L’avancée en âge des personnes atteintes de troubles du spectre de l’autisme. Éléments cliniques et psychopathologiques

ObjectivesThis article attempts, from a psychopathological perspective, to clarify the clinical evolution of patients with ASD during adulthood and into old age, and to assess the risks and the chances. In addition, the article also attempts to address the experiences of these people confronted with their own aging, the death of loved ones, and their own mortality. This study of a cohort of 314 elderly patients can provide some data concerning these changes.MethodThe study of the cohort of 314 adult and aging patients makes it possible to specify several aspects of ASD in adulthood: level of severity, associated disorders and co-morbidities (psychiatric disorders, intellectual deficit, epilepsy, neurosensory disorders, genetics). At the clinical and psychopathological level, the behavioral disorders are described therein with reference to the dominant psychopathological modes of functioning: typical autistic modalities (notion of post-autistic recourse), symbiotic modalities, acute anxious exacerbations, depressive and manic functionings.ResultsPropose an elucidation of challenging behaviors (or problem behaviors) and make it possible to address them; demonstrate that their evolution during advancing age is rather favorable while insisting on the permanent vulnerability of certain subjects. Specify the main courses of action, insisting on spatial, temporal, and relational security; on the central place of care procedures (fundamental physiological needs, consideration of somatic pathologies, specific care with psychotropic drugs, psycho-corporal approaches); and on the attention paid to everyday life, a major therapeutic mediator, through maintaining a reasonable amount of activity.DiscussionThe approach proposed here confirms that the main problem facing adults diagnosed with ASD is that of associated disorders and psychiatric co-morbidities, more than that of the fundamental symptomatic particularities necessary for the diagnosis of ASD (the autistic tripod). This requires going beyond the notion of challenge behavior and adopting a functional perspective that ultimately reveals sometimes major psychic suffering and the adaptive attempts that these patients make to cope with it.ConclusionThe clinical work with this particular population confirms the need for structured institutional work, the only thing that can ensure the coherence of the approaches to working with this diverse patient population, one that is diverse, with generally favorable developments, but which still remains very vulnerable.     

Quinze ans après le rapport de l’Inserm. L’efficacité de la psychanalyse ré-évaluée

ObjectiveSince the 2000s, “mental health” policies in France have to be based on evidence. A report on various forms of psychotherapy, published by the INSERM (the French National Institute of Health and Medical Research) in 2004, and whose conclusion was that there is no evidence of effectiveness for psychoanalysis, remains an important reference. The aim of this article is to re-examine its scientific value, fifteen years later.MethodAfter returning to the context in which this report was written and the controversies surrounding its publication, we propose a review of the efficacy studies that have since evaluated psychoanalysis. This recent literature, mostly international, remains relatively little known in France.ResultsThe INSERM's expert report – whose status could in part be promoted at the time of its publication – now appears to be relatively dated, both in terms of methodology and in its conclusions. The majority of current efficacy studies show that psychoanalytical and cognitive-behavioral therapies do not show any significant differences in efficacy for almost known disorders.DiscussionThese results give rise to debate. Some scientists believe that they are only due to a lack of rigor in the experimental protocols. Others, on the contrary, maintain that the search for specific factors of efficacy is a dead end and promote studies in natural conditions, in order to assess the cumulative contextual factors of therapeutic effectiveness.ConclusionsWithout prejudging future research orientations and results, it nevertheless appears that the INSERM report can no longer be the dominant reference in France today for recommending psychotherapeutic “good practices.” Research has progressed considerably. In view of the international scientific literature available today, psychoanalysis is one offer of care to be advocated among others – a position to which many countries subscribe.     

L’évaluation des stades de changement dans les addictions

The assessment of stages of change, the main component of the Transtheoretical Model, is at the same time a very appealing and clinically useful task, but yet difficult. Several instruments of evaluation of these stages exist to date in the Anglo-Saxon countries. In France, this model remains relatively little used and only some treatment settings currently assess stages of change. This is due partly to the absence of validated instruments of assessment in French. The object of this article is to present the main instruments of assessment of stages of change in addictions and their advantages and limits. Another aim of this article is to present the last progress in the assessment of stages of change. Lastly, this article shows the clinical utility of the assessment of stages of change. Assessed in an adequate way, stages of change provide an interesting and useful way to segment the process of change. This can thus increase the comprehension by the clinicians of clients’ motivation and offer a differentiated and rich perspective on the process of behaviour change. Clinicians can also adapt the psychotherapeutical strategies to the stage of change or the degree of readiness to change of a client. The stage of change assessment has an important predictive value: readiness to change was the best predictor of treatment outcomes in several researches.     

Considérations sur la préparation médico-psychologique des personnels de l’armée de l’Air

The medical and psychological preparation of personnel in the armed forces is designed to facilitate the adaptation of an individual, with all their singularities, to an environment with specific constraints. In an idealized flight operation that has become real thanks to the implementation of more and more sophisticated tools, Air Force personnel must deal with the dangers inherent in an aeronautical environment. These specific constraints (the decrease of atmospheric pressure, constraints related to the aircraft, equipment and mission) justify an adaptation of the current medical-psychological training in the armed forces. This preparation is continuous throughout the different stages of an airman's career, both in terms of expertise and medical and psychological support, through a process carried out by different actors, which include the medical service of clinical psychology applied to aeronautics (SMPCAA). It aims to ensure both flight safety and the mental health of the flight crew. The medical-psychological assessment in aeronautics is based on military and international regulations. A qualified psychiatrist, having adequate knowledge and experience in aviation medecine, explores anamnesis and the behavioral, affective and cognitive fields to evaluate the airman's prognosis for adaptation. In addition to the medical history or current psychiatric disorders, the psychiatrist looks for a pathological or delusional personality, contraphobic, escapist, fragile or non-authentic motivation. An airman's mental fitness during their career is more nuanced than their initial mental health which does not take into consideration the necessary adaptation to the job. Medical and psychological support takes place in the continuity of the normal fitness assessment. SMPCAA coordinates this support, with the Air Force's clinical psychology unit (CPC’Air). This unit, which was initially created to carry out post-immediate medical-psychological interventions following serious traumatic events, also provides training, operational psychological support, and psychotherapy.     

Facteurs de protection dans les conduites d’alcoolisation chez les étudiants de l’université Saint-Esprit de Kaslik au Liban. Étude transversale effectuée sur des étudiants séminaristes et non séminaristes

ObjectivesAlcohol consumption is facilitated in university students by personal risk factors such as initiation with the substances at an early age, a low self-esteem, a lack of social aptitudes and heredity. Protective factors are characteristics of the personality like optimistic attitude towards the future, good coping strategies, good self-esteem and good capacity of resilience. The objective of our study consists in comparing the alcohol consumption of subjects between 18 and 25 years old within the Holy Spirit University of Kaslik in Beirut. We postulate that the alcohol consumption and the protection factors in the same university vary, as the students are seminarists or not. We tried to see if the seminarists students have lesser alcohol consumption (binge drinking, abuse, dependence) than none seminarists students and to see if they have personal psychological protection factors (optimism, high self-esteem, positive coping strategies to resolve the problems and resilience) higher than none seminarists students.Subjects and methodsOur study concern a Lebanese sample of 200 students of the Holy Spirit University of Kaslik, Lebanese Francophone University, aged between 18 and 25 years, distributed on four faculties (theology, management, science and medicine) of 50 persons each one. The students were informed and agreed to pass two anonymous questionnaires: the first one help to detect subjects having alcohol drinking (binge drinking, abuse and dependence) whose a part corresponds to the test AUDIT measuring the alcoholic dependence; and the second allows evaluating personal psychological factors of protection (optimism, good self-esteem, positive coping strategies and resilience) whose a part concerning the self-esteem is the one of Rosenberg, the part relating to the coping strategies is inspired by the “Brief cope” scale of Carver; the part concerning the optimism is inspired by the LOT “Test Life orientation” of Schier and Carver and the part relating to the resilience is inspired by “the control and the self-resilience” scale.ResultsTheology students have personal factors of protection, which protect them from alcohol drinking: higher optimism than others, more positive coping strategies, a better resilience and a good self-esteem more than those in other faculties. This differentiates them from other students concerning the risk use and the “binge drinking” and did not significantly differentiate them concerning the abuse and the dependence. The binge drinking seems to be significantly higher at the students in management, sciences and medicine. Their search for domination, which accompanies the competition between each others, where it is socially “virile” to drink important quantities of alcohol around games, can influence their behavior. So, we can understand why such behaviors do not seem to interest the seminarists. The risk use on the test of the AUDIT seems to be significantly lower in seminarists students than in sciences and management. This can be explained by their less frequent use of substances to resolve their conflicts and their use of coping strategies such as prayers and by their vision in the life is based on the hope, faith and carrier of optimism. The major problem of Lebanese students remains the “binge drinking”.ConclusionIt would be interesting to propose interventions within the university. Talking groups could be settled to help them talking about their own consumption of alcohol.     

La fonction de l’inquiétante étrangeté dans les difficultés des apprentissages

Aims

The starting point is the observation that learning difficulties, often coming under terms with the prefix “dys”, and learning disorders contained in the international classifications of child psychiatry, can be consubstantial with the emergence of phenomena relating to “the uncanny” in children. The aim of this article is to explore the place of these phenomena in the period when the child starts to learn to read and write, which is a time when the original loss that enabled the subject to appropriate language and speech is reactivated.

Effets de l’huile des fruits de Dacryodes edulis sur les symptômes de l’anxiété et les performances cognitives chez la souris,après administration prolongée

ObjectiveTo study the effects of prolonged administration of Dacryodes edulis (G. Don) H.J. Lam (HDE) fruit oil on the symptoms of anxiety and cognitive performance in mice.MethodsAnxiolytic activity and effects of HDE (5 and 10 ml/kg) on cognitive performance were evaluated in male mice after oral administration for 45 days. Anxiolytic effects were investigated in open field test, elevated plus Maze and hole board test. The Morris Water Maze test was used to evaluate cognitive performance in mice. Efficacy of HDE (5 and 10 ml/kg) was compared with that of fluoxetine (2 mg/kg p.o).ResultsHDE decreases the total distance traveled, significantly increases the number of adjustments and the number of entries in the central area of open field. In the elevated cross labyrinth test, HDE increases the number of entries and the time spent in the open arms. HDE significantly increases the number of head insertion into the holes. In the Morris Water Maze test, HDE reduces latency before finding the platform and increases the time spent in the target quadrant.ConclusionThe results confirm anxiolytic effects and improved cognitive performance after prolonged oral administration of HDE in rodents.     

L’effet de l’âge et de la durée d’incarcération sur la santé mentale des détenus âgés

Inmate aging is considered to start at the age of 50, which is early in relation to aging in the general population. The aging of the criminal population in France poses a real public health problem. There is very little research on the mental health (mental and cognitive disorders) of older inmates.ObjectivesThe objective of this study was to evaluate the effect of age and time spent in prison on mental disorders and cognitive performance of elderly prison inmates. We put forward the hypothesis that age and amount of time spent in prison are associated with the deterioration of older inmates’ mental health, that is, an increase in the prevalence of psychiatric disorders and a decrease in cognitive performance.MethodsWe recruited 138 men aged 50 and over in seven French prisons. The research protocol included a semi-directive interview, the Mini International Neuropsychiatric Interview (MINI DSM-IV) for the assessment of mental disorders, as well as the Rapid Battery for Frontal Efficiency (BREF) and the Mini Mental State Examination (MMSE) for the evaluation of cognitive performance.ResultsThe average age of the inmates (N = 138) was 59.7 years (range 50–84, SD = 8.02). The average sentence was approximately 13.5 years (SD = 7) and the average time spent in prison was 6.9 years (SD = 5.9). The results showed a very high prevalence of mental disorders, notably depression and anxiety, and cognitive disorders. However, the probability of occurrence of certain psychiatric diagnoses decreases with age (major depressive episode, agoraphobia, post-traumatic stress disorder and generalized anxiety). In addition, logistic regression estimates showed no significant relationship between time spent in prison and mental disorders. However, there is a significant link between time spent in prison and cognitive impairment.ConclusionOur hypothesis is partially validated. Indeed, age is not associated with mental or cognitive disorders. However, the amount of time spent in prison has an effect on the deterioration of certain cognitive functions. It appears that after the age of 50, it is not chronological age but environmental factors that mainly explain cognitive decline. Our study shows that the longer the detention period, the greater the inmate's cognitive decline. These results highlight the very high vulnerability of elderly prisoners in terms of mental health and emphasize the importance of implementing appropriate detection and care measures to address the needs of this segment of the criminal population. Routine screening for cognitive impairment in all older prisoners should be carried out by caregivers in penitentiary institutions. Furthermore, better follow-up and cognitive assessment of prisoners aged 50 or more and whose length of incarceration exceeds five years could make it possible to detect subjects at risk and to propose appropriate activities to reduce and/or delay the effects of aging in detention.     

Le trouble dissociatif de l’identité : les mythes à l’épreuve des recherches scientifiques

Dissociative Identity Disorder (DID) has long been the subject of controversy in scientific literature and in clinical practice. This article identifies the main beliefs of clinicians and compares them to the scientific studies on this subject by presenting the main research of DID specialists and the opponents of this disorder. It results the following from this review of the literature: (1) DID is a different disorder from schizophrenia; (2) it exists independently of any iatrogenic influence of the therapist or of the media; (3) these patients are not particularly prone to suggestibility or fantasy; (4) DID appears outside of any hypnotherapeutic treatment; (5) it is the most severe of the traumatic disorders; (6) amnesia of childhood trauma is a proven phenomenon; (7) the extent of extreme physical and sexual abuse of children, sometimes infants, by individuals or organized groups, is known to police and judicial authorities.