Insight et bipolarité

Contrarily to schizophrenia, a few studies are published on insight in bipolar disorders. In literature, it appears that the presence of psychotic symptoms and manic polarity are related to an important alteration of clinical insight. However, these two factors have not been found in several studies. There is only one study on cognitive insight with preliminary data. However, data on neurocognitive variables and clinical insight are heterogeneous and contradictory. We think that a conceptual approach on insight could help to better understand those contradictory results about insight in bipolar disorder.     

Transsexualisme/transgenderism : psychothérapie et transformation hormonale et chirurgicale

Objectives

At the end of the French evaluations and the international revision concerning the standard of care (SOC) for transsexual and transgender patients, the interest to propose psychotherapy as a supplement to the sex reassignment therapy (SRT) was unanimously recognized. But, it is clear that the works concerning this subject are rare, and that the methods of this proposal remain ill-defined. So, many questions remain unsettled such its frame, modalities, methods, objectives and its place and relation with or in the SRT, as well as on the theoretical models on which these psychotherapies base themselves. The goal of this article is therefore to present the conception and the evolution of this psychotherapy in the various versions of the standards of care, as well as the theoretical approaches on which the current model is established, then to expose the questions which according to us, still persist concerning this subject, as well as our remarks and proposals relating to the latter.

Hypothalamus et diabète

Sans résuméAvec 2 figures     

Anticipation et dépression

Depression can be seen as an anticipation disorder. Anticipation is a psychological mecanism underlying project. The study of depressed elderly with the “anticipation test” of M. Berta accentuates the psychic polarisation and implies the hypothesis of a “container” for the anticipation functioning.     

Solitudes et mélancolies

Objectives

The aim here is to reflect on melancholia by exploring the role of the other and of his or her absence.

Tentative de suicide chez l’enfant et l’adolescent et bipolarité

Background

Child and adolescent psychiatrists are frequently confronted with suicide attempts and comorbid mood disorders. Diagnoses of juvenile bipolar disorders (BD) are rare and controversial and standardized assessment is helpful for a reliable diagnosis. The main objective of this study was to identify the number of juvenile bipolar disorder diagnoses according to DSM-5 criteria in a population of children and adolescents hospitalized for suicide attempts. Secondary objectives were the assessment of a patient's characteristics and the comparison of suicide attempt recurrence during 12 months of follow-up.

Passions et Radicalités : Nouvelles formulations et dynamique sociétale

It is a conceptual approach to the notion of passion, its evolution over time. The methodology is based on the analysis of original texts and the search for terms and themes that persist in contemporary thought. The author analyses the appearance of the link between passion and madness since ancient philosophers and the persistence of the relationship to reason and subcategories of passions, such as hatred and can inform terrorism-related radicalizations. The author analyses the appearance of the link between passion and madness from ancient philosophers and the persistence of the relationship to the reason of subcategories of passions such as hatred and radicalities. Initially focused on the individual, we see the extension of its use towards the group with the notion of social passion. An affective state dominating the life of an individual's mind, passion is subsequently analyzed successively as subordinate to reason and likely to become a form of madness among the Stoics. The theological–political power will cause them to be regarded as attitudes of incapacity and disobedience to the divine law. Viewed first as an opinion, the passage to the medical and alienist current leads to the characterization of nosographic entity before the particular context of radical thoughts and the questioning of religious and philosophical radicalities is emphasized. The analyses of doctors and alienists will reflect the conceptions of their time but will gradually emerge from the religious context. The relation to the rational and the true will be restored in the analysis of the delusions in the 19th century. The analysis of radical thoughts and radicalities will be late and will include the passage from individual passions to collective passions and social passions.     

Tako-tsubo et comorbidités psychiatriques

Tako-tsubo syndrome or stress-induced cardiomyopathy is a cardiovascular disease that mimics an acute coronary syndrome without angiographic stenosis on coronary angiogram. Its physiopathology is not well known but is clearly in relation with a physical or psychological acute stress. Patients with tako-tsubo syndrome met during our activity ask the link between comorbid psychiatric diseases and tako-tsubo. This article, by a review of literature, answers this question: are there populations with increased risk to develop tako-tsubo syndrome?     

Efficacité et efficience des psychotropes

In current literature, the concept of efficacy refers to the knowledge about drugs obtained from randomised controlled trials, whereas effectiveness is put forward as far as results under ordinary clinical conditions are concerned. Discrepancies between results from efficacy studies and effectiveness research have been linked to differences in patients included and methods used. Advantages and pitfalls of both types of studies have been stressed too. In efficacy studies patients are selected to have but one diagnosis, whereas patients in effectiveness studies usually have multiple problems and more severe disorders. Patients in clinical practice enter a kind of treatment by active shopping; in contrast they are included in efficacy studies by the passive process of random assignment to treatment. Treatment in the field is not of fixed duration and is self correcting, in contrast to what is observed in controlled trials. Efficacy studies usually focus only on specific symptom reduction whereas treatment in clinical practice is concerned with improvement in the general functioning of patients. Beyond omitting the important symptoms and other clinical variables that identify pertinent subgroups, controlled-trials information also often omits clinical details that may be crucial for therapeutic decisions. Placebo controlled-trials have been submitted to special criticism. Results in effectiveness studies are often biased by variation in diagnostic accuracy, compliance and coverage. Recent attempts have been made to improve the transition from basic efficacy research to effectiveness studies. Phenomenology and Existential analysis may open new avenues to effectiveness research by providing new tools to understand how the patient’s subjectivity may give sense of healing to the process of change induced by psychotropic drugs.     

Consommations d’alcool,de cannabis et de tabac et qualité d’attachement

Substances’ consumption among young adults is a major public health problem. In the scientific literature, the links proposed with substance abuse are mostly biological, psychological and environmental. Some authors proposed to analyze these consumptions in connection with the parents-children's relationships as well as the way individuals cope with problems and regulate emotions. The present study aimed to investigate the link between alcohol consumption and attachment style. Additionally, this study wanted to investigate what are the relationships between attachment style and the tobacco and cannabis, two psychoactive substances present in polyconsumption with alcohol. We hypothesized that alcohol consumption is correlated with insecure-preoccupied attachment, that cannabis use is correlated with insecure attachment-detached and that tobacco consumption is correlated with insecure attachment in general. In order to test this, we used the AUDIT to measure the alcohol consumption, the Fagerstrom scale to measure tobacco use, the CAST to measure the consumption of cannabis, the RSQ and RQ for measuring attachment, among 88 people recruited on an internet specialized site. We counterbalanced the questionnaires in two sequences to control the possible effects of the subjects’ attachment system activation. In our sample, there are positive significant correlations between the consumptions of alcohol and cannabis (r = .45, P = .02) and the consumptions of cannabis and tobacco (r = .51 P = .03). Comparison analyzes of attachment dimensions and alchool consumption, have shown that subjects with no harmful consumption (M (E-T) = 2.94 [.82]) have significantly higher means in the preoccupied attachment dimension (RSQ) ([F(2) = 3.16; P = .05]) than those with harmful drinking (M (E-T) = 2.38 [.61]). Subjects with harmful consumption (M (E-T) = 3.23 [1.30]), in turn, tend to code higher in the detached scale (RQ) (F(2) = 2.90; P = .06) than subjects with no harmful consumption (M (E-T) = 2.39 [1.21]). On the other hand, correlation analysis between cannabis use and insecure-preoccupied attachment (RSQ) show that these variables tend to be inversely correlated (r = –0.31; P = 10). No other significant differences or correlations were observed between attachment dimensions and the different types of alcohol consumption, tobacco or cannabis consumption. The importance of the study is discussed on the light of the link found, in our sample, between alcohol and cannabis consumption and the two subtypes of insecure attachment, preoccupied and detached.     

Dimensions affectives et impulsives dans le trouble bipolaire et le trouble de la personnalité borderline

Background

Studies have shown that patients with borderline personality disorder are often misdiagnosed to have bipolar disorder and conversely. Indeed, a number of characteristics common to both disorders could explain this problem: emotional instability as well as impulsivity represent confounding factors and contribute to the risk of misdiagnosis. However, it appears that these characteristics manifest themselves in different ways according to the pathology. The aim of the study is to show differences between affective lability, emotional intensity and impulsivity dimensions. The clinical aim is to refine bipolar disorder and borderline personality disorder diagnosis, to improve psychological care for these patients in the long-term.

Globalisation des politiques de santé et psychiatrie française : enjeux et impacts

Objective

In recent years, the French psychiatric landscape seems to be shifting towards an approach that focuses on community care. The purpose of this article is to comment on this recent evolution as well as the impact of these changes. It is important to discuss because of the links that our psychiatric institutions have established with organizations entertaining a global view of mental health, such as the World Health Organization.

Hibernation et Hypothermie des Mammifères

Ohne Zusammenfassung     

Dysphasie et/ou psychose ?

Many children are diagnosticated psychotics because they present language disorders. A delay of language is often evocated. This work attempts to interrogate specific language disorders from dysphasia in comparison with psychotics language disorders. According to international classifications, dysphasia excludes psychotics disorders (or “pervasive developmental disorders”). Therefore, this point of view doesn’t make unanimity. After a short French overview on this subject, we’ll see that a partition can be clearly distinguished between dysphasia and psychosis. The only symptomatology from language disorders can’t be an assured guide for the diagnostic. At the end, we’ll bring a conceptual bridge between dysphasia and “debility” according to specific meaning gived by J. Lacan.