Efficacité de la médecine thermale en psychiatrie

Objectives

Relatively little known in psychiatry, spa psychiatric medicine is an original approach, which has started to form the subject of thorough assessments. It concerns 3 week spa therapy stays in practice, the patient being totally free and self-sufficient, though having to go to 3 to 4 prescribed daily bathing sessions and to the medical and psychotherapy follow-up provided within the scope of their medical care. Since the beginning of the years 2000, Spa Medicine has been subject to studies that have better shown the outline and its potential application areas. We present you here, through a review of the literature from these past 30 years, the main elements of scientific proof of its therapeutic activity and as a result, its best documented indications in psychiatry. Therefore, the article is stated by chapter, indication by indication.

Freins à l’abord des troubles du comportement alimentaire en médecine générale

IntroductionGeneral practitioners (GP) are the most suitable candidates to screen for eating disorders (ED), which affect 0.6 to 4.5% of the population over their lifetime. 13% of adolescents are concerned if we consider sub-syndromic form. The outcome of ED improves with early detection but 50% of patients are still not identified in primary care.AimTo explore GP's representations of ED and the barriers they face while broaching the subject in practice and to understand this under-screening of ED.MethodIt was a qualitative study by focus groups. The five focus-group need for data saturation were transcribed and the verbatim was double coded and analyzed by the grounded theory.ResultsThe focus on anorexia nervosa, a BED remaining unrecognized and the misidentification of obesity as an ED were the main representations of the asked GPs. They considered ED as being bound to the intimacy of patients, just as sexuality would be, they feared to be too intrusive while approaching them and to compromise the patient-doctor relationship. The time-consuming part of such consults, the unknown assessment tools, a perceived lack of communication and psychological skills, the feeling of helplessness and lack of a psychiatric support stood in the way of approaching ED in general practice.ConclusionTraining for time-saving communication techniques, organizing a dedicated screening consult, a well identified psychiatric network or free psychotherapy sessions are ways to improve screening of ED. To study how psychiatry can be more positively perceived would be a first step to overcome its induced mistrust.     

Alcoolisation à risque chez des étudiants en médecine parisiens

Objectives

Binge drinking is widespread in medical students but is poorly studied in France. The aim was to evaluate the number of binge drinking episodes and to better characterize them among a sample of French medical students.

Perceptions des externes en médecine lors de leur stage en pédopsychiatrie : étude qualitative

ObjectiveA part of medical students complete their psychiatric traineeship in adolescent psychiatry. They have to face with patients close in age. Furthermore, a few medical students are themselves still in an adolescent stage: cerebral changes of pubertal development occur until 24 years old; while medical studies length prevent from earlier empowerment. This study seeks to understand medical students’ personal experience during their adolescent psychiatric clerkship to enhance mentoring.Patients and methodsA multicentric qualitative study was conducted using Interpretative Phenomenological Analysis methodology. Data were collected through semi-structured face-to-face interviews among eight medical students from 18 to 25 years old after completing their clinical clerkship. In-depth analysis were performed using Nvivo software program.ResultsData analysis found three major themes; 1) loss of usual clinical work references and confusion regarding their previous experiences (absence of white coat, fewer traditional medical hierarchy, adjustment of appropriate relationship with patient, difference between normal and pathology); 2) discovery of psychiatric care supports both moving beyond first stigmatization attitude toward patient with psychiatric disorders and increasing empathy toward patients’ stories; 3) strength of psychoaffective involvement and identification, including confusion between patients and their own family stories.ConclusionAdolescent psychiatry clinical clerkship means a particular involvement for undergraduate medical students. It suggests a need to enhance mentoring.     

Distorsion des consensus scientifiques dans les thèses de médecine dédiées à l’hyperactivité/TDAH en France

Attention Deficit and Hyperactivity Disorder has first been defined in the third version of the DSM published in 1980. Though it still lacks a consensual biological etiology, ADHD is the most common mental disorder among school-age children nowadays. Several recent studies have however highlighted considerable distorsions between international scientific consensus and information provided to the general public. Those distorsions always favor biomedical approaches of ADHD and support the use of psychostimulant medication. They hence overshadow the psychosocial factors contributing to the disorder and leave no room for other therapeutic approaches like psychodynamic psychotherapies. We therefore deemed it necessary to investigate the content of medical theses focusing on this particular disorder. In this article, we examine the representations of hyperactivity in medical theses dedicated to ADHD in France, based on the systematic analysis of a corpus of 45 theses defended between 1990 and 2018. Our corpus was analyzed using the following questions: 1) does the thesis support a biomedical or psychoanalytical approach to ADHD? We used the term “combined approach” when both points of view were argued; 2) for each thesis, is the biological etiology of ADHD – genetic, neurological or neurodevelopmental – mentioned and discussed?; 3) are the environmental and social factors of hyperactivity also discussed?; 4) do medical theses present the risks associated with ADHD: academic failure, delinquency, substance abuse?; 5) what treatment do medical theses recommend in the care and support of children diagnosed with hyperactivity: drug treatment, psychotherapy or a combination of both?; 6) does the use of a psychostimulant treatment protect against the risk of school failure: yes/no/both opinions?; 7) is it possible to diagnose ADHD hyperactivity by brain imaging?; 8) finally, we sought references to scientific work or experts involved in conflicts of interest with the pharmaceutical industry – references in the text body or bibliography. We also looked for critical indications for the risks of over-medication of ADHD. The results we obtained indicate major distortions (94.5 %) in scientific knowledge concerning the etiology of ADHD, the approved methods for diagnosis or the benefits of psychostimulant medication on academic performances. Indeed, though hundreds of studies using MRI imaging have failed to show any neurological lesion associated with ADHD, 91 % of our corpus supported a neurological etiology of this disorder. Similarly, 87 % of our corpus wrongly described ADHD as a genetic disorder, and more than 50 % still affirmed MRI could be used to diagnose ADHD, despite the scientific consensus claiming the opposite. Psychostimulant medication was also the most mentioned form of treatment, despite it theoretically being a « last resort » treatment. Our results suggest there might be a biomedical ideology determining physicians’ representations of ADHD. This ideology could have an impact on physicians’ care pratices with children suffering from ADHD and their families, thus possibly increasing the risk of over-medication. It could also lead future practitioners to underestimate the importance of their diagnostic skills and the therapeutic work they engage into.     

L’expertise en santé: quel devenir?

This text presents some elements of reflection of the president of the national company of medical experts of justice on the future of the expertise in health according to the current state. In particular, it stresses the importance of scientific progress in constant change, and the importance of the impact of digital with instantaneous and global dissemination of data via the Internet. However, there is still a question about the reality of the future, which often involves unforeseen data.     

Le trouble de conversion en médecine interne : 37 observations

ObjectivesTo describe the clinical characteristics of a series of patients presenting conversion disorder in a general internal medicine ward and outpatient clinic, the arguments retained by the physicians in favour of the diagnosis, the somatic and psychiatric co-morbidities, the management and the outcome of the disorder.MethodsWe report the study of 37 patients diagnosed with conversion disorder in an internal medicine department of a French university hospital over a period of 14 years. We retrospectively reviewed the charts of the patients and contacted their primary care physicians to obtain follow-up data. No structured instrument was used for the diagnosis of conversion disorder or for the assessment of psychiatric comorbidities.ResultsAs expected, patients were mostly young females, although a great variety of age, gender, and socio-cultural background was observed. Motor symptoms predominated (62%). A relevant psychogenic factor was explicitly mentioned in only 43% of the cases. In many cases, organic disease was also present, and an organic cause for the symptom initially considered as conversion was suspected in 3 cases. Depressive and anxious disorders were present respectively in 38% and 35% of cases. A pain complaint was associated in half of the cases. Among patients for whom follow-up data is available, conversion symptoms persisted or recurred in 70% of cases and were associated with a poor quality of life.ConclusionThis case series confirms that the DSM-IV-TR criterion of “psychogenicity” (later abandoned in DSM-5) is highly problematic in clinical practice. It suggests a close relationship between conversion disorder and unexplained chronic pain.     

Burnout chez les résidents en médecine tunisiens : à propos de 149 cas

Background

Burnout is a professional psychological chronic stress-induced syndrome defined by three dimensions: emotional exhaustion, depersonalization, and low personal accomplishment. This syndrome concerns all professions but especially healthcare staff. Numerous studies have attempted to document the impact of work activities on the doctor's mental health. According to the literature, junior doctors are more vulnerable to develop this syndrome.

L’auto-expérimentation physiothérapique et médicamenteuse,d’Esquirol à Cornelia Quarti

Various examples of self-testing of substances and therapeutic methods used in the field of mental medicine are given: shower, rotary machine, electroshock, Datura, nitrous oxide, rye ergot and haschisch, intravenous acetylcholine and chlorpromazine. What drives a doctor to experiment and not to experiment, what personal experience brings to scientific knowledge and medical practice.     

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.

Itinéraire thérapeutique des enfants atteints de paralysie cérébrale admis en médecine physique et de réadaptation (MPR) à Abidjan en 2018

ObjectiveTo analyze the different stages of the medical and rehabilitation follow-up of children with cerebral palsy (CP) before their admission to the PMR department.MethodsCross-sectional study analyzing the care pathway of 58 children with PC before their admission to the MPR department of the Yopougon University Hospital over the period from June to September 2018.ResultsThe majority of children with male CP (58.6%) were the first or second child in the siblings. The parents lived as a couple (84%) and resided in the city of Abidjan (87%) but the children lived with both parents in 77.6%. Diagnosis made in a university hospital (46.5%) or in a clinic private (29.3%) by specialists in pediatrics (53.4%) and neurology (34.5%). The time to diagnosis was more than 6 months in 55.2 %. These parents used several therapies: medical (62.07%), traditional (31.03%) and spiritual (6.90%). The most used therapeutic route was medical-traditional-medical (29.3%). The factors influencing the choice of route were the parents’ culture and beliefs (75.9%) and family and economic factors.ConclusionNeed to develop a precise therapeutic circuit for children with CP.