Rôle des schémas précoces inadaptés (SPI) dans le dysfonctionnement relationnel des personnes ayant un trouble bipolaire en phase d’euthymie

DUPOUY, Manon; ROUX, Paul; MUNUERA, Caroline; WEIL, François; PASSERIEUX, Christine; M'BAILARA, Katia

doi:10.1016/j.encep.2023.06.016

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DUPOUY, Manon
Centre hospitalier Charles Perrens [Bordeaux]

ROUX, Paul
Université de Versailles Saint-Quentin-en-Yvelines [UVSQ]
Centre Hospitalier de Versailles André Mignot [CHV]
Fondation FondaMental [Créteil]

MUNUERA, Caroline

Laboratoire de psychologie [LabPsy]

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L'Encéphale. 2023-08-19

Résumé

Objectifs. – Cette étude vise à explorer les associations entre les domaines de schémas précoces inadap-tés (SPI) et le dysfonctionnement relationnel chez des personnes ayant un trouble bipolaire en phased’euthymie.Méthode. – Les critères d’inclusion étaient d’être âgé entre 18 et 65 ans, d’avoir rec¸ u un diagnostic detrouble bipolaire (DSM), et d’être en phase d’euthymie au moment de l’étude. Les domaines des sché-mas précoces inadaptés étaient évalués au moyen du YSQ-3 version courte (Young Schema Questionnaire3 Short Form) et le dysfonctionnement relationnel actuel au moyen de la FAST (sous-échelle du FunctioningAssessment Short Test).Résultats. – Avoir des symptômes dépressifs résiduels est un facteur associé au dysfonctionnementrelationnel des personnes ayant un trouble bipolaire en phase d’euthymie. Avoir des schémas préco-ces inadaptés activés en particulier dans le domaine de séparation et rejet (p < 0,0001), le domained’orientation vers les autres (p = 0,031) et le domaine de survigilance et d’inhibition (p = 0,005) augmentele risque d’avoir un dysfonctionnement relationnel important.Discussion. – Cette étude est la première à montrer que le fait d’avoir plusieurs domaines de SchémaPrécoces Inadaptés activés est un facteur de compréhension des difficultés que les personnes ayant untrouble bipolaire en phase d’euthymie ont dans les relations interpersonnelles. En ce sens les schémasprécoces sont un levier pour la rémission fonctionnelle. Il s’avère donc pertinent d’orienter les personnesreportant des problèmes relationnels vers une thérapie des schémas.< Réduire

Résumé en anglais

Objectives. – Although free from characterized manic and depressive episodes, the euthymic period inbipolar disorder (BD) remains characterized by a whole host of difficulties, particularly relational. Thesedifficulties are factors of vulnerabilities and relapses. People’s perception of their own relationships hasan impact on their symptomatology, their responses to treatment and on relapse rates. Young’s earlymaladaptive schemas (EMS) approach proves to be relevant for understanding the construction of theseperceptions and working on them. Nevertheless, to this date, few studies have investigated which EMSare related to relationship dysfunction in this particular population. Determining the link between EMSand relationship difficulties would be relevant to understand psychosocial impairment of people with BDin euthymic states. The present study aims to investigate the associations between the different domainsof EMS and relationship dysfunction among patients with bipolar disorder in the euthymic phase.Methods. – Data are extracted from the FACE-BD cohort, within the BD Expert Center in Versailles. Inclu-sion criteria were to be aged between 18 and 65 and to be an outpatient with a diagnosis of bipolardisorder (DSM-IV-TR). Patients had to be euthymic at the time of inclusion, according to DSM-IV-TR cri-teria with a cut-off score of 14 on the Montgomery-Asberg Depression Rating Scale and the Young ManiaRating Scale. Non-inclusion criteria were meeting at the time of the study the criteria for characteristicdepressive episode, hypomania or mania according to the DSM-IV-TR. Sociodemographic data, clinicalfeatures associated with relationship dysfunction were assessed. EMS and EMS domains were assessedwith the YSQ-R short form (Young Schema Questionnaire 3 Short Form) and current relationship dys-function were assessed with the FAST (Functioning assessment short test subscale). Successive simplelinear regression analyses were performed to investigate the association between the severity scores ofeach EMS and the intensity of relationship dysfunction. Furthermore, successive simple linear regressionanalyses investigated the association between EMS domain scores and intensity of relationship dysfunc-tion. Multiple linear regression analyses were performed to test the association between EMS scores,then EMS domains, and the intensity of relationship dysfunction after adjusting for age as well as theintensity of residual depressive and manic symptoms. Results. – Relationship dysfunction is partly associated with EMS activation in particular in the separationand rejection domain (P < 0.0001), the other-directedness domain (P = 0.031) and the over-vigilance andinhibition domain (P = 0.005). Having residual depressive symptoms is also among the factors contribut-ing to the relationship dysfunctions of people with bipolar disorder in the euthymic phase.Discussion. – This is the first study demonstrating that the activation of several domains of EMS is a riskfactor of relationships difficulties for people in euthymic phase of bipolar disorder. It is necessary to iden-tify which EMS are specifically activated and their domains of belonging in order to prevent and reducethem. EMS are a lever for functional remission. It is therefore relevant to refer people reporting relation-ship problems to schema therapy consistent with a personalized care. Finally, future studies should focuson the mechanisms underlying the complex relationship between EMS domains and relationship dys-function in people with bipolar disorder in the euthymic phase. It may also be relevant for future researchto control for different types of relationship dysfunction. EMS may be differentially associated with sev-eral types of interpersonal problems. The relations between different adaptation styles and EMS shouldbe further investigated to offer more personalized care, with the aim to improve functional remission.< Réduire

Mots clés

Schémas précoces inadaptés

Domaines de schémas précoces inadaptés

Dysfonctionnement relationnel

Relations interpersonnelles

Troubles bipolaires

Euthymie

Mots clés en anglais

Bipolar disorders

Euthymic state

Early Maladaptive Schemas (EMS)

Domains of Early Maladaptive Schemasinterpersonal relationship

Relationship dysfunctiona

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