Catherine Bungener

Affect dysregulation in cannabis abusers

Psychiatric comorbidity and impaired emotional functioning have been previously reported in adult substance abusers but have been less well documented in adolescents. Thus, we investigated mental health problems and emotion regulation abilities in adolescents and young adults with cannabis dependence. Moreover, we explored the relationships between consumption modalities and affective style. Therefore, 32 cannabis abusers (CA) and 30 healthy controls completed a battery of self-reports measuring depression (BDI-13), anxiety (STAI-Y), alexithymia (TAS20; BVAQ-B), anhedonia (PAS; SAS), and sensation seeking (SSS). The MINI was administered to evaluate cannabis dependence and axis I DSM-IV comorbid diagnoses. A semi-structured clinical interview was given to determine psychoactive substance use. Statistical analyses revealed that more than half of the CA reported at least one other non-drug or alcohol comorbid diagnosis. The most common were mood and anxiety disorders. CA subjects scored significantly higher on all affective dimensions except alexithymia total scores; however, they had greater scores for the two subscales measuring the difficulties in identifying feelings. Logistic regressions demonstrated that CA subjects were more likely to experience high levels of trait anxiety, physical anhedonia and sensation seeking than the controls. Various correlations were observed between the affective scores and the substance considered. The amount of substance use and, particularly, the prevalence of polydrug use we observed are alarming. This study demonstrates that cannabis dependence in adolescents and young adults is related to a great psychological distress and specific emotional dimensions and puts emphasis on the importance of substance use prevention as early as middle school.

Affective disturbances in Alzheimer's disease.

To evaluate the emotional disturbances in patients with Alzheimers disease (AD) using both a categorical and a dimensional approach.

Pathological gambling and sensation seeking–How do gamblers playing games of chance in cafés differ from those who bet on horses at the racetrack?

The purpose of this study was to study the sensation seeking personality trait in two groups of French pathological gamblers: one group who play games available in cafés (n = 57) and one group who bet on horses at the racetrack (n = 42). Sensation seeking was measured with the Zuckermans Sensation Seeking Scale; intensity of gambling behavior with the South Oaks Gambling Screen and the DSM-IV criteria of pathological gambling. Pathological gamblers who bet at the racetracks had significantly higher scores on Sensation Seeking than those who play games available in cafés. These findings are consistent with the idea of identifying clinically distinct subgroups of gamblers essential in the treatment pathological gambling. One subtype is made of those who play “active” games who gamble for the arousal produced by the game. The second subtype would be one made up of those who play “passive” games who gamble to avoid unpleasant emotional states.

Quality of life in relation to mood, coping strategies, and dyskinesia in Parkinson's disease.

Given the variability of the results found in the literature, the current study is a step toward better clarifying the influence of motor and nonmotor factors on quality of life in Parkinsons disease. A total of 135 participants with Parkinsons disease were selected. Semistructured interviews were carried out, after which their mental and cognitive states were assessed using different scales (MINI, MADRS, EHD, HAMA). Finally, all participants completed 3 self-report questionnaires: 2 assessing coping strategies (WCC, CHIP) and 1, quality of life (Parkinsons disease questionnaire-39). It appears that the presence of dyskinesia, depression, and anxiety were linked to a poor quality of life. Interestingly, some different coping strategies, namely diversion as well as emotional strategies, were associated with a poor quality of life. These results encourage us to develop interventions focused on coping strategies and tailored to the emotional and clinical characteristics of each patient.

Psychopathology in amyotrophic lateral sclerosis: A preliminary study with 27 ALS patients

Considering the few studies published on the psychopathology of ALS patients, we carried out a preliminary study evaluating depression, anxiety, emotional reactions and coping strategies in such patients. Twenty‐seven ALS patients were included and evaluated using a semi‐structured interview, after which they were asked to complete a questionnaire. The rater asessed the DSM‐IV criteria for a major depressive episode, dysthymia and generalized anxiety, using the MADRS scale for depression, the Covi anxiety scale and the Depressive Mood scale. Subsequently, patients completed the Ways of Coping checklist. Patients were neither anxious nor depressed. Patients whose diagnosis was recent (less than six months) presented greater emotional deficit. Patients younger than 50 years of age used problem focused strategies more frequently. Those having received the diagnosis in the preceeding six months used emotion focused strategies significantly more often.The absence of characterized depression and anxiety confirmed results of the literature. The significance of this study is found in the observation of specific emotional reactions present in the first six months following diagnosis disclosure. The results show that it is useful to continue the affective evaluation of these patients and to undertake longitudinal studies starting at the time of diagnosis disclosure.

Coping and quality of life of patients with Parkinson disease who have undergone deep brain stimulation of the subthalamic nucleus

BACKGROUND Although the positive effect of DBS of the STN on motor signs and mobility in PD is indisputable, the effect on mental health (depression and anxiety) as well as on QoL is subject to more debate. Some works have already shown that coping strategies have an impact on QoL, depression, and anxiety. To date, no studies have examined the coping strategies used by patients with PD who undergo STN stimulation. We decided to investigate the coping strategies of patients with PD who have undergone an STN DBS and their relationship with QoL while taking depression and anxiety into account. METHODS A total of 40 patients stimulated for 12 months and 40 patients under dopatherapy were compared. The 2 groups were matched according to age, sex, age at disease onset, severity of disease, motor scores, daily treatment dosage, and professional status. Semistructured interviews were carried out, after which, their mental and cognitive states were assessed using different scales (MINI, MADRS, EHD, HAMA, FAB). Finally, all subjects completed 3 self-report questionnaires: 2 assessing coping strategies (WCC, CHIP), and 1, QoL the Parkinson Disease Questionnaire (PDQ-39). RESULTS Depression and anxiety were not significantly influenced by the type of treatment. Concerning coping strategies, we found a significant effect of the stimulation on instrumental strategies with higher scores for patients under dopatherapy. As for QoL, the only difference concerned communication with a poorer QoL for stimulated patients. We noted no significant correlations between any coping strategies and all of the dimensions of QoL in the stimulated group, whereas we found the opposite result for the dopatherapy group. CONCLUSIONS These results encourage us to prepare patient candidates for such stimulation by developing interventions focused first on their expectations and second, on their coping strategies.

Coping Strategy and Anxiety Evolution in Multiple Sclerosis Patients Initiating Interferon-Beta Treatment

This study (ACSEPT) aimed to assess anxiety evolution according to coping strategy in patients with multiple sclerosis (MS) during their first months of treatment with interferon (IFN)-β1a. Recently diagnosed relapsing-remitting MS (RRMS) patients (n = 255) were included and received standardized information on MS. At inclusion, the preferred coping mode was determined using the Coping Inventory for Stressful Situations (CISS). Anxiety and depression were assessed at inclusion and after 3 months using the Spielberger State-Trait Anxiety Inventory and the Beck Depression Inventory, respectively. At inclusion, the preferred coping strategy was task-oriented for most patients (53%), 51% were considered as anxious, and the mean Beck depression score was low. Emotion-oriented patients were more anxious and more depressed than the 2 other coping groups (task- and avoidance-oriented). During the first 3 months of IFN treatment, the anxiety level slightly decreased in the total population, more intensively in the emotion-oriented group, and there were no clinically significant changes in the Beck depression score. Anxiety and depression remained stable or decreased during the first 3 months of IFN treatment, depending on coping strategy. Identifying these coping strategies during therapy initiation may allow customized support and improve treatment adherence.

Individual psychology of risk-taking behaviours in non-adherence

This paper presents some theoretical considerations based on the theories of risk about non-adherence in the field of health care. Traditional models as the Health Belief Model and the Theory of Reasoned Action are presented and criticized. In order to enable the use of other theoretical frameworks, it is argued that non-adherence can be studied within the general frame of risk-taking. The behavioural decision theory is presented and it is argued that cognitive biases like unrealistic optimism play a major role in non-adherence as in risk-taking. It is also argued that these cognitive biases depend on self-related motivation factors. Results of a pilot study involving 16 patients are presented. These results only partly support the theoretical analysis and underline that it would be necessary to take mood factors into consideration in further research.

Cognitive and emotional deficits in early stages of HIV infection : An event-related potentials study

1. In order to inventory different Event-Related Potentials (ERP) modifications in HIV-infection the authors have evaluated 23 HIV-positive subjects and 12 HIV-negative subjects. ERP were recorded during an auditory oddball task. 2. Electrophysiological results showed that the latency of the N100 component of the ERP was significantly increased in HIV-positive subjects compared to the HIV-negative subjects. The latency of the N200 component of the ERP showed a similar tendency which just failed to reach significance when considering HIV-positive subjects vs HIV negative subjects. This result was in agreement with the literature which reported increased latencies in HIV infection. 3. Considering all subjects the authors have observed a correlation between the amplitude of the P300 and the emotional deficit. This correlation was stronger in subjects who presented an emotional deficit and was independent of any other psychopathological symptom. 4. The use of ERP appeared to be a sensitive technique to detect subclinical manifestations in HIV asymptomatic subjects and therefore would help to identify subjects at higher risk for developing cognitive impairments.

Loss of control of pre-motor activation in anxious agitated and impulsive depressives. A clinical and erp study

1. Current research uses a variety of traditional validation methods in order to test the clinical expression of biological models in psychiatry. The application of these methods has resulted in a paradoxical situation which requires the definition of new objectives in biological and pharmacoclinical research: the biological specificity of new psychotropic drugs does not assume any congruence between their pharmacological and their therapeutic effects, but raises the question of the relationship between biological systems and clinical symptomatology. The dimensional description of psychopathological disorders may be more appropriate to biological studies in psychiatry. 2. A study was undertaken on a population of twenty-one in-patients fulfilling the DSM III-R criteria for major depressive episode. They were divided into two groups on the basis of contrasting clinical dimensions: anxious-agitation and impulsiveness versus retardation and affective blunting. 3. Significant clinical differences between the two groups on mood profiles were echoed by contrasts in event-related potentials during a go-nogo task: only anxious agitated and impulsive patients developed an abnormal cortical activity, as measured by contingent negative variation (CNV), in the nogo condition. 4. This paper suggests how a paradigm with control of motor action leads to specify premotor activation abnormalities in the agitated impulsive depression subtype.