L’échographie obstétricale : l’e-baby et la parentalité

Objective

To become a interdisciplinary medico-psycho-social prevention area, obstetric ultrasound invites to overcome the cleavage between specialists of the soma and the psyche at the Maternity Hospital. This contribution is evidence of action research aimed at this goal in a maternity award.

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.

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.     

L’effet de la méthylphénidate sur l’appétit et le poids

Objectives

To better delineate in the medical literature the effect of methylphenidate on weight and appetite.

Qu’en est-il de l’équilibre psychique des enfants réfugiés ?

ObjectiveThe aim of this study is to determine to what extent the psychological balance of Syrian refugee children in Lebanon can be altered. Our goal is to identify the influence of the children's history and their current living conditions on their psychological balance. War refugees, and more particularly children and young adolescents, experience different crises and traumas linked to war, loss, exile, poor living conditions and integration in the host country. The current issue and the various researches that have been carried out have led to several questions about the impact that the war experience, the migratory history and the living conditions of these children can have on their psychological balance. The main questioning which therefore guides this research project is whether the psychological balance of these Syrian refugee children is altered and if so, to what extent. We have seen from the literature that studies on war refugees are rather rare. Immigrant populations in European populations are those that are generally studied because of their proximity and the relative ease of making contact, which is not the case in refugee camps. This is all the accurate for Lebanon, a country which, as we have seen, lacks any framework, procedure and structure relating to the organized reception of refugees. The main hypothesis of this research is that Syrian children living in more precarious living conditions and having a past history marked by potentially traumatic events, will have a less developed mental balance than others.Materials and methodsTwo groups of Syrian children living in Lebanon, aged between 8 and 12 years old, took part in this study. One of the groups being made up of children living in refugee camps and the other one made up of non-refugee children, living in conditions similar to their own in Syria. This research includes both girls and boys. All the children are of Syrian nationality, grew up in Syria and currently live in Lebanon. The collection of information and the study of the influence of the migratory experience of war and the living conditions of the children on their psychological balance, were carried out by means of three main tools: A semi-structured clinical interview available in three languages (in French, English and Arabic). A post-traumatic stress symptom rating scale was included in the questionnaire, the CRIES-13, which is an assessment questionnaire designed to measure the impact of events on children, and the free drawing test was proposed, followed by a survey following the child's production, analyzed from the model of Georges and Anna Cognet.ResultsThe collected data made it possible to observe an alteration in the psychological balance of Syrian refugee children, as well as significant differences between the two groups of children who participated in the study.ConclusionsThis is a study with a population that has so far not aroused much interest, despite the multitude of migratory crises of our century on all continents, and which could contribute to the assessment and the care of immigrant or displaced populations all over the world. Indeed, in view of the results obtained, the research contributes to the need for refugee support by countries and supranational organizations having the means or the responsibility to do so. The question of the consequences of the living conditions of refugees in the long term arises with the imperative, as a health professional, to find means of logistical, physical and in particular psychological care, for this fragile and large population. need for appropriate follow-up and support.     

L’abord phénoménologique de l’épistémologie de la psychiatrie,selon Georges Lantéri–Laura

ObjectiveThe article aims to give an account of the construction, by G. Lantéri–Laura, philosopher and historian of psychiatry, of a phenomenology of psychiatry dedicated to the critical elucidation of its foundations, inseparable from the concrete approach of its history, apprehended with the methods of structuralism.MethodThe stages of this construction are summarized and connected to the path of their author, while paying tribute to him and his work.ResultsThis phenomenology of the psychiatric fact privileges the study of the sign and its effects of meaning, and requires the clarification of the conditions of its production, including the knowledge and the know-how that it supposes. Extending the work of E. Minkowski thanks to the principles of structuralism, G. Lantéri–Laura considers the structure of the semiotics of psychiatry and makes numerous contributions to its semiology, notably of language. Considering the investigation of its praxis to be inseparable from its history, he forges a periodization of it in various paradigms, in conformity with T. Kuhn's epistemology and with C. Lévi–Strauss's conception of history.DiscussionLantéri–Laura links this phenomenology with an approach to subjectivity that keeps Husserl's vow of evidence, but without rejecting the unconscious, thus resisting the hegemonic and totalizing tendency of any psychopathology through the rigorous elucidation of the semiotics of psychiatry and the emphasis put on the regional, plural, and historical characters of its epistemology.ConclusionG. Lantéri–Laura has proposed a phenomenological epistemology of psychiatry, inseparable from the three dimensions of semiotics, subjectivity, and its history.     

Humaniser l’orthopédie

Orthopedic care of cerebral palsy kids responds to a natural need for comfort and to permanent pathological constraints that professionals are familiar with. These require the use of devices that extend our actions and which we are forced to impose the use to families and non rehabilitation professionals. This text proposes hypotheses to analyze the difficulties that we encounter on this subject.     

Impact d’une vidéo pédagogique sur les croyances et représentations relatives à l’électro-convulsivothérapie chez les psychiatres des Hauts-de-France et d’Occitanie

IntroductionDespite its effectiveness and good tolerance, electro-convulsive therapy (ECT) is under-used in current clinical practice probably because of stigma and the negative image of this treatment. The main objective of this study was to evaluate the impact of an educational video on the representations of ECT among psychiatrists and psychiatric residents in the North and in Occitanie districts of France.MethodWe evaluated the representations of ECT through the Questionnaire on Attitudes and Knowledge of ECT (QuAKE) before (T0) and after (T1) viewing a short educational video. Scores at T0 and T1 were compared with a paired t-test. Factors associated with the improvement of the representations were investigated using a logistic regression model.ResultsIn all, 195 responses were obtained. The QuAKE score at T1 was significantly better than at T0 (29.4 at T1 vs. 31.5 at T0, P < 0.001). The more negative the representations were at T0, the higher the probability of a decrease in the score at T1 (OR = 1.07 [1.02–1.13], P = 0.003).DiscussionOur study showed a beneficial effect of a short educational video on psychiatrists’ representations of ECT. The wide use of this type of media, allowing information and destigmatization, could considerably optimize access to ECT for patients.     

Phénoménologie du vécu hyperphagique dans l’obésité : le corps,le monde et l’autre

Objectives

In a phenomenological approach, eating disorders imply a mode of being in the world, a mode of existence in which the act of eating occupies central position and becomes a source of suffering as a result of incapacity to have control over eating habits. In this article, our objective is to analyze the hyperphagic experience, which is experienced in obesity.

La législation actuelle face à l’évaluation des comportements criminels violents : l’urgence d’une réforme

The clinical examination of mental patients committed to specialized hospitals as well as the practice of criminal psychiatric expertise do not at present allow the serious assessment of the dangerousness and risk of violent recidivism. The use of diagnostic and predictive scientific methods has become indispensable. In criminal cases, the expert must also take into account the actual facts of the offense: degree of premeditation, organization of the crime scene, dynamics and typology of violence, relational and environmental context, victimology, judicial information. Traditional psychiatric expertise must now give way to a comprehensive, multidisciplinary criminological form of analysis combining all individual and collective factors of a subjective and objective nature.     

Étude des références pronominales à soi dans les témoignages d’événements traumatiques de guerre et d’attentats

ObjectivesThe traumatic experience is characterized by “unspeakability:” there are no words to truly express, to translate, to represent the horror. And yet, paradoxically, the main access to our knowledge of traumatic dissociation comes from what patients manage to tell us, if only partially, chaotically… The lexical, syntactic, and pragmatic imprints of the trauma on discourse, which we have baptized psycholinguistic traumatic syndrome (SPLIT), are expressed according to an automatico-voluntary dissociation taking gradual form: the more the trauma appears present, the more the psycholinguistic stigmata manifest themselves; the more the subject psychically moves away from the trauma and its consequences, the more the discourse returns to the nominal state. How can the subject become master of his own life, of his own speech, without being constrained by trauma? How do some subjects manage, alone or with the help of others, to extract themselves from their flashbacks by narrativizing the traumatic scene? These spaces of return to the “I” have never been studied in French in the discourse of patients suffering from posttraumatic stress disorder. In addition to the linguistic form “I,” what other forms (personal, exclusive, inclusive, generic) do speakers of traumatic narratives use in their discourse in order to refer to themselves?MethodsBased on the testimonies of survivors of the Bataclan attack collected immediately after the event and a few years later, as well as on the narratives produced by military patients suffering from chronic posttraumatic stress disorder, we analyze, through the precise linguistic study of pronominal markers, how the speakers refer to themselves.ResultsA detailed analysis of the pronominal forms and the different values they signify led us to four main findings: (i) over-representation of the first person in traumatic narratives, both by the use of the pronoun “I” and by others pronouns including the speaker; (ii) predominance of the use of generic pronominal values in traumatic narratives; (iii) preferential use of the exclusive value of the pronoun “on” in the “War in Afghanistan” corpus; and finally (iv), the temporal unfolding of these first three results mirrors the habitual chronology that characterizes the clinical evolution of posttraumatic stress disorder.DiscussionThe narratives of trauma survivors contain significantly more occurrences of the pronoun “I,” but also other forms of self-reference, compared to control subjects. The use of the first-person pronoun mainly reflects the singularity of the trauma: what is traumatic for one person at a particular moment in his or her history will not necessarily be traumatic for someone else who, objectively, went through the same ordeal (in terms of place, date of the event, intensity of the sounds, extent of physical injuries, etc.). To say “I” is also to fight against dissociative symptoms, first and foremost depersonalization bordering on reification and desubjectification. However, the trauma clings to subjects’ first attempts to extract themselves from it: the preeminence of the pronoun “I” appears in parallel as a mark of repetition in the discourse, a disjunction between the lexical and pragmatic dimensions of enunciation. Because of massive dissociation, the discursive “I” sometimes even refers to a form of asubjectivity in the traumatic scene, an “Out-of-Language Experience:” the subject sometimes says “I” but without talking about her/himself. Moreover, the use of generic pronouns is found with greater frequency in accounts of traumatic events, particularly in the “later Bataclan” corpus, whereas controls use them significantly less. By using the generic “vous” (the formal or plural form of second-person address) or the informal “tu” (“you”), it is as if the speaker were saying: if you had been in my place in that circumstance, this is what you would have felt, seen, heard, thought, because any human, in those circumstances, would feel what I felt. In a sense, I am a “normal” human being, but at the same time, I avoid my own subjectivity, which is a form of depersonalization. Through the use of a generic “you,” or even more so through a familiar “you,” a change in cognitive perspective is adopted to describe the experience; the psychically injured subject looks at the experience described from the outside. Thus, the process of traumatic dissociation remains untouched, or even extends itself, by including the interlocutor in the traumatic scene, suggesting an empathic quest, as if to make him or her a captive, an invited witness, or a forced participant in the verbal scene. Finally, while the control subjects use “I” and “on” (a commonly used French pronoun that expresses, alternately or simultaneously, “one” and “we”) in an equivalent way, with the psychologically injured subjects, the further one moves away temporally from the trauma while its clinical consequences persist, the more the use of the pronoun “I” increases and the more the use of the pronoun “on” decreases, while the latter takes on an exclusive or generic character. These intersecting evolutions, which suggest an attempt to resort to self-affirmation and to a dissolution into an external collective, signal the presence of traumatic dissociation in the discourse. These results are consistent with the chronological clinical evolution of posttraumatic stress disorder from the immediate phase marked by acute stress disorder, to the deferred phase, which is often followed by an intermediate latent period, and then to chronic symptoms evolving into a multiplicity of suffering.ConclusionThe linguistic approach can offer us both an understanding of the general marks of the psychic wound in the discourse and of the trauma, in the sense of the singularity of the experience. While traumatic psycholinguistic syndrome results from linguistic wound constitutive of the trauma, conversely, it is a singular word, which makes it possible to extract oneself from flashbacks. Undoubtedly, life-saving processes occur thanks to the intersubjective relationship between the patient and others, through the co-construction of a discourse. The analysis of the restoration of this language, particularly its pronominal forms, could unify a specific conception of the alleviation of traumatic consequences while defining objective linguistic markers that could help clinicians evaluate the effectiveness of recommended treatments.     

Développement d’un réseau nosographique collaboratif

ObjectivesThe use of massive amounts of digital data in mental health offers interesting perspectives that could influence the evolution of psychiatric nosography. The characteristics of this data could become key elements to understand the future organization of knowledge — and debates — in psychiatry. Such an evolution could take different shapes, including the development of a collaborative and networked psychiatric classification.Materials and methodsSeveral issues related to the use of large amounts of data in psychiatry were identified and developed in this context: (1) the growth of new health related data producers and storers, which could influence the development of some research topics or diagnostics to the detriment of others, depending on the availability or profitability of this data; (2) the fact that mental health data is often available in an unstructured form: textual data, like reports of complementary examinations, reports of hospitalization or expertises, but also imageries or videos, from institutional or alternative sources; (3) the need of scalability and flexibility of this data, to make it possible to integrate recent discoveries as well as to take into account the phenomenon of pathomorphosis or cultural factors in psychiatry. A collaborative framework is proposed to answer each of these issues, including the possibility of integration of different data forms, associated with a complete traceability of sources and a nominal registration. The need to structure data is also specified, with the use of tags to modelize diagnostic consensus that include professionals, patients and families. This collaborative tool would make it possible to consider data resulting from perceptions of patients or their families, enabling patients to benefit from a higher level of confidence and engagement, and limiting the deleterious effects of stigmatization.ResultsThe possibilities of a collaborative web tool integrated into the French Shared Medical File (Dossier Medical Partagé) are described, and two examples of practical situations are presented: A mental health professional reporting his influences on the diagnosis of schizophrenia: he integrates the symptoms described by the German psychiatrist Karl Leonhard (Leonhard classification), cultural references (cinematographic reference like A beautiful mind directed by Ron Howard), and links to articles on medical and psychiatric comorbidities among adults with schizophrenia. In the other example, a psychiatrist uses this tool to develop a collaborative diagnosis that integrated an active participation of the patient around the diagnostic. In France, the latest version of the digital Shared Medical File was launched in November 2018. The integration of a collaborative nosographic tool into this file would be an interesting answer to the difficulties that might happen for its use with patients suffering from mental disorders. It could thus limit the stigmatization of a shared diagnosis and enable a better understanding of practices among mental health professionals.ConclusionThe psychiatrists use specific knowledge resulting from multiple influences and theoretical orientations. The risk of incomprehension of practices in psychiatry by patients and their families being major, nosographic research trying to include the coexistence of these orientations appears necessary. Moreover, in the context of the development of large-scale data processing, it is essential that a collaborative human-scale interpretation of this knowledge exists. This would make the psychiatric nosography an ethical tool, allowing an active participation and dialogue between patients, families and health professionals, that could become key features of future psychiatric nosography.     

L’enfant autiste et son parent face à l’échec de l’intersubjectivité : une clinique de la narrativité

Aim

This article examines the failure of the processes enabling access to intersubjectivity and to primary subjectivation in the treatment of small children presenting autism, and the consequences thereof in the development of parenting exercised by the mothers and fathers of such children. The psychotherapeutic processes implemented via narrative and testimonial functions during consultations appear necessary to relaunch narrative identity and the capacity for parental reverie.

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.