La faible estime de soi est corrélée à l’intentionnalité suicidaire,indépendamment de la sévérité de la dépression

Introduction

Suicide is a major Public Health concern, and low self-esteem might represent a major risk factor. Our main objective was to assess the correlation between self-esteem and suicide intent. More specifically, we aimed to examine the relationship between the different dimensions of self-esteem (total, general, familial, professional and social) and suicide intent. We also sought the role of depression in the relationship of self-esteem to suicide intent.

Jeu d’argent problématique et responsabilité pénale

ObjectivesIn total, 14% to 30 % of individuals with gambling disorder engage in illegal acts to finance such behavior. This clinical situation could be explained by higher gambling severity, associated substance use disorder, antisocial personality disorder and economic factors (debts, financial problems). The present work focuses, more broadly, on criminal responsibility of problematic gamblers.MethodsWe will discuss this question through different typical situations that medical experts of criminal responsibility may have to face. We will address each of the following cases: 1) isolated problematic gambling; 2) problematic gambling associated with antisocial personality disorder; 3) problematic gambling associated with a manic episode; 4) problematic gambling associated with substance use disorders; and 5) problematic gambling associated wiht dopamine agonist treatment.ResultsIsolated problematic gambling, (not associated with any psychiatric or addictive disorder): it seems consensual that individuals committing infractions in this case are criminally responsible. However, impeded ability to action control and possible sentence attenuation could be discussed in case of severe gambling disorder. Problematic gambling associated with antisocial personality disorder: if the penal offence reports solely to personality disorder, criminal responsibility would be attributed. However, if illegal or violent acting is directly linked to co-cocurrent delusional symptoms, it could be a cause of criminal non-responsibility. Problematic gambling associated with manic episode: manic episode related offence could lead to negation of criminal responsibility, while a hypomanic episode may provide grounds for sentence reduction. Problematic gambling associated with substance use disorders: in France, addiction is not considered to remove nor to impede a person's ability to understand or control his actions and is excluded from criminal non-responsibility causes. However, substance induced delusional or confusional episodes could abolish a subject's discernment or his ability to control his actions yielding to penal non-responsibility. Problematic gambling associated with dopamine agonist treatment: Criminal responsibility for dopamine agonist induced gambling related illegal acts is still controversial. Nevertheless, people committing an infraction linked to associated dementia or dopamine agonist induced mania should be considered as criminally non-responsible.ConclusionsSome clinical dimensions such as craving intensity, compulsivity, disorder's severity, volitional control might be forensic targets to assess criminal responsibility.     

Spasticité chez l’enfant paralysé cérébral : quelle définition pour quelle évaluation clinique ?

Spasticity is a common motor impairment in children with cerebral palsy (CP). Since the version of Lance in 1980, the definition of the term “spasticity” has been modified many times without becoming consensual. Since many years, spasticity is integrated in global concepts and defined as one of factors leading to an increase neuromuscular resistance of spastic and paretic muscle lengthening. The clinical assessment of spasticity is classically performed using ordinal scales, which psychometrics properties are limited. Distinguishing spasticity from others factors and accurate quantification of its level are majors’ difficulties. The objective of this article is (1) to clarify the sense of the term “spasticity” from a summary of the evolution of its definition since 1980 to nowadays, (2) describe psychometrics properties of the clinical scales assessing spasticity.     

La vasomotricité cérébrale du point de vue clinique et thérapeutique

Résumé Les auteurs rapportent 82 observations d'hémiplégie d'origine vasculaire traitées par le blocage chirurgical ou pharmacodynamique du sympathique cervical. Les résultats observés sont dans l'ensemble décevants. Cependant, des améliorations incontestable et par-fois spectaculaires peuvent être obtenues par l'infiltration stellaire, chez des malades vus très précocement, dans les six heures qui suivent le début de leur affection.

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Zusammenfassung Die Autoren berichten über 82 Fälle von Hemiplegien vasculärer Genese, die durch chirurgische oder pharmakodynamische Blockade des cervikalen Sympathicus behandelt wurden. Die erzielten Resultate sind im allgemeinen enttäuschend. Immerhin können unbestreitbare und oftmals unglaubliche Besserungen durch Infiltration des Ganglion stellatum bei Kranken erzielt werden, die frühzeitig, in den ersten sechs Stunden nach Beginn des Insults, der Behandlung zugeführt werden.

     

Cancer du sein,activité physique adaptée et qualité de vie

Objectives

According to the National cancer institute (2013) and with 43,763 listed cases in France during the year 2012, breast cancer is the most frequent cancer for women. With a survival rate of 85% after 5 years, the prognosis is very positive. After a breast cancer diagnosis, an estimated of 60% of the women develop one or several side effects (fatigue, life quality deterioration, risk of gaining weight, physical deterioration, risk of lymphedema, etc.). Studies show that physical activity (PA) has positive effects on these risk factors which form the co-morbidity linked to breast cancer, as well as the patients’ quality of life. Moreover, the adapted physical activity (APA) adds to the recommendations of cancer plans 2 and 3, which promotes PA to all cancer patients in order to reduce after effects and risks of recurrence. PA means all the different movements, made by the contraction of inner skeleton muscles, leading to an increase of physical and energy exertion (professional or occupational activities, leisure activities, domestic activities, moving activities). APA is setting in motion the people who, due to their physical, mental, or social status are not able to have a normal/common PA. The word “adapted” means that the PA is adjusted to everyone's abilities and capacities, which means to the participants’ capacities and not to their incapacities. Researches have shown that a regular APA allows an organism activation which fights off harmful effects of sedentary lifestyle and thus avoiding interactions with existing pathologies or specific lifestyle conditions. Besides, studies show that breast cancer patients that have no PA feel more anger, fatigue, depression and mood disorder than the ones who have that activity. Adapted physical activity fencing (APAE) was created in Toulouse by Hornus-Dragne (2014). Fencing has easily became the most adapted activity for the patients (body movement, possibility of changing lateral dominance, combative spirit, etc.)

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.     

Charles Féré (1852–1907)

Journal of Neurology -     

Trouble de personnalité borderline et temps vécu

Objectives

Starting from the semiological heterogeneousness of borderline patients, we try to understand the everyday life of such subjects, and to determine the psychopathological structure of Borderline Personality Disorder.

Variabilité phénotypique et corrélations génotype-phénotype des dystrophinopathies : contribution des banques de données

The objective of this work was to study the natural history of dystrophinopathies and the genotype-phenotype correlations made possible by the development of the clinical part of the French DMD database. The collection of 70,000 clinical data for 600 patients with an average longitudinal follow-up of 12 years enabled clarification of the natural history of Duchenne and Becker muscular dystrophies and clinical presentations in symptomatic females. We were able to specify the phenotypic heterogeneity of motor, orthopedic and respiratory involvements (severe, standard and intermediary form), of the cardiac disorder (severe, standard or absent cardiomyopathy, absence of correlation between motor and cardiac involvements), and of brain function (mental deficiency in the patients with Becker muscular dystrophy, psychopathological disorders in dystrophinopathies). Phenotypic variability did not correlate with a specific mutational spectrum. We propose a model of phenotypic analysis based on the presence or not of muscular and cardiac involvements (described by age at onset and rate of progression) and brain involvement (described by the type and the severity of the cognitive impairment and of the psychological disorders). The methodology developed for the DMD gene can be generalized and used for other databases dedicated to genetic diseases. Application of this model of phenotypic analysis for each patient and further development of the database should contribute substantially to clinical research providing useful tools for future clinical trials.     

Morbidité psychiatrique différentielle selon le niveau socio-culturel

Résumé Cette recherche est consacrée à la morbidité différentielle psychiatrique publique adulte selon le niveau socio-culturel. Les résultats présentés sous forme de tableaux croisés mettant en relation des groupes ou des catégories diagnostiques avec les paramètres retenus, nous montrent des liaisons significatives en ce qui concerne la nationalité, le niveau d'instruction et de formation professionnelle, la profession, le type de logement, l'état matrimonial et le revenu familial pour quatre grands groupes ou catégories diagnostiques: les psychoses chroniques non organiques; les psychoses aiguës; l'alcoolisme; l'ensemble des états névrotiques, des personnalités pathologiques et des états dépressifs non psychotiques. De plus, cette morbidité différentielle joue différemment selon qu'il s'agit d'hommes ou de femmes.Cette recherche porte sur la morbidité psychiatrique prise en charge par sept secteurs publics d'adultes dont la comparaison et la référence à la population générale ont été effectuées dans une étude antérieure. Son objectif est de mettre en évidence une éventuelle morbidité différentielle selon le niveau socio-culturel.

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Summary The aim of the study is to demonstrate differences in psychiatric morbidity according to socio-cultural context. Four groups of disorders were studied; these were chronic non-organic psychoses, acute psychoses, alcoholism and a mixture of neurotic states, personality disorders and non-psychotic depressions. Data for these groups are presented in relation to nationality, education and further training, profession, type of housing, marital status and family income. Significant findings emerged for many of these variables, though the pattern of differential morbidity was found to be different for men when compared to women.

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Cette recherche entre dans le cadre d'une ATP INSERM n 75.52

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Chargées de Recherche à l'INSERM, Unité de Recherches de l'INSERM sur l'Epidémiologie des Troubles mentaux, Directeur: R. Sadoun. Avec la collaboration technique de M. Morel.