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French

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10670/1.g8t9rp

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The rule of alexithymia in pathogenesis of non decompensated psychosis

Abstract

As hypothesis, we propose that alexithymie is a personality trait of schizophrenia responsible of the drug addiction and the use of methadone treatment. Methadone is an antipsychotic. Clinically, this study stresses the importance of the diagnosis of emotional disorders and personality. It demonstrates that TAS-20 and MMPI-2 are disposal tools for diagnosis of schizophrenia. Therapeutically, the importance of diagnosis is to treat comorbidities and to orientate the care. The approach of schizophrenia from the concept of alexithymia enrolled us in an integrative approach, which takes into consideration the neuropsychiatric and psychodynamic concepts.In the first part, we conducted a longitudinal study with follow-up 6 months with drug addict on methadone or buprenorphine, admitted to CSAPA-UTTD Montpellier. The control group includes 28 addicts out without disorder. Six months later, 15 users conducted the study to completion (age = 35 years, SD = 6.43). 11 addicts with schizophrenia, depression and anxiety (age = 39 years, SD = 6.9) constitute the experimental group. The procedure was to diagnose personality disorders in the control group; to evaluate drug dependence and the level of alexithymia in the groups. We used : the MMPI-2 for the diagnosis of personality disorders; DAST-20 for evaluate dependence according to DSM-IV and the TAS-20 to measure alexithymia. The TAS-20 was administered during treatment and six months after. The results MMPI-2 describe a prevalence of schizophrenic 33% and 20% invalid protocols. The DAST-20 has a low level of dependence in the control group and 1.93 1.49 experimental. In the control group, the scores of alexithymia and its sub-dimensions increase six months after treatment TAS-TOT 52.88% and 55.2%; DIF 19.54 et19.9; DDF 14.87% and 15.57%; EOT 18.47% and 19.73%. Alexithymia is a trait (z = .21, p = .834) and a state of personality (r = .621 *; p = .013). In the experimental group, the TAS-TOT confirms lower scores, but the analysis of sub-dimensions admits that this decrease is not significant TAS-TOT 56% and 54.36%; DDF 17% and 16.36%; DIF 18.45% and 18.18%; EOT 20.55% and 19.82%. Alexithymia is a personality trait (z = .4, p = .689). High alexithymia scores were observed among addicts diagnosed with schizophrenia in both groups. In the TAS-TOT control group 59% and 65.2%; DIF 19.53% and 19.9%; DDF 14.87% and 15.57%; EOT 18.47% and 19.73%. In the10experimental group TAS-TOT 63% and 57%; DIF 21% and 18%; DDF 24% and 21%; EOT 18% and 18%. Alexithymia is a trait (z = 1.21, p = .225) and a state (r = .90 * P = .015) personality in schizophrenics control group. Regarding schizophrenia in the experimental group, lower TASTOT scores 63% and 57% alexithymia is a state.In the second part, discourse analysis detected specific signifying units of alexithymia and psychosis. The methodology focuses on clinical cases. We use semi-structured interview with addicts without personality disorder. They were transcribed on paper according to the analytical method. We use psychoanalytic paradigms, phenomenological and psychosomatic. The narrative description shall include four stages: the anamnesis, the expression of feelings, entry into drug addiction and Methadone Program. The analysis of stories attests a set of clinical signs resulting from the non-extraction of the object, prototype of psychosis. Alexithymia translates clinically by white relationship.Ultimately, the results of the joint analysis recognize that alexithymia is present in drug addiction and schizophrenia. Among drug users, high alexithymia scores are diagnoses of schizophrenia indications, regardless of primary or secondary in nature. Alexithymia is a polydrug factor.Keywords : schizophrenia-alexithymia-drug addiction-methadone-buprenorphine-

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