Place des thérapies comportementales dans la prise en charge des insomnies

Insomnia is among the most common health complaints in medical practice and the most prevalent of all sleep disorders. Generally, hypnotics and sedative drugs are widespread used, despite new knowledge in medical literature. Chronic insomnia can be a symptom, a syndrome and co morbid disorder. Its diagnostic relies on subjective reports from patient and sleep diary. Different subtypes of insomnia are defined: prolonged sleep latency (sleep onset insomnia), difficulties in maintaining sleep (sleep maintenance insomnia), early insomnia or a mix of different sleep complaints (mixed insomnia). Beside nights complaints, diurnal consequences are reported, include fatigue, mood disruption impaired attention… First, identification and treatment of primary psychiatric disorders or medical conditions or specific sleep disorders (apnea syndrome or periodic limb movement) are essential and associated with sleep hygiene (therapeutic education). If this first step is not sufficient, behavioral therapy (BT) (stimulus control and sleep restriction) or cognitive-behavioral therapy (CBT) of insomnia have demonstrated considerable efficacy within randomized clinical trials. Other techniques exist: relaxation, biofeedback… But CBT or BT is gold standard. Nevertheless, treatment of insomnia is an individual course of care.     

Comparaison des bénéfices médico-économiques des antipsychotiques dans la prise en charge de la schizophrénie en France

Introduction

The course of schizophrenia can vary widely, and patients experience remission phases alternating with relapse episodes, which generally lead to hospitalisation and have a significant impact on the burden of disease. The prevalence of schizophrenia in France is estimated to be approximately 600,000 people, with an incidence of 10,000 new patients per year. Patients with schizophrenia represent the largest group of hospitalised patients in French public institutions and specialised centres, and the French authorities recognise that the management of schizophrenia is a major public health concern. The Haute Autorité de Santé (HAS) and most of the evidence-based guidelines for the maintenance treatment of schizophrenia recommend long-acting injectable (LAI) antipsychotics to be used predominantly in the prevention of relapse for non-compliant patients; however, in clinical practice, the use of LAIs remains low.

L’évaluation des bains thérapeutiques dans la prise en charge de la douleur des enfants polyhandicapés en SSR pédiatrique

Pain management for children who have severe neurological diseases (polyhandicap), in a pediatric post-acure care and rehabilitation, is daily and work frequently with palliative approach. Cares for these children, with complex illness are a multidisciplinary approach. Treatments establishment or equipment, intervention, adaptation take place with respect and comfort concern about child or adolescent dignity. For this, drug free techniques are more and more integrated in the pain management in hospitals. Balneotherapy is one of them, essentially used for orthopaedic, rhumatological or neurological diseases (hemiplegia for example). Caregivers doesn’t have specific bath for balneotherapy in our establishment, that why we put in place some bath, called “therapeutic bath” or “relaxation bath”. The impression was a better feeling of comfort and better-being on these children. This encourages us to pursue the study to evaluate the real benefits.     

Perspective de prise en charge d’enfants atteints de troubles du spectre autistique par psychothérapie inspirée des thérapies basées sur la mentalisation

Mentalization is a process by which a subject makes sense of both his own mental representations and of those around him. Disturbances in the mentalization process are found in several psychiatric disorders, notably borderline personality disorders for which mentalization-based treatments (MBT) have been developed and evaluated. Children with Autism Spectrum Disorder (ASD) display a theory of mind impairments, which corresponds to disturbances in the mentalization process. Although no MBT protocol for patients with ASD has been described in the literature, such treatment appears promising to improve theory of mind and functional outcome of these children. In this paper, we propose to discuss the theoretical ground of MBT therapeutic effect in children with ASD without intellectual disabilities and to describe a clinical protocol to test this perspective.     

Image et culture dans la prise en charge de mineurs isolés étrangers

Aims

Through the implementation of photographic mediation, we aim to show the advantages of the use of a mediation-based group system in a migratory context. The focus is on the expression of affects within a group and the articulation between the subject and the group in the setting of this particular type of treatment.

Intérêts et limites des hospitalisations séquentielles dans la prise en charge des états de stress post-traumatique

Beyond emergency, many patients with Post-Traumatic-Stress-Disorder may evolve into a lasting alteration of their previous health status consisting of polymorphic and durable psychiatric symptomatology. In the Army, the path of these « psychic wounded » is accompanied by different institutional services from recognition to rehabilitation. Thinking the long term psychiatric accompaniment of these patients recquires to question the place of the different interlocutors. In this works we make a feedback about a sequential hospitalization experience taking place in an Army Instruction Hospital by questioning the contributions as the limits. We emphasize notably the difficulty of empirically establishing and reproducing the validity of an therapeutic intervention.     

Psychotraumatologie de la guerre en Ukraine : la question de la prise en charge psychologique des victimes réfugiées ou restées en Ukraine

The war in Ukraine is a major poly-traumatic event, which leads to massive population displacements. The question of the evaluation and psychological care of psychotraumatised people is an urgent matter. As many countries hosting refugees are well endowed with a number of psychologists, some of these interested professionals should mobilise themselves and make themselves known to carry out these clinical acts. Priority should be given to trained and experienced psychologists to support victims. The language barrier will have to be overcome. Initially, it would be desirable to make contact or get closer to local and national refugee centres to facilitate these operations. Face-to-face or remote consultations, as developed during the Covid-19 pandemic, are possible. Reinforcements of available and dedicated psychologists, including remotely, from the countries hosting the most refugees are also desirable. The issue of detection, assessment and care of psychologically traumatised people who remained in the Ukrainian territory is probably even more massive. Whether non-combatants or combatants, part of the international psychological community should mobilise, in addition to local colleagues, to provide them with this psychological help. These humanitarian actions would be feasible depending on the evolution of the conflict. Whether it is psychological support for refugees or people still on the Ukrainian soil, models for organizing and coordinating these actions must be carefully thought out and implemented in an evolving way to optimise their effectiveness.     

Contrainte carcérale,soin et prise en charge en art-thérapie

AimsThis article is a reflection on the issues of health and care in prison in the setting of art therapy workshops. The questions raised by the practice of art for therapeutic purposes lead on to consideration of many forms of relationships between the individual and society.MethodAn ecological approach makes it possible to take the individual into account via a set of phenomena, using the contemporary art therapy methods specific to the Association Française de Recherches et Applications des Techniques Artistiques en Pédagogie et Médecine (AFRATAPEM). This approach takes the form of a phenomenology of artistic action for therapeutic purposes. The artistic phenomenon is articulated around four phases: impression, intention, action and production.ResultsThe results show that art affords scope for change by way of the use of concepts and phenomena that belong to the artistic phenomenon as a whole. The plasticity that is an integral part of the phenomenological organisation of humans can be used in art therapy. Prison changes people as a result of its violence, while art therapy can help to reduce its harmful impact.DiscussionIn prison, relationships are controlled, and maintained at a certain level of violence, which is coherent with the setting. Thus, in the care plan offered to a detainee, the question of health and well-being is central to the social issues involved, and to how they are dealt with. It is for caregivers to assess the limits of tolerability, and when the intolerable threatens the very humanity of the individual, the legitimacy of the response needs to be discussed. The prison environment lays claim to legitimacy that could be understood as way of changing society. The person discharged after a prison sentence carries with him violence that compounds the violence pre-existing his incarceration. Because imprisonment is not envisaged in terms of its function and in the long term, just as the economy has not taken account of ecology, prisons no longer protect society from violence, but, quite the reverse, manufacture and disseminate it.     

Une étude clinique autour de la parentification et de son élaboration dans la psychothérapie psychanalytique

ObjectiveThe purpose of this article is to highlight the imprint of the parentification process in a patient in the context of a four-year psychoanalytic psychotherapy, through the analysis of the parentification process in its intrapsychic, intersubjective, and transsubjective dimensions.MethodAfter the end of the therapy, the psychotherapist returns to the material, which involved a patient who presented a depressive disorder and a parentification process during their childhood. We analyzed different themes related to parentification: infantile history, parental imagos, identifying dynamics, parental couple and conjugality, siblings, family functioning, choice of professional career and the relationship to work, and finally, a possible intergenerational or transgenerational transmission of parentification.ResultsWe observed changes to the patient's subjective suffering: better insight, changes in parental imagos, and also changes in the relationship with others (partner and children) as a consequence of an elaborative process around her parentification. In this case, parentification appears as a response to the traumatic infantile parental perception, as a defensive organization, as a survival solution organized around the symbiotic relationship between the child and the sick parent and, later, in relationships of great dependence with her spouse or her children. Throughout the psychotherapy process we observed: a childhood story marked by a generational reversal, an invasive parental imago, narcissistic identificatory dynamics, a parental couple characterized by dysfunctional conjugality, a special place in her siblings, a familial functioning marked by confusion between roles and generations, a professional choice in the field of care, a potential intergenerational or transgenerational transmission of parentification, and finally a dysfunctional parenthood over several generations. The narcissistic dimension of parentification observed in this patient seems to be linked to the omnipotent position vis-à-vis her “failed” parents, which activates a megalomaniacal narcissism and a heroic masochism.DiscussionFor the psychotherapist, the method of treatment and the method of research overlap. The work of writing this case of psychoanalytical psychotherapy allows for new reflections in its aftermath, other elaborations on the material of the sessions, and a tridimensional exploration of the process of parentification: intrapsychic, intersubjective, and transubjective.ConclusionWe underscore the contribution of the clinical elements revealed by the analysis of the transfer/counter-transference dynamics in the process of deparentification.     

La psychothérapie centrée sur le lien transférentiel dans la clinique des addictions sexuelles

ObjectiveThe article aims to share theoretical, clinical, and technical findings on the treatment of subjects with severe sexual addiction.MethodBased on theoretical research and clinical practice with sex-addicted patients, we examine the models (PFT) which led us to conceive of a psychoanalytical psychotherapy centered on the transferential link integrating the works of Kernberg, Fonagy, Bateman, but also those put into perspective by Anzieu, Bouvet, and Roussillon in France.ResultsIf these modalities of framework and technical interpretation were first developed for a population of borderline subjects, our empirical clinical findings tend to verify the performative value, for subjects presenting a severe sexual addiction, of a psychodynamic therapeutic process centered on the link.DiscussionAlthough the efficacy of pharmacological treatments, cognitive therapies, or group therapies has been demonstrated in the treatment of subjects with severe sexual addiction, no randomized controlled study currently exists to verify the efficacy of a bonding-focused analytical psychotherapy with this population.ConclusionThe article provides empirical qualitative results and opens a dialogue with other psychotherapeutic methodologies in order to think about a diversified offer of care models adapted to this population.     

Ressenti des sages-femmes dans la prise en charge en suites de couche des patientes avec troubles psychiques sévères : une analyse qualitative

BackgroundA significant proportion of women with Severe Mental Illness (SMI) will become mothers during their reproductive life. These pregnancies are, however, more at risk of psychiatric, obstetrical and neonatal complications (increased risks of post-partum depression, relapse, suicide, gestational diabetes, placental abnormalities or low birth weight). Midwives often feel isolated and resourceless when taking care of these women. Specialized units such as mother-infant psychiatric units or the Transversal Unit of Perinatal Care (UTAP) in the Grenoble Alpes University Hospital (CHUGA) enhance the coordination between psychiatric and obstetrical teams and have shown effectiveness in improving maternal and child outcomes.Objectivesi) to assess midwives’ feelings about the postpartum care of women with SMI; ii) to determine UTAP's impact on this feeling and its determinants; iii) to look for unmet needs.MethodsThis study is a prospective, exploratory, qualitative analysis. Twenty midwives from Grenoble Alpes University Hospital who took care of one of the selected patients participated in this study. Two women had schizophrenia and one bipolar disorder. Interviews realized with a semi-structured guide were fully transcribed, anonymized and thematically analyzed. Topics have been structured according to the number of occurrences to build a thematic tree.ResultsMidwives felt insecure and resourceless when the postpartum care was unclear, insufficiently anticipated and in case of a danger for the women or the children. They felt uneasy when not feeling able to provide usual care to these patients (due to lack of specific knowledge about SMI and to the impossibility to consider their patient otherwise than through their pathology). Midwives felt at ease and secure when the postpartum care was anticipated. UTAP was identified as a resource for midwives. Specific training and improvements in the organization of the pre and post-natal care could improve midwives’ feelings when taking care of women with SMI.