Facteurs de risque de passage à l’acte d’homicide chez des patients marocains atteints de schizophrénie

Background

Persons with schizophrenia are thought to be at increased risk of committing violent crime – 4 to 6 times the level of general population individuals without this disorder. The relationship between schizophrenia and homicide is complex and cannot be reduced to a simple causal link.

Étude de l’observance thérapeutique chez une population de patients atteints de schizophrénie au Maroc

Background

Schizophrenia is a chronic, relapsing, mental disorder, and lack of adherence is a common and severe problem in such patients leadingto global and heavy consequences for patients (relapses, hospitalizations, impaired quality of life…), for the family and for society. Improved understanding of the underlying reasons will help to form intervention strategies relevant to the context.

Construction à Étampes d’un premier programme d’éducation thérapeutique du patient à destination des personnes soignées pour une schizophrénie et de leurs aidants

In 1997, an expert group from WHO Europe made a report and international recommendations for training and practice in therapeutic education of the patient. The French version of the text was published the following year. In France, it is the law of 21 July 2009, called “Patient Health Territory Hospital”, which formalizes this practice and inscribes it in the course of care of patients suffering from chronic diseases. The TPE is regulated by official texts and must respect the recommendations of the High health authority. That is the French peculiarity. Thus, any TPE program must be authorized by the Regional Health Agency (ARS) on which the establishment is dependent. Practices that would not be authorized by these ARS are not entitled to be called TPE, even if they meet all of the criteria. Although included in the law in 2009, this practice of TPE remains long unknown in France to most hospital practitioners. Thus, concerning our psychiatric hospital, located 50 km south of Paris, it is a certification visit that requires us in 2011 to register the TPE in our program of establishment. A small group of professionals of varied training (psychiatrist, addictologist, general practitioner, pharmacist, psychologist, nurse, social worker, educator, legal agent, dietician, caregiver) is working on this task in the course of the year 2012. We decide to build a program for people suffering from schizophrenia. We form a partnership with an association of Patient families, the UNAFAM. We choose to do only group support, more effective in the pathology we have retained. When the practitioners involved present their project in front of their peers, they have not yet received the mandatory 40 hours training required by the HAS for any therapeutic education workshop facilitator. This may explain that our project is being received with so little enthusiasm. We are faced with many reproaches. However, we are pursuing the construction of the workshops, which will be disturbed by the compulsory training of 40 hours that only be in 2013. We realize that the support of our hierarchy is essentially moral, since no dedicated time will be assigned to this program, which we have to carry out with the same means. We start our first workshops in September 2014, with ARS funding as an experimental project. Our program includes the following eight workshops: “Living with your illness”, “understanding and managing your treatment”, “social skills”, “lifestyle”, “addicts”, “Libido”, “do”, “do with”, “do together”, “caregivers”. The nurse coordinator carries out the educational diagnosis and the participant decides which workshops he wants to participate in. This nurse coordinator participates in all the workshops in addition to the specific animators. The workshops follow each other and two programs are closed over the year. There is no mandatory order and participants can integrate a program at any time. Often, they ask to participate in other workshops than those initially chosen after having experienced the group. The approach of the workshop animators is based on the motivational approach. After four years of operation, the effectiveness of this program is being evaluated. The feedback from participants is in any case very favorable, and they all underline their pleasure in having interlocutors who are no longer in the usual caregiving posture. But we also measure the fragility of this program, depending on a very small number of people.     

Le passage à l’acte à l’épreuve du post-contemporain

Objective

The starting-point of this article consists in considering what is contemporary as being post-contemporary. Like the present, what is contemporary is something that cannot be pinned down. It requires hindsight in order to analyse it. Our first objective is to approach our post-contemporary age as being characterised by radicality. This takes the form of a search for origins, which shows up in a return of the religious, alongside the emergence of an anguish reducing things to nothingness. Solitude is a characteristic of this radical position, raising the issue of an otherness that turns anguish into hatred, whether of oneself or of the other. Indeed, the post-contemporary subject acts-out when faced with social ties and a culture that can no longer uphold him. Our second objective is to demonstrate that the effect of this radical position leads the subject to use his body as the only way out. Having become an external organism, the body comes to represent that which is intolerable for the subject. In order to escape anguish turned into hatred, the subject excludes himself from his own body. Finally, the third objective is to show how the free radical subject is a product of ‘liberal’ society, seeking to create his freedom at every moment.

Bénéfice d’un programme d’éducation thérapeutique agréé sur la qualité de vie et le bien-être psychologique de sujets souffrant de schizophrénie

Introduction

In schizophrenic disorders, supportive psychosocial therapies have been used as adjuncts to pharmacotherapy to help alleviate residual symptoms and to improve social functioning and quality of life. Among these therapies, psychoeducational therapies showed a significant efficacy on improving drug adherence and on reducing relapses. However, according to the French Health Agency, fewer than 10% of psychiatric structures in France offer registered psychoeducation programs. Caregiver apprehension of patients’ depressive reactions to the awareness of the disease could underlie the underuse of psychoeducation therapies. Indeed, the psychoeducation programs’ impact on objective and subjective quality of life is discussed among the literature. In this context, we conducted a retrospective, monocentric, open-labelled and non-controlled pilot study to measure the impact of a registered psychoeducation program on objective and subjective quality of life of patients suffering from schizophrenia. Secondary objectives included measures of the effects on drug observance and awareness of the disease.

L’utilisation des thérapies assistées par ordinateur et des jeux vidéo à visée thérapeutique dans les soins de réhabilitation psychosociale chez les sujets souffrant de schizophrénie,revue de la littérature

Objectives

Video games and virtual reality have recently become used by clinicians for training or information media or as therapeutic tools. The purpose is to review the use of these technologies for therapy destined for schizophrenia patients.

Évaluation de l’autonomie sociale et de ses facteurs associés chez des patients tunisiens suivis pour schizophrénie

IntroductionSocial autonomy concerns specific areas that people with chronic psychiatric disorders, such as schizophrenia, face daily when they live in the community. The degree of social autonomy is one of the principal determinants of success of the therapeutic project for patients suffering from schizophrenia. However, the domains of social autonomy would depend on the socio-cultural context and the familial and professional environment of the country.ObjectivesThe objectives of this study were to evaluate the social autonomy level and to research its associated factors in a sample of Tunisian out-patients with schizophrenia.MethodsIt was a cross-sectional study of 115 out-patients (mean age: 37.6 ± 10.2 years, 75.7% male), followed for schizophrenia according DSM-IV diagnostic criteria and treated with long-term antipsychotics, mainly first generation (81%), with a mean daily dosage of 1130 ± 875 mg in chlorpromazine equivalent. Data were collected during interviews with patients and their family members and supplemented by the review of medical records. Degree of social Autonomy was assessed by the Leguay's 17-items Social Autonomy Scale (EAS), exploring five dimensions: personal care, management of daily life, resource management, relationship with outside and affective and social relations. Global functioning level was assessed by the Global Assessment of Functioning (GAF) scale.ResultsThe total EAS score ranged from 14 to 90 with a mean score of 56.6 ± 16.8. Higher sub-scores indicating a poor social autonomy concerned the dimensions of “relationship with the outside world”, “resource management” and “management of daily life”. A negative correlation was found between the EAS total score and the GAF score (r = −0.78, P < 0.0001). Thus, the lower GAF score suggesting impaired global functioning was associated to the higher EAS score in favor of altered social autonomy. Altered social autonomy was associated with low school level (P = 0.02), lack of regular professional activity (P = 0.001), disorganized subtype (P = 0.002), negative symptoms at the last hospitalization (P = 0.03), continuous course (P < 0.0001) and daily dosage of antipsychotic medication (P = 0.02). However, age or gender of the patients, psychiatric family history, age of onset, duration of untreated psychosis, number and duration of previous hospitalizations, antipsychotic treatment generation were not associated with social autonomy in our sample.ConclusionsDespite therapeutic advances in recent decades, the social autonomy of our patients with schizophrenia remains precarious. Several socioeconomic and clinical factors seem to be involved. Further interventions will be needed to enable our patients to function more actively and autonomously in society.     

L’analyse lexicale au service de l’évaluation d’un dispositif d’accompagnement socio-sanitaire à destination de personnes vivant avec une schizophrénie

ObjectiveThrough the study of a social and health care program supporting the recovery of people living with schizophrenia (PASSVers), this article aims to show the interest of using the Alceste lexical analysis method to evaluate health-promoting activities.MethodSemi-structured interviews were conducted with users supported for 12 to 20 months (n = 21), nurses and social workers (n = 11), and family caregivers (n = 6). The corpus was analyzed using Alceste software.ResultsEach population used a specific vocabulary to evaluate the program, reflecting different viewpoints towards it. The contextualization of the vocabulary significantly present in the discourse classes highlighted the program's effects on each of the three groups. We noticed a shift in posture among professionals with a detachment from purely medical concerns, as well as the impact of the support on the health of the users and on the well-being of their relatives.DiscussionLexical analysis appeared particularly relevant for evaluating a health promotion program such as PASSVers. Indeed, this tool for interpreting a corpus is based on the distribution of vocabulary, excluding any judgment by the analyst. Thus, this method ensures a rigorous methodological basis for determining the classes of discourse to be interpreted.ConclusionThe Alceste method enables the rigorous study of a corpus through a detailed analysis of the vocabulary. In the evaluation of the PASSVers program, it allowed us to highlight the specific points of view of each group, and to identify the benefits of the program for each of them.     

Un référentiel national pour l’éducation thérapeutique des patients atteints d’épilepsie(s), enfants et adultes

Epilepsy is a chronic disease with a wide range of presentations occurring at any age. It affects the patient's quality of life, implying a need for numerous healthcare services. Therapeutic education programs (TEPs) are designed to match patient age, disease course, and individual learning abilities. In France, these programs are proposed by the national health authorities (Superior Health Authority), and authorized by the Regional Health Agencies. Two years ago, a Therapeutic Education Programs Commission (TEPC), supported by the French League against Epilepsy (FLAE), was created. The goal was to bring together representative healthcare professionals in a working group in order to standardize practices. This led to the creation of a national reference of healthcare skills specific for children and adults with epilepsy. Five tables, for five “life periods”, outline the framework of this professional reference tool. Program personalization, an essential part of TEPs, is necessary to develop a creative atmosphere. This slow process is specific to the various stages of life and can be influenced by the occurrence of various handicaps. Family and caregivers make key contributions to the process. The national framework for therapeutic education in epilepsy serves as a central crossroad where professions can find essential information to create or adapt their own TEPs. In the near future, regional experiences will be documented and collected for regular updates. This professional therapeutic education network will help promote therapeutic education programs and facilitate standard practices. Finally, several TEP files and tools will be shared on the FLAE website available for professional access. Today, the group's goal is to achieve national deployment of this “referential” framework.     

Particularités de l’accompagnement en soins palliatifs d’un patient atteint de schizophrénie en secteur psychiatrique

Objectives

The studies of comorbidities, risk factors of organic pathologies, or declining life expectancy of patients with mental disorders, particularly psychotic disorders, are the subject of many publications. The cares, including palliative care, for these patients, but also the patients and caregivers experience in these situations are rarely described in the literature. From the story of Peter, we evoke the palliative support and the management of these patients in a psychiatric hospital.

Influence d’un programme d’éducation thérapeutique du patient (ETP) sur la qualité de vie de personnes souffrant d’un trouble bipolaire : premiers résultats

IntroductionBipolar disorder is a mental illness that is associated with a long-term impairment in psychosocial functioning and quality of life. The objective of this study was to evaluate the influence of a therapeutic education program on the quality of life of patients with bipolar disorder (type 1 or 2).MethodThis study included 18 patients with bipolar disorder (type 1 or 2) following the therapeutic education program on bipolar disorder which includes 8 sessions of 2 hours each. The assessment of quality of life and mood, self-esteem, insight and global functioning was performed before and after the program using the following tools: World Health Organization Quality Of Life questionnaire in short version (WHOQOL-Bref), Hamilton Depression Rating Scale, Young Mania Rating Scale, Rosenberg Self-Esteem Scale, Birchwood Insight Scale and Global Assessment of Functioning Scale. The total score of WHOQOL-Bref constitutes the primary study outcome. The under-scores of WHOQOL-Bref as insight, self-esteem, functioning, depression and mania scores constitute secondary outcomes.ResultsOur results show an improvement in quality of life, regarding global and main dimension scores of WHOQOL-Bref. The mean total scores for quality of life at the beginning and the end of the program were respectively 55.47/100 (standard deviation = 14.11) and 60.03/100 (standard deviation = 12.62). However, the difference was still not significant even after statistical adjustment with depression, mania and functioning scores. Self-esteem was significantly improved (P = 0.0469). Quality of life and self-esteem evolutions were strongly related (correlation coefficient = 0.80, P = 0.0006). At the end of the program, the less depressed the patients were, the better their quality of life was (correlation coefficient = 0.67, P = 0.0090). We did not find any correlation between quality of life and mania intensity or global functioning level at the end of the program.ConclusionThis study suggests a need to focus on self-esteem perception in order to understand and ameliorate the quality of life of patients with bipolar disorders. Going further, the use of bipolar disorder specific scales to assess quality of life would be more relevant.     

L’accès à l’aide médicale à mourir pour les personnes souffrant de troubles mentaux

Since the Carter judgment in 2015, voluntary euthanasia and assisted suicide are legal in Canada. The purpose of this article is to analyze the relevance of making people with mental disorders eligible for medical aid in dying (MAD). The text consists of three parts. The first part presents the history of the legalization of the MAD in Canada. In the second part, we discuss the extension of the MAD to individuals suffering from mental disorders. We then insist on five aspects: the MAD and suicide in Quebec, suicide's place in the values of Quebec society, a reflection on rational suicide and the impact of mental health on the ability to make decisions, the respect of the laws and their application as well as assisted suicide of people with mental disorders in Belgium and the Netherlands. In the third part, we suggest four recommendations: to extend the requests to cases with mental disorders whose suffering is refractory to all care, to increase the minimum delay for the treatment of these requests, to systematically include a mental health specialist and to involve the loved ones throughout the process.