This study explored the effects of exemplar changes on visual object recognition in patients with... more This study explored the effects of exemplar changes on visual object recognition in patients with schizophrenia and paired control subjects. The experimental design was derived from the process-dissociation procedure (PDP: Jacoby, 1991 ). The objects presented at test could be the same exemplar as at study (physically identical picture), a different exemplar of the same object category, or a new, non-studied object. In the inclusion task, participants had to generalize their recognition to the conceptual level by accepting both different and identical exemplars as old. In the exclusion task, on the other hand, they had to accept only the same exemplars of the studied objects as old. Overall, performance was better on the inclusion task than on the exclusion task; schizophrenia patients performed worse than controls on the inclusion task but not the exclusion task, misrecognizing different exemplars more often than healthy controls. The present findings reveal that both recollection and familiarity are impaired in patients with schizophrenia, who present a relational, conceptually driven memory deficit. This deficit does not allow them to recognize an object as a member of a specific category independently of perceptual variations. This retrieval mode influences their subjective awareness of items׳ familiarity, and should be considered as a target for remediation.
ABSTRACT Au-delà du débat sur l’étiologie des troubles de l’identité de genre (TIG), le rôle du p... more ABSTRACT Au-delà du débat sur l’étiologie des troubles de l’identité de genre (TIG), le rôle du psychiatre dans la prise en charge des transsexuels est fondamental. En effet, quelle que soit l’origine des TIG, toutes les études montrent que le succès de la réassignation sexuelle par traitement hormonochirurgical (THC) dépend de la qualité de la démarche diagnostique et de facteurs psychiques et/ou psychopathologiques qu’il faut avoir dépistés et pris en charge. Le rôle du psychiatre dans la prise en charge des dysphorie de genre consiste à : confirmer le diagnostic de trouble de l’identité de genre ; éliminer un éventuel diagnostic différentiel des troubles de l’identité de genre ; dépister et traiter d’éventuelles comorbidités psychiatriques ; détecter et informer le patient des facteurs prédictifs positifs et négatifs le concernant et discuter des bénéfices/risques d’une conversion chirurgicale ; repérer les attentes irréalistes pour éviter des frustrations et des déceptions inadaptées qui vont retentir sur l’équipe chirurgicale. Les objectifs du psychiatre vis-a-vis des patients : prévenir d’éventuelles complications psychosociales du traitement hormonochirurgical et optimiser les chances d’une transformation réussie, en termes de satisfaction globale du patient et d’adaptation psychosociale au nouveau genre. Des études réalisées sur le devenir des transsexuels opérés montrent que 2 % d’entre eux présentent des regrets définitifs quant à la transformation, 10 % expriment des regrets transitoires. Les taux de dépressions sévères et de décès par suicide sont significativement supérieurs à ceux de la population générale. L’évaluation psychiatrique permet de dépister les patients vulnérables et à leur proposer une prise en charge adaptée et personnalisée avant tout recours chirurgical. Les objectifs du psychiatre vis-à-vis de l’équipe de genre : des facteurs psychologiques prédictifs d’une évolution péjorative des troubles après conversion sexuelle ont été mis en évidence par des travaux rétro- et prospectifs. Pour chaque patient, ces éléments pronostiques doivent être discutés en équipe afin que la décision de traitement hormonochirurgical (THC) soit l’objet d’une information éclairée tant du patient que de l’équipe soignante et particulièrement du chirurgien qui peut être confronté à des regrets ou des revendications résultant d’une évaluation globale insuffisante. Même si ces facteurs de vulnérabilité ne constituent pas en eux-mêmes des contre-indications à la conversion sexuelle, ils doivent inciter à la prudence et permettre au chirurgien d’évaluer les répercussions de son geste. Summary The cause of gender identity disorder (GID) is a subject that has always been a main focus in the care of transsexual patients: is this a psychiatric pathology, a problem of identity, or is it due to genetic or hormonal factors? Moving beyond these issues, the psychiatrist's role in the care of transsexuals is fundamental because, regardless of the origin of the GID, all studies concur that the success of Sex Reassignment Surgery (SRS) depends principally on psychological and psychopathological factors. The role of the psychiatrist in assessing patients with gender dysphoria (GD) is fundamental in order to confirm the GD diagnosis that justifies a therapeutic treatment for this disorder-induced condition of distress; establish the differential diagnosis of GD related to or associated with a psychiatric pathology (a period of delirium revolving around ideas of body transformation, sexual ambiguity, fetishistic transvestitism, dysmorphophobia, etc.); detect and inform the patient of negative predictive factors that apply in his case and that should be considered when assessing the benefits of surgical reassignment; detect unrealistic expectations in order to prevent undue frustrations and disappointment that will also have consequences on the surgical team. The psychiatrist's objectives with regard to the patients are to optimize a successful transformation, in terms of the patient's global satisfaction and psychosocial adapting to the new gender. Studies conducted on the outcome of patients operated for sex-change reveal that 2% express permanent regrets and 10% express temporary regrets. The rates of severe depression and death after suicide are significantly higher than in the rest of the general population. The psychiatric assessment enables vulnerable patients to be identified, for whom a suitable and personalized treatment can be proposed prior to surgery. The psychiatrist's objectives with regard to the gender team: the psychological predictive factors of a poor outcome of post-sex-change disorders, which have been evidenced by retro- and prospective works (personality disorder, psychiatric pathology, adaptation disorders, low satisfaction capabilities, risk-prone behaviour, psychosocial problems) must be discussed within the team to ensure that the sex-change surgery decision is the result of an…
Repetitive transcranial magnetic stimulation (rTMS) is a brain stimulation technique that has bee... more Repetitive transcranial magnetic stimulation (rTMS) is a brain stimulation technique that has been investigated as a novel treatment for psychiatric disorders, notably in major depression, and has shown statistically significant effects. The authors found it necessary to propose an up-to-date review of positive predictors for antidepressive response to repetitive transcranial magnetic stimulation. Based on an exhaustive consultation of Medline data, supplemented by a manual research, only works evaluating response factors of rTMS in major depression were retained. Twenty-nine studies were retained, including meta-analyses, reviews, randomized controlled trials and open trials. The most concordant data clearly indicate that a high score of treatment resistance, a long duration of current episode, advanced age, and psychotic symptoms are negative predictors for treatment response to rTMS. In the older patients, menopausal women are especially concerned. However, some parameters should be adapted to the degree of cortical atrophy such as intensity of stimulation or total number of rTMS sessions. Previous response to rTMS therapy seems to be a good predictor contrary to non-response to electroconvulsive therapy. Adjunctive antidepressant treatment shows greater responsiveness to rTMS contrary to benzodiazepine or anticonvulsant treatment. To our knowledge, no study compares unipolar and bipolar depression, the profile of depression is not established yet. Imaging studies show that TMS antidepressant responders differed from non-responders in inferior frontal activity, at baseline, and even more so following treatment. Furthermore, reduced baseline cerebral metabolism in cerebellar, temporal, anterior cingulate and occipital regions of the brain was correlated with improvement after two weeks of fast (20Hz) left dorsolateral prefrontal cortex (DLPFC) rTMS. Additionally, a right frontal region emerges with divergent polarity in the metabolic prediction of response to low rTMS. Inhibiting right DLPFC or stimulating DLPFC shows similar results, the choice on the side of stimulation does not seem determining. Bilateral stimulation for the moment does not seem superior to unilateral stimulation. Parameters of stimulation associated with effectiveness of rTMS are an intensity of stimulation higher than 100% of the motor threshold, a number of stimulations per sessions superior to 1000, and a full number of days of treatment greater than 10. Parameters of stimulation must be adapted according to the treated patients. For example, older patients who present cortical atrophy need higher intensity of stimulation. Other criteria could influence effectiveness of rTMS in the same way. Would it be necessary, for example, to adapt the duration or the intensity of stimulation according to the severity of the depressive episode or its duration of evolution? Do antecedents of resistance to a pharmacological treatment oblige us to stimulate differently? Few studies exceed 10 days of treatment; will longer duration of treatment be more effective? Also, we did not find any data on the interest of maintenance treatment among responders. Should the characteristics of the depressive disorder or its evolution require maintenance treatment? What will be its rhythm and its duration? Should we adapt rTMS parameters to abnormalities highlighted by functional neuroimagery? The prospects for work remain numerous.
ABSTRACT Introduction Evaluation of subjective quality of life in schizophrenia is a recent pheno... more ABSTRACT Introduction Evaluation of subjective quality of life in schizophrenia is a recent phenomenon. Few subjective quality of life questionnaires are available and validated, especially in French. Most of the available scales are hetero questionnaires based on experts’ opinion. We describe the development and the validation of a new self-rating questionnaire of quality of life for schizophrenic patients, the S-QoL. The S-QoL was based on Calman's approach to the subject's point of view. The S-QoL is a multidimensional instrument. Generation of the items was based on three series of semi-directive interviews with patients’ various types (hospitalized, ambulatory, acute phase, stabilized…). Synthesis of the interviews permitted the elaboration of a pre-questionnaire of 97 items. Setting A first version of the questionnaire (V0) was used in a sub-group of 141 schizophrenic patients. After a preliminary study of the psychometric properties a first questionnaire (V1) of 53 items was elaborated. A second experimental study was performed in a group of 207 patients. A shorter version (41 items) was developed and a validation study was conducted. Eight dimensions were isolated. Methods Nomological validity was studied with clinical parameters (clinical severity, psychotic symptomatology, global functioning) correlated with the S-QoL. The trait validity was estimated by measuring the correlation of the S-QoL with two other instruments : the QoLi and the SF 36. The test-retest reliability was estimated on a subgroup of 53 patients stabilized in a 30-day period. Results The coefficients of correlation were from 0.64 to 0.79. The acceptability of the S-QoL was good (missing rate of data lower than 10 % for all the scores and the rate of spontaneous refusal between 8 and 12 %). The average time of completion was 13.6 ± 10.8 minutes. Sensitivity to change was studied in a population of 46 patients between day 0 and day 30. The S-QoL was also sensitive to the change. The S-QoL measures the impact of schizophrenia on quality of life of the individuals suffering from the disease. Conclusion -The S-Qol is a new self-administered questionnaire able to follow the evolution of the disease. S-Qol covers domains that differ from areas tapped in other measures of quality of life. The use of the S-QoL in the assessment of the efficacy of the clinical programme will be evaluated.
ABSTRACT In spite of the frequency of sexual dysfunction in schizophrenic patients and antipsycho... more ABSTRACT In spite of the frequency of sexual dysfunction in schizophrenic patients and antipsychotic-treated schizophrenic patients, few studies have been performed. The relationship of schizophrenia to sexual pathology is variable and complex, and of course different between men and women. Few evaluation methods have been proposed or validated. Antipsychotics may improve some aspects of sexual behaviour in schizophrenic patients. However, sexual dysfunction is also a possible side effect of these drugs. The evaluation of antipsychotics is often restricted to prolactin measurement, the relationship with sexual disorders of which has not been fully established. Preliminary data suggest that the capacity to induce sexual disorders differs from one antipsychotic to another. The available data on the mechanisms of sexual dysfunction, the pharmacological profile and the sexual effects of classical neuroleptics (haloperidol and thioridazine) and second generation antipsychotics available in France (amisulpride, clozapine, risperidone, olanzapine) are reviewed.
Suicide is the leading cause of premature death in schizophrenia. Approximately 10 to 13% of deat... more Suicide is the leading cause of premature death in schizophrenia. Approximately 10 to 13% of deaths in schizophrenia are explained by suicide, despite widespread availability of generally effective antipsychotic treatments and suicide attempts have been reported among 20 to 50% of patients. This relatively low ratio of attempts/suicide is consistent with greater lethality of means - more violent - and intents - less ambivalence - in this population. Many studies have focused on risk factors and clinical characteristics for completed and/or attempted suicide. Commonly, sociodemographic risk factors for suicide are male sex, younger age and, among women, being unmarried, divorced or widowed. Previous suicidal behaviour is a strong risk factor for suicide and contrary to the common view, schizophrenic patients often communicate their suicidal intents shortly before death. Moreover, family history of suicide is associated with a heightened risk of suicide and is independent of the diagnosis, according to the growing literature that shows that vulnerability to suicidal behaviour is independent of psychiatric diagnosis. Suicide can occur throughout the entire course of schizophrenia. This is particularly true in those high-risk periods: early phase of the disease, active illness phase, period of relapse or during a depressive episode. The role of insight and positive symptoms remains unclear and probably needs further studies. Although not specifically for people with schizophrenia, hopelessness is a major risk factor and tragic loss is often presented as a trigger for suicide. It has been suggested that treatment side-effects, such as akathisia are associated with suicidal behaviour. A better knowledge of risk and protective factors is necessary to prevent suicide and suicidality.
If hallucinations are the most common of schizophrenic symptoms, they have been described in othe... more If hallucinations are the most common of schizophrenic symptoms, they have been described in other pathologies such as Parkinson's disease (PD) but may differ considerably in their phenomenology. However, no multi-modal clinical scale with a transnosographic approach has been developed today. The purpose of this study was to create and validate a new tool for the hetero-assessment of all sensory modalities of hallucinations schizophrenia (SCZ) and in PD. Scale items were generated by literature review and validated by medical board. A study was then made to evaluate psychometric properties of the Psycho-Sensory hAllucinations Scale (PSAS) that include four domains (auditory, visual, olfactory and gustatory, cenesthetic modalities) and one specific item 'guardian angel'. It was then validated in 137 patients: 86 PD (53.5% male; mean age=53.3years) and 51 SCZ (64.7% male; mean age=38.5years). Factorial analysis of the PSAS found four factors. The PSAS showed good internal ...
This study explored the effects of exemplar changes on visual object recognition in patients with... more This study explored the effects of exemplar changes on visual object recognition in patients with schizophrenia and paired control subjects. The experimental design was derived from the process-dissociation procedure (PDP: Jacoby, 1991 ). The objects presented at test could be the same exemplar as at study (physically identical picture), a different exemplar of the same object category, or a new, non-studied object. In the inclusion task, participants had to generalize their recognition to the conceptual level by accepting both different and identical exemplars as old. In the exclusion task, on the other hand, they had to accept only the same exemplars of the studied objects as old. Overall, performance was better on the inclusion task than on the exclusion task; schizophrenia patients performed worse than controls on the inclusion task but not the exclusion task, misrecognizing different exemplars more often than healthy controls. The present findings reveal that both recollection and familiarity are impaired in patients with schizophrenia, who present a relational, conceptually driven memory deficit. This deficit does not allow them to recognize an object as a member of a specific category independently of perceptual variations. This retrieval mode influences their subjective awareness of items׳ familiarity, and should be considered as a target for remediation.
ABSTRACT Au-delà du débat sur l’étiologie des troubles de l’identité de genre (TIG), le rôle du p... more ABSTRACT Au-delà du débat sur l’étiologie des troubles de l’identité de genre (TIG), le rôle du psychiatre dans la prise en charge des transsexuels est fondamental. En effet, quelle que soit l’origine des TIG, toutes les études montrent que le succès de la réassignation sexuelle par traitement hormonochirurgical (THC) dépend de la qualité de la démarche diagnostique et de facteurs psychiques et/ou psychopathologiques qu’il faut avoir dépistés et pris en charge. Le rôle du psychiatre dans la prise en charge des dysphorie de genre consiste à : confirmer le diagnostic de trouble de l’identité de genre ; éliminer un éventuel diagnostic différentiel des troubles de l’identité de genre ; dépister et traiter d’éventuelles comorbidités psychiatriques ; détecter et informer le patient des facteurs prédictifs positifs et négatifs le concernant et discuter des bénéfices/risques d’une conversion chirurgicale ; repérer les attentes irréalistes pour éviter des frustrations et des déceptions inadaptées qui vont retentir sur l’équipe chirurgicale. Les objectifs du psychiatre vis-a-vis des patients : prévenir d’éventuelles complications psychosociales du traitement hormonochirurgical et optimiser les chances d’une transformation réussie, en termes de satisfaction globale du patient et d’adaptation psychosociale au nouveau genre. Des études réalisées sur le devenir des transsexuels opérés montrent que 2 % d’entre eux présentent des regrets définitifs quant à la transformation, 10 % expriment des regrets transitoires. Les taux de dépressions sévères et de décès par suicide sont significativement supérieurs à ceux de la population générale. L’évaluation psychiatrique permet de dépister les patients vulnérables et à leur proposer une prise en charge adaptée et personnalisée avant tout recours chirurgical. Les objectifs du psychiatre vis-à-vis de l’équipe de genre : des facteurs psychologiques prédictifs d’une évolution péjorative des troubles après conversion sexuelle ont été mis en évidence par des travaux rétro- et prospectifs. Pour chaque patient, ces éléments pronostiques doivent être discutés en équipe afin que la décision de traitement hormonochirurgical (THC) soit l’objet d’une information éclairée tant du patient que de l’équipe soignante et particulièrement du chirurgien qui peut être confronté à des regrets ou des revendications résultant d’une évaluation globale insuffisante. Même si ces facteurs de vulnérabilité ne constituent pas en eux-mêmes des contre-indications à la conversion sexuelle, ils doivent inciter à la prudence et permettre au chirurgien d’évaluer les répercussions de son geste. Summary The cause of gender identity disorder (GID) is a subject that has always been a main focus in the care of transsexual patients: is this a psychiatric pathology, a problem of identity, or is it due to genetic or hormonal factors? Moving beyond these issues, the psychiatrist's role in the care of transsexuals is fundamental because, regardless of the origin of the GID, all studies concur that the success of Sex Reassignment Surgery (SRS) depends principally on psychological and psychopathological factors. The role of the psychiatrist in assessing patients with gender dysphoria (GD) is fundamental in order to confirm the GD diagnosis that justifies a therapeutic treatment for this disorder-induced condition of distress; establish the differential diagnosis of GD related to or associated with a psychiatric pathology (a period of delirium revolving around ideas of body transformation, sexual ambiguity, fetishistic transvestitism, dysmorphophobia, etc.); detect and inform the patient of negative predictive factors that apply in his case and that should be considered when assessing the benefits of surgical reassignment; detect unrealistic expectations in order to prevent undue frustrations and disappointment that will also have consequences on the surgical team. The psychiatrist's objectives with regard to the patients are to optimize a successful transformation, in terms of the patient's global satisfaction and psychosocial adapting to the new gender. Studies conducted on the outcome of patients operated for sex-change reveal that 2% express permanent regrets and 10% express temporary regrets. The rates of severe depression and death after suicide are significantly higher than in the rest of the general population. The psychiatric assessment enables vulnerable patients to be identified, for whom a suitable and personalized treatment can be proposed prior to surgery. The psychiatrist's objectives with regard to the gender team: the psychological predictive factors of a poor outcome of post-sex-change disorders, which have been evidenced by retro- and prospective works (personality disorder, psychiatric pathology, adaptation disorders, low satisfaction capabilities, risk-prone behaviour, psychosocial problems) must be discussed within the team to ensure that the sex-change surgery decision is the result of an…
Repetitive transcranial magnetic stimulation (rTMS) is a brain stimulation technique that has bee... more Repetitive transcranial magnetic stimulation (rTMS) is a brain stimulation technique that has been investigated as a novel treatment for psychiatric disorders, notably in major depression, and has shown statistically significant effects. The authors found it necessary to propose an up-to-date review of positive predictors for antidepressive response to repetitive transcranial magnetic stimulation. Based on an exhaustive consultation of Medline data, supplemented by a manual research, only works evaluating response factors of rTMS in major depression were retained. Twenty-nine studies were retained, including meta-analyses, reviews, randomized controlled trials and open trials. The most concordant data clearly indicate that a high score of treatment resistance, a long duration of current episode, advanced age, and psychotic symptoms are negative predictors for treatment response to rTMS. In the older patients, menopausal women are especially concerned. However, some parameters should be adapted to the degree of cortical atrophy such as intensity of stimulation or total number of rTMS sessions. Previous response to rTMS therapy seems to be a good predictor contrary to non-response to electroconvulsive therapy. Adjunctive antidepressant treatment shows greater responsiveness to rTMS contrary to benzodiazepine or anticonvulsant treatment. To our knowledge, no study compares unipolar and bipolar depression, the profile of depression is not established yet. Imaging studies show that TMS antidepressant responders differed from non-responders in inferior frontal activity, at baseline, and even more so following treatment. Furthermore, reduced baseline cerebral metabolism in cerebellar, temporal, anterior cingulate and occipital regions of the brain was correlated with improvement after two weeks of fast (20Hz) left dorsolateral prefrontal cortex (DLPFC) rTMS. Additionally, a right frontal region emerges with divergent polarity in the metabolic prediction of response to low rTMS. Inhibiting right DLPFC or stimulating DLPFC shows similar results, the choice on the side of stimulation does not seem determining. Bilateral stimulation for the moment does not seem superior to unilateral stimulation. Parameters of stimulation associated with effectiveness of rTMS are an intensity of stimulation higher than 100% of the motor threshold, a number of stimulations per sessions superior to 1000, and a full number of days of treatment greater than 10. Parameters of stimulation must be adapted according to the treated patients. For example, older patients who present cortical atrophy need higher intensity of stimulation. Other criteria could influence effectiveness of rTMS in the same way. Would it be necessary, for example, to adapt the duration or the intensity of stimulation according to the severity of the depressive episode or its duration of evolution? Do antecedents of resistance to a pharmacological treatment oblige us to stimulate differently? Few studies exceed 10 days of treatment; will longer duration of treatment be more effective? Also, we did not find any data on the interest of maintenance treatment among responders. Should the characteristics of the depressive disorder or its evolution require maintenance treatment? What will be its rhythm and its duration? Should we adapt rTMS parameters to abnormalities highlighted by functional neuroimagery? The prospects for work remain numerous.
ABSTRACT Introduction Evaluation of subjective quality of life in schizophrenia is a recent pheno... more ABSTRACT Introduction Evaluation of subjective quality of life in schizophrenia is a recent phenomenon. Few subjective quality of life questionnaires are available and validated, especially in French. Most of the available scales are hetero questionnaires based on experts’ opinion. We describe the development and the validation of a new self-rating questionnaire of quality of life for schizophrenic patients, the S-QoL. The S-QoL was based on Calman's approach to the subject's point of view. The S-QoL is a multidimensional instrument. Generation of the items was based on three series of semi-directive interviews with patients’ various types (hospitalized, ambulatory, acute phase, stabilized…). Synthesis of the interviews permitted the elaboration of a pre-questionnaire of 97 items. Setting A first version of the questionnaire (V0) was used in a sub-group of 141 schizophrenic patients. After a preliminary study of the psychometric properties a first questionnaire (V1) of 53 items was elaborated. A second experimental study was performed in a group of 207 patients. A shorter version (41 items) was developed and a validation study was conducted. Eight dimensions were isolated. Methods Nomological validity was studied with clinical parameters (clinical severity, psychotic symptomatology, global functioning) correlated with the S-QoL. The trait validity was estimated by measuring the correlation of the S-QoL with two other instruments : the QoLi and the SF 36. The test-retest reliability was estimated on a subgroup of 53 patients stabilized in a 30-day period. Results The coefficients of correlation were from 0.64 to 0.79. The acceptability of the S-QoL was good (missing rate of data lower than 10 % for all the scores and the rate of spontaneous refusal between 8 and 12 %). The average time of completion was 13.6 ± 10.8 minutes. Sensitivity to change was studied in a population of 46 patients between day 0 and day 30. The S-QoL was also sensitive to the change. The S-QoL measures the impact of schizophrenia on quality of life of the individuals suffering from the disease. Conclusion -The S-Qol is a new self-administered questionnaire able to follow the evolution of the disease. S-Qol covers domains that differ from areas tapped in other measures of quality of life. The use of the S-QoL in the assessment of the efficacy of the clinical programme will be evaluated.
ABSTRACT In spite of the frequency of sexual dysfunction in schizophrenic patients and antipsycho... more ABSTRACT In spite of the frequency of sexual dysfunction in schizophrenic patients and antipsychotic-treated schizophrenic patients, few studies have been performed. The relationship of schizophrenia to sexual pathology is variable and complex, and of course different between men and women. Few evaluation methods have been proposed or validated. Antipsychotics may improve some aspects of sexual behaviour in schizophrenic patients. However, sexual dysfunction is also a possible side effect of these drugs. The evaluation of antipsychotics is often restricted to prolactin measurement, the relationship with sexual disorders of which has not been fully established. Preliminary data suggest that the capacity to induce sexual disorders differs from one antipsychotic to another. The available data on the mechanisms of sexual dysfunction, the pharmacological profile and the sexual effects of classical neuroleptics (haloperidol and thioridazine) and second generation antipsychotics available in France (amisulpride, clozapine, risperidone, olanzapine) are reviewed.
Suicide is the leading cause of premature death in schizophrenia. Approximately 10 to 13% of deat... more Suicide is the leading cause of premature death in schizophrenia. Approximately 10 to 13% of deaths in schizophrenia are explained by suicide, despite widespread availability of generally effective antipsychotic treatments and suicide attempts have been reported among 20 to 50% of patients. This relatively low ratio of attempts/suicide is consistent with greater lethality of means - more violent - and intents - less ambivalence - in this population. Many studies have focused on risk factors and clinical characteristics for completed and/or attempted suicide. Commonly, sociodemographic risk factors for suicide are male sex, younger age and, among women, being unmarried, divorced or widowed. Previous suicidal behaviour is a strong risk factor for suicide and contrary to the common view, schizophrenic patients often communicate their suicidal intents shortly before death. Moreover, family history of suicide is associated with a heightened risk of suicide and is independent of the diagnosis, according to the growing literature that shows that vulnerability to suicidal behaviour is independent of psychiatric diagnosis. Suicide can occur throughout the entire course of schizophrenia. This is particularly true in those high-risk periods: early phase of the disease, active illness phase, period of relapse or during a depressive episode. The role of insight and positive symptoms remains unclear and probably needs further studies. Although not specifically for people with schizophrenia, hopelessness is a major risk factor and tragic loss is often presented as a trigger for suicide. It has been suggested that treatment side-effects, such as akathisia are associated with suicidal behaviour. A better knowledge of risk and protective factors is necessary to prevent suicide and suicidality.
If hallucinations are the most common of schizophrenic symptoms, they have been described in othe... more If hallucinations are the most common of schizophrenic symptoms, they have been described in other pathologies such as Parkinson's disease (PD) but may differ considerably in their phenomenology. However, no multi-modal clinical scale with a transnosographic approach has been developed today. The purpose of this study was to create and validate a new tool for the hetero-assessment of all sensory modalities of hallucinations schizophrenia (SCZ) and in PD. Scale items were generated by literature review and validated by medical board. A study was then made to evaluate psychometric properties of the Psycho-Sensory hAllucinations Scale (PSAS) that include four domains (auditory, visual, olfactory and gustatory, cenesthetic modalities) and one specific item 'guardian angel'. It was then validated in 137 patients: 86 PD (53.5% male; mean age=53.3years) and 51 SCZ (64.7% male; mean age=38.5years). Factorial analysis of the PSAS found four factors. The PSAS showed good internal ...
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