Encephale
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Why are some individuals more likely than others to develop a posttraumatic stress disorder (PTSD) in the face of similar levels of trauma exposure? Monitoring the traumatic process combining the antecedents, the determinants of the psychic trauma and the acute symptoms can clarify the causes of the final onset of a chronic repetition syndrome. Epidemiologic research has clarified risk factors that increase the likelihood of PTSD after exposure to a potentially traumatic event. PTSD is an interaction between a subject, a traumatogenic factor and a social context. With each epidemiological, psychopathological and more particularly neurogenetic study, we will expand on the impact of these interactions on the therapeutic treatment of psycho-traumatised persons. ⋯ Chronic PTSD can manifest itself in different clinical forms. The repetition syndrome can appear a long time after the traumatic event, following a paucisymptomatic latency period, which can last several years or even decades. The absence of complaints from the patient is common, the latter suffering in silence. Often other comorbid disorders and other complaints arise sooner than the clinical picture. Thus a depressive episode characterised as drug-seeking behaviour is frequently encountered. The therapeutic accompaniment traditionally combines a pharmacological and a psychotherapeutic treatment even if recommendations are rare. A posttraumatic stress disorder is never just a coincidence. The different stages of the evolution and the establishment of a PTSD are the expression of an interaction between the outside and the inner self. Despite a known progression of the posttraumatic stress disorder, this deleterious evolution is far from being a foregone conclusion. On the contrary, several levels of prevention are possible at each stage of its structuration to propose treatments to subjects who are vulnerable and/or present symptoms. No neurobiological study has yet found a biological marker, which would apparently and inevitably destine a subject to structure, a posttraumatic stress disorder in reaction to a stress. Conversely, the psychopathological study finds afterwards that a particular subject has necessarily built a traumatic repetition syndrome according to the concordance of significant data relative to his/her history. The event strikes a repression or an anterior biographical deadlock and of which the thematic questions the fundamentals of human culture in its emancipation with nature, like the question of death and its consequences: bereavement, parentality, transgenerational transmission and organicity often linked to the illness. A therapeutic proposal constitutes an environmental factor par excellence which can be either protective or deleterious. If the traumatic repetition syndrome has been known since Antiquity, the birth of PTSD has followed the chronology of the DSM according to the sociopolitical contexts encountered. A PTSD does not occur by chance: the conditions of possibility of the trauma are established by genetic and psychological determinants interactively integrated at the heart of a social context. After the increase in a psychotraumatic interest in international publications since the 1980s, a fight against over-victimisation seems to be setting in. The advances in genetic and neuroimaging techniques are in the process of superseding psychometric studies in terms of reliability and validity; maybe we should see in this social evolution the changes of tomorrow concerning the clinical of PTSD and its treatment. The healing of the psycho-traumatised subject cannot just be established on the passive status of victim, which would be detrimental to reflection and ultimately reconstruction: the rebirth of the subject will require active commitment, which could distract from the deadly repetition. Whilst the confrontation with death resembled nonsense, the subject will question the psychotraumatic determinants of his/her life history to reinstate this tragic event within a search for meaning. Such restructuring is built on the intersubjectivity of the clinical relationship, which occurs within a social context. PTSD is a pathology which interacts with the societal context: on the one hand the trauma is established on the brutal reconsideration of social values which seem immutable and on the other hand, the clinical and nosographical concept of PTSD is changing with the evolution of society.
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The study of children's personality and its development has generated several theoretical models in psychology. In a developmental approach, Buss and Plomin elaborated a genetic model of temperament that involves four dimensions: emotionality (refers to the negative quality of the emotion and the intensity of the emotional reactions), activity (intensity and frequency of a person's energy output in motor movements and speech), sociability (search for social relationships and preference for activities with others) and shyness (behavioural inhibition and feelings of distress when in interaction with strangers). The psychobiological approach postulates a biological model of personality. Thus, in Gray's first model, there are two brain systems that explain behaviours: the Bbehavioural Activation System (BAS) related to impulsivity and the Behavioural Inhibition System (BIS) linked to anxiety. Finally, dispositional theories seek to identify functional units of the normal personality from the factorial approach. Accordingly, Barbaranelli et al. build a questionnaire, the big five questionnaire for children (BFQ-C), which is intended to estimate the emergence of five fundamental dimensions (energy/extraversion, agreeableness, conscientiousness, emotional instability and intellect/openness) in children from 8 to 18 years. The clinical study we will present concerns the personality of children suffering from attention-deficit hyperactivity disorder (ADHD). STUDY 1: ⋯ It is interesting to note that children have a less stable representation of their own temperament as compared to the evaluation of their parents. This study replicates the findings of previous research on adults with ADHD regarding neuroticism (emotional instability), but contrary to findings in adults with ADHD, children obtained elevated scores on the conscientiousness and agreeableness subscales. In accordance with our hypotheses, children with ADHD could be distinguished from control participants on the BAS, particularly for the drive and reward responsiveness subscales. Furthermore, they also obtained higher scores on the extraversion subscale of the BFQ-C and the on the EAS activity subscale.
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A positive link between alexithymia and delinquency, as well as a negative link between alexithymia and emotional intelligence, has already been demonstrated. Previous studies have highlighted that emotional intelligence is associated with antisocial behaviour. Even though the frequency of alexithymia has been explored in non-clinical samples of adolescents, the relationship between alexithymia and delinquency has not been studied in community samples of adolescents. Furthermore, the link between alexithymia, emotional intelligence and interpersonal delinquency has never been explored in such a sample. The aim of the current study was to explore the relationship between alexithymia, emotional intelligence and interpersonal delinquency in a sample of high-school students. ⋯ Our findings suggest the importance of taking into account the emotional dimensions in the care of teenagers presenting antisocial behaviours. It appears of prime importance to lead young people presenting antisocial behaviours to identify their feelings.
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Dysphagia is a common symptom in the general population, and even more among psychiatric patients, but rarely seen as a sign of seriousness. It is a cause of death by suffocation, and more or less serious complications, and therefore should be diagnosed and treated. Among psychiatric patients, organic and iatrogenic aetiologies, as well as risk factors are identified, which worsen this symptom when associated. It is now accepted that neuroleptics can aggravate or cause dysphagia. They act by several pathophysiological ways on the different components of swallowing, which can be identified by dynamic tests in the upper aerodigestive tract endoscopy. ⋯ The swallowing disorder caused by neuroleptics may occur regardless of the molecule or drug class to which it belongs. It can be found even in the absence of any other neurological signs. It is important to search for the aetiological diagnosis for treatment. At the crossroads of several specialties, swallowing disorders are difficult to diagnose and treat. They are frequently underestimated, partly because patients rarely complain. In our case report, the diagnosis was ascertained by the removal of the medication, without functional evidence, probably by a lack of collaboration between the physician and the endoscopist who had not performed any dynamic investigation of swallowing. This case illustrates the importance of knowing the different mechanisms underlying dysphagia in psychiatric patients, and good communication with gastroenterologists to establish a precise diagnosis of the disorder, and adapt the therapy.
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Personality and its disorders have been the subject of many studies in philosophy, psychology or medicine. Current nosology gives preference to categorical classifications, but a dimensional approach may also be considered. Supported by Cloninger's psychobiological model, it refers to concepts of temperament (novelty seeking, reward dependence, harm avoidance and persistence) and character dimensions (self-directedness, cooperativeness and self-transcendence). Categorical and dimensional approaches do not appear antinomic, and the PerCaDim study tries to verify the hypothesis of correlations existing between them. ⋯ These results confirm previous findings that Cloninger's dimensions can objectify personality disorders. Few dimensions of the Temperament and Character Inventory can be considered as vulnerability factors. The use of the Temperament and Character Inventory will most certainly be of good help in the future to detect or prevent a personality disorder in some subjects at risk.