Environnement familial et consommation de substances psychoactives à l’adolescence : facteurs de vulnérabilité et d’adaptation

This literature review synthesizes what is known about family vulnerability and adaptation factors towards substance use in adolescents. The introduction resets individual risk factors, such as aggressiveness, impulsiveness, sensation and novelty seeking, and psychopathological comorbidity frequently associated with addictive disorders (anxiety and depression). Peer influence plays an important role in drug experimentation and consumption in adolescence. The context of protective family dimensions is also described. Thus, parental supervision of the young, clear family rules, low levels of family conflict, as well as good communication between the young and his parents are protective dimensions with respect to substance consumption. The first part of this paper deals with family vulnerability factors involved in the development of addictive behaviors. There seem to be structural and functional differences in consumer families. Teenagers living in a single-parent family, or with divorced parents, or sharing the daily life of a parent dependent on psychoactive substances, seem more attracted by substances. Family dynamics may be dysfunctional, with problems noted including low levels of cohesion, poor adaptability and poor communication between family members. A low level of cohesion implies low attachment bonds between members. Low adaptability seems to be a strong predictor of teenagers’ addictive behaviors. The nature of relationships between family members is problematic: we can note the presence of “intergenerational coalition”, “perverse triangulation” and often a poor quality relationship with the fathers. These families also show difficulties to elaborate the process of separation and individuation, behavior allowing the teenager to aspire to independence, even if dependence to the family remains. Communication skills of consumer families seem to be poor and associated with high intensity conflicts. Mothers of dependent patients would express more hostile feelings towards consumers. To date, studies of families that have adolescents with drug problems have focused on family vulnerability factors, involved in the development of addictive behaviors, but few researchers have assessed the impacts of a consumer's addiction on his relatives. Therefore, the second part concerns the cognitive, emotional and behavioral impacts of a consumer's addiction on his relatives, and presents the different coping strategies used by relatives. Addiction causes chronic stress to the environment that could be a source of physical (e.g. sleep or appetite disturbances) and psychological (anxiety and depression) disturbances, as well as a feeling of burden. On the emotional level, negative valence feelings prevail (e.g. shame, fear, anger, sadness, guilt…). Faced with this aversive situation, relatives try to adapt by using coping strategies. There are different types of coping and some seem more appropriate, allowing an increase in physical and psychological well-being. Efficiency of coping seems to depend on the relatives’ understanding of the addiction, namely that addictions are complex, uncontrollable and joining on the long term. This review opens new research perspectives related to the practice of clinical psychologists in families that have an adolescent with substance use disorders. We could investigate individual parental coping in a multidimensional and situational prospect. Moreover, further studies could examine the couples’ adaptation strategies by investigating dyadic coping. Coping efficiency could then be analyzed and discussed with regard to family dynamics and the psychological distress perceived by the parents.     

Insight et schizophrénie : quels rôles dans le risque suicidaire ?

Suicide is the leading cause of premature death in patients with schizophrenia. Suicide risk is increased during the early stages of the disease, especially the first year after diagnosis. In this population, the coexistence of a mood disorder is an identified risk factor for suicide. Results from literature are consensual about the association between a good level of insight and an increased risk of suicide. The hypothesis that the association between insight and suicide risk is linked to the existence of depressive symptoms or hopelessness remains to be confirmed. A study of 61 patients assessed the clinical and cognitive dimensions of insight and confirms the association between a high level of insight and suicide risk. Patients who received a psycho-educational intervention had better insight. These data raise an apparent paradox. If the alteration of insight is a recognized factor of poor prognosis in schizophrenia, improve awareness of the disease should be one of the main therapeutic goals. However, a good insight is also associated with significant adverse effects. Among the programs of health education, interventions, which target and modify negative beliefs about psychotic disorders, may have an effect on reducing the risk of suicide. Regardless of the intervention model aimed at improving insight, maintaining an optimal therapeutic alliance is probably the best way to reduce the risk of suicide.     

Outils numériques en psychiatrie et art-thérapie,quels points de rencontre possibles ?

Digital has gradually infiltrated all areas of our daily lives. Health and mental health have not escaped the arrival of new technologies and has seen many new devices of care, using connected objects, applications, or artificial intelligence. However, addressing the digital issue is a delicate subject as it is clear that this field is wide and constantly evolving. However, the new possibilities offered by digital are an incredible opportunity to modernize the therapeutic setting. Moreover, the arrival of the new generation which have grown with these digital technologies requires to consider the responses to be made to the changes induced by digital technology. One of the domains which has been used by psychiatric to care their patient for years was the art therapy. This field is interested in expression and creation as a possible source of recovery. And the question of digital technology in art therapy is all the more important than numeric has already been integrated in art through the concept of numeric art. Despite this observation it could be difficult to envisage therapeutic setting modification to incorporate digital field in art-therapy as it is also important to take account of pathological aspects. To address this issue, we propose to develop in this article the current knowledge about digital application in mental health. In this part we develop three paragraphs about the applications in psychiatry, the serious games and the virtual reality, and the devices online such as massive open online courses and social networks. We then propose to present the current status of numeric art with a presentation of the history of numeric art and some examples of this construct. And then we propose to discuss of the possible mutation in art therapy in touch with digitals mutations. This discussion implies to address the question of the therapeutic setting in art therapy and the general question of changes induces by digital in our thinking and habits. This discussion also proposes to develop concrete possibilities to set up these technologies in art therapy.     

Diabète insulino-dépendant et troubles des conduites alimentaires : quels progrès ?

Objectives - To review studies on eating disorders (ED) in insulin-dependant diabetes mellitus (IDDM), published after our first review in 1990 and meta-analysis by Nielsen et Mølbak (1998).Results - Prevalence of ED in IDDM does not seem significantly higher than in the general population. Very large IDDM populations would be necessary to give a definitive answer to this question. The last studies on the topic do not give further information. There are no studies to explain the biological and psychopathological association between ED and IDDM. All the studies agree with the fact that ED in IDDM are a risk factor for higher glycosylated hemoglobin (HBA1c) and retinopathy. A new way of work seems to be the relationships between overweight, ED and IDDM. Self-induced glycosuria seems particularly interesting to explain the bad metabolic control. Chronic high levels of HBA1c lead to microvascular complications.Conclusion - We propose a profile of typical IDDM patient with ED. We need studies to assess validity of therapeutic procedures for this special and severe comorbidity.     

La construction relationnelle et affective des personnes sans domicile fixe : quels attachements ?

Context

People without fixed residence are considered most of the time in many a priori. We would like to have a clinicosocial approach in these phenomenons of marginalisation and relations to others, by this study. The trajectories of life of homeless persons are all different and thus, seem to be reflected by many ruptures of bonds, in present instant but much more in their childhood. Social wandering and precariousness: could they find their origins in internal models build from childhood or in reverse, is it the unsocialization which inducts a style of preferencial attachment?

Method

We propose to better determine the construction of attachment for these people in regard to maintenance of adult attachments and of quotation of speech by Edicode. As from as 25 adult attachment interviews (AAI), we have worked out a comparaison between homeless people and general population about attachment stategy (secure attachment, ambivalent and insecure resistant attachment).

Results

We can notice by this study that even the secured attachment can be a strategy prefered by certain homeless men, detachment can stay the most impregnated mode of relation to the others. Also, we observe a lot of without fixed residence people who unresolved attachment strategy employed. This result asks a question about the psychotic disorders in this homeless population. From these first results of exploratory researches, we would like to identify at best specific needs for these homeless persons in order to propose an adapted accompaniment.     

Dimensions de personnalité et facteurs de stress chez les policiers

ObjectivesPolice officers are exposed to chronic and cumulative potentially traumatic events in their careers. The personality influences the development of pathological stress. Literature highlights that positive valence personalities (conscientiousness, extraversion, and openness) are less susceptible to the development of pathological stress than neuroticism. The aim of this study is to assess the influence of personality dimensions on the development of acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) among police officers.Patients or materials and methodsWe presented the research project to several police department heads and police officers in Belgium. We were contacted by volunteer police officers. Then, we organized interviews lasting nearly 2 hours. First, we conducted an anamnesis during which police officers identified the most traumatic events experienced in their career. Secondly, we administered diagnostic instruments evaluating ASD (SASRQ), PTSP (TraumaQ) and personality dimensions (BFI-fr). The population includes 83 police officers.ResultsMultiple linear regression analyzes show that neuroticism is the personality dimension influencing the development of acute stress disorder and post-traumatic stress disorder. It is positively associated with most of their symptoms. Moreover, extraversion appears as the most protective personality dimension against pathological stress symptoms.ConclusionsThe assessment of trauma and personality is therefore important in the selection process of police officers’ candidates and throughout the career. It can be useful in identifying signs of anxiety, or even acute or post-traumatic stress and risk factors related to their development.     

Caïn et Abel, fils prodigues de la psychanalyse ?

This paper argues that Freud's insights into human aggression can at the very least be viewed as one-sided and problematic, and that the heuristic potential of the Œdipus myth, correspondingly, is limited. It considers how the Hungarian psychiatrist Lipót Szondi, tries to bridge this gap using the myth of Cain and Abel. The aim of this paper is to explore how Szondi's interpretation of this myth offers a much more subtle approach to human aggression. Szondi's alternative and distinctive look at aggressive phenomena offers an exciting and fruitful addition to Freud's interpretation as exclusively referring to sadism and/or the death instinct. This contribution wants to highlight Szondi's amendment to Freud's Œdipus and aims to show that psychoanalysis can benefit from taking into account the mythical figures of Cain and Abel as its “prodigal sons”.     

Séquences et temporalité de la révélation : quels effets sur le développement et la construction psychique ?

The authors analyse the phenomenon of revelation of sexual assault and abuse using their experience as child psychiatrists and forensic experts. They emphasize the particularities of the contemporary context because of the media impact and the difficulty for the professional to access the child's speech. There are specific questions that underlie any examination of the relationship between victims and perpetrators and access to narrativity for each one. The study of the temporality of revelation must be done according to the stages of the child's development taking into account the age at which he was abused and the age at which he revealed the facts. Clinical vignettes illustrate these aspects. Added to this, is the need to take into account the complexity of family and environmental interactions, the phenomena of grip and constraint, widespread guilt, as well as the nature of the links between the victim and the aggressor.     

Réunion de synthèse et groupe de travail : quelle spécificité ?

A working method in psychiatric institutions and child care, the “synthesis” meeting is rarely a topic of reflection or research. To discuss its functioning, the author proposes two clinical vignettes, one involving an outside therapist's participation at the “synthesis”, the other not. Using this alternative as a starting point, the author offers an overview of the procedure, in the context of the development of community psychotherapy. To take the analysis one step further, “synthesis” and “meeting” are examined separately. The meanings of “synthesis” are sought mainly in the works of Freud, who described it as both the opposite of analysis and as accomplished by the patient's ego. But what about the patients whose ego cannot achieve synthesis? One possible answer is offered by examining the specific features of the “meeting” of a working group where the emphasis is on understanding the relationship with the patient, but where the relationships between participants are no less important. While not excluding conflicts, “synthesis” requires various forms of convergence as well as resonance. The author formulates the hypothesis of an advanced form of resonance called “totallization”, which consolidates perception of a patient's image, shared at a deep emotional level by all participants at the “synthesis” meeting.     

Apathie et maladie de Parkinson : aspects cliniques,physiopathologie et évaluation

Apathy is a loss of motivation compared to the previous level of functioning of the subject. It affects the subject's behavior, cognition and emotional state. It is one of the main behavioral manifestations of Parkinson's disease. Although it may be a symptom of depression, it often exists as an isolated syndrome in Parkinson's disease patients. Apathy is usually not related to the severity of the motor symptoms, but frequently associated with the severity of cognitive impairment. Apathy is also a possible complication of treatment by stimulation of the subthalamic nucleus. Screening and assessment of apathy require the use of specific tools, some of which are validated in Parkinson's disease. From a pathophysiological point of view, apathy results from a dysfunction of the limbic circuit connecting the ventral striatum to orbitofrontal and anterior cingulate cortex. The dopaminergic denervation in these regions seems to play a key role, but other mechanisms are probably involved. Further studies are warranted to progress in the therapeutic management of this invalidating syndrome.