Répercussions psychologiques de la pandémie de COVID-19 chez les enfants et les adolescents et modalités de prise en charge

Children and adolescents were particularly affected by the psychological consequences of the COVID-19 health crisis. They were faced with multiple stressors such as repeated confinements, the use of masks, the disruption of daily routines, the lack of social interactions following the closure of schools and the cessation of extra-curricular activities. These adversities dramatically weakened their coping strategies and their resources. In this interview with Jean-Pierre Bouchard, Olivier Sorel, Juliane Tortes Saint-Jammes et Sandie Meillerais discuss the changes that have been implemented in their clinical practice for children in the context of the COVID-19 pandemic. Then, they will also identify, by using clinical examples, the procedures specifically used to develop, reinforce or reactivate the resources of children and adolescents during the therapy. Finally, they address the very notion of clinical support, with an emphasis on EMDR therapy and a family-centered approach.     

Séances par téléphone dans le contexte du Covid-19 : le cadre et ses limites

To deal with the Covid 19 pandemic, health protection measures require changes to our clinical practices. Faced up with the unprecedented nature of this situation, the liberal psychotherapist is led to rethink some aspects of the framework of his practice in order to preserve the thread of the transferential relationship. The authors develop a clinical reflection on the clinical setting in a pandemic period by exploring in particular the dynamics of telephone sessions. For telephone interviews, the question of the sound envelope is central, in particular regarding the psychic function of silence. We choose to illustrate our point with short vignettes than by relying on long-term clinical cases, more likely to represent the variety of new clinical situations encountered and the questions that accompany them. This article introduces his point by recounting the plague epidemic in ancient Greece to show the impact of the environment on humans and its collective fantasy implications. Being faced up with death, contamination, the invisible enemy brings out a palpable concern. It is indeed quite remarkable that these same reactions and concerns in front of death caused by the pandemic match whith what is related by Thucydides who survived the plague, which affected Athens during the Peloponnesian War. In another context, Winnicott highlights the place and importance of the therapeutic environment. It is both a question of adjusting the framework according to the context while maintaining certain intangible aspects representing the permanence of the link and its framework. A framework cannot exist without being kept, which is equivalent to thinking of the framework above all as an internal framework, questioning the clinician about what he values and what he makes sense in his practice. In the current context, these questions arise from the perspective of a certain flexibility, depending on the human context (child, adolescent, consultations, etc.) or external context (crisis linked to a virus, etc.) showing that it is more than never question of exercising on a case-by-case basis, taking into account changes in the environment. The initial observation during this period of confinement concerns the fact that some patients contact a therapist for the first time by telephone and wish to initiate psychotherapy (during this period) when they explain that such an initiative was not possible. despite the difficulties already encountered in the past. But there is also the opposite case: patients who have no intention of continuing the work already started during this time. Thus, faced up with the injunction of confinement, they show themselves in the psychic impossibility of following the treatment by other means such as, for example, telephone sessions. In this perspective, the silence on the phone takes on a different tone; silence reveals itself to be a source of greater anxiety than in presence: the presence of bodies, of its movements perceptible as imperceptible, of a gesture that carries or accompanies the senses, breathing, the visual context of the office and of its “decor”, represent as many essential elements in the usual capacity of the frame; in the absence of these basic sensory elements, silence can be experienced as a void, or even a gap in the bond, opening Pandora's box of paranoid fantasies acting unconsciously. If silence is representative of the whole framework, it promotes in this context the partialization of the clinician's body reduced to one ear and not to a whole body. Here, it is the change of framework that mobilizes the difference, established by Mr. Klein, between the partial and total object; this circumstance neo-framework could therefore call for regressive movements, undoing the silence of its symbolic function when the bodies are present.     

Comportements suicidaires à l’adolescence en situation de migration : expériences masculines

ObjectivesSuicide is the second leading cause of death among adolescents. Boys are more affected than girls, although they report fewer suicide attempts and rely less on care. Few studies have examined the experience of suicidal thoughts and behavior among young boys. In order to improve their health care, it is necessary to consider the socio-cultural aspects and the construction of the meaning given by adolescent boys to suicidal behaviors in France.MethodThis is a qualitative, complementary and inductive study. All teens included have presented suicidal thoughts in the months preceding the inclusion. The existence of self-mutilation and/or suicidal act is sought but is not included within the criteria of inclusion, the various contexts will enrich the data. Semi-structured interviews are transcribed and analyzed by the Interpretative Phenomenological Analysis.ResultsTen adolescents between 14 and 20 years old were included in the study. Three axes of experience emerge: the relationship to oneself, the relationship to the other, the relationship to death. Some themes are common to experiences of both boys and girls, others are more specific to the boys’ experience. The inner struggle, testing one's limits and an isolating unspeakable are thus common, highlighting the difficulty for adolescents to mentalize and verbalize emotions and feelings. Difficulties in connecting with others, and feelings of loneliness and isolation, are at the core of the participants’ experience. However, the experience of boys appears specific in the difficulty to represent the irreversibility of death which can lead to suicidal behavior without direct intentionality. The narrative of suicidal acts, in its formulation, is quite different from that of young girls. One can assume that the difficulty of expressing suffering could lead young boys to develop a discourse that overshadows the question of their death, or in contrast magnifies it in a rewarding stage from which they pride themselves. The fear of being isolated or rejected seems almost insurmountable for the boys interviewed. The fear of the judgment of peers or the family is mixed with the imperative to face the problem by oneself and reinforces the feeling of isolation in a retroactive loop. The story of the suicidal act can take a positive and enriching tone in the participant's stories. This only applies to adolescents with a history of suicidal gesture. The experience of acting out and its consequences seems to be integrated by the adolescent as elements which participate to a certain extent to the construction of their identity. This ameliorative feature can be compared to the hegemonic social models of masculinity. The sociological notion of gender identity makes it possible to think of this construction in a dynamic way and to propose adaptations of the caregivers’ attitude during the first interviews with a suicidal teenager. During the first meetings, the caregiver should explore the adolescent's representations of the suicidal crisis in a neutral, self-interested, and unbiased way, including when the representations are disturbing or shocking for the caregiver. For example, when the patient values or glorifies suicidal behavior or when care is experienced as a sign of weakness and vulnerability. Respect of these proposals can indeed support weakened narcissistic foundations and favor encounter and alliance. This can only be done with the conviction that these representations are not frozen, but in construction, and that they can be secondarily mobilized in the therapeutic relationship. For that purpose, a work of elaboration on the representations of the masculinity will be able to lead the young person to reconsider his perception of care and suicidal behaviors. Reflexivity on the part of the caregiver about his own representations of masculinity seems necessary.ConclusionTherapeutic management must explore and respect the adolescent's representations of masculinity and then mobilize them to bring the young person to reconsider his perception of care and suicidal behavior.     

Quand l’incertitude de la maladie cancéreuse attaque les liens : effet de la dynamique transférentielle

Cancer is a disease that is widely known to the general public. It is also one of the most feared diseases in France. Thus, when it strikes, everything is shattered and life becomes uncertain. The pathology is a source of uncertainty for the patient but also for his family and loved ones. Nevertheless, how do we cope with it, with these changes and these new points of reference in life? This questioning marks the starting point for our reflection on the process of uncertainty in oncology. This article focuses on the experiences of uncertainty experienced by cancer patients, their families and carers. Here we will focus on the question of the patient's links concerning transfer, and we will attempt to understand how cancer and the related uncertainty will impact, attack or create these links and, more generally, how the transferential relationship will modulate uncertainty. In this paper and to understand this complex process, we will illustrate our sentiments through the journey of a patient, encountered at different times during her illness.     

Impact psychologique de la pandémie de la COVID-19 : comparaison entre des Français métropolitains et de l’île de La Réunion

ObjectivesThe COVID-19 pandemic raised a lot of anxiety around the world. France is composed of several overseas territories with major cultural differences but also with a different exposure to the COVID-19. Reunion Island is the most populated overseas French department, but few researches have focused on this population. Therefore, the main objective was to explore and compare the impact of the COVID-19 pandemic (perceived stress, risk and fear of being infected, severity, lockdown respect, perceived stress, quality of life, quality of relationship, loneliness, resilience) during the lockdown among residents of metropolitan France and of Reunion Island.Material and methodsA sample of 347 participants, aged from 18 to 78 (M = 37.90; DS = 13.20) replied to a questionnaire posted online during the last ten days of the lockdown in France. The sample is divided into 227 metropolitans (M = 38.24 DS = 13.41; 13.2% of men) and 120 residents of Reunion Island (M = 37.26; DS = 12.81; 31.7% of men). Resilience, loneliness and perceived stress have been assessed using validating scales while specific items have been created to assess COVID-19 impacts.ResultsThe majority of the total sample has been little exposed to the COVID-19, but the estimated severity was high throughout the sample. Several significant differences have been observed between overseas and metropolitans. The latter, who were more exposed, were more respectful of lockdown measures and felt more concerned about being contaminated. They also had different professional activities (work at home, stop working) since the lockdown than did the overseas sample. Non-significant higher scores of resilience and quality of life during the lockdown contrast in the overseas sample, who estimated risk, fear and severity similarly. In correlational analyses, many relationships were significant only in one sample. For example, in metropolitans the higher the loneliness, the higher the severity. In the other sample, the higher the perceived stress, the higher the respect of lockdown measures, while more metropolitans felt lonely the more they respected these measures. Regressional analysis showed different predictive variables of the scores of perceived stress and fear of being contaminated. In metropolitans, stress was explained by COVID-19 related variables (fear, severity, respect), loneliness and negatively by resilience and quality of life while in the other sample it was explained by fear of being infected and negatively by resilience. Fear of being infected was explained by risk and stress in the overseas, but also by quality of life in the metropolitan sample.ConclusionsThis study brings new data on the important psychosocial impact of the COVID-19 pandemic on two French samples. Observed differences highlight a higher fear of being infected among the metropolitans who were generally more exposed. Overseas from La Réunion did not feel more spared by this risk, despite the limited number of cases since the appearance of the first case in March 11th and the end of the lockdown in May 11th. Despite exposure, our results could be explained by several cultural differences such as way of life or beliefs. Overseas life in Reunion Island might bring more resilience and less loneliness given the particular familial, social and religious functioning. Given the limits of this study and the lack of similar comparisons, more work could highlight the protective factors of these populations.     

Psychopathologie phénoménologique et monde social : les limites de l’empathie et de la sympathie chez le pervers,le psychopathe et le schizophrène

ObjectivesThe aim of this paper is to highlight some conceptual difficulties related to the notions of empathy and sympathy in the field of psychopathology.MethodsStarting from a definition of these concepts inherited from Max Scheler, we study three diagnostics: the pervert, the psychopath, and the schizophrenic.ResultsEach of these diagnostic entities is characterized by specific modalities of adherence to the social world revealed by an in-depth analysis of empathy and sympathy.DiscussionWhile the psychopath and the pervert appear to be empathic (but have a different relationship to sympathy), the schizophrenic presents an empathic deficit while preserving a sympathetic consideration of others necessary to identify in a therapeutic context.ConclusionsTaking phenomenological psychopathology and the social world into account is instructive and provides clarifications about the psychological functioning of the three figures studied.     

Immuno-psychiatrie et pandémie de SARS-CoV-2 : liens et possibles conséquences

ObjectiveThe SARS-CoV-2 (or COVID-19) pandemic has been propagating since December 2019, inducing a drastic increase in the prevalence of anxious and depressive disorders in the general population. Psychological trauma can partly explain these disorders. However, since psychiatric disorders also have an immuno-inflammatory component, the direct effects of the virus on the host's immune system, with a marked inflammatory response, but also the secondary inflammation to these psychosocial stressors, may cause the apparition or the worsening of psychiatric disorders. We describe here the probable immunopsychiatric consequences of the SARS-CoV-2 pandemic, to delineate possible screening actions and care that could be planned.MethodData from previous pandemics, and existing data on the psychopathological consequences of the SARS-CoV-2 pandemic, allowed us to review the possible immunopsychiatric consequences of the SARS-CoV-2 pandemic, on the gestational environment, with the risk of consecutive neurodevelopmental disorders for the fetus on one hand, on the children and adults directly infected being at increased risks of psychiatric disorders on the other hand.ResultsAs in previous pandemics, the activation of the immune system due to psychological stress and/or to infection during pregnancy, might lead to an increased risk of neurodevelopmental disorders for the fetus (schizophrenia and autism spectrum disorders). Furthermore, in individuals exposed to psychological trauma and/or infected by the virus, the risk of psychiatric disorders, especially mood disorders, is probably increased.ConclusionIn this context, preventive measures and specialized care are necessary. Thus, it is important to propose a close follow-up to the individuals who have been infected by the virus, in order to set up the earliest care possible. Likewise, in pregnant women, screening of mood disorders during the pregnancy or the postpartum period must be facilitated. The follow-up of the babies born during the pandemic must be strengthened to screen and care for possible neurodevelopmental disorders.     

Facteurs prédictifs de l’anxiété des étudiants durant la pandémie (COVID-19)

IntroductionThe coronavirus disease (COVID-19) pandemic has caused a major health crisis and the quarantine of most of the planet's population. During confinement, anxiety symptoms may appear. The pandemic dramatically changes the lives of individuals by becoming a concrete manifestation of the threat. Constant exposure to information about the virus can increase anxiety, especially since the information may be erroneous or contradictory. This article examines the factors that predict student anxiety in the context of a pandemic.MethodThe quantitative study involves a sample of 445 students from the University of Quebec in Abitibi-Témiscamingue. Anxiety was measured using the Beck Anxiety Inventory, and several sociodemographic variables were tested.ResultsThe results demonstrated the effects of certain variables on anxiety, especially for women and non-binary people, were more marked than for men. Having dependent children has proven to be a protective factor.ConclusionThe study suggests that this variability is now considered when proposing intervention measures in a containment context. The limitations and perspectives of the study are presented and analyzed.     

Traumatisme et résilience associés à la pandémie de la COVID-19 dans les villes de Bafoussam et de Dschang au Cameroun

IntroductionThe emergence of the Covid-19 pandemic in Cameroon, as in Africa and around the world, was marked by a suddenness and unpredictability that fascinated the imagination. The considerable psychic and social repercussions of the pandemic mobilized a significant anguish of death. The sudden onset of the pandemic was followed by spectacular, high-profile deaths that fascinated the imagination, listing it in the order of traumatic events, provoking reactions of astonishment, flight and avoidance.GoalThe objective of this study is to determine the symptomatology of post-traumatic stress disorder, as well as the resilience, associated with the Covid-19 pandemic in the Western Region of Cameroon.MethodologyThe research was carried out following the model of general population mental health surveys. The availability of area frames (sampling) made it possible to opt for probabilistic calculations. First and second year master's students in clinical psychology from Dschang University were involved in data collection. They benefited from a two-day seminar on data collection techniques in the general population. The calculated sample size is 384 households. The anticipated response rate, set at 90%, made it possible to increase robustness and to anticipate a total sample of 424 households, spread over 3 districts of Bafoussam and Dschang, according to the choice previously made. The study followed the ethical provisions of the Helsinki Protocol. The data collection tools used are: the Impact of Event Scale-Revised and the Connor-Davidson Resilience Scale.Results409 subjects were recruited, representing a completion rate of 106.5%. 70.7% of subjects exhibited symptoms of PTSD. These symptoms are more often mild (40.9%) or moderate (25.6%). Women are more affected (73.7%) by PTSD than men (67.9%). In addition to sex and age, area of residence and marital status, appear to be significantly associated with symptoms of PTSD: subjects under 35 years of age have a significantly higher prevalence rate than those over 35; the rate of PTSD is significantly higher in subjects living in urban areas than in those living in rural areas; single subjects are more affected by PTSD (40.1%) than married subjects (26.7%). The average score recorded on the CD-RISC is 64.3, the standard deviation is 15.3 and the coefficient of variation is 24%. This average falls into the second quartile of the distribution, indicating average resilience. CD-RISC scores are not affected by gender, age, marital status, level of education, or occupational status. These characteristics are therefore not factors of resilience.ConclusionThe Covid-19 pandemic has had a psychological impact in Cameroon which has made it a major psychosocial stressor. More than 6 in 10 people have symptoms of PTSD. But this symptomatology is often weak or moderate, testifying to an effective resilience, to balance the traumatic effects of the pandemic.     

La force du vrai en déclin : les formes de subjectivation à l’ère de la post-vérité

ObjectivesIt has become a commonplace in research in human, social, and political sciences to refer to the current era as being one of “post-truth”. Considering the discontinuity between discourse and truth today, this article aims to identify under which regimes the force of truth is in decline and to indicate some contributions of authors from the psychoanalytic tradition, in order to reflect on the engagement of subjects in discourses of truth.MethodFrom a historical perspective, we refer to Foucault's analysis to identify, in the notion of “force of truth”, a conception of truth established between knowing and power. Then, we propose, based on the theoretical propositions of Freud and of Deleuze and Guattari, (1) an interpretation of the current decline of the truth, and, from Lacan's contributions; (2) possibilities for emphasising the dimensions of otherness and of the limits of the discursive in the experience of truth.ResultsGiven the failure of modern regimes of truth based on the knowledge model and the detachment of subjectivities from the discourses of truth, we identify the rise of a narcissism of small differences and a modality of fascism that submits differences to a principle of identity. Considering this scenario, the psychoanalytic approach demonstrates how powerfully the other occupies an unavoidable place of difference in the experience of truth. This perspective recovers another tradition of truth, which, associated with the subject's work on her/himself, implies the possibility of subjective transformation.DiscussionBy problematising the experience of truth based on knowledge and determined by a metaphysical tradition of the soul (psykhé), that is, by defining ontology as the subject's way of being, we highlight other possibilities of the subjectivation of truth based on the dimension of life (bíos) and of existence. By conceiving of telling the truth in psychoanalysis according to Lacan's reading, we question how this perspective reintroduces the question of the force of truth in the field of ethical discussion.ConclusionsBy promoting the return of truth through a clinical investigation of the subject, Lacan's contribution to psychoanalysis allows us to establish a critique of contemporary forms of subjectivation based on the principle of identity, and to redefine the place of otherness in discourses of truth. The determination of the limits of speech in the apprehension of the real does not give rise to a renunciation of the experience of truth, since, besides being inscribed in the tradition of knowledge, it can be situated in an aesthetic approach, in which the force of truth engenders stylistics of existence.     

Variation des fonctions cognitives et de la glycémie lors de l’exercice physique durant le jeûne du mois de Ramadan

IntroductionDuring the month of Ramadan, Muslims fast every day from dawn to sunset. Several studies have shown that Ramadan fasting affects biochemical parameters, sleep/wake cycle, behaviour and food habits.The purpose of the study was to evaluate the effect of Ramadan fasting (RF) and physical exercise on cognitive functions, blood glucose.MethodsEleven healthy male volunteers aged 20.45 ± 1.65 years were assessed before RF (B.RF), during the 1st week (wk), 3th wk and 1 wk B.RF, in blood sugar, work memory (WM), visual perception (VP), before exercise (B. Ex) and after exercise (A. Ex) exercise of 1000 m.ResultsCompared to control days (B.RF), there were no significant changes in body mass index. Physical performance declined significantly during 1st wk (p < 0.001), 3th wk (p < 0.013) and before (p < 0.046) of RF.At the level of the glycemia, the results show a significant effect of Ramadan by increasing gradually during Ramadan but nevertheless, the values remain lower of 100 mg/dl. No significant change was observed between B. Ex and A. Ex value in WM during RF. However, the WM A. Ex value increase significantly during and after RF (respectively 1st wk (p < 0.013), 3th wk (p < 0.005) and before (p < 0.003). The VP was significantly affected by fasting effect (F = 16.84, p < 0.001) and exercise effect (F = 14.01, p < 0.0001), and was progressively increased 15.56% in the 1st wk, 25.69%, the 3th wk during RF, and 27.07% A.RF, but no significant change was found in errors performances of VP during and after RF.ConclusionThese results showed that the intermittent fasting imply differently effects on cognitive functions and physiological.     

Quand l’homme est battu par la femme : réflexions psychanalytiques sur l’inversion des pôles de violence de genre dans le couple

Objective

In this article, the authors explore the clinical issues of domestic violence from a particular viewpoint: when the man is beaten by the woman.

Familles et patients souffrant de schizophrénie : comment envisager les soins et l’accompagnement lors de l’avancée en âge ?

One may often find it difficult to envisage how a patient with a long-term disease might worry about their future, particularly about how they will adapt to their ageing process. Disease, old age and death are realisations that go beyond the mind's integration capacity. This capacity might also be further impaired by the symptoms. After many years of pain one may still hope for a recovery. This might not always be possible. The disease's general course is in most cases unpredictable and requires anticipation, planning of life conditions, and provision of care. The relatives who are also getting older should be able to count on a reliable presence for the disabled person throughout the multiple risks of disruption in the treatment and on-going support. Finally, should a worsening process be feared, as in the senile evolution? These topics are seldom raised in the medical world and often go unaddressed in professional assessments of patients’ care and social life. The scarcity of epidemiological studies on the matter supports this point. The transition from autonomy to dependency should systematically be envisaged and should not be limited to the 60-year-old threshold.