Cliniques urbaines africaines

The team of therapists who gathered around Henry Collomb at the Fann Hospital of Dakar in the sixties has noticed the particularities of the African psychiatry with a noticeable predominance of delirious puffs on the other pathologies. In the eighties, Maurice Dorès drew attention to the evolution of this situation marked by a notable reduction of the delirious puffs in favor of hysterical psychosis and other symptomatologies. This text accounts for the psychotherapeutics of patients who come to consult a psychologist in urban area and currently the most frequent motivations of this approach.     

Délivrance du titre de psychologue en France : entre nécessité et absence de formation à l’exercice des psychothérapies

In France, the establishment and professional activity of psychologists develops in many areas, while their initial training remains deficient in terms of expectations and needs of their patients. This is particularly the case with psychotherapy. While the denomination of psychologist also allows the use of the appellation “psychotherapist”, regulated since 2010, academics in psychology, despite this regulation, continue to massively issue this appellation to students whom they have not trained in the area of psychotherapies. Many of these academics are even not qualified psychologists and many more do not have significant experience as psychologists, but yet, must train psychology students. Through these deleterious practices, these so-called psychologists/psychotherapists, often without the expected qualifications, are thus unnecessarily growing each year. At the end of the chain, it is the users who suffer from these serious and costly malfunctions. Logically, the denomination of psychologist should be awarded only to students who have validated a good level of skills to carry out their professional acts, in particular those performing psychotherapies in institutional and liberal settings. This question is inseparable from that of the essential revision of the qualification and recruitment criteria for academics in psychology. The requirement of long and high-level professional experience should be the most important qualification and recruitment criteria for lecturers and professors in psychology. Being well trained by experienced and competent trainers is an essential requirement which psychologists can no longer make exceptions to. In this interview, Professor Cyril Tarquinio makes a critical analysis of the serious shortcomings in the psychotherapies’ training for qualified psychologists in France.     

Comment « défusionner » de la scène traumatique ? La pratique du « défusing » : trente ans de discours spécialisé psychiatrique et psychologique

BackgroundNotably organized by the medical-psychological emergency cells (CUMP) in France, the immediate care offered after confronting a potentially psychotraumatic event has been able to spill a lot of ink between those who adulate them or those who hate them, as much in the specialized press as through the media intended for the general public. Indispensable practice aimed at treating psychological wounds for some, charlatanism providing worsening of post-traumatic symptoms for others, medico-psychological recommendations have long remained cryptic in the face of the absence of studies of enough level of scientificity. Thirty years after its first formalizations, no study has offered a critical synthesis of the notion of “defusing”.ObjectivesOur main objective is to study the specialized discourse concerning “defusing” as defined and relayed by psychiatrists and psychologists in French-language journals. We seek to identify the stages of the construction of this treatment time, the maturation of its practice by synthesis of the “defusing type” and the theorization of its therapeutic mechanisms.MethodsFrench-language articles published between January 1, 1990 and December 31, 2019 were selected from the entry of the keyword “defusing” in five search engines as well as in the thesauri of the interuniversity library of medicine and the central library of the army health service. The extracted data combine: the number of article (s) per year of publication, the names of the journals and the authors (research team, place of practice, statutes). The titles, summaries and body of texts were examined by three speech analysis software programs with quantification of textual units and facilitation of return to text by keyword.ResultsLess than 30 articles mention the notion of “defusing” in French-speaking literature, of which only 2 are in their titles and finally, no reference is fully dedicated to it. Compared to the adjacent chapters dealing with the organization of CUMPs, the emergency clinic, and debriefing, the articles referenced do little to address the notion of “defusing”. If the conception of psychological trauma is popularized by its clinical and etiopathogenic dimensions (essentially psychopathological, ignoring neurobiological or socio-anthropological aspects), immediate treatment is only sketched out (by its organizational, theoretical and practical developments). All these notions turn out to be approached in a segmental fashion via adjacent paragraphs with no obvious links between them. Very few articulations are advanced with the concepts of psychiatry or general psychology, or the inclusion of defusing within a global theory of psychotherapy. Materializing numerous literal repetitions from one article to another, the synthesis organizing the qualitative data revealing the practical definition of defusing is rather brief. All references combined, only a few sentences briefly addressing the notions of language recovery and capacities of levels of representation can enlighten us on the supposed therapeutic processes. In addition, certain areas are barely addressed: little mention of family traumas, relative silence concerning specificities in children, absence of scientific studies concerning the effectiveness of defusing.DiscussionIn the referenced texts, if the part devoted to the organization of care is significant in terms of volume, it is because it participates conceptually in the appeasement by restitution of an environment allowing to get out of the traumatic scene. Then, the apparent simplicity of the therapeutic concepts in reality reveals cardinal prerequisites: clinical analysis, permanent adjustment of the right relational distance, ability to receive the suffering of others, sustained attention over time, technical skill in particular inter-transferential mobilizations, ability to develop adaptive skills. The attitude and words of the practitioner are based above all on their experiences in clinical analysis and psychotherapeutic care in general. This is undoubtedly the main reason for the absence of scientific studies on defusing facing the same material difficulties as the evaluation of psychotherapy. While only the nonspecific factors of effectiveness of psychotherapies appear to be recognized today, first and foremost the flexibility of the practitioner in the face of his theoretical references, would it be possible to recognize principles specifically effective in the treatment of post-traumatic symptoms?ConclusionWhile several authors still bring together defusing and debriefing to the point of speaking of “immediate and post-immediate debriefing”, the confusion induced is perhaps only relative in view of specific therapeutic mechanisms aimed at appeasing dissociation. Speech constitutes the tool, the cement allowing to bridge dissociative fractures, to connect the psychic, neuropsychic and social spaces which were previously disjointed. Prompted or even guided by the practitioner, this therapeutic word deserves to be qualified as “maieutics”, from the name of the science of childbirth: thought is not developed here prior to its elocution, but the inaugural word, as it arises, as it is expressed, creates thought. By “giving” his word, by “lending” his language, the practitioner actively listens to the mentally injured person and guides them to find the words that they are not able to speak spontaneously. Thanks to the development of a partly common discourse, resulting from intersubjectivity, the capacities of singular elaborations and mentalizations are enhanced, on the side of the patient, and on the side of the practitioner, without the created senses necessarily being the same.     

De l’incarcération du corps au vécu d’enfermement. Le destin des pulsions contre les murs de la prison

ObjectiveThis article questions the impact of imprisonment on the subjective investment of the body of the drives. The author postulates the hypothesis of a reification of the object following the process of incarceration, which would have a direct impact on the subject's investment of his own body, as well as on the trajectories followed by his drives.MethodThe author exposes the case of psychotherapy with a patient in a medical care unit in a prison environment.ResultsThe analysis of this case illustrates how confinement artificially accentuates the outlines of areas left blank in the libidinal distribution of the erogenous body, and how, on the contrary, the source areas constrain the realization of the expression of the drives; an overinvestment of the intensity of the constrained thrust becomes itself the goal.DiscussionThe possibility of overcoming perceptual confinement in a clinical encounter is only present when there is a reversal on both sides of perceptual and affective elements, at a distance from successful representations. However, it would seem illusory to deny the very impact of representation in the associative process, if only through the narrative work that begins here, work that carries in itself the conditions for going beyond the perceptual in the transference.ConclusionThe drive, turned “upside down” by the ordeal of confinement, tends to come undone, in a way that recalls the undoing performed perverse processes. This can lead to a series of decompensations, themselves pretexts for the demand for care.     

Nonpharmacologic Interventions for Family Caregivers of People Living With Dementia in Latin-America: A Scoping Review

ObjectiveDementia prevalence in Latin America (LATAM) is rapidly increasing, contributing to significant family burden. As families are responsible for care, supportive interventions are critical. To understand the state-of-the-science, a scoping review was conducted of non-pharmacologic interventions for caregivers of people living with dementia (PLWD) in LATAM.DesignEight databases were searched (PubMed, Embase, PsycINFO, Scopus, Scielo, Lilacs, Redalyc, Google Scholar) for nonpharmacological intervention studies published up to July, 2021 in LATAM reporting at least 1 caregiver outcome. A qualitative synthesis examined study designs, participants, and outcomes characteristics.ResultsForty-five studies were identified from 25.8% (n = 8/31) of LATAM countries (28 = Brazil, 4 = Chile, 4 = Cuba, 4 = México, 2 = Colombia, 1 = Perú, 1 = Ecuador, 1 = Argentina): 29% (n = 17) were randomized clinical trials (RCT), 7% (n = 3) nonrandomized comparison trials, 42% (n = 19) pre-post trials, 9% (n = 4) postintervention analyses, and 4% (n = 2) single case studies, comprising a total of 1,171 caregivers and 817 PLWD. For 20 RCT and nonrandomized comparison trials, 31 interventions were tested of which 48.4% (n = 15) targeted caregivers and 32.3% (n = 10) dyads. Most studies involved daughters with less than 12 years of education and tested multicomponent interventions involving disease education (90%), and cognitive behavioral coping (45%). Half of interventions (51.6%; n = 16/31) tested were adapted from other countries, and reported benefits for caregiver depression, quality of life, and burden.ConclusionStudies were conducted in a limited number of LATAM countries and few were RCTs. Results of RCTs showed benefits for socially vulnerable caregivers on psychosocial outcomes. There is an urgent need to rigorously evaluate more country/culturally specific interventions addressing unmet familial needs beyond psychosocial support.     

心理测评与团体心理治疗纳入社区卫生服务中心管理的应用

目的了解上海市浦东新区社区卫生服务中心内员工的整体心理状况,探索缓解医务人员心理压力、提升心理健康水平和掌握自我情绪管理能力的效果。方法选取上海市浦东新区3家社区卫生服务中心,采用GHQ-12、SAS、SDS和MBIGS等量表评估中心内员工的心理状况,对存在焦虑、抑郁或职业倦怠者开展团体心理治疗,干预人群基本情况相匹配且无心理问题的医务人员作为对照组,评价干预效果。结果机构员工12项一般健康问卷总分为(22.17±5.24)分,焦虑自评量表标准分为(40.67±10.82)分,抑郁自评量表标准分为(41.14±11.95)分,Maslach职业倦怠调查普适量表总分为(19.79±15.77)分。团体心理治疗干预前两组人群在SAS、SDS、GHQ-12以及MBI-GS量表各因子中均具有显著差异(P0.01)。干预后两组人群在SDS、MBI-GS的情绪衰竭、工作态度和总均分/总分等因子中仍存在显著差异(P0.01),其余量表与因子则无差异。结论基层社区卫生服务中心员工的心理状况与普通人群接近,医疗业务、预防保健、行政等科室以及工龄较高且职称较低的员工是心理弱势群体,团体心理治疗能够明显改善心理异常员工的焦虑并提升其成就感。     

心理干预对骨科患者负性心理及疼痛的影响

目的观察心理干预对骨科患者负性心理及疼痛的影响。方法将2011年3月至2012年3月该院骨科医院的182例患者分为对照组（94例）和干预组（88例）,对照组给予骨科常规治疗;干预组除常规治疗外加以心理干预。同时,采用问卷调查,包括Zung的焦虑自评量表（SAS）、Zung的抑郁自评量表（SDS）和视觉模拟评分法（VAS）,对患者手术前、后的负性心理及疼痛等情况进行评定。结果两组患者在术后12h的SAS、SDS评分均低于入院时．干预组分值下降大于对照组,差异均有统计学意义（P〈0．05）;两组患者的VAS评分在术后随着时间的延后而下降．干预组下降程度大于对照组,差异有统计学意义（P〈0．05）。结论有效的心理干预可以改善患者负性心理和疼痛,促进患者的康复。     

不同方法治疗磨牙症的有效性分析

目的探讨不同方法治疗磨牙症的效果,寻找最佳的治疗方法。方法选择2010年12月至2012年12月在该院接受治疗的150例磨牙症患者作为研究对象,并分成观察组和对照组,各75例。对照组通过佩戴牙合垫治疗磨牙症,观察组在对照组的基础上配合心理疗法,对比两组患者的康复情况。结果治疗后,观察组的停止磨牙率和每天磨牙减少时间优于对照组,总有效率[96.0%（72/75）]明显优于对照组[80.0%（60/75）],舒适度[97.3%（73/75）]明显优于对照组[78.7%（59/75）],差异均有统计学意义（P〈0.05）。结论通过佩戴牙合垫结合心理疗法治疗磨牙症疗效显著,并发症少,值得在临床推广应用。     

Evaluating treatment of posttraumatic stress disorder with cognitive processing therapy and prolonged exposure therapy in a VHA specialty clinic

This retrospective chart review evaluates the effectiveness of manualized cognitive processing therapy (CPT) protocols (individual CPT, CPT group only, and CPT group and individual combined) and manualized prolonged exposure (PE) therapy on veterans’ posttraumatic stress disorder (PTSD) symptoms in one Veterans Health Administration (VHA) specialty clinic. A total of 517 charts were reviewed, and analyses included 178 charts for CPT and 85 charts for PE. Results demonstrated CPT and PE to significantly reduce PTSD Checklist (PCL) scores. However, PE was significantly more effective than CPT after controlling for variables of age, service era, and ethnicity. Additional findings included different outcomes among CPT formats, decreased treatment dropouts for older veterans, and no significant differences in outcome between Hispanic and White veterans. Study limitations and future research directions are discussed.     

Drug refusal skills training does not enhance outcomes of African American adolescents with substance use problems

In prior research by Witkiewitz and colleagues, African American adults receiving refusal skills training (RST) had fewer heavy drinking days and were categorized as having more successful outcomes. This study extends findings to adolescents receiving the Adolescent Community Reinforcement Approach (A-CRA). Propensity score matching was used to create three groups equivalent on baseline characteristics, including: African Americans receiving refusal skills training (AA + RST; n = 214), African Americans not receiving RST (AA-RST; n = 212), and Caucasians receiving RST (CA + RST; n = 214). In propensity weighted regression models that controlled for overall A-CRA exposure, racial group by RST status was not a significant predictor of substance use frequency or abstinence/early remission outcomes. Higher exposure to A-CRA, however, was a significant predictor of both outcomes. Universal receipt of RST may not improve the outcomes of African American adolescents with substance use problems, and outcomes may be driven more by the overall number of A-CRA procedures received.