Quelle définition du délire dans la psychose ? Pour une approche fonctionnelle du processus délirant

In referring to various theories from psychoanalytic epistemology, the author develops a definition of psychotic delusion as operating as possible. To do this, he compares, on the one hand, a conception of delusion based on the relation to reality with, on the other hand, a functional approach of delusional activity that takes into account subjective issues of delusion. Different theoretical paradigms are discussed in order to identify the respective implications of a realist conception of delusion and an approach of delusion from their subjective features. In this perspective, delusion is less regarded as an abnormal way of perceiving the world than as an attempt of solution to the resurgence of an unthought primary trauma. From a qualitative methodology based on a clinical case study, the author highlights three main functions achieved by the delusion in its attempt of self-therapy resolution. The first, conceptualized under the term “containing function”, carries out the shaping and the significant transformation of what could never be symbolized of the traumatic experience. The second, called “localizing function”, tries to locate outside of the subject the instinctual overflow inherent to the primary trauma. The third, named “identifying function”, enables the delusional person to assume an identificatory principle which, in a self-created way, compensates for the enigma of his senseless history. Furthermore, the analysis of clinical data underlines that these three functions of the delusional activity are not randomly accomplished but are organized according to a particular logic. From its triple operation, it appears that psychotic delusion tends to develop into a “delusional process”, by which the subject can make thinkable and bearable the trauma he has experienced during his history. Finally, referring to the various results of this study, the author proposes to reconsider the issues of clinical devices with delusional patients. Instead of trying to suppress delusion, it would be possible to accompany the subject in the development of inventive potentialities that sustain the delusional process.     

Quatre approches des processus inconscients : l’expérience de mort imminente,la pneumanalyse,la méditation,la psychose aiguë

The unconscious is not conscious ! Thus, there are only partial events obtained as a result of specific psychotherapeutic approaches: the dream, the parapraxis, the transference in Freud, the “relaxation” in Ferenczi, the symbolism in Jung, the deconstruction of speech in Lacan. Recent decades have proposed new pathways: the scientific study of “near-death experiences”, hyperventilation exercises, and meditation, particularly. These three experiences reveal the same course with three formal processes that occur in succession: “the essence of energy” (close to the Freudian unconscious), “the nature of the spirit” and “the intimate of the relationship” (close to Jung's collective unconscious). This formalization of unconscious processes leads to three major developments: the explanation of the progress of acute psychosis.     

Syndrome de Cotard et fuite des idées

From a case of anxious melancholia including delusions of negation: organs, death and language, we would like to demonstrate, on one hand, the specific nature of Cotard's syndrome manic depressive psychosis. On the other hand, it concerns the study of body somatic and overvalued signifiers. We consider the logical relationships between Cotard's syndrome and the flight of ideas, as a manic symptom “par excellence”. According to this case, we consider language related to melancholia, with no holes always fleeing to the same point, as an organised sort of flight of ideas. What we call confused flight of ideas, an expansive and auto-destructive flight could be comprehended as the reverse of melancholic language which may underly somatic symptoms. This methodology allow us to define criteria for the diagnosis for melancholia as related to metonymies and the foreclosure of the Name-of-the-Father. In other words, this study allows us to theorise foreclosure as a partial process.     

Die Symptome des kindlichen Autismus aus ethologischer Sicht

Zusammenfassung Es wird versucht, eine Reihe von typischen Symptomen des kindlichen Autismus, insbesondere Stereotypien, aber auch Selbstbeschädigung, Grußzeremonien, zwanghafte Fortbewegung im Raum und vermindertes Schmerzempfinden als phylogenetische Atavismen zu erklären. Es werden dazu zahlreiche Beispiele von Verhaltensweisen aus der Tierwelt, besonders von Primaten herangezogen. Die psychotischen symptome werden als Regression infolge gestörter — vor allem verminderter — Wahrnehmungssynthese aufgefaßt.     

Le Dr Jules Séglas (1856-1939), président de la Société Médico-Psychologique, sa vie et son œuvre

Personality and scientific publications of Jules Séglas, alienist of the Paris hospitals between 1886 and 1921, have not yet been completely studied, although his name is frequently quoted by his contemporaries. In a lst part, the authors relate the principal stages of Seglas's biography and medical course in the Salpêtrière hospital. They evoke his personality and his empirical approach of mental illness and psychiatry — a century before DSM-IV. A 2nd part is devoted to the review of his semiologic works, during the period 1881-1934. The authors try to state precisely his specific contributions, in perspective with Kraepelin, Janet and Clerambault's works. Then a 3rd part reviews the present extension, often unknown, of his works in several domains : clinic, epistemology (concepts of syndrome and comorbidity in psychiatry), psychopathology (phenomenological approach of delusion, personality disorders).     

Psychopathologie der Encephalitis vom temporalen Typ

Zusammenfassung Encephalitiden vom temporalen Typ zeigen psychopathologische Symptome, die eher einer endogenen Psychose als einer exogenen Reaktionsform entsprechen. Befindlichkeitsstörungen, psychotische Symptome, motorische Stereotypen und eine eigenständige Bewußtseinsstörung werden unter biochemischen und neurophysiologischen Gesichtspunkten erörtert. Die Befindlichkeitsstörung ist durch eine Fremdheit gekennzeichnet, die Analogien zu experimentellen Befunden am limbischen System aufweist. Psychotische Symptome und motorische Stereotypien haben Beziehung zu noradrenergen und dopaminergen Mechanismen, die bei experimentellen Psychosen, wie der Amphetamin-Psychose, bekannt sind. Die Bewußtseinsstörung ist nicht durch beeinträchtigte Wachheit, sondern durch gestörte Reizverarbeitung bei Habituation und Konditionierung bestimmt. Die Schwierigkeiten in der Klassifikation sporadischer Encephalitiden werden nach virologischen und neuropathologischen Aspekten dargestellt.     

Le comportement d’observance des patients atteints de schizophrénie : impact du diagnostic et du traitement. Analyse phénoménologique de trois attitudes

The aim of this study is to analyze the different characteristics of three patient clusters defined according to their relationship toward their disease. Based on the 40 patients collected data, we were able to identify three patient groups: 23 patients were qualified as “active” as they showed a more collaborative participation in career venues and higher acceptance of comprehensive treatment plans (57.5 %). Seven patients were qualified as “passive” as they had less autonomy and therefore were less concerned with the treatment modalities (17.5 %). Ten patients were qualified “ambivalent” as they had a more conflicted understanding and insight of their disease, of their careers and their family dynamics (25 %). “Active” patients had a higher level of understanding of their diagnosis, were more aware of prescribed treatments and of the negative consequences of poor compliance. “Passive” patients were more willing to learn about their diagnosis, while having a significantly lower baseline knowledge of it, were more often prescribed an atypical neuroleptic and reported higher satisfaction with their medical treatment. “Ambivalent” patients had a higher propensity for disagreeing with the negative consequences of their disease, were more often prescribed two classic neuroleptics, reported higher rate of self-discontinuation of treatment and were overall less satisfied with their treatment. It appears that the disagreement with the understanding of the disease and its seriousness has a major impact on the acceptance of the treatment modalities and leads to reduced adherence to treatment plan.     

Éléments d’introduction à la question du rêve dans la psychose

Many psychotic patients bring into psychotherapy or into psychoanalytic treatment some elements of dreams. Sometimes, psychoanalysts or psychologists are quite embarrassed by these elements: should we interpret them? Should we encourage these patients to associate? For beginning, the author proposes few Freudian references concerning relations between dreams and psychosis. Then, we’ll see how many authors consider the role of dream into psychosis. Therefore, we’ll show the difference between dream and delirium, and we’ll insist on which utilization of his dream the psychotic patient can make. At last, we’ll consider three psychoanalytic concepts: the “umbilicus of dream”, the Real (Réel, in French), and the “semblant” (these two last concepts are lacanian concepts). With these concepts, we’ll apprehend the structure of psychotic dream, his statute, his function, and how it could help us in our profession.     

Qu’en est-il de l’annonce du diagnostic de schizophrénie aujourd’hui en France ?

Introduction

The progressive shifts in the legal and social contexts, along with major changes in information seeking habits with the development of the Internet, have placed patients’ information at the core of medical practice. This has to be applied to the psychiatric fields as well, and to questions about how schizophrenic patients are being told their diagnosis nowadays in France.

Comment se libérer des souffrances mentales. Qu’est-ce que la résilience ?

Why and how do minds suffer? The prior and existing clinical classification and psychopathology cannot treat the suffering mind in an integrated way. In this article, resilience will be discussed at both invisible (mind) and visible (brain) level in relation to healing of the suffering mind. Our theory of neo organodynamism allows us to recognize the mental state as a spectrum ranging from a healthy to a pathological mental state. This theory seeks to eradicate prejudice against mental illness by highlighting the fact that anyone can become psychotic if they placed at the same environment and/or stress. How does the mind as a metaphysical entity can have an effect on the brain as a material entity? To answer this question, we have proposed the theory of psychiatric monistic parallelism. We wondered about the consciousness in its intrinsic definition through approach to life as a fundamental particle. The use of the weak measurement in quantum mechanics that can obtain the information of a mental state without disturbing its state allows us to reach their individual virtuality. The resilience is considered as the power of restoration of the mind-body complex and the spontaneous power of remission. In other words, considering the resilience as the visible level (the brain) and the invisible level (mind) makes possible to gain the key for cure from a pathological mental state. For this, we must understand first what the mental disorder is. The psychosis is the synaptic disorder as the visible result, but its true origin is in the mind. The mind cannot get sick. We do not know all the elements that constitute the mind as itself. The environment influences the neural network of the brain by sensory perceptions (quantum potential), then the psychotic symptoms are observed. The environment determines the dynamism of the neural network. Although the mind seems to be dominated by uncertainty, the influence of the environment can act and change the mental state. Thus, the mental state is constantly changing depending on the surrounding environment. Therefore, we can see that all mental disorders are spectrum of the mental state. According to our theory of psychiatric monistic parallelism, the event changes the magnetic field strength and makes appear an individual virtuality. The mind is thus transformed into a function of the modified strength in the magnetic field, it is called “Intensité”. The “Intensité” can act directly on brain cells by changing the potential of the neuronal cell membrane. Thereby, the “Intensité” influences the metabolism of brain cells. The mental transformation that is caused by the change in the environment may be occurred as a result of a changed state of the potential of the network of neural circuit and of a modification of the strength of an individual magnetic field (the “Intensité”). The mind (the invisible entity) and brain (the visible entity) can be considered as a magnetic material, and mutually interact each other through this magnetic effect. The “Intensité” moves on the spectrum of psychic state. Therefore, the change of the mental state is the change of the “Intensité”. The “Intensité” that undergoes the influence of the mental state varies depending on the degree of disorder of the meta-noesis. The mental state varies between a healthy state and a psychopathological state, following the organic degeneration caused by various influences such as stress. The displacement of the “Intensité” to the upstream in the spectrum of mental state is called resilience, or spontaneous remission. And its downstream displacement is considered the worsening of the mental state. The “Intensité” itself can become either the aggravating factor of the mental state or the engine of the resilience. At the visible level of the resilience, the basis of mental transformation is mainly the remodeling of the GABAergic neural network. In other words, before the reorganization of the pathogen synapse fixed by neuronal accessory pathways formed by stress stimuli, it is needed for the resilience that restoring original neuronal conduction of the main neural network must be primarily carried out. In this meaning, we must focus on the rehabilitation and the repetition of learning and activities for the visible level of resilience. This is the mechanism of resilience or spontaneous remission in the visible and invisible level.