共查询到20条相似文献，搜索用时 15 毫秒
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D. Bailly 《L'Encéphale》2017,43(1):69-74
Objective
To review the options for psychosocial interventions in pediatric bipolar disorders.Methods
A comprehensive literature review of randomized clinical trials and open-label studies was conducted.Results
Randomized controlled trials show that psychosocial interventions involving families (i.e. family-focused treatment) or individual and family therapy (i.e. multi- or individual-family psychoeducational psychotherapy, child- and family-focused cognitive-behavioral therapy, dialectical behavior therapy) may be effective through added benefit to pharmacotherapy. All these interventions share numerous common therapeutic elements such as psychoeducation and skills training. Individual interventions (i.e. interpersonal and social rhythm therapy and cognitive-behavioral therapy) are to date less well documented. However that may be, outcome studies remain few, and numerous methodological limitations (small sample sizes, designs not very rigorous) restrict the interpretability and generalisability of their results. In addition, most studies were conducted in specialty centers with highly trained therapists, and the feasibility and acceptability of these interventions in practice settings remain to be shown.Conclusion
Despite recent developments in identifying effective psychosocial interventions, numerous critical gaps remain, and more longitudinal studies are needed to clarify how these interventions work. 相似文献2.
Objectives
To better delineate in the medical literature the effect of methylphenidate on weight and appetite.Methods
A search on PubMed was carried out for articles published with no restrictions on language or year of publication using the terms: “methylphenidate”; “weight”; “appetite”.Results
Methylphenidate increases dopamine and noradrenaline in synapses because of its blockage of the transporters of these monoamines in the frontal cortex and insular lobe. The intracerebral activity of methylphenidate is incriminated in the dysregulation of appetite due to its probable effect stimulating the disgust sensation generated after the activation of the insular lobe by the drug. The anorexigenic effect of methylphenidate has been demonstrated in preclinical studies although the dosage and the administration routes differ in animals from those used for human beings. In clinical studies, methylphenidate decreases the weight of children and adolescents during the first 3 to 6 months after its initiation due to the appetite reduction effect that it generates with a tendency of weight curves to rejoin the curves of subjects who did not receive the treatment a few years after its initiation.Conclusion
The anorexigenic effect of methylphenidate does not persist over the long-term in children and adolescents who receive it. 相似文献3.
Xanthie Vlachopoulou 《L'évolution Psychiatrique》2018,83(1):67-76
Aims
There are numerous concerns about the increasing use of screens: do screens isolate us, make us violent, or addicted? The aim of this paper is to propose sound theoretical foundations and to open up reflection on the often disproportionate concerns about the use of technical and scientific virtual objects.Methodology
We base our apprehension of virtual reality and its uses on the valuable contributions of philosophy and psychoanalysis. We propose a return to the notions of the uncanny and the pharmakon, and we also look at the place of tools in the history of humanity. The notion of addiction is then discussed, and a review of the contributions of contemporary authors to the literature is proposed.Results
The notions of the uncanny and the pharmakon highlight an essential aspect in the misunderstandings around the psychopathology of virtual reality: it is often apprehended without taking into account the personal involvement of the clinician via his own approach to virtual realities. These new digital objects are envisaged as tools with a place in the history of technology, and also as cultural objects. The psychopathological issue is apprehended by defining its contours, to avoid the approximations that often characterise the manner in which it is approached. The body emerges as an essential axis in the way the psychopathology of virtual reality is apprehended, in particular in the asceticism that can be seen in the avoidance of offline contact.Discussion
The theoretical proposals made here provide new insight into the notion of addiction, which is often misused, creating epistemological confusion. The psychopathologies of virtual reality should be considered with caution, taking into consideration commonplace reliance on tools, the uncanny and the balance between remedy and poison in the pharmakon.Conclusion
This article explores addiction to virtual worlds through the prism of psychoanalysis, also including other disciplines and approaches via the literature review on the issue. It provides to the reader with the possibility of envisaging virtual reality while at the same time disengaging himself from technophobic preconceptions on this subject. 相似文献5.
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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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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.Methodology
We discuss here the psychotherapeutic work conducted with Bernard over a period of seven years. He had chronic renal failure and was treated by hemodialysis.Results
Bernard led us to wonder about the poisonous nature of blood ties, of a family body that had contaminated his body and his psyche, including his genitals and his kidneys, even to his bones. This was linked to latent associations between his skeleton and the ossuary of Douaumont. In his psychotherapy, he explored turning points linked to life and death, the fantasized foundations of his flesh, and in particular his premature birth, where his physical death seemed to him comparable an explosion.Discussion
Bernard and our daily practice in hemodialysis clinic led us to reflect on the specificities of chronic renal failure treated by hemodialysis in work on hypochondria. We also explored the accumulation of trauma, endless mourning and figures of cruelty, such as “sur-vivance”, vampirism, haematophilia, cadaveric identification and cannibalistic introjection. Finally, we explored the transgenerational myth and primitive scenes, especially through what is inherited by and in the body.Conclusion
The bodily complaints and the work on hypochondria enable work on dreaming, extending to creation, in order to revive, re-humanize and re-objectify the subject. 相似文献13.
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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17.
《Annales médico-psychologiques》2022,180(1):76-84
Psychiatry, like all areas of existence, is made up of the different dimensions of time, the present, the past and the future. We will discuss the reflection on future trajectories in two areas corresponding to our experience : on the one hand, Psychiatry in the dynamics of various medical-educational and therapeutic establishments (rehabilitation, rehabilitation, socio-psychotherapy etc.) for the child, the adolescent the adult (diversified social protection). And on the other hand, the issues concerning the support of families in the light of our studies and our practice of university training of professionals. Of course, the future of our profession is dominated, as we know, by two main general areas : The regulation of problems and conceptions of ethics from the beginning to the end of life on the one hand, and on the other hand the consolidation of structuring Humanism in the midst of currents wanting to deploy transhumanism. In this study, we will start from concrete and conceptual current realities. From an Institutional point of view, we will focus on two important areas for the future. The need for continuity in the function of psychiatry and its practices even within the diversity of personal situations, even within the Institutions and in relation to the different clinical approaches carried out (from the youngest children to adults). And on the other hand, the importance of the coordination of psychiatric practices and conceptions in the face of the current fragmentation and compartmentalisation of practices. Psychotherapies have of course to respond to very specific and well adapted indications and this need for coordination is already well recalled. But it should certainly also correspond to modifications of the training programs of psychiatry developing versatility in future psychiatrists and taking more into account the plurivalence of people as well as the philosophical and anthropological reflection capable of promoting the most complex coordinations. From the point of view of family issues, faced with the constant worsening of disruptions, professionals will have to consider family situations in a different way, taking more into account the modalities of diverse pathological family expressions than is necessary. It will act more to consider systematically in the forms of ordinary models, but as manifestations of dysfunction and suffering for children and for adults, calling for diverse and specialized help. These considerations bring us to the urgent need for measures to prevent family disturbances in the development of modalities for structuring education for young people. All these areas will need to be further supported by general epistemological and anthropological conceptions. It will be a matter of further developing integrative epistemology capable of taking account the different psychological and psychopathological conceptions (development of the child psychologies of consciousness and the unconscious, cognitivism, systemic understanding, etc.) to take more into account the structuring anthropology allowing to consider the child, the teen ager and the adult in a constructive dynamic of all the physical, psychic, noetic and spiritual components of the personalities capable of helping them to regain control and meaning of their existence. 相似文献
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