Psychothérapie interpersonnelle de groupe : une revue de littérature

La psychothérapie interpersonnelle (PTI) a d’abord été conçue en tant qu’approche psychothérapeutique pour traiter la dépression, mais on l’a depuis largement utilisée pour traiter plusieurs autres pathologies. Récemment, on a aussi adapté la PTI à un format de groupe, qui comporte à la fois les avantages et les désavantages des autres psychothérapies de groupe. Utilisée pour la première fois par Wilfley et ses collègues, cette adaptation garde les principales caractéristiques de la PTI, c’est-à-dire le rôle central de l’axe interpersonnel et l’identification d’un (ou de deux) des quatre domaines interpersonnels problématiques (le deuil pathologique, la transition de rôle, les conflits de rôles et les déficits interpersonnels). L’adaptation conserve aussi le rôle actif du thérapeute et du patient individuel au sein du groupe. À ce jour, la psychothérapie interpersonnelle adaptée aux groupes (PTI-G) a servi à traiter plusieurs pathologies (les Troubles des conduites alimentaires non spécifiques, la boulimie, les troubles dépressifs et les troubles de stress post-traumatique [TSPT]) et ce, auprès de plusieurs populations (adolescents, aînés, femmes enceintes ou « nouvelles mères », femmes toxicomanes incarcérées). Bien que la qualité générale des études sur les résultats soit à ce jour plutôt pauvre, l’examen de l’état actuel des connaissances indique que la PTI-G peut s’avérer utile et qu’elle peut présenter un certain nombre d’avantages dans le traitement de divers troubles psychiatriques auprès de plusieurs populations de patients.Interpersonal Psychotherapy was conceived as a psychotherapeutic approach to treating Depression, but has since now been broadly used to treat many other disorders. It has also recently been adapted to delivery in the group setting, with both advantages and disadvantages as other group psychotherapies. This adaptation, first used by Wilfley and colleagues, maintained the main features of IPT, i.e. the central role of the interpersonal focus and identification of one (or two) out of four problem interpersonal areas (Grief; Role Transition; Role Disputes; Interpersonal Deficits). It also kept the active role of the therapist and individual patient within the group. To date, G-IPT has been used for several diseases (Eating Disorders not Otherwise Specified, Bulimia Nervosa, Depressive Disorder, Posttraumatic Stress Disorder) and several populations (Adolescents, Older People, Pregnant Women or “New-Mothers,” Substance-abusing Female Prisoners). Although the overall quality of most of outcome studies is to date quite poor, the review of the current state of knowledge shows the G-IPT may be helpful and present a number of advantages to treat different psychiatric disorders in several populations of patients.La psicoterapia interpersonal (PTI) fue inicialmente concebida como enfoque psicoterapéutico para tratar la depresión, pero desde entonces ha sido utilizada ampliamente para tratar varias otras patologías. Recientemente también ha sido adaptada a un formato de grupo que comprende a la vez las ventajas y desventajas de las otras psicoterapias de grupo. Utilizada la primera vez por Wilfley y sus colegas, esta adaptación conserva las principales características de la PTI, es decir, el rol central del eje interpersonal y la identificación de uno (o dos) de los cuatro aspectos interpersonales problemáticos (el duelo patológico, la transición del rol, los conflictos de roles y los déficits interpersonales). La adaptación conserva también el rol activo del terapeuta y del paciente individual en el seno del grupo. A la fecha, la psicoterapia interpersonal adaptada a los grupos (PTI-G) ha servido para tratar varias patologías (los trastornos de conductas alimenticias no específicos, la bulimia, los trastornos depresivos y los trastornos de estrés postraumático [TSPT], en pacientes de diversas poblaciones (adolescentes, ancianos, mujeres embarazadas o “madres primerizas”, mujeres toxicómanas encarceladas). Aunque la calidad general de los estudios acerca de los resultados a la fecha es más bien pobre, el examen del estado actual de los conocimientos indica que la PTI-G puede ser útil y puede presentar un cierto número de ventajas en el tratamiento de diversos trastornos psiquiátricos en varias poblaciones de pacientes.A Psicoterapia Interpessoal (PTI) foi concebida primeiramente como abordagem psicoterapêutica para tratar a depressão, mas desde então, ela é vastamente utilizada para tratar várias outras patologias. Recentemente, ela foi adaptada ao formato de grupo, que comporta ao mesmo tempo as vantagens e as desvantagens das outras psicoterapias de grupo. Utilizada pela primeira vez por Wilfley e seus colegas, esta adaptação mantém as principais características da PTI, ou seja, o papel central do eixo interpessoal e a identificação de uma (ou de duas) das quatro áreas interpessoais problemáticas (luto patológico, transição de papéis, conflitos de papéis e déficits interpessoais). A adaptação conserva também o papel ativo do terapeuta e do paciente individual dentro do grupo. Até hoje, a psicoterapia interpessoal adaptada aos grupos (PTI-G) serviu para tratar várias patologias (Transtornos de condutas alimentares não específicas, bulimia, transtornos depressivos e transtornos de estresse pós-traumático [TSPT]) junto a várias populações (adolescentes, idosos, mulheres grávidas, ou “novas mães”, mulheres toxicômanas detidas). Apesar da qualidade geral dos estudos sobre os resultados ser até hoje relativamente pobre, o exame do estado atual dos conhecimentos indica que a PTI-G pode tornar-se útil e que ela pode apresentar um certo número de vantagens no tratamento de vários transtornos psiquiátricos junto a várias populações de pacientes

Rorschach assessment in suicide survivors: Focus on suicidal ideation

Background: The study of Suicidal ideation (SI) in people bereaved through suicide (Suicide Survivors, SSs) could be hampered by the person's willingness to admit it, or by their limited awareness of it. Our main hypothesis is that SI is common in these people, especially if they are parents or children of the victim. For its potential in shedding light on specific unconscious processes, Rorschach test was chosen for our investigation, for the first time in SSs literature. Rorschach suicide ideation and selected variables were further analyzed to better delineate their psychological profile. Method: Rorschach according to Exner's Comprehensive System was administered to 21 people bereaved through suicide presenting as outpatients at SOPROXI Project Service-Padova Mental Health Center- and 23 healthy controls. Beck Depression Inventory (BDI) was routinely administered to SSs and considered in the study. Results: T-tests showed significantly higher mean SI score (S-Con) as it emerged from the Rorschach test S-Con scores in SSs compared to control participants. SI found only weak correlation with the BDI item in which SSs can explicitly state the desire for their death. Within-group analysis revealed higher S-Con mean scores in bereaved children and parents of the victim compared to other kind of kinships. Morbid content (MOR) has been fund as the most characterizing variable in SSs' S-Con in terms of effect size, followed by a low number of responses with an ordinary form (X +%). Human movements (M), Special Scores related to thought slippage (ALOG, FABCOM2, INCOM2, and CONTAM) and poor human representations (PHR) have been shown to be more significantly present in SSs compared controls. Discussion: Psychodynamic interpretations of our results are provided. Clinical practice should consider Rorschach as one of eligible tools of investigation on this field

Empathy profiles differ by gender in people who have and have not attempted suicide

Peer reviewe

High hs-CRP levels after an attempted suicide : A matched case-control study

Publisher Copyright: © 2022 The AuthorsWe found significantly higher levels of hs-CRP in 27 subjects who had recently attempted suicide compared to 27 age- and sex-matched healthy subjects. Moreover, the levels of hs-CRP in suicide attempters were not related to background or psychopathological characteristics, nor to the methods of suicide attempt. Our matched case-control study confirms previous observations of high levels of the inflammation marker hs-CRP in patients who have attempted suicide, irrespective of their underlying type and levels of psychopathology.Peer reviewe

Rorschach Assessment in Suicide Survivors: Focus on Suicidal Ideation

Background: The study of Suicidal ideation (SI) in people bereaved through suicide (Suicide Survivors, SSs) could be hampered by the person's willingness to admit it, or by their limited awareness of it. Our main hypothesis is that SI is common in these people, especially if they are parents or children of the victim. For its potential in shedding light on specific unconscious processes, Rorschach test was chosen for our investigation, for the first time in SSs literature. Rorschach suicide ideation and selected variables were further analyzed to better delineate their psychological profile.Method: Rorschach according to Exner's Comprehensive System was administered to 21 people bereaved through suicide presenting as outpatients at SOPROXI Project Service—Padova Mental Health Center- and 23 healthy controls. Beck Depression Inventory (BDI) was routinely administered to SSs and considered in the study.Results:T-tests showed significantly higher mean SI score (S-Con) as it emerged from the Rorschach test S-Con scores in SSs compared to control participants. SI found only weak correlation with the BDI item in which SSs can explicitly state the desire for their death. Within-group analysis revealed higher S-Con mean scores in bereaved children and parents of the victim compared to other kind of kinships. Morbid content (MOR) has been fund as the most characterizing variable in SSs' S-Con in terms of effect size, followed by a low number of responses with an ordinary form (X +%). Human movements (M), Special Scores related to thought slippage (ALOG, FABCOM2, INCOM2, and CONTAM) and poor human representations (PHR) have been shown to be more significantly present in SSs compared controls.Discussion: Psychodynamic interpretations of our results are provided. Clinical practice should consider Rorschach as one of eligible tools of investigation on this field

Immunolocalization of Nesfatin-1 in the Gastrointestinal Tract of the Common Bottlenose Dolphin Tursiops truncatus

First identified as an anorexigenic peptide, in the last decades, several studies have suggested that Nesfatin-1 (Nesf-1) is a pleiotropic hormone implicated in numerous regulatory processes in peripheral organs and tissues. In vertebrates, Nesf-1 is indeed expressed in the central nervous system and peripheral organs. In this study, we characterized the pattern of Nesf-1 distribution within the digestive tract of the common bottlenose dolphin (Tursiops truncatus), composed of three gastric chambers and and intestine without a clear subdivision in the small and large intestine, also lacking a caecum. Our results indicated that Nesf-1 is widely distributed in cells of the mucosal epithelium of the gastric chambers. Most of the immunoreactivity was observed in the second chamber, compared to the first and third chambers. Immunopositivity was also found in nerve fibers and neurons, scattered or/and clustered in ganglion structures along all the esaminaned gastrointestinal tracts. These observations add new data on the highly conserved role of Nesf-1 in the mammalian digestive system

Language production impairments in patients with a first episode of psychosis

Language production has often been described as impaired in psychiatric diseases such as in psychosis. Nevertheless, little is known about the characteristics of linguistic difficulties and their relation with other cognitive domains in patients with a first episode of psychosis (FEP), either affective or non-affective. To deepen our comprehension of linguistic profile in FEP, 133 patients with FEP (95 non-affective, FEP-NA; 38 affective, FEP-A) and 133 healthy controls (HC) were assessed with a narrative discourse task. Speech samples were systematically analyzed with a well-established multilevel procedure investigating both micro- (lexicon, morphology, syntax) and macro-linguistic (discourse coherence, pragmatics) levels of linguistic processing. Executive functioning and IQ were also evaluated. Both linguistic and neuropsychological measures were secondarily implemented with a machine learning approach in order to explore their predictive accuracy in classifying participants as FEP or HC. Compared to HC, FEP patients showed language production difficulty at both micro- and macro-linguistic levels. As for the former, FEP produced shorter and simpler sentences and fewer words per minute, along with a reduced number of lexical fillers, compared to HC. At the macro-linguistic level, FEP performance was impaired in local coherence, which was paired with a higher percentage of utterances with semantic errors. Linguistic measures were not correlated with any neuropsychological variables. No significant differences emerged between FEP-NA and FEP-A (p≥0.02, after Bonferroni correction). Machine learning analysis showed an accuracy of group prediction of 76.36% using language features only, with semantic variables being the most impactful. Such a percentage was enhanced when paired with clinical and neuropsychological variables. Results confirm the presence of language production deficits already at the first episode of the illness, being such impairment not related to other cognitive domains. The high accuracy obtained by the linguistic set of features in classifying groups support the use of machine learning methods in neuroscience investigations

Balancing risks and benefits of cannabis use: umbrella review of meta-analyses of randomised controlled trials and observational studies

Objective: To systematically assess credibility and certainty of associations between cannabis, cannabinoids, and cannabis based medicines and human health, from observational studies and randomised controlled trials (RCTs). Design: Umbrella review. Data Sources: PubMed, PsychInfo, Embase, up to 9 February 2022. Eligibility criteria for selecting studies: Systematic reviews with meta-analyses of observational studies and RCTs that have reported on the efficacy and safety of cannabis, cannabinoids, or cannabis based medicines were included. Credibility was graded according to convincing, highly suggestive, suggestive, weak, or not significant (observational evidence), and by GRADE (Grading of Recommendations, Assessment, Development and Evaluations) (RCTs). Quality was assessed with AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews 2). Sensitivity analyses were conducted. Results: 101 meta-analyses were included (observational=50, RCTs=51) (AMSTAR 2 high 33, moderate 31, low 32, or critically low 5). From RCTs supported by high to moderate certainty, cannabis based medicines increased adverse events related to the central nervous system (equivalent odds ratio 2.84 (95% confidence interval 2.16 to 3.73)), psychological effects (3.07 (1.79 to 5.26)), and vision (3.00 (1.79 to 5.03)) in people with mixed conditions (GRADE=high), improved nausea/vomit, pain, spasticity, but increased psychiatric, gastrointestinal adverse event, and somnolence among others (GRADE=moderate). Cannabidiol improved 50% reduction of seizures (0.59 (0.38 to 0.92)) and seizure events (0.59 (0.36 to 0.96)) (GRADE=high), but increased pneumonia, gastrointestinal adverse events, and somnolence (GRADE=moderate). For chronic pain, cannabis based medicines or cannabinoids reduced pain by 30% (0.59 (0.37 to 0.93), GRADE=high), across different conditions (n=7), but increased psychological distress. For epilepsy, cannabidiol increased risk of diarrhoea (2.25 (1.33 to 3.81)), had no effect on sleep disruption (GRADE=high), reduced seizures across different populations and measures (n=7), improved global impression (n=2), quality of life, and increased risk of somnolence (GRADE=moderate). In the general population, cannabis worsened positive psychotic symptoms (5.21 (3.36 to 8.01)) and total psychiatric symptoms (7.49 (5.31 to 10.42)) (GRADE=high), negative psychotic symptoms, and cognition (n=11) (GRADE=moderate). In healthy people, cannabinoids improved pain threshold (0.74 (0.59 to 0.91)), unpleasantness (0.60 (0.41 to 0.88)) (GRADE=high). For inflammatory bowel disease, cannabinoids improved quality of life (0.34 (0.22 to 0.53) (GRADE=high). For multiple sclerosis, cannabinoids improved spasticity, pain, but increased risk of dizziness, dry mouth, nausea, somnolence (GRADE=moderate). For cancer, cannabinoids improved sleep disruption, but had gastrointestinal adverse events (n=2) (GRADE=moderate). Cannabis based medicines, cannabis, and cannabinoids resulted in poor tolerability across various conditions (GRADE=moderate). Evidence was convincing from observational studies (main and sensitivity analyses); in pregnant women, small for gestational age (1.61 (1.41 to 1.83)), low birth weight (1.43 (1.27 to 1.62)); in drivers, car crash (1.27 (1.21 to 1.34)); and in the general population, psychosis (1.71 (1.47 to 2.00)). Harmful effects were noted for additional neonatal outcomes, outcomes related to car crash, outcomes in the general population including psychotic symptoms, suicide attempt, depression, and mania, and impaired cognition in healthy cannabis users (all suggestive to highly suggestive). Conclusions: Convincing or converging evidence supports avoidance of cannabis during adolescence and early adulthood, in people prone to or with mental health disorders, in pregnancy and before and while driving. Cannabidiol is effective in people with epilepsy. Cannabis based medicines are effective in people with multiple sclerosis, chronic pain, inflammatory bowel disease, and in palliative medicine, but not without adverse events

Depression in Primary care: Interpersonal Counseling vs Selective serotonin reuptake inhibitors. The DEPICS Study. A multicenter randomized controlled trial. Rationale and design

<p>Abstract</p> <p>Background</p> <p>Depression is a frequently observed and disabling condition in primary care, mainly treated by Primary Care Physicians with antidepressant drugs. Psychological interventions are recommended as first-line treatment by the most authoritative international guidelines but few evidences are available on their efficacy and effectiveness for mild depression.</p> <p>Methods/Design</p> <p>This multi-center randomized controlled trial was conducted in 9 Italian centres with the aim to compare the efficacy of Inter-Personal Counseling, a brief structured psychological intervention, to that of Selective Serotonin Reuptake Inhibitors. Patients with depressive symptoms referred by Primary Care Physicians to psychiatric consultation-liaison services were eligible for the study if they met the DSM-IV criteria for major depression, had a score ≥13 on the 21-item Hamilton Depression Rating Scale, and were at their first or second depressive episode. The primary outcome was remission of depressive symptoms at 2-months, defined as a HDRS score ≤ 7. Secondary outcome measures were improvement in global functioning and recurrence of depressive symptoms at 12-months. Patients who did not respond to Inter-Personal Counseling or Selective Serotonin Reuptake Inhibitors at 2-months received augmentation with the other treatment.</p> <p>Discussion</p> <p>This trial addresses some of the shortcomings of existing trials targeting major depression in primary care by evaluating the comparative efficacy of a brief psychological intervention that could be easily disseminated, by including a sample of patients with mild/moderate depression and by using different outcome measures.</p> <p>Trial registration</p> <p>Australian New Zealand Clinical Trials Registry ACTRN12608000479303</p