Comment les Annales Médico-Psychologiques parlaient-elles de l’encéphalite léthargique voici cent ans ?

A century ago, when the so-called Spanish flu epidemic was spreading, René Cruchet in France and Constantin von Economo in Austria drew the attention of military and civilian physicians to the existence of another pandemic, encephalitis lethargica. After a more or less prolonged phase of irrepressible drowsiness, those who survived progressively developed permanent sequelae, i.e. parkinson’ syndrome, or various types of paroxysmal dystonia. The patients were often children and young adults. From 1920 to 1946, the Société Médico-Psychologique devoted twenty sessions to the study of the neuropsychiatric sequelae of these encephalitides. In addition to abnormal movements, psychiatrists treated hallucinatory delusions, violent and aggressive behaviors with sexual disinhibition, myoclonic epilepsy, etc. The clinical presentations summarized here seem to demonstrate that this pandemic allowed psychiatrists to relate psychiatric deterioration to diencephalic and mesencephalic lesions in a way that they had never done before. The current etiological hypothesis concludes this presentation.     

Encéphalopathie hypoxique prolongée

Résumé On présente l'étude histopathologique d'un cas d'encéphalopathie hypoxique prolongée. Il s'agit d'un adulte qui au cours d'une rachianesthésie présente une syncope respirtoire suivie d'un état comateux qui a duré 4 jours, intervalle pendant lequel il fut soumis à une réanimation. A l'examen microscopique, on a mis en évidence des lesions neuronolytiques des éléments ganglionnaires, surtout du cortex cérébral et de la couche des cellules de Purkinjé. En même temps des processus de démyélinisation. La démyélinisation était observée surtout autour des longs vaisseaux de l'axe gyral des circonvolutions. On insiste sur la pathogénie des altérations hypoxiques cérébrales.

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Zusammenfassung Histopathologische Befunde eines Falles von protrahierter hypoxischer Encephalopathie. Es handelte sich um einen erwachsenen Patienten, bei dem es während der Anaesthesie zum Atemstillstand und hernach zu einem komatösen Zustandsbild von viertägiger Dauer kam. In diesem Zeitraum wurden Wiederbelebungsversuche unternommen. Der histologische Hirnbefund ergibt nekrotisierende Läsionen des Zellparenchyms, insbesondere der Großhirnrinde und der Purkinjezellschicht der Kleinhirnrinde, sowie Entmarkungsvorgänge, die vorwiegend um die langen Windungsmarkgefäße angetroffen werden. Die Pathogenese der hypoxischen Hirnschäden wird diskutiert.

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Avec 2 figures dans le texte     

Exposition aux violences professionnelles à l’hôpital chez les jeunes médecins : l’étude nationale MESSIAEN

BackgroundHospital professional violence is defined as hostile and aggressive behavior exerted by health professionals on other health professionals. No quantitative study has been carried out to date on French hospital professional violence among young physicians, while recent qualitative studies have suggested a potential high frequency. The main objective was to determine the prevalence of exposure of young doctors to hospital violence. The secondary objective was to determine their characteristics and consequences as well as to determine if students and young physicians (resident and young MD) differed.MethodsThe study was a national cross-sectional observational epidemiological study that included 4th-year medical students and young physicians (MD for less than 2 years). Thirty-seven French faculties of medicine were contacted for email recruitment of participants. Social networks were used to increase the visibility of the study. The questionnaire was developed after exhaustive review of the international literature dealing with professional violence in hospitals, its characteristics and its consequences in terms of mental health, addiction, personal and professional life. The report of these events was also explored.ResultsIn total, 2003 participants have been included. More than nine out of ten participants were exposed to hospital violence at least once and nearly 42% to moral harassment as defined by the French law. This violence does not differ between the students and the residents/young MDs, suggesting that working time in the hospital does not seem to affect this risk. Nearly 80 % of interns and young MDs reported working more than the legal time. The perpetrators of violence include in almost all cases at least one man, often a senior doctor, but students reported the presence of at least one woman among the perpetrators in ¾ of cases. The victims are as often men as women. Compared to the undergraduate medical students, residents and young MDs more frequently reported poor outcomes on their mental health, addictive behavior, personal and professional lives. The majority of victims reported the event to a peer but fewer than 10% to the head of the department, a professor or an instance that could have acted. In almost all cases, participants reported the continuation of abusive behavior after the event. In total, 42% of students think that this is simple part of medical studies that they must endure.ConclusionThese results suggest the need to develop specific information and prevention programs for professional hospital violence in France.     

Humaniser l’orthopédie

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.     

Télémédecine et troubles du spectre de l’autisme de l’enfant et de l’adolescent : guide théorique et pratique

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.     

De l’intérêt d’évaluer l’anxiété : impact de l’utilisation d’une EVA sur la consommation de benzodiazépines

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.

La législation actuelle face à l’évaluation des comportements criminels violents : l’urgence d’une réforme

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.     

Le travail de l’hypocondrie chez le sujet en insuffisance rénale chronique et hémodialysé

Aim of the research

Since the interiority of the body is redefined by the experience of a chronic somatic disease and its therapies, one of the psychic approaches we propose to study is the work on hypochondria.

Le passage à l’acte à l’épreuve du post-contemporain

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.