De l’intérêt d’évaluer l’anxiété : impact de l’utilisation d’une EVA sur la consommation de benzodiazépines

Background

The optimal management of psychiatric symptoms requires constant adaptation of therapeutic strategy to clinic evolution. If benzodiazepines are a treatment of choice for acute anxiety states in hospitals, their excessive consumption is a concern, revealing a preference of chemical anxiolysis to non-drug alternatives, yet effective for episodes of low or moderate intensities. Faced with an acute anxiety, choice of various therapeutic options requires evaluating its intensity in order to establish an appropriate therapeutic response. To enable systematic and accurate evaluation of an anxious state, Visual Analogue Scale (VAS) seems to be the most suitable tool. The application of VAS to measure anxiety is widely validated by previous research on the subject. We assume that the self-assessment of anxiety is likely to lead to a reduction in benzodiazepine use.

Utilisation de l’activité physique pour la prise en charge thérapeutique de l’épisode dépressif caractérisé chez l’adulte

The impact of exercise has been the subject of significant work for two to three decades. The results of these studies have enabled national and international comities to issue specific recommendations. Their impact on physical health is now well documented. The effect of physical activity on mental health in general, and for the management of major depressive disorder in particular, is the subject of more recent interest. The purpose of this article is first to carry out a review of the literature on this subject in order to identify the level of evidence of the effectiveness of use of exercise in the treatment of major depressive disorder. Secondly, the known data on the impact of physical exercise on physical health are summarized. Finally, the article provides an update on the regulatory framework for its use in France and the methods of use in current practice by the clinician.     

Proposition d’une méthode d’évaluation de l’entretien psychodynamique : analyse approfondie d’une étude de cas en oncologie

ObjectivesThe aim of this study is to evaluate the effects of the psychodynamic approach in the context of psychoanalytical psychotherapy in clinical interviews conducted by the clinical psychologist.MethodologyIt involves analyzing the narrative productions of the interaction patient–psychologist to determine mental processes in a single-case design protocol. This approach integrates the three dimensions qualitative, quantitative and statistical of research. We will test the clinical study with a intensive case or a deeply analyzed single case.EthicsOur approach answers to the inquiry of evaluation in Public Health, according to the psychoanalytical epistemology into methodology, principle and practice of objectification, intersubjectivity and singularity. By combining research and clinical interviews we would like to respond to be the closest of the patient's experience and his work of mental development.ResultsThis work should help to argue the interest of proposals for supportive or psychodynamic psychotherapy in psychiatry as well as medical departments. Being at the heart of the clinic, we focus on the changing processes at work in psychological development work without ever reaching a standardized clinic which would replace the theoretical-clinical orientation of the practitioners.     

Présomption d’imputabilité et apport de l’expertise judiciaire

The notion of accountability has language variants depending on whether one refers to the familiar language, of daily use, or to the specialized language, whether medical or legal; it also refers to a question on two modes of reasoning relating to causality. Accountability has a dual legal and social attribution meaning. The search for accountability is based on, which is part of a legal proceeding, is based on the application of seven criteria derived from the assessment of personal injury. It is the basis of medico-legal causality and differs from legal causality. Collective Psychogenic Phenomena (CPD) bring together diverse entities before which the search for accountability remains complex, the notion of causality remains difficult to establish. In these situations with multiple clinical contours, social treatment and the search for social adaptability are now preferred.     

Télémédecine et troubles du spectre de l’autisme de l’enfant et de l’adolescent : guide théorique et pratique

ObjectivesThe development of telemedicine for children and adolescents is a real need because of difficult accessibility of mental health and the paucity of childhood psychiatrists. Thus the American Academy for Child and Adolescent Psychiatry (AACAP) published in 2008 good practice recommendations for telepsychiatry in children and adolescents based on clinical consensus and scientific evidence. In France the legal framework defines four practical modalities according to the presence or not of a health professional or a psychologist with the practitioner accomplishing the teleconsultation act. Data exist about the outcome of children and adolescents who benefited from therapeutic interventions with technological media. Effect size is modest but it doesn’t justify ruling out these techniques. Children who present with a developmental disorder or who cannot cooperate are evaluated with a certain degree of uncertainty. By contrast, some children with severe Attention Deficit with or without Hyperactivity (ADHD), social anxiety or Autism Spectrum Disorders (ASD) can be more easily engaged within a teleconsultation model. Teleconsultations in autism spectrum disorders (ASD) are feasible because of the nature of diagnosis and the type of care recommended in this disorder. The behavioral nature of the disorder and the behavioral therapeutic approaches recommended in North America culture highlight the potential interest of telemedicine because these disorders are easily observable. Literature suggests new opportunities in order to facilitate the care process for the ASD person and his family: the first one is diagnosis with use of validated instruments such as the Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview (ADI). Parental accompaniment is the second opportunity. Development of telemedicine for ASD could be a complementary approach for diagnosis and medical care.MethodSince 2015, a program called PROMETTED (PROgramme MEdical de Télépsychiatrie pour enfants et adolescents présentant un Trouble Envahissant du Développement) was supported by Regional Health Agency of Île-de-France. It was developed and managed by the team of a Diagnosis Center Evaluation for Autism (DCEA) of Paris area in collaboration with a DCEA of Île-de-France region. Five medico-social structures for children and adolescents with autistic disorders and the two diagnosis centers of evaluation for autism co-elaborated a scheme of intervention with telemedicine. The remote evaluation is a 4-step process: a first teleconsultation structured around the medical history of the subject in order to complete his medical file and the observation of the young subject; a second teleconsultation structured around the ADI-R interview with parents; the third teleconsultation is a mixed teleconsultation associating the medical expert of the DCEA and a psychologist trained in the use of the Childhood Autism Rating Scale (CARS) and the Vineland Adaptive Behavior Scales (VABS). The fourth teleconsultation consists of the psychiatrist giving feed-back to parents about the results of the observations of the DCEA team.ResultsThe four-step program is well-accepted and the use of validated instruments for diagnosis or functional evaluation appears feasible. Medical data were completed for 44% of cases; complementary genetic or medical investigations were prescribed for 50% of cases; medical advice about psychotropic or vitaminic medication was given for 31% of cases. Mean duration of evaluation was 11.1 weeks ± 9.4.ConclusionsThe PROMETTED program empirically validates the concept of remote evaluation for children and adolescents with ASD. The need to extend the use of telemedicine to tele-expertise for medicine monitoring or behavioral disorder management has been noted.     

Le rapport de la schizophrénie au désir dans l’enseignement de Lacan

Objectives

In psychoanalytic research on psychosis, the tendency in Lacan's thinking, as well as among his readers and commentators, is to focus work on paranoia. However, it is here counterbalanced by a specific approach to schizophrenia. It is also against the current trend of positioning Desire in psychosis as a deficiency that we explore what might be the “desiring” economy of the schizophrenic.

Danger et dérive de l’utilisation des nouveaux mots de la peur

The more frequent use of words concerning the dangerousness, recidivism, or risk assessment and management, only translates the fear that now governs psychiatry. It is thus expected that this type of terminology reassures citizens concerned about mental illness. The clinic based on classical semiology does not suffice anymore, neither do therapies that give importance to consent, free will and above all hope that a change is possible. Evaluations are based on exterior criteria to patients (social and family background, childhood, etc.), under the pretext of a statistical logic, clinical observation and the presence of symptoms are being replaced. They now are not always necessary to qualify a psychiatric condition.     

Présentation d’un outil d’évaluation de l’évolution des processus psychiques au sein d’un dispositif thérapeutique en clinique du traumatisme

ObjectivesOur project consists in the implementation and the evaluation of a care system for children in a child protection NGO in Cambodia. In view of the cultural differences and specificities of the field, taking into account only the symptoms do not seem to sufficiently account for the processes involved within the system. Based on the observation that there is a lack of tools that would allow us to apprehend these processes, our study focused on the creation of a scoring grid for psychological processes that could be used in the humanitarian field and could support clinical practice.MethodDuring one year, we met ten children confronted with traumatogenic events, within a device based on therapeutic mediations. The corpus studied is based on observation notes inspired by Esther Bick's methodology. The study of the corpus and its theoretical linkage made it possible to identify five main processes as well as six channels of transfer.ResultsUsing the NVivo software, the observation notes were rated using the grid. Each of the sessions with the children was thus analyzed. By means of a matrix crossing query, we identified the processual evolution over the whole follow-up.DiscussionThis rating grid allows us to identify the psychic movements at play during the encounters and raises new questions about the diagnosis on humanitarian grounds.ConclusionThis work has allowed us not only to create a rating grid but also to enrich and complete it during the rating process. This grid allows a processual evaluation within the therapeutic follow-ups and constitutes a support for the clinician confronted with a loss of reference points and a massive counter-transference.     

Implications du trouble déficitaire de l’attention en psychiatrie légale : revue de littérature systématique

Introduction

Attention deficit hyperactivity disorder (ADHD) is one of the most common and challenging childhood neurobehavioral disorders. ADHD may have behavioral consequences and involvements in minor and serious crimes. Our work aims to establish links between ADHD and forensic psychiatry.

Troubles de l’humeur et chirurgie de l’épilepsie : une revue de la littérature

AimsHistorically, there is a strong link between depression and epilepsy. Patients with epilepsy are four to five times more likely to develop a depressive syndrome. It seems that the link between epilepsy and depression is bidirectional. There is little data on mood disorders secondary to epilepsy surgery. The goal of epilepsy surgery is to reduce the number and frequency of attacks, which in turn would allow improvements in mood disorders and cognitive impairment.MethodsA systematic search of the international literature was performed using the bibliographic search engines PubMed and Embase. The following MESH terms were used: epilepsy surgery AND (depression OR depressive disorder OR mood disorder). We also used the “related articles” of PubMed, bibliography surveys, conference abstracts and Google Scholar to identify additional relevant papers.ResultsOf the 130 studies found by the systematic search, 112 are excluded because they did not take into account the mood disorders secondary to epilepsy surgery. Fifteen studies are included in this review of the literature with a case study. Depression is the psychopathological condition that is the most frequently studied. According to several studies, the prevalence of depression is approximately 30% with nearly 70% of cases diagnosed during the first three months following epilepsy surgery. The majority of patients presented depressive symptoms during the first 3 to 12 months after epilepsy surgery. In these studies, the risk of developing depression is correlated with the existence of previous depressive elements relative to the epilepsy surgery. A small number of studies reported cases of de novo depression. Studies have shown a correlation between very good to excellent control of epileptic seizures and a persistent improvement of mood disorders. It would seem that depressive symptoms post-surgery are more common when the surgical intervention concerns the temporal lobe and in particular mesial resections. There are only very few cases of maniac episodes. Hamid et al. showed an increased risk of suicide waning after the epilepsy surgery over a period of 5 years.ConclusionMood disorders are common psychiatric comorbidities in epilepsy surgery. The detection, prevention, and treatment of these symptoms in patients eligible for epilepsy surgery pose major challenges for psychiatrists and neurologists, requiring their close collaboration.     

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.

Penser la formation des familles et de l’entourage d’une personne atteinte de schizophrénie

Shifting care from hospitals to the community has significantly changed the perception on families. The family home is now the primary means of hosting patients. Given this radical change in psychiatric care approach, training programs dedicated to the patient's entourage have developed. We question the large number of these programs and we aim to analyze whether there are important variations from one to another. It is about detecting differences but also convergence points between these programs in order to understand and better address the specific needs and difficulties encountered by families of persons with psychiatric disorders. In this article, we will take the profile of the designers of these programs as a variable. We will compare two training programs designed by professional caregivers and two other training programs designed within family associations by families themselves, who therefore are both designers and recipients of these programs. We will see how the designer profile has an impact on training goals, on the substance but also on how this information is passed, as well as on the assessment criteria of these trainings. In addition, we will see that the very concept of “entourage” and “family” varies according to the nature and function of the designer. Secondly, we will see how this comparative approach helps us to better understand the impact of changes in psychiatric care on families and to detect new arising questions such as: “Are entourage members intended to become care assistants?”, “Should family carers be professionalized?”, “Should the family home be considered as a place of care?”, “How to define the patient's family?”, “Who are the people concerned by the changes in caring and hence by these trainings?” This original comparative approach allows us to take into account the complexity of these changes and to detect how strong their impact can be on the schizophrenic person's entourage. It raises the question of training to other stakeholders, including in the social and medical-social sectors, since families cannot handle by themselves the shifting of care to the community.