Pourquoi la clinique de la douleur est-elle une clinique de la complexité ?

Easily understood on a daily basis as a signal for somatic disturbance, pain cannot be apprehended so easily. Definition and clinical of pain remind us of a key principle: there is no physical pain without psychological counterpart, and vice versa; and there is no psychological disorder without a physical correlation. However, the complex nature of the pain clinic does not stop there. We can distinguish is at least six dimensions allowing us to answer the uncertainty and the difficulty of its apprehension: through language, through culture, through representation, through personality organization, through pain's functions and other additional complications due to the confusion taking place in the designations, and through the different nosographic classifications. Pain is the limit of all knowledge, may it be medical, nursing, psychology, and invites us all to confront with other schools of thought and to work together to hear what is said and not said by the subject. In this singular clinic, the specificity of the psychologue and the importance of his view reside precisely in an appreciation of the psychic dynamics of the patient which interact with pain and which express itself within pain beyond somatic aspects.     

Les progrès dans la réalisation de la classification quantitative de la psychopathologie

Shortcomings of approaches to classifying psychopathology based on expert consensus have given rise to contemporary efforts to classify psychopathology quantitatively. In this paper, we review progress in achieving a quantitative and empirical classification of psychopathology. A substantial empirical literature indicates that psychopathology is generally more dimensional than categorical. When the discreteness versus continuity of psychopathology is treated as a research question, as opposed to being decided as a matter of tradition, the evidence clearly supports the hypothesis of continuity. In addition, a related body of literature shows how psychopathology dimensions can be arranged in a hierarchy, ranging from very broad “spectrum level” dimensions, to specific and narrow clusters of symptoms. In this way, a quantitative approach solves the “problem of comorbidity” by explicitly modeling patterns of co-occurrence among signs and symptoms within a detailed and variegated hierarchy of dimensional concepts with direct clinical utility. Indeed, extensive evidence pertaining to the dimensional and hierarchical structure of psychopathology has led to the formation of the Hierarchical Taxonomy of Psychopathology (HiTOP) Consortium. This is a group of 70 investigators working together to study empirical classification of psychopathology. In this paper, we describe the aims and current foci of the HiTOP Consortium. These aims pertain to continued research on the empirical organization of psychopathology; the connection between personality and psychopathology; the utility of empirically based psychopathology constructs in both research and the clinic; and the development of novel and comprehensive models and corresponding assessment instruments for psychopathology constructs derived from an empirical approach.     

Uso de la polipíldora cardiovascular en la prevención secundaria de la enfermedad cerebrovascular

IntroductionThere is little control of cardiovascular (CV) risk factors in secondary prevention after an ischaemic stroke, in part due to a lack of adherence to treatment. The CV polypill may contribute to proper treatment adherence, which is necessary for CV disease prevention. This study aimed to establish how and in what cases the CV polypill should be administered.MethodsA group of 8 neurologists drafted consensus recommendations using structured brainstorming and based on their experience and a literature review.ResultsThese recommendations are based on the opinion of the participating experts. The use of the CV polypill is beneficial for patients, healthcare professionals, and the health system. Its use is most appropriate for atherothrombotic stroke, lacunar stroke, stroke associated with cognitive impairment, cryptogenic stroke with CV risk factors, and silent cerebrovascular disease. It is the preferred treatment in cases of suspected poor adherence, polymedicated patients, elderly people, patients with polyvascular disease or severe atherothrombosis, young patients in active work, and patients who express a preference for the CV polypill. Administration options include switching from individual drugs to the CV polypill, starting treatment with the CV polypill in the acute phase in particular cases, use in patients receiving another statin or an angiotensin ii receptor antagonist, or de novo use if there is suspicion of poor adherence. Nevertheless, use of the CV polypill requires follow-up on the achievement of the therapeutic objectives to make dose adjustments.ConclusionsThis document is the first to establish recommendations for the use of the CV polypill in cerebrovascular disease, beyond its advantages in terms of treatment adherence.     

Relation entre la violence intra-hospitalière des patients avec psychoses et la violence dans la communauté

Background

Violence is a common issue in psychiatry and has multiple determiners. The aim of this study is to assess the psychotic inpatients’ violence in association with the violence of the neighborhood from which the patients are drawn and to estimate the impact of this environmental factor with regard to other factors.

Prévenir la violence associée à la schizophrénie avec la remédiation cognitive

Objectives

The association between schizophrenia and violence represents an important issue in psychiatry. Often highly publicized, violent acts raise the question of their detection, prevention, management and treatment. There is no single, direct and exclusive link between aggressiveness and the underlying psychiatric disorder. On the contrary, the processes underlying this violence are multiple and interlinked. In addition to static and dynamic risk factors, cognitive deficits play an important role in the genesis and maintenance of violent and aggressive behavior.

La alteración de la mielina en la enfermedad de Alexander

Introduction

Alexander disease (AxD) is a type of leukodystrophy. Its pathological basis, along with myelin loss, is the appearance of Rosenthal bodies, which are cytoplasmic inclusions in astrocytes. Mutations in the gene coding for GFAP have been identified as a genetic basis for AxD. However, the mechanism by which these variants produce the disease is not understood.

Sur la pathogénie de la Sclérose Tubéreuse

Résumé Les auteurs ont étudié cinq cas de sclérose tubéreuse, dont trois autopsiés. À partir des lésions cutanées, ils ont soupçonné que le processus était essentiellement une perturbation métabolique des organes atteints, due à des malformations vasculaires. L'étude des lésions encéphaliques confirma l'hypothèse. En effet, l'examen microscopique de coupes colorées par les méthodes classiques pour l'étude des cellules nerveuses, de la glie et des vaisseaux révélèrent que les cellules monstrueuses de la sclérose tubéreuse sont des éléments dégénérés des trois lignages qui donnent le tissue nerveux, et, d'un autre côté, montrèrent que, semblablement à ce qui arrive pour le peau, les vaisseaux de ce tissu sont mal formés dans cette maladie. À partir de ces données, ils formulèrent une nouvelle conception pathogénique pour expliquer la maladie.

---

Zusammenfassung Die Verfasser untersuchten fünf Fälle von tuberöser Sklerose, darunter drei autoptisch verifizierte. Auf Grund der Hautveränderungen vermuten sie, daß der Prozeß im wesentlichen eine Stoffwechselstörung der betroffenen Organe infolge von Gefäßmißbildungen darstellen könnte. Die Untersuchung der Hirnveränderungen bekräftigte diese Hypothese. Die histologische Untersuchung mittels der klassischen Routinefärbungen für Nervenzellen, Glia und Gefäße zeigte, daß es sich bei den Monstrezellen der tuberösen Sklerose um degenerierte Elemente der drei Bauteile des Nervengewebes handelt und daß anderseits — in Analogie zu den Hautveränderungen — eine Fehlbildung der Gefäße im ZNS vorliegt. Auf Grund dieser Befunde wird eine neue pathogenetische Konzeption der Erkrankung formuliert.

---

---

Avec 5 illustrations dans le texte

---

Ouvrage couronné du prix Alvarenga de 1963 de l'Académie Nationale de Médicine du Brésil.     

Determinación de la temperatura de respuesta nociceptiva sobre la cola de ratones albinos de la cepa Balb/c

IntroductionDesigns for determining nociceptive response in rodents are of great use in neurology and experimental neuroscience. Immersing mice's tails in warm water is one of the most widely used procedures to evaluate this response; however, a wide range of temperatures are used in different studies. Knowing the temperature that produces a powerful nociceptive response in the tail of BALB/c mice is extremely useful.MethodsEight 2-month-old male BALB/c mice were used. A 14-cm high beaker was filled with water up to 13 cm. The animals’ tails were immersed in the container with a starting temperature of 36 °C. The water temperature was raised in 1 °C increments until we identified the temperatures that produced nociceptive responses. That response was determined by counting the time taken before the mouse shook its tail to remove it from the water.ResultsSix of the 8 mice began shaking their tails at the temperature of 51 °C. All animals removed their tails from the water at the temperatures of 54 °C, 55 °C, and 56 °C, taking a mean time of 8.54, 7.99, and 5.33 seconds, respectively. ANOVA applied to the response times for each of the 3 temperatures indicated revealed a value of F=2.8 (P=.123).ConclusionsThe response time was statistically similar for the temperatures of 54 °C, 55 °C, and 56 °C; however, the data were less dispersed for the latter temperature.     

Phénoménologie de la curiosité comme rupture temporelle : sur la route de la Beat Generation

Jack Kerouac's famous autobiographical novel “On the Road” tells the epic journey through the magnificent landscapes of the American continent through frantic, jazz-rhythmic writing. In this book, beyond the classical framework of a travel journal, Kerouac aspires to tell a style of existence through a style of writing. The perpetual feast of the senses and the erotic evokes the exalted adventure of the Beat Generation and testify to this style of existence characteristic of what phenomenology calls existential curiosity. In the midst of unexplored landscapes, unexpected encounters, in the aftermath of a flight to be pursued without ceasing, Kerouac aimed at the permanent improvisation, that of the “bebop”, that of the “instant literature”. The writing of a road that takes shape at the moment under the wheels of the car that traces its way as fast as it does erase it. And this is a perpetual quest for novelty, in openness to curiosity. It appears then that the phenomenological notion of this experience of curiosity, makes possible to approach the foundations and the wanderings of the beat generation, and more broadly the experience of the generations, which have succeeded.     

Epilepsia en el anciano: ¿la edad de inicio marca la diferencia?

IntroductionEpilepsy is most frequent in children and elderly people. Today's population is ageing and epilepsy prevalence is increasing. The type of epilepsy and its management change with age.MethodsWe performed a retrospective, observational study comparing patients aged ≥ 65 years with epilepsy diagnosed before and after the age of 65, and describing epilepsy characteristics and comorbidities in each group.ResultsThe sample included 123 patients, of whom 61 were diagnosed at < 65 years of age (group A), 62 at ≥ 65 of age (group B). Sex distribution was similar in both groups, with 39 men (62.9%) in group A and 37 (60.7%) in group B. Mean age was 69.97 ± 5.6 years in group A and 77.29 ± 6.73 in group B. The most common aetiology was unknown in group A (44.3%, n = 27) and vascular in group B (74.2%, n = 46). History of stroke was present in 12 patients from group A (19.7%) and 32 (51.6%) in group B. Antiepileptic drugs were prescribed at lower doses in group A. Statistically significant differences were found between groups for history of ischaemic stroke, cognitive impairment, psychiatric disorders, and diabetes mellitus; degree of dependence; and number of antiepileptic drugs.ConclusionAge of onset ≥ 65 years is closely related to cardiovascular risk factors; these patients require fewer antiepileptic drugs and respond to lower doses. Some cases initially present as status epilepticus.     

La classification de la paranoïa dans la psychiatrie américaine contemporaine : une revue de la littérature

Objective

The main objective of this paper is to undertake a literature review on the classification of the paranoia in contemporary American psychiatry.

Valor predictivo de la resonancia magnética para la identificación de compresiones neurovasculares en la neuralgia del trigémino

IntroductionMicrovascular decompression (MVD) is accepted as the only aetiological surgical treatment for refractory classic trigeminal neuralgia (TN). There is therefore increasing interest in establishing the diagnostic and prognostic value of identifying neurovascular compressions (NVC) using preoperative high-resolution three-dimensional magnetic resonance (MRI) in patients with classic TN who are candidates for surgery.MethodsThis observational study includes a series of 74 consecutive patients with classic TN treated with MVD. All patients underwent a preoperative three-dimensional high-resolution MRI with DRIVE sequences to diagnose presence of NVC, as well as the degree, cause, and location of compressions. MRI results were analysed by doctors blinded to surgical findings and subsequently compared to those findings. After a minimum follow-up time of six months, we assessed the surgical outcome and graded it on the Barrow Neurological Institute pain intensity score (BNI score). The prognostic value of the preoperative MRI was estimated using binary logistic regression.ResultsPreoperative DRIVE MRI sequences showed a sensitivity of 95% and a specificity of 87%, with a 98% positive predictive value and a 70% negative predictive value. Moreover, Cohen's kappa (CK) indicated a good level of agreement between radiological and surgical findings regarding presence of NVC (CK 0.75), type of compression (CK 0.74) and the site of compression (CK 0.72), with only moderate agreement as to the degree of compression (CK 0.48).After a mean follow-up of 29 months (range 6-100 months), 81% of the patients reported pain control with or without medication (BNI score i-iiiI). Patients with an excellent surgical outcome, i.e. without pain and off medication (BNI score i), made up 66% of the total at the end of follow-up. Univariate analysis using binary logistic regression showed that a diagnosis of NVC on the preoperative MRI was a favorable prognostic factor that significantly increased the odds of obtaining an excellent outcome (OR 0.17, 95% CI 0.04-0.72; P=.02) or an acceptable outcome (OR 0.16, 95% CI 0.04-0.68; P=.01) after MVD.ConclusionsDRIVE MRI shows high sensitivity and specificity for diagnosing NVC in patients with refractory classic TN and who are candidates for MVD. The finding of NVC on preoperative MRI is a good prognostic factor for long-term pain relief with MVD.     

Psychopathologie de la dysmorphie musculaire : analyse critique de la littérature internationale

Introduction

Muscle dysmorphia is a contemporary subject of interest officially inscribed in the DSM- 5 in 2013 under the body dysmorphic disorder “muscle dysmorphia”. It does not yet have its own nosographic entity.

Importancia de la arteriografía cerebral y la monitorización neurofisiológica intraoperatoria en la endarterectomía carotídea

It is an increasingly common practice to indicate a carotid endarterectomy procedure based on the information provided by non-invasive tests like Duplex ultrasound, MR angiography or CT angiography, thereby obviating the performance of a conventional cerebral angiography. We present a case of symptomatic left carotid artery 80% stenosis in which cerebral angiography showed absence of the right A1 segment and bilateral anterior cerebral artery territories that filled only from a left injection. Just 90 seconds after carotid artery clamping at the neck, brain oximetry and somatosensory evoked potentials significantly dropped, that recovered after immediate clamp removal. Endarterectomy was dismissed and a carotid stent was successfully placed. This case highlights the importance of knowing the dynamics of cerebral blood circulation distal to the stenosis. If endarterectomy had been attempted, unawareness of the information provided by the cerebral angiography would have likely result in severe bi-hemispheric ischemia.