Center of Besançon (France). Migraine impact and disability were evaluated using the Headache Impact Test (HIT-6) questionnaire and Migraine Disability Assessment (MIDAS) questionnaire. Patients also completed several self-administered psychological questionnaires in their validated French versions: the Medical Outcome Survey 36-Item Short-Form Health Survey, the Cungi Scale, the State-Trait Anxiety Inventory, the Beck Depression Inventory, the Relationship Scales Questionnaire and the Sarason's Social Support Questionnaire. Results: The distribution of attachment profiles was different from that of the general population, with an overrepresentation of insecure attachment styles ( p = 0.018). Our study showed that migraine patients had less social support than the general population, both in terms of the number of people providing support ( p = 0.002) and the level of satisfaction concerning this social support (p = 0.000). We also found that neither the number of available persons score nor the satisfaction score were statistically different between the four attachment categories ( p = 0.49). Patient's attachment style and social support influence the patient-doctor relationship, the therapeutic alliance and health behaviors such as treatment adherence. Conclusions: Based on the data we obtained, we developed applications in patient care for people with particular attachment styles and low social support. A treatment plan adapted to the patient's attachment profile should be created to develop “precision medicine” using a personalized approach to the doctor-patient relationship. We would also recommend encouraging patients to participate in support groups, in order to strengthen their attachment systems and gain social support. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03577548 , identifier NCT03577548