L'inquiétante étrangeté à l'opéra. À propos du Tour d'écrou de Benjamin Britten

The concept of “disturbing weirdness” was first introduced in psychoanalysis by Freud based on a single opera: Offenbach's Hoffmann's Tales, but this work is far from being the only one to be built on such an atmosphere of “disturbing weirdness” (Unheimlichkeit, in German). Benjamin Britten's The Turn of the Screw, for instance, shows the same characteristics and suggests a new extension of the Freudian concept. The story, first written by Henry James, takes place in a strange English manor, where two children Miles, a boy, and Flora, a girl, seem to have been corrupted by a former female private tutor and a male servant who are supposed to be dead but who are still appearing as ghosts on a high tower or across a lake. Nobody is sure they are really dead, because they keep talking and singing to attract and seduce the children. Distress and anguish hang over the entire opera, which ends tragically for the boy who dies when the new governess tries to extract the secret she thinks he keeps in his mind from him. The author investigates all the possibilities of clarifying the situation and proves that this opera might suggest new meanings and new significations to the Freudian concept of “Unheimlichkeit”.     

Tempérament et créativité

The idea that there is a direct link between genius and madness has been a persistent theme from the early Greek times. The scientific literature provides a large body of evidence supporting the notion that the artistic output may be associated with a mental disorder. It appears that the enthusiasm for associating creativity and psychiatric disorders exceeds the scientific evidence. Indeed, most recent studies suggest that schizophrenia is incompatible with sustained writing creativity. However, soft bipolar disorders and cyclothymia are over-represented among writers. These results allow the generation of some hypotheses concerning the dimensions involved in creativity. Some data suggest that a form of affective instability may contribute to the emergence of creativity. Indeed, cognitive and emotional traits associated with some personality features, in particular with the cyclothymic temperament, are likely involved in the creation processes. Furthermore, the consistent reports of increased rates of mood disorders in creative people, and the existence of a genetic component involved in these disorders and in creativity, suggest that in an evolutionistic perspective, the bipolar disorder is necessary for society despite its high human cost. Thus, in clinical practice we need to investigate the consequences of treatments on creativity in bipolar patients.     

L’anxiété préopératoire : manifestations cliniques, évaluation et prévention

Preoperative anxiety consists of physiological and psychological discomfort that manifests itself at the possibility of a surgical intervention. When the anxiety is weak or moderate, it is considered to be an adaptive response to a potentially anxiety producing situation. Prior research has established that high levels of preoperative anxiety increase the risk for postoperative complications as well as emotional and behavioral difficulties. Despite these sometimes severe medical and psychological consequences, very little literature exists aimed at French health care workers on the subject. The goal of this article is to synthesize the existing knowledge on preoperative anxiety, including its clinical manifestations and methods of evaluation and prevention.     

Apports des dispositifs robotisés à la rééducation du membre supérieur hémiplégique

Introduction

Poststroke rehabilitation care has evolved considerably over the last decade. The emergence of the concepts of brain plasticity and motor learning has led to the development of new therapeutic approaches. Most of the new strategies are based on movement therapy, which can have a real impact on neurological recovery, sometimes with significant functional benefit for the patient.

State of the Art

In this context of evolving practices, the hemiplegic arm is the subject of special attention. Considering the often unfavorable “natural” prognosis and the relatively limited impact of conventional therapies; researchers have focused work on new alternatives. Cooperation between developers of technological advances and the medical community has led to the development of innovative therapeutic options often based on the use of specific technological tools (functional electric stimulation, virtual reality, transcranial magnetic stimulation…) to solicit or facilitate movement.

Perspectives/conclusion

Robot-assisted rehabilitation lies within this scope. The positive results reported in the most recent publications and the growing interest for this type of therapy in the fields of medical and engineering research should open the way for extremely promising prospects. The technological performance of new robots has nevertheless raised a large number of unanswered questions, implying a significant amount of further research.     

Thrombose veineuse cérébrale et polyradiculonévrite aiguë révélant un lupus érythémateux disséminé

Introduction

Neurological manifestations of systemic lupus erythematosus are frequent and polymorphic. In 40% of cases, lupus can be revealed by neurological symptoms. Cerebral nervous system complications predominate and can be a negative factor for prognosis. Peripheral features are rare and various and can compromise functional prognosis, sometimes with fatal outcome.

Case report

We report the case of a 30-year-old woman who presented a cerebral venous thrombosis of the superior longitudinal sinus. Outcome was favorable with antibiotics and anticoagulants. Four months later, she developed an acute polyradiculoneuritis associated with an inflammatory syndrome and positive tests for antinuclear antibody and antinuclear anti-DNA. The diagnosis of neurolupus was retained on the basis of four criteria of the American college of Rheumatology. The patient was given steroid therapy associated with a course of intravenous immunoglobulin. She has fully recovered her deficit.

Conclusion

Cerebral venous thrombosis and acute polyradiculonévrites are rare events in systemic lupus erythematosus. Early diagnosis and management are crucial.     

Fonctionnement cognitivo-émotionnel : le rôle de l’intensité émotionnelle chez les individus anxieux

Anxiety is an emotional disorder widespread in the general population and it seems to be linked to depression symptoms. The aim of this study is to test the hypothesis of relations between cognitivo-emotional functioning, anxiety and depressive symptoms. The study sample was formed from a group of 50 female subjects, aged from 18 to 65. Participants completed the Hospital Anxiety and Depression scale (HAD), the Affect Intensity Measure (AIM), the Emotional Expressivity Scale (EES) and the Levels of Emotional Awareness Scale (LEAS). The results show that strong positive correlations between anxiety symptoms affect intensity, emotional expressivity and the level of emotional awareness. To conclude, these results point out the importance of emotional variables in the study and treatment of subjects suffering from anxiety symptoms.     

Séquelles délirantes d’une psychose puerpérale ancienne, un climat d’inquiétante étrangeté : observation clinique

Mr and Mrs P., recently settled in the area, are experiencing difficulties. Mr P. suffering from depression has to be admitted to the hospital. Mrs P., who suffered for years from bipolar trouble, is sent to the outpatients department for medical supervision of her lithium treatment. Discussions with her and the reading of a text she wrote years before bring back a delirious experience, which happened 20 years ago involving the disturbing strangeness of a world of goats. This looking back into the past becomes the starting point of an intense pictorial productivity on which the psychotherapy will be based… An eight months effort which will succeed in obtaining the normalization of family life and a better adaptability to reality.     

Origine et renouveau du concept de démence dans la schizophrénie

An increasing amount of current literature on schizophrenia is devoted to the role dementia may play in its course. This renewed interest had the way paved by the very history of the dementia concept. Before Kraepelin coined the term of "dementia praecox" as the hallmark of a common terminal state for hebephrenia, catatonia and paranoid psychosis, dementia acquired, as soon as the end of the 18th-century its cognitive meaning. In France, Pinel yet spoke of an "abolition of thinking", but in the same time considered dementia as one of the four forms of mental alienation, alongside with mania, melancolia and idiotism. During the 19-th century dementia was defined as an acquired deficit of intelligence supported by a brain disease, but which could be due to a mental illness. Owing to progress in neuropathology, several diseases such as Alzheimer or Pick illnesses were identified as causes of dementia, so that the concept was annexed by neurologists and received less interest from psychiatrists, during the last century. That seemed to change, twenty years ago, when clinical discussions emerged around the issues raised by depressive (pseudo) dementia. In psychiatry, the broader conceptualization of schizophrenia introduced by Bleuler in 1911 has not been widely adopted, many authors having been continuing sharing the Kraepelinian view that, at least one form of the disease, was a chronic progressive illness leading to severe impairments in cognitive and social functioning. Historical variations in diagnostic criteria used for schizophrenia had an impact on the way psychiatrists assessed outcome of the disease, leading some of them to consider schizophrenia as a nosological category without natural boundaries and propose to abandon the concept. However the use of narrow criteria is currently prevailing. Advances in neurocognitive testing and changes in theoretical models allowed, at the end of the last century, to document that schizophrenia was characterized by a broadly based cognitive impairment. Deficits were found in various domains: global and selective verbal memory, non-verbal memory, bilateral and unilateral motor performance, visual and auditory attention, general intelligence, spatial ability, executive function, language and interhemispheric tactile-transfer test performance. The hypothesis according to which the vast majority of these cognitive deficits had a neurodevelopmental origin was recently challenged by findings from longitudinal neurocognitive and neuroimaging studies. Some studies, for example, show that if first episode patients have smaller left hippocampal volumes as compared with controls, there is also an association of smaller right hippocampal volumes with increased illness duration in chronic schizophrenia. Others have shown that neuropsychological evaluations before treatment permitted differentiation of primary deficits from changes secondary to medication or chronicity. Clinicians reported that in some cases of chronic schizophrenic patients, dementia could be a complication of the disease, sharing common neuropsychological features with frontotemporal dementia. The effect of age was discussed too, as seeming to play sometimes a part. Even if the cause of the degenerative process that appears to occur in the brains of some schizophrenic patients remains largely unknown, advances in neuropathological models of degeneration in the brain as well as in mechanisms and factors underlying its process, gave rise to hypotheses liable to explain how degenerative dementia could occur in schizophrenia. Excess products of membrane degeneration which was evidenced by magnetic resonance spectroscopy suggests increased apoptosis in some schizophrenic patients. Deficits in neurotrophic factors, free radical oxidation, excess glutamate activity have been implicated as well as abnormalities in dopamine and cortisol metabolism. Growing evidence that some newer antipsychotics seem capable to interfere with these processes, slowing down their progression and even stopping it, has contributed to the renewal of the concept, opening new avenues to preventive strategies in the treatment of schizophrenia.     

Dystonies monogéniques : l’hypothèse dopaminergique revisitée

Dystonias are clinically and genetically heterogeneous neurological disorders that affect movement, and are the focus of much investigative work. The recent identification of mutations in the gene THAP1 in DYT6 dystonia reopens the very interesting question of the in fine involvement of dopamine in the different types of dystonia. In this review, we will go through the recent literature in order to evaluate the many contributions to this theory as well as to highlight the difficulties in identifying a global regulatory pathway for the different forms of this disease that we are just starting to decipher.     

Réflexions sur la pratique de l'expertise pour Majeurs Protégés. À propos d'une étude de 110 dossiers sur 25 ans

This study concerns the evolution of expertise related to protected mentally incompetent elderly adults with old age pathologies. This difficult practice requires the expert to have specific expertise, an extended medical formation and to be interested in social problems. The study shows that some improvement is needed in the teaching of forensic psychiatry and in the relationships with justice representatives and with collaborating physicians.     

Une approche pédagogique multimodale en mathématiques auprès d’élèves avec infirmité motrice cérébrale

The pedagogical approach presented provides successful solutions for cases of difficulty in treating numerical information. The remediation relies on tools to allow access to various mathematical activities. They have proven themselves effective with children with cerebral palsy where motor impairment is associated with cognitive impairment. They have also facilitated the learning of ordinary pupils identified with learning difficulties. The learning aids circumvent the instrumental difficulties to free attention for mental manipulation. To counter the many difficulties observed in handling tasks in the non-symbolic stage, the emphasis is placed on the presymbolic tasks already sufficiently organized to successfully access the symbolic tasks. Three principles ensure the success of the remediation implemented: they are based on multimodal input (gestural, visual and verbal), they ensure accurate results and allow the formation of cognitive relations within mathematics and also more generally in the development of the pupil. In providing the child with reliable tools, he finds pleasure in using his preserved cognitive abilities, thus installing confidence.     

À propos d’un cas pédiatrique de diplégie spastique : évaluations et élaboration d’un projet thérapeutique à court et moyen terme

We report a case of cerebral palsy, following premature birth, in a young girl presenting with spastic diplegia. At age 8 years, she benefited from a complete and in depth clinical evaluation, including two major aspects: motor functions and neuropsychology, without forgetting pediatric data. This assessment was based on the “factorial evaluation”, as proposed by G. Tardieu and further developed by Mr Le Métayer. Such an evaluation was performed by a multidisciplinary team including a physiotherapist, a psychomotor therapist, a speech therapist and a psychologist, under supervision of the pediatrician in charge of the reeducational day center. Systematic evaluation led to organize a consistent therapeutic plan of care given previous major surgery, the orthopedic issues was the first concern and we described specificity of motor cares of the child at several levels: orthopedic devices, kinesitherapy, oral and topic treatment of spasticiy and previous surgical interventions. On the other hand, we emphasized on the need to consider visuospatial and orthoptic problems, as well as psychosocial considerations and their impact on the efficiency of reeduction and functional outcome. The ultimate goal of the reeduction is to provide to this child all necessary tools in order to maximize her autonomy level throughout her life.     

Mélanome malin leptoméningé primitif : une étiologie rare de pachy- et leptoméningite

Introduction

Leptomeningitis and pachymeningitis are known to occur consecutive to many causes.

Observation

We report the case of a 24-year-old woman with symptoms of raised intracranial pressure and repeated switching transient hemiparesis. The magnetic resonance imaging (MRI) showed a pachyleptomeningitis. Search for a cause was negative. The pathology examination of meningeal tissue revealed a malignant melanoma, without any sign of cutaneous melanoma, leading to the diagnosis of primary leptomeningeal malignant melanoma.

Conclusion

A meningeal biopsy can enable the rare diagnosis of primary leptomeningeal malignant melanoma in a patient with unexplained pachyleptomeningitis.     

Rechute intracérébrale isolée dans la maladie de Hodgkin

Isolated brain relapse is uncommon in Hodgkin's lymphoma and often linked with advanced or refractory disease.

Case reports

We report two patients with stage IV Hodgkin's disease, previously treated with chemotherapy, who later developed neurological symptoms. Brain MRI demonstrated two different types of lesions. Histological findings were consistent with intracranial location of Hodgkin lymphoma. Both of the patients presented only with isolated CNS relapse of the lymphoma.

Conclusion

The two cases demonstrated the MRI appearance of intracranial involvement can be varied and mimic other disease processes in patients with a previous history of Hodgkin's lymphoma. Thus, a biopsy is necessary for diagnosis and correct treatment.