The interplay between relationship effectiveness,life stress,and sleep: A prospective study

Research has shown that greater stress responses predict worse sleep and that the quality of one's current romantic relationship predicts one's sleep. Despite these established links, research has not examined connections between ongoing patterns of interpersonal experiences and competencies (relationship effectiveness) and stress exposure on sleep. Participants in the Minnesota Longitudinal Study of Risk and Adaptation (MLSRA) completed measures assessing relationship effectiveness and stress exposure at ages 23 and 32 years, as well as sleep quality/duration at age 37 years. Analyses demonstrate that relationship effectiveness at age 23 years positively predicts sleep quality—but not sleep duration—at age 37 years via reduced stress exposure at age 32 years. These findings highlight the effects of relationship effectiveness and stress exposure across early to middle adulthood on sleep.     

Analyse et comparaison de discours de patients douloureux chroniques durant une thérapie de soutien par opposition à l’utilisation de la thérapie Eye Movement Desensitization and Reprocessing (EMDR)

IntroductionThe use of EMDR – Eye Movement Desensitization and Reprocessing – being innovative in the area of chronic pain. If his efficiency as show in the specific litterature, the way its work it is really different than usual therapy.ObjectiveThe main objective of this work is to compare the speech of patients during the use of EMDR vs. supportive therapy in a supported unit of chronic pain to the hospital.MethodsForty-five patients divided into three groups received EMDR therapy (standard protocol), EMDR therapy (pain protocol) as well as supportive therapy. All interviews were transcribed and analyzed using the software Alceste.ResultsThe results show that the semantic classes differ between the three forms of therapy, as well as passive or active posture of the patient during the therapy.ConclusionThese results give us an additional insights into what happens in fine in different types of therapy.     

Inhibitory Learning for Anxiety-Related Disorders

This article reviews the articles in this issue that describe the strategies derived from the inhibitory learning model as applied to exposure therapy for anxiety disorders. The major principles of inhibitory learning are to create and strengthen nonthreat associations in memory (largely by engaging prefrontal cortical regions), and to effectively retrieve those nonthreat associations in the long term. Several case vignettes are provided that demonstrate how the principles of inhibitory learning (which include maximizing expectancy violations, limiting distraction, fear antagonistic actions, deepened extinction, elimination of safety behaviors, occasional reinforced extinction, increasing variability of exposures and offsetting reinstatement and context renewal effects) can be applied in clinical practice.     

Antidepressant Medication: Is It a Viable and Valuable Adjunct to Cognitive-Behavioral Therapy for School Refusal?

Cognitive-behavioral therapy (CBT) is an evidence-based treatment for school refusal. However, some youth do not respond to CBT. The serious risks associated with school nonattendance call for novel approaches to help those who do not respond to CBT. Because school refusal is commonly associated with anxiety disorders, and the combination of CBT and antidepressant medication enhances outcomes in the treatment of anxiety disorders, combined treatment may be effective for school refusal. This narrative review evaluates the current evidence base for adding antidepressant treatment to CBT for school refusal. Six randomized controlled trials (RCTs), two open trials, six case studies/series, and one observational study were identified and reviewed. There is support for combined CBT and imipramine, but this medication is not typically used due to the risk of concerning side effects. Two recent RCTs failed to provide evidence for the superiority of combined CBT and fluoxetine. Further research in this area is required because the extant studies have a number of methodological limitations. Recommendations are provided for clinicians who consider prescribing antidepressant medication or referring for adjunctive antidepressant treatment for school refusal.     

Le juge,le médecin et le détenu. Regard critique sur la suspension de peine pour raison médicale

The purpose of the article is to give a critical view of the “suspension médicale” (a kind of compassionate release), which is often considered as a “humanist” law. Based on a research conducted on the experience of prisoners at the end of their lives, it appeared that many more or less objective criteria are involved in the decision-making process. In this context, physicians and magistrates try to articulate their actions according to expertise. The decision of granting or refusal also depends on the perception of the prisoner's personality. The application of the law thus reflects the tensions and alliances between medicine and justice in the treatment of a deviant and vulnerable population.     

Quelle juridiction est compétente pour juger des faits commis par un professeur des universités-praticien hospitalier qui sont en rapport avec son activité d’enseignement ?

Constituted courts of ordinal authorities are not competent to judge facts committed by a university professor-hospital practitioner, which are related to his teaching activity. Only the court specific to hospital teachers, which is seized by the ministries of health and higher education, is competent to judge those facts.     

Les limites de l’approche fondée sur le risque de la loi du 5 mars 2012 relative aux recherches impliquant la personne humaine,dite « loi Jardé »: Lecture critique des arrêtés du 12 avril 2018

Thanks to the publication of the two decrees of 12 April 2018, and six years after the promulgation of the Jardé law, the scope of the law of 5 March 2012 as well as the different categories of research involving the human person finally appear clearly. Beside interventional research that includes intervention on the person that is not justified by usual care, the contours of two categories of research have been precised: interventional research with minimal risk and minimal burden and “non-interventional” research, whose name is questionable. If the latest decrees have managed to reach a more coherent set of rules, the French legal and regulatory provisions remain complex and incomplete. Complex, in view of the multiplicity of statutory texts adopted since the promulgation of the Jardé law. Incomplete, because the needs for ethical evaluation provided for by the international ethical principles of research are not systematically covered by French law.     

Religious education,a matter of understanding? reflections on the final report of the Commission on Religious Education

In this article we offer reflections on the final report of the Commission on Religious Education (CoRE) that was published in England in 2018. We expose and problematise the prominent place of understanding in the report, not only as an educational method, but also the underlying world view of the report itself, a world view which we characterise as ‘hermeneuticism’. We raise educational, theological and political concerns about the particular approach taken in the report. We propose instead that religious education (RE) should be considered first of all in terms of what it means to live with a religious or non-religious orientation, conceived in existential terms rather than in terms of beliefs or practices or objectified world views. Educationally we show that what we term a non-hermeneutic way of viewing our humanity would open different possibilities for RE and its future.     

Evidence for a sensitive period in the effects of early life stress on hippocampal volume

Exposure to stress has been causally linked to changes in hippocampal volume (HV). Given that the hippocampus undergoes rapid changes in the first years of life, stressful experiences during this period may be particularly important in understanding individual differences in the development of the hippocampus. One hundred seventy‐eight early adolescents (ages 9–13 years; 43% male) were interviewed regarding exposure to and age of onset of experiences of stress; the severity of each stressful event was rated by an objective panel. All participants underwent structural magnetic resonance imaging, from which HVs were automatically segmented. Without considering the age of onset for stressful experiences, there was a small but statistically significant negative association of stress severity with bilateral HV. When considering the age of onset, there was a moderate and significant negative association between stress severity during early childhood (through 5 years of age) and HV; there was no association between stress severity during later childhood (age 6 years and older) and HV. We provide evidence of a sensitive period through 5 years of age for the effects of life stress on HV in adolescence. It will be important in future research to elucidate how reduced HV stemming from early life stress may contribute to stress‐related health outcomes.     

The relationship between religion and health-related behaviours in patients with borderline personality disorder

With addictive disorders frequently co-occurring among patients with borderline personality disorder (BPD), exploring factors that may influence health-related behaviours, like religious involvement, is important. This study assesses whether religious involvement is associated with smoking and alcohol use disorders (AUDs) in BPD subjects. This study used data from Wave 2 of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), which used the Alcohol Use Disorder and Associated Disabilities Interview Schedule–DSM-IV (AUDADIS-IV) as its assessment instrument. The AUDADIS-IV assessed personality disorders, tobacco usage, the presence of AUDs, and religious involvement. Attending a place of worship and weekly or more frequent worship attendance were significantly associated with reduced likelihood of current smoking and AUDs among BPD subjects. AUDs were also significantly less common in those reporting higher subjective religiousness. In conclusion, people with BPD who are religiously inclined are less likely to engage in addictive behaviours, specifically smoking and AUDs.