Analyse du sens d’un trouble du comportement dans la démence

The behavior disorders are frequent in Alzheimer's disease. They sometimes reflect a tension between on the one hand what the patient did, what he would like to continue and on the other hand the frame of the caregivers’ horizon. Poor praxis, instrumental difficulties, are sources of failure in what patients undertake and of relational difficulties within the human surrounding where he/she is no more understood. We propose in this article, from a clinical case, a method of analysis of the practices’ adjustments of demented person with the aim of an adaptation of the care. We insist in this article on the analysis of the interrelations of the systematic components to release the sense direction of what the patients tries through their behavior, by taking account of their points of view and those of their formal or informal caregivers. In the reported case, through a behavioral disorder, the demented person raises the question of his/her identity. Sense of the behavior disorder, such as the nursing can understand it, is then his demand of identity's support, and not simply in a palliative help of failing practices.     

Crise suicidaire et maladie d’Alzheimer débutante : intérêt d’une analyse neuropsychologique détaillée

IntroductionThe role of Alzheimer's disease as a risk factor for suicide is unclear. The aim of this study was to understand neuropsychological component of the suicidal crisis in Alzheimer's disease.MethodUsing an extensive neuropsychological battery, different aspects of cognitive inhibition were particularly examined: Access to relevant information (using the Reading with distraction task), suppression of no longer relevant information (Trail Making Test, Rule Shift Cards), and restraint of cognitive resources to relevant information (Stroop test, Hayling Sentence Completion test, Go/No-Go). One female Alzheimer depressed case was assessed before and after a suicide attempt.ResultsTen days after the patient's suicide attempt, dementia was still moderate with a MMSE score at 21/30 but with a worsening of executive functions (FAB at 8/18) in the context of depression and suicide. The Hamilton-Depression Rating Scale was at 24 (maximal score at 52), and the Cornell Scale for Depression was at 21 (maximal score at 38). Suicidal intent was moderate with a score of 9 on the Beck Suicide Intent Scale (maximal score at 25). The patient did not present a delirium, psychotic symptoms, or anosognosia. Her episodic memory was altered as shown by her semantic performance on verbal fluency (naming 12 animals in 120 seconds) and on lexical fluency (naming 8 words beginning with the letter P). Initially preserved, executive function declined during a suicidal crisis in a context of depression in Alzheimer's disease case. Neuropsychological testing confirmed a dysexecutive syndrome (FAS at 8/18), with an impairment in her conceptualization capacity (MCST) and a deficit in cognitive inhibition and its access (reading task in the presence of distractors), deletion (TMT) and restraint (Stroop, Go/No-Go, Hayling) functions. Computed tomography has shown no signs of intracranial expansive process.ConclusionAssessing predictors of suicide and means of completion in patients with dementia may help the development of interventions to reduce risk of suicide among the growing population of individuals with dementia. Because of Alzheimer's-related cognitive inhibition impairment, identification and intervention addressing the complex issues of depression, executive dysfunction and dementia may help clinicians to mitigate the risk of suicide in patients with Alzheimer's disease.     

Présentation d’un outil d’évaluation de l’évolution des processus psychiques au sein d’un dispositif thérapeutique en clinique du traumatisme

ObjectivesOur project consists in the implementation and the evaluation of a care system for children in a child protection NGO in Cambodia. In view of the cultural differences and specificities of the field, taking into account only the symptoms do not seem to sufficiently account for the processes involved within the system. Based on the observation that there is a lack of tools that would allow us to apprehend these processes, our study focused on the creation of a scoring grid for psychological processes that could be used in the humanitarian field and could support clinical practice.MethodDuring one year, we met ten children confronted with traumatogenic events, within a device based on therapeutic mediations. The corpus studied is based on observation notes inspired by Esther Bick's methodology. The study of the corpus and its theoretical linkage made it possible to identify five main processes as well as six channels of transfer.ResultsUsing the NVivo software, the observation notes were rated using the grid. Each of the sessions with the children was thus analyzed. By means of a matrix crossing query, we identified the processual evolution over the whole follow-up.DiscussionThis rating grid allows us to identify the psychic movements at play during the encounters and raises new questions about the diagnosis on humanitarian grounds.ConclusionThis work has allowed us not only to create a rating grid but also to enrich and complete it during the rating process. This grid allows a processual evaluation within the therapeutic follow-ups and constitutes a support for the clinician confronted with a loss of reference points and a massive counter-transference.     

Présentation du musée d’art et d’histoire de l’Hôpital Sainte-Anne (MAHHSA). La Collection Sainte-Anne. De sa constitution au Musée d’Art et d’Histoire de l’Hôpital Sainte-Anne (MAHHSA)

The Sainte-Anne Collection, by its history and the diversity of its works, is a metaphor for the question of the multiplicity of springs of creativity. If its constitution is in 1950 (at the end of the first international exhibition of psychopathological art held during the first world congress of psychiatry in Paris at Sainte-Anne hospital), its existence is closely linked to the artistic, political, psychiatric history of the first part of the twentieth century. The Centre d’Étude de l’Expression has managed this collection since 1973, and it is a question of making sure that this unique set of works is inventoried, restored, preserved in good conditions and presented at numerous exhibitions, around specific themes, open to the public. Each exhibition has the opportunity to destigmatize these works. The Sainte-Anne Collection is not part of a parallel story, but of the history of contemporary art. This is how special recognition was granted in 2016, since the Musée d’Art et d’Histoire de l’Hôpital Sainte-Anne has received the Musée de France designation.     

L’écrivain schizophrène et la construction du délire

Aims

This article aims to examine the effect of writing when used as self-medication in psychosis and particularly in schizophrenia.

Le rôle des facteurs psychologiques dans la réalisation d’une démarche de dépistage du VIH

Objectives

Despite of regional, national and international plans which have been implemented to struggle against the Human Immunodeficiency Virus (HIV), the global prevalence of this disease continues to increase. While the General Assembly of the United Nations is aiming at putting an end to the Acquired Immune Deficiency Syndrome (AIDS) epidemic in the world by 2030, it appears necessary to draw up the list of the main factors involved in the HIV test process. Indeed, a better knowledge of the factors, facilitating or hindering the uptake of a HIV screening test, enables to make more effective prevention campaigns which aim at improving people's knowledge of their serological status. The purpose of this article is to underline the impact of psychological factors involved in the HIV test process. From the literature reviews already established, the main psychological factors, facilitating or hindering the uptake of a HIV screening test have been identified.

Les défis du droit pénal face à l’urgence sécuritaire

Following the attacks in January and November 2015, France passed laws specially turned to terrorism prevention, increasing the powers of judicial police and the prosecution, by the use of proactive investigations highly intrusive. New offenses relative to advocating terrorism revive the debate about the legitimacy of such offenses, including under the principal of legality of offenses and penalties.     

Colite ischémique sous quétiapine associée à d’autres molécules anticholinergiques : à propos d’un cas

Introduction

The aim of this paper is to underline the need for systematic monitoring of patients treated with anticholinergic antipsychotic drugs. We present the clinical history of a 34-year-old adult, treated with quetiapine in combination with other drugs with anticholinergic effects.

Étude rétrospective des bénéfices développementaux et comportementaux d’une intervention psycho-éducative pour des enfants porteurs d’un Trouble du Spectre de l’Autisme

The purpose of the study is to measure the impact of a 4-year-psycho-educative intervention on the skills and behaviors of 26 children with autism located a Day Center Hospital of High Normandy. Communication, autonomy and social abilities are the main area stimulated in order to develop the skills of the children. Autistic behaviors are referring to the behavioral patterns associated to autism which could limit social integration as well as the availability of the child for the proposed acquisitions. To estimate the children's progress during the period of intervention, tests and scales adapted for autism, recommended and validated are used (PEP, Vineland and ECA). The evolution rates are calculated from the scores obtained every year in these evaluations. They allow to quantify in percentage the evolution between two dates. These analysis show evidence of 89% of increasing in psycho-educative abilities (PEP), 79% in socio-adaptive competencies (Vineland) and 73% of decreasing in autistic behavior (ECA). The children's acquisitions testify of progress in favor of new skills development from one year to the next: faster progress are observed at the beginning of the program, a threshold effect is noticed after several years of intervention. The regulation of the autistic behavior is globally more and more effective during the intervention, although punctual periods of outbreaks of this behavior are observed. The length of the intervention also has a favourable impact on the progress in all the domains.     

L’efficacité thérapeutique du Montage Composite Réceptif à visée Projective (MCR-P) contre la dépression en psychiatrie

ObjectivesThe Receptive Projective Composite Montage (RPCM) is a short-term therapy associating musicotherapy and clinical psychology in order to improve the psychiatric treatment of depression. This study aims at showing the therapeutic efficiency of the RPCM on depression and anxiety symptoms and on the in-patient's alexithymia level. Furthermore, this study explores the explanatory processes of the therapeutic effects in order to bring an additional dimension to this approach.MethodThe sample consists of 23 patients diagnosed with depression, aged between 27 and 73 (average age = 49.91 ± 10.47) who receive psychiatric treatment. Participants have been categorized into two experimental groups: the therapeutic group who received 3 sessions of RPCM (n = 13) and the control group who received psychiatric treatment only (n = 10). These two groups allowed us to achieve a test re-test method over three weeks with a comparative group. The evaluation tools are the Beck's Depression Inventory (BDI) for the evaluation of depression, the Hospital Anxiety and Depression Scale (HADS) for the anxiety level and the Toronto Alexithymia Scales-20 (TAS) for the alexithymia level.ResultsOver a three-week therapy with the RPCM, in-patients from the therapeutic group have a significantly lower level of depression, anxiety and alexithymia after therapeutic process (P = .002; P = .001 and P = .009 respectively). Moreover, depression scores of experimentals groups are significantly different during second evaluation (P = .006). Finally, therapeutic group depression and anxiety scores have a medium effect size (d = .5).Discussion and conclusionWith these results, the RPCM seem to be a tool with beneficial effects on the in-patient's symptomatology of depression. The RPCM can be used as a support technique in order to maximize the treatment of depression. We recommend using a minima three RPCM section at the start of internment by a trained therapist. More experimental and complementary studies are necessary to confirm these results.     

Étude de l’évolution cognitive,socio-émotionnelle et des comportements autistiques d’enfants avec autisme et autre trouble envahissant du développement bénéficiant d’une intervention structurée,la méthode Applied Behavior Analysis (ABA)

Context

Recommendations of the Great Health Authority (HAS, 2012) indicate that children with autism and other pervasive developmental disorders have to benefit of scientifically validated behavioral and developmental structured interventions as early as possible, such as for example Applied Behavior Analysis (ABA). In this context, this not randomized and with no controlled group longitudinal study aims at confirming the interest of the behavioral approach ABA intervention for children with autism (n = 10) cared in a Parisian educational establishment dedicated to autism.

La dépression majeure à caractéristique atypique comme facteur de risque du syndrome d’apnées obstructives du sommeil chez le jeune adulte

ObjectivesIn the literature, several studies have investigated the particular relationship between major depression and obstructive sleep apnoea syndrome (OSAS). However, most of these studies have focused primarily on middle-aged to elderly individuals (≥ 40 years) which means that this problem has been little studied in young adults (< 30 years). Nevertheless, in young adults the prevalence of major depression (particularly its atypical subtype) is not negligible, which seems to justify carrying out additional investigations in order to allow a better understanding of the potential role played by major depression in the pathophysiology of OSAS in this particular subpopulation. The aim of this study was therefore to empirically investigate the prevalence of OSAS in young adults and to study the risk of OSAS associated with major depression in this particular subpopulation.MethodsPolysomnographic and demographic data from 264 young adults were collected from the Erasme Hospital Sleep Laboratory (Brussels, Belgium) database to enable our analyses. During their two-night stay (including a first night of habituation and a night of polysomnography) at the Sleep Laboratory, these individuals underwent a complete somatic assessment (including blood test, electrocardiogram, daytime electroencephalogram and urinalysis), a systematic psychiatric assessment by a unit psychiatrist and an assessment of their complaints related to sleep. These different steps made it possible to systematically diagnose all somatic pathologies, psychiatric disorders according to the diagnostic criteria of the DSM-IV-TR and sleep pathologies according to the diagnostic criteria of the AASM. This allowed the selection of young adults included in our study based on our inclusion and exclusion criteria. Polysomnographic recordings from our Sleep Laboratory were visually scored according to AASM criteria. An obstructive sleep apnoea-hypopnoea index ≥ 5/hour was used for the diagnosis of OSAS. At the statistical level, in order to allow our analyses, we subdivided our sample of young adults into two groups: a control group without OSAS (n = 215) and a patient group with OSAS (n = 49). After checking the normal distribution of our data, normally distributed data were analysed with t-tests whereas asymmetrically or dichotomously distributed data were analysed with Wilcoxon tests or Chi² tests. Univariate regression models were used to study the risk of OSAS associated with major depression (categorized: absent, typical, atypical) in young adults and potential confounding factors. In multivariate regression models, the risk of OSAS associated with major depression (categorized: absent, typical, atypical) in young adults was adjusted only for confounding factors significantly associated with OSAS during univariate analysis. These confounding factors were introduced in a hierarchical manner in the various multivariate regression models constructed.ResultsThe prevalence of OSAS in our population of young adults was 18.6 %. During univariate analyses, atypical depression [OR 2.51 (95% CI 1.18–5.32), p-value = 0.014], male gender [OR 4.53 (95% CI 2.20–9.34), P-value < 0.001], presence of snoring [OR 2.51 (95% CI 1.33–4.75), P-value = 0.005], presence of at least one cardio-metabolic alteration [OR 2.26 (95% CI 1.19–4.28), P-value = 0.012], body mass index> 30 kg/m² [OR 4.55 (95% CI 2.07–10.03), P-value < 0.001] and ferritin ≥ 150 μg/L [OR 3.28 (95% CI 1.69–6.36), P-value < 0.001] were associated with increased risk of OSAS in our population of young adults. After adjusting for these major confounding factors associated with OSAS (gender, body mass index, cardio-metabolic alterations, ferritin level, and snoring) in the four models studied, multivariate regression analyses confirmed that unlike typical depression, atypical depression [OR 3.09 (95% CI 1.26–7.54), P-value = 0.019] was a risk factor for OSAS in young adults.ConclusionsIn our study, we demonstrated that the prevalence of OSAS was 18.6 % in young adults referred to the Erasme Hospital Sleep Laboratory. In addition, we have shown that unlike typical depression, atypical depression was associated with an increased risk of OSAS in young adults, which seems to justify more systematic research of this pathology in young adults suffering from atypical depression in order to allow the establishment of adapted therapeutic strategies and avoid the negative consequences associated with the co-occurrence of these two pathologies.     

L’orientation des patients souffrant d’un trouble dépressif aux urgences psychiatriques par le médecin traitant est-elle associée à la décision d’hospitalisation : étude observationnelle

IntroductionDepressive disorders affect nearly 350 million people worldwide and are the world's leading cause of incapacity. Patients who are depressed preferentially approach their general practitioner (GP), who is their first point of contact, in 50–60% of cases. The aim of our study is to assess whether the orientation of patients suffering from anxiety-depressive disorder towards a GP in a general emergency is a factor associated with hospitalization when compared to patients who present themselves spontaneously for the same disorders. Our secondary objective was to identify the different profiles of patients who were hospitalized for these disorders as an emergency.Materials and methodsWe conducted a cross-sectional study for the year 2015, targeting patients who presented as general emergencies at the centre hospitalier de Troyes and who had received a psychiatric diagnosis in the context of an anxiety or depressive disorder.ResultsFive hundred and twenty four patients were included. A univariate analysis showed that referral by the attending physician was associated with hospitalization in 57.9% vs. 42.1% cases (P = 0.007), at an odds ratio at 1.98 [1.22–3.21] by multivariate analysis. Analysis by ascending hierarchical classification made it possible to identify 3 profiles for hospitalized patients: 1) patients with a known psychiatric history, a history of past or current follow-ups directed by a psychiatrist, with at least one psychotropic treatment, the presence of psychotic symptoms and a low suicidal risk compared to the rest of the study population; 2) patients without a psychiatric history, or a history of past or ongoing psychiatric follow-up and the absence of ongoing psychotropic treatment. These patients were referred by a GP (67% vs 23%, P < 0.001) and their suicidal risk was higher (59% vs 26%, P < 0.001); 3) patients about whom the psychiatrist had little information at the time of the emergency consultation.ConclusionsThe relevance of GPs in orientation towards emergencies pleads in favor of a partnership and an early exchange between treating physicians and the psychiatrists.