[Validation of the French version of the "Beliefs About Voices Questionnaire-Revised" (BAVQ-R)]. / Validation de la version française du « Beliefs About Voices Questionnaire-Revised ¼ (BAVQ-R).

INTRODUCTION: The BAVQ-R explores the beliefs and reactions that "voice hearers" have about their voices. Recently, the BAVQ-R was translated into French, but little is known regarding its validity and reliability. Thus, the aim of this study was to examine further the psychometric characteristics of the BAVQ-R French version. METHOD: Seventy-six adult outpatients participated in the study. In addition to the BAVQ-R, patients were administered a psychiatric symptoms severity interview, and self-esteem and quality of life questionnaires. Then, the BAVQ-R was again completed six weeks later after the seven sessions of brief group cognitive behavioral therapy: the Voices Group. RESULTS: The BAVQ-R was well accepted and was completed in less than 10minutes. All items presented floor and ceiling effects. For 15 items, item-total correlations were inferior to 0.30. Internal consistency was 0.83 for the global score, 0.83 for the malevolence, 0.81 for the benevolence, 0.64 for the omnipotence, 0.82 for the resistance and 0.77 for the engagement. The temporal stability was superior to 0.70, except for the omnipotence (0.65). Regarding, the construct validity, on the one hand malevolence, omnipotence and resistance were correlated (0.56≤r≤0.64; P<0.001) and on the other hand benevolence and engagement (r=0.62; P<0.001). Regarding convergent validity significant correlations were found between malevolence, omnipotence resistance and severity of anxio-depressive symptoms, negative self-esteem (0.40≤r≤0.52; P<0.001). The BAVQ-R allows discriminating neither between psychotic and non-psychotic patients (Mann-Whitney, all P>0.05) nor between groups established on the basis of the voice sources (Kruskal-Wallis, all P>0.05). Moreover, the BAVQ-R does not seem to be sensitive to change: no difference was observed after Voices Group intervention (Mann-Whitney, all P>0.05). Sociodemographic variables are not related to BAVQ-R. DISCUSSION: The French version of the BAVQ-R has sufficiently adequate psychometric characteristics to be used in a clinical setting. However, floor and ceiling effects suggest a lack of sensitivity of the items. Psychometric characteristics of the BAVQ-R could be improved by selecting items and extending the Likert scale to score them.

[Psychometric properties of the Questionnaire de Fonctionnement Social in borderline personality disorder]. / Caractéristiques psychométriques du Questionnaire de Fonctionnement Social chez des patients borderline.

OBJECTIVE: Social functioning is a primordial aspect of mental health and it should be considered as an important outcome measure in psychiatric treatments and studies. Few short and simple assessment instruments are available in French. Recently, the Questionnaire de Fonctionnement Social (QFS) was developed to study social behavior of psychiatric patients. The QFS is a 16-item self-report questionnaire assessing the frequency of and the satisfaction with social behavior during the last two weeks. The aim of the present study is to explore QFS psychometric properties in a sample of patients with borderline personality disorder. METHODS: Eighty-six outpatients (78 women and eight men, mean age: 30.5+/-8.6) with borderline personality disorder and 100 healthy matched control subjects (89 women and 11 men, mean age: 30.2+/-7.7) completed the QFS. The convergent and divergent validities of the QFS were tested with the following instruments: Social Adaptation Self-Evaluation Scale (SASS), Brief Symptom Inventory (BSI), Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS) and a visual scale of suffering (EVS). Test-retest reliability of the QFS was calculated in a sub-sample of 28 subjects and its sensitivity to change was measured for 45 patients. RESULTS: Internal consistency of the QFS' global index was satisfying (Cronbach alpha from 0.59 to 0.84). Test-retest reliability of the QFS indexes ranged from 0.77 to 0.79 (intraclass correlation coefficient). Correlations between QFS and SASS demonstrated moderate convergent validity (r>0.59) whilst associations with others psychological measures (BSI, BDI, BHS, EVS) showed satisfying divergent validity (-0.42

[Validation of the QFS measuring the frequency and satisfaction in social behaviours in psychiatric adult population]. / Validation du Questionnaire de fonctionnement social (QFS), un autoquestionnaire mesurant la fréquence et la satisfaction des comportements sociaux d'une population adulte psychiatrique.

INTRODUCTION: Although everyone working in routine mental health services recognizes the scientific and ethical importance to ensure that treatments being provided are of highest quality, there is a clear lack of consensus regarding what outcome domains to include, what measure of assessment to use and, moreover, who to question when assessing. LITERATURE FINDINGS: Since the fifties, social functioning is considered as an important dimension to take into account for treatment planning and outcome measuring. But for many years, symptoms scales have been considered as sufficient outcome measures and social functioning improvement expected on the basis of symptoms alleviation. As symptoms and social adjustment sometimes appear relatively independent, no accurate conclusion concerning the patient's social functioning can so be driven on the basis of his clinical symptoms. More attention has then been directed toward the development of instruments specifically intended to measure the extent and nature of social functioning impairments observed in most psychiatric syndromes. Many of these instruments are designed to be completed by caregivers or remain time consuming and difficult to use routinely. Presently, in clinical practice, there is a need to rely on simple and brief instruments considering patients'perspective about their social adjustment as a function of time. AIM OF THE STUDY: The aim of this study is to present a new instrument, the QFS, initially developed in order to assess social functioning in patients involved in group psychotherapy programs conducted in a specialist mental health setting, as well as its psychometric characteristics. METHODOLOGY: It was designed to be completed in less than 10 minutes and the questions are phrased in a simple and redundant way, in order to limit problems inherent to illiteracy or language comprehension. The QFS is a 16 items self-report instrument that assesses both the frequency of (8 items) and the satisfaction with (8 items) various social behaviours adopted during the 2 weeks period preceding the assessment. It yields three separate indexes of social functioning, defined a priori and labelled "frequency", "satisfaction" and "global". The higher the scores, the better the social functioning. The QFS was administered to 457 subjects, aged between 18 and 65, including 176 outpatients (99 with anxious or depressive disorders, 25 with personality disorders and 52 with psychotic disorders) and 281 healthy control subjects. RESULTS: No significant difference was found between patients and controls according to age or gender distribution. Acceptance rate was high (>95%). Moreover, the QFS was generally acceptable to the clinicians who used it. Internal consistency calculated for each index ranged from 0.65 to 0.83 (Cronbach alpha). Test-retest reliability, calculated within a 15 days time interval on a sample of 49 healthy controls, ranged from 0.69 to 0.71 (intraclass correlation coefficient). Discriminant validity was calculated on healthy controls and patients divided into sub-groups according to their diagnosis. It showed to be excellent, with significantly higher scores in control subjects than in psychiatric patients and significant differences across diagnostic categories (Kruskal-Wallis ANOVA with post-hoc tests, all p<0.05). The convergent validity of the QFS with other measures of social functioning was calculated, using the Social Adaptation Self-Evaluation Scale (SASS) and the Social Adjustment Scale Self-Report (SAS-SR). With the SASS, the convergent validity was higher among patients (Spearman rS 0.71 to 0.92, p<0.01) than controls (rS from 0.49 to 0.66, p<0.001). In healthy controls, correlation with the SAS-SR was moderate but statistically significant (rS from - 0.21 to - 0.44, p<0.05). When comparing QFS scores with self-rated symptoms severity, lower levels of social functioning were significantly associated with more severe symptoms according to the Brief Symptom Inventory (BSI: rS from - 0.38 to - 0.65, p<0.001). The QFS indexes demonstrated sensitivity to change (Wilcoxon: all p<0.05) on a sample of 27 out-patients suffering from anxious-depressive disorders questioned before and after 4 months of cognitive behavioural group therapy running on a weekly basis during 16 sessions of 2 hours each.The factorial validity of the QFS was measured through 3 separate factor analysis conducted using the data of 457 subjects. The first analysis considered only Frequency items; 7 out of 8 items had loadings above 0.5 on Factor 1 accounting for 30.7% (unrotaded) of the variance. The second analysis considered only Satisfaction items; all items had loadings above 0.6 on Factor 1 explaining 43.4% (unrotaded) of the variance. And finally, in the third factor analysis, all QFS items were included; 15 out of 16 items had loadings above 0.4 on Factor 1 accounting for 30% (unrotated) of the variance. Concerning the factorial validity of the instrument, these results suggest that all QFS items belong to the same underlying dimension. DISCUSSION: Finally, provisional norms for the QFS are provided for healthy controls, in order to characterise individual patients or patient subgroups. In conclusion, the need for assessment in clinical routine, in order to estimate different aspects of patients conditions as well as the quality of the treatment provided, has contributed to the development of a large variety of instruments measuring several domains. Concerning the level of social functioning, many instruments fail to meet chief criterion of feasibility, remaining often too complex or time onsuming. Moreover, only few of them are available in French. CONCLUSION: The QFS presented here is a brief, simple and easy to administer self-rating scale that displays satisfactory psychometric properties. It seems to be a valuable instrument for the monitoring of social functioning in psychiatric patients which, from a therapeutic point of view, may have a clear impact as it sets up expectation of change and allows both to reality test patients and therapists beliefs about the presence of progress or not and to identify if therapy is working on this specific outcome domain. Though, to date, the administration of the QFS to other populations and treatment modalities requires further investigation.

[Influence of attention on an auditory-verbal learning test in schizophrenic patients]. / Influence de l'attention sur une épreuve d'apprentissage auditivo-verbal chez des patients schizophrènes.

Schizophrenic patients are known to feature alterations in their cognitive performances, principally in executive functions, attention and memory. In this last domain, studies have shown a relatively severe and global deficit, which can be assessed in chronic and first episode patients. It seems that the memory dysfunction is independent of age and intellectual level, but does correlate with negative psychopathology and global functioning. In the study of memory dysfunction, attentional capacities, information processing and symptomatology have to be considered as determining factors. It has been shown that patients with schizophrenia perform poorly in selective attention tasks and that this deficit may interfere with learning. In the same way, the slowing of information processing contributes to a superficial and incomplete learning. The impact of symptomatology has also to be considered, as negative and depressive symptoms are linked to mnesic performances. The majority of studies bearing on working memory and schizophrenia show an alteration of performances, but studies on long term memory are more equivocal. Procedural memory seems to be preserved, while declarative memory is impaired. These results support the hypothesis that in schizophrenia, memory processes that are consciously controlled are impaired, contrary to implicit learning which may be intact. Nevertheless, studies bearing on semantic memory and episodic memory show controversial results. Still, many authors argue that schizophrenic patients have difficulties in recalling learned material, specially when a delay or a interfering task are introduced in the test. Besides, the schizophrenic subjects do not use the semantic properties of the words, as well as the control subjects, when they have to learn a words list for example. The main goal of the present study was to examine the auditory-verbal learning capacities of 31 schizophrenic patients (20 men and 11 women, 19-56 years old), compared to 27 healthy subjects (11 men and 16 women, 23-56 years old). All subjects received an evaluation including the Rey Auditory-Verbal Learning Test, used to study the progressive acquisition of 15 disyllabic words which are successively orally presented five times to the subject. About forty-five minutes after the last of the five immediate recalls, the delayed recall is assessed and a percentage of retention is also calculated. Visual reasoning and attention capacities were studied with the Progressive Matrix and the d2 encumbrance test respectively. Global psychiatric symptomatology of the patients group was assessed with the Brief Psychiatric Rating Scale. Considering the literature existing on the verbal learning capacities of schizophrenic patients, it was expected that the patients would perform poorly and learn slower than controls. The initial learning of the material, which is a critical stage for schizophrenic patients, was studied with particular attention as well as the effect of the introduction of a delay upon the recall of the words list. A secondary objective of the study was to investigate the role of visual reasoning and attention upon auditory-verbal learning process. According to published studies, it is expected that schizophrenic patients manifest some impairment in the domains of visual reasoning and attention. The question is to know whether it alters performances in the auditory-verbal learning test or not. Finally, the links between clinical characteristics of the patients, like age and illness duration, and their learning performances were explored. Statistical analysis included first a descriptive analysis of data to examine differences between the two groups. Second, ANCOVAs were used in order to control the respective impact of educational level, attention capacities and verbal reasoning capacities upon learning performances. Third, Spearman's correlations were used to detect links between clinical characteristics of the patients and learning performances. The comparisons between patients and controls confirmed that schizophrenic patients scored less in the attentional and visual reasoning tasks. They also featured a lower educational level compared to the healthy subjects. In the auditory-verbal learning test, the patients showed altered performances in the five recalls, as well as in the delayed recall and for the retention percentage. In order to control the impact of educational level, attentional and visual reasoning capacities, these parameters were introduced in the statistical analyses. Educational level did not influence memory alterations in the schizophrenic group. However, attention and, to a lesser extend, visual reasoning had an impact on the comparison of memory scores: when controlling attention, almost no significant group effect remained. Finally, the exploratory analyses of links between clinical characteristics and memory only revealed the presence of a significant negative correlation between illness duration and learning performances. Thus, the analyze of data showed that schizophrenic subjects featured poor performances in the domains of attention, verbal reasoning and auditory-verbal memory. Further analyses taking into account group differences on attention suggest that the impairment featured by schizophrenic patients in the domain of verbal memory strongly relies on an attentional deficit. These results are discussed according to the existing literature and methodological limitations. Clinical implications are also discussed.

Relationship between subjective cognitive symptoms and frontal executive abilities in chronic schizophrenic outpatients.

The aim of this study was to investigate the relationship between executive abilities and subjective basic symptoms in a group of outpatients with schizophrenia. Fifty patients underwent a neuropsychological testing battery. Basic symptoms were assessed using the Frankfurt Complaint Questionnaire. Using Pearson's product-moment correlations or partial correlations calculated by regression procedure, cognitive performance was not related to subjective experience. When patients were divided into two groups, with and without 'hypofrontality', as assessed by the neuropsychological testing, we did not find any significant difference in basic symptoms rating. Thus, it is likely that basic symptoms and neurocognitive functioning are unrelated in schizophrenic outpatients, probably because the expression of subjective experience and cognitive impairment is less pronounced than in inpatients. Also, subjective self-perceived basic symptoms and neurocognitive functioning may be unrelated, because these concepts are based on different theoretical backgrounds.

Evolución de la psicoterapia grupal en la asistencia psiquiátrica: la Batería "Bel-Air" / Group psychotherapy in psychiatric care: the Bel-Air Evaluation Battery

En el presente trabajo se revisa, en primer lugar, la literatura sobre la eficacia global de las psicoterapias de grupo en relación con las individuales y luego se comparan los resultados de las terapias grupales duraderas con las breves y de las de diferentes orientaciones teóricas (dinámica, cognitivo-comportamental y psícoeducativa) entre sí y en pacientes con distintos diagnósticos. Algunos estudios meta-analíticos muestran un "efecto talla" ("effect size") similar al que se puede obtener en los estudios de eficacia de los psicofármacos. Hay algunos trabajos de revisión que afirman que no existen claras ventajas de unas variedades respecto de otras pero otros estudios, en cambio, privilegian ya sea las unas o las otras. Después discutimos el grado de objetividad de las investigaciones en el campo y de los instrumentos que se han utilizado con más frecuencia. Finalizamos describiendo la Batería "Bel-Air" de evaluación que utilizamos en el Departamento de Psiquiatría de la Facultad de Medicina de la Universidad de Ginebra. Consta de tres instrumentos adaptados de otros conocidos en la literatura: Una lista corta de síntomas (The Brief Symptoms Inventory, BSI), La Escala de Funcionamiento Global (GBS), El Cuestionario de Estrategias de Enfrentamiento de ("Coping index" de K. Sherrer y U. Scherrer) y El Cuestionario de Clima Grupal (adaptado de McKezie, 1990). Hemos añadido también dos instrumentos de creación propia. El cuestionario de evaluación de las relaciones con los demás (ERA, Fredenrich & Zinetti, 2000, en prensa) y el Cuestionario de Funciones sociales (QFS). Todos estos instrumentos permiten medir características comunes a grupos de muy diverso tipo en un tiempo corto. En cada grupo específico, se pueden naturalmente añadir otros instrumentos específicos para distintas patologías para otras variables. (AU)

A study of visual and auditory verbal working memory in schizophrenic patients compared to healthy subjects.

Impaired working memory (WM) performance is considered as a central feature of schizophrenia. Divided into two components, verbal and spatial, WM has been shown to involve frontal and parietal regions. Verbal WM can be tested either visually or aurally. The present study aimed to test schizophrenic patients in both visual and auditory verbal WM in order to assess a possible distinct pattern of alteration of these two modalities. Twenty-four schizophrenic patients and 24 healthy controls were compared with 2-back continuous visual and auditory verbal WM testing. Both groups were also tested on a neuropsychological battery including Wisconsin Card Sorting Test (WCST). Schizophrenic patients were less efficient in both verbal WM tests. When taking age and educational level as covariates and both WM modalities as dependent variables, there was no differential effect of modalities across groups. In further exploratory analyses, partial correlations brought association between verbal WM and psychosocial adaptation, WCST and length of illness. These results suggest a similar pattern of alteration of both modalities of verbal WM in schizophrenic patients. The implications of this finding are discussed.

Small hepatocellular carcinoma treated with percutaneous ethanol injection: unenhanced and gadolinium-enhanced MR imaging follow-up.

PURPOSE: To determine the value of magnetic resonance (MR) imaging in follow-up of small (< 3 cm) hepatocellular carcinoma treated with percutaneous ethanol injection (PEI). MATERIALS AND METHODS: Fifty-seven patients underwent MR imaging before and after PEI. At follow-up every 6 months, MR images were correlated with results of fine-needle aspiration biopsy (FNAB). In 12 patients, correlation with histologic findings in surgical specimens was possible. RESULTS: In 39 patients followed up for 24 months, the treated lesions showed hypointensity on unenhanced (T2-weighted) images and loss of enhancement on enhanced (T1-weighted) images. At 6-month follow-up in six patients, the lesions showed areas of hyperintensity on unenhanced images and enhancement on enhanced images. These lesions contained residual viable tumor at FNAB. Twelve patients underwent surgical resection after 6-month follow-up. Correct diagnosis of complete or partial tumor necrosis was made in nine of these 12 patients with enhanced images and in three with unenhanced images. CONCLUSION: Gadolinium-enhanced T1-weighted MR imaging is more accurate than unenhanced T2-weighted MR imaging in evaluation of PEI therapy.

Efficacy of SH U 508 A (Levovist) in color Doppler ultrasonography of hepatocellular carcinoma vascularization.

To assess the efficacy of a new US contrast agent [SH U 508 A (Levovist), Schering] in evaluating hepatocellular carcinoma (HCC) vascularization, 38 patients with 43 lesions were submitted to color Doppler US before and after i.v. contrast medium administration. Four patients were studied after arterial chemoembolization. The patients had been selected on the basis of suboptimal color Doppler signals on baseline images. Each patient received two to four injections of Levovist in standard doses. Tumor vascularization was qualitatively graded on a 0-3 scale. Twelve tumors (27.9%) appeared avascular at baseline examinations, while 31 (72.1%) exhibited low to moderate flow signals. After contrast agent administration, color Doppler signals were markedly enhanced in 35/43 lesions (81.4%), lasting 40 to 240 seconds. The lack of enhancement was related to tumor hypovascularity (necrosis at CT), portal vein thrombosis, deep location and successful chemoembolization. The detection of flow signals in chemoembolized tumors was explained by the persistence of viable tumor tissue. After Levovist administration, flow signals were detectable in 97.6% of the HCCs. Therefore, Levovist proved to be an effective tool for color Doppler evaluation of HCC vascularization.

[Invasive carcinoma of the cervix uteri (Stage IB-IIB). Comparison of CT and MR for the assessment of the parametrium]. / Il carcinoma invasivo della cervice uterina (Stadio IB-IIB). Confronto TC-RM nella valutazione del parametrio.

In the patients with invasive cervical carcinoma, the accurate assessment of parametrial invasion greatly affects the therapeutic choice between surgery and radiation therapy. As a matter of fact, surgery is usually performed only in the patients with carcinoma confined to the cervix, whereas those with parametrial involvement, or more advanced stages, are treated with radiation therapy. This prospective study was aimed at investigating the comparative adequacy of CT and MR imaging in assessing parametrial status in the patients with invasive cervical cancer. Twenty-one consecutive patients, with histologic diagnosis of cervical carcinoma, were investigated. All of them were clinically considered as having invasive cervical cancer (FIGO stages IB-IIB), and subsequently underwent surgery. In all cases, detailed histology of the parametrium was obtained. Pathologic data were compared with CT and MR findings in all cases. As for assessing parametrial involvement by cancer, CT had 62% accuracy, 63% sensitivity, and 60% specificity, versus MR imaging 81% accuracy, 69% sensitivity, and 80% specificity. Therefore, MR imaging appears to be superior to CT in assessing the parametrial status of patients with invasive cervical carcinoma; the method yields valuable information for treatment planning.

[Conventional radiography and digital radiography of the thorax: evaluation of anatomo-radiological parameters]. / Radiografia tradizionale e radiografia digitale del torace: valutazione di parametri anatomo-radiologici.

We report the results of a comparative study of digital and conventional chest radiographs to detect normal anatomical structures of the thorax. A digital Toshiba unit (TCR 201) was used to examine 100 selected patients who were diagnosed with no chest pathologic conditions. The images in both modes were submitted for interpretation to five radiologists. The depiction of nine normal anatomical structures was more accurate on digital than on conventional radiographs. The mean confidence levels achieved in viewing digital images were higher than those obtained with conventional radiographs. This difference was statistically significant (p = 0.002).