Sortir des addictions : à l’alcool,par l’alcool ou vers l’alcool

Pathways from alcoholism to recovery are documented; less often are those from drug addiction to alcoholism. Biographical approaches allow analyzing how people change their uses and talk about their trajectories of recovery.

Traitement pharmacologique du trouble bipolaire chez l’enfant et l’adolescent

Objective

To review the options for acute and maintenance pharmacological treatment of bipolar disorder in children and adolescents.

Incursion dans l’hypertemps

The pandemic has transformed our relationship to time, as it has disrupted our work habits. To understand how these changes affect our world view, it is useful to examine the fundamental patterns that govern our relationship to time, which can be called Destiny, Progress, Hypertemps and Deadlines. What are the links between them? And above all, like leaving a conflicting vision of opposition to build a more peaceful relationship to time. À time when “having time” could retain meaning?     

Le passage à l’acte à l’épreuve du post-contemporain

Objective

The starting-point of this article consists in considering what is contemporary as being post-contemporary. Like the present, what is contemporary is something that cannot be pinned down. It requires hindsight in order to analyse it. Our first objective is to approach our post-contemporary age as being characterised by radicality. This takes the form of a search for origins, which shows up in a return of the religious, alongside the emergence of an anguish reducing things to nothingness. Solitude is a characteristic of this radical position, raising the issue of an otherness that turns anguish into hatred, whether of oneself or of the other. Indeed, the post-contemporary subject acts-out when faced with social ties and a culture that can no longer uphold him. Our second objective is to demonstrate that the effect of this radical position leads the subject to use his body as the only way out. Having become an external organism, the body comes to represent that which is intolerable for the subject. In order to escape anguish turned into hatred, the subject excludes himself from his own body. Finally, the third objective is to show how the free radical subject is a product of ‘liberal’ society, seeking to create his freedom at every moment.

De l’absence ou non de contrainte dans l’École Freinet

AimThe article raises the question of the bodily and therapeutic constraints that pervade the methods of Elise and Célestin Freinet, pedagogues in the Freinet School in Vence over time.MethodsThis paper is based on the work conducted by a team of researchers from Nancy, France, on the objectification of the educational practices of the Freinet School in Vence, including both historical-philosophical and ethno-didactic aspects.ResultsThis exploration, beyond the doxa of the “Freinet pedagogy”, demonstrates the existence of a specific dialectic between constraint and freedom in the history of the Freinet School pedagogy.DiscussionThis pervasiveness of the therapeutic constraint at Vence can be seen in the very organization of the educational environment in the school. It is fully articulated with the educational project.ConclusionAlthough the Freinet School has evolved since its opening in 1934 and its purchase by the State in 1991, and although the issue of therapeutic restraint has dwindled, a style of thinking has nevertheless remained in the educational practices. This strongly questions our educational habits.     

Tentative de suicide chez l’enfant et l’adolescent et bipolarité

Background

Child and adolescent psychiatrists are frequently confronted with suicide attempts and comorbid mood disorders. Diagnoses of juvenile bipolar disorders (BD) are rare and controversial and standardized assessment is helpful for a reliable diagnosis. The main objective of this study was to identify the number of juvenile bipolar disorder diagnoses according to DSM-5 criteria in a population of children and adolescents hospitalized for suicide attempts. Secondary objectives were the assessment of a patient's characteristics and the comparison of suicide attempt recurrence during 12 months of follow-up.

Formations de l’idéal,Hikikomori et virtuel à l’adolescence

Goals

Withdrawal behaviours among teenagers have become a major topic in both clinical practice and the specialized literature. Known since the 1980s in Japan as Hikikomori, these behaviours are found across international nosographies in a variety of models. They are not always accompanied by intensive video gaming. There are varied uses of digital technology among teenagers, in terms of both quantity and quality. They can relate to the formation of an ideal, on the boundaries between virtual reality and illusion, it can also be a step toward the renewal of social relationship, since it enables a less threatening confrontation with the object.

Humaniser l’orthopédie

Orthopedic care of cerebral palsy kids responds to a natural need for comfort and to permanent pathological constraints that professionals are familiar with. These require the use of devices that extend our actions and which we are forced to impose the use to families and non rehabilitation professionals. This text proposes hypotheses to analyze the difficulties that we encounter on this subject.     

Une clinique de l’apotemnophilie

IntroductionThe term of apotemnophily was used for the first time by Money in 1977 to name patients who desire an amputation of a healthy limb.CaseWe present a case report of a thirty-two years old military woman, who was hospitalized in a neurology service because of a chronic pain syndrome. The disorders began with a knee trauma complicated by chronic pain causing multiple complaints. At first sight, we are challenged by her desire to amputate her lower limb.DiscussionA literature review highlights controversial positions regarding the nosographic place of apotemnophily: initially classified within paraphilias, the desire to amputation of a healthy limb was later identified by some authors as a body integrity and identity disorders and then studied as a neurological disorder. The clinic of our patient open minded our diagnostic reasoning to other clinical entities such as a depressive disorder with melancholic and psychotic characteristics, an illness anxiety disorder, a body dysmorphic disorder.ConclusionBeyond the controversies, the main risk for these patients is to meet a doctor who decides to treat them with a mutilatory surgical gesture. The therapeutic challenge is to create the conditions of reception of this complaint and to hear the identity claim that it carries. The multidisciplinary approach associating psychiatrist, clinical psychologist and sometimes surgeons when it's appropriate, must prevent medical nomadism and must try to relieve the patient from the suffering of identity.     

De l’incestuel à l’enfant-sorcier : des mots pour le dire

Aims

This paper sets out to explore the unconscious meanings and functions of the “witch-child” aetiology appearing in the discourse of families from sub-Saharan Africa (in the present instance Bamileke), and its possible links with an “incestuel” (as opposed to incestuous) family dynamic. We have sought to show the possible points of transition between concepts that belong to different resisters, using a singular clinical situation which is nevertheless just one of the possible manifestations of the link between the witch-child and an “incestuel” family climate. From this particular issue, we also seek to show the permanent articulation between psyche and culture, and the way each casts light on the other. This dimension appeared to us to be particularly important for the reflection of the clinician, for a finer understanding of the clinical setting, and thus for the psychotherapeutic process enacted with these families.

Peur de l’intimité dans la relation amoureuse adolescente : implication de l’attachement parental et de l’attachement romantique

Teen dating is a developmental stage questioning dramatically the relationships to be expected with others, especially when feelings of tenderness and love are involved. It mobilizes parental attachment and the internal working models related to it, while being colored by the emerging romantic attachment and its brand new internal working models. Attachments are deeply shaped by a dynamic interaction whereby the self tries to figure out how to reach security and autonomy still taking the other into account. This considered, intimacy also implies a dynamic feature: on the one hand, closeness and sharing of feelings and/or experiences, and on the other hand, individuality and maintaining of one's ego. However, just like attachments may be insecure, a fear of intimacy cannot be underestimated during dating. Eventually, bearing in mind the societal and cultural components of attachment and intimacy, gendered explanations cannot be ignored, especially during adolescence.

Les organes endommagés dans la constitution de l’image de l’esprit

Objective

This article sets out to clarify the relationship between the organic pathologies and the images of the corresponding organs. In this type of construction, it is as if the mind were confronted with an internally generated form of pareidolia. As in maladjustment, manifestations of pareidolia undergo change when the organ is damaged; it is thought that the subject has a distortion in the production of images. In this work, we compared two very different diseases: a skin disease (psoriasis) and a heart disease (coronary heart disease). Here is the hypothesis we propose.

La législation actuelle face à l’évaluation des comportements criminels violents : l’urgence d’une réforme

The clinical examination of mental patients committed to specialized hospitals as well as the practice of criminal psychiatric expertise do not at present allow the serious assessment of the dangerousness and risk of violent recidivism. The use of diagnostic and predictive scientific methods has become indispensable. In criminal cases, the expert must also take into account the actual facts of the offense: degree of premeditation, organization of the crime scene, dynamics and typology of violence, relational and environmental context, victimology, judicial information. Traditional psychiatric expertise must now give way to a comprehensive, multidisciplinary criminological form of analysis combining all individual and collective factors of a subjective and objective nature.     

Télémédecine et troubles du spectre de l’autisme de l’enfant et de l’adolescent : guide théorique et pratique

ObjectivesThe development of telemedicine for children and adolescents is a real need because of difficult accessibility of mental health and the paucity of childhood psychiatrists. Thus the American Academy for Child and Adolescent Psychiatry (AACAP) published in 2008 good practice recommendations for telepsychiatry in children and adolescents based on clinical consensus and scientific evidence. In France the legal framework defines four practical modalities according to the presence or not of a health professional or a psychologist with the practitioner accomplishing the teleconsultation act. Data exist about the outcome of children and adolescents who benefited from therapeutic interventions with technological media. Effect size is modest but it doesn’t justify ruling out these techniques. Children who present with a developmental disorder or who cannot cooperate are evaluated with a certain degree of uncertainty. By contrast, some children with severe Attention Deficit with or without Hyperactivity (ADHD), social anxiety or Autism Spectrum Disorders (ASD) can be more easily engaged within a teleconsultation model. Teleconsultations in autism spectrum disorders (ASD) are feasible because of the nature of diagnosis and the type of care recommended in this disorder. The behavioral nature of the disorder and the behavioral therapeutic approaches recommended in North America culture highlight the potential interest of telemedicine because these disorders are easily observable. Literature suggests new opportunities in order to facilitate the care process for the ASD person and his family: the first one is diagnosis with use of validated instruments such as the Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview (ADI). Parental accompaniment is the second opportunity. Development of telemedicine for ASD could be a complementary approach for diagnosis and medical care.MethodSince 2015, a program called PROMETTED (PROgramme MEdical de Télépsychiatrie pour enfants et adolescents présentant un Trouble Envahissant du Développement) was supported by Regional Health Agency of Île-de-France. It was developed and managed by the team of a Diagnosis Center Evaluation for Autism (DCEA) of Paris area in collaboration with a DCEA of Île-de-France region. Five medico-social structures for children and adolescents with autistic disorders and the two diagnosis centers of evaluation for autism co-elaborated a scheme of intervention with telemedicine. The remote evaluation is a 4-step process: a first teleconsultation structured around the medical history of the subject in order to complete his medical file and the observation of the young subject; a second teleconsultation structured around the ADI-R interview with parents; the third teleconsultation is a mixed teleconsultation associating the medical expert of the DCEA and a psychologist trained in the use of the Childhood Autism Rating Scale (CARS) and the Vineland Adaptive Behavior Scales (VABS). The fourth teleconsultation consists of the psychiatrist giving feed-back to parents about the results of the observations of the DCEA team.ResultsThe four-step program is well-accepted and the use of validated instruments for diagnosis or functional evaluation appears feasible. Medical data were completed for 44% of cases; complementary genetic or medical investigations were prescribed for 50% of cases; medical advice about psychotropic or vitaminic medication was given for 31% of cases. Mean duration of evaluation was 11.1 weeks ± 9.4.ConclusionsThe PROMETTED program empirically validates the concept of remote evaluation for children and adolescents with ASD. The need to extend the use of telemedicine to tele-expertise for medicine monitoring or behavioral disorder management has been noted.     

De l’antipsychiatre à la post-psychiatrie

The history of Psychiatry, its objectives, the ideas or the means that were put in place by those who took care of the mental health of populations or those who have lost it has not stopped changing the rhythm of the successive mutations, technological, philosophical or societal. The approach of “psychiatry” to adapt the social representation of madness to the language and methods of medicine has always encountered epistemological difficulties sometimes irreconcilable resulting in successive configurations of knowledge and practices or “paradigms” in the sense from Kuhn (from insanity to mental alienation, mental illness or the notion of psychopathological structures) to explain the signifier and the causes of the “mental thing”. Since the 1980s, we have seen the domain of the biomedical and technological model, in which mental phenomena are explained by alterations in cerebral biochemistry, setting aside the social and cultural roots of “madness” or considering them as accessories and without importance. Since a few years of absolute domain, the Biological or Bio-commercial Psychiatry begins to show its limits in the action and in these theories at the same time as the social demands of the complex assumption have not ceased to increase and that the groups of users of psychiatry assert their legitimate rights, the situation has become a real “time bomb” in the context of a new crisis comparable to that triggered by Antipsychiatry during the “sixties”. In 2001, the BMJ published a founding article for a new beginning for our discipline, entitled “Postpsychiatry: a new direction for mental health” which the authors reported that today's society requires a different type of psychiatry and a new type of psychiatry “pact” between health professionals and users. The debate is open again but this time it goes well beyond the confrontation Psychiatry/Antipsychiatry. Post-Psychiatry proposes a paradigm shift in a post-modern approach in which psychiatry can leave aside its previous “certainties” to incorporate other “speeches” in search of a new integrative epistemology; in short, a psychiatry of diversity.