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Contexte : Les étudiants en médecine peuvent présenter des attitudes négatives envers les entraînements aux compétences communicationnelles (CC), limitant leur efficacité et transfert dans la pratique. Objectifs : Traduire et valider les propriétés psychométriques de la version francophone du questionnaire Communication Skills Attitude Scale (CSAS) ; examiner d’éventuelles corrélations entre les attitudes de nos étudiants et certaines variables sociodémographiques et éducationnelles ; explorer les attitudes négatives de nos étudiants par le biais de données qualitatives. Méthodes : Un questionnaire auto-administré a été proposé à des étudiants de première, deuxième et troisième années de médecine lors de l’année universitaire 2018–2019. Le questionnaire contenait le CSAS traduit en français, des questions sociodémographiques, éducationnelles, un questionnaire explorant les compétences émotionnelles et une question ouverte pour les étudiants qui rapportaient un score extrême à l’item 19 du CSAS. Résultats : 262 étudiants ont rempli ce questionnaire. Dans l’ensemble, l’analyse en composantes principales accrédite la structure originale du CSAS en deux composantes. Le test-retest montre des corrélations significatives en faveur de la fidélité de cette échelle. La validation convergente a été observée via des corrélations positives significatives entre attitudes positives et compétences émotionnelles. Les femmes ont présenté des scores significativement plus élevés d’attitudes positives que les hommes. L’analyse de contenu thématique a permis d’identifier différents thèmes au sein des explications données par les étudiants à leur score à l’item 19. Conclusion : Cette étude offre une version francophone du CSAS utilisable pour des objectifs de recherche et d’éducation auprès d’étudiants francophones en médecine. Nos résultats invitent à explorer le fait que les scores d’attitudes positives et négatives pourraient être déterminés par des processus différents ainsi que l’intérêt de coupler l’utilisation de ce questionnaire à des outils de récolte de données qualitatives.

It is often assumed that there is a robust positive symmetrical relationship between happiness and social behavior: Social relationships are viewed as essential to happiness, and happiness is thought to foster social relationships. However, empirical support for this widely held view is surprisingly mixed, and this view does little to clarify which social partner a person will be motivated to interact with when happy. To address these issues, we monitored the happiness and social interactions of more than 30,000 people for a month. We found that patterns of social interaction followed the hedonic-flexibility principle, whereby people tend to engage in happiness-enhancing social relationships when they feel bad and sustain happiness-decreasing periods of solitude and less pleasant types of social relationships that might promise long-term payoff when they feel good. These findings demonstrate that links between happiness and social behavior are more complex than often assumed in the positive-emotion literature.

Editor's Perspective What We Already Know about This Topic The antidepressant effect of ketamine is associated with increased activity in the reward circuitry of the brain and a suppression of circuitry that mediates perceptual processing of negative emotions. The duration of ketamine effect on these brain structures remains to be defined. What This Article Tells Us That Is New As expected, ketamine administration led to an improvement in mood and global vigilance. The improvement in mood was accompanied by an increased recruitment of the orbitofrontal cortex, ventral striatum, medial substantial nigra and ventral tegmental area, structures that are part of the reward circuitry. Responses in the mesolimbic structures (amygdala, medial substantial nigra and ventral tegmental area, orbitofrontal cortex) to negative stimuli were decreased after ketamine administration. The data are consistent with the premise that ketamine induces sustained changes in the mesolimbic neural circuits to reset pathological reward and emotional processing. Background: Ketamine rapidly improves maladaptive mood states in major depressive disorder, and some of the neural substrates underlying this therapeutic effect have been identified. This study aimed to identify functional changes within neural networks that may underlie the impact of ketamine on both reward and emotional processing in patients with treatment-resistant major depression. Methods: Ten adult patients with a Montgomery-Åsberg Depression Rating Scale score above 25 were enrolled to receive a single intravenous administration of ketamine (0.5 mg/kg). Patients' performance along with related neural network activations were analyzed in a game-like reward task and in an emotional judgment task using functional magnetic resonance imaging 1 day before and 1 and 7 days after ketamine administration. Results: A significant correlation (R2 = 0.46, P = 0.03) between the improvement of depression scores and the enhanced reaction time for positive items was found in the game-like reward task 1 day after ketamine administration. This enhanced sensitivity for rewarded items was accompanied by increased activity of reward-related brain regions, including the orbitofrontal cortex, ventral striatum, and the ventral tegmental area, an effect that persisted up to 1 week after ketamine injection. In the emotional judgment task, it was found that ketamine rapidly modified local brain activities in response to emotionally negative, positive, or neutral stimuli in the amygdala, insula, anterior cingulate cortex, and in the ventral tegmental area. Conclusions: Single bolus ketamine administration rapidly triggers lasting changes in mesolimbic neural networks to improve pathologic reward and emotional processing in patients with major depressive disorder.

Contexte : Il a été montré que bien que la simulation soit un moyen efficace d’entraîner les compétences communicationnelles (CC), le débriefing peut avoir des effets délétères sur le sentiment d’efficacité personnelle (SEP) et les attitudes de certains étudiants.Buts :Nous avons implanté un entraînement aux CC auprès de nos étudiants en médecine. Nos objectifs sont : 1) faire évaluer la qualité du climat instauré par le formateur lors du débriefing de la séance de simulation ; 2) connaître le SEP et les attitudes des étudiants envers les CC après le débriefing et ; 3) voir s’il existe des corrélations entre ces variables et l’évaluation qui est faite du climat de débriefing.Méthodes :167 étudiants en troisième année de médecine ont répondu à un questionnaire en ligne clôturant la fin d’un entraînement aux CC. Ce questionnaire quantitatif investiguait leur perception quant à la qualité du climat du débriefing, leur SEP rétrospectivement rapporté avant et après l’entraînement et leurs attitudes.Résultats :Les résultats indiquent une augmentation du SEP à l’égard des CC après l’entraînement. En outre, des corrélations positives significatives ont été identifiées entre une évaluation favorable du climat de débriefing et des scores élevés d’amélioration de SEP et d’attitudes positives envers l’entraînement aux CC.Conclusion :Une évaluation favorable du climat de débriefing semble liée à des scores élevés de SEP et d’attitudes positives rapportés après l’entraînement. Cette étude exploratoire invite à s’intéresser davantage à ces variables (évaluation du débriefing, SEP, attitudes) et leur lien avec le transfert des CC entraînées vers la pratique.

Objectives This study aims to investigate whether stress, depression and emotional competencies can help to predict medical students’ attitudes towards communication skills training (CST). Anxiety and negative attitudes towards CST have been shown to be linked. Conversely, emotional competencies (EC) were associated with positive attitudes. Exploring these psycho(patho)logical variables therefore seems to be a promising approach to better understanding, or even modifying, attitudes towards CST. Methods 179 third year medical students were asked to complete the Communication Skills Attitude Scale (CSAS), the Perceived Stress Scale (PSS), the Montgomery-Asberg Depression Rating Scale Self-assessment (MADRS-S) and the Profile of Emotional Competence (PEC). Results 168 students completed the entire questionnaire. The stepwise regression model first revealed that, taken together, intrapersonal EC “Utilization” and interpersonal EC “Expression” account for 17% of the variance in positive attitudes. Secondly, taken together, intrapersonal EC “Utilization” and interpersonal EC “Expression” account for 16% of the variance in negative attitudes. Conclusion The more competent a student is in “Utilization” and “Expression”, the more positive attitudes and the less negative attitudes he/she has towards CST. In addition, measuring a large set of bio-psycho-social factors might be a way of capturing more variance in attitudes towards CST. Practice implications In the study of variables influencing attitudes towards CST, emotional competencies cannot be ignored. The context of the medical consultation encourages the discussion of various emotions felt by the patient. As educationalists, we should prepare the student for this by integrating the notion of EC within the CST.

Research has shown a decline in empathy as medical studies progress. Among various hypotheses, an explanation track evoked is the first contact with the internship.Objectives This quasi-experimental study was designed to examine the impact of the first internship in medical students. Our research question was: “to what extent the first internship may decreased the empathy’s scores of our 3d year medical students?”Methods We measured the empathy of 220 third year medical students before and after their first internship (3 weeks) in family medicine. Using online surveys methodology, we collected data about empathy (“Interpersonal Reactivity Index”: IRI), epidemiology, professional orientation choices.Results Statistical analyses revealed a small but significant decrease in IRI’s “fantasy,” “empathic concern” and “personal distress” subscales.Conclusion These results suggest a potential impact of the first internship on empathic skills. The fact that the students’ score for the “personal distress” subscale (which characterizes a difficulty in managing their emotions) decreases is actually a rather good thing. These data raise the question of the “function” of this loss of empathy. The fact that this score decreases after first internship, may indicate a positive change for these medical students: towards better emotional regulation and more functional affective empathy., La recherche a identifié un déclin d’empathie à mesure que les études en médecine progressent. Parmi les différentes hypothèses, une explication souvent évoquée est le premier contact avec les stages. Cette étude quasi expérimentale a été conçue pour examiner l’impact du premier stage chez les étudiants en médecine. Notre question de recherche était : « dans quelle mesure le premier stage peut diminuer les scores d’empathie de nos étudiants en médecine de 3e année » ? Nous avons mesuré l’empathie de 220 étudiants de 3e année en médecine avant et après leur premier stage (de 3 semaines) en médecine générale. En utilisant la méthodologie des enquêtes en ligne, nous avons recueilli des données sociodémographiques, d’empathie (Interpersonal Reactivity Index [IRI]) et de souhait de choix de carrière. Les analyses statistiques ont révélé une diminution légère, mais significative des sous-échelles « fantaisie », « intérêt empathique » et « détresse personnelle » de l’IRI. Ces résultats suggèrent un impact potentiel du premier stage sur les compétences empathiques. Le fait que le score des étudiants à la sous-échelle « détresse personnelle » (qui caractérise une difficulté à gérer les émotions) diminue est en réalité plutôt une bonne chose. Ces données soulèvent donc la question de la « fonction » de cette perte d’empathie. Le fait que ce score diminue après le premier stage pourrait indiquer un changement positif pour ces étudiants en médecine : vers une meilleure régulation émotionnelle et une empathie affective plus fonctionnelle.

International audience; Attention Deficit/Hyperactivity Disorder (ADHD) often persists into adulthood. However, few screening tools have been adaptedto assess adult ADHD using the DSM-5 criteria. This study assessed the diagnostic accuracy of a French version of the ADHDSelf-Report Screening for DSM-5 (ASRS-5). This multicentric cross-sectional study included 557 participants: 309 adult ADHDoutpatients without bipolar disorder (BD)/borderline personality disorder (BPD) (n = 236) or with BD/BPD (n = 36) and 285adults without ADHD who were either healthy volunteers (n = 248) or outpatients with BD or BPD (n = 37). Measures includedADHD diagnosis and the ASRS-5. The ASRS-5 was a good predictor of ADHD diagnosis (cut-off score ! 13/24: sensitivity =84.3%, specificity = 91.9%) in the sample of adult outpatients without comorbid disorders/healthy controls. Performances werelower with this cut-off score in some subgroups, notably low-severity ADHD symptomatology (sensitivity = 63.5%) and participantswith BD or BPD (sensitivity = 91.7%, specificity = 54.1%). The French ASRS-5 had acceptable screening properties,even if its performance varied according to clinical variables. Further evidence is needed for patients with comorbid disordershaving overlapping symptoms.

Dependence on the Internet and video games would have an impact on academic performance and mental health.Objective Highlight some of the interest factors in a first-year medical student population who will be subjected during their studies and future to the intensive use of these technologies.Method A self-questionnaire was proposed, from a free access link from February to March 2014, to all first-year medical students at the University of Namur in Belgium. It consisted of questions related to socio-demographic data, Perceived Stress Scale (PSS 14), the Internet Addiction Test (IAT), the Problem Video Game Playing (PVP) and the Montgomery and Asberg Depression Rating Scale (MADRS).Results According to the Internet Addiction Test (IAT), 1% of the students are addicted to the Internet and 24,4% have occasional problematic use. According to Problem Video Game Playing (PVP), 11,4% of the students playing video games are problem gamblers. The data also show significantly higher scores for problematic use of the Internet and video games among stressed students, depressed students and those with poor academic performance.Conclusion We draw attention to the necessary debate between the rational use and the problematic use of new technologies as well as the need for longitudinal prevention from the beginning of studies.

Objectives To study longitudinally students’ attitudes towards communication skills (CS) in order to examine whether CS training (CST) has an enduring impact on medical students’ attitudes toward being a lifelong learner of CS. Methods 105 students completed the Communication Skills Attitude Scale at 4 times: before CST, after CST and before and after a traineeship. Results Our final sample size is 105 students. CST improved the attitudes of our students toward CS, and the traineeship stabilised those attitudes. However, while the improvement in positive attitudes was sustained over time, negative attitudes increased 6 months after CST. Conclusion CST using experiential methods in a safe environment has the potential to improve students’ attitudes towards CS. A short traineeship in general medicine allows students to quickly integrate CST into clinical practice, without deteriorating their attitudes toward CS. However, 6 months of medical lessons without CST reinforces students’ negative attitudes. Practice implications To avoid the deterioration of attitudes over time, CST should be continuous or at least spaced at intervals less than 6 months and supported by the institutional authorities. In addition, placing the CST close to an observation traineeship in general practice seems an interesting way to prevent further deterioration of attitudes.

Aims - Our main objective was to explore the motivations that led our third year Belgian students to study medicine.Method - We used a mixed method as we collected both quantitative and qualitative measures at the same time through online surveys. Chi-Square tests were used to examine differences in motivation between gender of the participants. A thematic content analysis was then conducted on the open-ended question using a qualitative approach.Results and conclusions - The final sample consists of 243 third-year students (87 men and 156 women). Chi-square analyses revealed gender differences in motivations to study medicine. The motivation most often reported by our students in both qualitative and quantitative analyses is “altruistic motivation”. The qualitative analysis identified, within this category, sometimes unrealistic beliefs about the practice of medicine, leading to the conclusion that it is necessary to put medical students in contact with the reality of the field as soon as possible. Furthermore, the lack of focus on the relationship with the patient within the formal curriculum and subsequent medical practice could be the cause of a form of disillusionment among these students. We believe that more lessons on relational aspects should be offered to them.Perspectives - Finally, in addition to identifying and classifying the motivations present among medical students, we believe that some perspectives are the analysis of the interactions between these motivations in 1) the determination of the choice of study and 2) the attitudes and behaviours that will result from it.

Background: Schizophrenia has been defined as a dysconnection syndrome characterized by aberrant functional brain connectivity. Using task-based fMRI, we assessed to what extent the nature of the cognitive context may further modulate abnormal functional brain connectivity. Methods: We analyzed data matched for motion in patients with schizophrenia and healthy controls who performed 3 different tasks. Tasks 1 and 2 both involved emotional processing and only slighlty differed (incidental encoding v. memory recognition), whereas task 3 was a much different mental rotation task. We conducted a connectome-wide general linear model analysis aimed at identifying context-dependent and independent functional brain connectivity alterations in patients with schizophrenia. Results: After matching for motion, we included 30 patients with schizophrenia and 30 healthy controls in our study. Abnormal connectivity in patients with schizophrenia followed similar patterns regardless of the degree of similarity between cognitive tasks. Decreased connectivity was most notable in the medial prefrontal cortex, the anterior and posterior cingulate, the temporal lobe, the lobule IX of the cerebellum and the premotor cortex. Limitations: A more circumscribed yet significant context-dependent effect might be detected with larger sample sizes or cognitive domains other than emotional and visuomotor processing. Conclusion: The context-independence of functional brain dysconnectivity in patients with schizophrenia provides a good justification for pooling data from multiple experiments in order to identify connectivity biomarkers of this mental illness.

Background Racing and crowded thoughts are frequently reported respectively in manic and mixed episodes of bipolar disorder (BD). However, questionnaires assessing this symptom are lacking. Here we aimed to investigate racing thoughts across different mood episodes of BD through a self-report questionnaire that we developed, the 34-item Racing and Crowded Thoughts Questionnaire (RCTQ). In addition to assessing its factor structure and validity, we were interested in the RCTQ's ability to discriminate mixed and non-mixed depression. Methods 221 BD patients and 120 controls were clinically assessed via the YMRS (mania) and the QIDS-C16 (depression), then fulfilled the RCTQ, rumination, worry, and anxiety measures. Three depression groups were operationalized according to YMRS scores: YMRS scores 2 > 6 and YMRS scores = 1 or 2, for respectively mixed and non-pure depression, and YMRS = 0 for pure-depression. Results Confirmatory factor analysis showed that the three-factor model of the RCTQ yielded the best fit indices, which improved after the removal of redundant items, resulting in a 13-item questionnaire. Hypomanic and anxiety symptoms were the main predictors of scores; rumination was not a significant predictor. RCTQ results were similar between mixed groups and non-pure depression, and both were higher than in pure-depression. Limitations Patients’ pharmacological treatment might have influenced the results. Conclusions The 13-item RCTQ captures different facets of racing thoughts heightened in hypomanic and mixed states, but also in depression with subclinical hypomanic/activation symptoms (e.g. non-pure depression characterized by enhanced subjective irritability), suggesting that it is particularly sensitive to activation symptoms in BD, and could become a valuable tool in the follow-up of patients.

Impairment in mental flexibility may be a key component contributing to cardinal cognitive symptoms among mood disorders patients, particularly thought control disorders. Impaired ability to switch from one thought to another might reflect difficulties in either generating new mental states, inhibiting previous states, or both. However, the neural underpinnings of impaired cognitive flexibility in mood disorders remain largely unresolved. We compared a group of mood disorders patients (n = 29) and a group of matched healthy subjects (n = 32) on a novel task-switching paradigm involving happy and sad faces, that allowed us to separate generation of a new mental set (Switch Cost) and inhibition of the previous set during switching (Inhibition Cost), using fMRI. Behavioral data showed a larger Switch Cost in patients relative to controls, but the average Inhibition Cost did not differ between groups. At the neural level, a main effect of group was found with stronger activation of the subgenual cingulate cortex in patients. The larger Switch Cost in patients was reflected by a stronger recruitment of brain regions involved in attention and executive control, including the left intraparietal sulcus, precuneus, left inferior fontal gyrus, and right anterior cingulate. Critically, activity in the subgenual cingulate cortex was not downregulated by inhibition in patients relative to controls. In conclusion, mood disorder patients have exaggerated Switch Cost relative to controls, and this deficit in cognitive flexibility is associated with increased activation of the fronto-parietal attention networks, combined with impaired modulation of the subgenual cingulate cortex when inhibition of previous mental states is needed.

Increasing evidence suggests that sleep spindles are involved in memory consolidation, but few studies have investigated the effects of learning on brain responses associated with spindles in humans. Here we used simultaneous electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) during sleep to assess haemodynamic brain responses related to spindles after learning. Twenty young healthy participants were scanned with EEG/fMRI during (i) a declarative memory face sequence learning task, (ii) subsequent sleep, and (iii) recall after sleep (learning night). As a control condition an identical EEG/fMRI scanning protocol was performed after participants over-learned the face sequence task to complete mastery (control night). Results demonstrated increased responses in the fusiform gyrus both during encoding before sleep and during successful recall after sleep, in the learning night compared to the control night. During sleep, a larger response in the fusiform gyrus was observed in the presence of fast spindles during the learning as compared to the control night. Our findings support a cortical reactivation during fast spindles of brain regions previously involved in declarative learning and subsequently activated during memory recall, thereby promoting the cortical consolidation of memory traces.

The current study aims at documenting the psychometric properties of the Subjective Distress Associated with Adult ADHD-Self-Report (SDAAA-SR), a newly developed instrument for the assessment of psychological suffering in ADHD adults. The SDAAA-SR was administered to 247 students and 142 ADHD adults. Factor structure, internal consistency, test–retest reliability, convergent validity and discriminant validity were assessed. Sensitivity to change was examined in a subsample of 25 ADHD patients who participated in a 1-year therapy. The initial pool of 62 items was reduced to 33 items distributed in a three-component structure. Internal consistency was excellent for the “distress due to inattention/disorganization” subscale and good for the “distress due to hyperactivity/impulsivity” and “distress due to self-esteem deficit” subscales. Test–retest reliability in a subsample of 98 students was substantial for all three subscales. ADHD patients scored significantly higher than students on distress due to “inattention/disorganization” and “hyperactivity/impulsivity,” but no difference was observed for “self-esteem deficit.” The components “inattention/disorganization” and “hyperactivity/impulsivity” displayed moderate to large correlations with the corresponding dimensions of the Adult Self-Report Scale for ADHD (ASRS-V1.1). Distress due to “inattention/disorganization” and “self-esteem deficit” was significantly associated with lower satisfaction with social behaviors (QFS, social functioning questionnaire) and quality of life (WHOQOL-BREF). Distress due to “inattention/disorganization” and “self-esteem deficit” significantly decreased after a 1-year therapy. The SDAAA-SR represents a reliable and valid measure of adult ADHD-associated distress, an important but often undocumented parameter in the clinical setting. Its use as an outcome variable in psychological interventions deserves further investigation.

Cet article est le premier de deux articles explorant les liens bidirectionnels entre le concept d’adaptation et celui de neurosciences. Nous verrons tout d’abord dans cet article que les neurosciences peuvent être perçues comme ambitieuses et toutes-puissantes oscillant entre un danger réductionniste et déshumanisant ou bien cristallisant certains fantasmes de maîtrise. Nous verrons ensuite que la société s’adapte aux neurosciences en intégrant certaines méthodologies et certaines découvertes dans des domaines très variés, au point que nous pouvons nous questionner sur la neurosociété de demain. Ensuite nous verrons que la méthodologie des neurosciences est elle-même fréquemment remise en question et nécessite que chacun en connaisse les limites sans s’en tenir aux seules promesses. Après cela, nous verrons que l’adaptation vue comme une promesse d’un but déterminé et fini peut s’avérer rassurante mais est surtout improbable., This article is a first article in a series of two articles exploring the bidirectional links between the concept of adaptation and of neuroscience. In this first article, first of all we will see that neurosciences can be seen as ambitious and all-powerful oscillating between a reductionist and dehumanizing threat or crystallizing some control fantasies. We will then see that society adapts itself to neurosciences methodologies and incorporate some discoveries in various fields so that we can ask ourselves about the neuro-society of tomorrow. Then we will see that the methodology of neurosciences themselves is frequently challenged and requires that everyone knows the limitations and not only stick to promises. After that, we will see that the adaptation seen as the promise of a determined and finite goal may be reassuring but is most unlikely.

In this commentary on Firestone & Scholl's (F&S's) article, we argue that researchers should use brain-activity modelling to investigate top-down mechanisms. Using functional brain imaging and a specific cognitive paradigm, modelling the BOLD signal provided new insight into the dynamic causalities involved in the influence of cognitions on perceptions.

Functional neuroimaging studies have provided key insights into the neural causes, consequences, and correlates of sleep disorders. Brain imaging studies during normal sleep have revealed dynamic neural activity, characteristically different from wakefulness and correlated with electroencephalographic sleep oscillations. Sleep deprivation causes activations and deactivations in several brain regions, and white matter densities predict its detrimental effect on cognitive ability. Functional neuroimaging studies in insomnia support hyperarousal theory, notably with decreased inhibition shown during the transition from wakefulness to sleep. Structural findings in insomnia are less consistent, with alterations detected in the hippocampus, prefrontal cortex, and rostral anterior cingulate cortex. In narcoleptic patients, functional and structural abnormalities are found mainly in the hypothalamus, supporting a hypocretinergic dysfunction, whereas altered limbic responding may relate to emotional dysregulation. Thalamic hypoperfusion seems to underlie Kleine–Levin syndrome (KLS), a type of central hypersomnia. Neuroimaging studies of obstructive sleep apnea have focused on its negative neuropsychological effects, linking them to structural alterations in the prefrontal cortex, hippocampus, parietal cortex, and white matter tracts, as well as to functional changes in the default-mode network. Only some of these changes seem reversible by treatment with continuous positive airway pressure (CPAP). In restless legs syndrome (RLS), iron depletion in the substantia nigra (SN) may interact with dopaminergic dysfunction to disturb the sensorimotor control of pain. A single case report of a sleepwalking episode demonstrated prefrontal hypoperfusion and posterior cingulate hyperperfusion. Lastly, functional and structural studies of rapid eye movement sleep behavior disorder converge on pontine abnormalities, as well as presynaptic dopamine dysfunction related to the development of synucleinopathy.

Despite the persuasiveness of Keven & Akins' (K&A) review, we argue that mentalization, or the ability to interpret the mental states of oneself and others, is required to construct the neonate mind, going far beyond sensorimotor imitation. This concept, informed by certain psychoanalytic and attachment theories, has produced a form of therapy called mentalization-based psychotherapy, which aims to improve emotional regulation. Our aim here is to shed light on a form of neonatal imitation that goes beyond sensorimotor imitation.

We used functional magnetic resonance imaging (fMRI) to examine affective control longitudinally in a group of patients with bipolar disorder (BD). Participants comprised 12 BD patients who underwent repeated fMRI scans in euthymic (n=11), depressed (n=9), or hypomanic (n=9) states, and were compared with 12 age-matched healthy controls. During fMRI, participants performed an emotional face-word interference task with either low or high attentional demands. Relative to healthy controls, patients showed decreased activation of the cognitive control network normally associated with conflict processing, more severely during hypomania than during depression, but regardless of level of task demand in both cases. During euthymia, a decreased response to conflict was observed only during the high load condition. Additionally, unlike healthy participants, patients exhibited deactivation in several key areas in response to emotion-conflict trials - including the rostral anterior cingulate cortex during euthymia, the hippocampus during depression, and the posterior cingulate cortex during hypomania. Our results indicate that the ability of BD patients to recruit control networks when processing affective conflict, and the abnormal suppression of activity in distinct components of the default mode network, may depend on their current clinical state and attentional demand.

Summary The current trend is to reserve the diagnosis of premature ejaculation (PE) for cases where penetration lasts for about one minute or less. The rationale is that the aetiology is primarily bio-constitutional, and that long-term pharmacological treatment is the only viable option. However, the literature contains little scientific evidence to support this argument. In fact, a good number of individuals who suffer from overly rapid ejaculation present with penetration duration exceeding one minute, and even severe forms of PE have responded favourably to psycho-sexological treatment. Moreover, although certain biological variables are known to influence ejaculation latency time, nothing indicates that they play an exclusive role of psychosocial etiological factors in severe PE. Therefore, it would be ‘premature’ to base a PE diagnosis on a maximum penetration duration of one minute, which should instead be considered a severity gradient. Given that desired criteria for penetration duration often exceed biological norms, it would be inappropriate to propose that only the most severe forms of PE have constitutional origins. In any case, the constitution is relatively flexible, and can respond to adaptive learning. An adaptive learning approach would undoubtedly be more difficult to apply in severe cases, but not impossible. The issue of whether to use pharmacological versus psycho-sexological treatment could be sidestepped by moving beyond the single criterion of ejaculation latency.

Resume Il existe actuellement une tendance a reserver le diagnostic de trouble de l‘ejaculation precoce (EP) aux seuls cas caracterises par des durees de penetration inferieures ou egales a une minute environ. L’idee sous-jacente est que ces situations releveraient d’une etiologie essentiellement bio-constitutionnelle et qu’un traitement pharmacologique au long cours constituerait l’unique option therapeutique valable. A l’examen de la litterature cependant, les evidences scientifiques invoquees en soutien de cette proposition apparaissent assez faibles. Bon nombre de personnes souffrant d’ejaculer trop rapidement presentent en effet des durees de penetration superieures a une minute, et il semble que les formes severes d’EP puissent aussi repondre favorablement a des traitements psycho-sexologiques. En outre, s’il s’avere certain que des variables biologiques influencent la latence ejaculatoire, rien ne permet cependant de pretendre qu’elles jouent, dans les formes severes d’EP, un role exclusif de facteurs etiologiques psychosociaux. Il apparait ainsi « premature » de fonder le diagnostic d’EP sur une duree de penetration d’une minute maximum, ce critere determine plutot un gradient de severite du trouble. Considerant que, en matiere de duree de penetration, les criteres de desirabilite se situent souvent au-dela des normes biologiques, il semble delicat de soutenir que seules les formes d’EP les plus severes auraient une origine bio-constitutionnelle. Dans tous les cas au demeurant, la constitution s’avere relativement plastique, sensible aux apprentissages a visee adaptative. Ceux-ci sont sans doute plus difficiles a realiser par les porteurs d’une forme severe du trouble, mais pas impossibles. La question de l’indication d’un traitement pharmacologique ou psycho-sexologique gagnerait a se degager d’un simple critere de latence ejaculatoire.

Objectives: Thought disorders such as rumination or flight of ideas are frequent in patients with mood disorders, and not systematically linked to mood state. These symptoms point to anomalies in cognitive processes mediating the generation and control of thoughts; for example, associative thinking and inhibition. However, their neural substrates are not known. Method: To obtain an ecological measure of neural processes underlying the generation and suppression of spontaneous thoughts, we designed a free word association task during fMRI allowing us to explore verbal associative patterns in patients with mood disorders and matched controls. Participants were presented with emotionally negative, positive or neutral words, and asked to produce two words either related or unrelated to these stimuli. Results: Relative to controls, patients produced a reverse pattern of answer typicality for the related vs unrelated conditions. Controls activated larger semantic and executive control networks, as well as basal ganglia, precuneus and middle frontal gyrus. Unlike controls, patients activated fusiform gyrus, parahippocampal gyrus and medial prefrontal cortex for emotional stimuli. Conclusions: Mood disorder patients are impaired in automated associative processes, but prone to produce more unique/personal associations through activation of memory and self-related areas.