In patients with schizophrenia, symptoms improvement can be uncorrelated with quality of life improvement.

OBJECTIVES: Quality of life has been found to be associated with symptoms in patients with schizophrenia. Nevertheless, the mechanism that underlies this association is still unclear. The objective of this paper is to prospectively evaluate the quality of life of patients with schizophrenia in relation to the concurrent evolution of their symptoms, their expectations and their perceived position in life. METHODS: Participants included 306 outpatients with schizophrenia who were interviewed at baseline, 6 and 12 months, about their quality of life (Outcome revealed by Preference in Schizophrenia, OPS) and symptoms (Positive and Negative Syndrome Scale, PANSS). RESULTS: Quality of life relative to subject expectations remained stable over time. A decrease in symptoms was correlated to an increase in both expectations and perceived position in life but did not correlate to quality of life. CONCLUSION: The level of expectations seems to play a major role in the subjective assessment of quality of life in patients with schizophrenia. Symptom improvement is not necessarily associated with quality of life improvement relative to subject expectations. Caregivers should be aware of this result so as to deal with possible disappointments in patients receiving a new efficient treatment.

Strength of shock-loaded single-crystal tantalum [100] determined using in situ broadband x-ray Laue diffraction.

The strength of shock-loaded single crystal tantalum [100] has been experimentally determined using in situ broadband x-ray Laue diffraction to measure the strain state of the compressed crystal, and elastic constants calculated from first principles. The inferred strength reaches 35 GPa at a shock pressure of 181 GPa and is in excellent agreement with a multiscale strength model [N. R. Barton et al., J. Appl. Phys. 109, 073501 (2011)], which employs a hierarchy of simulation methods over a range of length scales to calculate strength from first principles.

ELISA: a cryocooled 10 GHz oscillator with 10(-15) frequency stability.

This article reports the design, the breadboarding, and the validation of an ultrastable cryogenic sapphire oscillator operated in an autonomous cryocooler. The objective of this project was to demonstrate the feasibility of a frequency stability of 3x10(-15) between 1 and 1000 s for the European Space Agency deep space stations. This represents the lowest fractional frequency instability ever achieved with cryocoolers. The preliminary results presented in this paper validate the design we adopted for the sapphire resonator, the cold source, and the oscillator loop.

The detection of intentional contingencies in simple animations in patients with delusions of persecution.

BACKGROUND: It has been proposed that delusions of persecution are caused by the tendency to over-attribute malevolent intentions to other people's actions. One aspect of intention attribution is detecting contingencies between an agent's actions and intentions. Here, we used simplified stimuli to test the hypothesis that patients with persecutory delusions over-attribute contingency to agents' movements. METHOD: Short animations were presented to three groups of subjects: (1) schizophrenic patients; (2) patients with affective disorders; and (3) normal control subjects. Patients were divided on the basis of the presence or absence of delusions of persecution. Participants watched four types of film featuring two shapes. In half the films one shape's movement was contingent on the other shape. Contingency was either 'intentional': one shape moved when it 'saw' another shape; or 'mechanical': one shape was launched by the other shape. Subjects were asked to rate the strength of the relationship between the movement of the shapes. RESULTS: Normal control subjects and patients without delusions of persecution rated the relationship between the movement of the shapes as stronger in both mechanical and intentional contingent conditions than in non-contingent conditions. In contrast, there was no significant difference between the ratings of patients with delusions of persecution for the conditions in which movement was animate. Patients with delusions of persecution perceived contingency when there was none in the animate non-contingent condition. CONCLUSIONS: The results suggest that delusions of persecution may be associated with the over-attribution of contingency to the actions of agents.

[Formal thought disorders: French translation of the Thought, Language and Communication assessment scale]. / Troubles formels de la pensée: traduction française de l'échelle d'évaluation de la pensée, du langage et de la communication.

This article proposes a french translation of Andreasen's Thought, Language and Communication (TLC) scale (Andreasen, 1979). This scale is widely used in current literature and remains a reference due to the fact that it has made it possible to establish a consensus with regard to formal thought disorders and has contributed to the operationalisation of the concept of dissociation. This scale consists of 18 items. Each item is clearly defined through the use of clinical examples, rated from 0 to 4 as a function of the intensity of the disorder (absent, slight, medium, severe, extreme). The interview conditions are also stated: free interview of minimum 10 minutes followed by a more structured interview. Some items of the TLC are taken directly from the SANS and SAPS. Their translation has been taken over from french translations already validated by Lecrubier and Boyer (1987). The others were translated within the department and have been verified by a native English speaker. The entirely of the translation has been verified by Andreasen. The metrological qualities of this french translation have been studied in a population of 107 schizophrenic patients who fulfilled all the DSM IV criteria: 73 males and 34 females, mean age 33.4 9 years, in or outpatients, all under neuroleptic treatment and all evaluated by an experienced clinician. Thirty one patients have been filmed to assess the interjudge reliability. The results indicate a high level of interjudge consistency (interclass correlation coefficient 0.96). The global score was 17 9.4. In the factorial analysis before rotation we observe a main factor that makes it possible to calculate a global score. The results of factor analysis of the TLC variables after rotation yield five factors that have an eigen value greater than 1. These five factors explain 66% of the variance. All items have a weight greater than 0.45. The first factor includes Poverty of content speech, Tangentiality, Derailment, Incoherence, Illogical thinking, Loss of goal and Perseveration. It reflects thinking disorganisation. The second factor includes Pressure of speech, Circumstantiality, Self reference and Poverty of speech (negative weight). This factor reflects verbal production. The third factor is composed of Clanging, Neologisms, Word approximation and Echolalia. This factor reflects verbal structure. The fourth factor is only composed of Stilted speech and the fifth one composed of Distractible speech and Blocking. These data have been compared to those reported in the literature: Andreasen in 1979 (113 patients: 32 suffering from manic disorder, 36 from depressive disorder and 45 schizophrenic disorder) and in 1986 (194 subjects: 94 controls, 25 suffering from manic disorder, 25 schizoaffective disorder and 50 schizophrenic patients), Harvey in 1992 (115 schizophrenic patients) and Peralta in 1992 (142 schizophrenic patients). Response levels for each item of the TLC french translation were very close to those found in the english versions. Differences in scores can be explained by clinical differences between populations studied. Factorial analyses also correspond well to such versions. In particular, after rotation, the three factorial subscores found representative of disorganisation, verbal production and verbal structure respectively are closed to those proposed by the english versions. In conclusion, the translation of Andreasen's Thought, Language and Communication (TLC) scale (Andreasen 1979) that we propose here therefore appears to exhibit metrological qualities sufficiently close to those reported in literature to permit its generalised use in France.

Context-dependent information processing in patients with schizophrenia.

Thirty schizophrenic patients fulfilling the Diagnostic and Statistical Manual of Mental Disorders IV criteria for schizophrenia and 30 control participants were shown a set of incomplete sentences, and were asked to complete them with the first word(s) that came to mind. Target sentences included an ambiguous word, the ambiguity of which was not resolved within the clause. However, completion necessarily required participants to select one specific meaning. Each target sentence was preceded by another sentence playing the role of context, which was designed to prime the less frequent meaning of the ambiguous word. The results showed that schizophrenic patients, especially those with thought disorder [on the basis of their TLC scores (Thought, Language and Communication Scale; Andreasen, N.C., 1979. Thought, language and communication disorders. Clinical assessment, definition of terms and evaluation of their reliability. Diagnostic significance. Arch. Gen. Psychiatry 39, 778-782)], used the most common meaning of the ambiguous word more frequently than controls, thus revealing a specific deficit in context use. The deficit was observed whether or not the relation between context and target sentences was made explicit. These results are in line with the cognitive models of schizophrenia that postulate a decreased ability to use context information. However, when considered in the light of prior studies (e.g., Bazin, N., Perruchet, P., 1996. Implicit and explicit memory in patients with schizophrenia. Schizophr. Res. 22, 241-248), they suggest that the deficit in processing contextual information is limited to what Baddeley (Baddeley, A.D., 1982. Domains of recollection. Psychol. Rev. 98, 708-729) called the interactive context (which affects the meaning, or the interpretation, of the target event) in contrast to the independent context (which does not interfere with the meaning-based interpretation of the target event).

[Alzheimer type dementia: is early diagnosis significant?]. / Démence d'Alzheimer: le diagnostic précoce a-t-il un intérêt?

ADVANTAGES OF EARLY DIAGNOSIS: Better prognosis and quality of life for patients with Alzheimer's disease and their caregivers depends on early diagnosis as specific treatment (anticholinesterase drugs) early in the disease process can have a beneficial effect on cognition and psychiatric or behavioral disorders. In addition early diagnosis gives the physician the opportunity to provide adapted advice for the patient and caregivers especially important in preventing complications and helping the family cope with the inevitable disruption of the family pattern caused by the disease, a situation which is particularly for the "designated caregiver". PREDEMENTIA STATES: The question of early diagnosis raises several types of problems. Defining the limits of the disease is particularly difficult: when does Alzheimer type dementia start? what is the definition of predementia? A growing body of work suggests that it is warranted to identify patients at risk of developing Alzheimer type dementia since, according to certain authors, they can benefit from specific treatment. RISK FACTORS: The only fully recognized risk factors are age, family history of dementia and presence of the allele epsilon 4 of the apolipoprotein E gene. There are probably several other risk factors. Their identification is a current subject of debate. TOOLS FOR EARLY DIAGNOSIS: Psychometric tests have been shown to provide specific information useful for interpreting the clinical assessment which must focus on detecting early signs and exploring even minimal memory deficiencies.

[What information do patients with schizophrenia have about their illness and treatment?]. / De quelles informations les patients souffrant de schizophrénie disposent-ils sur leur maladie et leur traitement?

Improved compliance with antipsychotic medication is a major issue in schizophrenic management. For this purpose educational programs have been used, but up to now, little or no information has been gathered or published in France concerning schizophrenic patients' opinion on information they have about their disease and their treatment. Thus we conducted a survey in concert with 78 psychiatrists from the French psychiatric health service. From this cross sectional survey we assessed 336 outpatients (male: 72%; mean age: 36 +/- 10.4 years) with schizophrenia according to the DSM IV (paranoid sub type: 57%, disorganized: 12%, catatonic: 1%, undifferentiated: 12%, residual: 18%). The mean duration of the illness was 11.6 years (sd: 8.5) and the mean duration of the follow up with the same psychiatrist was 5.4 years (sd: 5.1). Patients completed a questionnaire which assessed their level of information on mental illness and treatment. The diagnosis of schizophrenia has been told to their patients by 39% of the psychiatrists, and treatment has been explained to the patients by 96% of the practitioners. Results indicate less than half of the patients (45%) felt ill, only 46% thought they knew their illness well or very well (nevertheless only 31% of them named spontaneously the diagnosis of schizophrenia or psychosis), and 61% considered that they had been given sufficient information. Most of the patients (79%) were persuaded that their treatment was useful, and 75% of patient were completely satisfied with their treatment. Surprisingly 92% reported taking their medication regularly. Most patients think that a high level of information about their illness (74%) and treatment (79%) help them to cope better with their schizophrenia. Analysis performed according to patients characteristics indicated that paranoid patients felt more ill (p = 0.035) than others, thought to know less about their illness (p = 0.0065), and were less satisfied with their treatment (p = 0.04) and their level of information (p = 0.03). Patients with a duration of their illness longer than 10 years were more convinced of the utility of their treatment (p = 0.02) and had debated more on the choice of their treatment with their psychiatrist (p = 0.047). Patients older than 35 years were more satisfied with their information (p = 0.002). More patients with atypical antipsychotics accepted to take their treatment on a regular basis (p = 0.035) compared to patients under classical neuroleptics. This survey underlines that mental health consumers' opinions can be obtained even in the field of schizophrenia, and argues in favour of further such investigations. It also highlights the need for educational programs on schizophrenia and antipsychotic medications.

What is the schizophrenic patients' level of information about their disease and their treatment?

Improved compliance with antipsychotic medication is a major issue in schizophrenic management. For this purpose educational programs have been used, but up to now, little or no information has been gathered or published in France concerning schizophrenic patients' opinion on information they have about their disease and their treatment. Thus we conducted a survey in concert with 78 psychiatrists from the French psychiatric health service. From this cross sectional survey we assessed 336 outpatients (male: 72%; mean age: 36 +/- 10.4 years) with schizophrenia according to the DSM IV (paranoid sub type: 57%, disorganized: 12%, catatonic: 1%, undifferentiated: 12%, residual: 18%). The mean duration of the illness was 11.6 years (sd: 8.5) and the mean duration of the follow up with the same psychiatrist was 5.4 years (sd: 5.1). Patients completed a questionnaire which assessed their level of information on mental illness and treatment. The diagnosis of schizophrenia has been told to their patients by 39% of the psychiatrists, and treatment has been explained to the patients by 96% of the practitioners. Results indicate less than half of the patients (45%) felt ill, only 46% thought they knew their illness well or very well (nevertheless only 31% of them named spontaneously the diagnosis of schizophrenia or psychosis), and 61% considered that they had been given sufficient information. Most of the patients (79%) were persuaded that their treatment was useful, and 75% of patients were completely satisfied with their treatment. Surprisingly 92% reported taking their medication regularly. Most patients think that a high level of information about their illness (74%) and treatment (79%) help them to cope better with their schizophrenia. Analysis performed according to patients characteristics indicated that paranoid patients felt more ill (p = 0.035) than others, thought to know less about their illness (p = 0.0065), and were less satisfied with their treatment (p = 0.04) and their level of information (p = 0.03). Patients with a duration of their illness longer than 10 years were more convinced of the utility of their treatment (p = 0.02) and had debated more on the choice of their treatment with their psychiatrist (p = 0.047). Patients older than 35 years were more satisfied with their information (p = 0.002). More patients with atypical antipsychotics accepted to take their treatment on a regular basis (p = 0.035) compared to patients under classical neuroleptics. This survey underlines that mental health consumers' opinions can be obtained even in the field of schizophrenia, and argues in favour of further such investigations. It also highlights the need for educational programs on schizophrenia and antipsychotic medications.

Implicit and explicit associative memory in patients with schizophrenia.

Control and Schizophrenic subjects performed memory tests under conditions in which performance is influenced by newly acquired information about associations between pairs of normatively unrelated words (a 'context' word and a target word). In Experiment 1, the associative memory test was implicit. Control and schizophrenic subjects reached the same level of performance and, more importantly, both groups used contextual information to the same extent. In Experiment 2, subjects were submitted to an explicit and an implicit memory test in succession. Overall performance of schizophrenic patients was impaired in the explicit memory test. But, as in Experiment 1, the two groups did not differ in the overall level of implicit memory, and context improved performance to the same extent in both tests. These results run counter to the widespread idea that schizophrenic patients exhibit a deficit in processing all types of contexts, and suggest that the deficit may be limited to the processing of what Baddeley (1982) calls 'interactive' context.

[4 years using clozapine in community psychiatry]. / Quatre ans d'utilisation de la clozapine en psychiatrie de secteur.

This study report clinical experience of Clozapine treatment in 48 chronic schizophrenic patients. At the study time, 35 patients are still under this treatment while 13 patients have stopped it. These two populations and their differences are presented. Clozapine experience is positive as testifies quality of life and social situation improvement in numerous cases.

Mood congruence effect in explicit and implicit memory tasks: a comparison between depressed patients, schizophrenic patients and controls.

This study investigates mood congruence effect in explicit and implicit memory tasks in 23 inpatients fulfilling DSM-III-R criteria for major depressive disorder. Performances were compared to those of 15 in- or outpatients fulfilling DSM-III-R criteria for schizophrenia, and 37 normal subjects serving as euthymics controls. All subjects were submitted to a standard cued recall test and to a word stem completion test devised to assess the effect of the initial presentation without the explicit retrieval of the words being necessary. The material used for these two tasks consisted of emotionally negative and positive words. The results show a mood congruence effect in the ;;;implicit;; memory task (and not in the ;;;explicit;; memory task) only in patients who had recovered from their major depressive episode (and not in depressed patients, schizophrenic patients, or controls). These results suggest that implicit and explicit emotional information processing differ from one another in certain respects.

[Cognition disorders related to psychotropic treatments]. / Troubles cognitifs liés aux traitements psychotropes.

Evaluation of cognitive disorders induced by treatment with psychotropic drugs is complex due to the involvement of several factors that can intervene in the pathogenesis and the evaluation of these disorders. Nevertheless, studies are numerous in the field, and we present the main reports. Most studies evaluating the influence of psychotropic drugs in healthy subjects indicate the existence of cognitive changes. On the contrary, aside from the effect of tranquillizers, and the sedative effect and/or the anticholinergic action of certain psychotropic drugs, in treated patients the individual responsibility of these drugs in cognitive disorders appears to have been often overestimated.

Severe psychiatric side effects observed during prophylaxis and treatment with mefloquine.

Mefloquine hydrochloride is now one of the major antimalarial drugs used both in prophylactic and therapeutic regimens. Large-scale studies have shown that it is efficacious and relatively well tolerated. However, some severe side effects, particularly neuropsychiatric reactions, have been described. We describe two young men with no previous medical history who experienced severe psychiatric reactions during prophylactic and curative mefloquine therapy. In both cases, full recovery was rapid after cessation of the therapy. There is no explanation for these reactions. Serum levels of mefloquine were within the normal range. The absence of contraindications and minor side effects during an initial course of mefloquine should be confirmed before another course is prescribed.

The dissociation of explicit and implicit memory in depressed patients.

Twenty-three in-patients fulfilling DSM-III-R criteria for major depressive disorder were submitted to a standard cued recall test, and to a word-stem completion test devised to assess the effect of the initial presentation without the explicit retrieval of the words being necessary. Results show that depressed patients are impaired on the cued recall task in comparison with controls matched for sex, age, and educational level. However, the two groups do not differ in the word-stem completion task. This dissociation between explicit and implicit expressions of memory disappeared when patients recovered, although they were still hospitalized and under psychotropic medication. These results are examined in the light of the distinction between effortful and automatic processes.

Person identification and self-concept in the delusional misidentification syndrome. A case study.

This study on a delusional misidentification patient with both Frégoli symptoms and intermetamorphosis investigates the cognitive structure of others and of the self-representations with a new clustering method (HICLAS conjunctive model). Results show that this patient, free from face recognition disorders, shows severe structural anomalies in the mapping of misidentified others, and of the self. Disturbances in the cognitive structure and person identification are discussed in reference to a psychopathological explanation of the misidentification syndrome.