[Influence of resistance to voices on depression]. / Influence de la résistance aux hallucinations auditives sur la dépression : étude au moyen du questionnaire révisé des croyances à propos des voix.

OBJECTIVE: Beliefs about voices and reactions to voices have been proposed as important variables influencing the course of depression in schizophrenia. Consequences of auditory hallucinations are different according to identity, goals, omnipotence, omniscience, and meanings attributed to voices by the client. Ten to 15 % of the general population experience auditory hallucinations during lifetime without any distress or need for medical care. In addition, neither frequency of voices, nor their topography, influence the emotional consequences of auditory hallucinations experiences, but the relationships to voices. The Revised Belief about Voices Questionnaire analyzes voices along 5 dimensions: malevolence, benevolence, omnipotence, resistance, and engagement. Malevolent voices are related to depression, whereas benevolent voices engender more positive emotions. Subjects usually engage with benevolent voices, and resist to malevolent voices. But resistance strategies are barely efficient and often backfire. Patients resisting to their voices consider them more malevolent and present with more depressive symptoms. This research aims at studying the influence of resistance to auditory hallucinations on depression in a group of patients suffering from schizophrenia and experiencing auditory hallucinations, using the Revised Beliefs About Voices Questionnaire (BAVQ-R). It also provides a study of the psychometrics properties of the French language version of the BAVQ-R. METHOD: Thirty-eight patients suffering from paranoid schizophrenia, undifferentiated schizophrenia or schizoaffective disorder, have been tested with the French versions of the Revised Beliefs About Voices Questionnaire (BAVQ-R), the Positive and Negative Syndrome Scale (PANSS), and the Calgary Depression Scale for Schizophrenia (CDSS). Each patient presented with auditory hallucinations during the week before evaluation, with a minimum score of 3 on P3 item of PANSS. Mean age was 39.39 years (SD 11.33); mean duration of symptoms was 13.92 years (SD 10.81), and patients' mean history of hospitalizations was 7.66 (SD 9.24). Each patient was receiving an antipsychotic medication at the time of evaluation, with a mean chlorpromazine equivalent dose of 806.69 mg/d (ET 539.51); 18.5 % of patients were receiving serotonin reuptake inhibitor, and 31.57 % once committed a suicide attempt. RESULTS: The French version of the BAVQ-R presents with a satisfying internal consistency (Cronbach's alpha=0.74). Similar to the original version, Malevolence and Resistance, and Benevolence and Engagement dimensions are strongly correlated (r=0.73, and r=0.90, P<0.05, respectively). The BAVQ-R scores correlate with the CDSS (r=0.40, P<0.05) and the PANSS General Psychopathology subscale scores (r=0.44, P<0.05), but not with the Positive and Negative subscales. (r=0.17, and r=0.13, P>0.05, respectively). Correlations and forced entry multiple regressions analyses show that Resistance and Malevolence are both strongly correlated to depression, but Resistance is the only dimension that influences depression. Moreover, clients presenting with depressive symptoms resist more to their auditory hallucinations. Finally, emotional resistance, in comparison to behavioral resistance, is responsible for depression in people suffering from auditory hallucinations. CONCLUSION: Emotional resistance to auditory hallucinations constitutes the most important variable influencing depression in schizophrenia comparing to what the voices say or are supposed to know, their malevolence or benevolence. Demonstration of the influence of resistance to voices on depression would help the development of new therapeutic practices.

Risk factors of anaemia among rural school children in Kenitra, Morocco.

OBJECTIVE: To determine the prevalence of anaemia and factors associated with iron deficiency among school children in rural Kenitra, Morocco. METHODS: 295 students between 6 and 16 years old composed the study group. The level of haemoglobin was measured in a group of 295 school children. The iron status was determined by ferritin level in serum, and anaemia was defined when haemoglobin <11.5 g/dl. Iron deficiency was defined as ferritin level <15 microg/l. A questionnaire was developed to obtain information on the socio-economic and demographic status of the family such as the size of household, the income and possessions as well as educational status of the parents. RESULTS: The mean haemoglobin concentration was 12.4 g/dl in boys and 12.5 g/dl in girls, whereas the mean ferritin level was 26.7 microg/l in boys and 27.9 microg/l in girls. The overall prevalence of anaemia in the studied population was 12.2% and iron deficiency was 20.4%. There was a significant relationship between education of the mother and anaemia in children (p= 0.01). Serum ferritin (SF), serum iron concentrations and mean corpuscular volume (MCV) were significantly correlated with haemoglobin by multiple regression analysis. However, using logistic regression analysis, the results showed that anaemia was not significantly associated with gender, parents' employment and monthly family income. CONCLUSION: Anaemia remains a common problem in the young children particularly the primary education school boys of the households of low income. The results suggest also, that iron deficiency is an important determinant of anaemia in this population; however, whole anaemia cannot be solely explained by iron deficiency. Further studies are needed to consider micronutrients status and exposure to environmental pollutants.

[The early maladaptive schemas: a study in adult patients with anxiety disorders]. / Les schémas précoces dysfonctionnels: étude chez des patients adultes souffrant d'un trouble anxieux.

The theory of early maladaptive schemas was initiated by Young, who postulated that each pathology is supported by one or several schemas. Adults with anxiety disorders more activate schemas that controls. This hyper activate schemas would go back the childhood. In this study, we measure some cognitive schema's activation, with the Schmidt and al. Questionnaire: this schema's questionnaire measures the dysfunctional schemas in actual way. Our purpose was to compare early maladaptive schema's activation of adults with anxiety disorders and adults healthy. The results indicate that each dysfunctional schema is more significatively activate by the adults with anxiety disorders that adults healthy. He doesn't exist schema typical of anxiety, but just a more important activation of all schemas of adults with -anxiety disorders. All subjects (with anxiety disorder and healthy) activate the schemas in the same order. It would appear that schema who imply an action of subject was more activate. So, in our study, we doesn't observe schema typical of anxiety, as opposed to postulate of Young and Klosko. In fact, in comparison with healthy subjects, all early maladaptive schemas of subjects with anxiety disorders were hypervalent. The order of schema's activation was the same in the two groups, but the activation in the anxious is always more important that in the healthy. All early maladaptive schemas would so hyperactivate in the anxious and a important activation of this schemas in the infancy would predispose to adult's anxious pathology. We consider this research as a preliminary work about early maladaptive schemas. In order to specify the research about schemas in the anxious, il will be interesting to observe this schemas according to different anxious disorders and to study prospectively the evolution of child's schemas.

[Is there an interpretational bias for childhood events in anxious adult patients?]. / Existe-t-il un biais d'interprétation des événements d'enfance chez les patients adultes anxieux?

During anamnesis, we attempted often to include the events reported by the patients in our own functional explanation of the disorder. We forget on one hand that the patient reports events intrinsically linked to his pathology, and on the other hand, that an event could not be understood without its context. Concerning the links between the pathology and what is narrated, it is known for a long time that the anxious disorders modify the perception of world by some processes, like the fast detection of the threat in the environment. Questions are: are the anxious encoding bias active to the restitution phase of information processing? Do these bias influence the recall of childhood events? In this article, we present theoretical data and set of experiments who leads us to say that anxious bias exist in the interpretation of childhood events made by anxious patients.