Géographie et psychose : territoire et perte du corps commun

Faced with the observation of clinical stalemate that may cause psychotic subject's speech, the authors suggest an alternative methodology based on the report of the subject to its own geography and its faculty of “territorialisation”. Based on arguments coming from ethology and phenomenology, they suggest an epistemological reflection of the act for the practice of clinical psychology with psychotic patients. These acts consisting the refrain, the social adjustment, the emotional regulation or even the relational intuition are witnesses stating that the central problem of psychosis is within the broad spectrum and complex of the loss of common sense and common body.     

La créativité du patient parkinsonien

Objectives

Enhancement of pre-existing artistic talent as well as the emergence of a new artistic tendency has been associated with fronto-temporal dementia (FTD) but is an unusual finding in Parkinson's disease (PD). PD is typically characterized by loss of function and previous abilities, often accompanied by complications of treatment in the later stages of disease progression. Creativity has recently been described in Parkinson's disease as a symptom from the “dopamine dysregulation syndrome” (DDS) in association with pathological gambling, hypersexuality, compulsive shopping, binge eating, punding or hobbyism, or compulsive dopaminergic medication use.

Patients and methods

We report two patients who developed artistic skills after changing of their dopamine treatment-dose. These two patients suffered from idiopathic Parkinson's disease; one became an accomplished writer and the other one developed embroidery creative activities. These case reports offer insight into the physiopathology of the artistic creativity.

Results

Four main physiopathological hypotheses, which are not mutually exclusive, are currently proposed: (i) creativity is a mechanism of sublimation, (ii) creativity is due to hyperactivity and behavioural desinhibition, (iii) development of artistic activities is a consequence of enhancing premorbid personality or (iv) creativity is due to serotoninergic stimulation by dopamine agonists.

Conclusion

A number of aetiological hypothesis on creativity exist. Although there are still many controversies among the experts in the field, we may infer that dopamine agonists should be drugs that enhance creativity in Parkinson's patients.     

Exercice de la psychiatrie dans le monde du travail

Sectorization has been set up to allow the practice of psychiatry closer to people by opening community mental health centers in most cities. Since this advent, the sociology of cities has changed and this response to mental health issues is no longer fully appropriate. Time is accelerating and the waiting list for an appointment has extended. In addition, the “village” has disappeared; families are often single parents because of divorces. The main socializing area is now the company. Also, in these work environments, many human tragedies such as suicides are increasing. These tragedies are not always directly related to the company's issues and internal functioning's. Psychiatrists have a duty to invest the social fields more. This new area of expertise in psychiatry is called upon most often as a preventive measure when faced with potential psychological vulnerabilities. It implies risk assessment of psychosocial origins, accompaniment of a social transition, maintaining human capital, psychological support following difficult and/or brutal events (such as suicides, accidents, etc.). Often, this type of exercise requires adjustment of our practices (ethics, limits of intervention). In these new fields, the objective is to take care of people in order to avoid the appearance of psychiatric disorders (adjustment disorders, etc.) that are not easily absorbed by the current health institutions. Hence these potential disorders may lead to the exclusion of individuals due to their inability to work.     

Localisation des centres du langage par l'analyse quantifiée de l'EEG (versus test de Wada) dans l'épilepsie temporale chez le droitier

Spectral analysis of the EEG alpha rhythm was studied in nine temporal epileptic right-handed patients in order to predict localization of the speech area. We studied the variation of the spectral power of the alpha rhythm during an activation paradigm previously validated in normal right-handed subjects. Significant alpha power decreases in the left hemisphere during writing with the right hand (as compared to resting) and/or significant alpha power decreases in the right hemisphere during left-hand recognition and classification of cardboard objects (as compared to resting) were considered as consistent with left-hemisphere dominance for language. The results of EEG spectral analysis were compared with those of the Wada test. The left hemisphere was dominant for language according to the Wada test in eight subjects and the right hemisphere in one subject. Six patients had a significant alpha power reduction in the hemisphere concerned during lateralized cognitive tasks, consistent with language localization in the left hemisphere according to the Wada test. The three remaining patients had no significant EEG spectral power variations. A significant decrease of alpha power in the active hemisphere during cerebral activation seems statistically related to left-hemispheric dominance for language in right-handed subjects (hemispheric specialization). However, the localization of the speech area using this electrophysiological method does not appear clinically relevant for a case-by-case decision in individual patients.     

La connotation dans les paroles de patients atteints de la maladie d’Alzheimer : une méthode d’écoute

The change of the semantic memory in the Alzheimer's disease makes complex the understanding speech of patients. The very important lexical reduction in this disease does not allow to understand the sense of speech. These patients keep an intact phonological capacity. It will be separated of what is pronounced of the whole verbal exchange. The said is often qualified as semantic no sense. The questions of nurses and families to clarify the requests fail. The patient is only repeating his request. For example, the patients ask to see a dead person (her mother) or a requirement (take a taxi). The explicit, literal sense (denotation), does not any more allow to understand this phonological production. It is impossible to act for these pressing requests. For us, these words are full of sense but condensed. The concept of connotation (say it) allows to seize the wide sense of the intention. From clinical examples, we propose answers according to the connotation of what is pronounced. So, we determine a first method of care to understand the requests of these persons.     

Mise en scène et origine perçue des voix hallucinées dans des discours de patients schizophrènes

This research explores how hallucinated voices appear in schizophrenic patient's narrations. Fourteen narrations of hallucinated patients were studied and are reported. Results show significant differences regarding the prevalence of use in the types of reported speeches, the ones most employed are reported speech and undetermined reported speech as respectively cited. The report mentions that hallucinated discourse is entirely separate and autonomous from the rest of the narration. These results underscore the xenopathic characteristic of hallucinated voices in the elaboration of the narration. These results are discussed for future research in this perspective and for the impact of the evaluation of psychotherapeutic treatment of these patients.     

Traumatisme de l’inceste et destin du féminin

In the juvenile surrection can be added the violence of the sexual traumatism, hindering this possible moment of narcissistic reconstruction to an incest victim. We suggest analyzing the possible investment of female identity (envelope feminity and orifice feminity) to a prepubescent girl, victim of childhood incest. We put the hypothesis, which the expulsion of the representations bound to the incest affects the possible investment of the feminine body and its containment function. We referred to three studies, using projective tests, concerning teenagers (some were hospitalized after a suicide attempt and the others had no psychiatric care) and women, victims of childhood incest or which suffered from maltraitant in childhood. To our subject, the projective tests (Rorschach and Thematic Aperception Test) give evidence of the repression of the female identity, a lack of dynamism and mobility of the thought and relational problems. The question of the sexual identity seems evaded by the problem of the identity, the cruelty to one and others being a way of protecting herself from any link.     

Résisteur de starling et stabilité du couple sommeil-ventilation

The upper airway can be described as a collapsible segment (the pharynx) interposed between two rigid bony (the cavum) or cartilaginous (the trachea) segments. Due to this structure, the pharynx behaves as a collapsible tube, in which airflow does not depend on the downstream pressure, but is limited to a maximum value which depends only on the upstream pressure and on the pressure surrounding the collapsible segment; itthis behavior, known as a Starling resistor can be modeled by the waterfall effect. Thus, the upper airways can be in three different conditions: an occluded condition, in which no flow is possible, a patent condition, in which flow depends on the difference between upstream and downstream pressures (according to Poiseuille 's law), and a situation in which flow is limited. The behavior of the upper airway is largely dependent on its anatomic structure, but functional factors play a critical role. Among these sleep state is both a determinant of the collapsibility of the pharynx, and determined by the simulation of upper airway mechanoreceptors whose activity depends on the activity of respiratory muscles. Thus the interplay of three factors: ventilatory drive, upper airway collapsibility, and arousal threshold can predict most of the situations of stable and unstable ventilatory behavior during sleep. The level of the arousal threshold governs the stability of the ventilatory pattern, as it determines whether a combination of flow, respiratory effort, and blood gases can be maintained or is interrupted by an arousal.     

Épidémiologie du trouble bipolaire

The lifetime prevalence of bipolar disorders is 1.5% in the general population which is similar to that for one year since this is a chronic disease. Estimates of incidence vary (0.3 to 3 cases per 10 000). This general morbidity is less important that what is found in institutions, since patients presenting with bipolar disorders are not necessarily in care. Bipolar disorder affects men and women in equal proportions, and independently of ethnic and cultural background or of socioeconomic status. It is nevertheless more prevalent in urban than in rural areas, and is more common in subjects who are divorced, separated or have never married than in married subjects who have never divorced. It mainly affects younger subjects, with the mean age of onset being about 20 years. Furthermore, it appears to be more common in subjects born since 1930–1940. Finally, it is often associated with other mental disorders, particularly alcoholism and drug dependence.     

Mémoire émotionnelle du soi

Emotion shapes autobiographical memory (AM) by tagging events that are relevant for the narrative self, which may be viewed as a hierarchical network of interconnected goals. Subsequent AM retrieval is a reconstruction process that grounds the self by providing coherent narratives organized to elicit a sense of identity across the time. The lateral and medial prefrontal cortices underlie reconstruction and self-referential processing, respectively, whereas the lateral and medial temporal cortices underlie semantic and episodic aspects, respectively. Additionally, the posterior cortical midline structures and the amygdala are involved in visual and emotional aspects, respectively. These regions have been found to display aberrant functioning in major depression. Accordingly, major depression is associated with impairments of AM retrieval combining mood-congruency, overgenerality, intrusive memories and third-person visual perspective.     

Neurosciences et phénoménologie-II : sortir du bocal à mouches

In this second part, we suggest how phenomenology allows to disrupt the circularity of the scientific method. Then, we show how much this philosophy is compatible and coherent with the second cybernetics’ principles and an epistemology of complexity. At last, we will propose a neurophenomenology taking into account this second cybernetics and getting away the conventional paradigm of cognitive neurosciences.     

Les structures de réhabilitation : du secteur au réseau

Patients suffering from schizophrenia usually stay excluded from the society despite the development of the psychiatric system for the last 50 years. To look for root cause and to consider the organization to set around the concept of the fourth paradigm, it appears relevant to cross local experience gained from a team of psychiatric practitioners to theoretical thinking.     

Données sur la représentation morale du dopage chez l’enfant et l’adolescent

Two chronometric studies are described with the goal of outlining a moral representation of doping for children and adolescents. The first study, a moral chronometric task, was proposed to a sample of participants from children to adults. The conclusions indicated that children had a superficial understanding and a lack of internalisation concerning doping. A second study, a moral Stroop task, focalised on adolescence, which is a significant period of risk for doping and drug addiction. The aim of this study was to investigate whether young adolescents displayed an attentional bias to doping words and whether this attentional bias was related to physical self-esteem. Results indicated carry-over effects in young adolescents only for doping words. In addition, a poor physical self-esteem significantly enhanced carry-over effects. Finally, the results emphasise the complexity and at the same time the singularity of the morality of doping in terms of moral judgement.     

Information et vécu parental du diagnostic de l’autisme II. Effets des troubles et qualité de vie

This article is part two of a study whose aim is to provide the current state of knowledge concerning the parental contribution in early identification and diagnostic patterns of children with autism spectrum disorder. The first article was an update on the age of recognition of early symptoms by parents and the initial diagnosis as well as the nature of concerns. The purpose of this one is to evaluate the psychosocial repercussions of child's trouble on parents, and therefore on their quality of life and their strategies used to cope with the disorder. Our aim is also to analyze the factors that determine the differences. We assume that the knowledge of these effects is also involved in the knowledge and diagnosis of the autistic spectrum disorder.     

Psychiatrie et précarité : permanence du lieu ou permanence du lien ?

The help given, to the homeless patients appearing to suffer mentally or that have grave mental disorders, requires a specific approach. These meetings can sometimes take place in a fix and determined area. However, from time to time, it can prove to be impossible. A more permanent type of interaction or link is then important to be able to build whilst avoiding institutional burdens.     

Quel avenir pour le sport ?

Technological progress stands as a force for improvement, but simultaneously it can also be seen as an element that is wearing away the ethical and political core of sport. If, before a deadline that is looming ever closer, the world of sport fails to take steps to protect itself in one particular respect, that of considering what is at stake in terms of the changing relationships between science, mankind, sport and technology, then we may be seeing the end of competitive sport, at least as we know it. What will tomorrow be made of? The technological change that is coming with the move towards nanosciences and nanotechnology will bring with it a transversal phenomenon known as “metaconvergence” resulting in a revolution in the human condition that has led some scientific organisations to raise the prospect of a human being in transition, a kind of transhumanism. Hubris was the word used by the ancient Greeks for that which went too far, but one needs to be in a position to say where the limits lie. How far can we go before it becomes too far? The challenge is that of technological hubris.     

L’activité mentale du coureur

The cognitive orientations of runners consist mainly in associative thoughts (bodily sensations and attending to physical symptoms) and in dissociative thoughts (distraction from bodily sensations). In a recent study investigating runner's cognitions during a marathon, Stevinson and Biddle (1998) have quantified the proportion of the race during which the participants were engaged in four different categories of thoughts: associative with inward monitoring (bodily sensations), associative with outward monitoring (pace of the race), dissociative with outward focus (people and landscape) and dissociative with inward focus (daydreams). Inward monitoring seems to be the most frequent category of thoughts for any runner, whatever the level of expertise. Inward focusing (daydreams, preoccupations) is associated with a lower level of performance whether outward focusing, together with inward monitoring, seems to partly protect runners from “hitting the wall”.     

Le dérapage psychotique dans le grand âge : une voie d’expression du désir

Old age, with the accompanying physical transformations and social modifications, is a period requiring a psychical reorganization. This reorganization will help the elderly to cope with everyday life. Many events put the elderly to the test. Some elderly persons will have enough strength to affront these events with a certain amount of support from a stable environment. Others will need to be helped and will ask for help. But for some elderly people this situation will be a drama, which disrupts the bio-psycho-social order and may entrain different disorders including a massive withdrawal blocking the psyche and leading to its annihilation or delirious behaviour evoking a diagnosis of psychosis with a well-known pernicious effect. The frequency of depression associated with somatic diseases is known to be high. Psychotic symptoms are essentially delusions leading toward paranoiac delirium. The main signs of these disorders are disturbances that usually require sedation. The author suggests leaving room for patient's expression and, via the psychotherapy of a 78-year-old patient, shows that human beings exist with their own transmissible history. The author then analyses the sense of the delirium trouble in order to optimize the treatment taking into account all clinical features.     

Conduites à risques et variation de l’estime de soi chez les adolescents : l’exemple du parkour

The aim of this study was to explore the relationships between general self-esteem, physical self-worth, sport competence, physical condition, an attractive body, physical strength and the involvement in a risk-taking sport: The parkour. This sport may be included in gymnastics and acrobatics but it is practised outside of the gymnasium. Indeed, serious parkouristes are tremendous athletes who practice their stunts in a controlled environment such as a gymnasium, with mats, pads and foam pits. Many of these participants have some gymnastics or martial arts training, and they are also fully aware of the risks involved in practicing this sport. It consists of finding new and potentially dangerous ways to traverse the city landscape. Parkour is said to be the art of moving fluidly from one part of the environment to another. It may also be known as: the art of movement, free running, urban-running or obstacle coursing. This activity is a way of using obstacles in one's path in order to jump and perform acrobatics. It involves the scaling of walls, roof-running and leaping from building to building. These multiple acrobatics are submitted to peers appreciation considering fluidity, aesthetics and originality. Self-perception is of great importance in the construction of self-esteem. This concept has been identified as a state which evolved depending on spatiotemporal factors of the environmental context. It can be measured with the Physical-Self Inventory (PSI). This is a six-item questionnaire especially developed for repeated measurements. It measures six dimensions hierarchically organized Global Self-Esteem (GSE), Physical Self-Worth (PSW), Physical Condition (PC), Sport Competence (SC), Attractive Body (AB), Physical Strength (PS). Seventy-six male participants were asked to take part in the study: Group 1: Parkour (n = 32, M_age = 15.07 years, E.t. = 1.98) and Group 2: acrobatics (n = 41, M_age = 14.96 years, E.t. = 2.01). The PSI-6 was taken at three different times: Time 1 (T1, pre-test before practicing parkour), Time 2 (T2, just after having stopped the parkour), Time 3 (T3, two hours after T2). As expected, and with the exception of PC and PS, the data confirmed the prediction that, compared to Group 2, Group 1 would score significantly higher on each subscale of the PSI, including GSE, PSW, SC, and AB. That is to say, skydiving could de used as a way to regulate self-esteem, this confirms our assumption. Self-esteem has recurrently been invoked as a contributing or explanatory factor for socially problematic behavioural outcomes (i.e., risk-taking behaviours such as restrictive or dysfunctional eating, substance abuse, aggression). In relation to our results, sports could bring an extra dimension to studies on risk-taking especially among adolescents. Indeed, risk-taking sports are usually perceived as an intrinsically gratifying practice that is socially adapted and accepted. However, benefits in self-esteem regulation derived from an engagement in a risk-taking sport must be put into perspective. Although the results indicated for Group 1: a lower level of self-esteem before practice and a higher level after, the retention test shows that these results do not last more than two hours. This finding suggests that, even if the emotion regulation produced by parkour is positive, one session is not enough for adolescents to experience positive rewards from their engagement in a risk-taking behavior. Thus, in order to recreate the positive emotional state they were in, they may possibly put themselves in another risk-taking situation. However, the link with addiction cannot be made directly as it implies several factors which have not been measured in this study. Future research should take this interesting point in account and use a longitudinal methodology. This will authorize authors to draw out our assumptions and emphasize the possible link between addiction and risk-taking sports.