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.     

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.     

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.     

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.     

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.     

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.