De l’épistémologie de la psychiatrie à une épistémologie psychanalytique. Entretien avec Paul Bercherie, 17 avril 2021

ObjectiveThis interview with the psychiatrist and psychoanalyst Dr. Paul Bercherie attempts to mobilize the major questions that traverse the epistemology of psychiatry and of psychoanalysis. Our conversation covers his work on classical psychiatric knowledge–the subject of his doctoral dissertation–as well as more recent work that questions the conceptual geography of the contemporary psychoanalytic field.MethodIn this open conversation, Paul Bercherie speaks about his training at the end of the 1960s, his various experiences of analysis, and his research path, which led him to develop a singular method of investigation at the interface between practice and theory. The richness of this unique journey is also supported by numerous references to the intellectual context of the time.ResultsReturning to the foundations of psychiatry allows us to revisit the complexity of these texts and illustrates the fruitfulness of the dialogue between French and German psychiatry, which nevertheless has the same objectivist and organicist basis. The author also sheds light on the inconsistency of certain nosographic elaborations. A second series of works serves to resituate Freud in his theoretical context. It results in the demonstration that the discovery of the unconscious is developed within a dated theoretical framework that is poorly suited to its innovation.DiscussionThe Freudian subject of autonomy, the perceptive, cognitive subject, which was that of classical psychology and philosophy, will be called into question by the theories of structuralism, which bases the subject on a heteronomous theory, in which the latter is conceived as a response to the linguistic and social structures which determine it.ConclusionsContemporary psychoanalysis unfolds in the form of separate currents, based on different ethical and theoretical conceptions. However, an analysis shows that the four main currents are individualized from different dimensions already included in the Freudian text. Paul Bercherie argues that these currents should not only be opposed but, instead, that they could benefit from being integrated into a multi-referential clinical orientation. This makes it possible to offer differential but complementary approaches for the patient.     

Opioids and psychological issues: A practical, patient-centered approach to a risk evaluation and mitigation strategy

The use of long-term opioid therapy for the management of chronic pain remains controversial. The highlighted consequences of long-term opioid therapy are aberrant drug-taking behaviors, abuse, and dependence. However, the limitations of this treatment modality usually can be attributed to a lack of efficacy and adverse events. Patients that remain refractory to long-term opioid therapy for chronic pain often have a psychiatric disorder that is acting as a barrier to effectiveness. While standardized approaches to the evaluation of a patient to receive long-term opioid therapy are established, little data exists to document their ability to limit opioid abuse or enhance their efficacy. Screening questionnaires and other attempts at predicting or detecting opioid-related substance use disorders fail to determine the presence of comorbid psychiatric disorders. A comprehensive approach for the psychiatric evaluation of patients with chronic pain will address specific barriers to successful chronic pain management and optimize the chances for success with long-term opioid therapy.     

Décès et engagement du pronostic vital chez les enfants et les adolescents ayant un trouble psychiatrique : revue de la littérature et exemple dans un service universitaire d’hospitalisation pédopsychiatrique

BackgroundDeath is a rare event in child psychiatry and still not widely studied.MethodsHere, we report a review of literature concerning mortality in child psychiatry and a retrospective study (begun in 2007) of the implementation of “mortality and morbidity reviews” carried out in a university hospital within several inpatient units.ResultsThe review pulled together 73 studies, all of them confirming the excess mortality of children and adolescents in child psychiatry, whether in the general/non-specific populations (ex : hospitalized patients) or in specific populations (e.g. : autistic patients). The causes of excess mortality are undoubtedly suicide but also many natural causes (e.g. : complications due to addiction or anorexia nervosa). Our study includes 11 patients (mean average age = 15.5 years; 9 girls and 2 boys) and saw 5 deaths and 14 life-threatening situations. Again, suicides and serious suicide attempts were very common (n = 8 including 2 deaths), but the study also describes somatic causes, complications of pathological behaviour (n = 5 : undernutrition in the context of anorexia, water poisoning) or underlying somatic disease (n = 5, including 2 deaths related to Sanfilippo disease and infiltrative brain lymphoma).ConclusionAs with adult psychiatry, children and adolescents with mental disorders appear to have a lower life expectancy compared to the general population. Nevertheless, death in child psychiatry remains a rare phenomenon, especially when it happens in hospital care. Our study shows that cases of death or life-threatening situations in hospitalized child psychiatry are due to somatic diseases (that are more or less entangled with psychiatric disorders) or due to suicides.     

帕利哌酮片在精神科联络会诊中的临床应用

目的探讨帕利哌酮在精神科联络会诊中的临床应用及其安全性,旨在提高治疗效果。方法本研究选取2010年1月至2011年4月在泸州医学院附属医院治疗的精神分裂症患者138例作为研究对象。将所有患者随机分为治疗组与对照组,治疗组给予帕利哌酮治疗,对照组给予利培酮治疗。观察并比较两组的治疗效果和不良反应的发生情况。结果帕利哌酮治疗组痊愈14例,显著进步28例,进步14例,无效13例;阿立哌唑组痊愈13例,显著进步27例,进步12例,无效17例。Ridit分析结果显示,两组间差异无统计学意义(P>0.05)。帕利哌酮治疗组在锥体外系反应(EPS)、嗜睡、体质量增加、胃肠道反应及心慌及便秘、体位性低血压等方面的不良反应发生率小于对照组(P<0.05)。结论帕利哌酮治疗精神分裂症在临床疗效,在精神科联络会诊中具有重要的临床应用。     

Meeting Highlights on Psychiatric Clinical Challenges and Advancing the Science of Treatment: The 3 Annual Chair Summit

Health care providers encounter many patients who have a typical, bread-and-butter symptom presentation and illness course, and for whom developing a treatment plan is relatively straightforward. However, some patients have cases that are challenging because 1) their illnesses are atypical, severe, or treatment-refractory in nature; 2) their conditions are less frequently encountered in the clinical setting; or 3) optimal treatment has not yet been well-studied and clearly defined. In the neurosciences, such challenges often seem to be the rule more than the exception. Continuing medical education (CME) can help clinicians address these challenges and promote clinical competence regarding innovations in neuroscience technologies. In August 2010, psychiatry and neurology health care providers participated in a comprehensive neuroscience CME conference—The 3^rd Annual Chair Summit, The Master Class for Neuroscience Professional Development—that featured faculty chairpersons of psychiatry and neurology departments. This 4^th article of 5 in a CME-certified companion series presents meeting highlights on managing the complexities of neuropsychiatric care and on scientific advances, especially technology-based innovations. Specifically, clinical topics focus on recognizing attention deficit hyperactivity disorder that persists into adulthood; differential diagnosis of rage and aggression; treating borderline personality disorder; preventing suicide; and implementing care strategies for physician addiction. Rounding out this attention to difficult cases, technology highlights pertained to advanced diagnostic innovations in functional magnetic resonance imaging and to brain stimulation treatment strategies (ie, electroconvulsive therapy, deep brain stimulation, repetitive transcranial magnetic stimulation, and vagus nerve stimulation). This article contains several patient cases and summary points connecting research to clinical practice.     

精神科风险评估量表的编制和应用

目的解决目前精神科医疗风险评估中缺乏统一规范的评定标准的问题。方法自行编制精神科医疗风险评估量表,并对量表进行专家论证、一致性检验、和临床应用。结果从实用性、便捷性、不易漏项目、满意度等条目进行对比分析,使用量表组明显优于对照组(P<0.01)。结论该量表有较好的实用性,操作便捷,不易遗漏项目,得到了应用者的好评。两组间比较存在显著差异(P<0.01)。