Gheel et la Société Médico-Psychologique : relecture d’une controverse

The controversy around the village Gheel, also known as the “village of fools”, which occurred between 1860 and 1870 to the Société Médico-Psychologique has been the subject of several analyzes at different periods of history. In these years of political turmoil, corresponding to liberal turn of the Second Empire, the leading names in French alienism compete around the mode of assistance to insane. Since the seventh century, Gheel host the insane throughout Europe, because the place is reputate to healing. From the early nineteenth century, it is subject to many reforms in order to make a real foster family care. Several psychiatrists therefore see it as a plausible alternative to asylums, increasingly overloaded. In France, the debate is particularly important. The study of the debates held in the Société Médico-Psychologique between 1860 and 1865 and published in the major journals of the day French texts reveals major issues for the discipline. These include consolidating its expertise vis-à-vis lawyers and religious in particular. This also echoes the current issues. Indeed, our period saw the emergence of the concept of experiential knowledge of users, which is proposed as a complementary and not competitive concept of medical knowledge, but this notion is contested even within the profession.     

Migraine vestibulaire : critères diagnostiques. Document consensuel de la Société Bárány et de la Société internationale des céphalées

This paper presents diagnostic criteria for vestibular migraine, jointly formulated by the Committee for Classification of Vestibular Disorders of the Bárány Society and the Migraine Classification Subcommittee of the International Headache Society (IHS). The classification includes vestibular migraine and probable vestibular migraine. Vestibular migraine will appear in an appendix of the third edition of the International Classification of Headache Disorders (ICHD) as a first step for new entities, in accordance with the usual IHS procedures. Probable vestibular migraine may be included in a later version of the ICHD, when further evidence has been accumulated. The diagnosis of vestibular migraine is based on recurrent vestibular symptoms, a history of migraine, a temporal association between vestibular symptoms and migraine symptoms and exclusion of other causes of vestibular symptoms. Symptoms that qualify for a diagnosis of vestibular migraine include various types of vertigo as well as head motion-induced dizziness with nausea. Symptoms must be of moderate or severe intensity. Duration of acute episodes is limited to a window of between 5 minutes and 72 hours.     

Les courants épistémologiques dans les travaux et discussions de la Société Médico-Psychologique

IntroductionThe term epistemology was first used by the Scottish metaphysician James Frederick Ferrier (1808–1864), in his book Epistemology or Theory of Knowing (1854). The generalization of its use will not occur until the end of the 19th century in the texts of English and continental philosophers and scientists, and thereafter in North America. The discussions of the members of the Société Médico-Psychologique, created in 1852, were not reflected in the Annales Médico-Psychologiques until 1853, and questions related to epistemology were then assigned to the fields of the philosophy of knowledge or the philosophy of science.MethodologyThis article is based on the approach of comparative epistemology (G.G. Granger), on an historical and clinical approach, on the critical analysis of language, and on the authors’ own research. Epistemology is “a critical study of the principles, hypotheses and results of the various sciences, intended to determine their logical (non-psychological) origin, their value, and their objective significance.”AnalysesThe authors employ the chronological score proposed by G. Lantéri-Laura by showing in parallel the evolution of the questions treated by the philosophy of science, then by epistemology. They analyze successively the impact of the philosophy of science on the Société Médico-Psychologique during the 19th century during the period of 1852–1902, then the anchoring of the epistemological tradition at the Société Médico-Psychologique due to the contribution of Pierre Marchais, and finally, the incursion of the North American approach at the beginning of the 21st century.ConclusionIt is illusory to seek a single, definitive scientific method, which is applicable in all situations, because the scientific objective does not dispense with the relationship to the concrete. For psychiatry, whatever knowledge is presented as new, problems arise from different perspectives, in different contexts, because the dynamics of the development of each discipline or sub-specialty are updated periodically.     

Les débuts de la Société Médico-Psychologique,entre philosophie et système nerveux central

French psychiatry around 1850 is characterized by the paradigm of unitary alienation (Pinel, Esquirol), the preeminence of the moral treatment, the secondary function of the brain (after the decline of the works of Georget and Bayle and of the phrenology), the development of the asylum system (distinct from general hospitals), the theoretical rivalry between sensationalism or “physiology” (Cabanis) and spiritualism or “psychology” (Maine de Biran). The founders of the Société Médico-Psychologique (Baillarger, Moreau de Tours, Brierre de Boismont) are inspired by the latter, politically conservative, beside their inquiries about the central nervous system. After a slow genesis, between 1843 and 1852, the society begins its reunions during the “authoritary” period of the 2nd Empire. They are characterized by the clinical (on monomania and hallucinations) and forensic discussions between alienists and philosophers around free will. During the decade 1860, the organic theories prevail, through hereditary degeneration (Morel), strengthened by the growth of fundamental sciences and cerebral anatomo-physiology. On the other hand, discussions on classifications and “folie raisonnante” allow the transition towards the paradigm of mental illnesses (J. Falret), later adopted in Germany by Kraepelin.     

La naissance de la Société Médico-Psychologique. Mise en perspective et regard sur la naissance de l’American Psychiatric Association

The authors retrace the various stages of the birth of the Société Médico-Psychologique (SMP), which celebrated its 170th anniversary in 2022. They recall the context, notably a law enacted in 1838 that was considered as a foundation text for what was then called alienism and which would eventually become psychiatry. The work of Philippe Pinel and Jean Étienne Esquirol played an essential role in the founding of the SMP, and more broadly in the genesis of the discipline. Three phases can be distinguished in the foundation of the SMP: (1) the creation of the Annales Médico-Psychologiques (AMP), in 1843, a journal that would become the SMP bulletin; (2) the first constitution of the SMP which was announced by Jules Baillarger in the first issue of the AMP in 1848 and which included the first organizational rules and a first list of members; (3) For political reasons (The revolution of February 1848, a political coup d’état on December 2, 1851), the foundation of the SMP would officially first take place in 1852. A commission of members modified the first internal rules. A principle was established whereby the Society would be composed of physicians, philosophers, magistrates, clergymen, moralists, teachers, poets, etc. The professional journals announced at the time the establishment of a Society where “all the instruments of psychological analysis will be gathered and applied simultaneously”. The first meeting of the Society was held on the 26th of April 1852. The authors provide a list of the founding members, although there were some notable absences. The relations between the SMP and the Academy of Medicine, founded in 1820, are detailed. The first international members are mentioned. They came from The Netherlands, Spain, Italy, Russia, Austria and Germany, and at the end of the 19th century, from America as well During the same time period, similar learned societies were established, notably in the United Kingdom, Germany and Russia. The authors describe in detail the creation of the Association of Medical Superintendents of American Institutions for the Insane (ASAMSAII), the future American Psychiatric Association (APA), and of its Journal which would become the American Journal of Psychiatry. The details of joint meetings between the APA and the SMP in 1978 are reported. The birth of the SMP and of other learned societies in Germany, France and the United Kingdom marked the beginning of a discipline which was then called alienism and which would become Psychiatry.     

Les discussions sur les classifications psychiatriques à la Société Médico-Psychologique (1860–2014)

The Société Médico-Psychologique has devoted in the 19th century two series of discussions during several months about psychiatric classification. In 1860–1861, the discourse of Jules Falret recommends to use the evolutive criteria rather than the psychological one (Delasiauve). It allows the transition from unitary mental alienation to several psychiatric diseases and the decline of the monomanias. The aetiological criteria of Morel are discussed. In the same way, in 1888–1889, the classification of Magnan, axed on mental degeneracy, presented by his pupil Paul Garnier, is not admitted by all. Its opponents propose symptomatic (Dagonet, Ball) or anatomic classifications (Voisin, Luys). The discussion came to nothing, but the word psychosis begins to be currently used. Only 75 years later, the Société Médico-Psychologique debates again about the nosology. Between 1966 and 2014, seven discussions, each during one day (two days in 1994), are brought by clinical innovations or by the publication of official classifications, either French, or international. In 1966, are discussed the progresses involved by psychopharmacology and statistics. In 1978, the French classification of the Inserm is compared with the ICD-9 and the DSM-III, in preparation. In 1988, the clinical applications of the DSM are discussed, but there are always communications about the French classification of delusional disorders and about the paraphrenias. In 1994, the transnosography tries to open the way from a “categorical” classification to a “dimensional” one. In 2001 and 2010, two revised versions of the CFTMEA (French Classification of Mental Disorders of Child and Adolescent) are presented. In 2014, a discussion is devoted to the DSM-5. There is an agreement since 50 years about the interest of “mixed” classifications (symptomatic, evolutive and aetiological), about the necessity to avoid too frequent revisions, to obtain a consensus and to simplify the nosology.     

De l’aliénation mentale de l’enfant et de l’adolescent à la pédopsychiatrie dans les communications à la Société Médico-Psychologique de 1852 à 1937

In 1848, the Société Médico-Psychologique was founded. Its aims is to promote the study and improvement of mental pathology. During the 19th century, François Arnaud (1858–1927), Claude-Etienne Bourdin (1815–1886), Michel Catsaras (1860–1939), Louis Delasiauve (1804–1893), Eugène Dally (1833–1887), Jules Fournet (1812–1888), Paul Garnier (1848–1905), Valentin Magnan (1835–1916), Jacques-Joseph Moreau De Tours (1805–1884), Emmanuel Régis (1855–1918), Paul Sollier (1861–1933), Edouard Toulouse (1865–1947), Auguste Voisin (1829–1898) and Jules Voisin (1844–1920) were the alienists or not, French or foreigners who succeeded at the chair of the Société Médico-Psychologique. This later presented observations of children or teenagers. The communications and discussions but also the issues raised by the alienists, neuro-psychiatrists then child psychiatrists will contribute to the reflections of members of the Société Médico-Psychologique over the course of the last century. But, they also forced us to take a more perceptive look at the child's mental health. Its communications and their authors belong to their time and to a time or even a place where they emerged. Apart from to looking into the topics pursued (deficiency, dementia praecox, epidemic encephalitis, autism, etc.) concerning the infantojuvenile psychiatry, we will carry out a work of communications contextualization focused on the child's mental health at the Société Médico-Psychologique during 170 years.     

Obésité et bypass gastrique,impact sur la qualité de vie et le risque suicidaire : revue de la littérature

In the last few years, the flourishing number of surgery for morbid obesity induces a growing interest in the short, medium and long-term consequences of the operative procedures. Both massive overweight and its surgical treatment such as gastric bypass can influence the mental health of patients and have an impact on their risk of suicide and suicide rates. Indeed, the suicide rate after the surgical treatment of obesity is increased; although medical literature is prolific on the subject of quality of life after gastric bypass surgery, less is known about the causes of postoperative suicide. There are few theories that allow discussion or hypothesis making and among these none can explain alone the excess of preventable deaths. This raises many questions about the management of candidates for gastric bypass: Is it possible to improve preoperative screening of patient's compliance? Should psychiatric follow-up become compulsory after surgery? It appears obvious from the current literature that suicide rates are higher among gastric bypass patients than the general population. It is reasonable to assume that this finding is related to the psychological difficulties experienced by patients, the impact on their quality of life and social functioning, on emotional and on a professional level. The intervention and massive weight loss can often destabilize an already precarious balance. It seems necessary to strengthen the psychiatric treatment of candidates for bariatric surgery and discuss the value of mandatory postoperative follow-up, as well as to promote patient compliance. Bariatric surgery patients with a history of psychiatric comorbidities should benefit from strict preoperative consultations and appropriate medication in order to rigorously balance their condition before surgery. Postoperative measures should include monitoring of high-risk populations such as patients with psychiatric comorbidity, as well as considering couple psychotherapy or support groups for patients and their relatives.     

Effets de la ventilation en pression positive continue sur la dépression,l’anxiété et la qualité de vie au cours du syndrome des apnées-hypopnées obstructives du sommeil

IntroductionThe obstructive sleep apnea hypopnea syndrome (OSAHS) is a chronic stressor that may alter the emotional state and quality of life (QOL) of patients suffering from it. In this work, we proposed to estimate the prevalence of depression and anxiety, to assess the QOL in a Tunisian population of apneic patients, and to assess their evolution under continuous positive airway pressure (CPAP).MethodsWe conducted a prospective study, involving 33 apneic patients followed for SAHOS with moderate or severe class disease in the pneumology department at Hedi Chaker university hospital in Sfax, Tunisia. They received CPAP treatment for three months. We used an epidemiological record. Two scales, the Hospital Anxiety and Depression Scale (HADS) and the 36-item Short-Form Health Survey (SF-36), were completed before and after treatment to evaluate the effect of three months of treatment with CPAP.ResultsThe prevalence of depression in the study's patients, according to the HADS, was 45.5% and that of anxiety was 21.2%. After 3 months of CPAP, the prevalence of depression and anxiety had become 18.2% and 6.1%, respectively. QOL was impaired in 81.8% of cases before treatment, according to the SF-36. This figure had decreased to 69.7% after 3 months of treatment with CPAP. Apart from the third dimension (physical pain), all other dimensions were significantly improved after 3 months of CPAP treatment. The treatment with CPAP induced a significant improvement in the average scores of depression (P < 0.001), anxiety (P = 0.002) and QOL (P < 0.001).ConclusionsThese results attest to the importance of the frequency of anxio-depressive disorders as well as an altered QOL in patients with OSAHS. CPAP treatment was shown to be effective in improving these parameters, but this efficacy was partial. Specialized care may be needed in cases of residual anxio-depressive symptoms.     

Hyperphagie boulimique : liens avec la personnalité et l’émotionnalité

Objectives

Our two objectives were: (1) to investigate the relationship between binge eating disorder, dimensions of personality (according to the Big Five model of Costa and McCrae) and those of emotionality in the “tripartite” model of emotions of Watson and Clark; (2) to evaluate the correspondence between the Binge Eating Scale (BES) and the Eating Disorder Inventory (EDI-2) scores.

Insight et dangerosité psychiatrique : revue de la littérature

Introduction

Violence committed by individuals with severe mental illness has become an increasing focus of concern among clinicians, policy makers, and the general public, often as the result of tragic events. Research has shown in the past two decades an increased risk of violence among patients with mental disorder. Nevertheless, of those suffering from mental illness, perpetrators of other directed violence form a minority subgroup. The means by which there is this association between mental illness and violence has remained controversial. Factors such as positive psychotic symptoms, medication non-adherence, alcohol or psychoactive substance abuse and antisocial personality were found to be predictive of violence. Overall, literature provides support to the assertion that violent behavior of mentally ill patients is a heterogeneous phenomenon that is driven by multiple inter-related and independent factors. Furthermore, psychiatrists are often asked to predict an individual's future dangerousness, in a medical or a legal context. In the process of risk assessment of dangerousness, more focus has been placed on dynamic risk factor. In this context, lack of insight has established itself both as a part of violence risk models and as a clinical item in structured approaches to measure dangerousness. However, few studies have tested these associations. The main purpose of this paper is to review the literature concerning the relationship between insight and dangerousness and discuss the contributions of the insight in the assessment of dangerousness in patients with mental illness. We included twenty studies that evaluated the association between insight and variable such as physical or verbal violence, aggressiveness, hostility or sexual aggression.