The metacognitive link between co-occurring intra- and interpersonal symptoms in major depression.

OBJECTIVES: Co-occurring symptoms in depressed people currently in a relationship are sometimes considered to be due to interpersonal variables like dyadic adjustment, or intrapersonal factors such as a lack of dispositional mindfulness. Recent theories of emotional distress have, however, proposed that metacognitive beliefs could be a better link between these frequently co-occurring symptoms in major depression. METHODS: In a French sample of depressed inpatients currently in a relationship (n=30), we conducted a mediation analysis to assess whether the score of the Metacognitions Questionnaire-30 mediated the relation between on the one side the Beck depression inventory and on the other side the dyadic adjustment scale, the Beck anxiety inventory, and the five facets mindfulness questionnaire. RESULTS: By using a multiple linear regression and the Sobel test, we found that the Metacognitions Questionnaire fully mediated the association of depression severity with both anxiety and the affectionate expression of the Dyadic Adjustment Scale, and partially mediated that of the Five Facets Mindfulness Questionnaire with depression severity. CONCLUSIONS: These results obtained in a clinical sample gave support for the mediating role of dysfunctional metacognitive beliefs on some aspects of depressive symptomatology, as well as the likely metacognitive nature of important dispositional mindfulness facets. Limitations of this study are discussed, including its cross-sectional design as well as its sample size.

[Validation of the bias against disconfirmatory evidence in a French-speaking sample of schizophrenic patients]. / Validation du biais contre les indices infirmatoires chez un échantillon francophone de patients schizophrènes.

PURPOSE: The purpose of this study was to verify the generality of the bias against disconfirmatory evidence in a French-speaking sample of schizophrenic patients. This bias is a heightened persistence of incorrect interpretations in front of contradictions, previously demonstrated in schizophrenic patients coming from non-French-speaking communities. METHOD: In a pictorial decision task, 20 schizophrenic, 20 depressive and 20 control participants reappraised during eight successive steps, six interpretations proposed for emotionally neutral but initially incomplete pictures. Each step added a fragment of the picture represented. The reappraisal of the plausibility of incorrect interpretations between each step (change score [CS]) was measured for all the participants. The positive and negative symptoms scale as well as the scale for the assessment of positive symptoms were only administered to schizophrenic patients. RESULTS: Evolution of CS as a function of the seven last steps was significantly less pronounced in the schizophrenic samples. Only the negative dimension of the PANSS was correlated to the CS. DISCUSSION: These results replicated the BADE in a small French-speaking schizophrenic sample. The absence of a significant correlation between the BADE and the positive symptoms and measures of delusion was discussed with regard to both the small size of the sample and the explicative status of this bias.

[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.

[Mortality among chronic schizophrenic patients: a prospective 14-year follow-up study of 150 schizophrenic patients]. / Mortalité et causes de décès dans la schizophrénie: étude prospective entre dix et 14 ans d'une cohorte de 150 sujets.

OBJECTIVE: The aim of this study was to quantify the mortality risk in chronic schizophrenic patients, ten to 14 years after the initial evaluation. Furthermore, using sociodemographical, clinical and psychometrical variables evaluated at inclusion, predictors of global or mortality by suicide were explored. METHODS: One hundred and fifty subjects meeting the research diagnostic criteria (RDC) for chronic schizophrenia were included in the study between 1991 and 1995. At the initial assessment, the following variables were assessed: sex, age, level of education, number of hospitalisations, mean duration of the illness, scores on the physical anhedonia scale, the brief psychiatric rating scale (BPRS), the positive and negative syndrome scale (PANSS), and Beck's depression inventory (BDI). In May 2005, all the subjects were assessed using direct or indirect methods. Survival analysis was conducted using the Kaplan-Meier product-limit estimator and a standardized mortality ratio (SMR) was calculated. Multivariate Cox regression was performed to detect predictive factors associated with mortality. RESULTS: The absolute mortality rate was of 18.57% and the RSM of 4.83. The absolute mortality rate for suicide was 6.98%. Multivariate Cox regression analyses showed that two factors (high rate of males, high dose of antipsychotics) were related to an increase in global mortality risk. Moreover, high dose of antipsychotics and a high rate of "positive" subjects, as evaluated by the PANSS, were related to an increase in mortality risk by suicide. CONCLUSION: High dose of neuroleptics could characterize the severe form of schizophrenia, the risk of mortality of which was higher than that of the less severe forms. Another explanation was that high doses of neuroleptics could lead to severe side effects and thus an increase in the vulnerability of schizophrenics to organic diseases. Positive, contrary to negative, symptoms could increase the risk of suicide. This 14-year follow-up study confirmed the increased mortality rates by natural and non natural causes observed in chronic schizophrenic subjects.

[Psychometric properties of the French versions of the Cognitive Slippage Scale and Schizotypal Ambivalence Scale in 340 subjects]. / Traductions françaises et validations des échelles de dérapage cognitif (Cognitive Slippage Scale, Miers et Raulin, 1987) et d'ambivalence schizotypique (Schizotypal Ambivalence Scale, Raulin, 1986).

AIMS: The aim of this article is firstly to present the French translations of the Cognitive Slippage (Miers and Raulin, 1987) and the Schizotypal Ambivalence Scales (Raulin, 1986), and secondly to determine their psychometric properties in different samples of non-clinical and clinical subjects. BACKGROUND: Chapman et al. have developed trait-oriented scales based on Meehl's manual of schizotypy, such as the Physical and Social Anhedonia Scales, the Perceptual Aberration Scale, the Magical Ideation Scale, the Impulsive Nonconformity Scale, the Cognitive Slippage Scale (CSS), and the Schizotypal Ambivalence Scale (SAS). The Chapman scales of psychosis proneness are the most internationally used instruments for the assessment of schizotypy and some of them such as the Cognitive Slippage and Schizotypal Ambivalence Scales were still not available in French. METHOD: The study was conducted in three different samples: the non-clinical sample (n=158) comprised firstly 128 university students (113 females, 15 males) with a mean age of 24.67 years (sd=5.18) and secondly 30 healthy subjects (12 males, 18 females) with a mean age of 33.26 years (sd=7.35); the clinical sample (n=167) comprised firstly 106 psychiatric patients hospitalized in a general hospital (73 males, 33 females) with a mean age of 38.35 years (sd=11.60) and 61 (35 males, 26 females) in or outpatients of a psychiatric department with a mean age of 37.75 years (sd=10.72); 15 schizotypal university students presenting high score of the Revised Social Anhedonia Scale (1 male, 14 females) with a mean age of 21.26 years (sd=1.1). Using the ICD-10, the diagnoses for the general hospital sample were neurotic or anxious disorders (47%) and depressive disorders (24%). For the psychiatric department sample, the diagnoses were schizophrenic disorders (29%), mood disorders (16%), neurotic disorders (18%) and personality disorders (15%). The internal consistency was determined by the Kuder-Richardson coefficient (KR 20) (CSS: KR 20=0.85 in the university sample; 0.89 in the general hospital sample; 0.87 in the psychiatric department sample; SAS: KR 20=0.79 in the university sample; 0.82 in the general hospital sample; 0.85 in the psychiatric department sample). RESULTS: The mean of the correlations between each item and the total score was calculated (CSS: 0.41 in the university sample; 0.44 in the general hospital sample; SAS: 0.46 in the university sample; 0.49 in the general hospital sample). The discriminant validity was studied by a Student's t test showing that the schizotypal university students had significant higher scores on the CSS and SAS than the healthy university students. The reliability was explored using a test-retest in the 30 healthy subjects. The subjects filled out the scales three months after the first testing. The intraclass coefficients were 0.81. Finally, the cutoff scores were calculated following the procedure described by Chapman et al. (score higher than two standard deviations above the mean of the university sample). The values for the CSS and SAS were respectively 15 and 12 for males and females.

Relationships between subjective experiences of deficit and other psychopathological features in schizophrenia.

The study of subjective symptomatology among schizophrenic patients has been neglected. Even if the patient complaints have always been at the root of the psychiatrist's work, it has not been conceivable to integrate them in objective studies. Since 1950, Huber has been interested in the basic symptoms and has developed his concept of 'a pure defect state', a syndrome which is present as soon as the beginning of the disease and on which episodes of decompensation would crop up. In the 1980s, a majority of the scales for the assessment of subjective complaints appeared. Our study used the French version of the Scale of Subjective Experiences of Deficit, a scale which has a good internal consistency and interrater and test-retest reliability. In this study of 50 longterm schizophrenic patients, we compare subjective symptoms and objective symptoms using the Positive and Negative Syndrome Scale. We point out - in agreement with previous work - a statistically significant correlation between subjective symptoms and positive symptoms.

[Cause of mortality in schizophrenic patients: prospective study of years of a cohort of 150 chronic schizophrenic patients]. / Causes de la mortalité chez les schizophrènes: étude prospective sur 8 ans d'une cohorte de 150 schizophrènes chroniques.

UNLABELLED: Overmortality in schizophrenic patients in comparison to the reference population has been found. At the present time this over mortality is mainly due to suicide or certain natural causes such as respiratory, cardio-vascular and cerebro-vascular diseases. In France there are not psychiatric cas registers that could allow us to study the mortality of psychiatric patients. The aim of the study was first to determine the standardized mortality ratio (SMR) in a group of 150 chronic schizophrenics followed during 8 years and secondly to detect the variables that could predict this mortality. METHOD: The subjects filled out the RDC criteria for definite chronic schizophrenia and were included from 1991 to 1995. The subjects were inpatients or outpatients and their evaluation was made by psychiatrist. The subjects were selected from the different departments of two psychiatric hospitals corresponding to two French geographic areas (the Somme and Oise, two French "département"). At the initial assessment socio-demographic, clinical and psychometrical variables were collected: sex, age, educative level, number of hospitalizations, mean duration of the illness, scores on the Physical Anhedonia Scale, Brief Psychiatric Rating Scale (BPRS), Positive and Negative Syndrome Scale (PANSS). For the BPRS and PANSS, negative, positive and general subscales were extracted. In May 1999 all the subjects were contacted in order to know if they are alive or not and if they are death to know the date and the causes of their death. For the subjects that were still alive we used either direct assessment by interview of their psychiatrist or general practioner or indirect assessment by interview of their family. For the deceased subjects, we obtained informations about the date and the causes of the death by their psychiatrist or general practioner. If the patients were lost sight of we send a letter to the city of their place of birth in order to know if they are alive or not and if they are dead to know the date of their death. Moreover demographic data concerning the French and the Somme populations as well as the corresponding data concerning the mortality according to age and gender were obtained. A comparison of global mortality between patients and the French general or the Somme populations was made by the SMR. Moreover the deceased subjects and the survivors were compared by unidimensional statistical tests (chi 2 analyses for qualitative variables or Student's t test for quantitative variables) for the sociodemographic, clinical or psychometric variables. For each significant difference at p level < or = 0.05, the corresponding variable was retained for a multivariate step by step discriminant analysis. RESULTS: We found 13 deaths (10 males, 3 females): 3 suicides, 3 cardiac diseases, 2 cancers, 1 respiratory disease, 1 car crash, 1 homicide, 1 infectious disease, 1 respiratory arrest. The mortality rate (without correction for age) were 1.08% for both sexes, 1.44% and 0.6% for males and females respectively. The mortality rates (corrected for age) were 2.47% in our cohort and 0.988% in the Somme population. The corresponding SMR was 2.5. (chi 2 = 3.15, df = 1, p < 0.01). The overmortality was found only for males (chi 2 = 2.57, df = 1, p < 0.01) and not for females (chi 2 = 0.034, df = 1, p > 0.05). Concerning the comparisons between the deceased subjects and the survivors, there were five significant differences: gender, age, duration of the illness, neuroleptic dosage, negative symptoms (BPRS negative subscale). The deceased subjects were older, there was more men, the duration of the illness and the neuroleptic dosage were higher and the BPRS negative subscale was lower. These five variables were introduced in the discriminant analysis to explore notably their respecting weight. The corresponding power of the five variables were in decreasing order: neuroleptic dosage, negative symptoms, age, gender, duration of the illness. DISCUSSION: Our study confirm the overmortality in schizophrenic patients, this overmortality was especially explained by natural and non natural causes of death. The overmortality concerned only schizophrenic males patients whereas schizophrenic females did not have an overmortality. This negative result could be explain by a bias selection, the males being overrepresented in our cohort. Among the variables that were linked to the overmortality, the low level of negative symptomatology confirmed previous studies that have shown a low suicide rate in deficit schizophrenic. Moreover a high level of positive symptomatology could lead to high risk behaviors (suicide attempts, sexual disinhibition...). The neuroleptic dosage was the variable whom discriminate power was the highest. At least two explanations can be proposed. (ABSTRACT TRUNCATED)

[Subjective Experience of Deficits Scale in schizophrenic patients]. / L'échelle des expériences subjectives des déficits (EESD) chez les patients schizophrénes.

The aim of the study is to present the French version of the scale for the assessment of subjective experiences of deficits in schizophrenia (SEDS, Liddle and Barnes, 1988). The metrological parameters of the French version of the SEDS were studied in 50 RDC chronic schizophrenics. The interraters reliability was determined using the Kappa and Kendall coefficients of concordance. Among the 50 schizophrenics 30 filled out once again one month later the French version of the SEDS and the temporal stability of each scale's item was calculated using frequency (%). The construct validity was determined using first the Cronbach alpha coefficient and secondly by calculating the Pearson correlation coefficient between each item and the total score. The Kappa coefficients were higher than 0.4 for 15 items out of 22. The Cronbach value was 0.87 19 items out of 22 had a temporal stability from 64.2% to 100%. Thus the French version of the SEDS seems to be reliable and could allow to study subjective experiences of deficits in schizophrenia.

[French translation of the Frankfurt Complaint Questionnaire (Frankfurter Beschwerde-Fragebogen, FBF, Süllwold, 1986)]. / Traduction française du questionnaire de plaintes de Francfort (QPF) (Frankfurter Beschwerde-Fragebogen, FBF, Süllwold, 1986).

Observable behaviors play the predominant role in the clinical assessment of schizophrenia, while only secondary emphasis is placed on exclusively subjective complaints. Huber employed the phenomenological approach to obtain subjective symptoms that he named "basic symptoms". Subjective symptoms constitute an important component of the schizophrenic symptomatology. They may play a predominant role during the prodromal or early phases of the disease, they may be useful in elucidating cognitive and perceptual disturbances in schizophrenia. In the last decade, the assessment of patients' subjective experiences has acquired significance with the development of several instruments for their specific evaluation. The Frankfurt Complaint Questionnaire (FCQ, Süllwold, 1986) is the instrument most widely used in Europe for assessing subjective experiences. It covers a wide range of complaints of cognitive deficits that Süllwold compiled from the complaints of schizophrenic patients. We present the French translation of the FCQ. The availability of the FCQ in French could be an important step in promoting the study of subjective experiences in research and clinical activities.