De quels troubles psychiatriques souffrent les personnes détenues en France ?

The presence of detainees suffering from psychiatric disorders has been observed since the birth of the modern prison system, and the numbers have fluctuated since then, depending on the evolution of psychiatric facilities and the French legislative framework. As of January 1, 2022, almost 70,000 people were incarcerated in the 187 French correctional institutions in metropolitan and overseas France. Many psychiatric disorders are over-represented in the correctional population compared to the general population, and they include disorders such as depressive, psychotic, bipolar, post-traumatic stress, and substance abuse disorders together with neurodevelopmental disorders such as attention deficit disorder with/without hyperactivity. In this interview with Jean-Pierre Bouchard, Thomas Fovet and Marion Eck discuss this phenomenon based on recent epidemiological data and their personal experience. Some specific clinical aspects of psychiatry in the correctional environment are also discussed.     

Neurologie et psychiatrie. Des relations historiques complexes

In France, in the 19th century, French neurologists emerged as specialists among general medicine practitioners with no direct relationship to alienists. La Pitié-Salpêtrière was the Mecca of neurology and the Sainte-Anne Hospital Center that of psychiatry. The chair occupied by Charcot was above all neurologically unambiguous, unrelated to alienists. In the 20th century, the creation of a Certificate of Higher Studies (CES) in neuropsychiatry was decreed in 1949. In 1968, in accordance with the work of Henri Ey, it was proposed that neuropsychiatry be divided into two distinct CESs: neurology and psychiatry. This governmental decision was taken in a very particular context, that of the social upheaval and demonstrations of May 1968, which culminated in numerous demands and various reforms. The evolution of these two fields in France took a different path from that of Germany and the countries under its influence. In America, which is a mixture of cultures, there has been a development that could be considered to be a hybrid progression that was alternately in step with the French and at times more linked to Germany. We evoke the particular case of Jean Lhermitte. In recent years, many psychiatrists and neurologists, of all generations, have expressed the desire for a new reconciliation of these two specialties.     

Caregivers of people with disorders of consciousness: Relationship continuity and rupture

ObjectivesThis study seeks to better understand caregivers’ experience of the support their loved ones, with disorders of consciousness, receive in a dedicated unit.MethodsThe focus here is on the qualitative component of a larger study that also includes a quantitative component. An inductive and iterative approach was privileged, i.e., one similar to grounded theory; a thematic analysis was used to analyze 20 comprehensive semi-structured interviews.ResultsThree main themes emerged: the discovery of a new world by a patient's loved ones, i.e., the disorders of consciousness; the psychological and somatic impact on loved ones; and the relationships between family caregivers and professionals of the dedicated unit.DiscussionThe new living situation of people in an disorders of consciousness state of consciousness requires caregivers to engage in an intense psychological process. First, this is necessary to understand the situation and its consequences. Second, it allows them to cope with the reorganization of the emotional and relational ties between the patient and the caregiver, and in the entire family dynamic. Lastly, healthcare professionals consider that caregivers are also the witnesses of the patient's past life, capable of linking the past and present, and often the interpreters of patients’ emotional reactions according to their former personality.ConclusionCaregivers are affected by the frailty and somatic dependence of their loved ones, and they also bear the history and psychological continuity of patients. Professionals must take into account this double burden, which helps explain families’ psychological exhaustion and their need for help. Understanding these phenomena is crucial for improving patient care in dedicated units.     

Children suspected of having intracranial infection with normal brain magnetic resonance imaging may be associated with the myelin oligodendrocyte glycoprotein antibody

PurposeTo confirm whether encephalitis due to unknown causes but with normal brain magnetic resonance imaging (MRI) may be associated with the myelin oligodendrocyte glycoprotein (MOG) antibody.MethodsWe retrospectively analyzed and summarized the characteristics of three patients initially suspected of having intracranial infections with normal brain MRI, and ultimately tested positive for anti-MOG antibody.ResultsThe three patients mainly presented with long-term fever accompanied by headaches and drowsiness. Auxiliary examinations showed obvious leukocytosis in peripheral blood and leukocytosis and increased protein expression in cerebrospinal fluid (CSF); furthermore, brain MRI was normal. These findings suggested intracranial infection, especially bacterial meningitis. No patient showed a response to prolonged anti-bacterial therapy; however, they recovered with glucocorticoid therapy, which was prescribed after anti-MOG antibodies were detected in the serum and CSF samples.ConclusionAnti-MOG antibody detection should be performed early for patients with suspected encephalitis due to unknown causes with normal brain MRI, to identify whether they have MOG antibody-associated diseases (MOGAD).     

The development of burn scar contractures and impact on joint function,disability and quality of life in low- and middle-income countries: A prospective cohort study with one-year follow-up

ObjectiveThe aim of this study was to assess the development of burn scar contractures and their impact on joint function, disability and quality of life in a low-income country.MethodsPatients with severe burns were eligible. Passive range of motion (ROM) was assessed using lateral goniometry. To assess the development of contractures, the measured ROM was compared to the normal ROM. To determine joint function, the normal ROM was compared to the functional ROM. In addition, disability and quality of life (QoL) were assessed. Assessments were from admission up to 12 months after injury.ResultsThirty-six patients were enrolled, with a total of 124 affected joints. The follow-up rate was 83%. Limited ROM compared to normal ROM values was observed in 26/104 joints (25%) at 12 months. Limited functional ROM was observed in 55/115 joints (48%) at discharge and decreased to 22/98 joints (22%) at 12 months. Patients who had a contracture at 12 months reported more disability and lower QoL, compared to patients without a contracture (median disability 0.28 versus 0.17 (p = 0.01); QoL median 0.60 versus 0.76 (p = 0.001)). Significant predictors of developing joint contractures were patient delay and the percentage of TBSA deep burns.ConclusionThe prevalence of burn scar contractures was high in a low-income country. The joints with burn scar contracture were frequently limited in function. Patients who developed a contracture reported significantly more disability and lower QoL. To limit the development of burn scar contractures, timely access to safe burn care should be improved in low-income countries.     

Insights on the Potential Mechanisms of Action of Functional Electrical Stimulation Therapy in Combination With Task-Specific Training: A Scoping Review

ObjectivesThis scoping review was undertaken to synthetize and appraise the literature on the potential mechanisms of action of functional electrical stimulation therapy in combination with task-specific training (FEST + TST) in the rehabilitation following stroke, spinal cord injury, traumatic brain injury, or multiple sclerosis.Materials and MethodsThe literature search was performed using multiple databases (including APA, PsycInfo, Medline, PubMed, EMBASE, CCRCT, and Cochrane Database of Systematic Reviews) from 1946 to June 2020. The literature search used the following terms: (spinal cord injury, paraplegia, tetraplegia, quadriplegia, stroke, multiple sclerosis, traumatic brain injury, or acquired brain injury) AND (functional electrical stimulation or FES). The search included clinical and preclinical studies without limits to language.ResultsOf the 8209 titles retrieved from the primary search, 57 publications fulfilled the inclusion and exclusion criteria for this scoping review. While most publications were clinical studies (n = 50), there were only seven preclinical studies using animal models. The results of this review suggest that FEST + TST can result in multiple effects on different elements from the muscle to the cerebral cortex. However, most studies were focused on the muscle changes after FEST + TST.ConclusionsThe results of this scoping review suggest that FEST + TST can result in multiple effects on different elements of the neuromuscular system, while most research studies were focused on the muscle changes after FEST + TST. Despite the efficacy of the FEST + TST in the neurorehabilitation after CNS injury or disease, the results of this review underline an important knowledge gap with regards to the actual mechanism of action of FEST + TST.