Background: For optimizing the validity of diagnoses of mental disorders, several sources of information should be used to assess psychopathological symptoms. Among these are relatives of patients with mental illness. The very low number of empirical studies examining the assessment of psychopathology by relatives of adult, nondemented mentally ill patients stands in significant contrast to the clinical importance of this source of information, however. Sampling and Methods: Using the Positive and Negative Syndrome Scale (PANSS), researchers asked 163 relatives of patients with the main clinical ICD-10 diagnosis of schizophrenic, recurrent depressive or bipolar disorders to rate the current symptoms of the patients at the time of outpatient community-oriented treatment. Results: On average, severity of symptoms was rated as absent or minimal, although anxiety, depression and passive/apathetic social as well as emotional withdrawal, motor retardation, poor attention, and disturbance of volition were clearly rated above the PANSS mean total score for all patients. A six-factor structure identified by factor analysis better illustrates the significant differences in the assessments of the three main diagnostic groups than the three established PANSS scales. With the exception of ‘problematic social behavior’, differences among the diagnostic groups appeared in all factors and were particularly pronounced for ‘delusional beliefs’ and ‘motor impairments’. Conclusions: The results of this study showed that the use of standardized instruments such as PANSS for the assessment of psychopathology by relatives is not only practical, but produces adequately reliable results. The use of PANSS for this purpose, however, requires interviewing of relatives by trained experts able to explain technical terms. Because this study did not sufficiently explore the validity of this approach, further research on this specific issue is urgently needed and should, for example, assess the concordance of ratings between professionals and relatives as well as correlation with suitable external criteria. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Thèse (M.Ps.) -- Université du Québec à Chicoutimi, 2004. / "Mémoire présenté à l'Université du Québec à Chicoutimi comme exigence partielle de la maîtrise en psychologie offerte à l'Université du Québec à Chicoutimi en vertu d'un protocole d'entente avec l'Université du Québec à Trois-Rivières." Comprend des réf. bibliogr. : f. 103-108. Document électronique également accessible en format PDF.

Background. Evidence suggests that in affective, non-psychotic disorders: (i) environmental exposures increase risk of subthreshold psychotic experiences (PEs) and strengthen connectivity between domains of affective and subthreshold psychotic psychopathology; and (ii) PEs are a marker of illness severity. Method. In 3021 adolescents from the Early Developmental Stages of Psychopathology cohort, we tested whether the association between PEs and presence of DSM-IV mood disorder (MD)/obsessive–compulsive disorder (OCD) would be moderated by risk factors for psychosis (cannabis use, childhood trauma and urbanicity), using the interaction contrast ratio (ICR) method. Furthermore, we analysed whether the interaction between environment and PEs was mediated by non-psychotic psychopathology. Results. The association between PEs and MD/OCD was moderated by urbanicity (ICR = 2.46, p = 0.005), cannabis use (ICR = 3.76, p = 0.010) and, suggestively, trauma (ICR = 1.91, p = 0.063). Exposure to more than one environmental risk factor increased the likelihood of co-expression of PEs in a dose–response fashion. Moderating effects of environmental exposures were largely mediated by the severity of general non-psychotic psychopathology (percentage explained 56–68%, all p < 0.001). Within individuals with MD/OCD, the association between PEs and help-seeking behaviour, as an index of severity, was moderated by trauma (ICR = 1.87, p = 0.009) and urbanicity (ICR = 1.48, p = 0.005), but not by cannabis use. Conclusions. In non-psychotic disorder, environmental factors increase the likelihood of psychosis admixture and helpseeking behaviour through an increase in general psychopathology. The findings are compatible with a relational model of psychopathology in which more severe clinical states are the result of environment-induced disturbances spreading through a psychopathology network.

Background: For optimizing the validity of diagnoses of mental disorders, several sources of information should be used to assess psychopathological symptoms. Among these are relatives of patients with mental illness. The very low number of empirical studies examining the assessment of psychopathology by relatives of adult, nondemented mentally ill patients stands in significant contrast to the clinical importance of this source of information, however. Sampling and Methods: Using the Positive and Negative Syndrome Scale (PANSS), researchers asked 163 relatives of patients with the main clinical ICD-10 diagnosis of schizophrenic, recurrent depressive or bipolar disorders to rate the current symptoms of the patients at the time of outpatient community-oriented treatment. Results: On average, severity of symptoms was rated as absent or minimal, although anxiety, depression and passive/apathetic social as well as emotional withdrawal, motor retardation, poor attention, and disturbance of volition were clearly rated above the PANSS mean total score for all patients. A six-factor structure identified by factor analysis better illustrates the significant differences in the assessments of the three main diagnostic groups than the three established PANSS scales. With the exception of ‘problematic social behavior’, differences among the diagnostic groups appeared in all factors and were particularly pronounced for ‘delusional beliefs’ and ‘motor impairments’. Conclusions: The results of this study showed that the use of standardized instruments such as PANSS for the assessment of psychopathology by relatives is not only practical, but produces adequately reliable results. The use of PANSS for this purpose, however, requires interviewing of relatives by trained experts able to explain technical terms. Because this study did not sufficiently explore the validity of this approach, further research on this specific issue is urgently needed and should, for example, assess the concordance of ratings between professionals and relatives as well as correlation with suitable external criteria. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

A gold standard measurement does not exist to assess fatigue symptoms across patient populations. Current tools only consist of self-report measures that may not assess fatigue objectively. The National Institutes of Health-Brief Fatigue Inventory (NIH-BFI) is a clinician-administered instrument developed as a more objective assessment of fatigue symptoms. This study assessed the NIH-BFI's validity in diverse clinical populations, which included patients diagnosed with a mood disorder, Parkinson's disease, cancer, and healthy controls. Results suggest good criterion-related and convergent validity for the NIH-BFI. Results also indicate significant differences in fatigue severity between cohorts. Moreover, the data also suggest significant differences among groups in depression, anxiety, pain catastrophizing, sleep quality, global mental and physical health, and cognitive functioning. This study proposes that the NIH-BFI is a valid clinician-administered measure of fatigue that can be administered in multiple clinical populations.

Fragestellung: Nur wenige Kliniken für Kinder- und Jugendpsychiatrie (KJP) bieten eine ambulante Behandlung von Jugendlichen mit Substanzkonsumstörungen (SUDs) an. Daher fehlen Angaben, welche Konsummuster, SUDs und begleitenden psychischen Störungen diese Jugendlichen aufweisen. Methodik:N = 201 Patient_innen einer universitären Spezialambulanz (12–19 Jahre alt) wurden bezüglich Konsummustern, SUDs und aktuellen psychischen Störungen mittels Interview untersucht. Es wurden diesbezüglich deskriptive Darstellungen zu Prävalenzzahlen der SUDs, Konsummustern und begleitenden psychischen Störungen aufgeteilt nach Geschlecht und aktuellem Alter erstellt. Ergebnisse: Tabak (88 %) und Cannabis (86 %) waren die verbreitetsten Substanzen. Bei 67 % aller Patient_innen wurde mehr als eine SUD festgestellt. SUDs bezogen sich am häufigsten auf Cannabis (84 %), gefolgt von Tabak (77 %). 72 % aller Patient_innen zeigten eine die SUD begleitende psychische Störung, insbesondere Störungen des Sozialverhaltens (40 %), hyperkinetische Störungen (21 %) und depressive Störungen (18 %). Schlussfolgerungen: Ambulant behandelte jugendliche KJP-Patient_innen mit SUDs präsentieren sich häufig mit begleitenden psychischen Störungen. Angebotene Behandlungsprogramme sollten in der Behandlung von SUDs insbesondere Störungen des Sozialverhaltens, Depressionen und hyperkinetische Störungen berücksichtigen. / Objective: Only few clinics offer the outpatient treatment of substance use disorders (SUDs) among adolescents. Therefore, only limited data describe substance use patterns, SUDs, and co-occurring psychiatric disorders characteristic of adolescents who present in such outpatient clinics specialized in the treatment of SUDs. Method: Via interview we collected data from n = 201 patients between 12 and 19 years concerning their substance use, SUDs, and current co-occurring psychiatric disorders. We created descriptive presentation of data regarding use patterns, SUDs, and co-occurring disorders divided by sex and current age. Results: Tobacco (88 %) and cannabis (86 %) were the most frequently used substances. 67 % of all patients presented with more than one SUD, cannabis use disorder being the most prevalent one (84 %). 72 % presented with at least one co-occurring disorder, with conduct disorders (40 %), attention deficit (hyperactivity) disorders (21 %), and depressive disorders (18 %) being the most frequent ones. Conclusions: Adolescent SUD patients often present with co-occurring psychiatric disorders. Institutions for adolescent SUD treatment should also focus on treating co-occurring conduct disorders, depression, and attention deficit disorders.

In the early 20th century, there were few therapeutic options for mental illness and asylum numbers were rising. This pessimistic outlook favoured the rise of the eugenics movement. Heredity was assumed to be the principal cause of mental illness. Politicians, scientists and clinicians in North America and Europe called for compulsory sterilisation of the mentally ill. Psychiatric genetic research aimed to prove a Mendelian mode of inheritance as a scientific justification for these measures. Ernst Rüdin’s seminal 1916 epidemiological study on inheritance of dementia praecox featured large, systematically ascertained samples and statistical analyses. Rüdin’s 1922–1925 study on the inheritance of “manic-depressive insanity” was completed in manuscript form, but never published. It failed to prove a pattern of Mendelian inheritance, counter to the tenets of eugenics of which Rüdin was a prominent proponent. It appears he withheld the study from publication, unable to reconcile this contradiction, thus subordinating his carefully derived scientific findings to his ideological preoccupations. Instead, Rüdin continued to promote prevention of assumed hereditary mental illnesses by prohibition of marriage or sterilisation and was influential in the introduction by the National Socialist regime of the 1933 “Law for the Prevention of Hereditarily Diseased Offspring” (Gesetz zur Verhütung erbkranken Nachwuchses).

Les antipsychotiques de deuxième génération (ADG) sont de plus en plus employés dans le traitement de troubles psychiatriques. Selon de nombreuses observations cliniques, les effets secondaires reliés à la prise d’ADG diffèrent chez les patients atteints de schizophrénie (SCZ) et de maladies affectives (MA) éprouvent divers. Ainsi, il s’avère nécessaire d’étudier la fréquence et l'intensité des effets secondaires induits par les ADG qui pourraient différer selon le diagnostic. Pour ce faire, nous avons effectué une revue systématique de la littérature afin d’identifier l’ensemble des études rapportant les effets secondaires de cinq ADG (aripiprazole, olanzapine, quétiapine, rispéridone et ziprasidone) dans le traitement de la schizophrénie ou des maladies affectives. Les effets secondaires métaboliques et extrapyramidaux ont été recueillis séparément pour les deux groupes de patients, puis ont été combinés dans une méta-analyse. Des méta-régressions ainsi que des sous-analyses ont également été effectuées dans le but de regarder l’effet de différents modérateurs (i.e. âge, genre, et dose). Dans la présente méta-analyse, 107 études ont été inclues. Les résultats montrent que le traitement avec l’olanzapine a occasionné une plus importante prise de poids chez les patients SCZ comparativement aux patients MA. De plus, le traitement à la quétiapine a amené une hausse significative du taux de LDL et de cholestérol total dans le groupe SCZ par rapport au groupe MA. Selon nos résultats, les symptômes extrapyramidaux étaient plus fréquents dans le groupe MA, excepté pour le traitement à l'olanzapine qui a induit davantage de ces symptômes chez les patients SCZ. Également, nos résultats suggèrent que les patients SCZ seraient plus vulnérables à certains effets métaboliques induits par les ADG dû à une possible susceptibilité génétique ou à la présence de facteurs de risque associés au style de vie. D'autre part, les patients MA en comparaison aux SCZ étaient plus enclins à souffrir de troubles du mouvement induits par les ADG. Bref, les ADG semblent exacerber certains types d’effets secondaires tout dépendant de la maladie dans laquelle on les utilise. / Second generation antipsychotics (SGAs) are extensively prescribed for psychiatric disorders. Based on clinical observations, schizophrenia (SCZ) and affective disorders (AD) patients experience different SGAs side effects. The expanded use of SGAs in psychiatry suggests a need to investigate whether there is a difference in the incidence and severity of side-effects related to diagnosis. A comprehensive literature search was conducted to identify studies reporting side effects of five SGAs (aripiprazole, olanzapine, quetiapine, risperidone and ziprasidone) in the treatment of SCZ or AD. The metabolic and extrapyramidal side effects were collected separately for each group, and then were combined in a meta-analysis. Meta-regression and sub-analyses were also performed to investigate the role of different moderators (e.g., age, dose and gender). One hundred and seven studies were included in the analysis. Olanzapine induced a body weight gain significantly higher in SCZ patients than in AD patients. In addition, quetiapine treatment led to significantly higher LDL and total cholesterol mean change in the SCZ group relative to the AD group. Based on our results, the incidence of extrapyramidal side effects was more frequent in the AD group, except for olanzapine that caused more parkinsonism in SCZ patients. Our results suggest that SCZ patients may be more vulnerable to some SGA-induced metabolic disturbances, in which lifestyle risk factors and a possible inherent genetic vulnerability may play a role. Most of the studied SGAs caused more movement disorders in AD patients than in schizophrenics. It might be that an antipsychotic induces severity of side effect according to the phenotype.

Réalisé sous la co-direction de Linda Booij, Catherine Herba et Patricia Garel / Contexte : la présence d’un biais cognitif négatif chez les individus qui souffrent de dépression majeure (DM) et ceux qui y sont à haut risque (e.g. enfants de mères qui souffrent de DM) est maintenant établie. Aucune étude portant sur la vulnérabilité cognitive (VC) des membres de la fratrie n’est rapportée. Objectifs : la présente étude a pour but de vérifier si la fratrie des adolescents qui souffrent de DM présentent une VC qui les prédisposent à la DM. Méthode : cette étude porte sur 49 adolescents (18 participants traités pour une DM, 16 membres de la fratrie et 15 participants témoin), âgés entre 12 et 20 ans. La VC de chaque participant est quantifiée via un questionnaire qui mesure la réactivité cognitive (RC), soit le LEIDS-R, et une tâche de reconnaissance des expressions faciale (REF). La cognition sociale des participants est mesurée par le MASC, un outil qui évalue la cognition sociale par médium vidéo et que notre équipe a traduit de l’allemand au français. Résultats : les résultats préliminaires de la présente étude indiquent qu’une différence de réactivité cognitive est présente entre les adolescents traités pour une DM et les participants du groupe témoin (p < 0,001). L’analyse préliminaire tend à indiquer qu’une différence est présente entre la fratrie et le groupe contrôle. Conclusion : plusieurs de nos résultats tendent en faveur de la présence d’une VC prédisposant à la DM chez la fratrie des adolescents souffrant de DM. Ces résultats préliminaires doivent être confirmés par des études longitudinales. / Background: a negative cognitive bias is present among individuals who suffers from major depression. This bias is also reported among individuals at high risk of major depression (e.g. child of depressed mother). No study to date aimed to evaluate cognitive vulnerability of siblings of depressed individuals. Objectives: the present study aim to verify if siblings of depressed adolescents present a cognitive vulnerability that would predispose them to develop a major depression. Method: This study evaluates 49 adolescents (18 participants treated for depression, 16 siblings and 15 controls), aged between 12 and 20 years old. The cognitive vulnerability of every participant has been assessed using an auto-report questionnaire of symptoms (LEIDS-R) that evaluates cognitive reactivity and a task of facial recognition. Social cognition of participants is measured using the Movie for Assessment of Social Cognition (MASC) that we translated from german to french. Results: the preliminary analyses of this study concludes that a significant difference of cognitive reactivity is present between adolescents treated for depression and controls (p < 0.001). Conclusion: some of our results tend to confirm the presence of a cognitive vulnerability to depression among siblings of depressed adolescents. Those results are still preliminary and need to be confirmed by longitudinal studies.

Schwere psychische Erkrankungen wie Schizophrenie und affektive Störungen haben nicht nur einen erheblichen Einfluss auf das Leben der Patienten, sondern auch ihrer Bezugspersonen. Die Entdeckung der Lebensqualität und ihrer relevanten Faktoren für pflegende Angehörige von Patienten mit psychischen Erkrankungen hilft Gesundheitsfachkräften sowie dem System, besser mit pflegenden Angehörigen zusammenzuarbeiten. Außerdem hilft es den Pflegekräften, auf eine adaptive Weise mit Patienten umzugehen. Die Studie zielte darauf ab, die Belastung und Lebensqualität von Pflegekräften, ihre spezifischen Bedürfnisse und Bewältigungsstrategien zu identifizieren. Außerdem sollte ein neuer Fragebogen entwickelt werden, um die Lebensqualität der Pflegekräfte zu messen. Diese Studie wendet einen Mixed-Method-Ansatz mit drei explorativen, quantitativen und ergänzenden Phasen an. Die qualitative explorative Phase der Studie wurde mittels halbstrukturierter Interviews mit 45 Betreuern von Patienten mit Schizophrenie und affektiven Störungen durchgeführt. Die Daten wurden durch qualitative Inhaltsanalyse untersucht. Die quantitative Phase diente der Entwicklung und Validierung eines neuen Instruments zur Messung der Lebensqualität von Pflegekräften sowie der Bereitstellung von Hauptfragen des Interviews für die zusätzliche Phase der Studie. Die Ergänzungsphase der Studie wurde in halbstrukturierten Interviews mit 18 Betreuern von Patienten mit Schizophrenie sowie affektiven Störungen durchgeführt. Die Daten wurden mittels Grounded-Theory-Analyse untersucht. Die Ergebnisse der Studie ermittelten die Hauptbelastungen, denen die Pflegepersonen ausgesetzt waren. Darüber hinaus wurden durch die Entwicklung und Validierung eines neuen Fragebogens die wichtigsten Faktoren für die Lebensqualität aufgedeckt. Ergebnisse der Ergänzungsphase der Studie identifizierten das Kernkonzept der Pflegeerfahrung sowie deren Hauptkategorien. Außerdem werden verschiedene Arten von Bewältigungsstrategien vorgeschlagen, die die Pflegekräfte übernommen haben. Weiterhin zeigt diese Phase die Trajektorie von Pflegeerfahrung und Bewältigungsstrategien in verschiedenen Phasen der Erkrankung. Die Studie bietet einige Vorschläge für das System, Fachkräfte im Gesundheitswesen sowie Pflegekräfte an, um die Lebensqualität der Pflegekräfte zu verbessern und die Absicht zu vermindern, Patienten einem institutionellen Pflegezentrum anzuvertrauen. / Severe mental illnesses, such as schizophrenia and affective disorders, have a considerable impact on the lives of not only patients but also their caregivers. Discovering the quality of life and its contributing factors for family caregivers of patients with mental illnesses helps health-care professionals as well as the system to work better with family caregivers. Also, it helps the caregivers to cope with patients in an adaptive way. The study aimed to identify the burden and quality of life of caregivers, their specific needs and coping strategies. Also, it aimed to develop a new questionnaire to measure caregivers’ quality of life. This study applied a mixed-method approach with three exploratory, quantitative and supplementary phases. The qualitative exploratory phase of the study was conducted via semi-structured interviews with 45 caregivers of patients with schizophrenia and affective disorders. Data were analyzed through qualitative content analysis. The quantitative phase was designed to develop and validate a new instrument to measure caregivers’ quality of life as well as to provide main questions of the interview for the supplementary phase of the study. The supplementary phase of the study was conducted by semi-structured interviews with 18 caregivers of patients with schizophrenia and affective disorders. Data were analyzed by grounded theory analysis. Findings of the study identified main burdens that the caregivers endured; additionally, main factors which contributed to the quality of life were revealed by developing and validating a new questionnaire. Findings of the supplementary phase of the study identified the core concept of caregiving experience as well as its main categories. Also, it proposes different kinds of coping strategies that caregivers adopted. Furthermore, this phase shows the trajectory of caregiving experience and coping strategies in different phases of the illness. The study provides some suggestions for the system, health-care professionals as well as caregivers in order to increase caregivers’ quality of life and to lessen the intention to entrust patients to an institutional take care center.