Orientador: Maria Eugenia Boaventura / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Estudos da Linguagem / Made available in DSpace on 2018-08-14T17:45:19Z (GMT). No. of bitstreams: 1 Buzelli_JoseLeonardoSousa_M.pdf: 58875345 bytes, checksum: 8f49d88e9c383c4a6a162eeda93862a5 (MD5) Previous issue date: 2009 / Resumo: A presente dissertação analisa o processo de escrita do romance Triste fim de Polycarpo Quaresma (1911), de Afonso Henriques de Lima Barreto (1881-1922), levando em conta todos os testemunhos que chegaram até nós, a saber: a caderneta de apontamentos "O prêmio", os manuscritos Episódios da vida do Major Quaresma, o texto da obra tal como publicado no Jornal do Commercio, entre 11 de agosto e 19 de outubro de 1911, e em livro, publicado em 1916 (apesar de trazer a data de 1915). Além disso, transcreve e edita todo o Corpus Polycarpiano, inclusive com uma edição diplomática dos manuscritos. / Abstract: This dissertation first presents an analysis of the writing process of Triste fim de Polycarpo Quaresma (1911 - Polycarpo Quaresma's sad ending; a.k.a. The patriot), a novel by Afonso Henriques de Lima Barreto (1881-1922), and draws on all the historical source materials passed down to us, namely: the notebook "O prêmio" ("The prize"), the manuscripts Episódios da vida do Major Quaresma (Episodes from Major Quaresma's life), the text as published in Jornal do Commercio between 11th August and 19th October 1911, and as in the 1916 book (although its front page bears the year 1915). The dissertation then goes onto transcribe and edit the entire Polycarpian Corpus, including a diplomatic edition of the manuscripts. / Mestrado / Literatura Brasileira / Mestre em Teoria e História Literária

INTRODUÇÃO: A depressão bipolar (DB) é uma condição altamente prevalente associada a déficits cognitivos que persistem mesmo na fase eutímica da doença. Os tratamentos farmacológicos para DB podem agravar ainda mais o comprometimento cognitivo, destacando a necessidade de desenvolver intervenções que tenham segurança cognitiva. A Estimulação Magnética Transcraniana \'profunda\' através de bobina H1 (EMTr-H1) é uma nova modalidade de neuromodulação com eficácia estabelecida para a depressão unipolar. Este é o primeiro estudo em caráter exploratório e controlado por placebo, a avaliar os efeitos cognitivos da EMTr-H1 em pacientes com DP resistente ao tratamento. MÉTODO: Quarenta e três pacientes foram randomizados para receber 20 sessões de EMTr-H1 ativa (55 séries de estímulos direcionados à área pré frontal esquerda, a 18Hz e 120% de intensidade do limiar motor em repouso) ou de EMTr-H1 placebo, em um ensaio duplo-cego, controlado por estimulação simulada. Uma bateria de avaliação neuropsicológica contendo 20 testes cognitivos, agrupados em seis domínios cognitivos (atenção e velocidade de processamento, memória de trabalho e função executiva, controle inibitório, linguagem, memória verbal imediata e memória verbal de longo prazo), foi realizada imediatamente antes do início das sessões de EMTr-H1 (avaliação basal - semana 0) e após 4 (20ª e última sessão - semana 4) e 8 semanas (seguimento de mais 4 semanas sem novas intervenções - semana 8) do início deste estudo. Sintomas depressivos e maníacos também foram avaliados. A medida clínica de desfecho primária foi à redução percentual do escore basal da Escala de Hamilton para avaliação da depressão com 17 itens (HDRS-17) após 20 sessões de estimulação (semana 4). A medida de segurança durante as 8 semanas incluiu, além da Escala de Mania de Young (YMRS) para avaliar ciclagens de mania emergentes possivelmente relacionados ao tratamento (TEMS), principalmente, uma bateria de testes de avaliação neuropsicológica, que avaliou a possibilidade de sequelas e/ou reparações cognitivas em relação ao método. RESULTADOS: Entre os 50 pacientes que iniciaram o estudo, 2 do grupo placebo EMTr-H1 e 5 do grupo EMTr-H1 ativo, desistiram de participar do ensaio e não completaram as avaliações, sendo excluídos da análise (\"dropouts\"), portanto, 43 pacientes finalizaram o estudo. O grupo EMTr-H1 ativo apresentou uma resposta clinica antidepressiva superior ao placebo na semana 4 (diferença favorecendo EMTr-H1=4,88; 95% CI=0,43 a 9,32, p=0,03), mas não nas semanas de seguimento. Houve também uma tendência para maiores taxas de resposta no grupo ativo (48%) vs. placebo (24%) (OR=2,92; 95% CI=0,87 a 9,78, p=0,08). As taxas de remissão não foram estatisticamente diferentes. Não foram observados episódios de TEMS. Foi constatada uma melhoria cognitiva em relação a todos os domínios cognitivos, mas que ocorreu ao longo do tempo e independentemente do grupo de intervenção e da melhora da depressão. Não foi encontrada correlação entre a melhora da depressão e da cognição. LIMITAÇÕES: Ausência de um grupo controle saudável. CONCLUSÕES: A EMTr \'profunda através da bobina H1 é uma terapia antidepressiva de adição potencialmente eficaz e bem tolerada em pacientes com depressão bipolar resistente que receberam farmacoterapia adequada. Os resultados cognitivos deste estudo exploratório fornecem evidências sobre a segurança cognitiva da EMTr-H1 para pacientes com DB. Não foram observados supostos efeitos deletérios e nem pró-cognitivos da EMTr-H1 na DB, mas pesquisas adicionais se fazem necessárias por meio de outros estudos similares e que contemplem a cognição / INTRODUCTION: Bipolar depression (BD) is a highly prevalent condition associated with marked cognitive deficits that persist even in the euthymic phase of the illness. Pharmacological treatments for BD might further aggravate cognitive impairment, highlighting the need of developing interventions that have cognitive safety. \'Deep\' H1-coil Transcranial Magnetic Stimulation (H1-rTMS) is a new modality of neuromodulation with established efficacy for unipolar depression. This is the first exploratory, placebo-controlled study evaluating the cognitive effects of rTMS in patients with treatment-resistant bipolar depression. METHODS: Fourty-three patients were randomized to receive 20 sessions of active (55 trains directed to the left prefrontal area, 18Hz, 120% resting motor threshold intensity) or sham rTMS within a double-blind, sham-controlled trial. A battery of neuropsychological assessment with 20 cognitive tests, grouped in 6 domains (attention and processing speed, working memory and executive function, inhibitory control, language, immediate verbal memory, and long-term verbal memory) was performed at baseline (week 0) and after 4 (20th and last session - week 4) and 8 weeks (follow-up of 4 weeks without further intervention - week 8) of trial onset. Depressive and manic symptoms were also evaluated. The primary clinical outcome measure was percentage reduction of the baseline score of the Hamilton Scale for assessment of depression with 17 items (HDRS-17) after 20 stimulation sessions (week 4). The safety measure during the 8 weeks included, in addition to the Young Mania Scale (YMRS) wich evaluated the emergent mania possibly related to treatment (TEMS), mainly a battery of neuropsychological evaluation tests, which evaluated the possibility of sequelae or cognitive repairs in relation to the method. RESULTS: Among the 50 patients who started the study, 2 of the sham H1-rTMS group and 5 of the active H1-rTMS group, gave up participating in the trial and did not complete the assessments, being excluded from the analysis (\"dropouts\"), therefore, 43 patients completed the study. The active H1-rTMS had an antidepressant clinical response higher than placebo at week 4 (difference favoring H1-rTMS=4.88; 95% CI=0.43 to 9.32, p=0.03) but not at weeks of follow-up. There was also a trend for greater response rates in the active (48%) vs. sham (24%) groups (OR=2.92; 95% CI=0.87 to 9.78, p=0.08). Remission rates were not statistically different. No TEMS episodes were observed. A cognitive improvement was observed in all cognitive domains, but it occurred over time and independently of the intervention group and depression improvement. No correlation was found between improvement of depression and cognition. LIMITATIONS: Absence of healthy control group. CONCLUSION: Deep H1-rTMS is a potentially effective and well-tolerated add-on antidepressive therapy in resistant bipolar depressed patients to received adequate pharmacotherapy. The cognitive results of this exploratory study provide evidence on the cognitive safety of H1-coil rTMS for BD patients. No deleterious or pro-cognitive effects of H1-rTMS in BD have been observed, but further research is needed through other similar studies that contemplate cognition

Multimodality MR imaging of pathological changes in schizophrenia Aim: To prove structural changes of the neocortex and white matter of the brain indicating connectivity disorder in early phases of schizophrenia. Material and methods: A prospective monocentric study comparing a cohort of patients after the first episode of schizophrenia (on average 15.6 days after the initial hospitalization) with a control group of healthy persons. Probands were examined using a complex MRI protocol. Twenty-six patients and twenty-four healthy persons were examined in total. Three dimensional T1 and T2 data and DWI data were analyzed using TBSS FA, FBA a surface- based morphometry. Results: Large areas of dispersively decreased FA were found in patients compared to control group using TBSS. Several fixels of decreased FD metric were found using FBA in the anterior commissure of patients and one sporadic fixel of decreased FDC metric was found in frontal white matter of the brain. No statistically significant areas of cortical surface area and cortical thickness differences were found using SBM. Conclusions: Large areas of decreased microstructural integrity of the white matter of the brain were found. However, it was not possible to specify the nature of its corruption using FBA. Our findings indicate the crucial role of...

京都大学 / 0048 / 新制・課程博士 / 博士(情報学) / 甲第21397号 / 情博第683号 / 新制||情||118(附属図書館) / 京都大学大学院情報学研究科社会情報学専攻 / (主査)教授 吉川 正俊, 教授 黒田 知宏, 教授 守屋 和幸 / 学位規則第4条第1項該当 / Doctor of Informatics / Kyoto University / DFAM

Bakgrund: Psykossjukdom är en av de allvarligaste psykiatriska sjukdomarna. Trots att det finns effektiva behandlingsstrategier får inte alla med psykossjukdom specialiserad vård, vilket kan ha allvarliga konsekvenser för deras livslängd och välbefinnande. Diskriminering och stigma kring psykossjukdom kan påverka patientens hälsa och prognos. Det är viktigt att tidigt upptäcka och behandla psykossjukdomar för att minimera funktionsnedsättning och förbättra prognosen. En utmaning inom vården för personer med förstagångsinsjuknande är att bibehålla terapeutisk allians och främja återhämtning. Syfte: Syftet var att beskriva patienters erfarenheter av vården vid förstagångsinsjuknande i psykos. Metod: En litteraturstudie med strukturerat tillvägagångssätt och kvalitativ ansats. 15 originalartiklar inkluderades och tematisk dataanalys genomfördes enligt Braun och Clarke. Resultat: Litteraturstudien sammanställer tidigare forskning inom området och efter dataanalys framkom tre teman: Värdefulla relationer, Hjälpande insatser, Hinder och utmaningar för delaktighet med respektive subteman. Slutsats: Erfarenheterna från vården för personer med förstagångsinsjuknande med psykos berör relationer till personal och medpatienter, praktiskt stöd och psykoedukation, och faktorer som rädsla för vården, bristande tillit och kontinuitet. / Background: Psychotic disorders are among the most severe psychiatric illnesses. Despite the availability of effective treatment strategies, not all individuals with psychotic disorders receive specialized care, which can have serious consequences for their longevity and well-being. Discrimination and stigma surrounding psychotic disorders can impact the patient's health and prognosis. Early detection and treatment of psychotic disorders are crucial to minimize disability and improve prognosis. One challenge in the care of individuals experiencing first-episode psychosis is maintaining therapeutic alliance and promoting recovery. Aim: The objective was to describe patients' experiences of care during first-episode psychosis. Method: A literature study with a structured approach and qualitative approach. 15 original articles were included and thematic data analysis was conducted according to Braun and Clarke. Results: The literature review compiles previous research in the field, and after data analysis, three themes emerged: Valuable relationships, Supportive interventions, and Barriers and challenges to engagement, each with respective sub themes. Conclusions: The experiences of healthcare for individuals with first-episode psychosis involve relationships with staff and fellow patients, practical support and psychoeducation, as well as factors such as fear of healthcare, lack of trust, and continuity.

Dans cette thèse, nous nous sommes intéressé aux très bons élèves et à leur façon d'étudier les mathématiques, en tenant compte du fait que tout ce qu'il y a à étudier mathématiquement n'est pas désigné par les professeurs. Partant de l'hypothèse que leur façon d'étudier leur permet de mieux réussir, nous avons suivi pendant deux années scolaires de très bons élèves de cinq établissements différents. Par une enquête anthropologique et ethnologique de terrain, nous les avons observés après les séances de cours en classe, sur leur lieu de travail (le bureau, la chambre ou un coin spécialement aménagé); en train de faire des exercices, des enquêtes, des recherches mathématiques sur les objets d'études des grands chapitres de la classe terminale scientifique (l'analyse, lois de probabilités continues, la géométrie, les similitudes...) ; chacun à sa manière, avec des supports didactiques de son choix. Cette forme d'observation particulière que nous appelons avec Mercier la méthode des épisodes biographiques, nous a permis de constituer des épisodes de leur biographie en mathématique, c'est-à-dire des moments où l'on peut attester qu'une question nouvelle se pose à eux, qu'ils apprennent quelque chose de nouveau en cherchant la réponse à la question donnée, et qu'ils identifient ce qu'ils ont appris en l'interrogeant depuis ce qu'ils savaient déjà. Nous montrons ainsi, comment les très bons élèves de terminales scientifiques fabriquent un répertoire de savoirs efficaces: leur répertoire épistémologique et heuristique. Pour construire ce répertoire, ils ont besoin d'aller enquêter loin de la classe, dans l'espace ou dans le temps (dans de nombreux manuels, scolaires ou non, dans des anciens livres, sur internet, quelques fois avec l'aide d'un membre de la famille ou d'un copain). C'est cette manière d'enquêter que nous appelons la transhumance didactique. / In this thesis, we were interested in the very good students and their way studying mathematics taking account of the fact that what there is to study mathematically is not always indicated by the professor in the courses of the various school grades. Based on the hypothesis that their way of studying enables them to succeed better in mathematics, we followed very good students from five different schools for two school years. Thus, using anthropological and ethnological field study methods, we observed the students after classroom hour, in their individual workplace settings (office, room or an especially arranged corner) doing exercises, investigations, mathematical research studies, each one in different way, with different didactic supports. This particular kind of observation, that we are calling the biographic episode method, enabled us to constitute episodes of their cognitive biography in mathematics, in other words moments of independent study where one can observe that they are faced with a news question, they learn something new by seeking the answer to a given problem, and they identify what they learned by questioning it in what they knew already. Thus we show how last year secondary school science students manufacture or build a directory of effective knowledge: the epistemological and heuristic directory. To build this directory, they need to seek learning away from the classroom, physically or temporally (using many textbooks or not, old textbooks, the Internet, or with the help of a family member or friend). It is this need for investigation which we call didactic transhumance.

This thesis is based on a population study conducted to explore ethnic inequalities in cardiovascular disease using Hospital Episode Statistics (HES). The Hospital Episode Statistics have significant potential for health studies for ethnic groups, due to the large number of events from minority ethnic groups, comprehensive clinical information, full England coverage and fine geographical scale. However, the percentage of Finished Consultant Episodes (FCEs) with invalid ethnicity codes is at a high level. This thesis starts by developing a record linkage method and a coding rate method to improve the data quality of ethnicity codes in the HES. This thesis then further examines ethnic inequalities in cardiovascular disease incidence in England at both national and local geographical scales. The patterns of ethnic inequalities in cardiovascular disease appear to have changed little in the last ten years. However, large variations of geographical relative risk of cardiovascular disease were observed for ethnicity-sex groups. The relationships between areal socioeconomic status measured at different geographical scales and ethnic inequalities in different types of cardiovascular disease were also explored. As there are very limited data on the mortality of minority ethnic groups in the UK, few studies have compared the incidence and outcome of cardiovascular disease from the same population. This thesis came up with some novel findings, for example, that people from minority ethnic groups, who generally have increased risk of cardiovascular disease incidence, have better cardiovascular disease survival than white people. The contribution of areal socioeconomic status, distance to treatment sites and cardiovascular disease severity and treatment to the ethnic inequalities in cardiovascular survival was examined. The relationships between socioeconomic status measured at different geographical scales and ethnic inequalities in cardiovascular disease severity and treatment were investigated in this thesis as well.

De nos jours, l’idée selon laquelle bon nombre d’individus atteints de psychose peuvent se rétablir sensiblement au fil du temps est de plus en plus répandue. Alors que le milieu médical associe le rétablissement à la rémission symptomatique, les usagers de services en santé mentale le voient plutôt comme un processus où l’absence de symptômes n’est pas une condition sine qua non. Ne s’opposant à ni l’un ni l’autre de ces points de vue, le traitement actuel des psychoses vise le retour à un fonctionnement social approprié. Chez les jeunes atteints d’un premier épisode psychotique, une diminution marquée des symptômes après un traitement pharmacologique se traduit rarement en une amélioration significative du fonctionnement, ce qui justifie la mise en place d’interventions psychosociales. On connait aujourd’hui quelques variables associées au fonctionnement social chez cette population, mais celui-ci a peu été étudié de façon spécifique. De même, on connait mal la manière dont ces jeunes vivent leur rétablissement en tant que processus. Cette thèse porte donc sur le rétablissement et le fonctionnement social de jeunes en début de psychose. La première partie consiste en une introduction aux concepts de rétablissement et de réadaptation, et en une revue de la littérature des interventions psychosociales pouvant favoriser leurs rétablissement et fonctionnement. Plus spécifiquement, nous illustrons comment ces interventions peuvent s’appliquer aux adolescents, clientèle sur laquelle peu de littérature existe actuellement. La deuxième partie présente les résultats d’une étude sur la valeur prédictive de variables sur trois domaines du fonctionnement social de 88 jeunes adultes en début de psychose. Des équations de régression multiple ont révélé qu’un niveau plus élevé de dépression était associé à une vie sociale moins active, qu’un moins bon apprentissage verbal à court terme était associé à un plus bas fonctionnement vocationnel, que le fait d’être de sexe masculin était négativement associé aux habiletés de vie autonome, et qu’un niveau plus élevé de symptômes négatifs prédisait de moins bonnes performances dans les trois sphères du fonctionnement. Finalement, la troisième partie s’intéresse au processus de rétablissement en début de psychose par l’analyse de récits narratifs selon un modèle en cinq stades. Nous avons découvert que l’ensemble de notre échantillon de 47 participants se situaient dans les deux premiers stades de rétablissement lors du premier temps de mesure, et que le fait de se trouver au deuxième stade était associé à de meilleurs scores d’engagement social et de fonctionnement occupationnel, à un meilleur développement narratif, à moins de symptômes négatifs et positifs, et à plus d’années de scolarité. Par ailleurs, l’examen des stades à deux autres temps de mesure a révélé des profils relativement stables sur une période de neuf mois. En somme, les résultats démontrent la nécessité d’évaluer le fonctionnement social de façon plus spécifique et l’importance d’offrir des interventions psychosociales en début de psychose visant notamment le développement des relations et l’intégration scolaire/professionnelle, ou visant à améliorer le faible développement narratif. Cette thèse est, de plus, un premier pas dans l’étude du processus de rétablissement des jeunes atteints de psychose. / Currently, the idea that several individuals experiencing psychosis can show evidence of recovery over time is gaining in popularity. Although recovery is viewed as the disappearance of symptoms in the medical field, consumers of mental health services see it more as process in which the complete absence of symptoms is not a sine qua non. Nevertheless, the current treatment for psychosis is aimed at regaining a satisfactory level of social functioning. In individuals experiencing a first psychotic episode, a noticeable decrease in symptoms is rarely associated with a significant improvement in functioning. Therefore, psychosocial interventions are necessary to assist in recovery. The literature has identified a number of variables associated with social functioning in this population, but to date, there are no studies investigating this aspect in details. Furthermore, very little is known about how these youth experience the process of recovery. This thesis dissertation will therefore address recovery and social functioning in young people experiencing a first episode of psychosis. A first section will serve as an introduction to the concepts of recovery and rehabilitation and a review of the literature on psychosocial interventions promoting recovery and functioning. Specifically, we will illustrate how these interventions can apply to adolescents, a population for which very few studies have been published. A second section will present the results of a study on the predictive value of variables on three domains of social functioning in 88 young adults in early psychosis. Multiple regression analyses showed that a more severe depression was associated with a less active social life; that a poorer short term verbal learning ability was associated with poorer vocational functioning; and that men showed poorer independent living skills. Furthermore, more severe negative symptoms were associated with poorer performances in all three spheres of social functioning. Finally, the third section will address the recovery process in early psychosis through the analysis of narratives using a five stage recovery model. We determined that overall, our sample of 47 individuals were classified within the first two stages of recovery at baseline and that those classified in the second stage showed better social engagement and vocational functioning scores, a better narrative development, less severe positive and negative symptoms, and had attained a higher educational level. Furthermore, the analysis of the stages of recovery across two others time points show that these profiles are relatively stable over a 9 month period. In conclusion, these results show that it is necessary to evaluate social functioning in a more detailed manner, and reaffirms the importance of making psychosocial interventions available to service users experiencing early psychosis. It highlights, in particular, the need for services aimed towards the development of social relationships and educational/vocational integration, or interventions addressing deficits in narrative development. Moreover, this thesis dissertation is a first step towards the study of the recovery process of young adults experiencing psychosis.

Au Canada, chaque nuit, en moyenne 6000 jeunes sont sans-abri. Ceux souffrant de psychose et de toxicomanie sont particulièrement à risque d’itinérance. La littérature suggère qu’il y a nécessité de soins adaptés pour cette population. Une équipe d’intervention intensive de proximité ÉQIIP SOL (ES) fut créée au CHUM en 2012 afin de mieux offrir une approche adaptée la clientèle des jeunes itinérants souffrants d’un premier épisode psychotique et de toxicomanie (JIPEPT). Objectif : Étudier l’impact de l’ajout de l’ES aux services de la Clinique spécialisée d’intervention précoce pour la psychose (CIP) sur l’évolution symptomatique et fonctionnelle et l’utilisation de services des JIPEPT. Méthode : Étude de suivi longitudinale comparant l’évolution des JIPEPT suivis par l’ES en ajout à une CIP depuis 2012 à ceux suivis dans une CIP (2005-2011). La stabilité à l’hébergement (issue primaire), l’autonomie en hébergement, l’évolution fonctionnelle (SOFAS) et clinique globale (GAF, CGI), la sévérité de la toxicomanie (AUS, DUS), et l’utilisation de services (consultations à l’urgence et hospitalisations) ont été collectées de manière prospective durant 24 mois. Résultats : Le suivi de l’ES+CIP est associé à un taux plus élevé de JIPEPT en hébergement stable que le traitement régulier CIP seul (RR=2,38, p=0,017). L’évolution fonctionnelle, clinique et de la toxicomanie des 2 groupes sont similaires. Conclusion : L’ajout de l’ES à une CIP semble permettre d'augmenter le taux de stabilité en hébergement chez les JIPEPT. Toutefois, les facteurs de mauvais pronostic prémorbides et l’intensité déjà élevée du traitement comparateur (CIP) expliquent possiblement que l’ES n’ait pas d’impact supplémentaire sur l’évolution du fonctionnement et de la toxicomanie à court terme. / In Canada, every night, about 6000 youths are homeless. Those suffering from psychosis and substance use disorder (SUD) are at higher risk for homelessness. Today’s literature suggests the need for dedicated interventions for this population. In 2012, an intensive outreach team (ÉQIIP SOL (ES)) was created at the CHUM, to help homeless youth suffering from psychosis and SUD (HYPS). Objective: Explore the impact of ES added to an early intervention for psychosis clinic (EIC) on service use and the symptomatic and functional outcome for the HYPS. Method: Longitudinal study comparing the outcome of HYPS who received care from ES in addition to an early intervention for psychosis clinic (EIPC) (2012-2015) to an HYPS historical cohort who received care from EIPC only (2005-2011). Housing stability (main outcome), living arrangement autonomy, global assessment of functioning scale (SOFAS), clinical global assessment scales (GAF, CGI), SUD severity (AUS, DUS) and services use (Emergency consultations and hospitalizations) have been collected prospectively for 24 months. Results: With ES + EPIC, there is a higher rate of HYPS in stable housing than with EIPC only (RR=2,38, p=0,017). Symptomatic and functional outcomes as well as drug and alcohol misuse are somewhat similar for the 2 groups. Conclusion: The addition of ES to an EIPC seems to benefit HYPS in increasing housing stability. However, poor prognostic factors of HYPS and the high intensity of the comparator treatment (EPIC) may explain why ES does not seem to have an additional impact on shortterm symptomatic, functional and SUD outcome.

L'objectif général de cette thèse est d'examiner le lien entre les traits de personnalité évalués selon l'approche des cinq facteurs et les résultats des traitements psychosociaux auprès de jeunes adultes présentant un premier épisode psychotique. Afin d'atteindre cet objectif, 129 personnes ont été recrutées à participer à une étude expérimentale randomisée. Les participants ont été assignés soit à un groupe de thérapie cognitive-comportementale, soit à un groupe d'entraînement aux habiletés sociales visant la gestion des symptômes, soit à une liste d'attente. Les participants ont complété pré- et post-traitement le Questionnaire bref de personnalité NEO Révisé (Costa & McCrae, 1992), l'Échelle abrégée d'évaluation psychiatrique (Lukoff et al., 1986; Ventura et al., 1993) et l'Échelle d'adaptation cybernétique (Edwards & Baglioni, 1993). Dans le premier article, les profils de personnalité et la stabilité temporelle des traits de personnalité des jeunes adultes présentant un premier épisode psychotique ont été étudiés. Les résultats révèlent différents profils de personnalité et une stabilité des traits de personnalité. Dans le second article, les profils de personnalité et la valeur prédictive des traits de personnalité ou des profils sur les résultats thérapeutiques ont été investigués. Les résultats révèlent aussi différents profils de personnalité, aucun spécifiquement lié aux symptômes. Aucun lien n'a pu être rapporté entre les traits de personnalité et l'amélioration symptomatologique. Toutefois, les traits de personnalité et les profils sont liés à l'amélioration des stratégies actives d'adaptation. Dans le dernier article, la valeur prédictive des traits de personnalité sur les résultats thérapeutiques selon le groupe de traitement spécifique a été étudiée. Les résultats démontrent un lien entre les traits de personnalité et l'amélioration symptomatologique et des stratégies d'adaptation selon le traitement. Les traits de personnalité sont particulièrement liés aux résultats thérapeutiques des stratégies actives d'adaptation. Cette thèse contribue à l'avancement des connaissances en se penchant sur l'importance des traits de personnalité dans le traitement psychosocial des jeunes adultes présentant un premier épisode psychotique et en soulignant la nécessité d'étudier davantage les différences individuelles de la personnalité de cette clientèle. Les implications cliniques des résultats et les recommandations pour la recherche sont présentées. / The aim of this thesis was to elucidate the link between personality traits based on the Five Factor Model of personality and therapeutic outcomes of two group treatments for first episode psychosis: cognitive behavior therapy and skills training for symptom management. One hundred and twenty-nine individuals with first episode psychosis were recruited to participate in a randomized controlled trial. Participants were randomized to one of two group treatments or to a wait-list control group. Measures pre- and post-treatment included the shorter version of the Revised NEO personality Inventory (Costa & McCrae, 1992), measures of Brief Psychiatric Rating Scale-Expanded (Lukoff et al., 1986; Ventura et al., 1993) and the shorter version of the Cybernetic Coping Scale coping strategies (Edwards & Baglioni, 1993). In the first article, personality profiles and stability over time of personality traits of individuals with a first episode of psychosis were investigated. Results showed that individuals with a first episode of psychosis present with different personality profiles. Moreover, personality traits of the first episodes showed stability over time. In the second article, personality profiles and predictive value of personality traits or profiles on therapeutic outcomes of treatments for first episode psychosis were investigated. Results revealed also different personality profiles, none specifically linked to psychotic symptoms. No links could be demonstrated between personality traits and symptom improvements but personality traits and profiles were linked to therapeutic improvements in active coping strategies. In the last article, predictive value of personality traits on therapeutic outcomes accordingly to specific group treatments for first episode psychosis was investigated. Results showed links between personality traits, symptoms and coping outcome measures, according to specific group treatments. Personality traits were particularly linked to therapeutic improvements in active coping strategies. In sum, this thesis contributed to the field of personality traits in those with a first episode psychosis by investigating the pertinence of personality traits in the choice of psychosocial treatments and highlighting the need for further study considering individual differences in psychosis. Clinical implications are discussed and recommendations for clinical research offered.