Investigating theory of mind in schizophrenia: influence of verbalization in disorganized and non-disorganized patients.

The ability to attribute intentions to others was studied in 13 disorganized and 13 non-disorganized schizophrenic patients, 13 depressed and 13 normal controls. Subjects were asked to complete 28 comic strips requiring theory of mind skills by choosing one out of three answer cards. The answer cards were simple pictures in a first condition and short sentences in a second condition. This study, which used the cognitive neuropsychological approach, underlies the existence of a link between disorganization patterns in schizophrenia and a deficit in the attribution of intentions to others, independently of the pictorial or verbal form of the mode of answering. In addition, results show that the non-disorganized schizophrenic group, depressed and normal controls perform similarly in both pictorial/verbal conditions. The influence of the absence/presence of verbal material on a task investigating theory of mind in schizophrenia is discussed.

The measurement of retardation in depression.

The description of clinical features helps to distinguish between depressive illness and nondepressive psychic pain and enables the clinician to decide whether prescription of an antidepressant is beneficial. Psychomotor retardation is probably a central feature of depression, and this review discusses the methods available for measuring it. The Salpêtrière Retardation Rating Scale (SRRS) specifically measures psychomotor retardation; the scale and applications are described. Means of measuring motor and speech activity and an experimental approach for understanding the process underlying psychomotor retardation are reviewed. Comparison of the SRRS and other rating scale scores demonstrates that retardation is related to depression severity and therapeutic change and is a good criterion for prediction of therapeutic effect. The SRRS has been used to show that selective antidepressants target specific clinical dimensions of depression depending on the patient subgroup treated. Measures of motor and speech activity are sensitive to therapeutic response. Choice Reaction Time and Simple Reaction Time tasks are particularly suited for examining psychomotor retardation because they test the decision process while avoiding motivation and attention interference. Psychomotor retardation is a constant and probably central feature of depression. Means available for measuring it can be used to assess the effects of antidepressants on specific clinical dimensions.

[Memory disorders: from lesional deficit to functional disorders]. / Pathologie de la mémoire: du déficit lésionnel au trouble fonctionnel.

The purpose of this presentation of pathological data is to demonstrate how our ideas have developed from a chronological point of view to our present interest in elementary cognitive processes. The present relative rarity of significant data in brain imagery, compared with what is observed in other fields of neuro-psychology, is probably due to the complexity of this cognitive processes.

Impairment of semantic categorization processes among thought-disordered schizophrenic patients.

OBJECTIVE: To explore semantic categorization strategies in patients with schizophrenia. METHOD: A short-term memory-recognition task that reveals the effects associated with categorization was created and applied to 2 groups of patients with schizophrenia and depression. RESULTS: Only the schizophrenic subgroup with formal thought disorder (measured using Andreasen's Thought, Language, and Communication [TLC] scale) exhibited a deficiency in semantic categorization strategies during the task. CONCLUSION: These results support the hypothesis of the impairment of the processes involved in the processing of contextual information in patients with schizophrenia who suffer from formal thought disorder.

Heterogeneity in cognitive functioning of schizophrenic patients evaluated by a lexical decision task.

BACKGROUND: The disorganization pattern in schizophrenia, which involves formal thought disorders, is thought to be correlated with a deficit in integrative processes of contextual information. We tested the hypothesis that thought disordered schizophrenics, unlike non-though disordered schizophrenics, would present a deficit in the processing of the context during a task which involves these integrative processes. METHODS: A group of 22 schizophrenic patients diagnosed in accordance with DSM-III-R criteria and a group of 11 control subjects were compared using a semantic priming version of the lexical decision task. The experimental design used low-level structuration of verbal material to reveal the difficulty that schizophrenic patients encounter in using semantic regularities. RESULTS: A significant difference in priming effect was found between the three groups. Control subjects and non-thought disordered schizophrenics exhibit a priming effect for related word pairs when compared with unrelated pairs (respectively F(1,10) = 17.7; P < 0.002 and f(1,10) = 14.5; P > 0.003) but thought disordered schizophrenics did not (F(1,10) < 1; NS). CONCLUSIONS: This finding provides evidence for the cognitive heterogeneity of schizophrenic subjects. This absence of priming effect in thought-disordered schizophrenic subjects supports the hypothesis that these patients present a deficit in the post-lexical controlled information processing that permits the integration of semantic information.

Attribution of intentions to others in people with schizophrenia: a non-verbal exploration with comic strips.

Several clinical and experimental data suggest that some people with schizophrenia have an impaired ability to attribute relevant mental states to other people. We tested this notion in 24 schizophrenic patients and two control groups, who performed a task devised to test understanding of the intentions of nonverbal comic strip characters. Only the schizophrenic subjects with thought and speech disorganization had specific difficulties attributing mental states to others. The findings support cognitive models which postulate a link between planning process disorders and a deficit in mentalizing skills. The hypothesis that the more frequent an action is in everyday life, the more easily it is understood by schizophrenic subjects, is discussed.

Discrimination and response bias in memory: effects of depression severity and psychomotor retardation.

Although memory disorders have been well documented in depression, there is controversy concerning depressives' performance on recognition memory tasks; e.g. whether they have impaired discrimination and conservative or liberal response bias according to signal detection theory. In addition, symptomatic correlates of discrimination and response bias indices have been lacking. A word recognition memory task analyzed according to the two high threshold theory was administered to 26 depressives and 26 controls. Depressives obtained a lower index of discrimination (Pr) than controls. The index of response bias (Br) was not different between groups. In the depressed group, overall severity of depression was related to discrimination, whereas psychomotor retardation level was related to response bias. Cognitive performance of depressives could be advantageously analyzed in terms of these two dimensions of symptomatology.

[Deficit in selective attention and its evolution in depression]. / Le déficit de l'attention sélective et son évolution au cours de la dépression.

Selective attention was measured in 34 depressed patients and 34 controls using a computerized version of the Stroop test, that included a manipulation of the stimulus onset asynchrony (SCA) in order to explore the efficacy of cognitive inhibition as a function of depression and of clinical amelioration of degression after therapy. Clinical tests included a measure of psychomotor slowing [Echelle de Ralentissement de Widlöcher (ERD), the Hamilton (Psychiatric Rating Scale for Depression (HAMD), and the Brief Psychiatric Rating Scale (BPRS)]. Selective attention was measured with the Stroop test, which includes four measures: Word, Color, Color-Word, and Color-Word minus Color, or interference. All of these measures were deficient in the depressed patients, particularly Stroop interference. Even when additional time was given to inhibit the Stroop distractor in the SOA condition, depressed subjects still showed significantly inferior performance. After four weeks of anti-depressive treatment, fifteen of the patients were retested, and showed significant improvement on all the Stroop measures, particularly on Stroop interference. The improvement in performance on the attentional measures was comparable in magnitude to that seen on the clinical scales, and suggests that the interference measure can be a sensitive indicator of clinical status in depressed patients.

Are there differential effects of fluoxetine in retarded/blunted affect versus agitated/anxious depressives? A clinical study.

BACKGROUND: Clinical selectivity of antidepressants with pharmacological specificity still remains under debate. METHOD: In the open trial presented below, the effects of fluoxetine, a selective serotonin re-uptake inhibitor (SSRI), were compared across two groups of depressive inpatients contrasted on their symptomatological expression (agitated/anxious versus retarded/blunted affect). Sixteen patients (8 in each groups) were included in the 4-weeks treatment period and submitted to a weekly-based evaluation. Global depression, retardation, emotional blunting, agitation, anxiety and mood profile were assessed. RESULTS: Significant improvements of the HDRS and MADRS scores were observed in both groups. Although no group x treatment interaction was found on the global scores of depression, a differential effect according to the group was observed on anxiety, agitation, irritability and emotional lability. DISCUSSION: These preliminary results support the hypothesis that the effect of fluoxetine on positive clinical dimensions could lead to a differential effect in patients with agitation/anxiety when compared with patients with retardation/blunted affect.

Attribution of mental States to others by schizophrenic patients.

The purpose of this paper is to validate experimentally the hypothesis that postulates a distorted attribution of mental states to others in schizophrenics. Twelve subjects with a diagnosis of schizophrenia were compared with a normal and a clinical control group. Subjects were asked to read a comic strip (with no verbal material) and to choose one of the two answer cards which seemed the most logical to complete the sequence based on the supposed mental state of the character. The results of this study confirm the principal hypothesis that schizophrenics with thought and language disorders have an impaired ability to attribute intentions and false beliefs as they figure in this experiment. Although the theory of mind deficit was specific to schizophrenia for the attribution of false beliefs, no difference was found between the schizophrenic group and the depressed group for the attribution of intentions. Schizophrenics' choice is based specifically on a socially familiar experience rather than the context of the story.

Attention deficits in depression: an electrophysiological marker.

EVENT-RELATED POTENTIALS were recorded in young depressed subjects and compared with results from controls. Subjects were required to respond to targets (rare high-frequency sounds) presented to a designated ear, and to ignore targets presented to the non-designated ear as well as standards (frequent low-frequency sounds) presented to either ear. The results confirm those previously obtained with elderly depressed patients, showing the same general profile of electrophysiological and behavioural differences, and in particular a substantial reduction of the N200 amplitude in response to attended targets in depressed subjects. It is suggested that the N200 component could be a marker of depression.

[Dissociative hysteria]. / Hystéries dissociatives.

Under the term of dissociative hysteria are described a set of clinical syndromes characterized by behavioral disorders and psychic activity anomalies. The nature of the symptoms seems very similar to hysterical conversion. Psychogenic amnesia, psychogenic fugues and multiple personality disorder are described. There is some evidence that the symptoms are related to psychic affective traumatisms and no physiological alteration. Two mechanisms are proposed: dissociation of personality and amnesia. Clinical course generally improves spontaneously. Various forms of psychotherapy may be used.

[Translation and validation of the Revised Social Anhedonia Scale (SAS Social Anhedonia Scale, M.L. Eckblad, L.J. Chapman et al., 1982). Study of the internal and concurrent validity in 126 normal subjects]. / Traduction et validation de l'Echelle Révisée d'Anhédonie Sociale (SAS Social Anhedonia Scale, M.L. Eckblad, L.J. Chapman et al., 1982). Etude des validités interne et concourante chez 126 sujets sains.

The Revised Social Anhedonia Scale (SAS) with 40 items (Eckblad et al., 1982) which studies the social dimension of anhedonia has been validated in the United-States (Mishlove & Chapman, 1985). However, no french translation and validation of this scale has been made to date. This work presents the french translation of the Social Anhedonia Scale and its validation. After a back-translation and final adjustment, it has been submitted to a sample of 126 control subjects from the general population. Furthermore, they were asked to fill two other scales: the Chapman Physical Anhedonia (PAS) with 61 items and the Fawcett Pleasure Scale (36 items), both of them exploring the subjects answer in terms of anhedonia/hedonia towards social, sensorial and/or physical experiences. The internal validity has been determined on the one hand by the Cronbach alpha coefficient which showed a strong unidimensional characteristic (0.80) and the other hand by the correlation of each item with the total score using the point biserial coefficient which ranged from .204 to .559. The concurrent validation has been determined by the Pearson correlation coefficient between the french version of social anhedonia scale and the french version of physical anhedonia scale. The values were .42, p = .001. Furthermore, this two scales are significant inversely correled to the french version of the pleasure scale: r = -.22, p = .0125 for the first, and r = -.26, p = .0027 for the second. The internal and concurrent validity of the french version of the revised social anhedonia scale should allow to improve our understanding of anhedonia in psychiatry and psychopathology.

Semantic inhibition disorders in schizophrenic patients assessed by a lexical decision task.

Lexical decision tasks were used in 17 schizophrenic subjects and 11 control subjects, to evaluate the so-called automatic priming of semantic links, and the controlled processes which involve longer lexical anticipation strategies. In this type of trial, inhibition in the recognition of the target word, when the preceding priming word is not semantically linked to it, indicates the activation of such controlled processes. Postulating that patients in the schizophrenic group were heterogeneous in terms of cognition, we compared the resultant scores in two subtypes of schizophrenic patients: paranoid and hebephrenic (CIM-9 criteria). The study demonstrated that there was a difference in performance between the schizophrenic subtypes. Although these findings need to be confirmed, they demonstrate the necessity of determining individual profiles of patients entering the trial, to take into account those of their phenomenological differences that may correspond to differences in cognitive functioning. The results indicate an absence of inhibition, but only in the paranoid group. In these subjects, results were consistent with the hypothesis of a failure to set up controlled processes rather than a stronger "automatic" activation of the semantic links. However, as the results were not significant, the hypothesis remains open to further investigation. The reasons for the nonsignificance of the results and alternative hypotheses are discussed.

Emotional deficit: an adaptative and evolutive process in HIV infection.

The objective of the present study was to evaluate emotional disturbances and psychopathological symptoms in early stages of human immunodeficiency virus (HIV) infection. Seventy-one homosexual subjects, positive to HIV and two groups of HIV-negative subjects (32 homosexuals and 26 heterosexuals) were evaluated in a semi-structured interview by two trained raters. The results showed the presence of emotional perturbations already in asymptomatic HIV-positive individuals even in the absence of caracterized depression and/or anxiety. This emotional deficit seemed to be more important in more advanced stages of the disease. Depressive and anxious symptoms appeared to be slightly but significantly present in both groups of homosexual men. This emotional deficit could be the reflect of an adaptative process to the threatening consequences of HIV-infection. Emotional perturbations, even mild should not be neglected, because their reduction contributes to the psychological well being of HIV-positive subjects.

A case is not a fact.

Why do we publish clinical data? Between the scientistic illusion that assumes that cases are objective data and the disillusioned observation that psychoanalytic literature is mainly used to boost identity feelings, what role is played by such publications? New psychoanalytical knowledge results from clinical practice and not from scientific experiments or observations. A clinical vignette, even more than a full monograph, is clearly not designed to prove a theory from objective facts but to illustrate a particular clinical view. The quality of a case report relies on at least three criteria: data economy; adequacy to the proposed thesis; and convincingness or persuasion. A case is not a fact, because understanding it presupposes 'semantic holism': understanding any mental state requires taking into consideration a 'world of knowledge'. Empathy results from an unlimited work of inferences. In presenting a case, the psychoanalyst is always in a sense a 'thought-reader'. He describes what he believes he discovers.

[Psychological theories on the vulnerability to depression]. / Les théories psychologiques, la vulnérabilité et la dépression.

The problem of psychological vulnerability refers back to the dysymetric interactions between biological, life-event and personality factors. The term "personality" must be defined in terms of three factors: differential characteristics of the primary traits, "temperament" from the purely biological stand-point, and psychodynamic organization. The following discussion will deal solely with notions of temperament and psychodynamic organization. The renewed interest in the notion of temperament for the constitution of depression has been evoked in a number of recent studies, and allows an integrative approach of the biological phenomena. From the stand-point of psychodynamic organization, we should be less concerned with a strictly etiological role than with the mechanisms involved: loss of the object, in the neurotic model (depressive neurosis?) absence of the object (severe narcissistic disorders). This psychodynamic clinical approach must also take into account the triggering or unmasking effects of the depressive state itself on the underlying personality structure.