Strategies for Achieving Better Cognitive Health in Individuals with Schizophrenia Spectrum: A Focus on the Canadian Landscape: Stratégies pour atteindre une meilleure santé cognitive chez les personnes souffrant du spectre de la schizophrénie : un regard sur le paysage canadien.

BACKGROUND: Schizophrenia spectrum disorders (SSDs) are a group of psychiatric disorders characterized by positive and negative symptoms as well as cognitive impairment that can significantly affect daily functioning. METHOD: We reviewed evidence-based strategies for improving cognitive function in patients with SSDs, focusing on the Canadian landscape. RESULTS: Although antipsychotic medications can address the positive symptoms of SSDs, cognitive symptoms often persist, causing functional impairment and reduced quality of life. Moreover, cognitive function in patients with SSDs is infrequently assessed in clinical practice, and evidence-based recommendations for addressing cognitive impairment in people living with schizophrenia are limited. While cognitive remediation (CR) can improve several domains of cognitive function, most individuals with SSDs are currently not offered such an intervention. While the development of implementation strategies for CR is underway, available and emerging pharmacological treatments may help overcome the limited capacity for psychosocial approaches. Furthermore, combining pharmacological with non-pharmacological interventions may improve outcomes compared to pharmacotherapy or CR alone. CONCLUSION: This review highlights the challenges and discusses the potential solutions related to the assessment and management of cognitive impairment to help mental health-care practitioners better manage cognitive impairment and improve daily functioning in individuals with SSDs.

Improving Thinking Skills in People With Schizophrenia: A Focus on CanadaPlain Language SummarySchizophrenia spectrum disorders (SSDs) are mental health conditions that can cause a mix of symptoms making everyday life difficult for people. For example, some people might experience positive symptoms like seeing and hearing things that are not there, having false believes, or feeling suspicious. Others might experience negative symptoms like isolating from social interactions, having trouble showing emotion, or finding it hard to connect with others. Finally, they might also have trouble with thinking skills, like paying attention, planning and organizing, remembering things, or understanding social cues. While some medicines can help with some of the symptoms, they often do not help with improving thinking skills. In addition, these thinking problems are not checked often enough in patients with SSDs. In fact, there are not many proven ways to help with these issues. One method that can help with thinking skills is called cognitive remediation (CR), but it is not offered to most people with SSDs. There are ongoing efforts to make CR more available. It is also possible that CR may be combined with new medicines to make it work better than using just one treatment. This article looks at ways to improve thinking skills in people with SSDs, with a focus on what is happening in Canada. We present the challenges and possible solutions for checking and managing thinking problems, to help health-care workers better care for people with SSDs.

A replication study of sHLA-E influence on schizophrenia and bipolar disorder.

OBJECTIVES: Schizophrenia (SZ) and bipolar disorders (BP) are chronic and severe neuropsychiatric diseases. These disorders are tightly related to immune deregulations. In the current study, we intended to replicate the previously reported involvement of the soluble HLA-E isoforms (sHLA-E) in the risk of developing the two conditions along with disease severity in a Tunisian population group. PATIENTS AND METHODS: One hundred and twenty-four patients with schizophrenia and 121 with bipolar disorder meeting the DSM-IV criteria along 111 healthy controls were included in this present case-control study. The soluble HLA-E isoforms circulating levels were measured using the ELISA method. The statistical analyses were performed using Kruskal-Wallis and Wilcoxon rank sum tests by R software and GraphPad prism 9. RESULTS: We found that the sHLA-E circulating levels were significantly higher in BP patients as compared to healthy controls (P<0.0001) and that such increases were mainly observed in patients during an acute phase of their disease (P<0.0001). In SZ patients, while we failed to observe an association with the levels of sHLA-E in the entire SZ sample, we found that high sHLA-E levels characterized stabilized patients in comparison with those during an acute episode (P=0.022). Finally, we did not observe any association between sHLA-E circulating levels and symptoms assessed by the classical clinical scales either in BP or SZ patients. CONCLUSION: Overall, the present findings replicate in a Tunisian population group the previously demonstrated implication of sHLA-E circulating levels in the risk of developing BP or SZ in a French patient cohort. Such replication allows to consider HLA-E as a potent and true inflammatory marker in the context of the two disorders.

[IPA's clinical expertise in the identification and assessment of somatic pain in schizophrenic patients]. / Expertise clinique de l'IPA PSM dans le repérage et l'évaluation de la douleur somatique chez les personnes schizophrènes.

Identifying and assessing somatic pain in people with schizophrenia remains a major public health issue for this vulnerable population. In France, Advanced Practice Nursing is developing, based on a practice built around clinical expertise. How can the clinical expertise of psychiatric and mental health APNs improve the identification and assessment of somatic pain in these patients, and thus help to improve their somatic health?

Design of quetiapine fumarate loaded polyethylene glycol decorated graphene oxide nanosheets: Invitro-exvivo characterization.

Quetiapine Fumarate (QF) is an atypical antipsychotic with poor oral bioavailability (9%) due to its low permeability and pH-dependent solubility. Therefore, this study aims to design QF-loaded polyethylene glycol (PEG) functionalized graphene oxide nanosheets (GON) for nasal delivery of QF. In brief, GO was synthesized using a modified Hummers process, followed by ultra-sonication to produce GON. Subsequently, PEG-functionalized GON was prepared using carbodiimide chemistry (PEG-GON). QF was then decorated onto the cage of PEG-GON using the π-π stacking phenomenon (QF@PEG-GON). The QF@PEG-GON nanocomposite underwent several spectral characterizations, in vitro drug release, mucoadhesion study, ex vivo diffusion study, etc. The surface morphology of QF@PEG-GON nanocomposite validates the cracked nature of the nanocomposite, whereas the diffractograms and thermogram of nanocomposite confirm the conversion of QF into an amorphous form with uniform distribution in PEG-GON. Moreover, an ex vivo study of PEG-GON demonstrates superior mucoadhesion capacity due to its surface functional groups and hydrophilicity. The percent drug loading content and percent entrapment efficiency of the nanocomposite were found to be 9.2±0.62% and 92.3±1.02%, respectively. The developed nanocomposite exhibited 43.82±1.65% drug release within 24h, with the Korsemeyer-Peppas model providing the best-fit release kinetics (R2: 0.8614). Here, the interlayer spacing of PEG-GON prevented prompt diffusion of the buffer, leading to a delayed release pattern. In conclusion, the anticipated QF@PEG-GON nanocomposite shows promise as a nanocarrier platform for nasal delivery of QF.

Association between genetic variants of TLR2, TLR4, TLR9 and schizophrenia.

BACKGROUND AND STUDY AIM: Schizophrenia (SZ) is a multifactorial disorder involving complex interactions between genetic and environmental factors, where immune dysfunction plays a key etiopathogenic role. In order to explore the control of innate immune responses in SZ, we aimed to investigate the potential association between twelve TLR2, TLR4 and TLR9 variants (TLR2: rs4696480T>A, rs3804099T>C, rs3804100T>C; TLR4: rs1927914G>A, rs10759932T>C, rs4986790A>G, rs4986791T>C, rs11536889G>C, rs11536891T>C; TLR9: rs187084A>G, rs352139T>C and rs352140C>T) and SZ susceptibility in a Tunisian population. PATIENTS AND METHODS: This study included 150 patients and 201 healthy controls with no history of psychiatric illness. Genotyping was done using a TaqMan SNP genotyping assay. We also assessed a haplotype analysis for TLR2, TLR4 and TLR9 variants with SZ using Haploview 4.2 Software. RESULTS: We found that the AA genotype of the TLR2 rs4696480T>A variant was significantly associated with an increased risk of SZ (46% vs. 31%, P=4.7×10-3, OR=1.87 and 95% CI [1.18-2.97]). The frequency of the TA genotype was significantly higher in the control group than in SZ patients (27% vs. 43%, P=2.1×10-3) and may be associated with protection against SZ (OR=0.49 and 95% CI [0.30-0.80]). Whereas, the TLR9 rs187084-GG genotype was higher in the control group compared to patients (16% vs. 5%, P=1.6×10-3) and would present protection against SZ (OR=0.28, CI=[0.10-0.68]). The ACT haplotype of the TLR2 and the ACC haplotype of the TLR9 gene were identified as a risk haplotypes for SZ (P=0.04, OR=9.30, 95% CI=[1.11-77.71]; P=3×10-4, OR=6.05, 95% CI=[2.29-15.98], respectively). CONCLUSION: The results indicate that TLR2 and TLR9 genetic diversity may play a role in genetic vulnerability to SZ. However, including more patients and evaluation of TLR2 and TLR9 expression are recommended.

CSMD1 rs10503253 increases schizophrenia risk in a Tunisian population-group.

OBJECTIVES: Schizophrenia is a complex and chronic neuropsychiatric disorder. Recent genome-wide association studies have identified several at risk genetic variants, including two single nucleotide polymorphisms, namely the rs10503253 and the rs1270942 respectively located in the CSMD1 and the CFB loci. The present case-control study was designed to assess potential associations between the two variants and the risk of developing schizophrenia and disease severity. Further we demonstrate the relationship between these variants and clinical characteristics in a population-group from Tunisia. PATIENTS AND METHODS: In total, 216 patients diagnosed with schizophrenia along with176 healthy controls were included in this case-control study. The molecular analysis of the two polymorphisms was performed using tetra the Primer Amplification Refractory Mutation System-Polymerase Chain method. The statistical analysis was done using Compare V2.1 software, and correlations between genetic results and clinical characteristics were examined by Kruskal-Wallis testing. RESULTS: The frequency of the rs10503253A allele was found significantly higher among patients with schizophrenia as compared to healthy controls and associated with high negative PANSS scores. While no association was found concerning the implication of the rs1270942 variant in schizophrenia risk, a positive correlation with high positive PANSS scores was further observed. CONCLUSION: The present finding confirms the previously reported association between the Cub and Sushi multiple Domain 1 rs10503253A allele and the risk to develop schizophrenia and identified the rs1270942 variant as a potential disease risk modifier. Such observations may be important for the definition of the susceptible immunogenetic background in North African individuals at risk to develop mental disorders.

[Role of the IPA in the empowerment of the patient with schizophrenia and use of incentive advance directives in psychiatry]. / Rôle de l'IPA dans l'empowerment du patient atteint de schizophrénie et usage des directives anticipées incitatives en psychiatrie.

Interruption of treatment and lack of follow-up are the main causes of relapses and iterative emergency hospitalizations of people with schizophrenia. Recognition of mental illness, adherence to therapy and the ability to attribute psychotic phenomena to the pathology promote patient empowerment. In terms of APN's skills, it seems interesting to understand how the proactive supervision of people suffering from schizophrenia by this professional can meet the empowerment needs of this population.

Metabolic disorders induced by psychotropic drugs.

Psychotropic drugs may be associated with metabolic disorders, often but not only triggered by weight gain. Disorders include dysglycemia and diabetes, atherogenic dyslipidemia and metabolic syndrome. Overall, metabolic risk is lower with antidepressants than with antipsychotics. Among antidepressants, metabolic disorders may occur with both selective serotonin reuptake inhibitors and tricyclics, but with some between-molecule differences in each pharmacological family. Among antipsychotics, the risk is higher with second-generation (atypical) than first-generation agents. Higher risk was reported with clozapine and olanzapine, and lower risk with risperidone and aripiprazole. Weight gain is associated with increased insulin resistance, but impaired insulin secretion was also reported with clozapine and olanzapine. Metabolic disorders may be attenuated by the medication withdrawal and replacement by another safer drug. Besides deleterious effects of medications, the psychiatric population is also exposed to bad lifestyle habits (unhealthy diet and sedentary life), which also increase the risk of metabolic disorders. Management should first reinforce lifestyle measures. If this proves insufficient, specific drugs may be considered to tackle the metabolic disorder on a strategy similar to that applied in the general population.

Polysensoriality and Aesthetics: The Lived Sensory Experiences of Adults with Mental Illness.

Background. Research in neuroscience shows that adults with schizophrenia or related psychotic disorders experience atypical sensory processing (e.g., deficits in sensory gating and mismatch negativity). Despite significant evidence proving these biomarkers are common among adults with serious mental illness, it is unclear how their sensory experiences impact their occupations in daily life (i.e., real-world implications of atypical sensory processing). Purpose. To explore how the lived sensory experiences of adults with psychotic disorders affect their occupations. Method. We used Walking with Video, photo-elicitation, and semi-structured interviews to study how the lived sensory experiences of adults with psychotic disorders (N = 6) relate to their occupations. Informed by a phenomenological perspective, we analysed data from semistructured interviews, and undertook analyses through iterative rounds of coding to develop themes and two cycles of group reflective practices to identify researcher biases and assumptions. Findings. Analyses revealed the following themes: polysensoriality, embodied aesthetics of everyday life, habits of sensing and sensory anchors, and active sensory beings. Implications. In clinical contexts, occupational therapists should carefully consider the situatedness of sensory experiences while avoiding assumptions that sensory preferences and aversions mechanistically generalize across contexts and occupations.

Validation of Beck Cognitive Insight Scale - Arabic version in a Tunisian sample.

OBJECTIVES: Cognitive insight reflects cognitive processes concerning patients' capacity of distancing from and reevaluation of anomalous beliefs and misinterpretations. The purpose of the present study was to examine the reliability and validity of the Arabic version of the Beck Cognitive Insight Scale. METHODS: The English language version of the Beck Cognitive Insight Scale was translated into Literary Arabic. A total of 150 patients with and without psychosis completed the Arabic version of Beck Cognitive Insight Scale and additional evaluations to assess psychopathology. Psychometric properties including content validity, construct validity using confirmatory factor analysis, discriminant validity and reliability were assessed for this translated measure. RESULTS: Our results revealed that the Arabic version of the Beck Cognitive Insight Scale showed adequate psychometric properties that permitone to assess impairments of cognitive insight in patients with psychosis and in patients without psychotic features. The fit indices of the confirmatory factor analysis supported the validity of the two-factor structure corresponding to self-reflectiveness and self-certainty subscales. Psychotic patients were significantly more confident in their beliefs compared with non-psychotic patients. Scores of self-certainty were significantly higher in psychotic patients. Cronbach's alpha reliability indicator of the Arabic version was equal to 0.60. Cronbach's alpha coefficients were 0.60 and 0.53 for the self-reflectiveness sub-scale and the self-certainty sub-scale, respectively. CONCLUSIONS: The Arabic version of the Beck Cognitive Insight Scale is valid and reliable for the assessment of cognitive insight. It may improve the detection and the prevention of impairments in cognitive insight.

[Toward a better understanding of fatigue in schizophrenia]. / Vers une meilleure compréhension de la fatigue dans la schizophrénie.

Despite being one of the most common complaints of people with schizophrenia, fatigue remains largely unexplored in this population. The lack of knowledge regarding this complex symptom makes it often underdiagnosed and undertreated in schizophrenia. The aim of this brief perspective review is to outline the potential origins (distinguishing primary and secondary fatigue) and consequences of fatigue and to explore some potential treatments in this population. The current literature in schizophrenia has mainly investigated fatigue as a trait, using a self-administered questionnaire. Beyond this observational approach, which does not allow to capture the symptom in real life situations where high levels of fatigue can emerge rapidly, we propose to consider the state level of fatigue, for instance occurring after a prolonged period of cognitive activity (i.e. mental fatigue). We elaborate on the potential relationships between mental fatigue and negative symptoms of schizophrenia and propose some research avenues to test the effects of acute fatigue on effort intentions and behaviours. The consideration of the multidimensional aspects of fatigue will allow to move beyond the sole pharmacological approach to treat fatigue in schizophrenia. Targeting the cognitive as well as the performance components of fatigue through interventions such as concomitant aerobic exercise - mental training offers attractive prospects to reduce fatigue in this population and minimize its functional negative impact.

[Psychoses on the Schizophrenia Spectrum in Adolescence: A Cross-sectional Study of Factors Influencing Neuropsychology, Treatment Outcome, and Negative Symptoms]. / Psychosen aus dem schizophrenen Formenkreis im Jugendalter: Einflussfaktoren auf Neuropsychologie, Behandlungserfolg und Negativsymptomatik.

Psychoses on the Schizophrenia Spectrum in Adolescence: A Cross-sectional Study of Factors Influencing Neuropsychology, Treatment Outcome, and Negative Symptoms Abstract: Objective: The present study evaluated the factors influencing the course of disease of children and adolescents in an inpatient rehabilitation suffering from psychosis within the schizophrenia spectrum. Methods: 33 patients (mean age 19.4 years, SD = 2.3), 12 of (36 %) were female, participated. They were assessed with clinical interviews (IRAOS, SANS/SAPS), neuropsychological tests (WAIS-IV, TMT), and questionnaires (FBB, BSCL). Results: The neuropsychological functioning level and the premorbid cognitive performance were correlated, as were treatment success from the patient's perspective with a good relationship with the therapist, and greater negative symptomatology with a longer duration of untreated psychosis (DUP) and a longer initial hospital stay. Conclusion: Possible approaches to improving the treatment of adolescents with psychosis of the schizophrenic spectrum include a shortening of the DUP and a good therapeutic relationship.

Clinical profile of schizophrenia comorbid with obsessive-compulsive symptoms: A comparative study.

OBJECTIVE: Describe and compare the clinical profile of schizophrenic patients with and without obsessive-compulsive symptoms and obsessive-compulsive disorder (OCD) patients. METHODS: A descriptive and analytical cross-sectional study was carried out at the psychiatry department of Hassan II University Hospital in Fez over 12 months to compare three groups of patients: "schizo-obsessive" (n=32), "schizophrenia" (n=34), and "OCD" (n=46). All participants (n=112) were assessed using the mini-international neuropsychiatric interview (MINI), the Yale-Brown obsessive-compulsive scale (Y-BOCS), the Brown assessment of beliefs scale (BABS), the Hamilton anxiety rating scale (HAM-A), the Beck's depression inventory (BDI-II), the positive and negative syndrome scale (PANSS), and the clinical global impressions-severity scale (CGI-S). RESULTS: The "schizo-obsessive" group differed from the "schizophrenia" group in: more severe psychotic symptoms (mean=64.16±17.049, P<0.001), higher anxiety (mean=8.87±5,655, P<0.001) and depression (mean=7.50±5.989, P<0.001) scores, more prevalent suicide attempts (46.9%), higher illness severity score (mean=5.13±1.157, P=0.02), and more professional disinsertion (78.1%). The "schizo-obsessive" group (mean= 14.47±3.388) had significantly poor insight (P<0.001) compared to the "OCD" group (mean= 8.35±4.542). There were similarities in the obsessive and compulsive themes between the "schizo-obsessive" and the "OCD" groups, with no significant difference of severity (P=0.26). CONCLUSION: A careful assessment of obsessive symptomatology is essential in schizophrenia for better patient management and prognosis.

Quetiapine-associated thrombocytopenic purpura in a young man with a first episode schizophrenia.

BACKGROUND: We aimed to contribute to the current limited literature addressing quetiapine-associated thrombocytopenia. We report the case of a young man with a first episode schizophrenia who experienced thrombocytopenic purpura following the administration of quetiapine co-prescribed with valproic acid. CASE REPORT: HA is a 19-year-old single man who had no history of systemic or hematologic diseases and no personal psychiatric history. He presented with psychotic symptoms that have been continuously evolving since ten months. His psychiatrist put him on treatment with 400 mg/day of quetiapine and 1500 mg/day of valproic acid over a three-week titration. Twelve days later, the patient developed a sudden onset of thrombocytopenic purpura without fever, which resolved over two weeks after cessation of both drugs. CONCLUSION: Although uncommon and reversible, thrombocytopenia induced by quetiapine can be life-threatening. Clinicians should carefully follow-up the hematological data when prescribing quetiapine. The unnecessary use of valproic acid should be avoided as a first-line treatment for young people with first-episode schizophrenia.

Barriers in psychiatrists' mind to active smoking cessation promotion in severe psychiatric disorders.

BACKGROUND: Promoting the cessation of smoking in mental healthcare is a priority of international health organizations as it is the most cost-effective intervention in psychiatry. AIM: To explore the representations of psychiatrists on their role in active smoking cessation prevention in severe psychiatric disorders. METHODS: Psychiatrists and residents in psychiatry were recruited at a national level by professional mailings. RESULTS: One thousand four hundred and sixty participants were included in the study, and only 46% reported actively promoting smoking cessation. In multivariate analyses, participants aged<35years were more likely to promote cessation of tobacco smoking, as well as the two thirds who believe that psychiatry is a systemic discipline with complex interactions between brain, body and mind. Almost two thirds of those promoting tobacco cessation reported lacking time to combine psychiatric and physical examination during one session. The psychiatrists who reported not promoting tobacco smoking cessation also reported never dealing with physical health in case of the absence of a general practitioner and thinking that physical examination may have a negative impact on the therapeutic relationship. Almost all (96%) reported promoting the need for a general practitioner for their patients. We found no significant difference between the public and private sectors (P>0.05). INTERPRETATION: Young psychiatrists are more prone than their elders to promote smoking cessation but report lacking time to include it in their daily practice. Promotion of tobacco smoking cessation should be included in the components for quality evaluation for mental health services and specific sessions dedicated to this intervention.

La hipótesis de la saliencia aberrante: unificando la neurobiología y la fenomenología de la esquizofrenia / A hipótese da saliência aberrante: unificando a neurobiologia e a fenomenologia da esquizofrenia / The aberrant salience hypothesis: Unifying the neurobiology and phenomenology of schizophrenia / L'hypothèse de la saillance aberrante: unifier la neurobiologie et la phénoménologie de la schizophrénie

Introducción: La popularización del reduccionismo neurobiológico en psicopatología conlleva la idea de que la esquizofrenia puede entenderse simplemente como el producto de alteraciones en el funcionamiento cerebral. Por otro lado, y criticando esta tradición, el enfoque fenomenológico propone que la esquizofrenia debería entenderse como un trastorno del yo. Si bien ambas tradiciones son relevantes en la actualidad, creemos que una comprensión completa del fenómeno psicótico envuelve una integración de ambas. Objetivo: Este artículo plantea que la hipótesis de la saliencia aberrante es un buen candidato para unificar la tradición fenomenológica y la neuropsiquiátrica en el estudio de la esquizofrenia. Procedimiento: Luego de examinar la hipótesis en cuestión en profundidad, exploramos la forma en que podría explicar algunos de los síntomas positivos de la esquizofrenia de forma consistente con sus descripciones fenomenológicas. Conclusiones: Finalmente, se ofrecen algunas consideraciones generales respecto de las consecuencias de nuestro análisis para el campo de la psicopatología.

Introdução: A popularização do reducionismo neurobiológico na psicopatologia traz a ideia de que a esquizofrenia pode ser entendida simplesmente como o produto de alterações na função cerebral. Por outro lado, e criticando essa tradição, a abordagem fenomenológica propõe que a esquizofrenia seja entendida como uma desordem do eu. Embora ambas as tradições sejam relevantes hoje, acreditamos que uma compreensão completa do fenômeno psicótico envolve uma integração de ambas. Objetivo: Este artigo argumenta que a hipótese da saliência aberrante é uma boa candidata para unificar as tradições fenomenológica e neuropsiquiátrica no estudo da esquizofrenia. Procedimento: Depois de examinar a hipótese em questão em profundidade, exploramos como ela pode explicar alguns dos sintomas positivos da esquizofrenia de maneira consistente com suas descrições fenomenológicas. Conclusões: Por fim, são oferecidas algumas considerações gerais sobre as consequências de nossa análise para o campo da psicopatologia.

Background: The popularization of neurobiological reductionism in psychopathology involves the idea that schizophrenia can be fully understood as the mere product of brain-functioning alterations. Criticizing this tradition, the phenomenological approach proposes that schizophrenia should be understood as a self-disturbance. Although both traditions are relevant, we believe that a comprehensive understanding of schizophrenia involves the integration of these two frameworks. Aim: This article proposes that the aberrant salience hypothesis is a good candidate for unifying the phenomenological tradition with the neuropsychiatric approach to psychosis. Methods: After examining the aberrant salience hypothesis in detail, we explore the way in which it can explain the positive symptoms of schizophrenia respecting being consistent with their phenomenological descriptions. Conclusion: we conclude with some considerations about the consequences of our analysis for the field of psychopathology.

Introduction: L'idéal du réductionnisme neurobiologique en psychopathologie implique l'idée que la schizophrénie peut être comprise simplement comme le produit d'altérations du fonctionnement cérébral. D'autre part, et critiquant cette tradition, l'approche phénoménologique propose que la schizophrénie soit comprise comme un trouble de soi. Bien que les deux traditions soient pertinentes aujourd'hui, nous pensons qu'une compréhension complète du phénomène psychotique implique une intégration des deux. Objectif: Cet article soutient que l'hypothèse de la saillance aberrante est un bon candidat pour unifier les traditions phénoménologique et neuropsychiatrique dans l'étude de la schizophrénie. Procédure: Après avoir examiné en profondeur l'hypothèse en question, nous explorons comment elle pourrait expliquer certains des symptômes positifs de la schizophrénie d›une manière cohérente avec leurs descriptions phénoménologiques. Conclusions: Enfin, quelques considérations générales sont proposées concernant les conséquences de notre analyse pour le domaine de la psychopathologie.

Do funcionamento autoerótico à desfusão pulsional: um modelo teórico para a etiologia do recurso à droga na esquizofrenia / From autoerotic functioning to instinctual defusion: a theoretical model for the etiology of drug use in schizophrenia / Du fonctionnement autoérotique à la défusion pulsionnelle: un modèle théorique pour l'étiologie de l'usage de drogues dans la schizophrénie / Del funcionamiento autoerótico a la defusión pulsional: un modelo teórico para la etiologia del consumo de drogas en la esquizofenia

O artigo apresenta a construção de um modelo teórico-clínico em psicopatologia psicanalítica, acerca dos determinantes estruturais do recurso à droga na psicose e, em especial, na esquizofrenia. Partimos da tese de Lacan acerca dos efeitos de adesão ao gozo autoerótico decorrente da ruptura com o gozo fálico, que coloca o problema relativo ao estatuto dessa ruptura na toxicomania e, em especial, da função do recurso à droga sobre os efeitos desta ruptura. Nossa hipótese é que o recurso à droga obedece a uma tentativa de refusão pulsional com consequências catastróficas. Conduzimos o levantamento dos textos de Freud que se organizam em torno da economia pulsional, tanto na sua abordagem do recurso à droga, como na sua abordagem da etiologia da psicose e da função reparadora do delírio. Como resultado, obtivemos os índices estruturais para o diagnóstico do recurso à droga na psicose.

Resumos The article presents the construction of a theoretical-clinical model in psychoanalytic psychopathology about the structural determinants of drug use in psychosis and in schizophrenia. We start from Lacan's thesis about the effects of adherence to autoerotic jouissance resulting from the rupture with phallic jouissance, which poses the problem concerning the status of this rupture in drug addiction and the role of drug use on the effects of this rupture. Our hypothesis is that the use of drugs follows an attempt at instinctual refusion with catastrophic consequences. We conducted a survey of Freud's texts that are organized around the drive economy, both in his approach to the use of drugs and in his approach to the etiology of psychosis and the reparative function of delusion. As a result, we obtained the structural indices for the diagnosis of drug use in psychosis..

L'article présente la construction d'un modèle théorico-clinique, en psychopathologie psychanalytique à propos des déterminants structurels de l'usage de drogues dans la psychose et, en particulier, dans la schizophrénie. Nous partons de la thèse lacanienne sur les effets d'adhésion à la jouissance autoérotique résultant de la rupture avec la jouissance phallique, ce qui pose le problème du statut de cette rupture dans la toxicomanie et, en particulier, du rôle de l'usage de drogues sur les effets de cette rupture. Notre hypothèse est que le recours aux drogues obéit à une tentative de refusion pulsionnelle aux conséquences catastrophiques. Nous avons mené l'enquête sur les textes de Freud qui s'organisent autour de l'économie pulsionnelle, tant dans son approche de la ressource médicamenteuse que dans son approche de l'étiologie de la psychose et de la fonction réparatrice du délire. Nous avons ainsi obtenu les indices structurels pour le diagnostic de l'usage de drogues dans la psychose.

Este artículo presenta la construcción de un modelo teórico-clínico en psicopatología psicoanalítica sobre los determinantes estructurales del consumo de drogas en la psicosis y, en particular, en la esquizofrenia. Partimos de la tesis de Lacan sobre los efectos de la adhesión al goce autoerótico resultante de la ruptura con el goce fálico, que plantea el problema del estatuto de esta ruptura en la drogadicción y, en particular, el papel del consumo de drogas en los efectos de esta ruptura. Nuestra hipótesis es que el uso de drogas sigue un intento de rechazo instintivo con consecuencias catastróficas. Realizamos un recorrido por los textos de Freud que se organizan en torno a la economía pulsional, tanto en su abordaje del uso de drogas como en su abordaje de la etiología de la psicosis y de la función reparadora del delirio. Como resultado obtuvimos los índices estructurales para el diagnóstico del consumo de drogas en psicosis.

[Management of patients with addictions in units for difficult patients]. / Prise en charge de patients présentant des addictions en unité pour malades difficiles.

The links between mental pathologies and violent acts, which can go as far as homicide, are a major concern for many mental health professionals. Addictive co-morbidities, which are increasingly frequent, are an additional risk factor for some of these patients to commit dangerous acts. Psychiatric and psychological care for pathological perpetrators of such violence can be provided under certain conditions in units for difficult patients, with addiction treatment if necessary.

[Effectiveness of peer helper interventions for people with schizophrenia or bipolar disorder: A literature review]. / Efficacité des interventions de pair-aidants (schizophrénie, trouble bipolaire). Revue systématique de la littérature.

OBJECTIVE: The effectiveness of programs integrating trained and paid peer helpers on symptoms, quality of life and recovery of persons with bipolar disorder or schizophrenia is still poorly understood. The factors influencing the integration of peer helpers into healthcare teams are also poorly understood. METHOD: A systematic review of the literature was performed. We systematically searched multiple electronic databases for articles: (i) exploring the effectiveness of the intervention of trained and paid peer helpers in bipolar disorder and schizophrenia (ii) reporting barriers and facilitators to the integration of peer helpers. RESULTS: Forty-eight articles were included, 24 on the effectiveness of the intervention of peer helpers, 18 on barriers and 13 on facilitators to the integration of peer helpers in health teams. Of them, 25 were based upon qualitative methods (7 concerning the effectiveness of the intervention of peer helpers, 14 the barriers and 7 the facilitators to their integration); 23 were based upon quantitative methods (9 studies focused on the effectiveness of peer helper intervention, 2 on barriers and 6 on integration facilitators). The 23 quantitative studies included 8 randomized controlled trials. CONCLUSION: In spite of their heterogeneity, the results suggest that that interventions of peer helpers have a positive impact on the recovery, quality of life, social functioning, physical health and clinical outcome of persons with bipolar disorder or schizophrenia. The results also showed that the integration of peer helpers is favored by caregivers' awareness about the role of peer helpers and knowledge about the recovery model. The results highlight the need for peer helpers to have a well-defined role and to be supervised, preferably by another peer helper.

[The value of cognitive restructuring of reference ideas in schizophrenia]. / Intérêt de la restructuration cognitive des idées de référence dans la schizophrénie.

The process and results of cognitive restructuring of disabling reference ideas are presented through the study of a case of schizophrenia. The clinical evolution is measured according to an applied behavior analysis protocol that targets psychotic symptomatology and illness awareness. The results are encouraging since we observe a clinically significant decrease in the severity of reference ideas, anxiety and an improvement in illness awareness in only ten sessions.