Ataxie familiale du lapin,différente de la maladie héréditaire de Sawin-Anders

Résumé Présentation anatomoclinique de quatre lapins (dont trois avec vérification anatomique) appartenant à la race Chinchilla-Tchécoslovaque, provenant de deux nichées issues de la même femelle, mais de deux pères différents, atteints d'une ataxie et de parésie spastique des pattes.L'affection diffère de l'ataxie héréditaire du lapin deSawin-Anders par son début périnatal et par sa survie prolongée.Anatomiquement il s'agit d'une atteinte généralisée de tous les neurones du système nerveux central et même des ganglions. La lésion se présente comme un oedème cellulaire suivi d'une fonte des structures intraneuronales. D'importantes réactions gliales (oligodendrocytaires et astrocytaires) accompagnent les changements des neurones.Tous les sujets malades étaient mâles. La femelle de la même nichée avait un système nerveux intact.L'image anatomique fait penser à des troubles du métabolisme de l'eau et des electrolytes probablement conditionnés génétiquement. La souche des lapins reste en observation.Zusammenfassung Klinisch-anatomische Beschreibung von vier Kaninchen (davon drei morphologisch untersuchte) der tschechoslovakischen Chinchilla0Rasse, die zwei Würfen desselben Weibchens, aber verschiedener Väter, entstammen und Ataxie sowie spastische Paresen der Extremitäten boten.Die Erkrankung unterscheidet sich von der hereditären Ataxie des Kaninchens (Sawin-Anders) durch ihren perinatalen Beginn und die verlängerte Überlebenszeit.Morphologisch handelt es sich um eine generalisierte Affektion sämtlicher Neurone des ZNS und der Ganglien. Die Veränderungen manifestieren sich als Zellödem, das von einem Verlust intraneuronaler Strukturen gefolgt ist. Erhebliche Gliareaktion (der Oligo- und Astroglia) begleiten die neuronalen Läsionen.Bei sämtlichen erkrankten Tieren handelte es sich um Männchen; die Weibchen desselben Wurfes boten ein intaktes Nervensystem.Das morphologische Bild läßt möglicherweise genetisch bedingte Störungen des Wasser- und Elektrolytstoffwechsels vermuten. Die betreffende Kaninchensippe bleibt in Beobachtung.     

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.

L’abord phénoménologique de l’épistémologie de la psychiatrie,selon Georges Lantéri–Laura

ObjectiveThe article aims to give an account of the construction, by G. Lantéri–Laura, philosopher and historian of psychiatry, of a phenomenology of psychiatry dedicated to the critical elucidation of its foundations, inseparable from the concrete approach of its history, apprehended with the methods of structuralism.MethodThe stages of this construction are summarized and connected to the path of their author, while paying tribute to him and his work.ResultsThis phenomenology of the psychiatric fact privileges the study of the sign and its effects of meaning, and requires the clarification of the conditions of its production, including the knowledge and the know-how that it supposes. Extending the work of E. Minkowski thanks to the principles of structuralism, G. Lantéri–Laura considers the structure of the semiotics of psychiatry and makes numerous contributions to its semiology, notably of language. Considering the investigation of its praxis to be inseparable from its history, he forges a periodization of it in various paradigms, in conformity with T. Kuhn's epistemology and with C. Lévi–Strauss's conception of history.DiscussionLantéri–Laura links this phenomenology with an approach to subjectivity that keeps Husserl's vow of evidence, but without rejecting the unconscious, thus resisting the hegemonic and totalizing tendency of any psychopathology through the rigorous elucidation of the semiotics of psychiatry and the emphasis put on the regional, plural, and historical characters of its epistemology.ConclusionG. Lantéri–Laura has proposed a phenomenological epistemology of psychiatry, inseparable from the three dimensions of semiotics, subjectivity, and its history.     

Psychédéliques,psychothérapie et symbolisation : une revue de littérature dans le champ de la dépression

AimThis article proposes a literature review focused on the so-called “classic” psychedelics (LSD, psilocybin, DMT, and mescaline) and, more specifically, on their use in the psychotherapy of major depressive disorders and the way they affect symbolization processes.MethodAfter some introductory remarks on psychedelics and depressive disorders, we describe some modern clinical trials, and then explore the peculiar phenomenology occurring in the psychedelic experience, as well as its therapeutic effects on depressive symptoms. The underlying mechanisms are discussed from a perspective at the crossroads of cognitive neurosciences and psychoanalysis. We conclude with some reflections on the crucial role of the setting.ResultsThe results already obtained suggest that a single dose, taken in a supportive environment, may be sufficient to produce significant and immediate therapeutic effects, which are still present six months after the dose, although less so for some patients. Clinical response depends on the subjective aspects of the individual experience. More specifically, it seems correlated with the ability to “let go” and to allow autobiographical memories to emerge, along with the intense emotions they carry. It also relies on the presence and intensity of mystical-type experiences, characterized by feelings of “ego dissolution,” unity with everything, transcendence of space and time, and ineffability.DiscussionPsychedelic-assisted therapy seems to promote the emergence of primary processes and the lifting of defense mechanisms. Psychedelics would thus catalyze the resumption of symbolization processes, favoring in particular the integration of unconscious conflicts as well as the remodeling of pathogenic object relationships. On the neurobiological level, these processes would be underpinned by a decrease in the activity of the default mode network – sometimes considered the primary biologic substrate of the Freudian ego –, associated with an increase in brain entropy and in neuroplasticity. These different elements entail a decrease in depressive symptomatology, particularly ruminations. Common factors identified as the cause of positive changes in classical psychotherapies appear naturally amplified in the psychedelic experience, which requires the containing function of a therapist and a supportive clinical setting to allow a resumption of symbolic processes. To ensure the perpetuation of the observed transformations, which often exceed the simple withdrawal of symptoms, an extended psychotherapeutic monitoring would be appropriate.ConclusionThe psychedelic substance acts as a catalyst, allowing an access to otherwise inaccessible unconscious materials, which can then be processed both spontaneously and within the therapeutic relationship. Considering the data discussed in this review, we emphasize the need for further research exploring the potential of this treatment, which also offers the hope of a renewed dialogue between psychiatry and psychology, neurosciences and psychoanalysis.     

Psychiatrie phénoménologique,médecine de la personne et big data

Next to psychoanalysis, neurosciences and cognitivism is a historical trend in psychiatry, which lies in the minority and is not taught much: phenomenological psychiatry. Inspired by Husserl and Merleau-Ponty, it echoed in Ricoeur's work; carried by Binswanger, Minkowski, Tatossian, Lanteri-Laura, it still has its promoters and its researchers. The pathology thought as a lost of “pouvoir-être” allows oneself to consider the patient as his or her own norm. The whole analysis of the diagnostical process (between intuition and inference) and the “constructions” of the various theoretical resorts leading to practice are thus put to work. We will state how the everyday life of clinical psychiatry borrows more, sometimes without knowing it, from phenomenological psychiatry than from neurosciences or from the tools of clinical standardisation. Then, we would like to look into the possibility that this psychiatry inspired by philosophy might contribute to the dialogue between this medicine known as personalized or precision medicine (use of big data to come) as renewal of the Evidence-Based Medicine and, on the other side, the medicine of the person (cf. francophone observatory of the medicine of the person), which links with the Values Based Medicine we will examine.     

Accessibilité de la remédiation cognitive en Île-de-France,en psychiatrie adulte et infanto-juvénile,et dispositifs de réhabilitation

Cognitive remediation (CR) aims to decrease cognitive deficits and provide palliative strategies for reintegration of patients with psychic disability. It is part of a personalized care program and requires multidisciplinary assessment and management, including eventually other psychosocial therapies. This study, carried out in 2016, aims to establish an inventory of accessibility and practice of the CR in Île-de-France, to promote broad access and systematize the integration of CR in a global and coherent course. The CR is proposed by nearly 58 % of the structures that answered the survey, but its implementation could be improved: it stands for 58 % in a specific project and the multidisciplinary evaluation before/after is carried out at 51 % in Adult Psychiatry and 20 % in Child and Teen Psychiatry (CTP), perhaps due to a lack of qualified staff (neuropsychologists). The programs used in CTP are nonspecific. The accommodation capacity should be increased by group programs. Despite a lack of knowledge to fill, there is an important interest for the CR with a will expressed by 12 structures to be trained. Other psychosocial therapies, although better known, would benefit from being more often proposed and labeled by the Regional Health Agency. Our results confirm a scarcity of psychiatric care's supply in 77, 91 and 93. Four rehabilitation units in the 77 and 3 in the 91 are being trained. Three structures in the 77 and 2 in the 91 are willing to get trained. Supporting them is all the more important as the good practice of CR has a direct effect on social costs’ benefits. Since then, in the entire region, 8 structures have proposed for a CR and rehabilitation platform.     

TDAH et comorbidités en pédopsychiatrie. Pathologies psychiatriques,affections médicales,troubles de l’apprentissage et de la coordination

ADHD is a common disorder for children and is highly comorbid with a number of psychiatric and somatic disorders, which leads to important social consequences. Therefore, it is important to screen for the presence of other disorders when a diagnosis of ADHD is considered. Because of the associated pathologies, the clinical picture of the ADHD is more complex and represents a diagnostic challenge. Furthermore, the prognostic and the future of children with a comorbid ADHD is much more unfavorable than that of children with ADHD only. It is thus necessary to recognize the presentation of ADHD associated with various and frequently comorbid pathologies knowing that those will change according to age and the developmental stage. The objective of this article is to describe these comorbidities. We are going to discuss pathologies most often associated with ADHD and the impact of its symptomatology on psychiatric disorders, medical affections and other disorders such as learning disorder and developmental coordination disorder. Along these lines, we carried out a mini review of ADHD and comorbidities. Results showed that comorbid psychiatric disorders such as conduct disorders, mood disorders and anxiety are among the most frequently associated with ADHD in clinical practice. Disruptive disorders are the most common comorbidities found with ADHD. Among these disorders, oppositional defiant disorder must be distinguished from conduct disorders. Conduct disorders are highly comorbid with ADHD (in more than a third of the cases) and increase the severity of the clinical picture. When children show at the same time ADHD and a conduct disorder, they are at risk to have an antisocial personality disorder as well as addictive disorders in adulthood. Depressive disorders can be triggered by ADHD since these young patients have to face numerous failures and difficulties in their family, social and school lives. With respect to bipolar disorders, links exist with ADHD. Bipolar disorder and ADHD treatment is complex: both thymoregulators and medication of ADHD are necessary. Finally, anxiety disorders are concomitant in 33 % of ADHD children, an association which deteriorates the symptoms of inattention and distractibility. Furthermore, there is also some overlap between ADHD and addictive behavior, obsessive-compulsive disorder, tics, sleeping disorder and specific learning disorder. There is a high prevalence of the association between ADHD and addictive behaviors in connection with impulsiveness, lack of control, automedication and similarity in the neurobiological circuits. Children with an obsessive-compulsive disorder have ADHD in 33 % of the cases. Although treatments of ADHD and obsessive-compulsive disorder differ, they must be taken simultaneously. It seems that sleeping disorders are not co-occurring with ADHD but intrinsic. Besides, sleeping disorders during childhood can mime an ADHD and complicate the diagnosis to be established, in particular when restless legs syndrome or sleep apnea is present. The comorbidity of ADHD and specific learning disorders is high. Children with specific learning disorders have difficulties staying attentive and their academic performance is often below their full potential, just like the ADHD children. Therefore, clinicians who assess patients for ADHD have to systematically screen for the presence of specific learning disorders and vice versa. Likewise, autistic spectrum disorder and eating disorder are more and more recognized as comorbid entities. The DSM-IV made impossible the concomitance between autism spectrum disorders and ADHD. However, the DSM-5 did recognize the existence of this comorbidity. The association of those two pathologies results in more severe dysfunction for the children, but the treatment of ADHD is going to facilitate the medical care of autism spectrum disorders. ADHD is described as a risk factor for eating disorders. Besides, the co-occurrence of obesity with ADHD is connected to impulsiveness and the tendency to addictive behaviors. Relationships of ADHD with posttraumatic stress disorder and attachment disorder have also been noted. Similarities between ADHD and posttraumatic stress disorder can cause diagnostic errors. Indeed, for both disorders we find the following: agitation, irritability, hypervigilance, sleeping disorders, attention disorders and disorders in the executive functions. Therefore, during the assessment of a child with a clinical picture of ADHD, anamnesis must be completed with the search of traumatic events. On the other hand, attachment disorder can also be confused with ADHD. Difficult temperament can disrupt the process of attachment and is associated with a bigger risk of ADHD. Finally, other medical issues should be considered in the assessment of ADHD: brain injury, epilepsy and obesity for example. ADHD children with a co-occurring condition may be severely impaired and treatment is more complex. ADHD is strongly comorbid with a large number of psychiatric and physical pathologies. It is probably more a set of affections than a homogeneous clinical entity. The longitudinal studies of children with one or several comorbidities showed that the outcome of these children was unfavorable, the association of pathologies causing an important dysfunction. The explanations proposed for this strong tendency of comorbidity with ADHD are that comorbidities have the same risk factors (genetic and environmental) and/or that one of the disorder is a subcategory of another. This leads us to conclude that a better comprehension of the high rates of comorbidities with ADHD is essential to optimize treatment of this condition and prevent some of the negative outcomes associated with comorbid ADHD.     

Corrélats anatomocliniques au cours de la démence de la maladie de Parkinson

IntroductionCognitive disorders such as deficit of attention and executive and visuoconstructive dysfunctions occur in Parkinson's disease dementia (PDD). Memory impairment is not an early feature and statement not well delimited.Case reportA 78-year-old man with PDD underwent neuropsychological assessment and moreover demonstrated memory decline. After death, pathology examination of the brain and immunohistochemy analysis confirmed PD and showed Lewy body pathology (LBP) in the insula, limbic and especially in CA3 hippocampus areas. Hippocampus and gyrus parahippocampic also exhibited neurofibrillary tangles. Lack of senile plaque and lack of beta A4 amyloid deposition were noticeable in the whole brain examination.ConclusionSevere executive dysfunctions are probably related to LBP and dysfunction in memory process may be related to DNF lesions in medial temporal area.     

Efficacité des interventions de pair-aidants (schizophrénie,trouble bipolaire). Revue systématique de la littérature

ObjectiveThe effectiveness of programs integrating trained and paid peer helpers on symptoms, quality of life and recovery of persons with bipolar disorder or schizophrenia is still poorly understood. The factors influencing the integration of peer helpers into healthcare teams are also poorly understood.MethodA systematic review of the literature was performed. We systematically searched multiple electronic databases for articles: (i) exploring the effectiveness of the intervention of trained and paid peer helpers in bipolar disorder and schizophrenia (ii) reporting barriers and facilitators to the integration of peer helpers.ResultsForty-eight articles were included, 24 on the effectiveness of the intervention of peer helpers, 18 on barriers and 13 on facilitators to the integration of peer helpers in health teams. Of them, 25 were based upon qualitative methods (7 concerning the effectiveness of the intervention of peer helpers, 14 the barriers and 7 the facilitators to their integration); 23 were based upon quantitative methods (9 studies focused on the effectiveness of peer helper intervention, 2 on barriers and 6 on integration facilitators). The 23 quantitative studies included 8 randomized controlled trials.ConclusionIn spite of their heterogeneity, the results suggest that that interventions of peer helpers have a positive impact on the recovery, quality of life, social functioning, physical health and clinical outcome of persons with bipolar disorder or schizophrenia. The results also showed that the integration of peer helpers is favored by caregivers’ awareness about the role of peer helpers and knowledge about the recovery model. The results highlight the need for peer helpers to have a well-defined role and to be supervised, preferably by another peer helper.     

Utiliser les psychédéliques pour « guérir » des adolescents homosexuels ? Essai de thérapie de conversion,France, 1960

Between 1960 and 1962, a children's judge placed two French adolescents in a psychiatric hospital in Alsace. Described as “delinquent sexual perverts”, Michel, 15, and Bernard, 18, were in fact two young homosexuals. However, at the time, homosexuality was considered a psychiatric disorder that should be “cured”. With this in mind, psychiatrists set up shock or disgust therapies to push patients to become heterosexual. In this hospital, the chief doctor tested two new substances on them: mescaline and LSD. Injected in very high doses, the idea was to cause a powerful psychological shock in the hope of changing the adolescents’ sexual orientation. This type of placement as well as the treatment inflicted were then common (lobotomies or electroshocks were part of the “therapeutic” possibilities to “cure” homosexuality). Two aspects of these experiments are however particularly original: on the one hand, the use of substances such as mescaline and LSD, on the other hand, the very type of “therapy” implemented. It would thus seem, in the current state of knowledge on the use of LSD and mescaline in psychiatric therapy, that these experiences were isolated facts: the literature remains silent on the subject of the use of mescaline to “cure” homosexuality, and the few known therapies carried out using LSD were offered to adults and above all volunteers. Finally, these therapeutic methods were the opposite: psychotherapies in which particular attention was paid to patients and their well-being in the United States or in England and “psychic shocks” in Alsace. This hospital is the only French example of an attempt to “treat” homosexuality using psychedelics. The use of these substances by the French team therefore began in 1960; it involved administering mescaline or LSD in high doses (an exceptional characteristic in Europe where psychiatrists were in favor of therapy with low doses known as “psycholytic”) and in injections, ranging from 200 to 1200 mg for mescaline and for LSD from 100 to 800 micrograms. By way of comparison, a recreational dose is 300 to 500 mg for mescaline and 100 micrograms for LSD, administered orally. In order to create “psychic shock”, the effects of the substances were immediately stopped by the injection of chlorpromazine, a powerful neuroleptic. The authors noted that for all patients, “two modes of behavior are common: stupor and agitation”. They sometimes tore their sheets or pajamas or grabbed the examiner, asking for support. The sessions were linked: in 118 days, Bernard would undergo 16 of these sessions, one every 7 days on average. Michel, during one of the sessions, felt like he had been killed by his psychiatrists. Neither would subsequently become heterosexual. Elsewhere in the world, other forms of LSD conversion therapy have emerged. However, these were benevolent psychotherapies; the product was not injected but taken orally (therefore with more progressive effects), and the approach was not the same. Thus, acceptance of their homosexuality by patients was considered as desirable an option for therapists as was conversion to heterosexuality. For French practitioners, on the contrary, “healing” was the only objective. This article will highlight a double French specificity in the use of psychedelics: first, the refusal to introduce the new method of administering these substances, called “set and setting”, theorized from the late 1950s in Anglo-Saxon countries, and yet known and discussed by French experimenters. Then, it will show the use of these substances in shock therapy, particularly in the treatment of homosexuality.     

La place de la compréhension des proverbes et des métaphores dans la compréhension des troubles du cours de la pensée dans la schizophrénie : apport de l’évaluation clinique,de l’imagerie cérébrale fonctionnelle et de la neurophysiologie

According to Bleuler (1911), language impairments were indicative of thought disorders, a fundamental feature of schizophrenia. The objectives of the present review are twofold: (1) to present the clinical interest of the use of the tests of proverbs and metaphors comprehension for the evaluation of the characteristics of thought disorders in schizophrenia, and to highlight the heterogeneity of the forms of their interpretations; (2) to present the results from neuroimaging and neurophysiological studies of metaphor comprehension in order to identify the neurocognitive mechanisms underlying metaphorical language comprehension of patients with schizophrenic disorders. Results from the reviewed clinical applications of proverbs tests showed that thought disorders in individuals with schizophrenia are illustrated by different forms of proverb interpretations: literal, concrete, idiosyncratic, over-inclusiveness and unconventional. Results from the reviewed brain imaging and neurophysiological studies showed that these different forms of figurative misinterpretations may be related to different neurocognitive mechanisms: concreteness appears to be related to the dysfunction of the left inferior frontal gyrus and inverted brain lateralization during metaphor processing in individuals with schizophrenia compared to healthy individuals. During novel metaphor comprehension, which is highly effortful, individuals with schizophrenia, relative to controls, demonstrate increased activation of the right precuneus, a region that mediates complex and highly integrated functions including retrieval of episodic memory and mental imagery. These results may suggest that individuals with schizophrenia use mental imagery to support comprehension of both literal and metaphoric language. Furthermore, it was demonstrated that over-inclusive thinking, which is exhibited by individuals with schizophrenia during figurative language comprehension, could be related to very early right hemispheric hyper-activation (when a left early activation is expected) and to reduced bilateral brain activity during semantic processing. Such as reversed brain activation may explain why the individuals with schizophrenia are relatively over reliant on early-stage coarse or large semantic processing and may be prone to form meanings that are idiosyncratic and highly unconventional.