Syndrome de Susac : étude de cinq cas

IntroductionSusac syndrome is a rare microangiopathy, responsible for small cerebral, retinal and cochlear infarcts. The classic clinical triad includes multiple neurologic signs (from headaches to coma), retinal branch occlusions and sensorineural hearing loss.MethodsWe report a series of five patients with Susac syndrome followed in our department from 1997 to 2007.ResultsThere were four women and one man (mean age at onset: 35.2 years). Clinical symptoms at onset were neurological (n = 1), ophthalmological (n = 1), auditory (n = 1) and clinical triad (n = 2). Neurologic symptoms included encephalopathy (n = 2), headache (n = 5), transient ischemic attacks (n = 1). Brain MRI showed T2 lesions in the white and grey matter, corpus callosum and gadolinium-enhanced punctiform lesions. Cerebrospinal fluid contained an elevated protein level in three cases. Immunologic treatments (steroids [n = 4], cylophosphamid [n = 3], intravenous immunoglobulins [n = 5]) associated with aspirin and/or oral anticoagulants, despite early relapses (n = 2), led to dramatic clinical improvement (n = 5).ConclusionDue to its polymorphism the SS is difficult to diagnose when the clinical triad is lacking. In the absence of clinical trial and consensus treatment is empiric and based on supposed pathogenesis.     

Aspects cliniques et évolutifs de la maladie de Moyamoya chez des adultes français

Background and purposeMoyamoya disease is rare among non-Asian populations and its clinical features are ill-defined. We report 12 new cases of Moyamoya disease in French, non-Asian adults.MethodsWe identified adults with Moyamoya disease managed at a French University Hospital from 1998 through 2006. We reviewed baseline clinical and radiological data and collected follow-up data between March and June 2008. The risk of recurrent stroke was determined using the Kaplan-Meier method.ResultsTwelve patients, 10 women and two men, were included. The mean age at baseline was 31.1 years. The initial clinical manifestation was ischemic stroke in 10 patients. The disease was clinically asymptomatic in two patients. The mean follow-up in the 10 symptomatic patients was 52.4 months. Only one patient was surgically treated. The one and five-year risk of recurrent stroke were both 50%. At the end of the follow-up, one patient was dead, four patients had no functional impairment (grade 0–1 on the Rankin scale), and seven patients had moderate functional impairment (grade 2–3 on the Rankin scale). A cognitive dysfunction as identified by failure on the Trail Making Test part B was found in six of ten patients evaluated.ConclusionMoyamoya disease in this cohort of French, non-Asian adults was associated with high rates of both recurrent stroke and cognitive impairment. The findings suggest that Moyamoya disease in non-Asian adults is a potentially severe disease.     

Les facteurs de rémission du trouble de l’adaptation : la parole aux patients. Une étude qualitative

Background

Adjustment disorder (AD) is a frequent clinical diagnosis defined by the patient's reaction to an external factor and reversibility. While it is known that the prevalence of AD varies depending on setting and diagnostic tools utilized, the literature is rather scarce when it comes to AD's investigation or remission factors. Unlike other psychiatric disorders, the fact that there is a factor triggering AD makes it especially suitable to learn more about triggering elements, reversibility and factors of remission.

Les manifestations psychiatriques dans la polyarthrite rhumatoïde

BackgroundRheumatoid arthritis (RA) is a chronic inflammatory degenerative disease whose symptoms are mainly joint with significant functional impact, resulting in a restriction of the activities of the patient and increasing the impact on mental well-being. Several studies have been conducted to explore psychiatric disorders comorbid with RA.ObjectiveThe objective of this review is to present the various psychiatric manifestations of RA reported in the medical literature.MethodsA literature review was conducted using the Pubmed search with the following keywords: psychiatry, psychiatric manifestations, rheumatoid arthritis. Three hundred and sixty-one articles were reviewed for relevance and 47 references were selected.ResultsAmong the major psychiatric disorders found in RA, the anxiety and depressive disorders are prevalent (13 to 48% of patients), as well as suicide, insomnia and tiredness. The impairment of quality of life is markedly after age 65. The association between RA and schizophrenia seems negative so that factors predisposing one is protective for the other.ConclusionComorbid psychiatric disorders with RA are prevalent and may increase the impairment of quality of life for patients. The detection and treatment of psychiatric disorders improve the care of patients with RA.     

Les enjeux de la transition dans l’anorexie mentale vus par les professionnels : une étude qualitative

IntroductionAnorexia nervosa (AN) is an eating disorder (ED) that emerges during adolescence and may be lasting several years, or even becoming chronic. For these patients, the transition to adult care is a period of high risk of instability, relapse, symptomatic re-aggravation and increased development of co-morbidities or eventually leading to care drop-out or medical nomadism. Professionals involved in the transition process with AN patients are often challenged with various difficulties, and confronted with the need to plan this care stage. This study sought to understand the pediatricians and (child) psychiatrists experience of this transition step and to identify national practices around the transition process for adolescents and young adults with anorexia nervosa.MethodA qualitative study was carried out on the basis of thirteen recorded individual interviews with physicians specialised in eating disorders working in hospital adolescent medicine units or in adult medicine units. The methodology used was IPA (Interpretative Phenomenological Analysis).ResultsVarious difficulties and obstacles to a successful transition emerged as well as perspectives to improve the transition to adulthood care: early identification of the target population, choice of the most adapted unit to the severity level of the disease, family support during the transition, identification of a coordinating physician and enhanced networking support. The opportunity of a transition program is discussed among physicians, who are consistent on the need for guidelines.ConclusionThis qualitative study allowed us to highlight the difficulties of specialized professionals faced to the transition period with AM patients but also to consider the need for specific tools and guidelines to promote continuity to adulthood care.     

Les temps de 1968 : des sources sociophilosophiques aux restructurations anthropologiques — les fonctions de la Psychiatrie

We will focus to consider the dimensions before and after the May 1968 event, and not its history; And we will tackle four main themes: 1. The historical and societal context: on the one hand, the difficult years of France from 1960 to 1964 closely related to the events in Algeria and, on the other hand, the project of the University Reform dominated by the selection at the entrance of the University. The three evolutionary phases of events are well known: student crisis, union crisis, political crisis. In the midst of the many interpretations, we will retain especially the positions of L. Ferry and A. Renaut. The movement would be like “a cradle of the new bourgeois society. The various cultural movements are part of a dynamic that is that of individualism” (Tocqueville). 2. The general philosophical sources are thus very precise: the theme of the end more or less of philosophy which claims to be a science. The dissolution of the idea of truth. The end of any reference to the Universal. 3. The problems of Humanism: it is the appearance of anti-humanism and the development of the defeat of thought. The work of A. Finkielkraut develops very well the consequences of these currents in culture, history, sociology, literature and even the clinic with structuralism. It's time for deconstruction and great leaders M. Foucauld, P. Bourdieu, J. Derrida. This is the time of the death of the man and the agony of the subject. 4. The functions of psychiatry and psychopathology. It is in this same period, and especially after 1968, that we will see the development of the action and thought of the great psychiatrists who will focus to construct psychiatry and related sciences on the basis of anthropological structuring. Psychiatry is individualized. The reaction to anti-psychiatry is organized. And the very strong references to the great phenomenological philosophers of France, Germany and Austria contribute to the development of an open and constructive anthropology. The three major dimensions must be taken into account: bodily existence, integrative consciousness, creative freedom. And we know that clinical, therapeutic and institutional areas can benefit from the development of these major currents.     

De la vengeance pathologique : étude sur Titus Andronicus,de Shakespeare

ObjectivesThis article aims to account for the pathological dimension of certain forms of revenge.MethodologyFrom Titus Andronicus, Roman tragedy of W. Shakespeare, it's to highlight the determinants that precede the act of revenge as such, the pathological dimension of violence and revenge at Titus, and the “psychotic” signature of these acts, their unlimited nature, without brake, with the persecutives notes that one perceives in the Titus report to others as in his report to the words. Beforehand, we considered useful to make a brief summary of the literature devoted to this theme of revenge.ResultsWe’ll see how the impulsive reactions, in “mirror”, murderous and cruel of Titus, which grew still more from beginning to the end of the play, can teach us about a revenge described as “paranoïd”.DiscussionThe discussion is — among other things — the report perversion/psychosis, especially because of the cruelty of the acts committed. We’ll see that the approach from the only perspective of revenge, or only from the perspective of the “perversion” of certain acts, cannot account sufficiently the complexity of this Shakespearean character. The paranoid logic of this literary “case” seems to us more a way forward.ConclusionTitus Andronicus is a tragedy of violence and revenge. It's the first tragedy of Shakespeare, with his interests and imperfections, often criticized, little read, little staging, little commented, but interesting and teaching us about a topic revenge little studied too in the field of psychiatry, psychopathology and psychoanalysis.