A Mindfulness-Based Intervention: Differential Effects on Affective and Processual Evolution.

OBJECTIVES: A 20-minutes-a-day, self-help, mindfulness-based intervention was conducted for 6 weeks with a French community sample. First, the intervention effects on affective and functioning variables were evaluated. Then, a differential approach was used to examine improvement potentiality and the perceived benefits of mindfulness according to the participants' baseline mindfulness competencies. METHOD: Participants were non-randomly assigned to a control group on the waiting list (n = 44) or a mindfulness group (n = 47). Self-report measures assessed anxiety, depression, psychological distress, mindfulness, negative self-oriented cognition, and experiential avoidance. RESULTS: Improvements in the variables were observed for the mindfulness group but not for the control group, with effect sizes ranging between .53 and .88. Low baseline levels of mindfulness predicted greater improvement in mindfulness (r = -0.55, p < .001) than high baseline levels. CONCLUSIONS: Mindfulness practice elicited several positive outcomes regarding affective variables, highlighting emotional functioning changes.

Rumination and Mindlessness Processes: Trajectories of Change in a 42-Day Mindfulness-Based Intervention.

This preliminary study aimed to understand the effects of an autonomous mindfulness-based intervention (MBI) on mindlessness propensities: rumination, automatic pilot functioning, and attentional distractibility. The ecological momentary assessment was completed by community participants assigned to two nonrandomized groups: an experimental group (n = 45) that practiced 20-minute daily mindfulness meditation for 42 days and a control group (n = 44) that was on the waiting list for the MBI. All participants completed a self-assessment on rumination and mindlessness propensities twice a day. The MBI led to a favorable gradual decrease in automatic pilot functioning and attentional distractibility. Rumination evolved in three stages: a rapid decrease during the first week, a stabilization phase between the 10th and 30th days, and an additional decrease after 30 days of practice. This innovative study provides a promising perspective regarding rumination, automatic pilot functioning, and attentional distractibility dynamic trajectories over the course of an MBI.

Construction and validation of a dimensional scale exploring mood disorders: MAThyS (Multidimensional Assessment of Thymic States).

BACKGROUND: The boundaries between mood states in bipolar disorders are not clear when they are associated with mixed characteristics. This leads to some confusion to define appropriate therapeutic strategies. A dimensional approach might help to better define bipolar moods states and more specifically those with mixed features. Therefore, we proposed a new tool based on a dimensional approach, built with a priori five sub-scales and focus on emotional reactivity rather than exclusively on mood tonality. This study was designed to validate this MAThyS Scale (Multidimensional Assessment of Thymic States). METHODS: One hundred and ninety six subjects were included: 44 controls and 152 bipolar patients in various states: euthymic, manic or depressed. The MAThyS is a visual analogic scale consisting of 20 items. These items corresponded to five quantitative dimensions ranging from inhibition to excitation: emotional reactivity, thought processes, psychomotor function, motivation and sensory perception. They were selected as they represent clinically relevant quantitative traits. RESULTS: Confirmatory analyses demonstrated a good validity for this scale, and a good internal consistency (Cronbach's alpha coefficient = 0.95). The MathyS scale is moderately correlated of both the MADRS scale (depressive score; r = -0.45) and the MAS scale (manic score; r = 0.56). When considering the Kaiser-Guttman rule and the scree plot, our model of 5 factors seems to be valid. The four first factors have an eigenvalue greater than 1.0 and the eigenvalue of the factor five is 0.97. In the scree plot, the "elbow", or the point at which the curve bends, indicates 5 factors to extract. This 5 factors structure explains 68 per cent of variance. CONCLUSION: The characterisation of bipolar mood states based on a global score assessing inhibition/activation process (total score of the MATHyS) associated with descriptive analysis on sub-scores such as emotional reactivity (rather than the classical opposition euphoria/sadness) can be useful to better understand the broad spectrum of mixed states.

Does a geriatric oncology consultation modify the cancer treatment plan for elderly patients?

BACKGROUND: This study was performed to describe the treatment plan modifications after a geriatric oncology clinic. Assessment of health and functional status and cancer assessment was performed in older cancer patients referred to a cancer center. PATIENTS AND METHODS: Between June 2004 and May 2005, 105 patients 70 years old or older referred to a geriatric oncology consultation at the Institut Curie cancer center were included. Functional status, nutritional status, mood, mobility, comorbidity, medication, social support, and place of residence were assessed. Oncology data and treatment decisions were recorded before and after this consultation. Data were analyzed for a possible correlation between one domain of the assessment and modification of the treatment plan. RESULTS: Patient characteristics included a median age of 79 years and a predominance of women with breast cancer. About one half of patients had an independent functional status. Nearly 15% presented severe undernourishment. Depression was suspected in 53.1% of cases. One third of these patients had >2 chronic diseases, and 74% of patients took > or =3 medications. Of the 93 patients with an initial treatment decision, the treatment plan was modified for 38.7% of cases after this assessment. Only body mass index and the absence of depressive symptoms were associated with a modification of the treatment plan. CONCLUSION: The geriatric oncology consultation led to a modification of the cancer treatment plan in more than one third of cases. Further studies are needed to determine whether these modifications improve the outcome of these older patients.

[Elderly distress: cognitive schemas identification]. / Détresse du sujet âgé : identification des schémas cognitifs.

International classifications of psychiatric disorders appear to be insufficient to account for the psychological distress associated with aging. Identification of cognitive schemas can be very useful for the diagnostic and therapeutic levels in aged subjects. The aim of this study was to explore the facets of cognitive distress in these subjects, that is how can be integrated specific diagrams related to psychological changes related to aging with more general schemas identified with young adults, and whose interest was confirmed in old subjects. An inventory of sixty thoughts representative of maladaptive schemas was proposed to 160 subjects aged from 65 to 102 years and to a control group of 38 subjects aged from 50 to 64 years. The factorial analysis results showed that 9 distinct schemas accounted for 60% of the explained variance: six general (fear of losing control, dependence, vulnerability, abandonment, incompetence, self-sacrifice) and three specific to aging (disengagement, refusal of assistance, loss of individuality). A minority of schemas presented marked links with depression or anxiety without never merging with their assessment. In the same way, autonomy and institutionalization were significantly linked to some schemas, in particular those specific to aging. The interest to develop an standardized inventory from this set of schemas is discussed.

Evidence for two types of bipolar depression using a dimensional approach.

BACKGROUND: Although there is a great heterogeneity of depressive states in bipolar patients, there is only one definition in international classifications for describing them. However, this variety seems particularly important to recognize because of the possible exacerbation of some of these bipolar depressive states by antidepressants. We aimed at assessing whether it is possible to distinguish different forms of bipolar depression using a dimensional approach. METHODS: We characterized 60 bipolar patients with a Major Depressive Episode (DSM-IV) using a new tool (MAThyS; Multidimensional Assessment of Thymic States), assessing five fundamental dimensions (emotional reactivity, cognitive speed, psychomotor function, motivation, and sensory perception) of mood states. RESULTS: A cluster analysis using the items of the dimensional scale revealed two types of depressive state: group 1 (n = 38), which had a low score, is characterized by an inhibition in all dimensions, whereas group 2 (n = 22) is characterized by an overactivation. The emotional reactivity is the most relevant dimension for discriminating these two types of depression (group 1: hyporeactivity; group 2: hyperreactivity), whereas sadness is not. CONCLUSIONS: Bipolar depressive states are not homogeneous. A dimensional approach based on emotional reactivity could be useful for discriminating the different forms of bipolar depression. Bipolar depressions may be classified as hyporeactive or hyperreactive. This classification might have therapeutic implications, because hyperreactive depression should belong to the broad spectrum of mixed states.

[Multisite validation study of questionnaire assessing out-patient satisfaction with care questionnaire in ambulatory chemotherapy or radiotherapy treatment]. / Validation multicentrique d'un questionnaire de satisfaction des soins lors d'un traitement de chimiothérapie ou radiothérapie ambulatoire.

Patient satisfaction is now recognised as an important quality of care outcome which is particularly relevant in oncology. Adapted from the EORTC In-Patsat32, the Out-Patsat35 is a 35-item satisfaction with care questionnaire measuring cancer outpatients' perception of hospital doctors and nurses, as well as aspects of care organisation and services. This study assessed the psychometric properties of this scale. Patients undergoing ambulatory chemotherapy (CT) or radiotherapy (RT) in 7 cancer centres in France were invited to complete at home the Out-Patsat35 as well as EORTC QLQ-C30 for psychometric testing. Of 416 eligible patients recruited, 96% returned the questionnaire. Most patients (71% in CT; 69% in RT) completed this scale within 15 minutes and the mean rate of item omission was only 4.4%. Confirmatory analyses revealed good convergent validity and excellent internal consistency, although some subscales within the Out-Patsat35 were relatively highly correlated. Items and subscales of the Out-Patsat35 and of the QLQ-C30 were not significantly correlated, underlying that the two questionnaires are assessing quite distinct concepts. The subscales of the Out-Patsat35 were not related to age, gender and education, suggesting a cultural evolution in French cancer patients towards a greater homogeneity in their opinion toward care. This study supports the acceptability to patients, and the psychometric properties of the EORTC Out-Patsat35 questionnaire.