Encephale
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The use of psychoactive drugs by militaries is not compatible with the analytical skills and self-control required by their jobs. Military physicians take this problem into consideration by organising systematic drugs screening in the French forces. However, for technical reasons, opiates are not concerned by this screening with the agreement of the people concerned. The estimated number of militaries who use an opiate substitute may be an approach of heroin consumption in the French forces. This study describes buprenorphine and methadone reimbursements made during 2007 by the national military healthcare centre to French militaries. ⋯ In our observation, the military physician is almost always excluded the process of substitution. His/her different responsibilities of care, but also in determining the working aptitude, lead to dissimulation behaviour by the militaries. The difficulty for military physicians is to identify such consumption. They have to evaluate the capacity to work through a physical and psychological examination.
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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.
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The main objective of this study was to support the existence of emotional dimensions common to anxiety and depressive symptomatology, and confirm the common elements of emotional vulnerability, characterized by negative affectivity and alexithymia. The second objective of this study was the identification of characteristics specific to each disorder. We made three assumptions: there is a significant relationship between anxiety and depressive symptoms, exists on community processes between these two entities, objectified by the sub dimensions of negative affectivity and the difficulty in identifying emotions certain dimensions are specific to each disorder. ⋯ Our study reveals the existence of a "common nucleus of vulnerability" characterized by negative affectivity associated with difficulty identifying emotions. Specific dimensions nevertheless appear to exist, and depression is strongly explained by low positive affect (anhedonia dimension); anxiety associated specifically to emotional activation and finally thought outward, marking the size limitation. The imaginary life in alexithymia, appears to operate in depression, perhaps as a mechanism of emotional repression. The involvement of alexithymia in the functioning of the affective disorder is confirmed, this helps to clarify the modalities of therapeutic care that we offer.
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Comparative Study
[Recognition of facial emotions and theory of mind in schizophrenia: could the theory of mind deficit be due to the non-recognition of facial emotions?].
The deficits of recognition of facial emotions and attribution of mental states are now well-documented in schizophrenic patients. However, we don't clearly know about the link between these two complex cognitive functions, especially in schizophrenia. In this study, we attempted to test the link between the recognition of facial emotions and the capacities of mentalization, notably the attribution of beliefs, in health and schizophrenic participants. We supposed that the level of performance of recognition of facial emotions, compared to the working memory and executive functioning, was the best predictor of the capacities to attribute a belief. ⋯ Our results confirmed, in a sample of schizophrenic patients, the deficits in the recognition of facial emotions and in the attribution of mental states. Our new result concerned the demonstration that the performances in the recognition of facial emotions are the best predictor of the performances in the attribution of beliefs. With Marshall et al.'s model on empathy, we can explain this link between the recognition of facial emotions and the comprehension of beliefs.