Construction and validation of a dimensional scale exploring mood disorders: MAThyS (Multidimensional Assessment of Thymic States)

<p>Abstract</p> <p>Background</p> <p>The boundaries between mood states in bipolar disorders are not clear when they are associated with mixed characteristics. This leads to some confusion to define appropriate therapeutic strategies. A dimensional approach might help to better define bipolar moods states and more specifically those with mixed features.</p> <p>Therefore, we proposed a new tool based on a dimensional approach, built with a priori five sub-scales and focus on emotional reactivity rather than exclusively on mood tonality. This study was designed to validate this MAThyS Scale (Multidimensional Assessment of Thymic States).</p> <p>Methods</p> <p>One hundred and ninety six subjects were included: 44 controls and 152 bipolar patients in various states: euthymic, manic or depressed. The MAThyS is a visual analogic scale consisting of 20 items. These items corresponded to five quantitative dimensions ranging from inhibition to excitation: emotional reactivity, thought processes, psychomotor function, motivation and sensory perception. They were selected as they represent clinically relevant quantitative traits.</p> <p>Results</p> <p>Confirmatory analyses demonstrated a good validity for this scale, and a good internal consistency (Cronbach's alpha coefficient = 0.95). The MathyS scale is moderately correlated of both the MADRS scale (depressive score; r = -0.45) and the MAS scale (manic score; r = 0.56).</p> <p>When considering the Kaiser-Guttman rule and the scree plot, our model of 5 factors seems to be valid. The four first factors have an eigenvalue greater than 1.0 and the eigenvalue of the factor five is 0.97. In the scree plot, the "elbow", or the point at which the curve bends, indicates 5 factors to extract. This 5 factors structure explains 68 per cent of variance.</p> <p>Conclusion</p> <p>The characterisation of bipolar mood states based on a global score assessing inhibition/activation process (total score of the MATHyS) associated with descriptive analysis on sub-scores such as emotional reactivity (rather than the classical opposition euphoria/sadness) can be useful to better understand the broad spectrum of mixed states.</p

Mind wandering and driving: a responsibility case-control study

Objective To assess the association between mind wandering (i.e. thinking unrelated to the task at hand) and the risk of being responsible for the crash. Design Responsibility case-control study. Setting Adult emergency department of the Bordeaux University hospital (France) from April 2010 to August 2011. Participants 955 injured drivers presenting as a result of motor vehicle crash. Main outcome measures The main outcome variable was responsibility for the crash. Exposures were mind wandering, external distraction, negative affect, alcohol use, psychotropic medicine use, and sleep deprivation. Potential confounders were sociodemographic and crash characteristics. Results Beyond classical risk factors found to be associated with responsibility, the results showed that intense mind wandering was associated with being responsible for a crash (17% [responsible] vs. 9% [not responsible]; adjusted OR [95% CI]=2.12 [1.37-3.28]). Conclusions Mind wandering while driving, by decoupling attention from visual and auditory perceptions, may jeopardize the ability of the driver to incorporate information from the environment, thereby threatening safety on the roads. Our findings provide support for the latest research designed to develop systems to detect periods of driving vulnerability related to inattention. In addition, further research is recommended to assess how these results could lead to innovative interventions such as attentional training for drivers at risk of inattention

Etude de la réactivité émotionnelle chez les patients bipolaires

BORDEAUX2-BU Sci.Homme/Odontol. (330632102) / SudocSudocFranceF

L'éducation thérapeutique : un modèle pertinent pour accompagner les parents d'enfant avec un Trouble du Spectre de l'Autisme ?

Reconnue comme une prise en charge à part entière par la loi Hôpital, Patients, Santé, Territoire et désormais inscrite dans le code de santé publique, l'Éducation thérapeutique (ETP) doit être intégrée au parcours de la personne. La mise en place de ce modèle reste encore timide dans de nombreux contextes à l'image de ce qui est observé dans le cas de l'accompagnement des parents d'enfant avec un Trouble du Spectre de l'Autisme (TSA). L'objectif de cette étude est d'une part, de présenter les étapes méthodologiques du développement d'un programme d'ETP destiné aux parents d'enfants avec un TSA et, d'autre part d'en tester la validité sociale. Le programme ETAP (Éducation thérapeutique Autisme et Paternité) a été construit selon les différentes étapes méthodologiques recommandées par la Haute Autorité de Santé. Le format du programme et le contenu des sessions ont été définis à partir des résultats d'études antérieures, de l'évaluation des besoins des parents (N = 74) et, grâce à l'avis de 9 experts. La participation des parents implique quatre phases successives : le diagnostic éducatif pré-intervention, sept séances groupales, le diagnostic éducatif post-intervention et la session « booster » à 3 mois. L'évaluation de la validité sociale a été réalisée auprès de 30 parents d'enfants atteints de TSA âgés de 3 à 10 ans. Nos résultats ont montré que l'implémentation dans le contexte de prise en charge, l'accessibilité et la satisfaction des participants sont positives. Le programme ETAP propose une approche globale et novatrice visant à développer à la fois des compétences centrées sur l'enfant et les défis éducatifs mais aussi des compétences centrées sur les besoins des pères et des mères, leurs relations avec leur environnement et leurs projets personnels. Des futures études sont nécessaires pour évaluer l'effet du programme ETAP auprès de cette population

Defining bipolar mood states with quantitative measurement of inhibition/activation and emotional reactivity.

International audienceThe MATHYS scale, providing a score for inhibition/activation process and a score for emotional reactivity, is clearly useful to distinguish bipolar depressive episodes without manic symptoms from those with manic symptoms. This last type of depression appears to belong to a broad spectrum of mixed state. To go further we need to explore if these two types of depression are underlined by different mechanisms and what is the most appropriate treatment for each of them

Determinants of the remission heterogeneity in bipolar disorders: the importance of early maladaptive schemas (EMS)

Background: A crucial health issue is to understand the remission heterogeneity of Bipolar Disorders by con- sidering symptomatology as well as functioning. A new perspective could be elements of the construction of individual identity. This exploratory study aimed to explore the remission heterogeneity of patients with BD in terms of Early Maladaptive Schemas (EMS) by preferring a person-oriented approach. Methods: This study included euthymic patients recruited into the FACE-BD cohort. The remission was assessed by the Montgomery-Asberg Depression Rating Scale and the Young Mania Rating Scale for its symptomatic dimension and by the Functioning Assessment Short Test for its functional dimension. The activation of the eighteen EMS was assessed by the Young Schema Questionnaire 3 Short Form. Clustering was performed to identify profiles according to the patients’ remission. Clusters identified were compared on the EMS activation by using analysis of variance and post-hoc tests. Results: Among the 100 euthymic patients included, four profiles of remission were identified: cluster 1 “Global Remission” (34%), cluster 2 “Hypomanic residual” (20%), cluster 3 “Depressive residual and functional im- pairment” (36%) and cluster 4 “Global handicap” (10%). Two out of three EMS discriminated against these profiles. The activation of specific EMS clarifies the singularity of each remission profile. Limitations: For the symptomatic dimension, cut-offs chosen could be discussed as well as the scale assessing residual depressive symptoms. Conclusions: This study participates in a comprehensive model of remission by integrating the symptomatology, the functioning, and the EMS. Identifying and treating EMS may improve patients remission to reach recovery

Rôle des schémas précoces inadaptés (SPI) dans le dysfonctionnement relationnel des personnes ayant un trouble bipolaire en phase d'euthymie

International audienceObjectives: Although free from characterized manic and depressive episodes, the euthymic period in bipolar disorder (BD) remains characterized by a whole host of difficulties, particularly relational. These difficulties are factors of vulnerabilities and relapses. People's perception of their own relationships has an impact on their symptomatology, their responses to treatment and on relapse rates. Young's early maladaptive schemas (EMS) approach proves to be relevant for understanding the construction of these perceptions and working on them. Nevertheless, to this date, few studies have investigated which EMS are related to relationship dysfunction in this particular population. Determining the link between EMS and relationship difficulties would be relevant to understand psychosocial impairment of people with BD in euthymic states. The present study aims to investigate the associations between the different domains of EMS and relationship dysfunction among patients with bipolar disorder in the euthymic phase. Methods: Data are extracted from the FACE-BD cohort, within the BD Expert Center in Versailles. Inclusion criteria were to be aged between 18 and 65 and to be an outpatient with a diagnosis of bipolar disorder (DSM-IV-TR). Patients had to be euthymic at the time of inclusion, according to DSM-IV-TR criteria with a cut-off score of 14 on the Montgomery-Asberg Depression Rating Scale and the Young Mania Rating Scale. Non-inclusion criteria were meeting at the time of the study the criteria for characteristic depressive episode, hypomania or mania according to the DSM-IV-TR. Sociodemographic data, clinical features associated with relationship dysfunction were assessed. EMS and EMS domains were assessed with the YSQ-R short form (Young Schema Questionnaire 3 Short Form) and current relationship dysfunction were assessed with the FAST (Functioning assessment short test subscale). Successive simple linear regression analyses were performed to investigate the association between the severity scores of each EMS and the intensity of relationship dysfunction. Furthermore, successive simple linear regression analyses investigated the association between EMS domain scores and intensity of relationship dysfunction. Multiple linear regression analyses were performed to test the association between EMS scores, then EMS domains, and the intensity of relationship dysfunction after adjusting for age as well as the intensity of residual depressive and manic symptoms. Results: Relationship dysfunction is partly associated with EMS activation in particular in the separation and rejection domain (P < 0.0001), the other-directedness domain (P = 0.031) and the over-vigilance and inhibition domain (P = 0.005). Having residual depressive symptoms is also among the factors contributing to the relationship dysfunctions of people with bipolar disorder in the euthymic phase. Discussion: This is the first study demonstrating that the activation of several domains of EMS is a risk factor of relationships difficulties for people in euthymic phase of bipolar disorder. It is necessary to identify which EMS are specifically activated and their domains of belonging in order to prevent and reduce them. EMS are a lever for functional remission. It is therefore relevant to refer people reporting relationship problems to schema therapy consistent with a personalized care. Finally, future studies should focus on the mechanisms underlying the complex relationship between EMS domains and relationship dysfunction in people with bipolar disorder in the euthymic phase. It may also be relevant for future research to control for different types of relationship dysfunction. EMS may be differentially associated with several types of interpersonal problems. The relations between different adaptation styles and EMS should be further investigated to offer more personalized care, with the aim to improve functional remission

Improving the Assessment Process of Family Functioning in Adult Bipolar Disorders: A PRISMA Systematic Review

International audienceIn order to determine family functioning in the treatment of adults with bipolar disorders, guidelines are needed regarding the way family functioning may be assessed. The present systematic review aims to investigate how family functioning is assessed in this context. Following PRISMA guidelines, a total of 29 studies were reviewed. Results showed that although there was no consensual family functioning assessment across studies, 27 studies (93%) relied on self-report questionnaires, 12 studies (41%) relied on one family member as an informant (adult with bipolar disorder or other) and the adult considered was mostly a woman in the acute phase of bipolar I disorder. Significant heterogeneity was observed in the assessment of family functioning. Methodological considerations regarding the assessment of family functioning are discussed

Weben am Handwebstuhl

Weben am Handwebstuhl / Günther Kapfhammer ... - München : Inst. für Film u. Bild in Wiss. u. Unterricht, 1975. - Film + Begleittext (4 S.