L'adolescent malade : quelle guérison pour le corps ?

The legitimacy of therapeutic mediations has long been asserted in care centres. Yet non verbal, body-oriented mediations appear to have retained a singular status, particularly in those psychiatric institutions concerned with the adolescent and the young adult. Traditional ergotherapy has adapted to the new mediators of the young (video games, multimedia, cinema, etc.). At the same time it has made a step in the direction of occupations which involve the physical body more explicitly - when any such association had usually been excluded from therapeutic mediations that privileged the verbal expression as the principal tool to restart the symbolisation process. We have set out to investigate the part such body-oriented mediations play, and whether they are a superior mean in dealing with patients resistant to other forms of assistance. We have concerned ourselves with the indoor climbing activities which take place in the out patient “care and study” department of the hospital (Clinique Dupré). We reason that the learning and safety aspects of indoor climbing permit to re-enact regressive phenomena associated to the repetition of early experiences of distress. Climbing as a mediation opens the therapeutic doors by allowing the physical resurrection of those early experiences which had yet to be symbolised.     

Concentrative movement therapy as body-oriented psychotherapy for inpatients with different body experience

Restricted body experience is frequently found in psychotherapeutic inpatients. Therefore, body-oriented psychotherapy is often applied as an adjuvant method. The authors investigated whether the quality of body experience influences the therapeutic process in concentrative movement therapy (Konzentrative Bewegungstherapie [KBT]) and treatment outcome. Sixty-two inpatients were assigned to 3 different types of body experience based on cluster analysis of their answers in the Assessment of the Own Body Questionnaire. The therapeutic process in KBT was studied using the Group Experience in KBT Questionnaire. A score for global treatment outcome and KBT treatment outcome was multidimensionally determined. The results show that different qualities of body experience do exist but do not have predictive value for (a) treatment outcome, (b) patient differentiation during the course of treatment, and (c) the connection between group experience and treatment outcome. The results do not confirm the clinical opinion that patients show different courses and results in body-oriented inpatient psychotherapy because of different quality of body experience.     

Improving interoception and self-disgust in the treatment of patients with anorexia nervosa

Anorexia nervosa (AN) is a mental disorder in which sufficient evidence points towards the presence of a high level of disturbed interoception and self-disgust. High arousal mood induction is a therapeutic technique that helps improve a patient's interoceptive capacities. With some adjustments to this technique such as adding a challenging behavior that induces a “flow” state or a mindfulness component such as in mindful awareness in body-oriented therapy (MABT), it is expected that patients with AN may benefit from an integrative treatment strategy that helps them improve their symptoms of high self-disgust and low interoception.     

The place of psychodynamic psychotherapy in the integrated treatment of posttraumatic stress disorder and trauma recovery

Psychodynamic psychotherapists treating posttraumatic stress disorder (PTSD) sufferers can draw on an accumulated body of trauma studies from their own field to guide their work. However, these reports, often based on case studies or conceptual reviews, do not have the same empirical conclusiveness as more recent evidence-based research demonstrating the efficacy of cognitive-behavioral and body-oriented therapies. In this article, a psychodynamic psychotherapist reflects on his treatment of an Israeli man who developed PTSD after enduring 4 terrorist attacks. The author shows how assimilative integration offered him a theory- and research-based model that helped him comfortably combine separate treatment interventions. He also shows how this model helped him locate with some precision the specific contribution of psychodynamic psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved).     

Implikationen neurobiologischer Forschungsergebnisse für die Körperpsychotherapie unter spezieller Berücksichtigung der Affekte

Contemporary neurobiological theory and research indicate the necessity to systematically integrate the human body in psychotherapeutic treatment. Psychotherapy is conceived as a process heading for growth and change. According to recent findings from neurobiological research, the process of growth and change in psychotherapy is only to a minor extent achieved by cognitive insight. Growth and change require significant emotional experiences within a therapeutic relationship, the destabilization of automated dysfunctional regulatory mechanisms, the implementation and rehearsal of alternative reactions and behaviors. Bioenergetic analysis, rooted in psychoanalysis and in the tradition of Wilhelm Reich and Alexander Lowen, has explored the complex relationship between body and mind and has developed a great variety of body-oriented techniques. Experiential data has been assigned priority over objective measurements. Three experiential situations are described utilizing body-psychotherapeutic techniques. In psychotherapeutic settings the application of these techniques requires the patients' informed consent and considerations of the relational context and of transference and counter-transference aspects.     

Body-oriented therapy for anorexia nervosa patients

Though the disturbed body image is an essential phenomenon of anorexia nervosa, hardly any specific attempts are described to alter the way these patients experience their bodies. The authors present a body-oriented treatment method aimed at curbing hyperactivity, rebuilding a realistic self-concept, learning to enjoy one's own body, and developing social skills. The therapy is a mixture of different techniques among which video-confrontation appears to be an important element.     

Knock, and it will be opened to you? An evaluation of meridian-tapping in obsessive-compulsive disorder (OCD)

Meridian-tapping (MT) is a body-oriented therapeutic technique which among other psychological problems targets anxiety disorders. Despite bold claims by some of its advocates that it brings lasting success in the vast majority of patients with anxiety disorders, solid empirical evidence for its effectiveness is scarce and its theoretical foundations are refuted by many scientists. The present study tested the effectiveness of a published MT self-help approach for obsessive-compulsive disorder (OCD). Following a baseline assessment over the internet including standard outcome measures for OCD (Y-BOCS, OCI-R) and depression (BDI-SF), 70 participants with OCD were randomly allocated to MT or to progressive muscle relaxation (PMR). Four weeks after the dispatch of the self-help manuals (including video demonstrations of the technique), participants were requested to take part in a post assessment. Whereas subjects found MT more helpful than PMR in retrospect (39% versus 19%) and would continue to use it in the future (72% versus 48%) there was no evidence for a stronger decline of OCD symptoms under MT on any of the psychometric measures. Moreover, Y-BOCS scores did not significantly change across time for both interventions. The present study does not support bold claims about the effectiveness of MT as a stand-alone technique. Cognitive-behavioral therapy remains the treatment of choice for OCD. While self-help MT may enhance the well-being of a subgroup of participants, its potential for OCD appears to be small. Exaggerated success claims on the effectiveness of MT in conjunction with degrading appraisals of conventional psychotherapy as made by some of its leading figures may in our view foster fatalism in patients not experiencing major symptom relief by MT.     

非清髓性异基因造血干细胞移植基础及临床研究进展

非清髓性异基因造血干细胞移植现在被广泛的用在由于年龄或合并症而不适应行传统HCT的患者身上,采用非清髓性预处理策略,移植后形成供受体造血细胞混合嵌合状态,淋巴细胞供受体双向免疫耐受,即非清髓性干细胞移植。通过非清髓性预处理方案,移植后形成供受体细胞嵌合状态,发挥移植物抗肿瘤效应,来达到治疗目的,与传统HCT中文？相比有较低的移植相关死亡率,术后GVHD中文？发生减少,且扩大了适应症范围,并且非清髓性预处理方案的改进、移植后相关疾病发生的防治可以进一步提高治疗效果。虽然有许多治疗策略被提出,并在动物模型上取得了成功,但其在人体方面的应用仍需得到进一步的证实和研究。     

Long-term stability of body experience after in-patient group psychotherapy with concentrative movement therapy

Body experience of 34 patients was investigated two years after the end of treatment with Concentrative Movement Therapy (KBT) in an in-patient integrative psychotherapy. Change in body experience at the end of treatment and after the two year period was compared to symptomatic strain and the amount of interpersonal problems. Body experience was rather restricted in the beginning of treatment. The improvement of body experience during treatment showed to be stable after two years, as did the symptomatic strain. Interpersonal problems were not reduced as much during treatment but in the follow-up period. Patients with benefit from KBT treatment through a better approach to their body, felt more bodily self-confident at the end of treatment. They also had less feelings of insecurity and apprehension concerning their body than those who could profit little from KBT. In both groups a reduction of symptomatic strain was found. Patients with little profit from KBT had higher symptomatic and interpersonal strain and more feelings of insecurity concerning their body in the beginning of the treatment. Their improvement at the time of follow-up was low. Results are discussed regarding the relevance of different elements of integrative in-patient therapy and the possibility of differential indications for body-oriented psychotherapy.     

Chronic inflammatory demyelinating polyneuropathy--update on pathogenesis, diagnostic criteria and therapy

PURPOSE OF REVIEW: Chronic inflammatory demyelinating polyneuropathy (CIDP) is a treatable but possibly underdiagnosed disorder of the peripheral nerve. This review covers the growing literature of the past years that deals with the pathogenesis, diagnostic criteria and treatment of CIDP. RECENT FINDINGS: The recent development of a biphasic animal model of experimental autoimmune neuritis may provide further insights into the pathogenesis of inflammatory demyelination of the peripheral nerve, such as in CIDP, and may allow the development of further innovative therapeutic strategies. In patients, the contribution of immune processes to the dysfunction in hereditary polyneuropathies and the association of hereditary neuropathy and CIDP has been described. Commonly used therapies remain corticosteroids, intravenous immunoglobulin and plasmapheresis; however, newer immunosuppressant approaches using mycophenolate mofetil or cyclosporin A, or immunomodulating therapies using monoclonal antibodies or interferons are presently under investigation. SUMMARY: The growing body of knowledge on the pathogenesis of CIDP and further diagnostic differentiation of subforms may help to develop more-effective therapies for CIDP in the next few years.     

Mechanisms of epileptogenesis in tuberous sclerosis complex and related malformations of cortical development with abnormal glioneuronal proliferation

Malformations of cortical development (MCDs) are increasingly recognized as causes of medically intractable epilepsy. In order to develop more effective, rational therapies for refractory epilepsy related to MCDs, it is important to achieve a better understanding of the underlying mechanisms of epileptogenesis, but this is complicated by the wide variety of different radiographic, histopathological, and molecular features of these disorders. A subset of MCDs share a number of characteristic cellular and molecular abnormalities due to early defects in neuronal and glial proliferation and differentiation and have a particularly high incidence of epilepsy, suggesting that this category of MCDs with abnormal glioneuronal proliferation may also share a common set of primary mechanisms of epileptogenesis. This review critically analyzes both clinical and basic science evidence for overlapping mechanisms of epileptogenesis in this group of disorders, focusing on tuberous sclerosis complex, focal cortical dysplasia with balloon cells, and gangliogliomas. Specifically, the role of lesional versus perilesional regions, circuit versus cellular/molecular defects, and nonneuronal factors, such as astrocytes, in contributing to epileptogenesis in these MCDs is examined. An improved understanding of these various factors involved in epileptogenesis has direct clinical implications for optimizing current treatments or developing novel therapeutic approaches for epilepsy in these disorders.     

Assessment of suitability for psychotherapy. II. Assessment based on basic process goals

Part II of this paper presents an outline for the assessment of suitability for psychotherapy based on the patient's ability to participate in the basic tasks of the therapeutic process and provides a coherent approach to this complex and difficult task. Several factors, such as therapeutic interaction and relational history, influencing the patient's ability to form a productive working relationship can be assessed clinically and are well supported by research. Others, such as motivation and supportive life circumstances, although less supported by research, still appear to be clinically important. Influences on the ability to create a model of the patient's psychopathology, such as introspection, circumscribed focus, and some aspects of the model itself, are supported by limited research but important for some therapies. There is little research on trial interventions, though these remain a crucial assessment dimension for short-term therapies, particularly. Countertransference, although traditionally not viewed as part of assessment, is actually an important tool that has been validated by research.     

Les thérapeutiques non médicamenteuses en psychiatrie

Resistance to psychopharmacological and psychotherapeutic therapies is a frequent difficulty clinicians are confronted to, with a frequency of 20 to 30 % concerning depression disorders. Other therapeutic approaches hence seem unavoidable to optimize treatments: structured psychotherapies such as behavioural and interpersonal therapies have shown their efficiency in anxiety and depression disorders, psychoeducational approaches help better observance in chronic pathologies. Biological and non medicinal approaches such as electroconvulsive therapy are still a therapy of reference for treating mood disorders and remain an indication for resisting schizophrenic disorders.     

Dopamine receptor homooligomers and heterooligomers in schizophrenia

Over the past two decades the dopamine D2 receptor has been undoubtedly the most widely studied dopamine receptor for the therapeutic treatment of schizophrenia, as the majority of antipsychotics exhibit antagonism at this receptor. However, the cognitive symptoms of the disorder are mostly resistant to the majority of available antipsychotic treatments and, as a result, there is a critical need to develop novel therapies that ameliorate all symptoms. The recognition that dopamine receptors, such as all G protein-coupled receptors (GPCRs), exist as oligomeric complexes has provided new avenues for drug design in the search for novel therapies. Furthermore, that it is now known that dopamine receptors can form heteromers, such as the dopamine D1-D2 receptor heteromer, with pharmacology and function distinct from its constituent receptors, has significantly expanded the range of potential drug targets. The aim of this review is to discuss the therapeutic relevance of these dopamine receptor oligomers to schizophrenia and to address the potential value of dopamine receptor heteromers in the search for new therapeutic strategies.     

Sweet and sour--oxidative and carbonyl stress in neurological disorders

The nervous system is a unique network of different cell types and comprises a variety of proteins, lipids, and carbohydrates that have an important interplay with all major organs in the body. Homeostatic regulation of nervous tissue turnover must be carefully controlled, taking into account interactions of the nervous, endocrine, and immune systems. Clinical conditions affecting the nervous system range from mild cognitive perturbations such as headache, to life-threatening acute courses such as meningitis and glioblastoma, and to chronic neurodegenerative diseases such as multiple sclerosis. One unifying feature in normal developmental or homeostatic functions and clinical dysfunctions within the nervous system is redox regulation, with an imbalance in oxidative/carbonyl stress versus antioxidants being characteristic of pathological conditions. In this review we consider the state of current knowledge regarding structural, genetic, proteomic, histopathological, clinical, and therapeutic perspectives of oxidative and carbonyl stress within the nervous system.     

Treatment of idiopathic inflammatory myopathies

PURPOSE OF REVIEW: This article reviews the results of recent therapeutic trials in dermatomyositis, polymyositis, and inclusion body myositis and suggests an approach to treating patients with inflammatory myopathy. RECENT FINDINGS: We reviewed 10 double-blind, placebo-controlled therapeutic trials in patients with inflammatory myopathy. Only one, using intravenous immunoglobulin in refractory dermatomyositis, indicated benefit. A brief trial of azathioprine in polymyositis and eight studies using various treatments in inclusion body myositis did not show benefit. SUMMARY: There have been no adequate double-blind, placebo-controlled therapeutic trials of dermatomyositis and polymyositis. It is generally accepted, however, that these disorders respond to immunosuppressive agents. Prednisone is usually the initial treatment. There is no agreement on how prednisone should be administered and even less agreement about other agents. Inclusion body myositis, which now appears to be the most common (in adults), is unresponsive to immunosuppressive and immunomodulating therapies. There are candidate treatments for inclusion body myositis and a need for additional double-blind, placebo-controlled therapeutic trials in all patients with inflammatory myopathy.     

A proposed ethical framework for interventional cognitive neuroscience: a consideration of deep brain stimulation in impaired consciousness

Advances in neuromodulation techniques offer the promise of new therapeutic interventions for patients with neuropsychiatric maladies. Several complex social, ethical and policy issues will attend developments in this area. In this paper an ethical framework for clinical research in interventional cognitive neuroscience is advanced. Deep brain stimulation in traumatic brain injury is considered as a paradigm case to examine ethical obligations in human subject research. These include balancing access to novel therapies versus protection of vulnerable study populations, rational evaluation of study design and research strategies, informed consent, and the importance of achieving societal consensus for this line of scientific inquiry.     

The use of antidepressants in novel combination therapies

Antidepressant monotherapy is used more often than other therapies to achieve symptom remission in depressed patients; however, for patients resistant to antidepressants, other strategies are necessary. Many novel combination therapies have been proposed to treat resistant depression. The efficacy of combination therapies such as lithium augmentation of antidepressants is supported by a large amount of evidence including data from controlled trials. Nonetheless, anecdotal reports suggest that these combinations are underutilized. Data from studies of the use of the combination of atypical antipsychotics and selective serotonin reuptake inhibitors suggest that this is a particularly promising therapeutic avenue. However, more research is needed to corroborate these early results.     

Plasticity

Over the past 20 years, evidence has mounted regarding the capacity of the central nervous system to alter its structure and function throughout life. Injury to the central nervous system appears to be a particularly potent trigger for plastic mechanisms to be elicited. Following focal injury, widespread neurophysiological and neuroanatomical changes occur both in the peri-infarct region, as well as throughout the ipsi- and contralesional cortex, in a complex, time-dependent cascade. Since such post-injury plasticity can be both adaptive or maladaptive, current research is directed at understanding how plasticity may be modulated to develop more effective therapeutic interventions for neurological disorders, such as stroke. Behavioral training appears to be a significant contributor to adaptive plasticity after injury, providing a neuroscientific foundation for the development of physical therapeutic approaches. Adjuvant therapies, such as pharmacological agents and exogenous electrical stimulation, may provide a more receptive environment through which behavioral therapies may be imparted. This chapter reviews some of the recent results from animal models of injury and recovery that depict the complex time course of plasticity following cortical injury and implications for neurorehabilitation.