Annie Lemoigne

Psychodynamic-oriented psychological assessment predicts evolution to schizophrenia at 8-year follow-up in adolescents hospitalized for a manic/mixed episode: Interest of an overall subjective rating

Little is known concerning the prognostic significance of manic/mixed episodes in adolescents. In particular, whether the use of psychodynamic-oriented projective psychological testing predicts evolution to schizophrenia at follow-up has not been established. Eighty subjects, aged 12-20years old, consecutively hospitalized for a manic or mixed episode between 1994 and 2003 were recruited. All patients were contacted in 2005-2006 for a follow-up assessment. For the subgroup of adolescents (N=40) who had psychodynamic-oriented psychological testing (Rorschach and TAT), two scores regarding psychosocial risk and schizophrenia risk were computed using the clinical global impression (CGI) assessment based on an overall subjective rating given by a panel of expert psychologists who reviewed all protocols. At follow-up (average 8years), 25 (62.5%) patients, 16 females and nine males, were assessed: 14 still had a diagnosis of bipolar disorder; eight changed to schizo-affective disorder and three to schizophrenia. Inter-rater reliability of both CGI-risk scores (psychosocial risk and schizophrenia risk) showed good clinical consensus with intraclass correlation and Kappa scores ranging from 0.53 to 0.75. Univariate analysis showed that CGI-psychosocial risk score (p=0.017), type of index episode (p=0.049) and CGI-schizophrenia risk score (p=0.09) were associated with transition to schizophrenia spectrum disorder at follow-up. Age, sex, socioeconomic status, duration of stay and the presence of psychotic features at index episode were not associated with the transition. We conclude that the CGI assessment appears to be valid to score risk of poor outcome using psychodynamic-oriented psychological testing and that these scores may predict, in part, the transition to schizophrenia in adolescents with a history of manic/mixed episode.

Narcissisme et fonctionnements limites à l'adolescence à travers l'étude du TAT

A partir de l’etude approfondie de deux protocoles de TAT d’adolescents qui presentent un fonctionnement limite, les auteurs se proposent d’en degager les modalites defensives et les problematiques en utilisant la feuille de depouillement du Nouveau manuel du TAT (ed. 2003). En s’etayant sur les procedes CN (Investissement narcissique) et CL (Instabilite des limites), les auteurs se sont interroges sur l’expression des problematiques de perte d’objet et leur articulation avec le narcissisme. Les qualites du narcissisme leur ont paru un point nodal pour degager differentes modalites de fonctionnement limite.

Un fonctionnement limite à l'adolescence: Ou comment la représentation de l'acte peut se substituer à la représentation de la perte d'objet

ResumeL’analyse du TAT d’une adolescente de 16 ans deprimee et presentant des troubles obsessionnels compulsifs est centree sur l’articulation entre perception et fantasme au cours de l’elaboration des recits. L’analyse du Rorschach apporte un eclairage complementaire sur le systeme defensif actuellement mis en place par cette adolescente.