Relation entre l'alliance thérapeutique infirmière/patient, et les contrôles perçus par le patient en traitement de dépendances

Le but de cette étude était d'investiguer l'association entre l'alliance thérapeutique et le contrôle de substances, comme il est vécu par le patient. La théorie de King et le concept de l'alliance thérapeutique figuraient comme cadres théoriques. L'investigation se faisait à l'aide d'un questionnaire auto-administré, incluant l'instrument working alliance inventory (WAI) dans sa forme abréviée, traduit et validé en français, visant un échantillon de convenance (n=28). L'alliance thérapeutique était évaluée sur une échelle Likert à 12 questions, et les alliances thérapeutiques se sont révélées comme bonnes (x=61.68, max=84). Mais il y a une relation linéaire négative significative entre le degré à quel point les contrôles sont perçus comme pesants, évalués par une question supplémentaire sur une visual analog scale (VAS), et l'établissement d'une alliance thérapeutique (r =-0.67, p-value>0.001). De plus, la forme d'admission joue un rôle significatif, car dans cette étude, les patients admis sous pression de l'extérieur (n=7) ont de moins bonnes alliances (t, p-value=0.018) et vivent les contrôles comme plus pesants (Z, p-value=0.004) que les patients admis de leur propre gré (n=21). Malgré que ces résultats ne sont, vu le petit échantillon (n=28), pas généralisables, ils pourraient impliquer pour la pratique de repenser la prise d'urine et d'être sensibilisés aux conséquences possibles. Des options, comme l'introduction d'une supervision par caméra ou le retrait complet de l'infirmière de référence de toute sorte de contrôles, seraient imaginables. Au moins pour les personnes hospitalisées sous pression de l'extérieur et qui sont probablement, pour cette raison, plus susceptibles à tout dérangement de la relation.

The relation between internet use and overweight among adolescents: a longitudinal study in Switzerland.

OBJECTIVE: This longitudinal study aimed to investigate the characteristics and predictive risk factors of overweight among adolescents. The hypothesis was that baseline overweight predicted most overweight over time compared to other factors, especially excessive internet use. SUBJECTS: A sample of 621 youths were followed from age 14 (T0 Spring 2012) to age 16 (T1 Spring 2014) in Switzerland. Participants were divided into two groups according to their weight at the final assessment: overweight and non-overweight. At T0, participants reported demographic, health, substance use and internet use data. A logistic regression was performed to assess the explanatory variables of overweight at T1. Data are presented as adjusted odds ratios (aORs) with 95% confidence interval. RESULTS: The 2-year evolution showed a net BMI increase of 4.8%. Overweight adolescents were significantly more likely to be male, to live in an urban area, to be on a diet and to report using the internet more than 2 h per day on weekends at T0. However, with the addition of baseline overweight, only the excessive use of internet on weekends remained as an explanatory variable. An adolescent who was already overweight at T0 had a more than 20-fold risk (aOR 21.04) of being overweight 2 years later. Moreover, among adolescents becoming overweight between T0 and T1, internet use did not show any significant effect. CONCLUSION: The risk of being overweight is mostly influenced by weight status at baseline compared to excessive internet use. Thus, our results do not confirm the negative effect of internet on healthier activities. Internet use could at most reinforce an already existing risk of being overweight.

Female common lizards (Lacerta vivipara) do not adjust their sex-biased investment in relation to the adult sex ratio.

Sex allocation theory predicts that facultative maternal investment in the rare sex should be favoured by natural selection when breeders experience predictable variation in adult sex ratios (ASRs). We found significant spatial and predictable interannual changes in local ASRs within a natural population of the common lizard where the mean ASR is female-biased, thus validating the key assumptions of adaptive sex ratio models. We tested for facultative maternal investment in the rare sex during and after an experimental perturbation of the ASR by creating populations with female-biased or male-biased ASR. Mothers did not adjust their clutch sex ratio during or after the ASR perturbation, but produced sons with a higher body condition in male-biased populations. However, this differential sex allocation did not result in growth or survival differences in offspring. Our results thus contradict the predictions of adaptive models and challenge the idea that facultative investment in the rare sex might be a mechanism regulating the population sex ratio.

Maladaptive emotion regulation strategies and stress sensitivity mediate the relation between adverse life events and attenuated positive psychotic symptoms.

INTRODUCTION: There is now solid evidence for a relation between adverse life events (ALE) and psychotic symptoms in patients with psychosis and in the general population. A recent study has shown that this relation may be partially mediated by stress sensitivity, suggesting the influence of other factors. The aim of this study was to assess the mediation effect of emotion regulation strategies and stress sensitivity in the relation between ALE and attenuated positive psychotic symptoms (APPS) in the general population. METHODS: Hundred and twelve healthy volunteers were evaluated with measures of APPS, emotion regulation strategies, ALE and stress sensitivity. RESULTS: Results demonstrated that the relation between ALE, hallucination and delusion proneness was completely mediated by maladaptive emotion regulation strategies, but not by stress sensitivity. However, in addition to maladaptive emotion regulation strategies, stress sensitivity demonstrated a mediation effect between ALE and attenuated positive psychotic positive symptoms when positive psychotic symptoms were grouped together. CONCLUSIONS: There are probably several possible trajectories leading to the formation of positive psychotic symptoms and the results of the present study reveal that one such trajectory may involve the maladaptive regulation of negative emotions alongside a certain general vulnerability after experiencing ALE.

Attachment and coping in psychosis in relation to spiritual figures

Background: Studies have found higher levels of insecure attachment in individuals with schizophrenia. Attachment theory provides a framework necessary for conceptualizing the development of interpersonal functioning. Some aspects of the attachment of the believer to his/her spiritual figure are similar to those between the child and his/her parents. The correspondence hypothesis suggests that early child-parent interactions correspond to a person's relation to a spiritual figure. The compensation hypothesis suggests that an insecure attachment history would lead to a strong religiousness/spirituality as a compensation for the lack of felt security. The aim of this study is to explore attachment models in psychosis vs. healthy controls, the relationships between attachment and psychopathology and the attachment processes related to spiritual figures. Methods: Attachment models were measured in 30 patients with psychosis and 18 controls with the AAI (Adult Attachment interview) in relationship with psychopathology. Beliefs and practices related to a spiritual figure were investigated by qualitative and quantitative analyses. Results: Patients with psychosis showed a high prevalence of insecure avoidant attachment. Spiritual entities functioned like attachment figures in two thirds of cases. Interviews revealed the transformation of internal working models within relation to a spiritual figure: a compensation process was found in 7 of the 32 subjects who showed a significant attachment to a spiritual figure. Conclusions: Attachment theory allows us to highlight one of the underlying dimensions of spiritual coping in patients with psychosis.

La relation thérapeutique centrée sur les motifs. Comment individualiser l'offre relationnelle sous l'angle de la responsivité appropriée

Un cas exemplaire, un cas d'école, un beau cas, un cas de figure, un cas extrême, un cas particulier, un cas épineux, un cas limite ... Les modalités de l'étude de cas sont multiples et expriment le fait que tout raisonnement suivi, toute explication, toute théorie bute une fois ou l'autre sur la nécessité d'explorer et d'approfondir les propriétés d'une singularité accessible à l'observation. Publier un ouvrage sur la question du cas unique, c'est participer à ce moment de réflexion sur les méthodes scientifiques en psychologie. C'est aussi oeuvrer à un repositionnement constructif de cette modalité de faire science, en donnant la parole aux auteurs spécialistes de ces questions ou directement concernés par celles-ci à travers leurs recherches ou leurs pratiques.