Khadija Chahraoui

Emotional Factors and Subjective Quality of Life in Subjects with Spinal Cord Injuries

Bénony H, Daloz L, Bungener C, Chahraoui K, Frenay C, Auvin J: Emotional factors and subjective quality of life in subjects with spinal cord injuries. Am J Phys Med Rehabil 2002;81:437–445. Objective To compare depression, subjective perception of quality of life, and social support in patients with spinal cord injuries 4 yr or more after trauma vs. controls. Design The Rorschach inkblot method, the Diagnostic Interview Schedule Self-Administered, the Progressive Matrix 38, the Social Support Appraisals, and the Subjective Quality of Life Profile were used to assess 33 patients with spinal cord injuries and 33 matched controls. Results No significant difference was observed for levels of general intelligence and depressive disorders. Subjects with spinal cord injuries assessed the general subjective quality of life as satisfactory, with exceptions for sexuality, physical condition, leisure activities, and holidays. A high degree of satisfaction with medical staff and inward life was observed. Social support was perceived as positive. However, they presented emotional distress, deteriorating perceptions, extreme preoccupation with their bodies, and diffuse anxiety. Conclusion Although quality of life as evaluated by the persons concerned was good, areas of their lives remained unsatisfactory and a source of mental suffering. The next stage would study the factors involved and the means needed to help these subjects improve these aspects of life.

Error in intensive care: psychological repercussions and defense mechanisms among health professionals.

Objective: To identify the psychological repercussions of an error on professionals in intensive care and to understand their evolution. To identify the psychological defense mechanisms used by professionals to cope with error. Design: Qualitative study with clinical interviews. We transcribed recordings and analysed the data using an interpretative phenomenological analysis. Setting: Two ICUs in the teaching hospitals of Besançon and Dijon (France). Subjects: Fourteen professionals in intensive care (20 physicians and 20 nurses). Interventions: None. Measurements and Main Results: We conducted 40 individual semistructured interviews. The participants were invited to speak about the experience of error in ICU. The interviews were transcribed and analyzed thematically by three experts. In the month following the error, the professionals described feelings of guilt (53.8%) and shame (42.5%). These feelings were associated with anxiety states with rumination (37.5%) and fear for the patient (23%); a loss of confidence (32.5%); an inability to verbalize one’s error (22.5%); questioning oneself at a professional level (20%); and anger toward the team (15%). In the long term, the error remains fixed in memory for many of the subjects (80%); on one hand, for 72.5%, it was associated with an increase in vigilance and verifications in their professional practice, and on the other hand, for three professionals, it was associated with a loss of confidence. Finally, three professionals felt guilt which still persisted at the time of the interview. We also observed different defense mechanisms implemented by the professional to fight against the emotional load inherent in the error: verbalization (70%), developing skills and knowledge (43%), rejecting responsibility (32.5%), and avoidance (23%). We also observed a minimization (60%) of the error during the interviews. Conclusions: It is important to take into account the psychological experience of error and the defense mechanisms developed following an error because they appear to determine the professional’s capacity to acknowledge and disclose his/her error and to learn from it.

Vécu psychologique des soignants en réanimation : une étude exploratoire et qualitative

OBJECTIVES Study the subjective and emotional experience of health care professionals in intensive care unit in front of sources of professional stress connected to the emergency and to the gravity of the pathologies of hospitalized patients. PATIENTS AND METHODS A clinical interview was proposed to health care professionals of an intensive care unit during which they had to develop their personal feeling about the organization of the work and their management of the most stressful emotional situations. All interviews were entirely recorded and rewritten. Then, they were the object of a procedure of coding and a thematic analysis was detailed with the consensus of several individuals. RESULTS Eighteen professionals agreed to participate in this research. The analysis of these clinical interviews showed a strong feeling of pressure in works as being mainly focused on the necessity of control the procedures and the technical means involved in intensive care unit and in the strong emotional load due to deaths of patients and to the pain of families. The management of the death and its conditions appears as a major and central difficulty. CONCLUSION The discussion approaches the question of the feeling of pressure at works and its various items by underlining the interpersonal variations of these experiences, then the question of the emotional adaptation through the individual and collective defensive strategies organized to cope with these various situations.

Longitudinal study of alexithymia and multiple sclerosis

The aim of this study was to investigate the course of alexithymia and its relation with anxiety and depression in patients with multiple sclerosis (MS), over a period of 5 years.

Prevalence and determinants of post-traumatic stress disorder, anxiety and depression symptoms in street children survivors of the 2010 earthquake in Haiti, four years after

Working with street children and adolescents who lived through the 2010 earthquake in Port-au-Prince, this paper aims to assess the prevalence of symptoms of PTSD, anxiety and depression in relation to peritraumatic distress, and age, and to explore other risk factors and socio-demographic characteristics, four years after the events. Between March and June 2014, with a sample of 128 children and adolescents (120 boys and 8 girls) aged between 7 and 18, of an average age of 13.88 (SD=2.15), all living on the streets of Port-au-Prince, we used the following scales: the Trauma Exposure (TE), the Life Events Subscale of the CAPS; the Peritraumatic Distress Inventory (PDI); the Childrens Revised Impact of Event Scale (CRIES-13) and the Children Depression Inventory (CDI); (BAI). Our study reveals a high prevalence of PTSD, depression and anxiety among street children. It also demonstrates that this prevalence is lower than that of several other groups of children who were also victims of the 2010 earthquake in Port-au-Prince. Children living in the streets for economic reasons presented a lower prevalence of symptoms of PTSD, anxiety and depression than those who were on the streets as a result of psychological or physical abuse within their own families, in adoptive families or in childrens homes. This study demonstrates the importance of care provision for these children in terms of helping them develop coping and resilience strategies. It also stresses the importance of providing them with nonviolent living environments and opportunities to facilitate their return to normality.

Psychopathologies des demandeurs d’asile en Europe, traumatisme et fonctionnement défensif

Refugees seeking asylum are a particularly vulnerable population. It has been observed that among the most commonly-occurring disorders exhibited in this population, there is a high incidence of post-traumatic stress disorder, generalized anxiety disorder, and depression. These disorders may be linked to the difficult paths that refugees are forced to undertake, as well as to different traumatic events which are particularly destructive psychologically (deliberate physical, sexual and/or psychological violence, traumatic bereavements in the context of war, or social and political instability, socio-economic, familial or administrative difficulties), which compromise their view of their short-term futures. In the face of the weight of these life events, the question of the psychological resources of the individual is at the forefront of our understanding of mental health and the capacity to adjust to trauma. Our study aims to apprehend in a dynamic way, the different strategies used by asylum seekers in our western countries to adjust psychologically to traumatic and stressful events. The aim of this research is to study the links between mental health and anxious and depressive psychopathologies as well as the defensive modalities of these subjects. One hundred and twenty adult asylum seekers, living in refugee centres in Slovakia, France and Norway have agreed to participate in this study. We tried to assess the psychopathological disorders manifesting in these populations, notably PTSD, major depression and generalized anxiety disorder. Using the DSQ-60 we also tried to establish the links between the psychopathologies observed in this population and the defence mechanisms employed. Our results reveal that 60% of subjects do indeed suffer from psychopathological disorders with an important comorbidity of PTSB and depression (64.2%). Furthermore, the seriousness of the symptoms is correlated with less adaptive defence mechanisms (a higher incidence of defence mechanisms such as acting-out and distorted self-image). The recourse to mechanisms such as affiliation, repression and idealization is found to be used less by the studys target group. Rather, they tend to resort to defence mechanisms such as projection, low self-esteem, withdrawal, acting-out and hypochondria. Our results highlight the importance of the affiliation mechanism, which holds the potential to facilitate adaptation and resilience in these vulnerable subjects. It could also be offered as part of a therapeutic care proposal.

Styles d’attachement et soutien social perçu chez des femmes déprimées

Resume Cette etude s’inspire du modele de l’attachement et des travaux sur le support social pour mettre en evidence une relation entre vulnerabilite depressive, styles d’attachement et support social. Elle porte sur l’investigation des styles d’attachement actuels et de la qualite du soutien social percu chez 35 sujets deprimes hospitalises compares a 35 temoins ne presentant aucune pathologie. Chaque sujet participe, apres avoir donne son consentement, a une investigation psychologique approfondie comportant un entretien clinique enregistre et plusieurs echelles cliniques. L’etude ne presente ici que les reponses au questionnaire de Perception des relations (4) qui distingue quatre styles d’attachement (secure, detache, preoccupe et desorganise) et au questionnaire de Soutien social (SSQ6) (46) qui comprend deux dimensions : la disponibilite et la satisfaction sociales. Les resultats ont fait l’objet d’une analyse statistique comparative entre les deux groupes et correlationnelle entre les dimensions du soutien social et celles du style d’attachement. L’etude met en evidence une plus faible disponibilite percue du reseau social chez les deprimes, l’absence de relation intime actuelle avec autrui et l’absence de confidents, ce qui est a relier a un plus grand nombre de pertes vecues par le sujet deprime, en particulier des figures d’attachement (pere et mere). Par ailleurs, les sujets deprimes presentent davantage des styles d’attachement preoccupe et desorganise qui se caracterisent comme des modeles de soi negatif. La discussion porte sur la maniere de comprendre ces styles d’attachement : representent-ils la consequence de la pathologie depressive ou bien sont-ils le reflet d’un style relationnel plus ancien ?

Potential influence of Type A personality on plasma C-reactive protein levels in people with diabetes

AIM Type A personality, although classically known as a factor linked to increased vascular risk, has recently been associated with increased survival in patients with diabetes. As low-grade inflammation predicts a poor outcome, the present study explored the potential associations between Type A and plasma levels of C-reactive protein (CRP) in diabetes. METHODS Type A personality was assessed by the Bortner questionnaire in people with diabetes. The association between Type A and plasma CRP levels was examined by multivariable linear regression, and structural equation modelling (SEM) was performed to determine the impact of the major clinical, biological and psychological confounders. RESULTS The study included 626 participants with type 1 and type 2 diabetes from the Diabetes and Psychological Profile study. Multivariable analyses showed an independent inverse association between Type A score and CRP levels. The structural model adjusted for age, gender, diabetes type and duration, body mass index (BMI), smoking status, alcohol abuse, oral antidiabetic and statin treatments, HbA1c levels, lipids, perceived stress, anxiety and depression revealed significant associations between CRP and Type A (β=-0.135, 95% CI: -0.242, -0.028; P=0.014), BMI (β=0.194, 95% CI: 0.038, 0.350; P=0.015) and HDL cholesterol (β=-0.132, 95% CI: -0.245, -0.020; P=0.014). CONCLUSION Our present study data indicate that Type A personality is independently associated with lower CRP levels. This lower level of inflammation might explain the better clinical outcomes associated with Type A personality in patients with diabetes.

Type A personality is not associated with poor glycaemic control: Data from cross-sectional and longitudinal surveys of people with type 1 or type 2 diabetes

Diabetes & Metabolism - In Press.Proof corrected by the author Available online since lundi 8 aout 2016

Psychopathology of Alexithymia and Multiple Sclerosis

The notion of alexithymia was introduced by Sifneos (Psychother Psychosom 22:255–62, 1973) to define a set of affective and cognitive characteristics observed in patients with psychosomatic diseases. Alexithymia appears to be a multidimensional and transnosographic concept ranging from normal to pathological, and it is important to regard alexithymia as a disorder of emotional regulation, which can be found in different populations and not only in somatic diseases.