Facteurs associés aux tentatives de suicide des adolescents d’origine maghrébine en France

This exploratory study compared the attempted suicides of Maghrebine adolescents of the first and second generation and adolescents without a migratory background. This raises the question of an eventual specificity of the Maghrebine adolescents’ attempted suicides. The data consisted of the records of 339 adolescents, aged from 15 to 25, seen at the emergency room of the Avicenne Hospital, after an attempted suicide. The statistical analyses show that the two groups of patients differ concerning their becoming after the emergency hospitalization and the reported triggering event for the attempted suicide. The intergenerational relations are more frequently reported to be the cause of the Maghrebine adolescents’ attempted suicides. The results are discussed taking into account the transcultural living conditions of these adolescents.     

Trente ans après : la révolution psychiatrique italienne en perspective

Background

In May 1978, was voted Law 180, forbidding any new admission in Italian mental hospitals. Many authors set it as an example to be followed in other countries; others contradict this point of view. The purpose of this paper is to analyse the Italian psychiatric revolution in retrospect thirty years later.

Method

Several articles and books written by stakeholders and by social researchers were reviewed.

Results

The occurrence of the Italian psychiatric revolution cannot be understood without considering the backward situation of mental care in Italy at the time. Changes began before 1978 but were accelerated and shaped by the law. However, some flaws of the previous system have remained over time, most of all, the North-South gap.

Discussion

Three points are specially original in Italy and need to be considered before advocating a similar law in another country: first, phasing out psychiatric hospitals went along with difficult problems, second in Italy, local human action is very important, so that implementation of such a law is a bottom-up process, and third, the history of the Italian mental care system has created in the general population a lower propensity to seek care than in other countries.     

Les thromboses veineuses cérébrales en milieu hospitalier à Ouagadougou (Burkina Faso)

Introduction

Cerebral venous thrombosis (CVT) is a rare condition difficult to diagnose because of the wide variability of the clinical presentations. The goal of our survey was to study the clinical, etiological and progressive aspects of the CVT in Burkina.

Patients and method

We conducted a prospective study for two years, including patients with a diagnosis of CVT based on clinical and imaging criteria. Age, gender, clinical findings and results of complementary tests were recorded as was the clinical outcome.

Results

The study included 17 patients (seven men and ten women) mean age 42.5 years. The inaugural signs were sub-acute in two-thirds of the patients. Headache was a constant finding (n = 17 patients, 100%); 15 patients (88%) had unilateral or bilateral motor deficits. An infectious syndrome was common (60%). The brain CT scan generally revealed spontaneous high density signals from a sinus. d-dimeres were high in 15 cases. Four patients were HIV-1 seropositive and four had rhino-sinusitis. The other etiological factors were rare. Heparin was administred in 80% of patients, followed by oral anticoagulation for three months on average.

Conclusion

Our cohort presents a relatively different clinical picture compared with the literature due to the high frequency of the infectious etiologies. A prospective multicentric study with more specific diagnostic tools could be useful to learn more about the epidemiology of CVT in Subsaharan Africa.     

Troubles psychiatriques associés à l'hépatite C et à son traitement par l'interféron alpha : revue de la littérature

The hepatitis C virus is a major public health problem. The prevalence of serum antibodies to the hepatitis C virus in the world is estimated at 3% of the population. Although the incidence of new infection is declining, a large asymptomatic population with chronic hepatitis C exists. This infection often affects persons with psychiatric and substance use problems. Neuropsychiatric symptoms are commonly associated with chronic hepatitis C virus infection, and its treatment by interferon-alpha. During hepatitis C infection, discomfort, fatigue, and depressive symptoms are frequently reported, before IFN-a treatment. Many side effects are reported during the IFN-a treatment. Neuropsychiatric symptoms frequently occur in hepatitis C patients treated with IFN-a. These side effects are troublesome and frequently account for dose reduction or treatment discontinuation. These symptoms include cognitive, affective, and behavioural components. The cognitive changes include impaired concentration, decreased alertness, deficits in verbal memory and mental slowing. These cognitive changes can be related to the IFN-a treatment or to the action of the hepatitis C virus on the brain. Depression is the most common psychiatric side effect. The reported rates of depressive symptoms range from 10 to 40%. The rates are higher in studies that used specific tools to assess for depression and in prospective studies. Depressive symptoms associated to the IFN-a treatment are particular: irritability, emotional lability, insomnia, behavioural disorders, impulsivity, fatigue, loss of interest. Occasional cases of mania and psychosis have been reported. There have been reports of anxiety disorders, including phobias, obsessive thoughts and rituals, and post-traumatic stress disorder. Several studies have shown that patients with chronic hepatitis C have a reduced quality of life. The impact of IFN-a is not clear. The quality of life may be related to the cognitive change or to the stage of the liver disease according to the authors. A large study showed that successful therapy with IFN-a improves quality of life. Studies of mechanisms of IFN-a neuropsychiatric effects are preliminary, so theories remain speculative. IFN-a may directly affect the central nervous system and affects neuroendocrine, cytokine, and neurotransmitter pathways. Identification and treatment of chronic hepatitis C infections are likely to become more aggressive with the improved prognosis offered by combination therapy (IFN-a and ribavirin). Psychiatrists will increasingly be involved in the care of such patients. Psychiatrists are often involved in the care of intravenous drug users and alcoholics, both of whom have high rates of hepatitis C infection. Depression may also be the visible symptom of a chronic hepatitis C infection, early detection of hepatitis C might lead to secondary prevention and improved outcomes. Recognition of depression associated to IFN-a is important, for treatment and for the possibility of improving adherence to IFN-a. The nature and severity of the neuropsychiatric adverse effects are, in part, dose dependent, though there is significant variability. No risk factor of psychiatric effects is clearly identified. All patients who receive interferon should be considered at some risk of developing neuropsychiatric adverse effects. Baseline assessments of mood and cognitive functions will help the clinician determine if behavioural symptoms are interferon-related. In clinical practice, SSRIs appear to be used commonly and to be helpful. The choice of therapy is based on the visible mood symptoms and the adverse effect profile of the antidepressants. The antidepressants drugs recommended are citalopram, sertraline, tianeptine, milnacipram and viloxazine. The efficacy of prophylactic antidepressant treatment is a matter of clinical debate. Non-pharmacological interventions are also useful. Education regarding the possible neuropsychiatric changes secondary to interferon treatment may prepare patients and make earlier interventions possible. Improved understanding of the mechanisms of neuro-psychiatric symptoms and their treatment may help patients with chronic hepatitis C sustain treatment, which will ultimately prolong their life and improve their quality of life. Research should include patients with psychiatric problems so that they are not excluded from effective treatments for hepatitis C.     

Séjours de répit dans un service de médecine physique et réadaptation pédiatrique : intérêt pour les patients polyhandicapés

Introduction

The respite care meets a real need for families of children with multiple disabilities. The service of Physical Medicine and Paediatric Rehabilitation of the University Hospital of Saint-Etienne offers to accommodate a patient with multiple disabilities already known by the service for short periods to provide respite for his families. The objective of this study is to assess the value for patients.

Method

It is a retrospective qualitative study, starting from an exhaustive review of medical records of 19 patients who were admitted in the department since the opening of beds in December 2004. The parents of these children answered to a telephone questionnaire and physicians and senior health care providers of the department were interviewed.

Results

The vast majority of stays went well. Irrespective of the relief expected, they sometimes induced medical and paramedical acts such as changes in the treatment or equipment, the use of expert advice, requirements of additional tests… All children underwent a clinical examination for admission. There was also a secondary benefit with parents relaxed and reassured by the hospital.

Conclusion/Discussion

This survey confirms the importance of these respite stays for children with multiple disabilities in this department but raises another question: is the role of the hospital there to compensate for the lack of temporary shelter bed? It also highlights the total lack of knowledge of these hospital admission opportunities from general practitioners and the public.     

Facteurs prédictifs du devenir des patients psychotiques et états limites hospitalisés à la Clinique Dupré pour des projets soins études

Long-term hospitalization is often proposed in the initial phases of treatment of psychotic adolescents or borderline cases. A review of the literature on the subject shows that although hospitalization appears to be indispensable in certain severe cases, the value of this approach is more difficult to justify later on, particularly when as at the Dupré Clinic of Sceaux patient management includes periods of hospitalization of up to or even more than twelve months in the context of a specific approach which combines treatment and study. It therefore seems logical to consider as one of the main priorities the introduction of assessment criteria to evaluate the utility of our complex mental healthcare system, and to attempt to more objectively justify the impressions obtained from an analysis of a large number of case histories which demonstrate the positive effects of our specific treatment-combined with-study project in a wide variety of clinical situations. Another important issue is that of determining the relevant clinical or contextual elements that can provide better indications for a project, and assist in making choices on the duration of hospitalization and the development of our institutional projects. Following a review of reports in the literature on the outcome of adolescents hospitalized for psychiatric disorders and the brief presentation of a specific project at the Dupré Clinic, this article describes a preliminary study made at this institution with the aim of resolving some of the above-mentioned questions. The results of this preliminary study have been presented and its major methodological and theoretical limitations have been discussed; some propositions have also been put forward so that an attempt can be made to improve upon these limitations in subsequent studies.     

Psychopathologie et répercussions de la douleur chronique : conséquences pour la pratique clinique et recommandations thérapeutiques

Objectives

The first aim of this paper was to analyze the Minnesota Multiphasic Personality Inventory (MMPI)-2 profiles of chronic pain patients using a hierarchical cluster method, in order to find subgroups of patients with differing psychopathological profiles and then to assess variations in the intensity and repercussions of pain among the subgroups. The Visual Analogue Scale (VAS) is a measurement technique commonly used in the assessment of intensity and repercussions of pain in chronic pain patients. The second aim was to examine the relationship between VAS measures of repercussions and scale scores on the MMPI-2. The final goal was to give recommendations to improve therapeutic decision-making for each patient. The best-known classification, the P.A.I.N. cluster typology, is based on the first version of the Minnesota Multiphasic Personality Inventory (MMPI). Keller and Butcher reviewed the data on patients with chronic pain obtained from the first version of the MMPI. In the same publication, they used a hierarchical cluster analysis, basing their process of agglomeration on the MMPI clinical scales of the second version (MMPI-2) to classify the patients into different groups whose members shared characteristics on the MMPI clinical scales. In Table 1, we have summarized and classified cluster labels used in the literature with the MMPI-2 since Keller and Butcher's MMPI-2 work.

Patients and methods

Patients (148) went into hospital for a one-day assessment. The assessment included the validated French version of the MMPI-2 and Visual Analogue Scale for pain intensity and repercussions. The local ethics committee approved this study, conducted in agreement with the declaration of Helsinki. We used a hierarchical cluster method to establish subgroups of patients with different psychopathological profiles and evaluated variations between the subgroups on measures of intensity and repercussions of pain.

Results

Figs. 1 to 2 show scale profiles for three- and four-cluster hierarchical analyses. A three-cluster solution best fitted the data (Fig. 1 and Table 2). The three clusters, which were of approximately equal size, were: (1) “Within Normal Limits”; (2) “Conversion-V”; and (3) “General Elevation”. We found significant differences between the “General Elevation” and “Within Normal Limits” clusters on the VAS measures of activity, sadness and depression. The only significant difference between the “Within Normal Limits” and “Conversion-V” clusters was on the activity scale. Patients in the “General Elevation” cluster were in the most urgent need of psychiatric help – it could be called a high distress, high disturbance cluster as Baker has described it. The four-cluster analysis of the MMPI-2 clinical scales (Fig. 2 and Table 2) gave four patterns showing the same “Conversion-V” and “Within Normal Limits”, but the “General Elevation” divided into a “Hypochondriac Depressive” cluster with 2-D scale elevated but with 1-Hs at the same level as the depressive scale, and the rest of “General Elevation” cluster could be split in a five-cluster solution into two very small subgroups, a “Psychotic V” cluster with a true V-shaped psychotic pattern with scores above those of the V-shaped neurotic triad scales, and a “Depressive General Elevation” cluster where the 2-D scale was the highest score in the profile but with all other scales also elevated except 9-Ma

Conclusions

These results showed that, firstly, different profiles of psychopathology were found even though there were no significant differences between the clusters in the level of pain intensity and pain duration; secondly, patients reporting more repercussions on the VAS measures showed profiles with more psychopathology. They were the patients most in need of psychological treatment. Finally, these results and the recommendations given could improve the therapeutic decision for each patient's subgroup.     

Application de la résolution de problème dans une unité de suicidants et suicidaires : premiers résultats auprès de 53 patients hospitalisés

Suicidal behaviour is a clinical problem that has posed major challenges to efforts in its understanding and treating. There are many studies on the various mental disorders presumed to underlie suicidal behaviour. Less than 50 randomized clinical trials have been conducted evaluating treatments aimed specifically at treating individuals with high suicidal risk. There is sparse data regarding treatments for primary mental disorders, which actually reduce the risk of suicide attempts or of suicidal ideation. The authors think that focussing efforts on treatment of suicidal behaviours may improve our understanding of the mechanisms related to suicidal behaviour and mining them for ideas will lead to effective interventions. For over a year the authors introduced the problem-solving therapy in their broad program for treating suicidal inpatients. In this pilot study the authors observed that assisting patients in developing a more positive problem-solving orientation may modify customary attitudes of avoiding problems and reduce tendencies to respond in an impulsive or careless manner.     

Une nouvelle prise en charge de la sphère oro-faciale des enfants paralysés cérébraux par un jeu interactif en 3D

Rehabilitation of facial praxia in children affected by cerebral palsy is an important goal, although its efficiency remains hard to evaluate. We have listed difficulties encountered by a child during a session of classical rehabilitation, and we propose a novel technique of rehabilitation based on the use of an interactive avatar. In addition to the game-like use of this interactive tool, motions captures that will be recorded during work sessions will also be usable to get metric measurements of the buccofacial movements of children with cerebral palsy. For each child, we will be able to define their own characteristics, which will probably reflect the great heterogeneity of clinical aspects and movements developed by these children. This study will require that each patient will be his own control to evaluate the efficiency of this new protocol.     

Apports des dispositifs robotisés à la rééducation du membre supérieur hémiplégique

Introduction

Poststroke rehabilitation care has evolved considerably over the last decade. The emergence of the concepts of brain plasticity and motor learning has led to the development of new therapeutic approaches. Most of the new strategies are based on movement therapy, which can have a real impact on neurological recovery, sometimes with significant functional benefit for the patient.

State of the Art

In this context of evolving practices, the hemiplegic arm is the subject of special attention. Considering the often unfavorable “natural” prognosis and the relatively limited impact of conventional therapies; researchers have focused work on new alternatives. Cooperation between developers of technological advances and the medical community has led to the development of innovative therapeutic options often based on the use of specific technological tools (functional electric stimulation, virtual reality, transcranial magnetic stimulation…) to solicit or facilitate movement.

Perspectives/conclusion

Robot-assisted rehabilitation lies within this scope. The positive results reported in the most recent publications and the growing interest for this type of therapy in the fields of medical and engineering research should open the way for extremely promising prospects. The technological performance of new robots has nevertheless raised a large number of unanswered questions, implying a significant amount of further research.     

Projet d’évaluation en continu des caractéristiques délictueuses, des aspects diagnostiques, de l’environnement social et de la prise en charge des auteurs d’infractions a caractère sexuel (AICS) au sein d’équipes de santé spécialisées en Région wallonne

The purpose of the study aims at determining the level of responsibility of the sex offenders like the recidivism rates. The study constitutes a research action of the prospective type in the long run. This one will be done from the implementation of an instrument evaluating the variables related on the offenses, the mental diagnoses, the socio-environmental parameters relating to the variables of responsibility. This instrument would allow a follow-up of the evolution of the sex offenders within the ambulatory care system (specialized teams) suggested in Walloon region. It would cover a big number of fields such as: static level of recidivism risk of the sex offender during its release; type of release; follow-up within one or several specialized teams of health; diagnostic criteria; characteristics related to the social environment in which sex offender evolves. These various dimensions are known as being predictive of a potential recidivism risk. They make it possible to also determine the needs for the sex offender as for a possible assumption of their level of receptivity.     

Les « pousseurs de métro » : à propos de huit cas de patients hospitalisés en unité pour malades difficiles

“Subway pushers” have been newspapers' highlights but also a forensic subject. Through eight case reports of offenders sent to high secure unit (unité pour malades difficiles Henri Colin), a profile of homeless psychotic man without any outpatient treatment has been found. Crimes seem unmotivated, where as delusions or hallucinations exist. Meta-analysis confirms this profile, though some alcoholic pushers have been described. Prevention of these tragic accidents rests on psychiatrists' awareness of homeless mentally ill people risk and safety subway programs.     

Deux curiosités historiques : l’hôpital civil et les cellules de Compostelle de l’asile d’aliénés de Cadillac

In 1617, the first duke d’Épernon founded Cadillac hospital and granted it financial autonomy on two conditions: (1) that 12 beds should serve for the free treatment of ill local people; (2) that six other beds should be used for the free accommodation for one or two nights of travelers and pilgrims on the road to Santiago de Compostella. The “civil hospital” was the beginning of the Cadillac lunatic asylum, of which it was to become an “annex”. Right up to its closure in 1972, it was still used for its original purpose: to provide general medical care. However, to this day, two of the six original cells for travelers are still operational as such. Hence, almost four centuries after its foundation, Cadillac hospital continues to serve its original purpose as a temporary place of accommodation for pilgrims that its founder wished it to serve.