Étude de l’évolution clinique et des modifications de fluidité membranaire chez des patients schizophrènes traités par neuroleptiques

Numerous physiopathological hypotheses were proposed concerning schizophrenia. The membrane hypothesis is one of them, which considers schizophrenia as a global pathology expressed in through all the cells of the body. The phospholipidic metabolism would be disrupted, associating an essential fatty acid deficit of incorporation in the membrane and an increase of their destruction. In addition, the membrane fluidity depends directly on the lipidic composition and consequently would be abnormal during the schizophrenia. Furthermore, the membrane fluidity is a property indispensable to the good functioning of the cell and more particularly of receptors. This synthesis of the data of literature allowed to envisage the following hypothesis : the evolution of the clinical state of patients suffering from schizophrenia, treated by neuroleptics, could be correlated with the evolution of the membrane fluidity in the course of time. To support this hypothesis, a study approved by the CCPPRB Auvergne wich is scheduled for one year has already included 11 patients over a period of five months. Patients corresponding to the criteria of inclusion enter the study while they are stabilized and are treated by risperidone or haloperidol. Their assent is obtained, a first measure of membrane fluidity is made on lymphocytes and erythrocytes, and scales of evaluation of the clinical state are past (BPRS and PANSS). The same protocol is applied to three months, six months, and in case of relapse. The first results show a modification of the membrane fluidity compared with the established standards as in the evolution during time.     

Thérapie par l’exercice et myopathies

Since the first consensus papers published early in the 2000s, a growing number of recent publications has shown that adapted physical activity is not only safe in the context of myopathy but also potentially effective as a therapeutic tool. After a short recall of the different exercise modalities, the mechanical strain they induce and the expected muscular benefits, the present paper reviews the different studies related to exercise therapy in myopathic patients and provides a critical analysis of the topic. Myopathies are rare diseases with many different etiologies and a large number of training modalities which could be useful for the different muscular challenges have been proposed. We have chosen to focus on several specific training modalities and to discuss the results from the most recent papers. The purpose of this review is to, firstly, update physical training guidelines for patients with myopathy and, secondly, highlight some common pitfalls associated with this strategy. This is particularly important for medical and allied professionals involved in prescribing and managing exercise therapy protocols.     

L’enseignement du syndrome catatonique en France : enquête nationale et état des lieux

ObjectivesCatatonia is a transnosographic syndrome described by K. Kahlbaum in 1874. Catatonia can be life-threatening due to its complications and in case of malignant catatonia. Safe and effective treatments have been identified (benzodiazepines and electro-convulsive-therapy). The prevalence of this syndrome is important and represents about 10% of inpatients in an acute psychiatric ward. However, this syndrome appears to remain under-diagnosed and poorly known. We were, therefore, interested in the current knowledge of French psychiatry residents and young psychiatrists as well as the education they had received about catatonia.MethodsA questionnaire was submitted to French psychiatry residents and young psychiatrists with fewer than 5 years of experience. It included questions about knowledge of the symptoms, complications, causes and treatments of catatonia. Participants were also asked about their confidence in the management of a patient with catatonia and about the number of catatonic patients they had already met. The type of lecture and teaching about catatonia was also assessed.ResultsAmong the 376 psychiatrists that completed the questionnaire, 37.5% never had received any specific teaching about catatonia. Concerning the 62.5% who benefited from a specific lecture, this was mainly delivered as part of psychiatry DES. Heterogeneity in the education delivery on the French territory had been highlighted. In addition, participants’ knowledge of catatonic syndrome seems incomplete. However, knowledge of catatonic symptoms and first intention treatments was significantly better among respondents who were part of the “with education” group. The confidence in catatonia recognition and management, as well as the number of catatonic patients they met, are also significantly higher in the group “with education”.ConclusionSpecific education seems to improve the knowledge of young doctors and their ability to diagnose and treat catatonic patients. This education remains poorly provided and heterogeneous on the French territory. Catatonia deserves a place in the teaching program of the psychiatry DES, thus to become systematic.     

Effets aversifs et appe´titifs induits par stimulation me´sence´phalique et hypothalamique

Approach and escape latencies induced by hypothalamic or central grey stimulation were measured in the rat by means of a shuttle-☐ technique. In order to compare the effects obtained at various brain sites, the maximal value of the escape latency/approach latency ratio was determined within a given range of stimulation intensities. The ratio was shown to have high values at sites located in the ventral part of the central grey (in or near the dorsal raphe nucleus) or in the lateral hypothalamus. It was equal to zero for most of the sites located in the dorsal part of the central grey, as the rat regularly interrupted the stimulation without initiating it again. Intermediate values were obtained at sites located in the medial hypothalamus and in the dorsal pontine tegmentum.     

Syndrome de Cotard et fuite des idées

From a case of anxious melancholia including delusions of negation: organs, death and language, we would like to demonstrate, on one hand, the specific nature of Cotard's syndrome manic depressive psychosis. On the other hand, it concerns the study of body somatic and overvalued signifiers. We consider the logical relationships between Cotard's syndrome and the flight of ideas, as a manic symptom “par excellence”. According to this case, we consider language related to melancholia, with no holes always fleeing to the same point, as an organised sort of flight of ideas. What we call confused flight of ideas, an expansive and auto-destructive flight could be comprehended as the reverse of melancholic language which may underly somatic symptoms. This methodology allow us to define criteria for the diagnosis for melancholia as related to metonymies and the foreclosure of the Name-of-the-Father. In other words, this study allows us to theorise foreclosure as a partial process.     

La pensée et le langage par le corps dans la schizophrénie

Connections between body and psyche are regularly studied in the field of psychosis. One of the reasons of that recurrence is the fact that schizophrenic psychosis deconstructs the discursive system and exposes its bodily roots. In the first part of this paper, we remind several authors (Dolto, Pankow, Aulagnier, Golse, Delion, Piaget, Stern i.e.), whose works are showing how the mind develops on the basis of sense - and bodily experiences. In the second part, we examine the specificity of the schizophrenia as regression to the autoerotism and we mention Freud's idea of the “organ's language”. The organ's language represents the use of bodily symbols into the discourse; those symbols have to be interpreted like dreams. Finally, two clinical examples illustrate those elements. We examine the idea that, even if the nosographic category “schizophrenia” has not necessarily to be defended, there is perhaps a common clinical feature defined by the place of the body in the discourse.     

Apathie ou dépression ? Une question de nez ? Illustration par quatre cas de tumeurs frontales paramédianes

We report four cases of patients with clinically isolated apathy which was mistaken for depression even though they were suffering from voluminous brain tumors. These cases remind us that rigorous clinical analysis is essential: searching for signs of organic origin or psychiatric etiology is fundamental to avoid an incorrect diagnosis. In particular, these four patients displayed anosmia, an uncommon symptom for patients suffering from depression. In addition, brain imaging is important to correctly identify the most prudent medical and/or surgical management strategy. In this short discussion, we propose an algorithm for the clinical diagnosis of apathy.     

Peut-on tuer (violer) par procuration ? Traumatisme et transmission transgénérationnelle

This article considers the possibility that some delictuous acts or crimes in the family can be unconsciously induced in the author by a member of his family. Several clinical examples are presented including one concerning an adolescent who seriously beat his cousin, resulting in her death. Although the adolescent acted on his own, he also unconsciously repeated the story and the problem configuration of his mother. The principal works concerning the process of inter- and transgenerational transmission of phenomena of maltreatment and of traumatism are recalled. Mutual projective identification seems to be at work. The article ends with a plea for the investigation (court-ordered appraisal) and taking in charge of the family group as a whole, and not only the perpetrator.