Le structuralisme abordé à partir du paradigme du style : implications cliniques en psychothérapie

The term “structuralism” designates a “method” and certain presumptions principally that of unconscious phenomena, which organize human groups, and therefore, the subjects themselves.The meaning and spirit of structuralism are sometimes misunderstood and identified to a simplified semiology or to complex and little understood modelizations. Structuralism will first be defined by its founders: Galois, Saussure, Lévi-Strauss, and described in his reports on psychoanalysis: Freud and Lacan.The concept of “style” will be our “guide” throughout the text, to lead to the idea according to which psychotherapic cure can resemble “stylistic work”. The “style” will thus correspond to the particular approach of a subject to jouissance, which results in the notion of “analysis of style” as a diagnostical path and the “stylistic work” as a cure. Such a method can lead the way to a return to the notion of “therapeutic art” to promote “a clinic of the detail”.     

Tracking online poker problem gamblers with player account‐based gambling data only

The aim was to develop and validate an instrument to track online problem poker gamblers with player account‐based gambling data (PABGD). We emailed an invitation to all active poker gamblers on the online gambling service provider Winamax. The 14,261 participants completed the Problem Gambling Severity Index (PGSI). PGSI served as a gold standard to track problem gamblers (i.e., PGSI ≥ 5). We used a stepwise logistic regression to build a predictive model of problem gambling with PABGD, and validated it. Of the sample 18% was composed of online poker problem gamblers. The risk factors of problem gambling included in the predictive model were being male, compulsive, younger than 28 years, making a total deposit > 0 euros, having a mean loss per gambling session > 1.7 euros, losing a total of > 45 euros in the last 30 days, having a total stake > 298 euros, having > 60 gambling sessions in the last 30 days, and multi‐tabling. The tracking instrument had a sensitivity of 80%, and a specificity of 50%. The quality of the instrument was good. This study illustrates the feasibility of a method to develop and validate instruments to track online problem gamblers with PABGD only. Copyright © 2016 John Wiley & Sons, Ltd.     

The antinociceptive action of an α2-adrenoceptor agonist in the spinal dorsal horn is due to a direct spinal action and not to activation of Descending Inhibition

In this electrophysiological study we tried to find out whether the spinal antinociceptive effect of a supraspinaly administered α₂-adrenoceptor agonist is due to a direct spinal effect or to activation of descending inhibition. The responses to wide-dynamic range (WDR) neurons of the spinal dorsal horn were studied following application of medetomidine, a selective α₂-adrenergic agonist, into the rostroventromedial medulla (RVM) or directly onto the spinal cord of the Intact and in spinal rats. The noxious electrical stimuli were applied to the ipsilateral receptive field in the plantar region of the hind paw, and responses mediated by A- and C-fibers to WDR neurons were separately evaluated. The reversal of medetomidine-induced effects was attempted by a systemic administration of atipamezole, a selective α₂-adronoceptor antagonist. Medetomldine injection into the RVM produced a dose-dependent, atipamezole-reversible attenuation of the C-fiber-mediated responses to WDR neurons of the spinal dorsal horn in both intact and spinal rats. Paradoxically, the spinal aMFnociceptive effect of supraspinally administered medstomidine was stronger in spinal rats. The A-fiber-mediated responses were significantly less attenuated by medetomidine than the C-fiber-mediated responses to the WDR neurons. Also a direct application of medetomidine onto the spinal cord produced a dose-dependent, atipamezole-reversible attenuation of the C-fiber-mediated responses, and this effect was identical in intact and in spinal rats. The medetomidins doses producing spinal antinociception were considerably lower with a direct spinal application than with a supraspinal application. These results indicate that spinal antinocicsption following spinal or supraspinal application of an α₂-adrenergic agonist is due to a direct activation of spinal α₂-adrenoceptors and not to descending inhibition. Activation of supraspinal α₂-adrenoceptors counteracts the spinal antinociceptive effect.     

Marguerite Burnat-Provins la visionnaire ou L'œuvre imposée. Sur « Ma ville » : visions du Réel et dialogue avec l'objet a

The writer and painter Marguerite Burnat-Provins (1872-1952) was a French-born artist. Part of her work is now exhibited in the supplementary collections of Primitive Art in Lausanne. In 1919, a first vision led to a long series of drawings, a series which she entitled “My town”. These drawings were “dictated” to her, as were the names and particularities of the characters she depicted, an experience she was unable to avoid. In this manner, Marguerite Burnat-Provins produced nearly three thousand figures which today are scattered far and wide, and as many comments about the identity of the characters that she depicted. The hypothesis developed in this article is that of the establishment of a sort of dialogue throughout her work with the enigmatic part of her personality which continued to influence her; but also its production, and she attempted by representation and in writing to express this enigmatic aspect and at the same time to authenticate it. The work of art “My town”, a series which has been qualified as “hallucinatory”, meets this definition. It can also be viewed as the treatment, essentially by representation, of a subject that acquired all its importance in Marguerite Burnat-Provins’work, the gaze on the characters’faces. The way in which she has treated their gaze does not denote psychosis in spite of the imposed nature of the subject matter that she herself emphasized, and categorizing “My town” as a hallucinatory work is unjustified. The strange series entitled “My town” is both a return to the enigma womanhead and a sublimatory attempt to express this enigma, without recourse to representations of the Real. Marguerite Burnat-Provins is clearly a visionary artist.     

Seizure lateralization in scalp EEG using Hjorth parameters

ObjectiveThis paper describes and assesses a new semi-automatic method for temporal lobe seizures lateralization using raw scalp EEG signals.MethodsWe used the first two Hjorth parameters to estimate quadratic mean and dominant frequency of signals. Their mean values were computed on each side of the brain and segmented taking into account the seizure onset time identified by the electroencephalographist, to keep only the initial part of the seizure, before a possible spreading to the contralateral side. The means of segmented variables were used to characterize the seizure by a point in a (frequency, amplitude) plane. Six criteria were proposed for the partitioning of this plane for lateralization.ResultsThe procedure was applied to 45 patients (85 seizures). The two best criteria yielded, for the first one, a correct lateralization for 96% of seizures and, for the other, a lateralization rate of 87% without incorrect lateralization.ConclusionsThe method produced satisfactory results, easy to interpret. The setting of procedure parameters was simple and the approach was robust to artifacts. It could constitute a help for neurophysiologists during visual inspection.SignificanceThe difference of quadratic mean and dominant frequency on each side of the brain allows lateralizing the seizure onset.     

Criminalité sexuelle et processus autocalmant

The sex criminality seems a self calming process front of threats of collapse of the psychotic or anaclitic type. Following work of C. Balier about the concept of “recourse to the act”, we propose a contribution to a theorization of the sexual criminality which rests on the failure of the transitionnality space and hallucinatory satisfaction. The sexual aggression concerns a “homo-erotism” with body or sex of the victim. The victim plays the part of “utilitarian object” against an invasion of excitation impossible to bind to a representation. Paradoxical, the temporary appeasing obtained after the criminal act is connected with anti traumatic regulation.     

The “tree‐pruning hypothesis” in bilingualism

Background: The “tree‐pruning hypothesis” (TPH) suggests that syntactic deficits in agrammatic production are highly selective: most patients have impaired tense inflection while their agreement inflection is preserved. The TPH states that the split‐inflection tree is pruned at the tense node, which is why an obvious dissociation in performance exists between tense and agreement.

Aims: This study aims to determine whether the TPH applies to a bilingual individual by examining whether a dissociation in performance exists between agreement and tense inflection in the bilingual speaker's two languages: German and Luxembourgish. We expect the pattern of grammatical impairment to support the validity of the TPH in German and Luxembourgish.

Methods & Procedures: The participant examined in this study, AM, is a pre‐onset balanced German–Luxembourgish speaker with Broca's aphasia and moderate agrammatism. We used a verb completion and grammatical assessment task to examine whether a dissociation in performance existed between tense and agreement in both languages.

Outcomes & Results: The results comply with the TPH. The agreement results produced by the participant were significantly better than the tense results in both German and Luxembourgish.

Conclusions: The results show a clear dissociation in each language as predicted by the TPH. This confirms that the TPH can be applied to both German and Luxembourgish.     

Nuevos datos normativos de la versión española de la Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) forma A

IntroductionThe Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is frequently used in clinical practice to evaluate cognitive function. It is quick to administer (20-30 minutes) and is not influenced by a learning effect. The RBANS includes 4 parallel versions and has a high discriminative ability.Our study provides normative data from the RBANS-E (Spanish-language version of RBANS form A) for a Spanish population aged 20 to 89 years.MethodsThe study included 609 subjects aged 20 to 89 years. Participants were evaluated at baseline with a short interview, a cognitive screening test (Mini–Mental State Examination), and a functional scale (Rapid Disability Rating Scale). The RBANS-E was then administered to all 609 participants.ResultsOur results show the influence of education on all subtest scores. Sex was observed to have no impact on any subtest.ConclusionOur study provides highly useful normative data for the cognitive evaluation of young and adult populations.     

Souviens-toi. Processus de deuil,processus de création

ObjectivesThe authors set out to cast light on certain psychic mechanisms that help to give meaning to death, in particular via objects of great symbolic value, as links between the dead and the survivors.MethodsIn this clinical article using a heuristic methodology, we combine the analysis of a clinical situation of antenatal death, a paradigm of loss with a pathological risk, and that of the artistic creation of Michel Nadjar, linked to the genocide of the Jews.ResultsThe psychic processing of the loss of a loved one is accompanied by considerable psychopathological risk. While funeral rites, whether religious or lay, and the support of the family and the community often provide mourners with a framework that favours the achievement of the period of mourning, so as to continue living with the loss (rather than living with the deceased person), there are certain traumatic situations that make access to a non-pathological mourning process impossible.DiscussionThe authors reappraise the exclusiveness of Freud's mourning and melancholia model, and consider Winnicott's theoretical model of transitional phenomena to cast light on the psychic processes at work.ConclusionsThe creativity operating in the two situations maintains a certain distinction: sublimation for the artist, resurgence of transitional phenomena for the bereaved individual.     

« L'extraction de la pierre de folie » : impact de la découverte d'une tumeur frontale calcifiée chez un patient mélancolique

Mood disorders can take some atypical, hermetic, inaccessible aspects. The case of a young officer submerged by death impulses questions us about the origin of a melancholic depressive recurrent disorder since two years. The brutal rupture with his previous state, the resistance to antidepressants, the obstinate negative symptoms and an unexplained escape incite us to ask for a cerebral imagery: “the left frontal lobe is invaded by a 6 cm diameter calcified mass”. The comorbidity between cerebral tumor and mood disorders isn’t frequent. Yet, their intricacy is revealed here in the order of the real, the imaginary and the symbolic. This “pierre de folie” hides a previous structural failure. Far to heal it, the extraction of the tumor confronts our patient to a psychic emptiness. The therapeutic strategies should respect this narcissistic fragility ready to blow out.     

Two persons with multiple disabilities use a mouth-drying response to reduce the effects of their drooling

These two studies involved a boy and a man with multiple disabilities, who were taught to use a mouth-drying response to reduce the effects of their drooling. Both studies relied on microswitch technology to monitor the drying response and follow it with positive stimulation (i.e., during intervention). In Study I, the boy performed the drying response via a special napkin. The microswitch technology consisted of touch/pressure sensors and a radio transmitter hidden inside the napkin. Drying responses led the boy to 8 s of preferred stimulation. In Study II, the man performed the drying response via a handkerchief. The microswitch technology consisted of an optic sensor and a radio transmitter at the man's chest. Drying responses led the man to 8–10 s of preferred stimulation. The stimulation time/conditions were subsequently modified to promote a reduction in the man's response frequency. The experimental design involved an ABAB sequence (Study I) or an ABABB¹B² sequence (Study II), with the second B or the B¹B² combination spreading over periods of about 3 months. The results indicated vast increases in drying responses and decreases in chin wetness during the intervention phases. The frequencies of the drying response remained consistent for the boy and stabilized at a lower level (i.e., in line with the manipulation of the stimulation conditions) for the man. Implications of the findings and limitations of the studies are discussed.     

Transgression et recours à l’acte à l’adolescence : une forme agie d’appel à l’objet

The author, based upon personal writings and clinical observations, considers some delinquent acts of adolescents within a continuity of fantastical over-activity strengthening narcissistic ideals and desires of omnipotence. The minor unlawful acts undertaken to show a psychic situation of suffering appear under a double aspect: a trouble with limits, external as well as psychic, and a superego dysfunction, leading to masochism.On a conceptual plane, from a psychoanalytical point of view existing knowledge about the “problematic of the act” indicates that the terms “passage à l’acte” and “acting out” give no information about the specificity of this kind of symptom. The author thinks these characteristics of the act, helping the homeostasis of the ego via a third party require a new denomination: the “recourse to act”. The recourse to act, a Freudian expression, includes a specific act language concerning pregenital tendencies without physical violence. It designs all symptomatic acts, allowing later psychic elaboration, thus allowing a representation of this depressive transition inherent to the adolescent's process. This socialisation contributes to an experience which restores the difference between reality and imagination and tends to maintain the reality Principle; the adolescent in quest of object internalisation can then appropriate part of his internal conflicts. Thus, without resolving his personal and infantile problematic, the recourse to act produces an experience presenting a symbolic activity in the service of the adolescence process.     

Matching resources to care: the acceptability, validity and inter-rater reliability of a new instrument to assess severe mental illness (MARC-1)

Background: Most definitions of severe mental illness (SMI) are categorical and assign the patient to either SMI or not-SMI status. While this is useful for some purposes, it is a rather limited approach. The purpose of the present study is to develop a new method of addressing the issue of ‘severity’, and to develop a dimensional rather than a categorical approach. The paper reports on the acceptability, reliability and validity of a method developed to collect a standard set of data covering the majority of items specified in the academic and policy literature as characterising SMI. Method: A single page form, Matching Resources to Care (MARC-1), containing most of the items used in definitions of SMI was used to collect data from community mental health staff about their current open caseload, in four co-terminous health and social services settings during a census week (n = 2139). In addition to the data from the four pilot sites, we conducted a sub-study (n = 91), in which two raters rated the same cases during the same week. Results: The MARC-1 scores were able to distinguish between patients in receipt, and those not in receipt, of specific types of community care (level of care, eligibility for care and statutory aftercare) (P < 0.001). The MARC-1 score was modestly but significantly correlated (r = 0.28) with the Global Assessment Scale (P < 0.001). The mean percentage inter-rater agreement for the MARC-1 score items was 87%. Conclusion: It is possible to use a simple census form in both health and social services agencies. The completion rates were good in both services. The levels of reliability were good, and concurrent validity was established with specific types of care in the community. Accepted: 7 March 2000     

Validity and reliability of the Dutch version of the displaced aggression questionnaire

BACKGROUNDDisplaced aggression occurs when a person encounters a provoking situation, is unable or unwilling to retaliate against the original provocateur, and subsequently aggresses against a target that is not the source of the initial provocation. The displaced aggression questionnaire (DAQ) was developed to measure individual differences in the tendency to displace aggression. AIMTo develop a Dutch version of the DAQ and examine relationships between the DAQ and novel individual differences. METHODSThe Dutch version of the DAQ was created using a back-translation procedure. Undergraduate students (n = 413) participated in the current study. The questionnaires were administered online. RESULTSThe results confirmed the original three-factor structure and showed good reliability and validity. We also found differential relationships between trait displaced aggression, social anxiety and cognitive distortions. CONCLUSIONThe results may indicate that distinct patterns exist in the development of the different dimensions of trait displaced aggression. This study adds to the growing cross-cultural literature showing the robustness of trait displaced aggression in several different cultures.     

Lipoprotein a levels in pediatric migraine

The purpose of this study was to examine the lipoprotein (a) [Lp(a)] levels in children with migraine to see a possible relationship between migraine and stroke via high Lp(a) levels. Plasma levels of Lp(a) were determined in 63 patients and age-matched control subjects. The mean age in the control group was 10.57 ± 3.63 years and 11.51 ± 3.19 years in the migraine patient group. The mean Lp(a) levels in control group were 10.36 ± 10.41 ng/mL and 17.09 ± 12.12 ng/mL in migraine group (P < 0.05). The median Lp(a) level in the control group was 49.38 ng/mL and was 77.62 ng/mL in the migraine group (P < 0.05). Twelve patients (19%) had Lp(a) levels of >30 ng/mL in the migraine group and 4 (6.3%) in the control group (P < 0.05). Several prothrombotic factors related to an increased risk of stroke have been studied in migraine patients. It has recently been reported that high Lp(a) concentrations represent a risk factor for migraine, thus establishing a novel plausible link between migraine and stroke. The current study suggests evidence of high Lp(a) concentrations in childhood migraine; perhaps a novel link exists between migraine and stroke.     

High test–retest reliability of checkerboard reversal visual evoked potentials (VEP) over 8 months

ObjectiveThe inter-individual variation in the shape of a visual evoked potential (VEP) is large even for simple stimuli. We compared the inter-individual variation in VEP waveform to the intra-individual stability.MethodsWe recorded VEP with checkerboard stimulation in 10 women aged 19–29 years in two sessions. We determined the latencies and the peak-to-peak amplitude of N75 and P100. As a new approach in VEP research, we regressed VEP waveforms pairwise onto each other and calculated a t-value between all sessions. The maximal t-value was taken to indicate recognition for all 19 comparisons performed with one session. The recognition rate was cross-validated in a generalized linear regression model (GLM).ResultsThe number of sessions correctly matched to the correct subject was 19 of 20 (true positives) leading to a sensitivity of 95.0% with confidence interval [75.1% 99.9%] for the method. The number of true negatives was 359 of 360 leading to a specificity of 99.7% [98.5% 100.0%].ConclusionsThe VEP waveform shows high intra-individual stability compared to the inter-individual variation in healthy women.SignificanceWith a new statistical approach the effect of external factors on the VEP waveform can now be contrasted against the normal variability over time in longitudinal studies.     

An autoradiographic study of the organization of intrahippocampal association pathways in the rat

The longer associational connections of the hippocampal formation have been studied autoradiographically in a series of adult rats after small injections of ³H-amino acids into each of its various cytoarchitectonic fields. The major findings can be summarized as follows. The dentate gyrus projects in a topographically ordered manner upon the pyramidal cells of the regio inferior by way of the supra- and infrapyramidal bundles of mossy fibers. Certain cells in the hilar region of the dentate gyrus (which operationally may be defined as constituting field CA₄ of Ammon's horn) give rise to a hippocampodentate projection to the inner one-quarter of the molecular layer of the dentate gyrus. Either the same or closely related cells give rise to fibers which join the Schaffer collateral system from field CA₃ to the stratum radiatum and stratum oriens of the regio superior. The regio inferior is also characterized by a longitudinally directed associational bundle which runs throughout the septo-temporal extent of the hippocampus and is centered in the region of subfield CA_3a. The regio superior has no reciprocal projection to the regio inferior but sends a substantial projection back to the subiculum and to the entorhinal area. There is also a projection to the subiculum from the regio inferior, and the subiculum itself probably contributes significantly to the projection to the entorhinal and perirhinal cortices. There is a striking parallelism between certain of these associational connections and the commissural projections to the hippocampus and dentate gyrus. Each cytoarchitectonic field that contributes a commissural projection also gives rise to an ipsilateral associational pathway which in its intrahippocampal course and its mode of termination exactly matches that of the commissural projection, although in general, the associational connections are more extensive in their distribution along the septo-temporal extent of the hippocampus than the corresponding commissural connections. The reverse is not true; there are a number of associational projections which are not paralleled by commissural projection. All of the associational projections are topographically arranged, but those which extend across the transverse axis of the hippocampus usually show considerable divergence so that afferents from different levels overlap fairly considerably within their respective projection fields.     

The War Events Questionnaire

Background: The measurement of exposure to war in large epidemiological studies necessitates the use of easily administered and reliable questionnaires that cover a range of war events. The War Event Questionnaire (WEQ) was designed by our group to address these issues and has proved to be quite easy to administer. The aim of this study is to establish the inter-rater reliability of the WEQ. Method: Two trained interviewers alternated in administering parts I and II of the WEQ. Results: The Kappa statistics used to calculate the degree of agreement between the two raters ranged from 0.281 to 0.774 for part I events and from 0.189 to 1.000 for part II events. Conclusion: The WEQ has proved to be a useful instrument that addresses both objective and the subjective war experiences; it is a fairly reliable instrument and has helped us avoid tautological assessment of the mental health effects of war. Accepted: 28 May 1998     

Le travail de l’exil à l’adolescence. Dispositif d’étayage groupal et de médiation par la bande dessinée

ObjectiveThe exile is particularly traumatic for adolescents who, in the host country, live the post-migration experience in uncertainty. In order to enhance the continuous sense of being and the imaginary of a group of young unaccompanied minors, and to promote the narrative of their exile, we have set up a group mediated by comics. We strive to understand how and by which processes a comic mediation group could enable the support of the continuous sense of being as well as the imagination in a group of unaccompanied minors.MethodSix (n = 6) adolescents aged 15 to 17 were invited to design a group comic strip. Participants were invited to create a comic in group. The study was divided in three specific times: (1) the first was to invent a story, (2) the second was to do a storyboard and (3) the third and last one consisted in the creation of a comic. The group proceeded in X session and each session ended with a speaking time. We chose to create a comic as a medium because of its formal qualities: the specificity and complexity of its codes seemed appropriate to work on the time and space. Therefore, the breaks and discontinuities as essential parts of the comic structure allowed the participants to work out their temporal and special experiences of exile. As working in group enables to enhance the creative processes, we have designed and set up a comic mediation group.ResultsWe observed that the creation of the comic facilitates the updating of break and loss experiences, because of its formal structure. This sometimes made the group envelope porous and fragile, and damaged the group associative chain. The mediation group allowed participants to express and transform their primary affects through images and words, which led them to go from a fixed time to a historicized time. The comic became an object that represents the individual psychic reality work, the group work but also refers to the common societal reality that concerns those adolescents. Through the comic, they question the adults, the institutions and the environments that are supposed to protect them. The structure of the comic and the group setting helped participants to restore a sense of security. Moreover, the secure and containing space created by the setting allowed the group to enhance its imagination.DiscussionThe setting permitted participants to be in an active position, which supported them in the process of identity reconstruction. They used comics to transform and make sense of a painful part of their story in order to appropriate it. It is necessary to keep doing research on this subject to improve the support given for this young people. Moreover, it is essential to offer them places where they can be accompanied in the crossing of their exile experience.