Faut-il répéter l’angiographie cérébrale après hémorragie sous-arachnoïdienne périmésencéphalique ?

BACKGROUND AND PURPOSE: In patients with perimesencephalic subarachnoid hemorrhage (pSAH) DSA is recommended to exclude aneurysms to due false negative findings in CT-angiography. However, whether a second DSA is indicated during the clinical course to exclude--in addition to aneurysms--fistulas, too, is still under debate. We aimed to evaluate the benefit of repeated DSA in patients with pSAH. METHODS: The source of data was a prospective database set up at the neurological, neurosurgical and neuroradiological departments in our institution. A total of 69 patients with pSAH were enrolled and analyzed by reviewing the medical records and neuroradiological findings. RESULTS: 68 patients presented with Hunt & Hess Grade I-II and one patient with Hunt & Hess Grade III. Median in-hospital stay was 8 days (3-22). In 2 patients mild vasospasm were diagnosed. DSA was performed in all patients at least once. DSA was repeated in 38 patients (55%) after a median of 7 (3-21) days. None of the repeated DSA did show any additional distinctive features with respect to the first DSA. CONCLUSIONS: In our opinion the procedure of repeating DSA in patients with pSAH is likely to become obsolete. One DSA should be performed prior to discharge--and subsequent to possible vasospasm--to exclude hemorrhage caused by aneurysms of the posterior circulation mimicking a perimesencephalic SAH pattern.     

L'arrêt du sport intensif : révélation d'addictions ?

This study aims to show the impact of ending intensive sport activities on the psychic life of two former high level sportsmen and this under a psychoanalytical point of view. The question is to know whether ending intensive sport activities can be at the origin of an addiction of replacement (knowing meanwhile that the sportsman cannot accept the loss of his high level athlete statute) and whether the depression and the drop in self-esteem at the end of a sportsman's career are inevitable. The ending of a sportsman's career also puts an end to his quasi-pathological identity research, research which could be compared to a borderline behaviour. Moreover, a high level sportsman is more vulnerable at the end of his career and can be much more inclined to become dependent on drugs or on other addictions. During his career two distinct worlds surround him: the sporting family of adoption and the family unit. We can therefore question whether the sportsman dissociates these two families on a psychical level in order not to fall into a depression or into another dependence. Stopping sport activities is thus synonymous with a total loss of oneself; and this can therefore involve an anguish of separation and a probable fall into a social vacuum and into addiction.     

Surmortalité dans un hôpital psychiatrique pendant la guerre (Leyme) : cas particulier ou représentatif ?

A number of studies have highlighted the above-average death rate of psychiatric patients during World War II due to major food deficiency. The authors studied the death rate in the psychiatric hospital of the Lot department during this period. The fact that the medical establishment was in an agricultural area probably helped protect the patients, this is underlined even though according to death certificates, a total of 26 patients died of causes related to food or medicine deficiency. Through a perusal of documents of the period, it seems that many psychiatrists vigorously protested against the living conditions reserved for their patients.     

Psychose hystérique : solution psychotique à l’irruption de la sexualité génitale ?

The notion of hysterical psychosis implies the paradox of a psychotic genitality. Leaning on the psychoanalytic, phenomenological and gestaltist approach of Gisela Pankow, we try to define this nosographic entity, by underlining in a patient a special kind of relationship with imagos and own body we called dialectic of penetration. In that kind of pathological functioning, De Clérambault's syndrome could be understood as the realization, in the psychotic experience area, of a sort of intrusive genital sexuality, and delusion as a new performance of œdipal drama on the delusional scene. We finally question the place of a lacunar Oedipus complex in non-schizophrenic psychoses.     

Les dyskinésies paroxystiques kinésigéniques : une « canalopathie » ? Étude de 19 cas

Introduction

Paroxysmal kinesigenic dyskinesia (PKD) is characterized by brief episodes of dystonia and choreoathetosis triggered by sudden voluntary movements. Disease onset is seen in the first or second decade. The attacks typically last less than one minute. Three autosomal dominant PKD loci are identified: EKD1, EKD2 and EKD3. EKD1 has an overlap with the locus of the “Infantile Convulsion and Choreoathetosis (ICCA) syndrome”. The favorable natural history, the episodic nature of the symptoms and their sensitivity to anticonvulsant therapy suggest channelopathy as a mechanism of PKD.

Patients and methods

We reviewed the clinical features, the family history, the treatment response, the evolution and the technical investigations in 19 affected individuals.

Results

All cases were idiopathic. Ten patients had a positive familial history. Three patients suffered from ICCA syndrome. Some atypical features were seen, such as the association of kinesigenic and nonkinesigenic attacks and the presence of migraine, ataxia, seizures and myoclonus. Acetazolamide responsiveness was seen in two patients.

Conclusion

The coexistence of PKD and nonkinesigenic dyskinesia in several patients confirms the earlier described presence of intermediary forms, nonrepresented in the current classification of paroxysmal dyskinesias. Our study results suggest channel dysfunction and basal ganglia involvement in the pathophysiology of PKD.     

La réaction à la nouveauté : un indice de dépistage précoce de l’autisme ?

A certain number of autistic children seem to develop normally for the first 12 months of their lives to regress then or have their development stop, and manifest a pathology of autism near 18months. From the data present in the literature, and our clinical observation in this article we will attempt to demonstrate that it is possible to diagnose the autistic pathology within the aforementioned category of infants before the appearance of the obvious symptoms, that is to say during their 1st year as well as to propose a reflection on the aptitudes that fall into place during this period and which prepare the sequel of their development, and finally, to examine the possible role of the reaction to the novelty of the stimuli in the early diagnosis of this pathology. It has to be said that the clinical observation of autistic children, the testimony of their parents and of young high level autistic adults underline a recurrent symptom in this population, whatever their age or level of achievement: It is the difficulty or even the impossibility they experience when faced with new situations, demonstrated by a marked resistance to changes in their daily routine. These subjects appear to present an obsessive and anguished need to preserve a stable environment without the slightest transformation. It seems that they have an extremely intense reaction to the novelty of stimuli. Does this particularity exist in the infant who will become an autistic child, could parents identify this particularity, and could it constitute a sign for the early diagnosis of autism? Around 60 % of these children “become” autistic after their first birthday. In some, the developmental curve shifts and the signs of autism appear gradually. In others, a phenomenon of regression is described at the same time as the emergence of behavioral problems. The fields where this regression is most obvious are language and social interaction. Our hypothesis is that the syndrome of autism does not suddenly appear at the age of eighteen months, but that its ‘emergence’ is in the making during the infant's first months through a series of dysfunctional phenomena, that are unobtrusive and so go unnoticed by the parents. We have explored these phenomena, using the cognitive genesis habitually described in children with a typical development. We arrived at the conclusion that the subtle disorders relative to the perceptive-sensorial treatments have since the beginning gradually invaded the sphere of their relation to the surrounding world, perturbing their experience of closeness and bonding. Anomalies which lead to faults in the pattern of expected aptitudes, faults which undermine and weaken the foundations, leading to a movement of reversal during the second year and to the massive actualization of the signs of autism, which had previously been latent because the aptitudes, which should have been the base on which the subsequent ones stand, cannot develop due to the missing support of the previous ones, so that the evolutional dynamics are interrupted. Communicational and social behavioral disorders in autistic subjects might come, at least in part, from a major difficulty early on, in processing new aspects of their environment, which are often saturated with dynamic informations. Our study leads us to think that the abnormal reaction of patients with autism faced with the novelty of a situation constitutes one of the key deficits of autism and could be a sign for the diagnosis of this pathology in the first months of life.     

Aider les parents à être parents ? Modèles et pratiques des programmes « evidence-based » d’aide à la parentalité

Objectives

In France, these last years have been characterized by the emergence of a new public health movement aiming at promoting children and parents’ mental health through the implementation of evidence-based programs. If a certain number of interventions tend to be developed under a similar terminology, their contents are not homogeneous. This phenomenon compromises the clarity of the political recommendations made for this matter and engenders difficulties in regard to political decision-making. This article seeks to clarify the different types of parenting programs that can be found in international scientific literature and to present their conceptual, practical and epistemological frames.

Material and methods

A literature review has been performed on articles published between 1992 and 2012 focusing on preventive parenting programs. A qualitative approach using thematic, lexical and content analysis was used to describe the operational and specific objectives of the interventions, their contents (mode and place of intervention), the targeted populations (parents and children) and their theoretical framework.

Results

A diversity of approaches have been identified. The analyses revealed the existence of six fields of interest within parenting programs (physical health, mental health, positive parenting, substance use prevention, violence prevention and cognitive development). Seven distinct theoretical approaches emerged from the data (cognitive, systemic, psychoeducational, psychoanalytical, coaching, community and ecological). Different thematic of interventions as well as different modes and places of interventions were found within the 785 publications. Finally, social regulation and health promotion were identified as two polar social objectives in preventive parenting programs. Hence, within a typology, we defined parental education and parenting support as two global categories of preventing parenting programs. This paper summarizes the principal characteristics of the two categories that emerged from empirical data. Five examples of parenting programs are proposed to illustrate these categories.

Conclusions

Whereas most of the identified programs refer to health promotion model, their different modes of interventions do not cover all the objectives of health promotion values (i.e., strengthening community action, creating supportive environments, reorienting health services…). The reference to epidemiology and public health demonstrates the focus on risk and preventive logics. By privileging evidence based studies, scientific literature tends to promote educational programs aimed at developing individual parenting skills rather than global community actions or other types of individual interventions, which are difficult to translate in scientific experimental disposals (such as clinical interventions relying on psychodynamic models).     

La rééducation du membre supérieur assistée par robot contribue-t-elle à améliorer le pronostic de l’hémiparésie vasculaire ?

Introduction

Upper limb robot-assisted rehabilitation is a novel physical treatment for neurological motor impairments. During the last decade, this rehabilitation option utilizing technological tools has been evaluated in hemiparetic patients, mostly after stroke.

State of art

Studies at acute and chronic stages suggested good tolerance and a significant and persistent reduction of motor impairment; a real impact on disability has been shown in acute/sub acute patients.

Perspectives

Improved access to rehabilitation robots and an optimal use will probably be associated with higher efficiency of rehabilitative work in the paretic upper limb.

Conclusions

Even if this treatment is still confined to a narrow circle of users, the device's biomechanical properties and clinical suggestions from the literature may show promise for the future of rehabilitation.     

Comment penser l’évaluation des psychothérapies dans le contexte général de l’évaluation des thérapeutiques ?

The methodology of evaluation of medicinal products is well established. Is this also the case with psychotherapies? The opinions are divided. Four key methodological points related to the evaluation of therapeutics will be successively approached in a first time: what are the therapeutics that will be compared? Who are the patients included? How to evaluate the effectiveness of the treatments? How to ensure the comparability of the treatments groups? We will see that the evaluation of medicinal products or psychotherapies remain basically on the same methodology. We will see in a conclusion that the evaluation of medical treatments is presently in a kind of revolution, with a decline of the role of randomized controlled trials. Curiously, this revolution has been anticipated by certain methodologies used in the evaluation of psychotherapies.     

Devenir enseignant : quels « choix » inconscients ? Étude de cas

The authors analyze the elements, which lead to the choice of teaching. First, they approach the teaching function and the questions inherent to the evolution of the profession. Secondly, they present the various aspects of the parental function, the notion of prohibition of incest and the psychic dimension at work. The clinical analysis of a female schoolteacher then allows him to check the hypothesis according to which the oedipal problem in connection with parental images is present in the case studied and that it influences the unconscious professional “choice” of the subject.     

Que changent les « entendeurs de voix » à l’écoute des hallucinations ? I. Genèse d’un mouvement

Objectives

Traditionally considered psychopathological auditory-verbal hallucinations, the voices heard by patients, but also by many people from the general population, are currently the subject of much attention from researchers, clinicians and public authorities. Auditory-verbal hallucinations are the most studied hallucinations. Several studies have shown their high prevalence of so-called “voices” in non-psychiatric individuals. From the 1980s, British and Dutch researchers have highlighted those individuals – adults and teenagers – who spontaneously developed strategies to cope with their voices. This research has been mixed with a movement of social protest carried by individuals – often mental health services users – living these hallucinations, sometimes in a mono-symptomatic and adaptive way. Quickly established as an international movement, the “voice-hearers” relativize but also fertilize the clinical knowledge on the listening of hallucinations. This paper proposes to introduce the somewhat symbolic genesis of this movement (the case of Patsy Hage treated by Marius Romme, and the media call to voice-hearers) and how it leads to reconsider the treatment of hallucinations and even their very definition.

Materials

This paper reviewed the main books and articles that launched the Hearing Voices movement since the 1980s, from the Netherlands. Then, to support our analysis, we used several selected critical commentaries on the experience of hearing voices.

Results

It appears from our analysis that the Hearing Voices movement disrupt the psychiatric landscape while succeeding in its legitimization. For clinicians, this movement changes the way we diagnose and treat hallucinations. For example, the part played by paranormal or spiritual interpretations of hallucinations requires repositioning the clinical setting with respect to the beliefs of the patient and those of the clinician.

Conclusions

Voice-hearers embody the public health problem posed by hallucinations experiences in the general population. They claim to represent “the voice of patient” and a lay knowledge in the clinical field. The success of this movement made it the figurehead of the broader movement of “recovery” which is currently challenging the psychiatric power in order to substitute it by other forms of management of mental health.     

Dystonie focale fixée de l’épaule à distance d’un traumatisme scapulaire minime : une entité pour quels mécanismes ?

Introduction

Whether post-traumatic focal fixed dystonia has a physiological or psychologically-mediated mechanism is discussed.

Case report

We report the case of an active 22-year-old soldier with shoulder-fixed dystonia, eight months after a fall with minor right-acromioclavicular sprain.

Conclusion

Psychiatric examination and search of complex regional pain syndrome, radicular or accessory nerve damage, and genetic predisposition to dystonia are necessary for selecting a difficult treatment in these patients.     

Biofeedback et épilepsie pharmacorésistante : le retour d’une thérapeutique ancienne ?

Biofeedback is a complementary non-pharmacological and non-surgical therapeutic developed over the last thirty years in the management of drug-resistant epilepsy. Biofeedback allows learning cognitive and behavioral strategies via a psychophysiological feedback loop. Firstly, this paper describes the different types of biofeedback protocols used for the treatment of drug-refractory epilepsy and their physiological justifications. Secondly, this paper analyzes the evidence of effectiveness, from a medical point of view, on reducing the numbers of seizures, and from a neurophysiological point of view, on the changing brain activity. Electroencephalography (EEG) biofeedback (neurofeedback) protocol on sensorimotor rhythms (SMR) has been investigated in many studies, the main limitation being small sample sizes and lack of control groups. The newer neurofeedback protocol on slow cortical potential (SCP) and galvanic skin response (GSR) biofeedback protocols have been used in a smaller number of studies. But, these studies are more rigorous with larger sized samples, matched control groups, and attempts to control the placebo effect. These protocols also open the way for innovative neurophysiological researches and may predict a renewal of biofeedback techniques. Biofeedback would have legitimacy in the field of clinical drug-resistant epilepsy at the interface between therapeutic and clinical neurophysiology.     

TDA/H : intérêt de l’association entre pharmacothérapie et psychothérapie analytique ?

Interest in attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD) is growing, as evidenced by the number of scientific publications on the topic, as well as by the number of requests for child psychiatric consultations to diagnose ADD. The current clinical consensus is the result of the long evolution of a historical dichotomy between advocates for an organogenetic or psychopathological etiology of the disorder. Today, we question whether a “double reading” is possible taking into consideration both neuro-developmental factors as well as psychopathological elements? The contribution of complexity theorists and developmental phenomenology could help to conceptualize the ADD/ADHD as a complex and multifactorial disorder, which would support a “transversal” therapeutic approach involving psychoanalytical and psychopharmacology. However, questions remain regarding the effectiveness of psychoanalytical therapy and its association with pharmacotherapy in treating ADHD – and there appears to be little evidence of its effectiveness in existing literature. Thus, the possibility of a future therapeutic consensus for ADHD could be expected.     

Réunion de synthèse et groupe de travail : quelle spécificité ?

A working method in psychiatric institutions and child care, the “synthesis” meeting is rarely a topic of reflection or research. To discuss its functioning, the author proposes two clinical vignettes, one involving an outside therapist's participation at the “synthesis”, the other not. Using this alternative as a starting point, the author offers an overview of the procedure, in the context of the development of community psychotherapy. To take the analysis one step further, “synthesis” and “meeting” are examined separately. The meanings of “synthesis” are sought mainly in the works of Freud, who described it as both the opposite of analysis and as accomplished by the patient's ego. But what about the patients whose ego cannot achieve synthesis? One possible answer is offered by examining the specific features of the “meeting” of a working group where the emphasis is on understanding the relationship with the patient, but where the relationships between participants are no less important. While not excluding conflicts, “synthesis” requires various forms of convergence as well as resonance. The author formulates the hypothesis of an advanced form of resonance called “totallization”, which consolidates perception of a patient's image, shared at a deep emotional level by all participants at the “synthesis” meeting.     

Interaction Between Ca<Subscript>v</Subscript>2.1α<Subscript>1</Subscript> and CaMKII in Ca<Subscript>v</Subscript>2.1α<Subscript>1</Subscript> Mutant Mice, <Emphasis Type="Italic">Rolling Nagoya</Emphasis>

It has been reported earlier that interactions between Ca_v2.1α₁ and calcium/calmodulin-dependent protein kinase II (CaMKII) in the presynaptic fraction and between the NMDA receptor subunit NR2B and CaMKII in the postsynaptic density (PSD) fraction are important for neuronal function. Ca_v2.1α₁, CaMKII, and NR2B are predominantly expressed in the hippocampus. To examine the above interactions and CaMKII activity in the hippocampal presynapse and PSD of Rolling Nagoya mice carrying a mutation in Ca_v2.1α₁ subunit, we performed immunoprecipitation and Western blot analyses. In the presynapse, the interaction between Ca_v2.1α₁ and CaMKII and the phosphorylation of CaMKII (at Thr286) and its substrate Synapsin I (at Ser603) were decreased in mutant mice compared to wild-type mice. In the PSD, a similar pattern was observed for the interaction between NR2B and CaMKII and the phosphorylation of CaMKII (at Thr286) and its substrate AMPA receptor subunit glutamate receptor 1 (at Ser831) between mutant and wild-type mice. Our data indicate that disruption of the interaction between Ca_v2.1α₁ and CaMKII may down-regulate presynaptic CaMKII activity and that Rolling Nagoya mice would be a useful model for examining presynaptic function.