Détection et intervention précoce : un nouveau paradigme

Treating psychotic disorders in their earliest stages has become a focus for research and clinical care worldwide. Specialized programs for early detection and early intervention in psychosis in adolescents and young adults have developed in many countries and have shown their effectiveness. After a first psychotic episode, the quality of functional remission is best when specialized care is proposed at the earliest. Moreover, the period preceding the emergence of a constituted disorder (“prodromal”) is a period of opportunity for preventive interventions that reduces the risk of transition to psychosis. These programs have further shown that the evolution of a mental state at-risk of psychotic transition, presenting some symptoms, towards a full-blown psychotic episode or from a psychotic episode to a chronic schizophrenic disorder are not inevitable. France has not yet developed these practices at the national level, but some initiatives are emerging and the French Transition network, within the Institute of Psychiatry, participates in the French-speaking branch of IEPA. The deployment of such programs is a real societal challenge and represents a paradigm shift: it questions the practices and the organization of the healthcare system, but also the way health care professionals and the general public look at these diseases.     

La pensée et le langage par le corps dans la schizophrénie

Connections between body and psyche are regularly studied in the field of psychosis. One of the reasons of that recurrence is the fact that schizophrenic psychosis deconstructs the discursive system and exposes its bodily roots. In the first part of this paper, we remind several authors (Dolto, Pankow, Aulagnier, Golse, Delion, Piaget, Stern i.e.), whose works are showing how the mind develops on the basis of sense - and bodily experiences. In the second part, we examine the specificity of the schizophrenia as regression to the autoerotism and we mention Freud's idea of the “organ's language”. The organ's language represents the use of bodily symbols into the discourse; those symbols have to be interpreted like dreams. Finally, two clinical examples illustrate those elements. We examine the idea that, even if the nosographic category “schizophrenia” has not necessarily to be defended, there is perhaps a common clinical feature defined by the place of the body in the discourse.     

La gestion des affects dans la relation thérapeutique chez le patient schizophrène

This article studies schizophrenic patient's affective conflict by non-integrated ambivalence and absence of symbolisation of affect. Through the meet with a psychotic patient, the authors show that evolution of therapeutic relation is on a par with affect-representation link and its expression in therapy. The authors differentiate processes, which are involved in affect-representation link ; ones concern on representation (in particular déscénarisation and démétaphorisation), others concern on affect, as “thinging” of affects and external deposit of affect. The term of “insulating split”, a form of psychotic insulation, is used to describe this process.     

Remarques sur la théorie lacanienne des psychoses

The lacanian paradigm of the psychosis continues to be productive in the apprehension of reality at the clinic, enabling clinicians to find an orientation of their practice, if they want it. The extention to linguistics, literature and topology is only contributing to the effort begun by Lacan trying to know more about the real of madness in the human who remains for us an exception in the nature.     

Metachromatische Leuko- dystrophie mit dem klinischen Erscheinungsbild einer schizophrenieähnlichen Psychose

Zusammenfassung Anhand des Fallberichts einer adulten metachromatischen Leukodystrophie (MLD) mit schizophrener Symptomatik und schweren Dyskinesien werden die diagnostischen Schwierigkeiten der Früherkennung dieses seltenen Krankheitsbildes diskutiert. Im vorliegenden Fall wurde erst nach langj?hrigem Verlauf durch MRT und durch systematische klinisch-biochemische Untersuchungen die dem psychiatrischen Krankheitsbild zugrundeliegende Hirnerkrankung entdeckt.      

Schizophrene mit typischen Defektzuständen nach ihren eigenen Schriftstücken

Zusammenfassung Die schriftlichen Äuerungen zweier Schizophrener, die über Jahrzehnte hin verfaßt wurden, gaben die Möglichkeit, zwei typische Endzustände zu veranschaulichen. Das Spezifische der schizophrenen Sonderformen tritt in der Selbstschilderung des einen Patienten und in den Schriftstücken des anderen sehr klar hervor. Der typische Defekt ist in beiden Fällen auf den Krankheitsvorgang selbst zurückzuführen und hätte durch Maßnahmen im Sinne einer Resozialisierung nicht verhütet werden können. Die Briefe, die van Gogh an seinen Bruder schrieb, zeigen dagegen, daß er keine Schizophrenie hatte.     

Psychosis and trauma. Theorical links between post-traumatic and psychotic symptoms

Introduction

The co-occurrence between post-traumatic symptoms and psychotic symptoms is well described in the immediate suites of a trauma but can also be chronic. This symptomatic co-occurrence, rarely studied in the literature, is often approached under the sole angle of a primary post-traumatic stress disorder (PTSD) or of a primary psychosis, without federative will to unify the psychotic and post-traumatic symptoms within the same nosological framework. Individuals with schizophrenia or schizoaffective disorder report higher rates of trauma and assault than the general population.

Literature findings

High rates of PTSD have been noted in severe mental illness cohorts. Psychotic phenomena may be a relatively common manifestation in patients with chronic PTSD.

Aim

The purpose of this paper is to expose the various theorical psychopathological aspects between the symptoms of psychosis and PTSD. In populations of veterans, positive and negative symptoms of psychosis in PTSD are described as delusional thoughts and hallucinations often combat-specific.

Clinical findings

When a PTSD becomes established at a subject to the personality of neurotic structure, the intensity of the PTSD's symptoms lead to a psychotic expression which constitutes a factor of seriousness. Besides, PTSD often induces a risk of substance use disorder supplying psychotic symptoms. Cannabis increases the hallucinations, cocaine strengthens an underlying paranoid tone, and alcohol implies withdrawal hallucinosis. Moreover, such consumption could be a risk factor for the future development of chronic psychosis. From another point of view, by basing themselves on the plasma dopamine beta-hydroxylase activity, some authors made the analogy between psychotic major depression and PTSD with psychotic features (also characterized as a distinct psychotic subtype of PTSD). However, other studies found no correlation between PTSD with psychotic features and family predisposition for schizophrenia or schizoaffective disorder.

Discussion

The determination of the structure of personality seems fundamental in the understanding of the symptoms. A personality of psychotic structure increases the risk of traumatization and PTSD. At the same time, the fragility of this structure causes an increased sensitivity to the trauma, which takes on a particular echo. Moreover, a trauma can test a latent psychotic structure to reveal its existence. The experience of psychosis may be traumatic in itself for patients with, notably, seclusion and sedation during hospitalization. Lastly, the symptoms of this post-traumatic psychosis will be differentiated from neurological confusion caused by a traumatic brain injury. Clinicians often fail to screen routinely for trauma and PTSD symptoms in patients with severe mental illness because few systematic guidelines exist for the identification and treatment of this comorbidity.

Conclusion

The links between psychotic and psycho-traumatic symptoms are complex and multidirectional; this co-occurrence is a factor of seriousness. The clinician, while paying attention to these symptoms, has to distinguish the structure of the personality of the subject to articulate the psychotherapy and the pharmacological treatment. Further investigational studies may determine whether antipsychotics will enhance treatment response in PTSD patients with psychotic features.     

Le sacrifice fait à Dieu de Séraphine de Senlis

Séraphine Louis, called “Séraphine de Senlis”, is a french painter whose work itself was known to the public at the beginning of the 20th century, further to an exhibition at Senlis, a small town of the department of Oise where she lived up to 1932. Her creative work, remarkable for the multiplicity of its themes and the exceptional richness of its colours, worthy of the most beautiful medieval inspiration, still to-day produces a real attraction. This warranted no less than a film in 2008 as well as an exhibition at the Maillol museum in Paris in 2009. Concerning our interest, this rests mainly on the clinical reading of the case and that from the strict indications given in the psychiatric reports of Clermont and also according to the evidence given by relatives and especially that of Anne-Marie Uhde — sister of the collector Wilhem Uhde, which accounts for her reputation — and set down by the art historian, Alain Virccondelet in his thesis dedicated to the artist. We shall then show clearly, beyond the esthetical representation to which the film of Martin Provost pays tribute what we choose to qualify as the “logical run”, which questions the rule and the function of creation for Séraphine de Senlis. Within this perspective, our concern will especially be to show how the public success and recognition of the artist and her work have not been beneficial to her.