Bilan d’années d’art-thérapie

Our experience of twenty years in art-therapy confirms its great difficulty, if its aim may be a true psychotherapy.     

Les délires d’infestation cutanée parasitaire. Syndrome d’Ekbom

Ekbom's syndrome (delusional cutaneous parasitosis) is an “uncommon psychiatric syndrome” characterized by a strong certainty that insects, lice, maggots or other small vermin are living or otherwise thriving in the skin and sometimes in other parts of the body (Enoch, Ball, 2001). Described by Thiebierge (1894) and Perrin (1896), two dermatologists, it received the name of zoophobia, parasitophobia, acariophobia. The eponymous designation is Ekbom syndrome from the Swedish neurologist who described its principal manifestations (1937-1938). Annika Skott (1978) published the pivotal monograph (based on 354 cases, 1954-1961) with the title term Dermatozoenwahn coined by Ekbom, as did Michael Musalek in his book published in German (1991). It is a rare condition (7 per 10 000 psychiatric admissions according to Marneros et al (1998). Several other surveys report series of patients seen in dermatology clinics. It is seen occasionally by dermatologists, exceptionally by psychiatrists. Typically it is supposed to be cured by Pimozide or other neuroleptic or new antipsychotic drugs. A majority of patients are aged females, living alone in bad material conditions. Some patients are chronically addicted to cocaine and amphetamine-like drugs. This delusion could be psychologically contagious with cases of “délire à deux (à trois)”, or by proxy… Another phenomenon is called “the Morgellons disease”, described by Thomas Browne (1690) (A Letter to a friend) in Languedoc. For the CDC there is no proof that the Morgellons is a separate pathology. On the contrary, Mary Leitao (McMurray, Pennsylvania 2002) gave the name of “Morgellons disease” to what she considered the resurgence of an ancient and forgotten malady, which affected children of Languedoc in 17th century. There is an Morgellons Research Foundation (MRF) to encourage research about this infectious malady similar to scabies and pediculosis. The website claims that more than 12 000 families affected by Morgellons are registered with the foundation, and self accounts of affected individual are over flowing.     

Le corps anorexique comme le lieu d’expression d’une souffrance familiale

Anorexia nervosa fascinates because it re-enacts death in such an ostentatious way that it causes a turbine of such strength that it destabilises the family environment, awakens the spectres and threatens the foundations on which the family is built. Through the prism of food, these young girls talk to us about questions of importance for society: the weight of the family history on the construction of the modern family, intergenerational transmission, the evolution of the parental role, our relationship with death, etc. In order to be effective, the treatment of anorexia requires a complete, multimode takeover, in which the maltreated body and mind are taken care of in their mental and physical entirety. Our clinical experience enables us to better comprehend the intergenerational mechanisms that characterise the transmission of family suffering. It also reminds us that the body has a formidable individual, collective, transgenerational and even phylogenetic memory. In this article, we present a summary of our observations of the results of the multimode treatment we offer our anorexic patients at our psychiatric clinic. We specify the articulation of the family therapy to reveal the spectres (Abraham and Torok, 1978) [5] that impregnate the relational fabric within these family bubbles, the bodily work which enables the re-establishment of contact with a physical memory attached to these spectres and the individual psychotherapy which enables the verbalisation of the spectral memory.     

Expérience d’un groupe d’habiletés sociales : une année de pratique avec trois adolescents porteurs du syndrome d’Asperger

Though individuals with Asperger's syndrome may develop academic skills, their cognitive particularities often affect their adaptative behaviors. As adolescents, the deficits in communication observed in infancy are generally improved, but difficulties persist in interactions with pairs and in the domain of autonomy. This article illustrates the experience of a social skills training group including three adolescents with Asperger's syndrome. The training went from formal comprehension of interactions to concrete situations in order to increase the autonomy of the adolescents with Asperger's syndrome.     

Spécificités des crises d’épilepsie chez le sujet âgé : proposition d’un score électro-radioclinique d’orientation

Diagnosis of epileptic seizure may be difficult in older patients because seizure manifestations are often unusual: confusion, paresis… and because there are multiple differential diagnoses (syncope, transient ischemic attack, transient global amnesia…). To promote and facilitate the diagnosis of seizures in the elderly, neurologists and gerontologists must work together and focus their strategy on two points: firstly, the knowledge of the specific presentation of seizures in elderly patients, and secondly, the adoption of a reasoning based on seizures and not epileptic syndromes. A multidisciplinary group worked on epilepsy of the elderly to elaborate an electro-clinical score which aims to help establish the diagnosis of epilepsy in elderly patients in different clinical settings. This electro-clinical score is based on a systematic review of scientific literature and the recommendations are explicitly linked to supporting evidence. Further, clinical validation of the electro-clinical score is required.     

Expériences d’utilisation d’hyperinsufflation chez l’enfant polyhandicapé trachéotomisé et ventilé

Children with severe cerebral palsy requiring invasive mechanical ventilation need respiratory physiotherapy. Hyperinsufflation to improve respiratory drainage and reduce pulmonary restriction, appears relevant. Invasive mechanical ventilation by VIVO 50 allows to set an hyperinsufflation profile as well as to display insufflate volume.     

Néologisme et maladie d’Alzheimer

The verbal productions of persons affected by Alzheimer's disease or similar diseases do not make sense. Nevertheless, the production of neologisms does prove the existence of a statement. By an analytical and pragmatic philosophical approach, we have been concerned not to consider statements of mentally ill persons only under their meaningless angle. A statement (the fact of saying) overrides saying in the study of insane statements. The neologism of the mentally ill person is thus considered as a construction in the same way as a witty remark. Based on Freud and on Lacan, we have tried to show the persistence of a psychic life in dementia.     

Normalisation d’une batterie d’évaluation de l’imagerie mentale visuelle et de la perception visuelle

Introduction

The relationship between visual perception and visual mental imagery are at the center of a lively theoretical debate between those postulating common neurocognitive processes between perception and imagery and those who emphasize the differences between these two entities. Neuropsychology can make an important contribution to this debate, by assessing associations and dissociations between perceptual and imaginal deficits in patients with brain damage. However, currently there is no standardized test battery available for such assessments.

Material and methods

Here we present a battery of paper-and-pencil tests assessing different domains of visual mental imagery and visual perception abilities: object form and color, animals, orthographic material, numbers, faces, and space. We also explored the effects of age, educational level and gender on performance on a group of 103 participants free of neurological damage.

Results

The battery includes two parts: one composed of 14 tests assessing mental imagery and the second part composed of eight tests assessing the abilities of visual perception. We calculated the correlations between the tests, and found that, with the exception of orthographic material, there were generally poor correlations between imagery and perceptual tests.

Conclusion

This result seems inconsistent with hypotheses postulating a strict correspondence between perceptual and imagery abilities.     

Cannabis et trouble bipolaire : recherche d’une association à partir d’une revue de la littérature

Introduction

It has been established that cannabis use is involved in the emergence and evolution of psychotic disorders. Although cannabis use is very frequent in mood disorders, there has been a considerable debate about the association observed between these two disorders. This review aims to clarify the relation between cannabis use and bipolar disorder, in order to unveil a possible causality and find the effect of cannabis on the prognosis and expression of bipolarity.

Methods

The review used MedLine database using the keywords “cannabis” or “marijuana” and “bipolar” or “mania” or “depression”. This search found 36 articles who were clinically relevant to the subject and were included and discussed in this review.

Results

The first studies discussing the link between cannabis use and psychotic disorders reveal manic features in the substance abuse group, hence suggesting a possible association between cannabis use and bipolar disorder, in favor of triggering a manic episode. According to the studies, between 25 and 64% of bipolar patients are cannabis users, and the prevalence is higher in younger and male patients. The risk of developing a mood disorder is higher among cannabis users compared to the general population. This substance abuse in bipolar disorders would increase the frequency and duration of manic episodes without changing the total duration of mood episodes. In a first episode of bipolar disorder, the use of cannabis would increase the rate of relapses of manic episodes and worsen the prognosis of the disorder.

Discussion

The frequency of substance abuse in bipolar disorders is higher than the prevalence in the general population, and cannabis is one of the most used illegal substances in the worldwide. Hence, the association between cannabis use and bipolar disorders is frequent. Cannabis users may experience euphoria, relaxation and subjective feelings of well-being; this substance may also have antiepileptic effect, which may explain some of the effects of cannabis on bipolar disorders. In fact, the use of cannabis would increase the frequency and duration of manic episodes in bipolar patients without increasing the total duration of mood episodes, suggesting a possible antidepressing and mood stabilizing effects. This impact of cannabis on mood disorders and its possible pharmacological effect is still controversial and needs further experiencing to be proved.