Accompagnement d’enfants avec handicap : faire le bien ou affronter le mal ?

Ethics is not only establishing guaranteed beneficent processes, but it is also and firstly facing evil. Accompaniment of handicapped children reveals itself as one of these urgent and extreme situations that tear us apart. Meditating on evil will prevent us from being self-satisfied in our practice and, far from leading us to abdicate, will make us more sensitive to sorrow and pain, and will allow us to establish more human relationships with and for accompanied children.     

Mais de quoi est donc constitué le savoir-faire psychiatrique ?

Psychiatry has been searching its foundations for a long time. Neither neurologist nor psychologist, a psychiatrist holds a specific know-how that he names and passes little on to others. To come nearer to such a notion, we will follow three stages. At first, we’ll find an archeology, chosen from oriental (Kimura Bin) and occidental (Paul Ricœur) phenomenology. Since its early stages, phenomenology offers a critical attitude to approach the knowledge's prerequisite, from natural sciences to human sciences. Then, we will climb up the steps towards the know-how's base: Theory of practice as the gap between theories and their practical applications in everyday psychiatry. At last we will describe a methodology, upper floors building the know-how, its sources and regulations. We will conclude by the examination of the building style.     

Santé mentale et Santé bucco-dentaire : de l’intérêt de faire tomber le masque

The mouth is at the heart of our daily life. However, oral health is often overlooked, especially in people with mental illness. The objectives of this review were to identify the factors that can increase their vulnerability toward oral diseases, to describe the consequences in terms of health and quality of life, and to explore solutions for preventing and managing oral diseases in this population.Why are patients with mental illnesses more at risk of poor oral health?The mental illnesses themselves, which can alter one's self-image and perception of the body, may decrease motor skills or disorganize daily life, contribute to a decrease in the practice of daily oral hygiene or in seeking healthcare services. The presence of vomit or gastroesophageal reflux stimulates the demineralization of dental surfaces. Addictive substances, the consumption of which is frequent in this population, particularly tobacco, have a direct impact on the oral mucosa and contribute to poor oral health as well as to a reduction of the effects of pharmacological treatments used to treat psychiatric pathologies. By stimulating the appetite, they promote snacking. By inhibiting the production of saliva, they prevent it from playing its role as a natural oral lubricant. It has a negative effect on self-cleaning dental surfaces, the neutralization of oral acidity and defensive power but also on food pre-digestion, chewing, swallowing and speaking. Finally, by inducing abnormal movements of the lips, tongue or jaw, problems of lip incompetence, breathing through the mouth or bruxism may develop. Difficulties in accessing oral care can also contribute to patients’ poor oral health. They may be related to mental pathology: the failure to keep appointments, refusal of care, anxiety, to the lack of information and understanding of their rights for health insurance and transportation to a dental office. They can also be linked to a stigmatizing or critical attitude or a rush to provide care from some dentists that can discourage the patient from continuing his/her oral follow-up.What are the consequences?Xerostomia has several consequences: difficulty in chewing, swallowing, speaking, wearing removable dentures and altered taste, bad breath, cracked lips, and burning mouth. The patient will then modify his/her diet and increase their consumption of soft drinks and soft foods, which adhere more to dental surfaces. Patients have an increased risk of carious lesions, erosion of the teeth, and periodontal lesions accentuated by smoking. People with substance addiction are roughly three times more likely to have periodontal pockets than control groups. People with eating disorders are five times more likely to have dental erosion, responsible for sensitive teeth than control groups due to vomiting or gastroesophageal reflux. Finally, the problem of dental caries is more severe in people suffering from mental illness: People with schizophrenia seem to be the most affected with 7.7 more tooth decay, missing and filled teeth on average than do control participants. Oral afflictions are responsible for acute and chronic pain and infection. Patients with severe mental illness are 2.8 times more likely to lose all their teeth than those in control groups. Edentulism has many repercussions for the patient's health and quality of life, (eating disorders, speech impediments, and deformed smiles, all of which can lead to low self-esteem and social isolation).What are the solutions?A set of measures can be proposed against xerostomia: frequent intake of unsweetened, non-acidic drinks, chewing sugar-free chewing gum with xylitol, salivary substitutes or salivary stimulants. Support measures to encourage patients to quit smoking, when possible and compatible with the patient's clinical condition, should be offered during psychiatric follow-up. Patients could be encouraged, as soon as their mental pathology has stabilized, to select a dentist and to consult him/her at least once a year for dental care and preventative measures and to become accustomed to receiving dental care. The continuum between psychiatric care and oral care is important, as is the training of medical teams. The number of dental treatments and/or the mental pathology of some patients can cause them to be uncooperative and may necessitate the use of a general anaesthesia during oral care, but this procedure has many limitations. For long-term health improvement and to avoid the accumulation of comorbidities, therapeutic patient education seems to be an appropriate complementary approach. Integrating oral health with psychiatric care would make it possible to encourage patients to develop habits of healthy eating and good oral hygiene, to seek dental care, and to acquire improved social behaviours.     

Patients souffrant de schizophrénie en EHPAD : quel rôle pour l’équipe de psychiatrie de secteur ?

Old people's homes take in elderly persons who present more and more organic and/or psychic pathologies as they grow older. But what is the care proposed for residents suffering from psychiatric chronic pathologies such as schizophrenia and living in these establishments for several years? What are the difficulties met in these establishments (except the problem of psychiatric treatment and its effects) and which solutions can be envisaged? What will then be the role for a regional psychiatric team?     

Quelles pistes pharmacologiques non-dopaminergiques pour le traitement de la maladie de Parkinson ?

It has become increasingly evident over the past years that the pathological process in Parkinson's disease extends well beyond the substantia nigra and involves non-dopaminergic neurotransmitter systems that mediate motor and non-motor symptoms. In this article, both the pathophysiology and the pharmacological management of these non-dopaminergic symptoms are discussed.     

Imagerie fonctionnelle : quelle place dans le diagnostic et l’évaluation thérapeutique de la maladie de Parkinson ?

Functional imaging is a tool that has been long restricted to research programs. However, the availability of ¹²³I-Ioflupane SPECT imaging has developed its’ clinical utilization with a risk of misuse. There is room for improvement for the differential diagnosis between idiopathic Parkinson's disease (PD) and atypical parkinsonian syndromes and the measure of brain glucose metabolism with PET might fill this gap in the future. Conversely, functional imaging is still a major tool for the evaluation of new experimental therapeutic strategies in PD, especially for those aiming at restoring or protecting striatal dopaminergic innervation.     

Qu’est-ce que le politique ?

The question “What is politics?”, considered not from a particular philosophical tradition, but from our common experience of twenty-first century individuals, leads us to recognize in politics a specific way of being, evidently rooted in natural human sociality, but nevertheless distinct from all forms of natural existence. It rises with the awareness that social order is the result of a positive will, brought forth by some human collectivity. This does not imply democracy, but it does imply the capacity of that collectivity to turn back and reflect on itself, that is to dissociate from itself. This reflexive capacity claims ever more explicitly its abstract and universal quality. We shall have to ask whether this should be understood as a new and specifically modern turn, or if it has always been a fundamental trait of political agency, raised to a new intensity in the modern context. From the answer to this question depends the issue of a possible “overstretching” of human consciousness by politics: My argument being that politics as such drive human groups beyond any form of nature-guaranteed identity. The mere existence of a “city” is already the result of an overwhelming abstraction, that the individual can never completely assimilate. The more universal forms of being-together nation, European Community or world government only take this abstractness one or several steps further. A tremendous political skill is certainly required to make sure these steps, too hastily taken, do not lead to Terror or Tyranny. But their ultimate goal, unity of mankind, is essentially implied in any political association.     

Quelle place pour le trouble spécifique du développement du langage oral,ou dysphasie de l’enfant,dans le champ de la psychopathologie ?

The encounter with a population of dysphasic children in a Language Impairment Centre has raised questions notably regarding the articulation with the organisation of each personality and the project of care to be proposed.     

Que devient la formation de psychothérapeute, pour le médecin et le psychologue, après la nouvelle loi française ?

The recent French law regulating the psychotherapist title grants it to doctors, psychologists and psychoanalysts. Three requirements are emerging: training to practices, lectures and clinical interships. This law may transform the psychotherapist in a psychiatrized, medicalized, paramedicalized and regulated professional ! What will be his notoriety in a few times? To avoid this risk, we have to keep in mind that the psychotherapist has to carry out a personal therapy and has to get personally involved in an experiential training preferably integrative to make his being therapist happen promoting more the relationship with the patient than technics and theories.     

Transidentités et changement de sexe : le point de vue du sociologue,le rôle du psychiatre

What does the term ‘trans identity’ mean? Why do transgender people want or not want to change sex? What is the role of the psychiatrist in a sex change for transgender people? These are the questions— often rooted in complex issues — that the sociologist Arnaud Alessandrin and the psychiatrist Thierry Gallarda answer in this interview.