Anxiety and performance.

In the world of sport, athletes and their trainers see competitive emotions and, in particular, performance anxiety as one of the most important factors likely to influence the outcome of a sports competition. These emotions attract such vast interest because even today they continue to raise many questions. While positive emotions are generally considered to be largely facilitative to an athlete's performance, the link between negative emotions, and particularly competitive anxiety, and performance seems less unanimous. Some view anxiety as a phenomenon which hampers performance; for them, an anxious athlete is a fragile one. Others view anxiety as a driver and give as examples those athletes who only perform well under the pressure of competition and the anxious state it elicits. There is currently no single model for the relationship between anxiety (or emotions) and performance on which everybody agrees, in spite of the fact that the scientific community has been striving for some time to better understand the links between them. Research carried out to confirm these links has produced inconsistent results which are difficult to interpret as the variables measured (anxiety, emotional states, performance) and the framework of the studies (characteristics of the participants, importance of the sports event) most often differ.

Photoallergic Contact Dermatitis to Sunscreens Containing Oxybenzone in La Plata, Argentina. / Dermatitis por contacto fotoalérgica a protectores solares con oxibenzona en La Plata, Argentina.

BACKGROUND: Photoallergic contact dermatitis (PACD) to oxybenzone was reported for the first time in 1980. Oxybenzone is the most common photoallergen in the United States and Canada and the fourth most common .in Europe. There are no studies or data on the prevalence of oxybenzone PACD in Argentina. OBJECTIVE: To determine the proportion of photosensitive patients with PACD to oxybenzone. METHODS: We conducted a descriptive cross-sectional study of 35 patients with photosensitivity reactions confirmed by photopatch testing at the Research Center of Hospital Público San Martín in La Plata, Argentina, in 2015 and 2016. RESULTS: PACD was identified in 6 patients (17.14%). Five of these (14.28%) had at least one positive reaction to oxybenzone in the photopatch test; 4 had a reaction at irradiated sites only (5 J/cm2 UVA) and one had a reaction at both irradiated and nonirradiated sites. CONCLUSIONS: PACD to sunscreens containing oxybenzone is common and is probably underdiagnosed due to a lack of confirmation by photopatch tests or other diagnostic tools. Sensitization rates vary according to region and are influenced by sunscreen ingredients and variations in the use of sunscreen products, cosmetics, and topical drugs.

[The information of the schizophrenic patient: actuality]. / L'information du sujet schizophrène en pratique clinique: données actuelles.

Social isolation has got to be one of the greatest losses in schizophrenia. For many authors, people with schizophrenia can have no friends, no spouse, and sometimes no family. Two thirds of patients with schizophrenia return to their parents' house after discharge from a hospital for the first psychosi episode. Family members generally receive very little education as to what they can expect. They may not know the importance of medication compliance. Family members are the primary victims of violence from psychotic individuals, usually their own son or daughter, and most families cannot believe their own son or daughter would be capable of such a thing. Although families are usually the main care givers at the beginning of schizophrenia they often find their experience very frustrating for a number of reasons, and relationships suffer. Family education and support have been shown to improve outcomes considerably and family education is the second strongest factor in relapse prevention. Without education and good relapse prevention families often burst out. Most of the homeless mentally ill in downtown city cores have lost their family relationships. It is not a reflection on their families so much as the lack of adequate treatment and support. The families tried and tried and lost their ill relative. A patient writes: "My father lives just outside of Monaco. My mother developed Alzheimer's a couple of years ago or so and with a series of mild strokes died recently. I haven't seen either of them very much in the last fifteen years. I have a sister, Nicole, who also lives in Paris. I lost those relationships to some degree over the years. I am rebuilding them now. Enter the professional friend, the case manager, usually in cases where the individual is quite disabled by schizophrenia and/or at considerable risk of relapse, and usually when the individual has lost their family relationships to some degree. I had a case manager for several years and always looked forward to her visits. Case managers help negotiate compliance to medication, housing, meaningful activity, substance abuse, poverty, isolation, and everything else living in the community can throw at you. Without a spouse you tend to spend a lot of time alone. One of the main reasons Marie-Claude and I moved in with each other was that neither of us was enjoying living alone. It was very romantic at first but now we are just friends who see less and less of each other. I suspect schizophrenia interferes with the quality and depth of relationships you have with other people. Amongst the people I know, schizophrenia has meant a pretty solitary life of poverty. I have a lot of acquaintances, and colleagues, but few close friends when not at work. Over the last ten years of living with schizophrenia on medication it is celibacy that has hurt the most. It saps the life out of you, your self confidence, your self esteem. In some Scandinavian countries and Holland disabled people are allowed monthly visits by state approved sex workers. To me that is only common sense. To live without sex is unnatural and can only cause emotional suffering. We don't recognize the importance of quality sexual experience in keeping people healthy and happy in France. That doesn't mean it isn't I have a pretty high profile in my community through the meaningful activity I do. From having a half dozen names and faces to remember, I now have what seems like hundreds. I have a lot of trouble remembering people's names and faces. I am still meeting new people but I'm rarely invited to socialize with any after work. They have families, full time jobs, kids, cars, cottages, etc. My life at home is pretty solitary. It's a nuisance to travel across the city to visit people. There are few people that I share a similar background with. Since people with schizophrenia tend to have trouble learning new things, and change very little as a result, we tend to have trouble making new friends. People with schizophrenia can come alive talking about things in the past before they became ill. It's as if their life grinded to halt when they became sick. I'm stuck in the mid seventies, and that's the music I like. Everybody I know with schizophrenia is quite isolated socially and I don't really know why. That is especially true for the older people in my age group. Younger people seem to be doing much better. Many still live with their parents. Most older people live alone. There is also the odd person who recovers well, returns to a career, and marries someone without schizophrenia. In cases where marriage predates the onset of schizophrenia, the outcome is often divorce although women are more likely to stick with their husbands with schizophrenia than vice versa, especially if there are already children. I hope the next generation who appears to be less disabled survives better than people of my age with schizophrenia. The goal of community integration is one that requires: more effective treatments and/or more financial support and/or a compassionate non-discriminating community. The combination of early diagnosis and atypical medications will change the face of schizophrenia. I'm not expecting more financial support from the government, but many more people with schizophrenia will start working again instead. Their social networks will develop but social networks are probably the hardest hit in schizophrenia. It's better that you never lose your friends in the first place". This testimony shows how the information of the schizophrenic patient is necessary, and underlines the importance of the relationships between the patient and his family. Our article insists on this theme, rarely developed in the literature.

[About the use of seclusion in psychiatry: the patients' point of view]. / A propos de l'utilisation de l'isolement en psychiatrie: le témoignage de patients.

In this study of psychiatric inpatients' perceptions of the seclusion-room experience, 67 admitted inpatients were interviewed during 6 Months within 3 days of the experience, and 24 hours after. A 35-items semistructured interview schedule was used to obtain information on six research questions. Subjects' perception of the reasons for their seclusions varied greatly from perceptions of staff members. Findings implied that for some patients seclusion may have been unnecessary, but for others it was beneficial. Subjects who reported out-of-control impulses or pathological intensity of relationships prior to seclusion and who showed positive change in mood, behavior, or thinking toward staff and/or other patients during or after seclusion seem to have benefited from the experience. Seclusion is a common practice in most psychiatric inpatient settings. The reported incidence of seclusion varies from 4% to 66% of admissions to psychia-tric facilities. But seclusion is controversial. Opponents of seclusion have based their arguments on a concern for the rights of mental patients and a dedication to treat patients in the least restrictive environment. Proponents of seclusion have based their arguments on the theoretical benefits of isolation and the reduction of external stimuli. However, little information about the psychiatric patients experience before, during and after seclusion is currently available. The purpose of this exploratory descriptive study is to gather information on psychiatric patients' perceptions of their seclusion-room experiences, their experiences immediately before and after seclusion, and how they thought these experiences affected them or others. Subjects and staff described the reasons for seclusion differently. For example, subjects described situations leading up to seclusion, but staff described aggressive behavior justifying seclusion. Yet, almost all reasons provided by both groups involved subjects' out-of-control impulses or problems in relationships. The physical, behavioral, and emotional responses of patients to seclusion have been the subject of both observation and more formal investigation. In a study of 263 seclusion episodes, Gerlock and Solomons (1983) noted that 83% of the patients evidenced disturbed behavior at the initiation of seclusion and only 23% did so on release. In a study of the use of the quiet room on a children's unit, Joshi et al. (1988) observed that 92% of the patients who were agitated when placed in the quiet room were calm on release and that 79% were able to rejoin group activities. As for nonempirical investigations, Gair et al. (1965) observed no ill effects (such as fear, withdrawal, or disorganization) and an improvement in inner controls as a result of the use of seclusion on a children's unit. Way and Banks (1990) cautioned against the side effects of humiliation, disorientation, and medical complications of restraint and seclusion in the elderly. As previously noted, many re-presentatives of the psychiatric consumer/survivor movement have characterized seclusion as an extraordinarily traumatic intervention. It is therefore important to examine empirical studies of the emotional effects of this intervention on patients. Perhaps the best-known study is that of Wadeson and Carpenter (1976), which involved 62 mostly unmedicated patients on an NIMH research unit with a seclusion rate of 66%. Patients were asked to draw their experiences and feelings connected with their illness and treatment in three art sessions (2 weeks after admission, 2 weeks before discharge, and 1 Year later). Thirty-three percent of the patients drew the seclusion experience. Their art work and their discussions of it revealed negative feelings (fear, estrangement, hostility, retaliation, guilt, paranoia, bitterness) as well as sadomasochistic conflicts and comforting hallucinations (possibly as a response to sensory deprivation). Several other studies have investigated patients' emotional responses to seclusion. Binder and Mac Coy (1983) conducted semistructured interviews with 24 patients who had been secluded. Thirteen of the 24 patients had no idea or a false idea as to why they had been secluded, 22 were unaware that staff checked on them every 15 minutes, and 13 felt that there was nothing good about the experience. Ne-vertheless, half of the 24 patients felt that the intervention had been necessary and about half felt that it would not adversely affect their attitudes toward treatment. Plutchik et al. (1978) investigated the perceptions of seclusion of patients who had or had not been secluded. Patients who had not been secluded felt safer when they saw others being secluded. Patients who had been secluded felt angry when others were secluded and bored and angry while in seclusion, but the majority felt that seclusion helped calm them down. Patients accurately perceived the precipitants of seclusion. Plutchik et al. also looked at staff perceptions. They found that although most staff felt that seclusion was beneficial to patients, professional staff had the most "regrets" about it. Patients accurately estimated and staff significantly underestimated the average duration of seclusion. Joshi et al. (1988) noted that 14% of children who had been secluded on their unit were angry and 17% were sad while they were in seclusion. Sheridan et al. (1990) observed a 2:1 ratio of negative-to-positive attitudes toward seclusion among patients interviewed at a VA hospital. They also noted that patients' attitudes toward initial seclusion had no effect on subsequent seclusion rates. Thus, although it appears to be reasonably well-established that seclusion "works", i.e., it provides an effective means for preventing injury and reducing agitation, it is at least equally well-established that this procedure can have serious deleterious physical and (more often) psychological effects on patients.

Robot-aided sensorimotor arm training improves outcome in patients with chronic stroke.

Thirty patients with chronic stroke received 6 weeks of sensorimotor robotic training in a pilot study that targeted motor function of the affected shoulder and elbow. The impairment and disability scores were stable during a 2-month observation/measurement period, improved significantly by program completion, and remained robust in the 3-month follow-up. Task-specific motor training attenuated a chronic neurologic deficit well beyond the expected period for improvement after stroke.

[About the use of restraints in psychiatry: the patient's point of view]. / De l'utilisation des contentions en psychiatrie: le point de vue des patients.

Previous research about the use of restraints has mainly sought generalizations regarding who is likely to be restrained, the frequency of the use of restraints, and the behavior that precipitates the application of restraining devices. Therefore, there has been a paucity of research that attempts to understand the impact of restraint on the restrained person. The purpose of this study is to understand the meaning of the experience of being restrained for 43 psychiatric patients who had been restrained in leather restraints. Participants were interviewed in unstructured interviews. The taped interviews were transcribed and analyzed by means of a modification of an interpretive process, grounded in phenomenology. In this article, the theme of power is reported and discussed.

[Characteristics of patients hospitalized in a specialized hospital center after after attempted suicide]. / Caractéristiques des patients hospitalisés dans un centre hospitalier spécialisé après une tentative de suicide.

Authors have counted, during a period of one year, the totality of patients having been admitted to the Centre Hospitalier Spécialisé de la Savoie (Chambéry) following a volunteer medicinal intoxication; 227 patients have been thus included, this type of acting out concerning third more women than men. The higher impact is found in young adults (20-40 years). Professional inactivity appears as a favoring factor, while the way of life (bachelor or in couple) does not seem to have consequence on the frequency of occurrence of the suicidal attempts. Relapses are numerous, and happen in most cases during the year. Concerning used medicines, they have been generally prescribed by a practitioner or a psychiatrist. The prominent fact is the presence of a very short period between the prescription, the deliverance of the medicine and the acting out. Plurimedicinal intoxications are increasingly frequent, with often concurrent absorption of alcohol. The diminution of the use of barbiturics in ambulatory medicine to the profit of other molecules, and especially the benzodiazepines, has reduced the frequency of their use in volunteers medicinal intoxications. Benzodiazepines are the most employed medicines in this type of acting out. This epidemiological and toxicological study confirms that used substances during volunteer medicinal intoxication are a reflection of the general medicinal consumption.

Robot-aided neurorehabilitation: from evidence-based to science-based rehabilitation.

There is no "magic bullet" in rehabilitation. In the absence of direct neural transplants, neurological rehabilitation is an arduous process. We have pioneered the clinical application of robotics in stroke rehabilitation and have shown evidence of the positive impact of targeted exercise on stroke recovery. In this article, we will review results obtained in the initial clinical trials with 96 stroke patients at the Burke Rehabilitation Hospital. We will provide evidence that robot-aided training enhances recovery, that this enhanced recovery is sustained in the long term, and that this recovery is not due to a general physiological improvement--in fact, it appears to be limb and muscle group specific. An evidence-based approach must now segue into a more scientific approach to stroke rehabilitation. Given the length of the required protocols and patients' variability and limited census, the practical limitations of the evidence-based approach are self-evident and extend trials for years. Each patient and lesion is unique in stroke rehabilitation, so there is no reason to believe that a "one-size-fits-all" optimal treatment exists. To optimize therapy for individual patients, we need science-based models. In this article, we will summarize the scientific tools and models that we are investigating and present some of the results to date.

[Restraint and seclusion in psychiatry: review and prospects]. / Isolement thérapeutique et contention en psychiatrie: bilan et perspectives.

In this article, the authors reviewed the literature published since 1965 concerning restraint and seclusion. They synthesized the contents of the articles reviewed using the categories of indications and contraindications; rates of seclusion and restraint as well as demographic, clinical, and environmental factors that affect these rates; effects on patients and staff; implementation; and training. The literature on restraint and seclusion supports the following: 1) Seclusion and restraint are basically efficacious in preventing injury and reducing agitation; 2) It is nearly impossible to operate a program for severely symptomatic individuals without some form of seclusion or physical or mechanical restraint; 3) Demographic and clinical factors have limited influence on rates of restraint and seclusion; 4) Training in prediction and prevention of violence, in self-defense, and in implementation of restraint and/or seclusion is valuable in reducing rates and untoward effects; 5) Studies comparing well-defined training programs have potential usefulness.

[Apropos of sleep quality in students: prospective study]. / A propos de la qualité du sommeil des lycéens: étude prospective.

This study about the pupils' sleep in the academy of Aix-Marseille has been realized after the observations of second cycle's teachers; they have noted a somnolence by an important number of pupils during lessons, consequence of a supposed sleep lack able to have repercussions on the scholastic success. Hearing teachers and pupils' suggestions, the authors have established a questionnaire with 20 items; this study is concerning 1,300 pupils, 15 to 20 years old, in classic, technical and agricultural high schools, both in public and private establishments. The most salient characteristic is the differences between the sleep of the scholastic period and the sleep of week end or holiday. In the future, a better knowledge of pupils' sleeping habits could be the starting point of information and prevention campaign.

[Apropos of using patient isolation in psychiatry: point of view of nurses]. / A propos de l'utilisation de l'isolement en psychiatrie: le témoignage des soignants.

Seclusion continues to be used in the care of acutely disturbed psychiatric patients despite often emotionally charged debate about its appropriateness within mental health services. Powerful legal and moral arguments about the use of seclusion emphasize an urgent need to critically examine its role in the care of mentally ill people. This paper examines the use of seclusion on psychiatric departments in the management of acutely disturbed patients: 36 psychiatric nurses working in 6 departments in a specialized hospital (the CHS de la Savoie, in Chambery) were interviewed in relation to their perceptions of the role of seclusion. Data were analysed using grounded theory methodology revealing the core conceptual category "controlling" and two sub-categories "watching out for" and "watching over". Seclusion was found to be used as an adjunctive treatment in the care of individuals considered to be "out of control". Clinicians expressed comfort with the use of seclusion, citing a strict protocol that provided parameters for its use. While expert therapeutic interventions were described by clinicians, they are contextualized within a framework of power and control--a framework that stands in stark contrast to contemporary philosophies of nursing care, providing impetus for a reconsideration of the use of constraining practices in the care of mentally ill people.

[The use of therapeutic isolation and confinement in psychiatry. A prospective study]. / Utilisation de l'isolement thérapeutique et des contentions en psychiatrie. Enquête prospective.

Despite recent developments in psychopharmacology and a better understanding of agitation patterns in psychiatric patients, the use of seclusion and restraint procedures remains a matter of daily practice. Little or no time is spent on its teaching in a formal way. There is almost no literature on these issues, and it has grown only since legal procedures initiated by patients, which forced practitioners to spend some time analysing these methods. Facing this problem, we realized a prospective study at the CHS de la Savoie, in Chambéry, so as to clarify the current modes of these procedures. This study was led among 460 secluded patients, during one year. 11 data were studied, such as the duration of the seclusion, the reason and the medical history, the desire of the patient to be liberated ... The review or awareness of certain variables may give clinicians a better perspective on the use of procedures which, unfortunately, continue to be the cause of deaths in psychiatric practice.

[Between compliance and freedom: the patient's statement]. / Entre compliance et liberté: le témoignage d'un patient.

According to the patient, obtaining a good compliance is related to a good relationship with his practitioner; this relationship is directly connected to being a good listener for the patient, and not only for their symptoms. If the individual motivation is very important at the beginning, it will be itself greatly influenced by the relationship between the practitioner and the patient. It is one of the rare factors with a positive correlation with compliance, that's what almost all of the researches on medical psychology have observed. Once the problem is sumed up, it's the turn to speak for the patient, who explains how he considers compliance.

[About ethics in psychiatry and psychiatrists facing ethics]. / De l'éthique en psychiatrie au psychiatre face à l'éthique.

The plug in account of the suffering, notably psychological, in a consultation, puts the problem of the relationship between suffering and ethics. However, the originality of the ethical step is justly not to be confined to the social norm conformism, but being specific to the individual dimension. The psychiatric pathology offers in this area of particularities interesting. The neurotic, as the obsessed, suffering inwardly pathological manifestations that he judges absurd, replies to the medical moral in asking a care. The psychotic, which projects his suffering on the other, does not feel sick, requests no therapeutic assistance. As such he contests the medical order in an immoral position by definition, and the patient represents from then on a social and medical scandal. In front of a such clinical diversity, we can easily underline that approaching the theme of ethics in psychiatry isn't a well-off exercise, and necessitates a precise locating registered in the history of the patient.

Entropy measures of heart rate variation in conscious dogs.

Our goal was to determine the contributions of sympathetic and parasympathetic activity to entropy measures of heart rate variability (HRV). We compared our results with two commonly used methods to analyze HRV: standard deviation (SDNN) and power spectral analysis (HF norm). Beat-by-beat analysis of R-R intervals was performed in conscious dogs. The R-R intervals were analyzed with approximate entropy (ApEn) and entropy of symbolic dynamics (SymDyn) to assess the effects of reducing system complexity. This was achieved by pharmacologically inhibiting sympathetic, parasympathetic, and total autonomic nervous system regulation of heart rate. Three conditions were examined: rest, standing, and systemic hypotension. At rest or standing, sympathetic inhibition (propranolol) had no effect on ApEn or SymDyn, whereas parasympathetic (atropine) and combined (propranolol + atropine) inhibition reduced both entropy measures to near zero. Systemic hypotension reduced both entropy measures in intact dogs. When hypotension was induced after sympathetic inhibition, ApEn was increased compared with hypotension alone, whereas parasympathetic inhibition with hypotension resulted in near-zero ApEn. Changes in the entropy measures of HRV were directionally similar to changes in SDNN and HF norm. These results indicate that the entropy of R-R intervals reflects parasympathetic modulation of heart rate.

Heart rate, heart rate variability, and blood pressure during perioperative stressor events in abdominal surgery.

STUDY OBJECTIVE: To define the behavior of power spectral heart rate variability (PSHR) during potentially stressful events in the perioperative period, and relate it to changes in blood pressure (BP) and heart rate (HR). DESIGN: Longitudinal clinical study. SETTING: Operating room and recovery suites of a large tertiary care referral center. PATIENTS: 26 ASA physical status I, II, and III patients undergoing elective abdominal surgery. INTERVENTIONS: Anesthesia was induced with thiopental sodium and fentanyl, and maintained with isoflurane/nitrous oxide (N2O)/relaxant or enflurane/N2O/relaxant. The trachea was intubated and intraabdominal surgery was performed. MEASUREMENTS AND MAIN RESULTS: Observations consisted of HR, noninvasive blood pressure, and PSHR. They were made before and after induction of anesthesia, tracheal intubation, and surgical incision, and during maximal surgical stimulation and skin closure. HR and mean arterial pressure (MAP) maxima were also recorded for one hour before and after emergence from anesthesia. PSHR was obtained using a special algorithm and data acquisition system for real time spectral analysis of the instantaneous HRversus time function. The HR power spectrum parameters analyzed were low-frequency (LFA; powerband = 0.04 to 0.10 Hz), respiratory-induced frequency (RFA; powerband = respiratory frequency +/- 0.06 Hz), and the ratio of LFA to RFA. With induction of anesthesia, only RFA power decreased significantly. LFA power reduction became significant only after intubation and continued so until after incision. Immediately after induction, the decline in RFA power (vs. preinduction) was more pronounced when compared with the decline in LFA power (76% vs. 34%; p = 0.01). Hence, the ratio LFA/RFA increased significantly after induction of anesthesia. It was significantly higher than at postintubation, preincision, or skin closure. A significant elevation in LFA, LFA/RFA ratio, and BP occurred with maximal abdominal surgical stimulation. Only preinduction LFA, RFA, and LFA/ RFA ratio were predictive of MAP changes with induction of anesthesia (p = 0.006). In 8 of the 15 patients who had MAP changes of at least 10 mmHg with induction, PSHR indices correctly predicted a change of this magnitude. Late intraoperative HR maxima were positively correlated with the change in HR and incision (r2 = 0.58; p < 0.01). The change in BP with incision was positively correlated with early postoperative HR maxima (r2 = 0.60; p < 0.01). CONCLUSIONS: On anesthetic induction, preoperative, but not intraoperative, spectral indices were predictive of BP changes. Power spectral analysis of HR may provide information about the autonomic state that is not evident from BP or HR. The HR power spectrum, in particular, indicated a striking autonomic imbalance immediately after the induction of anesthesia despite stable HR and BP. LFA and LFA/RFA ratio appeared to track sympathetic autonomic activation during abdominal surgical stimulation, but not during other perioperative stressor events.

[Social trajectory and schizophrenia]. / Trajectoire sociale et schizophrénie.

On the occasion of the Clozapine symposium we have had cause to reflect on the social life-histories of schizophrenic patients. After an analysis of a cohort of 40 patients aged over 65 years, whose medical records had been kept up since the start of their disease, we have set up a methodology which enables us to study the social life-histories of these patients. Our aim is ultimately to compare the course of the disease with the treatments received by these patients and the therapeutic structures they have been offered. For this purpose, we shall study three criteria of social exposure: 1) Autonomy, 2) Integration into the family, 3) Integration through work. The aim of the present paper is to record our initial analytical findings in these three years.