Ce travail de thèse s’inscrit dans une approche dimensionnelle de la psychopathologie et son objectif est d’apporter de nouvelles connaissances au champ de recherche qui considère l’existence d’un continuum entre schizophrénie et trouble bipolaire ainsi qu’entre traits de personnalité et pathologies. Afin d’explorer ces continuums, nous avons étudié, grâce à la méthode des potentiels évoqués cognitifs et l’étude de certaines de leurs composantes (N400, LPC), les processus neurocognitifs sous-tendant l’intégration d’un contexte sémantique et sémantico-émotionnel dans la schizophrénie, le trouble bipolaire, les traits de personnalité schizotypique et les traits de personnalité hypomaniaque. Premièrement, nous avons montré, que les patients schizophrènes stabilisés et les patients bipolaires euthymiques présentent des patterns de modulation de la N400 différents lors de tâches impliquant l’intégration d’un contexte sémantique ou sémantico-émotionnel. Néanmoins, ces résultats en défaveur de l’existence d’un continuum entre schizophrénie et trouble bipolaire pourraient être la conséquence de l’absence de symptomatologie commune entre nos deux échantillons de patients. Deuxièmement, les résultats des études portant sur la population pathologique et ceux des études portant sur la population générale présentant des traits de personnalité semblent en faveur de l’existence d’un continuum entre population générale et pathologie. En effet, les personnes présentant des traits de personnalité hypomaniaque présentent des similitudes dans les atteintes des processus neurocognitifs sous-tendant l’intégration d’un contexte sémantique et sémantico-émotionnel avec les patients bipolaires, et les personnes présentant des traits de personnalité schizotypique présentent des similitudes dans les atteintes des processus neurocognitifs sous-tendant l’intégration d’un contexte sémantico-émotionnel avec les patients schizophrènes. L’ensemble de nos résultats associés à ceux de la littérature semblent en faveur d’une approche dimensionnelle de la psychopathologie bipolaire et schizophrénique où les symptômes, davantage que le diagnostic, doivent être envisagés comme le point central du continuum. / This work is part of a dimensional approach of the psychopathology. Its goal is to bring new knowledge to the field of research that considers the existence of a continuum between schizophrenia and bipolar disorder as well as between personality traits and pathologies. In order to explore these continuums, we have studied, thanks to event-related potential method and the study of N400 and LPC components, neurocognitive processes involved in the integration of semantic and semantico-emotional context in schizophrenia, bipolar disorder, schizotypal personality traits and hypomanic personality traits. We have first demonstrated that stabilized schizophrenic patients and euthymic bipolar patients have different patterns of the N400 modulation during tasks involving semantic and semantico-emotional integration. However, these results against the existence of a continuum between schizophrenia and bipolar disorder could be due to the lack of common symptoms in both samples. Secondly, the results of our studies dealing with clinical population and those dealing with general population with personality traits seem to be in favor to the existence of a continuum between general population and pathology. As a matter of fact individuals with hypomanic personality traits have similitude with bipolar patients in disturbance in neurocognitive processes involved in the integration of semantic and semantico-emotional context. Furthermore, individuals with schizotypal personality traits have common difficulties with schizophrenic patients in neurocognitive processes involved in semantico-emotional context integration. The results of our investigation, combined with those in the literature, are in favor of a dimensional approach of schizophrenic and bipolar psychopathology. And this approach is more about considering the symptoms as the central point of the continuum rather than the diagnostic.

Background: Behavioral disturbances following chemotherapy with cisplatin are rare. Here, we report a patient with temporary loss of moral behavior in the setting of cisplatin-based chemotherapy for treatment of tonsillar cancer. Case presentation: A 66-year-old Caucasian male with no psychiatric or violent history was started on chemotherapy with cisplatin for treatment of tonsillar cancer. During the following weeks, the patient developed profound personality changes involving volatile emotions and impulsive aggression with verbal and physical assaults on others. Admitted to the hospital, the patient lacked any awareness that his behavior was wrong. Chemotherapy was discontinued and the patient was prescribed risperidone. Aside from mild cognitive impairment, comprehensive neuropsychological, neuroradiological and lab testing were unremarkable. Three weeks following cessation of chemotherapy, the patient had recovered to his original mental state and he was completely aware of his wrongdoing and social misconduct. Conclusion: Since neurotoxic effects of chemotherapeutics on the brain are not yet sufficiently elucidated, our case emphasizes that early signs of behavioral abnormalities in patients receiving chemotherapy should trigger comprehensive psychiatric evaluation and ongoing monitoring of the patients’ mental state.

Background: Bipolar disorders (BD) are among the most severe mental disorders with first clinical signs and symptoms frequently appearing in adolescence and early adulthood. The long latency in clinical diagnosis (and subsequent adequate treatment) adversely affects the course of disease, effectiveness of interventions and health-related quality of life, and increases the economic burden of BD. Despite uncertainties about risk constellations and symptomatology in the early stages of potentially developing BD, many adolescents and young adults seek help, and most of them suffer substantially from symptoms already leading to impairments in psychosocial functioning in school, training, at work and in their social relationships. We aimed to identify subjects at risk of developing BD and investigate the efficacy and safety of early specific cognitive-behavioural psychotherapy (CBT) in this subpopulation. Methods/Design: EarlyCBT is a randomised controlled multi-centre clinical trial to evaluate the efficacy and safety of early specific CBT, including stress management and problem solving strategies, with elements of mindfulness-based therapy (MBT) versus unstructured group meetings for 14 weeks each and follow-up until week 78. Participants are recruited at seven university hospitals throughout Germany, which provide in- and outpatient care (including early recognition centres) for psychiatric patients. Subjects at high risk must be 15 to 30 years old and meet the combination of specified affective symptomatology, reduction of psychosocial functioning, and family history for (schizo)affective disorders. Primary efficacy endpoints are differences in psychosocial functioning and defined affective symptomatology at 14 weeks between groups. Secondary endpoints include the above mentioned endpoints at 7, 24, 52 and 78 weeks and the change within groups compared to baseline; perception of, reaction to and coping with stress; and conversion to full BD. Discussion: To our knowledge, this is the first study to evaluate early specific CBT in subjects at high risk for BD. Structured diagnostic interviews are used to map the risk status and development of disease. With our study, the level of evidence for the treatment of those young patients will be significantly raised.

This study explored the Object Relations of a sample of 45 subjects who were using alcohol and were diagnosed with co-morbid Depressive or Bipolar disorders and/or Personality disorders. All subjects were receiving treatment at a government psychiatric hospital in South Africa. The similarities and differences in the Object Relations of these individuals were identified. A biographical questionnaire, the Alcohol Use Disorder Test (AUDIT), which was used as a screening measure, and the Bells Object Relations and Reality Testing Inventory (BORRTI) were administered to obtain information from a purposive sample. Descriptive and inferential statistics were used to analyse the results of the assessment measures. Analysis of the BORRTI data indicated a high rate of depressive and personality disorders within this sample. Results of the sub-sample (n=29) whose scores were included in the Pearson’s Correlation Coefficient analysis indicate that higher levels of alcohol consumption result in increased levels of hallucinations and delusions. Other correlations were identified between high levels of alcohol consumption and heightened levels of reality distortions and more uncertainty in the perceptions of these individuals. Significant differences in the scores of the male and female participants were identified. With the female participants, the higher the level of alcohol consumption, the lower the individuals scored in terms of pathological levels of egocentricity, uncertain perceptions, insecure attachments, alienation, social incompetence as well as hallucinations and delusions. Alternatively, in the male sample, higher levels of alcohol consumption result in increased hallucinations and delusions, reality distortions, uncertainty in perceptions, alienation, social incompetence and egocentricity. / Psychology / M.A. (Research Psychology)

Background: Bipolar disorders (BD) are among the most severe mental disorders with first clinical signs and symptoms frequently appearing in adolescence and early adulthood. The long latency in clinical diagnosis (and subsequent adequate treatment) adversely affects the course of disease, effectiveness of interventions and health-related quality of life, and increases the economic burden of BD. Despite uncertainties about risk constellations and symptomatology in the early stages of potentially developing BD, many adolescents and young adults seek help, and most of them suffer substantially from symptoms already leading to impairments in psychosocial functioning in school, training, at work and in their social relationships. We aimed to identify subjects at risk of developing BD and investigate the efficacy and safety of early specific cognitive-behavioural psychotherapy (CBT) in this subpopulation. Methods/Design: EarlyCBT is a randomised controlled multi-centre clinical trial to evaluate the efficacy and safety of early specific CBT, including stress management and problem solving strategies, with elements of mindfulness-based therapy (MBT) versus unstructured group meetings for 14 weeks each and follow-up until week 78. Participants are recruited at seven university hospitals throughout Germany, which provide in- and outpatient care (including early recognition centres) for psychiatric patients. Subjects at high risk must be 15 to 30 years old and meet the combination of specified affective symptomatology, reduction of psychosocial functioning, and family history for (schizo)affective disorders. Primary efficacy endpoints are differences in psychosocial functioning and defined affective symptomatology at 14 weeks between groups. Secondary endpoints include the above mentioned endpoints at 7, 24, 52 and 78 weeks and the change within groups compared to baseline; perception of, reaction to and coping with stress; and conversion to full BD. Discussion: To our knowledge, this is the first study to evaluate early specific CBT in subjects at high risk for BD. Structured diagnostic interviews are used to map the risk status and development of disease. With our study, the level of evidence for the treatment of those young patients will be significantly raised.

The aim of the research was to explore perceived stigmatization of People with Bipolar Disorder to deepen the knowledge for Glocal Social Work Practice by means of an Interview and Literature Study. The data of the research was gathered from the perspective of people with bipolar diagnosis and a peer within the field, about whether stigma is experienced by people with bipolar disorder and how their resilience factors i.e. strength factors can be supported and enhanced. A qualitative study was conducted with the purpose of expanding the evidence-based knowledge base by exploring how people with bipolar disorder with resilience experienced stigmatization, and the factors that supported their resilience versus inhibited their resilience in their adversity. The research results were analyzed through literature reviews and interviews to gain an in-depth knowledge of the phenomena. The findings indicated that stigma was experienced by the people with bipolar disorder, and was experienced as affecting recovery negatively, creating reluctance to seek help and adding more stress factors. It was mentioned that a healthy social network for support (spouses, relatives, friends andprofessionals) i.e. inclusion along with an active lifestyle, defined goals in life andpurpose, spirituality, nature, faith and hope for a better tomorrow assisted in building and cementing resilience. The findings also indicated that education and anti-stigmainterventions helped in establishing better attitudes revolving around mental illness, especially interventions with personal encounters with people with mental illness.

The aim of the research was to explore perceived stigmatization of People with Bipolar Disorder to deepen the knowledge for Glocal Social Work Practice by means of an Interview and Literature Study. The data of the research was gathered from the perspective of people with bipolar diagnosis and a peer within the field, about whether stigma is experienced by people with bipolar disorder and how their resilience factors i.e. strength factors can be supported and enhanced. A qualitative study was conducted with the purpose of expanding the evidence-based knowledge base by exploring how people with bipolar disorder with resilience experienced stigmatization, and the factors that supported their resilience versus inhibited their resilience in their adversity. The research results were analyzed through literature reviews and interviews to gain an in-depth knowledge of the phenomena. The findings indicated that stigma was experienced by the people with bipolar disorder, and was experienced as affecting recovery negatively, creating reluctance to seek help and adding more stress factors. It was mentioned that a healthy social network for support (spouses, relatives, friends andprofessionals) i.e. inclusion along with an active lifestyle, defined goals in life andpurpose, spirituality, nature, faith and hope for a better tomorrow assisted in building and cementing resilience. The findings also indicated that education and anti-stigmainterventions helped in establishing better attitudes revolving around mental illness, especially interventions with personal encounters with people with mental illness. / <p>Godkända - Studie resultat: D</p>

Background: Research suggests that a low omega-3 index may contribute to the low heart rate variability and the increased risk of cardiovascular morbidity and mortality in bipolar disorders. However, so far, no intervention trial with EPA and DHA has been conducted in bipolar patients attempting to increase their heart rate variability. - Methods: 119 patients with bipolar disorder according to DSM-IV were screened, with 55 euthymic bipolar patients—owing to inclusion criteria (e.g. low omega-3 index (< 6%), SDNN < 60 ms.)—being enrolled in a randomized, double-blind, 12-week parallel study design with omega-3 fatty acids (4 capsules of 530 mg EPA, 150 mg DHA) or corn oil as a placebo, in addition to usual treatment. Heart rate variability as well as the omega-3 index were measured at baseline and at the endpoint of the study. - Results: A total of 42 patients (omega-3: n = 23, corn oil: n = 19) successfully completed the study after 12 weeks. There was a significant increase in the omega-3 index (value at endpoint minus value at baseline) in the omega-3 group compared to the corn oil group (p < 0.0001). However, there was no significant difference in the change of the SDNN (value at endpoint minus value at baseline) between the treatment groups (p = 0.22). In addition, no correlation between changes in SDNN and change in the omega-3 index could be detected in the omega-3 group (correlation coefficient = 0.02, p = 0.94) or the corn oil group (correlation coefficient = − 0.11, p = 0.91). Similarly, no significant differences between corn oil and omega-3 group regarding the change of LF (p = 0.19), HF (p = 0.34) and LF/HF ratio (p = 0.84) could be demonstrated. - Conclusions: In our randomized, controlled intervention trial in euthymic bipolar patients with a low omega-3 index and reduced heart rate variability no significant effect of omega-3 fatty acids on SDNN or frequency-domain measures HF, LF and LF/HF ratio could be detected. Possible reasons include, among others, the effect of psychotropic medication present in our trial and/or the genetics of bipolar disorder itself. Further research is needed to test these hypotheses.