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Influence de la résistance aux hallucinations auditives sur la dépression: Étude au moyen du questionnaire révisé des croyances à propos des voix

par Monestes, Jean Louis;Vavasseur-Desperriers, Julien;Villatte, Matthieu;Denizot, L.;Loas, Gwenolé ;Rusinek, Stéphane
Référence L'Encéphale, 41, 1, page (25-31)
Publication Publié, 2015-02

Article révisé par les pairs

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Objective. -Beliefs about voices and reactions to voices have been proposed as importantvariables influencing the course of depression in schizophrenia. Consequences of auditory hal-lucinations are different according to identity, goals, omnipotence, omniscience, and meaningsattributed to voices by the client. Ten to 15 % of the general population experience auditoryhallucinations during lifetime without any distress or need for medical care. In addition, neitherfrequency of voices, nor their topography, influence the emotional consequences of auditoryhallucinations experiences, but the relationships to voices. The Revised Belief about VoicesQuestionnaire analyzes voices along 5 dimensions: malevolence, benevolence, omnipotence,resistance, and engagement. Malevolent voices are related to depression, whereas benevolentvoices engender more positive emotions. Subjects usually engage with benevolent voices, andresist to malevolent voices. But resistance strategies are barely efficient and often back-fire. Patients resisting to their voices consider them more malevolent and present with moredepressive symptoms. This research aims at studying the influence of resistance to auditory hal-lucinations on depression in a group of patients suffering from schizophrenia and experiencingauditory hallucinations, using the Revised Beliefs About Voices Questionnaire (BAVQ-R). It alsoprovides a study of the psychometrics properties of the French language version of the BAVQ-R.Method. - Thirty-eight patients suffering from paranoid schizophrenia, undifferentiated schi-zophrenia or schizoaffective disorder, have been tested with the French versions of the RevisedBeliefs About Voices Questionnaire (BAVQ-R), the Positive and Negative Syndrome Scale (PANSS),and the Calgary Depression Scale for Schizophrenia (CDSS). Each patient presented with audi-tory hallucinations during the week before evaluation, with a minimum score of 3 on P3 itemof PANSS. Mean age was 39.39 years (SD 11.33); mean duration of symptoms was 13.92 years(SD 10.81), and patients' mean history of hospitalizations was 7.66 (SD 9.24). Each patientwas receiving an antipsychotic medication at the time of evaluation, with a mean chlorproma-zine equivalent dose of 806.69 mg/d (ET 539.51); 18.5 % of patients were receiving serotoninreuptake inhibitor, and 31.57 % once committed a suicide attempt.Results. - The French version of the BAVQ-R presents with a satisfying internal consistency(Cronbach's alpha = 0.74). Similar to the original version, Malevolence and Resistance, andBenevolence and Engagement dimensions are strongly correlated (r = 0.73, and r = 0.90, P < 0.05,respectively). The BAVQ-R scores correlate with the CDSS (r = 0.40, P < 0.05) and the PANSS Gene-ral Psychopathology subscale scores (r = 0.44, P < 0.05), but not with the Positive and Negativesubscales. (r = 0.17, and r = 0.13, P > 0.05, respectively). Correlations and forced entry mul-tiple regressions analyses show that Resistance and Malevolence are both strongly correlated todepression, but Resistance is the only dimension that influences depression. Moreover, clientspresenting with depressive symptoms resist more to their auditory hallucinations. Finally, emo-tional resistance, in comparison to behavioral resistance, is responsible for depression in peoplesuffering from auditory hallucinations.Conclusion. - Emotional resistance to auditory hallucinations constitutes the most importantvariable influencing depression in schizophrenia comparing to what the voices say or are suppo-sed to know, their malevolence or benevolence. Demonstration of the influence of resistanceto voices on depression would help the development of new therapeutic practices.