La place du désir dans la dysphorie de genre : une étude qualitative auprès de personnes transgenres sous traitement de réassignation sexuelle

ObjectivesThe DSM-5 defines gender dysphoria as a significant distress caused by the experience of an incongruence with regard to the person's biological sex. The diagnosis of gender dysphoria, not determined by biological, psychological and cultural elements, relies primarily on the anamnesis and the narrative of the transgender persons.MethodIndividual interviews were conducted with a sample of nine patients consulting a gender dysphoria consultation, who benefited from sexual reassignment treatments. The interviews were analyzed with the Interpretative Phenomenological Analysis (IPA).ResultsParticipants describe the development of their transgender identity as a desire to live in a body, which is culturally assigned to the opposite gender, and to be recognized by society as such. This desire – related to affects and not cognitions – is triggered by events, such as the experience of being attracted to persons with the same sex, but without feeling homosexual, or by differences experienced with same-sex peers during socialization. The desire is experienced at various stages of the development and expressed in various ways, depending on the person's biography and his way of being in and relating to the world. When the desire emerges, it is more or less easily welcomed, and at times also repressed; a consequence of this repression may be, that the body as place of this desire may be attacked. In this last situation, the dysphoric state may be caused by the impossibility to accept and to realize the emerging desire. Contextual elements, such as being forced for professional reasons to clarify the transgender issue or the encounter with a key person, move the evolution of this desire. On the contrary, negative attitudes of family members or significant others may impede gender identity formation.DiscussionThe analysis of these narratives allowed to consider the condition of transgender persons not only as dysphoria, and thus situate it in a traditional medical perspective which distinguishes between normal and pathological, but also to conceive it as a “career” towards the possible and desirable. While, the term dysphoria relates to a problematic side of the transgender condition, we consider that the perspective of a desire provide a more constructive way to conceive transgender identity.ConclusionThe challenge for the expert-psychiatrist is to grasp the different expression of this desire and to allow it to freely emerge and evolve, and to express and realize itself. The role of the psychiatrist is thus not limited to be a “gatekeeper” in the treatments of sexual reassignment, but to accompany transgender persons in their career of gender transition. As such, the psychiatrist adopts a therapeutic stance, which aims–as in other conditions–to help that desires can circulate more freely.     

Developing a Brief Neuropsychological Battery for Early Diagnosis of Cognitive Impairment

ObjectivesEarly diagnosis of cognitive impairment is increasingly emphasized in the literature to facilitate timely preventive interventions. Although bedside cognitive tests such as the Montreal Cognitive Assessment (MoCA) are widely used for such early diagnostic purposes, they may not have comparable performance to a full neuropsychological battery (FNB) in diagnosing early cognitive impairment. This study investigated whether a small subset of neuropsychological tests can be added on to MoCA to match its performance to that of the FNB in discriminating mild cognitive impairment and dementia (MCI/dementia) from normal cognition.DesignCross-sectional diagnostic study.SettingAlzheimer's Disease Centers across the United States.ParticipantsOlder participants (≥50 years) who completed MoCA and the FNB (N = 9187).MeasuresThe study sample was split into two: the derivation sample (n = 1837) was used to develop a brief neuropsychological battery that best discriminated MCI/dementia (using the best-subset approach with 10-fold cross-validation); while the validation sample (n = 7350) verified its actual performance in discriminating MCI/dementia.ResultsA 3-item neuropsychological battery was identified, comprising MoCA, Benson Complex Figure Recall, and Craft Story 21 Delayed Recall. It had excellent performance in discriminating MCI/dementia from normal cognition (area under the receiver operating characteristic curve [AUROC] 90.0%, 95% confidence interval [CI] 89.2%-90.7%), which was comparable to that of the FNB (AUROC 88.4%, 95% CI 87.6%-89.2%). By contrast, MoCA alone had significantly worse AUROC (86.9%, 95% CI 86.0%-87.7%) than that of the FNB.Conclusions/ImplicationsUsing rigorous methods, this study developed a brief neuropsychological battery that maintained the brevity of a bedside cognitive test, while rivaling the diagnostic performance of an FNB in early cognitive impairment. This brief battery offers a viable alternative when the FNB is needed but cannot be feasibly administered in nonspecialty clinics. It can have a wider health systems effect of improving patients’ access to accurate diagnosis in early cognitive impairment and facilitating timely interventions to delay the progression of cognitive impairment.     

Le fil institutionnel en période Covid : utilisation de la plateforme Discord au CMPA

The COVID crisis led hospitals to reorganize care services and to develop innovative strategies to provide care at a distance. In our health care and education centre for adolescents, which provides both long-term psychiatric care and high school education, inpatients and outpatients were mostly confined at home. In order to ensure continuity of care as well as maintain institutional ties, different communication tools were used. Among them, we particularly relied upon Discord (social network initially designed for gamers) which allowed us to set up an entire virtual ward, maintain individual and group care programmes as well as team meetings. This innovation generated a number of preliminary questions and precautions which guided our decisions regarding the server settings. The outcome of this experiment is globally positive, both quantitatively and qualitatively, even if care at a distance showed its limits. Despite the involvement and creativity of health professionals, the confinement period disrupted and even led to the discontinuation of some care projects.     

La Passion Bartleby ou la passion en négatif

Bartleby, by Melville, a pale character who by his strange formula, unleashes passions within and outside the novel. From literature to psychoanalysis via philosophy and psychiatry, the author will go through the various attempts to shed light on this enigmatic passion.