L'action d'adrénaline,d'acétylcholine,d'histamine sur les vaisseaux normaux et dénervés

Résumé Des expériences avec l'oreille isolée du lapin perfusée par l'artère centrale montrent que les substances comme l'adrénaline, l'acétylcholine, l'histamine agisent directement sur la périphérie extrême, c'est-à-dire sur les muscles lisses.

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Summary Experiments on the isolated perfused rabbits' normal and denervated ears showed that adrenaline, acetylcholine, histamine and their competitive antagonists act directly on the end structures (smooth muscle cells) and not through the nerves.

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Zusammenfassung Der Verfasser zeigt an Hand von Durchströmungsversuchen an Kaninchenohren, daß Adrenalin, Azetylcholin, Histamin und ihre kompetitiven Antagonisten unmittelbar auf das Endorgan (glatte Muskelzellen) ohne Beteiligung des Nervensystems wirken.

     

Défaite sociale et schizophrénie : hypothèses,arguments, mécanismes

There is growing evidence for a main role of environment in the occurrence of mental disorders such as a psychosocial risk factor, for example, childhood trauma, discrimination linked to minority status, or migrant status. One hypothesis is that social adversity factors influence the risk of schizophrenia through a common pathway: social defeat which could be defined as the impotence of a subject in the face of a situation of social adversity, with a consequential experience of devaluation on the social scale. This review proposes to explain the animal model of social defeat which provides an overview of the neurobiological consequences of chronic stress. Then, we expose this topic in humans, the assessment methods, and its psychopathological field. Finally, we expose epidemiologic and neurobiological evidences, in particular the dopaminergic sensitization process, which provide evidence of a significant role of social defeat in schizophrenia risk due to exposure to psychosocial factors. This etiopathogenic hypothesis has several issues. First, a common pathway to several environmental risk factors could allow an ethiopathogenic model more parcimonious for schizophrenia. It could also allow the assessment and prevention of adversity factors involved in social defeat so as to finally improve the outcome of subjects who have an individual risk for schizophrenia.     

Hémiplégie cérébrale infantile : épidémiologie,aspects étiologiques et développements thérapeutiques récents

IntroductionHemiplegic (or spastic unilateral) cerebral palsy accounts for about 30% of all cases of cerebral palsy. With a population prevalence of 0.6 per 1000 live births, it is the most common type of cerebral palsy among term-born children and the second most common type after diplegia among preterm infants.State of the artMany types of prenatal and perinatal brain injury can lead to congenital hemiplegia and brain MRI is the most useful tool to classify them with accuracy and to provide early prognostic information. Perinatal arterial ischemic stroke thus appears as the leading cause in term infants, whereas encephalopathy of prematurity is the most common cause in premature babies. Other causes include brain malformations, neonatal sinovenous thrombosis, parenchymal hemorrhage (for example due to coagulopathy or alloimmune thrombocytopenia) and the more recently described familial forms of porencephaly associated with mutations in the COL4A1 gene.PerspectivesIn adjunction with pharmacologic treatment (botulinium neurotoxin injection), new evidence-based rehabilitational interventions, such as constraint-induced movement therapy and mirror therapy, are increasingly being used.     

Syndromes myasthéniques congénitaux : difficultés diagnostiques, évolution et pronostic,thérapeutique L’expérience du réseau national « Syndromes Myasthéniques Congénitaux »

Congenital myasthenic syndromes (CMS) are a heterogeneous group of disorders caused by genetic defects affecting neuromuscular transmission and leading to muscle weakness accentuated by exertion. Three different aspects have been investigated by members of the national French CMS Networ: the difficulties in making a proper diagnosis; the course and long-term prognosis; and the response to therapy, especially for CMS that do not respond to cholinesterase inhibitors. CMS diagnosis is late in most cases because of confusion with other entities such as: congenital myopathies, due to the frequent presentation in patients of myopathies such as permanent muscle weakness, atrophy and scoliosis, and the abnormalities of internal structure, diameter and distribution of fibers (type I predominance, type II atrophy) seen on biopsy; seronegative autoimmune myasthenia gravis, when CMS is of late onset; and metabolic myopathy, with the presence of lipidosis in muscle. The long-term prognosis of CMS was studied in a series of 79 patients recruited with the following gene mutations: CHRNA; CHRNE; DOK7; COLQ; RAPSN; AGRN; and MUSK. Disease-course patterns (progressive worsening, exacerbation, stability, improvement) could be variable throughout life in a given patient. DOK7 patients had the most severe disease course with progressive worsening: of the eight wheelchair-bound and ventilated patients, six had mutations of this gene. Pregnancy was a frequent cause of exacerbation. Anticholinesterase agents are the first-line therapy for CMS patients, except for cases of slow-channel CMS, COLQ and DOK7. In our experience, 3,4-DAP was a useful complement for several patients harboring CMS with AChR loss or RAPSN gene mutations. Ephedrine was given to 18 patients (eight DOK7, five COLQ, four AGRN and one RAPSN). Tolerability was good. Therapeutic responses were encouraging even in the most severely affected patients, particularly with DOK7 and COLQ. Salbutamol was a good alternative in one patient who was allergic to ephedrine.     

Psychiatrie phénoménologique,médecine de la personne et big data

Next to psychoanalysis, neurosciences and cognitivism is a historical trend in psychiatry, which lies in the minority and is not taught much: phenomenological psychiatry. Inspired by Husserl and Merleau-Ponty, it echoed in Ricoeur's work; carried by Binswanger, Minkowski, Tatossian, Lanteri-Laura, it still has its promoters and its researchers. The pathology thought as a lost of “pouvoir-être” allows oneself to consider the patient as his or her own norm. The whole analysis of the diagnostical process (between intuition and inference) and the “constructions” of the various theoretical resorts leading to practice are thus put to work. We will state how the everyday life of clinical psychiatry borrows more, sometimes without knowing it, from phenomenological psychiatry than from neurosciences or from the tools of clinical standardisation. Then, we would like to look into the possibility that this psychiatry inspired by philosophy might contribute to the dialogue between this medicine known as personalized or precision medicine (use of big data to come) as renewal of the Evidence-Based Medicine and, on the other side, the medicine of the person (cf. francophone observatory of the medicine of the person), which links with the Values Based Medicine we will examine.     

Délires paranoïaques,dangerosités et homicides

“Are you threatening to kill me?”, asks the psychiatrist. “It's not a threat, it's a promise!”, replies the paranoiac patient. In just a few short words, this exchange raises the issue of a dangerous, potentially homicidal nature linked to paranoia. This mental disorder is such that it severely complicates interpersonal relationships. Its mechanisms and delusional themes often cause paranoiac individuals – male or female – to have difficult, tense, conflictual and even violent relationships both inside and outside of the family. These difficult relationships can sometimes lead to serious non-lethal attacks or, more exceptionally, single or multiple homicides that have frequent precursory warning signs. The motives for homicides committed by paranoiacs are linked to the themes of their delusions: persecution, prejudice, jealousy, filiation, erotomania, betrayal, etc. The therapeutic alliance, frequently difficult to set up and maintain, makes healthcare treatment difficult for dangerous paranoiac individuals. Ideally, this treatment is based on two key approaches: medicinal treatment and psychotherapy. When these people are not considered to be criminally responsible for the acts that they have committed they are forced to receive care.     

La localisation viscérale des passions selon Pinel,Esquirol et leurs prédécesseurs,et le concept contemporain d’intéroception

Seventeenth-century philosophers used the terms “passions” or “passions of the soul” to refer to what we call emotions. The debate as to whether their origin was cerebral or peripheral, i.e. epigastric, was at that time led by two famous protagonists, René Descartes and Marin Cureau de la Chambre. These concepts were still subject to controversy at the beginning of the 19th century, by which time the debates were no longer philosophers, but rather alienists. Philippe Pinel and his student Jean-Étienne Esquirol remained staunch epigastralgists, as was Pierre-Antoine Prost. Their writings indicate that they were unaware of the work of certain physiologists who were their contemporaries, such as Pierre Brisseau and François Pourfour du Petit, and who were uncovering a new physiology, that of the autonomic nervous system. Over the next century, the theories concerning emotions benefited from constant advances in physiology and pathophysiology but continued to confront the problem of their central or peripheral origin. The 21st century finally combined the two theories within a concept of interoception or the physiological sense of the perception of the body's state. This article covers three centuries of evolution in the concepts and knowledge of the physiology of what brings colour to life, our emotions.     

Ataxie familiale du lapin,différente de la maladie héréditaire de Sawin-Anders

Résumé Présentation anatomoclinique de quatre lapins (dont trois avec vérification anatomique) appartenant à la race Chinchilla-Tchécoslovaque, provenant de deux nichées issues de la même femelle, mais de deux pères différents, atteints d'une ataxie et de parésie spastique des pattes.L'affection diffère de l'ataxie héréditaire du lapin deSawin-Anders par son début périnatal et par sa survie prolongée.Anatomiquement il s'agit d'une atteinte généralisée de tous les neurones du système nerveux central et même des ganglions. La lésion se présente comme un oedème cellulaire suivi d'une fonte des structures intraneuronales. D'importantes réactions gliales (oligodendrocytaires et astrocytaires) accompagnent les changements des neurones.Tous les sujets malades étaient mâles. La femelle de la même nichée avait un système nerveux intact.L'image anatomique fait penser à des troubles du métabolisme de l'eau et des electrolytes probablement conditionnés génétiquement. La souche des lapins reste en observation.Zusammenfassung Klinisch-anatomische Beschreibung von vier Kaninchen (davon drei morphologisch untersuchte) der tschechoslovakischen Chinchilla0Rasse, die zwei Würfen desselben Weibchens, aber verschiedener Väter, entstammen und Ataxie sowie spastische Paresen der Extremitäten boten.Die Erkrankung unterscheidet sich von der hereditären Ataxie des Kaninchens (Sawin-Anders) durch ihren perinatalen Beginn und die verlängerte Überlebenszeit.Morphologisch handelt es sich um eine generalisierte Affektion sämtlicher Neurone des ZNS und der Ganglien. Die Veränderungen manifestieren sich als Zellödem, das von einem Verlust intraneuronaler Strukturen gefolgt ist. Erhebliche Gliareaktion (der Oligo- und Astroglia) begleiten die neuronalen Läsionen.Bei sämtlichen erkrankten Tieren handelte es sich um Männchen; die Weibchen desselben Wurfes boten ein intaktes Nervensystem.Das morphologische Bild läßt möglicherweise genetisch bedingte Störungen des Wasser- und Elektrolytstoffwechsels vermuten. Die betreffende Kaninchensippe bleibt in Beobachtung.     

L’abord phénoménologique de l’épistémologie de la psychiatrie,selon Georges Lantéri–Laura

ObjectiveThe article aims to give an account of the construction, by G. Lantéri–Laura, philosopher and historian of psychiatry, of a phenomenology of psychiatry dedicated to the critical elucidation of its foundations, inseparable from the concrete approach of its history, apprehended with the methods of structuralism.MethodThe stages of this construction are summarized and connected to the path of their author, while paying tribute to him and his work.ResultsThis phenomenology of the psychiatric fact privileges the study of the sign and its effects of meaning, and requires the clarification of the conditions of its production, including the knowledge and the know-how that it supposes. Extending the work of E. Minkowski thanks to the principles of structuralism, G. Lantéri–Laura considers the structure of the semiotics of psychiatry and makes numerous contributions to its semiology, notably of language. Considering the investigation of its praxis to be inseparable from its history, he forges a periodization of it in various paradigms, in conformity with T. Kuhn's epistemology and with C. Lévi–Strauss's conception of history.DiscussionLantéri–Laura links this phenomenology with an approach to subjectivity that keeps Husserl's vow of evidence, but without rejecting the unconscious, thus resisting the hegemonic and totalizing tendency of any psychopathology through the rigorous elucidation of the semiotics of psychiatry and the emphasis put on the regional, plural, and historical characters of its epistemology.ConclusionG. Lantéri–Laura has proposed a phenomenological epistemology of psychiatry, inseparable from the three dimensions of semiotics, subjectivity, and its history.     

Psychédéliques,psychothérapie et symbolisation : une revue de littérature dans le champ de la dépression

AimThis article proposes a literature review focused on the so-called “classic” psychedelics (LSD, psilocybin, DMT, and mescaline) and, more specifically, on their use in the psychotherapy of major depressive disorders and the way they affect symbolization processes.MethodAfter some introductory remarks on psychedelics and depressive disorders, we describe some modern clinical trials, and then explore the peculiar phenomenology occurring in the psychedelic experience, as well as its therapeutic effects on depressive symptoms. The underlying mechanisms are discussed from a perspective at the crossroads of cognitive neurosciences and psychoanalysis. We conclude with some reflections on the crucial role of the setting.ResultsThe results already obtained suggest that a single dose, taken in a supportive environment, may be sufficient to produce significant and immediate therapeutic effects, which are still present six months after the dose, although less so for some patients. Clinical response depends on the subjective aspects of the individual experience. More specifically, it seems correlated with the ability to “let go” and to allow autobiographical memories to emerge, along with the intense emotions they carry. It also relies on the presence and intensity of mystical-type experiences, characterized by feelings of “ego dissolution,” unity with everything, transcendence of space and time, and ineffability.DiscussionPsychedelic-assisted therapy seems to promote the emergence of primary processes and the lifting of defense mechanisms. Psychedelics would thus catalyze the resumption of symbolization processes, favoring in particular the integration of unconscious conflicts as well as the remodeling of pathogenic object relationships. On the neurobiological level, these processes would be underpinned by a decrease in the activity of the default mode network – sometimes considered the primary biologic substrate of the Freudian ego –, associated with an increase in brain entropy and in neuroplasticity. These different elements entail a decrease in depressive symptomatology, particularly ruminations. Common factors identified as the cause of positive changes in classical psychotherapies appear naturally amplified in the psychedelic experience, which requires the containing function of a therapist and a supportive clinical setting to allow a resumption of symbolic processes. To ensure the perpetuation of the observed transformations, which often exceed the simple withdrawal of symptoms, an extended psychotherapeutic monitoring would be appropriate.ConclusionThe psychedelic substance acts as a catalyst, allowing an access to otherwise inaccessible unconscious materials, which can then be processed both spontaneously and within the therapeutic relationship. Considering the data discussed in this review, we emphasize the need for further research exploring the potential of this treatment, which also offers the hope of a renewed dialogue between psychiatry and psychology, neurosciences and psychoanalysis.     

La psychiatrie connectée,une psychiatrie augmentée ?

The use of digital technologies in medicine is constantly growing. The adoption of digital technologies in the clinical practice in psychiatry seems to be a question of when, not if. How can we use those tools effectively? To address those issues, this short review discusses three of the major contributions of digital psychiatry: 1/the assistance and improvement of current care; 2/the development of new treatments; 3/the production of scientific and medical knowledge.     

Post-vérité, un symptôme du lien social ?

ObjectivesThis work attempts to understand, on a subjective and societal level, the psychic processes involved in the phenomenon of the emergence and proliferation of narrative constructions concerning the post-truth.MethodTaking into account the unconscious aspects that contribute to the construction of narratives and beliefs within human groups, and putting these theoretical milestones into perspective with the psychoanalytical concepts of psychic truth, construction, and the need to believe will lead us to problematize our conception of post-truth.ResultThe study of this phenomenon in the light of psychoanalytical conceptions of the delusional construction, the elaboration of religious beliefs, and constructions in analysis will lead us to understand the discursive regimes of post-truth as collective unconscious products that can give a form to nuclei of psychic truth that are not fully developed by the social.DiscussionThis interpretation of the conspiratorial phenomenon will allow us to take into account how these “alternative narratives” could solicit unconscious processes of the people who adhere to them, because the post-truth may represent a deformed and inappropriate way of expressing that which does not find a place of enunciation in shared discourses and narratives.ConclusionsAs a symptom in the social bond, this phenomenon questions the forms of failure of the work of culture and the crisis of the structures of shared meaning. This exploration reminds us of the necessity of thinking critically about our own constructions and paradigms.     

Phénoménologie du vécu hyperphagique dans l’obésité : le corps,le monde et l’autre

Objectives

In a phenomenological approach, eating disorders imply a mode of being in the world, a mode of existence in which the act of eating occupies central position and becomes a source of suffering as a result of incapacity to have control over eating habits. In this article, our objective is to analyze the hyperphagic experience, which is experienced in obesity.