Le problème des cooccurrences des DYS…

For one child, combination of DYS may report: associated school symptoms in case of dual task; association of school symptoms referring to a same cognitive origin; several cognitive problems…; be careful with child in trouble may seem inattentive… This distinction has very practical consequences for teachers and parents.     

Construction des liens et continuité des soins à l’adolescence

In childhood the intra-psychological world needs continuity so that internal and external relationships may build up in adolescence. If a normal adolescence is characterised by a transformation of relationships, a pathological adolescence may be understood as a partial, or more global failure of the capacity to transform these relationships that were well, or less well established during childhood. Taking care of these adolescents requires taking into account this manner of defining the pathology at this age and, of course, one should not iatrogenically reinforce the failure to transform or set up these relationships.     

Évaluation des besoins des patients et éducation thérapeutique

Therapeutic education aims at helping patients acquire of maintain competencies they need to cope with chronic illness. It goes further than simple information because its objective is to improve autonomy and quality of life, not just treatment observance. Therapeutic education is an important instrument for psychiatric rehabilitation, notably in foster home care. Because of the various possible themes of therapeutic education, our institution worked toward the identification of situation needing a structured program of therapeutic education. A pluridisciplinary group was set up, aiming at building structured therapeutic education programs and following their implementation. This group built a questionnaire for mental health team members, care givers and patients. Mental health team members expressed their views during a focus group. They identified several issues such as: food and overweight, digestive problems, medication side effects, smoking, diabetes. The questionnaire was sent by post to foster caregivers: 63% of them answered. Sixty-four percent of the answers identify one or several problems encountered by patients: lack of information concerning treatment (27%), stress due to vexation (26%), medication side effects (18%), lack of information concerning mental illness (9%). Twenty-four patients were interviewed, expressing their difficulties: over sedation, loneliness and boredom, anxiety, food, information concerning medication and mental illness. Patients expressed specific needs: Food and overweight, information on medication and illness, activities, smoking cessation. This questionnaire, requiring approximately 45 minutes interview, was living positively by patients. This preliminary inquiry led to identification of difficult themes for therapeutic education: medication and illness, smoking, nutritional balance. In order to both identify unmet needs, we decided to use an instrument developed in Lausanne, called ELADEB (Lausanne instrument to evaluate patients’ needs and difficulties)     

Le Psychodynamic Diagnostic Manual (PDM) améliore-t-il le Diagnostical and Statistical Manual IV-R (DSM-IV-R) pour la classification des pathologies des adultes ? L’exemple des troubles psychotiques et des personnalités schizoïdes et paranoïdes

The Psychodynamic Diagnostic Manual (PDM), published in 2006 by the Alliance of Psychoanalytic Organisations, had for goal to complement the Diagnostic and Statistical Manual (DSM) published by the American Psychiatric Association. The main complement brought by the PDM is the addition of psychological and psychodynamic dimensions into the DSM's diagnostics. These addictions are all empirically based, and for this latter reason the PDM seems a sound attempt to articulate the richness of psychodynamic point of view and the reliability of empirically based researches. The goal of this article is, first: present to French professionals the PDM, and, second: to discuss his theoretical and technical choices and his articulation with DSM-IV-R. These discussions are illustrated by the diagnostic of psychotic disorders and the schizoid personality disorders. The PDM's limits are discussed too, specifically the ambiguity of his relation with the DSM: complement or concurrent? A discussion about the evolution of the DSM-V (publication planned for 2013), some of these evolutions take into account the psychodynamic point of view of the PDM, and their consequences on PDM conclude this article.     

Certaines caractéristiques des nouvelles parentalités favorisent-elles la violence des enfants ?

The profound changes of marriage and parenting, both in terms of their legal and their symbolic frame of reference and in terms of the ways in which they are actually put into practice, have led to a dramatic transformation in the environment in which today's children are brought up. Within the family, the media now occupy an increasingly large part of children's lives, both in the information they provide for children's understanding of the world and in the models of behaviour or values they present, which in the last resort constitute the values of contemporary western society. The different parameters of this environment contribute in part to a more frequent and widespread expression of violence on the part of children and teenagers : the principle of authority has been replaced by the principle of consensus as a basis for organising the way family life functions and hedonism has become a core value in family life whilst duty has been pushed into the background. Dominant individualism implies a significant loss of interest in society and its demands (the social contract). The result is a diminution in the instinctual limitations and a significant boost to environmental forces, in particular those of the media (c.f. advertising), a reduction in the strength of the superego and an ideal of self which is poorly defined.     

Fréquence des stéréotypies chez des patients cocaïnomanes en centre de soins

Cocaine is known to induce stereotyped movements and psychotic symptoms. We measured stereotyped movements in a clinical sample of 89 cocaine addicts in an outpatient setting with the cocaine induced-psychosis (CIP) questionnaire. The rate of lifetime stereotyped behaviour associated with cocaine use was 67.4%. They were more severe in cocaine injectors.     

Étude des enjeux psychologiques dans la pratique féminine des sports à risques

Studies investigating risk-taking behaviours in the sports domain have often been conducted with men. It was not known if women reacted in a similar manner when confronted with risk. In order to better understand their motives and individual personality characteristics, we investigated the psychological actual experience of women involved in risk-taking sports. The research sample comprised 16 women in two separate groups: 1) hazardous sport professions: mountain guide, skydiving instructor, rally pilot, sailor (n = 10, Mage = 34,2 ± 9,81) ; 2) high risk sports: alpinist, BASE jumper, ski bump (n = 6, Mage = 26.8 ± 1.47). Semi-structured interviews were conducted using Patton's qualitative evaluation methodology (1990). The hierarchical theme analyses which were carried out emphasized several factors: 1) relationship with risks; 2) emotional regulation; 3) need for gratefulness; 4) relationship with parents; 5) gender identity. Contrarily to quantitative studies, the results underline the fact that the sensation seeking personality factor is not the major one for women involved in high risk sports: the emotional factors seem to be more important. Indeed, for non-professionals, hazardous sports are lived as a means of forgetting one's emotional distress and uneasy feelings momentarily, and as a way of getting away from everyday life, whereas professionals master potentially dangerous situations much better in hazardous sports, anticipating and preparing themselves more efficiently for the events. Professionals do not use risk as a means of escape from themselves or from any possible emotional problems. In summary, emotional regulation appears to be a central concept in risk-taking behaviours, and extreme sports could be used to promote a positive construction of identity. Extreme sports could give individuals the opportunity to feel more in charge of their practice. These results plead in favour of setting up specific processes in the psychology of risk-taking of women in sports.     

L'atteinte des repères et des limites identitaires dans la démence sénile

This article suggests a reflection about identity marks and limits using a dialectics between inside/outside, ego/non-ego, in senile demented patients. From the senile demented persons'talks and their responses to the Rorschach test, five symptoms of identity impairment emerge: progressive lack of distinction in perception and representation, identity contents confusion, sexual identifications uncertainly, anxiety related to an unsteady and non-unified body schema and regressive object relationship. However it seems that, in spite of this psychic desorganization, some sort of affects can still somehow go on in these patients.     

Soins des personnes fragiles : des compétences professionnelles à celles plus profanes des aidants familiaux,que reste-t-il de l’acte médical ?

A new ethical and societal dimension emerges gradually from the legal arsenal, in particular the care, a cardinal part of what it was advisable to call the sanitary democracy today. The care is not any more shot to the individual but concerns the Person matching with its environment. The healthcare professionals have to respect the dimension of humanity of the patients and encourage the role of their informal carers by integrating into the approach of care the link between dignity and technicity. The dignity of the frail patients is still concerned by the challenge of access to healthcare and the respect of their need to be actively involved in their care. The health environment participates in the care by a mutual collaboration. Family caregivers, mostly laymen regarding technical care, have to become partners and participate in more contributory relations with medical staff. The intervention of the laymen in the world of high technicality, sometimes dehumanized modern medicine is so questioned in the ethical plan.     

Évaluation des interactions précoces

Using adult-baby interactions scales is important for clinicians and researchers. Authors define interactions and describe five scales: a guide-book for assessing the dialogue between the adult and the child (GEDAN); Bobigny's early interactions grid; the CARE-index; global ratings for mother-infant interactions at two and four months; and Brazelton neonatal behavioral assessment scale. Each tool is presented as well as its method for coding and analysing.     

Les troubles des conduites alimentaires : évaluation des troubles obsessionnels compulsifs et leur influence sur l’expression clinique des troubles

To estimate the prevalence of obsessive-compulsive disorder (OCD) in patients with eating disorders, the difference of prevalence of OCD and the distribution of autogenous and reactive obsessions according to the subtype of eating disorder (ED) and the degree of intensity of ED according the presence or not of OCD, 10 patients with restricting anorexia nervosa, 19 with bulimia nervosa and 14 with obsessive-compulsive disorder were assessed. The results showed that the prevalence was higher in bulimic patients than in anorexic patients, which is in accordance with most international studies. On the other hand, this research revealed a different distribution of autogenous and reactive obsessions in these patients, and a particular correlation between the presence of OCD and the intensity of the eating disorders.     

Diagnostic des dystrophies musculaires progressives des ceintures de type 2A ou calpaïnopathies : étude des patients du centre de référence des maladies neuromusculaires de Bordeaux (France)

Background

Limb girdle muscular dystrophies are rare genetic diseases. Despite constant progress in genetics and biochemistry, the pathogenic mechanisms are not completely understood. Calpainopathy (LGMD2A) has been reported to be the most frequent autosomal recessive form of muscular dystrophy in several populations. Point mutations in CAPN3 are difficult to identify and the analysis is long and costly. The use of western blot does not seem to provide the expected sensitivity and specificity.

Patients and method

We studied all the patients diagnosed in the neuromuscular center of Bordeaux (France) with confirmed calpainopathy in order to establish the appropriate diagnostic approach (inclusion criteria: muscular biopsy with calpain 3 western blot study, two mutations in CAPN3). Patients with highly suspected calpainopathy (same criteria with only one mutation) were also analyzed.

Results

Our 13 patients belonged to 10 different families. Four patients had a normal western blot for calpain (WBn). We found high phenotypic variability with frequent atypical signs. The WBn group had less severe disease (a statistically significant later age of onset, a tendency toward lower CK levels and a slower disease course). We extended this comparison to the single mutation patients and we found the same results.

Conclusion

Considering the lack of sensitivity of western blot protein analysis in LGMD2A, a normal western blot for calpain should not halt the genetic analysis. The western blot result seems to have prognostic value. A normal western blot may help genetic testing by highlighting some mutational hot spots in the CAPN3 gene.