L’importance du discours intérieur dans la sémiologie psychiatrique

ObjectivesEntangled in a semiology that aspires to imitate medical semiology, psychiatry does not take seriously enough the question of internal discourse, while many psychiatric phenomena relate to the articulation between internal discourse and external discourse.The intention of this article is to draw the attention of psychiatry to the issue of internal discourse, which is insufficiently addressed within the discipline. Psychiatric semiology should be more interested in and should approach this issue of internal discourse differently. For this, it could integrate the contribution of modern linguistics and rediscover Jacques Lacan's theory of language.MethodThe article first recalls the basic principles of psychiatric semiology based on the work of Lanteri-Laura, Henri Ey, and, more recently, that of Steeves Demazeux. He shows how psychiatry has moved from a classical semiology based on the body to that of mental faculties, more or less attached to bodies. The question of internal discourse does not find its place in these approaches.DiscussionHallucinations, delusions, obsessive and melancholy ruminations… All these phenomena are related to the question of inner speech. This does not mean that they are similar or should be approached in a comparable way.ConclusionHuman beings seem to be both speaking through their outwardly directed speech and partly spoken, through their internal speech. This must be taken into account not only from a semiological point of view but also when it comes to organizing care.     

Prosthetic treatment in the adult French population: Prevalence and relation with demographic,socioeconomic and medical characteristics

BackgroundThe aim of this study was to estimate the prevalence of dental prosthetic treatment and to investigate the demographic, social, economic and medical factors associated with the use of fixed and removable dentures in a representative sample of adults living in France.MethodsThe data were obtained from the 2002–2003 Decennial Health Survey, a cross-sectional study of a representative sample of the population living in France, which included 29,679 adults. Information was collected by interview. The variables collected were fixed denture, removable denture, age, gender, number of children, area of residence, nationality, educational attainment, family social status, employment status, annual household income per capita, supplementary insurance, chronic disease, eyesight problems/glasses, hearing problems/hearing aids. Multinomial logistic regression models were used to study the relationship between prosthetic treatment and demographic, socioeconomic and medical characteristics unadjusted, adjusted for age and adjusted for all the characteristics.ResultsThe prevalence of prosthetic treatment was 34.6% (95% confidence interval (CI): [34.1; 35.2]) for fixed prosthetic dentures and 13.8% (95% CI: [13.4; 14.2]) for removable prosthetic dentures. We showed a gradient between educational attainment and removable dentures; the odds ratio adjusted for all the variables (aOR) associated with no or primary education compared to post-secondary education was 2.56; 95% CI: [2.09; 3.13]. When annual household income per capita was low, subjects were less likely to report fixed dentures (aOR = 0.68; 95% CI: [0.62; 0.75]) than those with high annual household income per capita. Individuals without insurance less often reported fixed dentures than those with private insurance. Those reporting chronic disease were less likely to report fixed dentures (aOR = 0.87; 95% CI: [0.79; 0.95]) but more likely to report removable dentures (aOR = 1.29; 95% CI: [1.17; 1.43]) than those without chronic disease.ConclusionThis study reveals social, economic and medical inequalities in fixed and removable prosthetic treatment among adults in France.     

L’examen clinique psychiatrique standardisé pour l’étudiant,c’est possible !

The systematic approach and the examination of patients are central for the teaching of medicine. However, a very large proportion of medical students are not taught to examine patients with psychiatric disorders. This article summarizes the didactic reflection behind the development of a guide for medical observation in psychiatry for medical students. This guide was built from the framework of a classic medical examination (history of illness, biography, etc.). It also incorporates the different steps from the Mental Status Examination (MSE) as well as questions from several standardized tools. This guide document is intended to be simple and easy to use (check box system) to facilitate the interviews of medical students and residents in psychiatry. Master the clinical examination is an essential step in the process of learning medicine that will then allow to integrate, with experience, the flexibility and adaptability necessary for a psychiatric interview.     

Épidémiologie de l’insuffisance rénale aiguë

The acute renal failure is common in the hospitalized patients with the incidence is increasing. This results from the aging of the population and the widespread use of nephrotoxic therapies or diagnostic techniques. The acute renal failure is associated with an increased length of stay in hospital and the short and long-term mortality. The most common histological injury is the acute tubular necrosis. Although the most of acute renal failure is recovering, recent works have shown that there is a strong association between an acute renal failure and the increased risk of developing a chronic kidney disease.