Les tuteurs de résilience dans un univers juif orthodoxe. Partie II

After defining the salient features (“marqueurs”) of a Jewish orthodox society (part I) we try to expose the resilient factors for this microsociety. To this end, we are reflecting on the link between salient features (“marqueurs”) and resilient factors (“facteurs de resilience”).ObjectivesWe emphasize this microsociety's resilient factors and we hypothesize the following idea: what about disembodied tutors? the resilient factors could be not embodied values in a world merely based on belief.MethodAfter describing this world (“Resilience tutors … - part I”), we asked them about a difficult par of their life: the Holocaust. Thus, in a situation of transmission to their children, we perceive the resilient features. They exercised self-censorship (don’t speak about the worst events, the worst sensations, the worst feelings), but they wish to express the basis of their strength, that we called resilient factors.ResultsWe propose four “concepts-resilient factors” (“concepts-tuteurs de résilience”): (1) the silence of the spouse, (2) the law, (3) the filiation, (4) the daily ritual based on practicticing jewish life.DiscussionThe notion of “concept-resilient factors” is not linked to a human being who knew how to overcome the lack of an attachment pattern but to an absolute element of faith, which would give to this microsociety the ways to its proper resilience.ConclusionTo validate this hypothesis, we should generalize the study the link between faith and religion. Otherwise, the idea of conceptualized tutor is particularly interesting in a context where it's merely the faith, which put them in considerable danger.     

Les tuteurs de résilience dans un univers juif orthodoxe. Partie I

This reflection comes from interviews with survivors of the Holocaust. Some survivors arise from a profoundly religious environment. We noticed that the environment, the tools set up to take (bring) out there were different (because of the context) from what we had met until now. The concept of resilience is dynamic and must inevitably consider the environment and the context of their life. We hypothesize that for each micro society must be found its own strength, which induce its way of being resilient.ObjectivesWe hypothesis that this microsociety developed in itself the way to get out of its traumatic events. To showcase these resilience factors (part II) we try to define the salient features of those members (les “marqueur”).MethodWe had about twenty semi-directed interviews on the subject of the WWII and its transmission to the children of survivors. Working on this population is innovative. This microsystem is not interested in university, and Holocaust is not either a matter of subject. At first, we propose five defining criterias for this microsystem: (1) god's place and faith (2) exiles and sufferings (3) the strength of the law, (4) ancestry and filiation (5) grouping around a “Rebbe”. Then, we will discuss about the “resilience's tutors” for this microsociety.ResultsWe propose four resilience's tutors, and each of them is conceptual, not ingrown: (1) the silent of the spouse, (2) law, (3) filiation, (4) daily rite.DiscussionThe notion of “concept-tuteur de resilience” refers not in human being who could palliate lack of figure of attachment but to an absolute figure of faith which would give to this microsystem the ways of resilience.ConclusionWe should, to validate this notion, diply study the relation between faith and resilience. It makes sens for the microsystem because faith and Jewish identity are exactly the reason, which officially put them in danger.     

Traumatisme et résilience associés à la pandémie de la COVID-19 dans les villes de Bafoussam et de Dschang au Cameroun

IntroductionThe emergence of the Covid-19 pandemic in Cameroon, as in Africa and around the world, was marked by a suddenness and unpredictability that fascinated the imagination. The considerable psychic and social repercussions of the pandemic mobilized a significant anguish of death. The sudden onset of the pandemic was followed by spectacular, high-profile deaths that fascinated the imagination, listing it in the order of traumatic events, provoking reactions of astonishment, flight and avoidance.GoalThe objective of this study is to determine the symptomatology of post-traumatic stress disorder, as well as the resilience, associated with the Covid-19 pandemic in the Western Region of Cameroon.MethodologyThe research was carried out following the model of general population mental health surveys. The availability of area frames (sampling) made it possible to opt for probabilistic calculations. First and second year master's students in clinical psychology from Dschang University were involved in data collection. They benefited from a two-day seminar on data collection techniques in the general population. The calculated sample size is 384 households. The anticipated response rate, set at 90%, made it possible to increase robustness and to anticipate a total sample of 424 households, spread over 3 districts of Bafoussam and Dschang, according to the choice previously made. The study followed the ethical provisions of the Helsinki Protocol. The data collection tools used are: the Impact of Event Scale-Revised and the Connor-Davidson Resilience Scale.Results409 subjects were recruited, representing a completion rate of 106.5%. 70.7% of subjects exhibited symptoms of PTSD. These symptoms are more often mild (40.9%) or moderate (25.6%). Women are more affected (73.7%) by PTSD than men (67.9%). In addition to sex and age, area of residence and marital status, appear to be significantly associated with symptoms of PTSD: subjects under 35 years of age have a significantly higher prevalence rate than those over 35; the rate of PTSD is significantly higher in subjects living in urban areas than in those living in rural areas; single subjects are more affected by PTSD (40.1%) than married subjects (26.7%). The average score recorded on the CD-RISC is 64.3, the standard deviation is 15.3 and the coefficient of variation is 24%. This average falls into the second quartile of the distribution, indicating average resilience. CD-RISC scores are not affected by gender, age, marital status, level of education, or occupational status. These characteristics are therefore not factors of resilience.ConclusionThe Covid-19 pandemic has had a psychological impact in Cameroon which has made it a major psychosocial stressor. More than 6 in 10 people have symptoms of PTSD. But this symptomatology is often weak or moderate, testifying to an effective resilience, to balance the traumatic effects of the pandemic.     

Place de la psychiatrie dans l’accompagnement des enfants et adolescents avec transidentité

Among mammals, there are males and females, recognizable by their reproductive genitalia. Human beings, on the other hand, have a reflexive consciousness. He thinks himself. In this experience of oneself, the binary limits of the body no longer exist. Until today, however, it seemed obvious that the biological reality of the body, the reality of the genitals, had to be the support for its identity construction. You must have a penis to feel like a man, you must have a vagina to feel like a woman. We then distinguished the normal sexual identity or there was congruence between the reproductive genitalia and the fact of feeling like a woman or a man. It was a strictly binary system, in which it was obligatory as a human being to be able to designate oneself as a man or as a woman. People who could designate themselves as a woman or as a man without being congruent with their genitals were designated as suffering from transsexualism or gender identity disorder. This disorder was considered inaccessible to any form of therapy and necessitated a medical-surgical reassignment to make the body conform as far as possible to the lived identity. In the 1990s, the work of Judith Butler appeared. There is then a questioning of the “obvious association” between the biological reality of the genital organs designated under the term sex, with the identity experience allowing to call oneself man and/or woman. A depathologization begins. It is then no longer possible to use the notion of norm of identity construction. The experience of being a man and/or a woman is then freed from the biological limits of the body without this being reduced to a disorder. It is in this state of mind that appears in the fifth version of the American manual of classification of mental illnesses the notions of gender dysphoria. The term transsexualism was then abandoned and there was no longer any reference to a so-called normal sexual identity. However, some people may experience significant psychological suffering related to social interactions, the gaze of others or of themselves on their body. This specific psychic suffering is then referred to as Gender Dysphoria and justifies psychiatric treatment. However, mental health professionals must respect the identity of the person and not try to “normalize” it and find with the patient the tools that will reduce his suffering. But this new diagnosis “Gender dysphoria” if it represents progress in the recognition of the diversity of identity constructions, maintains this problem in the field of psychiatry. Finally, if it has become possible to think of oneself as a man or a woman without limiting oneself to the realities of one's genitals, other assumptions are called into question. Is it mandatory to have to designate yourself as a man or a woman in your identity experience? This is what appears with the non-binary approach to gender. We can think of ourselves as half-man, half-woman, neither man nor woman, with a fluctuating gender without this taking on a pathological character. Also, all these people, whether they recognize themselves as a woman and/or a man, by freeing themselves from the biological limits of the body in their identity experience, recognize themselves in the notion of transidentity. Regarding sociological, anthropological, and philosophical developments on gender issues, there is no longer any legitimate theory today, in our Western society, which can account for the process of identity development, the connections between realities and the biological limits of sexed body and gender experiences. This allows all feelings to be welcomed without a symptomatologic approach. It is then no longer possible to envisage a psychopathological evaluation of transidentity in the absence of normative criteria. It is important to welcome all his words both from the side of the young person but also that of the parents, even of the wider family without any a priori, without judgment, without normative criteria. It is necessary to give up the temptation of the why in favor of a proposal of aid for both the young person and his family. On the young person's side, the professional can help him put words to what he feels and accompany him to feel the best possible to be able to live all the experiences he wishes to live at this age: to have projects school, professional, to make friends, to be in love, to plan. On the side of the parents, the family, it is necessary to be able to welcome all their questions, their concerns, their projections, to reflect on them with them. Most often, it is therefore desirable to have differentiated spaces about the support of the young person and that of his parents with of course solid links between these two spaces of words. However, how to define the criteria allowing doctors to calmly accompany children and adolescents as well as their parents in medico-surgical acts. Several problems arise, the evaluation of the discernment of the child and the adolescent which makes it possible to ensure that the treatment envisaged responds well to the patient's request. Does this young patient perceive all the medium and long-term consequences of the therapeutic actions envisaged? What is the place of parents in these assessments, knowing that in any case it will be necessary to consider the legal aspects of the concept of parental authority? Who are the legitimate professionals to do these assessments? There are therefore still many questions to be explored around the support of people with trans identity. It is essential to address these questions without ideological preconceptions and to welcome all the words of the people concerned to develop with them the strategies best suited to their well-being and their development at all ages of life.     

Effets de la maltraitance sur la régulation émotionnelle des enfants et des adolescents confiés à l’Aide Sociale à l’Enfance

ObjectivesThis research aims to compare coping strategies (strategies developed to cope with stress) and temperamental dimensions used by children and adolescents have not been maltreated and those who have been. The aim of these analyzes is to identify the effects of age as well as vulnerabilities and resources for children and adolescents who have been maltreated.Materials and methodsA total of 232 children and adolescents aged 7 to 16 years participated in this study including 115 who have never been maltreated (control group) and 117 have been maltreated and are living in foster care (placed group). Each young people responded to a scale measuring the frequency of coping strategies (Kidcope) as well as a questionnaire of temperament (questionnaire d’auto- et d’hétéro-évaluation du tempérament en sept facteurs pour l’enfant d’âge scolaire et l’adolescent).ResultsAn analysis of variance (ANOVA) was performed for each coping strategy and temperamental dimension to evaluate the consequence of maltreatment on the emotional regulation, according to the slice of age. The age-based comparison of control and placed groups reveals major differences in the use of certain coping strategies as well as in the temperamental dimensions of maltreated children and adolescents. This confirms that the child's life experience influences his way of understanding his environment and affects his individual resources.ConclusionsThe results show vulnerabilities of emotional regulation for children and adolescents who have been maltreated. These aspects underline the importance to think about supports in order to promote the development of some coping strategies and to reduce the stressors. These points will be discussed with preventive and therapeutic used to improve coping skills and emotional regulation.     

Répondre à la douleur des enfants atteints de paralysie cérébrale

With SPARCLE studies, the prevalence of pain in children with cerebral palsy is now better known: 60% of children aged 8 to 12-years-old and amounts to 69% in adolescents 13 to 17-years-old. The pain relief was also identified as a priority issue in a prospective study of la Fondation Motrice published in 2009. Yet iatrogenic pain is under-treated in this population although many assessment tools are validated. The use of assessment tools requires good knowledge of their psychometric properties and limitations. But pain assessment is not limited to the application of a scale. Current knowledge regarding the pain expression and ability to cope in this population are essential. International guidelines stress the importance of a multidisciplinary approach from assessment to management, in way to increase the synergistic effects of several therapeutic options (pharmacological and non-pharmacological). Finally, it also seems worthwhile to question our representations of pain reported by those with atypical development.     

Répercussions psychologiques de la pandémie de COVID-19 chez les enfants et les adolescents et modalités de prise en charge

Children and adolescents were particularly affected by the psychological consequences of the COVID-19 health crisis. They were faced with multiple stressors such as repeated confinements, the use of masks, the disruption of daily routines, the lack of social interactions following the closure of schools and the cessation of extra-curricular activities. These adversities dramatically weakened their coping strategies and their resources. In this interview with Jean-Pierre Bouchard, Olivier Sorel, Juliane Tortes Saint-Jammes et Sandie Meillerais discuss the changes that have been implemented in their clinical practice for children in the context of the COVID-19 pandemic. Then, they will also identify, by using clinical examples, the procedures specifically used to develop, reinforce or reactivate the resources of children and adolescents during the therapy. Finally, they address the very notion of clinical support, with an emphasis on EMDR therapy and a family-centered approach.     

Les proches aidants des personnes en état de conscience altérée : ruptures et continuité dans les relations

ObjectivesThis study seeks to better understand caregivers’ experience of the support their loved ones, with disorders of consciousness, receive in a dedicated unit.MethodsThe focus here is on the qualitative component of a larger study that also includes a quantitative component. An inductive and iterative approach was prioritized, i.e., one similar to grounded theory; a thematic analysis was used to analyze 20 comprehensive semi-structured interviews.ResultsThree main themes emerged: the discovery of a new world by a patient's loved ones, i.e., the disorders of consciousness; the psychological and somatic impact on loved ones; and the relationships between family caregivers and professionals of the dedicated unit.DiscussionThe new living situation of people with disorders of consciousness requires caregivers to engage in an intense psychological process. First, this process is necessary to their understanding of the situation and its consequences. Second, it allows them to cope with the reorganization of the emotional and relational ties between the patient and the caregiver, and in the entire family dynamic. Lastly, healthcare professionals consider that caregivers are also the witnesses of the patient's earlier life, capable of linking the past and present, and often the interpreters of patients’ emotional reactions according to their former personality.ConclusionCaregivers are affected by the frailty and somatic dependence of their loved ones; and they also bear the history and psychological continuity of patients. Professionals must take this double burden into account, which helps explain families’ psychological exhaustion and their need for help. Understanding these phenomena is crucial for improving patient care in dedicated units.     

Traumatismes et résiliences chez les enfants de 3 à 6 ans dans trois quartiers de Port-au-Prince après le séisme de 2010 en Haïti

The paper describes an action research for indicative assessment of psychological problems of young children following the 2010 earthquake in Haiti, and the interest of using the Creole version of the questionnaire PSYCa 3-6. The survey took place in Port-au-Prince, and the evaluators were trained to a proper standardized administration of the questionnaire.

Les adolescents vulnérables et les alternatives thérapeutiques en protection de l’enfance

Adolescents faced with numerous difficulties in the course of their stay in foster care become vulnerable. Most of them experience trouble in their relationships (attachment to their family, trauma…). We observe that these factors are often not addressed by institutions. Sometimes there is lack of continuity in the services offered to these youth, which implies many breaks within therapeutic and foster care. Using a clinical example, we would like to discuss issues related to institutions, as well as therapeutic alternatives to institutional care.     

Étude des références pronominales à soi dans les témoignages d’événements traumatiques de guerre et d’attentats

ObjectivesThe traumatic experience is characterized by “unspeakability:” there are no words to truly express, to translate, to represent the horror. And yet, paradoxically, the main access to our knowledge of traumatic dissociation comes from what patients manage to tell us, if only partially, chaotically… The lexical, syntactic, and pragmatic imprints of the trauma on discourse, which we have baptized psycholinguistic traumatic syndrome (SPLIT), are expressed according to an automatico-voluntary dissociation taking gradual form: the more the trauma appears present, the more the psycholinguistic stigmata manifest themselves; the more the subject psychically moves away from the trauma and its consequences, the more the discourse returns to the nominal state. How can the subject become master of his own life, of his own speech, without being constrained by trauma? How do some subjects manage, alone or with the help of others, to extract themselves from their flashbacks by narrativizing the traumatic scene? These spaces of return to the “I” have never been studied in French in the discourse of patients suffering from posttraumatic stress disorder. In addition to the linguistic form “I,” what other forms (personal, exclusive, inclusive, generic) do speakers of traumatic narratives use in their discourse in order to refer to themselves?MethodsBased on the testimonies of survivors of the Bataclan attack collected immediately after the event and a few years later, as well as on the narratives produced by military patients suffering from chronic posttraumatic stress disorder, we analyze, through the precise linguistic study of pronominal markers, how the speakers refer to themselves.ResultsA detailed analysis of the pronominal forms and the different values they signify led us to four main findings: (i) over-representation of the first person in traumatic narratives, both by the use of the pronoun “I” and by others pronouns including the speaker; (ii) predominance of the use of generic pronominal values in traumatic narratives; (iii) preferential use of the exclusive value of the pronoun “on” in the “War in Afghanistan” corpus; and finally (iv), the temporal unfolding of these first three results mirrors the habitual chronology that characterizes the clinical evolution of posttraumatic stress disorder.DiscussionThe narratives of trauma survivors contain significantly more occurrences of the pronoun “I,” but also other forms of self-reference, compared to control subjects. The use of the first-person pronoun mainly reflects the singularity of the trauma: what is traumatic for one person at a particular moment in his or her history will not necessarily be traumatic for someone else who, objectively, went through the same ordeal (in terms of place, date of the event, intensity of the sounds, extent of physical injuries, etc.). To say “I” is also to fight against dissociative symptoms, first and foremost depersonalization bordering on reification and desubjectification. However, the trauma clings to subjects’ first attempts to extract themselves from it: the preeminence of the pronoun “I” appears in parallel as a mark of repetition in the discourse, a disjunction between the lexical and pragmatic dimensions of enunciation. Because of massive dissociation, the discursive “I” sometimes even refers to a form of asubjectivity in the traumatic scene, an “Out-of-Language Experience:” the subject sometimes says “I” but without talking about her/himself. Moreover, the use of generic pronouns is found with greater frequency in accounts of traumatic events, particularly in the “later Bataclan” corpus, whereas controls use them significantly less. By using the generic “vous” (the formal or plural form of second-person address) or the informal “tu” (“you”), it is as if the speaker were saying: if you had been in my place in that circumstance, this is what you would have felt, seen, heard, thought, because any human, in those circumstances, would feel what I felt. In a sense, I am a “normal” human being, but at the same time, I avoid my own subjectivity, which is a form of depersonalization. Through the use of a generic “you,” or even more so through a familiar “you,” a change in cognitive perspective is adopted to describe the experience; the psychically injured subject looks at the experience described from the outside. Thus, the process of traumatic dissociation remains untouched, or even extends itself, by including the interlocutor in the traumatic scene, suggesting an empathic quest, as if to make him or her a captive, an invited witness, or a forced participant in the verbal scene. Finally, while the control subjects use “I” and “on” (a commonly used French pronoun that expresses, alternately or simultaneously, “one” and “we”) in an equivalent way, with the psychologically injured subjects, the further one moves away temporally from the trauma while its clinical consequences persist, the more the use of the pronoun “I” increases and the more the use of the pronoun “on” decreases, while the latter takes on an exclusive or generic character. These intersecting evolutions, which suggest an attempt to resort to self-affirmation and to a dissolution into an external collective, signal the presence of traumatic dissociation in the discourse. These results are consistent with the chronological clinical evolution of posttraumatic stress disorder from the immediate phase marked by acute stress disorder, to the deferred phase, which is often followed by an intermediate latent period, and then to chronic symptoms evolving into a multiplicity of suffering.ConclusionThe linguistic approach can offer us both an understanding of the general marks of the psychic wound in the discourse and of the trauma, in the sense of the singularity of the experience. While traumatic psycholinguistic syndrome results from linguistic wound constitutive of the trauma, conversely, it is a singular word, which makes it possible to extract oneself from flashbacks. Undoubtedly, life-saving processes occur thanks to the intersubjective relationship between the patient and others, through the co-construction of a discourse. The analysis of the restoration of this language, particularly its pronominal forms, could unify a specific conception of the alleviation of traumatic consequences while defining objective linguistic markers that could help clinicians evaluate the effectiveness of recommended treatments.     

Utilisation de la réalité virtuelle dans les troubles des conduites alimentaires

Virtual reality is a new technology that can be used to model an environment with which an individual can interact using all five senses. It is notably used in psychiatry for anxiety disorders and addictions, and its use in eating disorders has been growing in recent years. Indeed, virtual reality offers interesting advantages, such as its ability to personalize any environment, which is also more secure and controllable. Recent studies show promising results in the understanding, evaluation, and therapeutic management of eating disorders. The use of avatars in anorexia nervosa allows for a correct assessment of the perceptual (body image distortion) and cognitive-affective (body dissatisfaction) components of the body image disorder in a similar way to conventional methods, but also for a better understanding of them. Moreover, avatars allow the development of innovative therapeutic protocols and are thus used in the context of exposure therapy. The new body swapping protocol, based on a multisensory illusion, offers particularly promising results in the reduction of body image disorder. For bulimia nervosa and binge eating disorder, virtual reality has made it possible to better characterize the triggering mechanisms of binge eating episodes through studies that have observed different responses to food-related environments and stimuli. At the therapeutic level, virtual reality cue exposure therapy has the most empirical support. Its aim is to reduce or eliminate the anxiety and craving felt by a patient in response to exposure to food or other food-related cues by preventing the patient from consuming food, and results show clear reductions in anxiety, craving and binge eating episodes. While all these results seem to indicate a bright future for virtual reality in eating disorders, further studies are needed to validate the positive impact of its use, but also its limitations. Notably, cyber sickness could alter the smooth running of virtual reality therapy sessions by causing nausea and disorientation. Moreover, it is important to verify that a therapeutic protocol does not lose its effectiveness when it is transposed into virtual reality. However, virtual reality seems to be a therapeutic tool that is better accepted by patients, and even better by adolescents, which is very interesting for eating disorders since adolescents are the most affected. Virtual reality could therefore help motivate patients to pursue treatment and reduce the dropout rate while offering good therapeutic results. Thus, studies conducted in recent years have shown that virtual reality is a promising tool in the understanding, assessment and treatment of eating disorders, and future research should confirm this, particularly in the adolescent population.     

Les postes de préjudice et les nouveaux postes de préjudice

The assessment of damages, consequences of a harmful event, is based on medical expertise. The essential issue during this medical expertise, whether judicial or not, is that of accountability. This accountability must be argued and the expert must draw his argument from the objective data contained in the victim's medical records. The assessment of all damages is then facilitated and must include all the declarative data provided by the victims and their various counsel (doctors and lawyers). À perfect knowledge of the definitions of the different damage items will ensure fair and complete compensation for the victim.     

Accompagner les professionnels de santé dans la révélation de l’erreur : de la révélation à soi à la révélation à l’autre

Error disclosure is now an ethical and professional obligation for health professionals and seeks to improve quality and safety in healthcare. Literature has highlighted the numerous benefits of error disclosure and several authors have described the options for handling this situation. However, it is not quite that simple to be honest and open and follow a protocol that instructs professionals to explain, support and apologise in situations where they are subject to criticism. While the many personal, institutional and social factors that hinder open disclosure have been identified, little attention has been paid to the obstacles associated with the psychological impact of disclosure, thereby limiting the debate on how professionals might be supported in their efforts to cope with error disclosure. The psychological impact of error on professionals is a well-established fact. Physicians are “second victims” likely to be emotionally affected by medical error. Emotional distress, anger, isolation, fear, guilt and shame can be intense, suggesting that, far from being an isolated act in professional practice, a medical error is a life event that modifies the psychological balance of a professional. Studies in the humanities have shown how work shapes individuals’ identities. The choice to heal and care for is indicative of the ideals related to professionals’ life histories, cultures, family models and representations of health and disease. Work and, more specifically, recognition at work from their peers, patients and relatives enables health professionals to support their ideals and establish a coherent identity, and to belong to a workgroup. The error foreshadows a rupture which plunges the professional and the team in a state of vulnerability that rules out the professional's or the team's possibility to be part of a process of disclosing the error. In these conditions, a policy of security of care also involves a guarantee of the caregiver's and the team's psychological security. The term psychological security was developed by the psychoanalysis who emphasised the individual's need to evolve in a “sufficiently good” protective environment that allows him/her to contain his/her emotions, while giving the individual the possibility to express and discuss them. This space implies a relation of trust between individuals. Trust refers to the idea that the individual can trust someone, it is based on the capacity to create relations. It is only through trust that the professional will be able to open him/herself to others and construct a space where the errors and the doubts that he/she has in the context of work are shared. But if trust is essential, it is also dangerous because it implies accepting the risk of being dependent on those considered as trustworthy and the risk that they will not live up to the professional's expectations. As a consequence, the professional will only have trust when he/she has evaluated the possibility of cooperation and more precisely, as stated by Hardin, a cooperation in which the professional's interests are “encapsulated interests”, in other words the interests of others. Therefore, this cooperation depends on each member of the team seeing his/her interests as being partially those of the others. Cooperation within a service reveals the relations of trust between the professionals and shows the relations of dependence that each one maintains with the others for the good administration of care. Thus the creation of relations of cooperation between the team members proves to be an important indicator to determine the professional's possibility to adhere to a process of disclosing the error. This approach shows that professionals must address multiple rather than single disclosures: to the self, and to others (colleagues, hierarchy, patients and families) who will mobilise specific knowledge, emotions and psychological defences. To avoid cases where disclosure takes on dimensions as tragic as the actual errors committed, it is important to pay attention to the psychic state of healthcare professionals by offering a space of free expression that enables them to better understand their feelings and gain a sense of support in order to restore their ideals and professional identities. Finally, it's important to emphasize that disclosure also depends on the preservation or restoration of the relations of cooperation within the team. Disclosure cannot be prescribed, it must emerge within a workgroup who allows the error to be thought over, communicated and shared. In this context, disclosure becomes a group rule that is known to all. A health professional who feels sufficiently supported might, in turn, support a patient and/or his/her relatives and engage in meaningful disclosure.     

Séquelles post-traumatiques à long terme rencontrées chez les enfants et adolescents victimes de violence sexuelle : implications pour l’expertise de crédibilité

We present the state-of-the-arts linked to long-term posttraumatic functioning of sexually abused children and adolescents, and especially their risk of disruption of body image, impairment of identity construction, dysfunction of memory and posttraumatic dissociation. The judicial expert who is in charge of an expertise of credibility with the alleged victim has to consider the effects of defence mechanisms and coping strategies on emotional memory, tending to distort facts in order to preserve psychic survival. Thus, current discourse analysis procedures, such as CBCA (Criteria-based content analysis), have to be interpreted with caution, taking into account the whole clinical context.     

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.