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M. Roudévitch 《Motricité Cérébrale》2018,39(4):115-118
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. 相似文献
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《Annales médico-psychologiques》2019,177(7):702-709
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. 相似文献
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Gaël Fournis Clémence Avril Lou Madieta Jade Corbes Clara Bourillon Jean-Bernard Garré Bénédicte Gohier 《Annales médico-psychologiques》2018,176(10):943-947
Background
The optimal management of psychiatric symptoms requires constant adaptation of therapeutic strategy to clinic evolution. If benzodiazepines are a treatment of choice for acute anxiety states in hospitals, their excessive consumption is a concern, revealing a preference of chemical anxiolysis to non-drug alternatives, yet effective for episodes of low or moderate intensities. Faced with an acute anxiety, choice of various therapeutic options requires evaluating its intensity in order to establish an appropriate therapeutic response. To enable systematic and accurate evaluation of an anxious state, Visual Analogue Scale (VAS) seems to be the most suitable tool. The application of VAS to measure anxiety is widely validated by previous research on the subject. We assume that the self-assessment of anxiety is likely to lead to a reduction in benzodiazepine use.Objective
This study aims to determine the impact of systematic evaluation of acute anxious state by VAS, on consumption of benzodiazepines, by proposing a therapeutic strategy adapted to the anxiety level.Methods
This is a comparative, prospective, multicentric study. Both studied samples came from a population of patients hospitalized in psychiatric crisis service, and recruited sequentially over a period of three months each. For the first group, our practices did not change; for the second group, we introduced VAS as a systematic tool for evaluating each acute episode. Have been included all patients over a period of six months, for which was provided a conditional anxiolytic treatment by benzodiazepine, regardless of their pathology. Then we have compared individual and overall consumption of benzodiazepines (in mg diazepam-equivalent per day of hospitalization) of the two samples. Finally, we compared the consumption of the service during the inclusion period with the consumption of the previous years at the same time of the year.Results
Our study did not reveal the impact of the introduction of EVA on the consumption of benzodiazepines (P = 0.44). However, we observed a decrease in overall average consumption during the same period in the previous year.Discussion
The evaluation of a symptom, subjective by nature, by an outside observer, is undeniably biased. The benefit of self-evaluation has been proven in the treatment of other acute symptoms such as pain. With VAS, the objective is to better know the intensity of a symptom, to offer the patient a matched care. Its use as an investigative tool of acute anxious states in hospitals appeared to be a promising lead, especially concerning the implementation of non-pharmacological anxiolytic strategies, as an alternative to over-consumption of benzodiazepines. Unfortunately, its use to evaluate acute anxious states didn’t permit to reduce benzodiazepines’ consumption. Our results are compared with data from the actual scientific literature.Conclusion
The adaptation of the therapeutic anxiolytic strategy by self-assessment of the intensity of an anxiety state appears unfortunately inappropriate, both on an individual level, and as a public health point of view. We have to try to find other ways, which would allow preferring non-drug strategies and reducing the consumption of benzodiazepines. 相似文献6.
Michel Bénézech 《Annales médico-psychologiques》2018,176(4):404-409
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. 相似文献
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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.Method
Our method uses clinical practice. We work from two contrasting clinical fields; on the one hand acting out in the form of acts of murder or suicide, on the other hand acts of passage from one gender to another.Results
Acting out and acts of passage both relate to these free radical subjects who shape their own body, or who shape the body of the other as though it were their own.Discussion
We will discuss the points of convergence and divergence between these two situations.Conclusion
Our conclusion demonstrates that acts on the body of the other and acts on one's own body coincide. Acting out in the form of murder or suicide masks the wish for an act of passage, which is however impossible. The act of passage from one gender to the other requires an acting out that sometimes cannot be countenanced. With those whose aim is an act of passage, it is an acting out that must be sought. Similarly, with those who act-out, the need is to try to restore, in the aftermath, the possibility of an act of passage. 相似文献9.
《Annales médico-psychologiques》2022,180(7):683-687
The impact of exercise has been the subject of significant work for two to three decades. The results of these studies have enabled national and international comities to issue specific recommendations. Their impact on physical health is now well documented. The effect of physical activity on mental health in general, and for the management of major depressive disorder in particular, is the subject of more recent interest. The purpose of this article is first to carry out a review of the literature on this subject in order to identify the level of evidence of the effectiveness of use of exercise in the treatment of major depressive disorder. Secondly, the known data on the impact of physical exercise on physical health are summarized. Finally, the article provides an update on the regulatory framework for its use in France and the methods of use in current practice by the clinician. 相似文献
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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.Methods
This current practice study consecutively included children and adolescents aged 6 to 18 years and hospitalized for a suicide attempt in a French University Pediatric Hospital over a 4-month period. Patients were assessed at baseline, at 3 months and at 12 months. The standardized assessment was realized by the investigator using semi-structured interview K-SADS-PL (2013) to diagnose juvenile bipolar disorders based on DSM-5 criteria. Clinical diagnoses based on medical charts and according to ICD-10 criteria were also collected at 12-month follow-up. Standardized assessment was completed by the French validated K-SADS-PL (2004) for comorbidities (DSM-IV), dimensional assessment by MADRS–YMRS–ARI–C-SSR, and C-GAS at inclusion. Patients were divided into two groups: (1) those presenting juvenile bipolar disorder according to DSM 5 (BD+) and (2) those without criteria for bipolar disorder (BD?). Suicide risk factors and suicide attempt relapse were assessed at 3 and 12 months of follow-up.Results
Twenty-six inpatients (22 female and 4 male) aged 14.5 years (SD 1,5) were consecutively included. Twenty patients were followed up during the 12-month period. At baseline, 5 patients (19.2 %) presented a diagnosis of BD (DSM-5): 1 BD type 2, 2 non specified BD, 2 cyclothymic disorders. According to the medical charts (ICD-10), none of the patients had been diagnosed with BD but had diagnoses of dysthymia, of borderline personality disorder and of conduct disorder corresponding to DMDD in 3, 2 and 1 patient respectively. During the 12-month follow-up, 9 patients of the BD? group and none of the BD+ presented recurrence of suicide attempt with 67 % during the first 3 months and 3 patients with multi-relapses. These 3 patients were female adolescents out of care and carrying at least three suicide risk factors. Six patients have been lost to follow-up (1 BD+, 5 BD?). In the BD+ group, 3 patients out of 4 had a persistent diagnosis (DSM-5) of BD at 12 months.Conclusion
In our adolescent population hospitalized for suicidal attempt, 19,2 % present BD using DSM-5 criteria. Diagnoses are stable during 12 months of follow-up, but under diagnosed in current clinical practice. DSM-5 standardized assessment appears to be very important to diagnose juvenile BD, mandatory for medium and long-term psychiatric follow-up, especially for suicide prevention and psychopharmacologic therapeutics. Nevertheless, no recurrence of suicide attempts has been observed in our BP+ group, contrary to BP?, possibly due the absence of BP 1 disorder. 相似文献11.
Sylvain Missonnier 《Annales médico-psychologiques》2018,176(3):282-285
Objective
To become a interdisciplinary medico-psycho-social prevention area, obstetric ultrasound invites to overcome the cleavage between specialists of the soma and the psyche at the Maternity Hospital. This contribution is evidence of action research aimed at this goal in a maternity award.Results
In its customary practice, the ultrasound frame now plays a vital role in the evolution of maternal and paternal processes, confronted with the disturbing strangeness of the fetus and the uncertainty of its human future. Like a projective test, ultrasound examination induces a parental psychic outpouring by amplifying the conflicts inherent to the prenatal parenting process. At this meeting, parents and professionals are in close intersubjective reciprocity. The threat or confirmation of a fetal anomaly that may lead to a possible IMG (often recklessly denied), gives a potentially tragic tone to this ultrasound approach to antenatal diagnosis.Conclusions
The sonographer is a mediator/translator. In this position, he can promote the structuring potential of this examination but, equally, stigmatize the disorganizing valence. In this context, professionals will benefit from a Balint-type group. The formalization of the negotiation between caregivers and parents of a mutually informed consent of this examination and its consequences occupies a crucial place in its ethical and clinical legitimacy. A group of parents led by sonographers will provide a space for reflexivity on antenatal diagnosis. 相似文献12.
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J.-C. Cuvellier 《Revue neurologique》2009,165(6-7):521-531
Chronic daily headache (CDH) affects 2 to 4% of adolescent females and 0,8 to 2% of adolescent males. CDH is diagnosed when headaches occur more than 4 hours a day, for greater than or equal to 15 headache days per month, over a period of 3 consecutive months, without an underlying pathology. It is manifested by severe intermittent headaches, that are migraine-like, as well as a chronic baseline headache. Silberstein and Lipton divided patients into four diagnostic categories: transformed migraine, chronic tension-type headache, new daily-persistent headache, and hemicrania continua. The second edition of the International Classification of Headache Disorders did not comprise any CDH category as such, but provided criteria for all four types of CDH: chronic migraine, chronic tension-type headache, new daily-persistent headache, and hemicrania continua. Evaluation of CDH needs to include a complete history and physical examination to identify any possibility of the headache representing secondary headaches. Children and adolescents with CDH frequently have sleep disturbance, pain at other sites, dizziness, medication-overuse headache and a psychiatric comorbidity (anxiety and mood disorders). CDH frequently results in school absence. CDH management plan is dictated by CDH subtype, the presence or absence of medication overuse, functional disability and presence of attacks of full-migraine superimposed. Reassuring, explaining, and educating the patient and family, starting prophylactic therapy and limiting aborting medications are the mainstay of treatment. It includes pharmacologic (acute and prophylactic therapy) and nonpharmacologic measures (biobehavioral management, biofeedback-assisted relaxation therapy, and psychologic or psychiatric intervention). Part of the teaching process must incorporate life-style changes, such as regulation of sleep and eating habits, regular exercise, avoidance of identified triggering factors and stress management. Emphasis must be placed on preventive measures rather than on analgesic or abortive strategies. Stressing the reintegration of the patient into school and family activities and assessing prognosis are other issues to address during the first visit. There are limited data evaluating the outcome of CDH in children and adolescents. 相似文献
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M.-E. Lampin A. Dorkenoo M.-D. Lamblin A. Botte F. Leclerc S. Auvin 《Revue neurologique》2010,166(6-7):648-652
Morbidity and mortality are high in children with refractory status epilepticus (RSE). Here, we assess the efficacy of midazolam for RSE in children.MethodsThis was a retrospective analysis of 29 children admitted to the Lille University Hospital pediatric intensive care unit (PICU) for RSE between May 2006 and July 2008. The onset of the study corresponded with a new therapeutic protocol applied in the PICU for RSE where midazolam was proposed as the first-line treatment (bolus ten continuous infusion until control) to be replaced by thiopenthal in case of failure.ResultsWe recorded 29 patients with RSE during the study period: 26 were treated with midazolam, including two where midazolam replaced thiopenthal because of hypotension. Midazolam successfully controlled RSE in 58% of patients. Mean delay to cessation of RSE was 48 ± 65 minutes. Hypotension was observed in 8% of midazolam-treated patients and 71% of thiopenthal-treated patients. Overall mortality was 15% (4/26). Two deaths occurred long after the cessation of RSE. None of the deaths occurred in midazolam-treated patients.ConclusionMidazolam is an efficient treatment for RSE in children. Morbidity and mortality appear to be lower with midazolam compared with other antiepileptic drugs used for the treatment of RSE. 相似文献
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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.Method
Using a clinical case of a fifteen-year-old teenager secluded in his home for eighteen months, we will explore the interactions between withdrawal behaviours and digital usages, from the perspective of the formation of an ideal. We will study how they intertwine with the formation of identity and with the processing of loss.Results
In Japan, where a cultural and sociological explanation of the Hikikomori is preferred, reference to psychiatry is excluded. The withdrawal can be understood within a particular form of culture, or rather a counter-culture, an idiom, a singular form of adolescent suffering that uses virtual reality as a specific mode of relationship with others and the world. The ideal, like adolescence itself, is characterized by its incompletion. It is also paradoxical, between confrontation with inadequacies and solutions to solve them. Virtual reality can thus enable the subject to fight against the consequences of the losses that define the process of adolescence.Discussion
Withdrawal behaviours occur in various psychic systems, all the more so when they start in adolescence or in early adulthood. The use of digital technologies makes it possible to freeze the course of time and to limit the impact of pubertal transformations and the confrontation with sexuality. For Maxime, the investment in the ideal and in virtual reality is deployed in a continuum between toxicity and creativity. Toxicity can be seen in the completion of the adolescent process and the preservation of a narcissistic omnipotence via an ideal self.Conclusion
Teenagers withdrawn into their home do not all exhibit an intensive use of digital technology which can be perceived as trophy at this age. Video games enable narcissistic reinforcement, less threatening object relationships, and a less painful confrontation with loss for the most vulnerable teenagers. Virtual reality and the construction of an ideal can together contribute to the resumption of the adolescent process. 相似文献18.
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Lucas Bloc Dominique Pringuey Mareike Wolf-Fédida 《Annales médico-psychologiques》2018,176(3):236-242
Objectives
In a phenomenological approach, eating disorders imply a mode of being in the world, a mode of existence in which the act of eating occupies central position and becomes a source of suffering as a result of incapacity to have control over eating habits. In this article, our objective is to analyze the hyperphagic experience, which is experienced in obesity.Patients or Materials and Methods
The phenomenological approach to the body discusses the current habitual dimension of eating and observes a certain imbalance between the body as subject and the body as object in the hyperphagia experienced in obesity. Contributions by Merleau-Ponty's philosophical phenomenology, as well as Tatossian's clinical phenomenology are the basis of our study. After that, we approach the hyperphagia experienced in obesity, assessing clinical interviews with Louise and Marine. Used in the form of vignettes in order to illustrate the hyperphagia experienced in obesity, these interviews of phenomenological nature, realized right in the heart of an obesity medicine service in Paris, allow us to understand the meanings of the patients’ experience. The questions proposed concerned the state of being obese, as a mode of being-in-the-world, as well as the eating experience.Results
Inspired by a phenomenological approach to the body, it might be understood that the hyperphagic body is in a short-circuit, or rather in an imbalance between the body as subject and the body as object. On the one hand, the hyperphagic person does not feel their own body — body feelings are not experienced. On the other hand, they lose connection and contact with themselves and with others. Such connection would be the supplier of the means for a possible control over the act of eating. There is a rapid alternation between being and having a body, and that is anchored in the imbalance that results in the pathological process characterized by the condition of not being able to stop overeating. The clinical interviews allowed us to have direct contact with the experiences of two patients and four strands were explored: the body and the other one in obesity, body feelings and loss of control, the act of eating as a means to fulfill feelings of emptiness as well as the need for something to happen, and the non-addictive dimension of hyperphagia.Conclusions
It is observed that the great suffering experienced by an obese person with hyperphagia is connected to a body condition, the impossibility of not eating and not being able to control the urge to eat. The act of eating is experienced as an imposition and not as a choice, an urge that suppresses an individual's liberty and that frequently incites guilty feelings. The body is believed to be controlled by the urge to eat, and it is thoroughly crisscrossed by our relations with our own bodies, with others and with food. 相似文献20.
Alexandra Bernard Almudena Sanahuja Sarah Bydlowski Tarek Serrier 《Annales médico-psychologiques》2017,175(4):345-352