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Proceedings of the 13th annual conference of INEBRIA
CITATION: Watson, R., et al. 2016. Proceedings of the 13th annual conference of INEBRIA. Addiction Science & Clinical Practice, 11:13, doi:10.1186/s13722-016-0062-9.The original publication is available at https://ascpjournal.biomedcentral.comENGLISH SUMMARY : Meeting abstracts.https://ascpjournal.biomedcentral.com/articles/10.1186/s13722-016-0062-9Publisher's versio
Lâexploration des SchĂ©mas PrĂ©coces InadaptĂ©s (SPI) chez les personnes adultes atteintes de troubles bipolaires: une revue systĂ©matique de la littĂ©rature scientifique
En raison des enjeux cliniques actuels concernant les troubles bipolaires et des arguments théoriques en
faveur de lâapproche centrĂ©e sur les schĂ©mas comme modĂšle de comprĂ©hension, cette revue systĂ©matique
de la littĂ©rature a pour objectif dâĂ©valuer la pertinence de ce modĂšle au regard des donnĂ©es empiriques.
MĂ©thodes. â Cette revue a Ă©tĂ© menĂ©e suivant la mĂ©thode Preferred Reporting Items for Systematic Reviews
and Meta-Analyses (PRISMA) sur les bases de données électroniques Cochrane, PsycArticles, Psycho logy and Behavioral Sciences Collection, PsycInfo, PubMed, ScienceDirect et Scopus avec les mots-clés
« early maladaptive schemas » et « bipolar disorder ». Seuls les articles rĂ©pondant aux critĂšres dâĂ©ligibilitĂ©
pouvaient ĂȘtre inclus (ex. population et mesures).
RĂ©sultats. â Parmi 39 publications, 10 articles ont Ă©tĂ© retenus aprĂšs analyse de leur titre, rĂ©sumĂ© et contenu
intĂ©gral. MalgrĂ© les biais identifiĂ©s limitant leur portĂ©e et lâabsence dâun pattern homogĂšne de schĂ©mas
activés, les résultats suggÚrent que les schémas précoces inadaptés permettent de distinguer les individus
prĂ©sentant des troubles bipolaires de ceux nâayant aucun trouble, et de ceux souffrant de troubles dĂ©pres sifs ou de personnalitĂ© borderline, tout comme ils peuvent rendre compte de lâhĂ©tĂ©rogĂ©nĂ©itĂ© clinique des
troubles bipolaires. Enfin, leur retentissement est important sur le cours de la pathologie (suicidalité et
handicap fonctionnel).
Conclusions. â Lâapproche centrĂ©e sur les schĂ©mas sâavĂšre pertinente bien que les donnĂ©es empiriques ne
permettent pas encore de comprendre la disparitĂ© de profils durant la pĂ©riode intercritique et dâindiquer
la thérapie des schémas de maniÚre adaptée. Une perspective de recherche est alors envisagée afin de
pallier ces manques identifiĂ©s dans la littĂ©rature.Objectives. â Clinical heterogeneity during euthymic states is a crucial issue in bipolar disorders. Indeed,
actual data are not sufficient to understand why some patients are unharmed by subthreshold symptoms
and have functional impairments whereas others have a functional remission but have subthreshold
symptoms. Based on the Ball model, cognitive and schematic vulnerability interact with genetic vul nerability and trigger affective symptoms with the intervention of s according to this model, adjustment and adaptation to illness assessed by functional outcome and illiness experience are associated with this cognitive and schematic vulnerability. So, theoretical arguments
support that childhood adversity and temperamental deregulation characterize patients with bipolar
disorders. Thus, the aim of this study is to systematically review studies of Early Maladaptive Schemas in
bipolar disorder, to determine whether Early Maladaptive Schemas have specificity in bipolar disorder in
comparison with other populations, and to identify which Early Maladaptive Schemas could be activated.
The challenge of this review is to identify if the taking of early maladaptive schemas into account could
allow us to better identify, understand and manage bipolar disorders.
Methods. â This systematic review was led according to the Preferred Reporting Items for Systematic
review and Meta-Analysis statement on the electronic databases Cochrane, PsycArticles, Psychology and
Behavioral Sciences Collection, PsycInfo, PubMed, ScienceDirect and Scopus with « early maladaptive
schemas » AND « bipolar disorder » as keywords. Only studies meeting eligibility criteria concerning
publication status, language, population and outcomes were included after several screenings on basis
of title, abstract and full-text. Then, we carried out data extraction in accordance with criteria defined
in principle (about characteristics of participants, objectives, materiel and methods, principle results and
bias).
Results. â Among 39 records identified, a total of 10 studies met eligibility criteria for inclusion in this
review. Synthesizing findings across the studies revealed three important topics. First, early maladaptive
schemas appear as potential cognitive characteristics that clinicians have to investigate in clinical practice.
Indeed, patients with bipolar disorders present greater activation of the early maladaptive schemas in
comparison with people who have no disorder. This point supports the first part of Ballâs theoretical model
that considers schemas as a vulnerability to bipolarity. Secondly, early maladaptive schemas are relevant
to distinguish bipolar disorders from unipolar depression and borderline personality disorder. A greater
and a lower activation are respectively identified among bipolar disorders. Thirdly, supporting the second
part of Ballâs model, early maladaptive schemas play a key role in recovery regarding their impact on the
course of bipolarity, in particular on suicidality and functional impairment. Finally, these dysfunctional
schemas allow us to understand the clinical heterogeneity of bipolar disorder, and among others, about
the type of bipolarity. These results have several implications, but there are some limits in this systematic
review. First, no French study has been done. Then, reduced sample sizes in these studies increased the
risk to conclude wrongly to an activation difference between groups. Furthermore, probably due to the
variety of methods and populations, we could not identify an homogeneous pattern of early activated
maladaptive schemas. Overall, scientific approaches used in these studies are based on statistical models
using mean and standard deviation. These types of statistical analyses are the main limit because they
cannot represent the heterogeneity of early maladaptive schemas profiles.
Conclusions. â Schema theory proves to be a relevant approach in bipolar disorders, and early maladaptive
schemas appear to be important to take into account in clinical practice. Nevertheless, in order to propose
schemas therapy appropriately, it is necessary to specify if early maladaptive schemas are activated and
to specify therapeutic indications because of clinical heterogeneity. Moreover, data do not yet allow us to
understand the disparity of profiles during the inter-episode period. Indeed, a French research perspective
is being considered that will prefer a person-oriented approach
Introducing the fit-criteria assessment plot â A visualisation tool to assist class enumeration in group-based trajectory modelling
Background and objective Group-based trajectory modelling is a model-based clustering technique applied for the identification of latent patterns of temporal changes. Despite its manifold applications in clinical and health sciences, potential problems of the model selection procedure are often overlooked. The choice of the number of latent trajectories (class-enumeration), for instance, is to a large degree based on statistical criteria that are not fail-safe. Moreover, the process as a whole is not transparent. To facilitate class enumeration, we introduce a graphical summary display of several fit and model adequacy criteria, the fit-criteria assessment plot. Methods An R-code that accepts universal data input is presented. The programme condenses relevant group-based trajectory modelling output information of model fit indices in automated graphical displays. Examples based on real and simulated data are provided to illustrate, assess and validate fit-criteria assessment plot's utility. Results Fit-criteria assessment plot provides an overview of fit criteria on a single page, placing users in an informed position to make a decision. Fit-criteria assessment plot does not automatically select the most appropriate model but eases the model assessment procedure. Conclusions Fit-criteria assessment plot is an exploratory, visualisation tool that can be employed to assist decisions in the initial and decisive phase of group-based trajectory modelling analysis. Considering group-based trajectory modelling's widespread resonance in medical and epidemiological sciences, a more comprehensive, easily interpretable and transparent display of the iterative process of class enumeration may foster group-based trajectory modelling's adequate use