[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.

[Decisions in conditional situation and theory of mind in schizotypy]. / Décisions en situation probabiliste et théorie de l'esprit dans la schizotypie.

INTRODUCTION: Theory of mind (ToM) is defined as a capacity to infer mental states, intentions, and emotions in others. Two principal theories in the field of cognitive psychology have tried to explain mechanisms underlying this capacity. Theory-theory hypothesizes that people interpret cues from others in social interactions with a folk psychology composed of data about social human behavior. In contrast, Simulation-Theory proposes a capacity to take different perspectives and mentally simulate others' behavior. As a result, one could guess a person's intention or emotion by comparison with his state of mind when he/she behaves in the same way. BACKGROUND: Difficulties in ToM have been frequently observed in schizotypal subjects and subjects with schizophrenia. Some authors have proposed that this impairment could lead to persecution delusions or be linked with disorganized thought. A tendency to make choices with few cues in conditional situation has also been observed in both populations. When they are asked to make a decision about cues they can choose to see or not, schizotypal subjects and patients with schizophrenia tend to make up their mind after significantly less cues than control subjects. This tendency has been called "jump to conclusion". OBJECTIVE: Our study tests the correlation between low performances at a ToM task and a tendency to jump to conclusion in conditional situation. PARTICIPANTS: We tested this hypothesis with 25 participants scoring high on a social anhedonia scale (J Abnorm Psychol 85 (1976) 374-382), one of the main characteristics of schizotypy, and with 20 control participants. Participants were students with a mean age of 20. We included in the experimental group, subjects with a score on social anhedonia scale superior to 17 for females and 19 for males, and seven for control participants (modal score). METHODS: We used "jar and beads", a conditional reasoning task. Two jars are presented to a participant: a white one containing 85% of white beads and 15% of black beads, and a black one filled with the opposite ratio. The participant has to decide from which jar comes successive beads shown to him. Dependent measure is the number of beads seen before decision. ToM task is an adaptation from (Schizophr Res 17 (1995) 5-13). Twenty short interactions between two characters are read to a participant. For example: John has a phone call with a friend for one hour. He says: "My mother ought to call me in a few minutes". QUESTION: What does John really mean? Cue: John adds: "I could call you tomorrow morning". QUESTION: What does John want to do? RESULTS: Results show significantly lower performances at the ToM task in experimental than in control participants (52.36 (S.D., 6.73) vs. 59.05 (S.D., 1.60); t, 4.33; p<0.001; maximum possible, 60). The experimental group asked for significantly less cues to conclude in the conditional situation (2.22-S.D., 1.29). Mean number of beads asked for in the control group was 3.05 (S.D., 1.30) and t, 2.13; p<0.05. There was no correlation between performances at conditional reasoning task and ToM task. We observed this absence of correlation in all of the participants and in the experimental and control groups separately. DISCUSSION: Absence of relationship between performances in both tasks may be attributed to a discrepancy between experimental and ecological contexts for conditional reasoning task. During interpersonal relationships, search for cues in order to make a decision about others' intentions and mental states represents a real cost in terms of energy and time. These costs are absent in the "jar and beads situation". Moreover, people with social anhedonia may attribute a special value of quickly understanding personal interactions. This conditional reasoning task does not imply this parameter. CONCLUSION: Ecological decision in conditional reasoning tasks could be approached by adding a system of points to spend, asking for more cues, or to earn, finally finding the correct answer. Decision would then depend on the ratio between possible gains, by guessing or not the correct answer, and the cost of searching for more cues before making a decision.