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 (ß=-0.135, 95% CI: -0.242, -0.028; P=0.014), BMI (ß=0.194, 95% CI: 0.038, 0.350; P=0.015) and HDL cholesterol (ß=-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.

[Psychopathology of asylum seekers in Europe, trauma and defensive functioning]. / 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 study's 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.

[Studying dysfunctional personality trends among sex offenders]. / Étude des tendances dysfonctionnelles de la personnalité chez des auteurs d'infractions sexuelles.

OBJECTIVE: A review of the literature reveals a consensus on the high prevalence of personality disorders among sexual offenders. Studies show that there is no unique personality profile for sex offenders. In France, little research has been conducted on this population with standardized assessment tools. The objective of the present study is to identify the distribution of personality disorders among sexual offenders using a new French questionnaire, i.e. the TD12. In view of the literature, we postulate that this tool will identify the diversity of personality disorders observed by various authors, but with a higher proportion of cluster B disorders. METHODOLOGY: This study was conducted among 56 men, including 28 sex offenders aged from 21 to 70 years old, and a control group of 28 men without psychiatric disorders. The sex offenders in this study are men convicted or charged with sex offenses of various kinds: exhibitionism, the recording, distribution and possession of pornography depicting minors, aggravated corruption of a minor, sexual assault of a minor, or rape of a minor. They were examined using an inventory of dysfunctional trends recently developed by Rolland and Pichot with the aim of assessing dysfunctional personality styles. The TD-12 questionnaire is composed of 140 items describing thoughts, feelings and behaviors. It is based on the diagnostic criteria of Axis II of DSM IV-TR and consists of twelve scales that match the personality disorders described in this diagnostic manual (ten officially recognized disorders and two additional disorders). RESULTS: From a categorical viewpoint, results indicate rigid dysfunctional trends with regard to avoidant personality disorder in sex offenders compared to the control group (Chi(2)=9.16; P=0.005). However, there were no significant differences between the two groups regarding the number of rigid dysfunctional trends. Potentially controllable dysfunctional personality trends are identified for the dependent personality (Chi(2)=6.72; P=0.02) and the depressive personality (Chi(2)=9.63; P=0.004). Moreover, the results show differences related to type of crime. The mean score on the Docile-Dependent scale is higher among subjects who had only downloaded images of child pornography (n=8) compared to subjects who had committed at least one sexual offense against a victim (n=20) (58.75±8.43 versus 49.55±11.66, P=0.04). CONCLUSION: These results are somewhat in contradiction with previous studies. The often described cluster B personalities are not significantly observed in this study. These results show the prevalence of avoidant personality disorder, which in fact corresponds to a clinically observed sex offender profile characterized by inhibition, relationship difficulties with adults, fear of being judged or rejected, and social isolation. The study also shows the value of considering the personality profile in relation to the modus operandi. It is important to continue this research on larger groups in order to refine the results.

[Evolution in styles of romantic and interpersonal attachment in depressed adult women during hospitalization]. / Évolution des styles d'attachement romantique et interpersonnel au cours de l'hospitalisation chez des femmes adultes déprimées.

INTRODUCTION/OBJECTIVE: Bowlby (1984) regarded attachment as a model of psychological vulnerability to depression. Since then, a large number of studies have considered vulnerability to depression in light of the idea of attachment style. Attachment styles correspond to two dimensions observed in relationships (anxiety and avoidance) evoking ideally the internal operating models of self and other respectively, as first described by Bowlby (1984). Two types of adult attachment styles are evaluated in our study: romantic attachment (Hazan and Shaver, 1987) and interpersonal attachment (Bartholomew and Horowitz, 1991). The existing literature indicates that depression is associated with the insecure attachment styles, in both romantic an interpersonal relationships. Nevertheless, a question remains concerning the nature of the link between attachment style and depression: are attachment styles stable and independent of the depression or are they modified as the depression evolves? The aim of the present study was to investigate the relationships between attachment and depression in adult women hospitalized for depression; following up the evolution in their romantic and interpersonal attachment styles from the beginning to the end of their hospitalization. METHODOLOGY: The study population consisted of 50 women hospitalized for an episode of major depression (Axis I, DSM IV). Individuals exhibiting bipolar disorders and other pathologies linked to depression were not included in the population. Sixty-eight percent of the depressed women in our population had previously experienced depressive episodes and 42% of them also exhibited a personality disorder (Axis II, DSM IV). The clinical group participated in two psychological investigations, one at the beginning (T1) and one at the end of the hospitalization (T2), including each time a clinical interview during which the depression as well as the romantic (ECR, 1998) and interpersonal (RQ, 1991) attachment styles were evaluated. STUDY RESULTS: Our findings showed that depression is positively correlated with the "avoidant" dimension of the romantic attachment style and negatively with the "secure" dimension of the interpersonal attachment style. Between the beginning and the end of hospitalization, only the "secure" and "fearful" dimensions of the interpersonal attachment styles were modified, whereas the styles of romantic attachment remained stable. In terms of the links between attachment styles and the evolution of depression during hospitalization (between T1 and T2), we noted that an increase in security of attachment was correlated with a decrease in the depressive symptomatology. Conversely, the other romantic and interpersonal attachment styles were not linked with the evolution of the depressive symptomatology. DISCUSSION/CONCLUSION: Our results confirm that romantic and interpersonal styles of attachment constitute factors of vulnerability to depression. But more importantly, these findings open up new perspectives in terms of the nature of the relationships between attachment styles and depression. They provide matter for discussion concerning the stability or the change in romantic and interpersonal attachment styles. Indeed, we have revealed the stable and independent nature of romantic attachment styles in relation to depressive symptomatology. On the contrary, security in the interpersonal attachment style was shown to be a factor of change, associated with the evolution of the depressive symptomatology in progress. In the quest to take combined account of romantic and interpersonal attachment styles and their links with the evolution of depression, the present study results in a new understanding of depression, viewed from the perspective of the model of attachment in adults.

[Psychological experience of health care professionals in intensive care unit: a qualitative and exploratory study]. / 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.

[Subjective quality of life profile in patients with multiple sclerosis]. / Profil de qualité de vie subjective chez les sujets atteints de sclérose en plaques.

OBJECTIVES: This study aimed to assess subjective quality of life in patients with multiple sclerosis regarding the criteria of satisfaction and importance attached to various domains of life. METHOD: Sixty-one subjects took part in this study. The psychological evaluation consisted of a clinical interview and three questionnaires: subjective quality of life profile (PQVS), State-Trait anxiety inventory (STAI), Beck depression inventory (BDI). RESULTS: The results show a low level of general satisfaction of subjective quality of life. Fatigue and pain are the most unsatisfactory domains of life while the relationships with close relations and medical staff are perceived as the most satisfactory and important domains of life. Some differences are observed between men and women regarding the satisfaction of conjugal life and fatigue perception. The subjective quality of life seems mainly correlated to anxiety, depression and to the level of handicap. CONCLUSIONS: Our results emphasize the necessity of taking into account the subjective perception of the disease which can lead in an appropriated treatment. These results underline the place of anxious and depressive disorders associated with multiple sclerosis, which seem to have a certain impact on the subjective quality of life.

[Alexithymia and links with depression and anxiety in multiple sclerosis]. / Alexithymie et liens avec la dépression et l'anxiété dans la sclérose en plaques.

OBJECTIVES: This study evaluates the prevalence of alexithymia in multiple sclerosis and examines the links between alexithymia, depression and anxiety. METHOD: Sixty-one subjects aged between 18 and 60 years and suffering from multiple sclerosis took part in the study. The psychological assessment consisted of an interview with a psychologist and three questionnaires: the Toronto Alexithymia Scale (TAS), the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory (BDI). RESULTS: The prevalence of alexithymia was 42.5%, 34.4% for depression and 44.3% for anxiety (high and moderate level). The alexithymic subjects were more depressed and anxious. Results indicated positive correlations between anxiety (state and trait), depression and alexithymia scores. The various dimensions of alexithymia were found to be diversely correlated with anxiety and depression. CONCLUSIONS: Our results point out the importance of anxiety in multiple sclerosis and the specificity of alexithymia.

[Link between depression and academic self-esteem in gifted children]. / Lien entre dépression et estime de soi scolaire chez les enfants intellectuellement précoces.

INTRODUCTION: Studies of the psychology of gifted children frequently refer to their relatively immature affective development in terms of their intellectual capacities and the relational difficulties they experience with regard to their peers, teachers, close acquaintances and sometimes their parents. From a psychopathological viewpoint, various types of problem have been observed such as depressive symptoms, motor instability coupled with hyperactivity, attentional deficits, impulsivity and a fall in self-esteem. OBJECTIVE: In this study, we wished to verify the links between self-esteem and psychopathological symptoms in these children. METHOD: The total population studied consisted of 58 pupils taken from two teaching establishments in Dijon who were subdivided into two groups (gifted children and adolescents versus control children and adolescents). Of these 58 subjects who took part in the tests, 8 were eliminated either due to their results on the "lie" scale of the self-esteem scale (score greater than or equal to 5) or to their age. In effect, a high score on this scale implies that the subjects want to show themselves in a better light than is actually correct. It is then assumed that the subjects had sought the examiner's approval by presenting the best possible image of themselves; 23 gifted children, referred to as GC (10 girls, 13 boys) aged between 9 and 13 years (mean age=11 years 3 months or 135 months, standard deviation=14) took part in the study. The selection criteria required the subjects to possess an Intelligence Quotient (IQ) calculated using one of the Weschler tests (WPPSI or WISC III depending on age) greater than or equal to 130 (mean IQ=145.23, standard deviation=7.93); 20 were attending private schools and 3 were in the state education system. They were all attending special "GC" classes to which they had been admitted solely on the basis of an IQ test conducted by a psychologist. Their teachers had volunteered to take these classes and had received appropriate training. The pupils had no record of any neurological or physical antecedents, were all French-speaking, were not taking any toxic substances and had never consulted a psychologist or psychiatrist. They were all in advance by one to two years in terms of academic level. They were matched with the control subjects by real age and not mental age and as a function of their parents' socio-economic level. The mean age of this latter group was 11 years, 4 months (standard deviation=14 months; minimum=8 years 11 months, maximum=13 years 1 month) and the group consisted of 14 girls and 9 boys. It was similar to the target group in terms of age, gender, key childhood experiences, divorces, separations and the death or illness of close relations. They had never consulted a child psychologist or been hospitalized for related problems, were not following any psychotherapy, were neither behind nor advanced in terms of academic age and came from normal classes. Their mean Intelligence Quotient (IQ) was 106.04 (standard deviation=5.39). Children attending special classes (European, Franco-German, music, sport, etc.) were excluded in order to obtain as "standardized" a group as possible. The following tools were used: 1) The Child Behaviour Check List (CBCL), a self-questionnaire developed in 1978 by Achenbach in the USA, which is one of the most frequently used child psychopathology measuring tools both in research and in clinical practice. It is intended to provide a standardized description of emotional and/or behavioral problems as observed by parents in children aged between 4 and 16 years. A French version, "la liste des comportements pour les enfants", has been developed and used for a subsample of the boys aged between 6 and 11 years (Fombonne and Vermeersch, 1997). 2) Carré's "self-esteem inventory" (SEI) was created by Carré (1984) in order to test the level of self-esteem. This tool is designed to measure the subject's evaluation of himself or herself in the social, family, academic and general fields. A "lie" scale makes it possible to reject invalidated tests. 3) The EDICODE is an instrument designed to gather and quantify the speech produced by the subject during a semi-structured interview. It is rated by the interviewer and is therefore dependent on his or her subjective evaluation. It was constructed within a clinical research perspective (Pierrhumbert et al., 1999) and is based on the theory of attachment (Main and Goldwyn, 1985-1994). EDICODE consists of 21 items presented in the form of differential semantic scales. These items are then grouped into 5 factors or scales (containing non-redundant items) that cover the following dimensions: fluidity (associative richness, ease of access to memories, participation in the interview), coherence (the speech is "focused" and structured), appropriateness (appropriate relational distance, confidence in relations, capacity for emotional control), reflection (consideration of one's own mental state and that of others as well as of the influence of such states), authenticity (spontaneous, lively speech). RESULTS: The comparison of 23 gifted children (GC) and 23 controls matched on age, sex and school grade revealed that the scores for academic self-esteem, total self-esteem and lie-scale were significantly lower than those observed in the control group (p<0.006, p=0.03, p<0.0001 respectively) and that the depression scores were significantly higher in the gifted children (p=0.021). Significant correlations are only observed in the group of gifted children. The correlation analyses reveal that the lower the general self-esteem, academic self-esteem and total self-esteem values had fallen, the higher the depression (r=- 0.59, r=- 0.67 and r=- 0.76 respectively), hyperactivity (r=- 0.47, r=- 0.82 et r=- 0.59) and total psychopathology (r=- 0.56, r=- 0.67 et r=- 0.75) scores were. Similarly, the lower the general and total self-esteem scores, the higher the aggression scores (r=- 0.56 and r=- 0.68 respectively). Academic self-esteem was the only value to be negatively correlated with communication disorders (r=- 0.79) and somatization symptoms (r=- 0.49). Finally, social self-esteem, family self-esteem and the lie scale were not correlated with any CBCL variable. The regression analyses indicate that academic self-esteem is the variable that explains the depression scores. DISCUSSION: The gifted children in our study therefore manifested a lack of self-esteem, and in particular a lack of academic self-esteem, coupled with depressive symptoms. For Coopersmith (1984), self-esteem is a function of experienced events in the various sectors in question, while Gibello (1992) sees a link between inhibition or academic disinvestment and everything that may generate anxiety and/or depression in the subject. We can hypothesize that the difficulties experienced by these children derive, at least in part, from their specific characteristics, namely their internal and social dysschynchronism (Terrassier, 1981). Among its other effects, this dyssynchronism leads to a school life that is often difficult or even chaotic, resulting in a general level of self-esteem, and more particularly an academic self-esteem, that is lower than the mean. These considerations might then, in their turn, generate psychopathological symptoms such as depression or hyperactivity (Revol et al., 2002) which have repercussions that affect the effectiveness of the children's school work. This study suggests the need to verify whether similar results are observed in gifted children who do not attend special classes and children who have not yet been identified as gifted. Furthermore, our results indicate that these children are liable to a specific vulnerability in the emotional and behavioral domains that needs to be emphasized. They stress the need for early preventive measures to combat the emotional and behavioral difficulties experienced by gifted children and emphasize the importance of continuing to conduct this type of study in order to explain and specify the origin of these difficulties.

[Aesthetic surgery and quality of life before and four months postoperatively]. / Chirurgie esthétique et qualité de vie subjective avant et quatre mois après l'opération.

AIMS: To evaluate the improvement in the subjective quality of life and mental health after Aesthetic surgery on the basis of indices of patient satisfaction. METHOD: The population consisted of 25 women who had requested cosmetic surgery (mean age: 34.76) including 19 for breast augmentation and 6 for abdominal plastic surgery. After giving their written consent, the subjects took part in a psychological evaluation conducted at two different times: the first at the time of the second medical consultation and the second 4 months after surgery. In each case, the psychological evaluation consisted of a clinical interview and two questionnaires: the subjective quality of life profile (SQLP) and the general health questionnaire (GHQ12). RESULTS: The results of the study revealed the benefits of cosmetic surgery for the patients' subjective quality of life. The subjects' mental health and quality of life improved on a number of dimensions: physical health, pain, physical appearance, social life and inner life. Improved physical health during the postoperative period was associated with the quality of the relations with the doctor whereas deterioration in health was associated with excessively high initial expectations concerning the relations with doctors and physical health.

[Styles of attachment and social support perceived in depressed women]. / Styles d'attachement et soutien social perçu chez des femmes déprimées.

RESULTS: This study, inspired by the attachment model and research in the field of social support, attempts to reveal the link between styles of attachment, social support and depressive vulnerability. AIM OF THE STUDY: It investigates current styles of attach-ment and the quality of social support perceived by 35 hospitalized, depressed subjects compared to 35 control subjects who exhibited no pathology. After giving their consent, each subject took part in an in-depth psychological investigation consisting of a recorded clinical interview and various clinical scales. METHOD: The study presents only the responses to the Perception of Relations questionnaire which distinguishes between four styles of attachment (secure, detached, preoccupied and disorganized) and the Social Support Questionnaire (SSQ6) which contains two dimensions: social availability and social satisfaction. The results were subjected to statistical analyses: a comparative analysis between the two groups and a correlational analysis between the dimensions of social support and the dimensions of style of attachment. On the one hand, the study reveals that the social network is perceived to be less available by depressed subjects, together with the absence of a current intimate relationship with other people, the absence of people to confide in, and a relationship between this absence and the large number of losses experienced by depressed subjects, in particular the loss of figures of attachment (father and mother). On the other hand, depressed subjects tend to exhibit a preoccupied, disorganized style of attachment which is characterized by negative models of the self. DISCUSSION: The discussion addresses the way these styles of attachment should be understood: do they represent the consequence of the depressive pathology or an older relational style?

[Alexithymia and psychological trauma--analysis of verbal expression of subject with post-traumatic stress disorder: an exploratory study]. / Alexithymie et traumatisme psychique--analyse du récit chez des sujets souffrant d'état de stress post-traumatique: une étude exploratoire.

The aim of this preliminary study is the analysis of the utterances of subjects suffering from Post-traumatic disorder. The study is based on the recent methods of discourse analysis developed in France by Ghiglione and Blanchet (1991, 1998). We have tried to know how victims of psychical trauma verbalize their different emotional reaction to the traumatic event. We expected to find discursive indicators characteristics of alexithymia when they speak about their emotion associated to traumatic event, that is to say an inhibition of the verbal expression of emotion, a factual, descriptive and objective discourse, a diminution of the personal engagement, difficulties to give explanations about the violent trauma. This study shows that the victims of psychical trauma don't present a lack of verbalization of their emotions but a dissociation in the expression of their emotions. The emotional words are more frequently associated to the symptoms than to the traumatic event that had been at the origin of the symptoms. This dissociation is similar to a particularity of alexithymia as it was described by Sifnéos (1996). The study also shows that the distribution of the discursive indicators in the different themes discussed by the subjects constitutes an interesting way of work needing then the application of experimental and comparative methods.

[Stressful life events: models and methodology. Critical considerations]. / Evénements stressants de la vie: modèles et méthodologies. Quelques réflexions critiques.

Many recent studies tend to show that life events play an important role in provoking, solving or maintaining psychic troubles. The proposed approach is interesting as far as it brings back into the model many psychosocial factors implied in psychic or somatic problems. We wanted to review the interest of the main theoretical and methodological approaches in that field and also to stress their drawbacks. One many improve the life events approach by taking into account the difficulties associated with that type of research and by avoiding an oversimplification of the relationship between life events and health. The links are complex, the impact of life events results from depressive mechanisms, adjustment strategies, social support, age, sex, personality, history, past experience and sociocultural representations. This complex picture compels clinicians to take a complementarist attitude when all the theories are scrutinized in order to understand the links between life events and health. From a methodological point of view, the most relevant approach seems to be the combination of standardized scales and semi-structured interviews allowing a contextual approach of events.