Le travail de la souffrance au cours d’une situation de handicap : le cas de la drépanocytose

ObjectiveSickle cell disease is the most common genetic disease in the world. Africa is the continent most affected by this disease, which is costly to manage for patients and their families. When not properly managed, it takes a huge toll in terms of suffering and disability on the sick person and their families. This article presents the results of a study which focused on the work of suffering, during a situation of disability, induced by this context of chronic and progressive pathology.Participants and methodOf the 12 patients solicited, 3 agreed to participate in this research. These 3 participants, whose ages ranged from 18 to 27 years, were interviewed in a hospital in Yaoundé. The data were collected via a clinical research interview recorded by a dictaphone. These anonymous data were subjected to a logical-semantic content analysis.ResultsThe analysis and the interpretation of data allowed us to observe that the work of suffering in these three participants takes on various aspects as heterogeneous as they are spectacular, made up of neurotic and manic arrangements, of conducts centered on the body or of theoretical constructions elaborated around the illness, the handicap and/or the filiation. The subjects powerless in the face of the chronicity and disabling nature of sickle cell disease are in a permanent process of searching for meaning concerning the disease and, of course, themselves as people affected by this disease. This permanent quest for meaning makes them more active against the disease and less powerless against it.ConclusionThe work of suffering, as put forward by the patients, can be thought of, therefore, as a manifestation of the global process of sexualization that phenomenological and psychoanalytical theories deal with. It opens on a redistribution of the libido, a rearrangement of the relation to the disease and the handicap. The position of narcissistic withdrawal which characterizes the situation of handicap, and the somatic attack is abandoned in favor of an effort of objectal reinvestment which the subject uses to get out of a handicapping position made of passivity, abandonment to the medical body, assignment to a stigmatizing status of sick or unfit. For the practitioner who works with patients, these results suggest various practical and therapeutic implications.     

Parcours de soins et expertises psychiatriques pré-sentencielles : une étude descriptive au centre pénitentiaire de Château-Thierry

ContextThe high prevalence of psychiatric disorders among people in prison is well documented, and several hypotheses have been proposed to explain this overrepresentation. In France, the decrease in the number of people found by the judge to be not criminally responsible on account of mental disorder after a psychiatric expertise could play a crucial role. The Château-Thierry prison is a high-security correctional facility where prisoners whose integration into a “standard” prison is complicated because of behavioural problems, reside. We conducted the first study to describe the judicial and healthcare trajectories of people incarcerated in this facility.MethodAll the people incarcerated in the Château-Thierry prison between May and September 2019 were included in this cross-sectional study. In addition to sociodemographic characteristics, data on the psychiatric care before and during incarceration as well as information on the judicial and prison history were collected. We also analyzed all the pre-sentencing psychiatric reports in order to collect the degree of discernment determined by the psychiatrist expert for each included individual.ResultsSixty-eight (97%) of the 70 people detained at the Château-Thierry prison during the study period were included and 92 pre-sentencing psychiatric reports were analyzed. The population studied was exclusively male, with an average age of 40 years, low socio-economic status and frequent criminal history (79%). About half of them (46%) had already been hospitalized in a psychiatric community hospital prior to incarceration, and 79% have been hospitalized in a psychiatric facility during their incarceration. Disciplinary sanctions were frequent (72%) as well as convictions for offenses committed while in prison (57%). When at least one pre-sentencing psychiatric report was carried out (29 persons had a single psychiatric forensic evaluation and 27 ones had multiple evaluations), at least one psychiatric expert had concluded to a diminished (but not lack of) criminal responsibility in almost half of the cases (44%).ConclusionThis study shows the extent to which people incarcerated in the Château-Thierry prison are affected by psychiatric disorders. It also highlights the difficulties of coping with the prison environment for people suffering from psychiatric disorders. Finally, it raises the question of the lack of diversion programs for the individuals in France with mental health problems whose responsibility has been considered as full or diminished.     

Le syndrome de Morpheus : symptômes psychotiques chez une série de cas de patients atteints de la COVID-19

During the first wave of the COVID-19 epidemic, the Colmar hospital was at the epicenter of the pandemic in France because of a religious gathering that caused a wave of contamination. In order to face the growing wave of admissions in intensive care, the state in partnership with the army set up the operation MORPHEE aiming at transferring intubated patients to other hospitals. On their return to Alsace, the inter-service liaison psychiatry team was called upon for several of them who presented psychotic disorders on waking up, even though they had no previous psychiatric history, and who had resolved spontaneously. These pictures do not correspond to the delirious pictures usually observed in the ICU, such as “reanimatory black-holes” or “near-death-experience”. No iatrogenic origin was found and the imaging examinations do not allow to explain this picture; therefore, we cannot exclude that this picture could be a neurological manifestation of COVID-19. The disorder appeared to be spontaneously resolving, so we would urge caution about a drug approach to this problem.     

Thérapie cognitivo-comportementale et psychanalyse : une efficacité comparable au cours de la crise dépressive ?

Our study compares the efficacy of two therapeutic treatments, cognitive behavioral and psychoanalytic, on a depressed population hospitalized in the same institution. We recorded the degree of intensity and improvement of fifteen subjects in a depressive state followed by a psychologist trained in CBT, and recorded the same for fifteen subjects followed by a psychoanalytical psychologist, using the Montgomery–Asberg Depression Rating Scale (MADRS). Both the first and final follow-up scores were compared, and the difference between the two depression scores was calculated. At the same time, the degree of therapeutic alliance was measured using the therapeutic alliance scale, therapist version (WAI-T). The comparison of the MADRS averages and the point spread demonstrate a significant and equivalent reduction in the depressive crisis for both groups. The WAI-T scores and the comparison of the average to the overall score indicate a similar quality of alliance. These results suggest that the frame of reference is not the cornerstone of a psychotherapy's efficacy, but is rather based on the foundation of a good therapeutic alliance with benevolent neutrality, the maintenance of a good distance, the ability to maintain the frame, a sufficient management of anxiety in the face of suicidal thoughts, with a structuring implication towards the subject. This, associated with a more active relational dynamic on the part of the therapist, compared to the investment he would develop in other types of follow-ups. These results demonstrate that the collaboration between professionals using a different theoretical framework can contribute to obtaining attractive benefits for the subjects.     

Le malentendu dans les activités sexuelles à l’adolescence : un signe de sexualité préoccupante ?

ObjectivesThe adolescence corresponds to this existential period when the violence in its creative and destructive functions is the mainspring at the same time and challenge. During this time of passage, the young has to negotiate with himself, his family and the others. Stage of transformation and transfer, revival of multiple psychic conflicts, the adolescence sees the sexuality penetrating the reality of the body. In this context in which the rising sexual activity is associated with a concern, the misunderstanding occupies a central place in the sense where most of the time the protagonists involved in acting him hardly took the opportunity to speak to itself and to get on. Behind a misunderstanding, there are on one side facts and the other one a subject which put them in act.Patients and methodsThe article develops a clinical label involving three adolescents, a boy and two girls. Misunderstandings quickly appear about activity of sexual nature. The excitement gets involved in the fears not without generating of the ambivalence. The mutual incomprehension contains a potential trauma. It is then relevant to intervene without wanting inevitably to define the truth in its material translation of the reality. A type of dense and flexible care gives encouraging results as for the reduction of the traumatisation of a particular event. We move forward stage by stage by proposing times of meeting with a rhythm enough steady and by lending us if necessary as media of expression. Yet it is hardly always well-to-do to act not in the haste but with density and speed in the interest of some of the others. It is essential to take into account at the same time relational stakes, their impacts on the individualities, and the psychic dimensions appropriate to every protagonist. A collective and personal historian can develop in these testing moments of crisis on basis of an intervention such as sketched here, by considering repercussions at the level of the socio circle of acquaintances.ResultsThe approaches which establish themselves on the only reality of the behaviour risk to evacuate the subject which puts the qualified act of worrying. For us we suggest dreading the subjective dimension by examining the question of the sexuality from the point of view of the functioning of a personality. In other words, the question is not only of knowledge which is the act which was put, but to know which committed it. We thus watch to construe the subjective impact of the act, by reminding that the human being becomes established as subject of his speech and as agent of his act. The misunderstanding also constitutes an original media of meeting of the teenager in question. We propose a categorization of worrisome sexual activities by underlining that, in number of scenarios, the young person shows elements of several categories: a/the young people in sexual life without restraint; b/the young people confronted with the constraint of the anxiety; c/the young people led by an intense need for love; d/the young people committing sexual abuses; e/the young people showing a perversion. Besides, we shall not evoke rare disturbing sexual activities put aside by the young people in the psychotic functioning. The care leans on two concepts-keys, on one hand, the succession of two different phases, that are the evaluation and the treatment and on the other hand, the complementarity of several epistemology as well as the work in network. We advocate the establishment of a partnership envelope based on the collaboration and the respect of the principles of the shared secret.ConclusionsThe misunderstanding can reveal a worrisome sexual activity in the adolescence. Indeed let us limit the current trends “to tax” any sexual act of aggression, and his author of “abuser”, and the addressee to act him of “victim”! To limit, we determine what belongs to the physical, sexual exploration, including the consensus of the protagonists, what goes out again from the pathology. The distinction is essential at the risk otherwise to stigmatize certain young people in full constructive run-up by gathering in a single troop of the different profiles from each other. The misunderstanding represents a beautiful opportunity of meeting of a young person in the inviting to a correct interpretation of the facts, by taking into account the place they occupy in the psychic and relational functioning.     

Antibiomania : penser au syndrome maniaque secondaire à une antibiothérapie

Introduction

Antibiomania is characterized by the emergence of a manic episode in reaction to antibiotics. Although relatively uncommon, this kind of side effect is observed in a growing number of cases and mostly occurs in patients who do not have a history of bipolar disorder. Several dozen cases have been reported showing the onset of manic symptoms after taking antibiotics. The antibiotic most frequently involved is clarithromycin.

Le déni de grossesse relève-t-il d’une maladie mentale ?

The denial of pregnancy being partial, total or absolute, refers to cases where the child has a biological existence but where he is not spoken, thought nor desired. The children denied before birth and sometimes even up to their birth are said to be carried by women “without belly” and are not welcomed at a level of experience and awareness. During the period of denial, no naming can symbolize this foreign body occurring in the woman's body because no representation and no affect is summoned. In this study, we will hypothesize that a certain level of denial is a common coping mechanism for a woman who is expecting a baby. In most cases, the subjective work necessary to adopt this biological presence makes the “mother of” and the child “the child of”. This work can be done once the pregnancy is revealed by language (spoken words), often thanks to the medical practitioners. But when the case of denial of pregnancy is absolute this work is not achievable. In consequence, this risk of impulsive acting-out is very important. However, these cases of denial are rare. Indeed, most denials of pregnancy are not related to a confirmed mental pathology.     

Le temps d’une chanson : abord médiatisé de la blessure de guerre en thérapie de groupe

Post-traumatic stress disorders are a major concern for the armed forces. Certain pathognomonic symptoms of psychological trauma are expressed by isolation and avoidance behavior that are antithetical to the principle of group unity and cohesion that is so fundamental in the military. The Robert Picqué military hospital is located in the heart of a region where many operational regiments are stationed. For the past 20 years, the French army has been deployed in different countries at war, on foreign missions or OPEX (Afghanistan, Lybia, Mali) and interior operations or OPINT. The Robert Picqué psychiatric department has adapted its clinical activity to admit and treat the many soldiers who have been injured and has developed a multidisciplinary and integrative approach, which includes group therapy, to treat PTSD. In this context, the combination of two health professionals, one an occupational therapist and the other a psychomotor therapist, has resulted in the creation of an original therapeutic approach using musical and creative mediation in group activities. The benefits of therapeutic synergy help to build a framework for free expression and includes the use of songs and personal creative exercises using a variety of media. From the patients’ artistic creations, their drawings and writing, we can see how this double mediation favors social bonding and makes it possible to understand the personal, family, and professional repercussions of PTSD. Thus, the time of a song provides the patients with a space of relief, of security and the development of a collective elaboration of their suffering.