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Isabelle Poirot 《Annales médico-psychologiques》2012,170(3):202-207
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. 相似文献
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S. Druais A. Doutriaux M. Cognet A. Godet C. Lançon P. Levy L. Samalin P. Guillon 《L'Encéphale》2017,43(4):311-320
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.Objective
This analysis aimed to estimate and to compare the cost-effectiveness of the most common antipsychotic strategies in France in the management of schizophrenia.Methods
A Markov model was developed to simulate the progression of a cohort of patients with schizophrenia through four health states (stable treated, stable non-treated, relapse and death) and considered up to three lines of treatment to account for changes in treatment management. Antipsychotics including aripiprazole LAI (ALAI), olanzapine LAI (OLAI), paliperidone LAI (PLAI), risperidone LAI (RLAI), haloperidol decanoate (HD) and oral olanzapine (OO) were compared in terms of costs and clinical outcomes. Thus, costs, quality-adjusted life-years (QALYs) and number of relapses were assessed over five years based on three-month cycles from a French health insurance perspective with a discount rate of 4 %. Patients were considered to be stabilised after clinical decompensation and would enter the model at an initiation phase, followed by a prevention of relapse phase if successful. Data (e.g. relapse or discontinuation rates) for the initiation phase came from randomised clinical trials, whereas relapse rates in the prevention phase were derived from hospitalisation risks based on French real-life data in order to capture adherence effects. Safety and utility data were derived from international publications. Additionally costs were retrieved from French health insurance databases and publications. Robustness of results was assessed through deterministic and probabilistic sensitivity analyses.Results
First and second generations of LAIs were found to have similar costs over five years; i.e. approximately € 55,000, except for PLAI which was associated with a discounted cost of € 50,880. Oral antipsychotics were found to be less costly (i.e. OO cost € 50,379 after five years) but associated with a lower number of QALYs gained and relapse avoided. PLAI and RLAI were associated with the greatest number of QALYs gained; i.e. PLAI dominated ALAI, OLAI and HD and was associated with an incremental costs-effectiveness ratio (ICER) of € 2411 per QALY gained versus OO. Finally, PLAI and OLAI were associated with the lowest number of relapses; i.e. PLAI dominated RLAI, ALAI and HLAI and was associated with an ICER of € 1782 per avoided relapse compared to OO. OO and HD were found to have led to the highest number of relapses.Conclusion
This analysis, to the best of our knowledge, is the first of its kind to assess the cost-effectiveness of antipsychotics based on French observational data. PLAI was associated with the highest probability of being the optimal treatment from the French health insurance perspective. 相似文献4.
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O. Dufour 《Motricité Cérébrale》2018,39(1):30-37
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. 相似文献
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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. 相似文献
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Pietro Alfano Giuseppe Lo Piccolo Palma Audino Thierry Baubet 《L'évolution Psychiatrique》2018,83(4):557-578
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.Method
The Photolangage® group presented here is part of a system of care and psychological support targeting unaccompanied minors. The participants were five teenagers aged 15 to 17 years from sub-Saharan Africa and Bangladesh. For the analysis we used a clinical approach liable to promote links, representations and symbolization processes in a group situation.Results
The clinical elements observed show us how the cultural objects represented in and by the photographs and the use of the mother tongue by participants played the role of a mediation object, opening up a potential space enabling transformation and change. The cultural object is here a vehicle for affects and representations not yet accessible to the subjects.Discussion
Current migratory movements have very complex consequences, individual, collective socio-political and psychological. Unaccompanied minors and their care force us to review our care provision in a transcultural dimension and modify our ways of thinking and practising in clinical setting. The effects of colonialism on the psyche of migrants are still alive and can structure their subjective and collective identity, enabling a better understanding of their shared representations.Conclusion
The issues of migration in a context of social and collective violence need to be considered in relation to the complexity of the different psychic spaces mobilised. These issues are explored, brought into play, reappraised and sometimes invalidated in a transcultural context. The introduction of images as a form of mediation in the group favours the articulation of psychics spaces, and promotes the processes of bonding and representation of affects. 相似文献9.
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Gilles Thomas 《Annales médico-psychologiques》2018,176(5):511-514
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. 相似文献
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《Annales médico-psychologiques》2023,181(1):8-11
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. 相似文献
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《L'évolution Psychiatrique》2019,84(2):285-295
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. 相似文献
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《L'évolution Psychiatrique》2023,88(1):31-39
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. 相似文献
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《L'évolution Psychiatrique》2023,88(1):41-55
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. 相似文献
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《L'Encéphale》2020,46(3):226-230
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. 相似文献